ASTHO's reports provide recent, in-depth research on topics of importance and interest to state and territorial health officials, and provide usable, actionable information for ASTHO state and territorial health officials and partners.

Advancing Health Equity Through Immunization

December 31, 2021

The COVID-19 pandemic spotlighted health inequities at national, state, and local levels. This report details the role immunization can play in reducing these disparities, informed directly by conversations ASTHO held with state equity and immunization leaders from March - July 2021. We distill these conversations into 20 key actions health agencies can take to make an impact.Read More »

Restorative Justice in Schools: An Upstream Approach for Addressing Inequities in the Risk of Incarceration

December 30, 2021

Adverse Childhood Experiences are potentially traumatic events that occur in childhood (0-17 years), resulting in an increased risk of adverse health outcomes and decreased personal well-being. Related, school discipline policies can be associated with a child’s risk of future incarceration. Using exclusionary discipline practices (e.g., suspension or expulsion) as a form of punishment increases a student’s risk for arrest. In contrast, policies that keep students in a learning environment may reduce the risk of incarceration. This report discusses school restorative justice practices as a potential protective factor and an alternative to exclusionary discipline policies in K-12 school settings.Read More »

Initiating Cross-Sector Partnerships to Advance Population Health

November 23, 2021

Social determinants of healthcare the conditions in which people are born, live, work, play, worship, and age, all of which affect health and well-being. This report will share action steps that public health agencies can use to initiate and sustain a cross-sector partnership and highlight examples of successful public health collaborations with Medicaid, housing, and transportation agencies.Read More »

State Strategies for Advancing Viral Hepatitis Elimination

November 21, 2021

Cases of viral hepatitis are on the rise across the United States. This report synthesizes key actions and proven strategies for public health leaders to consider as they approach viral hepatitis elimination planning within their own jurisdictions.Read More »

Examining State Innovations to Advance Breastfeeding and Health Equity

November 16, 2021

Breastfeeding is considered the gold standard in postnatal care for both birthing persons and infants. Yet, despite national gains in breastfeeding initiation rates, racial disparities in breastfeeding initiation and duration rates continue to persist. Effective intervention strategies require a multi-level approach that includes comprehensive legal, policy, and programmatic efforts.Read More »

Digging Deeper Into Legionnaires’ Disease Guidance Needs for State and Territorial Health Agencies

August 26, 2021

As a follow-up to a 2019 report, ASTHO conducted key informant interviews with five state health agencies to better understand key topics. Targeted areas of discussion were the overall structure of Legionnaires’ disease programs, diagnosis and clinical testing protocols, surveillance and reporting, outbreak and response, water management programs and prevention, and risk communication. This report shares results and key takeaways from these interviews, including notable challenges.Read More »

Braiding and Layering Funding for Adverse Childhood Experiences Prevention

August 05, 2021

In recent years, states and territories have started looking at braiding and layering funding streams as a way to leverage existing resources to achieve population-level impact. Adverse childhood experiences (ACEs) is one area that lends itself well to braiding and layering funds, since the risk and protective factors for ACEs span across multiple program areas, including maternal and child health, violence prevention, substance misuse, behavioral health, housing, chronic disease, and early childhood education. This report aims to help state and territorial health agency staff understand the process of braiding and layering funds and identifying opportunities to maximize ACEs prevention resources and impact. ASTHO created this report with input from state and territorial health agency senior deputies, other senior leadership, federal partners, and internal ASTHO subject matter experts.Read More »

Innovations in Overdose Response: Strategies Implemented by Emergency Medical Services Providers

August 04, 2021

Initial estimates suggest that annual drug overdose deaths in the United States reached a record high in 2020, accounting for 93,000 deaths. As the healthcare provider with greatest access to individuals experiencing a nonfatal drug overdose, emergency medical services (EMS) agencies play an essential role in the prevention of fatal drug overdose. For this reason, integrating EMS strategies into an overdose system of care is critically important. This report presents findings of an environmental scan conducted to identify novel or innovative EMS-involved strategies to prevent fatal overdose; discusses challenges to implementing these strategies; and suggests ways in which state health leaders can support these strategies.Read More »

Implementing a Health in All Polices Approach to Lead Poisoning Prevention

August 03, 2021

There is no one-size-fits-all approach to using a Health in All Policies (HiAP) strategy to address lead poisoning prevention. When implementing HiAP activities, health agencies can exist in multiple phases of engagement at the same time, depending on the types of activities. ASTHO held key informant interviews with staff from four state health agencies to learn more about their state childhood lead poisoning prevention programs and better understand how each agency employs a HiAP approach in its programmatic work. The key themes pulled from the discussions can be found in this report.Read More »

Framing Health in All Policies: Terms That Resonate

July 29, 2021

Health in All Policies (HiAP) can be a successful strategy to expand collaboration between S/THAs and other partners, but the terminology used in programs focused on these efforts can differ. While some states use the term “health in all policies” to name these programs, others shy away from the terminology to avoid a feeling of health imperialism and other agencies’ limited understanding of what HiAP means. Equity is often a prominent part of these efforts, but is not always included in the program title. ASTHO partnered with the Kansas Health Institute to host listening sessions to better understand state terminology and framing around HiAP; explore lessons learned, challenges, and alternative framing for HiAP terminology; and assess how HiAP framing and associated efforts have evolved over time, especially in the context of COVID-19 and the increased spotlight on the importance of racial equity.Read More »

Partner Coordination Efforts to Strengthen Infection Prevention and Control Practices

April 09, 2021

In the United States, public health, healthcare, and long-term care facilities across the nation have faced staffing, testing, and personal protective equipment resource capacity challenges during the COVID-19 pandemic. As a result, some facilities have faced challenges with infection prevention and control, increasing their vulnerability to COVID-19 and other disease outbreaks. This report highlights examples of health department partnership coordination strategies to enhance surveillance, increase resource and staffing capacity, and improve communication and collaboration in order to strengthen infection prevention and control practices during the COVID-19 response.Read More »

State Approaches to Insecticide Resistance Testing

March 08, 2021

Emerging mosquito-borne threats are rising, and one new threat state and territorial health agencies must prepare for is the potential for mosquitoes to develop resistance to the insecticides typically used for their control. This report includes two case studies capturing how states are building capacity to address the threat of insecticide resistance. The case studies and analyses in this report may serve as a guide as states respond to similar problems in their jurisdictions.Read More »

Legal Challenges to State COVID-19 Orders

October 20, 2020

In response to the COVID-19 outbreak, state and territorial executive officials have issued declarations and orders aimed at mitigating the impact of the coronavirus. Across the country, these executive actions—including stay-at-home orders, public gathering limits, and emergency declarations—are being challenged in courts as violating constitutional and statutory provisions. This report examines the legal challenges being made against COVID-19 orders and looks at some of the early litigation results and emerging issues.Read More »

State and Territorial Preparedness for Drinking Water Emergencies

August 10, 2020

Managing an effective response to public drinking water emergencies is essential to maintaining critical operations of community infrastructure and protecting public health. ASTHO has worked with state and territorial health agencies and partners to facilitate dialogue and collect data on current gaps and resource needs in drinking water emergency preparedness. This report summarizes recent findings and recommendations for enhancing state and territorial water preparedness and collaborative emergency response efforts.Read More »

COVID-19 Case Investigation and Contact Tracing: Considerations for Using Digital Technologies

July 16, 2020

The COVID-19 Case Investigation and Contact Tracing: Considerations for Using Digital Technologies guide aims to orient decision-makers to the critical functionalities needed for case investigation and contact tracing, summarize the range of technology options emerging to support this work, and outline operational and privacy considerations when adopting these technologies.Read More »

Case Studies in Tick Surveillance and Tick-Borne Disease Prevention

June 01, 2020

Between 2004 and 2016, tick-borne disease cases almost doubled in the United States. This ASTHO report includes three case studies capturing how state vector-borne disease control officials have responded to specific issues relating to the public health threats posed by ticks. Given the rise in tick-borne disease, the case studies and analyses in this report may serve as a guide as states respond to similar problems in their jurisdictions.Read More »

Collaborations Between Health Systems and Community-Based Organizations

January 31, 2020

Across the nation, healthcare delivery systems and community-based organizations are developing partnerships to address the social determinants of health and behavioral health needs of the populations they serve. This report details strategies for overcoming early challenges to developing a new partnership, including approaches to ensure that community organizations and voices are heard during decision-making and priority-setting.Read More »

The Help End Addiction for Life Initiative

September 16, 2019

The Help End Addiction for Life (HEAL) initiative is a coalition of local providers and community stakeholders that formed in 2018 to address opioid addiction in Letcher County, Kentucky. This case study provides an in-depth examination of HEAL’s unique features and highlights the voices of local providers and stakeholders. The lessons learned by the HEAL coalition offer strategies for other communities to consider in their own collaborations to reduce opioid use.Read More »

Data-Driven Primary Prevention Strategies for Adverse Childhood Experiences

July 30, 2019

Preventing adverse childhood experiences (ACEs) is a critical place to start as states look to invest in upstream evidence-based prevention strategies to address the current opioid crisis. State health leaders play a critical role in promoting and facilitating ACEs data surveillance and monitoring. Surveilling and monitoring data is key to informing programmatic and policy work, documenting progress and impact, setting relevant ACEs-related state priorities, and influencing policy to address ACEs prevention. This report highlights ACEs-related data sources, provides examples of how states can use these data to inform their primary prevention work, offers resources for crafting data sharing agreements, and identifies challenges in collecting ACEs-related data.Read More »

Leveraging Public Health Assets in Medicaid Managed Care

May 29, 2019

State and territorial health agencies and Medicaid agencies each serve at-risk populations and may seek to align their resources to efficiently meet their goals. However, the two types of agencies have differences in terminology, tools, and orientation that can present barriers to alignment and collaboration. This three-part report maps the public health capacities, assets, and resources onto the obligations and direction of Medicaid agencies and their managed care health plans.Read More »

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