Labour market competition for public health graduates in the United States: A comparison of workforce taxonomies with job postings before and during the COVID-19 pandemic.

A strong public health workforce (PHW) is needed to respond to COVID-19 and public health (PH) issues worldwide. However, classifying, enumerating, and planning the PHW is challenging. Existing PHW taxonomies and enumerations focus on the existing workforce, and largely ignore workforce competition for public health graduates (PHGs). Such efforts also do not utilize real time data to assess rapid changes to the employment landscape, like those caused by COVID-19. A job postings analysis can inform workforce planning and educational program design alike. To identify occupations and industries currently seeking PHGs and contrast them with existing taxonomies, authors matched existing PHW taxonomies to standardized occupational classification codes, then compared this with 38,533 coded, US job postings from employers seeking Master's level PHGs from 1 July 2019 to 30 June 2020. Authors also analysed 24,516 postings from March 2019 to October 2019 and compared them with 24,845 postings from March 2020 to October 2020 to assess changing employer demands associated with COVID-19. We also performed schema matching to align various occupational classification systems. Job postings pre-COVID and during COVID show considerable but changing demand for PHGs in the US, with 16%-28% of postings outside existing PHW taxonomies, suggesting labour market competition which may compound PHW recruitment and retention challenges.

The New Public Health Workforce: Employment Outcomes of Public Health Graduate Students.

CONTEXT: Much has been written about the public health workforce, but very little research has been published-and none in a peer-reviewed journal or other report since 1992-regarding the employment outcomes and employment sectors of graduate students pursuing public health as an area of study. OBJECTIVES: Our objectives were to review the literature and analyze data regarding the employment outcomes of public health graduate students and to examine how public health schools and programs might respond to changes in the sectors hiring their graduates. DESIGN: We reviewed the literature regarding the employment of public health graduates; analyzed 5 years of graduate outcomes from Columbia University's Mailman School of Public Health using logistic regression; and we examined data collected by the Association of Schools & Programs of Public Health. PARTICIPANTS: The study included data from surveys of 2904 graduates of Columbia University's Mailman School of Public Health, across 5 graduating cohort years, for whom there were employment sector data available for 1932. RESULTS: Much of the research on the public health workforce has defined it as governmental public health. Across each of 5 graduating classes from Columbia University's Mailman School of Public Health, the odds of for-profit sector employment increased by 23% (2012-2016), while hiring by government agencies declined or remained flat. Publicly available employment data from the Web sites of schools of public health and from surveys by the Association of Schools & Programs of Public Health show that hiring of new graduates by for-profit corporations now either closely matches or exceeds governmental hiring at many schools of public health. CONCLUSIONS: Public health graduates are increasingly working outside of government, and additional analyses are required to determine whether core competencies of public health curricula reflect the needs of the employers that are hiring public health graduates today. Schools and programs of public health should invest in their career services offices and gather input from employers that are currently hiring their graduates, especially as the sectors hiring them may be changing.

Public health and health professional education at a tribal college: a collaborative immersion program in rural North Dakota.

INTRODUCTION: Native Americans have some of the worst health outcomes of any minority group in the USA, and are severely under-represented in the health professional workforce. From 2009 to 2015, partners from a tribal college in rural North Dakota and academic institutions in New York collaborated to create a program wherein non-Native health professionals traveled to the reservation to teach a summer course to Native students. This study assessed the impact of the program on both the Native students who took the course and the non-Native health professionals who taught the course. METHODS: Focus groups composed of former students in the program were held in Spirit Lake, North Dakota. Non-Native student teachers were surveyed using an online survey tool. Focus group data were analyzed using grounded theory methodology. Survey data were analyzed using descriptive statistics. RESULTS: Fifteen former students participated in the focus groups. Participants stated that their experiences in the course increased interest in health professions and knowledge of public health issues. Participants also described barriers to entering health professionals for Native students and the benefits of close interaction with non-Native individuals. Eighty-six percent (24/28) of former course teachers responded to the survey. Survey respondents stated their experiences in North Dakota increased their understanding of underserved populations and their interest in working in rural areas. CONCLUSION: This study assessed the successes and limitations of a collaborative, interprofessional immersion program in rural North Dakota. Similar programs may increase the number of Native Americans in health professions and increase non-Native health professional interest in and engagement with rural communities.

Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic.

OBJECTIVES: To determine the health literacy levels of persons living with human immunodeficiency virus (HIV) (PLWH) at a health clinic in the Dominican Republic (DR) and assess associations between health literacy, HIV-related knowledge, and health information behavior (how patients need, seek, receive, and use information). DESIGN AND SAMPLE: Cross-sectional, descriptive. Participants were 107 PLWH attending the Clinic. MEASURES: A theoretically based, 64-item survey assessing information behavior and HIV-related knowledge was administered in Spanish through individual interviews. Health literacy was assessed using the Short Assessment of Health Literacy-Spanish and English. RESULTS: On average, participants were 40.8 years old and had lived with HIV for 7.7 years. The majority (69.2%) had low health literacy. HIV-related knowledge and information behavior varied by health literacy level and uncertainty regarding a main indicator of disease progression, viral load, was demonstrated regardless of health literacy level. Participants with low health literacy were less likely to answer questions or answer questions correctly and many participants (39.2%) indicated viral transmission can occur through supernatural means. CONCLUSIONS: Findings demonstrate unmet information need and that information received may not always be understood. Methods to improve health education are needed to ensure patients receive health information in an understandable way.

Academic Health Center-Community Justice Program Partnerships: Linking Men in the Justice System to Health Care.

BACKGROUND: Linkage to community health and social services after incarceration is often inadequate. This is troubling, because risk taking and poor health are common immediately after release, and access to health providers and insurance helps individuals to transition home. OBJECTIVES: This article describes how faculty and clinicians at a large academic health center in New York City, established partnerships with justice programs to jointly develop services that aimed to increase health care access for men in the justice system. METHODS: We describe how faculty and students from Columbia University's Mailman School of Public Health (MSPH), clinicians from New York-Presbyterian Hospital's (NYPH) Young Men's Clinic (YMC) and project STAY, and staff from justice programs collaborated to increase access to care. RESULTS: We highlight the characteristics of successful partnerships drawn from the literature on community-based participatory research. CONCLUSION: We conclude with a discussion of some challenges we encountered and lessons we learned about establishing and sustaining partnerships with court, probation, parole, reentry, and diversion programs while educating the next generation of public health leaders.

Developing capacity for the American Indian health professional workforce: an academic-community partnership in Spirit Lake, North Dakota.

BACKGROUND: American Indians/Alaskan Native (AIAN) populations experience significant disparities in health when compared to the average US population who are under-represented in the health care professional workforce. Current research suggests that racial concordance between patients and providers has a positive effect on patient care. OBJECTIVE: We describe a successful academic-community partnership between a tribal college, a local state academic center, an urban public health institution, and an urban academic center all aligned with the goal to increase AIAN health care professional capacity. METHODS: A tribal college course and youth education program were developed with the intent to expose AIAN youth to the health care professions and encourage entry into health professional career tracks. Evaluation using a pre- and post-survey design is underway to assess the impact of the intervention on participating AIAN attitudes and career intentions. CONCLUSION: We believe this model is one way of addressing the need for an increased AIAN health care professional career force.

Cultural competency training for public health students: integrating self, social, and global awareness into a master of public health curriculum.

Cultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.

Skin cancer screening by dermatologists, family practitioners, and internists: barriers and facilitating factors.

OBJECTIVE: To determine barriers and facilitating factors to skin cancer screening practices among US primary care physicians and dermatologists. DESIGN: Survey. SETTING: Physicians randomly selected from the American Medical Association's Medical Marketing Services database from April 1 through November 30, 2005. PARTICIPANTS: A total of 2999 US dermatologists, family practitioners, and internists. MAIN OUTCOME MEASURES: Results based on 1669 surveys returned regarding practice characteristics, skin cancer screening behaviors, and barriers and facilitating factors to performing full-body skin examinations for patients. RESULTS: The overall response rate was 59.2%. More dermatologists (552 [81.3%]) reported performing full-body skin examinations on patients than did family practitioners (333 [59.6%]) (P < .05) or internists (243 [56.4%]) (P < .05). Among all physicians, time constraints, competing comorbidities, and patient embarrassment were reported as the top 3 barriers to performing full-body skin examinations, and these barriers were different among medical specialties. Among all physicians, having patients at high risk for skin cancer, patient demand for complete examination/mole check, and the influence of medical training were reported as facilitating factors to performing full-body skin examinations. CONCLUSION: Becoming more knowledgeable about physician barriers to skin cancer screening could help improve primary and secondary practices in both the primary care and dermatology settings.

Smoking and oral contraceptive continuation.

BACKGROUND: Smoking may be related to early discontinuation of oral contraceptives (OC). STUDY DESIGN: This was a planned secondary analysis of a randomized clinical trial. Women aged less than 25 initiating OC at three inner-city publicly funded family planning clinics enrolled in the study. Subjects reported smoking status at enrollment; 3- and 6-month interviews assessed OC continuation. RESULTS: One hundred eighty-nine (12%) of 1598 participants were current smokers. Smokers were more often lost to follow-up than nonsmokers (P<.01). Among participants with a 6-month interview, only 26% of smokers and 46% of nonsmokers were continuing OC (P<.001). After adjustment for confounding factors, smokers were still somewhat less likely to be continuing OC (adjusted OR 0.6, 95% CI 0.4-1.0). This association was unrelated to number of cigarettes smoked per day. CONCLUSIONS: These data suggest that young smokers may be more likely to discontinue OC within 6 months than nonsmokers. Smoking may be a marker for risk-taking behavior that extends to the premature discontinuation of OC.

Health practices and vaginal microbicide acceptability among urban black women.

BACKGROUND: Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Use of vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practices related to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs. Given the high rate of HIV infection among black women, research on practices and decision making relevant to microbicide acceptability is needed in this population. METHODS: Twenty-three black women in New York City, aged 25-64, completed in-person semistructured interviews and self-administered questionnaires. Quantitative analyses examined vaginal practices and willingness to use microbicides. Qualitative analyses explored underlying decision-making processes involved in choices regarding vaginal practices and general healthcare. RESULTS: Willingness to use vaginal products for HIV prevention was high, especially among more educated women. Safety was a major concern, and women were cautious about using vaginal products. Whereas some viewed synthetic products as having potentially harmful side effects, others perceived natural products as risky because of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy, prior experience, cultural background, and general approach to healthcare. CONCLUSIONS: The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention. Decision-making processes regarding vaginal practices were complex and were affected by social, cultural, and personal factors. Although specific preferences may vary, attitudes toward using a vaginal product are likely to be positive when side effects are minimal and the product is considered safe.

Prior pill experiences and current continuation among pill restarters.

CONTEXT: Discontinuation of oral contraceptives often puts women at risk for unintended pregnancies. Understanding why a woman discontinued pill use can provide insight into her risk of discontinuation if she restarts use. METHODS: Women younger than 25 obtaining oral contraceptives at three university health centers in 2003-2005 were recruited to participate in a randomized trial; 628 former users were interviewed about their previous experience with the method, and were followed up three months after restarting use. Bivariate and multinomial logistic regression analyses were used to assess the relationship between prior reasons for stopping pill use and method continuation. RESULTS: Women who had discontinued using oral contraceptives because of side effects were less likely to be very sure about restarting the pill at baseline (73%) than were those who had stopped for logistical or fertility-related reasons (88-94%). They also were less likely to have been satisfied with the pill in the last use interval (49% vs. 95-98%) and less likely to be satisfied with it in the three months after restarting (76% vs. 89-93%). These women were more likely to report a short duration of use than an intermediate duration or continuous use during follow-up (odds ratios, 2.5 and 4.5). CONCLUSIONS: When counseling women who are restarting pill use, providers should ask about their experiences with the method and reasons for discontinuation; counseling for women who discontinued because of side effects should address their risk factors for early discontinuation and informing them about other contraceptive choices.

Medical pluralism among American women: results of a national survey.

BACKGROUND: Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women. METHODS: A nationally representative telephone survey of 808 women >or=18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain--spirituality, religion, or prayer for health--during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use. RESULTS: Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions. CONCLUSIONS: Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.

Satisfaction with telephonic interpreters in pediatric care.

OBJECTIVES: To compare satisfaction among Spanish-speaking mothers who did and did not use telephonic interpreters during pediatric visits, and to examine resident physician attitudes about telephonic interpreter use. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: Anonymous surveys were administered to 98 mothers limited in English proficiency and presenting for well-baby visits in an urban university hospital-affiliated practice. Pediatric visits were performed by 24 non-Spanish-proficient pediatric residents. The first 46 women (baseline cohort) received routine services, including ad-hoc interpretation or no interpretation; the second 52 women (intervention cohort) used a dual-headset telephonic interpreter service. OUTCOME MEASURES: Mothers completed postvisit interviews assessing overall satisfaction, comfort and ease of communication. Pediatric residents completed self-administered questionnaires assessing attitudes about and experience with telephonic interpretation. RESULTS: The intervention cohort overwhelmingly rated telephonic interpretation as "very helpful" (94%), indicating the visit would have been "harder" without the service (98%). Significantly more intervention cohort mothers reported it was "very easy" to communicate with the physician (83% vs. 22%, P < 0.01), they understood "all" that the physician told them (97% vs. 80%, P < 0.05) and they were "very satisfied" with the clinic overall (85% vs. 57%, P < 0.05). Almost all intervention cohort mothers (96%) reported a preference to use telephonic interpretation at their subsequent visit; however, only one-third of residents believed their patients would prefer to use the telephonic interpreter in the future. CONCLUSIONS: Mothers who used telephonic interpretation reported significantly greater communication and overall satisfaction compared to mothers in routine care. Pediatric residents substantially underestimated their patients' desire to use telephonic interpreters.

Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial.

OBJECTIVE: To estimate whether young women taking the first pill on the day of prescription had higher continuation rates and lower pregnancy rates than women who waited until menses to start the oral contraceptive pill (OCP). METHODS: We recruited 1,716 women aged younger than 25 years seeking to initiate the oral contraceptive at three publicly funded family planning clinics, and randomly assigned them to conventional initiation of the pill (conventional start) or immediate, directly observed ingestion of the first pill (quick start) during the clinic visit. Women underwent follow-up interviews at 3 and 6 months. RESULTS: Sixty percent of participants discontinued the pill, and 8% became pregnant during follow-up. Women who took the first pill in the clinic were more likely to continue to the second OCP pack (odds ratio 1.5, 95% confidence interval 1.0-2.1.); however, the Quick Start approach did not improve OCP continuation rates at 3 and 6 months. Those assigned to Quick Start were slightly less likely to become pregnant within 6 months from the time they started the pill (hazard ratio 0.90, 95% confidence interval 0.64-1.25). Eighty-one percent of women rated the Quick Start approach as acceptable or preferable to waiting. Rates of serious adverse events were low and similar in the two groups. CONCLUSION: Protocols that require a woman to wait until the next menses to start hormonal contraceptives are an obstacle to contraceptive initiation. Directly observed, immediate initiation of the pill improves short-term continuation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00068848

Oral contraceptive discontinuation: do side effects matter?

OBJECTIVE: The purpose of this study was to assess self-reported side effects in women after they received the oral contraceptive (OC) and to compare discontinuation rates, according to presence or absence of side effects. STUDY DESIGN: The study comprised 1716 women aged <25 years who initiated the OC at 3 publicly funded family planning clinics and completed structured interviews after 3 and 6 months. RESULTS: Nearly 60% of subjects discontinued the OC by 6 months. Most subjects reported no changes in headaches, weight, moodiness, and sexual satisfaction during the first 3 months of OC use. Subjects with any complaints, especially women with increased headaches or moodiness, were more likely to discontinue the OC prematurely. Nonetheless, most discontinuation occurred for reasons that were unrelated to side effects. CONCLUSION: Side effects are absent or mild among most OC users, but women with complaints are more likely to discontinue. Side effects are less important reasons for discontinuation than widely believed.

The New York City Community Outreach Study: biomedical and mental health status among a community sample of urban Hispanics.

OBJECTIVE: This report provides a snapshot of health behavior and risk in one low-income, urban, Latino community. As part of a community health and education program, 200 adult residents were asked about their health status and behavior and screened for conditions known to constitute significant health risk. DESIGN: A random sample of 10 buildings around a large community-based organization (CBO) service area was selected to receive personal invitation and/or door-to-door flyers announcing several days of free health screening and education at the CBO. All individuals age > or = 18 years were eligible. Those who received screening were mailed lay descriptions of their results along with recommendations and locations for follow-up, if appropriate. SETTING AND PARTICIPANTS: Participants were adult residents of an economically and medically under-served district in New York City, where Latinos make up approximately 75% of the population. Free screening for high blood pressure, diabetes, high cholesterol, obesity, and depression was provided. MAIN OUTCOME MEASURES: The clinical outcomes of the aforementioned tests constitute the main outcomes of this report. RESULTS: Compared to national estimates for Hispanics, health risk was quite high in this sample, particularly with regard to diabetes and cholesterol. Moreover, participants were much less likely to have insurance or to have a regular source of health care than reported in national studies of Hispanics. CONCLUSIONS: Though site specific, these data provide critical information to local CBOs and can be used as a tool for comparison with national data and Healthy People 2010 goals.

Women's reasons for complementary and alternative medicine use: racial/ethnic differences.

OBJECTIVES: Although racial/ethnic differences in the prevalence of complementary and alternative medicine (CAM) utilization have been documented, differences in the reasons for using CAM have not been empirically assessed. In an increasingly diverse society, understanding differences in rates of and reasons for CAM use could elucidate cultural and social factors of health behaviors and inform health care improvements. The current study examines reasons for CAM use among women in four racial/ethnic groups. DESIGN: A national telephone survey of 3172 women aged 18 years and older was conducted in four languages. Respondents were asked about their use of remedies or treatments not typically prescribed by a medical doctor. This study focuses on those women who used CAM in the previous year and their reasons for using CAM. RESULTS: Non-Hispanic white women were most likely to cite personal beliefs for CAM use. Cost of conventional medicine was most prevalent among Mexican-American women CAM users. Physician referral, family and friends, and media sources were all equally likely to lead to CAM use in non-Hispanic white women. In contrast, informal networks of family and friends were the most important social influences of CAM use among African-, Mexican-, and Chinese-American women. CONCLUSIONS: Racial/ethnic differences in reasons for CAM use highlight cultural and social factors that are important to consider in public evaluation of the risks and benefits of CAM remedies and treatments.

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey.

OBJECTIVES: We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans. METHODS: We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women. RESULTS: Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans. CONCLUSIONS: CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.