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Preventive medicine (PM) physicians promote population-based approaches to health care with training that emphasizes public health, epidemiology, and policy. PM physicians use these skills in varied, often nonclinical, practice settings. PM career diversity challenges educators when designing residency curricula. Input from PM physicians about workforce environments is needed to ensure that residency requirements match skills needed post-residency. Graduates of one PM residency were sent a cross-sectional survey in 2016. Questions included professional experience, importance of 18 Accreditation Council for Graduate Medical Education sub-competencies and 13 leadership/management skills to current position, and residency training adequacy in those sub-competencies/skills. Responses were rated on 3-point Likert scales. Analyses were completed in 2017. Pearson's chi-square tests examined relationships between position type (academic/government) and perception of competencies' importance and training adequacy. Eighty PM physicians responded (46%): 44% worked in academia and 25% in federal/state/local government. Half (53%) were PM board certified. A total of 88% completed clinical residency prior to PM. Thirteen of 18 competencies were important to work, and respondents felt well trained in 16 of 18 competencies. Respondents did not feel well trained in emergency preparedness and surveillance systems during residency and their opinions about the importance of these sub-competencies varied based on where they worked. Respondents rated all 13 leadership/management skills as important, but reported inadequate residency training. In conclusion, respondents rated most Accreditation Council for Graduate Medical Education sub-competencies as important to current work and felt well trained, indicating good alignment between residency training and professional needs. Respondents also reported leadership/management training deficiencies. PM residencies might consider incorporating formal leadership training into curricula.

Context A literature review and environmental scan were conducted to develop a framework for interventions that utilize linkages between clinical practices and community organizations for the delivery of preventive services, and to identify and characterize these efforts. Evidence acquistion A search was made of four major health services and social science electronic databases and an Internet search was conducted to identify examples of linkage interventions in the areas of tobacco cessation, obesity, nutrition, and physical activity. Evidence synthesis In all, 49 interventions were identified, of which 18 examples described their evaluation methods or reported any intervention outcomes. Few conducted evaluations that were rigorous enough to capture changes in intermediate or long-term health outcomes. Outcomes in these evaluations were primarily patient-focused and did not include organizational or linkage characteristics. Conclusions An attractive option to increase the delivery of preventive services is to link primary care practices to community organizations; evidence is not yet conclusive, however, that such linkage interventions are effective. Findings provide recommendations to researchers and organizations that fund research, and call for a framework and metrics to study linkage interventions.

Background In 2005, CDC began the Diabetes Primary Prevention Initiative Interventions Focus Area (DPPI-IFA), which funded five state Diabetes Prevention and Control Programs (DPCPs) to translate diabetes primary prevention trials into real-world settings by developing and implementing a framework for state-level diabetes primary prevention. Purpose The purpose of this case study, conducted in 2007, was to describe DPPI-IFA implementation, including facilitators and challenges to the initiative. Methods Case studies of the five DPCPs in the DPPI-IFA involving site visits with key informant interviews of state staff and partners and archival record collection. Results Partners recruited for DPPI-IFA activities included local or state public health agencies (three of five DPCPs); regional or state nonprofit organizations (five DPCPs); businesses or employers (three DPCPs); and healthcare organizations (four DPCPs). The DPCPs implemented a variety of interventions in three main domains: diabetes primary prevention and prediabetes awareness, screening activities and lifestyle interventions, and prediabetes-related health policy efforts. Preliminary outcomes are described at the individual and organization/partnership levels. Results suggest the importance of utilizing preexisting partnerships to extend work into diabetes prevention, providing even small amounts of funding to partners, and prior program planning for diabetes prevention. Challenges for the DPPI-IFA included recruiting participants, establishing links with providers to obtain diagnostic testing for people screened for prediabetes, and offering a lifestyle intervention. Conclusions The DPPI-IFA represents a unique effort by state public health programs in the translation of diabetes primary prevention trials into real-world settings. The experiences of the DPPI-IFA programs offer valuable lessons for future community-based diabetes prevention initiatives, especially regarding the need to strengthen clinical–community partnerships for referral of people with prediabetes to evidence-based lifestyle programs.

The recent spread of crack cocaine use among inner-city teenagers has been accompanied by dramatic increases in juvenile delinquency and sexually transmitted diseases (STDs) among teenagers. This study examined the prevalence of five factors which promote STDs, including human immunodeficiency virus (HIV), among a sample of sexually active black adolescent crack users and non-users from the San Francisco Bay Area. Significant differences were observed between these groups with respect to history of engaging in sexual intercourse under the influence of drugs or alcohol, exchanging sexual favors for drugs or money, condom use in the most recent sexual encounter, and having five or more sexual partners in the last year. Approximately 63% of all respondents reported engaging in at least one of these risk behaviors. In multiple logistic regression analysis, reporting one or more of these STD/HIV risk behaviors was significantly associated with crack use and having one or more relatives who used drugs. Intervention efforts need to address both individual and environmental risk factors in order to reduce teens' risk for STDs, including HIV.