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Routine vaccination is an important public health measure to prevent severe illness from COVID-19. Although the determinants of vaccine hesitancy have been explored in prior research, limited information is available on the varying perceptions of the COVID-19 vaccines among previously vaccinated individuals. This study investigates how individuals previously vaccinated against COVID-19 might develop hesitancy toward future doses, a concept that the authors define as lingering hesitancy. The authors conducted an online cross-sectional survey with 560 vaccinated respondents in 6 urban Chicago community areas (n=440) and Stephenson County, a rural county in Northern Illinois (n=120), between December 2021 and April 2022. The authors explored the role of an individual's sociocultural context (i.e., urban/rural setting, political affiliation, and race/ethnicity) in developing lingering hesitancy. Lingering hesitancy was operationalized using 2 constructs: (1) negative COVID-19 vaccine attitudes and (2) COVID-19 vaccine safety concerns. The authors also investigated whether mistrust in the government and institutions as well as barriers to accessing the COVID-19 vaccines mediate the relationship between context and lingering hesitancy. The authors found significantly higher negative attitudes toward the COVID-19 vaccines and higher safety concerns among conservative versus liberal respondents (b=0.37, p<0.001; b=0.21, p<0.01, respectively) and among urban versus rural residents (b=0.45, p<0.001; b=0.37, p<0.001). Black/African American participants reported higher vaccine safety concerns than White participants (mean=2.6 vs 2.4, p<0.05). A significant portion of lingering hesitancy among conservative and Black/African American respondents was mediated by mistrust in the government and institutions. Barriers partially mediated vaccine safety concerns among Hispanic respondents. Most public health efforts aimed at COVID-19 vaccine outreach and messaging have focused on increasing vaccine uptake, thereby targeting unvaccinated individuals. As the focus shifts toward annual COVID-19 vaccinations, it is essential to consider lingering hesitancy among those who have received previous vaccine doses. This article provides a framework for implementing vaccine-messaging campaigns that increase confidence and build trust in routine vaccinations.

Diet, physical activity, and sleep are behaviors occurring at regular intervals over the 24-hour period. To better understand how they interact and impact the etiology and prevention of chronic diseases, studies are needed that collect data on all 3 behaviors. This scoping review of the authors' portfolio aimed to identify cohort and interventional studies funded by the National Cancer Institute; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases that collected measures on all 3 behaviors, on 2 behaviors to better understand existing gaps, and on those with data across a 24-hour period (temporal data). Cohorts receiving National Cancer Institute funding; studies identified in the National Heart, Lung, and Blood Institute National Sleep Research Resource and National Institute of Diabetes and Digestive and Kidney Diseases Central Repository; and active National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Diabetes and Digestive and Kidney Diseases intervention grants in Fiscal Years 2021-2022 were reviewed. Data were collected from 2021 to 2022 and analyzed from 2022 to 2023. Twenty-nine cohort and 47 interventional studies collected data on all 3 behaviors, of which 3 cohorts and 20 interventions collected temporal data. Forty-two cohort and 160 interventional studies collected data on 2 behaviors, of which 3 cohorts and 50 interventions collected temporal data; sleep data were most commonly missing. The most common temporal measures were 24-hour dietary recalls and actigraphy. Efforts to promote the collection of temporal data on all 3 behaviors simultaneously can support innovative research questions and analytic approaches focused on their interrelationships across the 24-hour period and health outcomes among various populations. Such efforts can inform tailored interventions and precision health research.

This study aimed to evaluate referral physician' confidence, practices, and barriers in justifying imaging referrals, with specific focus on the impact of training, workload, and guideline accessibility on referral appropriateness. A cross-sectional survey was conducted among 167 referral physicians across various hospitals in the United Arab Emirates. A validated, self-administered questionnaire captured demographic data, referral practices, confidence levels, guideline usage, training participation, and perceived barriers to appropriate imaging justification. Data were analyzed using descriptive statistics and inferential tests, including chi-square, Mann-Whitney U, and Kruskal-Wallis tests. Although 82% of physicians reported high confidence in assessing imaging necessity, over 60% acknowledged frequent issues with referral quality. More than half (51.5%) admitted that imaging referrals were sometimes unnecessary. Training participation was significantly associated with better guideline accessibility (chi-square=50.50, p<0.001), and a small but significant association was found between confidence and experience (U=1,903, p=0.038). Key improvement strategies included enhanced physician-radiologist communication, increased training, and better guideline access. Despite high self-reported confidence, systemic and educational gaps persist in imaging referral justification. Addressing training needs and improving access to guidelines can enhance appropriateness in clinical imaging decisions.

Previous research has shown an inverse relationship between cigarette smoking and educational attainment. However, there is relatively scarce research on the relationship between cannabis use and education level. This article examines whether the inverse relationship between cigarette smoking and educational attainment applies to cannabis use. The 2023 California Health Interview Survey, a representative population-based survey of California adults that assesses health behaviors, was analyzed to examine current cigarette smoking and cannabis use prevalence. Logistic regression was used to examine the association between cigarette smoking/cannabis use and educational attainment among adults aged >26 years (N=20,557), adjusting for age, sex, and race/ethnicity. In 2023, among California adults aged >26 years, current cannabis use prevalence was more than twice as high (13.5%) as current cigarette use prevalence (6.1%). Compared to the odds of being a current cannabis user for those who did not graduate high school, the odds were 2.05 times as high (95% CI=1.35, 3.12) for those who completed high school, 2.57 times as high (95% CI=1.73, 3.80) for those with some college education, and 2.17 times as high (95% CI=1.46, 3.23) for those who completed college. Compared to the odds of being a current cigarette smoker for those who did not graduate high school, the odds were 0.31 times as high (95% CI=0.22, 0.43) for those who completed college. Adults with higher education levels were more likely to be cannabis users than those with less education, which was inverse to the relationship between cigarette smoking and education. Efforts to prevent and reduce cannabis use should have additional focus on those who have completed high school and college.

Globally, COVID-19 has caused widespread morbidity and mortality, with comorbidities and demographic disparities shaping risk of severe illness. Although much focus has been on high-population areas and areas with deep public health responses, relatively few studies have examined the Southwestern U.S., particularly the interborder region with Mexico. This study investigates how the COVID-19 pandemic affected patients with common comorbid conditions and examines and compares outcomes in border counties and selected nonborder counties in southern New Mexico. The data set of COVID-19-positive patients (N=93,586) was collected from the New Mexico Department of Health (June 2020-December 2022). This study examined the associations between demographic characteristics; underlying comorbidities; and COVID-19 outcomes, including hospitalization and death. The patients assessed were more likely to be female (54.8%), Hispanic (48.5%), and border county residents (95.7%). Of all patients, 4,445 (4.8%) were hospitalized, and 1,517 (1.6%) died. Hispanics were associated with higher deaths (OR=1.60; 95% CI=1.28, 1.99), whereas hospitalization did not differ by ethnicity (p=0.072). Nonborder resident status (p<0.001) and pre-existing conditions were significantly associated with increased risk of hospitalization (OR=4.87; 95% CI=3.99, 6.00) and mortality (OR=2.92; 95% CI=1.72, 5.33). All comorbidities except psychiatric conditions were risk factors for severity and all-cause mortality (all p<0.001). This study identified key demographic and clinical factors associated with SARS-CoV-2 outcomes in the New Mexico-Mexico border region. Older age, male adults, residence in nonborder counties, and pre-existing medical conditions were significant predictors of hospitalization and mortality, with several comorbidities showing particularly strong associations. Unlike other studies, in the New Mexico/Mexico region, the greater access to screening and medical services in border zones, given the proximity to 2 larger cities (Las Cruces, NM and El Paso, TX), resulted in improved outcomes than in less well-resourced counties in New Mexico. State departments of health should target state regions with less access to nearby populated areas for their efforts to mitigate these disparities and improve health outcomes.

Vaccine hesitancy poses a hurdle toward achieving high population-level immunity and reducing disease transmission. One policy response adopted during the COVID-19 vaccination campaign was the implementation of vaccination-differentiated public health and social measures. This paper aims to evaluate the impact of vaccination-differentiated public health and social measures on COVID-19 vaccination rates in Singapore, with a specific focus on vaccine-hesitant persons. An interrupted time series design with segmented linear regression was utilized to assess the impact of the announcement of each vaccination-differentiated public health and social measure on vaccine uptake rates among the vaccine-naive population. Newey-West standard errors with a 7-day lag were applied to address potential autocorrelation in the data. Covariates adjusted for included day of the week, daily numbers of COVID-19-related cases, deaths, hospitalizations, and patients in the intensive care unit. The study found a significant and positive effect of vaccination-differentiated public health and social measure announcements on the daily vaccine uptake rate among the vaccine-naive population, specifically for dining out and patronizing shopping malls. When stratified by age group, the significant and positive effect of the announcement of mall access vaccination-differentiated public health and social measures persisted across all age groups, and it only persisted for individuals aged 13-17, 25-34, and 35-49 years for the announcement of dining vaccination-differentiated public health and social measures. Overall, the findings support the effectiveness of vaccination-differentiated public health and social measures in increasing vaccine uptake rates among vaccine-hesitant persons. However, the compelling evidence for complementary policies should also be considered.

There are important workplace health lessons to be learned from the pandemic. This study summarizes the relationships between workplace safety practices, fear, resources, and employee engagement during the COVID-19 pandemic through a narrative review on articles published between January 2020 and June 2025 using a primary literature search base. Organizations have had to implement workplace safety management practices aligned with their occupational safety and health management systems in response to COVID-19. Safety management practices include safety initiatives and training as well as employee involvement. Methods to increase employee involvement include fear and anxiety. However, although fear and anxiety promote safety compliance and safe behavior, they also wear down employees and increase their work distraction and turnover intentions. Therefore, social and psychological resources need to be strengthened to overcome this dilemma. These resources can also help safety management practices today as the pandemic begins to wind down. Future research should focus on identifying ways to strengthen employees' social and psychological resources without relying on disasters. To this end, an integration of conservation of resource theory and behavioral theory may be useful.

Studies have shown that patient portals facilitate cancer screening, but less is known about how. Causal pathway diagrams, which include influencing factors such as mechanisms and moderators, can be used to understand how portals improve screening. The authors conducted a scoping review of influencing factors to inform early causal pathway diagrams of the portal as a strategy to increase cancer screening. The authors searched PubMed for U.S. studies published from 2014 to 2024, including average-risk patients; portal interventions/evaluations; and primary outcomes of breast, cervical, colorectal, or lung cancer screening. Two authors completed manuscript screening and data extraction and synthesized findings to create causal pathway diagrams. Thirty-two studies met inclusion criteria. Studies were often set in large academic health systems (n=13) or utilized survey data from nationally representative cohorts (n=11); 6 were RCTs. Most studies focused on breast (n=10) or colorectal (n=9) cancer screening. Of 21 studies comparing portal use with no use, 18 found that portals were associated with increased screening. Most proposed influencing factors were hypothetical, citing findings from prior literature rather than observed directly. Of the 10 studies that performed statistical analysis, significant moderators included provider recommendation for self-scheduling; significant mechanisms included cancer worry and patient activation for general portal use, cancer fatalism and patient activation for secure messaging with providers, and choice architecture for interventions delivered through secure messaging. Few studies directly tested influencing factors, suggesting a significant research gap. More research is needed to further evaluate proposed mechanisms to understand how portals facilitate cancer screening and optimize implementation. The protocol for this scoping review was registered through Open Science Framework.

Patient navigation is an evidence-based intervention that can be used to address patient-level barriers and ultimately increase colorectal cancer screening rates. Because implementation can affect the effectiveness of navigation programs, it is important to study the implementation and effectiveness of the programs to inform future work. The authors conducted a systematic review of English-language academic journal articles published from 2004 through 2023 and covering studies conducted in the U.S. After literature searches in 4 databases, reviewers independently screened titles and abstracts for potential relevance, followed by a full-text review of articles. The authors abstracted data from included articles, including study characteristics, cancer screening and intervention characteristics and outcomes (when provided), and screening outcomes. The authors assessed the quality of included studies using the Cochrane Risk of Bias Tool for Randomized Trials (ROB 2). The approach adhered to the PRISMA recommendations. The authors included 30 studies, and nearly all (n=29) reported implementing multicomponent interventions, such as patient reminders, small media, mailed stool blood tests, and addressing structural barriers alongside navigation. Existing staff or healthcare providers, research team members, and lay people served as patient navigators. After implementing patient navigation as part of the intervention, most studies reported improvement in screening uptake, averaging 16.9 percentage points. Little information was provided on implementation outcomes. Patient navigation can be an effective strategy for improving colorectal cancer screening uptake. Further research is needed to understand implementation outcomes to bolster screening impact, inform resource allocation, promote equitable implementation, and improve patient outcomes.

People living with HIV are at increased risk for human papillomavirus infection, precancerous lesions, and cervical cancer, with current guidelines recommending regular cervical cancer screening for this population. At Dartmouth Health HIV clinics, 37 patients were identified as overdue for screening. To explore potential barriers, the authors conducted interviews with 24 of these patients. Most interviewees had previously undergone cervical cancer screening and felt confident in their understanding of its importance. However, several barriers to timely screening emerged. The most commonly reported challenges included being too busy, fear of pain, and the belief that screening was not necessary in the absence of symptoms. Other discouraging factors included prior negative experiences and lack of transportation. Despite these barriers, 11 patients expressed interest in learning more about cervical cancer screening, and 11 were open to staff assistance in scheduling an appointment. After outreach, 6 appointments were scheduled, and 10 patients received follow-up education from their primary nurses. These findings highlight the need for more frequent, trauma-informed conversations as well as targeted education and logistical support. Proactive, patient-centered engagement may improve cervical cancer screening rates and outcomes among people living with HIV.

Research examining the relationship between vision impairment and falls is limited among older Mexican Americans. The purpose of this study was to determine the relationship between vision impairment and new-onset falls among Mexican American older adults without a history of falls at baseline over 16 years of follow-up. The authors studied 851 participants aged &#x2265;72 years from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2000/2001-2016). Fall status was categorized as having no falls and having 1 or more falls. Self-reported vision impairment was defined as difficulty in recognizing a friend at arm's length's away, across the room, or across the street. Covariates included sociodemographics, BMI, Mini Mental State Examination, depressive symptoms, smoking status, and hearing impairment. Generalized estimating equation models were used to examine the relationship between near vision impairment, distant vision impairment, and vision impairment (near or distant) and falls. Percentage of falls ranged 4.17% to 35.63% over time. Greater odds of falls (OR=1.45, 95% CI=1.00, 2.10) were found for participants with near or distant vision impairment and near vision impairment (OR=2.08, 95% CI=1.22, 3.55) over time, controlling for all covariates. However, no significant association was found between distant vision impairment and incident falls over time (OR=1.30, 95% CI=0.89, 1.92), controlling for all covariates. Participants with vision impairment had greater odds of falls over time. Near vision impairment was the primary vision impairment category driving this relationship, suggesting timely near vision impairment screening among older Mexican Americans as an important step in preventing falls.

In medical research, study samples are used to estimate and compare characteristics of target populations. However, because samples inevitably differ from their target populations, statistical inferences are subject to inherent uncertainty. Among various contributing factors, sample size plays a critical role in determining the reliability and precision of research findings. This study used data simulations to examine how sample size affects statistical outcomes and its relationships with key metrics of statistical inference. Two normal distributions, representing the null and alternative hypotheses, were generated to illustrate the relationships between type I error, type II error, statistical power, and sample size. Statistical power and theoretical p-values were calculated using a two-sample t-test for equal sample sizes ranging from 10 to 300 per group and Cohen's standardized effect sizes (d) of 0.2, 0.5, and 0.8 to demonstrate the interactions between these factors. Additionally, five representative scenarios were constructed to compare p-values and 95% confidence intervals in relation to statistical significance, clinical importance, and precision of effect estimates. Required sample size is determined by expected effect size, variability, significance level, and desired statistical power. As sample size increases, statistical power increases and p-values decrease when a true effect is present; both metrics gradually level off as they approach their theoretical limits. In contrast, effect estimates remain relatively stable, while their 95% confidence intervals become narrower, reflecting improved precision. Compared with p-values, confidence intervals provide more comprehensive information, including direction, magnitude, precision, statistical significance, and clinical importance of effect estimates. Therefore, reporting effect estimates and 95% confidence intervals alongside p-values is essential for transparent and meaningful interpretation of research findings. Sample size estimation is a critical component of rigorous study design. It ensures adequate statistical power, improves precision, and facilitates meaningful interpretation of research findings.

The aim of this study was to describe travel from residence to healthcare facilities among individuals with Duchenne muscular dystrophy. The sample included 302 males with Duchenne muscular dystrophy born on January 1, 2000, and followed through December 31, 2015. Using geocoded residential and facility addresses, the authors estimated travel time for trips to unique facilities. The authors identified 7,546 provider visits and 6,064 visits to unique facilities. Over an average of 4.8 person-years of follow-up, the authors estimated a mean of 5.3 unique provider visits and a mean of 4.3 unique visits to facilities per person-year. Overall median drive time exceeded 1.5 hours roundtrip, and averaged overall median 1-way public transit time was 1.9 hours. The longest drive times were detected among younger, non-Hispanic Whites, and other race/ethnicity groups. The findings suggest long travel times for clinical care for a subset of individuals. Additional research is needed to examine the burden associated with traveling to healthcare facilities.

Skin cancer remains a major public health concern, and White individuals carry the highest lifetime risk and mortality. Ultraviolet exposure and sunburn are well-established skin cancer risk factors, yet regular sunscreen use remains low among U.S. adults. Few studies have assessed barriers to sunscreen use in the U.S., and prior studies are often geographically or demographically limited, restricting comparability among subgroups. A cross-sectional online panel survey of White U.S. adults (N=739) was developed and administered. Participants selected all personally relevant barriers, followed by their top barrier. Descriptive statistics summarized perceived barriers to sunscreen use. Separate multivariable logistic regression models explored the associations between demographic characteristics and barrier endorsement. Overall, 20.3% of participants reported no barriers. The most commonly endorsed barriers were forgetting to bring or apply sunscreen (52.1%), disliking the feel or smell (24.2%), cost (21.7%), inconvenience (20.3%), preference for being tanned (14.1%), and difficulty in selecting an appropriate sunscreen (12.6%). Younger cohorts had greater odds of reporting at least 1 barrier than baby boomers. Generational differences were observed for forgetfulness, inconvenience, product selection, and tanning preference. Men had lower odds of endorsing a preference for being tanned than women. Skin phototype was associated with differences in cost, tanning preference, forgetfulness, and product selection. Differences in barriers were also observed for marital status, education, and income. Findings support audience-segmented approaches to improve sunscreen use by gender, generation, skin phototype, and socioeconomic factors. Individual-level strategies include integrating sunscreen into daily routines and using cues to action to support bringing, applying, and reapplying sunscreen. Multilevel approaches that shift tanning norms, improve product acceptability, strengthen product selection guidance, and reduce cost may further reduce barriers and support sustained use.

Exposure to extreme heat and wildfire-related hazards, such as poor air quality, can increase the risk of acute cardiovascular events. This study assessed whether acute myocardial infarction-related emergency department visits increased in 2023-a year of increased heat and wildfire smoke exposure in the U.S.-compared with visits in the 5 preceding years combined. This serial cross-sectional study identified acute myocardial infarction-related emergency department visits among adults aged &#x2265;18 years from National Syndromic Surveillance Program data using discharge diagnosis codes. Daily mean acute myocardial infarction-related emergency department visit rates per 100,000 all-cause emergency department visits during May-September 2023 were compared with those during May-September 2018-2022 for adults overall and by subgroup. During May-September 2023, the daily acute myocardial infarction-related emergency department visit rate (699.5 acute myocardial infarction-related emergency department visits per 100,000) was 16.5% (95% CI=14.8, 18.2) higher than the rate in 2018-2022 (600.4 acute myocardial infarction-related emergency department visits per 100,000). Overall, acute myocardial infarction-related emergency department visit rates increased across age groups, in both sexes, and in most HHS regions. HHS Regions 2 and 4 reported the largest relative increases in acute myocardial infarction-related emergency department visit rate (27.0% [95% CI=22.9, 31.4] and 30.0% [95% CI=27.7, 32.5], respectively). Acute myocardial infarction-related emergency department visit rates were higher in May-September 2023 than in May-September 2018-2022. Near real-time surveillance data can be leveraged to monitor emergency department visits for acute cardiovascular conditions across different time periods to inform clinical and public health practices.

The COVID-19 pandemic posed challenges to traditional in-person methods used to deliver lifestyle-change programs. This comparative effectiveness study examined how virtual delivery of the Diabetes Prevention Program performed relative to established in-person delivery in real-world conditions, comparing changes in weight, fruit and vegetable consumption, and physical activity levels from baseline to program completion in the Rio Grande Valley, Texas. A secondary data analysis was conducted among adults enrolled in the Rio Grande Valley Coordinated Diabetes Prevention Program Project from 2018 to 2021. During this period, programs were delivered either in person or virtually. Covariate-adjusted regression models were used to evaluate 12-month changes in study outcomes by delivery mode. Data were analyzed in 2023 using STATA (Version 17). There were 609 participants in the in-person group and 283 in the virtual group. After adjustment for baseline characteristics, participants with BMI &#x2265;30 in the virtual group lost more weight (-8.19 lb vs. -5.19 lb, p<0.001). Across all participants, those in the virtual group had greater increases in physical activity (+575 MET minutes/week vs. -58, p<0.001) and fruit and vegetable consumption (+1.9 vs. +0.5 servings/day, p<0.001) compared with in-person participants. Virtual delivery of the Diabetes Prevention Program is a viable alternative to traditional in-person delivery, with both modes achieving meaningful improvements in weight, physical activity, and fruit and vegetable consumption among underserved adults at high risk for Type 2 diabetes. These findings support consideration of virtual Diabetes Prevention Program delivery for Hispanic and other underrepresented populations living with obesity and at risk for Type 2 diabetes mellitus.

This study was aimed to evaluate follow-up after benign or low-grade colposcopic findings and identify the factors associated with delayed care. The authors completed a retrospective study to evaluate follow-up for patients with benign or low-grade colposcopy findings over a 4-year period at a single institution. Demographics as well as cotesting and pathology results were abstracted. Descriptive statistics and bivariate associations were completed. Of 393 patients, 20.6% had an on-time follow-up. The majority of patients (50.4%) had delayed follow-up, with a mean time to repeat evaluation of 27.6 months. There were no differences in follow-up cytology and human papillomavirus test results between those patients who followed up within 12 months and those who were evaluated later. Tobacco nonsmoking and initial biopsy with indeterminate findings were associated with on-time follow-up. This study demonstrated significant delays in follow-up after colposcopy, consistent with prior work showing insufficient cervical cancer screening and prevention nationally. Improving follow-up times and rates will likely depend on addressing barriers that impact access to care.

Individuals living in neighborhoods with high levels of violence are exposed to chronic stress, which can have deleterious effects on health. In addition, subjective appraisal of stress may influence health outcomes. The authors conducted structural equation modeling. The authors used data collected between May and August 2022, which included 127 older Black men who resided in Chicago, to explore the extent to which perceptions of stress and violence exposure mediate the relationship between actual neighborhood homicide rate and health outcomes. Bivariate statistics showed that the upper quartiles of homicide rates were associated with higher hair cortisol concentration (p=0.01) but not with depression and post-traumatic stress disorder. Both perceived stress (p=0.01) and perceived violence exposure (p=0.001) were significantly associated with the homicide rate quartiles. Structural equation modeling results showed that with perceived stress as a mediator, there was a significant direct effect (p=0.03) and total effect (p=0.04) of homicide rate on hair cortisol. Although perceived stress was significantly associated with depression (p=0.01) and post-traumatic stress disorder (p=0.03), the direct and total effects of the homicide rate were not statistically significant. With perceived violence exposure as a mediator, there were no significant direct or indirect effects of the homicide rate on hair cortisol, depression, and post-traumatic stress disorder. Even when older Black men do not perceive or report stress and violence exposure, neighborhood violence still affects their physiologic stress response. The impact of stress can be more accurately assessed by considering both actual and perceived stress measures as well as incorporating stress biomarkers.

The authors investigated trends in U.S. state and local government health employees per million persons at the aggregated 50-state, regional, and state levels. The authors used repeated cross-sectional data from the Annual Survey of Public Employment & Payroll. Joinpoint regression was used to estimate average annual percentage changes and annual percentage changes from 2000 through 2023. State and local full-time and part-time government health employees included public health and several other categories of health workers. State and local government health employees per million persons remained stable in the U.S. from 2000 through 2023. Heterogeneous trends in state and local government health employees were observed by region: Northeast (average annual percentage change=0.5% increase, 95% CI=0.3%, 0.7%), Midwest (average annual percentage change=0.9% increase, 95% CI=0.6%, 1.1%), South (average annual percentage change= -0.7% decrease, 95% CI= -0.9%, -0.5%), and West (average annual percentage change=0.1% increase, 95% CI= -0.1%, 0.2%). The authors observed further variation in state-stratified analyses. Most U.S. states experienced decreasing trends during the Great Recession (2007-2009) and increasing trends during the COVID-19 pandemic (2020-2023). Stable and long-term funding streams are essential to support consistent recruitment, training, and retention of state and local government health employees. Health policies should account for regional variations in health needs and employment trends when planning the state and local government health hiring.