Public Health in the Rockies 2026

Background/Purpose:

Since 2016, 715 Coloradans have had a Centers for Disease Control and Prevention-confirmed case of active tuberculosis. Many of these cases could have been prevented by treating patients’ latent tuberculosis infection (LTBI) before it progressed to contagious, active tuberculosis disease. The care cascade for LTBI includes 1) chest x-ray completion, 2) treatment initiation, and 3) treatment completion. Patient navigators assist patients throughout the care cascade by identifying barriers to care, connecting patients to resources, and providing education and helpful reminders. We sought to explore the association between receiving LTBI-focused navigation and failure to progress along the LTBI care cascade.




Methods:

This project took place at a safety-net health system in Denver, Colorado between October 1, 2023 and September 30, 2025. Among 1,136 primary care patients with positive interferon-gamma release assay, we randomized 50% (n=566) to receive LTBI-focused care navigation and 50% (n=570) to receive standard clinic care. We used multivariable log-binomial regression modeling that accounted for clinic-level clustering to compare chest x-ray noncompletion, treatment non-initiation, and treatment noncompletion among patients with LTBI receiving LTBI-focused care navigation and those receiving standard clinic care.



Results:

We found that patients receiving care navigation had a significantly decreased risk of chest x-ray noncompletion [adjusted risk ratio (aRR) = 0.90, 95% confidence interval (CI) 0.86-0.95, p

Background: Syphilis remains a public health priority nationally and in Colorado. Test Yourself Colorado (TYC) is an online, at-home STI testing program administered by the Denver Sexual Health Clinic that provides free mailed HIV tests and/or gonorrhea (GC) and chlamydia (CT) testing statewide. In 2026, TYC launched a pilot at-home syphilis self-testing program as an additional service for clients reporting never having syphilis.

Methods: The TYC at-home syphilis pilot utilizes the First to Know® Syphilis Test, the first FDA authorized over-the-counter self-administered test. The test utilizes fingerstick blood and results in 15 minutes. Clients are provided with resources for seeking further clinical evaluation in the event of reactive results. Syphilis test kits were offered as part of TYC first from 2/15/2026 -2/28/26 and then again starting 4/10/2026. We report initial programmatic results from the syphilis at-home testing pilot program as of 5/8/2026. Future evaluations will assess client satisfaction and barriers to use.

Results: During the pilot, 417 total orders were placed with TYC. Of these, 154 (37%) included a syphilis test. Of syphilis orders, 45 (29%) were among cis-men; 106 (69%) were among cis-women; 2 (1%) were among trans clients. Eighty-seven (56%) syphilis orders were among White, Non-Hispanic individuals; 7 (5%) were among Black non-Hispanic clients; and 31 (20%) were among Hispanic clients. The remaining orders (29; 19%) were among individuals who preferred not to answer the race/ethnicity question or who identified as a different race/ethnicity. Fifteen (10%) syphilis orders were among men who have sex with men.

 Implications: Initial utilization of TYC’s at-home syphilis testing service indicated modest interest in the syphilis test. Ongoing efforts to promote the program in addition to the importance of syphilis screening among priority populations are merited. As efforts continue to address the syphilis epidemic, at-home testing services should be considered.

Background: As Colorado expands dental scope of practice to include immunizations related to oral and respiratory health, understanding future oral health professionals’ preparedness for human papillomavirus (HPV)-associated oropharyngeal cancer prevention is essential. This study assessed HPV-related knowledge, attitudes, and willingness to vaccinate among Colorado dental and dental hygiene students. It was hypothesized that greater HPV knowledge and stronger perceptions of HPV prevention as a dental professional responsibility would be associated with willingness to vaccinate.

Methods: Colorado dental and dental hygiene students were recruited to complete an anonymous cross-sectional survey. The survey, adapted from prior dental student HPV research, included HPV knowledge questions and Likert-style items assessing communication comfort, barriers, professional role perceptions, curricular experiences, and vaccine training and administration interest. Descriptive statistics and regression analyses evaluated predictors of willingness to engage in vaccination training and administration.

Results: 88 students were surveyed. 88.6% and 80.7% believed discussing HPV-associated oropharyngeal cancer and recommending HPV vaccination are appropriate dental roles, respectively. 93.2% expressed at least some interest in administering HPV vaccines within dental settings. However, only 9.1% reported comfort discussing sexually transmitted infection-related topics with patients. Regression analysis showed willingness to vaccinate was significantly associated with perceiving HPV prevention as a dental professional role (p < 0.001), while HPV knowledge was not independently associated with willingness to vaccinate.

Implications: Oral health students generally support expanded HPV prevention efforts but may benefit from additional communication training and stronger curricular emphasis on HPV prevention. As Colorado implements dental immunization authority, strengthening HPV vaccination education within oral health programs may support interdisciplinary oral-public health collaboration, expand preventive care workforce capacity, and improve access to cancer prevention services. Future work will evaluate educational and systems-level implementation strategies to prepare oral health professionals for vaccine delivery.

Background/Purpose: Urban heat islands accelerate ground-level ozone formation through photochemical reactions, creating compound exposures that increase asthma emergency visits by 6–8% per 1°C temperature rise. This study examines how surface temperature, ozone, and built environment factors jointly drive asthma prevalence across New York City.

Methods: Asthma prevalence for 2,071 Census Tracts was obtained from the CDC 500 Cities database. Fifteen indicators were integrated — including spring and winter land surface temperature (Landsat), ozone concentration, building density, land use mix, employment accessibility, food environment access, income, car ownership, and race/ethnicity. Ordinary Least Squares (OLS) and Multiscale Geographically Weighted Regression (MGWR) captured spatial heterogeneity across scales. XGBoost-SHAP analysis identified non-linear predictor importance and interaction effects beyond the capacity of regression models.

Results: MGWR substantially outperformed OLS (R²≈0.90 vs. 0.47), confirming significant spatial non-stationarity in the built and social environmental drivers of asthma prevalence. correlation analysis indicating significant seasonal variation in the thermal environment's effect on asthma risk. MGWR assigns each predictor its own optimal bandwidth; smaller bandwidths indicate more localized effects. High-income proportion was the strongest factor (bandwidth=56, most localized), while car-free household proportion showed the strongest positive association with asthma (bandwidth=2,000, city-wide). Black/non-Hispanic population share significantly elevated asthma burden at a meso-scale (bandwidth = 500), reflecting persistent spatial inequities linked to historical residential segregation. Preliminary SHAP analysis further identified non-linear threshold effects, where asthma risk accelerates significantly above critical ozone concentration levels.

Implications: Heat and ozone co-exposure create spatially concentrated asthma disparities in low-income, minority neighborhoods. MGWR and SHAP together pinpoint where cooling infrastructure, street greening, and transit interventions can most effectively reduce asthma burden.

Long COVID is a complex and emerging chronic condition. Patients frequently encounter provider interactions in healthcare settings where symptoms are invalidated, downplayed, or dismissed, a phenomenon known as medical gaslighting. This research sought to analyze if having symptoms of Long COVID was associated with higher odds of experiencing medical gaslighting, hypothesizing that it would be. Perceived reasons for this medical gaslighting were further examined in those with Long COVID symptoms and those without. This addresses the need for continued exploration of the Long COVID patient experience through quantitative data analysis, providing information specific to the Colorado population and relevant to Colorado health practitioners.

This study utilized data from the 2025 Colorado Health Access Survey, a cross-sectional survey of Colorado that employed oversampling and population weighting to improve representation. This analysis included 3,782 individuals. Covariates evaluated include age, gender, race, and insurance type. The analysis utilized multivariate logistic regression models to estimate prevalence odds ratios. Additionally, secondary sub-analyses used logistic regression on a subset of participants (N=454) which examined perceived reasons for medical gaslighting.

This analysis found that those with Long COVID symptoms had 3.06 times the odds [95% CI: 2.42, 3.86] of experiencing medical gaslighting in comparison to those without. Further, these individuals had 2.40 times higher odds of feeling ignored, 1.94 times higher odds of feeling that they were not provided with a treatment plan or referral, and 1.67 times higher odds of feeling that their symptoms were attributed to mental health.

This analysis demonstrates that patients with Long COVID face significant challenges in receiving care, further examining the reasons that these patients felt that they were ignored, dismissed, or had their medical concerns go unaddressed. This work aims to be integrated into Colorado health practitioner training to shape the landscape of Long COVID diagnosis and treatment.

BACKGROUND: Recently-enacted cuts in government funding for Medicaid, public health, and social service programs threaten to increase uncompensated medical care and medical debt levels as more people lose insurance coverage, experience preventable health conditions and seek treatment in costly emergency department and hospital settings. Intentional efforts to align medical, social, and public health delivery systems can help communities share resources and mitigate these problems. We use novel data from the National Longitudinal Survey of Public Health Systems (NALSYS) to identify which communities have achieved strong alignment among these different systems, and to quantify the health end economic benefits of this alignment.

METHODS: We followed a national sample of 618 U.S. communities using NALSYS collected approximately every two years from 2014 through 2026, including 32 Colorado communities. Public health officials reported information about the implementation of 20 guideline-recommended public health practices, and the networks of organizations that collaborate to implement each practice, including medical, public health and social service organizations. We constructed network measures of systems alignment in each community, including shared financing, decision-making, and service delivery. We linked NALSYS with contemporaneous CMS data on uncompensated hospital costs and data on medical debt from consumer credit records. Generalized linear models with two-way fixed effects are estimated to assess how changes in system alignment influence uncompensated care and medical debt.

RESULTS: 28% of communities improved system alignment by at least 10 percentage-points (pp) over the 12-year period, while 37% experienced reduced alignment of at least 10 pp. Improved alignment was associated with a 5.9 pp decrease in hospital uncompensated care (p

Background

Emerging and re-emerging infections continue to challenge public health disease control programs. The United States’ measles elimination status is currently at risk of revocation. In 2025, the U.S. had 2,288 cases of measles, compared to 191 in 2015. Local public health must reexamine internal processes and employ more sustainable approaches to time-intensive communicable disease investigations.

Methods

The Denver Department of Public Health & Environment (DDPHE) Epidemiology and Disease Control team has 9 staff tasked with responding to communicable diseases, including measles. DDPHE’s nursing and emergency preparedness programs are also intimately involved in response efforts, as well as colleagues from jurisdictions across the region and The Colorado Department of Public Health & Environment (CDPHE).

Results

Two hundred and fifty contacts were identified in response to a single Denver County infant measles case in 2025. Three additional Denver cases were identified between April and August 2025, totaling 4 cases for the year. Additionally, DDPHE further responded to 520 measles contacts in 2025 and coordinated post-exposure prophylaxis for numerous residents. In response to out-of-jurisdiction cases identified in 2026, DDPHE has already investigated 35 contacts (as of May 2026).

To accommodate increased workloads while maintaining core services, DDPHE has had to thoughtfully adjust investigation methods.

Strategies have included:

* Use of current epidemiologic data to adjust measles testing and assessment criteria
* Use of mHealth surveys and press releases
* Partnership with The Public Health Institute at Denver Health
* Use of CDPHE’s Team EDIT for support
* Prioritization of moderate/high-risk contacts for direct follow-up
* Virtual delivery of quarantine and isolation orders
* Early coordination with neighboring jurisdictions

Implications

Strained budgets and the threat of new and re-emerging diseases continue to stress public health capacity. Methods to create sustainable and practical response strategies are imperative to balance staff burnout and disease prevention in our communities.