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OBJECTIVES: Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. METHODS: An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents' skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). RESULTS: Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (ß estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. CONCLUSIONS: Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.

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CONTEXT: Public health departments play an important role in the preparation and response to mass fatality incidents (MFIs). OBJECTIVE: To describe MFI response capabilities of US state health departments. DESIGN: The data are part of a multisector cross-sectional study aimed at 5 sectors that comprise the US mass fatality infrastructure. Data were collected over a 6-week period via a self-administered, anonymous Web-based survey. SETTING: In 2014, a link to the survey was distributed via e-mail to health departments in 50 states and the District of Columbia. PARTICIPANTS: State health department representatives responsible for their state's MFI plans. MEASURES: Preparedness was assessed using 3 newly developed metrics: organizational capabilities (n = 19 items); operational capabilities (n = 19 items); and resource-sharing capabilities (n = 13 items). RESULTS: Response rate was 75% (n = 38). Among 38 responses, 37 rated their workplace moderately or well prepared; 45% reported MFI training, but only 30% reported training on MFI with hazardous contaminants; 58% estimated high levels of staff willingness to respond, but that dropped to 40% if MFIs involved hazardous contaminants; and 84% reported a need for more training. On average, 76% of operational capabilities were present. Resource sharing was most prevalent with state Office of Emergency Management but less evident with faith-based organizations and agencies within the medical examiner sector. CONCLUSION: Overall response capability was adequate, with gaps found in capabilities where public health shares responsibility with other sectors. Collaborative training with other sectors is critical to ensure optimal response to future MFIs, but recent funding cuts in public health preparedness may adversely impact this critical preparedness element. In order for the sector to effectively meet its public health MFI responsibilities as delineated in the National Response Framework, resources to support training and other elements of preparedness must be maintained.

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In September 2008, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention sponsored a meeting of public health and infection-control professionals to address the implementation of surveillance for multidrug-resistant organisms (MDROs)-particularly those related to health care-associated infections. The group discussed the role of health departments and defined goals for future surveillance activities. Participants identified the following main points: (1) surveillance should guide prevention and infection-control activities, (2) an MDRO surveillance system should be adaptable and not organism specific, (3) new systems should utilize and link existing systems, and (4) automated electronic laboratory reporting will be an important component of surveillance but will take time to develop. Current MDRO reporting mandates and surveillance methods vary across states and localities. Health departments that have not already done so should be proactive in determining what type of system, if any, will fit their needs.

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BACKGROUND: A significant number of college women are at risk for alcohol-exposed pregnancies because the ages of the heaviest alcohol consumption is typically 18 through 21 years, and contraception may be used ineffectively or not at all. These risks call for greater prevention efforts. OBJECTIVE: Collaboration between a higher education institution and a government health agency to reduce alcohol-exposed pregnancies in Oregon. METHODS: Health professionals from the Fetal Alcohol Syndrome (FAS) Prevention Program of the Oregon Public Health Division presented current research and explained the mission of a Center for Disease Control (CDC) cooperative agreement to university students in a Health Communication course. The students then developed social marketing messages that targeted alcohol use and/or contraception behavior. RESULTS: At the end of the course, the students presented their campaigns campus-wide, and to the state agency. Four of the theory-based messages are illustrated in this article. CONCLUSION: The students brought to the state FAS Program a specific range of knowledge, vocabulary and creative skills to create messages for young adults. University students reported benefits of becoming familiar with government agencies and working on "real-life" projects that had the potential to be used in community settings.

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Pandemic influenza is an imminent threat, with the April/May 2009 A(H1N1) outbreak as a testament to the potential for rapid transmission and spread of a novel influenza strain. Research has shown that there are great disparities in state pandemic planning; however, little work has been done to assess how health department structure impacts pandemic preparedness. The purpose of this article was to examine the impact of state health department structure on state pandemic influenza plan integration of federal recommendations. The study consisted of a cross-sectional analysis of 41 states and found that structural and strategy-making variables have the greatest impact on pandemic plan inclusion of federal recommendations. Strong, multilayered health department hierarchies and the tenure of senior staff are negatively associated with preparedness, whereas professionalization is positively associated with pandemic plan comprehensiveness. State health departments can take minimally invasive steps to increase their effectiveness in pandemic preparedness by reducing layers of bureaucracy and increasing training for staff.

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Underserved communities with high cancer rates often are not involved in implementing state cancer control activities locally. An East Tennessee State University research team formed 2 Appalachian Community Cancer Research Review Work Groups, 1 in northeast Tennessee and 1 in southwest Virginia. During 4 sessions, the research team presented regional cancer data to the work groups. Work group participants explored research from a lay perspective and identified possible reasons for cancer disparities in central Appalachia. The fifth session was a community dissemination activity in which work group participants engaged in cancer education and action by presenting the research to their local communities in unique ways. During a sixth session, both work groups discussed these interventions and further attempted to answer the question, "What makes the experience of cancer unique in Appalachia?" This article describes the key steps of this community-based participatory research process.

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Statewide efforts and partnerships were used for nursing workforce development to address the nursing shortage in Texas. A statewide strategic action plan was developed where partnerships and collaboration were the key components. One of the most important outcomes of these statewide partnerships was the passage of the Nursing Shortage Reduction Act 2001. Through this legislation, the Texas Center for Nursing Workforce Studies and its advisory committee were established. This article describes how a statewide infrastructure for nursing workforce policy and legislative and regulatory processes were further developed. An overview is provided on the contributions made by the organizations involved with these strategic partnerships. The ingredients for establishing successful, strategic partnerships are also identified. It is hoped that nursing and health care leaders striving to address the nursing shortage could consider statewide efforts such as those used in Texas to develop nursing workforce policy and legislation.

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This article describes how a mental health disaster response plan, which resulted from a collaborative effort between the Arkansas Department of Health and the Arkansas Chapter of the National Association of Social Workers, was used successfully to meet the needs of more than 1,000 displaced survivors of Hurricane Katrina. Included is a discussion of how the components of established disaster response protocols can be integrated with evolving theory on the psychological effect of catastrophic events on micro-, mezzo-, and macro-level systems to advance the field of disaster mental health response.

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OBJECTIVES: We explored the effect of disseminating evidence-based guidelines that promote physical activity on US health department organizational practices in the United States. METHODS: We implemented a quasi-experimental design to examine changes in the dissemination of suggested guidelines to promote physical activity (The Guide to Community Preventive Services) in 8 study states; the remaining states and the Virgin Islands served as the comparison group. Guidelines were disseminated through workshops, ongoing technical assistance, and the distribution of an instructional CD-ROM. The main evaluation tool was a pre- and postdissemination survey administered to state and local health department staffs (baseline n=154; follow-up n=124). RESULTS: After guidelines were disseminated through workshops, knowledge of and skill in 11 intervention-related characteristics increased from baseline to follow-up. Awareness-related characteristics tended to increase more among local respondents than among state participants. Intervention adoption and implementation showed a pattern of increase among state practitioners but findings were mixed among local respondents. CONCLUSIONS: Our exploratory study provides several dissemination approaches that should be considered by practitioners as they seek to promote physical activity in the populations they serve.

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Strategies for establishing a national voluntary public health agency accreditation program have been gathering momentum. Recent efforts funded by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC) have made a significant impact on the potential for national diffusion of accreditation models. The Exploring Accreditation Project was a collaboration of the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the National Association of Local Boards of Health with a national steering committee that studied the feasibility and desirability of a national voluntary accreditation program for state and local public health agencies. Concurrently, the Robert Wood Johnson Foundation funded the "Multi-State Learning Collaborative on Performance and Capacity Assessment or Accreditation of Public Health Departments" (MLC). Among the other purposes of the MLC was the intent for states already engaged in accreditation or assessment activities to inform the national accreditation debate. Five states were selected to be MLC grantees from 18 states completing a formal application process. This article reviews data extracted from the applications of 16 of the 18 applicant states and reviews common themes emerging across programs. Other states contemplating similar programs, as well as those charged with implementing the voluntary model at the national level, may find guidance from these examples.

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The capacity of state and territorial health departments to investigate foodborne diseases was assessed by the Council of State and Territorial Epidemiologists from 2001 to 2002 with a self-administered, Web-based survey. Forty-eight health departments responded (47 states and 1 territory). The primary reason for not conducting more active case surveillance of enteric disease is lack of staff, while the primary reasons for not investigating foodborne disease outbreaks are limited staff and delayed notification of the outbreak. Sixty-four percent of respondents have the capacity to conduct analytic epidemiologic investigations. States receiving Emerging Infections Program (EIP) funding from the Centers for Disease Control and Prevention more often reported having a dedicated foodborne disease epidemiologist and the capability to perform analytic studies than non-EIP states. We conclude that by addressing shortages in the number of dedicated personnel and reducing delays in reporting, the capacity of state health departments to respond to foodborne disease can be improved.

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BACKGROUND: The threat of mass casualties and widespread infectious disease caused by terrorism is now a challenge for our government and public health system. Funds have been granted to the states by the Centers for Disease Control and Prevention and the Health Resources and Services Administration to establish bioterrorism preparedness and response capabilities. METHODS: Hartford Hospital has been designated as a Center of Excellence for Bioterrorism Preparedness by the Commissioner of the Connecticut Department of Public Health. The Center of Excellence has implemented strategies to prepare for a possible bioterrorist attack. A unique model that combines epidemiology and traumatology is being used to guide the preparedness activities. Although the focus of the grant from the Connecticut Department of Public Health is bioterrorism, the application of the model can apply to preparation for all terrorist events. RESULTS: Implementation of strategies indicates that bioterrorism preparedness is well underway. Similar initiatives should be achievable by other trauma systems throughout the country. CONCLUSION: A Center of Excellence for Bioterrorism Preparedness in Connecticut is successfully modifying a trauma system to meet the challenge of a new public health threat, terrorism.

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The Connecticut Department of Public Health (DPH) entered into a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to establish public health preparedness and a response plan for bioterrorism. With funds from the CDC and an additional grant from the Health Resources and Services Administration (HRSA), the DPH designated Hartford Hospital as one of two Centers of Excellence that will coordinate and manage a statewide system for bioterrorism preparedness. This paper reviews the progress that Hartford Hospital has made in meeting this challenge. Highlighted are the development of a Web application to use for statewide preparedness and response, and the preparation for a smallpox vaccination program at Hartford Hospital.

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This article presents a consensus-building initiative to develop a statewide research agenda that responds to the needs of Illinois's child welfare community. Researchers conducted this process through a university-community partnership to engage those interested in child welfare services. The process and findings resulted in a living document that will guide child welfare research throughout the state. Findings of the inquiry suggest that the development of best practice models may be one of the most important contributions research can make to practice.

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Limited knowledge about state health agencies' strategic management capabilities constrains their capacity to improve public health. The current study addresses this gap through two objectives: 1) To assess agencies' strategic management capabilities, conceptualized through a learning framework and 2) To portray both those capabilities and where the agencies have progressed along a developmental pathway of strategic management ability. Forty-one state health agencies' documents from 1995-2000 were content analyzed. Latent Trait Analysis (LTA) was used to depict both the progressive levels of strategic management capabilities and states' relative mastery along the continuum. Findings indicate that strategic management capabilities have path dependent characteristics and a distinct learning paradigm exists. Therefore, policy-makers wishing to improve agency performance can utilize this framework to assess and target capabilities that need improvement.

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