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Publications (9)45.45 Total impact

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    ABSTRACT: Since 2001, the Council of State and Territorial Epidemiologists (CSTE) periodically has conducted a standardized national assessment of state health departments' core epidemiology capacity (1-4). During August-September 2013, CSTE sent a web-based questionnaire to state epidemiologists in the 50 states and the District of Columbia. The questionnaire inquired into workforce capacity and technology advancements to support public health surveillance. Measures of capacity included the total number of epidemiologists, a self-assessment of the state's ability to carry out four of the 10 essential public health services* most relevant to epidemiologists, and program-specific epidemiology capacity. This report summarizes the results, which indicated that in 2013, most of these measures were at their highest level since assessments began in 2001, including the number of epidemiologists, the percentage of state health departments with substantial-to-full (>50%) capacity for three of the 10 essential public health services, and the percentage with substantial-to-full epidemiology capacity for eight of 10 program areas. However, >50% of states reported minimal-to-no (<25%) epidemiology capacity for four of 10 program areas, including occupational health (55%), oral health (59%), substance abuse (73%), and mental health (80%). Federal, state, and local agencies should work together to develop a strategy to address continued outstanding gaps in epidemiology capacity.
    MMWR. Morbidity and mortality weekly report 04/2015; 64(14):394-8.
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    ABSTRACT: Since 2001, CSTE has been performing periodic assessments of epidemiology capacity in state health departments. The Epidemiology Capacity Assessments (ECA) have measured ability to perform core epidemiology functions, estimated additional epidemiology capacity needed, and assessed competency of the epidemiology workforce in state health departments. CSTE administered the 2013 ECA in September 2013 and completed data collection in January 2014. It included questions on trends in the number of epidemiologists working in ten program areas, the funding sources for epidemiologists, self-evaluation of capacity to carry out core public health functions, estimates of additional workforce need, and gaps in epidemiology competencies. The ECA also assessed workforce training, recruitment, and retention and health departments’ capacity in health information technology. Analyses included frequencies and percentages of responses to these questions across all states and determination of trends over time using chi-square testing when applicable. The total number of epidemiologists working at the state level has increased approximately 8% since 2010, with increases in infectious disease, bioterrorism/emergency response, maternal and child health, and oral health, and decreases in chronic disease, environmental health, injury, and occupational health program areas. Further results of trend data will be presented with particular attention to assessing any impact of the state and federal budget crises on the number of epidemiologists in state health departments and the ability to perform core epidemiology functions since CSTE’s last enumeration in 2010. Trends in workforce training and retention and in technologic capacity will also be discussed. The 2013 ECA provides information needed to assess the current status of the epidemiology workforce and epidemiology capacity in state health departments and evaluate the impact of the sustained budgetary crisis on national epidemiology capacity. Periodic public health workforce assessments like the ECA are essential to planning as we continue in a period of constrained federal and state resources.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background. The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. Methods. From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. Results. The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2–17 years, whereas other viruses had varied patterns among age groups. Conclusions. The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children.
    The Journal of Infectious Diseases 06/2014; 209(11):1715-1725. DOI:10.1093/infdis/jit806 · 5.78 Impact Factor
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    ABSTRACT: Please cite this paper as: Fowlkes et al. (2012) Estimating influenza incidence and rates of influenza-like illness in the outpatient setting. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12014. Background:  Estimating influenza incidence in outpatient settings is challenging. We used outpatient healthcare practice populations as a proxy to estimate community incidence of influenza-like illness (ILI) and laboratory-confirmed influenza-associated ILI. Methods:  From October 2009 to July 2010, 38 outpatient practices in seven jurisdictions conducted surveillance for ILI (fever with cough or sore throat for patients ≥2 years; fever with ≥1 respiratory symptom for patients <2 years). From a sample of patients with ILI, respiratory specimens were tested for influenza. Results:  During the week of peak influenza activity (October 24, 2009), 13% of outpatient visits were for ILI and influenza was detected in 72% of specimens. For the 10-month surveillance period, ILI and influenza-associated ILI incidence were 20·0 (95% CI: 19·7, 20·4) and 8·7/1000 (95% CI: 8·2, 9·2) persons, respectively. Influenza-associated ILI incidence was highest among children aged 2-17 years. Observed trends were highly correlated with national ILI and virologic surveillance. Conclusions:  This is the first multistate surveillance system demonstrating the feasibility of using outpatient practices to estimate the incidence of medically attended influenza at the community level. Surveillance demonstrated the substantial burden of pandemic influenza in outpatient settings and especially in children aged 2-17 years. Observed trends were consistent with established syndromic and virologic systems.
    Influenza and Other Respiratory Viruses 09/2012; DOI:10.1111/irv.12014 · 1.90 Impact Factor
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    JAMA The Journal of the American Medical Association 06/2012; 307(23):2478-2480. · 30.39 Impact Factor
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    Angela J Beck · Matthew L Boulton · Jennifer Lemmings · Joshua L Clayton
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    ABSTRACT: With nearly one quarter of the combined governmental public health workforce eligible for retirement within the next few years, recruitment and retention of workers is a growing concern. Epidemiology has been identified as a potential workforce shortage area in state health departments. Understanding strategies for recruiting and retaining epidemiologists may help health departments stabilize their epidemiology workforce. The Council of State and Territorial Epidemiologists conducted a survey, the Epidemiology Capacity Assessment (ECA), of state health departments to identify recruitment and retention factors. The ECA was distributed to 50 states, the District of Columbia (DC), and four U.S. territories in 2009. The 50 states and DC are included in this analysis. The State Epidemiologist completed the organizational-level assessment; health department epidemiologists completed an individual-level assessment. Data were analyzed in 2010. All states responded to the ECA, as did 1544 epidemiologists. Seventeen percent of epidemiologists reported intent to retire or change careers in the next 5 years. Ninety percent of states and DC identified state and local government websites, schools of public health, and professional organizations as the most useful recruitment tools. Top recruitment barriers included salary scale, hiring freezes, and ability to offer competitive pay; lack of promotion opportunities and merit raise restrictions were main retention barriers. Although the proportion of state health department epidemiologists intending to retire or change careers during the next 5 years is lower than the estimate for the total state public health workforce, important recruitment and retention barriers for the employees exist.
    American journal of preventive medicine 01/2012; 42(1):76-80. DOI:10.1016/j.amepre.2011.08.021 · 4.28 Impact Factor
  • Lisa D. Ferland · James Hadler · Edward Chao · Jennifer Lemmings
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    ABSTRACT: Since 2001, CSTE has been performing periodic assessments of epidemiology capacity (ECA) at state health departments. They have provided baseline measurements of ability to perform core epidemiology functions, a basis for estimation of additional epidemiology capacity, and assessment of epidemiology competencies present in state health departments. The 2009 ECA will be administered March-April 2009. It includes core questions to enable determination of trends in the number of epidemiologists working in nine epidemiology program areas, the funding sources associated with epidemiologists, self-evaluation of the extent of capacity to carry out core public health functions, enumeration of additional needs and gaps in epidemiology competencies. It also includes new questions to establish baseline data of funding streams and to assess technologic epidemiology capacity. Analyses will focus on frequencies and percentages of responses to these questions across all states and determination of trends over time using chi-square for trend if applicable. Results of trend data for those epidemiology capacity questions included on previous surveys will be presented with particular attention to the impact of reductions in BT funding on the number of epidemiologists and of ability to perform core epidemiology functions. Results of new questions related to the relative importance of different sources of funding and current technologic epidemiology capacity will also be presented. The 2009 ECA provides needed information to assess the initial impact of reductions in federal BT funding and to describe current epidemiology capacity and gaps for planning as we enter a fiscally unstable time period.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
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    Matthew L Boulton · Jennifer Lemmings · Angela J Beck
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    ABSTRACT: To assess the number of epidemiologists and national epidemiology capacity, the Council of State and Territorial Epidemiologists surveyed state health departments in 2001, 2004, and 2006. This article summarizes findings of the 2006 assessment, analyzes trends in epidemiology workforce, and examines statistical associations between the number of epidemiologists and measures of capacity. The on-line surveys collected information from 50 states and the District of Columbia about the number of epidemiologists employed, their training and educational background, program capacity, organizational structure, and funding sources. The State Epidemiologists and/or their designees answered the questionnaire. The number of epidemiologists in state health departments increased approximately 40 percent from 2001 to 2006. All programs except occupational health experienced increase in the number of epidemiologists; the greatest increase occurred in bioterrorism programs. Estimated epidemiology capacity increased in all programs except environmental health and occupational health. The Epidemiology Capacity Assessment survey indicates that state health departments need 30 percent more epidemiologists. A linear correlation existed between the number of epidemiologists and state population. Federal emergency preparedness funding supported most of the increase in epidemiologists, which could fall as funding decreases. To function at full capacity, states need approximately one epidemiologist per 100 000 population for all program areas. Current estimates of workforce capacity need to be refined.
    Journal of public health management and practice: JPHMP 01/2009; 15(4):328-36. DOI:10.1097/PHH.0b013e3181a01eb3 · 1.47 Impact Factor
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    Maureen Lichtveld · Matthew Boulton · Jennifer Lemmings · James Gale
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    ABSTRACT: We determined the competency of the public health epidemiolOgy workforce within state health agencies based on the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs). The competence level of current state health agency staff and the need for additional training was assessed against 30 mid-level AECs. Respondents used a five-point Likert scale-ranging from "strongly agree" to "strongly disagree"-to designate whether staff was competent in certain areas or whether additional training was needed for each of the competencies. Most states indicated their epidemiology workforce was competent in most of the AECs subject areas. Subject areas with the greatest number of states reporting competency (82%) are creating and managing databases and applying privacy laws. However, at least one-third of the states reported a need for additional training in all competencies assessed. The greatest reported needs were for additional training in surveillance system evaluation and use of knowledge of environmental and behavioral science in epidemiology practice. The results indicate that most epidemiologists mastered the traditional discipline-specific competencies. However, it is unclear how this level of competency was achieved and what strategies are in place to sustain and strengthen it. The results indicate that epidemiologists have lower levels of competence in the nontraditional epidemiologic fields of knowledge. Future steps to ensure a well-qualified epidemiology workforce include assessing the full AECs in a subgroup of Tier 2 epidemiologists and implementing competencies in academic curricula to sustain reported competency achievements.
    Public Health Reports 02/2008; 123 Suppl 1:128-35. · 1.64 Impact Factor