Health and Equity Data to Teach the Next Generation of Public Health Leaders.

The COVID-19 pandemic restructured university learning environments while also underscoring the need for granular local health data. We describe how the University of Memphis School of Public Health used the City Health Dashboard, an online resource providing data at the city and neighborhood level for more than 35 measures of health outcomes, health drivers, and health equity for all US cities with populations >50 000, to enrich students' learning of applying data to community health policy. By facilitating students' engagement with population needs, assets, and capacities that affect communities' health-key components of the master of public health accreditation process-the Dashboard supports in-person and virtual learning at undergraduate and graduate levels and is recommended as a novel and rigorous data source for public health trainees.

Impact of a Multidisciplinary Approach on Cardiometabolic Risk Reduction in a Multiracial Cohort of Adults: A 1-Year Pilot Study.

Evidence examining specific effects of a multidisciplinary team (MDT) on cardiometabolic risk factors (CMRFs) among multi-ethnic patients in real-world clinical settings is lacking. This one-year retrospective chart review (2018) analyzed 598 adults (African American 59%, Hispanic 35%, and Caucasian 6%) with mean age of 43.8 ± 14.0 years. Qualifying patients with primary inclusion criteria of having body mass indices and blood pressure (BP) measurements in the first and last quarter of the study period were treated under an MDT protocol and compared to those qualifying for MDT but treated solely by a primary care provider (PCP). MDT included endocrinologist-directed visits, lifestyle counseling, and shared medical appointments. MDT patients experienced a greater reduction (ß; 95% CI) in weight (-4.29 kg; -7.62, -0.97), BMI (-1.43 kg/m2; -2.68, -0.18), systolic BP (-2.18 mmHg; -4.09, -0.26), and diastolic BP (-1.97 mmHg; -3.34, -0.60). Additionally, MDT patients had 77%, 83%, and 59% higher odds of reducing ≥5% of initial weight, 1 BMI point, and ≥2 mmHg DBP, respectively. Improvements in hemoglobin A1C measurements were observed in the MDT group (insufficient data to compare with the PCP group). Compared to PCP only, MDT co-management improves CMRF related to adiposity and hypertension in a multiethnic adult cohort in real-world clinical settings. Patient access to best practices in cardiometabolic care is a priority, including the incorporation of culturally adapted evidence-based recommendations translated within a multi-disciplinary infrastructure, where competing co-morbidities are better managed, and associated research and education programs can promote operational sustainability.

A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3-5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health. METHODS: We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded. OBSERVATIONS: Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga's ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury. CONCLUSION AND RELEVANCE: This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.

Association of masking policies with mask adherence and distancing during the SARS-COV-2 pandemic.

BACKGROUND: Quantification of the impact of local masking policies may help guide future policy interventions to reduce SARS-COV-2 disease transmission. This study's objective was to identify factors associated with adherence to masking and social distancing guidelines. METHODS: Faculty from 16 U.S. colleges and universities trained 231 students in systematic direct observation. They assessed correct mask use and distancing in public settings in 126 US cities from September 2020 through August 2021. RESULTS: Of 109,999 individuals observed in 126 US cities, 48% wore masks correctly with highest adherence among females, teens and seniors and lowest among non-Hispanic whites, those in vigorous physical activity, and in larger groups (P < .0001). Having a local mask mandate increased the odds of wearing a mask by nearly 3-fold (OR = 2.99, P = .0003) compared to no recommendation. People observed in non-commercial areas were least likely to wear masks. Correct mask use was greatest in December 2020 and remained high until June 2021 (P < .0001). Masking policy requirements were not associated with distancing. DISCUSSION: The strong association between mask mandates and correct mask use suggests that public policy has a powerful influence on individual behavior. CONCLUSIONS: Mask mandates should be considered in future pandemics to increase adherence.

Transforming Healthcare Cybersecurity from Reactive to Proactive: Current Status and Future Recommendations.

The recent rise in cybersecurity breaches in healthcare organizations has put patients' privacy at a higher risk of being exposed. Despite this threat and the additional danger posed by such incidents to patients' safety, as well as operational and financial threats to healthcare organizations, very few studies have systematically examined the cybersecurity threats in healthcare. To lay a firm foundation for healthcare organizations and policymakers in better understanding the complexity of the issue of cybersecurity, this study explores the major type of cybersecurity threats for healthcare organizations and explains the roles of the four major players (cyber attackers, cyber defenders, developers, and end-users) in cybersecurity. Finally, the paper discusses a set of recommendations for the policymakers and healthcare organizations to strengthen cybersecurity in their organization.

A cross-sectional study of the influence of neighborhood environment on childhood overweight and obesity: Variation by age, gender, and environment characteristics.

To examine the influence of neighborhood environment on childhood overweight and obesity in Shelby County Schools, Tennessee, and whether and to what extent that influence varies by age, gender, and the specific environment characteristics. 41,283 students were surveyed covering both individual-level covariates and several objective measures of neighborhood environment. Multilevel logistic regressions were used to examine the influence of neighborhood-level variables on overweight+obesity and obesity with adjustment of individual-level covariates. Further, a stratified analysis for each of the six groups by school level and gender. For both overweight+obesity and obesity, younger children were less sensitive to neighborhood characteristics than older children, and boys are less sensitive than girls. For girls in middle and high schools, the risk of overweight+obesity and obesity were positively associated with population density, and negatively associated with percent of poverty and percent of unhealthy food. Boys' risk of overweight+obesity and obesity were positively associated with distance to park. Neighborhood environment plays an important role in childhood overweight and obesity, and the effects vary by age, gender, and the specific neighborhood characteristic. Intervention programs tailored to specific groups may be more effective than ones targeted to children as a whole.

Milk, juice, or cola? Exploring the effect of product placement on children's attitudes and behavior.

Childhood obesity is a significant public health concern, and scholars and academicians have proposed the use of successful marketing and advertising tactics as a means of influencing healthy behaviors. This research investigates product placement to assess its potential effects on attitudes and behavior when utilized in an animated children's television show. Results from an experiment suggest that multiple product placements may affect children's attitudes toward certain drinks, but also suggest that a child's existing favorite drink is a stronger predictor of actual beverage choice. Implications are provided.

Marketing active transportation to school to improve children's health: Utilizing parental perspectives from an inner-city environment.

Thirty years ago, nearly half of the children in the United States walked or rode their bikes to school. Today, less than 15% of children actively commute to school. With the growing obesity epidemic, encouraging children to walk or bike to school has become a national priority. This research examines factors that influence parental decisions allowing their children to walk to school in an urban environment to identify effective marketing and communication strategies to reach those parents. Results indicate differences in parental perspectives across populations; suggestions for effectively marketing the Safe Routes to School program to minority populations are provided.

Lessons Learned in a Breastfeeding Media Campaign.

Breastfeeding is well accepted as the optimal nutrition for babies. The American Academy of Pediatrics states that infant feeding should no longer be thought of as a lifestyle choice, but rather as a public health issue. In Shelby County, Tennessee, rates of breastfeeding continue to be disparately low. To address this public health problem, a focus group study was conducted with the Shelby County population least likely to breastfeed. Following participants' suggestion to use a billboard campaign with pictures of local mothers and families, one highway billboard and ten bus stop signs were placed around the city in areas of the lowest breastfeeding rates. Self-administered surveys were completed by convenience sampling in target population areas with women least likely to breastfeed, both before placing the signs and 6 months later. No significant differences were noted in knowledge, attitudes, or practices after the media campaign, but trends toward increased intention to breastfeed were noted among expectant mothers. With collapsed data (pre and post), a majority of participants believed that breastfeeding is the best way to feed a baby and they were significantly more likely to plan to breastfeed if they knew about health benefits to the baby and to themselves. If they had heard about breastfeeding on the TV or radio, they were more likely to believe breastfeeding is important for long-term health. These findings suggest that a media campaign could have a complementary role in promoting breastfeeding among women with low initiation rates.

Active Travel to School: Findings From the Survey of US Health Behavior in School-Aged Children, 2009-2010.

BACKGROUND: Whereas children's active travel to school (ATS) has confirmed benefits, only a few large national surveys of ATS exist. METHODS: Using data from the Health Behavior in School-aged Children (HBSC) 2009-2010 US survey, we conducted a logistic regression model to estimate the odds ratios of ATS and a linear regression model to estimate the adjusted mean differences of the percentage of ATS within a school. RESULTS: Overall, 21.4% of children engaged in at least one way of active travel to or from school. ATS was less common for trips to school than from school. Greater distance to school was a major barrier preventing children from ATS. Children living in large cities were more likely to engage in ATS, and schools located in a large city had higher proportions of ATS rate. Children having lower family satisfaction, or engaging in a greater number of physically active days during the past week were all more likely to engage in ATS. CONCLUSIONS: Although ATS is low among US children, significant variation exists. HBSC is a promising data source for an ATS study. As the first study to explore the variation of ATS at school level, this research contributes uniquely to current knowledge.

Innovations in public health education: promoting professional development and a culture of health.

As the field of public health advances toward addressing complex, systemic problems, future public health professionals must be equipped with leadership and interprofessional skills that support collaboration and a culture of health. The University of Memphis School of Public Health has infused innovative strategies into graduate education via experiential learning opportunities to enhance leadership, collaboration, and professional development. Novel training programs such as Day One, Public Health Interdisciplinary Case Competition, and Memphis Healthy U support Association of Schools and Programs of Public Health cross-cutting competencies and prepare Master of Public Health and Master of Health Administration graduates to function effectively at the outset of their careers and become catalysts for creating a culture of health.

Barriers to breastfeeding in the African American population of Shelby County, Tennessee.

Breastfeeding is recommended exclusively for the first 6 months of life, with continuation after the addition of complementary foods for at least 1 year of life. Breastfeeding rates are low in the Southeastern United States, especially among African Americans. Disparities in breastfeeding rates between African Americans and whites are especially pronounced in Memphis (Shelby County), TN. Our research objectives were to explore this disparity using focus groups, specifically to identify perceived barriers, and also to seek possible solutions from the target population. Focus groups were conducted in nine community settings within the county. Groups primarily consisted of women of childbearing years, but groups with men, grandmothers, and teens were also conducted. Common barriers for breastfeeding that were identified included pain, embarrassment with public nursing, going back to work, concern about "partying" and breastfeeding, and "just not wanting to" breastfeed. A notable finding was a substantial concern about sexuality and breastfeeding. As a possible solution, participants recommended putting breastfeeding educational materials widely across the county in many venues. Barriers to breastfeeding in Memphis are similar to those in other areas, with key concerns about sexuality and partying. Involving the target population yielded specific recommendations to improve breastfeeding promotion efforts.

Self-reported training needs of emergency responders in disasters requiring military interface.

OBJECTIVE: The purpose of this study is to identify perceived training needs of emergency responders to understand their needs to interface effectively with military operations for emergency response in the event of a disaster. DESIGN: A Web-based survey with civilian medical practitioners and public health professionals was conducted to identify their perceptions of training needs related to civilian-military interface in disaster response. SETTING: Lists of potential survey participants were obtained from local health departments and LISTSERVS in the two regions of interest: the South and the Midwest. PARTICIPANTS: Participants (n = 673) included health practitioners (medical, emergency care, and public health personnel) from hospitals, public service, and other nonprofit and governmental workers. MAIN OUTCOME MEASURE(S): Outcomes include perceived training needs, barriers to training, and preferred training formats and modalities. RESULTS: Data indicate a perceived knowledge gap of civilian healthcare providers to interface effectively with military healthcare providers. Nearly three-fourths of respondents did not feel well-trained to work with the military during a disaster response or were unsure if they were well trained. Key areas for training include communication, chain of command during a disaster, and logistics of working with military personnel. Barriers to training include expense; ineffective, boring formats; and excessive time requirements. Most respondents favor interactive exercises rather than didactic training. CONCLUSIONS: Poor communication and lack of familiarity with military operations create barriers to effective coordinated response between military units and civilian responders in federal disaster response. Identifying gaps and training needs for these responders have far-reaching implications in public health's ability to coordinate medical response as part of Emergency Support Function-8.

Dietary water and sodium intake of children and adolescents with sickle cell anemia.

Dietary fluid and sodium intake may influence the risk for vasoocclusive events in persons with sickle cell anemia (SCA). The objective of this study was to examine the dietary intake of water and sodium in children and adolescents with SCA and identify possible factors influencing intake. We compared water (mL) and sodium (mg) intake in 21 patients with SCA, aged 5 to 18 years, to reported adequate intake for water, daily fluid requirement, upper limit for sodium, and National Health and Nutrition Examination Survey 2005 to 2006 data for sodium, and sociodemographic factors. Dietary intake from 3-day food records was evaluated retrospectively. Median water intake was significantly lower than adequate intake, and median sodium intake was significantly higher than sodium upper limit. Sociodemographic factors were not associated with dietary water or sodium intake. Our results suggest that children and adolescents with SCA would benefit from education regarding increasing fluid intake and limiting high sodium foods.

The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma.

Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically underserved inner-city children attending Memphis City schools. Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size, percentage of children with asthma enrolled, and percentage of children eligible for free or reduced-price lunch. Schools were randomized to either a nurse CM intervention or a usual care (UC) condition. The CM group included 115 students; 128 students were in the UC group. A longitudinal design was used to follow students' progress. Students were primarily African-American children diagnosed with asthma. In CM schools, nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum, followed up on students' school absences, and coordinated students' asthma care with families, school personnel, and medical providers. In UC schools, students received routine school nursing services. CM students had fewer school absences than their counterparts in UC schools (mean 4.38 vs 8.18 days, respectively) and experienced significantly fewer emergency department visits (p < .0001) and fewer hospital days (p < .05) than UC students. No such differences existed before program initiation. Replication and follow-up in year 2 showed continued significant improvements. School-based nurse CM can achieve significant improvements in school attendance and medical utilization.