Shaping undergraduate public health education through critical race theory: a case study.

In 2020, the American Public Health Association declared structural racism a public health crisis acknowledging the long-lasting and harmful effects of prejudice, including relatively high rates of morbidity and mortality in many communities of color. Critical Race Theory (CRT) has become an essential lens to view and reconsider education's role in perpetuating racial and ethnic discrimination. Debates over integrating CRT in higher education with the intent to acknowledge and address racial equality and justice are more present than ever, and the discussions held in public health classrooms are no different. We present a case study of CRT integration into the Bachelor of Arts in Public Health (BAPH) program at the University of Hawai'i at Manoa. In line with Solorzano's framework of CRT in education, initial goals of integrating CRT in instruction and advising included fostering discussions of race and racism, using a social justice framework to highlight opportunities to reduce health inequities, and validating the experiential knowledge of people of color. By engaging in active discussions with community leaders and participating in experiential learning throughout the program, students develop empathy and many underrepresented and marginalized students engage actively in their home communities. Specific examples of CRT integrated in the curriculum and examples of student projects that integrate a CRT lens are provided for educators and researchers.

The Impacts of the COVID-19 Pandemic on Service-Learning Experiences Among Undergraduate Public Health Students in Hawai'i.

Service-learning is a high-impact educational practice at the core of the undergraduate public health degree at the University of Hawai'i at Manoa (UHM). This practice provides an invaluable learning experience and professional opportunity for students to collaborate with community partners and make significant contributions in the field. The COVID-19 pandemic halted or disrupted service-learning experiences as community partners adapted to shifting mandates and emergency orders. Surveying the rapidly evolving landscape of partner organizations to support service-learning is a challenge. Assessing changes to the program mentorship or satisfaction is the first step to developing protocols to ensure standardization of service-learning during times of crisis. This study will address if and how the pandemic impacted students' satisfaction with required service-learning experiences. Furthermore, authors hope to create a comprehensive list of practicum partnering organizations, both focused on pandemic response and, more generally, of the service-learning students at UHM, with the intent to increase students and community partners in local service-learning. Assessments were conducted to assess the impact of COVID-19 on undergraduate students' experiences with service-learning through use of a program exit survey. The authors hypothesized pandemic-related adjustments would not affect student satisfaction or skill development. Despite challenges associated with the pandemic and emergency online transitions, students persisted in personal and professional growth associated with service-learning. This developed resilience supports students as they graduate and enter a workforce adapting to remote work demands and community needs.

Improving Communication of Public Health Bachelor's Degree Programs Through Visual Curriculum Mapping.

Undergraduate students balance course requirements for the university, college, school, and major. Each set of requirements, including degree-specific curriculum, is intended to promote synergistic interaction of competence, skills, and knowledge, beyond serving as a collection of individual courses. Understanding of curriculum is important for program recruitment as undergraduate students are more informed when deciding between bachelor's degrees options. Among cohorted programs, this understanding is also helpful in communicating and promoting common intellectual experiences. Comprehension of curriculum is especially important for persistence when students are better able to articulate the connections between course and competencies needed to advance in coursework. To improve universal design for learning within program advising, visual curriculum maps were created as infographics to support student understanding of Bachelor of Arts in Public Health degree requirements and specific capstone course pathways. This map is printed as a small booklet and has been pilot tested among prospective students with positive feedback, then implemented in routine advising sessions. Visual maps of capstone requirements were well-received in concept, however constructive student feedback during pilot testing necessitated further revision. Student feedback also encouraged the application of culturally appropriate visuals and analogies to celebrate student diversity. Visual aids such as these may improve access to information among students through universal design, and also improve recruitment, retention efforts, and student buy-in to degree curricula.

What Can You Do With a Bachelor's in Public Health? A Case Study of Graduate Outcomes From the University of Hawai'i.

Since the development of a Bachelor of Arts in public health, a common question among prospective students, faculty, and community members has been asked: "What will students do after graduation?" While national data on graduates are abundant, community inquiries sought more detailed profiles of local graduates. To address this need, data on 224 graduates of the Bachelors of Arts in Public Health (BAPH) degree at the University of Hawai'i at Manoa were collected through alumni outreach efforts and professional online profile searches. Data were compiled into a summary presentation and program "resume". Findings indicated roughly 30% of BAPH graduates pursued graduate-level education and 43% were employed within a year of graduation. Employment in local NGOs and healthcare organizations was common, while bureaucratic challenges limited hiring at public agencies. A review of job titles suggested graduates were employed in program coordination or support staffing. Local program profiles, such as this one, complement national employment data. Moreover, these efforts may foster interest among prospective students and support from faculty, administrators, and employers.

Aloha Undergraduates: Development and Application of Local & Indigenous Topics into an Undergraduate Public Health Curriculum.

As public health education expands to include undergraduate students, it is important to include discussion of local public health topics and issues to provide a sense of place to the educational experience. Inclusion of Native Hawaiian and indigenous issues and perspectives is also an established priority of the University of Hawai'i system. To address both needs, a required course was created during development of a new Bachelor of Arts (BA) public health program at the University of Hawai'i at Manoa to specifically focus on discussion of local and indigenous public health topics of interest. Public Health Issues in Hawai'i is an introductory course included early in the recommended undergraduate curriculum and emphasizes the application of public health skills and principles to local issues (e.g., state-level legislative awareness and local sustainability topics). The Public Health Issues in Hawai'i course further challenges students to recognize public health practice in their daily activities, and encourages them to become actively engaged in local community issues early in their public health educational careers. Among multiple advantages, improved awareness of local health challenges and early connections to community members and organizations have been instrumental in actively engaging local students in their education, and has also proved beneficial for students participating in required undergraduate applied learning capstone experiences and entry-level public health careers following graduation. Here we present insights into course development, articulation with broader program curricula, and successes and challenges in the past 4 years of implementation and instruction.

Developing an Undergraduate Public Health Introductory Core Course Series.

The number of undergraduate public health education programs is increasing, but few publications provide examples of introductory public health courses that provide foundational knowledge and meet 2016 Council on Education in Public Health (CEPH) accreditation standards. This article presents the development and testing of a three-course, introductory series in public health at the University of Hawai'i at Manoa (UHM). Development was informed by best pedagogical practices in education, web review of existing programs, literature review, key informant interviews, and accreditation standards. Student mastery of required concepts, domains, and competencies is assessed through testing and class assignments. Data from course evaluations, students' exit questionnaires at graduation, and faculty feedback were used to continuously evolve and adapt the curriculum. The three-course series-including Introduction to Public Health, Public Health Issues in Hawai'i, and Introduction to Global Health-was designed to provide incoming undergraduate public health students with a foundation in local, national, and global public health concepts and domains, while improving their skills in public health communication and information literacy. Data from class assignments, examinations, and later coursework suggest students are mastering the course materials and gaining required competencies. Data from course evaluation and exit questionnaires suggest that the students appreciate the series' approach and the challenge to apply course concepts locally and globally in subsequent courses. This foundational public health series provides a model for an introductory course series that can be implemented with existing resources by most programs, meets the new CEPH requirements, is well-received by students, and prepares students well for upper-division public health courses.

E-cigarette advertising exposure and implicit attitudes among young adult non-smokers.

BACKGROUND: This study tested whether exposure to e-cigarette advertising affects the subliminal-spontaneous or automatic-attitudes towards e-cigarettes as a more pleasant or safer alternative to cigarettes among non-smoking young adults. METHODS: 187 young adult (mean age=21.9; SD=4.1) current non-smokers who had never used an e-cigarette were randomly assigned to one of the 3 conditions that involved viewing magazine advertisements. Two of the 3 conditions were experimental conditions where thematically different [harm-reduction ("Health") vs. social enhancement ("Social") focused] e-cigarette ads were interspersed among ads of everyday objects. The third condition was the control condition in which participants viewed ads of everyday objects only. Participants provided data on explicit (e.g., harm perceptions) and implicit [e.g., Implicit Association Test (IAT), Affect Misattribution Procedure (AMP)] measures after viewing the ads. RESULTS: Relative to the Control condition, participants in the Social condition showed 2.8 times higher odds of being open to using an e-cigarette in the future. Participants in the Health condition showed significantly higher implicit attitudes towards e-cigarettes as a safer alternative to cigarettes than participants in the Control condition. E-cigarette stimuli elicited more positive spontaneous affective reactions among participants in the Social condition than participants in the Health condition. CONCLUSIONS: E-cigarette ads may implicitly promote e-cigarettes as a reduced-harm cigarette alternative. Marketing of e-cigarette use as a way to enhance social life or self-image may encourage non-smoking young adults to try e-cigarettes. Findings may inform regulations on e-cigarette marketing.

Receptivity to e-cigarette marketing, harm perceptions, and e-cigarette use.

OBJECTIVE: To test whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes. METHODS: Data were collected from 307 multiethnic 4- and 2-year college students; approximately equal proportions of current, never, and former cigarette smokers [mean age = 23.5 (SD = 5.5); 65% female]. RESULTS: Higher receptivity to e-cigarette marketing was associated with perceptions that e-cigarettes are less harmful than cigarettes, which in turn, were associated with higher recent e-cigarette use. CONCLUSIONS: The findings provide preliminary support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults. The findings have implications for development of e-cigarette regulations.

Examining Factors Associated with Heavy Episodic Drinking Among College Undergraduates.

Heavy episodic drinking among college students is a serious health concern. The purpose of this study was to identify factors associated with heavy episodic drinking behaviors amongst a predominately Asian undergraduate college student population in the United States. A survey measuring alcohol use behaviors was completed by a random sample of 18-24 year old undergraduates during April, 2011. A multivariate logistic regression analysis was conducted to determine factors associated with students' heavy episodic drinking behavior. Independent factors associated with heavy episodic drinking included living on campus, ethnicity, perceived drinking behavior among peers, and a belief that alcohol is a central part of one's social life. Heavy episodic drinking was also associated with poor academic performance. Campus-wide educational strategies to reduce heavy episodic drinking among college undergraduates should incorporate accurate information regarding alcohol use norms to correct students' perceived over estimation of their peers alcohol consumption rates and the under estimation of students protective alcohol use behaviors. These efforts should focus in on-campus residence halls where a higher occurrence of heavy episodic drinking is often found.

Education and self-rated health: An individual and neighborhood level analysis of Asian Americans, Hawaiians, and Caucasians in Hawaii.

Focusing on Asian Americans, Hawaiians, and Caucasians in Hawaii, this study contributes to the literature by examining (1) the geographical distributions of education in relation to self-rated general health at neighborhood levels, and (2) the individual variations in self-rated health by ethnicity and education at both individual and neighborhood levels. Using the 2007 Hawaii Health Survey with linked zip-code information, and applying GIS (Geographic Information System) and binary logistic regression models, this study found that (1) there are significant between ethnic differences in self-rated health in Hawaii, with Hawaiians being the most disadvantaged population compared to Japanese, Chinese, and Caucasians; (2) individual socioeconomic characteristics are all related to self-rated health, and education (in particular) mediates the Japanese vs. Hawaiian and Chinese vs. Hawaiian health differences; (3) the neighborhood level of education has an independent effect on self-rated health over and above individual characteristics for the whole sample and it partially mediates the between ethnic health differences; and (4) the relative importance of education to self-rated health is more significant and salient for Caucasians and Japanese/Chinese than for Filipinos and Hawaiians. In sum, this study not only demonstrates a geographical profile of health and education distributions in Hawaii, but also reveals significant mediating effects of education, at both individual and neighborhood levels, in explaining the between and within ethnic differentials in self-rated health.