Boundary networks and Rochester's "smart" lead law: the use of multidisciplinary information in a collaborative policy process

Anti-racism Training Using the Biopsychosocial Model: Frederick Douglas' Earthquake, Whirlwind, Storm and Fire

Rochester, New York is home to George Engel and the Biopsychosocial (BPS) model. Rochester was also home to Fredrick Douglas and a stop on the Underground Railroad. More recently, Rochester, New York is also where Daniel Prude died at the hands of the police. In this article, we discuss how our department of family medicine has incorporated race and racism into the BPS model and how we have used it to help primary care trainees become more effective in their work with Black Indigenous and people of color (BIPOC) patients.

Bridging Silos: A Research Agenda for Local Environmental Health Initiatives

The environment and public health are managed by separate institutions that often operate in isolation from each other. This system is often referred to as managing in "silos." The resulting lack of coordination, inadequate consideration of cumulative effects, and diffuse targets for change contribute to the persistence of many environmental justice problems. There are many barriers to bridging these silos, particularly at state and federal levels. Local collaborations, however, may have greater potential for changing these systems. There has been limited assessment of successful local environmental health initiatives. This paper explores three case studies of local collaboration: lead poisoning prevention in Rochester, New York; promoting a healthy and equitable built environment in Duluth, Minnesota; and increasing consideration of community health in decisions around the ports of Los Angeles and Long Beach, California. It develops a research agenda to inform future collaborations to improve environmental health equity through local systems change.

Professionals' Perceptions: "Why is Lead Poisoning Prevalent in Lancaster County?"

Background: The prevalence of lead poisoning in children under the age of six years living in Lancaster County, Pennsylvania continues to be greater than the state-wide prevalence for this age group. This study aims to determine the factors that contribute to the high lead poisoning rates. Methods: For this qualitative study, the researchers recruited a convenience sample of professionals providing healthcare and social welfare services in the county. Researchers conducted in-depth interviews with participants. The research team audio recorded, transcribed verbatim, and analyzed each interview using NVivo 12 software. Results: The 16 interviewed participants identified factors that contribute to high lead poisoning rates including knowledge levels, housing status, and competing interests. Specifically, low knowledge levels, renting as opposed to home ownership, and having competing interests seemed to minimize the attention directed towards preventing lead poisoning. The experts offered recommendations to address the high lead poisoning rates including increasing lead knowledge levels of both community members and landlords, through creating and distributing health promotion material, enacting policies to empower renters, and systematically collaborating to streamline lead poisoning related information and services. Conclusions: Findings provide insights to factors that Lancaster can address to achieve a decrease in lead poisoning rates. This study provides information that can be utilized by public health professionals to develop appropriate interventions.

Collaborating for Systems Change: A Social Science Framework for Academic Roles in Community Partnerships

Environmental health researchers, government agencies, and community groups have endorsed long-term community-academic partnerships as an effective strategy to support science-based improvements in environmental health. Social sciences concepts, approaches, and methods are fundamental to these translational partnerships. However, appropriate roles for academic partners vary throughout the process of changing systems (policies, practices, programs, etc.). This can complicate planning, evaluating, and sustaining such partnerships. We set forth a conceptual framework for academic partners' roles at different stages of systems change. We apply this framework to three longstanding academic-community partnerships involving National Institute of Environmental Health Sciences Community Outreach and Engagement Cores. We conclude by discussing how the framework can help academic partners tap appropriate expertise, redefine their roles, and evaluate their contributions to community efforts to improve environmental health.

Evaluating community engagement in an academic medical center

From the perspective of academic medical centers (AMCs), community engagement is a collaborative process of working toward mutually defined goals to improve the community's health, and involves partnerships between AMCs, individuals, and entities representing the surrounding community. AMCs increasingly recognize the importance of community engagement, and recent programs such as Prevention Research Centers and Clinical and Translational Science Awards have highlighted community engagement activities. However, there is no standard or accepted metric for evaluating AMCs' performance and impact of community engagement activities.In this article, the authors present a framework for evaluating AMCs' community engagement activities. The framework includes broad goals and specific activities within each goal, wherein goals and activities are evaluated using a health services research framework consisting of structure, process, and outcome criteria. To illustrate how to use this community engagement evaluation framework, the authors present specific community engagement goals and activities of the University of Rochester Medical Center to (1) improve the health of the community served by the AMC; (2) increase the AMC's capacity for community engagement; and (3) increase generalizable knowledge and practices in community engagement and public health.Using a structure-process-outcomes framework, a multidisciplinary team should regularly evaluate an AMC's community engagement program with the purpose of measurably improving the performance of the AMC and the health of its surrounding community.

Declines in elevated blood lead levels among children, 1997-2011

BACKGROUND

Early childhood lead exposure is associated with numerous adverse health effects. Eliminating blood lead poisoning is a national health objective for 2020.

OBJECTIVE

To assess temporal trends in childhood elevated blood lead level (EBLL) rates.

METHODS

Laboratory surveillance data were collected from 1997 to 2011 and analyzed in 2013 using linear regression to assess trends in confirmed EBLL rates among children aged <6 years in the U.S., New York State ([NYS], excluding New York City), and Monroe County NY. Monroe County was also examined as a case study of local public health efforts to reduce childhood lead exposures. Blood lead screening and home lead hazard inspection data were collected from 1990 to 2012 and analyzed in 2013.

RESULTS

The prevalence of EBLL≥10 μg/dL per 100 tested children decreased from 13.4 to 1.1 in Monroe County, 6.3 to 1.0 in NYS, and 7.6 to 0.6 in the U.S. between 1997 and 2011. The absolute yearly rate of decline in Monroe County (slope=-0.0083, p<0.001) occurred 2.4-fold faster than that in NYS (slope=-0.0034, p<0.001) and 1.8-fold faster than that in the U.S. (slope=-0.0046, p<0.001). The childhood blood lead testing rate was consistently higher in Monroe County than in NYS and the U.S.; however, testing increased for all three areas (all slopes>0, p<0.05), with greater improvements observed for U.S. children overall (slope=0.0075, p<0.001).

CONCLUSIONS

In addition to national and statewide policies, local efforts may be important drivers of population-based declines in childhood EBLL rates.

Advancing environmental and policy change through active living collaboratives: compositional and stakeholder engagement correlates of group effectiveness

OBJECTIVE

This study aims to evaluate compositional factors, including collaborative age and size, and community, policy, and political engagement activities that may influence collaboratives' effectiveness in advancing environmental improvements and policies for active living.

DESIGN/PARTICIPANTS/SETTING

Structured interviews were conducted with collaboratives' coordinators. Survey items included organizational composition, community, policy, and political engagement activities and reported environmental improvements and policy change. Descriptive statistics and multivariate models were used to investigate these relationships.

MAIN OUTCOME MEASURE(S)

Environmental improvement and policy change scores reflecting level of collaborative effectiveness across 8 strategy areas (eg, parks and recreation, transit, streetscaping, and land redevelopment).

RESULTS

Fifty-nine collaborative groups participated in the interview, representing 22 states. Groups have made progress in identifying areas for environmental improvements and in many instances have received funding to support these changes. Results from multivariate models indicate that engagement in media communication and advocacy was statistically correlated with higher levels of environmental improvement, after adjusting for age of group and area poverty levels (P < .01). Groups that frequently solicited endorsements from community leaders and offered testimony in policy or legal hearings reported significantly more policy change, after adjusting for age of group and area poverty levels (P < .01 for both).

CONCLUSIONS

Active living collaboratives are translating the evidence on environmental and policy approaches to promote active living from research to practice. Investing in community and policy engagement activities may represent important levers for achieving structural and policy changes to the built environment.

Active living collaboratives in the United States: understanding characteristics, activities, and achievement of environmental and policy change

Introduction

Changing the built environment to promote active lifestyles requires collaboration among diverse sectors. Multisectoral collaborative groups in the United States promote active lifestyles through environmental and policy changes. The objective of this study was to examine the characteristics of these collaborative groups and the extent to which they have achieved change.

Methods

We identified, recruited, and interviewed the coordinators of active living collaborative groups in the United States. We used descriptive statistics to characterize groups by composition, stakeholder engagement, and the extent of environmental and policy change in 8 strategic areas.

Results

Fifty-nine groups from 22 states participated in the study. Most groups had a diverse set of partners and used a range of activities to advance their agendas. Most groups achieved some form of environmental or policy change. On average, groups reported working on 5 strategy areas; parks and recreation (86%) and Safe Routes to School (85%) were named most frequently. More than half of groups reported their environmental initiatives as either in progress or completed. Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. Complete Streets policy and zoning ordinances were the most frequently cited policy types. Engaging in media activities and the policy-making process in addition to engaging stakeholders appear to influence success in achieving change.

Conclusion

Although many groups successfully worked on parks and recreation improvements, opportunities remain in other areas, including transit and infill and redevelopment. Additional time and resources may be critical to realizing these types of changes.