Research collaboration with 2-1-1 to eliminate health disparities: an introduction

Examining food insecurity and areas with unmet food needs during COVID-19: A geospatial, community-specific approach

Food insecurity is a public health issue that has increased in the U.S. since the 2020 COVID-19 pandemic. Understanding how this increase occurs locally is crucial in informing appropriate food insecurity-related responses. Analyzing 2-1-1 call data is one way to examine food insecurity-related needs at a zip code level. The purpose of this work was to: (1) examine overall call trend data to 2-1-1 from March through July 2019 and March through July 2020, (2) examine changes in food need call volume to 2-1-1 during COVID-19 by zip code, and (3) identify areas with unmet food needs during COVID-19 in central Texas. Data for 2-1-1 calls from Travis County zip codes for March through July 2020 were compared to calls for March through July 2019 and categorized by reason for calling. Descriptive statistics and paired t-tests were used to analyze food need calls by zip code and mapped using ArcGIS. Communities with high food call volume and no emergency food assets located within the zip code were categorized as areas with unmet food needs. Results indicated there were more overall calls to 2-1-1 in 2020 (N=37,572) than in 2019 (N=28,623), and significantly more food need calls in 2020 than in 2019 (p<0.01). Eastern Travis County, a racially and ethnically diverse and lower-income area, had the largest increase in food need calls. Two zip codes were identified as having unmet food needs, which informed the strategic placement of emergency food assets. This study illustrates how 2-1-1 data can result in rapid translation of research to policy and program implementation.

Geographically Indexed Referral Databases to Address Social Needs in the Emergency Department

Introduction

Unmet health-related social needs (HRSN) are among the drivers of disparities in morbidity and mortality during public health emergencies such as the novel coronavirus 2019 (Covid-19) pandemic. Although emergency departments (ED) see a high volume of patients with HRSN, ED providers have limited time to complete detailed assessments of patients’ HRSN and are not always able to provide up-to-date and comprehensive information to patients on available community resources. Electronic, geographically indexed resource database systems have the potential to provide an efficient way for emergency physicians to rapidly identify community resources in settings where immediate social work consultation is not accessible.

Methods

We conducted a systematic review of papers examining the use of geographically indexed resource database systems in healthcare to better understand how these services can be used in emergency care. We then conducted simulated, standardized searches using two nationally available databases (211 and Aunt Bertha), applied to a single metropolitan area (Boston).

Results

Our systematic review found that most public health and screening interventions using nationally available databases have focused on chronic care needs. A small subset of publications demonstrated that these databases were mobilized during disasters to successfully aid vulnerable populations during Hurricanes Katrina and Rita. A total of 408 standardized searches were conducted to identify community resources related to four domains of social needs (food, transportation, housing, and utilities). Although 99% of the resources identified by both databases were relevant to the search domains queried, a significant proportion of the resources identified by each database were restricted to a specific demographic (eg, veterans).

Conclusion

Our findings demonstrate that geographically indexed referral databases may be an effective tool to help ED providers connect patients to nearby community resources during public health emergencies. We recommend that EDs select a referral database based on the greatest number of resources that are not demographically restricted.

Mapping Food Insecurity-Related 2-1-1 Calls in a 10-County Area of Central Texas by Zip Code: Exploring the Role of Geographic Food Access, Urbanicity and Demographic Indicators

Food insecurity is a public health issue that affects 12% of Americans. Individuals living in food insecure households are more likely to suffer from conditions such as undernutrition, obesity and chronic diseases. Food insecurity has been linked to limited geographic access to food; however, past studies have used limited measures of access which do not fully capture the nuances of community context. The purpose of this study was to explore the association between food insecurity and geographic food access by level of urbanicity. 2-1-1 calls made in 2018 in Central Texas were classified as food needs versus non-food needs. Supermarket and convenience stores were mapped using ArcGIS. Geographic food access was operationalized as the presence of supermarkets and convenience stores: within the zip code; only in neighboring zip codes; and not located within or in neighboring zip codes. Descriptive statistics and binomial logistic regression were used to examine associations between geographic access and 2-1-1 food calls, stratified by level of urbanicity. 11% of the 2-1-1 calls made in 2018 (N = 55,405) were regarding food needs. Results showed that peri-urban and rural callers living in zip codes that only had supermarkets in neighboring zip codes had greater odds of calling about food needs compared to those that had supermarkets within the zip code. These findings indicate that geographic food access is associated with food insecurity, but this relationship varies by urbanicity. Thus, the development of food insecurity mitigation programs in peri-urban and rural areas is needed.

To Text or Not to Text? Technology-based Cessation Communication Preferences among Urban, Socioeconomically Disadvantaged Smokers

Objective

Effective smoking cessation interventions are needed to reduce tobacco-related disparities. Communication technology-based interventions are increasingly being employed to help smokers quit, with controlled research demonstrating efficacy of text messaging and email in increasing abstinence. Understanding preferences for such strategies among socioeconomically disadvantaged smokers can inform targeted intervention planning. The aims of this study were to: 1) examine socioeconomically disadvantaged smokers' use of and access to communication technology; and 2) elucidate preferences for receiving quitting information and support via email and text message.

Design

This cross-sectional, mixed-methods study collected data from a self-administered survey and focus groups in September 2017.

Participants

A community-based, sample of 15 predominantly African American, socioeconomically disadvantaged smokers aged 21-64 years.

Results

Smartphone ownership was high, although use of communication-based cessation resources such as web sites and smartphone apps was low. Four themes emerged relevant to preferences for receiving quitting information and support via email and text message: access, appropriateness, intended use, and satisfaction. Although initially participants were mixed in their preferences for receiving emails vs texts, 80% preferred emails over texts when presented with sample emails and text messages containing cessation information.

Conclusions

In this sample of socioeconomically disadvantaged smokers, emails were preferred over text messages for smoking cessation assistance. Although both email and text message strategies may be acceptable to socioeconomically disadvantaged smokers generally, issues such as access and intended use should be considered to inform specific disparity-reducing intervention approaches.

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating network center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration is often advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN's multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. This paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control.

Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals

Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N= 1,090) with at least one behavioral risk factor or cancer screening need were randomly assigned to one of three health referral interventions: verbal referrals only, verbal referrals + a tailored mailed reminder, or verbal referrals + telephone health navigator. After 1 month, we assessed whether the nonhealth problems that prompted the 2-1-1 call had been resolved. Logistic regression estimated effects of having the problem resolved on calling a health referral. Callers were predominantly female (85%) and had a high school education or less (61%); nearly half (47%) had incomes under $10,000. The most common service requests were for utility assistance (35%), home/family problems (23%), and rent/mortgage assistance (12%). At follow-up, 38% of callers reported that all problems prompting their 2-1-1 call had been resolved, and 24% reported calling a health referral. Resolving all problems prompting the 2-1-1 call was associated with a higher odds of contacting a health referral (odds ratio = 1.44, 95% confidence interval [1.02, 2.05]) compared to people whose problems were not resolved. Multifaceted interventions that help meet non-health-related needs and provide support in reaching health-related goals may promote health in vulnerable populations.

The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice

BACKGROUND

Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions.

METHODS

The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model.

RESULTS

We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice.

CONCLUSIONS

The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control.

IMPACT

Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.