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.

Ang Kalusugan at Kayamanan: The Health and Wealth of Hawai'i Filipinos.

BACKGROUND: Many Filipinos suffer from high rates of chronic diseases, while systemic and cultural barriers make it challenging for them to access care. Culturally relevant programs that integrate community perspectives and values are essential to improve Filipino health. OBJECTIVES: To understand how health may be improved using self-identified community strengths and assets, researchers partnered with Filipino residents of the Kalihi neighborhood in Honolulu, Hawai'i. METHODS: Researchers conducted a focused ethnographic study in spring 2016 with 52 adult residents of Kalihi to document Filipino perspectives on the overlapping concepts of health and wealth. Specifically, facilitators led culture circles, resulting in semi-structured discussions of community wellness. RESULTS: Participants shared perspectives of Filipino community health and wealth, resulting in 2 categories-self and relationships, 14 thematic codes and 7 definition components. These components informed the development of a new holistic health framework. The proposed framework may inform the development of more effective health programs rooted in extant community assets. DISCUSSION: This study sought to empower Filipino residents by acknowledging their views on wellness and prosperity that may not be reflected in conventional health care models. Further research is needed to deepen the understanding of the complex cultural relationships between health and wealth in communities of color.

Community Health Scholars: a summer program developing a public health workforce pipeline for diverse high school students.

In response to the growing interest in public health and needs to both increase and diversify the public health workforce, opportunities to engage students early in their educational journey are essential. The University of Hawai'i at Manoa launched the Community Health Scholars Program to provide activities for high school students to learn about and build enthusiasm for the field of public health. During the 6-week, in-person summer program, students underrepresented in higher education and who are from historically underrepresented communities completed a college course and participated in activities to enhance their successful entry into a higher education institution. The Community Health Scholars completed an introduction to public health course and gained an array of public health skills through different hands-on activities. The students gained self-confidence and expanded their social capital by attending workshops led by campus faculty, staff, and community partners. A final project highlighting what students learned about themselves and their community was part of a final program showcase. Here we share information about the process of developing the program, the components of the program curriculum, and feedback from both students of the initial cohort and program faculty, where overall satisfaction with the program was reported.

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.

Comparative Analysis of Metabolic Syndrome Diagnostic Criteria and Its Effects on Prevalence in a Multiethnic Population.

Background: Accurate prevalence measurement and diagnosis to prevent type 2 diabetes mellitus and cardiovascular disease cannot occur without consistent diagnostic criteria that can be applied to varying populations. Objective: The objective of this study was to determine the prevalence of metabolic syndrome in Caucasian, Filipino, Native Hawaiian, and Japanese populations utilizing different definitions. Methods: This study utilized cross-sectional study data from the Native Hawaiian/Multiethnic Health Research Project, collected from a population living in Kohala, Hawai'i. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPII), International Diabetes Federation (IDF), and World Health Organization (WHO) definitions were utilized, and each of the 1452 participants were evaluated on the criteria for metabolic syndrome based on all three definitions. Additionally, the average biomarker values associated with the diagnosis were taken for each ethnic group represented in the study and compared with Caucasians. Results: The overall prevalence of metabolic syndrome in this population varied from 22.31% to 39.05% using the different definitions. Ethnic disparities also occur, implying that certain populations are more prone to having severe abnormalities than others-shown when comparing the average biomarker values associated with metabolic syndrome diagnosis. Of all ethnic groups included in the study, Caucasians had the lowest prevalence of metabolic syndrome, while part-Hawaiians had the highest prevalence. Additionally, within the same ethnic group, the definitions yielded varying prevalence values. Conclusions: This implies that discrepancies exist among the criteria alone. Implications of this study revolve around not only the correct definition to apply to the population being studied but also the most accurate way to detect certain biomarker abnormalities to accurately assess the prevalence of metabolic syndrome in a multiethnic population.

Evaluating Potential Mosquito Breeding Sites on a University Campus.

In recent decades, mosquito-borne diseases (MBDs) such as Zika, chikungunya, malaria, and dengue have spread to more urban areas previously free of such diseases. Globalization has increased the infection potential for diseases and their vectors, placing tropical tourist destinations, such as Hawai'i, at risk for MBD epidemics. A cross-sectional study was conducted on the University of Hawai'i at Manoa campus to assess potential mosquito breeding sites. The campus was stratified by land use designation and randomly sampled. Residential areas had the highest potential for breeding sites with high numbers of discarded plastic food and beverage containers. Recommended prevention strategies to curb littering in the residential area include awareness campaigns and encouraging collaboration between maintenance authorities to enhance oversight. This study highlights the importance of individual awareness and prevention of environment modifications that could contribute to the development of mosquito breeding sites.

Using Deliberative Pedagogy as a Tool for Critical Thinking and Career Preparation Among Undergraduate Public Health Students.

Engagement of undergraduate public health students in active learning pedagogy has been identified as critical for recruitment, retention, and career preparation efforts. One such tool for engagement that has proven successful in STEM programs is deliberative pedagogy, where it is used to stimulate student interest in research and policy applications of technical course content. Broadly applied, deliberative pedagogy is a consensus model of decision-making, applied as an in-class exercise, where students work in small groups and model a community task force with assigned group roles. In these groups, students collect evidence from literature and media sources, and prepare a consensus response to an assigned question. Here we present an adaptation of this pedagogy to provide undergraduates with the tools needed to actively engage in public health policy and planning work groups. This adaptation is first applied during an introductory public health course, where it is used as a tool for engagement and excitement, and as a critical thinking exercise. It additionally serves as an opportunity for students to apply information literacy skills and engage with research and policy initiatives discussed in class. The same tool is reintroduced prior to graduation in a capstone course, where the emphasis shifts to application of research skills and analytical concepts. The activity is also an opportunity for students to apply professional skills needed for engagement in program development, program evaluation, institutional policy, and legislative advocacy. Through application of this pedagogical tool at two critical time points in an undergraduate curriculum, students develop skills necessary for early career professionals and are better prepared to actively engage in policy and planning as it relates to critical public health initiatives, both locally and globally.

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.

Using spatial analysis to examine best placement of electronic benefit transfer services at farmers' markets in Honolulu County, Hawaii, USA.

OBJECTIVE: Farmers' market interventions are a popular strategy for addressing chronic disease disparities in low-income neighbourhoods. With limited resources, strategic targeting of interventions is critical. The present study used spatial analysis to identify where market interventions have the greatest impact on healthy food access within a geographic region. DESIGN: All farmers' markets in a mixed urban/rural county were mapped and those that accepted Supplemental Nutrition Assistance Program (SNAP) electronic benefit transfer (EBT) cards identified. Households were grouped into small neighbourhoods and mapped. The area of 'reasonable access' around each market (walking distance (0·8 km; 0·5mile) in urban areas, driving distance (15 min) in rural areas) was calculated using spatial analysis. The percentage of county low-income households within a market's access area, and the percentage of county SNAP-participating households within an EBT-accepting market's access area, were calculated. The ten neighbourhoods with the most low-income households and with the most SNAP-participating households were then identified, their access areas calculated and mapped, and those lacking access identified. County-level gains resulting from improving market accessibility in these areas were calculated. SUBJECTS: None. SETTING: Honolulu County, Hawaii, USA. RESULTS: Only 44 % of SNAP-participating households had EBT-market access. Six of the ten highest SNAP-participant neighbourhoods lacked access. Improving access for these neighbourhoods increased county-level access by 23 %. Market access for low-income households was 74 %. Adding markets to these low-income neighbourhoods without market access increased county-level access by 4 %. CONCLUSIONS: Geographic identification of market access demographics, and strategic targeting of EBT interventions, could improve regional access to healthy foods.

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.

Key Factors in Obstetric Delivery Decision-Making among Asian and Pacific Islander Women by English Proficiency.

Childbirth is the most common reason women are hospitalized in the United States. Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. Diverse Asian American and Pacific Islander (AA/PI) perspectives on such topics are understudied, particularly among those with limited English proficiency (LEP). LEP is defined as having a limited ability to read, write, speak, or understand English. To address this research gap, we interviewed 400 women (18+ years) with a recent live birth on O'ahu, Hawai'i. Participants completed a 1-hour, in-person interview in English (n=291), Tagalog (n=42), Chinese (n=36), or Marshallese (n=31). Women were asked (1) what information was most important in deciding where to deliver and why; and (2) who participated in the decision-making and why. Responses were compared by LEP (n=71; 18%) vs English-proficient (n=329; 82%) in qualitative and quantitative analyses. Both LEP and English-proficient participants reported their obstetrician as the most important source of health information. Significantly more LEP participants valued advice from family or acquaintances as important sources of information compared to English-proficient participants. The top three health decision-makers for both those with LEP and English-proficient participants were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency. These findings provide insights into health information sources and decision-making across diverse AA/PI populations, including those with LEP, and can help direct health interventions such as disseminating patient education and healthcare quality information.

Insights in Public Health: Training Today's Students to Meet Tomorrow's Challenges: Undergraduate Public Health at the University of Hawai'i at Manoa.

The University of Hawai'i at Manoa (UHM) has long provided public health graduate education. The University's Office of Public Health Studies (OPHS) has recently started to offer a Bachelor of Arts in Public Health (BA PH) degree in response to the growing need for professionals in the health field. The purpose of this paper is to describe how UHM operates the BA PH and how the program complements OPHS's mission and goals. First, we describe the overall scope of the BA PH within OPHS and within UHM. Then we provide examples of how the BA PH program and past undergraduate student projects align with OPHS's four main goals: (1) education, (2) research, (3) service, and (4) program development.

Developing an undergraduate applied learning experience.

To foster student development, critical thinking, and application skills among public health students at the University of Hawai'i at Manoa, a three-course capstone series was developed as a key component of the public health Bachelor of Arts degree program. Over the course of 1.5 academic years students are actively involved in developing an interdisciplinary project proposal, then executing and presenting an independent, supervised, applied learning project. In the first course, students are introduced to a diverse range of public health projects and methods while working to develop their own project proposal - the foundation for the applied learning experience. The project execution course is designed to allow students to execute their proposed applied learning projects. This experience focuses on the application and integration of public health knowledge, skills, and practice acquired during the bachelor's degree course of study. Finally, students will be involved in reflecting on, finalizing, and sharing their completed projects in an undergraduate capstone seminar. Through implementation of this series, the program hopes to provide students with the opportunity to actively apply academic skills to real-world application.