Public Health Framework Research Articles

Chronic Traumatic Encephalopathy as a Preventable Environmental Disease.

In this Perspective we explore the evolution of our understanding of chronic traumatic encephalopathy (CTE) and its relationship with repetitive head injury. As with many neurodegenerative conditions, there is an imperfect correspondence between neuropathology and clinical phenotype, but unlike other neurodegenerative diseases, CTE has a discrete and easily modifiable risk factor: exposure to repetitive head injury. Consequently, evaluation of the evidence regarding exposure to repetitive head injury and CTE risk should be undertaken using public or occupational health frameworks of medical knowledge. The current debate over the existence of CTE as a disease of concern is fuelled in part by immediate medico-legal considerations, and the involvement of high-profile athletes, with inevitable media interest. Moving beyond this debate has significant potential to address and reduce disease impact in the near future, and provide novel insights into mechanisms underlying abnormal protein accumulation in CTE and other neurodegenerative diseases.

Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory.

This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.

Exploring a public health approach to modern slavery: potential, problems and translating principles into practice

This reflective article was drafted in November 2020. Since this time, the authors have worked with the counter-slavery sector to co-develop a refined public health framework to address modern slavery (Such et al, 2021). Significant knowledge mobilisation has also occurred with a range of stakeholders, and the Independent Anti-Slavery Commissioner has encouraged the UK Home Office and the Home Secretary to embed a public health approach within the UK’s response to modern slavery (IASC/Home Secretary, 2021). Key references and insights from research in 2021 are available as a collection.

From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem.

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.

Utilizing Public Health Frameworks and Partnerships to Ensure Equity in DNA-Based Population Screening.

DNA-Based population screening in the United States has the promise to improve the health of all people in all communities. We highlight recent DNA-based population screening examples at the state, local, and individual level. Key public health principles and concepts with a focus on equity appear to be lacking in current efforts. We request ‘A Call to Action’ that involves all partners in DNA-based population screening. Potential actions to consider include: a) identification and elimination of systemic barriers that result in health inequities in DNA-based population screening and follow-up; b) creation of a national multidisciplinary advisory committee with representation from underserved communities; c) revisiting well-described public health screening principles and frameworks to guide new screening decisions and initiatives; d) inclusion of the updated Ten Essential Public Health Services with equity at the core in efforts at the local, state and national level.

Proposal for Life Course Intervention Researcher Core Competencies.

Proposal for Life Course Intervention Researcher Core Competencies.

Reciprocal associations between housing instability and youth criminal legal involvement: a scoping review

BackgroundYouth experiencing homelessness have disproportionate contact with the criminal legal system. This system contact represents a critical inflection point for enhancing risk or opportunities for stabilization; however, the policy and scholarly traditions examining the criminal legal system have not traditionally incorporated housing or other social determinants as a central focus of intervention.MethodsWe conducted a scoping review using PRISMA-ScR guidelines to examine how the research literature is currently addressing housing within the context of youth involvement in the legal system. Databases searched included PubMed, Web of Science, and Academic Search Complete. Google Scholar was used to identify papers not indexed in the academic databases of interest. Database searches were conducted between September and December 2019 and articles were restricted to those published in English between the year 2000 and 2019. Key study components extracted included demographic information regarding each sample, type of article, study methodology, direction of effects of interest, outcome measures and primary findings, as well as theoretical frameworks engaged by the authors.ResultsThe search results returned 2154 titles for review. After screening all 2154 titles, 75 met eligibility for inclusion. reviews were conducted for all 75 papers. 36 abstracts met eligibility criteria and underwent full-text review. Ultimately, 29 articles satisfied eligibility criteria and were included in this scoping review.ConclusionsPublications are primarily focused on the social epidemiology of risk factors and behaviors determining youth justice contact, but relatively less so on studies of interventions targeting youth delinquency, crime reduction, or recidivism that included housing support. The lack of continuity in theorizing from epidemiology to applied science in this area represents a gap in the literature that is likely reducing the effectiveness of interventions to interrupt patterns of legal system contact for youth. Integrating a public health framework that emphasizes the upstream social determinants leading to contact with the youth justice system would represent a paradigm shift for the field that would have beneficial effects on long term health outcomes for youth.

Central and territorial governmental institutions involved in health promotion for older people in European Union countries


 Defining, planning and achieving health goals including health promotion and health promotion for older people (HP4OP) are always the responsibility of the public authority. In European countries the public health and health promotion strategic framework, including HP4OP is provided by the ministry of health or others national public health organisations, which are responsible for defining of legal regulations on the different aspects of health promotion.
 The goal of this article is the analysis of the central and territorial government (CTG) sector’s involvement in the issue of HP4OP, their functions, activities and responsibilities in this area. The analysis is focused on the main differences and similarities between CTG’s institutions.
 The authors triangulated data collected using varied methods: literature review, questionnaire research (conducted in European Pro-Health 65+ project’s countries) and in-depth interviews with national experts from selected countries.
 In the majority of analysed countries, the central government and municipalities are the main stakeholders responsible for providing funding for these programs. The operational level for the implementation of majority HP4OP is the local level. Research countries have been identified as strongly varying in institutional, legal and political specificity. The analysis shows the increasing position of HP4OP in public health policy. Many of the identified problems come from the implementation of a fragmented approach, the duplication of efforts undertaken by different stakeholders and the lack of a co-ordinated strategy and dedicated legal regulations at both the national and regional/local levels.

From Pathology to Intervention and Beyond. Reviewing Current Evidence for Treating Trauma-Related Disorders in Later Life.

BackgroundAn emerging body of empirical research on trauma-focused interventions for older adults experiencing symptoms of posttraumatic stress disorder or PTSD has yielded encouraging results. Nevertheless, up to date, the evidence remains scattered and is developed within rather specific groups, while studies have focused mostly on individual psychopathology, overlooking the relevance of resilience and recovering in one's social environment.ObjectiveThis study aims at summarizing the emerging evidence on treating trauma-related disorders in older adults, followed by implications for clinical practice and future research. Specifically, the following research questions are addressed: Which factors may optimize access to intervention, what treatment benefits can be realized, and how to improve resilience by using individual as well as community-oriented approaches?MethodsA systematic literature research of intervention studies on PTSD among older adults, published between 1980 and December 2021, was expanded by cross-referencing, summarized in a narrative synthesis and supplemented with a clinical vignette reflecting qualitative outcomes.ResultsFive RCTs compared varying types of trauma-focused Cognitive Behavioral Therapy with non-trauma-focused control conditions. From one of them, qualitative results were reported as well. The most recent studies reported encouraging results, confirming the suggestion that evidence-based psychotherapy for PTSD can be safely and effectively used with older adults.ConclusionsSince evidence-based psychotherapy for PTSD can be safely and effectively used with older adults, new avenues for practice and research may be found in a resilience perspective and a public mental health framework.

Perspectives on the Future of Burnout in Sport

The present editorial provides a series of perspectives on the future of burnout in sport. Specifically, for the first time, seven burnout researchers have offered their opinions and suggestions for how, as a field, we can progress our understanding of this important topic. A broad range of ideas are discussed, including the relevance of the social context, the value of theory and collaboration, and the use of public health frameworks in future work. It is hoped that these perspectives will help stimulate debate, reinforce and renew priorities, and guide research in this area over the coming years.

Adding a Correction Factor to the Allocation of Scarce Life-saving Resources in a Pandemic

Adding a Correction Factor to the Allocation of Scarce Life-saving Resources in a Pandemic

Integrating rare disease management in public health programs in India: exploring the potential of National Health Mission

Rare diseases (RD) are conditions that affect a small number of people and hence do not get the focus on government health priorities in a resource-constrained setting such as India. Therefore, it is essential to focus on strengthening and utilizing the existing public health framework for the optimal usage of healthcare resources. In this regard, National Health Mission (NHM) is one of the crucial programs initiated by the government of India to address the health needs of the under-served. As Phase 1 of the NHM moves towards completion, we explored the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH + A) program under NHM to assess their potential and limitations to aid RD care. We found that some of the disease-prevention initiatives of NHM address certain RDs and can easily be expanded to manage many such preventable RDs. In addition, NHM programs can provide a unique epidemiological data repository to strengthen the National Rare Disease Registry. These programs can also play important role in providing a continuum of care for many RDs that need lifelong management. However, existing programs have a limited scope to provide specialized RD-related treatments, which is better served in a more focused system. Thus, considering RDs in the design of the existing programs may help RD management better through prevention, data collection, and providing a continuum of care.

Using behavioural science in public health settings during the COVID-19 pandemic: The experience of public health practitioners and behavioural scientists

IntroductionThe emergence of COVID-19 and the importance of behaviour change to limit its spread created an urgent need to apply behavioural science to public health. Knowledge mobilisation, the processes whereby research leads to useful findings that are implemented to affect positive outcomes, is a goal for researchers, policy makers and practitioners alike. This study aimed to explores the experience of using behavioural science in public health during COVID-19, to discover barriers and facilitators and whether the rapidly changing context of COVID-19 influenced knowledge mobilisation. MethodsWe conducted a semi-structured interview study, with ten behavioural scientists and seven public health professionals in England, Scotland, Wales, The Netherlands and Canada. We conducted an inductive thematic analysis. ResultsWe report three key themes and 10 sub-themes: 1.Challenges and facilitators of translation of behavioural science into public health (Methods and frameworks supported translation, Lack of supportive infrastructure, Conviction and sourcing of evidence and Embracing behavioural science) 2. The unique context of translation (Rapid change in context, the multi-disciplinary team and the emotional toll). 3. Recommendations to support future behavioural science translation (Embedding experts into teams, Importance of a collaborative network and showcasing the role of behavioural science). DiscussionBarriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individual people; and those related to materials, such as the use of frameworks and an overwhelming amount of evidence and literature. ConclusionPeople and frameworks were seen as important in facilitating behavioural science in practice. Future research could explore how different frameworks are used. We recommend a stepped competency framework for behavioural science in public health and more focus on nurturing networks to facilitate knowledge mobilisation in future emergencies.

Reflections on an interview with the late Prof Maria Antonia Modolo Considerazioni su di un'intervista alla Prof Maria Antonia Modolo, recentemente scomparsa.

The Author, now a Research Assistant at the Department of Public Health of the University of Milan, Italy, in the period she was a Resident of the School of Public Health of the University of Perugia, had the occasion to interview Prof Maria Antonietta Modolo, one of the most significant pioneers of Health Education and Health Promotion both in Europe and in this Country, and her mentor at that time. Prof Modolo, who recently passed away, in that occasion explained in detail all the goals of these disciplines, and the impact they can show on the life of the population of developed and developing countries, if applied within a robust public health framework.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

ObjectiveThe global population is rapidly ageing. To tackle the increasing prevalence of older adults’ chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study...

Examining the Built Environment for Healthy Living via Virtual Street Audits.

During the fall 2019 and spring 2020 semesters, 156 MPH students enrolled in the Integrative Learning Experience at the University of Alabama at Birmingham School of Public Health explored concepts of the built environment and health by auditing 2500 street segments in 4 urban neighborhoods in Birmingham, Alabama. In teams of 4 to 5, in-class and online students worked collaboratively to assess 63 built environment variables related to transportation, land use, advertisement, and neighborhood physical disorder. This type of “community assessment” is the first stage of the Evidence-based Public Health Framework and consistent with the applied nature of an MPH degree. Authors conducted secondary data analysis of final team assignments to demonstrate how students translated observations and ratings into practical recommendations for neighborhood improvements to promote physical activity. Students recommended improvements in neighborhood infrastructure and services, specifically: creating exercise space, providing outdoor exercise equipment, improving neighborhood safety, and cultivating a culture of health. The Integrative Learning Experience course encouraged students to use their knowledge and skills to prioritize recommendations to improve neighborhood conditions. Variable ratings and observations increased student awareness of the built environment and its potential to impact individual and community health. Moreover, the project helped students make connections between proximal outcomes, such as improving neighborhood walkability, and distal outcomes, such as improved health outcomes among residents. Finally, this project modeled for students the use of evidence-based strategies for making data-informed decisions, which are essential skills for new and emerging public health professionals.

Infodemiological Examination of Personal and Commercial Tweets About Cannabidiol: Term and Sentiment Analysis.

BackgroundIn the absence of official clinical trial information, data from social networks can be used by public health and medical researchers to assess public claims about loosely regulated substances such as cannabidiol (CBD). For example, this can be achieved by comparing the medical conditions targeted by those selling CBD against the medical conditions patients commonly treat with CBD.ObjectiveThe objective of this study was to provide a framework for public health and medical researchers to use for identifying and analyzing the consumption and marketing of unregulated substances. Specifically, we examined CBD, which is a substance that is often presented to the public as medication despite complete evidence of efficacy and safety.MethodsWe collected 567,850 tweets by searching Twitter with the Tweepy Python package using the terms “CBD” and “cannabidiol.” We trained two binary text classifiers to create two corpora of 167,755 personal use and 143,322 commercial/sales tweets. Using medical, standard, and slang dictionaries, we identified and compared the most frequently occurring medical conditions, symptoms, side effects, body parts, and other substances referenced in both corpora. In addition, to assess popular claims about the efficacy of CBD as a medical treatment circulating on Twitter, we performed sentiment analysis via the VADER (Valence Aware Dictionary for Sentiment Reasoning) model on the personal CBD tweets.ResultsWe found references to medically relevant terms that were unique to either personal or commercial CBD tweet classes, as well as medically relevant terms that were common to both classes. When we calculated the average sentiment scores for both personal and commercial CBD tweets referencing at least one of 17 medical conditions/symptoms terms, an overall positive sentiment was observed in both personal and commercial CBD tweets. We observed instances of negative sentiment conveyed in personal CBD tweets referencing autism, whereas CBD was also marketed multiple times as a treatment for autism within commercial tweets.ConclusionsOur proposed framework provides a tool for public health and medical researchers to analyze the consumption and marketing of unregulated substances on social networks. Our analysis showed that most users of CBD are satisfied with it in regard to the condition that it is being advertised for, with the exception of autism.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set.

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action ‘Mental health promotion and prevention’ indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

Progress Toward a Multisectoral Community Intervention Approach to Prevention of the Word Gap.

Children learn language through the interactions they have with their parents/caregivers beginning at birth. Hart and Risley (1995) discovered an inequity in the home language input children received from parents/caregivers. Children reared in low-income families received less input (conversations, turns) from parents than did children reared in more advantaged families. Less language input was linked to a disparity in children’s vocabulary learning by age 3. The long-term result of this social determinant of early language/literacy learning is a life trajectory of poor educational, economic, and health attainment for many children in families with limited resources, at vast cost to individuals, communities, and the nation. What is needed is an approach to word-gap prevention that is capable of achieving positive individual, community, and population outcomes. Translating research into practice, we developed the Bridging the Word Gap Community Action Planning Guide (BWG-CAPG) using a combined behavior-analytic, community psychology, and public health framework for this purpose (Greenwood et al., 2017). We also developed a progress-monitoring measure, the online BWG Community Check Box Evaluation System, to provide feedback on a community’s actions and progress in implementing their plan. Results from an initial pilot investigation within and across three community sectors in a large urban city were promising. BWG Community Check Box results indicated a number of desired outcomes: (a) capacity development and mobilization, (b) community implementation actions, and (c) community changes in practices, programs, and policies. Implications are discussed.

Public Health Frameworks in Audiology Education: Rationale and Model for Implementation

Purpose: Hearing health care is a public health priority at the national and global levels, yet training in clinical audiology programs lacks formal public health education. The purpose of this review article is to discuss audiology concepts in terms of the public health framework of assessment, policy, and assurance and describe two approaches for implementing public health frameworks into audiology doctoral programs. Method: This review article provides a review of audiology concepts through the framework of public health and discusses the rationale for why public health concepts are critical to achieving population-level objectives in hearing health care. We compare competencies of audiology and public health education and then provide a model for two methods for implementing public health education into audiology doctoral programs: (a) formal integration of public health concepts into existing coursework or curricula and (b) a dual doctor of audiology (AuD) and master's in public health (MPH) degree track. Conclusions: Public health is present in the field of audiology, and the field has many public health objectives; however, audiologists do not receive the training necessary to recognize public health concepts or meet population-level objectives. Educating future audiologists in public health concepts will provide them with the tools needed to work with other hearing professionals to make population-level advances in hearing health care. A subset of students may want to become experts in public health and wish to pursue a dual AuD/MPH track.