Public Health Reports in 2021: Impact Factor Increase and New Article Collections on Racism and COVID-19

Published continuously since 1878, Public Health Reports (PHR), the official journal of the Office of the US Surgeon General and the US Public Health Service, is the oldest scholarly public health journal in the United States and one of the oldest public health journals in the world.^1,2 In 2021, PHR launched the Public Health Reports: Year in Review article series to inform its contributors and readers about its latest publication metrics, content, and planned improvements. ³ The series started with a review of the journal’s publications and operations in 2020. This second installment compares 2021 and 2020 data and adds a few new metrics that were not captured in 2020 (eg, turnaround times associated with postacceptance editing). While the journal’s content continues to be assembled into issues, the realities of scholarly publishing increasingly demand that articles be published online as soon as possible. To allow for historic volume-based comparison, the analysis of PHR’s 2021 published content was performed by volume, not online publication date, making an exception for time-sensitive COVID-19 articles, which were analyzed by online publication date.

Journal’s 2021 Performance Metrics

In 2021, PHR received its highest impact factor ever, 2.792, a 58.3% increase from 2020 (Figure 1). The metric is calculated based on the previous year’s citations to the articles published within 2 preceding years. ⁴ Further analyses are needed to understand what portion of this increase can be attributed to the recent change in how the impact factor metric is calculated, ⁵ what portion of the increase can be attributed to other factors, and whether the trend will continue.

Figure 1.

Changes in Public Health Reports’ 2-year impact factor from 1997 to 2020. Two-year impact factor is defined as the number of citations during the citation year to articles published during the 2 preceding years divided by the number of articles published during these preceding years. ⁴ The impact factor is released in the year following the citation year.

During 2021, PHR received 1166 new submissions, including 1098 for its regular bimonthly issues and 68 for the invited or sponsored supplemental issues. (This number is variable because some articles that were submitted late in 2021 were incomplete and were resubmitted in 2022.) This number represents a 29.2% increase in new submissions from 2020, including a 27.0% increase for regular-issue submissions and a 78.9% increase for supplement submissions. The journal’s 2021 acceptance rate for bimonthly peer- or editor-reviewed content was 13.7%: 1069 total final decisions were made in 2021, including 146 acceptances and 923 rejections. These data exclude articles in supplements and articles that were not peer or editor reviewed, such as Surgeon General’s Perspective and Executive Perspective articles (the latter are commentaries by US Department of Health and Human Services [HHS] officials). However, these data do include such content as letters to the editor and responses to such letters, peer-reviewed Reports and Recommendations articles, and contributions to the departments of Law and the Public’s Health and From the Schools and Programs of Public Health, which are reviewed by the department’s associate editor and may undergo peer review. This acceptance rate represents a 21.7% reduction from 2020, which is likely the result of increased volume of COVID-19 submissions, including those out of scope for the journal (eg, international and clinical submissions without direct relevance to US public health). The decline in acceptance rate may also reflect the journal’s adoption of a more rigorous publication standard.

In 2021, PHR’s editor in chief made 1073 first decisions on bimonthly peer-reviewed content (compared with 899 first decisions in 2020 ³ ). This number differs from the number of articles submitted in 2021 (1166), because decisions made in early 2021 may include late 2020 submissions, and conversely, articles submitted late in 2021 may have received their first decision in 2022. The time to first decision was a mean (range) of 24 (1-180) days, and a median (interquartile range [IQR]) of 14 (8-24) days. These values represent a 31.4% improvement from the mean time to first decision in 2020 (35 days) and a 34.3% improvement from the maximum time to first decision in 2020 (274 days). This increase in the speed to first decision likely resulted from a more efficient identification of peer reviewers and a higher proportion of COVID-19 submissions that received expedited peer review, including many out-of-scope articles that were rejected prior to review. It also reflects the growth of PHR’s editorial board and several process efficiencies introduced in 2021, such as the appointment of a peer-review supervisor and implementation of associate editor performance reports. Articles with a long time to first decision were delayed because of difficulties in finding reviewers and transitions in associate editor and peer review staff.

PHR published 103 articles in volume 136 (January–December 2021), including research contributions (n = 49), commentaries (n = 15), case studies (n = 12), public health methodology articles (n = 7), brief reports (n = 6), public health evaluations (n = 3), contributions to From the Schools and Programs of Public Health (n = 2) and Law and the Public’s Health (n = 2) departments, topical or scoping reviews (n = 2), Surgeon General’s Perspective articles (n = 2), and 3 other articles (In Memoriam, Public Health Reports: 2020 in Review, and Acknowledgment of Reviewers; Table 1). PHR published 8% fewer articles in volume 136 (2021) than in volume 135 (2020; 103 vs 112). The biggest changes by department included an increase in case studies, brief reports, and commentaries. This rise is likely due to the generally higher prevalence of COVID-19 content, in which these article types are highly represented (vs, for example, research) given the in-progress nature of the COVID-19 science. In 2021, PHR published no Executive Perspective articles (vs 3 in 2020). A similar drop (0 vs 2) occurred in Reports and Recommendations articles published in 2021 versus 2020 (these articles are typically authored by recommendation-setting public health entities). This decrease may reflect the redirection of these groups’ resources toward competing priorities, including pandemic response. Among those articles published in 2021 that were reviewed (N = 98; excluding Surgeon General’s Perspective articles, an In Memoriam article, Acknowledgment of Reviewers, and Public Health Reports: 2020 in Review), the time from original submission to final acceptance was a mean (range) of 241 (77-547) days and a median (IQR) of 203 (148-297) days (Table 2). This 16.0% reduction in mean time from 2020 (287 days) is likely the result of an increase in COVID-19 submissions, which were expedited through peer review relative to non–COVID-19 articles. The time from final acceptance to online publication for the 102 articles in volume 136 (excluding only Acknowledgment of Reviewers) was a mean (range) of 56 (12-247) days and a median (IQR) of 44 (32-74) days. This 21.7% increase in mean time from 2020 (46 days) could be attributed to changes in PHR’s production processes implemented in 2021. Analysis by department did not reveal any substantial differences in turnaround times among the article categories. Published content quality, proxied by the number of corrigenda, was high in 2021 (0 author-requested corrigenda in volume 136 compared with 2 in volume 135).

Table 1.

Content of volume 136 (January–December 2021) of Public Health Reports (PHR), compared with content of volume 135 (January–December 2020), by department

Department	No. (%) of articles in 2020 (n = 112)	No. (%) of articles in 2021 (n = 103)	% Change from 2020 a
Research	59 (52.7)	49 (47.6)	−9.7
Commentary	11 (9.8)	15 (14.6)	+49.0
Case Study	4 (3.6)	12 (11.7)	+225.0
Public Health Methodology	10 (8.9)	7 (6.8)	−23.6
Brief Report	3 (2.7)	6 (5.8)	+114.8
Public Health Evaluation	5 (4.5)	3 (2.9)	−35.6
From the Schools and Programs of Public Health	3 (2.7)	2 (1.9)	−29.6
Law and the Public’s Health	3 (2.7)	2 (1.9)	−29.6
Surgeon General’s Perspective	2 (1.8)	2 (1.9)	+5.6
Topical or Scoping Review	0	2 (1.9)	— b
Letter to the Editor	4 (3.6)	0	−100.0
Executive Perspective	3 (2.7)	0	−100.0
Reports and Recommendations	2 (1.8)	0	−100.0
Other c	3 (2.7)	3 (2.9)	+7.4

^aChange in the percentage of articles in each category from 2020 to 2021. Data for 2020 are from Kuzmichev et al. ³

^bThere were no articles in this category in 2020.

^cOther articles include In Memoriam, Public Health Reports: 2020 in Review, and Acknowledgment of Reviewers articles.

Table 2.

Journal performance metrics for articles published in volume 136 (January–December 2021) of Public Health Reports (PHR), by performance area

Metric	No. of articles contributing to metric	Mean (range), days	Median (IQR), days	2020 Mean days (% change of mean from 2020 to 2021) a
Time from original submission to final acceptance b	98	241 (77-547)	203 (148-297)	287 (–16.0)
Time from final acceptance to publication online c	102	56 (12-247)	44 (32-74)	46 (+21.7)
Time from original submission to CAPE decision b	98	183 (59-451)	154 (115-217)	NA d
Time from CAPE decision to publication online c	102	113 (25-377)	98 (64-155)	NA d

Abbreviations: CAPE, conditional acceptance pending editing; IQR, interquartile range; NA, not applicable.

^aData for 2020 are from Kuzmichev et al. ³

^bThese data exclude supplements and articles that are not peer reviewed or editor reviewed, such as Surgeon General’s Perspective articles, Executive Perspective articles, and other submissions (eg, In Memoriam, Public Health Reports: 2020 in Review, Acknowledgment of Reviewers). However, these data do include contributions to the departments of Law and the Public’s Health and From the Schools and Programs of Public Health.

^cFor all published bimonthly content, excluding only Acknowledgment of Reviewers.

^dThis metric was not captured in 2020 because the CAPE process was not yet fully implemented in that year. A CAPE decision is issued when an article has been recommended for acceptance by reviewers and PHR editors but still requires technical editing. An article is final accepted after completion of technical editing.

In 2021, PHR completed the transition to a new editing process in which postreview editing is performed before final acceptance (vs after final acceptance, as was done before). This change was formalized by the introduction of the conditional acceptance pending editing (CAPE) decision, which indicates that the article has cleared peer review and is ready for postreview editing. With CAPE, peer review and production times are better captured by such metrics as time from original submission to CAPE and time from CAPE to publication online (vs final accept times in the 2020 analysis). For peer-reviewed volume 136 content (defined previously), time from original submission to CAPE was a mean (range) of 183 (59-451) days and a median (IQR) of 154 (115-217) days. Common barriers for articles in the top percentile for the time to CAPE included associate editor reassignment and difficulty securing reviewers or reviews for original submissions. For articles with the longest times from CAPE to publication, the common pitfalls were delays with author copyright forms and COVID-19–related backlogs in editing, approvals, author responses, and web posting.

One hundred corresponding authors of regular articles in volume 136 (excluding the supplement and the Acknow-ledgment of Reviewers) were from US institutions; 2 were from other countries, including 1 from Canada (University of Toronto) and 1 from Turkey (Ankara University). The 100 US authors were affiliated with academia (n = 61; 61%); HHS (eg, Centers for Disease Control and Prevention [CDC], National Institutes of Health, and Office of the Assistant Secretary for Health; n = 14; 14%); state, local, tribal, and territorial public health departments (n = 9; 9%); the health care sector (n = 11; 11%); nonprofit organizations (n = 4; 4%); and private organizations (n = 1; 1%). An increase in academia and health care authorship in 2021 (compared with 46.7% and 4.7%, respectively, in 2020) and a reduction in HHS and local public health–authored content (26.2% and 15.0%, respectively) is likely the result of the increased dominance of COVID-19 contributions, which tend to feature academic research more prominently than public health agencies’ practice-centered narratives. The COVID-19 response might have also reduced the publishing opportunities of HHS and state and local health department staff members.

Editorial Updates

In 2021, PHR embarked on a series of activities to examine, quantify, and expand its equity practices. We reviewed and improved operational procedures to support a more diverse, equitable, and inclusive peer review process. We increased the number of peer reviewers, adding 595 new reviewers in 2021, a 31.2% increase from 2020, when 451 new reviewers were added, and a 104.4% increase from 2019 (291 new peer reviewers).

We also increased the diversity of topics published in the journal and of PHR’s author base. One example of diversity in topics is the article published in the March/April 2021 issue on food worry in the deaf and hard-of-hearing population during COVID-19. ⁶ This study adds to the small number of articles in public health journals focused on this population. Since its publication, we have received 3 additional submissions addressing this population.

To improve our scientific editing, we adopted updated guidance on the reporting of race and ethnicity from the AMA Manual of Style: A Guide for Authors and Editors ⁷ and developed additional guidance on language concerning health equity, race and ethnicity, and diversity in our manuscripts. We also incorporated in our work several health literacy practices, such as ensuring that plain language is used in all published articles. Finally, we transitioned all our supplements from issue based to rolling online publication (with an opt-out option) to ensure that all PHR content is produced following the same processes.

Important editorial changes in 2021 included the appointment of 9 new editorial committee members. These appointments increased the number and knowledge base and expanded the racial and ethnic, gender, age, and career-stage diversity of the PHR editorial committee. Sadly, Dr. Robert Rinsky, PHR’s former editor in chief (2000-2008), died in 2021. ⁸

Topics of PHR Articles Published in 2021

Thematically, content in volume 136 (102 articles, excluding Acknowledgment of Reviewers but including such special article types as In Memoriam and Public Health Reports: 2020 in Review) can be grouped into 11 public health topics (not mutually exclusive; Table 3). The top 3 most common topics in 2021 were infectious diseases (65 articles), health disparities and the health of racial and ethnic minority populations (45 articles), and chronic health conditions (29 articles). Compared with 2020, these numbers represent a 98.4% increase in the proportion of articles about infectious diseases, a 65.8% increase in the proportion of articles about health disparities, and a 20.7% decrease in the proportion of articles about chronic health conditions. Other notable changes among categories represented by >10 articles in either 2020 or 2021 included an 87.7% increase in the proportion of articles on public health policy and law (from 7.3% to 13.7%) and a 60.9% increase in the share of content on emergency preparedness and response (from 12.8% to 20.6%). These changes likely resulted from the larger number of COVID-19 contributions published in 2021 than in 2020, including on pandemic-related policy issues, such as social distancing regulations and vaccination authority.

Table 3.

Content of volume 136 (January–December 2021) of Public Health Reports (PHR), by topic ^a

Topic	Includes	No. (%) of articles in 2020 (n = 109)b,c	No. (%) of articles in 2021 b (n = 102)	% Change from 2020
Infectious diseases	Influenza, hepatitis, HIV, human papillomavirus, measles, meningococcal disease, mumps, norovirus, herpes simplex virus, tuberculosis, Zika virus disease, COVID-19, sexually transmitted infections, multidrug-resistant organisms, and vaccination	35 (32.1)	65 (63.7)	+98.4
Health disparities and the health of racial and ethnic minority and other socially or economically disadvantaged populations	Disparities among populations by race and ethnicity, age, sex/gender identity minority status, residence in urban versus rural areas, socioeconomic status, and social determinants of health	29 (26.6)	45 (44.1)	+65.8
Chronic health conditions	Diabetes, hypertension, heart disease, cancer, reproductive health, mental health, substance use, tobacco, and smoking cessation	39 (35.8)	29 (28.4)	−20.7
Public health practice	Public health surveillance and other data collection methods; public health program evaluation; statistical methods; and work of state, local, territorial, and tribal public health agencies	22 (20.2)	26 (25.5)	+26.2
Emergency preparedness and response	Response to national and international outbreaks of infectious diseases and natural disasters, risk and emergency communication, outbreak investigation, resilience factors	14 (12.8)	21 (20.6)	+60.9
Public health policy and law	Public health and health care law; federal, state, and local policies and regulations; health impact of policies; legal epidemiology; and policy’s evidence base and effectiveness evaluations	8 (7.3)	14 (13.7)	+87.7
Public health workforce	Training, teaching, and workforce size	8 (7.3)	10 (9.8)	+34.2
Injury and violence prevention	Prevention and control of injury (including due to animal encounters and firearms) and violence (including intimate partner violence, bullying, and sexual harassment and assault)	7 (6.4)	5 (4.9)	−23.4
Public health history	Response to previous pandemics and evolution of public health practices and reporting	1 (0.9)	3 (2.9)	+222.2
Global health	Response to global emerging infectious diseases and natural disasters; diet, health, and public health practice in other countries and their effect on the United States; and the global burden of chronic disease	4 (3.7)	1 (1.0)	−73.0
Environmental health	Climate change and the climate’s health effects	2 (1.8)	0	−100.0

^aTopics were derived inductively from article content as part of the Public Health Reports: 2020 in Review article. ³ Articles analyzed exclude Acknowledgment of Reviewers but include such special article types as In Memoriam and Public Health Reports: 2020 in Review.

^bNumbers might not add up to year’s totals because an article might span >1 topic area.

^cNumbers and percentages for 2020 are from Kuzmichev et al. ³

The increase in the number of articles on health disparities and racial and ethnic minority health represents a welcome development likely reflecting both the authors’ and editors’ increased sensitivity to this timely, nationally visible topic. This increased editor sensitivity, however, is unlikely to have influenced topic-specific acceptance rates: an analysis of 2021 COVID-19 submissions with a final decision date during the same year (n = 546) identified 34 acceptances and 512 rejections, yielding an acceptance rate of 6.6% for COVID-19 content, which is lower than the overall 2021 acceptance rate. In the future, a more detailed analysis of acceptance rates (including at the presubmission and prereview evaluation stage) by various topics could help the journal increase the diversity of its content and authorship. This analysis may be particularly relevant for articles focusing on health disparities and minority health, as such review may identify malleable barriers for certain subject areas and author groups. ⁹

Racism and Health Publications in PHR

In 2021, racism continued to be an important determinant of health and focus of PHR. To better highlight this connection, we performed a systematic search of the journal’s articles focused on racism. As a result, PHR launched a collection of its articles mentioning racism in the abstract or title. ¹⁰ While 5 articles published in PHR in 2021 mentioned “racism” anywhere in the text, using this collection’s criteria, which are similar to those of Hardeman et al ¹¹ and Krieger et al, ⁹ we highlight the 3 articles published in volume 136 that named “racism” in their titles or abstracts.^12-14 Other articles published in PHR in 2021 discussed racism and its health implications,^15,16 but it is critical to highlight the ones that named and centered on racism rather than those that only mentioned it as a discussion point to explain observed patterns. Of 3 such articles, 2 were research and 1 was a systematic review (Table 4). Two focused on “structural racism” (ie, the combination of “historically contingent and persistent ways in which social systems and institutions generate and reinforce inequities in access to power, privilege, and other resources among racial/ethnic groups”)^12,14 and a third on “vicarious racism” (ie, the kind of racism that is “experienced indirectly, by hearing about or seeing racist acts committed against other members of one’s racial group” ¹³ ). These 3 pieces are important because they illustrate different ways to be more explicit and precise in describing racism as a determinant of health, the health effects of racism, and methods to educate public health students about racism.

Table 4.

Articles with the search term “racism” in the abstract or title published in volume 136 (January–December 2021) of Public Health Reports (N = 3)

Author	Title	Article type	Inclusion of “racism” in title, abstract, or both	Type of racism discussed	Contribution to literature	Practice implications
Agénor et al 12	Developing a Database of Structural Racism–Related State Laws for Health Equity Research and Practice in the United States	Research	Both	Structural	The authors identified 843 state laws relating to structural racism in all 50 states and the District of Columbia over time and categorized them into 10 legal domains. Most states have laws related to structural racism despite modest changes in some protective laws.	The authors’ database provides rigorous evidence to assess states’ legal climates and effects on racial and ethnic health inequities.
Chae et al 13	Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans	Research	Both	Vicarious	A cross-sectional study of 604 Asian American and 844 Black American adults found associations between self-reported vicarious racism or vigilance (ie, changed perceptions or behaviors due to the possibility of being discriminated against because of race) and anxiety and depression. Findings suggest vicarious racism among Asian and Black Americans increased during the COVID-19 pandemic.	Implementation of antiracism policies and practices should be included in public health strategies to reduce levels of depression and anxiety among Asian and Black communities, with the aim of improving overall health outcomes, including for COVID-19.
Chandler et al 14	Training Public Health Students in Racial Justice and Health Equity: A Systematic Review	Systematic Review	Abstract	Structural	This review of pedagogical methods and curricula to support the training of US public health students in racial justice and health equity found that, of >6000 articles identified by a screening search strategy, only 11 discussed “teaching, training, and/or capacitating public health students in racial equity,” highlighting “little consensus” and “little rigorous evaluation” of teaching methods and curricula.	Findings underscore the need for future research on public health pedagogy on structural racism.

While the notion that laws and policies are key mechanisms through which structural racism acts is not new, the article by Agénor and colleagues ¹² offers thoughtful details about state laws that are related to structural racism (ie, voting rights laws, stand-your-ground laws, racial profiling laws, mandatory minimum prison sentencing laws, immigrant protections, fair-housing laws, minimum-wage laws, predatory lending laws, laws concerning punishment in schools, and stop-and-identify laws). In their original research, the authors found that most states have laws related to structural racism. ¹² Public health scholars and practitioners often discuss how policies shape opportunities to be healthy and well, yet few offer the detailed data, methods, and examples included in this article. Using a truly interdisciplinary approach, Agénor and colleagues also modeled the ways in which legal and public health scholars can combine their antiracism efforts. Their article highlights the important emerging field of legal epidemiology that includes the systematic tracking of laws and policies as determinants of disease etiology, distribution, and prevention. Legal epidemiology, as applied by Agénor and colleagues, provides important tools for monitoring the dynamic and complex ways that racism-related laws directly and indirectly affect health.

In addition to providing a model for more precisely describing how racism acts as a policy determinant of health, Chae and colleagues ¹³ document in their article the health effects of racism. Concurrent with the COVID-19 pandemic, coverage of anti–Asian American violence and sentiments and the racially motivated murders of Ahmaud Arbery, Breonna Taylor, George Floyd, and Rayshard Brooks were ubiquitous in the media. ¹³ Often, research on the health effects of racism focuses on explicit events of interpersonal discrimination rather than exposure to the type of racism called vicarious racism—this article’s unique contribution to the literature. The mental health effects of such “secondhand racism” (ie, exposure to racism directed at another individual) and the different rates and patterns of effects for Asian American and Black American people are understudied. The article by Chae and colleagues ¹³ is also particularly important to consider during the COVID-19 pandemic because stress can adversely affect the body’s immune response and make people more susceptible to COVID-19, ¹⁵ underscoring the need for implementation of policies and practices to mitigate racism and improve mental health, thereby reducing COVID-19 mortality and improving overall health outcomes.

Despite the volume and complexity of new information about the relationship between racism and health, curricular models that can be replicated, adapted, and scaled to teach public health students about racism are lacking. Chandler and colleagues screened >6000 articles to identify only 11 that discuss curricula, lessons, and competencies for teaching about the relationship between structural racism and health. ¹⁴ Their rigorous systematic review highlighted both the lack of consensus and lack of rigorous evaluation of teaching methods. As the authors noted, the finding that there are so few models for teaching professionals about structural racism 20 years after the American Public Health Association identified racism as a fundamental cause of racial health disparities ¹⁷ is alarming, yet makes their article even more timely and important.

In addition to the collection of articles that explicitly mention racism in the title or abstract, several articles published in 2021 discussed the health harms of racism as a fundamental cause of poor health and health disparities. For example, Griffith and colleagues ¹⁵ root their explanation of the disproportionate mortality that Black men have experienced during the COVID-19 pandemic in structural racism. Structural racism helps to explain why Black men—who already have the shortest life expectancy of any racial or ethnic group of men or women—had the greatest decline in life expectancy of 3.0 years from 2019 to 2020 in the provisional life expectancy estimates published in February 2021.^18,19 Being more precise about the nature of racism that Black men experience (ie, anti-Black gendered structural racism) by integrating syndemics—a framework recognizing that 2 or more epidemics can interact synergistically to exacerbate health consequences—and intersectionality, which maps the intersections of race and gender in ways that disrupt the tendency to see them as separable, into the lens through which we view these patterns facilitates creating more effective programmatic and policy interventions to reduce the disproportionate burden of COVID-19 experienced by Black men.

PHR and the COVID-19 Response

Since the beginning of the COVID-19 pandemic, there has been a need for science to play a key role in guiding programmatic and policy interventions in the United States. PHR continued to respond to the need and opportunity to disseminate impactful science on the COVID-19 pandemic by promoting a call for papers, COVID 19: Challenges, Lessons Learned, and Opportunities for Public Health Practice, that was launched on March 27, 2020. ²⁰ In response, PHR received 1086 original submissions and 656 presubmission inquiries through the end of 2021 (including 632 submissions and 344 inquiries in 2021) and published 73 articles through the end of 2021 (including 53 in 2021, based on the article’s first published online date and excluding corrigenda), a 165% increase from the 20 COVID-19 articles published in 2020 (including 6 in volume 135³).

Several COVID-19 articles published in 2021 were particularly noteworthy. For example, one article analyzed the effectiveness of the 6 most common social distancing policies in the United States during the pandemic’s early phase ²¹ (38 citations and 8965 views and downloads, as assessed on January 6, 2022), an article that reported high levels of COVID-19–related mental health distress among grocery store employees in Arizona ²² (5361 views and downloads), and a legal commentary on adolescent COVID-19 vaccine consent ²³ (1296 views and downloads).

Other important COVID-19 articles published in PHR in 2021 spotlighted the design and privacy protections of CDC datasets of patient-level data on COVID-19 cases ²⁴ ; a pooling-based testing strategy to facilitate in-person schooling ²⁵ ; national testing patterns among lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) populations ²⁶ ; the range of underestimation of COVID-19–associated mortality in Puerto Rico ²⁷ ; infection risks among immigrant essential workers ²⁸ ; adverse health effects associated with increased use of disinfectants during the pandemic ²⁹ ; and disproportionate COVID-19 test positivity among Black and Hispanic/Latino veterans. ³⁰ The full, continuously updated collection of PHR’s articles on COVID-19 is available online in open access. ³¹

Beyond COVID-19, in 2021 PHR published several articles of general public health interest that generated substantial scholarly, public, and media attention. These articles included a commentary, discussed widely on social media, proposing ways out of a funding paradox where government tasks its public health agencies with eliminating health inequities perpetuated by its own policies and practices ³² ; a commentary by the 20th US Surgeon General, Jerome Adams, on the importance of increasing public health efforts to prevent suicide, including among US veterans ³³ ; and a scoping review assessing ways in which employment outcomes of US students earning public health degrees are collected and described in the literature. ³⁴

In 2021, PHR articles were downloaded 703 866 times, a 68.2% increase from 2020. The 3 most downloaded articles from volume 136 included the aforementioned article on COVID-19 social distancing policies ²¹ (8965 views and downloads); a commentary arguing that social determinants of health underlying African Americans’ worse health outcomes, including for COVID-19, are rooted in systemic racism (7529 downloads as of February 3, 2022) ³⁵ ; and an overview of mental health providers’ role and challenges during COVID-19 (2984 downloads as of February 3, 2022). ³⁶

PHR’s historic content received continued media attention in 2021 as the COVID-19 pandemic evolved. A CNN story quoted extensively from an article (published in PHR’s 2010 special issue, “The 1918-1919 Influenza Pandemic in the United States: Lessons Learned and Challenges Exposed,” ³⁷ ) that provided an overview of public safety measures implemented during the 1918 influenza pandemic ³⁸ to illustrate the possibility that supposedly temporary COVID-19 isolation measures can have a lasting adverse social and psychological impact (Figure 2). ³⁹ Another article from the same PHR issue describing the state of microbiologic science and vaccine development in 1918 ⁴⁰ was cited by a New York Times commentary comparing COVID-19 vaccines with current and future vaccines against influenza, including vaccines potentially developed using COVID-19 technology. ⁴¹ It was also cited by a Reuters fact checker disproving misinformation that a US Army meningitis vaccine trial could have caused the 1918 influenza pandemic. ⁴² In his commentary in The Hill, Dr R. Besser, president of the Robert Wood Johnson Foundation, discussed the interconnectedness of economic and physical/mental health in the face of COVID-19 using a 2011 PHR commentary by David Williams and Chiquita Collins on the health harms of racial residential segregation ⁴³ to advocate for continued investment in housing equity. ⁴⁴ A Washington Post article discussing the validity of legal challenges to recent COVID-19 vaccine mandates ⁴⁵ cited PHR’s 2005 legal commentary discussing historic application of state-based police powers to ensure community public health standards. ⁴⁶ An opinion piece in The Conversation, reproduced by several media outlets, discussed whether schools can require COVID-19 vaccination using a 1969 historic review in PHR ⁴⁷ to trace the history of compulsory vaccination in the United States to early 20th century efforts to prevent the spread of smallpox. ⁴⁸ Similarly, PHR’s 2019 article on the history of measles vaccination ⁴⁹ was cited by several opinion pieces, including 2 from CNN^50,51 and 1 from The Daily Beast, ⁵² to argue, in the context of the COVID-19 vaccine mandate discussion, that such vaccine requirements had existed in the United States in the past.

Figure 2.

An image of a trolley car poster used in Cincinnati, Ohio, in 1918, from a 2010 Public Health Reports article overviewing public safety measures implemented during the 1918 influenza pandemic. ³⁸ The photo was reproduced in a 2021 CNN article that discussed the possibility that, similarly to what happened in 1918, the supposedly temporary COVID-19 isolation measures can lead to lasting adverse social and psychological effects; for example, when choosing travel destinations, people might have considerations they may not have contemplated in the past. ³⁹

Two historic PHR articles received new media attention in 2021. An overview of the history of vaccine development and vaccination coverage in the United States (which holds the highest Altmetric score [which reflects the article’s news and social media attention] of any PHR article [2763, representing the top 5% of all research outputs scored by Altmetric and falling within the 99th percentile of outputs of the same age] as of February 7, 2022) ⁵³ was referenced several times in a Stacker timeline of US vaccines and vaccine mandates, ⁵⁴ which was reproduced or cited frequently in 2021 in the media discussing recent COVID-19 vaccination requirements. Another, a 1962 US poliomyelitis surveillance report, ⁵⁵ owes (for the most part) its relatively high Altmetric score (1245, as assessed on February 7, 2022) to its vaccine-caused deaths table being mentioned in a single tweet by Clemens of the Center for Global Development (2859 retweets; 264 quote tweets; 8081 likes as of February 7, 2022) arguing that “breakthrough cases of polio—including deaths—were common during early polio vaccination. What kept us safe was not perfect vaccine efficacy. It was that Americans quickly & massively stepped up to get the imperfect vaccine, quashing transmission.” ⁵⁶

Supplement Published in 2021

In addition to 6 regular issues published during 2021, PHR published a supplemental issue, “The Surveillance of Nonfatal and Fatal Drug Overdoses: Best Practices, Innovations, and Lessons Learned.” ⁵⁷ The supplement was sponsored by the Division of Overdose Prevention in CDC’s National Center for Injury Prevention. It highlighted innovative overdose surveillance activities funded by the center’s Enhanced State Opioid Overdose Surveillance program to provide timely and comprehensive data on nonfatal and fatal opioid overdoses. Its highlights included a case study of implementation of a near–real-time fatal and nonfatal opioid overdose surveillance system using multiple data streams, ⁵⁸ a description of a new approach to improve the timeliness of reporting nonfatal opioid overdoses by supplementing traditional public health surveillance with emergency medical services and syndromic surveillance, ⁵⁹ and a pilot of a drug overdose and substance misuse surveillance system combining real-time reporting of emergency department visits with enhanced toxicology testing and medical record review. ⁶⁰

Future plans for the journal include continuing to emphasize equity in journal practices to improve author and reader experience, increasing its staff and content diversity, increasing the number of supplements published, and performing additional analyses of its historic content to inform current and future public health practice and policy.