Preparing future faculty and professionals for public health careers.

Recent years have brought rapid growth in schools of public health and an increasing demand for public health practitioners. These trends highlight the need for innovative approaches to prepare doctoral graduates for academic and high-level practice positions. The University of Maryland's School of Public Health developed a "Preparing Future Faculty and Professionals" program to enrich the graduate education and professional development of its doctoral students. We describe the program's key elements, including foundational seminars to enhance students' knowledge and skills related to teaching, research, and service; activities designed to foster career exploration and increase competitiveness in the job market; and independent, faculty-mentored teaching and research experiences. We present a model for replicating the program and share student outcomes of participation.

Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu.

BACKGROUND: India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world's largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women's access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women's use of maternal health services in Gujarat and Tamil Nadu. METHODS: Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. RESULTS: Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women's education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands' education predicted institutional delivery in Gujarat. CONCLUSIONS: Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.

Treating Behavioral Health Conditions of OEF/OIF Veterans and Their Families: A State Needs Assessment of Civilian Providers.

With the return of troops from Afghanistan and Iraq, increasing numbers of civilian behavioral health providers are treating veterans and their families for service-related conditions. However, little is known about civilian providers' capacity to meet the needs of this population. A statewide needs assessment of 1,665 clinicians examined their screening/referral practices, knowledge and confidence in treating 14 veteran conditions, and training interests. Overall, providers had limited knowledge and confidence to treat veteran conditions but reported high interest in training to enhance their clinical skills. Findings informed the training of more than 700 state clinicians to provide culturally competent behavioral health care for veterans and their families.

Teachers' challenges, strategies, and support needs in schools affected by community violence: a qualitative study.

BACKGROUND: Exposure to community violence compromises teacher effectiveness, student learning, and socioemotional well-being. This study examined the challenges, strategies, and support needs of teachers in urban schools affected by high levels of community violence. METHODS: Twenty teachers from 3 urban middle schools with predominantly low-income African American students completed open-ended interviews. Selected schools were in geographic areas with high violent crime levels. RESULTS: Consistent with an ecological risk and resilience framework, findings revealed that teachers experienced challenges and adopted coping strategies at the individual, family, school, and community levels. Teachers employed a number of strategies associated with resilience, such as prayer and seeking support from family and colleagues, but also engaged in some avoidant strategies, such as emotional withdrawal and avoiding difficult students. CONCLUSIONS: Findings suggest interventions to improve school safety and reduce the negative impact of violence-related stressors. Teacher training in behavior management, effective school leadership, improved school security, peer mediation, expanded mental health services, and parent involvement may promote resilience among both teachers and their students.

Work-related injuries among child street-laborers in Latin America: prevalence and predictors / Lesiones laborales en niños que trabajan en la calle en América Latina: prevalencia y factores de predicción

OBJECTIVES: To determine the prevalence and nature of occupational injuries among children working in the streets of four major cities in Latin America, as well as to identify factors that predict these work-related injuries. METHODS: This cross-sectional study interviewed 584 children from 5-17 years of age working on the streets of Bogotá, Colombia; Lima, Peru; Quito, Ecuador; and São Paulo, Brazil. Descriptive analyses and multivariate logistic regressions were conducted, with incidence and serious injuries regressed on occupational and sociodemographic variables. RESULTS: Approximately 39.6 percent of the child street-laborers surveyed reported an injury sustained while working in the streets: scratches (19.5 percent), cuts/lacerations (16.4 percent), burns (8.6 percent), car accidents (8.9 percent), sprains (4.6 percent), and amputations (0.3 percent). Working a high number of daytime hours and performing on the street predicted the greatest risk of injury, even after controlling for sociodemographic factors; specifically, each additional hour of daytime work increased the risk of injury by 1.4 percent. Child performers had three times the injury rate of children primarily selling products. Boys, older children, and children in Quito were more likely to experience moderate-to-severe injuries, than girls, younger children, and street children in the other study cities. CONCLUSIONS: Interventions are needed to address the substantial risk of injury experienced by children working on the city streets of Latin America.

OBJETIVOS: Determinar la prevalencia y la naturaleza de las lesiones laborales en niños que trabajan en las calles de cuatro grandes ciudades de América Latina e identificar los factores de predicción de esas lesiones. MÉTODOS: Estudio transversal mediante entrevistas a 584 niños de 5 a 17 años que trabajaban en las calles de Bogotá, Colombia; Lima, Perú; Quito, Ecuador; y São Paulo, Brasil. Se realizaron análisis descriptivos y regresiones logísticas multifactoriales de la incidencia y la gravedad de las lesiones con relación a las variables laborales y sociodemográficas. RESULTADOS: Aproximadamente 39,6 por ciento de los niños trabajadores de la calle encuestados informó haber sufrido lesiones mientras trabajaba: rasguños (19,5 por ciento), heridas/laceraciones (16,4 por ciento), quemaduras (8,6 por ciento), accidentes con automóviles (8,9 por ciento), esguinces (4,6 por ciento) y amputaciones (0,3 por ciento). Los factores de predicción de mayor riesgo de lesiones fueron trabajar en la calle muchas horas diurnas y realizar presentaciones callejeras, incluso después de controlar por factores sociodemográficos; específicamente, la adición de una hora de trabajo diurno aumentó el riesgo de lesión en 1,4 por ciento. Los niños que realizaban presentaciones callejeras presentaron una tasa de lesiones tres veces mayor que los niños que se dedicaban fundamentalmente a la venta de productos. Los niños varones, los de mayor edad y los de Quito presentaron mayor probabilidad de sufrir lesiones de moderadas a severas que las niñas, los más jóvenes y los que vivían en las otras ciudades estudiadas. CONCLUSIONES: Se requieren intervenciones para reducir el considerable riesgo de lesiones a que están sometidos los niños que trabajan en las calles de las ciudades de América Latina.

Work-related injuries among child street-laborers in Latin America: prevalence and predictors.

OBJECTIVES: To determine the prevalence and nature of occupational injuries among children working in the streets of four major cities in Latin America, as well as to identify factors that predict these work-related injuries. METHODS: This cross-sectional study interviewed 584 children from 5-17 years of age working on the streets of Bogotá, Colombia; Lima, Peru; Quito, Ecuador; and São Paulo, Brazil. Descriptive analyses and multivariate logistic regressions were conducted, with incidence and serious injuries regressed on occupational and sociodemographic variables. RESULTS: Approximately 39.6% of the child street-laborers surveyed reported an injury sustained while working in the streets: scratches (19.5%), cuts/lacerations (16.4%), burns (8.6%), car accidents (8.9%), sprains (4.6%), and amputations (0.3%). Working a high number of daytime hours and performing on the street predicted the greatest risk of injury, even after controlling for sociodemographic factors; specifically, each additional hour of daytime work increased the risk of injury by 1.4%. Child performers had three times the injury rate of children primarily selling products. Boys, older children, and children in Quito were more likely to experience moderate-to-severe injuries, than girls, younger children, and street children in the other study cities. CONCLUSIONS: Interventions are needed to address the substantial risk of injury experienced by children working on the city streets of Latin America.

Social skills and behavior problems of urban, African American preschoolers: role of parenting practices, family conflict, and maternal depression.

This study examined the role of parenting, family routines, family conflict, and maternal depression in predicting the social skills and behavior problems of low-income African American preschoolers. A sample of 184 African American mothers of Head Start children completed participant and child measures in a structured interview. Results of regression analyses revealed that mothers who utilized more positive parenting practices and engaged in more family routines had children who displayed higher levels of total prosocial skills. Positive parenting and lower levels of maternal depressive symptoms were predictive of fewer externalizing and internalizing child behavior problems. Lower family conflict was linked with fewer externalizing problems. Implications of the study for future research and intervention are discussed.