MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

INTRODUCTION: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

How Community and Individual Risk Factors Mutually Impact Youth's Perceived Safety: A Syndemic Analysis Using Structural Equation Modeling.

The purpose of this study was to evaluate the mutual impact of community and individual factors on youth's perceptions of community safety, using structural equation modeling (SEM) conceptualized by syndemic theory. This study used survey data collected from a county wide sample of middle and high school students (N=25,147) in West Central Florida in 2015. The outcome variable was youth's perceptions of community safety. Predictors were latent individual and community factors constructed from 14 observed variables including gun accessibility, substance use, depressive symptoms, and multiple neighborhood disadvantage questions. Three structural equation models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation. Each model's goodness of fit was assessed. Approximately seven percent of youth reported feeling unsafe in their community. After model modifications, the final model showed a good fit of the data and adhered to the theoretical assumption. In the final SEM model, an individual latent factor was implied by individual predictors measuring gun accessibility without adult's permission (ß=0.70), sadness and hopelessness (ß=0.52), alcohol use (ß=0.79), marijuana use (ß=0.94), and illegal drug use (ß=0.77). Meanwhile, a community latent factor was indicated by multiple community problems including public drinking (ß=0.88), drug addiction (ß=0.96), drug selling (ß=0.97), lack of money (ß=0.83), gang activities (ß=0.90), litter and trash (ß=0.79), graffiti (ß=0.91), deserted houses (ß=0.86), and shootings (ß=0.93). A second-order syndemic factor that represented the individual and community factors showed a very strong negative association with youth's safe perception (ß=-0.98). This study indicates that individual risk factors and disadvantaged community conditions interacted with each other and mutually affected youth's perceptions of community safety. To reduce these co-occurring effects and improve safe perceptions among youth, researchers and practitioners should develop and implement comprehensive strategies targeting both individual and community factors.

The Important Role for Physicians as Advocates for Firearm and Road Traffic Injury Prevention.

The purpose of this article is to discuss the important role for physicians in advocating for the prevention of road traffic and firearm injuries. Physicians have shown to be effective advocates for a variety of injuries, and this needs to continue and be enhanced for these injury categories. Road traffic and firearm injuries are among the leading causes of death across the lifespan. The influence and credibility of physicians enhance the messages they provide in advocacy efforts. It is important that physicians educate and counsel patients in a variety of healthcare settings along with joining advocacy efforts of professional associations. Recommendations are provided for advocacy components related to these injuries. Also, it is very important that physicians receive training in medical school and/or residency about injuries and how to successfully advocate for evidence-based injury prevention strategies.

The Activist Lab and the MOULA Program.

The Activist Lab at the University of South Florida College of Public Health is an exciting initiative that serves to build interdisciplinary advocacy and leadership skills for public health students and the community. The Lab is led by a very active student advisory group that with the Director develops the advocacy strategies and focus areas for change. The Activist Lab's More Opportunities to Use Learned Advocacy, or MOULA program, allows students to work side by side with local agencies to support their advocacy efforts. A recent student works with the local Guardian ad Litem program to determine needs and services for children in the foster care system who have also been trafficked. The student is working with attorneys, social workers, families, advocates, and others so that the best needs of the children are met. Students must apply and be selected for the MOULA program based on their responses as to how they could meet the agency's needs. The best responses and matches with the agencies are then determined. Students who participate in MOULA do midyear and final-year reports, evaluate their experiences, are evaluated by the agency mentor, develop a presentation on their experiences, and are interviewed on one of the Activist Lab podcast episodes. The Activist Lab and initiatives such as MOULA provide an opportunity for students to learn and advance critical public health advocacy skills and will help strengthen these skills for future success.

Interprofessional Education: Reaching Health Professionals With an Interactive Professional Virtual/Online Event on Advocacy and Policy.

Competencies in health policy and advocacy should be developed by all health professionals to effectively advance their professions but also effectively collaborate in interprofessional teams to improve public health. However, the COVID-19 epidemic presents a challenge to reaching students of health professions through face-to-face offerings. To meet this need, the University of South Florida College of Public Health developed asynchronous and synchronous online health policy and advocacy modules delivered to an interprofessional group of students pursuing health careers. After learning policy and advocacy material individually through a self-paced online curriculum, faculty gathered the students for a synchronous online event where they formed collaborative groups. In interprofessional teams, students prepared and presented advocacy briefs that were critiqued by the faculty. Post-event evaluation results showed that most students strongly agreed that the interprofessional event was very effective, and they all would recommend the program to other students. Universities and colleges educating students of health professions can take advantage of the technologies employed to keep students safe in the COVID-19 pandemic and still reach students effectively with interprofessional health policy and advocacy content.

Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida.

BACKGROUND: The specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5-11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing a large cohort of children, ages, 5-11, who play recreational football, soccer, and baseball/softball in Florida. The study venue was a large athletic facility in Hillsborough County, Florida. The sports observed were soccer (girls' and boys'), baseball, softball, and football. Internal and external advisory boards were consulted throughout the study. METHODS: Certified Athletic Trainers (ATCs) were hired to use High School Reporting Information Online (RIO) for injuries and the Ipad-administered pediatric concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concussion data. RESULTS: Over the course of the project, 26 RIO-reported injuries were reported. Football and soccer produced the greatest rate of injuries. There were 12 concussions which comprised nearly half of all the RIO injuries (46%). We conducted 882 baseline concussion tests and 13 follow-up tests over the 2 years. CONCLUSIONS: To the best of our knowledge, this is the first time data have been collected and reported on sports injuries in the study population. Future studies built on these findings will allow for the development of targeted guidelines and interventions for coaches, players, and parents so sports injury-related morbidity and mortality decrease in our youngest athletes.

MCH Workforce Capacity: Maximizing Opportunities Afforded by a Changing Public Health System.

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation.

An Examination of the Perceived Importance and Skills Related to Policies and Policy Making Among State Public Health Injury Prevention Staff.

OBJECTIVE: The purpose of this research is to use the Public Health Workforce Interests and Needs Survey to assess in greater detail state injury prevention staff perceptions of policy development and related skills and their awareness and perception of "Health in All Policies" (HiAP). DESIGN: The Public Health Workforce Interests and Needs Survey gauged public health practitioners' perspectives on workplace environment, job satisfaction, national trends, and training needs, and gathered demographics on the workforce. This study utilizes data from the state health agency frame only, focusing solely on those permanently employed, central office staff in injury prevention. Respondents were sampled from 5 paired Health and Human Services regions. SETTING/PARTICIPANTS: Approximately 25 000 invitations were sent to central office employees. The response rate was 46% (n = 10 246). The analysis in this article includes only injury prevention employees with programmatic roles, excluding clerical and custodial staff, providing us with a total of 97 respondents. When weighted, this resulted in a weighted population size of 365 injury prevention workers. MAIN OUTCOME MEASURES: The main outcome measures include demographics, responses to understanding of and skill levels related to policy development, and perceptions of HiAP public health trend. RESULTS: State injury prevention workers reported lower policy-making skill but had an overall appreciation of the importance of policies. In general, state injury prevention workers heard of HiAP, thought there should be more emphasis on it, but did not think that HiAP would have an impact on their day-to-day work. CONCLUSIONS/IMPLICATIONS FOR POLICY AND PRACTICE: Efforts are needed for all state injury prevention workers to become better skilled in policy development, implementation, and evaluation in order to become stronger injury prevention advocates and role models.

Analysis of Baseline Computerized Neurocognitive Testing Results among 5-11-Year-Old Male and Female Children Playing Sports in Recreational Leagues in Florida.

There is a paucity of data related to sports injuries, concussions, and computerized neurocognitive testing (CNT) among very young athletes playing sports in recreational settings. The purpose of this study was to report baseline CNT results among male and female children, ages 5-11, playing sports in Hillsborough County, Florida using ImPACT Pediatric, which is specifically designed for this population. Data were collected from 2016 to 2017. The results show that 657 baseline tests were conducted and t-tests and linear regression were used to assess mean significant differences in composite scores with sex and age. Results showed that females scored better on visual memory and in general as age increased, baseline scores improved. The results can be used to build further studies on the use of CNT in recreational settings and their role in concussion treatment, management, and interventions.

Preventing unintentional injuries in the home using the Health Impact Pyramid.

Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best.

A historical comparison of child and parent reports of injury prevention behaviors: findings from the Pinellas County Omnibus Study.

The purpose of this study was to analyze the motor vehicle injury prevention behaviors reported by the 12th-grade cohort of the Pinellas County Omnibus Study for years 2001-2002, compare these findings to those reported by parents in 1991-1992, and discuss the role of public health and injury prevention in these efforts. The questions in 2001-2002 were modeled after the Youth Risk Behavior Survey (YRBS) injury prevention items. Comparisons of findings in 2001-2002 and 1991-1992 were done using chi analyses. In addition, 2001-2002 results were compared to the 2001 Florida YRBS and national YRBS findings. The results of the study showed that the Omnibus cohort was significantly more likely to report safer motor vehicle injury prevention behaviors in 2001-2002 than what was reported by parents in 1991-1992. Also, the student cohort reported safer behaviors for all items than did Florida and US 12th-grade students as shown in the state and national YRBS results. The ecological model most likely contributed to these findings because there are comprehensive health education and injury prevention efforts in the state, Pinellas County schools, and in the community, including a very active community traffic safety team and the passage of significant statewide injury prevention legislation.

Injuries, injury prevention and public health.

OBJECTIVES: To introduce the readers to the field of injury prevention and comprehensive public health intervention approaches. METHODS: A review of injury epidemiology, statistics, definitions, intervention approaches, and the importance of health promotion is provided. RESULTS: Behavioral, environmental, and technological solutions will be necessary to reduce or eliminate the factors that lead to injury. CONCLUSIONS: Reductions in injury and their costs will need the support, collaboration, and partnering of several disciplines. The use of sound behavioral and social science theories and methods will be an essential component of intervention effectiveness.

Is adolescent sibling violence a precursor to college dating violence?

OBJECTIVE: To determine whether experiencing sibling violence in adolescence is a significant predictor for later dating violence. The influence of parent-to-child and parent-to-parent violence is also explored. METHODS: A modified version of the CTS2 was administered to community college students. The survey instrument used the CTS2 psychological and physical assault subscales. RESULTS: Adolescent sibling violence was a predictor for college dating violence. Males reported experiencing more sibling violence than females did, but females reported experiencing more dating violence, both as perpetrators and victims. CONCLUSION: Further research is needed to improve understanding of the reasons for and the long-term consequences of sibling violence.

Evaluation of the "Respect Not Risk" firearm safety lesson for 3rd-graders.

The purpose of this study was to evaluate the MORE HEALTH "Respect Not Risk" Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.