The Learning Collaboratory: developing and evaluating public health students' skills while promoting community health.

Introduction: Complex and continuous developments in health and healthcare require innovative changes in programs that educate public health scientists and professionals. Public health change agents need critical competencies to confront today and tomorrow's leading problems including leadership, communication, interprofessional practice, and systems thinking. The context challenges in public health education: Public Health training programs teach competencies through their applied field experience and culminating project, typically late in the program, and often implemented in isolation from peers and faculty. Objectives and skills do not always align closely with community-based program needs. Students pursuing a degree in science in public health need to deeply comprehend multi-dimensional and interconnected systemic problems and communicate with diverse stakeholders across disciplines to produce relevant community-engaged research. The University of Miami Public Health Learning Collaboratory (LC) was established to transform the learning experience of public health master's students by providing opportunities to develop necessary core skills for effective public health practice early in their training, while applying these skills to address real-world public health needs in the community. The Learning Collaboratory structure pedagogical approach and programmatic details: Spanning an average of 3 semesters, the LC promotes student involvement in collaborative and impactful capstone and thesis projects. Practice-based teaching and service learning are central approaches to teaching cross-cutting competencies of leadership, communication, problem solving, collaboration, and systems thinking in public health. Significant to the approach is the engagement of previous cohorts of senior students to teach back to junior students, further integrating concepts learned. Long term alumni feedback recognized strengths of the program, including its structure, teamwork & collaboration, critical thinking & problem solving, guidance, nurture & support, teaching back, and content & curriculum. Community partners agreed the LC prepared students to practice in the field of public health. Discussion: The LC is a promising model for master's level public health education and community application, given the opportunities it provides to strengthen and integrate students' public health skills in a supportive environment, and enhance the transferability and sustainability of student and faculty's community public health work.

Assessing the current and desired levels of training and applied experiences in chronic disease prevention of students during medical school.

INTRODUCTION: Chronic diseases account for approximately 70% of deaths in the U.S. annually. Though physicians are uniquely positioned to provide behavior change counseling for chronic disease prevention, they often lack the necessary training and self-efficacy. This study examined medical student interest in receiving chronic disease prevention training as a formal part of their education as part of an effort to enhance their ability to provide guidance to patients in the future. METHODS: A 23-question, online survey was sent to all undergraduate medical students enrolled in a large medical education program. The survey assessed medical student interest in receiving training related to chronic disease prevention. Survey topics included student awareness of primary prevention programs, perceived importance of receiving training and applied experience in chronic disease prevention, and preferences for how and when to receive this training. RESULTS: Of 793 eligible medical students, 432 completed the survey (54.5%). Overall, 92.4% of students reported receiving formal training in physical activity, public health, nutrition, obesity, smoking cessation, and chronic diseases was of "very high" or "high" importance. Despite this level of importance, students most frequently reported receiving no or 1-5 h of formal training in a number of topics, including physical activity (35.4% and 47.0%, respectively) and nutrition (16.9% and 56.3%, respectively). The level of importance given to public health training was significantly greater across degree type (p = 0.0001) and future specialty (p = 0.03) for MD/MPH students and those interested in primary care, respectively. CONCLUSIONS: While medical students perceive chronic disease prevention as an important topic, most reported receiving little to no formal training. To address the growing prevalence of chronic disease across our society, programs schools should place greater emphasis on integrating training in physical activity, nutrition, and obesity-related content into the medical education curriculum.

Columbia University Master of Public Health Core Curriculum: Implementation, Student Experience, and Learning Outcomes, 2013-2018.

OBJECTIVES: Public health education must respond to 21st-century public health challenges in an ever-evolving landscape. We describe implementation and educational outcomes of the Columbia University Master of Public Health (MPH) Core (hereinafter, Core) curriculum since its inception. METHODS: This retrospective evaluation combined 6 years (2013-2018) of student survey data collected from students (N = 1902) on the structure and delivery of the Core curriculum to quantify implementation, student experience, and learning outcomes, both during study (Core Evaluation Survey [CES]) and after graduation (Graduate Exit Survey [GES]). We used χ2 tests and analysis of variance to compare outcomes across years, and we used McNemar tests to compare differences in outcomes from the same students at different time points. RESULTS: Of 1902 respondents to the CES, 1795 (94.4%) completed the Core curriculum. During the study period, 81.7% of students were able to integrate concepts across Core curriculum modules with ease; postgraduation, a similar proportion of respondents were able to apply Core curriculum content to departmental and certificate coursework and applied field experiences. On-time graduation rates were high (range, 85%-93%). CONCLUSIONS: The high percentage of students who reported their ability to integrate concepts and who completed the Core during the study period likely reflected changes to teaching team structures, training, attention to inclusion and equity, and collaboration to implement active learning strategies. The Core curriculum meets its intended goals by providing critical learning abilities to support ongoing interdisciplinary work.

The New Public Health Workforce: Employment Outcomes of Public Health Graduate Students.

CONTEXT: Much has been written about the public health workforce, but very little research has been published-and none in a peer-reviewed journal or other report since 1992-regarding the employment outcomes and employment sectors of graduate students pursuing public health as an area of study. OBJECTIVES: Our objectives were to review the literature and analyze data regarding the employment outcomes of public health graduate students and to examine how public health schools and programs might respond to changes in the sectors hiring their graduates. DESIGN: We reviewed the literature regarding the employment of public health graduates; analyzed 5 years of graduate outcomes from Columbia University's Mailman School of Public Health using logistic regression; and we examined data collected by the Association of Schools & Programs of Public Health. PARTICIPANTS: The study included data from surveys of 2904 graduates of Columbia University's Mailman School of Public Health, across 5 graduating cohort years, for whom there were employment sector data available for 1932. RESULTS: Much of the research on the public health workforce has defined it as governmental public health. Across each of 5 graduating classes from Columbia University's Mailman School of Public Health, the odds of for-profit sector employment increased by 23% (2012-2016), while hiring by government agencies declined or remained flat. Publicly available employment data from the Web sites of schools of public health and from surveys by the Association of Schools & Programs of Public Health show that hiring of new graduates by for-profit corporations now either closely matches or exceeds governmental hiring at many schools of public health. CONCLUSIONS: Public health graduates are increasingly working outside of government, and additional analyses are required to determine whether core competencies of public health curricula reflect the needs of the employers that are hiring public health graduates today. Schools and programs of public health should invest in their career services offices and gather input from employers that are currently hiring their graduates, especially as the sectors hiring them may be changing.

The Future of Careers at the Intersection of Climate Change and Public Health: What Can Job Postings and an Employer Survey Tell Us?

Climate change is acknowledged to be a major risk to public health. Skills and competencies related to climate change are becoming a part of the curriculum at schools of public health and are now a competency required by schools in Europe and Australia. However, it is unclear whether graduates of public health programs focusing on climate change are in demand in the current job market. The authors analyzed current job postings, 16 years worth of job postings on a public health job board, and survey responses from prospective employers. The current job market appears small but there is evidence from job postings that it may be growing, and 91.7% of survey respondents believe the need for public health professionals with training in climate change may grow in the next 5-10 years. Current employers value skills/competencies such as the knowledge of climate mitigation/adaptation, climate-health justice, direct/indirect and downstream effects of climate on health, health impact assessment, risk assessment, pollution-health consequences and causes, Geographic Information System (GIS) mapping, communication/writing, finance/economics, policy analysis, systems thinking, and interdisciplinary understanding. Ensuring that competencies align with current and future needs is a key aspect of curriculum development. At the same time, we recognize that while we attempt to predict future workforce needs with historical data or surveys, the disruptive reality created by climate change cannot be modeled from prior trends, and we must therefore adopt new paradigms of education for the emerging future.

Health Information Seeking and Cancer Screening Adherence Rates.

Effective screening tools are available for many of the top cancer killers in the USA. Searching for health information has previously been found to be associated with adhering to cancer screening guidelines, but Internet information seeking has not been examined separately. The current study examines the relationship between health and cancer Internet information seeking and adherence to cancer screening guidelines for breast, cervical, and colorectal cancer in a large nationally representative dataset. The current study was conducted using data from the Health Information National Trends Survey from 2003 and 2007. The study examined age-stratified models which correlated health and cancer information seeking with getting breast, cervical, and colorectal cancer screening on schedule, while controlling for several key variables. Internet health and cancer information seeking was positively associated with getting Pap screening on schedule, while information seeking from any sources was positively associated with getting colorectal screening on schedule. People who look for health or cancer information are more likely to get screened on schedule. Some groups of people, however, do not exhibit this relationship and, thus, may be more vulnerable to under-screening. These groups may benefit more from targeted interventions that attempt to engage people in their health care more actively.

A Wellness Program for Cancer Survivors and Caregivers: Developing an Integrative Pilot Program with Exercise, Nutrition, and Complementary Medicine.

The Integrative Wellness Program (IWP) at the University of Miami Sylvester Comprehensive Cancer Center (SCCC) sought to provide integrative wellness education to cancer patients, survivors, and caregivers by offering instruction in exercise, nutrition, and complementary and alternative medicine. The objective of this study was to assess the impact of the IWP on the overall wellness of the individuals participating in the program. Three different 10-week versions of the IWP were conducted over a 1-year period. Each session focused on a different wellness topic presented through interactive lectures and applied activities. A series of self-report questionnaires were administered at baseline and again at the completion of the program to assess improvements in physical activity levels, dietary habits, sleep hygiene, and quality of life. Participants were generally older, Caucasian, female, had higher levels of education, and still currently receiving treatment. Significant changes were observed in two measures: Starting the Conversation (-2.0 ± 2.40, p = .037) and the Sticking To It subscale of the Self-Efficacy and Eating Habits Survey (1.7 ± 1.22, p = .0013). A trend for improvement in the Reducing Fat subscale of the Self-Efficacy Eating Habits (0.44 ± 0.60, p = .056) was also observed. Participant satisfaction surveys indicated high levels of satisfaction and applicability of the material presented. The significant improvements detected related to dietary habits, combined with the responses from the participant satisfaction surveys, suggest that the IWP was well received and can positively impact the overall wellness of cancer patients, survivors, and their caregivers.

Characterizing the Business Skills of the Public Health Workforce: Practical Implications From the Public Health Workforce Interests and Needs Survey (PH WINS).

CONTEXT: Public health financial competencies are often overlooked or underrepresented in public health training programs. These skills are important for public health workforce members who are involved in managing resources and strategic planning and have been defined as key competencies by several national entities. OBJECTIVE: To characterize business skills among state health agency employees and examine self-reported skill levels and their association with job satisfaction, worksite training and development opportunities, and annual salary. DESIGN: A cross-sectional survey, the Public Health Workforce Interests and Needs Survey (PH WINS), of state health agency central office employees was conducted in 2014. Multivariable logistic regression analyses, controlling for job classification, supervisory status, years of public health practice, annual compensation, educational attainment, geographic region, and sociodemographic status, were used to assess the relationship between business skills and training environment and job satisfaction. Linear regression was used to correlate business skills and annual compensation. SETTING AND PARTICIPANTS: A total of 10,246 state health agency staff completed a Web-based survey. MAIN OUTCOME MEASURE: Self-reported proficiency in business skills, job satisfaction, opportunities for training, and annual salary. RESULTS: The workforce reported high levels of proficiency in applying quality improvement concepts and managing change (67.5% and 69.2%, respectively). Half of the respondents reported proficiency in budget skills (49.3%). Participants who were proficient in applying quality improvement concepts were significantly more likely to report job satisfaction (OR = 1.27). A supportive training environment was significantly associated with business competencies (range of OR = 1.08-1.11). Managing change (ß = .15) and budget skill proficiency (ß = .37) were significantly associated with increased yearly compensation. CONCLUSIONS: Public health workers who self-report proficiency with business skills report increased job satisfaction, higher annual salary, and a supportive training environment. These findings support the need for the development of appropriately designed business skill training opportunities to increase competencies in this critical domain.

The Perceived Consequences of Gold Mining in Postwar El Salvador: A Qualitative Study.

OBJECTIVES: We investigated themes related to the health and environmental impacts of gold mining in El Salvador. METHODS: Over a 1-month period in 2013, we conducted focus groups (n = 32 participants in total) and individual semistructured interviews (n = 11) with community leaders until we achieved thematic saturation. Data collection took place in 4 departments throughout the country. We used a combination of criterion-purposive and snowballing sampling techniques to identify participants. RESULTS: Multiple themes emerged: (1) the fallacy of economic development; (2) critique of mining activities; (3) the creation of mining-related violence, with parallels to El Salvador's civil war; and (4) solutions and alternatives to mining activity. Solutions involved the creation of cooperative microenterprises for sustainable economic growth, political empowerment within communities, and development of local participatory democracies. CONCLUSIONS: Gold mining in El Salvador is perceived as a significant environmental and public health threat. Local solutions may be applicable broadly.

HPV knowledge and vaccine acceptability among Hispanic fathers.

The purpose of this study was to examine human papillomavirus (HPV) knowledge and vaccine acceptability in a convenience sample of immigrant Hispanic men, many of whom are parents of adolescents. Data on 189 male callers were collected from the National Cancer Institute's Cancer Information Service Spanish-language call center. Most participants were willing to vaccinate their adolescent son (87.5%) or daughter (78.8%) against HPV. However, among this sample, awareness of HPV was low and knowledge of key risk factors varied. These findings can help guide the development of culturally informed educational efforts aimed at increasing informed decision-making about HPV vaccination among Hispanic fathers.

Nodding syndrome in northern Uganda: overview and community perspectives.

The increasing prevalence of nodding syndrome in northern Uganda has generated a wide range of speculations with respect to etiology and natural history of and best possible medical treatment for this mysterious seizure disorder. Despite in-depth investigations by the United States Centers for Disease Control and Prevention and the Ministry of Health in Uganda, no clear causal factors have emerged. At the same time, northern Uganda communities are voicing concern for their lack of knowledge about nodding syndrome. The purpose of this commentary is to summarize northern Uganda community perceptions of this syndrome. These reflections demonstrate the need for larger investigations into the impact of nodding syndrome and other seizure disorders on local communities both in northern Uganda and throughout the world, in particular rural areas of resource poor countries.

Socioeconomic and geographic disparities in health information seeking and Internet use in Puerto Rico.

BACKGROUND: Geographically isolated Hispanic populations, such as those living in Puerto Rico, may face unique barriers to health information access. However, little is known about health information access and health information-seeking behaviors of this population. OBJECTIVE: To examine differences in health and cancer information seeking among survey respondents who ever used the Internet and those who did not, and to explore sociodemographic and geographic trends. METHODS: Data for our analyses were from a special implementation of the Health Information National Trends Survey conducted in Puerto Rico in 2009. We collected data through random digit dialing, computer-assisted telephone interviews (N = 639). The sample was drawn from the eight geographic regions of the Puerto Rico Department of Health. To account for complex survey design and perform weighted analyses to obtain population estimates, we analyzed the data using SUDAAN. Frequencies, cross-tabulation with chi-square, and logistic regression analyses were conducted. Geographic information system maps were developed to examine geographic distributions of Internet use and information seeking. RESULTS: Of 639 participants, 142 (weighted percentage 32.7%) indicated that they had ever gone online to access the Internet or World Wide Web; this proportion was substantially lower than that of US mainland Hispanics who reported using the Internet (49%). While 101 of 142 (weighted percentage 59.6%) respondents who used the Web had ever sought health information, only 118 of 497 (weighted percentage 20.0%) of those who did not use the Web had sought health information. The pattern was similar for cancer information: 76 of 142 respondents (weighted percentage 47.2%) who used the Web had ever sought cancer information compared with 105 of 497 (weighted percentage 18.8%) of those who had not used the Web. These results were slightly lower but generally consistent with US mainland Hispanics' health (50.9%) and cancer (26.4%) information seeking. Results of separate logistic regression models controlling for sociodemographic characteristics demonstrated that, compared with individuals who did not seek health or cancer information, those who did were over 5 times as likely to have used the Internet (odds ratio 5.11, P < .001). Those who sought cancer information were over twice as likely to have used the Internet (odds ratio 2.5, P < .05). The frequency of Internet use and health and cancer information seeking was higher in the San Juan metro region than in more rural areas. CONCLUSIONS: Our results contribute to the evidence base for health and cancer communication planning for Puerto Rico, and suggest that health education and outreach efforts should explore the use of available and trusted methods of dissemination such as radio and television, as well as community-based health care providers and organizations, to supplement and encourage use of the Internet as a source of health information.

Discussions of cancer clinical trials with the National Cancer Institute's Cancer Information Service.

Clinical trials are essential for the development of new and effective treatments for cancer; however, participation rates are low. One reason for this is lack of knowledge about clinical trials. This study assessed how often clinical trials are discussed on calls to National Cancer Institute's Cancer Information Service (CIS). The authors quantitatively analyzed 283,094 calls to the CIS (1-800-4-CANCER) over 3 years (2006-2008). They calculated descriptive statistics and multivariate regressions to determine whether specific caller characteristics are associated with the presence of a clinical trials discussion. In addition, 2 focus groups were conducted with CIS information specialists (n=12) to provide insight into the findings. The authors found that approximately 9.3% of CIS calls discussed clinical trials, with higher percentages for patients (12.5%) and family members (15.4%). Calls with Hispanics, Blacks, and Spanish speakers were less likely to include a conversation. For all cancers, patients who are in treatment or experiencing a recurrence were statistically significantly more likely to discuss clinical trials. CIS information specialists reported callers' limited knowledge of clinical trials. The CIS has the unique ability to make a substantial effect in educating patients about clinical trials as an option in cancer treatment and care.

Rural-urban differences in discussions of cancer treatment clinical trials.

OBJECTIVE: Compare the characteristics of rural and urban callers to NCI's Cancer Information Service (CIS), and explore the association of geographic location and discussion of cancer clinical trials. METHODS: Using CIS call data from 2006 to 2008, we assigned a rural or urban designation to caller ZIP codes using Rural-Urban Commuting Area Codes. Calls which discussed clinical trials were analyzed using univariate and multivariate analyses. RESULTS: The CIS received 227,579 calls from 2006 to 2008 where geographic location could be determined. Overall, 10.3% of calls included a discussion of clinical trials; there were significantly more discussions among urban dwellers than rural individuals (10.5% versus 9.4%, respectively). Multivariate regression analyses supported the univariate findings. In addition, compared to other callers, patients (OR 5.58 [95% CI: 4.88, 6.39]) and family and friends (6.26 [5.48, 71.5]) were significantly more likely to discuss clinical trials. CONCLUSION: Urban callers were more likely than their rural counterparts to discuss cancer treatment trials, placing individuals living in rural areas at a disadvantage in learning about and communicating with their providers about possible participation in clinical trials. PRACTICE IMPLICATIONS: Through its multiple access points, the CIS can serve as an important source of clinical trials information for rural cancer patients, family members, and providers.

Patient-centered communication in cancer care: the role of the NCI's Cancer Information Service.

While patient-centered care and the reduction of suffering due to cancer are primary goals of the NCI, improvement in the delivery of patient-centered communication has been identified as a key NCI research priority. As research on patient-centered communication evolves, the potential contributions of programs such as the National Cancer Institute's (NCI) Cancer Information Service (CIS) cannot be overlooked. The purpose of this paper is to describe how the six core functions of patient-clinician communication described in the literature (fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions and enabling patient-self management) are embedded in the work of the CIS. The communication process used by the CIS to extend the patient-centered communication role of the clinician will be discussed. CIS training and quality management systems will be described. Lastly, suggestions for the role of CIS in future health information delivery and research will be explored.

The Cancer Information Service: using CBPR in building community capacity.

The National Cancer Institute's (NCIs) Cancer Information Service (CIS) Partnership Program followed many of the key principles of community-based participatory research in providing technical assistance to partner organizations. Using five case studies, this article describes how the CIS Partnership Program served to identify community needs and leaders, bringing resources together to build capacity and increase knowledge, and facilitate further dissemination of findings. CIS Partnership Program staff transcended the traditional health education role by building the capacity of community partners to bring cancer information in culturally appropriate ways to their own communities. The lessons learned by the CIS Partnership Program are useful for both academics and service organizations that would benefit from working with medically underserved communities.

Knowledge of HPV among United States Hispanic women: opportunities and challenges for cancer prevention.

In the United States, Hispanic women contribute disproportionately to cervical cancer incidence and mortality. This disparity, which primarily reflects lack of access to, and underutilization of, routine Pap smear screening may improve with increased availability of vaccines to prevent Human Papillomavirus (HPV) infection, the principal cause of cervical cancer. However, limited research has explored known determinants of HPV vaccine acceptability among Hispanic women. The current study examines two such determinants, HPV awareness and knowledge, using data from the 2007 Health Interview National Trends Survey (HINTS) and a cross-section of callers to the National Cancer Institute's (NCI) Cancer Information Service (CIS). Study data indicate that HPV awareness was high in both samples (69.5% and 63.8% had heard of the virus) but that knowledge of the virus and its association with cervical cancer varied between the two groups of women. The CIS sample, which was more impoverished and less acculturated than their HINTS counterparts, were less able to correctly identify that HPV causes cervical cancer (67.1% vs. 78.7%) and that it is a prevalent sexually transmitted infection (STI; 66.8% vs. 70.4%). Such findings imply that future research may benefit from disaggregating data collected with Hispanics to reflect important heterogeneity in this population subgroup's ancestries, levels of income, educational attainment, and acculturation. Failing to do so may preclude opportunity to understand, as well as to attenuate, cancer disparity.

Health and cancer information seeking practices and preferences in Puerto Rico: creating an evidence base for cancer communication efforts.

Effective communication around cancer control requires understanding of population information seeking practices and their cancer-relevant risk behaviors, attitudes, and knowledge. The Health Information National Trends Survey (HINTS) developed by the U.S. National Cancer Institute (NCI) provides surveillance of the nation's investment in cancer communication tracking the effects of the changing communication environment on cancer-related knowledge, attitudes, and behaviors. The University of Puerto Rico Comprehensive Cancer Center (UPRCCC), the Puerto Rico Behavioral Risk Factors Surveillance System (PRBRFSS), and the NCI implemented HINTS in Puerto Rico in 2009. In this article we describe the health and cancer information seeking behaviors, sources of information, trust in information sources, and experiences seeking information among the population of Puerto Rico. A total of 639 (603 complete and 36 partially complete) interviews were conducted. Nearly one-third of respondents had ever looked for information about health (32.9%) or about cancer (28.1%). The Internet was the most frequently reported source of information. College educated (odds ratio [OR] = 7.6) and females (OR = 2.8) were more likely to seek health information. Similarly, college educated (OR = 5.4) and females (OR = 2.0) were more likely to seek cancer information. Only 32.7% of respondents had ever accessed the Internet, and college educated were more likely to use it (OR = 12.2). Results provide insights into the health and cancer information seeking behaviors and experiences of the population in Puerto Rico and contribute to the evidence base for cancer control planning on the island.

One size does not fit all: differences in HPV knowledge between Haitian and African American women.

BACKGROUND: Historically, all black persons, regardless of ancestry or country of origin, have been categorized as one group for cancer research and control efforts. This practice likely masks variability in exposure to determinants of disease, as well as in risk of cancer incidence and mortality. The current study examines potential differences in knowledge of human papilloma virus (HPV) between Haitian women living in Little Haiti, Miami, Florida, and a national sample of predominately African American women. METHODS: Data for Haitian women were collected in 2007 as part of an ongoing community-based participatory research initiative in Little Haiti. For purposes of comparison, we used data from a largely African American subsample of the 2007 Health Information National Trends Survey (HINTS). These data sources used identical items to assess HPV knowledge, providing a unique opportunity to examine how this outcome may vary between two very distinct populations who are often grouped together for research and disease surveillance. RESULTS: Relative to the HINTS sample, Haitian women were far less likely to have heard about HPV. CONCLUSIONS: Study data highlight important differences in Haitian and African American women's knowledge of HPV, a known determinant of cervical cancer risk. Such findings suggest that continuing to classify persons of similar phenotype but different cultural backgrounds and lifetime exposures as one group may preclude opportunity to understand, as well as attenuate, health disparity.

Cancer information-seeking experiences: the implications of Hispanic ethnicity and Spanish language.

BACKGROUND: Strategies to support cancer information-seeking among Hispanics are needed. METHODS: We analyzed data from the 2005 Health Information National Trends Survey (HINTS) to explore cancer information-seeking experiences among respondents according to ethnicity and language of interview. RESULTS: Over 80% of Spanish-speaking Hispanics had never looked for cancer information. Compared to English-speaking respondents, Spanish-speaking Hispanics who sought cancer information indicated their search took a lot of effort (67%), was hard to understand (54%), and frustrating (42%). Spanish-speaking Hispanics noted minimal confidence in obtaining cancer information. CONCLUSIONS: Language and cultural differences must be considered in the design, implementation, and dissemination of cancer information.