Public Health Reports最新文献

Objectives: Revised accreditation criteria from the Council on Education for Public Health (CEPH) in 2016 prompted schools and programs of public health to shift their master of public health (MPH) core curricula. Our objective was to provide data on revisions to MPH core curricula at CEPH-accredited schools and programs of public health and other descriptive statistics on the MPH core curriculum and required courses as of 2023.

Methods: We analyzed data from 67 accredited schools of public health and 130 accredited public health programs to assess changes from 2016 to 2023 in the MPH core curriculum. We examined the number of courses, the proportion of credit hours in the core curriculum, core curriculum composition, and course types.

Results: Almost half (49.2%) of schools, but only 16.9% of programs, made extensive changes to their MPH core curricula, an overall increase of 153.6% from 2020 to 2023. Approximately one-fifth of schools and programs made few to no changes to their core curricula and retained core courses in the 5 former core disciplines. On average, core curriculum credit hours comprised 37.8% of total credit hours for schools and 51.7% for programs. Half (50.0%) of all programs in the sample offered single-concentration MPH degrees. Schools and programs were more likely to continue requiring traditional biostatistics (81.7%) and epidemiology (81.2%) courses in the core curriculum compared with environmental health (69.0%), social and behavioral health (61.9%), and health policy and management (42.1%).

Conclusions: Most schools and programs modified their MPH core curricula, reflecting a departure from traditional public health courses toward innovative approaches to ensure knowledge and skill proficiency of graduates. Future research will determine if these curricular changes improve the knowledge and skill proficiency of public health graduates and the workforce.

Objectives: Migrant and seasonal farmworkers work in rural areas where internet access may be limited. We assessed internet access, cost of access, and devices available to farmworkers through a statewide survey in North Carolina.

Methods: During the 2023 agricultural season, we surveyed 1034 migrant and seasonal farmworkers during routine outreach visits in partnership with community health workers employed by 8 community health centers or by nonprofit health service agencies serving farmworkers in North Carolina. We surveyed participants aged ≥18 years by using time-venue sampling and surveyed up to 5 farmworkers at migrant housing locations. We weighted participants to the total population of farmworkers living in surveyed housing and calculated frequencies and percentages of internet access, internet speed, internet cost, available internet devices, and awareness and use of the Affordable Connectivity Program-a program that was run from 2021 through May 31, 2024, by the Federal Communications Commission to make internet access more affordable in the United States. We assessed predictors of internet access and ability to use online videos by using regression models.

Results: Participants were predominantly Spanish-speaking men who lived in housing provided by farm owners. Among participants, 9.8% had internet connections with a cable or digital subscriber line, and 23.5% did not have consistent internet access. Most participants used cellular network internet (84.9%) and mobile phone devices (93.9%). Even among farmworkers who lived in their housing year-round, few had heard of (34.4%), applied to (4.8%), or used (2.0%) the Affordable Connectivity Program.

Conclusions: Interventions are needed to increase internet access and digital inclusion for migrant and seasonal farmworkers in North Carolina. Development of state and county broadband infrastructure should consider farmworker housing.

Objectives: Although studies have addressed food insecurity among veterans, few have focused on active-duty soldiers or on variables associated with the military occupational context. We examined the link between marginal food insecurity (defined as anxiety over food sufficiency or shortage of food in the house) among US soldiers and demographic, behavioral health, and unit-related factors.

Methods: We analyzed survey data from 6343 active-duty soldiers using χ² tests, generalized linear mixed-effect models, and adjusted odds ratios (AORs) to identify significant differences between soldiers categorized as marginally food insecure versus those who were not.

Results: In a fully adjusted model taking unit into account, marginal food insecurity was associated with preferring not to report gender (vs reporting being male) (AOR = 1.39; 95% CI, 1.08-1.78), being married/in a relationship (vs being single) (AOR = 1.22; 95% CI, 1.06-1.40), junior enlisted rank (vs noncommissioned officer: AOR = 0.45; 95% CI, 0.37-0.54; and vs officer: AOR = 0.13; 95% CI, 0.09-0.19), less time in unit (vs more time) (AOR = 0.99; 95% CI, 0.99-1.00), screening positive for depression (vs not) (AOR = 2.67; 95% CI, 2.30-3.11), screening positive for hazardous drinking (vs not) (AOR = 1.34; 95% CI, 1.11-1.63), and lack of reported unit-related social support (vs support) (AOR = 0.52; 95% CI, 0.45-0.59).

Conclusions: In this sample, more than 1 in 5 US soldiers reported marginal food insecurity. In addition to supporting households with financial and food assistance and targeting junior enlisted personnel, policy makers and leaders should prioritize soldiers who are married or in a relationship, who are new to their unit, and who screen positive for depression and hazardous drinking, and they should encourage units to take care of unit members who need support. Policy makers and leaders can use these study results to direct prevention and early intervention initiatives.

A lack of infection prevention and control protections for essential industries in the United States led to increased risk and incidence of COVID-19 among essential workers during the COVID-19 pandemic. When the nation deems an industry essential during a disease outbreak, an ethical obligation exists to safeguard the health of workers who are at increased risk of being exposed to disease. The Global Center for Health Security at the University of Nebraska Medical Center began work to rapidly develop and disseminate infection prevention and control guidance for essential industries, such as meat processing. The Global Center for Health Security established an ethics advisory committee to support COVID-19 response efforts. The ethics advisory committee supported the development of guidance on infection prevention and control to promote justice, reciprocity, health, safety, and equity for workers in the meat processing industry. Our experience highlighted the fundamental role of ethical analysis in public health response efforts, but ethical analysis in this case required an interdisciplinary approach, including the need for effective community-relevant solutions. The integration of an ethics committee into public health emergency response efforts can address ethical concerns for workers in industries that must remain operational during public health emergencies.

Objectives: Intimate partner violence (IPV) has short- and long-term health effects, including physical injuries and traumatic brain injury, as well as sexual, reproductive, and mental health issues. However, accessing necessary health care is often challenging for IPV survivors and became even more difficult during the COVID-19 pandemic. We examined access to health care among those affected by IPV during the COVID-19 pandemic to better connect survivors to health and social support services.

Methods: The Health Resources and Services Administration's Office of Women's Health partnered with its Bureau of Primary Health Care, the Administration for Children and Families' Office of Family Violence Prevention and Services, and the National Domestic Violence Hotline (Hotline) on the 2-year Survivor Health Connection Project. The Hotline administered 2 surveys to its contacts: a 2-question postinteraction survey from March 29, 2021, through September 30, 2022, and a longer focused survey in 2021 and 2022 that measured barriers and restrictions to accessing health care, telehealth safety, and interactions with health care providers.

Results: Of 9918 respondents to the postinteraction survey, 6173 (62.2%) reported current health needs related to their abusive experience. Nearly half of 242 respondents to the 2021 survey (n = 106, 43.8%) indicated that the frequency or intensity of abuse increased during the COVID-19 pandemic, and 157 of 338 respondents to the 2022 survey (46.4%) reported that their partner had controlled and/or restricted their access to health care. Participants described barriers to accessing health care, including finances, health insurance coverage, and transportation.

Conclusions: Findings illuminate opportunities to further support the health and social needs of those experiencing IPV, including continued coordination of efforts across health care and social service delivery partners.

Objectives: Studies have demonstrated that people with disabilities are more likely to use cannabis than people without disabilities. However, less is known about novel forms of use, such as cannabis vaping, in this population. We examined the correlates of cannabis vaping among people with disabilities and the association between cannabis vaping and the frequency of cannabis use in any form.

Methods: We used data from the 2022 Behavioral Risk Factor Surveillance System to examine the association between disabilities and past-month cannabis vaping, as well as the number of days that cannabis was used in the past month, among US adults. We used weighted multivariable logistic and modified Poisson regression models with incidence rate ratios to examine the associations.

Results: The prevalence of cannabis vaping was higher among adults with any disability (4.6%) than among adults without disabilities (2.8%); adults with only cognitive disabilities had the highest prevalence (8.2%). Daily nicotine vaping (adjusted odds ratio [AOR] = 6.04; 95% CI, 4.14-8.80), former cigarette smoking status (AOR = 1.67; 95% CI, 1.25-2.25), and being aged 18-24 years (vs ≥65 y) (AOR = 11.07; 95% CI, 7.05-17.38) were associated with higher odds of cannabis vaping among adults with any disability. Disability status modified the relationship between cigarette smoking and cannabis vaping (P < .001). Additionally, among adults with disabilities, the rate of cannabis-use days was higher among adults who vaped cannabis (adjusted incidence rate ratio = 1.28; 95% CI, 1.19-1.36) than among adults who did not vape cannabis.

Conclusions: Among adults with disabilities, nicotine consumption by vaping was associated with cannabis vaping. Our findings highlight the need for interventions that reduce the risk of polysubstance use (ie, nicotine and cannabis) in this population.

Despite serving populations emphasized in the Ending the HIV Epidemic Initiative, emergency departments (EDs) infrequently offer routine HIV screening. The objective of this study was to characterize US EDs by whether they screen for HIV and to explore factors associated with screening. We surveyed a random sample of US ED directors to obtain data on ED-level and patient-level characteristics, as well as information on directors' perceived barriers to implementing preventive health services. Using descriptive statistics and regression modeling, we found that EDs that routinely screen for HIV, compared with those that do not, had higher median visit volumes (21 000 vs 12 600), were more often a teaching hospital (12.7% vs 4.3%), and had more availability of social workers (23.6% vs 9.4% had 24 hour/day coverage); their directors also less often expressed strong worry about costs (5.9% vs 28.2%), all significant at P < .05; in the regression analysis, only worry about costs was significant (relative risk = 0.13; 95% CI, 0.03-0.51). Our findings may reflect a need for additional funding and resources allocated to EDs to promote HIV screening.

Objectives: Military training centers and seagoing vessels are often environments at high risk for the spread of COVID-19 and other contagious diseases, because military trainees and personnel arrive after traveling from many parts of the country and live in congregate settings. We examined whether levels of SARS-CoV-2 genetic material in wastewater correlated with SARS-CoV-2 infections among military personnel living in communal barracks and vessels at US Coast Guard training centers in the United States.

Methods: The Coast Guard developed and established 3 laboratories with wastewater testing capability at Coast Guard training centers from March 2021 through August 2022. We analyzed wastewater from barracks housing trainees and from 4 Coast Guard vessels for the presence of SARS-CoV-2 genes N and E and quantified the results relative to levels of a fecal indicator virus, pepper mild mottle virus. We compared quantified data with the timing of medically diagnosed COVID-19 infection among (1) military personnel who had presented with symptoms or had been discovered through contact tracing and had medical tests and (2) military personnel who had been discovered through routine surveillance by positive SARS-CoV-2 antigen or polymerase chain reaction test results.

Results: Levels of viral genes in wastewater at Coast Guard locations were best correlated with diagnosed COVID-19 cases when wastewater testing was performed twice weekly with passive samplers deployed for the entire week; such testing detected ≥1 COVID-19 case 69.8% of the time and ≥3 cases 88.3% of the time. Wastewater assessment in vessels did not continue because of logistical constraints.

Conclusion: Wastewater testing is an effective tool for measuring the presence and patterns of SARS-CoV-2 infections among military populations. Success with wastewater testing for SARS-CoV-2 infections suggests that other diseases may be assessed with similar approaches.