Rosemary M. Caron

Community Ecology and Capacity: Keys to Progressing the Environmental Communication of Wicked Problems

Wicked problems are multifactorial in nature and possess no clear resolution due to numerous community stakeholder involvement. We demonstrate childhood lead poisoning as a wicked problem and illustrate how understanding a communitys ecology can build community capacity to affect local environmental management by (1) forming an academic–community partnership and (2) developing a place-specific strategy grounded in the cultural–experiential model of risk. We propose that practitioners need to consider a communitys ecology and social context of risk as it pertains to wicked problems. These factors will determine how a diverse community interprets and responds to environmental communication and capacity-building efforts.

Engaging Local Public Health System Partnerships to Educate the Future Public Health Workforce

The Institute of Medicine concluded that keeping the public healthy required a well-educated public health workforce, thus leading to its recommendation that “all undergraduates should have access to education in public health” [2]. In response to this call, the authors examined the current practice, feasibility, and value in strengthening (or building) a functional collaborative model between academic institutions and practitioners from local health departments to educate tomorrow’s public health workforce. Local and regional health departments in New England were surveyed to: (1) establish a baseline of existing working relationships between them and nearby academic institutions; (2) examine the barriers that inhibit the development of collaborations with academic partners; (3) assess how they jointly promote public health workforce development; and (4) analyze which essential public health services their partnership addresses. Despite the lack of financial resources often cited for the absence of academic-local health department collaborations, some New England states reported that their academic institution and local public health department partnerships were valued and productive. The authors discuss how effective academic-community collaborations have the potential to facilitate a broad-based appreciation of public health among students via a wide array of public health curricula and applied experiential learning opportunities in public health settings. The authors propose a model for how to combine basic public health lessons with practical experience and leadership offered by local health departments, in order to foster a real understanding of public health, its importance, practice, and relevance in today’s society from a public health workforce perspective.

An Academic-Community Outreach Partnership: Building Relationships and Capacity to Address Childhood Lead Poisoning

Background: Although academic institutions are rich resources for improving public health, academic partnerships with community organizations can be challenging. We describe a successful academic–community partnership composed of the Dartmouth Toxic Metals Research Program, the Manchester (New Hampshire) Health Department, and the Greater Manchester Partners Against Lead Poisoning (GMPALP). Objective: Partners collaborated to translate science and best practices into social action and policy change to address childhood lead poisoning. Methods: Using the evolution of a childhood lead poisoning prevention initiative, we discuss how an academic–community relationship can be created and sustained. Lessons Learned: Our experience demonstrates that broadbased partnerships are enhanced by the attributes of community-based participatory research (CBPR). We observe that engaging in community collaborations that are not driven by research eliminates potential conflicts for academic and community partners. Conclusion: We identify four core values, namely, (1) adaptability, (2) consistency, (3) shared authority, and (4) trust, as being constructive when working in such partnerships.

Public Health System Partnerships: Role for Local Boards of Health in Preparing the Future Public Health Workforce

The Institute of Medicine’s report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommended that public health education be accessible to undergraduate students. Promoting access to public health education will ideally contribute to a well-educated public health workforce, thus assuring the fulfillment of the public health mission. In response to this call to action, the authors examined the current practice, feasibility, and value in developing a functional partnership between academic institutions and local boards of health in preparing future public health professionals. Local boards of health in New England were surveyed to: (1) establish a baseline of existing working relationships between them and nearby academic institutions; (2) examine the barriers that inhibit the development of their collaborations with academic partners; and (3) assess how they jointly advance public health workforce development. Despite the main barriers of a lack of time, staff, and funding that are often cited for the absence of collaborations between institutions, one New England state, in particular, reported that their academic institution and local board of health partnerships were important and effective. The authors discuss how academic-practice collaborations hold the potential to combine basic public health principles with leadership and governance experience offered by local boards of health. Such partnerships are underutilized and have the potential to integrate core public health concepts while facilitating applied experiential learning opportunities in a professional public health setting, thus contributing to the development of the future public health workforce.

Childhood Lead Poisoning in a Somali Refugee Resettlement Community in New Hampshire

Despite the gradual decrease in childhood lead poisoning in the United States, the risk for lead poisoning among African refugee children who resettle in the United States remains elevated. Communication methods implemented by resettlement agencies in the public health system for preventing childhood lead poisoning in this at-risk population warrant further investigation. We utilized structured interviews with key stakeholders (resettlement agencies, social service agencies developed by African refugees and resettled Somali refugees) involved in the refugee resettlement process to (1) describe the agency’s role in the refugee resettlement process; (2) examine communication methods utilized and barriers experienced by the public health system in reference to childhood lead poisoning; (3) describe the refugee population’s perception of childhood lead poisoning; (4) examine general challenges experienced by the public health system and the refugee population during the resettlement process; and (5) describe stakeholders’ recommendations to improve health communication efforts. Based on our findings, we propose that communities are important determinants in health-related problems for refugee populations. Each community has its own environment and public health system that interacts with each other to influence health risks and risk perceptions of its populations. We advocate that understanding a community’s ecology and implementing a culture-centered approach is essential for the public health system to help educate and prevent communication inequalities and health disparities among an at-risk African refugee population. This action can reduce a population’s resistance to communication and help build a community’s capacity to address a persistent public health problem, such as childhood lead poisoning.

Sex disparities in pre-hospital and hospital treatment of ST-segment elevation myocardial infarction.

Abstract Objective: To determine whether sex disparities exist in pre-hospital and hospital time to treatment in patients with ST-segment elevation myocardial infarction (STEMI). Background: Evidence suggests that women experience poorer quality of care for STEMI. Methods: A retrospective cohort study was conducted on 177 consecutive patients with STEMI who received primary percutaneous coronary intervention at a rural, tertiary medical center between January 2006 and October 2009. A subgroup analysis was conducted to evaluate time to treatment during a period of no-focused process improvement compared with a time period of focused, non–sex-specific process improvement; the post period included implementation of the STEMI process upgrade (STEP-UP) quality-improvement (QI) program. Results: Median first-emergency-medical-services-contact-to-balloon (E2B) angioplasty time was significantly longer for women compared with men. A Cox proportional hazards model revealed that men had a significantly shorter E2B time than women. After adjustment for differences between sex groups at presentation, the effect of sex on E2B was no longer statistically significant. A similar effect was observed in door-to-balloon (D2B) angioplasty time. The subgroup analysis revealed that from baseline, both men and women experienced improvement in E2B time after implementation of the STEP-UP QI program. Men and women also experienced improvement in D2B time after implementation of the STEP-UP QI program. Conclusions: Women with STEMI experienced significantly longer E2B and D2B times compared with men with STEMI, although these differences did not persist after adjustment for differences between sex groups at presentation. In addition to standard STEMI-care QI practices, sex-specific processes and interventions at the systems level may be needed to improve time to treatment for women with STEMI.

Teaching epidemiology in the digital age: considerations for academicians and their students

The way in which we prepare future public health professionals is changing because of the digital age. Online education is expanding the accessibility of public health training to students and practitioners with diverse backgrounds. Online courses offer many advantages for students, including flexible schedules, elimination of commuting time, and fostering interactions among students and the instructor. A few disadvantages of online courses for the student can include a feeling of isolation, difficulty adjusting to the time-intensive nature, and the required self-discipline to regularly tend to online course materials that immature and working students can find challenging. For faculty who are faced with teaching epidemiology in these changing times of the traditional face-to-face classroom and the virtual classroom, the core teaching principles of this science of public health remain unchanged, yet how they are delivered in the online environment adds a layer of complexity not previously encountered. This paper presents practical considerations for faculty who will be teaching online and their students who will be learning online. In addition, a framework for an online epidemiology course is presented as a model by which faculty interested in teaching epidemiology online can modify the course structure, content, and assessment tools to fit their needs.

Environmental Inequality: Childhood Lead Poisoning as an Inadvertent Consequence of the Refugee Resettlement Process

Communities are important health determinants for resettled refugees. The risk for lead poisoning among African refugee children who resettle in the United States remains elevated, despite the gradual decrease in childhood lead poisoning in this country. We argue that the refugee resettlement process is a restricted system with a limited infrastructure that inadvertently contributes to the disproportionate burden of lead poisoning cases experienced by resettled African refugee children. We present childhood lead poisoning in a resettled African refugee population as a case study of environmental inequality. We propose recommendations for practitioners to reduce and ultimately eliminate this unintended environmental inequality.

English for Speakers of Other Languages (ESOL): Improving English Language Acquisition for Preliterate and Nonliterate Adult African Refugees

Language barriers lead to unemployment, poverty, diminished health status, and social isolation. Since some African refugee populations are often not literate in their own language as well as English, they experience difficulty integrating into their new community. Structured interviews and focus groups were conducted with African refugees regarding the effectiveness of English for speakers of other languages (ESOL) programs. Several factors were identified as impeding the participants success in the program: (a) lack of peer education; (b) short duration of classes; and (c) lack of consideration for native language illiteracy. Recommendations are offered to improve the effectiveness of ESOL programs for this target population.

Modeling Raccoon (Procyon lotor) Habitat Connectivity to Identify Potential Corridors for Rabies Spread

The United States Department of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), Wildlife Services National Rabies Management Program has conducted cooperative oral rabies vaccination (ORV) programs since 1997. Understanding the eco-epidemiology of raccoon (Procyon lotor) variant rabies (raccoon rabies) is critical to successful management. Pine (Pinus spp.)-dominated landscapes generally support low relative raccoon densities that may inhibit rabies spread. However, confounding landscape features, such as wetlands and human development, represent potentially elevated risk corridors for rabies spread, possibly imperiling enhanced rabies surveillance and ORV planning. Raccoon habitat suitability in pine-dominated landscapes in Massachusetts, Florida, and Alabama was modeled by the maximum entropy (Maxent) procedure using raccoon presence, and landscape and environmental data. Replicated (n = 100/state) bootstrapped Maxent models based on raccoon sampling locations from 2012–2014 indicated that soil type was the most influential variable in Alabama (permutation importance PI = 38.3), which, based on its relation to landcover type and resource distribution and abundance, was unsurprising. Precipitation (PI = 46.9) and temperature (PI = 52.1) were the most important variables in Massachusetts and Florida, but these possibly spurious results require further investigation. The Alabama Maxent probability surface map was ingested into Circuitscape for conductance visualizations of potential areas of habitat connectivity. Incorporating these and future results into raccoon rabies containment and elimination strategies could result in significant cost-savings for rabies management here and elsewhere.