Development and Evaluation of the Ally Sexual and Gender Minority Diversity and Inclusion Training at the Centers for Disease Control and Prevention.

CONTEXT: The Centers for Disease Control and Prevention (CDC) developed a workforce training on sexual and gender minorities (SGMs). OBJECTIVE: This article describes the evaluation of the training. DESIGN: Participants completed pre- and posttest surveys. After the pilot evaluation, some improvements were made to the curriculum and to the pre- and posttest questionnaires. Participants in subsequent (implementation) training were similarly asked to complete pre- and posttest questionnaires. SETTING: CDC. PARTICIPANTS: CDC staff. MAIN OUTCOME MEASURES: Participants' knowledge, ally identity, and perceptions of SGMs. RESULTS: Pilot and implementation training data showed increases in participant knowledge of 44% and 49%, respectively, increases in ally identity of 11% and 14%, respectively, and increases in positive perceptions of SGM of 25% and 31%, respectively. CONCLUSION: These results suggest that the CDC Ally Training may be a useful tool for improving staff knowledge and perceptions of SGM people.

Factors Affecting Implementation of Evidence-Based Practices in Public Health Preparedness and Response.

CONTEXT: There is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur. OBJECTIVE: This study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation. DESIGN: A Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed. SETTING: State, local, and territorial public health agencies across the United States. PARTICIPANTS: Preparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs). RESULTS: Respondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation. CONCLUSIONS: Findings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.

Enhancing community preparedness: an inventory and analysis of disaster citizen science activities.

BACKGROUND: Disaster citizen science, or the use of scientific principles and methods by "non-professional" scientists or volunteers, may be a promising way to enhance public health emergency preparedness (PHEP) and build community resilience. However, little research has focused on understanding this emerging field and its implications for PHEP. To address research gaps, this paper: (1) assesses the state of disaster citizen science by developing an inventory of disaster citizen science projects; (2) identifies different models of disaster citizen science; and (3) assesses their relevance for PHEP. METHODS: We searched the English-language peer-reviewed and grey literature for disaster citizen science projects with no time period specified. Following searches, a team of three reviewers applied inclusion/exclusion criteria that defined eligible disasters and citizen science activities. Reviewers extracted the following elements from each project: project name and description; lead and partner entities; geographic setting; start and end dates; type of disaster; disaster phase; citizen science model; and technologies used. RESULTS: A final set of 209 projects, covering the time period 1953-2017, were included in the inventory. Projects were classified across five citizen science models: distributed or volunteer sensing (n = 19; 9%); contributory (n = 98; 47%); distributed intelligence (n = 52; 25%); collaborative research (n = 32; 15%); and collegial research (n = 8; 4%). Overall, projects were conducted across all disaster phases and most frequently for earthquakes, floods, and hurricanes. Although activities occurred globally, 40% of projects were set in the U.S. Academic, government, technology, and advocacy organizations were the most prevalent lead entities. Although a range of technologies were used, 77% of projects (n = 161) required an internet-connected device. These characteristics varied across citizen science models revealing important implications for applications of disaster citizen science, enhancement of disaster response capabilities, and sustainability of activities over time. CONCLUSIONS: By increasing engagement in research, disaster citizen science may empower communities to take collective action, improve system response capabilities, and generate relevant data to mitigate adverse health impacts. The project inventory established a baseline for future research to capitalize on opportunities, address limitations, and help disaster citizen science achieve its potential.

Science as the Basis of Public Health Emergency Preparedness and Response Practice: The Slow but Crucial Evolution.

We discuss challenges to implementing evidence-based practice within the broad field of public health preparedness and response. We discuss the progress of public health preparedness and response in building and translating evidence to practice since the World Trade Center attacks of 9/11/2001. We briefly describe analogies to struggles that other professional disciplines face, and we highlight key factors that facilitate and impede the implementation of evidence-based practice. We recommend a partnership led by funding agencies and closely involving research organizations and professional associations as a means to ensure that the public health preparedness and response field continues to develop an evidence-based culture and practice.

"Why Even Bother; They Are Not Going to Do It?" The Structural Roots of Racism and Discrimination in Lactation Care.

Through semi-structured interviews with 36 International Board Certified Lactation Consultants (IBCLCs) who assist mothers with breastfeeding, this study takes a systematic look at breastfeeding disparities. Specifically, this study documents race-based discrimination against patients in the course of lactation care and links the implicit bias literature to breastfeeding disparities. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient's backs. This study connects patient discrimination in lactation to institutional inequality and offers suggestions to address these inequities.

"You Know if You Quit, That's Failure, Right?": Barriers to Professional Lactation Certification.

BACKGROUND: Researchers have confirmed that breastfeeding disparities persist and that International Board Certified Lactation Consultants (IBCLCs) play a key role in reducing them. However, there continues to be a limited availability of IBCLCs throughout the United States, with racial minorities facing persistent barriers during the certification process. Research aim: Using a critical race theory framework, the aim was to describe the barriers and supports that IBCLCs experience during the course of their certification. METHODS: This study used a prospective, cross-sectional, qualitative design with semistructured interviews with IBCLCs ( N = 36) from across the United States. Interviews were audio-recorded and professionally transcribed. Results were analyzed using an in-depth thematic analysis from the perspective of critical race theory. RESULTS: Women made up the majority ( n = 35; 97.22%) of the sample. People of color made up slightly less than half of the sample ( n = 16; 44.44%). Barriers were initially coded by the stages of the certification process. Existing healthcare providers experienced advantages in the certification process because of their connection to social networks and resources in their hospital or place of employment. Cost and racial discrimination were identified, using a structural racism lens, as primary barriers for certification. Race-related barriers were particularly pervasive and were detailed by each stage of the certification process. CONCLUSION: Lactation organizations and care providers need to consider ways to mitigate these perceived differences in support and infrastructure. These changes could help to ensure equity in the profession and may reduce racial discrimination in lactation care.