Objectives: This evaluation describes an innovative approach to align a master of public health (MPH) core curriculum with the Evidence-Based Public Health (EBPH) framework and the 2016 revised Council on Education for Public Health (CEPH) competencies. We describe implementation of revised core courses during the COVID-19 pandemic and student evaluation of the novel curriculum.Materials and Methods: Faculty mapped competencies to the EBPH framework, developed courses, and implemented the curriculum using a cohort model. For early cohorts enrolled from fall 2020 through summer 2021, faculty evaluated the effectiveness of the core courses, student satisfaction, and self-reported competency achievement through pre- and postcourse surveys starting in fall 2020. Additional qualitative insights were gathered from 6 focus groups (n = 50 students) and 10 interviews conducted in spring 2022.Results: The redesigned curriculum launched in fall 2020 and emphasized an interdisciplinary approach that incorporated vital domains: health equity, community engagement, and the essential public health services. Survey findings indicated increased student self-efficacy and achievement of CEPH competencies. High retention and positive qualitative feedback underscored this curriculum's relevance for students with diverse backgrounds, including those who were new to public health, online learning, or US graduate education. Ongoing quality improvement and iterative curriculum refinement ensure that the evolving needs of public health practice are met.Practice Implications: The lessons learned through developing and implementing this evidence-based curriculum across delivery modes serve as an opportunity for other institutions aiming to enhance public health education in diverse student populations and address workforce needs. Applying this framework ensures that students attain the competencies required for the 21st-century public health workforce.

Intimate partner violence (IPV) is a significant public health concern, affecting over 41% of women in the United States during their lifetime. IPV is particularly prevalent during reproductive years, including pregnancy and postpartum periods, and has severe adverse effects on both maternal and child health. Home visiting offers a promising context for prevention; however, persistent barriers to screening underscore the need for practical, implementation-ready tools to support home visitors in addressing IPV. This brief report describes a quality improvement initiative examining the implementation of the Futures Without Violence Connected Parents, Connected Kids (CPCK) cards within Alabama home visiting programs. Between September and December 2024, four Alabama local implementing agencies (LIAs) participated in the Home Visiting Collaborative Innovation and Improvement Network's (HV CoIIN) Sprint to Sustain Improvement in IPV (sprint). The sprint aimed to integrate CPCK cards into home visits, with a goal of educating 90% of families on healthy relationships and improving support for home visitors in discussing IPV. Data from Alabama's home visiting database were used to track IPV screening rates before and after the sprint. In addition, a survey was conducted to gather home visitors' perspectives on CPCK cards. Results showed that by the end of the sprint, all caregivers were educated about healthy relationships, and IPV screening rates improved at three LIAs and remained 100% at the fourth. Survey responses indicated that CPCK cards were valuable tools for facilitating conversations about healthy relationships and screening for IPV.

Purpose To evaluate patient satisfaction and preferences for portable versus table-mounted visual field (VF) devices in a rural telemedicine setting and identify influencing factors. Methods We conducted a sequential explanatory mixed methods study at three Federally Qualified Health Centers (FQHCs) within the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine (AL-SIGHT) study. Participants completed VF testing with table-mounted Humphrey Field Analyzer (HFA), tablet-based Melbourne Rapid Fields (MRF), and virtual reality (VR)-based VisuALL perimeters. Participants rated satisfaction, comfort, ease of use, and future testing preference. Chi-square tests assessed differences in device preferences. Twelve participants completed semi-structured interviews to explore reasons underlying preferences. Qualitative data were analyzed in NVivo 14 using reflexive thematic analysis. Results Among 271 respondents (mean age 60.4 years; 62.4% women), 50.6% preferred VR-based, 35.1% tablet-based, and 14.4% table-mounted for future testing (χ2 (2) = 53.52, p<0.001, Cramér’s V = 0.31). Satisfaction was highest for VR-based (56.9% very satisfied), followed by tablet-based (49.4%), and HFA (38.0%). VR-based perimeter was most frequently selected as the most comfortable (55.7%; χ2 (2) = 63.33, p<0.001, V = 0.34) and easiest to use (54.6%; χ2 (2) = 71.96, p<0.001, V = 0.36). Preferences did not vary significantly across demographic variables (all p>0.05). Qualitative themes identified four key drivers: comfort and physical experience, visual experience, ease of use and interaction, and psychological and motivational factors. Portability and community suitability were valued. Conclusion Rural underserved patients strongly preferred portable visual field devices, particularly VR-based, over table-mounted HFA. Comfort, ergonomic flexibility, immersive visual experience, and simplicity of interaction were central determinants of preference. Portable perimetry may enhance patient-centered glaucoma monitoring within telemedicine programs and access in resource-limited settings. ### Competing Interest Statement I have read the journal's policy and the authors of this manuscript have the following disclosures: E.K. Antwi-Adjei, None S. Datta, None C.A. Girkin, Heidelberg Engineering (F), Topcon (F) C. Owsley, Johnson & Johnson (C), Sanofi (C) L.A. Rhodes, IdentifEye Health (C) M. Fifolt, None L. Racette, Olleyes, Inc. (C). These relationships do not alter our adherence to PLOS ONE policies on sharing data and materials. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The protocol was approved by the Institutional Review Board of the University of Alabama at Birmingham, and all procedures adhered to the tenets of the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.

OBJECTIVE:To assess cross-sector preparedness and response capacity for a hypothetical Highly Pathogenic Avian Influenza (HPAI) H5N1 outbreak in Alabama using a statewide tabletop exercise (TTX) and to identify strengths, gaps, and corrective actions to inform future planning. DESIGN:Basic qualitative design using inductive data analysis of multi-source qualitative data, including participant discussion notes, hotwash debrief, feedback forms, and an After-Action Report/Improvement Plan (AAR/IP). SETTING:A 6-hour, in-person statewide TTX held in August 2025, facilitated by the Alabama Department of Public Health (ADPH), Alabama Department of Agriculture and Industries (ADAI), and the University of Alabama at Birmingham (UAB). PARTICIPANTS:Eighty-three representatives from federal, state, and local agencies; and professional associations. INTERVENTION:A multi-phase TTX simulating escalating zoonotic threats, from avian cases to human infections and sector-wide disruptions. Scenarios incorporated stakeholder-recorded audio vignettes to enhance realism and foster cross-sector discussion grounded in One Health principles. MAIN OUTCOME MEASURES:Identification of key strengths, areas for improvement, and corrective actions mapped to 6 exercise objectives focused on roles and responsibilities, priority-setting, procedural gaps, communication, resource needs, and interagency coordination. RESULTS:Participants demonstrated strong interagency relationships, robust surveillance systems, and shared understanding of zoonotic response roles. Key gaps included inconsistent communication and data-sharing protocols, insufficient engagement of local partners, procedural ambiguities (eg, specimen transport), and concerns regarding availability of critical resources, including Strategic National Stockpile assets. Workforce turnover and limited institutional knowledge were recurring barriers. The AAR/IP outlined 6 priority corrective actions, including development of a Multi-Agency Coordination Zoonotic Disease Workgroup. CONCLUSIONS:The Alabama HPAI H5N1 TTX revealed strong existing partnerships and surveillance capacity but highlighted vulnerabilities in communication, coordination, and resource readiness. Implementing corrective actions, strengthening workforce capacity, and expanding stakeholder engagement will enhance statewide preparedness for H5N1 and future zoonotic threats. The exercise materials and findings offer a model for other jurisdictions seeking to refine preparedness plans.

This article focuses on voices of parents of students who attend Magic City Acceptance Academy (MCAA), a unique, public charter school designed to address social, emotional, and academic needs of LGBTQ students and others. Authors conducted a focus group of parents of MCAA students to explore parents’ perceptions of their children’s school experiences before and after enrolling at MCAA. Parents overwhelmingly expressed positive comments and observations about their children’s experiences at MCAA. Emergent themes indicated that: Concern for the psychological and physical safety drew parents to MCAA , whether the threat to student safety came from others in their environment or through potential self-harm; Parents perceived MCAA to be a unique school and learning environment , especially in how faculty and staff members addressed social and academic needs of LGBTQ students and others; and Parents identified positive outcomes for their children at MCAA , noting the positive impact the school has had on their children. Implications for all school practitioners are discussed, encouraging school leaders to incorporate opportunities to listen to parents, face-to-face, to gain insights into what areas of their school life might be supported and enhanced to ensure a positive school experience, not just for LGBTQ students, but for all. Finally, the authors provide implications for future researchers.

Abstract Introduction During the COVID-19 pandemic, geographic isolation, host-nation healthcare limitations, and broader geopolitical considerations contributed to limited access to care for dependents of active duty service members in Okinawa. This research explored perceived healthcare access barriers among military spouses in Okinawa, Japan, during the COVID-19 Public Health Emergency and identified potential demographic and structural factors associated with perceived access and wellness outcomes. Materials and Methods This study used a cross-sectional online survey from February to May 2023 during the COVID-19 Public Health Emergency. Ethical approval was received from the University of Nebraska Medical Center. The 35-item instrument captured demographics, healthcare utilization, access barriers, and wellness perceptions. Access to emergency, urgent, routine, specialty, and preventive care was assessed against TRICARE standards, with percentages calculated to indicate whether benchmarks were met across demographic groups. Logistic regression evaluated associations between age, sponsor rank, and MTF assignment with access outcomes. Results Emergency care met TRICARE standards for 90% of respondents, but fewer met urgent (19%), routine (17%), specialty (25%), or preventive care (47%) benchmarks. Only 22% of spouses perceived they could access care when needed. Younger spouses (19-30) and those assigned to Kadena’s 18th Medical Group reported the lowest access. Nearly half reported worsened mental health, and 40% reported food or medical cutbacks. Enlisted spouses were disproportionately affected. Conclusions Military spouses in Okinawa perceived significant barriers to healthcare access during the COVID-19 pandemic, with military treatment facility (MTF) enrollment, sponsor rank, and age emerging as the most consistent factors associated with disparity. Policy implications include the need to provide military families with adequate and accurate information on MTF access to care wait times and civilian healthcare availability before arrival at a new duty station. These findings highlight the need for further research examining military spouse healthcare access in overseas and remote locations.

Many interventions aiming to improve medication adherence in primary open-angle glaucoma (POAG) have yielded equivocal findings. This equivocacy has been attributed to several factors, including limited incorporation of health behavior theory and patient preference into intervention design. In this study, we performed a literature review of interventions aiming to improve medication adherence in POAG to develop a taxonomy of behavior change techniques (BCTs). Eligible studies measured medication adherence using electronic monitors for a minimum of 3 months. For each study, we evaluated the effectiveness of the BCTs, their basis in health behavior theory, and their usefulness in day-to-day management of POAG by surveying a sample of patients and providers. Twelve studies were included. BCTs included knowledge shaping (education), prompts (reminders), behavioral rehearsal (eye drop instillation training), and pharmacological support (combination monotherapy vs. polytherapy). Knowledge shaping, prompts, health coaching, and motivational interviewing led to an improvement in medication adherence and were perceived as being most useful in day-to-day management of POAG. Taxonomies of BCTs can help researchers to improve the design and effectiveness of interventions for improving medication adherence in POAG.

Context: This article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. Objective: The objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition. Design: A team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation. Setting: The research team conducted interviews remotely with health departments located in the West and Midwest. Participants: Participants included adults at least 18 years old and employed in 1 of 4 health departments. Main Outcome Measures: Emergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM. Results: Participants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community. Conclusions: QI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.

Developing a skilled governmental public health workforce requires intentional training opportunities that extend beyond foundational skills. Field placement programs, offered through the Public Health Training Center Network, provide students with practical experience while supporting agency capacity. This Practice Brief Report examines governmental public health field placements sponsored by the Region IV Public Health Training Center between 2019 and 2024 (n = 75). Student evaluations showed frequent practice in data analytics and assessment, policy development and program planning, and communication skills, areas reflecting organizational strengths. However, the findings of Public Health Workforce Interest and Needs Survey highlighted critical workforce gaps in higher-level skills such as budget and financial management, policy engagement, and leadership and systems thinking. Field placement experiences offer an opportunity to introduce students to these complex competencies early in their careers. Intentionally integrating higher-level skills into placement design can strengthen student preparation and help ensure a future workforce ready to address evolving public health challenges.

Objective: This article focuses on supports and challenges to health equity that small local health departments (LHDs) experienced while working toward national reaccreditation or Pathways Recognition with the Public Health Accreditation Board’s Standards & Measures Version 2022 (PHAB S&M v2022). Design: The study team conducted 22 qualitative interview sessions with members of health department leadership teams. Setting: In the spring of 2024, participants from 4 small LHDs in the western and midwestern regions of the United States participated in individual remote interview sessions. Participants: Participants were members of leadership teams in LHDs with population jurisdictions less than 50 000. Main Outcome Measure(s): Common challenges relating to the health equity measures in the PHAB S&M v2022 included external influences on equity language; lack of small population data; and racially and ethnically homogeneous populations and staff. The main support was the national equity standards provided justification for pursuing equity work. Results: Strategies to overcome challenges associated with the equity measures included staff training, seeking alternative equity language, and examining socioeconomic inequities in addition to race and ethnicity. Internal workforce understanding of health equity was improved through department-wide training initiatives. When working under restrictive language requirements for state agencies, grants, and other funding sources, staff suggested using alternative phrases and keywords such as level playing field and equal access. When addressing racially and ethnically homogenous populations, staff pursued equity in terms of income and focused on those living with pre-existing conditions (ie, diabetes). Conclusions: Ensuring that LHDs can work toward health equity is crucial for reducing health inequities. While the equity focus of PHAB S&M v2022 proved challenging, for this selection of LHDs, participants affirmed that PHAB accreditation allowed them to solidify their equity work to better serve their communities.

This study investigated student experiences of community and belonging at the Magic City Acceptance Academy (MCAA) through photographs and descriptions submitted by students. The research team used an iterative process of data analysis by first coding photographs and descriptions and then grouping codes into emergent themes. Study findings revealed a wide array of places, people, events, and other conditions in which students felt a part of a community in their school. Furthermore, findings support and confirm elements of the conceptual framework of a need to belong, and especially the elements of psychological wellbeing and social relations.

This study explored the perspectives of interprofessional collaborative practice health care providers in 2 clinics in the southeastern United States. The research team conducted key stakeholder interviews with 22 health care providers between 2022 and 2023. Study findings revealed 4 themes: Interprofessional Team Roles, Value of Behavioral Health Integration, Holistic Patient-Centered Focus, and Empathy-Driven Health Care. Health care providers highlighted the importance of the resources available within the team and the role of empathy in establishing trust, respect, and care satisfaction among health care providers and patients.

Context: This paper describes experiences and views of leadership teams from 4 small local health departments (LHDs) seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. The Pathways program launched in 2022 provides additional supports for improvement of public health practice. Objective: Given the need to accelerate accreditation among small health departments, the purpose of this study is to share small health departments’ strategies for overcoming accreditation challenges and actionable advice for use by other health departments. Design: In this descriptive qualitative study, the study team conducted 22 individual interviews with 4 small LHDs from January to March 2024. Setting: Participating small health departments were located in the Midwestern and Western United States with staff sizes ranging from 3 to 47. Participants: Interview participants included small health department leadership teams, a local board of health member, and a contracted external accreditation consultant. Main Outcome Measures: We used a semi-structured interview guide to elicit participant experiences and views on accreditation processes, benefits, facilitators, strategies for overcoming challenges, and advice for other small health departments. Results: Participants suggested that accreditation benefits far outweighed the challenges. Perceived benefits included improved organizational procedures, equitable delivery of needed effective programs and services, and enhanced public perception. Key strategies to overcome staff capacity challenges were establishing a team approach and orienting and mentoring new staff in the “why” and “how” of accreditation. Advice included learning what is involved, taking the time to lay a foundation beforehand, and not waiting for a perfect time as accreditation is about improvement, not perfection. Conclusions: Small health departments can achieve and maintain PHAB accreditation by strategically implementing strategies to overcome staff capacity and other challenges. The Pathways Recognition program is a supportive option for small health departments wanting to improve public health practice.

This paper explores how small local health departments (LHDs) motivated staff members, communicated progress toward Public Health Accreditation Board accreditation or Pathways Recognition, and celebrated interim and final accreditation accomplishments. Qualitative key informant interviews were conducted with 22 employees and affiliates of 4 LHDs with jurisdiction populations <50 000. LHDs motivated staff through ownership, creative strategies to monitor and record progress, and meaningful no- or low-cost incentives. Participants communicated accreditation progress internally and externally through in-person and electronic communication. Individuals described small rituals and large, community-wide celebrations to express collective investment in and ownership of the accreditation process. Strategies to motivate staff were top-down and bottom-up, and accreditation status updates were communicated through multiple channels. Participants viewed celebrations as valuable aspects of the accreditation process. Reaccreditation participants deemed Public Health Accreditation Board accreditation worthy of celebration and an accomplishment to share with the community.

Background. In 2024, the Alabama Department of Public Health (ADPH) leveraged the Public Health Infrastructure Grant (PHIG) to support the development and training of Alabama’s public health workforce. Technical assistance was provided by the Region IV Public Health Training Center evaluation team to conduct ADPH’S Workforce Training Needs Assessment. Purpose. The purpose of this Research Brief is to report key findings from this needs assessment and discuss implications for public health practice in the Deep South. Methods. The evaluation team administered an online survey through Qualtrics to report key measures. Results. Survey responses were received from 1,434 ADPH employees for a response rate of 54%. Demographic characteristics of survey respondents reflected the ADPH workforce. Mid- and senior-level staff rated the training topics of Health Equity, Public Health Sciences, and Community Partnerships as important but the need for training as only somewhat needed. Perceptions of support were high, but potential reasons for leaving the organization included low pay, unfavorable work environment, no opportunity for advancement, and burnout. Conclusion. Results of this assessment will inform ADPH’s Workforce Development Plan, a key component of national accreditation. Assessments from multiple states may allow regional training centers to develop targeted trainings to meet needs across states (e.g., Deep South).

In response to the COVID-19 pandemic, the US government funded voluntary school-based testing to support safe, in-person learning. In Alabama, this effort led to over 925 000 tests across 814 schools. This Practice Brief Report outlines implementation challenges and adaptive strategies used by the Alabama COVID-19 Testing and Prevention program, led by School of Public Health faculty and staff at the University of Alabama at Birmingham School of Public Health. Key informant interviews revealed 4 main challenges: lack of buy-in, limited capacity, unclear program scope, and short lead time. The team responded by building relationships, offering incentives, engaging School Liaisons, hiring adaptable staff, and ensuring strong leadership. These efforts built trust, increased participation, and reduced staff burden. Findings highlight the importance of local engagement, flexibility, and trust-building in public health work. Lessons learned offer guidance for future school-public health partnerships, especially in politically conservative and resource-limited settings.

Established in 2021, the Alabama Regional Center for Infection Prevention and Control (IPC) aims to address critical gaps in IPC across Alabama's public health and health care systems. Through a comprehensive needs assessment, the Center identified priority areas which informed its targeted training and technical assistance programs. This paper examines the Center's multifaceted approach to addressing significant IPC challenges throughout the state, with particular emphasis on underserved areas.

Our research team explored a political campaign that targeted the Magic City Acceptance Academy (MCAA) as the 'first transgender public school in the South'. Located near Birmingham, Alabama, MCAA opened in fall 2021 as one of the first LGBTQ + affirming charter schools in the United States. In spring 2022, gubernatorial candidate Tim James launched a series of negative TV and radio ads that defamed MCAA, ostensibly to generate votes from the ultra-conservate right wing of the Republican party. Our team conducted an embedded case study of the Tim James campaign as part of a multifaceted phenomenological case study of MCAA. We drew data from media coverage, key informant interviews, and a student focus group. Study findings revealed three themes: concerns for student safety, community support, and unanticipated benefits. Findings further suggested that Tim James' overt heterosexist actions inherently endorsed binary framings of sexuality and gender, which served his political interests and sought to normalize and privilege cisnormativity and heterosexuality while marginalizing and excluding the needs of LGBTQ + students. The hate speech comprising James' TV and radio ads reflects anti-LGBTQ + ideology and may serve as a preview of future campaigns that seek to demonize the LGBTQ + community for political gain.