CONTEXT: Public health agencies require a competent, well-trained workforce to protect health and meet the specific needs of the communities served. In the US-Affiliated Pacific Islands (USAPI), geographic and educational barriers, and limited availability of culturally and linguistically appropriate training programs are unique challenges that contribute to public health workforce shortages. PROGRAM AND IMPLEMENTATION: The Pacific Public Health Fellowship Program (PPHFP) was introduced through a partnership between the Centers for Diseases Control and Prevention and the Pacific Island Health Officers Association. It was designed to address barriers to public health workforce development and capacity in USAPI. Established in 2019, PPHFP is a 2-year, full-time training program designed for USAPI residents who are recent college graduates with interests in pursuing careers in public health. The program includes a competency-based training curriculum and field-based projects at participating host sites to address local public health challenges. PPHFP has expanded from 2 fellows in 2021 to 43 fellows in 2024, with each USAPI having hosted fellows. EVALUATION: All 2021-2023 cohort respondents to the PPHFP exit survey have reported satisfaction with the program, increased knowledge and skills in public health, and readiness to enter the public health workforce. In addition, respondents reported that they have contributed to public health workforce capacity at their local host sites. In total, 16 of 17 graduates from these cohorts have been employed or continued their education in the public health field. DISCUSSION: PPHFP is a successful approach to addressing unique public health workforce challenges in USAPI through recruitment, training, and placement of residents at local host sites. This fellowship program can serve as a model for enhancing public health workforce capacity in other regions and globally.

OBJECTIVES: To systematically examine prevalence of first trimester prenatal care (FTPNC) in the 44 US counties and 80 Mexican municipios of the binational border region; and to describe disparities between border and nonborder areas within states, border states, and countries. METHODS: We combined 2009 records of singleton live births from the 10 US-Mexico border states (N=1,370,206) into a single file. We included FTPNC; county/municipio, state, and country of maternal residence; and demographic variables common to all records. We computed prevalence of FTPNC for border and nonborder residents by state and country. Using multivariable regression, we computed adjusted prevalence ratios (aPR) for FTPNC in border relative to nonborder residents, states relative to one another, and the US relative to Mexico. RESULTS: In 2009, 68.8% of US-Mexico border mothers and 72.9% of nonborder mothers received FTPNC. After adjustment, nonborder residents had higher prevalence of FTPNC than border residents in Sonora, New Mexico, Arizona, Coahuila, and Chihuahua (aPR=1.09-124). In US states, prevalence was 13%-36% higher in New Mexico, Arizona, and California than Texas. In Mexico, when compared with Coahuila, adjusted prevalence was 12%-20% higher in neighboring states. Between countries, FTPNC prevalence in border counties/municipios was higher in Mexico among women with low parity/low education and in the United States among women with high parity/high education. CONCLUSIONS: In the US and Mexico, women in border counties/municipios receive less timely prenatal care than their nonborder counterparts, but the magnitude of the disparity varies by state. Lack of a consistent, binational approach to birth data collection requires cautious interpretation of findings.