Kathleen E Angell, Janet Jarnefeld, Elizabeth K Schiffman, M Jana Broadhurst, Jianghu James Dong, Abraham Degarege, Roberto Cortinas, David M Brett-Major
{"title":"Active and Passive Vector Surveillance Systems in Lyme Endemic Minnesota and Their Correlation to Human Disease.","authors":"Kathleen E Angell, Janet Jarnefeld, Elizabeth K Schiffman, M Jana Broadhurst, Jianghu James Dong, Abraham Degarege, Roberto Cortinas, David M Brett-Major","doi":"10.1097/PHH.0000000000002140","DOIUrl":"10.1097/PHH.0000000000002140","url":null,"abstract":"<p><strong>Context: </strong>Vector surveillance is often used to predict tick-borne diseases in endemic regions. Active and passive vector surveillance systems offer differing benefits and limitations; understanding how the outputs of these systems differ and how they correlate to human disease is essential to public health decision-making. Active and passive vector surveillance systems in Minnesota between 2018 and 2023 present an opportunity for comparison between these surveillance methods.</p><p><strong>Objective: </strong>To (1) analyze, compare, and contrast the results of active vector surveillance with crowd-sourced approaches, and (2) explore how these sources predict risk of Lyme disease.</p><p><strong>Methods: </strong>In this ecological comparative analysis, descriptive statistics were performed to evaluate characteristics of each surveillance method to assess differences in seasonality, life stage, and species of ticks. Negative binomial regression was used to analyze correlation to Lyme disease.</p><p><strong>Results: </strong>There are differences between data sources in tick life stage, species, and seasonality. Active surveillance using small mammal trapping had a majority larval (85%) and I. scapularis (76%) ticks. In contrast, passive surveillance had a majority of adult (96%) and D. variabilis (75%) ticks. Observations in both data sources were skewed to the early third of the tick season, although this was more exaggerated in the passive surveillance data. Observations of ticks from both data sources positively correlated with cases of Lyme disease.</p><p><strong>Conclusions: </strong>Observed differences in tick characteristics between the 2 data sources may represent real differences between tick populations and human encounters. Some differences may be explained by observation, reporting, and sampling biases. Increased observations of ticks at the beginning of the season indicate potential utility of enhanced human Lyme disease surveillance at that time. These One Health findings signal an opportunity for early identification of high tick-borne disease years through integrated active and passive tick surveillance that informs the conduct of human disease surveillance.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"877-885"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maurica D Bynum, Gregory D Kearney, Stephanie B Jilcott Pitts, Annette G Greer, Satomi Imai
{"title":"Assessing Diversity, Equity, and Inclusion in the US Environmental Health Workforce: Challenges and Opportunities.","authors":"Maurica D Bynum, Gregory D Kearney, Stephanie B Jilcott Pitts, Annette G Greer, Satomi Imai","doi":"10.1097/PHH.0000000000002163","DOIUrl":"10.1097/PHH.0000000000002163","url":null,"abstract":"<p><strong>Context: </strong>Environmental health (EH) professionals play a critical role in the US public health workforce, performing a wide range of duties aimed at safeguarding community health. As the US population diversifies, the EH workforce needs to be culturally competent and reflective of this diversity. Current data show a predominantly White EH workforce, which may hinder the effectiveness and equity of public health interventions.</p><p><strong>Objective: </strong>The aims of this study were to assess EH professionals' perceptions of organizational commitment to diversity, equity, and inclusion (DEI), identify influencing factors, and examine the relationship between these perceptions and job satisfaction, engagement, and retention.</p><p><strong>Methods: </strong>This study utilized data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), targeting 137 447 public health workers with a response rate of 35% (n = 44 732). The survey included Likert scale questions to measure workplace satisfaction, awareness of DEI concepts, confidence in addressing DEI issues, and perceptions of organizational effectiveness in DEI.</p><p><strong>Results: </strong>Significant demographic disparities between BIPOC and White EH workers were identified. BIPOC workers were more prevalent in lower salary brackets and non-permanent roles, while White workers dominated supervisory and executive positions. Workplace satisfaction was similar across groups, but BIPOC workers reported lower pay satisfaction and job security. Awareness of DEI concepts was high among both groups, but BIPOC workers showed greater confidence in addressing health equity and structural racism. Perceptions of organizational effectiveness in DEI varied, with BIPOC workers perceiving a lower organizational commitment to DEI.</p><p><strong>Conclusions: </strong>These findings underscore the need for targeted DEI training, equitable workplace policies, and an inclusive organizational culture. Longitudinal research is recommended to track DEI progress and its impact on public health outcomes. Addressing DEI disparities within the EH workforce is critical for enhancing public health interventions and outcomes.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"787-794"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole D Ford, Sarah Baca, Alexandra F Dalton, Emilia H Koumans, Julia Raykin, Priti R Patel, Sharon Saydah
{"title":"Use and Characteristics of Clinical Coding for Post-COVID Conditions in a Retrospective US Cohort.","authors":"Nicole D Ford, Sarah Baca, Alexandra F Dalton, Emilia H Koumans, Julia Raykin, Priti R Patel, Sharon Saydah","doi":"10.1097/PHH.0000000000002137","DOIUrl":"10.1097/PHH.0000000000002137","url":null,"abstract":"<p><strong>Context: </strong>Little is known about when and how the ICD-10-CM diagnosis code for Post-COVID Conditions (PCC; U09.9) is being used to document PCC.</p><p><strong>Objectives: </strong>To examine the use and characteristics of clinical coding for PCC.</p><p><strong>Design: </strong>A retrospective cohort.</p><p><strong>Setting: </strong>Transaction-level medical encounters, laboratory testing results, pharmacy claims, and medical claims for inpatient and outpatient care from the HealthVerity database.</p><p><strong>Participants: </strong>382 400 US adults and children with private health insurance, Medicare, and Medicaid who had U09.9 code documented during October 1, 2021-June 30, 2023.</p><p><strong>Outcome measures: </strong>Count of first use of the U09.9 code, (a) overall, over time, and proportion by provider type; (b) prevalence of PCC-associated incident conditions co-documented with U09.9; (c) number of documented SARS-CoV-2 infections preceding U09.9; (d) timing between infection and U09.9; (e) encounters during the 6 months following first use of U09.9.</p><p><strong>Results: </strong>Overall, 0.6% of 65 556 068 patients had a PCC diagnosis code (64.6% female; 6 in 10 had ≥1 preexisting conditions). The highest count of new U09.9 codes occurred during Quarter 1 and Quarter 3 of 2022 and was documented by a variety of provider specialties. The most prevalent co-documented PCC-associated incident conditions were respiratory (13.4%) and malaise and fatigue (7.8%). Only 62% of patients had SARS-CoV-2 infection documented preceding U09.9; median time to PCC documentation was 17.0 days (interquartile range [IQR] = 5.0, 61.0). Patients with ≥1 encounters during which PCC was documented in the 6 months following their index encounter (n = 109 794) had, on average, 25.5 additional encounters (median = 14 [IQR = 7, 29]).</p><p><strong>Conclusions: </strong>Our study describes the sociodemographic characteristics, complex clinical manifestations, and high healthcare use of patients following a PCC diagnosis. These findings may inform efforts to identify and treat PCC, inform healthcare planning, and support efforts to educate clinicians about the definition of PCC and accurate application of the code.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"E292-E302"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cynthia K Perry, Jay E Maddock, Nathan F Dieckmann, Jim Winkle, Heather Franklin, Jessica J Currier, Elena Andreyeva, Rebecca A Seguin-Fowler
{"title":"Associations of Physical Activity-Related Social Norms and Frequency of Outdoor Walking with Perceived Walkability Among Rural Oregon Adults.","authors":"Cynthia K Perry, Jay E Maddock, Nathan F Dieckmann, Jim Winkle, Heather Franklin, Jessica J Currier, Elena Andreyeva, Rebecca A Seguin-Fowler","doi":"10.1097/PHH.0000000000002164","DOIUrl":"10.1097/PHH.0000000000002164","url":null,"abstract":"<p><strong>Context: </strong>Individuals who walk regularly are more likely to meet recommended physical activity guidelines than non-walkers; however, rural US adults walk less than urban adults. The built and social environment, perceived walkability and walking are bidirectionally related with each other.</p><p><strong>Objective: </strong>This study's purpose was to assess the associations of physical activity-related social norms and frequency of walking in the neighborhood with perceived walkability among rural adults.</p><p><strong>Study design main outcomes: </strong>The data for this cross-sectional analysis comes from a randomized trial with 18 rural Oregon libraries. As part of baseline assessment, participants completed surveys on physical activity-related social norms, perceived walkability, frequency of walking in the neighborhood, and demographic items. We assessed bivariate correlations and ran linear regression models with perceived walkability as the outcome and social norms (social environment) and frequency of walking in the neighborhood (built environment experience) as predictors with covariates of age, gender and income.</p><p><strong>Setting and participants: </strong>Adult residents of 18 rural communities in Oregon.</p><p><strong>Results: </strong>Of the 313 participants who completed the survey, 60% were 65 and older, 92% white and 86% women; 17% reported walking in the neighborhood less than once a month and 5% reported walking 5 or more days/week. We found positive correlations between perceived walkability and frequency of walking in the neighborhood ( r = .23, p < .01), and social norms ( r = .47, p < .01). The linear regression model explained 28% of the variance in perceived walkability (adj r -squared = 0.26). Social norms (unstandardized coefficient = 0.37, 95% CI: 0.28,0.46) and frequency of walking in the neighborhood, (unstandardized coefficient = 0.06, 95% CI: 0.02, 0.10) were positively associated with perceived walkability.</p><p><strong>Conclusions: </strong>Among a group of rural adults social norms had a greater influence on perceived walkability than frequency of walking in the neighborhood. Intervening in the social environment could impact perceived walkability and ultimately walking among rural adults.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"709-715"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emilie R Madsen, Paulani Mui, Beth Resnick, Valerie A Yeager
{"title":"Innovations and Hiring Improvements to Address Public Health Workforce Recruitment.","authors":"Emilie R Madsen, Paulani Mui, Beth Resnick, Valerie A Yeager","doi":"10.1097/PHH.0000000000002179","DOIUrl":"10.1097/PHH.0000000000002179","url":null,"abstract":"<p><strong>Objectives: </strong>This study engaged state and local health agency employees involved in the hiring process to examine the impact of hiring laws and civil service requirements on recruitment processes. Additionally, we identified innovative approaches to improve recruitment.</p><p><strong>Design: </strong>Key informant cross-sectional qualitative study.</p><p><strong>Setting: </strong>State and local U.S. governmental public health agencies.</p><p><strong>Participants: </strong>Health department hiring managers, human resources/workforce development directors and assistant directors, program managers, deputy commissioners, and other HR representatives.</p><p><strong>Main outcome measures: </strong>Experiences and perceptions of public health hiring approaches, processes, and civil service requirements.</p><p><strong>Results: </strong>Three themes emerged as solutions and innovations for public health agency recruitment: marketing strategies, organizational workforce development changes, and applicant experience improvements. Marketing strategies to improve recruitment included the expanded use of job wrapping and social media platforms. Organizational workforce development for recruitment and retention initiatives included paid fellowship programs, salary comparisons and market adjustments, expanded benefits, and the enhanced role of HR teams. Discussion of civil service requirements and hiring laws revealed that organizational and governance factors, such as hiring authority, were perceived as more consequential to effective recruitment than specific components of the law.</p><p><strong>Conclusions: </strong>Organizations should improve inefficient recruitment and hiring processes and systems where possible. Much of this is achievable through quality improvement initiatives rather than legal or regulatory changes. However, tracking the hiring process to identify inefficiencies is essential, as barriers likely differ across agencies and states. Finding ways to shorten the applicant review timeframe and improve communication with applicants throughout the hiring process may yield more successful recruitment efforts. Lastly, Public Health Infrastructure Grant (PHIG) funding and programming have led to recruitment innovations. Flexibility to adapt recruitment approaches to changing workforce and labor market dynamics is needed for an adequate workforce with the capacity to address foundational needs and public health challenges.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"806-817"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Call for Critical System Thinking in Addressing the 2024 Mpox Public Health Emergency.","authors":"","doi":"10.1097/PHH.0000000000002193","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002193","url":null,"abstract":"","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":"31 5","pages":"905"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Show Me the Values: Centering Communities and Co-Creation in an Equity-Driven Evaluation.","authors":"Kay Schaffer, Jamila M Porter","doi":"10.1097/PHH.0000000000002187","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002187","url":null,"abstract":"","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":"31 5","pages":"897-898"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In-Gu Kang, Nayoung Kim, Arianna Injeian, Beth H Chaney, Hee Yun Lee
{"title":"Factors Associated with Turnover Intention Among Early-Career US Governmental Public Health Employees and a Moderation Role of Race and Ethnicity.","authors":"In-Gu Kang, Nayoung Kim, Arianna Injeian, Beth H Chaney, Hee Yun Lee","doi":"10.1097/PHH.0000000000002176","DOIUrl":"10.1097/PHH.0000000000002176","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the associations between individual characteristics, organizational environmental perceptions, and turnover intention among early-career US governmental public health employees under 35 years of age.</p><p><strong>Design: </strong>Multivariable logistic regression was used to analyze turnover intention in relation to employee demographics, agency setting, global workplace satisfaction, and organizational environmental perceptions among early-career public health employees from the combined cross-sectional data of the 2017 and 2021 Public Health Workforce Interests and Needs Survey. Moderation effects of race and ethnicity on these relationships were also tested.</p><p><strong>Setting: </strong>US State Health Agency Central Offices and Local Health Departments.</p><p><strong>Participants: </strong>A total of 43 638 US governmental public health employees across state and local health agencies participated in this study.</p><p><strong>Main outcome measures: </strong>Self-reported turnover intention, coded as binary: \"No\" (0) for staying and \"Yes\" (1) for intention to leave within a year, excluding retirement.</p><p><strong>Results: </strong>A 35.7% of early-career US governmental public health employees under 35 years of age reported an intention to leave their agency within a year, exceeding the overall workforce rate of 25.4% ( P < .05). Men, individuals of other gender identities, racial and ethnic minorities, those with higher education, and younger employees were more likely to report turnover intention. In contrast, higher global workplace satisfaction, positive perceptions of talent and expertise utilization, and career development opportunities including training needs assessments and leadership development were associated with lower turnover intention. These relationships were moderated by race and ethnicity, with stronger protective effects for white employees compared to racial and ethnic minoritized employees.</p><p><strong>Conclusions: </strong>Early-career US governmental public health employees face high turnover risks, especially in certain demographic groups. Higher global workplace satisfaction and positive perceptions of skill utilization and career development opportunities reduce the odds of turnover intention, with stronger effects for white employees. Targeted human resource strategies are essential to improving retention in this workforce.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"E267-E275"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ear Care and Hearing Health Awareness Among Female Community Health Volunteers in Nepal.","authors":"Milan Maharjan, Samira Rajbhandari","doi":"10.1097/PHH.0000000000002174","DOIUrl":"10.1097/PHH.0000000000002174","url":null,"abstract":"<p><strong>Objective: </strong>The primary cause of hearing loss in Nepalese children is chronic otitis media. General lack of awareness about ear and hearing health, paired with usage of traditional malpractices to treat common ear problems, has contributed to an increased morbidity of chronic otitis media and consequent hearing loss. The aim is to evaluate the practices and awareness of ear and hearing health among female community health volunteers (FCHVs).</p><p><strong>Design: </strong>Cross-sectional study. Data were collected between January 2021 and January 2023.</p><p><strong>Setting: </strong>Seven municipalities of Kathmandu, Lalitpur, and Bhaktapur districts of Nepal.</p><p><strong>Participants: </strong>2154 female community health volunteers.</p><p><strong>Main outcome measures: </strong>FCHVs were interviewed using structured questionnaire prepared in local language to examine their level of awareness about ear care and hearing health. Demographics of the participants, awareness and common practices in ear and hearing health were documented and studied.</p><p><strong>Results: </strong>A total of 2154 FCHVs, age ranging from 20 to 65 years old participated in the study. The majority of the FCHVs have at least a secondary level education (n = 912, 42.34%) and only 14.21% (n = 306) of FCHVs surveyed are illiterate. Out of 2154 effective responses, 91.36% (n = 1968) reported cleaning their ears regularly using cotton buds, metallic loops and feathers. Sixty-one percent of them accept the traditional method of instilling oil or other home remedies into their ears, and 45.13% (n = 972) report using eardrops without prescription to self-treat ear problems. The majority of participants are aware that loud noise and ear infections may cause hearing loss.</p><p><strong>Conclusions: </strong>There is a poor knowledge about ear and hearing health among FCHVs in Nepal. Health volunteers play an integral role in promoting preventive care at the community level. This study highlights a need for awareness about ear and hearing health among this key demographic in order to prevent avoidable hearing loss in Nepal.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":"E286-E291"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashlyn Burns, Leslie Hulvershorn, Matthew C Aalsma, Zachary W Adams
{"title":"Age-Based Trends in Opioid Overdose-Related Emergency Medical Services Encounters, 2017-2023.","authors":"Ashlyn Burns, Leslie Hulvershorn, Matthew C Aalsma, Zachary W Adams","doi":"10.1097/PHH.0000000000002199","DOIUrl":"https://doi.org/10.1097/PHH.0000000000002199","url":null,"abstract":"<p><p>This repeated cross-sectional analysis uses 2017-2023 National Emergency Medical Services Information System (NEMSIS) data to characterize age-based trends in overdose-related EMS encounters. We calculated the annual rate of opioid overdose-related EMS encounters per 10 000 total EMS encounters across six age-groups. Among all age-groups, the annual rate of opioid overdose-related EMS encounters increased from 2019 to 2020. The largest increase was seen among adolescents under age 18, which increased by 70% (7.7-13.1 per 10 000 EMS encounters). From 2022 to 2023, the annual rate of opioid overdose-related EMS encounters decreased among all age-groups. Among those ages 18-24 and 25-34, overdose-related EMS encounters resemble pre-pandemic levels. In contrast, the annual rate among the under 18 group remained 62% higher (12.5 per 10 000 EMS encounters) than pre-pandemic levels. Given inaccurate beliefs that opioid overdoses only affect adults, system-level interventions are needed to expand access to youth-focused prevention, harm reduction, and treatment services.</p>","PeriodicalId":47855,"journal":{"name":"Journal of Public Health Management and Practice","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}