The U.S. has the highest number of coronavirus disease (COVID-19) cases and deaths of any nation. Deaths due to COVID-19, especially among older adults and people of color, have created an urgency for advanced care planning (ACP). Despite benefits of ACP, only one-third of U.S. adults have completed advance directives, in part due to a lack of death education. We recommend four actions to increase death education and ACP completion: (1) integrate death education into teacher preparation programs, (2) incorporate death education in undergraduate curricula, (3) provide better education in death and dying to future health professionals, and (4) educate the public. Community transmission of the coronavirus disease (COVID-19) was first reported in the United States in February 2020 (Centers for Disease Control and Prevention (CDC), 2020a). As of August 2020, the United States has nearly doubled the number of cases and the highest number of deaths compared to any other nation in the world (Johns Hopkins University and Medicine, 2020a). The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system, has reported hospitalization and mortality rates based on data collected since March 1, 2020 (Centers for Disease Control and Prevention (CDC), 2020b). According to this network, as of August 15, 2020, the overall cumulative hospitalization rate in the U.S. was 151.7 per 100,000 (Centers for Disease Control and Prevention (CDC), 2020b). The rate of hospitalization was highest among adults aged 65 (412.9 per 100,000), followed by adults aged 50-64 years (228.1 per 100,000; Centers for Disease Control and Prevention (CDC), 2020b). Hospitalizations and deaths due to COVID-19 have disproportionately affected populations of color (Centers for Disease Control and Prevention (CDC), 2020b; Moore et al., 2020). Non-Hispanic American Indians or Alaska Natives have COVID-19 hospitalization rates more than five times greater than non-Hispanic Whites; rates among Hispanics or Latinos and non-Hispanic Blacks are just under five times greater than non-Hispanic Whites (Centers for Disease Control and Prevention (CDC), 2020b). Although Blacks (13%) and Hispanics (18%) make up a smaller segment of the U.S. population than non-Hispanic Whites (60%), they have experienced nearly 30 and 40% of COVID-19-related deaths, respectively, compared to non-Hispanic Whites at more than 20% when adjusting for age (Centers for Disease Control and Prevention (CDC), 2020c). Spikes of new infections, hospitalizations, and deaths are expected in the future, with predictions that the pandemic will continue into 2022 (Center of Infectious Disease Research and Policy [CIDRAP], 2020; Kissler et al., 2020). As the population of the U.S. awaits a vaccination or herd immunity, three outcomes are certain to occur in the near future: more adults will be infected, more will be hospitalized, and more will die from COVID-19 (Johns Hopkins University and Medicine, 2020b).

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Objectives: Little is known about the health-risk behaviors of funeral directors. We undertook a study to examine their health behavior risks by assessing perceived health behaviors. Methods: The study was a cross-sectional, descriptive study of a sample of funeral directors in the US as of September 2018. We used online survey software to disseminate a multi-wave survey to funeral directors. Results: Overall, we received 132 completed surveys (16.5% response rate). Overall, funeral directors rated themselves as healthy, but 61% reported that their mental health was not good in the previous 30 days due to stress, depression, or problems with emotions. We found that 23% reported that their poor physical or mental health keep them from doing their daily activities such as self-care, work, or recreation in the last 30 days. Other behaviors such as screenings, weight management, stress management, and substance use were found to be concerns in this population. Conclusions: Public health efforts should focus on health promotion programming with an emphasis on improving the overall health and well-being of funeral directors in the US.

Background: End-of-life care is a required and important component of medical training for internal medicine residents; many of whom will go on to provide care for adults at the end-of-life stage. Although a body of past research suggests that physician training in end-of-life care needs significant improvement, a comprehensive national study of end-of-life education within US internal medicine residency programs has never been published.Objective: To determine the status of end-of-life education in internal medicine residency programs in the United States. Method:The study was a cross-sectional, observational study of all internal medicine Residency Program Directors in the US as of May 2015. Postal mail and email were used to disseminate a multi-wave survey to program directors.Results: More than half (52%) of all program directors completed the survey. Although directors strongly believed in the benefits of residents integrating end-of-life care components into clinical practice, only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Of those programs that taught endof-life topics or skills, the majority did not formally evaluate residents' competence. Moreover, 24% of residency programs did not have an end-of-life curriculum; 34% did not offer a rotation in hospice care; and 31% did not have structured conference teaching on topics dealing with end-of-life. Conclusions:Although end-of-life training of physicians has improved over the years, deficiencies remain within US internal medicine residency programs.