Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012–2018

Background An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. Methodology/Principle findings To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012–2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012–2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. Conclusions Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.

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Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

10.2196/preprints.21132 ◽

2020 ◽

Author(s):

Ruoyan Sun ◽

Henna Budhwani

Keyword(s):

Public Health ◽

United States ◽

Cumulative Incidence ◽

Hot Spots ◽

Adult Population ◽

State Level ◽

The United States ◽

Education Attainment ◽

Public Health Systems ◽

Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

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Patterns and correlates of mis-implementation in state chronic disease public health practice in the United States

BMC Public Health ◽

10.1186/s12889-020-10101-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Margaret M. Padek ◽

Stephanie Mazzucca ◽

Peg Allen ◽

Emily Rodriguez Weno ◽

Edward Tsai ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

Chronic Disease ◽

Multinomial Logistic Regression ◽

Public Health Practice ◽

State Level ◽

The United States ◽

Organizational Level ◽

Effective Programs

Abstract Background Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

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Patterns and Correlates of Mis-implementation in State Chronic Disease Public Health Practice in the United States

10.21203/rs.3.rs-32392/v3 ◽

2021 ◽

Author(s):

Margaret Padek ◽

Stephanie Mazzucca ◽

Peg Allen ◽

Emily Rodriguez Weno ◽

Edward Tsai ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

Chronic Disease ◽

Multinomial Logistic Regression ◽

Public Health Practice ◽

State Level ◽

The United States ◽

Organizational Level ◽

Effective Programs

Abstract Background: Much of the disease burden in the United States is preventable through application of existing knowledge. State-level public health practitioners are in ideal positions to affect programs and policies related to chronic disease, but the extent to which mis-implementation occurring with these programs is largely unknown. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Methods: A 2018 comprehensive survey assessing the extent of mis-implementation and multi-level influences on mis-implementation was reported by state health departments (SHDs). Questions were developed from previous literature. Surveys were emailed to randomly selected SHD employees across the Unites States. Spearman’s correlation and multinomial logistic regression were used to assess factors in mis-implementation. Results: Half (50.7%) of respondents were chronic disease program managers or unit directors. Forty nine percent reported that programs their SHD oversees sometimes, often or always continued ineffective programs. Over 50% also reported that their SHD sometimes or often ended effective programs. The data suggest the strongest correlates and predictors of mis-implementation were at the organizational level. For example, the number of organizational layers impeded decision-making was significant for both continuing ineffective programs (OR=4.70; 95% CI=2.20, 10.04) and ending effective programs (OR=3.23; 95% CI=1.61, 7.40). Conclusion: The data suggest that changing certain agency practices may help in minimizing the occurrence of mis-implementation. Further research should focus on adding context to these issues and helping agencies engage in appropriate decision-making. Greater attention to mis-implementation should lead to greater use of effective interventions and more efficient expenditure of resources, ultimately to improve health outcomes.

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Feeding the disparities: the geography and trends of breastfeeding in the United States

10.1101/451435 ◽

2018 ◽

Author(s):

Romain Garnier ◽

Ana I. Bento ◽

Pejman Rohani ◽

Saad B. Omer ◽

Shweta Bansal

Keyword(s):

Public Health ◽

United States ◽

Breast Milk ◽

Low Income ◽

Temporal Trends ◽

State Level ◽

The United States ◽

Poverty Level ◽

Future Health ◽

Breastfeeding Rates

AbstractThere is scientific consensus on the importance of breastfeeding for the present and future health of newborns, in high- and low-income settings alike. In the United States, improving breast milk access is a public health priority but analysis of secular trends are largely lacking. Here, we used data from the National Immunization Survey of the CDC, collected between 2003 and 2016, to illustrate the temporal trends and the spatial heterogeneity in breastfeeding. We also considered the effect sizes of two key determinants of breastfeeding rates. We show that, while access to breast milk both at birth and at 6 months old has steadily increased over the past decade, large spatial disparities still remain at the state level. We also find that, since 2009, the proportion of households below the poverty level has become the strongest predictor of breastfeeding rates. We argue that, because variations in breastfeeding rates are associated with socio-economic factors, public health policies advocating for breastfeeding are still needed in particular in underserved communities. This is key to reducing longer term health disparities in the U.S., and more generally in high-income countries.

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Mask adherence and rate of COVID-19 across the United States

10.1101/2021.01.18.21250029 ◽

2021 ◽

Author(s):

Charlie B. Fischer ◽

Nedghie Adrien ◽

Jeremiah J. Silguero ◽

Julianne J. Hopper ◽

Abir I. Chowdhury ◽

...

Keyword(s):

Public Health ◽

United States ◽

General Public ◽

State Level ◽

The United States ◽

Policy Makers ◽

Level Data ◽

High Adherence ◽

Key Factor ◽

Public Health Officials

AbstractMask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19. In the United States, policies on mask wearing have varied from state to state over the course of the pandemic. Even as more and more government leaders encourage or even mandate mask wearing, many citizens still resist the notion. Our research examines mask wearing policy and adherence in association with COVID-19 case rates. We used state-level data on mask wearing policy for the general public and on proportion of residents who stated they always wear masks in public. For all 50 states and the District of Columbia (DC), these data were abstracted by month for April ⍰ September 2020 to measure their impact on COVID-19 rates in the subsequent month (May ⍰ October 2020). Monthly COVID-19 case rates (number of cases per capita over two weeks) >200 per 100,000 residents were considered high. Fourteen of the 15 states with no mask wearing policy for the general public through September reported a high COVID-19 rate. Of the 8 states with at least 75% mask adherence, none reported a high COVID-19 rate. States with the lowest levels of mask adherence were most likely to have high COVID-19 rates in the subsequent month, independent of mask policy or demographic factors. Mean COVID-19 rates for states with at least 75% mask adherence in the preceding month was 109.26 per 100,000 compared to 249.99 per 100,000 for those with less adherence. Our analysis suggests high adherence to mask wearing could be a key factor in reducing the spread of COVID-19. This association between high mask adherence and reduced COVID-19 rates should influence policy makers and public health officials to focus on ways to improve mask adherence across the population in order to mitigate the spread of COVID-19.

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Perceptual basemaps reloaded: The role basemaps play in eliciting perceptions

Journal of Linguistic Geography ◽

10.1017/jlg.2018.7 ◽

2018 ◽

Vol 6 (2) ◽

pp. 145-166

Author(s):

Paulina Bounds ◽

Charles J. Sutherland

Keyword(s):

United States ◽

National Level ◽

State Level ◽

The United States ◽

The State ◽

The Other ◽

Striking Difference ◽

Perceptual Dialectology ◽

Other Hand ◽

Perceptual Maps

This article describes the influence of various basemaps in Perceptual Dialectology, on the national and state levels. The 180 perceptual maps of the United States and Tennessee were divided into six types of basemaps; tabulated results show that basemaps play a different role on the national and state level. On the national level, basemaps that have features reminiscent of boundaries (state lines or interstates) bias the respondents’ answers. On the state level, on the other hand, the map features do not seem to influence the results in any discernible way: at times the informants seemingly go against the details present on the basemap. This striking difference indicates that, though the respondents rely on basemap details at the national level, where they may not have enough experience with the whole country, they don’t pay much attention to the state-level basemap details as they follow their own more detailed ideas about perceptions.

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Public Health Implications of Google Searches for Sunscreen, Sunburn, Skin Cancer, and Melanoma in the United States

American Journal of Health Promotion ◽

10.1177/0890117118811754 ◽

2018 ◽

Vol 33 (4) ◽

pp. 611-615 ◽

Cited By ~ 9

Author(s):

Zachary H. Hopkins ◽

Aaron M. Secrest

Keyword(s):

Public Health ◽

United States ◽

Skin Cancer ◽

Search Engine ◽

State Level ◽

The United States ◽

Google Trends ◽

Search Term ◽

Melanoma Incidence ◽

Google Search

Purpose: Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for sunscreen, sunburn, skin cancer, and melanoma and their relationships with melanoma outcomes. Design: Google Trends was queried for US search volumes from 2004 to 2017. Time-matched search term data were correlated with melanoma outcomes data from Surveillance Epidemiology and End Results Program and United States Cancer Statistics databases (2004-2014 and 2010-2014, respectively). Setting: Users of the Google search engine in the United States. Participants: Google search engine users in the United States. This represents approximately 65% of the population. Measures: Search volumes, melanoma outcomes. Analysis: Pearson correlations between search term volumes, time, and national melanoma outcomes. Spearman correlations between state-level search data and melanoma outcomes. Results: The terms “sunscreen,” “sunburn,” “skin cancer,” and “melanoma” were all highly correlated ( P < .001), with sunscreen and sunburn having the greatest correlation ( r = 0.95). Sunscreen/sunburn searches have increased over time, but skin cancer/melanoma searches have decreased ( P < .05). Nationally, sunscreen, sunburn, and skin cancer were significantly correlated with melanoma incidence. At the state level, only sunscreen and melanoma searches were significantly correlated with melanoma incidence. Conclusions: We conclude that online skin cancer prevention campaigns should focus on the search terms “sunburn” and “sunscreen,” given the decreasing online searches for skin cancer and melanoma. This is reinforced by the finding that sunscreen searches are higher in areas with higher melanoma incidence.

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All Politics Is Local: The Reemergence of the Study of City Politics

Perspectives on Politics ◽

10.1017/s1537592709990892 ◽

2009 ◽

Vol 7 (3) ◽

pp. 611-618 ◽

Cited By ~ 62

Author(s):

Jessica Trounstine

Keyword(s):

United States ◽

Political Science ◽

Local Politics ◽

Local Level ◽

National Level ◽

State Politics ◽

State Level ◽

The United States ◽

Political Events ◽

Political Outcomes

The study of local politics has been relegated to the periphery of political science and many explanations have been offered for the marginalization of the subfield. I offer three related arguments for why scholars should revisit the study of sub-state politics. First, the local level is the source of numerous political outcomes that matter because they represent a large proportion of political events in the United States. Secondly, there are methodological advantages to studying local politics. Finally, analyzing politics at the sub-state level can generate thoroughly different kinds of questions than a purely national-level focus and can offer different answers to questions that apply more generally. Research on local politics can and should contribute to broader debates in political science and ensure that we understand both how and why cities are unique.

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National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1515528113 ◽

2016 ◽

Vol 113 (18) ◽

pp. 5107-5112 ◽

Cited By ~ 33

Author(s):

David P. Durham ◽

Martial L. Ndeffo-Mbah ◽

Laura A. Skrip ◽

Forrest K. Jones ◽

Chris T. Bauch ◽

...

Keyword(s):

United States ◽

Cervical Cancer ◽

Hpv Vaccination ◽

National Level ◽

Herd Immunity ◽

State Level ◽

Cost Effective ◽

Health Impact ◽

The United States ◽

Cervical Cancers

Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

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