A sustainable behavioral health program integrated with public health primary care.

The need for behavioral healthcare for the poor and indigent is well documented in rural North Carolina, and integrated behavioral healthcare--that is, mental health screening and treatment offered as part of primary care services--has proven a very effective and efficient method to improve patients' health. In 2000, the Buncombe County Health Center (BCHC) began a grant-funded program treating depressed patients in its public health clinics and school health programs. The Health Center used the opportunity to send a team to the Management Academy for Public Health to learn business principles that could be applied to the challenge of sustaining this program as part of its ongoing public health service delivery for the county. Using their business plan from the Management Academy, the BCHC sought funding from various stakeholders, and, through their support, was able to institute a fully integrated behavioral health program in 2004. The BCHC has now joined forces with other partners in the state to address statewide policy changes in support of such programs. These efforts are an example of how a community health center can apply entrepreneurial thinking and strategic business planning to improve healthcare and effect wide-ranging change.     

Implementation of school policies to prevent youth tobacco use in Alabama

BACKGROUND: Public health professionals must monitor the effectiveness of school policies and programs to prevent youth initiation, promote quitting, and eliminate secondhand smoke. This analysis of school tobacco policies was preliminary to release of a state tobacco prevention and control plan for 2010‐2015. METHODS: University health educators collaborated with the state health agency to review policies of 33 school systems in 5 Metropolitan Statistical Areas and 9 public health areas. Authors developed a systematic approach of 8 steps useful to rate implementation of school tobacco control and prevention policies and discuss implications for health education program planning. RESULTS: Thirty school policies prohibited possession and use of tobacco by students, faculty and campus visitors, and 26 of 33 specified disciplinary measures following violations. Only 4 public education agencies included 3 of the 6 elements of a model tobacco prevention and control policy as suggested by the state public health agency. None featured all 6 elements. None specified establishing school‐community partnerships for tobacco prevention and control. CONCLUSIONS: Preparing smoke‐free youth requires implementing and evaluating tobacco education in grades K‐12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.     

The Management Academy for Public Health: a new paradigm for public health management development.

Research has established a need to develop management skills among public health professionals. The University of North Carolina-Chapel Hill created the Management Academy for Public Health as a pilot program for this specialized training need. This article describes why a management academy for public health managers was formed, its curriculum and instructional methods, and the evaluation findings from its first year. The program sponsors hope to effect individual and organization level change, eventually leading to improved community health. Results suggest that this innovative program gives public health professionals needed skills and improves their job performance.     

The Preventive Health and Health Services Block Grant: the Massachusetts experience

The Preventive Health and Health Services Block Grant funds a variety of disparate programs in health promotion and disease prevention. Many of these programs were funded by categorical grants to the States prior to the creation of this block grant in 1981. This block grant allows States to set priorities among the different programs by shifting their funding allocations. In addition, there is considerable opportunity to use these funds creatively in shaping the content of their programs. The Massachusetts Department of Public Health's experience with this block grant is reviewed, showing the grant's critical importance in the department's statewide disease prevention efforts. In order to maximize public health impact, the department has shifted its funding allocations based on explicit criteria. These criteria represent a model that may have widespread applicability for other State health departments.     

Tobacco use among students aged 13-15 years--Philippines, 2000 and 2003

Tobacco use is one of the major preventable causes of premature death and disease in the world. A disproportionate share of the global tobacco burden falls on developing countries, where an estimated 84% of the world's 1.3 billion current smokers live. The Global Youth Tobacco Survey (GYTS), part of the Global Tobacco Surveillance System (GTSS) initiated by the World Health Organization (WHO) and CDC, was developed to monitor youth tobacco use, attitudes about tobacco, and exposure to tobacco smoke, and has been completed by approximately 1.4 million students in 133 countries. A key goal of GTSS is for countries to conduct the GYTS every 4 years. This report presents findings from the GYTS conducted in the Philippines in 2000 and 2003, which revealed substantial declines in the proportions of students aged 13-15 years who currently smoked cigarettes, currently used other tobacco products, were likely to start smoking in the next year, or were exposed to secondhand smoke in public places. The findings also indicated an increase in the proportion of students who supported bans on smoking in public places, had learned about the dangers of tobacco use in school, and had seen antitobacco messages in media and advertising. Public health authorities in the Philippines should evaluate their current tobacco-control programs and enhance or expand them to further reduce youth smoking.     

Tobacco use among students aged 13-15 years--Kurdistan Region, Iraq, 2005

Tobacco use is one of the major preventable causes of premature death and disease in the world. The Global Youth Tobacco Survey (GYTS), part of the Global Tobacco Surveillance System initiated by the World Health Organization (WHO), CDC, and the Canadian Public Health Association, was developed to monitor tobacco use, attitudes about tobacco, and exposure to secondhand smoke among youths and has been conducted in 140 countries. This report presents findings from the GYTS conducted in the Kurdistan region of Iraq (i.e., Irbil, as-Sulaymaniyah, and Dahuk governorates) in 2005, which revealed that one in 10 students currently smoked cigarettes or used other tobacco products. Boys (21%) were statistically significantly more likely than girls (2.1%) to smoke cigarettes, but no significant difference was observed between boys and girls in their use of other tobacco products. Public health authorities in the Kurdistan Region of Iraq can use the baseline information from the GYTS to design and implement tobacco-control programs to reduce youth smoking.     

Evaluating the impact of the Management Academy for Public Health: developing entrepreneurial managers and organizations.

The Management Academy for Public Health is a management development program with the goals of helping public health managers learn to manage people, data, and finance, to think and plan like entrepreneurs, and to strengthen public health organizations. Managers enroll as teams and develop business plans in the Academy's extensive project-based learning component. Extensive internal and external evaluation shows that the program improves managers' knowledge, skills, and confidence in key curriculum areas; that participants apply many of the skills in their jobs; that many of the business plans receive funding, resulting in new public health programs; that the training experience helped agencies respond and plan after September 11, 2001; and that many participants report beginning to think more like entrepreneurs through activities like teaming, partnering, innovating, negotiating, finding funds, and generating revenue. The program demonstrates that robust training including extensive work-based project work with coaching can help public health managers gain many skills needed for the drive to "reinvent" government.     

The Establishment of the School of Public Health at the State University of New York,Downstate Medical Center: The First Nationally Accredited School of Public Health in a Public University in New York City

The State University of New York (SUNY), Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve students entered the program in June 2002, and currently some 110 MPH students and 12 Doctor of Public Health (DrPH) students are enrolled. This article describes the long and complex process of transforming the original MPH degree program, with its single focus on urban and immigrant health, with a student enrollment of 12 and 8 full-time faculty, into a school of public health with a large student enrollment of 122 students, 25 full-time faculty, five MPH degree tracks, and four DrPH degree tracks. The process of establishing the SUNY Downstate School of Public Health in 2009 from its inception as an MPH program in 2001 spanned a period of 8 years. This process was guided by a commitment to two basic principles. The first was to maintain the original 2005 program accreditation by the Council on Education for Public Health (CEPH). The second was to sequentially secure accreditation for all subsequent four MPH and four DrPH degree tracks through CEPH’s procedure of substantive change approval. This policy assured continuous national CEPH accreditation of the original Urban and Immigrant Health MPH degree track and all added degree programs. The 5-year period following the initial CEPH accreditation of the MPH program in 2005 was one of intense development during which all of the essential elements for CEPH accreditation of a school of public health were put into place. This rapid development was made possible by the vision and full support of Downstate’s president, John C. LaRosa, MD, FACP, and the dedicated efforts of many. This included the students, faculty, staff, and administrators of the School of Public Health, the school’s Community Advisory Group, several external advisors, and many in the medical center’s Central Administration, College of Medicine, School of Graduate Studies, College of Nursing, College of Health Related Professions, and the University Hospital of Brooklyn. From the very beginning of the planning phase for an MPH program and through the ultimate accreditation of the School of Public Health in 2010, broad participation was solicited from all major units in the medical center. Thus, the MPH program became a center-wide initiative and not merely that of the College of Medicine’s Department of Preventive Medicine and Community Health. This broad participation has been continuously maintained through the involvement of leaders of other medical center academic units and the University Hospital of Brooklyn in the program’s and then the school’s standing and ad hoc committees, and in other activities as well. Similarly, community representation has been maintained, some through formal linkages relevant to the practical field experiences required of all students. In October 2010, the Board of Councilors of CEPH accredited the SUNY Downstate School of Public Health for a 5-year period through 31 December 2015. The accreditation of the school was a major milestone for Downstate, Brooklyn, and New York City. The SUNY Downstate School of Public Health is the first CEPH accredited school of public health in the history of Brooklyn, and only the second such school in New York City. It is also the first CEPH accredited school of public health at a publicly supported university in New York City. The school has already had a major impact on improving the health and well-being of the people of Brooklyn through its numerous collaborative community-based health promotion and disease prevention programs.     

Primary care and local health departments: The initiation of a state-sponsored grant program

This study examines factors that differentiate health service organizations that were successful applicants for a grant program to initiate primary-care services from a matched sample of organizations that did not apply for the program. Factors that were different between the two sets of organizations include the attitudes and behaviors of physicians in the local community, previous success of the organization in obtaining grant support, and employee perceptions of selected organizational and grant program characteristics. These findings suggest that factors both internal and external to the organization are influential in decisions to initiate activities sponsored through grant programs. Implications of these findings for the design of state block grant programs are discussed.Dr. Hernandez is with the School of Community and Allied Health, University of Alabama in Birmingham, Birmingham, Alabama 35294.Dr. Kaluzny is with the School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27514.This project was supported in part by Grant No. HS 01971 to the Health Services Research Center at the University of North Carolina at Chapel Hill from the National Center for Health Services Research, Department of Health and Human Services, and funds from the Division of Health Services, North Carolina Department of Human Services.     

Peer Helping/Involvement: An Efficacious Way to Meet the Challenge of Reducing Alcohol, Tobacco, and Other Drug Use Among Youth

ABSTRACT: Peer-led drug prevention programs for middle school youth are reviewed as to whether or not they are a vital resource in an overall effort to minimize the use of alcohol, tobacco, and other drugs (ATOD). The paper focuses on the following: a) results of a 120-study meta-analysis of school-based drug prevention programs and positive program features; b) considerations for falsely concluding that peer programs are ineffective; c) features of two model or stellar programs that compared interactive (peer leadership) to teacher/researcher-led (non-interactive) programs that followed National Peer Helpers Association (NPHA) Programmatic Standards; and d) suggestions for designing and implementing high-quality, peer-led programs. The authors conclude that interactive peer interventions for middle school students are statistically superior to non-interactive didactic, lecture programs led by teachers/researchers. Programs implemented according to NPHA Programmatic Standards may eliminate Type II (false negative) and III ("implementation failure" or ineffectively designed and implemented program) errors. Opportunities for prudent application of well-designed peer programs appropriately implemented and evaluated must remain a salient priority.     

The Management Academy for Public Health: the South Carolina experience.

In the late 1990s, the South Carolina Department of Health and Environmental Control (SCDHEC) was faced with the challenges of a workforce that was not prepared in public health; the impending loss of significant agency expertise, leadership, and institutional knowledge through retirement; the lack of available and accessible training; and continuing state budget cuts. Preparedness for bioterrorism and other public health emergencies was also of concern, a need made more urgent after 2001. To respond to current and emerging public health challenges, the SCDHEC had to have a workforce with the knowledge and skills necessary for the delivery of essential public health services. To address these challenges, the department partnered with the University of North Carolina in the pilot of the Management Academy for Public Health. The Management Academy is now integrated into the South Carolina workforce development strategy, and 199 staff members and 22 community partners have graduated from the program. Along with increased knowledge, skills, and abilities of individual staff and increased organizational and community capacity, a significant result of South Carolina's experience with the Management Academy for Public Health is the development of a training program for emergency preparedness modeled on the Management Academy. This highly successful program illustrates the replicability of the Management Academy model.     

The Southern Rural Access Program and Alabama's Rural Health leaders Pipeline: A Partnership to Develop Needed Minority Health Care Professionals

ABSTRACT: Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities, Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments.     

Recipients of the 1986 Metropolitan Life Foundation "Healthy Me" Awards

ABSTRACT: Since 1985, the Metropolitan Life Foundation has recognized exemplary schools, community groups, and teacher preparation programs that are meeting a special challenge: teaching children how to stay healthy.
In the second year of Metropolitan Life's four-year, $4 million "Healthy Me" campaign, 36 innovative programs were selected as the best school health education programs, and each received a $5,000 grant. An additional 13 community coalitions that actively promote comprehensive school health education also were recognized, and each received a $5,000 matching grant. The 1986 awards totaled $240,000.
The "Healthy Me" program, administered by the Health and Safety Division of Metropolitan Life, is funded by the Metropolitan Life Foundation which was established in 1976. Since then, the Foundation has contributed more than $42 million to support activities in health, education, civic affairs, and culture throughout the United States.
For more information on these exemplary programs, write: "Healthy Me," Metropolitan Life Insurance Co., Health and Safety Education Division (Area 16-UV), One Madison Avenue, New York, NY 10010–3690.     

Use of a School Referendum to Deter Teen-age Tobacco Use

Montana's 1991 school "tobacco referendum," authorized by the state legislature and approved by about 60% of approximately 50,000 students voting in grades 7-12, represents an innovative attempt to include youth in decisions regarding tobacco and health and to decisively demonstrate peer disapproval of tobacco use. The referendum asked students whether tobacco sellers should voluntarily refuse to sell cigarettes and tobacco to persons younger than age 18. Montana is one of five states which allow tobacco sales to minors but has one of the nation's lowest youth smoking rates. The statewide referendum follows the successful example of the Bozeman, Montana, school district's 1990 tobacco referendum, in which 80% of the 2,200 grade 7-12 students and staff voted to make their schools "tobacco-free."     

Developing a web-based data mining application to impact community health improvement initiatives: the Virginia Atlas of Community Health.

This article describes how a team from the Virginia Department of Health (VDH) and the Virginia Center for Healthy Communities (VCHC) attended the UNC Management Academy for Public Health to learn skills to address Virginia's commitment to using technology to improve the public's health. After creating a business plan for a food-safety information Web site, team members used that experience as well as Management Academy training in information technology, the management of data and finances, and strategic partnering to create a comprehensive tool with which to place customizable population data in the hands of anyone interested in pursuing population health improvement. The Virginia Atlas of Community Health, launched through the VCHC in 2003, places clear, compelling data in the hands of those who can influence decisions at the local level and create the most impact for health. Since the program's inception, more than 2,000 individuals have registered as ongoing users of the Virginia Atlas. Initially funded by a Turning Point grant from the Robert Wood Johnson Foundation, the program is sustained through a series of smaller grants and funding from the VDH.     

Peer education of tobacco issues in Hungarian communities of Roma and socially disadvantaged children

OBJECTIVE: The aim of this demonstration program was to examine the effectiveness of peer education in disseminating tobacco related information and influencing knowledge, attitudes and beliefs related to smoking in socially disadvantaged youth communities. METHOD: Peer educators were trained to become messengers of tobacco issues. Intervention sites were selected. Self-administered questionnaires were used to assess the effectiveness of interventions. Recommendations were drawn up on the inclusion of peer conducted health education into the comprehensive program of the Ministry of Health to improve the health situation of Roma (Gypsy) and disadvantaged population groups. RESULTS: Peer educators were recognised as trustworthy mediators of tobacco related information. Interventions resulted in an improved level of knowledge of and changes in attitudes towards smoking in the targeted youth communities. CONCLUSIONS: The program demonstrated that peer education is an effective tool to raise awareness on smoking issues in communities of Roma and disadvantaged children, when multiple socio-cultural-environmental factors facilitate the taking up of unhealthy habits. If disseminated, this tool could be effective in helping reduce teenage smoking in these communities.     

The Management Academy for Public Health: program design and critical success factors.

The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.     

Implementation of a coordinated school health program in a rural, low-income community

Background: Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and a low-income, high-need population. Methods: In 2001, Stafford County’s Unified School District 349 began a multiyear CSHP development process, which required adaptations for implementation in a rural area. First, a CSHP team was formed of community and administrative stakeholders as well as school system representatives. Next, the CSHP team assessed school district demographics so the program framework could be targeted to health needs. During a yearlong planning phase, the CSHP team determined 4 priority areas for program development, as limited staff and funds precluded developing programs in all 8 traditional CSHP areas. Program activities were tailored to the population demographics and available resources. Results: Program outcomes were supported by School Health Index (SHI) data. Of the 8 CSHP focus areas, the SHI found high scores in 3 of the Stafford CSHP’s priority areas: Health Services; Psychological, Counseling, and Social Services; and Physical Education. The fourth Stafford CSHP priority area, Nutrition Services, scored similarly to the less prioritized areas. Conclusions: The process by which the Stafford school district modified and implemented CSHP methods can serve as a model for CSHPs in other rural, high-need areas.     

Inhaltliche, konzeptionelle und organisatorische Bedingungen einer erfolgreichen schulischen Prävention des Rauchens

The US Centers for Disease Control and Prevention have published guidelines for school health programs to prevent tobacco use and addiction [Centers for Disease Control and Prevention (1994) Guidelines for school health programs to prevent tobacco use and addiction. MMWR 43 (No. RR-2): 1–18]. Seven recommendations summarize strategies that are effective in preventing tobacco use among youth. To ensure the greatest impact, schools should (1) develop and enforce a school policy on tobacco use, (2) provide instruction about (a) short- and long-term negative physiological and social consequences of tobacco use, (b) social influences on tobacco use, (c) peer norms regarding tobacco use, (d) refusal skills, and (e) life skills, (3) provide education on tobacco use prevention from kindergarten through 12th grade, (4) provide program-specific training for teachers,(5) involve parents or families in support of school-based programs to prevent tobacco use, (6) support cessation efforts among students and all school staff who use tobacco, and (7) assess the tobacco use prevention program at regular intervals. This paper examines opportunities and barriers for the implementation of these recommendations in German schools. It is concluded that the US Centers for Disease Control and Prevention guidelines should also be applied in Germany.     

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.