The Critical Value of Maternal and Child Health (MCH) to Graduate Training in Public Health: A Framework to Guide Education, Research and Practice.

INTRODUCTION: In light of persistent health inequities, this commentary describes the critical role of maternal and child health (MCH) graduate training in schools and programs of public health (SPPH) and illustrates linkages between key components of MCH pedagogy and practice to 2021 CEPH competencies. METHODS: In 2018, a small working group of faculty from the HRSA/MCHB-funded Centers of Excellence (COEs) was convened to define the unique contributions of MCH to SPPH and to develop a framework using an iterative and consensus-driven process. The working group met 5 times and feedback was integrated from the broader faculty across the 13 COEs. The framework was further revised based on input from the MCHB/HRSA-funded MCH Public Health Catalyst Programs and was presented to senior MCHB leaders in October 2019. RESULTS: We developed a framework that underscores the critical value of MCH to graduate training in public health and the alignment of core MCH training components with CEPH competencies, which are required of all SPPH for accreditation. This framework illustrates MCH contributions in education, research and evaluation, and practice, and underscores their collective foundation in the life course approach. CONCLUSIONS: This new framework aims to enhance training for the next generation of public health leaders. It is intended to guide new, emerging, and expanding SPPH that may currently offer little or no MCH content. The framework invites further iteration, adaptation and customization to the range of diverse and emerging public health programs across the nation.

Associations between Cigarette Smoking and Health-Related Quality of Life in Adult Survivors of Adolescent and Young Adult Cancer.

This cross-sectional, secondary data analysis examines the association between cigarette smoking and self-reported health-related quality of life (HRQoL) in adult survivors of Adolescent and Young Adult Cancer. Pooled data for survivors of Adolescent and Young Adult Cancer (N = 1495) were drawn from the 2016 and 2017 Behavioral Risk Factor Surveillance Survey. Binary logistic regression models were utilized to examine independent associations between each of the four HRQoL domains (i.e., self-related general health, activity limitation days, poor physical, and mental health days) and cigarette smoking. Of the 1495 Adolescent and Young Adult Onset Cancer Survivors (AYAO-CS) in this study, approximately 30% reported currently smoking cigarettes. Relative to never smokers, the odds of reporting fair/poor general health were significantly higher for current and former smokers: (OR = 3.95, 95% CI: 2.08-7.50) and (OR = 2.51, 95% CI: 1.46-4.32), respectively. Likewise, current smokers were significantly more likely to report frequent days of poor physical health (OR = 2.79, 95% CI: 1.38-5.65). The study findings suggest a significant cross-sectional association between cigarette smoking and poor health-related quality of life in adult survivors of adolescent and young adult cancer. These findings, although cross-sectional, underscore the need for prospective studies to examine the longitudinal association between HRQoL and cigarette smoking among cancer survivors. Findings also help establish both the need for smoking cessation programs and the importance of effective strategies for addressing HRQoL issues among cancer survivors.

Coping with Community Violence: Perspectives of African American Young Adult Men and Hispanic/Latino Young Adult Men.

Further study is needed regarding the intersection of community violence exposure, coping strategies, and health behaviors among young adult African American men and Hispanic/Latino men. This study did so in Lake County, Indiana, which contains multiple areas with disproportionate prevalence of violence relative to population size. Approximately 22 miles from Chicago, Lake County includes noteworthy mid-sized cities such as Gary, Hammond, and East Chicago. This study explored the perceptions of African American men and Hispanic/Latino men ages 18 to 25 regarding coping strategies and both healthy and health risk behaviors after directly witnessing or indirectly experiencing a violent act or event. We used aspects of social cognitive theory to design this community-based participatory research study. Thirteen males who self-identified as African American, Hispanic/Latino, or both, completed 34- to 80-minute, audio-recorded phone interviews. Audio recordings were transcribed, and NVivo 12 Windows was used by the research team (primary researchers and two coders) to complete transcript analysis. Findings from this study provided insight around African American men and Hispanic/Latino men regarding (a) witnessing violence directly or indirectly experiencing violence; (b) changes in everyday life experiences; (c) coping strategies that involved socio-emotional health, spiritual health, social health, and risky health behaviors; (d) rationales for not asking for help; (e) observations of significant others' coping; (f) what to do differently in the future; (g) beliefs about mentors; and (h) beliefs about mental health providers. Delving into participants' experiences revealed that African American men and Hispanic/Latino men in Lake County, Indiana chose to adopt a range of health risk and health positive strategies after directly witnessing or indirectly experiencing violence. Becoming knowledgeable about African American men's and Hispanic/Latino men's diverse coping strategies and health behaviors may help inform the community about how best to cocreate spaces that aim to alleviate the traumatic experience of having directly or indirectly experienced community violence.

Black/African American Women's Woes: Women's Perspectives of Black/African American Maternal Mortality in the USA.

BACKGROUND: Despite advances in perinatal care in the USA, maternal mortality is on the rise, and maternal death is higher than in any other high-income country. Maternal mortality in the USA is a persistent public health concern. This issue disproportionately affects Black/African American women, with their likelihood of pregnancy-related death being three times more likely compared to White women. This study aimed to explore the resources needed for Black/African American women to address the relatively higher maternal mortality rates recorded for them. METHODS: An anonymous link with demographic and open-ended questions was sent to US women 18 years and older to participate in the study. A total of 140 participants responded to the survey. We retained a final sample of 118 responses after eliminating responses with missing data. Descriptive statistics are reported for closed-ended items. Open-ended responses were analyzed using content analysis procedures, where we coded and categorized the data into themes. RESULTS: Six themes were identified from the study data: (1) Diversity, Equity, and Inclusion (DEI) training for health providers focused on racial bias and discrimination, (2) Advocacy, (3) Provider selection, (4) Researching doctors and delivery hospitals to inform women's birthing decision-making, (5) Women's care-seeking behaviors, and (6) Addressing the Social Determinants of Health. CONCLUSION: Based on the study's findings, we recommend DEI training for healthcare professionals providing direct care to pregnant and postpartum women, advocacy and resource-awareness training for pregnant Black/African American women and their spouses/partners, or a family member, to assist them in their pregnancy and birthing journeys.

Untold Narratives: Perceptions of Human Milk Banking and Donor Human Milk Among Ghanaian Immigrant Women Living in the United States.

BACKGROUND: Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother's own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA. METHODS: Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes. RESULTS: Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women's decision-making which is informed by external influences, (2) health provider's role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality. CONCLUSIONS: Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.

Women's perspectives on human milk banking in Ghana: results from a cross-sectional study.

Background: Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB. Methods: Quantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses. Results: In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana. Conclusions: Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality.

Preschool Environment: Teacher Experiences during the COVID-19 Pandemic in Ghana.

BACKGROUND: In Ghana, the COVID-19 pandemic led to the government's decision to shut down schools for nearly nine months. This study explores the experiences of preschool teachers in Ghana during the COVID-19 pandemic. METHODS: The study was carried out using the Qualitative Description approach and aspects of Albert Bandura's Social Learning Theory. Twenty-five teachers agreed to carry out face-to-face interviews with the researchers. An audio recorder device was used to record the interviews, with each interview lasting between 35-55 min. The analysis was carried out by two researchers who served as coders, and MAXQDA 2022 (VERBI Software GmbH) was used to do the analysis. RESULTS: All twenty-five participants indicated their awareness of COVID-19. Participants said they were so "Scared" when they heard about COVID-19 that it could spell the doom for all humanity. Participants also talked about the extra workload that came upon them as a result of the pandemic and the "financial challenges" that they went through during the pandemic because they had no income since they were not teaching. Study participants indicated that one benefit of the pandemic was the heightened awareness of the need to practice hygienic behavior in their classroom. CONCLUSION: Participants' beliefs about the virus being lethal led to mask wearing and the practice of hygienic behavior. Thus, although the COVID-19 pandemic negatively impacted the emotional and financial status of the studied participants, a positive outcome was the participants' awareness of the need to practice positive health behavior, which will contribute to the overall health and safety of everyone in the preschool environment.

Human Milk for Vulnerable Infants: Breastfeeding and Milk Sharing Practice among Ghanaian Women.

Human milk has the best impact on childhood survival. In Ghana, it is estimated that 43% of women exclusively breastfeed for 0-5 months and only 42% of breastfeeding mothers continue through 20-23 months. Although the Ghanaian government has implemented policies to facilitate exclusive breastfeeding, substantial gaps to achieve optimal newborn health and wellbeing remain. The purpose of this study was to evaluate breastfeeding prevalence and human milk sharing practices among Ghanaian women. Qualitative responses were received from Ghanaian females (n = 1050). In our sample, 81% indicated they breastfed their children and 8% reported ever sharing breastmilk with another mother. Reasons for sharing milk included (i) insufficient breastmilk production of the recipient mother, and (ii) mother's unavailability prompting women to offer their milk to a crying baby. About 60% of our sample reported that they were not concerned about sharing their milk. Findings present a strong indicator for milk donation towards the establishment of a human milk bank in Ghana. Health promotion efforts should aim at increasing education about the risks involved in milk sharing as well as the benefits of human milk donation through formal and safer channels such as a Human Milk Bank.

Training Public Health Professionals to Tackle Women, Children, and Families Health Issues: A "Skill-Based Qualitative Learning Approach".

Purpose: There are several teaching and learning approaches but finding the one that is appropriate for a particular field or training program is an arduous task. The purpose of this paper is to introduce the "Skill Based Qualitative Learning Approach" (SBQLA) in training health professionals. Description: The SBQLA is a pedagogical approach via which learners are trained in developing qualitative questionnaires and interview skills to learn from experts in the Public Health (PH) field. This teaching approach arms students with interview skills that help them identify and address PH roadblocks and get them authentic information from experts. It also equips them with techniques on how to do formalized presentations and come up with projects and interventions that help mitigate and eliminate drivers of health problems among women, children and families. Assessment: Learners' field experiences are shared in a professional presentation style in a class to help trainees benefit from each other's information and to get formalized feedback on their presentation. Assessment in this learning approach is based on a synthesis and an analysis of data collected from professionals. Conclusion: Findings from this learning approach enables experts to shed light on true stories shared by real and authentic individuals whose faces can be associated with their shared experiences. This learning approach makes it possible for trainees to also initiate projects that help them tackle existing and emerging public health issues in their future work.

Women's Perceptions about Breastfeeding: A Preliminary Study.

BACKGROUND: Breastfeeding rates are low in many communities in the United States and require attention to come up with ideas that will help increase breastfeeding. This study investigated the effects of income, age, race and education on mothers' perceptions about breastfeeding and whose needs and views should be considered in a women's breastfeeding journey. METHODS: A survey was distributed via email and Facebook to 525 participants; 453 participants (86.3%) responded to the survey. RESULTS: Younger adults were more likely to agree that fathers should have some say about breastfeeding. Those earning USD 0-USD 50,000 were more likely to agree relative to those with higher incomes on children being entitled to mother's milk, and children's needs over-riding those of others. There was a statistically significant difference by education about women's wishes about breastfeeding being considered more important than those of their spouses. However, there was no statistically significant difference for any demographic group for breastfeeding decisions coming from women only. On women's breasts being primarily for infant's nutrition, people who earned USD 0-USD 50,000 were more likely to agree relative to those who earned more than USD 50,000; younger adults were significantly more likely to agree. Those who earned USD 0-USD 50,000 were more likely to agree relative to those in other income brackets that extended family members should have input regarding babies being breastfed; minority participants were significantly more likely to agree relative to white participants; those with less than 4-year college education were more likely to agree relative to those with a minimum of four-year college education. Younger adults were more likely to agree that employers must provide extended maternity leave to make it easier for mothers to breastfeed. On women having the right to breastfeed in public places, younger adults were significantly more likely to agree compared to older adults. CONCLUSION: Women have favorable views about breastfeeding and prefer being in charge about decisions to breastfeed.

"Food is Environmentally and Culturally Specific!": A Preliminary Qualitative Study on U.S. Immigrant Parents' Perceptions of School Lunch.

Children spend most of their day hours in school, so the dietary choices they make during school days are important for their childhood development and later life. This research examined food choices among immigrant families with school-age children in Indiana, USA. Open-ended questions were answered by 52 immigrant parents in 2017. Parents who answered the questions had children in classes ranging from kindergarten to grade 12. NVivo 11 was used for the initial analysis of the dataset, and several themes were identified. After the initial analysis, the data were categorized into major themes to condense the themes. Thirty-eight (73%) of the respondents indicated that their children ate school lunch, 14 (27%) indicated that they prepared lunch for their children to eat at school, and 39 (75%), mostly from non-industrialized countries, indicated that their children ate their home-country staple foods for dinner and on non-school days. Parents indicated that schools are serving the needs of immigrant children by serving varieties of foods during lunchtime.

Associations between e-cigarette and combustible cigarette use among U.S. cancer survivors: implications for research and practice.

PURPOSE: Prior studies established significant associations between e-cigarette use and combustible cigarette smoking in the general population; however, little is known about such associations among cancer survivors. Thus, the current study examined possible associations between e-cigarette use and combustible cigarette smoking among U.S. cancer survivors. METHODS: Cross-sectional data were drawn from the 2016 Behavioral Risk Factor Surveillance System Survey. Binary logistic regression was used to analyze the associations between e-cigarette user status and combustible cigarette-smoking status in a sample of 4680 cancer survivors, controlling for alcohol use and sociodemographic factors. Analyses were weighted for unequal probability of sample selection to reflect national cancer survivor population estimates. RESULTS: Prevalence for current e-cigarette use and combustible cigarette smoking for cancer survivors was 2.57% and 16.16%, respectively. In the adjusted analyses, cancer survivors who reported current e-cigarette use, compared to never-users, had greater odds of being current combustible cigarette smokers (odds ratio [OR] = 11.81, 95% confidence interval [CI] = 5.38-25.93). Likewise, former e-cigarette users, compared to never-users, had greater odds of being current combustible cigarette smokers (OR = 15.90, 95% CI = 10.68-23.36). CONCLUSION: Among cancer survivors in the USA, e-cigarette use had a positive and highly significant association with combustible cigarette smoking. IMPLICATIONS FOR CANCER SURVIVORS: In order to prevent multiple and substitute use of nicotine-delivery products, prevention interventions and cessation programs designed for cancer survivors should specifically target both current combustible cigarette smokers and non-smokers who report former and current e-cigarette use.

Personal Cleanliness Activities in Preschool Classrooms.

One hundred and twelve preschool teachers in Indiana were asked to complete a questionnaire requesting them to indicate what personal health-related activities they were incorporating into their classroom routines, why they were incorporating them, and how often such activities were done. The results of the study indicate that the most incorporated activities were hand-washing, proper ways of coughing, and discussion on germs. The least incorporated personal health-related activities were proper use of bathroom and keeping things out of the mouth. Reasons for incorporating the activities include helping to curtail the spreading of colds and germs, helping the children to develop good life skills later in life, and helping the preschoolers know about the health hazards associated with germs, among others. The study recommends the need to make Health Education a core component of preschool teachers' training.

Teachers' Strategies in Combating Diseases in Preschools' Environments.

Scholarship on child health indicates that the early years of life are vital for all aspects of health and development. In particular, a solid health foundation predicts good life outcomes; therefore, systematic strategies for combating diseases are needed to ensure optimal health of young children in early care environments. This study examined strategies used by 48 preschool teachers from 10 pre-schools in the US Midwest in order to combat diseases. The following results emerged: Participants noted that children should not attend childcare if they are vomiting, have a fever or have diarrhea. They should be symptom-free for at least one day before returning to school. It is recommended that children be sent home if they have any disease deemed to have adverse effects on their health during the school day. Participants noted further that children must not share hats in their childcare environments to avoid transfer of head lice. Since no strategies were mentioned to help children cope with emotional distress and illness, it is recommended that teachers develop strategies that will address emotional childhood diseases in order to help all children.

African-American Women's Perceptions and Experiences About Breastfeeding.

There are health benefits to breastfeeding for both mothers and their children. The preventive health effects of breastfeeding continue into adulthood, lowering rate of various chronic illnesses. African-American women, especially of lower socioeconomic status, are less likely to breastfeed in comparison to their racial and ethnic counterparts. The purpose of this study is to explore how African-American women experience breastfeeding in the early stages of postpartum care. Two focus groups (N = 20, 10 in each group) were conducted with African-American mothers. Results revealed that participants felt that there were health benefits to breastfeeding, and organizations such as Women, Infants, and Children (WIC) provided support. However, participants stated that lack of information, negative perceptions, and unforeseen circumstances were barriers to breastfeeding. This study proposes support and interventions for this group to increase breastfeeding among this population.

Should gun safety be taught in schools? Perspectives of teachers.

BACKGROUND: Gun-related injuries and deaths among children occur at disproportionately high rates in the United States. Children who live in homes with guns are the most likely victims. This study describes teachers' views on whether gun safety should be taught to children in the preschool and elementary years. METHODS: A total of 150 survey questionnaires were distributed to public and private school teachers in preschools and elementary schools in 2 counties of a Midwestern state. RESULTS: In total, 62% of the 102 respondents indicated that they favored the teaching of gun safety, while 13% disapproved and 25% had no opinion. Overall, 28.4% of the respondents supported the teaching of gun safety in grades pre-K (pre-kindergarten) through first grade. About 54% indicated that police or trained military personnel should do the teaching of this subject in schools, while 6.9% suggested that teachers should do the teaching. CONCLUSION: With a majority of the teachers in favor of teaching gun safety in the schools, a larger study should be conducted that explores the introduction of gun safety into the curriculum in preschool through grade 6. Such a study should evaluate the efficacy of teaching gun safety as a measure to prevent gun violence and injuries involving guns.