Public Health Reports®

Electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health’s (MDH’s) outbreak response to EVALI, including challenges, successes, and lessons learned.

MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations.

MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners.

Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.

Syndromic surveillance can be used to enhance notifiable disease case-based surveillance. We analyzed features of varicella reported in Georgia to evaluate case detection through syndromic surveillance and to compare varicella reported through syndromic surveillance with varicella reported from all other sources.

Syndromic surveillance was incorporated into case-based varicella surveillance by the Georgia Department of Public Health (GDPH) in May 2016. A cross-sectional study design evaluated syndromic and nonsyndromic varicella reported to GDPH from May 1, 2016, through December 31, 2019. Varicella was reported by nonsyndromic sources including health care providers, schools, and laboratories. We identified syndromic varicella cases from urgent care and emergency department visit data with discharge diagnoses containing the terms “varicella” or “chickenpox.”

Syndromic notifications accounted for 589 of 2665 (22.1%) suspected varicella reports investigated by GDPH. The positive predictive value was 33.1% for syndromic notifications and 31.3% for nonsyndromic notifications. Mean days from rash onset to GDPH notification was 3.2 days fewer (P < .001) among patients identified through syndromic notification than among patients identified through nonsyndromic notification. The odds of varicella identified by syndromic notification being outbreak-associated were 0.18 (95% CI, 0.09-0.36) times those of varicella identified through nonsyndromic notification.

Syndromic notifications were an effective, timely means for varicella case detection. Syndromic patients were significantly less likely than nonsyndromic patients to be outbreak-associated, possibly because of early detection. Syndromic surveillance enhanced case-based reporting for varicella in Georgia and was a useful tool to improve notifiable disease surveillance.

To monitor stimulant-involved overdose (SOD) trends, the Centers for Disease Control and Prevention (CDC) developed and evaluated the validity of a syndromic surveillance definition for suspected nonfatal, unintentional/undetermined intent stimulant-involved overdose (UUSOD).

We analyzed all emergency department (ED) visits in CDC’s surveillance system that met the UUSOD syndrome definition (January 2018–December 2019). We classified visits as true positive, possible, or not UUSODs after reviewing diagnosis codes and chief complaints. We first assessed whether visits were acute SODs, subsequently classifying acute SODs by intent. The percentage of true-positive UUSODs did not include intentional or possibly intentional visits. We considered all visits with UUSOD diagnosis codes to be acute SODs and reviewed them for intent. We manually reviewed and double-coded a 10% random sample of visits without UUSOD diagnosis codes using decision rules based on signs and symptoms. The overall percentage of true-positive UUSODs was a weighted average of the percentage of true-positive UUSODs based on diagnosis codes and the percentage of true-positive UUSODs determined by manually reviewing visits without codes.

During 2018-2019, 40 045 ED visits met the syndrome definition for UUSOD. Approximately half (n = 18 793; 46.9%) of 40 045 visits had UUSOD diagnosis codes, indicating acute SOD; of these, 98.6% (n = 18 534) were true-positive UUSODs. Of 2125 manually reviewed visits without UUSOD diagnosis codes, 32.6% (n = 693) were true-positive UUSODs, 54.2% (n = 1151) were possible UUSODs, and 13.2% (n = 281) were not UUSODs. Overall, 63.6% of visits were true-positive UUSODs, 29.3% were possible UUSODs, and 7.1% were not UUSODs.

CDC’s UUSOD definition may assist in surveillance efforts with further refinement to capture data on SOD clusters and trends.

Overall trends in rates of fully alcohol-attributable mortality may mask disparities among demographic groups. We investigated overall, demographic, and geographic trends in fully alcohol-attributable mortality rates in Minnesota.

We obtained mortality data from Minnesota death certificates and defined fully alcohol-attributable deaths as deaths that would not occur in the absence of alcohol. We calculated age-adjusted death rates during 2000-2018 using 5-year moving averages stratified by decedents’ characteristics and geographic location.

Chronic conditions accounted for most of the alcohol-attributable deaths in Minnesota (89% during 2014-2018). Alcohol-attributable mortality rates per 100 000 population increased from an average rate of 8.0 during 2000-2004 to 12.6 during 2014-2018. During 2000-2018, alcohol-attributable mortality rates were highest among males (vs females), adults aged 55-64 (vs other ages), and American Indian/Alaska Native people (vs other racial and ethnic groups) and lowest among people aged ≤24 years and Asian or Pacific Islander people. During 2014-2018, the alcohol-attributable mortality rate among American Indian/Alaska Native people was more than 5 times higher than the overall mortality rate in Minnesota.

Results from this study may increase awareness of racial and ethnic disparities and continuing health inequities and inform public health prevention efforts, such as those recommended by the Community Preventive Services Task Force, including regulating alcohol outlet density and increasing alcohol taxes.

Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban–rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban–rural classification in each state.

We estimated current asthma prevalence among adults for urban–rural categories in the 50 states and the District of Columbia and among children for urban–rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban–rural classification scheme to define urban–rural status of counties.

During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban–rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban–rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest.

Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease–related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults.

Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease–related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing.

During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non–US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87).

Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease–related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.

The adverse effects that racial and ethnic minority groups experience before, during, and after disaster events are of public health concern. The objective of this study was to examine disparities in the epidemiologic and geographic patterns of natural disaster and extreme weather mortality by race and ethnicity.

We used mortality data from the Centers for Disease Control and Prevention from January 1, 1999, through December 31, 2018. We defined natural disaster and extreme weather mortality based on International Classification of Diseases, 10th Revision codes X30-X39. We calculated age-adjusted mortality rates by race, ethnicity, and hazard type, and we calculated age-adjusted mortality rate ratios by race, ethnicity, and state. We used geographic mapping to examine age-adjusted mortality rate ratios by race, ethnicity, and state.

Natural disasters and extreme weather caused 27 335 deaths in the United States during 1999-2018. Although non-Hispanic White people represented 68% of total natural disaster and extreme weather mortality, the mortality rate per 100 000 population among non-Hispanic Black people was 1.87 times higher (0.71) and among non-Hispanic American Indian/Alaska Native people was 7.34 times higher (2.79) than among non-Hispanic White people (0.38). For all racial and ethnic groups, exposure to extreme heat and cold were the 2 greatest causes of natural disaster and extreme weather mortality. Racial and ethnic disparities in natural disaster and extreme weather mortality were highest in the South, Southwest, Mountain West, and Upper Midwest.

Racial and ethnic minority populations have a greater likelihood of mortality from natural disaster or extreme weather events than non-Hispanic White people. Our study strengthens the current knowledge base on these disparities and may inform and improve disaster preparedness and response efforts.

Curative treatments for hepatitis C virus (HCV) infection are available, but access and barriers to treatment can delay initiation. We investigated the time to first negative RNA test result among people with HCV infection and examined differences by homeless status and whether people were tested at a correctional facility or substance use treatment facility.

We used surveillance data to identify New York City residents first reported with HCV infection during January 1, 2015–December 31, 2018, with ≥1 positive RNA test result during January 1, 2015–November 1, 2019. We used Kaplan–Meier survival analysis to determine the time from the first positive RNA test result to the first negative RNA test result, with right-censoring at date of death or November 1, 2019. We determined substance use treatment, incarceration, or homelessness by ordering facility name and address or from patient residential address.

Of 13 952 people with an HCV RNA–positive test result first reported during 2015-2018, 6947 (49.8%) subsequently received an RNA-negative test result. Overall, 25% received an RNA-negative test result within 208 (95% CI, 200-216) days and 50% within 902 (95% CI, 841-966) days. Homelessness, incarceration, or substance use treatment was indicated for 4304 (30.9%) people, among whom 25% received an RNA-negative test result within 469 (95% CI, 427-520) days and <50% received an RNA-negative test result during the study period.

Efforts to connect people to treatment should occur soon after diagnosis, especially for people who could benefit from hepatitis C care coordination.

In 2012, onetime hepatitis C virus (HCV) screening was recommended for all baby boomers (people born during 1945-1965) in the United States, but only 4.0%-12.9% of baby boomers have ever had a screening ordered by a health care provider. This study examined the HCV screening prevalence among adult patients in a large academic health care system and assessed factors associated with the completion of screening when ordered for baby boomers.

We defined HCV screening completion as the completion of an HCV antibody test when it was ordered. We used electronic health records to examine HCV screening completion rates among adults (N = 106 630) from August 1, 2015, through July 31, 2020, by birth cohort. Among baby boomers whose health care provider ordered HCV screening, we examined frequency and percentages of HCV screening completion by sociodemographic and clinical characteristics. We conducted univariate and multivariable logistic regression analyses to assess factors associated with HCV screening completion among baby boomers.

During the study period, 73.0% of baby boomers completed HCV screening when it was ordered. HCV completion did not differ by sex or race and ethnicity among baby boomers. Baby boomers with Medicare supplemental health insurance compared with commercial health insurance (adjusted odds ratio [aOR] = 1.87) and those seeing only advanced practice professionals compared with specialty care physicians (aOR = 2.24) were more likely to complete HCV screening when it was ordered.

Noncompletion of HCV screening is one of many barriers along the HCV treatment continuum. Our findings suggest a need for interventions targeting systems, health care providers, and patients to increase HCV screening rates in the United States.

Trends in the incidence of precancerous cervical lesions can be monitored to evaluate the impact of human papillomavirus (HPV) vaccination. The objective of this analysis was to determine whether declines in precancerous cervical lesions varied by area-based measures of poverty, race, and ethnicity.

We analyzed 11 years of incidence data (2008-2018) from a statewide active surveillance system of precancerous cervical lesions in Connecticut. We divided area-based measures of poverty, race, and ethnicity (percentage of the population in a census tract who were living below the federal poverty level, who were Black, and who were Hispanic) at the census-tract level into 4 groups (<5.0%, 5.0%-9.9%, 10.0%-19.9%, ≥20.0%) using recommended cut points from the Public Health Disparities Geocoding Project. We estimated incidence rates and average annual percentage changes (AAPCs) stratified by age and each area-based measure using Joinpoint regression software. We used total population and estimated screened population as denominators for each age group to calculate rates and AAPCs.

During 2008-2018 in Connecticut, 18 878 women aged 21-39 were diagnosed with precancerous cervical lesions. After adjusting for screening, the largest declines occurred among women aged 21-24 (AAPC = −11.5%; 95% CI, −13.6% to −9.4%). We found significant and similar annual declines (~10%-12%) in this age group across all 4 levels of poverty, race, and ethnicity.

This analysis adds to the growing body of evidence demonstrating the positive impact of population-level HPV vaccination among young women that appears similar across area-based measures of sociodemographic characteristics. Monitoring is necessary to ensure the continuation of this progress in all communities.

Take-home lead exposure involves lead dust inadvertently carried from the worksite by employees that becomes deposited in their homes and vehicles. We piloted a program in 2 counties in Michigan to investigate the countywide potential for take-home lead exposures across industries.

During 2018-2020, we identified establishments through internet searches and industry-specific registries. We visited establishments with a physical storefront in-person; we attempted to contact the remaining establishments via telephone. We administered questionnaires at the establishment level to assess the presence of lead and the current use of practices meant to mitigate the potential for take-home lead exposures. We recruited workers for wipe sampling of lead dust from their vehicle floors to test for lead levels.

We identified 320 establishments with potential lead use or exposures. Questionnaire responses revealed widespread worker exposures to lead and a lack of education and implementation of best practices to prevent lead from leaving the worksite. Dust samples (n = 60) collected from employee vehicles showed a ubiquitous tracking of lead out of the workplace, with a range of 5.7 to 84 000 µg/ft² and a geometric mean of 234 µg/ft². Of the sample results, 95.0% were above the lead dust clearance levels for homes established by the US Environmental Protection Agency.

This work suggests that take-home lead exposures are widespread and may be important sources of lead exposure among children. It also demonstrates the feasibility of a program for the identification of establishments whose employees may be susceptible to taking lead dust home with them and whose children may subsequently be targeted for blood lead monitoring.

Little is known about parents’ willingness to vaccinate their children against COVID-19. We assessed the prevalence of vaccine hesitancy among parents with a child or adolescent aged 12-15 years, examined predictors of parents’ COVID-19 vaccine hesitancy, their reasons for resisting a pediatric COVID-19 vaccine, and the correlation between parents’ intentions to vaccinate their child and the acceptance of a vaccine for themselves.

We conducted a national online survey of 637 parents of a child or adolescent aged 12-15 years in March 2021, before COVID-19 vaccines had been approved for this age group. We assessed univariate predictors of vaccine hesitancy, and we used logistic regression analysis to assess independent effects of variables on vaccine hesitancy.

Nearly one-third (28.9%; 95% CI, 25.5%-32.5%) of respondents reported pediatric vaccine hesitancy. Vaccine-hesitant parents were less knowledgeable about vaccines, more accepting of vaccine conspiracies, and less worried about COVID-19 risks to their child’s health than vaccine-accepting parents were. Vaccine hesitancy was higher among female (vs male), single (vs married/living as married), older (vs younger), low income (vs high income), non–college graduates (vs college graduates), and Republican (vs Democrat) parents. The primary concerns expressed by vaccine-hesitant parents pertained to vaccine safety rather than vaccine effectiveness. One-quarter of vaccine-hesitant parents preferred that their child obtain immunity through infection rather than vaccination. Non–vaccine-hesitant parents’ reasons for vaccinating focused on protecting the health of their child and others. Childhood COVID-19 vaccine acceptance was strongly associated with parents’ intentions to get the vaccine for themselves.

A messaging strategy for effective public health interventions that includes educating the public about vaccination, countering misinformation about vaccine development and safety, and stressing the safety of approved COVID-19 vaccines may boost vaccine acceptance among vaccine-hesitant parents.

Understanding COVID-19–related mortality among the large population of people experiencing homelessness (PEH) in Los Angeles County (LA County) may inform public health policies to protect this vulnerable group. We investigated the impact of COVID-19 on PEH compared with the general population in LA County.

We calculated crude COVID-19 mortality rates per 100 000 population and mortality rates adjusted for age, race, and sex/gender among PEH and compared them with the general population in LA County from March 1, 2020, through February 28, 2021.

Among adults aged ≥18 years, the crude mortality rate per 100 000 population among PEH was 20% higher than among the general LA County population (348.7 vs 287.6). After adjusting for age, the mortality rate among PEH was 570.7 per 100 000 population. PEH had nearly twice the risk of dying from COVID-19 as people in the general LA County population; PEH aged 18-29 years had almost 8 times the risk of dying compared with their peers in the general LA County population. PEH had a higher risk of mortality than the general population after adjusting for race (standardized mortality ratio [SMR] = 1.4; 95% CI, 1.2-1.6) and sex/gender (SMR = 1.3; 95% CI, 1.1-1.5).

A higher risk of COVID-19–related death among PEH compared with the general population indicates the need for public health policies and interventions to protect this vulnerable group.

Information on the effectiveness of COVID-19 contact tracing is lacking. We proposed 2 measures for evaluating the effectiveness of contact tracing and applied them in a public health unit in northern Portugal.

This retrospective cohort study included the contacts of people with COVID-19 diagnosed July 1–September 15, 2020. We examined 2 measures: (1) number needed to quarantine (NNQ), as the number of quarantine person-days needed to prevent 1 potential infectious person-day; and (2) proportion of prevented infectious days by quarantine (PPID), as the number of potential infectious days prevented by quarantine divided by all infectious days. We assessed these measures by sociodemographic characteristics, types of contacts, and intervention timings (ie, time between diagnosis or symptom onset and intervention). We considered 3 scenarios for infectiousness periods: 10 days before to 10 days after symptom onset, 3 days before to 3 days after symptom onset, and 2 days before to 10 days after symptom onset.

We found an NNQ of 19.8-41.8 person-days and a PPID of 19.7%-38.2%, depending on the infectiousness period scenario. Effectiveness was higher among cohabitants and symptomatic contacts than among social or asymptomatic contacts. NNQ and PPID changed by intervention timings: the effectiveness of contact tracing decreased with time from diagnosis to quarantine of contacts and with time from symptom onset of the index case to contacts’ quarantine.

These proposed measures of contact tracing effectiveness of communicable diseases can be important for decision making and prioritizing contact tracing when resources are scarce. They are also useful measures for communication with the general population, policy makers, and clinicians because they are easy to understand and use to assess the impact of health interventions.

Financial hardships, job losses, and social isolation during the COVID-19 pandemic have increased food insecurity. We examined associations between food insecurity–related interventions and mental health among US adults aged ≥18 years from April 2020 through August 2021.

We pooled data from the Household Pulse Survey from April 2020 through August 2021 (N = 2 253 567 adults). To estimate associations between mental health and food insecurity, we examined the following interventions: the Supplemental Nutrition Assistance Program (SNAP), Economic Impact Payments (stimulus funds), unemployment insurance, and free meals. We calculated psychological distress index (PDI) scores (Cronbach α = 0.91) through principal components analysis using 4 mental health variables: depression, anxiety, worry, and lack of interest (with a standardized mean score [SD] = 100 [20]). We conducted multivariable linear regression to estimate the interactive effects of the intervention and food insecurity on psychological distress, controlling for sociodemographic characteristics.

During the study period, adults with food insecurity had higher mean PDI scores than adults without food insecurity. Food insecurity was associated with increased PDI scores after controlling for sociodemographic characteristics. In stratified models, negative associations between food insecurity and mental health (as shown by reductions in PDI scores) were mitigated by SNAP (−4.5), stimulus fund (−4.1), unemployment insurance (−4.4), and free meal (−4.4) interventions. The mitigation effects of interventions on PDI were greater for non-Hispanic White adults than for non-Hispanic Black or Asian adults.

Future research on food insecurity and mental health should include investigations on programs and policies that could be of most benefit to racial and ethnic minority groups.

Visiting restaurants and bars, particularly when doing so indoors, can increase transmission risk of SARS-CoV-2, the virus that causes COVID-19, among people who are not fully vaccinated. We aimed to understand US adults’ self-reported protective behaviors when getting food from restaurants during the COVID-19 pandemic when vaccines were not widely available.

We used online nationwide survey data from January 2021 to assess self-reported restaurant-related behaviors of respondents (n = 502). We also used multiple logistic regression models to examine associations between respondents’ characteristics and these restaurant-related behaviors.

Half (49.7%) of respondents reported eating indoors at a restaurant at least once in the month before the survey. Respondents most likely to report eating inside restaurants were in the youngest age category (18-34 y), had personal COVID-19 experience, or indicated they felt safe eating inside a restaurant. Among respondents who had gotten food from a restaurant, more than 65% considered each of the following factors as important in their restaurant dining decision: whether the restaurant staff were wearing face masks, the restaurant requires face masks, other customers are wearing face masks, seating was spaced at least 6 feet apart, someone in their household was at risk for severe COVID-19 illness, and the restaurant was crowded. The most common protective behavior when eating at a restaurant was wearing a face mask; 44.9% of respondents who had eaten at a restaurant wore a face mask except when actively eating or drinking.

The need for practicing prevention strategies, especially for those not up to date with COVID-19 vaccines, will be ongoing. Our findings can inform COVID-19 prevention messaging for public health officials, restaurant operators, and the public.

Achieving widespread vaccine acceptance across various employment sectors is key to a successful public health response to COVID-19, but little is known about factors influencing vaccine acceptance among essential non–health care workers. We examined factors influencing vaccine acceptance among a sample of essential non–health care workers in California.

We conducted a survey in early spring 2021 at 2 corporations in Los Angeles County, California, to identify and describe factors influencing vaccine acceptance and the ability of incentives to increase this acceptance. We used modified Poisson regression analysis to estimate adjusted prevalence ratios and a best-subset selection algorithm to identify the strongest factors influencing vaccine acceptance.

Of 678 workers who completed the survey, 450 were unvaccinated. Among unvaccinated participants, having trust in information about the vaccine from public health experts, having ≥1 chronic health condition related to COVID-19 severity, being Asian, and perceiving risk for COVID-19 were factors that most influenced vaccine acceptance. Most (271 of 296, 91.6%) participants who had trust in information from public health experts and 30.6% (30 of 98) of participants who did not have trust in information from public health experts said that they would accept the vaccine. Seventeen of 24 (70.8%) vaccine-hesitant workers who had trust in information from public health experts and 12 of 72 (16.7%) vaccine-hesitant workers who did not have trust in this information said that they would be more likely to accept the vaccine if an incentive were offered.

Efforts to increase vaccine coverage at workplaces should focus on improving trust in the vaccine and increasing public awareness that the vaccine is free.

The COVID-19 pandemic has led to severe mental health repercussions. We examined rates of anxiety and depression in the United States during the pandemic by demographic characteristics, individual stressors, and COVID-19 infection rates and policy contexts.

We merged data from the April 2020–March 2021 US Household Pulse Survey with state-level data on COVID-19 rates and mitigation policies, including stay-at-home orders, face mask mandates, and restaurant closures. We estimated weighted logistic regression models to assess correlates of anxiety and depression.

Rates of anxiety and depression peaked in late 2020 at 39% and 32%, respectively. Food insecurity and disrupted medical care were associated with more than twice the odds of anxiety and depression (food insecurity: odds ratio [OR] = 2.58 for anxiety and 2.61 for depression; disrupted medical care: OR = 2.40 and 2.27). Being not employed (OR = 1.32 for anxiety and 1.45 for depression), uninsured (OR = 1.30 and 1.38), housing insecure (OR = 1.41 and 1.34), and experiencing disruptions in education (OR = 1.28 and 1.25) were linked to 25% to 45% increased odds of anxiety and depression. Increases in state COVID-19 infection rates were associated with significantly heightened odds of anxiety and depression (OR = 1.01 for anxiety and depression), but state mitigation policies were not.

Levels of anxiety and depression rose during the pandemic, particularly among economically vulnerable individuals and those experiencing economic and service disruptions. Future research should assess the effectiveness of policies targeting COVID-19 economic and service disruptions.

Because health care personnel (HCP) are potentially at increased risk of contracting COVID-19, high vaccination rates in this population are essential. The objective of this study was to assess vaccination status, barriers to vaccination, reasons for vaccine acceptance, and concerns about COVID-19 vaccination among HCP.

We conducted an anonymous online survey at a large US health care system from April 9 through May 4, 2021, to assess COVID-19 vaccination status and endorsement of reasons for acceptance and concerns related to vaccination (based on selections from a provided list).

A total of 4603 HCP (12.2% response rate) completed the survey, 3947 (85.7%) had received at least 1 dose of a COVID-19 vaccine at the time of the survey, and 550 (11.9%) reported no plans to receive the vaccine. Unvaccinated HCP were 30 times more likely than vaccinated HCP to endorse religious or personal beliefs as a vaccine concern (odds ratio = 30.95; 95% CI, 21.06-45.48) and 15 times more likely to believe that personal vaccination is not needed if enough others are vaccinated (odds ratio = 14.99; 95% CI, 10.84-20.72). The more reasons endorsed for vaccination (ß = 0.60; P < .001), the higher the likelihood of having received the vaccine. However, the number of concerns about COVID-19 vaccine was not related to vaccination status (ß = 1.01; P = .64).

Our findings suggest that reasons for vaccination acceptance and concerns about vaccination need to be considered to better understand behavioral choices related to COVID-19 vaccination among HCP, because these beliefs may affect vaccination advocacy, responses to vaccine mandates, and promotion of COVID-19 vaccine boosters.

The clinical professor track has expanded and reflects a trend toward hiring non–tenure-track faculty in public health; however, little is known about this track. We documented characteristics of clinical faculty at US schools of public health.

We surveyed clinical faculty at Council on Education for Public Health–accredited schools of public health in the United States in 2019, identified via each school’s website. We invited faculty (n = 264) who had the word clinical in their title (ie, apparently eligible faculty), had a working email address, and were not authors of this article to provide information about their rank, degree credentials, expectations for teaching, service, research and practice, and promotion criteria at their institution. In addition, we used open-ended responses to explain and contextualize quantitative data.

Of 264 apparently eligible faculty surveyed, 88 (33.3%) responded. We included 81 eligible clinical faculty in our final sample, of whom 46 (56.8%) were assistant professors and 72 (88.9%) had a terminal degree; 57 of 80 (71.3%) had an initial contract of ≤2 years or no contract. Most clinical faculty listed service (96.2%), teaching (95.0%), and student advising/mentoring (86.3%) as duties; fewer clinical faculty reported research (55.0%), practice (33.8%), or clinic (7.5%) duties. Only 37.1% of respondents agreed or strongly agreed that promotion policies for clinical track faculty were clear.

If most clinical faculty are at the lowest academic rank, with short contracts and unclear expectations, it will be difficult for clinical faculty to advance and challenging for schools of public health to benefit from this track. Clear institutional expectations for scope of work and promotion may enhance the contribution of clinical faculty to schools of public health and help define this track.

With the completion of the Human Genome Project and swift development of genomic technologies, public health practitioners can use these advancements to more precisely target disease interventions to populations at risk. To integrate these innovations into better health outcomes, public health professionals need to have at least a basic understanding of genomics within various disciplines of public health. This descriptive study focused on the current level of genomics content in accredited master of public health (MPH) programs in the United States.

We conducted an internet search on all 171 Council on Education for Public Health (CEPH)–accredited MPH programs in the United States for genomics content in required and elective courses using the search terms “genetics,” “genomics,” and “molecular.”

Of the 171 CEPH-accredited MPH programs examined, 52 (30.4%) schools and programs in 34 states offered some type of genomics education. Thirty-five (20.5%) schools and programs had a course in genetic epidemiology, 29 (16.9%) had a course in genetic biostatistics or bioinformatics, and 17 (9.9%) had a course in general public health genomics. The remaining 119 offered no course with a focus on genetics or genomics. In addition, some electives or specifically focused courses related to genomics were offered.

We found inadequate training in public health genomics for MPH students. To realize the promise of precision public health and to increase the understanding of genomics among the public health workforce, MPH programs need to find ways to integrate genomics education into their curricula.