Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship.

After the hurricanes in 2017 in the U.S. Caribbean, it was essential to rebuild, strengthen, and sustain essential environmental health (EH) services and systems. The National Environmental Health Association, in partnership with the Centers for Disease Control and Prevention, developed an online mentorship program for newly hired and existing EH staff and health department leadership in Caribbean health departments. Participants were provided with both practical and didactic learning and were allowed to evaluate the program. Both mentors and mentees were highly satisfied with the knowledge and skills acquired, and mentees expressed it was relevant to their daily work. Based on the findings, we recommend both an online and a hybrid mentorship program for leadership- and inspector-level workforces in EH and potentially in other fields.

Public health branch incident management and support as part of the Federal Government response during the emergency phase of Hurricanes Irma and Maria in Puerto Rico and the US Virgin Islands.

On September 6 and 20, 2017, Hurricanes Irma and Maria made landfall as major hurricanes in the US Caribbean Territories of the Virgin Islands and Puerto Rico with devastating effects. As part of the initial response, a public health team (PHT) was initially deployed as part of the US Department of Health and Human Services Incident Response Coordination Team. As a result of increased demands for additional expertise and resources, a public health branch (PHB) was established for coordinating a broad spectrum of public health response activities in support of the affected territories. This paper describes the conceptual framework for organizing these activities; summarizes some key public health activities and roles; outlines partner support and coordination with key agencies; and defines best practices and areas for improvement in disaster future operations.

Continuation of Mosquito Surveillance and Control During Public Health Emergencies and Natural Disasters.

Mosquitoborne disease outbreaks occur every year in the United States from one or more of the arboviral diseases dengue, West Nile, LaCrosse, Eastern equine encephalitis, and Zika (1). Public opinion communicated through traditional and social media and the Internet, competing public health and resource priorities, and local conditions can impede the ability of vector control organizations to prevent and respond to outbreaks of mosquitoborne disease. The Environmental Protection Agency (EPA) and CDC performed a coordinated review of the concerns and challenges associated with continuation of mosquito surveillance and control during public health emergencies and disasters. This report highlights the first joint recommendation from EPA and CDC. Mosquito surveillance and control should be maintained by state and local mosquito control organizations to the extent that local conditions and resources will allow during public health emergencies and natural disasters. Integrated pest management (IPM) is the best approach for mosquito control (2). IPM uses a combination of methods, including both physical and chemical means of control (3). For chemical means of control, CDC and EPA recommend the use of larvicides and adulticides following the EPA label. It is imperative that public health recommendations be followed to ensure the safety of the pesticide applicator and the public.

Identifying Needs for Advancing the Profession and Workforce in Environmental Health.

An ever-changing landscape for environmental health (EH) requires in-depth assessment and analysis of the current challenges and emerging issues faced by EH professionals. The Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health initiative addressed this need.After receiving responses from more than 1700 practitioners, during an in-person workshop, focus groups identified and described priority problems and supplied context on addressing the significant challenges facing EH professionals with state health agencies and local health departments. The focus groups developed specific problem statements detailing the EH profession and workforce's prevailing challenges and needs according to 6 themes, including effective leadership, workforce development, equipment and technology, information systems and data, garnering support, and partnerships and collaboration.We describe the identified priority problems and needs and provide recommendations for ensuring a strong and robust EH profession and workforce ready to address tomorrow's challenges.

Exploring the Benefits and Value of Public Health Department Internships for Environmental Health Students.

Internships are an essential component of preparing prospective college graduates for entering the practice-based field of environmental health (EH). EH professionals continually encounter events or hazards of high complexity and impact, and many experienced EH professionals are expected to retire within the next several years. Efforts are needed to ensure a supply of highly qualified and prepared graduates is available to sustain and strengthen the EH workforce. The National Environmental Public Health Internship Program (NEPHIP) addresses this need by supporting health department internships for EH students of academic programs accredited by the National Environmental Health Science and Protection Accreditation Council. We conducted an assessment to examine former NEPHIP intern and mentor experiences and perspectives on 1) how well the internships prepared interns for careers in EH and 2) to what extent the internships provided value to the host health department. Overall, the internships appeared to provide EH students with a well-rounded professional and practice-based experience, while health departments benefited from hosting interns with a foundational knowledge and college education in EH. Promoting the value of public health department EH internships could encourage more students and graduates to seek internship or employment opportunities with health departments, ultimately strengthening the EH workforce.

Centers for Disease Control and Prevention National Center for Environmental Health/Agency for Toxic Substances and Disease Registry Roles in Hurricane Response and Postdisaster Mosquito Control1.

Hurricanes and other natural disasters leave behind multifaceted and complex environmental challenges that may contribute to adverse health outcomes, such as increased potential for exposure to vector-borne disease. Through an incident management system tailored for the Centers for Disease Control and Prevention (CDC), the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) fulfills a leadership role in facilitating the agency's natural disaster emergency response activities through coordination with other CDC programs, liaising with other government agencies and impacted jurisdictions, and responding to requests for technical assistance. On the ground, NCEH/ATSDR deploys environmental health (EH) practitioners who provide consultation and inform mosquito control efforts from a systematic perspective. In the wake of recent hurricanes, NCEH staff mobilized to manage critical elements of the responses and to provide assets for addressing environmental hazards and conditions that contributed to the presence of mosquitoes. In this article, we describe NCEH/ATSDR's emergency response roles and responsibilities, interactions within the national emergency response framework, and provision of EH technical assistance and resources, particularly in the context of postdisaster mosquito control.

Environmental Health Practice Challenges and Research Needs for U.S. Health Departments.

BACKGROUND: Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations. OBJECTIVES: A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments. METHODS: A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic. DISCUSSION: EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161.

Uncovering Environmental Health: An Initial Assessment of the Profession's Health Department Workforce and Practice.

Environmental health (EH) professionals provide critical services and respond to complex and multifaceted public health threats. The role of these professionals is continually re-emphasized by emergencies requiring rapid and effective responses to address environmental issues and ensure protection of the public's health. Given the prominence of the EH profession within the public health framework, assessing the governmental health department workforce, practice, and current and future challenges is crucial to ensure EH professionals are fully equipped and prepared to protect the nation's health. Such an understanding of the EH profession is lacking; therefore, we initiated Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health (UNCOVER EH). Through a web-based survey, we identified EH professional demographics, characteristics, education, practice areas, and aspects of leadership and satisfaction. We distributed the survey to a convenience sample of EH professionals working in health departments, limiting the generalizability of results to the entire EH workforce. The results were strengthened, however, by purposive sampling strategies to represent varied professional and workforce characteristics in the respondent universe. The UNCOVER EH initiative provides a primary source of data to inform EH workforce development initiatives, improve the practice, and establish uniform benchmarks and professional competencies.

Environmental Health Program Performance and its Relationship with Environment-Related Disease in Florida.

This study used a unique approach to examine Florida county health department environmental health (EH) program performance of the 10 Essential Environmental Public Health Services (EEPHS) and its relationship with environment-related disease, described by enteric disease rates. Correlation analysis tested the association between performance of each EEPHS and five different enteric disease rates, while multivariate regression analysis further examined the relationships while considering program organizational characteristics as potential confounders. Correlation analyses revealed cryptosporidiosis was associated with EEPHS 2 diagnose (Tb = .195, p = .027) and EEPHS 8 workforce (Tb = .234, p = .006), and salmonellosis with EEPHS 4 mobilize (Tb = .179, p = .042) and EEPHS 6 enforce (Tb = .201, p = .020). Multivariate regression results showed EEPHS 2 diagnose (p = .04) and EEPHS 4 mobilize (p = .00) had statistically significant associations with cryptosporidiosis and salmonellosis, respectively, and suggested that improved performance of these two EEPHS may have decreased disease incidence. EH programs may benefit from improving the performance of EEPHS to address the incidence of certain enteric diseases. Continued efforts to develop a robust understanding of EH program performance and its impact on environment-related disease could enhance EH services delivery and ability to improve health outcomes.

Organizational Characteristics of Local Health Departments and Environmental Health Services and Activities.

The main objective of this research was to ascertain the association between organizational characteristics of local health departments (LHDs) and environmental health (EH) services rendered in the community. Data used for the analysis were collected from LHDs by the National Association of County and City Health Officials for its 2013 national profile study of LHDs. We analyzed the data during 2016. Apart from understanding basic characteristics of LHDs in the nation, we introduced new measures of these characteristics, including "EH full-time equivalents" per 100,000 population and "other revenue" (revenues from fees and fines) per capita. The association of these and other organizational characteristics with EH services were measured using likelihood ratio χ2 and t-tests. Out of 34 EH services considered, LHDs directly provided an average of 12 different services. As many as 41% of the 34 EH services were not available in more than 10% of the communities served by LHDs. About 70% of communities received some services from organizations other than LHDs. All the available organizational characteristics of LHDs had association with some of the EH services. Although we might assume an increase in per capita expenditure could result in an increase in LHDs' direct involvement in providing EH services, we found it to be true only for five (15%) of the EH services. The variation of EH services provided in communities could be explained by a combination of factors such as fee generation, community needs, type of governance, and population size.

A Performance Management Initiative for Local Health Department Vector Control Programs.

Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative.

Community-based control of the brown dog tick in a region with high rates of Rocky Mountain spotted fever, 2012-2013.

Rocky Mountain spotted fever (RMSF) transmitted by the brown dog tick (Rhipicephalus sanguineus sensu lato) has emerged as a significant public health risk on American Indian reservations in eastern Arizona. During 2003-2012, more than 250 RMSF cases and 19 deaths were documented among Arizona's American Indian population. The high case fatality rate makes community-level interventions aimed at rapid and sustained reduction of ticks urgent. Beginning in 2012, a two year pilot integrated tick prevention campaign called the RMSF Rodeo was launched in a ∼ 600-home tribal community with high rates of RMSF. During year one, long-acting tick collars were placed on all dogs in the community, environmental acaricides were applied to yards monthly, and animal care practices such as spay and neuter and proper tethering procedures were encouraged. Tick levels, indicated by visible inspection of dogs, tick traps and homeowner reports were used to monitor tick presence and evaluate the efficacy of interventions throughout the project. By the end of year one, <1% of dogs in the RMSF Rodeo community had visible tick infestations five months after the project was started, compared to 64% of dogs in Non-Rodeo communities, and environmental tick levels were reduced below detectable levels. The second year of the project focused on use of the long-acting collar alone and achieved sustained tick control with fewer than 3% of dogs in the RMSF Rodeo community with visible tick infestations by the end of the second year. Homeowner reports of tick activity in the domestic and peridomestic setting showed similar decreases in tick activity compared to the non-project communities. Expansion of this successful project to other areas with Rhipicephalus-transmitted RMSF has the potential to reduce brown dog tick infestations and save human lives.