The National Epidemic of Gun Violence: The Vermont Department of Health Response.

This case study details a 2018 "near miss" school mass-shooting event in Vermont that involved a former student and occurred contemporaneously with the Parkland, Florida, tragedy. The situation "jolted" this rural state's governor, lending urgency to the need to enact sensible gun control laws. He comes to support a series of proactive bills already in the legislature and advocate for further preventive strategies. The state's commissioner of health plays public health's traditional role within state government as trusted health promotion and education resource to frame the issue in public health and public safety terms. He portrayed health data on firearm injuries and deaths and formed a public health strategy including surveillance, identification of risk factors, and resources for school- and community-based prevention. On April 11, 2018, Governor Phil Scott signed a package of gun-related legislation that included increasing the legal age for gun purchases, expanding background checks for private gun sales, banning high-capacity magazines and rapid-fire bump stocks, and extreme risk protection orders. The final results were examined from an evidence-based public health standpoint, acknowledging the lack of gun research by federal agencies since the 1996 enactment of the Dickey Amendment that prohibits the Centers for Disease Control and Prevention from conducting firearms-related research. The case study illustrates the paradox of moving forward on gun safety, where more research is needed, but research does not necessarily influence political leaders or policy. It also demonstrates how prevention of gun violence can be portrayed in a public health framework, drawing upon data and strategies used in upstream preventive efforts in areas such as early childhood development, mental health, and substance misuse.

Developing Safe Syringe Exchange Programs: Role of the North Carolina Division of Public Health.

Syringe exchange programs became legal in North Carolina on July 11, 2016. A combination of forces led to this progressive public health measure, including advocacy of the State Health Official, in a state characterized by a conservative political climate. Data collected by the division of public health were a key contributor to the initiative. Nearly 5 North Carolinians died each day from unintentional medication or drug overdose. High rates of coinfection including hepatitis B and C, human immunodeficiency virus, and endocarditis were shown to have substantial economic consequences. The North Carolina Harm Reduction Coalition and use of Moral Foundations Theory in crafting messages were important in influencing legislation. North Carolina now has 30 active syringe exchange programs serving 40 counties. Individuals using intravenous drugs who take advantage of these syringe exchange programs are provided with clean needles to not only help prevent the spread of illness but also learn more about safe health practices.

Local Transmission of Zika Virus in Miami-Dade County: The Florida Department of Health Rises to the Challenge.

As early as 2015, Florida and Centers for Disease Control and Prevention (CDC) public health officials recognized the potential danger of Zika for US residents and visitors. The Zika virus, a mosquito-borne flavivirus, is transmitted through the bite of the Aedes aegypti mosquito. A physician in Miami-Dade notified the Florida Department of Health (DOH) of the first non-travel-related Zika case in the United States. A 23-year old pregnant woman had presented on July 7, 2016, at 23 weeks of gestation, with a 3-day history of fever, widespread pruritic rash, and sore throat. Three more cases, involving men, were reported in Dade and Broward counties. These notifications set into motion additional activities from the DOH's Zika Playbook: increased mosquito surveillance; collaboration with the CDC on recommendations for mosquito abatement techniques; and increased awareness of the risks of Zika. In August, the department reported that active transmission of Zika virus was occurring in one small area in Miami-Dade County known as Wynwood. Mosquito trapping in the area with local transmission identified large numbers of the Zika vector, Aedes aegypti females and a large number of mosquito larval sites. Control efforts included larviciding, eliminating standing water, and backpack and truck spraying of insecticides. A communication strategy was developed that addressed risk mitigation, public concerns over application of noxious pesticides, loss of tourist revenue, and reproductive issues. It was reported on December 28, 2016, that there had been 256 locally acquired cases of infection of Zika, 1011 travel-related cases, and 208 pregnant women with laboratory evidence of Zika. At the end of 2018, 2 years after active Zika virus transmission was controlled in Florida, there have been 101 reported cases of Zika during 2018 but none have been linked to local transmission.

Prevention screening and counseling: strategy for integration into medical education and practice.

Providing optimal preventive services across the life span is integral to improving the nation's health. However, teaching future health professionals evidence-based prevention screening and counseling has notable limitations. Applying the U.S. Preventive Services Task Force (Task Force) preventive services recommendations is necessary but not sufficient to teach comprehensive and practical preventive services delivery. Certain important health topics have not yet been investigated by the Task Force; other Task Force health topics have insufficient evidence or nonspecific recommendations. The purpose of the current paper is to provide a strategy and develop a tool to educate future healthcare professionals in recommendations for prevention screening and counseling. Age-specific preventive history charts for children and adults were created using a total of 60 recommendations from the following sources (with number of recommendations shown): the Task Force (n=37); four primary care professional organizations (n=15); and a representative panel of experts (n=8). Using a systematic approach that incorporates other accredited organizations and inclusion criteria (as described) yielded a practical tool that is applicable in both educational and clinical settings.