Labour market competition for public health graduates in the United States: A comparison of workforce taxonomies with job postings before and during the COVID-19 pandemic.

A strong public health workforce (PHW) is needed to respond to COVID-19 and public health (PH) issues worldwide. However, classifying, enumerating, and planning the PHW is challenging. Existing PHW taxonomies and enumerations focus on the existing workforce, and largely ignore workforce competition for public health graduates (PHGs). Such efforts also do not utilize real time data to assess rapid changes to the employment landscape, like those caused by COVID-19. A job postings analysis can inform workforce planning and educational program design alike. To identify occupations and industries currently seeking PHGs and contrast them with existing taxonomies, authors matched existing PHW taxonomies to standardized occupational classification codes, then compared this with 38,533 coded, US job postings from employers seeking Master's level PHGs from 1 July 2019 to 30 June 2020. Authors also analysed 24,516 postings from March 2019 to October 2019 and compared them with 24,845 postings from March 2020 to October 2020 to assess changing employer demands associated with COVID-19. We also performed schema matching to align various occupational classification systems. Job postings pre-COVID and during COVID show considerable but changing demand for PHGs in the US, with 16%-28% of postings outside existing PHW taxonomies, suggesting labour market competition which may compound PHW recruitment and retention challenges.

Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic.

OBJECTIVES: To determine the health literacy levels of persons living with human immunodeficiency virus (HIV) (PLWH) at a health clinic in the Dominican Republic (DR) and assess associations between health literacy, HIV-related knowledge, and health information behavior (how patients need, seek, receive, and use information). DESIGN AND SAMPLE: Cross-sectional, descriptive. Participants were 107 PLWH attending the Clinic. MEASURES: A theoretically based, 64-item survey assessing information behavior and HIV-related knowledge was administered in Spanish through individual interviews. Health literacy was assessed using the Short Assessment of Health Literacy-Spanish and English. RESULTS: On average, participants were 40.8 years old and had lived with HIV for 7.7 years. The majority (69.2%) had low health literacy. HIV-related knowledge and information behavior varied by health literacy level and uncertainty regarding a main indicator of disease progression, viral load, was demonstrated regardless of health literacy level. Participants with low health literacy were less likely to answer questions or answer questions correctly and many participants (39.2%) indicated viral transmission can occur through supernatural means. CONCLUSIONS: Findings demonstrate unmet information need and that information received may not always be understood. Methods to improve health education are needed to ensure patients receive health information in an understandable way.

Academic Health Center-Community Justice Program Partnerships: Linking Men in the Justice System to Health Care.

BACKGROUND: Linkage to community health and social services after incarceration is often inadequate. This is troubling, because risk taking and poor health are common immediately after release, and access to health providers and insurance helps individuals to transition home. OBJECTIVES: This article describes how faculty and clinicians at a large academic health center in New York City, established partnerships with justice programs to jointly develop services that aimed to increase health care access for men in the justice system. METHODS: We describe how faculty and students from Columbia University's Mailman School of Public Health (MSPH), clinicians from New York-Presbyterian Hospital's (NYPH) Young Men's Clinic (YMC) and project STAY, and staff from justice programs collaborated to increase access to care. RESULTS: We highlight the characteristics of successful partnerships drawn from the literature on community-based participatory research. CONCLUSION: We conclude with a discussion of some challenges we encountered and lessons we learned about establishing and sustaining partnerships with court, probation, parole, reentry, and diversion programs while educating the next generation of public health leaders.

Developing capacity for the American Indian health professional workforce: an academic-community partnership in Spirit Lake, North Dakota.

BACKGROUND: American Indians/Alaskan Native (AIAN) populations experience significant disparities in health when compared to the average US population who are under-represented in the health care professional workforce. Current research suggests that racial concordance between patients and providers has a positive effect on patient care. OBJECTIVE: We describe a successful academic-community partnership between a tribal college, a local state academic center, an urban public health institution, and an urban academic center all aligned with the goal to increase AIAN health care professional capacity. METHODS: A tribal college course and youth education program were developed with the intent to expose AIAN youth to the health care professions and encourage entry into health professional career tracks. Evaluation using a pre- and post-survey design is underway to assess the impact of the intervention on participating AIAN attitudes and career intentions. CONCLUSION: We believe this model is one way of addressing the need for an increased AIAN health care professional career force.

Cultural competency training for public health students: integrating self, social, and global awareness into a master of public health curriculum.

Cultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.

Skin cancer screening by dermatologists, family practitioners, and internists: barriers and facilitating factors.

OBJECTIVE: To determine barriers and facilitating factors to skin cancer screening practices among US primary care physicians and dermatologists. DESIGN: Survey. SETTING: Physicians randomly selected from the American Medical Association's Medical Marketing Services database from April 1 through November 30, 2005. PARTICIPANTS: A total of 2999 US dermatologists, family practitioners, and internists. MAIN OUTCOME MEASURES: Results based on 1669 surveys returned regarding practice characteristics, skin cancer screening behaviors, and barriers and facilitating factors to performing full-body skin examinations for patients. RESULTS: The overall response rate was 59.2%. More dermatologists (552 [81.3%]) reported performing full-body skin examinations on patients than did family practitioners (333 [59.6%]) (P < .05) or internists (243 [56.4%]) (P < .05). Among all physicians, time constraints, competing comorbidities, and patient embarrassment were reported as the top 3 barriers to performing full-body skin examinations, and these barriers were different among medical specialties. Among all physicians, having patients at high risk for skin cancer, patient demand for complete examination/mole check, and the influence of medical training were reported as facilitating factors to performing full-body skin examinations. CONCLUSION: Becoming more knowledgeable about physician barriers to skin cancer screening could help improve primary and secondary practices in both the primary care and dermatology settings.

Health practices and vaginal microbicide acceptability among urban black women.

BACKGROUND: Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Use of vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practices related to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs. Given the high rate of HIV infection among black women, research on practices and decision making relevant to microbicide acceptability is needed in this population. METHODS: Twenty-three black women in New York City, aged 25-64, completed in-person semistructured interviews and self-administered questionnaires. Quantitative analyses examined vaginal practices and willingness to use microbicides. Qualitative analyses explored underlying decision-making processes involved in choices regarding vaginal practices and general healthcare. RESULTS: Willingness to use vaginal products for HIV prevention was high, especially among more educated women. Safety was a major concern, and women were cautious about using vaginal products. Whereas some viewed synthetic products as having potentially harmful side effects, others perceived natural products as risky because of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy, prior experience, cultural background, and general approach to healthcare. CONCLUSIONS: The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention. Decision-making processes regarding vaginal practices were complex and were affected by social, cultural, and personal factors. Although specific preferences may vary, attitudes toward using a vaginal product are likely to be positive when side effects are minimal and the product is considered safe.

Satisfaction with telephonic interpreters in pediatric care.

OBJECTIVES: To compare satisfaction among Spanish-speaking mothers who did and did not use telephonic interpreters during pediatric visits, and to examine resident physician attitudes about telephonic interpreter use. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: Anonymous surveys were administered to 98 mothers limited in English proficiency and presenting for well-baby visits in an urban university hospital-affiliated practice. Pediatric visits were performed by 24 non-Spanish-proficient pediatric residents. The first 46 women (baseline cohort) received routine services, including ad-hoc interpretation or no interpretation; the second 52 women (intervention cohort) used a dual-headset telephonic interpreter service. OUTCOME MEASURES: Mothers completed postvisit interviews assessing overall satisfaction, comfort and ease of communication. Pediatric residents completed self-administered questionnaires assessing attitudes about and experience with telephonic interpretation. RESULTS: The intervention cohort overwhelmingly rated telephonic interpretation as "very helpful" (94%), indicating the visit would have been "harder" without the service (98%). Significantly more intervention cohort mothers reported it was "very easy" to communicate with the physician (83% vs. 22%, P < 0.01), they understood "all" that the physician told them (97% vs. 80%, P < 0.05) and they were "very satisfied" with the clinic overall (85% vs. 57%, P < 0.05). Almost all intervention cohort mothers (96%) reported a preference to use telephonic interpretation at their subsequent visit; however, only one-third of residents believed their patients would prefer to use the telephonic interpreter in the future. CONCLUSIONS: Mothers who used telephonic interpretation reported significantly greater communication and overall satisfaction compared to mothers in routine care. Pediatric residents substantially underestimated their patients' desire to use telephonic interpreters.

The New York City Community Outreach Study: biomedical and mental health status among a community sample of urban Hispanics.

OBJECTIVE: This report provides a snapshot of health behavior and risk in one low-income, urban, Latino community. As part of a community health and education program, 200 adult residents were asked about their health status and behavior and screened for conditions known to constitute significant health risk. DESIGN: A random sample of 10 buildings around a large community-based organization (CBO) service area was selected to receive personal invitation and/or door-to-door flyers announcing several days of free health screening and education at the CBO. All individuals age > or = 18 years were eligible. Those who received screening were mailed lay descriptions of their results along with recommendations and locations for follow-up, if appropriate. SETTING AND PARTICIPANTS: Participants were adult residents of an economically and medically under-served district in New York City, where Latinos make up approximately 75% of the population. Free screening for high blood pressure, diabetes, high cholesterol, obesity, and depression was provided. MAIN OUTCOME MEASURES: The clinical outcomes of the aforementioned tests constitute the main outcomes of this report. RESULTS: Compared to national estimates for Hispanics, health risk was quite high in this sample, particularly with regard to diabetes and cholesterol. Moreover, participants were much less likely to have insurance or to have a regular source of health care than reported in national studies of Hispanics. CONCLUSIONS: Though site specific, these data provide critical information to local CBOs and can be used as a tool for comparison with national data and Healthy People 2010 goals.

Women's reasons for complementary and alternative medicine use: racial/ethnic differences.

OBJECTIVES: Although racial/ethnic differences in the prevalence of complementary and alternative medicine (CAM) utilization have been documented, differences in the reasons for using CAM have not been empirically assessed. In an increasingly diverse society, understanding differences in rates of and reasons for CAM use could elucidate cultural and social factors of health behaviors and inform health care improvements. The current study examines reasons for CAM use among women in four racial/ethnic groups. DESIGN: A national telephone survey of 3172 women aged 18 years and older was conducted in four languages. Respondents were asked about their use of remedies or treatments not typically prescribed by a medical doctor. This study focuses on those women who used CAM in the previous year and their reasons for using CAM. RESULTS: Non-Hispanic white women were most likely to cite personal beliefs for CAM use. Cost of conventional medicine was most prevalent among Mexican-American women CAM users. Physician referral, family and friends, and media sources were all equally likely to lead to CAM use in non-Hispanic white women. In contrast, informal networks of family and friends were the most important social influences of CAM use among African-, Mexican-, and Chinese-American women. CONCLUSIONS: Racial/ethnic differences in reasons for CAM use highlight cultural and social factors that are important to consider in public evaluation of the risks and benefits of CAM remedies and treatments.

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey.

OBJECTIVES: We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans. METHODS: We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women. RESULTS: Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans. CONCLUSIONS: CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

Exploring parental grief: combining quantitative and qualitative measures.

PURPOSE: This study explores parental grief on the death of a child of any age. STUDY DESIGN: The sampling frame for the study consisted of 74 respondents reporting that they experienced the death of a living child. With the exception of standard demographic measures, the quantitative and qualitative items in the instrument were designed specifically for this project. The content validity of the instrument was assessed by a panel of experts on grief. Key quantitative items related to child loss and grief were formatted with between three- and five-point ordinal answer categories. Two types of qualitative items were developed by the authors. The reliability of the instrument designed for this study was not determined. RESULTS: This survey of parents who experienced the death of a child during their lifetime explores and extends current understanding of the complex emotional response of grief. The study offers empirical support for the notion of grief as ongoing in the life of a parent whose child had died. The findings have significant implications for further clinical research supporting studies to explore commonalities in the experience of grieving families regardless of the cause of and time since the death of their child. In addition, the findings may serve to inform the development and provision of services for bereaved parents.

Quick start: novel oral contraceptive initiation method.

Conventional oral contraceptive (OC) starting instructions require waiting until menses to begin the OC. The conventional approach requires detailed patient education about when to begin and also may require the use of less effective or less acceptable interim contraceptive protection until menses. At our urban family planning clinic, we routinely offer patients starting the OC the option of taking the first tablet sooner. We prospectively evaluated predictors of short-term OC continuation among 250 OC requestors who were offered several approaches to OC initiation. Telephone follow-up of 91% of participants showed that women who swallowed the first OC in the clinic were more likely to continue the OC until the second package than women who planned to start the OC later (adjusted OR 2.8, 95% C.I. 1.1-7.3). Other factors associated with short-term continuation were: partner's knowledge of planned OC use, older age, and participant's agreement that she would be very unhappy about becoming pregnant in the next 6 months.