Local Responses to Limits on U.S. Public Health Authority During the COVID‐19 Emergency

The International Journal of Health Planning and Management · 2026-01-27

Public health has become politicized in the U.S. Though research shows that limiting public health authority during emergency response puts community wellbeing and health outcomes at risk, during the COVID-19 emergency (2020-2021), some U.S. state policymakers limited the disease-preventing actions local public health agencies could take. This conflicts with public health agencies' mandate to protect lives. Using COVID-19 as a case study, we explored how local public health agencies upheld their mandate when faced with limited public health authority. We conducted qualitative semi-structured focus groups (October 2023) with a purposive sample of U.S. public health officials (n = 14) from seven U.S. states which experienced four types of restrictions on local public health actions (limits on the emergency authority of governor, chief executive, state health officer, and local government health officers). Participants discussed barriers and challenges faced, adaptations made, actions taken, and perspectives for the future. Emergent themes suggest that while limited resources and restricted public health authority caused strain, public health efforts were upheld through cross agency collaboration at the local level which supported innovation. To achieve this, trust-building and communication were vital. Limitations on local public health authority may increase in the U.S. in the coming years. To mitigate risks amidst future public health emergencies, public health leaders must focus on building trust, clear and consistent communication, and bolstering collaborative networks at the local level. The politicization of health policy at the state and federal level also needs to be addressed, as local action can only go so far.

Cultivating Human and Ecosystem Health: Planetary Health Applications Through Agroforestry in Rural Haiti

Research Square · 2026-04-10

AMPLIFICATION OF THE POWER OF NETWORK HUBS AND DEGREE SKEWNESS OVER INFECTIOUS DISEASE SPREAD DURING LULLS

medRxiv · 2025-03-28

ABSTRACT Just as individuals’ personal social network connections shape their susceptibility to disease, the structure of larger networks in communities shapes the extent of disease spread. We examine how heterogeneity in network structure at the population level affects the spread of disease – namely, COVID-19 – considering varying levels of disease transmissibility and in-person contact rates. Using dynamic simulations that take into account network structure, social contact rates given contextual features of the community (informed by real-life data on family local family structure, schools, workplaces, and daily shopping activities), and disease infection rates, we first confirm that the presence of network hubs and high network degree skewness results in a higher level of infected peak prevalence with infectious diseases such as COVID-19 during periods of low to moderate transmissibility. However, this effect is amplified during lulls in disease spread and is suppressed during periods of greater transmissibility, rendering social network structure more significant during lulls. Moreover, in the case of already highly transmissible diseases, the role of hubs and severe degree skewness is already more continually suppressed.

Prevalence of SARS-CoV-2 infection and immunity in a New York county in 2022 reveals frequent asymptomatic or undiagnosed infections

PLoS ONE · 2025-05-28

Accurate and timely surveillance of SARS-CoV-2 prevalence and immunity is critical to local and national COVID-19 pandemic responses. Representative surveillance surveys reveal more accurate estimates of COVID-19 infection than other measures based on reported test results. Our main research objectives were (i) to provide local health department officials with prevalence estimates calculated from a representative sample to better inform their decision-making efforts in response to the COVID-19 pandemic and (ii) to identify characteristics associated with COVID-19 infections among high-risk groups. Three municipalities were sampled at one timepoint (February, April, or October 2022) using a 2-stage cluster sampling design. Participants provided anterior nares swabs, which were tested for SARS-CoV-2 with a RT-PCR and for nucleocapsid protein and receptor binding domain antibodies by multiplex Luminex assay. Participants completed a survey on socio-demographics, SARS-CoV-2 prevention behaviors and attitudes, and vaccination and infection history. A total of 233 individuals from 221 households provided anterior nares swabs, and 215 samples were linked to survey data. After adjusting for study design, the household prevalence of PCR-positive tests was less than 5%, but approximately half of the population had antibodies from a prior infection and most (81% to 92%) had antibodies from either infection or vaccination. Discrepancies between self-reported positive test and vaccination status and antibody results suggested a high prevalence of asymptomatic infection and waning antibody titers. County-level infection prevalences, estimated from the county test reporting system, were 16.6% in February, 19.1% in April, and 23.8% in October, substantially lower than the prevalence of individuals with antibodies from infection in the surveys, also supporting a high prevalence of asymptomatic or unconfirmed infections. The overall small sample size precluded an analysis of characteristics associated with active or past infection. In conclusion, surveillance surveys can provide timely data on infection status and immunity to support public health responses.

Piloting a framework to explore the impacts of public health workforce capacity-building initiatives

Frontiers in Public Health · 2025-12-03 · 2 citations

Introduction To reinforce and re-build the public health workforce, many capacity building interventions are in place. While pre-post assessments are often used to describe short-term outcomes, methods to assess and describe longer-term outcomes and impacts are wanting. Our work aimed to help close this gap by exploring ways to assess and describe longer-term outcomes, including how capacity gains contribute to new actions taken by individual workers and organizations in support of public health goals. We hoped this work might inform development of an evaluation framework able to measure outcomes and impacts of public health workforce capacity-building initiatives. Methods Building from short-term outcomes data demonstrating changes in participant capacity (knowledge, skill, confidence), we used a multiple case study design to explore outcomes resulting from the use of the online Public Health Essentials (PHE) capacity building intervention. We conducted in-depth interviews with a purposive sample of eight PHE graduates (Summer 2023-Spring 2024) to elucidate both medium-term outcomes and potential longer-term impacts. Qualitative interviews were coded and analyzed using a priori and emergent themes (Spring-Fall 2024). Results Interview analysis revealed outcomes grouped into 13 themes. PHE graduates described how capacity growth influenced seven individual capabilities and their ability to take collective or shared actions in three areas. Further, they described their ability to influence changes in conditions in three areas critical public health: health equity, social determinants of health, and prevention. Conclusion Evaluating longer-term outcomes and impacts of capacity building interventions is crucial to both improve and justify public health workforce development initiatives, particularly as prevention and population health needs persist. We posit that evaluations will be more effective if standardized methods are used across interventions, and if there is a greater push to share and publish results. We present a conceptual framework that may inform and guide future evaluation and process improvement efforts.

Amplification of the power of network hubs and degree skewness over infectious disease spread during lulls

PLoS ONE · 2025-11-13

Just as individuals' personal social network connections shape their susceptibility to disease, the structure of larger networks in communities shapes the extent of disease spread. We examine how heterogeneity in network structure at the population level affects the spread of disease - namely, COVID-19 - considering varying levels of disease transmissibility and in-person contact rates. Using dynamic simulations that take into account network structure, social contact rates given contextual features of the community (informed by real-life data on family local family structure, schools, workplaces, and daily shopping activities), and disease infection rates, we first confirm that the presence of network hubs and high network degree skewness results in a higher level of infected peak prevalence with infectious diseases such as COVID-19 during periods of low to moderate transmissibility. However, this effect is amplified during lulls in disease spread and is suppressed during periods of greater transmissibility, rendering social network structure more significant during lulls. Moreover, in the case of already highly transmissible diseases, the role of hubs and severe degree skewness is already more continually suppressed.

Perceptions of and Responses to Wildfire Smoke Among New York State Residents: A Cross-Sectional Study

International Journal of Environmental Research and Public Health · 2025-02-14 · 1 citations

Exposure to wildfire smoke (WFS) is associated with detrimental physical and mental health. Periods of sustained WFS are predicted to increase with climate change, affecting populations globally. Using a retrospective cross-sectional study, we assessed perceptions of and responses to WFS in a cohort of New York State (NYS) residents in Summer 2023. Data were collected using an online survey from October to November 2023. Descriptive statistics summarized respondent experiences, while exploratory analyses identified high-risk populations using chi-square and t-tests. Our sample consisted of 609 primarily healthy, white, and well-educated individuals who spent most of their time in NYS during Summer 2023. Of the 99% that reported experiencing WFS, 92% received and 91% sought out WFS-related air quality information. While only 25% reported a WFS-related illness, 87% experienced at least one symptom with WFS, frequently citing watery eyes (63%), irritated throat (50%), and headaches (49%), with women reporting symptoms more frequently than men (89.1% vs. 81.6%; p = 0.034). A majority (93%) reported taking mitigation actions, including avoiding outdoor activities (75%) and wearing masks (54%). Our results highlight widespread impacts of wildfires in NYS during Summer 2023, with nearly all respondents reporting sustained periods of WFS. Most reported at least one adverse health symptom despite taking preventative measures, indicating that current protective strategies may be insufficient and more effective interventions are needed.

Representative Public Health Surveys Pose Several Challenges: Lessons Learned Across 9 Communities During the COVID-19 Pandemic

AJPM Focus · 2024-01-30

Community surveillance surveys offer an opportunity to obtain important and timely public health information that may help local municipalities guide their response to public health threats. The objective of this paper is to present approaches, challenges, and solutions from SARS-CoV-2 surveillance surveys conducted in different settings by 2 research teams. For rapid assessment of a representative sample, a 2-stage cluster sampling design was developed by an interdisciplinary team of researchers at Oregon State University between April 2020 and June 2021 across 6 Oregon communities. In 2022, these methods were adapted for New York communities by a team of veterinary, medical, and public health practitioners. Partnerships were established with local medical facilities, health departments, COVID-19 testing sites, and health and public safety staff. Field staff were trained using online modules, field manuals describing survey methods and safety protocols, and in-person meetings with hands-on practice. Private and secure data integration systems and public awareness campaigns were implemented. Pilot surveys and field previews revealed challenges in survey processes that could be addressed before surveys proceeded. Strong leadership, robust trainings, and university-community partnerships proved critical to successful outcomes. Cultivating mutual trust and cooperation among stakeholders is essential to prepare for the next pandemic.

Self-reported health effects from wildfire smoke: A cross-sectional study in New York State

European Journal of Public Health · 2024-10-28

Abstract Background Wildfires and exposure to wildfire smoke (WFS) are forecasted to increase, in part driven by climate change. As witnessed in 2023, regions in Europe and North America are facing more sustained periods of poor air quality due to WFS. Growing evidence suggests average daily WFS correlates with morbidity and mortality, but the impact of prolonged WFS exposure remains understudied, especially in areas where WFS is a newer occurrence. We examine associations between consecutive days of WFS experienced and self-reported health symptoms in the northeastern United States. Methods This retrospective cross-sectional study explored New York State (NYS) residents’ experience with WFS in summer 2023 via an online survey. Participants reported the longest period of consecutive WFS days and symptoms experienced. Log-binomial regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results 553 NYS residents were included, representing a healthy, primarily female and White population, ranging from 18 to 86 years. 549 (99.3%) reported experiencing WFS, with the longest period of consecutive WFS days varying (≤3 days: n = 152; 4 to 6 days: n = 255; ≥7 days: n = 146). 490 (88.6%) reported ≥1 health symptom, with itchy/watery eyes, sore throat, and headache as the most frequent. Compared to ≤ 3 consecutive WFS days, symptom prevalence was 9.1% higher for those reporting 4 to 6 days (PR [95% CI]:1.09 [1.00, 1.19]) and 16.7% higher for ≥7 days (1.17 [1.07, 1.27]). The trend of increased symptom prevalence with longer WFS periods persisted and was pronounced for specific symptoms. Control for potential confounders did not appreciably change estimates. Conclusions Our findings suggest longer sustained WFS exposure associates with higher symptom prevalence, which may be precursors to more serious health conditions. As global populations face more WFS with climate change, public health professionals should prioritize strategies to mitigate prolonged exposure. Key messages • In a convenience sample of 553 primarily healthy New York State residents, 99.3% reported experiencing wildfire smoke and 88.6% reported at least 1 symptom of poor health during summer 2023. • Associations between consecutive days of wildfire smoke experienced and prevalence of any and specific symptoms tended to vary in a dose-response manner.

Exploring the scalability and sustainability of community-based agroforestry to achieve planetary health benefits in Haiti’s Lower Artibonite Valley

PLOS Climate · 2024-10-01 · 2 citations

Community-based agroforestry, as a planetary health solution, can rebuild fertile soils, minimize climate risk, diversify farmer incomes, and provide a source of food, raw materials, and other vital ecosystem functions. Utilizing focus groups, individual semi-structured interviews, and field observations, we studied how the Haiti Timber Reintroduction Program (HTRIP), an agroforestry program operating in Haiti since 2005, leveraged institutional infrastructures and social networks to facilitate the adoption, scaling, and sustainability of community-based agroforestry as a solution for planetary health. Results show that the adoption and scaling of community-based agroforestry was facilitated by support from institutional and social networks. The results underscore the importance of cross-sector collaboration and coordination in creating the enabling conditions necessary for successful community-based agroforestry implementation. Additionally, strengthened social networks, cultivated through long-term participation in the HTRIP, contributed to the program’s sustainability. While competing socio-political problems in some low-income settings may seem insurmountable—particularly those in fragile states, where our study took place—our research demonstrates that community-based agroforestry solutions are possible. Where culturally relevant, this ecologically and socially based practice could be scaled up to amplify its benefits to more communities. We encourage further research to explore the scaling up of regenerative practices such as agroforestry for climate resilience and planetary health.