Kathleen R. Miner

Internet Use for Health Information Among College Students

Use of the Internet to retrieve health information is increasingly common. The authors surveyed 743 undergraduate students at 2 academic institutions to examine their Internet use, health-seeking behaviors, and attitudes related to the use of the Internet to obtain health information. Fifty-three percent of the respondents indicated that they would like to get health information online, and 28% reported that they would like to attend a health program online. Overall, 74% of the students reported having ever received health information online, and more than 40% reported that they frequently searched the Internet for information. They used various search engines and multiple Web sites to find health information. Issues related to the credibility of the information on health Web sites were crucial considerations for students. The study found differences in Internet use for health information by gender and by level of Internet experience.

Outcome-Based Workforce Development and Education in Public Health

The broad scope of the public health mission leads to an increasingly diverse workforce. Given the range of feeder disciplines and the reality that much of the workforce does not have formal training in public health science and practice, a pressing need exists for training and education throughout the workforce. Just as we in public health take a rigorous approach to our science, so too should we take a rigorous, evidence-driven approach to workforce development. In this review, we recommend a framework for workforce education in public health, integrating three critical conceptual approaches: (a) adult learning theory; (b) competency-based education; and (c) the expanded Dreyfus model in public health, an addition to the Dreyfus model of professional skills progression. We illustrate the application of this framework in practice, using the field of applied epidemiology. This framework provides a context for designing and developing high-quality, outcome-based workforce development efforts and evaluating their impact, with implications for academic and public health practice efforts to educate the public health workforce.

Intent to breast-feed: the impact of attitudes, norms, parity, and experience.

OBJECTIVE To examine the influence of breast-feeding attitudes, social norms, and prior experience on predicting breast-feeding intention utilizing the theories of reasoned action and planned behavior. METHODS Low-income pregnant women (n = 963) completed a theory-based questionnaire. RESULTS Attitudes were more predictive of breast-feeding intention than were norms, regardless of parity or prior behavior. Among multiparous women, amount of prior breast-feeding experience contributed independently to predicting breast-feeding intention and rendered norms insignificant. CONCLUSION Results support the theories. Breast-feeding promotions targeting low-income women should emphasize enhancing womens personal breast-feeding attitudes, and, among primiparous women, promoting positive breast-feeding attitudes among their significant others.

The MACH Model: From Competencies to Instruction and Performance of the Public Health Workforce

In A National Public Health Strategy for Terrorism Preparedness and Response 2003–2008, the Centers for Disease Control and Prevention (CDC) outlined the 11 imperatives for preventing death, disability, disease, and injury associated with urgent health threats.1 Imperative five, Competent and Sustainable Workforce, identifies four critical objectives: (1) increase the number and type of professionals who comprise a preparedness and response workforce; (2) deliver certification and competency-based training and education; (3) recruit and retain the highest quality workforce; and (4) evaluate the impact of training to ensure learning has occurred. The plan states: “Challenges that exist … include defining the role of certification, practicing quality assurance and performance measurement, developing customized standard competencies …”1 The MACH (Miner, Alperin, Cioffi, and Hunt) Model, developed at the Rollins School of Public Health, serves as a logic map that describes the associations among the objectives and challenges within this imperative. The MACH Model places into context the organizational and instructional theories that underpin workforce preparation and practice. It also accounts for the two general types of needs within public health: those of the employee with skill deficits for specific tasks, which can be met through training or other expert systems; and those of the institution with deficiencies in the work environment, which can be met through management practices and organizational priorities.

Predicting Breast-Feeding Intention among Low-Income Pregnant Women: A Comparison of Two Theoretical Models

This study examined the applicability of the transtheoretical model and a model derived from the theory of reasoned action for predicting breast-feeding intention among low-income pregnant women. Participants completed a 70-item self-report questionnaire assessing their breast-feeding attitudes, intentions, and support. A positive correlation existed between Stages of Change for breast-feeding and the number of Processes of Change used by respondents. A negative correlation existed between Stages of Change for breast-feeding and the number of negative breast-feeding beliefs held by respondents. Furthermore, women’s normative beliefs and outcome beliefs were significantly correlated with breast-feeding intention in manners consistent with the model developed from the theory of reasoned action. After accounting for significant sociodemographic and lifestyle factors, the Processes of Change and outcome beliefs remained independently correlated with breast-feeding intention. These models are capable of predicting the intention to breast-feed and might offer an innovative approach for further breast-feeding research and intervention development.

Developing competencies for applied epidemiology: from process to product.

Objectives. We developed competencies for applied epidemiologic practice by using a process that is based on existing competency frameworks, that engages professionals in academic and applied epidemiology at all governmental levels (local, state, and federal), and that provides ample opportunity for input from practicing epidemiologists throughout the U.S. Methods. The model set of core public health competencies, consisting of eight core domains of public health practice, developed in 2001 by the Council on Linkages Between Academia and Public Health Practice, were adopted as the foundation of the Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs). A panel of experts was convened and met over a period of 20 months to develop a draft set of AECs. Drafts were presented at the annual meetings of the Council of State and Territorial Epidemiologists (CSTE) and the American Public Health Association. Input and comments were also solicited from practicing epidemiologists and 14 national organizations representing epidemiology and public health. Results. In all, we developed 149 competency statements across the eight domains of public health practice and four tiers of applied epidemiologic practice. In addition, sub- and sub-subcompetency statements were developed to increase the documents specificity. During the process, >800 comments from all governmental and academic levels and tiers of epidemiology practice were considered for the final statements. Conclusions. The AECs are available for use in improving the training for and skill levels of practicing applied epidemiologists and should also be useful for educators, employers, and supervisors. Both CDC and CSTE plan to evaluate their implementation and usefulness in providing information for future competency development.

Environmental Health Promotion Interventions: Considerations for Preparation and Practice

Interventions to address current, future, and potential public health dilemmas, such as air pollution, urban sprawl, brown field reclamation, and threats of intentional toxic exposures would benefit from a synergy between the disciplines of environmental health and health education. A comparison between the Protocol for Assessing Community Excellence in Environmental Health and the PRECEDE-PROCEED model used in health education illustrates some similarities and differences in terminology, assessment procedures, intervention design, and types of evidence used by the two disciplines. Promising intervention strategies draw on the expertise of both fields and include social action, policy and media advocacy, coalition building, organizational change, lay health advisers, risk communication, and tailored educational messages. Appropriate targets of change can range from the equitable distribution of resources to individual behavior change. Significant interdisciplinary evaluation research is necessary to accelerate the identification of successful models for reducing the burden of environmental health problems in communities.

An informatics agenda for public health: summarized recommendations from the 2011 AMIA PHI Conference

The AMIA Public Health Informatics 2011 Conference brought together members of the public health and health informatics communities to revisit the national agenda developed at the AMIA Spring Congress in 2001, assess the progress that has been made in the past decade, and develop recommendations to further guide the field. Participants met in five discussion tracks: technical framework; research and evaluation; ethics; education, professional training, and workforce development; and sustainability. Participants identified 62 recommendations, which clustered into three key themes related to the need to (1) enhance communication and information sharing within the public health informatics community, (2) improve the consistency of public health informatics through common public health terminologies, rigorous evaluation methodologies, and competency-based training, and (3) promote effective coordination and leadership that will champion and drive the field forward. The agenda and recommendations from the meeting will be disseminated and discussed throughout the public health and informatics communities. Both communities stand to gain much by working together to use these recommendations to further advance the application of information technology to improve health.

Credentialing the public health workforce: an idea whose time has come.

The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels since the landmark 1988 Institute of Medicine report. The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. The fact that the public health workforce is not a single profession, but rather a fabric of many professions dedicated to a common endeavor, creates challenges to any singular approach. This article explores the relationships among competency, certification, and accreditation and summarizes the expert panel dialogue on workforce development incentives, specifically regarding certification and credentialing. The authors challenge public health leaders to become actively involved in framing the issues so the best possible strategies can be developed.

The Evidence Base for Effectiveness of Preparedness Training: A Retrospective Analysis

Objectives. In 2007, the Centers for Disease Control and Prevention (CDC) commissioned an Evidence-Based Gaps Collaboration Group to consider whether past experience could help guide future efforts to educate and train public health workers in responding to emergencies and disasters. Methods. The Group searched the peer-reviewed literature for preparedness training articles meeting three criteria: publication during the period when CDCs Centers for Public Health Preparedness were fully operational, content relevant to emergency response operations, and content particular to the emergency response roles of public health professionals. Articles underwent both quantitative and qualitative analyses. Results. The search identified 163 articles covering the topics of leadership and command structure (18.4%), information and communications (14.1%), organizational systems (78.5%), and others (23.9%). The number of reports was substantial, but their usefulness for trainers and educators was rated only “fair” to “good.” Thematic analysis of 137 articles found that organizational topics far outnumbered leadership, command structure, and communications topics. Disconnects among critical participants—including trainers, policy makers, and public health agencies—were noted. Generalizable evaluations were rare. Conclusions. Reviews of progress in preparedness training for the public health workforce should be repeated in the future. Governmental investment in training for preparedness should continue. Future training programs should be grounded in policy and practice needs, and evaluations should be based on performance improvement.