Delaware Division of Public Health

ObjectiveThis study examined the prevalence of food insecurity and its association with anxiety and depression among students at Delaware State University (DSU).MethodsA cross-sectional survey was administered to 117 students via classroom distribution, social media, campus events, and within the campus food pantry. Food insecurity was assessed using the USDA Six-Item Short Form, anxiety levels were determined using the GAD-7 survey tool, and depression scored with the PHQ-9 survey tool. Descriptive statistics were used to describe the population and the chi square test to analyze relationships between food security status and mental health outcomes.ResultsAmong respondents (n = 117), 97% were classified as food insecure (n = 113), and of those, 17% (n = 20) reported moderate-to-severe anxiety and 32% (n = 37) reporting moderate-to-severe depression. Only 37% (n = 43) of the students surveyed (n = 117) accessed mental health services within the past year and only 6% (n = 7) participated in food assistance programs. Although notable proportions of students experiencing food insecurity presented with elevated mental health symptoms, there was no statistically significant association between food security status and levels of depression or anxiety.ConclusionsThe lack of statistical significance does not rule out a meaningful relationship between food and psychological distress. Larger sample sizes, longitudinal studies, and the inclusion of impacting variables such as financial supports are warranted to get an accurate assessment of our current student needs. Developing targeted interventions addressing both nutrition and mental health are essential to improve student well-being at a critical “gateway” period—habits and health challenges that emerge in this life stage often influence lifelong health trajectories.

ObjectiveThis article details the results of focus groups with providers who work with LGBTQ+ youth experiencing or at risk of experiencing homelessness in Delaware.MethodsResearchers interviewed 16 service providers in four focus groups held between May 24, 2023 and June 5, 2023. Providers included housing support specialists, social workers, community health workers, school counselors, mental health care providers, and other community-service-based practitioners. Data were collected through semi-structured interviews conducted via Zoom, and the authors utilized inductive coding to identify emerging themes.ResultsThroughout Delaware, there are limited housing and public health supports in place for LGBTQ+ youth experiencing homelessness. Even when services are available, LGBTQ+ young people may have difficulty accessing them due to age restrictions, shelter segregation by sex or gender, or safety concerns. Providers working with this population face challenges including limited funding and staff, and a lack of specialized training. Changes at the local and state level—including increased funding, enhanced access to specialized training, and greater inclusivity on administrative forms—are important first steps to ensuring providers can adequately provide services to LGBTQ+ youth experiencing homelessness.ConclusionsLGBTQ+ youth are more likely to experience homelessness than their cisgender and heterosexual peers and yet face greater barriers to housing services throughout Delaware. The unique needs of this population necessitate specialized services and programs to ensure all young people have access to basic needs such as housing.Policy ImplicationsThe provider perspectives in this paper offer a firsthand account of the challenges of serving this population and opportunities for improvement in policy creation and program administration.

IntroductionAmerican College of Surgeons Commission on Cancer (CoC) quality measures are used to monitor and evaluate metrics among their CoC-accredited programs, which include seven of Delaware’s hospitals. The Delaware Department of Health and Social Services, Division of Public Health (DPH) also utilizes these metrics to monitor and evaluate Delaware’s overall performance on these standards of care as it relates to the health care provided to cancer patients.MethodsDelaware Cancer Registry (DCR) cases diagnosed in 2018 and 2019 were selected and were analyzed separately to calculate results for each selected measure by year: HT, nBX, LNoSurg, and RECRTCT.ResultsResults of the analysis showed that three out of the four CoC quality measures evaluated met the CoC standard of care for both 2018 and 2019 data. The three measures that met the CoC standards for 2018 were HT (90.4%), nBX (87.6%), and LNoSurg (93.3%). The RECRTCT measure did not meet the CoC standard for 2018 data with 71.4%. All four measures evaluated met the CoC standards for 2019 (HT – 91.6%; nBX – 85.2%; LNoSurg – 92.7%; RECRTCT – 92.3%).DiscussionA majority of cases assessed met the CoC quality measure standards, meeting standards of cancer care and treatment. More discovery work needs to be done to assess the RECRTCT metric to explore reasons why cases did not meet the CoC quality measure standards. There was notable improvement seen for the HT measure over time, where cases had not met the CoC standard in previous years.Public Health ImplicationsWhen CoC quality measures are met, medical providers can ensure patients receive effective and targeted cancer care. This practice ultimately saves resources, reduces cancer burden, impacts survival, and improves public health outcomes.

ABSTRACT.In July and October 2023, two live triatomine bugs were found inside a home in New Castle County, Delaware. The bugs were identified as Triatoma sanguisuga, the most widespread triatomine bug species in the United States. Triatoma sanguisuga is a competent vector of Trypanosoma cruzi, the causative agent of Chagas disease. The two specimens were tested via real-time PCR (qPCR) for infection with T. cruzi, and one of the specimens was positive. Despite T. sanguisuga being endemic to the area, attainment of accurate species identification and T. cruzi testing of the bugs required multiple calls to federal, state, private, and academic institutions over several months. This constitutes the first report of T. sanguisuga infected with T. cruzi in Delaware. In addition, this is the first published report of T. sanguisuga in New Castle County, the northernmost and most densely populated county in Delaware. New Castle County still conforms to the described geographic range of T. sanguisuga, which spans from Texas to the East Coast of the United States. The T. cruzi infection prevalence of the species has not been studied in the northeastern United States, but collections in southern states have found prevalences as high as 60%. The Delaware homeowner’s lengthy pursuit of accurate information about the vector highlights the need for more research on this important disease vector in Delaware.

Although many people who are incarcerated have risk factors for hepatitis A virus (HAV) infection, the proportion of hepatitis A cases among people with a recent incarceration is unknown. We examined the relationship between recent incarceration and HAV infection during community-based, person-to-person outbreaks to inform public health recommendations. The Centers for Disease Control and Prevention surveyed health departments in 33 jurisdictions reporting person-to-person HAV outbreaks during 2016-2020 on the number of outbreak-associated cases, HAV-infected people recently incarcerated, and HAV-associated hospitalizations and deaths. Twenty-five health departments reported 18 327 outbreak-associated hepatitis A cases during January 11, 2016-January 24, 2020. In total, 2093 (11.4%) HAV-infected people had been recently incarcerated. Of those with complete data, 1402 of 1462 (95.9%) had been held in a local jail, and 1513 of 1896 (79.8.%) disclosed hepatitis A risk factors. Eighteen jurisdictions reported incarceration timing relative to the exposure period. Of 9707 cases in these jurisdictions, 991 (10.2%) were among recently incarcerated people; 451 of 688 (65.6%) people with complete data had been incarcerated during all (n = 55) or part (n = 396) of their exposure period. Correctional facilities are important settings for reaching people with risk factors for HAV infection and can also be venues where transmission occurs. Providing HAV vaccination to incarcerated people, particularly people housed in jails, can be an effective component of community-wide outbreak response.

Vaccinations are the primary means used in public health to avert morbidity and mortality from preventable diseases and are crucial for reducing the development of infectious disease outbreaks. To ensure a high level of vaccine coverage, the State of Delaware requires that all children receive specific vaccinations against dangerous pathogens prior to enrolling in a school. By requiring all children to be vaccinated against certain diseases, individuals who have religious or medical exemptions for receiving vaccines are also protected. The percentage of vaccine coverage among kindergarten students is surveyed annually by the Delaware Immunization Program and the Centers for Disease Control and Prevention (CDC), via random sampling. Data acquired during the period from 2016 to 2021 shows that vaccine coverages have a declining trend, which may be due in part to the COVID-19 pandemic and increased vaccine hesitancy. Reviewing these data allows for a more robust understanding of disease trends and provides an indication as to where resources may need to be allocated to address lagging vaccine rates.

“Delawareans need to have access to usable, meaningful, timely, and high-quality data about the health of the communities in which they live,”1 so that data-driven evidence-based decisions result in community-focused solutions to affect positive change. This statement is the vision of the My Healthy Community (MHC) data portal,2 which serves as Delaware’s population health platform. The MHC platform shares data on a myriad of population health areas such as social vulnerability, community characteristics, the environment (e.g., public and private drinking water, air quality), chronic diseases, mental health and substance use, healthy lifestyles, maternal and child health, health care utilization, and infectious diseases. MHC continues to expand in both data and functionality to serve as a tool to track the outcomes of implementing data-driven population health interventions and utilizing technology to monitor and evaluate the effectiveness of interventions. Shortly after the coronavirus disease 2019 (COVID-19) pandemic took a foot hold in the United States, in April of 2020, only 11 months after MHC was publicly launched, the site also became Delaware’s coronavirus disease 2019 (COVID-19) dashboard, presenting statistics on COVID-19 cases, hospitalization, emergency department visits, testing, deaths, vaccination, contact tracing, and in-person contagious school cases. MHC’s origins lie in the intersection between public health informatics and epidemiology. Visionaries within Delaware’s public health agency paved the way to create MHC with the support of DPH leadership and the perseverance and dedication of a small team of public health professionals. With their own unique lenses, one of public informatics and the other of epidemiology, the team’s efforts materialized into a tool that continues to evolve and respond to Delaware’s changing needs.

Fecal contamination of waterways in Delaware pose an ongoing problem for environmental and public health. For monitoring efforts, Enterococcus has been widely adopted by the state to indicate the presence of fecal matter from warm-blooded animals and to establish Primary and Secondary Contact Recreation criteria. In this study, we examined sites within the Love Creek watershed, a tributary of the Rehoboth bay, using next-generation sequencing and SourceTracker to determine sources of potential fecal contamination and compared to bacterial communities to chemical and nutrient concentrations. Microbial community from fecal samples of ten different types of animals and one human sample were used to generate a fecal library for community-based microbial source tracking. Orthophosphate and total dissolved solids were among the major factors associated with community composition. SourceTracker analysis of the monthly samples from the Love Creek watershed indicated the majority of the microbial community were attributed to “unknown” sources, i.e. wildlife. Those that attribute to known sources were primarily domestic animals, i.e. cat and dog. These results suggest that at the state level these methods are capable of giving the start for source tracking as a means to understanding bacterial contamination.