Lessons Learned From an Intensive Writing Training Course for Applied Epidemiologists.

Although writing is a valued public health competency, authors face a multitude of barriers (eg, lack of time, lack of mentorship, lack of appropriate instruction) to publication. Few writing courses for applied public health professionals have been documented. In 2017 and 2018, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention partnered to implement a Morbidity and Mortality Weekly Report Intensive Writing Training course to improve the quality of submissions from applied epidemiologists working at health departments. The course included 3 webinars, expert mentorship from experienced authors, and a 2-day in-person session. As of April 2020, 39 epidemiologists had participated in the course. Twenty-four (62%) of the 39 epidemiologists had submitted manuscripts, 17 (71%) of which were published. The program's evaluation demonstrates the value of mentorship and peer feedback during the publishing process, the importance of case study exercises, and the need to address structural challenges (eg, competing work responsibilities or supervisor support) in the work environment.

Current Marijuana Use by Industry and Occupation - Colorado, 2014-2015.

The effects of marijuana use on workplace safety are of concern for public health and workplace safety professionals. Twenty-nine states and the District of Columbia have enacted laws legalizing marijuana at the state level for recreational and/or medical purposes. Employers and safety professionals in states where marijuana use is legal have expressed concerns about potential increases in occupational injuries, such as on-the-job motor vehicle crashes, related to employee impairment. Data published in 2017 by the Colorado Department of Public Health and Environment (CDPHE) showed that more than one in eight adult state residents aged ≥18 years currently used marijuana in 2014 (13.6%) and 2015 (13.4%) (1). To examine current marijuana use by working adults and the industries and occupations in which they are employed, CDPHE analyzed data from the state's Behavioral Risk Factor Surveillance System (BRFSS) regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who responded to the current marijuana use question. During 2014 and 2015, 14.6% of these 10,169 Colorado workers reported current marijuana use, with the highest reported prevalence among workers in the Accommodation and Food Services industry (30.1%) and Food Preparation and Serving (32.2%) occupations. Understanding the industries and occupations of adults with reported marijuana use can help direct and maximize impact of public health messaging and potential safety interventions for adults.

Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States.

Before 1999, the United States had no appropriated funding for arboviral surveillance, and many states conducted no such surveillance. After emergence of West Nile virus (WNV), federal funding was distributed to state and selected local health departments to build WNV surveillance systems. The Council of State and Territorial Epidemiologists conducted assessments of surveillance capacity of resulting systems in 2004 and in 2012; the assessment in 2012 was conducted after a 61% decrease in federal funding. In 2004, nearly all states and assessed local health departments had well-developed animal, mosquito, and human surveillance systems to monitor WNV activity and anticipate outbreaks. In 2012, many health departments had decreased mosquito surveillance and laboratory testing capacity and had no systematic disease-based surveillance for other arboviruses. Arboviral surveillance in many states might no longer be sufficient to rapidly detect and provide information needed to fully respond to WNV outbreaks and other arboviral threats (e.g., dengue, chikungunya).

National capacity for surveillance, prevention, and control of West Nile virus and other arbovirus infections--United States, 2004 and 2012.

In the first 5 years after its introduction in the United States in 1999, West Nile virus (WNV) spread to the 48 contiguous states, resulting in 667 reported deaths. To establish detection and response capacity, WNV surveillance and prevention was supported through CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreements with all 50 states and six large cities/counties. In 2005, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment of ELC recipients and determined that, since 1999, all had developed WNV surveillance and control programs, resulting in a national arboviral surveillance infrastructure. From 2004 to 2012, ELC funding for WNV surveillance decreased by 61%. In 2012, the United States had its most severe WNV season since 2003, prompting a follow-up assessment of the capacity of ELC-supported WNV programs. Since the first assessment, 22% of jurisdictions had stopped conducting active human surveillance, 13% had stopped mosquito surveillance, 70% had reduced mosquito trapping and testing, and 64% had eliminated avian mortality surveillance. Reduction in early detection capacity compromises local and national ability to rapidly detect changes in WNV and other arboviral activity and to initiate prevention measures. Each jurisdiction is encouraged to review its current surveillance systems in light of the local threat of WNV and emerging arboviruses (e.g., dengue and chikungunya) and ensure it is able to rapidly detect and respond to critical changes in arbovirus activity.

How school nurses can benefit from immunization information systems: information exchange to keep students in school and ready to learn.

Recorded and retrievable information from state immunization information systems (IIS)--previously known as immunization registries--benefits schools, students, families, state and local immunization programs, and the medical home. The National Association of School Nurses (NASN), the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the American Immunization Registry Association (AIRA) support state IIS as a way to facilitate immunization compliance, prevent immunization duplications, and sustain high immunization rates. There is much variability from state to state on who can access and/or input data into the IIS. School nurses need to know they can pick up the phone and contact their state IIS, and state IIS personnel need to know that school nurses desire full access to their state registry to view records and record vaccines administered and/or documented by families.

Extending the reach: local health department collaboration with community pharmacies in Palm Beach County, Florida for H1N1 influenza pandemic response.

OBJECTIVE: Palm Beach County Health Department (PBCHD) in Florida collaborated with pharmacists, community pharmacies, and pharmacy-based retail health clinics to increase access to influenza prevention through a widespread H1N1 influenza vaccination campaign and to disseminate timely and accurate public health recommendations and information using Flu Ready Cards. Selected pharmacy and store managers were surveyed, before and after distribution of H1N1 vaccine regarding issues facing pharmacists and the public in deciding whether or not to recommend or accept influenza vaccinations. PARTICIPANTS: Palm Beach County Health Department collaborated with Walgreens and CVS pharmacies, Publix and Winn-Dixie Super Market Pharmacies, and the Palm Beach County Pharmacy Association. OUTCOMES: More than 200000 Flu Ready Cards were distributed in 250 pharmacies between September 2009 and March 2010 as part the county-wide H1N1 influenza pandemic response. Approximately 40000 doses of H1N1 vaccine (12% of the PBCHD allocation) were shipped to local pharmacies and retail health clinics to immunize individuals and families, including those most at risk, vulnerable, or without a medical home. Eighty percent of surveyed store managers and 52% of pharmacists reported the Flu Ready Cards were useful and more than 60% of both groups felt partnership with the local health department was useful during the H1N1 pandemic. CONCLUSIONS: The collaborative relationship proved invaluable for distributing, transferring, and administering the H1N1 influenza vaccine, managing access to antivirals, and serving as a vital link to hospitals and other healthcare providers. Pharmacists can be an integral part of the nation's "first line resource" for health and wellness and can extend the reach for public health initiatives. The public-private collaboration between health departments and community pharmacists could improve individual and family readiness, increase access to trained and trusted professionals and strengthen overall preparedness and community resilience.

Preparedness: medical ethics versus public health ethics.

Medical ethics generally applies to individual interactions between physicians and patients. Conversely, public health ethics typically applies to interactions between an agency or institution and a community or population. Four main principles underlie medical ethics: autonomy, nonmaleficence, beneficence, and justice. By contrast, public health ethical principles address issues such as interdependence, community trust, fundamentality, and justice. In large part because of the significant community-level effects of public health issues, medical ethics are suboptimal for assessing community-level public health interventions or plans-especially in the area of emergency preparedness. To be effective, as well as ethical, public health preparedness efforts must address all of the core principles of public health ethics.

Preparing for the usual, preparing for the unusual: ethics in routine and emergency public health practice.

A tremendous amount of resources is being poured into public health agencies for the purpose of planning to prevent, respond to, and/or recover from all manner of emergencies. As planning and practice drills have progressed, many of the shortcomings of our current public health system are being recognized. Many gray areas, particularly legal and ethical, are coming into focus. There are many questions about whether the standards of medical care and public health practice will necessarily remain constant during emergencies. This article examines whether the same might be true of the ethical standards of public health practice. Will they or should they be the same regardless of whether we are working in "usual" times or "unusual" times?

Local health department and academic partnerships: education beyond the ivy walls.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Eliminating missing race/ethnicity data from a sexually transmitted disease case registry.

Data regarding race and ethnicity are usually requested when conducting public health surveillance. However, such data are frequently not included in case reports by providers. This report describes efforts to reduce the extent of missing race and/or ethnicity data in reports of sexually transmitted diseases in Massachusetts. A list of cases reported to the Department of Public Health between March 1 and May 31 1999 lacking race and/or ethnicity data was generated. A student intern tried contacting the providers with a request for complete information. Of the 2,954 cases of syphilis, gonorrhea, and chlamydia infection reported during the study period, 34.8% (1,028 cases) lacked race/ethnicity data. Despite an average of 2.27 calls and 1.5 transfers per call, data was successfully added to only 143 cases, increasing the percent of reported cases with complete data from 65.2% to 70.0%. The telephone calls, while inefficient for collecting this data, had some advantages. For example, they offered opportunities for communication between the STD Division and providers regarding other provider needs or services that the Division might meet. Consideration can also be given to using surnmame lists, ethnic marketing lists, birth records, and matching the case's address with census block data to infer race and/or ethnicity.