Public Health in the Rockies 2026

Background: The COVID-19 pandemic triggered unprecedented job losses, placing millions of working-age Americans at risk of losing employer-sponsored insurance (ESI). Despite growing evidence of overall coverage disruptions, little is known about how losses and recovery varied simultaneously by gender, race/ethnicity, marital status, education, and income using a comprehensive intersectional framework extending through 2024. This study addresses that gap by examining how ten distinct insurance coverage types changed across demographic groups during and after the pandemic.

Methods: This study uses American Community Survey (ACS) 1-year samples from IPUMS covering 2020–2024, providing nationally representative data on adults aged 18–64 (n=9,407,269). Ten insurance outcomes are examined: any coverage (HCOVANY), private coverage (HCOVPRIV), employer-sponsored (HINSEMP), direct purchase (HINSPUR), TRICARE (HINSTRI), any public coverage (HCOVPUB), Medicaid (HINSCAID), Medicare (HINSCARE), VA (HINSVA), and Indian Health Service (HINSIHS). Analyses include survey-weighted descriptive statistics, logistic regression, interaction models testing whether sex effects differ by race/ethnicity, age group, and income, and difference-in-differences models comparing expansion versus non-expansion states. All analyses apply person-level survey weights for nationally representative estimates.

Results: Overall, uninsurance declined from 13.2% in 2020 to 11.3% in 2023 but rebounded to 11.6% in 2024, likely reflecting Medicaid unwinding. Women were consistently 35% less likely to be uninsured than men. Black and American Indian and Alaska Native women showed the highest Medicaid dependence and largest gender gaps in uninsurance. The female ESI advantage grew significantly with income while the Medicaid advantage weakened at higher income levels.

Implications: Coverage inequities by gender, race/ethnicity, and income persisted throughout the pandemic and recovery without closing. Public health professionals should advocate for policies that strengthen Medicaid, expand outreach to vulnerable populations, and decouple health insurance from employment to advance equitable access to care across Colorado and the nation.

Diabetes prevention and management are key public health priorities in Colorado. The National Diabetes Prevention Program (National DPP) and Diabetes Self-Management Education and Support (DSMES) services are national, evidence-based programs for individuals living with diabetes or prediabetes. Approximately 44 DSMES programs and 23 National DPP programs exist throughout Colorado. However, programming is limited, particularly in rural areas of the state with dispersed populations, with the majority of National DPP and DSMES programs concentrated in urban areas in the middle of the state. In fact, 81% of rural and rural resort counties do not have a local National DPP, and 75% of rural and rural resort counties do not have local DSMES services. This reality makes telehealth and virtual program delivery options necessary for individuals living with diabetes or at risk for diabetes who have barriers to in-person programming. Research shows that program outcomes between in-person and virtual programming are similar. However, program providers and participants alike face barriers to telehealth programming. This presentation will clearly outline the successes, challenges, and lessons learned from diabetes prevention and management programs, gleaned from working directly with telehealth providers since 2021, as well as surveys conducted in early 2026. Creative solutions taking place in Colorado will be shared, and attendees will walk away with tangible examples of how to effectively deliver telehealth programming by increasing engagement, addressing digital literacy, investing in staff training, and adjusting workflows to best meet the needs of participants and program providers.

Background

Asthma affects 8-10% of school aged children in the United States and is a leading cause of both healthcare utilization and school absenteeism in this age group. Enhancing school-based asthma care is a key strategy to meet children and families where they are and improve asthma outcomes. To this end, Colorado Asthma Friendly Schools initiative was created to both recognize schools and school nurses providing appropriate asthma care in schools, as well as encourage ongoing improvements in holistic school-based asthma care.

Methods:

We adapted the American Lung Associations’ Asthma Friendly Schools Framework to address local contexts and created a self-assessment tool to evaluate schools’ performance in 4 key areas: maximizing delivery of school health services, building asthma education, providing a healthy school environment, and managing physical education and activity. Nurses indicated which strategies they were implementing in a few key areas. After a small first year pilot involving 13 schools, invitations to apply for recognition were distributed across a statewide listserv.

Results:

Nurses (n=137) providing care at 221 schools and 24 districts were recognized. Schools covered 126,043 students, which is approximately 14% of all students in Colorado. Two large school districts received special recognition due to their districtwide asthma-friendly efforts. Highly implemented strategies included protocols and training to manage asthma symptoms and emergencies, following care plans, and infrastructure such as integrated pest management plans, and HVAC improvements. Minimal implementation areas included targeted coordination for high-risk students, WSCC model integrations, EPA walkthroughs and idling policies, and integration with physical education (PE) teachers and activities

Implications:

There was high statewide interest in an initiative to recognize high quality asthma care in schools. While treatment of emergencies in schools was a priority, improving integration with physical education teachers and implementing more evidence based environmental mitigation strategies remain areas of opportunity.

Following a 2023 nationwide settlement the Colorado Attorney General’s Office secured against Juul Labs, Inc. on behalf of Coloradans because the company targeted young people in their marketing and misrepresented the health risks posed by their vaping products, $11.4 million in grant funds was awarded through the Vaping Prevention Education Grant (VPEG) to 28 school districts, charter schools, BOCES, and facility schools statewide. The Colorado Attorney General’s Office and the Colorado Department of Education partnered on the VPEG grant opportunity, a comprehensive, multifaceted approach combining education, prevention, and treatment – that now supports K–12 education providers across Colorado with funding and technical assistance in their efforts to combat youth vaping.

Aligning with Public Health in the Rockies focal areas related to prevention and health promotion, policy and systems change, health equity, and community-engaged public health practice, this presentation will provide an overview of the VPEG program structure, required grant components, equitable selection criteria, and implementation strategies from select grantees.

By highlighting current school-based initiatives supported by VPEG funding, we hope to demonstrate how education providers can act as valuable partners in supporting equitable, prevention-oriented, and community-engaged public health strategies