Equipping the Public Health Workforce of the Future: Evaluation of an Evidence-Based Public Health Training Delivered Through Academic-Health Department Partnerships.

OBJECTIVE: Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC). DESIGN: Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022. SETTING: Four US sites, each a partnership between a PRC, local or state health department, and a PHTC. PARTICIPANTS: Governmental public health staff and representatives from other organizations that implement public health programs in practice settings. MAIN OUTCOME MEASURES: Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n = 15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes. RESULTS: Statistically significant increases in all skills were observed from pre- to postcourse (n = 241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change = 1.22, standard error [SE] = 0.05) and developing an action plan (mean change = 1.07, SE = 0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course. CONCLUSIONS: Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.

Contextualizing Adverse Childhood Experiences: The Intersections of Individual and Community Adversity.

Adverse Childhood Experiences (ACEs) are traumatic childhood events that can undermine youth development, and are linked to chronic health problems, mental illness, and risk-taking behaviors in adulthood. ACEs are preventable, yet effective response strategies require comprehensive conceptualization and measurement of adversity. Although typically measured as individual experiences in the family and home (e.g., abuse, neglect), adversity also exists outside the home, in the many contexts in which youth development unfolds (e.g., communities, neighborhoods). Yet, such contexts and experiences are often absent in ACEs research. Using data from a nationally representative youth sample, this study addresses that gap, advancing a measure that contextualizes individual-level ACEs within social and structural domains of community-level adversity. Among 13,267 youth (mean age = 15.25 [range 12-18]; 51% female; 71% White; 13% Black; 10% Hispanic; 3% Asian; 2% American Indian/Multiracial), 61% and 73% were exposed to at least one individual and community ACE, respectively, while 15% of youth reported severe individual ACE exposure (≥3 ACEs) and 20% were exposed to severe (≥3) community ACEs. All ACE exposures were associated with problem behaviors later in adolescence, but youth reporting both severe individual and community ACEs were especially at high risk for later violence, delinquency, and other health-risk behaviors. These findings highlight that community adversity exacerbates the damaging effects of individual/family adversity and thus should be addressed in efforts to prevent ACEs and reduce their long-term harm.

Lost potential and missed opportunities for DCD liver transplantation in the United States.

BACKGROUND: Donation after cardiac death(DCD) has been proposed as an avenue to expand the liver donor pool. METHODS: We examined factors associated with nonrecovery of DCD livers using UNOS data from 2015 to 2019. RESULTS: There 265 non-recovered potential(NRP) DCD livers. Blood type AB (7.8% vs. 1.1%) and B (16.9% vs. 9.8%) were more frequent in the NRP versus actual donors (p < 0.001). The median driving time between donor hospital and transplant center was similar for NRP and actual donors (30.1 min vs. 30.0 min; p = 0.689), as was the percentage located within a transplant hospital (20.8% vs. 20.9%; p = 0.984).The donation service area(DSA) of a donor hospital explained 27.9% (p = 0.001) of the variability in whether a DCD liver was recovered. CONCLUSION: A number of potentially high quality DCD donor livers go unrecovered each year, which may be partially explained by donor blood type and variation in regional and DSA level practice patterns.

County-level Differences in Liver-related Mortality, Waitlisting, and Liver Transplantation in the United States.

BACKGROUND: Much of our understanding regarding geographic issues in transplantation is based on statistical techniques that do not formally account for geography and is based on obsolete boundaries such as donation service area. METHODS: We applied spatial epidemiological techniques to analyze liver-related mortality and access to liver transplant services at the county level using data from the Centers for Disease Control and Prevention and Scientific Registry of Transplant Recipients from 2010 to 2018. RESULTS: There was a significant negative spatial correlation between transplant rates and liver-related mortality at the county level (Moran's I, -0.319; P = 0.001). Significant clusters were identified with high transplant rates and low liver-related mortality. Counties in geographic clusters with high ratios of liver transplants to liver-related deaths had more liver transplant centers within 150 nautical miles (6.7 versus 3.6 centers; P < 0.001) compared with all other counties, as did counties in geographic clusters with high ratios of waitlist additions to liver-related deaths (8.5 versus 2.5 centers; P < 0.001). The spatial correlation between waitlist mortality and overall liver-related mortality was positive (Moran's I, 0.060; P = 0.001) but weaker. Several areas with high waitlist mortality had some of the lowest overall liver-related mortality in the country. CONCLUSIONS: These data suggest that high waitlist mortality and allocation model for end-stage liver disease do not necessarily correlate with decreased access to transplant, whereas local transplant center density is associated with better access to waitlisting and transplant.

Street Culture and Gun Violence: Exploring the Reputation-Victimization Paradox.

Anderson's thesis of a code of the street has been broadly applied to the study of violence, but race- and gender-specific multilevel analyses of gun violence are scant within the literature. An unresolved debate also surrounds the link between violent victimization and adherence to street culture; underscored by an apparent reputation-victimization paradox among those who engage in street behaviors. The current study contributes to the literature by assessing the direct influence of incident setting and victim-offender familiarity on the likelihood of gun use by Black males in the course of aggravated assaults; and the degree to which the confluence of these factors is conditioned by levels of disadvantage and violence in the community. To accomplish this, we apply hierarchical generalized linear modeling to incident-level data from the National Incident-Based Reporting System in conjunction with contextual-level data from the counties in which the incidents are nested. Our findings suggest victim-offender familiarity and public settings are negatively associated with gun violence and the confluence of these factors further reduces the probability of gun use. This relationship, however, is conditioned by levels of disadvantage and violence in the community, providing preliminary evidence of both the violence increasing and decreasing effects of street culture hypothesized by Anderson.