Advanced Public Health Research Articles

Advancing Public Health Through Tax-Exempt Hospitals: Nonprofits’ Revenue Streams and Provision of Collective Goods

Nonprofit organizations play an essential role in the provision of collective goods. Focusing on a unique subsector in the United States, this study examines the extent to which nonprofit hospitals’ provision of community benefits is related to their revenue streams. Building on existing theories, we postulate that as the proportion of a certain revenue source (i.e., government grants, private contributions, and program fees) increases, its corresponding benefits also increase. Using data from the Internal Revenue Service (IRS) 990 filed by tax-exempt hospitals nationwide, we performed panel data analysis with year and id fixed effects using robust standard errors. The findings show that the proportion of private donations is positively associated with community benefits, whereas that of program income is negatively related to community benefits. Overall, nonprofits’ decision to serve disadvantaged groups and larger communities is associated with their income sources. The study raises implications that are pertinent to nonprofit management, public administration, and health administration.

Addressing Knowledge Gaps in Adolescent Nutrition: Toward Advancing Public Health and Sustainable Development

ABSTRACTAdolescence marks a critical period of growth in the life course. Malnutrition among adolescents includes suboptimal dietary intake of macronutrients and micronutrients as well as overweight and obesity linked to poor dietary quality. We discuss adolescent nutrition and outline 3 knowledge gaps toward advancing adolescent health. First, micronutrient and macronutrient supplements have significant potential to improve nutritional status, but information on the most effective implementation strategies is lacking. Second, food system interventions offer a promising avenue to improve access to healthy foods, and school settings may be an important entry point for improving diets. Third, nutrition programs should be combined with delayed pregnancy interventions for greatest impact given the adverse effects of early pregnancy on maternal and infant health and nutrition outcomes. Evidence-based solutions for adolescent nutritional supplementation, food system and dietary intake interventions, and integration with sexual and reproductive health strategies present crucial opportunities for improving adolescent health and well-being.

Advancing Public Health Education Through Place-Based Learning: “On the Road in the Deep South”

Documented health disparities among racial and ethnic minorities exist in the United States, and health injustices frequently have deep historical ties, especially in the South. Therefore, it is critically important for students to understand root causes of both historical and contemporary public health issues and their effects on population health. In spring 2018, 15 undergraduate and graduate students from the University of Alabama at Birmingham participated in a six-credit-hour travel course by touring throughout the Deep South to learn more about the ways in which history and place interact with programs, policies, and practices to influence population health. Students saw firsthand how the social determinants of health frequently affected access to health care and discovered the value of a multidisciplinary approach to public health and health programs in addressing health equity. The purpose of this article is to describe student experiences with the travel course through an exploration of students’ reflective journal entries, blog posts, and student presentations. Additionally, the authors report results of a self-assessment designed to measure student interest and level of comfort in working with, or on behalf of, medically underserved populations. The article concludes with implications for public health and best practices for offering place-based courses across academic majors.

Challenges and Opportunities for Using Big Health Care Data to Advance Medical Science and Public Health.

Methodological advancements in epidemiology, biostatistics, and data science have strengthened the research world's ability to use data captured from electronic health records (EHRs) to address pressing medical questions, but gaps remain. We describe methods investments that are needed to curate EHR data toward research quality and to integrate complementary data sources when EHR data alone are insufficient for research goals. We highlight new methods and directions for improving the integrity of medical evidence generated from pragmatic trials, observational studies, and predictive modeling. We also discuss needed methods contributions to further ease data sharing across multisite EHR data networks. Throughout, we identify opportunities for training and for bolstering collaboration among subject matter experts, methodologists, practicing clinicians, and health system leaders to help ensure that methods problems are identified and resulting advances are translated into mainstream research practice more quickly.

Using a Studio-Academic Partnership to Advance Public Health Within a Pragmatic Yoga Setting.

Objectives: To explore community-based yoga studio practitioners’ psychosocial variables, behaviors, and studio satisfaction. Methods: Concurrent mixed-methods study consisted of a survey for demographic variables and psychosocial variables of interest (e.g., mindfulness, self-compassion, physical activity participation) and interviews regarding reasons for participating at the yoga studio. Results: Participants (N = 138) were, on average, 35.58 ± 14.09 years old and predominantly female (91.3%), married (40.6%) or single (37%), Caucasian (75%), and college (25.4%) or graduate/medical school (45%) educated, with 54% meeting physical activity recommendations. On a 5-point Likert-type scale, participants reported being moderately cohesive (Msumscore = 3.87 ± 0.62), stressed (Msumscore = 3.2 ± 0.39), mindful (Msumscore = 3.4 ± 0.41), and self-compassionate (Msumscore = 3.26 ± 0.56). A rapid content analysis of interviews (n = 18), indicated that participants primarily practiced at the studio for the sense of community. Conclusions: Yoga practitioners reported positive perceptions and behaviors; however, opportunities remain for interventions to improve mental and physical health among individuals already attending a yoga studio. Through an academic-studio partnership, studio offerings may include low-dose evidence-based interventions to improve access to and uptake of a yoga practice.

The New Harvard Doctor of Public Health: Lessons From the Design and Implementation of an Innovative Program in Advanced Professional Leadership.

We documented lessons learned in the initial design and development of the new Harvard doctor of public health (DrPH) degree, an innovative professional public health doctorate designed to provide advanced education in the field of public health. Using data from program documents, personal participation in the development and administration of the degree, and initial students' results, we present key learnings from this experience and describe the program's goals and processes. Now entering its fifth year, the new Harvard DrPH program has enrolled about 70 students and graduated its first 2 classes in a program that combines advanced public health study with leadership development and field engagement. Development of this transformational innovation in advanced public health education required creative approaches to competency development and curriculum design, engagement of faculty to become supportive stakeholders, and substantial support for educational administration. Demand for a program of this type is strong. Continuous improvement is ongoing.

Advancing Public Health Policy in Louisiana Through Evidence-Based Strategies: Successes and Opportunities.

In 2013, a team of public health professionals at Tulane University launched a project to explore strategies for shaping a healthier Louisiana. The team investigated methods for improving diet and physical activity behaviors in early childhood, school, and community settings that could be translated into specific policies. Through key informant interviews and scans of academic journals and reports issued by public health agencies, the team generated a set of actionable steps that could increase healthful behaviors. Previous efforts to address similar topics in Louisiana and other states, and their reception from policy makers, were also considered during analysis. Subsequently, a state legislator used the team's work to introduce public health legislation in 2014. The legislation led to a number of incremental changes in state policy and resolutions for additional policy-relevant studies. This case study summarizes the promising physical activity and nutrition strategies that were considered by the Tulane team, how the team's work product was integrated into state legislation, the outcomes of the legislation, and a set of recommendations for how Louisiana can expand on this work. This article demonstrates how the work of public health professionals can have a positive influence on the policy-making process through research and education.

Investigating a foodborne illness outbreak at a private girls' school in Mashonaland East Province, Zimbabwe, 2015.

Globally, it is estimated that foodborne-associated illness accounts for 2.2 million deaths. This is caused by contamination of food with toxins, parasites, bacteria or viruses that can lead to increased levels of morbidity and mortality. Although steps to conducting an outbreak investigation have been outlined in most epidemiology textbooks, identifying the causative agent for a foodborne illness outbreak can be complex based on the setting. In view of that, this case study was developed based on a foodborne illness outbreak at agirls’ boarding school to model the steps of an investigation. This case study will reinforce skills and theoretical knowledge attained by public health trainees, to be able to build competences in foodborne outbreak investigation. The target audiences are intermediate and advanced public health trainees. Estimated time of facilitation is 3 hours with a class size of 10- 20 students.

Addressing the Antinomy Between Health Education and Health Literacy in Advancing Personal Health and Public Health Outcomes.

Health literacy evolved from a standard of English language proficiency designed to promote patient compliance into an inferential for promoting positive health decision-making and health outcomes. In turn, the United States relegated health literacy as a national strategy to improve personal health and health care outcomes as well as reduce national health care expenditures. We reviewed the literature to assess the empirical research about health literacy and health behavior and health status outcomes. There is a paucity of empirical research supporting health literacy's capacity to improve personal health behavior or health outcomes. We submit that the process of acquiring scientifically valid health knowledge partnered with the skills for informed health decision-making as well as motivation to foster positive health behaviors and health outcomes is that of health education, and not that inferred by health literacy competency. We recommend that comprehensive school health education serve as the standard for advancing personal health and health outcomes. We recommend that elementary, secondary, and higher education institutions be charged with the objective to provide comprehensive school health education intervention to advance personal health, community health, and concomitantly moderate national health care expenditures.

Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice

Prevention of Legionnaires’ Disease in the 21st Century by Advancing Science and Public Health Practice

National Antimicrobial Resistance Monitoring System: Two Decades of Advancing Public Health Through Integrated Surveillance of Antimicrobial Resistance.

Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the United States Department of Agriculture, and state and local health departments, NARMS uses an integrated “One Health” approach to monitor antimicrobial resistance in enteric bacteria from humans, retail meat, and food animals. NARMS has adapted to changing needs and threats by expanding surveillance catchment areas, examining new isolate sources, adding bacteria, adjusting sampling schemes, and modifying antimicrobial agents tested. NARMS data are not only essential for ensuring that antimicrobial drugs approved for food animals are used in ways that are safe for human health but they also help address broader food safety priorities. NARMS surveillance, applied research studies, and outbreak isolate testing provide data on the emergence of drug-resistant enteric bacteria; genetic mechanisms underlying resistance; movement of bacterial populations among humans, food, and food animals; and sources and outcomes of resistant and susceptible infections. These data can be used to guide and evaluate the impact of science-based policies, regulatory actions, antimicrobial stewardship initiatives, and other public health efforts aimed at preserving drug effectiveness, improving patient outcomes, and preventing infections. Many improvements have been made to NARMS over time and the program will continue to adapt to address emerging resistance threats, changes in clinical diagnostic practices, and new technologies, such as whole genome sequencing.

Exploring collaboration in a community‐academic partnership

Community-academic relationships characterized by collaboration can contribute to the preparation of public health nursing students, sustainability of partnerships over time, and innovative solutions to pressing health problems. The purpose of this study was to describe and understand relationship characteristics in a community-academic partnership over time and how the relationship could be improved. A descriptive case study was conducted. Study participants included partnership staff, organizational leaders, community residents, and student nurses involved in the partnership between 2011 and 2015. Methods included focus groups, documents, interviews, and surveys. Four main themes emerged and include analysis findings that capture the relationship characteristics between partners and how the relationship could be improved: Time, Communication, Goals, and Sharing. Findings on how to improve relationship characteristics offer clear suggestions for academic and community partners on ways to move toward collaborative partnerships that can address health inequities and develop a competent and advanced public health nursing workforce in the 21st century.

Advancing Public Health Using Regulatory Science to Enhance Development and Regulation of Medical Products: Food and Drug Administration Research at the Center for Biologics Evaluation and Research

Center for Biologics Evaluation and Research enhances and supports regulatory decision-making and policy development. This work contributes to our regulatory mission, advances medical product development, and supports Food and Drug Administration’s regulatory response to public health crises. This review presents some examples of our diverse scientific work undertaken in recent years to support our regulatory and public health mission.

Parent-adolescent relationships in Hispanic versus Caucasian families: Associations with alcohol and marijuana use onset

Parent-adolescent relationship (PAR) factors such as social support and negative interactions are associated with initiation of alcohol and marijuana use during adolescence. However, few studies have examined whether the relationship between PAR, especially the paternal role, and substance use onset varies by ethnicity. This is important given that ethnic group differences have been related to alcohol and marijuana use, cultural values and parenting. This study examines whether ethnicity moderates the prospective prediction of substance use onset by PAR factors. The sample comprised 124 adolescents who self-identified as Hispanic and 795 adolescents who self-identified as non-Hispanic Whites, and was drawn from an ongoing longitudinal survey on adolescent substance use. Discrete-time survival modeling was used to prospectively predict age at onset of substance use among participants who were substance-naïve at baseline. Interactions between ethnicity and PAR factors indicated that PAR factors had a larger influence on age of alcohol and marijuana onset for Hispanics than for Caucasians. Among Hispanics, greater social support from and greater negative interactions with the father-figure were more predictive of earlier onset of alcohol, and greater social support from the mother-figure was more predictive of later alcohol onset, compared to Caucasians. Similarly, greater negative interactions with the father-figure were more predictive of earlier onset of marijuana use among Hispanics than among Caucasians. These findings suggest the influence of PAR on alcohol and marijuana use onset may be larger for Hispanics than for Caucasians. Incorporating these parenting factors in substance use prevention programs advances public health in a culturally sensitive manner that is relevant to at-risk Hispanic adolescents.

The Role of the Public Health Training Centers in Advancing Public Health Department Accreditation

In the past few years, the drive for public health department accreditation has continued to build momentum. As the Centers for Disease Control and Prevention notes, “Engaging in accreditation catalyzes quality and performance improvement within all public health programs and can help health departments be better prepared to proactively respond to emerging and reemerging health challenges”. Many organizations support accreditation efforts, including the Public Health Training Centers (PHTCs), which have been providing workforce development support since 1999. This article describes how one PHTC, the Midwestern Public Health Training Center, has supported capacity building for accreditation in partnership with other state-based organizations through the development of three major accreditation readiness activities: accreditation workshops, informational videos on Public Health Accreditation Board standards and measures, and competency-based workforce development assessments. Given the current and emerging public health challenges, the need for a well-prepared workforce is more important than ever to strengthen the public health system, and by engaging in activities to meet the accreditation standards, public health departments will be better positioned to respond to these challenges. PHTCs will continue to have a critical role in capacity building for accreditation.

Schooling and Children's Mental Health: Realigning Resources to Reduce Disparities and Advance Public Health.

Schools have long been the primary setting for children's mental health services but have neither the resources nor the expertise to manage these services independently. The critical importance of school success for children's adjustment provides a strong rationale for schooling as an essential component of children's mental health services. In this article, we review evidence for how schooling and mental health coalesce, suggesting an alignment of school and community mental health resources that prioritizes successful schooling as a key mental health outcome. We describe collaborative principles and ecological practices that advance a public health focus on children's mental health while also reducing the burden on schools to maintain mental health services. We close with a model of mental health services illustrating these principles and practices in high-poverty urban schools and propose future directions for research and practice to promote positive mental health for all children and youth.

Redefining public health leadership in the sustainable development goal era.

Adoption of the Sustainable Development Goals (SDGs) by member states of the United Nations (UN) has set a new agenda for public health action at national and global levels. The changed context calls for a reframing of what constitutes effective leadership in public health, through a construct that reflects the interdependence of leadership at multiple levels across the health system and its partners in other sectors. This is especially important in the context of Low and Middle Income Countries (LMICs) that are facing complex demographic and epidemiological transitions. The health system needs to exercise leadership that effectively mobilises all its resources for maximising health impact, and channels trans-disciplinary learning into well-coordinated multi-sectoral action on the wider determinants of health. Leadership is essential not only at the level of inspirational individuals who can create collective vision and commitment but also at the level of supportive institutions situated in or aligned to the health system. In turn, the health system as a whole has to exercise leadership that advances public health in the framework of sustainable development. This commentary examines the desirable attributes of effective leadership at each of these levels and explores the nature of their inter-dependence.

The DNP/MPH Dual Degree: An Innovative Graduate Education Program for Advanced Public Health Nursing.

Strong professional priorities, evolving Affordable Care Act requirements, and a significantly limited public health nursing workforce prompted the University of Colorado College of Nursing to collaborate with the School of Public Health to implement one of the first Doctor of Nursing Practice/Master of Public Health dual degree programs in the nation. Federal grant funding supported the development, implementation, and evaluation of this unique post-baccalaureate dual degree program, for which there were no roadmaps, models, or best practices to follow. Several key issues emerged that serve as lessons learned in creating a new, novel higher education pathway for Advanced Public Health Nursing. This paper highlights two of those: (1) marketing, admission, and matriculation across two programs, and (2) enhancing curricula through distance coursework and interprofessional education. When collaboration with a school of public health is possible, the Doctor of Nursing Practice/Master of Public Health dual degree is an efficient way to prepare public health nurses' with the highest level of public health knowledge, practice, and leadership expertise.

Advancing Public Health on the Changing Global Trade and Investment Agenda Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

Concerns regarding the Trans-Pacific Partnership (TPP) have raised awareness about the negative public health impacts of trade and investment agreements. In the past decade, we have learned much about the implications of trade agreements for public health: reduced equity in access to health services; increased flows of unhealthy commodities; limits on access to medicines; and constrained policy space for health. Getting health on the trade agenda continues to prove challenging, despite some progress in moving towards policy coherence. Recent changes in trade and investment agendas highlight an opportunity for public health researchers and practitioners to engage in highly politicized debates about how future economic policy can protect and support equitable public health outcomes. To fulfil this opportunity, public health attention now needs to turn to strengthening policy coherence between trade and health, and identifying how solutions can be implemented. Key strategies include research agendas that address politics and power, and capacity building for both trade and health officials.

Updated competencies for the dental public health specialist: using the past and present to frame the future.

A new set of competencies for entry-level specialists in dental public health (DPH) developed in 2016 updates the 1998 version. Our objective is to provide some context and perspective on this update. We discuss the evolution of this dental specialty, how it differs from other dental specialties, and its importance for the public's oral health. Some societal trends that provide the rationale for this update are summarized. The ways in which this set of competencies differs from the last version are described. The first set of behavioral objectives was established in 1974 and updated at workshops in 1988 and 1997. Advanced population-based knowledge and public health perspectives beyond that obtained in predoctoral dental education continue to be essential for the nation's oral health. Since 1998, the impact of the digital age, advances in science and technology, changes in population demographics, health status and increasing inequalities, treatment needs, prevention and treatment modalities, healthcare delivery systems, financing, personnel, legislation, and regulations have all influenced DPH practice. The updated competencies include guiding principles for the specialty, a new focus on social determinants of health, and more flexibility to address the increasing complexity and interdisciplinary nature of public health problems and the expanding knowledge and skills needed to address them. The rapid expansion of public health education might serve as an important pipeline for future DPH specialists. The updated competencies can guide the educational preparation of DPH specialists and are aligned with the rapidly changing environment.