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Wang T, Zhang S, Li Q, Liu H, Zhang S, Jian W, Guo J. Socioeconomic inequalities in the relationship between internet usage patterns and depressive symptoms: Evidence from a Chinese longitudinal study. J Glob Health 2024; 14:04127. [PMID: 39149826 PMCID: PMC11327895 DOI: 10.7189/jogh.14.04127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Abstract
Background The increasing prevalence of depressive symptoms has emerged as a critical public health issue globally, highlighting the need for analyses of the factors contributing to depressive symptoms within the Chinese population and the development of targeted recommendations for improving mental well-being. We aimed to explore the correlation between internet use and depressive symptoms and the role of socioeconomic inequalities in this association. Methods We included data on 8019 residents aged 18 years and above, which we retrieved from the 2018 and 2020 waves of the China Family Panel Studies. We used latent profile analysis to categorise individuals' internet usage patterns and multiple linear regression to determine their association with depressive symptoms. Results Higher socioeconomic status (SES) was associated with fewer depressive symptoms (τ = -0.08; 95% confidence interval (CI) = -0.36, -0.18). Individuals in the high-dependence group presented a greater likelihood of developing depressive symptoms (τ = 0.04; 95% CI = 0.007, 0.66). We observed no significant difference in the interaction effect between individual-level SES and the four patterns of internet usage. However, compared with urban-dwelling respondents, those in rural areas had a stronger association between internet usage patterns and depressive symptoms, especially those in the high-dependence group (τ = -0.07; 95% CI = -1.47, -0.20). Conclusions Our findings indicate a significant association between depressive symptoms and internet usage patterns, indicating a need for interventions related to internet use, especially those targeted at reducing the risk of depressive symptoms in individuals of lower SES.
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Howell CR, Zhang L, Clay OJ, Dutton G, Horton T, Mugavero MJ, Cherrington AL. Social Determinants of Health Phenotypes and Cardiometabolic Condition Prevalence Among Patients in a Large Academic Health System: Latent Class Analysis. JMIR Public Health Surveill 2024; 10:e53371. [PMID: 39113389 PMCID: PMC11322797 DOI: 10.2196/53371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/24/2024] [Accepted: 06/05/2024] [Indexed: 08/16/2024] Open
Abstract
Background Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. Objective This study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. Methods Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ≥30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg, phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs). Results Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59% female; n=1198, 50% non-White). Roughly 8% (n=179) reported housing insecurity, 30% (n=710) reported resource needs (food, health care, or utilities), and 49% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9%); (2) adverse neighborhood SDoH (n=1353, 56%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95% CI 1.06-1.33), hypertension (PR 1.14, 95% CI 1.02-1.27), peripheral vascular disease (PR 1.46, 95% CI 1.09-1.97), and heart failure (PR 1.46, 95% CI 1.20-1.79). Conclusions Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal.
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Affiliation(s)
- Carrie R Howell
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Li Zhang
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Olivio J Clay
- Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL, United States
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gareth Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Trudi Horton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Assari S, Zare H. Unequal Effect of Educational Attainment on Reducing Poverty and Welfare; Diminished Returns of American Indian/Alaska Native Populations. JOURNAL OF REHABILITATION THERAPY 2024; 6:1-11. [PMID: 39100915 PMCID: PMC11296615 DOI: 10.29245/2767-5122/2024/2.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Background American Indian and Alaska Native (AIAN) communities face pronounced economic and health disparities compared to White Americans, a situation rooted in long-standing historical injustices and segregation. The theory of Minorities' Diminished Returns (MDR) provides insight beyond the traditional focus on socioeconomic status (SES) disparities, such as educational attainment. It suggests that the beneficial outcomes of educational achievements on health and economic status are less substantial for marginalized and racially non-White groups compared to White Americans. Aims This study investigates the applicability of the MDR theory to AIAN populations by examining whether the positive effects of education on poverty reduction and the decreased risk of disability benefit dependency are weaker for AIAN adults relative to their White counterparts. Methods Utilizing data from the 2022 National Health Interview Survey (NHIS), this cross-sectional study analyzed a cohort of 20,743 adults, comprising 20,474 White and 269 AIAN individuals. We assessed the relationships between educational attainment, poverty level, and the likelihood of receiving disability benefits. A structural equation model was employed, with receipt of disability benefits as a latent factor influenced by racial background (AIAN) as a potential moderator, education as the main predictor, and poverty level and self-rated health as mediators. Gender, age, employment status, marital status, and Hispanic ethnicity served as additional covariates. Results Findings indicate that higher educational levels are generally associated with a lower likelihood of receiving disability benefits, mediated by improved health and economic status. Nonetheless, the interaction between race (AIAN) and education significantly influenced economic outcomes, subsequently affecting the risk of receiving disability benefits. This suggests that Whites benefit more economically from education than AIAN individuals do. Conclusion The study underscores the MDR theory's relevance to the disparities in educational outcomes related to poverty risk and receiving disability benefits among AIAN populations. The challenges AIAN individuals face in leveraging their educational achievements for economic gain relative to Whites may be attributed to pervasive racism and discrimination within various sectors, including employment and education. Addressing these disparities necessitates policy interventions that ensure educational returns are equitable across racial groups, with a focus on equal access to resources and opportunities.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, USA
- Department of Family Medicine, Charles R Drew University of Medicine and Science, USA
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, USA
- Marginalization-Related Diminished Returns (MDRs) Research Center, Charles R Drew University of Medicine and Science, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
- University of Maryland Global Campus, Health Services Management, USA
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Rodriguez A, Shambhunath S, Wijesiri TID, Biazus-Dalcin C, Mc Goldrick N. Co-design of health educational materials with people experiencing homelessness and support workers: a scoping review. FRONTIERS IN ORAL HEALTH 2024; 5:1355349. [PMID: 38919732 PMCID: PMC11196637 DOI: 10.3389/froh.2024.1355349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction People experiencing homelessness are often marginalised and encounter structural barriers when seeking healthcare. Community-based oral health interventions highlighted the need of well-trained practitioners for the successful engagement of service users and behaviour change. However, a lack of adequate information and specific training has been previously reported. The adoption of inclusive approaches, such as co-design, to develop tailored and meaningful health promotion training and educational materials capable of addressing the specific needs of this group is required. Co-design entails active involvement of different groups in research processes that acknowledge participants' needs and expectations. This scoping review aims to identify the available literature on the participation of people experiencing homelessness and/or their support workers in co-designing health and oral health promotion training/educational materials, approaches adopted, and barriers and enablers to develop these materials. Methods The Joanna Briggs Institute (JBI) Scoping Review Methodology informed the development of the scoping review. The protocol was registered on the Open Science Framework. Six electronic databases (Medline (OVID), PsychInfo (OVID), Scopus, Web of Science, Applied Social Sciences Index and Abstracts (ASSIA) (ProQuest) and CINHAL) were systematically searched using MeSH terms. An extensive grey literature search, consultation with experts and hand searching of reference lists took place. Records were screened independently and in duplicate using the Rayyan Qatar Computing Research Institute (QCRI) online tool, followed by qualitative content analysis involving descriptive data coding. Results Eight studies/materials were included. Key approaches adopted to co-design, enablers and barriers were captured. The enablers were inclusivity, a safe environment for positive participation, empowerment and flexibility, the barriers were difficulty in recruiting and sustaining participation, power differentials, and limited resources. Conclusion The evidence in this area is limited. This scoping review provided foundations for further research to examine the impact of different components of the co-design process including the environment in which the co-design process is conducted. Further studies with experimental design and reported using appropriate study design frameworks detailing active components of the co-design process would strengthen the evidence base in this area.
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Affiliation(s)
- Andrea Rodriguez
- Dental Public Health, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | | | | | - Camila Biazus-Dalcin
- Mother, Infant and Child Research Group (MIRU), School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Niall Mc Goldrick
- Dental Public Health, School of Dentistry, University of Dundee, Dundee, United Kingdom
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Moon D, Pabayo R, Hwang J. An evolution of socioeconomic inequalities in self-rated health in Korea: Evidence from Korea National Health and Nutrition Examination Survey (KNHANES) 1998-2018. SSM Popul Health 2024; 26:101689. [PMID: 38952742 PMCID: PMC11215416 DOI: 10.1016/j.ssmph.2024.101689] [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: 06/13/2023] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
Reducing socioeconomic inequalities in health has become an important health policy agenda. This study aimed to measure socioeconomic inequalities in health in Korea over the past two decades and identify the contributing factors to the observed inequalities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016/2018 were utilized. The concentration index (CI) was calculated to measure health inequalities, and decomposition analysis was applied to identify and quantify the contributing factors to the observed inequalities in health. The results indicated that health inequalities exist, suggesting that poor health was consistently more concentrated among Korean adults with lower income (1998: -0.154; 2016/2018: -0.152). Gender-stratified analyses also showed that poor health was more concentrated in lower income women and men, with the degree of inequalities slightly more pronounced among women. The decomposition approach revealed that income and educational attainment were the largest contributors to the observed health inequalities as higher income and education associated with better self-rated health. These findings suggest the importance of considering socioeconomic determinants, such as income and education, in efforts to tackling health inequalities, particularly considering that self-rated health is a predictor of future mortality and morbidity. Furthermore, it is essential to implement more egalitarian social, labour market, and health policies in order to eliminate the existing socioeconomic inequalities in health in Korea.
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Affiliation(s)
- Daseul Moon
- Centre for Labour Health, People's Health Institute, Seoul, South Korea
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksan, South Korea
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Merk K, Arpey NC, Gonzalez AM, Valdez KE, Cohen-Rosenblum A, Edelstein AI, Suleiman LI. Racial and Ethnic Minorities Underrepresented in Pain Management Guidelines for Total Joint Arthroplasty: A Meta-analysis. Clin Orthop Relat Res 2024; 482:00003086-990000000-01533. [PMID: 38497759 PMCID: PMC11343556 DOI: 10.1097/corr.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Total joint arthroplasty aims to improve quality of life and functional outcomes for all patients, primarily by reducing their pain. This goal requires clinical practice guidelines (CPGs) that equitably represent and enroll patients from all racial/ethnic groups. To our knowledge, there has been no formal evaluation of the racial/ethnic composition of the patient population in the studies that informed the leading CPGs on the topic of pain management after arthroplasty surgery. QUESTIONS/PURPOSES Using papers included in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines and comparing them with US National census data, we asked: (1) What is the representation of racial/ethnic groups in randomized controlled trials compared with their representation in the US national population? (2) Is there a relationship between the reporting of racial/ethnic groups and year of data collection/publication, location of study, funding source, or guideline section? METHODS Participant demographic data (study year published, study type, guideline section, year of data collection, study site, study funding, study size, gender, age, and race/ethnicity) were collected from articles cited by this guideline. Studies were included if they were full text, were primary research articles conducted primarily within the United States, and if they reported racial and ethnic characteristics of the participants. The exclusion criteria included duplicate articles, articles that included the same participant population (only the latest dated article was included), and the following article types: systematic reviews, nonsystematic reviews, terminology reports, professional guidelines, expert opinions, population-based studies, surgical trials, retrospective cohort observational studies, prospective cohort observational studies, cost-effectiveness studies, and meta-analyses. Eighty-two percent (223 of 271) of articles met inclusion criteria. Our original literature search yielded 27 papers reporting the race/ethnicity of participants, including 24 US-based studies and three studies conducted in other countries; only US-based studies were utilized as the focus of this study. We defined race/ethnicity reporting as the listing of participants' race or ethnicity in the body, tables, figures, or supplemental data of a study. National census information from 2000 to 2019 was then used to generate a representation quotient (RQ), which compared the representation of racial/ethnic groups within study populations to their respective demographic representation in the national population. An RQ value greater than 1 indicates an overrepresented group and an RQ value less than 1 indicates an underrepresented group, relative to the US population. Primary outcome measures of RQ value versus time of publication for each racial/ethnic group were evaluated with linear regression analysis, and race reporting and manuscript parameters were analyzed with chi-square analyses. RESULTS Two US-based studies reported race and ethnicity independently. Among the 24 US-based studies reporting race/ethnicity, the overall RQ was 0.70 for Black participants, 0.09 for Hispanic participants, 0.1 for American Indian/Alaska Natives, 0 for Native Hawaiian/Pacific Islanders, 0.08 for Asian participants, and 1.37 for White participants, meaning White participants were overrepresented by 37%, Black participants were underrepresented by 30%, Hispanic participants were underrepresented by 91%, Asian participants were underrepresented by 92%, American Indian/Alaska Natives were 90% underrepresented, and Native Hawaiian Pacific Islanders were virtually not represented compared with the US national population. On chi-square analysis, there were differences between race/ethnicity reporting among studies with academic, industry, and dual-supported funding sources (χ2 = 7.449; p = 0.02). Differences were also found between race/ethnicity reporting among US-based and non-US-based studies (χ2 = 36.506; p < 0.001), with 93% (25 of 27) of US-based studies reporting race as opposed to only 7% (2 of 27) of non-US-based studies. Finally, there was no relationship between race/ethnicity reporting and the year of data collection or guideline section referenced. CONCLUSION The 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines provide evidence-based recommendations that reflect the current standards in orthopaedic surgery, but the studies upon which they are based overwhelmingly underenroll and underreport racial/ethnic minorities relative to their proportions in the US population. As these factors impact analgesic administration, their continued neglect may perpetuate inequities in outcomes after TJA. CLINICAL RELEVANCE Our study demonstrates that all non-White racial/ethnic groups were underrepresented relative to their proportion of the US population in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines, underscoring a weakness in the orthopaedic surgery evidence base and questioning the overall external validity and generalizability of these combined CPGs. An effort should be made to equitably enroll and report outcomes for all racial/ethnic groups in any updated CPGs.
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Affiliation(s)
| | - Nicholas C. Arpey
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Alba M. Gonzalez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katia E. Valdez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, USA
| | - Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Linda I. Suleiman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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Ramalingam N, Coury J, Barnes C, Kenzie ES, Petrik AF, Mummadi RR, Coronado G, Davis MM. Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity. J Rural Health 2024; 40:272-281. [PMID: 37676061 PMCID: PMC10918036 DOI: 10.1111/jrh.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Colonoscopy can prevent morbidity and mortality from colorectal cancer (CRC) and is the most commonly used screening method in the United States. Barriers to colonoscopy at multiple levels can contribute to disparities. Yet, in rural settings, little is known about who delivers colonoscopy and facilitators and barriers to colonoscopy access through screening completion. METHODS We conducted a qualitative study with providers in rural Oregon who worked in endoscopy centers or primary care clinics. Semistructured interviews, conducted in July and August, 2021, focused on clinician experiences providing colonoscopy to rural Medicaid patients, including workflows, barriers, and access. We used thematic analysis, through immersion crystallization, to analyze interview transcripts and develop emergent themes. FINDINGS We interviewed 19 providers. We found two categories of colonoscopy providers: primary care providers (PCPs) doing colonoscopy on their own patients (n = 9; 47%) and general surgeons providing colonoscopy to patients referred to their services (n = 10; 53%). Providers described barriers to colonoscopy at the provider, community, and patient levels and suggested patient supports could help overcome them. Providers found current colonoscopy capacity sufficient, but noted PCPs trained to perform colonoscopy would be key to continued accessibility. Finally, providers shared concerns about the shrinking number of PCP endoscopists, especially with anticipated increased screening demand related to the CRC screening guideline shift. CONCLUSIONS These themes reflect opportunities to address multilevel barriers to improve access, colonoscopy capacity, and patient education approaches. Our results highlight that PCPs are an essential part of the workforce that provides colonoscopy in rural areas.
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Affiliation(s)
- NithyaPriya Ramalingam
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Chrystal Barnes
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Erin S. Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
| | - Amanda F. Petrik
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Rajasekhara R Mummadi
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Gloria Coronado
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Melinda M. Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
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Maynard MJ, Orighoye O, Apekey T, Simpson E, van Dijk M, Atherton E, Blackshaw J, Ells L. Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers. Front Public Health 2023; 11:1239668. [PMID: 38074747 PMCID: PMC10701265 DOI: 10.3389/fpubh.2023.1239668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. Methods A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. Results The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Conclusion Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.
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Affiliation(s)
- Maria J. Maynard
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | - Oritseweyinmi Orighoye
- Bradford Institute for Health Research, University of Bradford, Bradford, United Kingdom
| | - Tanefa Apekey
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ellouise Simpson
- School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Margie van Dijk
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Elizabeth Atherton
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Jamie Blackshaw
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
| | - Louisa Ells
- School of Health, Leeds Beckett University, Leeds, United Kingdom
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
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Peterson-Katz K, Piccone C, Tuzi N, Kulkarni C, Reynolds JN. Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis. FRONTIERS IN HEALTH SERVICES 2023; 3:1160217. [PMID: 37425993 PMCID: PMC10326629 DOI: 10.3389/frhs.2023.1160217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Introduction Developmental delay affects approximately 1 in 4 children under 6 years old. Developmental delay can be detected using validated developmental screening tools, such as the Ages and Stages Questionnaires. Following developmental screening, early intervention can occur to address and support any developmental areas of concern. Frontline practitioners and supervisors must be trained and coached to organizationally implement developmental screening tools and early intervention practice. No prior work has qualitatively investigated the barriers and facilitators to implementing developmental screening and early intervention in Canadian organizations from the perspectives of practitioners and supervisors who have completed a specialized training and coaching model. Methods and Results Following semi-structured interviews with frontline practitioners and supervisors, thematic analysis identified four themes: cohesive networks support implementation efforts, implementation success is dependent on shared perspectives, established organizational policies increase implementation opportunities, and COVID-19 guidelines create organizational challenges. Each theme encompasses sub-themes that describe implementation facilitators: strong implementation context, multi-level multi-sectoral collaborative partnerships, adequate and collective awareness, knowledge, and confidence, consistent and critical conversations, clear protocols and procedures, and accessibility to information, tools, and best practice guidelines. Discussion The outlined barriers and facilitators fill a gap in implementation literature by informing a framework for organization-level implementation of developmental screening and early intervention following training and coaching.
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Affiliation(s)
| | - Caitlin Piccone
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Nicole Tuzi
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chaya Kulkarni
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - James N. Reynolds
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Park S, Ahmed R. Communication Dimensions of Healthcare Engagement and Patient Health Literacy for Immigrant Populations: A Systematic Review. HEALTH COMMUNICATION 2023; 38:1359-1372. [PMID: 34894918 DOI: 10.1080/10410236.2021.2010328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Health literacy is an important social determinant of health. Achieving health literacy of immigrants can be critical to empower this disadvantaged population in healthcare communication. However, to achieve this goal, it is a prerequisite to examine the relationship between health literacy and patient engagement in healthcare communication. This systematic review conceptualizes behavioral, emotional, and cognitive dimensions of patient engagement in healthcare communication and examines how health literacy and patient engagement among immigrants shape each other. A systematic review was conducted to identify relevant articles from five databases between 2010 and 2020. The reviewers synthesized findings from 15 articles that met the inclusion criteria. The results indicate that communication researchers should be more attentive to the emotional dimension of patient engagement in healthcare communication and that more empirical studies are needed to evaluate the relationship between health literacy and patient engagement among immigrants. Practical implications and recommendations for future research are discussed.
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Affiliation(s)
- Seulgi Park
- Department of Communication, University at Albany, State University of New York
| | - Rukhsana Ahmed
- Department of Communication, University at Albany, State University of New York
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Okuyama S, White LL, Anderson KP, Medina E, Deutsch S, Ransom C, Jackson P, Kauffman TL, Mittendorf KF, Leo MC, Bulkley JE, Wilfond BS, Goddard KA, Feigelson HS. Evaluating cancer genetic services in a safety net system: overcoming barriers for a lasting impact beyond the CHARM research project. J Community Genet 2023:10.1007/s12687-023-00647-x. [PMID: 37126135 DOI: 10.1007/s12687-023-00647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/14/2023] [Indexed: 05/02/2023] Open
Abstract
Underserved patients face substantial barriers to receiving cancer genetic services. The Cancer Health Assessments Reaching Many (CHARM) study evaluated ways to increase access to genetic testing for individuals in underserved populations at risk for hereditary cancer syndromes (HCS). Here, we report the successful implementation of CHARM in a low-resource environment and the development of sustainable processes to continue genetic risk assessment in this setting. The research team involved key clinical personnel and patient advisors at Denver Health to provide input on study methods and materials. Through iterative and collaborative stakeholder engagement, the team identified barriers and developed solutions that would both facilitate participation in CHARM and be feasible to implement and sustain long term in clinical care. With a focus on infrastructure building, educational modules were developed to increase awareness among referring providers, and standard methods of identifying and managing HCS patients were implemented in the electronic medical record. Three hundred sixty-four DH patients successfully completed the risk assessment tool within the study, and we observed a sustained increase in referrals to genetics for HCS (from 179 in 2017 to 427 in 2021 post-intervention). Implementation of the CHARM study at a low-resourced safety net health system resulted in sustainable improvements in access to cancer genetic risk assessment and services that continue even after the study ended.Trial registration NCT03426878.
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Affiliation(s)
- Sonia Okuyama
- Division of Oncology, Denver Health and Hospital Authority, Denver, CO, USA.
| | - Larissa L White
- Institute for Health Research, Kaiser Permanente, Aurora, CO, USA
| | | | - Elizabeth Medina
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Sonia Deutsch
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Paige Jackson
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katrina Ab Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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12
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DeNunzio M, Miller M, Chase M, Kraak V, Serrano E, Misyak S. A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States. Am J Health Promot 2023; 37:401-419. [PMID: 36112805 DOI: 10.1177/08901171221125451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS Data were analyzed by the lead investigator and described narratively. RESULTS Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.
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Affiliation(s)
- Maria DeNunzio
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Makenzie Miller
- 4366Louisiana State University AgCenter, Baton Rouge, LA, USA
| | - Melissa Chase
- Department of Food Science and Technology, 118724Virginia Tech, Blacksburg, VA, USA
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
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13
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Wang Y, Hu M, Ding R, He P. The dynamic relationship between subjective social status and health: Evidence from a Chinese cohort study. Br J Health Psychol 2023; 28:1-21. [PMID: 35707905 DOI: 10.1111/bjhp.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Using nationally representative longitudinal data from 2010 to 2018 in China, this study systematically investigates the relationship between Subjective Social Status (SSS) and health (physical health and mental health) in the Chinese adult population. METHODS By applying between-within model, we disentangle the relationship between health outcomes and: (1) between-individual differences in SSS and (2) within-individual variations of SSS across time. In addition, to explore SSS mobility and trajectory, we further decomposed SSS into lagged SSS and the change between the current and lagged SSS (mobility). RESULTS We find that there is significantly positive and unique relationship (independent of Objective Social Status (OSS)) between SSS and physical and mental health. However, for physical health, we observed an Inverse-U effect of average SSS, after some point (SSS = 3.93), higher average SSS is associated with a score decrease. Through heterogeneity analysis, we find that for physical health, within- and between-effects decreases with age and for mental health, the within effect is only significant among the urban population. Individuals with high expected mobility are also found to have significantly better health. CONCLUSIONS These findings show that the personal relative deprivation has negative, particularly salient and unique effects on the health of the Chinese population, and it is important to consider the dynamic nature of SSS.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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14
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Marciano L, Viswanath K. Social media use and adolescents' well-being: A note on flourishing. Front Psychol 2023; 14:1092109. [PMID: 37089739 PMCID: PMC10116992 DOI: 10.3389/fpsyg.2023.1092109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Background Several large-scale studies and reviews have reported both negative and positive associations of social media use with well-being, suggesting that the findings are more complex and need more nuanced study. Moreover, there is little or no exploration of how social media use in adolescence influences flourishing, a more all-encompassing construct beyond well-being, including six sub-domains (i.e., happiness, meaning and purpose, physical and mental health, character, close social relationships, and financial stability). This paper aims to fill this gap by understanding how adolescents might flourish through social media activities by fulfilling the basic needs pointed out by the Self-Determination Theory, i.e., relatedness, autonomy, and competence. Methods The study is drawn on cross-sectional data collected from 1,429 Swiss adolescents (58.8% females, Mage = 15.84, SDage = 0.83) as part of the HappyB project in Spring 2022. Self-reported measures included the Harvard Adolescent Flourishing scale, positive and negative online social experiences, self-disclosure on social media, and social media inspiration. Control variables included, among others, self-esteem, ill-being, and personality. Results After applying Bonferroni's correction, results of the hierarchical regression analyses showed that positive social media experiences (β = 0.112, p < 0.001) and social media inspirations from others (β = 0.072, p < 0.001) and for others (β = 0.060, p = 0.003) were positively associated with flourishing. Flourishing was inversely associated with negative social media experiences (β = -0.076, p < 0.001). Among covariates, self-esteem (β = 0.350, p < 0.001), ill-being (β = -0.252, p < 0.001), perceived school environment (β = 0.138, p < 0.001), self-reported level of physical activity (β =0.109, p < 0.001), and perceived socio-economic status (β = -0.059, p = 0.001) were all related to flourishing. In contrast, gender, high school year, age, perceived stress, and personality (extraversion and neuroticism) were not. Conclusion Using a well-being framework to investigate social media use in adolescents is needed to go beyond the ill-being perspective. Our results align with the needs pointed out by the Self-Determination Theory. Carrying out social media activities in a way that promotes-rather than diminishes-flourishing should be included as an additional good habit influencing adolescents' development. We suggest that interventions aiming to foster adolescents' flourishing should include curricula aiming to promote a good use of social media through positive online social relationships and inspirational contents.
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Affiliation(s)
- Laura Marciano
- Harvard T. H. Chan School of Public Health, Lee Kum Sheung Center for Health and Happiness, Dana-Farber Cancer Institute, Boston, MA, United States
- Institute of Public Health, USI Università della Svizzera italiana, Lugano, Switzerland
- *Correspondence: Laura Marciano,
| | - Kasisomayajula Viswanath
- Harvard T. H. Chan School of Public Health, Lee Kum Sheung Center for Health and Happiness, Dana-Farber Cancer Institute, Boston, MA, United States
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15
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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16
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Marciano L, Viswanath K, Morese R, Camerini AL. Screen time and adolescents' mental health before and after the COVID-19 lockdown in Switzerland: A natural experiment. Front Psychiatry 2022; 13:981881. [PMID: 36465307 PMCID: PMC9709147 DOI: 10.3389/fpsyt.2022.981881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the COVID-19 lockdown in 2020, adolescents' mental health was largely undermined. A general increment in screen time was reported. However, the long-term effects of the latter on adolescents' mental health are still little explored. Methods In the present natural experiment, we investigated these effects using longitudinal data collected before and after the first lockdown in Switzerland. Data come from 674 Swiss adolescents (56.7% females, Mage = 14.45, SDage = 0.50) during Spring 2019 (T1) and Autumn 2020 (T2) as part of the longitudinal MEDIATICINO study. Self-reported mental health measures included somatic symptoms, inattention, anxiety, irritability, anger, sleep problems, obsessive-compulsive symptoms, loneliness, and depression. Measures for screen-media activities included time spent on the Internet, smartphones, social media, video gaming, instant messaging, and television viewing. They were all assessed at T1 and T2. Results Paired-sample t-tests with Bonferroni's correction showed that most mental health problems increased over time with an overall medium effect size (Hedge's g = 0.337). In particular, medium effect sizes were found for anxiety, depression, and inattention; small-to-medium effect sizes were reported for loneliness, sleep problems, and obsessive-compulsive symptoms; and a small effect size was found for somatic symptoms. Screen-media activities increased, with the exception of television viewing and video gaming. The results of the hierarchical regression analyses showed that, controlling for covariates, increased time spent on social media - calculated as the difference between T2 and T1 - was the only screen-media activity significantly associated with worse mental health at T2 (β = 0.112, p = 0.016). More time spent in structured media activities like television viewing diminished levels of inattention (β = -0.091, p = 0.021) and anxiety (β = -0.093, p = 0.014). Among covariates, being female, experiencing two or more life events, having mental health problems at T1, and using screens for homeschooling negatively influenced mental health at T2. Conclusion These results align with literature indicating a small but negative effect of social media time on mental health. Underlying mechanisms are manifold, including increased exposure to COVID-19 news, heightened fear of missing out, social comparison, and time-displaced for activities such as physical activity and green time. However, in line with the structured days hypothesis, getting involved in media-structured activities like television viewing might protect against mental health symptoms.
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Affiliation(s)
- Laura Marciano
- Harvard T. H. Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kasisomayajula Viswanath
- Harvard T. H. Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Rosalba Morese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
| | - Anne-Linda Camerini
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland
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17
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Wanahari TA, Bakhriansyah M, Haryati H, Rudiansyah M, Isa M, Djallalluddin D, Prenggono MD. Socioeconomic Determinants of Tuberculosis Cases in Indonesia, 2010–2013: An Ecological Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Indonesia encounters a serious issue of disparity in tuberculosis cases among provinces. These disparities are crucial since they may reflect a macro-level factor that could be modified to further reduce the cases. Some factors are identified contributing to this variation, including socioeconomic determinants.
AIM: This study investigated whether these socioeconomic determinants (i.e., poverty, unemployment, income inequality, and low education) can predict the variation of tuberculosis cases across provinces in Indonesia.
METHODS: We conducted an ecological analysis by using public-use data files of the Annual Indonesian Health Profile Report and The Indonesian Social and Population Profile Report consisting of data from 33 provinces, 2010–2013. The main outcome measures were province-level tuberculosis notification cases for all form of tuberculosis cases and new smear-positive cases. The correlation between socioeconomic determinants and tuberculosis notification cases was analyzed with bivariate analyses and multivariate linear regression analyses.
RESULTS: This study showed that poverty was strongly and positively correlated with tuberculosis notification cases, either all form or new smear-positive cases. Unemployment was also positively correlated with tuberculosis notification cases, but the power was lower. In contrast, income inequality and low education level were not statistically correlated with tuberculosis notification cases. In multivariate linear regression analyses, poverty is the strongest predictor for tuberculosis notification cases. Poverty had a bigger impact than unemployment in the increased tuberculosis notification cases.
CONCLUSION: Findings from this study suggest that poverty has a profound influence on the variation for tuberculosis notification cases across provinces in Indonesia.
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18
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Standen EC, Finch LE, Tiongco-Hofschneider L, Schopp E, Lee KM, Parker JE, Bamishigbin ON, Tomiyama AJ. Healthy versus unhealthy comfort eating for psychophysiological stress recovery in low-income Black and Latinx adults. Appetite 2022; 176:106140. [PMID: 35718313 DOI: 10.1016/j.appet.2022.106140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
Low-income Black and Latinx individuals are disproportionately vulnerable to chronic stress and metabolic disease. Evidence suggests that these populations engage in elevated levels of comfort eating (i.e., eating comforting food to alleviate stress), which can harm diet quality. For this reason, many interventions discourage comfort eating. However, if comfort eating does indeed buffer stress, it may be a protective health behavior, particularly if healthy foods (e.g., strawberries) buffer stress as effectively as traditional unhealthy comfort foods (e.g., brownies). By choosing healthy foods, people may be able to simultaneously improve their nutrition and reduce their stress levels, both of which have the potential to reduce health disparities among chronically stressed populations. The present study tested the efficacy of healthy and unhealthy comfort eating for improving psychophysiological stress recovery. A sample of low-income Black and Latinx individuals (N = 129) were randomly assigned to consume a healthy food (e.g., grapes), unhealthy comfort food (e.g., chips), or no food after exposure to a laboratory stressor. Throughout, we measured participants' psychophysiological stress responses, including self-reported stress, rumination, autonomic nervous system activation (i.e., electrodermal activity (EDA), heart rate variability (HRV)) and neuroendocrine responses (i.e., salivary cortisol). We compared participants' stress recovery trajectories by condition and found no significant group differences (p = 0.12 for self-reported stress; p = 0.92 for EDA; p = 0.22 for HRV, p = 1.00 for cortisol). Participants in all conditions showed decreases in self-reported stress and in cortisol post-stressor (ps < 0.01), but rates of decline did not differ by condition (i.e., healthy or unhealthy comfort food, brief no-food waiting period). Although null, these results are important because they challenge the widely-held assumption that comfort foods help people decrease stress.
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Affiliation(s)
- Erin C Standen
- University of Minnesota, Twin Cities, 75 E River Road, Minneapolis, MN, 55455, USA.
| | - Laura E Finch
- NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL, 60603, USA.
| | | | - Emma Schopp
- National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA.
| | - Kristen M Lee
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Jordan E Parker
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | | | - A Janet Tomiyama
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
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19
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Can social risks in early life predict children’s health and academic outcomes? An analysis of the Longitudinal Study of Australian Children. SSM Popul Health 2022; 17:101070. [PMID: 35313606 PMCID: PMC8933575 DOI: 10.1016/j.ssmph.2022.101070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Exposure to social risk in early life negatively impacts the health and wellbeing of children. While screening for social determinants of health is recommended, there is little evidence that identifying social risk early in life predicts longer-term poorer outcomes. The purpose of this study is to examine the extent to which assessing social risk using a standardized tool in young children up to age 6 years might predict poor health and academic performance at 10–11 years old. The social risk domains studied were housing instability, food insecurity, financial strain, transport problems, safety, lack of support and unemployment. The predictive validity of these social risk domains measured at 0–5 years was examined using data from the Longitudinal Study of Australian Children. Outcomes at 10–11 years included ongoing diseases and mental health conditions, hospitalization, injury, dental problems, overweight or obesity and academic achievement. Financial strain and inability to access support were the most sensitive measures of poor outcomes. Across all social risks, the positive predictive value was highest for academic outcomes. Across all domains, there was higher sensitivity for children with 2 or more social risks. Items in the social risk screening tool were moderate predictors of academic outcomes, but weak predictors of health outcomes at 10–11 years. This data will be useful for informing screening for social determinants of health. Social risks from 0 to 5 y were moderate predictors of 8-year-old school assessments. Financial strain and a lack of social support had modest sensitivity. Sensitivity is increased by applying a threshold of 2 or more social risks. The positive predictive value of social needs was highest for academic outcomes.
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20
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Cohen SA, Nash CC, Byrne EN, Mitchell LE, Greaney ML. Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity 2022; 6:178-188. [PMID: 35402770 PMCID: PMC8985531 DOI: 10.1089/heq.2021.0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Caitlin C. Nash
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Erin N. Byrne
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lauren E. Mitchell
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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21
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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22
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Brady LA, Tumiel-Berhalter LM, Schad LA, Bentham A, Vitale K, Norton A, Noronha G, Swanger C, Morley CP. Increasing Breast, Cervical, and Colorectal Cancer Screenings: A Qualitative Assessment of Barriers and Promoters in Safety-Net Practices. J Patient Cent Res Rev 2021; 8:323-330. [PMID: 34722800 PMCID: PMC8530240 DOI: 10.17294/2330-0698.1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters. METHODS Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each practice facilitation period, focus groups and key informant interviews were conducted with participating personnel. Content analysis was performed annually to identify barriers and promoters. A comprehensive final analysis was performed at project end. RESULTS Barriers included system-level (inconsistent communication with specialists, electronic health record system transitions, ownership changes) and practice-level challenges (staff turnover, inconsistent data entry, QI fatigue) that compound patient-level challenges of transportation, cost, and health literacy. Cyclical barriers like staff turnover returned despite attempts to resolve them, while successful implementation was promoted by reducing patients' structural barriers, adapting interventions to existing practice priorities, and enacting officewide policies. During the QI project, practices became aware of the impact of social determinants of health on patients' screening decisions. CONCLUSIONS The project's longitudinal design enabled identification of key barriers that reduced accuracy of practices' screening rates and increased risk of patients falling through the cracks. Identified promoters can help sustain interventions to increase screenings.
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Affiliation(s)
- Laura A. Brady
- Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY
| | - Laurene M. Tumiel-Berhalter
- Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY
- University at Buffalo Clinical and Translational Science Institute, Buffalo, NY
| | - Laura A. Schad
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Alexandrea Bentham
- Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY
| | - Karen Vitale
- University of Rochester Clinical and Translational Science Institute, Rochester NY
| | - Amanda Norton
- A. Mandatory, Inc. (consulting for SUNY Upstate Medical University), Groton, NY
| | - Gary Noronha
- Center for Primary Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carlos Swanger
- Center for Primary Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
- Health Reach for the Homeless, Rochester Regional Health, Rochester, NY
| | - Christopher P. Morley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
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Byker Shanks C, Calloway EE, Parks CA, Yaroch AL. Scaling up measurement to confront food insecurity in the USA. Transl Behav Med 2021; 10:1382-1389. [PMID: 33277900 DOI: 10.1093/tbm/ibaa112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
It is necessary to scale up measurement in order to confront the persisting problem of food insecurity in the United States (USA). The causes and consequences around food insecurity are briefly described in order to frame the complexity of the public health issue and demonstrate need for expanded measurement approaches. We assert that measurement of food security in the USA is currently based upon a core set of rigorous metrics and, moving forward, should also constitute a supplemental registry of measures to monitor and address variables that are associated with increased risk for food insecurity. Next, we depict dietary quality as a primary example of the power of measurement to make significant progress in our understanding and management of food insecurity. Finally, we discuss the translational implications in behavioral medicine required to make progress on achieving food security for all in the USA.
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Affiliation(s)
- Carmen Byker Shanks
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | | | | | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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24
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The relationship between insurance and health outcomes of diabetes mellitus patients in Maryland: a retrospective archival record study. BMC Health Serv Res 2021; 21:495. [PMID: 34030667 PMCID: PMC8146634 DOI: 10.1186/s12913-021-06534-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Past studies examining the health outcomes of diabetes mellitus (DM) patients found that social determinants of health disparities were associated with variabilities in health outcomes. However, improving access to healthcare, such as health insurance, should mitigate negative health outcomes. The aim of the study was to explore the association between four types of health insurance, namely, Medicare Fee-For-Service (FFS), Medicare Managed Care (MC), Private FFS, and Private MC plans, and the health outcomes of DM patients, controlling for patients’ social determinants of health. Methods This is a retrospective cross-sectional archival record study to explore the relationships between types of health insurance and health outcomes of DM patients who were at least 65 years old, or the elderly. Data was drawn from the 2012 Maryland Clinical Public Use Data and received an exempt status from our Institutional Review Board. Elderly Maryland residents with chronic DM were included in the study, resulting in a sample size of 43,519 individuals. Predictor variables were four types of insurance and health outcome variables were length of hospital stay (LOS), 30-day readmission, and end-stage renal disease (ESRD). Control variables included hospital characteristics, patient characteristics, and social determinants of health. Student’s t-tests determined the statistical differences for the control variables between the types of insurance. Multiple hierarchical regression analysis was applied to test the association between insurance plans and LOS, while logistic regression analyses were applied to test the association between insurance plans with 30-day readmission and ESRD. Statistical significance was set at p < 0.05. Results t-test results indicated minimal statistical differences between the health statuses of patients enrolled in different insurance plans. After factoring out the control variables, regression analyses indicated that Medicare FFS patients had the worst outcome for LOS, 30-day readmission, and ESRD rates. Although patients on Medicare MC plans had lower LOS, 30-day readmission, and ESRD rates compared to those on Medicare FFS, patients enrolled in Private MC plans had the lowest odds of a 30-day readmission and patients enrolled in Private FFS had the lowest odds of an ESRD. Conclusions The data suggests that insurance plans were related to the health outcomes of elderly DM patients after considering their social determinants of health. Specifically, DM patients enrolled in managed care and private insurance plans had better health outcomes compared to those on Medicare FFS plans.
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Alcántara C, Diaz SV, Cosenzo LG, Loucks EB, Penedo FJ, Williams NJ. Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities. Health Psychol Rev 2021; 14:132-144. [PMID: 31957557 DOI: 10.1080/17437199.2020.1718527] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.
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Affiliation(s)
| | | | | | - Eric B Loucks
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Chandanabhumma PP, Narasimhan S. Towards health equity and social justice: an applied framework of decolonization in health promotion. Health Promot Int 2021; 35:831-840. [PMID: 31236575 DOI: 10.1093/heapro/daz053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The pursuit of health equity and social justice lie at the heart of community-empowered health promotion practice. However, there is a need to address the colonial legacy and its contributions to health inequities. The process of decolonization is essential to eliminating the mechanisms that contributed to such inequities. To this end, we propose an Applied Decolonial Framework for Health Promotion that integrates decolonial processes into health promotion practice. We present characteristics of the framework, its values for health promotion transformations and considerations for using the framework in health promotion practice. The framework will help health promotion stakeholders attend to colonizing structures within the field and engage with communities to achieve social justice and health equity.
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Affiliation(s)
| | - Subasri Narasimhan
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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27
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Fein EH, Williams P, Chung PJ, Martinez A, Stewart C, Valeri A, Chung B. Engaging Community and Academic Partners to Explore Adolescent Emotional Well-Being. J Health Care Poor Underserved 2021; 32:506-522. [PMID: 33678710 DOI: 10.1353/hpu.2021.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In an under-resourced area of the South Bay of Los Angeles, partnerships were formed between community advocates with extensive research experience, less experienced academic investigators, and an urban public high school without partnered research experience. This article outlines the process of developing these partnerships through a community-academic research conference addressing a priority area identified by the local community to define and understand the importance and relevance of adolescent emotional well-being. Teen participants from the high school identified support from the community as the most crucial ingredient for achieving adolescent emotional well-being.
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Lock M, Argentieri MA, Shields AE. The contribution of ethnography to epigenomics research: toward a new bio-ethnography for addressing health disparities. Epigenomics 2021; 13:1771-1786. [PMID: 33653089 DOI: 10.2217/epi-2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article describes ethnography as a research method and outlines how it excels in capturing the salient experiences of individuals among diverse communities in their own words. We argue that the integration of ethnographic findings into epigenomics will significantly improve disparities-focused study designs within environmental epigenomics by identifying and contextualizing the most salient dimensions of the 'environment' that are affecting local communities. Reciprocally, epigenetic findings can enhance anthropological understanding of human biological variation and embodiment. We introduce the term bio-ethnography to refer to research designs that integrate both of these methodologies into a single research project. Emphasis is given in this article, through the use of case studies, to socially disadvantaged communities that are often underrepresented in scientific literature. The paper concludes with preliminary recommendations for how ethnographic methods can be integrated into epigenomics research designs in order to elucidate the manner in which disadvantage translates into disparities in the burden of illness.
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Affiliation(s)
- Margaret Lock
- Department of Social Studies of Medicine, McGill University, Montreal H3A 1X1, Canada
| | - M Austin Argentieri
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford OX2 6PE, UK.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02114, USA
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Molloy C, Moore T, O'Connor M, Villanueva K, West S, Goldfeld S. A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood. Acad Pediatr 2021; 21:236-243. [PMID: 33359515 DOI: 10.1016/j.acap.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.
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Affiliation(s)
- Carly Molloy
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Tim Moore
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Meredith O'Connor
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Karen Villanueva
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Centre for Urban Research, RMIT University (K Villanueva), Melbourne, Victoria, Australia
| | - Sue West
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia.
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30
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Sin CMH, Huynh C, Dahmash D, Maidment ID. Factors influencing the implementation of clinical pharmacy services on paediatric patient care in hospital settings. Eur J Hosp Pharm 2021; 29:180-186. [PMID: 33472818 DOI: 10.1136/ejhpharm-2020-002520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This systematic review (SR) was undertaken to identify and summarise any factors which influence the implementation of paediatric clinical pharmacy service (CPS) from service users' perspectives in hospital settings. METHODS Literature search from EMBASE, MEDLINE, Web of Science (Core Collection), Cochrane Library, Scopus and CINAHL databases were performed in order to identify any relevant peer-reviewed quantitative and qualitative studies from inception until October 2019 by following the inclusion criteria. Boolean search operators were used which consisted of service, patient subgroup and attribute domains. Studies were screened independently and included studies were quality assessed using Mixed Methods Appraisal Tool. The study was reported against the 'Enhancing Transparency in Reporting the Synthesis of Qualitative Research' statement. RESULTS 4199 citations were screened by title and abstract and 6 of 32 full publications screened were included. There were two studies that were graded as 'high' in quality, with four graded as 'moderate'. The analysis has led to the identification of seven factors categorised in five predetermined overarching themes. These were: other healthcare professionals' attitudes and acceptance; availability of clinical pharmacist on ward or outpatient settings; using drug-related knowledge to perform clinical activities; resources for service provision and coverage; involvement in a multidisciplinary team; training in the highly specialised areas and development of communication skills. CONCLUSION Evidence for paediatric CPS was sparse in comparison to a similar SR conducted in the adult population. An extensive knowledge gap within this area of practice has therefore been identified. Nevertheless, majority of the factors identified were viewed as facilitators which enabled a successful implementation of CPS in paediatrics. Further research is needed to identify more factors and exploration of these would be necessary in order to provide a strong foundation for strategic planning for paediatric CPS implementation and development.
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Affiliation(s)
- Conor Ming-Ho Sin
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK .,Pharmacy Department, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Dania Dahmash
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Ian D Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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31
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Galvão ALM, Oliveira E, Germani ACCG, Luiz ODC. Determinantes estruturais da saúde, raça, gênero e classe social: uma revisão de escopo. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo do artigo é explorar e sistematizar o conhecimento a respeito dos determinantes estruturais da saúde, por meio da revisão de escopo nas bases de dados: Web of Science, Cinahl, Scopus, Lilacs e PubMed e nas revistas: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health e American Journal of Epidemiology no período de 2005 a 2018, pelos termos de busca: Social Determinants of Health, Health Services, Health Policies, e Inequity. Como resultado, foram identificados 1.164 artigos e selecionados 19. Os determinantes estruturais, também chamados marcadores sociais, foram: raça, gênero, identidade de gênero, migração e classe social. As perspectivas teóricas direta ou indiretamente assumiram a saúde como direito. As políticas de saúde propostas tiveram como foco o impacto positivo na equidade através de funções de planejamento; capacitação de prestadores de serviços; redução de barreiras ao acesso e participação dos grupos excluídos. Assim, a literatura científica reforça que todo indivíduo deve ter a capacidade de alcançar seu estado de saúde ideal sem qualquer distinção de raça; cor da pele; religião; idioma; nacionalidade; recursos socioeconômicos; gênero; orientação sexual; identidade de gênero; incapacidade física, mental ou emocional; ou qualquer outra característica ligada à discriminação ou à exclusão de oportunidades sociais e políticas.
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Affiliation(s)
| | - Elda Oliveira
- Universidade de São Paulo. Faculdade de Medicina, Brasil; Universidade Federal de São Paulo, Brasil
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Examining the Association of Socioeconomic Position with Microcephaly and Delayed Childhood Neurodevelopment among Children with Prenatal Zika Virus Exposure. Viruses 2020; 12:v12111342. [PMID: 33238584 PMCID: PMC7700457 DOI: 10.3390/v12111342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.
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Faruqui N, Bernays S, Martiniuk A, Abimbola S, Arora R, Lowe J, Denburg A, Joshi R. Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage. BMC Public Health 2020; 20:1641. [PMID: 33143668 PMCID: PMC7607709 DOI: 10.1186/s12889-020-09758-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple barriers impeding access to childhood cancer care in the Indian health system. Understanding what the barriers are, how various stakeholders perceive these barriers and what influences their perceptions are essential in improving access to care, thereby contributing towards achieving Universal Health Coverage (UHC). This study aims to explore the challenges for accessing childhood cancer care through health care provider perspectives in India. METHODS This study was conducted in 7 tertiary cancer hospitals (3 public, 3 private and 1 charitable trust hospital) across Delhi and Hyderabad. We recruited 27 healthcare providers involved in childhood cancer care. Semi-structured interviews were audio recorded after obtaining informed consent. A thematic and inductive approach to content analysis was conducted and organised using NVivo 11 software. RESULTS Participants described a constellation of interconnected barriers to accessing care such as insufficient infrastructure and supportive care, patient knowledge and awareness, sociocultural beliefs, and weak referral pathways. However, these barriers were reflected upon differently based on participant perception through three key influences: 1) the type of hospital setting: public hospitals constituted more barriers such as patient navigation issues and inadequate health workforce, whereas charitable trust and private hospitals were better equipped to provide services. 2) the participant's cadre: the nature of the participant's role meant a different degree of exposure to the challenges families faced, where for example, social workers provided more in-depth accounts of barriers from their day-to-day interactions with families, compared to oncologists. 3) individual perceptions within cadres: regardless of the hospital setting or cadre, participants expressed individual varied opinions of barriers such as acceptance of delay and recognition of stakeholder accountabilities, where governance was a major issue. These influences alluded to not only tangible and structural barriers but also intangible barriers which are part of service provision and stakeholder relationships. CONCLUSION Although participants acknowledged that accessing childhood cancer care in India is limited by several barriers, perceptions of these barriers varied. Our findings illustrate that health care provider perceptions are shaped by their experiences, interests and standpoints, which are useful towards informing policy for childhood cancers within UHC.
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Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seye Abimbola
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia
| | - Ramandeep Arora
- Cankids … Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,George Institute for Global Health, New Delhi, India
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Stamatakis KA, Baker EA, McVay A, Keedy H. Development of a measurement tool to assess local public health implementation climate and capacity for equity-oriented practice: Application to obesity prevention in a local public health system. PLoS One 2020; 15:e0237380. [PMID: 32986698 PMCID: PMC7521675 DOI: 10.1371/journal.pone.0237380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities. METHODS We developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability. RESULTS Measures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong internal push (67%) was often accompanied by limited external political (25%) and community support (40%). Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice. Frequently identified (>70%) training needs included improving skills in applying frameworks, assessment methods, and evaluating collaborations around equity. CONCLUSION We developed a theory-based, practitioner-informed questionnaire to assess capacity for equity-oriented practice and identify opportunities for capacity building in local public health departments to engage in effective change toward health equity.
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Affiliation(s)
- Katherine A. Stamatakis
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, United States of America
| | - Elizabeth A. Baker
- Department of Behavioral Science and Health Education, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, United States of America
| | - Allese McVay
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, United States of America
| | - Hannah Keedy
- Center for Innovation in Pediatric Practice (The Abigail Wexner Research Institute), Nationwide Children's Hospital, Columbus, Ohio, United States of America
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Salas-Wright CP, Vaughn MG, Oh S. Commentary on Allen et al. (2020): Cannabis use during pregnancy-the importance of a life-course health disparities framework. Addiction 2020; 115:1717-1718. [PMID: 32428325 PMCID: PMC7574792 DOI: 10.1111/add.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher P. Salas-Wright
- School of Social Work, Boston University, 264 Bay State Rd,
Boston, MA 02215, United States,Department of Public Health Sciences, Division of
Prevention Science & Community Health, University of Miami, Miami, FL, United
States
| | - Michael G. Vaughn
- School of Social Work, College for Public Health and Social
Justice, Saint Louis University, St. Louis, MO, United States,Graduate School of Social Welfare, Yonsei University,
Seoul, Republic of Korea
| | - Sehun Oh
- School of Social Work, Ohio State University, Columbus, OH,
United States
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Martin-Howard S, Farmbry K. Framing a Needed Discourse on Health Disparities and Social Inequities: Drawing Lessons from a Pandemic. PUBLIC ADMINISTRATION REVIEW 2020; 80:839-844. [PMID: 32836464 PMCID: PMC7361609 DOI: 10.1111/puar.13265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 05/14/2023]
Abstract
COVID-19 provides numerous opportunities for policy makers to consider matters of social equity in relation to the field of public health. Specifically, by reflecting on health disparities in relation to the disproportionate impact of COVID-19 on minority and historically underserved populations, we can leverage a needed discourse on health outcomes for many communities. Grounded in the social determinants of health conceptual framework, this essay explores the application of the disproportionate impact of COVID-19 to vulnerable populations and communities of color for a discussion of strategies for minimizing health disparities.
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Sitapati AM, Berkovich B, Arellano AM, Scioscia A, Friedman LS, Millen M, Maysent P, Tai-Seale M, Longhurst CA. A case study of the 1115 waiver using population health informatics to address disparities. JAMIA Open 2020; 3:178-184. [PMID: 32734157 PMCID: PMC7382629 DOI: 10.1093/jamiaopen/ooaa019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/17/2020] [Accepted: 05/06/2020] [Indexed: 11/12/2022] Open
Abstract
As participants in the California Medicaid 1115 waiver, the University of California San Diego Health (UCSDH) used population health informatics tools to address health disparities. This case study describes a modern application of health informatics to improve data capture, describe health disparities through demographic stratification, and drive reliable care through electronic medical record-based registries. We provide a details in our successful approach using (1) standardized collection of race, ethnicity, language, sexual orientation, and gender identity data, (2) stratification of 8 quality measures by demographic profile, and (3) improved quality performance through registries for wellness, social determinants of health, and chronic disease. A strong population health platform paired with executive support, physician leadership, education and training, and workflow redesign can improve the representation of diversity and drive reliable processes for care delivery that improve health equity.
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Affiliation(s)
- Amy M Sitapati
- Division of General Internal Medicine and Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health, San Diego, California, USA
| | - Barbara Berkovich
- Hahn School of Nursing, University of San Diego, San Diego, California, USA
| | - April Moreno Arellano
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Angela Scioscia
- Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego Health, San Diego, California, USA
| | - Lawrence S Friedman
- Department of Medicine and Pediatrics, University of California San Diego Health, San Diego, California, USA
| | - Marlene Millen
- Division of General Internal Medicine and Division of Biomedical Informatics, Department of Medicine, Chief Medical Information Officer of Ambulatory and Affiliates, University of California San Diego, San Diego, California, USA
| | - Patricia Maysent
- University of California San Diego Health, San Diego, California, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, and Information Services, University of California San Diego Health, San Diego, California, USA
| | - Christopher A Longhurst
- Department of Biomedical Informatics, University of California San Diego Health, San Diego, California, USA
- Department of Pediatrics, University of California San Diego Health, San Diego, California, USA
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Cox A, Rhodes R. Increasing Physical Activity in Empty Nest and Retired Populations Online: A Randomized Feasibility Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3544. [PMID: 32438600 PMCID: PMC7277598 DOI: 10.3390/ijerph17103544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Despite the extensive evidence on the benefits of physical activity (PA) in older adults, including reduced risk of disease, mortality, falls, and cognitive and functional decline, most do not attain sufficient PA levels. Theoretical work suggests that behavioral change interventions are most effective during life transitions, and as such, a theory-based, online intervention tailored for recently retired and empty nest individuals could lend support for increasing levels of PA. The aim of this study is to examine the feasibility of the intervention and study procedures for a future controlled trial. This study has a randomized controlled trial design with an embedded qualitative and quantitative process evaluation. Participants are randomized at 1:1 between the intervention and waitlist controls. Potential participants are within six months of their final child leaving the familial home or within six months of retiring (self-defined), currently not meeting the Canadian PA guidelines, have no serious contraindications to exercise, and are residing in Victoria, British Columbia, Canada. Participants are recruited by online and print flyers as well as in-person at community events. The study aims to recruit 40 empty nest and 40 retired participants; half of each group received the intervention during the study period. The internet-delivered intervention is delivered over a 10-week period, comprising 10 modules addressing behavior change techniques associated with PA. Primary outcomes relate to recruitment, attrition, data collection, intervention delivery, and acceptability. Secondary behavioral outcomes are measured at baseline and post-treatment (10 weeks). Intervention-selected participants are invited to an optional qualitative exit interview. The results of this feasibility study will inform the planning of a randomized effectiveness trial, that will examine the behavior change, health-related fitness, and well-being outcomes by exploring how reflexive processes of habit and identity may bridge adoption and maintenance in behavioral adherence.
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Affiliation(s)
- Amy Cox
- Behavioural Medicine Laboratory, Department of Education, University of Victoria, Victoria, BC V8W 3N4, Canada;
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Porter K, Jackson G, Clark R, Waller M, Stanfill AG. Applying Social Determinants of Health to Nursing Education Using a Concept-Based Approach. J Nurs Educ 2020; 59:293-296. [DOI: 10.3928/01484834-20200422-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/17/2020] [Indexed: 11/20/2022]
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40
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Banasiak K, Hux J, Lavergne C, Luk J, Sohal P, Paty B. Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings. Health Place 2020; 61:102267. [PMID: 32329732 DOI: 10.1016/j.healthplace.2019.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation. Our research is situated at the intersection of these contradictory findings. We ask: What aspects of urban living impact the ability of those living with diabetes to reach optimal health? What contextual and structural factors influence how barriers are experienced in the everyday lives of those living with T2D? We conducted semi-structured interviews with 29 individuals living in Toronto and Vancouver. Interviews were recorded, transcribed, and systematically coded for themes and sub-themes. In addition to affirming readily acknowledged barriers to diabetes management, such as accessing healthy, culturally appropriate food and the cost of management, our findings suggest that the unpredictable nature of urban living creates barriers to routinizing self-management practices. As large, cosmopolitan centres with an abundance of activities on offer, cities pulls people away from home, making adherence to self-management recommendations more difficult. Moreover, our findings challenge commonly held assumptions about the mutually exclusive and static nature of barriers and facilitators. Public transit, a readily acknowledged facilitator of healthy living, can be experienced as a barrier to diabetes management. Participants report intentional non-adherence to their medication regimens for fear of hypoglycemia in subway or traffic delays. While the stimulating nature of cities promotes walkability, it produces barriers as well: participants partake in more restaurant eating than they would if they lived in a rural area and were home to cook their own meals. Understanding how barriers are experienced by people living with diabetes will help mitigate some of the unintended consequences associated with various contextual factors. We recommend that healthcare professionals acknowledge and support people with T2D in routinizing self-management and developing contingency plans for the unpredictability and complexity that urban living entails. We suggest further research be carried out to develop contextually-tailored municipal policies and interventions that will support self-management and improve outcomes for individuals living with T2D in urban settings.
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Affiliation(s)
- Molly Byrne
- Health Behaviour Change Research Group, National University of Ireland Galway, Galway, Ireland
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Ramanadhan S, Aronstein D, Martinez-Dominguez V, Xuan Z, Viswanath K. Designing Capacity-Building Supports to Promote Evidence-Based Programs in Community-Based Organizations Working with Underserved Populations. Prog Community Health Partnersh 2020; 14:149-160. [PMID: 33416638 PMCID: PMC11017196 DOI: 10.1353/cpr.2020.0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND It is critical to build capacity to use evidence-based health promotion programs in community-based organizations (CBOs), particularly those working with underserved populations. Packages of ongoing capacity-building supports seem to be critical, but it is not clear how best to design and deploy them. OBJECTIVES PLANET MassCONECT was a participatory research project to increase capacity for the use of evidence-based programs (EBPs) among CBO staff members in three Massachusetts communities experiencing health disparities. We assessed the impact of trainee engagement with capacity-building supports on the use of a systematic approach to program planning. METHODS Trainees were enrolled from 2010 to 2012 and engaged until 2014. The intervention started with a workshop and included ongoing capacity-building supports (a customized web portal and resources, networking events, minigrants, and technical assistance). Logistic regression was used to examine the relationship between trainee engagement with capacity-building supports offered after the workshop and key outcomes at year 1. RESULTS Of the capacity-building supports offered after the workshop, the web portal was the most popular. Higher use of systematic program planning approaches in the first year was predicted by web portal use (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.04-8.67; p = 0.04), and participation in the minigrant process (OR, 5.40; 95% CI, 1.09-28.69; p = 0.04). Separately, high intention to use systematic approaches for program planning was predicted by web portal use (OR, 3.47; 95% CI, 1.27-9.52; p = 0.02). CONCLUSIONS Ongoing capacity-building supports may promote EBP planning in CBOs, but institutional constraints may limit practitioners' ability to engage with such supports.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Ziming Xuan
- . Department of Community Health Sciences, Boston University School of Public Health, Boston, MA USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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43
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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Fagan AA, Bumbarger BK, Barth RP, Bradshaw CP, Cooper BR, Supplee LH, Walker DK. Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1147-1168. [PMID: 31444621 PMCID: PMC6881430 DOI: 10.1007/s11121-019-01048-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.
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Affiliation(s)
- Abigail A Fagan
- Department of Sociology, Criminology & Law, University of Florida, 3362 Turlington Hall, P.O. Box 117330, Gainesville, FL, 32611-7330, USA.
| | | | - Richard P Barth
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
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45
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Rideout K, Oickle D. Glossary of health equity in the context of environmental public health practice. J Epidemiol Community Health 2019; 73:806-809. [PMID: 31171580 DOI: 10.1136/jech-2018-210843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 02/21/2019] [Accepted: 05/23/2019] [Indexed: 11/04/2022]
Abstract
Health equity is increasingly present as an overarching goal in public health policy frameworks across the globe. Public health actions to support health equity are challenging because solutions to the root causes of health inequities often lie outside of the health sector, and a specific role for environmental public health practitioners has not been clearly articulated. The regulatory nature of the environmental public health profession means that their role is particularly ambiguous. Still, environmental public health practitioners are well situated to identify and respond to factors that contribute to health inequities because of their role as front-line professionals who interact with a wide cross-sector of the population. This Glossary, rooted primarily in the Canadian context but drawing on lessons from elsewhere, describes environmental public health regulatory practice in relation to health equity, including approaches that practitioners can use to contribute to addressing the social determinants of health.
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Affiliation(s)
- Karen Rideout
- Karen Rideout Consulting, Vancouver, British Columbia, Canada.,National Collaborating Centre for Environmental Health (NCCEH), Vancouver, British Columbia, Canada.,Environmental Health Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dianne Oickle
- National Collaborating Centre for Determinants of Health (NCCDH), Antigonish, Nova Scotia, Canada
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46
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Goldfeld S, O'Connor M, O'Connor E, Chong S, Badland H, Woolfenden S, Redmond G, Williams K, Azpitarte F, Cloney D, Mensah F. More than a snapshot in time: pathways of disadvantage over childhood. Int J Epidemiol 2019; 47:1307-1316. [PMID: 29878228 DOI: 10.1093/ije/dyy086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child's development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development. Methods Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10-11 years. Results We found four distinct trajectories of children's exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the 'most disadvantaged' trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity. Conclusions Children's overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Meredith O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shiau Chong
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Sue Woolfenden
- Department of Community Child Health, Sydney Children's Hospital Network, Sydney, NSW, Australia.,School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Gerry Redmond
- School of Social and Policy Studies, Flinders University, Adelaide, SA, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, VIC, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Francisco Azpitarte
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia.,Brotherhood of St Laurence, Melbourne, VIC, Australia
| | - Dan Cloney
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Australian Council for Educational Research, Melbourne, VIC, Australia
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
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47
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Babchuk WA. Fundamentals of qualitative analysis in family medicine. Fam Med Community Health 2019; 7:e000040. [PMID: 32148701 PMCID: PMC6910734 DOI: 10.1136/fmch-2018-000040] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/01/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
The primary purpose of this article is to provide family physician researchers interested in conducting a qualitative research study a concise guide to the analysis. Drawing from approaches outlined in popular research methodology textbooks and employing an exemplar from a minority health disparities research study, this article outlines specific steps useful for researchers and practitioners in the field of family medicine. This process of qualitative data analysis is situated within the larger framework of qualitative research to better position those new to qualitative designs to more effectively conduct their studies. A 10-step process useful for guiding qualitative data analysis is provided. The 10 steps include (1) assembling data for analysis, (2) refamiliarising oneself with the data, (3) open or initial coding procedures, (4) generating categories and assigning codes to them, (5) generating themes from categories, (6) strategies of validation, (7) interpreting and reporting findings from the participants, (8) interpreting and reporting findings from the literature, (9) visual representations of data and findings, and (10) strengths, limitations, delimitations and suggestions for future research. This work provides clear and accessible guidelines for conducting qualitative data analysis for emerging researchers that is applicable across a wide array of topics, disciplines and settings.
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Affiliation(s)
- Wayne A Babchuk
- Anthropology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.,Educational Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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48
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Griffiths LA, Griffiths MA. Evaluation of a School–Community Linked Physical Activity Intervention Targeting 7- to 12-Year-Olds: A Sociocultural Perspective. AMERICAN JOURNAL OF HEALTH EDUCATION 2019. [DOI: 10.1080/19325037.2019.1571961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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49
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Careyva BA, Hamadani R, Friel T, Coyne CA. A Social Needs Assessment Tool for an Urban Latino Population. J Community Health 2019; 43:137-145. [PMID: 28707180 DOI: 10.1007/s10900-017-0396-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Unmet social needs contribute significantly to health outcomes, yet they are not routinely assessed in health care settings. Identifying modifiable social needs and feasible tools to assess them may improve health and decrease costs. We conducted 18 focus groups with 115 participants, stratified by age (18-35, 36-64, and 65+), ethnicity (Hispanic, non-Hispanic), and language (English, Spanish) to explore priority social needs, images to depict social need categories, and acceptability of a computer-based program to identify these needs. The top three social need domains were access to care, health promoting behaviors, and family responsibilities. Participants voiced diverse social needs with notable differences across demographic groups. Both the 36-64 year old age groups and Spanish-speaking Hispanic patients were disproportionately impacted by unmet social needs. Perceptions regarding use of an interactive computer program to assess social needs varied by age. Most participants noted that a tablet computer was an acceptable venue to share social needs, though a tutorial may be needed for patients in the 65 and older group. Lastly, participants' ranking of icons were compiled to identify recognizable images of social need categories for those with literacy challenges. Unmet social needs were identified across all groups. This composite of information (priority social needs and images to represent them) will allow for creation of a tailored social need screening tool within an urban Hispanic population.
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Affiliation(s)
- Beth A Careyva
- University of South Florida Morsani School of Medicine, Tampa, FL, USA. .,Department of Family Medicine, Lehigh Valley Practice and Community Research Network, Lehigh Valley Health Network, One City Center, P.O. Box 1806, Allentown, PA, 18101, USA.
| | - Roya Hamadani
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - Timothy Friel
- University of South Florida Morsani School of Medicine, Tampa, FL, USA.,Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Cathy A Coyne
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
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50
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D’Agostino EM. Kenya Brown’s Summer of Opportunity: Where Schools, STEM Learning, and Health Inequalities Meet. Am J Public Health 2019. [DOI: 10.2105/ajph.2018.304821] [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)
- Emily M. D’Agostino
- Emily M. D’Agostino is with the Miami-Dade Department of Parks, Recreation and Open Spaces, Division of Health and Fitness, Miami, FL
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