Brandon Grimm

A Systems-Based Typological Framework for Understanding the Sustainability, Scalability, and Reach of Childhood Obesity Interventions

This article proposes a systems-based framework to examine 3 structural dimensions of childhood obesity interventions that can impact intervention sustainability, scalability, and reach. These 3 dimensions are the locus of intervention drivers (top-down vs. bottom-up), the locus of change effected (policy vs. individual behavior), and the public versus private sector. Interventions focused on individual behavior change often rely on bottom-up approaches and have generally been less sustainable than policy interventions. However, top-down (government or industry) support can lead to better funding and shifts in social norms. In the public sector, top-down efforts targeting individual behavior are generally also more scalable and have wider reach to diverse communities. In the private sector, behavior-change interventions tend to have greater resources and are sustained over longer periods, even when efficacy is in question; they may also be quite scalable. In a systems approach, a combination of approaches that encompass the structural dimensions in systems space will likely be needed to significantly impact childhood obesity. Next-generation childhood obesity interventions should be able to demonstrate sustainability, scalability, and reach as benchmarks of plausible success and criteria for investment.

Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study

Aim To examine the association between neighbourhood exposure to point-of-sale (POS) cigarette price promotions and financial stress among smokers in a Midwestern metropolitan area in the USA. Methods Survey data from 888 smokers provided information on sociodemographic and smoking related variables. Financial stress was measured with the question: ‘In the last six months, because of lack of money, was there a time when you were unable to buy food or pay any important bills on time, such as electricity, telephone, credit card, rent or your mortgage? (Yes/No).’ Using audit data from 504 tobacco retailers, we estimated a score of POS price promotions for each respondent by summing the different types of promotion in each store in their neighbourhood, as defined by a 1-km roadway buffer. Results Adjusted results provided strong support for an association between higher scores of neighbourhood POS cigarette price promotions and a higher probability of financial stress (p=0.007). Conclusion Exposure to POS cigarette price promotions is associated with financial stress. This finding, coupled with previous reports that smokers with financial stress are less likely to attempt to quit or succeed in quitting smoking, suggests that POS cigarette price promotions may act as an impediment to smoking cessation.

Cervical Cancer Attitudes and Knowledge in Somali Refugees in Nebraska

The state of Nebraska has a growing number of refugees with diverse backgrounds and health needs. To address these needs, a collaborative project was developed by the local performance site of the Midwestern Public Health Training Center at the University of Nebraska Medical Center, College of Public Health, and the Nebraska Department of Health and Human Services, Division of Public Health, Office of Women’s and Men’s Health. The purpose of this 2-year project is to improve the quality of services offered by the Office of Women’s and Men’s Health by assessing risk, knowledge, and preventive screening practices in refugee populations and provide recommendations to increase cancer-screening rates. The focus of the project was on cervical cancer prevention of Somali women refugees in Nebraska. In Year 1 of the project (2015-2016), a Refugee Screening Collaborative was created to provide input and recommendations throughout the project; focus groups and a literature review were completed to explore the knowledge, attitudes, and beliefs of cervical cancer screening and human papillomavirus vaccine among refugees and health care providers; and recommendations were made for the development and implementation of curricula and interventions that address the unique cultural and literacy needs of the population. This project demonstrates the importance of the Public Health Training Center program for building mutually beneficial partnerships between academia and practice.

Partnering With American Indian Communities in Health Using Methods of Strategic Collaboration

Background: The Association for Prevention Teaching and Research (APTR) sponsored six regional workshops in 2010 on community engagement and community-engaged research. One of the six workshops was a collaborative effort between the Great Plains Tribal Chairman’s Health Board (GPTCHB)–Northern Plains Tribal Epidemiology Center and the College of Public Health at the University of Nebraska Medical Center (UNMC-COPH).Objectives: To create a meaningful and dynamic forum for the exchange of ideas and co-learning between researchers from urban, tribal and nontribal communities and to build the groundwork for development of sustainable partnerships between researchers and American Indian (AI) communities to eliminate health disparities.Methods: To enhance meaningful community engagement, we utilized Methods of Strategic Collaboration using the Appreciative Inquiry, 4D Change Process Model and designed several interactive group activities including Collaborative Learning and Understanding Exercises (CLUE) and the Research Café.Results: The key themes that emerged from the interactive sessions stressed the importance of building relationships and trust; mutual use and sharing of data; and acquiring knowledge, skills, and abilities to enable sustainable research partnerships with AI communitiesConclusions: Innovative, dynamic, and strategic collaborative methods of Appreciative Inquiry and the World Café can served to engage people in a constructive dialogue to create a shared vision and plan for more meaningful research partnerships based on principles of equity and social justice, essential for the elimination of health disparities. These collaborative methods can be replicated and adapted in diverse communities, locally, nationally, and globally.

Cancer Community Education in Somali Refugees in Nebraska

Nebraska has one of the highest numbers of refugees per capita in the U.S. A high number of Somalis have resettled in Nebraska due to job opportunities and the low cost of living. In this paper, we report the process and the results of a cervical and breast cancer education program for Somali women conducted through a collaboration among public health, academia, and community entities. The curriculum was built to be suitable for the literacy level and cultural values of this community. Topics include female reproductive anatomy; breast and cervical cancer knowledge and screening; hepatitis C and liver cancer; and preparing for a health screening visit. Two community members trained as lay health workers conducted a pilot and an actual education session. The 2-day education program was attended by 52 women. Qualitative data showed the intervention to be promising for this and other African refugee populations.

The EDIC Method An Engaging and Comprehensive Approach for Creating Health Department Workforce Development Plans

In 2013, the Nebraska Department of Health & Human Services, Division of Public Health (Nebraska’s State Health Department); and the University of Nebraska Medical Center, College of Public Health developed a comprehensive approach to assess workforce training needs. This article outlines the method used to assess the education and training needs of Division staff, and develop comprehensive workforce development plans to address those needs. The EDIC method (Engage, Develop, Identify, and Create) includes the following four phases: (1) Engage Stakeholders, (2) Develop Assessment, (3) Identify Training Needs, and (4) Create Development Plans. The EDIC method provided a process grounded in science and practice, allowed input, and produced buy-in from staff at all levels throughout the Division of Public Health. This type of process provides greater assurance that the most important gaps in skills and competencies will be identified. Although it is a comprehensive approach, it can be replicated at the state or local level across the country.

Assessing the education and training needs of Nebraska's public health workforce

Introduction In 2012, the Great Plains Public Health Training Center (Grant #UB6HP22821) conducted an online survey of state and local health departments and the American Indian (tribal clinics, tribal health departments, and urban Indian clinic) public health workforce across three professional levels. The objectives of the needs assessment were to determine the competency levels of the state’s public health workforce, assess gaps in public health competencies, identify public health training interests, needs, and preferences, and to determine the barriers and motivators to participate in public health training. Methods The assessment was developed using the Council on Linkages Between Academia and Public Health Practice, Core Competencies for Public Health Professionals survey (1). The final assessment was created and piloted by numerous individuals representing practice and academia. Results Respondents identified cultural competency and communication skills as the two most important public health competency domains. Although the public health professionals perceived that they were least proficient in the area of policy development and program planning, participants identified the greatest needs for training in financial planning and management skills and analytical/assessment skills. In general, respondents preferred instructor-led interactive training sessions offered as onsite multi-day workshops or computer-based courses. Respondents identified obesity, health disparities, physical activity, chronic diseases, and diabetes as the top five public health topical areas. Conclusion These priorities align with State and National public health plans. The findings of the needs assessment were used to tailor educational opportunities to build the capacity of Nebraska’s public health system. Additionally, the results were used to develop workforce development plans for numerous local health departments throughout Nebraska.

Perceived Impacts of a Public Health Training Center Field Placement Program among Trainees: Findings from a Small Group Externship Experience.

There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews. We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training.

An Academic and Practice Partnership to Assess the Behavioral Health Needs of Nebraska

Schools of Public Health have a commitment to engage in practice-based research and be involved in collaborative partnerships. In 2016 the faculty, staff, and students from the University of Nebraska Medical Center College of Public Health and the Nebraska Department of Health and Human Services, Division of Behavioral Health collaborated to develop and administer a comprehensive assessment of the mental health and substance use disorder services provided by the Division of Behavioral Health. The purpose of this paper is to describe the process used to develop the trusting and mutually beneficial partnership and the data tools that were created and used to assess and determine the behavioral health needs. It is unrealistic to think that practitioners could undertake a project of this magnitude on their own. It is essential to have identified processes and systems in place for others to follow.

Common Diagnoses among Refugee Populations: Linked Results with Statewide Hospital Discharge Database

Background: According to the U.S. State Department’s Refugee Processing Center and the U.S. Census Bureau, in the fiscal year 2016, among all states in the United States, Nebraska resettled the highest number of refugees per capita. Objectives: The objectives of this study were to determine the most common reasons for refugees utilizing hospital services in Nebraska between January 2011 and September 2015, and to examine whether refugee patients had increased risks for adverse health conditions compared to non-refugee patients. Methods: Statewide linkage was performed between Nebraska Medicaid Program’s immigration data, and 2011–2015 Nebraska hospital discharge data inpatient and outpatient files. The linkage produced 3017, 5460, and 775 cases for emergency department visits, outpatient clinic visits, and inpatient care for the refugee sample, respectively. Findings: Refugee patients were at increased risk for a number of diagnoses or medical conditions, including pregnancy complications, abdominal pain, upper respiratory infections, viral infections, mood disorders, disorders of teeth and jaw, deficiency and anemia, urinary system disorders, headache, nausea and vomiting, limb fractures, spondylosis, essential hypertension, and uncomplicated diabetes mellitus. Conclusions: The findings suggest a greater emphasis on preventive healthcare, especially in areas of maternal health and perinatal outcomes, psychological counseling, screening for infectious diseases, nutrition and healthy eating, and oral health. Additionally, culturally appropriate measures to address prevention, health screening, and treatments should be adopted by health providers who care for refugees.