Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

August 5, 2026; 1–2 p.m. Data Centers and Health: Understanding the Impacts and Taking Action. 
Health professionals are increasingly concerned about the potential harms and impacts related to data centers and want to know how to respond. Join the Medical Society Consortium on Climate Change and Health, Healthy Climate Wisconsin, Physicians for Social Responsibility, Alliance of Nurses for Healthy Environments, and the American Public Health Association for a timely webinar series that will equip attendees with the knowledge they need to speak confidently about the health and environmental justice harms from the rapid buildout of data centers.

August 6, 2026; 12–1 p.m. Optimizing Cesarean Recovery to Support Breastfeeding and Lactogenesis – Dell Center for Healthy Living.
This webinar from the Michael & Susan Dell Center for Healthy Living will explore evidence-based anesthesia and recovery strategies that support maternal alertness, early skin-to-skin contact, breastfeeding initiation, and lactogenesis following cesarean birth. Participants will discuss multidisciplinary approaches involving obstetric, anesthesia, nursing, and lactation teams to enhance recovery and improve the breastfeeding experience for mothers and infants.

August 12, 2026; 1–2 p.m. From Problem To Prevention: Evidence-Based Public Health.
Curious about evidence-based public health (EBPH) but not sure where to start? This session from the Network of the National Library of Medicine (NNLM) will explain the basics of evidence-based public health (EBPH) and highlight essentials of the EBPH process such as identifying the problem, forming a question, searching the literature, and evaluating the intervention.

August 26, 2026; 11 a.m.–12:30 p.m.  Cystic Fibrosis Newborn Screen: What a Primary Care Provider Needs to Know.
Early diagnosis of cystic fibrosis can significantly improve health outcomes and provide access to life-changing therapies. This presentation from the DSHS Grand Rounds program will provide attendees with current screening and diagnostic practices, the clinical manifestations and treatment of cystic fibrosis, and the collaborative care model that supports patients and families throughout their lives. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 20 minutes reserved for Q&A.

Websites and reports on trending topics

CDC Wonder is the CDC Wide-ranging ONline Data for Epidemiological Research that provides access to an array of public health information. 
Search for and read published documents on public health concerns, including reports, recommendations and guidelines, articles and statistical research data published by CDC. It has reference materials and bibliographies on health-related topics. Query numeric data sets on CDC's information systems via fill-in-the-blank webpages. Public-use data sets about mortality (deaths), cancer incidence, HIV and AIDS, TB, natality (births), census data and many other topics are available for query, and 
the requested data are readily summarized and analyzed.

Learning Express Library, available through TexShare databases, offers interactive training modules. It covers topics like math and writing skills but also includes training on computer software like the Microsoft Office programs, Adobe Illustrator, and Adobe Photoshop. Email the library for TexShare access information.

ProQuest Public Health is also available through the TexShare databases. 
It is designed to be the ideal starting point for public health information and research. With journals, news, trade publications, reports and more, it covers a wide variety of disciplines ranging from social sciences and biological sciences to business. Journal results are indexed from core literature collected from publishers using appropriate public-health terminology.

State Trackers - NASHP, from the National Academy for State Health Policy (NASHP), monitors and displays state-level actions, legislation, and policies related to various healthcare topics. These trackers help state officials, researchers, and the public understand how states are addressing key healthcare issues, such as Medicaid coverage, prescription drug costs, and health system consolidation. The trackers can be filtered by policy area, topic, and state.

Journal articles of note

Geracci JP, Knierim SM, Bowers AF, et al. Expanding access to prehospital blood products: a narrative review of clinical evidence, systems barriers, and statewide strategies. Trauma Surg Acute Care Open. 2026;11(2):e002321. Published 2026 Jun 26. doi:10.1136/tsaco-2026-002321
Abstract
Traumatic hemorrhage remains a leading cause of preventable death in the USA, and early administration of blood products improves outcomes in hemorrhagic shock. However, access to prehospital transfusion on ground ambulances remains limited and uneven. This narrative review synthesizes current clinical evidence, implementation barriers, and emerging models for prehospital blood use in the USA, with a focus on the potential role of statewide coordination within trauma systems. A targeted review of peer-reviewed literature, consensus guidelines, and system implementation reports was conducted, examining clinical efficacy, trauma system integration, regulatory frameworks, logistical considerations, reimbursement challenges, and statewide strategies. Approximately 3% of the 11,450 eligible US 9-1-1 ground emergency medical service (EMS) units currently provide prehospital blood transfusion, with access largely determined by local resources rather than patient need. Major barriers include logistical and stewardship challenges, lack of sustainable reimbursement pathways, absence of centralized data infrastructure, and the decentralized nature of the US blood supply. Clinical evidence supports the use of blood products for both traumatic and non-traumatic hemorrhage, demonstrating improvements in early hemodynamics and survival. Emerging efforts, including those led by the Prehospital Blood Transfusion Coalition and coordinated initiatives in states such as Texas, West Virginia, Florida, Delaware, and Colorado, highlight the feasibility of state-level implementation through shared governance, blood rotation strategies, and public investment. Overall, evidence supports the use of prehospital blood in selected populations, yet access remains limited and uneven. State-directed coordination represents a pragmatic framework to align existing blood centers, hospitals, and EMS agencies, although additional research, data integration, and national policy development are needed to guide broader implementation.

Han P, Benjamin RH, Ludorf KL, et al. Maternal smoking and preterm birth among infants with orofacial clefts. Cleft Palate Craniofac J. Published online July 27, 2026. doi:10.1177/10556656261471958
Abstract
Objective: To evaluate the associations between maternal cigarette smoking and preterm birth (PTB) among infants with orofacial clefts (OFCs). 
Design: Population-based retrospective cohort study.
Setting: Using data from the National Birth Defects Prevention Study (NBDPS, 1997-2011 deliveries) and the Birth Defects Study To Evaluate Pregnancy exposures (2014-2021 deliveries), we evaluated the association between maternal smoking and PTB (<37 weeks) among liveborn infants with cleft lip with/without cleft palate (CL±P), cleft palate only (CP), or any OFC.
Participants: In total, 5618 liveborn infants with OFCs (3699 CL±P and 1919 CP). 
Main Outcome Measure(s): Adjusted relative risks (aRRs) and 95% confidence intervals (CIs) were calculated using Poisson regression, adjusted for covariates. For each OFC group, smoking (any vs none) was evaluated during 5 pregnancy timepoints (eg, first trimester). Analyses were repeated for smoking intensity (none, 1-14, ≥15 cigarettes/day) (NBDPS only). Any smoking and smoking intensity were also evaluated for extremely-to-very (<32 weeks) and moderate-to-late preterm (32 to <37 weeks).
Results: Among infants with OFCs, 14.5% were born preterm. Heavy smoking (≥15 cigarettes/day vs none) in the second trimester was associated with PTB among infants with CP (aRR: 1.89, 95% CI: 1.03-3.45) and extremely-to-very PTB among infants with any OFC (aRR: 3.37, 95% CI: 1.47-7.73). Associations were generally stronger for CP than for CL±P, though imprecise.
Conclusions: Heavy smoking during the second trimester may increase the risk of extremely-to-very PTB in infants with OFCs and PTB among infants with CP, further supporting the importance of promoting maternal smoking cessation or reduction.

Richard MA, Luke B, Jaime E, et al. A population-based study of the co-occurrence of hypospadias and congenital heart defects among boys conceived with in vitro fertilization†. Hum Reprod. 2026;41(8):1440-1447. doi:10.1093/humrep/deag093
Abstract
Study question: Is there an association of co-occurring hypospadias and congenital heart defects (CHD) with method of conception?
Summary answer: There is a small excess risk for co-occurring hypospadias and CHD among boys conceived through in vitro fertilization (IVF) not fully explained by other risk factors.
What is known already: We previously reported a higher prevalence of major CHDs among boys born with hypospadias. Our previous analyses leveraged 3.7 million pregnancies recorded through birth defect registries in 11 US states but could not evaluate the role of IVF in the risks for these pregnancy outcomes. Simultaneously, in registry data linked to fertility parameters, we observed excess risk for hypospadias and CHD with conception by IVF. The rarity of co-occurring birth defects requires large sample sizes with key information on both IVF treatment parameters and maternal characteristics to differentiate their roles in birth defects.
Study design, size, duration: We conducted a population-based study of live births in four US states (Massachusetts, New York, North Carolina, and Texas) from 2004 to 2018 and linked to IVF cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS). Information on the treatment cycle included the use of autologous or donor oocytes, fresh or frozen embryos, male infertility diagnosis, and the use of ICSI. Non-IVF births were sampled 10:1 at the time of IVF births. For the purposes of evaluating isolated and co-occurring hypospadias and CHD, our study included 731 838 boys born over the study period.
Participants/materials, setting, methods: State birth defect registries reporting British Pediatric Association codes were used to identify major birth defects. We formed four outcome groups: (i) boys with CHD alone, (ii) boys with hypospadias alone, (iii) boys with both (hypospadias-CHD), and (iv) boys without birth defects (comparison group). We used unadjusted and adjusted logistic regression to associate IVF conception with each outcome group relative to the common comparison group. Adjustments in each outcome model included backward elimination for birth year, plurality, maternal race/ethnicity, age, education, diabetes, hypertension, and parity. We additionally calculated the prevalence of CHD and hypospadias by IVF treatment parameters.
Main results and the role of chance: Among 731 838 boys, we identified 267 who had both hypospadias and a major CHD, 65 conceived through IVF and 202 controls. We observed strong unadjusted associations of IVF with hypospadias (OR 1.49, 95% CI 1.37-1.62), CHD (OR 1.64, 95% CI 1.49-1.81), and hypospadias-CHD (OR 2.63, 95% CI 1.39-4.69). The associations of IVF with isolated hypospadias and isolated CHD were attenuated, but not fully explained, after adjustment for key covariates (hypospadias adjusted OR 1.15, 95% CI 1.03-1.28; CHD adjusted OR 1.14, 95% CI 1.003-1.29). The adjusted association of IVF with hypospadias-CHD suggests a stronger association than for either defect alone (OR 2.16, 95% CI 1.17-3.99), and calculating the observed-expected multiplicative effect supports an excess risk for hypospadias-CHD co-occurrence among boys conceived through IVF (observed ratio 1.65 > expected ratio 1). Among boys with hypospadias, 4.4% (95% CI 4.0-4.8) of boys conceived without IVF also had a CHD, whereas 6.9% (95% CI 5.8-8.0) of boys conceived using IVF also had a CHD. We found that prevalence of CHD was highest among boys with the most severe form of hypospadias among those conceived with IVF (14.1% with CHD, 95% CI 5.5-22.6) or naturally conceived (10.8% with CHD, 95% CI 6.6-15.0). Calculating number needed to screen (NNS) suggests that incorporating information on hypospadias and method of conception could allow for targeted CHD screening opportunities (NNS range: 8-99). Description of fertility treatment parameters suggests the prevalence of hypospadias or CHD among boys conceived using frozen embryos (autologous or donor oocytes) is 2.8%, and is 2.7% among boys whose fathers were diagnosed with male infertility. For co-occurring hypospadias-CHD, the prevalence was highest among boys conceived using donor oocytes (both fresh or frozen embryos) and among boys whose fathers were diagnosed with male infertility, though the absolute risk remained low (0.09-0.12%). When further evaluating male infertility by the use of ICSI, we found that ICSI use increased the risk for isolated or co-occurring defects regardless of an underlying diagnosis of male infertility.
Limitations, reasons for caution: Based on the rarity of co-occurring birth defects (0.08% prevalence of hypospadias-CHD among boys conceived using IVF), we were not able to fully evaluate IVF treatment parameters or subfertility for their role in the co-occurrence of hypospadias and CHD. However, we adjusted for maternal characteristics related to both birth defect risks and fertility. We further sought to characterize treatment parameters that warrant follow-up in future studies of health outcomes among children conceived using IVF.

Stanley S, Patrick RC, Elkan M, et al. Genomic epidemiology of two travel-associated pediatric measles viruses within the B3 Lineage. J Clin Virol. 2026;185:105966. doi:10.1016/j.jcv.2026.105966
Abstract
Background: Children's Hospital of Philadelphia (CHOP) identified a MeV case in late 2023 and also early 2025, both of which were associated with international travel. Of the 24 MeV genotypes, the B3 and D8 lineages have been the most prevalent globally since 2021. Initial genotyping indicated that the two CHOP isolates belong to the B3 lineage.
Objectives: To inform MeV molecular surveillance, we conducted a genomic epidemiology analysis to situate the CHOP strains within the global genetic landscape of past and present MeV B3 cases.
Study design: We performed whole-genome amplification, genome assembly, and phylogenomics of our two MeV cases. These strains were then analyzed alongside all 168 National Center for Biotechnology Information near-full length MeV B3 genomes using population and evolutionary genetic approaches. This dataset includes strains isolated from 13 countries between 2005 and 2025.
Results: The two CHOP strains form a monophyletic group with 39 other isolates from four countries; 36 clade members form a discrete network connected by a 15 single nucleotide polymorphism (SNP) cutoff. The CHOP clade shares a Q45H phosphoprotein mutation at a codon undergoing diversifying selection, as with a H593R hemagglutinin mutation carried by the 2025 CHOP strain. The CHOP clade likely diverged in 2019 and has a median root-to-tip distance of 0.020 compared to 0.017 for the other B3 strains, consistent with this clade encompassing the most recently divergent nodes.
Conclusions: Our work places the CHOP MeV cases within a diversifying and emergent global clade of the dominating B3 lineage that is a future risk due to ongoing B3 MeV transmission.

Bustrak S, Rodriguez JD, Yeung LF, et al. Availability of folic acid fortified corn masa products in selected areas in the United States. Birth Defects Res. 2026;118(6):e70084. doi:10.1002/bdr2.70084
Abstract
Objective: To assess the availability of folic acid fortified corn masa (CM) products across selected areas/regions in the United States for neural tube defects (NTD) prevention 8 years after voluntary fortification of CM products was permitted.
Methods: Geographic selection using US census data included areas with majority Hispanic census tracts in California (CA), Georgia, and Texas (TX). A largely rural county in CA, an urban county in TX, and the metropolitan Atlanta area were selected as study sites. Stores selling groceries and snacks in the selected areas were visited and surveyed for CM products. A mobile application was used to record product data, including product identifiers (e.g., brand name, product type) and folic acid information (e.g., presence and amount of folic acid, folic acid graphical design element). Analyses were performed using R studio.
Results: In the 111 stores surveyed, products identified included 50 distinct retail CM flour bags, 178 distinct corn tortilla products, 88 distinct tostada products, and 223 other distinct CM products. Fifty percent of distinct CM flour bags (25/50) were fortified with folic acid. Additionally, 1% (2/178) of tortillas and about 3% (3/88) of tostadas were fortified. No other fortified products were identified.
Conclusion: Almost a decade after voluntary folic acid fortification of CM flour was allowed, very few ready-made CM products assessed in this study were fortified. As states work to initiate changes to increase the availability of fortified products, continued assessment can help monitor the availability of fortified products for NTD prevention.

Crisp CA, Milton S, Lutz CS, et al. Notes from the field: Initial public health response to a measles outbreak in a close-knit West Texas community - January-February 2025. MMWR Morb Mortal Wkly Rep. 2026;75(23):300-302. Published 2026 Jun 18. doi:10.15585/mmwr.mm7523a2
Summary
What is already known about this topic?
Measles is a highly contagious respiratory virus that can cause serious illness. A measles outbreak occurred in Texas during January–August 2025.
What is added by this report?
During January 29–February 28, 2025, Texas reported 207 confirmed measles cases, primarily among members of a close-knit west Texas community. Most cases occurred among unvaccinated persons or those with unknown vaccination status. Measles, mumps, and rubella (MMR) vaccine and measles testing clinics were offered; however, community members were hesitant to interact with public health and health care systems, and MMR vaccine acceptance was low. Educational materials on measles and measles prevention were developed and distributed.
What are the implications for public health practice?
In challenging community contexts, public health messaging intended to limit viral transmission and severe health outcomes could supplement standard control measures, including advising persons with suspected measles to avoid contact with other persons to prevent transmission and to seek medical care promptly.

Haas CB, Shiels MS, Luo Q, et al. Markers of immune function and survival among cancer patients with HIV in the United States: a population-based registry linkage study. Clin Infect Dis. Published online May 29, 2026. doi:10.1093/cid/ciag333
Abstract
Background: People with HIV (PWH) and cancer have greater cancer-specific mortality than patients without HIV, which may reflect effects of immunosuppression. We aimed to describe the associations between low CD4 cell counts and cancer-specific mortality in PWH with cancer.
Methods: We used linked data from HIV and cancer registries to study 12 common cancers in PWH in 14 registries in the United States and Puerto Rico in 2008-2019. We used Cox regression to estimate hazard ratios (HRs) for the association of CD4 counts measured after cancer diagnosis (0-49, 50-99, 100-199, and 200+ CD4 cells/mm3) with cancer-specific mortality, adjusted for demographic and cancer-related factors. We estimated 3-year cancer-specific cumulative mortality using Fine-Gray models.
Results: We evaluated 12,087 PWH and cancer (the most common being non-Hodgkin lymphoma [NHL, N=2311], prostate cancer [N=1681], and Kaposi sarcoma [KS, N=1423]). Cancer-specific mortality was significantly greater for individuals with a CD4 count of 0-49 compared to 200+ cells/mm3 for NHL (HR=1.82, 95%CI=1.30-2.53), prostate cancer (HR=3.98, 95%CI=1.56-10.15), KS (HR=4.16, 95%CI=1.49-11.67), lung cancer (HR=1.69, 95%CI=1.33-2.14), colorectal cancer (HR=2.79, 95%CI=1.58-4.92), and liver cancer (HR=1.44, 95%CI=1.01-2.70). For lung cancer, those with a CD4 count of 200+ cells/mm3 had 3-year cancer-specific cumulative mortality of 52% versus 72% for those with a CD4 count of 0-49.
Conclusion: Among PWH with cancer, cancer-specific mortality increased with lower CD4 counts, including for solid tumors not associated with HIV, e.g., prostate and lung cancer. These results highlight the role of immunity in control of cancer.

Maclin BJ, Pfeiffer RM, Luo Q, et al. Sex differences in cancer incidence among people with HIV infection in the United States. J Natl Cancer Inst. Published online June 12, 2026. doi:10.1093/jnci/djag185
Abstract
Objective: Males have a higher incidence of most non-reproductive cancers than females, which has often been attributed to differences in lifestyle or behaviors. We examined whether sex differences in cancer incidence are attenuated among immunocompromised adults.
Methods: Using data from population-based linkage study of HIV and cancer registries (2001-2019), we estimated male-to-female incidence rate ratios (M:F IRRs) among people with HIV (PWH) for 20 cancer sites. We used Poisson regression to adjust for age, race/ethnicity, calendar year, HIV transmission category, and HIV diagnosis year. We compared the M:F IRRs among PWH (M:F IRRPWH) to M:F IRRs in the general population (M:F IRRGP) with a chi-square test.
Results: PWH contributed 3,956,838 person-years of follow-up (53.6% among males, 46.4% among females). The M:F IRRPWH was significantly attenuated compared to the M:F IRRGP for 9 cancer sites: tongue (M:F IRRPWH 1.39 vs. M:F IRRGP 2.94; P<0.0001), oropharynx (1.80 vs 4.74; P<0.0001), esophagus (1.36 vs 3.43; P<0.0001), colon (0.90 vs 1.19; P=0.0002), liver (2.20 vs 4.22; P < 0.0001), larynx (1.50 vs 4.32; P<0.0001), lung (0.92 vs 1.39; P < 0.0001), bladder (1.21 vs 3.02; P<0.0001), and diffuse large B-cell lymphoma (1.35 vs 1.65; P<0.0001). Hodgkin lymphoma was the only site where the M:F IRRPWH was significantly larger than the M:F IRRGP (1.96 vs 1.45; P=0.0001).
Conclusions: Although the incidence of most cancers remained higher among male than female PWH, the sex difference was attenuated among PWH for 9 cancers, suggesting that important immune differences between males and females in the general population contribute to differences in cancer incidence.

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Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

July 7, 2026; 12–1 p.m. What’s Working Right Now: Low-Cost Tools from Local Health Departments.
Join NACCHO’s webinar series to hear directly from local health departments sharing practical, budget-friendly approaches to tackling real-world public health challenges. This webinar will cover two tools. Tool 1: Bend It Like REDCap: Leveraging REDCap to Build End-to-End Project Management Systems by Jennifer Lowe, Johnson County Department of Health and Environment. Public health agencies are increasingly looking for low-cost tools to streamline operations and track program performance. In this webinar, the Johnson County Department of Health and Environment will share how they expanded REDCap beyond surveys to serve as a centralized system for project management and performance tracking. Learn how this internally hosted, no-cost solution is used to monitor requests, timelines, and key performance indicators across multiple programs and how similar approaches can support operational efficiency and reporting in your organization. Tool 2: Mapmaking in R by Katherine Hathaway, San Antonio Metropolitan Health District (Metro Health). Many local health departments lack the resources to invest in costly GIS software, creating barriers to mapping and spatial analysis. In this webinar, participants will explore an open-source alternative using R, including packages like tidycensus and other tidyverse tools, to create meaningful public health maps. The session will also compare these approaches to traditional GIS solutions, highlighting both the cost-saving benefits and the level of technical expertise required, offering practical insights for agencies considering open-source mapping options.

July 16, 2026; 11 a.m.–2 p.m. Data and Situational Awareness for Medical and Public Health Preparedness and Response. 
This webinar from the National Academies will examine how medical, public health, emergency management, and critical infrastructure data are collected, integrated, analyzed, and translated into real-time situational awareness to support timely, coordinated decision-making across jurisdictions and sectors. The workshop series will consider these issues in the periods before, during, and after disasters and emergencies.

July 29, 2026; 11 a.m.–12:30 p.m. Self-Care for Helpers.
This webinar from the DSHS Grand Rounds program will explore the science of stress and burnout, including how the brain and nervous system respond to stress and why these responses are normal and adaptive. Participants will examine common barriers to effective self‑care in high‑stress work environments and learn practical, skills‑based strategies to address them. The session will also highlight evidence‑based, personalized approaches to self‑care that support resilience, reduce burnout, and sustain professional effectiveness. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 20 minutes reserved for Q&A.

July 29, 2026; 12–1 p.m. Building Better Brains: The Role of Sleep in Child Development.
Sleep is essential for the developing brain. This presentation from the Michael & Susan Dell Center for Healthy Living will explore how sleep supports memory, learning, emotional functioning, and neurodevelopment across childhood and adolescence. Drawing from developmental science and public health research, participants will learn how insufficient or disrupted sleep can shape developmental trajectories and identify practical strategies to support healthy sleep during critical periods of growth.

Websites and reports on trending topics

CINAHL Complete is a DSHS library e-resource that provides access to literature in nursing and allied health disciplines dating back to 1981. The full text of 600 journals can be found within, and over 5,600 journals are indexed, including virtually all English language nursing journals along with selected titles in biomedicine, alternative therapies, and consumer health. Please contact the library for remote access options.

Disaster Research Response (DR2) Resources Portal is a repository of data collection tools and related resources curated by the National Institutes of Health to empower human health research in response to disasters and public health emergencies.

ECRI Guidelines Trust is a publicly available repository of objective, evidence-based clinical practice guidelines that provides physicians, nurses, and other healthcare practitioners with up-to-date clinical practices to advance safe and effective patient care.

ERIC (Education Resources Information Center), sponsored by the U.S. Department of Education, is a bibliographic search engine providing free access to educational-related literature. ERIC provides coverage of journal articles, conferences, meetings, government documents, theses, reports, audiovisual media, and monographs.

Journal articles of note

Bustrak S, Rodriguez JD, Yeung LF, et al. Availability of folic acid fortified corn masa products in selected areas in the United States. Birth Defects Res. 2026;118(6):e70084. doi:10.1002/bdr2.70084
Abstract
Objective: To assess the availability of folic acid fortified corn masa (CM) products across selected areas/regions in the United States for neural tube defects (NTD) prevention 8 years after voluntary fortification of CM products was permitted.
Methods: Geographic selection using US census data included areas with majority Hispanic census tracts in California (CA), Georgia, and Texas (TX). A largely rural county in CA, an urban county in TX, and the metropolitan Atlanta area were selected as study sites. Stores selling groceries and snacks in the selected areas were visited and surveyed for CM products. A mobile application was used to record product data, including product identifiers (e.g., brand name, product type) and folic acid information (e.g., presence and amount of folic acid, folic acid graphical design element). Analyses were performed using R studio.
Results: In the 111 stores surveyed, products identified included 50 distinct retail CM flour bags, 178 distinct corn tortilla products, 88 distinct tostada products, and 223 other distinct CM products. Fifty percent of distinct CM flour bags (25/50) were fortified with folic acid. Additionally, 1% (2/178) of tortillas and about 3% (3/88) of tostadas were fortified. No other fortified products were identified.
Conclusion: Almost a decade after voluntary folic acid fortification of CM flour was allowed, very few ready-made CM products assessed in this study were fortified. As states work to initiate changes to increase the availability of fortified products, continued assessment can help monitor the availability of fortified products for NTD prevention.

Crisp CA, Milton S, Lutz CS, et al. Notes from the field: Initial public health response to a measles outbreak in a close-knit West Texas community - January-February 2025. MMWR Morb Mortal Wkly Rep. 2026;75(23):300-302. Published 2026 Jun 18. doi:10.15585/mmwr.mm7523a2
Summary
What is already known about this topic? Measles is a highly contagious respiratory virus that can cause serious illness. A measles outbreak occurred in Texas during January–August 2025.
What is added by this report? During January 29–February 28, 2025, Texas reported 207 confirmed measles cases, primarily among members of a close-knit west Texas community. Most cases occurred among unvaccinated persons or those with unknown vaccination status. Measles, mumps, and rubella (MMR) vaccine and measles testing clinics were offered; however, community members were hesitant to interact with public health and health care systems, and MMR vaccine acceptance was low. Educational materials on measles and measles prevention were developed and distributed.
What are the implications for public health practice? In challenging community contexts, public health messaging intended to limit viral transmission and severe health outcomes could supplement standard control measures, including advising persons with suspected measles to avoid contact with other persons to prevent transmission and to seek medical care promptly.

Haas CB, Shiels MS, Luo Q, et al. Markers of immune function and survival among cancer patients with HIV in the United States: a population-based registry linkage study. Clin Infect Dis. Published online May 29, 2026. doi:10.1093/cid/ciag333
Abstract
Background: People with HIV (PWH) and cancer have greater cancer-specific mortality than patients without HIV, which may reflect effects of immunosuppression. We aimed to describe the associations between low CD4 cell counts and cancer-specific mortality in PWH with cancer.
Methods: We used linked data from HIV and cancer registries to study 12 common cancers in PWH in 14 registries in the United States and Puerto Rico in 2008-2019. We used Cox regression to estimate hazard ratios (HRs) for the association of CD4 counts measured after cancer diagnosis (0-49, 50-99, 100-199, and 200+ CD4 cells/mm3) with cancer-specific mortality, adjusted for demographic and cancer-related factors. We estimated 3-year cancer-specific cumulative mortality using Fine-Gray models.
Results: We evaluated 12,087 PWH and cancer (the most common being non-Hodgkin lymphoma [NHL, N=2311], prostate cancer [N=1681], and Kaposi sarcoma [KS, N=1423]). Cancer-specific mortality was significantly greater for individuals with a CD4 count of 0-49 compared to 200+ cells/mm3 for NHL (HR=1.82, 95%CI=1.30-2.53), prostate cancer (HR=3.98, 95%CI=1.56-10.15), KS (HR=4.16, 95%CI=1.49-11.67), lung cancer (HR=1.69, 95%CI=1.33-2.14), colorectal cancer (HR=2.79, 95%CI=1.58-4.92), and liver cancer (HR=1.44, 95%CI=1.01-2.70). For lung cancer, those with a CD4 count of 200+ cells/mm3 had 3-year cancer-specific cumulative mortality of 52% versus 72% for those with a CD4 count of 0-49.
Conclusion: Among PWH with cancer, cancer-specific mortality increased with lower CD4 counts, including for solid tumors not associated with HIV, e.g., prostate and lung cancer. These results highlight the role of immunity in control of cancer.

Maclin BJ, Pfeiffer RM, Luo Q, et al. Sex differences in cancer incidence among people with HIV infection in the United States. J Natl Cancer Inst. Published online June 12, 2026. doi:10.1093/jnci/djag185
Abstract
Objective: Males have a higher incidence of most non-reproductive cancers than females, which has often been attributed to differences in lifestyle or behaviors. We examined whether sex differences in cancer incidence are attenuated among immunocompromised adults.
Methods: Using data from population-based linkage study of HIV and cancer registries (2001-2019), we estimated male-to-female incidence rate ratios (M:F IRRs) among people with HIV (PWH) for 20 cancer sites. We used Poisson regression to adjust for age, race/ethnicity, calendar year, HIV transmission category, and HIV diagnosis year. We compared the M:F IRRs among PWH (M:F IRRPWH) to M:F IRRs in the general population (M:F IRRGP) with a chi-square test.
Results: PWH contributed 3,956,838 person-years of follow-up (53.6% among males, 46.4% among females). The M:F IRRPWH was significantly attenuated compared to the M:F IRRGP for 9 cancer sites: tongue (M:F IRRPWH 1.39 vs. M:F IRRGP 2.94; P<0.0001), oropharynx (1.80 vs 4.74; P<0.0001), esophagus (1.36 vs 3.43; P<0.0001), colon (0.90 vs 1.19; P=0.0002), liver (2.20 vs 4.22; P < 0.0001), larynx (1.50 vs 4.32; P<0.0001), lung (0.92 vs 1.39; P < 0.0001), bladder (1.21 vs 3.02; P<0.0001), and diffuse large B-cell lymphoma (1.35 vs 1.65; P<0.0001). Hodgkin lymphoma was the only site where the M:F IRRPWH was significantly larger than the M:F IRRGP (1.96 vs 1.45; P=0.0001).
Conclusions: Although the incidence of most cancers remained higher among male than female PWH, the sex difference was attenuated among PWH for 9 cancers, suggesting that important immune differences between males and females in the general population contribute to differences in cancer incidence.

For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.

The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!

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Medical and Research Library News

Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

June 5, 2026; 1–2:30 p.m. Defining Ultraprocessed Foods: A Roadmap for U.S. Policy Action.
This Healthy Eating Research webinar will present findings from the HER Expert Panel report Ultraprocessed Foods in the U.S.: Recommended Definitions and Policies. Speakers will discuss recommended definitions of ultraprocessed foods, methods to operationalize the definitions for policy purposes, and practical policies to reduce widespread availability and consumption of UPFs.

Jun 10, 2026 1–2:30 p.m. How PubMed Works: Introduction.
If you’re new to PubMed or just want a refresher this online class from the Network of the National Library of Medicine (NNLM) is designed for you. You’ll learn what PubMed is and what it contains, how to find the original research behind a news article, locate articles by a specific author, and search for articles on a particular subject. The course also covers how to narrow your results to a more focused set and introduces the Advanced Search Builder and Search History tools.

June 17, 2026; 11 a.m.–12 p.m. My Health Beyond Pregnancy: Supporting Patients and Caregivers Postpartum.
This webinar from the Michael & Susan Dell Center for Healthy Living will explore maternal health beyond pregnancy, with a focus on postpartum cardiometabolic health and the importance of supporting both patients and caregivers after delivery. Dr. Ann Celi will discuss why maternal heart health matters after childbirth, common postpartum health risks, and strategies to improve long-term outcomes through patient-centered care. The session will also highlight the importance of listening to and amplifying the patient voice to better understand individual experiences, address barriers to care, and promote equitable and compassionate healthcare practices.

June 24, 2026; 11 a.m.–12:30 p.m. Medical-Dental Integration and Prenatal Care.
This webinar is offered by the DSHS Grand Rounds program. DSHS Grand Rounds explores the science and practice of population health and awards continuing education credits/contact hours for various disciplines. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 
20 minutes reserved for Q&A.

Websites and reports on trending topics

ASABE Technical Library from the American Society of Agricultural and Biological Engineers (ASABE), a professional and technical organization dedicated to the advancement of engineering applicable to agricultural, food, and biological systems, provides online access to ASABE standards, meeting and conference papers, textbooks, and monographs. 

FastStats A to Z provides quick access to statistics on topics of public health importance and is organized alphabetically. Links are provided to publications that include the statistics presented, to sources of more data, and to related web pages. From the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention.

National Technical Reports Library (NTRL) is a repository hosted by the National Technical Information Service (NTIS) that provides free access to thousands of U.S. government-funded technical reports across disciplines including environmental health, engineering, and biomedical research.

State Public Health Legislation Database covers topics related to public health including infectious disease prevention and treatment, public health reporting and workforce and vaccines. It includes all introduced legislation from 2021 to the present and is updated at least twice per month as legislation is identified by National Conference of State Legislatures (NCSL) staff.

Journal articles of note

McGee-Avila JK, Haas CB, Shing JZ, et al. Hepatocellular carcinoma survival in people with and without HIV in the United States, 2001-2019. Clin Infect Dis. Published online April 9, 2026. doi:10.1093/cid/ciag137
Abstract
Background: Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood.
Methods: We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001-2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH.
Results: A total of 71 516 cases of HCC including 1610 PWH occurred during 2001-2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27-1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01-1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001-2003 to 2016-2019 (Ptrends & .0002 and .06, respectively).
Conclusions: HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.

Ovuegbe S, Collier A, Forrest D, McKieran L, Tsai J. Access to care during COVID-19: A qualitative study of healthcare system resilience in San Antonio, Texas. J Public Health Res. 2026;15(2):22799036261441334. Published 2026 Apr 14. doi:10.1177/22799036261441334
Abstract
Background: The COVID-19 pandemic challenged healthcare systems across the United States. It had distinct effects in rapidly growing cities like San Antonio, Texas. San Antonio, one of the fastest-expanding metropolitan areas, faces high rates of uninsured residents and a mix of urban and semi-rural healthcare landscapes. This makes it a valuable case for understanding health system responses to access challenges during public health crises. This qualitative study examined how healthcare system leaders, frontline providers, and policymakers in San Antonio navigated three major challenges during COVID-19: system-level disruptions in healthcare delivery, telehealth access, and health insurance coverage.
Methods: From February to April 2023, data came from 2 focus groups (n = 20) and 12 key informant interviews. These were analyzed thematically using a grounded theory approach to identify barriers and evidence-based resolutions.
Results: Participants identified three core challenges: First, disruptions in healthcare delivery due to workforce shortages, reduced preventive care access, and discharge delays. Second, barriers to telehealth access related to the digital divide and health literacy. Third, instability in health insurance coverage following the rollback of pandemic-era Medicaid protections. Participants also shared practice-based recommendations. These included standardized screening for social determinants of health (SDOH) with linked referrals to resources, culturally responsive food assistance programs, and hybrid care models that integrate telehealth with in-person care.
Conclusion: This project shows that engaging local leadership and coordinating strategies can make systems more resilient. These actions improve healthcare access during public health crises and offer practical lessons for other urban healthcare systems.

Sheriff FR, Benjamin RH, Xiao Q, et al. Neighbourhood social vulnerability and preterm birth risk among infants with trisomy 21: a statewide analysis. Paediatr Perinat Epidemiol. Published online April 24, 2026. doi:10.1111/ppe.70143
Abstract
Background: Residing in socioeconomically vulnerable areas is known to be associated with increased preterm birth (PTB) risk in the general population. However, the relationship between social vulnerability and PTB remains unexplored among infants with trisomy 21, who experience more than twice the PTB rate of the general population.
Objectives: The primary objective was to examine the association between maternal socioeconomic vulnerability, as measured by the SVI, and PTB among infants with trisomy 21.
Methods: We conducted a retrospective cohort study among infants with trisomy 21 born in Texas (1999-2018). We examined the association between neighbourhood vulnerability, measured by Social Vulnerability Index (SVI) quartiles, and PTB utilising data from the Texas Birth Defects Registry. Using Poisson regression, we estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs), accounting for maternal demographic characteristics and health factors.
Results: Of the 8823 eligible infants included in the analysis, 2269 (25.7%) were born preterm. Maternal residence in the highest vulnerability quartile was associated with an increased risk of PTB (RR 1.17, 95% CI 1.04, 1.32) and moderate to late PTB (RR 1.19, 95% CI 1.05, 1.35), compared to the least vulnerable quartile. In secondary analyses stratified by race/ethnicity, the association with high vulnerability was particularly strong among non-Hispanic Black women (RR 1.44, 95% CI 1.00, 2.07).
Conclusions: These findings underscore the importance of neighbourhood social vulnerability in influencing perinatal health risks, particularly PTB among infants with trisomy 21.

Wolters R, Tark JY, Chambers TM, et al. Increased risk of sarcomas in children with congenital anomalies: findings from the genetic overlap between anomalies and cancer in kids (GOBACK) registry linkage study. Pediatr Blood Cancer. Published online May 22, 2026. doi:10.1002/1545-5017.70415
Abstract
Background: Pediatric sarcomas are a heterogeneous group of tumors that contribute disproportionately to cancer mortality in children. Although congenital anomalies are among the strongest known risk factors for childhood cancer, the risk of specific sarcoma subtypes among affected individuals has not yet been thoroughly evaluated.
Procedure: We obtained data on maternal and perinatal characteristics, congenital anomalies, and pediatric sarcoma diagnoses for all live births in nine states. We used Cox proportional hazards regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of sarcoma (overall and by subtype) among children with non-syndromic congenital anomalies. We considered all non-syndromic anomalies collectively, and when sample size allowed, we also evaluated specific anomaly-sarcoma associations.
Results: We evaluated 21,933,884 children, including 641,770 (2.9%) with major non-syndromic congenital anomalies. Compared to children without a congenital anomaly, children with a non-syndromic anomaly had a two-fold higher hazard for any soft tissue sarcoma (95% CI: 1.7-2.5), including rhabdomyosarcoma (HR 2.2, 95% CI: 1.7-3.0) and embryonal rhabdomyosarcoma (HR 2.5, 95% CI: 1.8-3.6), as well as non-rhabdomyosarcoma soft tissue sarcoma (HR 1.8, 95% CI: 1.3-2.5). The hazard of embryonal rhabdomyosarcoma was markedly increased in children with central nervous system anomalies (HR 7.9, 95% CI: 3.9-15.9), obstructive genitourinary defects (HR 4.6, 95% CI: 2.2-9.7), and limb reduction deformities (HR 3.8, 95% CI: 1.6-9.3).
Conclusions: Children with non-syndromic congenital anomalies are at increased risk of sarcomas, especially soft tissue sarcomas. Future studies should clarify shared developmental pathways and evaluate implications for sarcoma risk prediction and surveillance.

For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.

The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!

If you would like to subscribe, please send an email to library@dshs.texas.gov with Subscribe in the subject line. 

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