Ethics and schools of public health

Expected ethical competencies of public health professionals and graduate curricula in accredited schools of public health in North America

OBJECTIVES

We assessed expected ethics competencies of public health professionals in codes and competencies, reviewed ethics instruction at schools of public health, and recommended ways to bridge the gap between them.

METHODS

We reviewed the code of ethics and 3 sets of competencies, separating ethics-related competencies into 3 domains: professional, research, and public health. We reviewed ethics course requirements in 2010-2011 on the Internet sites of 46 graduate schools of public health and categorized courses as required, not required, or undetermined.

RESULTS

Half of schools (n = 23) required an ethics course for graduation (master's or doctoral level), 21 did not, and 2 had no information. Sixteen of 23 required courses were 3-credit courses. Course content varied from 1 ethics topic to many topics addressing multiple ethics domains.

CONCLUSIONS

Consistent ethics education and competency evaluation can be accomplished through a combination of a required course addressing the 3 domains, integration of ethics topics in other courses, and "booster" trainings. Enhancing ethics competence of public health professionals is important to address the ethical questions that arise in public health research, surveillance, practice, and policy.

Assessing the legal and ethical preparedness of master of public health graduates

OBJECTIVES

We explored the relationship between the preparedness of master of public health (MPH) graduates in public health law and ethics and their completion of courses in these areas.

METHODS

We reviewed accredited public health schools and programs to assess the supply of required and elective courses in law and ethics. In addition, we conducted an Internet-based scenario survey of MPH graduates. Survey results were analyzed, and relationships between scenario responses and completion of law and ethics courses were assessed.

RESULTS

Of the 93 programs and schools reviewed, 14% required a course in ethics and 16% required a course in law. The majority (range = 55%-76%) of the survey respondents indicated being "prepared" or "very prepared" for each of the 9 public health scenarios. There were no significant relationships between scenario responses and completion of an ethics course. Responses to 2 scenarios (one involving food code violations and one involving a prison population) were significantly related to participants' completion of a course in law.

CONCLUSIONS

Few public health schools and programs require graduate courses in ethics and law. Most MPH graduates report being prepared to address public health challenges. Additional research is necessary to improve techniques for measuring preparedness.

Using the case-study methodology to teach ethics to public health students

This article uses the case-study methodology as a strategy to facilitate examination of ethical principles that underlie developmental risk research carried out among adolescents. Description of the ethical dilemmas that arose during the implementation of a longitudinal randomized controlled trial is presented along with discussion guidelines. As youth were being enrolled and the trial was being conducted, it was noted that a small but significant number had responded "yes" to a question on suicidal ideation. After review by the Institutional Review Boards overseeing the trial, it was decided that confidentiality had to be breached. A revised protocol was implemented explicitly stating that confidentiality would be broken if a youth reported suicidal ideation. The number of youth reporting suicidal ideation after the consent form was amended decreased significantly. Presentation of this research by use of the case study method sensitizes students to issues that arise at the intersection of disease prevention and health promotion intervention research.

Public health ethics: teaching survey and critical review

The last decade has witnessed development of the new field of public health ethics, as well as growing emphasis on the importance of ethics education to both students and graduates of the health care professions. Using a topic-based interpretation of public health ethics this paper presents a questionnaire survey of the nature and content of teaching of public health ethics to medical undergraduates and public health postgraduate students in the United Kingdom. Completed questionnaires were returned by 76.9% (20/26) of medical schools and 76.7% (23/30) of institutions teaching postgraduate public health courses. Public health ethics was described as being taught in 75% of medical schools and 52% of institutions providing postgraduate education. However, in both types of location the content and nature of teaching was patchy and often minimal. If medical schools and postgraduate institutions are serious about improving the discussion and teaching of ethical issues in public health, there will need to be considerable investment and commitment, accompanied by creativity and imagination. In parallel, the debate about the meaning of, and approaches to, public health ethics needs to be broadened and enriched. The topic-based interpretation of public health ethics has limitations. Alternatives are explored and critically reviewed.

Prevalence of home pregnancy testing among adolescents

OBJECTIVES

This study estimated the prevalence of home pregnancy testing among adolescents.

METHODS

A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years.

RESULTS

The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant.

CONCLUSIONS

Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

Uses of Behavioral Risk Factor Surveillance System data, 1993-1997

OBJECTIVES

The purpose of this study was to document and describe Behavioral Risk Factor Surveillance System (BRFSS) data use patterns, benefits, and barriers from 1993 to 1997.

METHODS

Data use information was gathered via a Medline database search and a telephone survey of BRFSS program directors (n = 54).

RESULTS

The database search uncovered 109 BRFSS-based reports. Program directors indicated that BRFSS data frequently were used to support health policies regarding diabetes, physical activity, and smoking. Frequent data use barriers included insufficient special population data, insufficient city- or county-specific data, and insufficient staff.

CONCLUSIONS

Use of BRFSS data, which aid several state health activities, increased from 1993 to 1997.

Cigars, youth, and the Internet link

OBJECTIVES

This study examined the accessibility and appeal to youth of cigar marketing sites on the Internet.

METHODS

Sites marketing cigars (n = 141) were examined for age restrictions, prices, health warnings, and other elements.

RESULTS

Although it is illegal for minors to purchase tobacco, only 36 sites (25.5%) prohibited purchases by minors. Sites offered low prices, and 32% accepted money orders, cashier's checks, or cash-on-delivery (COD) orders. Almost 30% of the sites included elements with potential youth appeal; only 3.5% displayed health warnings.

CONCLUSIONS

The unregulated promotion of cigars on the Internet has the potential to attract youth, and there are few barriers to Internet tobacco purchases by minors.

Women and smoking in Hollywood movies: a content analysis

OBJECTIVES

We analyzed the portrayal of smoking in Hollywood films starring 10 popular actressess.

METHODS

Five movies were randomly sampled for each actress, for a total of 96 hours of film footage that was analyzed in 1116 5-minute intervals.

RESULTS

Leading female actors were as likely to smoke in movies aimed at juvenile audiences (PG/PG-13) as in R-rated movies, whereas male actors were 2.5 times more likely to smoke in R-rated movies. PG/PG-13-rated movies were less likely than R-rated movies to contain negative messages about smoking.

CONCLUSIONS

Smoking is highly prevalent in Hollywood films featuring popular actressess and may influence young audiences for whom movie stars serve as role models.

Predictors of continued smoking over 25 years of follow-up in the normative aging study

OBJECTIVES

This study tested the hypothesis that high daily cigarette consumption and addiction to smoking are risk factors for the long-term continuation of smoking.

METHODS

Using longitudinal data from 986 male smokers, we entered cigarettes per day, psychological addiction, age, and education into a survival analysis as predictors of continued smoking over a 25-year period.

RESULTS

Younger men and those who smoked more cigarettes per day were more likely to remain smokers in the long term. Addiction and education level were not significant predictors of continued smoking.

CONCLUSIONS

Heavier smokers are more at risk than lighter smokers for long-term smoking. It is therefore very important to provide smoking cessation treatments for heavy smokers as early as possible after the initiation of smoking.

The effects of race/ethnicity and income on early childhood asthma prevalence and health care use

OBJECTIVES

Asthma is the most common chronic illness among US children and is most prevalent in low-income and minority groups. We used multivariate models to disentangle the effects of race/ethnicity, income, and other individual-level risk factors on asthma in a population-based sample of children aged 3 years.

METHODS

Data are from the 1988 National Maternal and Infant Health Survey and 1991 Longitudinal Follow-Up. Odds ratios of asthma prevalence, hospitalization, and emergency room use were estimated, with control for socioeconomic characteristics, health behaviors, and insurance.

RESULTS

Asthma prevalence, hospitalization, and emergency room use declined with increasing income for non-Black but not Black children.

CONCLUSIONS

Lifetime income and sociodemographic characteristics do not explain the excess risks of asthma and emergency health care use for asthma among young Black children.

Thinking about vaginal microbicide testing

A vaginal microbicide could slow the spread of HIV. To date, volunteers in placebo-controlled trials of candidate microbicides have been counseled to use condoms. This does not reduce the number of volunteers exposed to possible risk, but it shifts the allotment of risk from those conducting the trial to those women who may be least able to make autonomous decisions. Alternative ways of meeting the obligation to offer volunteers active benefits are explored. Counseling the use of condoms prolongs clinical trials and could cause tens of thousands of otherwise avoidable deaths.