An analysis of ICAR recommendations for long-term care facilities in Alabama.

The Alabama Long-Term Care Strike Team was established in 2022 to help long-term care facilities build and maintain infection prevention and control (IPC) systems. Infection preventionists use CDC's Infection Control Assessment and Response (ICAR) tools to provide IPC-specific recommendations. Analysis of ICAR recommendations identified the 3 greatest training needs in Alabama: source control, hand hygiene, and environmental cleaning. The ICAR provides a standardized and objective way to monitor and mitigate IPC risk.

Expanding the Public Health Pipeline Through the Public Health Influencers Summer Institute.

The need for a robust public health system in the United States is critical for safeguarding population health. However, current data suggest an insufficient number of individuals entering or staying in the governmental public health workforce. Expanding the public health pipeline requires creative thinking about recruitment and training activities. To attract students to public health and other health-related fields, including medicine, one institution in the Southeast recently initiated the Public Health Influencers Summer Institute (PHISI), a program that addresses the beginning of the career development continuum: recruitment of high school students. For this investigation, we reviewed evaluation data of the PHISI and provided descriptive analyses and selected quotes to reflect student learning. Participants reported increased familiarity with all public health topics after participating in the program, with the greatest increases in public health policy and social determinants of health. In addition, all participants reported increased or significantly increased understanding of public health after participating in the program. While interest in the field of public health increased due to the COVID-19 pandemic, there are not enough individuals entering or staying in the public health workforce, leaving a critical shortfall. Introducing high school students to the field of public health may increase their interest in entering the public health workforce in the future, thereby strengthening the overall public health infrastructure. We propose that the PHISI may be an innovative strategy for increasing both the number and diversity of students interested in pursuing a career in public health.

The Need for Responsive Workforce Development During the Pandemic and Beyond: A Case Study of the Regional Public Health Training Centers.

CONTEXT: The COVID-19 pandemic underscored the importance of a strong public health infrastructure for protecting and supporting the health of communities. This includes ensuring an adaptive workforce capable of leading through rapidly changing circumstances, communicating effectively, and applying systems thinking to leverage cross-sector partnerships that help promote health equity. The 10 Regional Public Health Training Centers (PHTCs) advance the capacity of the current and future public health workforce through skill development and technical assistance in these and other strategic areas. PROGRAM: This study examines activities through which the Regional PHTCs and their partners supported the public health workforce during the pandemic. Representatives of the 10 Regional PHTCs completed a survey in the spring of 2022. The survey included (1) pulling trends in training usage from 2018-2021 annual performance reports and (2) questions assessing the type, content, and reach of training needs assessments, training and technical assistance, student placements, and PHTC Network collaborative activities that occurred from January 1, 2020, to December 31, 2021. Respondents also reflected on trends in use, challenges, lessons learned, stories of impact, and future PHTC practice. EVALUATION: During the pandemic, the Regional PHTCs engaged in numerous efforts to assess needs, provide training and technical assistance to the practice community, facilitate projects that built student competency to support public health agency efforts, and collaborate as the PHTC Network on national-level initiatives. Across these activities, the Regional PHTCs adjusted their approaches and learned from each other in order to meet regional needs. DISCUSSION: The Regional PHTCs provided student and professional development in foundational public health knowledge and skills within their regions and nationally while being flexible and responsive to the changing needs of the field during the pandemic. Our study highlights opportunities for collaboration and adaptive approaches to public health workforce development in a postpandemic environment.

Public Health Training Centers: More Relevant Than Ever.

Interest in and awareness of public health in the United States has grown due to COVID-19; however, state and local health departments have seen a mass exodus of leadership since the beginning of the pandemic. Based on the results of the de Beaumont Foundation's most recent Public Health Workforce Interests and Needs Survey (PH WINS), nearly one in three public health employees say they are considering leaving the profession due to stress, burnout, and low pay. One viable strategy for ensuring a diverse and competent public health workforce is the national network of Public Health Training Centers (PHTCs). This commentary describes the Public Health Training Center Network, with a specific focus on Region IV, and discusses challenges and opportunities for advancing the public health agenda in the United States. The national PHTC Network continues to provide invaluable services in terms of training, professional development, and experiential learning for the current and future public health workforce. However, increased funding would allow PHTCs to have a greater impact and reach through bridge programs for public health workers and others, additional field placement experiences, and expanded outreach to non-public health professionals in training activities. PHTCs have shown great adaptability over time and can once again pivot to meet the needs of a rapidly changing public health landscape demonstrating that PHTCs are truly more relevant than ever.

Preliminary Findings of the Birmingham Policy Surveillance Initiative.

Policy surveillance is becoming an increasingly powerful tool in public health to identify policies and programs that influence individual and community health. However, not many systems exist to track or facilitate greater understanding of policies at a city or county level. Furthermore, relatively little is known about which policies are being implemented and how they relate to population health goals. In 2019, the University of Alabama at Birmingham School of Public Health joined a consortium of universities to specifically track municipal policies in Birmingham, Alabama. Since its inception, the Birmingham Policy Surveillance Initiative has identified 443 policies and program initiatives related to 6 key areas of focus. The purpose of this article is to describe a policy surveillance system in Birmingham, Alabama. Results are intended to raise the profile of policy surveillance and inform policy makers of opportunities and gaps in policies that influence individual and community health.

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.

Exploring the Preliminary Steps of One County Health Department to Manage the COVID-19 Pandemic.

This case study describes how one county health department in Alabama used the best available evidence to address the needs of its citizens during the first 6 months of the COVID-19 pandemic. The authors explore issues of scope of authority by government officials, individual freedom versus population health, and challenges of health communication during a disease outbreak. Despite the availability of vaccines, boosters, and access to vaccines by children as young as 5 years, COVID-19 cases are on the rise across the United States more than 2 years after the official news broke out of Wuhan, China. Health officials have expressed concerns that backlash against governmental public health during the pandemic will limit public health authorities from responding to the traditional challenges that were present pre-COVID-19 and will remain in a post-COVID-19 world.

Reconsidering the "Place" in Field Placement.

Site-based, in-person field placement experiences prepare students for real-world community practice through reflection; direct, hands-on experience; and the completion of a project or set of deliverables that add value to the organization. These practice experiences encourage students to integrate classroom learning with the knowledge and skills of a workplace environment. In the Southeast United States, the Region IV Public Health Training Center (R-IV PHTC) provides students with practice experiences through the Pathways to Practice Scholars Field Placement Program. Before COVID-19, these field placement experiences were limited to in-person assignments in which students worked and lived in the communities they served. However, student and mentor experiences during the COVID-19 pandemic demonstrated that remote work arrangements offer a viable alternative to the onsite-only field placement experience. In this article, we describe student experiences with remote and hybrid work arrangements, highlight issues regarding equity and inclusion, and discuss implications for future public health practice.

Infectious Disease Hospital Preparedness: Lessons Learned From the 2019 Measles Outbreak.

OBJECTIVE: This paper: (1) explores the real and perceived threats to Emergency Departments (EDs) in addressing infectious disease cases in the US, like measles, and (2) identifies priorities for protecting employees, patients, and others stakeholders through hospital preparedness while streamlining processes and managing costs. METHODS: A case study approach was used to describe the events that triggered an infectious disease emergency response in 1 ED in the southeast. Development of the case study was informed by emergency preparedness literature on Homeland Security Exercise and Evaluation Program processes. RESULTS: Hospital staff and administrators identified a number of factors that either positively contributed to disease containment or exacerbated conditions for disease transmission. Successes included early recognition of the potential threat, development of a multidisciplinary taskforce, and implementation of a pre-incident response plan. Challenges comprised of patient flow in crisis response, lab turnaround time, and employee records. CONCLUSIONS: The threat of exposure challenged daily operations and raised situational awareness among administrators and providers to issues that might arise during an infectious disease exposure. Recording emergency preparedness successes, remediating challenges, and sharing information with others may help minimize the threat of communicable diseases within hospital settings in the future.

Gamification and education: A pragmatic approach with two examples of implementation.

Leveraging elements of game design and theories of human motivation, gamification provides a variety of techniques to engage learners in novel ways. Our Clinical and Translational Science Award created the software platform (Kaizen-Education©) to deliver gamified educational content in 2012. Here, we explore two novel use cases of this platform to provide practical insights for leveraging these methods in educational settings: (1) national training in rigor, reproducibility, and transparency and (2) attainment of learner competency (n = 7) as a gauge of curricular effectiveness across Master of Public Health degree tracks (n = 5). Data were captured in real time during player interaction with Kaizen-Education© to provide descriptive analyses of player engagement in both implementation examples. We then assessed item analysis to assess knowledge gain and competency attainment. We have just begun to leverage the potential for gamification to engage learners, enhance knowledge acquisition, and document completion of training, across various learning environments. We encourage a systematic approach to gamification applying insights from self-determination theory to learners and learning environments, a methodical approach to game design and rigorous analysis after implementation to generate evidence-based insights to maximize educational return for time invested.

Practice Transformation in HIV Primary Care: Perspectives of Coaches and Champions in the Southeast United States.

INTRODUCTION/OBJECTIVES: Across the United States, and particularly in the South, there is an urgent need to improve health outcomes for people with HIV. In response, the Southeast AIDS Education & Training Center (AETC) conducted a 4-year Practice Transformation (PT) initiative (2015-2018) in 12 mostly primary care clinics across 4 states in the region. Drawing on the leadership of PT facilitators ("coaches") from AETC partner sites throughout the region and specific clinic staff members ("champions"), clinics worked toward self-selected organizational goals to increase their HIV care capacity and improve HIV health outcomes. METHODS: To explore coaches' and champions' experiences and perspectives of PT, we conducted 2 focus group sessions, 1 tailored for coaches (n = 5) and another for champions (n = 9). RESULTS: Content analysis of qualitative data revealed 4 major themes around coaches' and champions' experiences and perspectives of PT. These themes include Challenges, Facilitators, Successes, and Suggestions for PT Improvement. CONCLUSION: Primary care and infectious diseases/HIV clinics can help improve HIV Care Continuum outcomes through increasing their capacity to serve the needs of their clients, as facilitated through coaches and clinic champions. Since no single clinic or clinic patient population is alike, it is important work within organizations to address specific needs and leverage unique skillsets. Future PT initiatives can learn from experiences of this PT program to optimize the effectiveness of their programs.

Marking time in lockdown: heroization and ritualization in the UK during the coronavirus pandemic.

Realism has predominated in discussions about the coronavirus pandemic where politicians, authorities, and commentators debate over the substance and consequence of scientific facts. But while biology played a crucial role in triggering the pandemic, the resulting crisis developed through a social process. In this paper, I argue that the coronavirus pandemic in Britain was successfully framed as a crisis, but that the ritualization of solidarity normally generated by this meaning was compromised. Through an analysis of media coverage and official statements from the government, I trace the discursive construction of the crisis through the deployment of battle metaphors. Building on this discourse analysis, I show how the symbolic alignment of the pandemic and the Second World War revived symbols and tropes that informed the cultural construction of pandemic heroes. To explain why the intensity of the crisis framing was not matched in ritual performance, I consider how the government's ambiguous policies and erratic social performance produced a state of indefinite liminality, subverting solidarity processes in lockdown. The paper offers insight into the experience of anomie during the pandemic and contributes to the strong program in cultural sociology by incorporating the crisis approach in disaster studies into the social drama framework.

Connecting Public Health Students to Rural and Underserved Areas: Promoting Health Equity Through Field Placement Experiences.

There is an increasing demand for public health workers due to the unmet needs of the poor and underserved populations. However, through field placement experiences, students can actively engage in their own learning while also addressing critical needs of rural and medically underserved populations. In this mixed-methods evaluation, we explored experiences of emerging public health practitioners who participated in the Region IV Public Health Training Center's Pathways to Practice Scholars program between 2014 and 2018. Based on student confidence level ratings and descriptions of field placement experiences, scholars participated in meaningful and enriching field placement experiences in rural areas or on behalf of medically underserved populations. Across all eight Council on Linkages Core Competency Domains, students recorded increased pre- to post-confidence scores, and for many, the field placement experience appeared to affirm their interest in addressing the needs of these communities in the future.

Life After Trauma: A Survey of Level 1 Trauma Centers Regarding Posttraumatic Stress Disorder and Acute Stress Disorder.

Patients admitted to Level 1 trauma centers in the United States are rarely assessed for or educated about the potentially devastating effects of acute stress disorder (ASD) or posttraumatic stress disorder (PTSD). This descriptive research was conducted to describe current levels of assessment and education of ASD and PTSD in Level 1 trauma centers in the United States. The aims of this article are to (1) determine the extent to which Level 1 trauma centers in the United States assess and educate patients and providers about ASD and PTSD and (2) identify clinical staff who administer assessments and provide educational resources. A web-based survey was distributed to the trauma program managers and trauma medical directors of 209 adult and 70 pediatric Level 1 trauma centers in the United States. For PTSD, 26 (25.00%) adult and 17 (36.17%) pediatric centers had an assessment protocol for use with trauma patients. For ASD, 13 (12.50%) adult and 13 (27.66%) pediatric centers utilized an assessment protocol for use with trauma patients. For PTSD, 12 (12.37%) adult and 8 (20.00%) pediatric centers offered educational protocols for use with trauma patients. Seven (7.22%) adult and 7 (17.50%) pediatric centers maintain educational protocols for ASD in trauma patients. Fewer centers had assessment or educational protocols targeting formal and informal caregivers. This study was limited to Level 1 trauma centers in the United States. Results indicate that trauma patients are rarely assessed for or educated about the potential effects of PTSD or ASD. Formal and informal caregivers are also assessed and educated at low rates. Assessment, education, and incidence of PTSD and ASD should be included as universally measured health outcomes across trauma centers.

The Search for Environmental Justice: The Story of North Birmingham.

Environmental justice is a rising social movement throughout the world. Research is beginning to define the movement and address the disparities that exist among communities exposed to pollution. North Birmingham, a community made up of six neighborhoods in Jefferson County, Alabama, in the United States, is a story of environmental injustice. Heavy industry, including the 35th Avenue Superfund Site, has caused significant environmental pollution over time, leaving residents concerned that their health and well-being are at risk from continued exposure. For years, pollution has impacted the community, and residents have fought and challenged industry and government. The United States (U.S.) Environmental Protection Agency (EPA), the U.S. Agency for Toxic Substances and Disease Registry (ATSDR), and the Jefferson County Department of Health (JCDH) in Alabama have historically played a role in working with the community regarding their health concerns. In this manuscript, we describe a city entrenched in environmental injustice. We provide the history of the community, the responsible parties named for the contamination, the government's involvement, and the community's response to this injustice. Through this manuscript, we offer insight into a global concern that challenges local communities on a daily basis.

Mississippi Medical Reserve Corps: Moving Mississippi From Emergency Planning to Response Ready.

OBJECTIVE: The purpose of this study was to identify factors that might impact a Medical Reserve Corps (MRC) volunteer's decision to respond to an emergency event. The 2 primary goals of this survey were to (1) establish realistic planning assumptions regarding the use of volunteers in health care emergency responses, and (2) determine whether barriers to volunteer participation could be addressed by MRC units to improve volunteer response rates. DESIGN: An anonymous online survey instrument was made available via Qualtrics through a customized URL. For the purpose of distribution, the Mississippi State Department of Health sent an electronic message that included the survey link to all MRC volunteers who were registered with the Mississippi Responder Management System (MRMS) as of September 2014. RESULTS: Approximately 15% of those surveyed indicated they would be available and able to deploy within 24 hours. The most common factors reported in terms of respondent decisions to deploy included risk to personal health (61.2%), length of deployment (58.8%), and the security of the deployment area (55.3%). In addition, 67% of respondents indicated that extended periods of deployment would have a negative financial impact on their lives. Respondents who have had training or previous deployment experience reported having greater knowledge of potential response roles, increased comfort in their ability to respond with the MRC, and increased confidence in responding to differing public health emergencies. CONCLUSIONS: Barriers to MRC volunteers being able to deploy should be addressed by each MRC unit. Issues such as risk to personal safety while on deployment, site security, and length of deployment should be considered by planners and those solutions communicated to MRC members during trainings. Emergency plans utilizing MRC volunteers will require significant evaluation to assess the risk of relying on an expected resource that could be severely limited during an actual emergency.

Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop.

HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre-post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop "excellent" and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, well-organized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH (p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.