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Park S, Park S, Ryu B, Baek J, Amano T, Kim B. Subsidized Senior Housing in the US: A Scoping Review. J Appl Gerontol 2024; 43:814-828. [PMID: 38116663 DOI: 10.1177/07334648231223028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Subsidized senior housing (SSH) is important to support healthy aging among vulnerable subgroups of older adults, yet progress in developing and expanding SSH has been limited. This scoping review had two research questions: (1) What are the trends in SSH empirical studies? (2) What are the main topics in the existing literature on SSH in the US? We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and collaborative partnerships between housing operators and healthcare providers. More than half of the studies were quantitative, while the rest were qualitative or mixed-methods. The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being, healthcare use and health behaviors, social relations, and housing relocation. We discussed implications for future research and program development efforts in SSH.
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Affiliation(s)
- Sojung Park
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA
| | - Soobin Park
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA
| | - Byeongju Ryu
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Jihye Baek
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA
| | - Takashi Amano
- School of Arts and Sciences, Rutgers University, Newark, NJ, USA
| | - Borin Kim
- School of Social Work, University of New Hampshire, Durham, NH, USA
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Lynch EB, Tangney C, Ruppar T, Zimmermann L, Williams J, Jenkins L, Epting S, Avery E, Olinger T, Berumen T, Skoller M, Wornhoff R. Heart 2 Heart: Pilot Study of a Church-Based Community Health Worker Intervention for African Americans with Hypertension. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:22-33. [PMID: 37418177 PMCID: PMC11133067 DOI: 10.1007/s11121-023-01553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 07/08/2023]
Abstract
African Americans (AAs) have higher prevalence of uncontrolled hypertension than Whites, which leads to reduced life expectancy. Barriers to achieving blood pressure control in AAs include mistrust of healthcare and poor adherence to medication and dietary recommendations. We conducted a pilot study of a church-based community health worker (CHW) intervention to reduce blood pressure among AAs by providing support and strategies to improve diet and medication adherence. To increase trust and cultural concordance, we hired and trained church members to serve as CHWs. AA adults (n = 79) with poorly controlled blood pressure were recruited from churches in a low-income, segregated neighborhood of Chicago. Participants had an average of 7.5 visits with CHWs over 6 months. Mean change in systolic blood pressure across participants was - 5 mm/Hg (p = 0.029). Change was greater among participants (n = 45) with higher baseline blood pressure (- 9.2, p = 0.009). Medication adherence increased at follow-up, largely due to improved timeliness of medication refills, but adherence to the DASH diet decreased slightly. Intervention fidelity was poor. Recordings of CHW visits revealed that CHWs did not adhere closely to the intervention protocol, especially with regard to assisting participants with action plans for behavior change. Participants gave the intervention high ratings for acceptability and appropriateness, and slightly lower ratings for feasibility of achieving intervention behavioral targets. Participants valued having the intervention delivered at their church and preferred a church-based intervention to an intervention conducted in a clinical setting. A church-based CHW intervention may be effective at reducing blood pressure in AAs.
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Affiliation(s)
- Elizabeth B Lynch
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Christy Tangney
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
- Dept. of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - Todd Ruppar
- Dept. of Adult Health and Gerontological Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Laura Zimmermann
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Joselyn Williams
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - LaDawne Jenkins
- Dept. of Community Health Equity and Engagement, Rush University Medical Center, Chicago, IL, USA
| | - Steve Epting
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
- Hope Community Church, Chicago, IL, USA
| | - Elizabeth Avery
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tamara Olinger
- Dept. of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Teresa Berumen
- Dept. of Community Health Equity and Engagement, Rush University Medical Center, Chicago, IL, USA
| | - Maggie Skoller
- Center for Health and Social Care Integration, Rush University Medical Center, Chicago, IL, USA
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Hansotte E, Andrea SB, Weathers TD, Stone C, Jessup A, Staten LK. Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic. Prev Med Rep 2024; 39:102645. [PMID: 38370984 PMCID: PMC10869924 DOI: 10.1016/j.pmedr.2024.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.
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Affiliation(s)
- Elinor Hansotte
- Marion County Public Health Department, 3838 N. Rural St., Indianapolis, IN 46205, United States
| | - Sarah B. Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Vanport Building, 1810 SW 5 Ave., Suite 510, Portland, OR 97201, United States
| | - Tess D. Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Cynthia Stone
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Alisha Jessup
- Eskenazi Health, 720 Eskenazi Ave., Indianapolis, IN 46202, United States
| | - Lisa K. Staten
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
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Abstract
We stand at a critical juncture in the delivery of health care for hypertension. Blood pressure control rates have stagnated, and traditional health care is failing. Fortunately, hypertension is exceptionally well-suited to remote management, and innovative digital solutions are proliferating. Early strategies arose with the spread of digital medicine, long before the COVID-19 pandemic forced lasting changes to the way medicine is practiced. Highlighting one contemporary example, this review explores salient features of remote management hypertensive programs, including: an automated algorithm to guide clinical decisions, home (as opposed to office) blood pressure measurements, an interdisciplinary care team, and robust information technology and analytics. Dozens of emerging hypertension management solutions are contributing to a highly fragmented and competitive landscape. Beyond viability, profit and scalability are critical. We explore the challenges impeding large-scale acceptance of these programs and conclude with a hopeful look to the future when remote hypertension care will have dramatic impact on global cardiovascular health.
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Affiliation(s)
- Simin Gharib Lee
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Naomi D.L. Fisher
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Promoting Physical Activity Among Immigrant Asian Americans: Results from Four Community Health Worker Studies. J Immigr Minor Health 2023; 25:291-305. [PMID: 36273386 DOI: 10.1007/s10903-022-01411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 03/07/2023]
Abstract
Racial/ethnic minorities have demonstrated lower rates of physical activity (PA) than non-Hispanic Whites. This study examined outcomes in PA measures after participation in a community health worker (CHW) intervention. We performed a secondary data analysis from four randomized controlled trials utilizing CHWs (n = 842) in New York City (Bangladeshi-diabetes management, Filipino-hypertension management, and Korean and Asian Indian-diabetes prevention). Outcomes included total weekly PA, PA self-efficacy, PA barriers, and PA social interaction. Each measure was examined at baseline and study endpoint. Generalized estimating equation models were fitted to assess the repeated measures over time, while accounting for study group and socio-demographic factors. Moderate PA, recommended PA, and self-efficacy increased significantly among treatment group participants. PA social interaction increased significantly among Filipinos and Asian Indians. In adjusted regression analysis, time x group interaction was significant for all PA outcomes except for PA barriers. Culturally-adapted lifestyle interventions may potentially improve PA-related outcomes in Asian immigrant communities. Trial registration at ClinicalTrials.gov includes: NCT03530579 (RICE Project), NCT02041598 (DREAM Project), and NCT03100812 (AsPIRE).
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Cené CW, Viswanathan M, Fichtenberg CM, Sathe NA, Kennedy SM, Gottlieb LM, Cartier Y, Peek ME. Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2023; 6:e2250654. [PMID: 36656582 PMCID: PMC9857687 DOI: 10.1001/jamanetworkopen.2022.50654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities. OBJECTIVE To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity. EVIDENCE REVIEW Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity). FINDINGS Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences. CONCLUSIONS AND RELEVANCE In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.
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Affiliation(s)
- Crystal W. Cené
- Department of Medicine, University of California, San Diego Health, San Diego
- School of Medicine, University of California, San Diego
| | - Meera Viswanathan
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Caroline M. Fichtenberg
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Nila A. Sathe
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Sara M. Kennedy
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Laura M. Gottlieb
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Yuri Cartier
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
| | - Monica E. Peek
- Section of General Internal Medicine, MacLean Center for Clinical Medical Ethics, Center for the Study of Race, Politics and Culture, The University of Chicago, Chicago, Illinois
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VanDevanter N, Zhong L, Dannefer R, Manyindo N, Walker S, Otero V, Smith K, Keita R, Thorpe L, Drackett E, Seidl L, Brown-Dudley L, Earle K, Islam N. Implementation Facilitators and Challenges of a Place-Based Intervention to Reduce Health Disparities in Harlem Through Community Activation and Mobilization. Front Public Health 2022; 10:689942. [PMID: 35558526 PMCID: PMC9090448 DOI: 10.3389/fpubh.2022.689942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background To address significant health inequities experienced by residents of public housing in East and Central Harlem compared to other New Yorkers, NYC Department of Health and Mental Health (DOHMH) collaborated with community and academic organizations and the New York City Housing Authority to develop a place-based initiative to address chronic diseases in five housing developments, including a community activation and mobilization component led by community health organizers (CHOs). Purpose Guided by the Consolidated Framework for Implementation Research (CFIR), we evaluated the initial implementation of the community activation and mobilization component to systematically investigate factors that could influence the successful implementation of the intervention. Methods Nineteen in-depth qualitative interviews were conducted with a purposive sample of CHOs, community members and leaders, collaborating agencies and DOHMH staff. Interviews were transcribed verbatim, and themes and codes were developed to identify theoretically important concepts of the CFIR and emergent analytic patterns. Results Findings identified important facilitators to implementation: positive community perception of the program, CHO engagement and responsiveness to community needs, CHO norms and values and adaptability of DOHMH and CHOs to community needs. Challenges included the instability of the program in the first year, limited ability to address housing related issues, concerns about long term funding, competing community priorities, low expectations by the community for the program, time and labor intensity to build trust within the community, and the dual roles of CHOs as community advocates and DOHMH employees. Conclusions Findings will guide future community activation and mobilization activities. The study demonstrates the value of integrating implementation science and health equity frameworks.
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Affiliation(s)
- Nancy VanDevanter
- Meyers College of Nursing, College of Global Public Health, New York University, New York, NY, United States
| | - Lynna Zhong
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Rachel Dannefer
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Noel Manyindo
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Sterling Walker
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Victor Otero
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Kimberly Smith
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Rose Keita
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Lorna Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Elizabeth Drackett
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Lois Seidl
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - La'Shawn Brown-Dudley
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | | | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States.,Department of Population Health, School of Medicine, New York University, New York, NY, United States
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Reininger BM, Mitchell-Bennett LA, Lee M, Yeh PG, Davé AC, Park SK, Xu T, Ochoa-Del Toro AG. Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss. Front Med (Lausanne) 2021; 8:661353. [PMID: 34881250 PMCID: PMC8645688 DOI: 10.3389/fmed.2021.661353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022] Open
Abstract
Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For "Effectiveness," we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into "low exposure" (2-3 outreach visits) vs. "high exposure" (4-5 outreach visits). Based on the RE-AIM Framework, the intervention "reached" its intended population of low-income Latinos, demonstrated "effectiveness" in improving hypertension and obesity, was "adopted" at a high level in all but one site, was "implemented" with fidelity to the intervention model with moderate success across locations, and showed high "maintenance" over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = -0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = -1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = -1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.
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Affiliation(s)
- Belinda M. Reininger
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Lisa A. Mitchell-Bennett
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paul G. Yeh
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
- Department of Physician Assistant Studies, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Amanda C. Davé
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
| | - Soo Kyung Park
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Tianlin Xu
- Department of Biostatistics and Data Science, University of Texas Health Science Center, University of Texas School of Public Health at Houston, Houston, TX, United States
| | - Alma G. Ochoa-Del Toro
- Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health in Brownsville, Brownsville, TX, United States
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Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach. J Ambul Care Manage 2020; 43:55-70. [PMID: 31770186 DOI: 10.1097/jac.0000000000000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.
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Thorpe LE, Anastasiou E, Wyka K, Tovar A, Gill E, Rule A, Elbel B, Kaplan SA, Jiang N, Gordon T, Shelley D. Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy. JAMA Netw Open 2020; 3:e2024385. [PMID: 33151318 PMCID: PMC7645700 DOI: 10.1001/jamanetworkopen.2020.24385] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Secondhand smoke (SHS) exposure is associated with many health conditions in children and adults. Millions of individuals in the US are currently exposed to SHS in their homes. OBJECTIVE To investigate whether a federal ban on smoking in public housing settings was associated with a decrease in indoor SHS levels in New York City public housing developments 12 months after the policy's implementation. DESIGN, SETTING, AND PARTICIPANTS This cohort study tracked indoor air quality longitudinally from April 2018 to September 2019 and used difference-in-differences analysis to examine SHS exposure before vs after implementation of the 2018 federal smoke-free housing (SFH) policy in 10 New York City Housing Authority (NYCHA) buildings vs 11 matched low-income buildings not subject to the SFH policy (ie, Section 8 buildings). EXPOSURES Federal SFH policy implementation, beginning July 30, 2018. MAIN OUTCOMES AND MEASURES Comparison of nicotine concentration levels from passive, bisulfate-coated filters before vs 12 months after implementation of the federal SFH policy. Secondary outcomes included changes in particulate matter less than 2.5 μm in diameter, measured with low-cost particle monitors, and counts of cigarette butts in common areas. RESULTS Air quality was measured repeatedly in a total of 153 NYCHA and 110 Section 8 nonsmoking households as well as in 91 stairwells and hallways. Before the SFH policy implementation, air nicotine was detectable in 19 of 20 stairwells (95.0%) in NYCHA buildings and 15 of 19 stairwells (78.9%) in Section 8 buildings (P = .19) and in 17 of 19 hallways (89.5%) in NYCHA buildings and 14 of 23 hallways (60.9%) in Section 8 buildings (P = .004). Nicotine was detected less frequently inside nonsmoking apartments overall (26 of 263 [9.9%]) but more frequently in NYCHA apartments (20 of 153 [13.1%]) than in Section 8 apartments (6 of 110 [5.5%]) (P = .04). One year after policy implementation, there was no differential change over time in nicotine concentrations measured in stairwells (DID, 0.03 μg/m3; 95% CI, -0.99 to 1.06 μg/m3) or inside nonsmoking households (DID, -0.04 μg/m3; 95% CI, -0.24 to 0.15 μg/m3). Larger decreases in nicotine concentration were found in NYCHA hallways than in Section 8 hallways (DID, -0.43 μg/m3; 95% CI, -1.26 to 0.40 μg/m3). CONCLUSIONS AND RELEVANCE The findings suggest that there was no differential change in SHS in NYCHA buildings 12 months after SFH policy implementation. Additional support may be needed to ensure adherence to SFH policies.
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Affiliation(s)
- Lorna E. Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Elle Anastasiou
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, The City University of New York Graduate School of Public Health and Health Policy, New York
| | - Albert Tovar
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Emily Gill
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Elbel
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Sue A. Kaplan
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Terry Gordon
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York
| | - Donna Shelley
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York
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11
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Freeman AL, Li T, Kaplan SA, Ellen IG, Gourevitch MN, Young A, Doran KM. Community Health Worker Intervention in Subsidized Housing: New York City, 2016-2017. Am J Public Health 2020; 110:689-692. [PMID: 32191526 DOI: 10.2105/ajph.2019.305544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
From April 2016 to June 2017, the Health + Housing Project employed four community health workers who engaged residents of two subsidized housing buildings in New York City to address individuals' broadly defined health needs, including social and economic risk factors. Following the intervention, we observed significant improvements in residents' food security, ability to pay rent, and connection to primary care. No immediate change was seen in acute health care use or more narrowly defined health outcomes.
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Affiliation(s)
- Amy L Freeman
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Tianying Li
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Sue A Kaplan
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Ingrid Gould Ellen
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Marc N Gourevitch
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Ashley Young
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
| | - Kelly M Doran
- Amy L. Freeman, Tianying Li, Sue A. Kaplan, and Marc N. Gourevitch are with the Department of Population Health, New York University (NYU) School of Medicine, New York, NY. Ingrid Gould Ellen is with NYU Furman Center, NYU Wagner School, New York, NY. Ashley Young is with Neighborhood Resource Center, Henry Street Settlement, New York, NY. Kelly M. Doran is with Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine
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Anastasiou E, Feinberg A, Tovar A, Gill E, Ruzmyn Vilcassim MJ, Wyka K, Gordon T, Rule AM, Kaplan S, Elbel B, Shelley D, Thorpe LE. Secondhand smoke exposure in public and private high-rise multiunit housing serving low-income residents in New York City prior to federal smoking ban in public housing, 2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 704:135322. [PMID: 31787288 PMCID: PMC6939143 DOI: 10.1016/j.scitotenv.2019.135322] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/08/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Tobacco remains the leading cause of preventable death in the United States, with 41,000 deaths attributable to secondhand smoke (SHS) exposure. On July 30, 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. OBJECTIVES Prior to SFH policy implementation, we measured self-reported and objective SHS incursions in a purposeful sample of 21 high-rise buildings (>15 floors) in New York City (NYC): 10 public housing and 11 private sector buildings where most residents receive federal housing subsidies (herein 'Section 8' buildings). METHODS We conducted a baseline telephone survey targeting all residents living on the 3rd floor or higher of selected buildings: NYC Housing Authority (NYCHA) residents were surveyed in April-July 2018 (n = 559), and residents in 'Section 8' buildings in August-November 2018 (n = 471). We invited non-smoking household participants to enroll into a longitudinal air monitoring study to track SHS exposure using: (1) nicotine concentration from passive, bisulfate-coated nicotine filters and (2) particulate matter (PM2.5) from low-cost particle monitors. SHS was measured for 7-days in non-smoking households (NYCHA n = 157, Section 8 n = 118 households) and in building common areas (n = 91 hallways and stairwells). RESULTS Smoking prevalence among residents in the 21 buildings was 15.5%. Two-thirds of residents reported seeing people smoke in common areas in the past year (67%) and 60% reported smelling smoke in their apartments coming from elsewhere. Most stairwells (88%) and hallways (74%) had detectable nicotine levels, but nicotine was detected in only 9.9% of non-smoking apartments. Substantial variation in nicotine and PM2.5 was observed between and within buildings; on average nicotine concentrations were higher in NYCHA apartments and hallways than in Section 8 buildings (p < 0.05), and NYCHA residents reported seeing smokers in common areas more frequently. CONCLUSIONS SFH policies may help in successfully reducing SHS exposure in public housing, but widespread pre-policy incursions suggest achieving SFH will be challenging.
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Affiliation(s)
- Elle Anastasiou
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA; Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA.
| | - Alexis Feinberg
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA
| | - Albert Tovar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
| | - Emily Gill
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
| | - M J Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, USA.
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA.
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, USA.
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA.
| | - Sue Kaplan
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA; Wagner Graduate School of Public Service, New York University, 295 Lafayette St, New York, NY 10012, USA.
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
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The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center. J Community Health 2019; 45:161-169. [PMID: 31451987 PMCID: PMC6954892 DOI: 10.1007/s10900-019-00712-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 11/01/2022]
Abstract
Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016-2017, the NYC Health Department's Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center's Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members' expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.
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Feinberg A, Seidl L, Dannefer R, Wyka K, Drackett E, Brown-Dudley L, Islam N, Thorpe LE. A Cohort Review Approach Evaluating Community Health Worker Programs in New York City, 2015-2017. Prev Chronic Dis 2019; 16:E88. [PMID: 31298212 PMCID: PMC6638594 DOI: 10.5888/pcd16.180623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to describe how a cohort review approach was applied as an evaluation framework for a community health worker intervention among adult residents in 5 public housing developments in New York City in 2015–2017. The cohort review approach involved systematically monitoring participants engaged in the Harlem Health Advocacy Partners program during a given time period (“cohort”) to assess individual outcomes and program performance. We monitored participation status (completed, still active, disengaged, on leave, or died) and health outcomes. In this example of a cohort review, levels of enrollment and program disengagement were higher in cohort 1 than in cohort 2. For 6-month health outcomes, the percentage of participants with hypertension who had controlled blood pressure was static in cohort 1 and improved significantly in cohort 2. The percentage of participants with diabetes who self-reported controlled hemoglobin A1c increased significantly in cohort 1 at 6-month follow-up. The cohort approach highlighted important outcome successes and identified workload challenges affecting recruitment and retention.
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Affiliation(s)
- Alexis Feinberg
- Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016.
| | - Lois Seidl
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Rachel Dannefer
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Katarzyna Wyka
- City University of New York Graduate School of Public Health and Health Policy, New York, New York
| | - Elizabeth Drackett
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | | | - Nadia Islam
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York, New York
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15
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Parekh TM, Copeland CR, Dransfield MT, Cherrington A. Application of the community health worker model in adult asthma and COPD in the U.S.: a systematic review. BMC Pulm Med 2019; 19:116. [PMID: 31242944 PMCID: PMC6593583 DOI: 10.1186/s12890-019-0878-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With rising medical costs, stakeholders and healthcare professionals are exploring community-based solutions to relieve the burden of chronic diseases and reduce health care spending. The community health worker (CHW) model is one example that has proven effective in improving patient outcomes globally. We sought to systematically describe the effectiveness of community health worker interventions in improving patient reported outcomes and reducing healthcare utilization in the adult asthma and chronic obstructive pulmonary disease (COPD) populations in the U.S. METHODS Studies were included if they were a randomized control trial or involved a pre-post intervention comparison with clearly stated disease specific outcomes, targeted adult patients with asthma or COPD, and were performed in the United States. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria and was registered with PROSPERO. RESULT The search yielded 4013 potential articles, of which 47 were chosen for full-text review and 4 were chosen for inclusion; all focused on asthma and three had a comparison group. CHW interventions demonstrated improvement in asthma-related quality of life, asthma control, home trigger scores, and asthma symptom free days. There were no studies that reported COPD specific outcomes as a result of CHW interventions. CONCLUSION Emerging evidence suggests CHW interventions may improve some aspects of asthma related disease burden in adults, however additional studies with consistent outcome measures are needed to confirm their effectiveness. Further research is also warranted to evaluate the use of community health workers in the COPD population.
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Stupplebeen DA, Sentell TL, Pirkle CM, Juan B, Barnett-Sherrill AT, Humphry JW, Yoshimura SR, Kiernan J, Hartz CP, Keliikoa LB. Community Health Workers in Action: Community-Clinical Linkages for Diabetes Prevention and Hypertension Management at 3 Community Health Centers. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:15-22. [PMID: 31285963 PMCID: PMC6603891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2014, the Hawai'i State Department of Health (HDOH) received funding from the Centers for Disease Control and Prevention (CDC), via the 1422 Cooperative Agreement, to conduct diabetes prevention and hypertension management. To implement one grant-required strategy-the engagement of community health workers (CHWs) to promote community-clinical linkages-the HDOH partnered with the Hawai'i Primary Care Association and 9 federally qualified health centers (FQHCs). This qualitative evaluation case study sought to understand how 3 of the funded FQHCs engaged CHWs, the types of community-clinical linkages the CHWs promoted, and the facilitators of and barriers to those linkages. Evaluators conducted 2 semi-structured group interviews with 6 administrators/clinicians and 7 CHWs in April 2018. The transcribed interviews were deductively and inductively analyzed to identify major themes. First, CHWs made multiple internal and external linkages using resources provided by the grant as well as other resources. Second, CHWs faced barriers in making community-clinical linkages due to individual patient, geographic, and economic constraints. Third, CHWs have unmet professional needs related to building community-clinical linkages including professional development, networking, and burnout. Reimbursement and payment mechanisms are an all-encompassing challenge to the sustainability of CHW positions, as disease-specific funding and a complete lack of reimbursement structures make CHW positions unstable. Thus, CHWs fulfill a number of grant-specific roles at FQHCs due to this patchwork of funding sources, and this relates to CHWs' experiences of burnout. Policy implications of this study include funding and reimbursement stabilization so FQHCs may consistently engage and support the CHW workforce to meet their patients' complex, diverse needs. More professional development opportunities for CHWs are necessary to build sustainable networks of resources.
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Affiliation(s)
- David A Stupplebeen
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS, CMP, LBK)
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS, CMP, LBK)
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS, CMP, LBK)
| | - Bryan Juan
- Hawai'i Primary Care Association, Honolulu, HI (BJ)
| | - Alexis T Barnett-Sherrill
- Chronic Disease Prevention & Health Promotion Division, Hawai'i State Department of Health, Kapolei, HI (ATB-S)
| | | | | | - Jasmin Kiernan
- West Hawai'i Community Health Center, Kailua-Kona, HI (JK, CPH)
| | - Claudia P Hartz
- West Hawai'i Community Health Center, Kailua-Kona, HI (JK, CPH)
| | - L Brooke Keliikoa
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI (DAS, TLS, CMP, LBK)
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17
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Cardozo RA, Feinberg A, Tovar A, Vilcassim MJR, Shelley D, Elbel B, Kaplan S, Wyka K, Rule AM, Gordon T, Thorpe LE. A protocol for measuring the impact of a smoke-free housing policy on indoor tobacco smoke exposure. BMC Public Health 2019; 19:666. [PMID: 31146711 PMCID: PMC6543633 DOI: 10.1186/s12889-019-7043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tobacco remains a leading cause of preventable death in the U.S., responsible for more than 440,000 deaths each year. Approximately 10% of these deaths are attributable to exposure of non-smokers to secondhand smoke (SHS). Residents living in public multi-unit housing (MUH) are at excess risk for SHS exposure compared to the general population. On November 30, 2016, the U.S. Department of Housing and Urban Development (HUD) passed a rule requiring all public housing agencies to implement smoke-free housing (SFH) policies in their housing developments by July 30, 2018. METHODS As part of a larger natural experiment study, we designed a protocol to evaluate indoor SHS levels before and after policy implementation through collection of repeat indoor air samples in non-smoking apartments and common areas of select high-rise NYCHA buildings subject to the HUD SFH rule, and also from socio-demographically matched private-sector high-rise control buildings not subject to the rule. A baseline telephone survey was conducted in all selected buildings to facilitate rapid recruitment into the longitudinal study and assess smoking prevalence, behaviors, and attitudes regarding the SFH policy prior to implementation. Data collection began in early 2018 and will continue through 2021. DISCUSSION The baseline survey was completed by 559 NYCHA residents and 471 comparison building residents (response rates, 35, and 32%, respectively). Smoking prevalence was comparable between study arms (15.7% among NYCHA residents and 15.2% among comparison residents). The majority of residents reported supporting a building-wide smoke-free policy (63.0 and 59.9%, respectively). We enrolled 157 NYCHA and 118 comparison non-smoking households into the longitudinal air monitoring study and performed air monitoring in common areas. Follow up surveys and air monitoring in participant households occur every 6 months for 2.5 years. Capitalizing on the opportunity of this federal policy rollout, the large and diverse public housing population in NYC, and robust municipal data sources, this study offers a unique opportunity to evaluate the policy's direct impacts on SHS exposure. Methods in this protocol can inform similar SFH policy evaluations elsewhere.
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Affiliation(s)
- Rodrigo Arce Cardozo
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Alexis Feinberg
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Albert Tovar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - M. J. Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010 USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Sue Kaplan
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027 USA
| | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205 USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010 USA
| | - Lorna E. Thorpe
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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Hernández D. Housing-Based Health Interventions: Harnessing the Social Utility of Housing to Promote Health. Am J Public Health 2019; 109:S135-S136. [PMID: 30785797 DOI: 10.2105/ajph.2018.304914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Diana Hernández
- Diana Hernández is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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19
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Yim B, Howland RE, Culp GM, Zhilkova A, Barbot O, Tsao TY. Disparities in Preventable Hospitalizations Among Public Housing Developments. Am J Prev Med 2019; 56:187-195. [PMID: 30553691 DOI: 10.1016/j.amepre.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This study assesses preventable hospitalization rates among New York City residents living in public housing developments compared with all New York City residents and residents in low-income areas. Additionally, preventable hospitalization rates by development (one or multiple buildings in close proximity and served by the same management office) were determined. METHODS The 2010-2014 New York City hospital discharge data were geocoded and linked with New York City Housing Authority records using building-level identifiers. Preventable hospitalizations resulting from ambulatory care-sensitive conditions were identified for public housing residents, citywide, and residents of low-income areas. Age-adjusted overall and ambulatory care-sensitive, condition-specific preventable hospitalization rates (11 outcomes) were determined and compared across groups to assess potential disparities. Additionally, rates were ranked and compared among public housing developments by quartiles. The analysis was conducted in 2016 and 2017. RESULTS The age-adjusted rate of preventable hospitalization was significantly higher among public housing residents than citywide (rate ratio [RR]=2.67, 95% CI=2.65, 2.69), with the greatest disparities in hospitalizations related to diabetes (RR=3.12, 95% CI=3.07, 3.18) and asthma (RR=4.14, 95% CI=4.07, 4.21). The preventable hospitalization rate was also higher among residents of public housing than low-income areas (RR=1.33, 95% CI=1.31, 1.35). There were large differences between developments ranked in the top and bottom quartiles of preventable hospitalization (RR=1.81, 95% CI=1.76, 1.85) with the largest difference related to chronic obstructive pulmonary disease (RR=3.38, 95% CI=3.08, 3.70). CONCLUSIONS Preventable hospitalization rates are high among public housing residents, and vary significantly by development and condition. By providing geographically granular information, geocoded hospital discharge data can serve as a valuable tool for health assessment and engagement of the healthcare sector and other stakeholders in interventions that address health inequities.
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Affiliation(s)
- Brian Yim
- Office of Policy, Planning and Strategic Data Use, New York City Department of Health and Mental Hygiene, New York, New York
| | - Renata E Howland
- Office of Policy, Planning and Strategic Data Use, New York City Department of Health and Mental Hygiene, New York, New York
| | - Gretchen M Culp
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, New York
| | - Anna Zhilkova
- Office of Policy, Planning and Strategic Data Use, New York City Department of Health and Mental Hygiene, New York, New York
| | - Oxiris Barbot
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Tsu-Yu Tsao
- Office of Policy, Planning and Strategic Data Use, New York City Department of Health and Mental Hygiene, New York, New York.
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Silveira MSVM, Moura Neto A, Sposito AC, Siminerio L, Pavin EJ. Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital. Diabetol Metab Syndr 2019; 11:6. [PMID: 30679959 PMCID: PMC6341746 DOI: 10.1186/s13098-019-0404-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. METHODS In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. RESULTS Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta - 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). CONCLUSIONS This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
- University of Pittsburgh, Pittsburgh, PA USA
| | - A. Moura Neto
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
| | - A. C. Sposito
- Cardiology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
| | - L. Siminerio
- Diabetes Division, University of Pittsburgh, Pittsburgh, PA USA
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo Brazil
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Nasser SA, Ferdinand KC. Community Outreach to African-Americans: Implementations for Controlling Hypertension. Curr Hypertens Rep 2018; 20:33. [PMID: 29637314 DOI: 10.1007/s11906-018-0834-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the impact and effectiveness of community interventions for controlling hypertension in African-Americans. The questions addressed are as follows: Which salient prior and current community efforts focus on African-Americans and are most effective in controlling hypertension and patient-related outcomes? How are these efforts implemented and possibly sustained? RECENT FINDINGS The integration of out-of-office blood pressure measurements, novel hypertension control centers (i.e., barbershops), and community health workers improve hypertension control and may reduce the excess hypertension-related complications in African-Americans. Several community-based interventions may assist effectiveness of clinical care teams, decrease care barriers, and improve adherence. A multifaceted, tailored, multidisciplinary community-based approach may effectively reduce barriers to blood pressure control among African-Americans. Future research should evaluate the long-term benefits of community health workers, barbershops as control centers, and out-of-office blood pressure monitoring upon control and eventually on morbidity and mortality.
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Affiliation(s)
- Samar A Nasser
- Department of Clinical Research & Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, USA
| | - Keith C Ferdinand
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, 1430 Tulane Avenue, #SL-8548, New Orleans, LA, 70112, USA.
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