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Weeks WB, Lavista Ferres JM, Weinstein JN. Health and Wealth in America. Int J Public Health 2024; 69:1607224. [PMID: 38559467 PMCID: PMC10979796 DOI: 10.3389/ijph.2024.1607224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, WA, United States
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Smith CS. Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health. Front Oral Health 2023; 4:1031574. [PMID: 37521174 PMCID: PMC10382250 DOI: 10.3389/froh.2023.1031574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives Clinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health. Methods This paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health. Results The needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations. Conclusion Socioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.
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Affiliation(s)
- Carlos S. Smith
- Department of Dental Public Health and Policy, Virginia Commonwealth University School of Dentistry, Richmond, VA, United States
- Affiliate Faculty, Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA, United States
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Booker SQ, Morais CA, Merriwether EN. Editorial: Advancing critical discovery of novel approaches to understanding and eliminating pain inequities. Front Pain Res (Lausanne) 2023; 4:1209573. [PMID: 37251593 PMCID: PMC10212755 DOI: 10.3389/fpain.2023.1209573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Staja Q. Booker
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Calia A. Morais
- Department of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
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Layne TM, Agarwal P, Rapkin BD, Jandorf LH, Bickell NA. Cancer beliefs and screening behaviors: The impact of neighborhood and other social determinants of health. Front Oncol 2023; 13:1072259. [PMID: 36776291 PMCID: PMC9911808 DOI: 10.3389/fonc.2023.1072259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Background Beliefs about cancer influence breast and colorectal cancer (CRC) screening behavior. Screening rates for these cancers differ in the contiguous neighborhoods of East Harlem (EH), Central Harlem (CH), and the Upper East Side (UES), which have distinct socio-demographic compositions. We assessed the belief-screening behavior relationship in these neighborhoods. Methods The 2019 Community Cancer Needs Survey included adults eligible for breast and/or colorectal cancer screening. Raking was used to generate neighborhood-specific distribution estimates. Categorical variables were compared using Chi-square tests. Stepwise logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between cancer beliefs and screening. Results Our weighted sample included 147,726 respondents. Screening was 75% in CH, 81% in EH, and 90% in the UES for breast cancer, and 71%, 76%, and 92% for CRC, respectively. The fatalistic belief "There's not much you can do to lower your chances of getting cancer" differed by neighborhood with screening more likely in CH respondents (breast OR =1.45 and colorectal OR =1.11), but less likely in EH (OR= 0.77 and 0.37, respectively). UES ORs were not generated due to too few unscreened respondents. Conclusions Cancer beliefs were inconsistently associated with breast and CRC screening across three NYC neighborhoods. This suggests that a given belief may either motivate or deter screening, depending upon context or interpretation. Once access is addressed, efforts seeking to enhance screening rates should consider implications of communities' varying beliefs.
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Affiliation(s)
- Tracy M. Layne
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology, and Reproductive Science, the Blavatnik Family Women’s Health Research Institute and the Center for Scientific Diversity at the Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Tracy M. Layne,
| | - Parul Agarwal
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bruce D. Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, United States,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Lina H. Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nina A. Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Arbour M, Fico P, Floyd B, Morton S, Hampton P, Murphy Sims J, Atwood S, Sege R. Sustaining and scaling a clinic-based approach to address health-related social needs. Front Health Serv 2023; 3:1040992. [PMID: 36926501 PMCID: PMC10012656 DOI: 10.3389/frhs.2023.1040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023]
Abstract
Objective Scaling evidence-based interventions (EBIs) from pilot phase remains a pressing challenge in efforts to address health-related social needs (HRSN) and improve population health. This study describes an innovative approach to sustaining and further spreading DULCE (Developmental Understanding and Legal Collaboration for Everyone), a universal EBI that supports pediatric clinics to implement the American Academy of Pediatrics' Bright Futures™ guidelines for infants' well-child visits (WCVs) and introduces a new quality measure of families' HRSN resource use. Methods Between August 2018 and December 2019, seven teams in four communities in three states implemented DULCE: four teams that had been implementing DULCE since 2016 and three new teams. Teams received monthly data reports and individualized continuous quality improvement (CQI) coaching for six months, followed by lighter-touch support via quarterly group calls (peer-to-peer learning and coaching). Run charts were used to study outcome (percent of infants that received all WCVs on time) and process measures (percent of families screened for HRSN and connected to resources). Results Integrating three new sites was associated with an initial regression of outcome: 41% of infants received all WCVs on time, followed by improvement to 48%. Process performance was sustained or improved: among 989 participating families, 84% (831) received 1-month WCVs on time; 96% (946) were screened for seven HRSN, 54% (508) had HRSN, and 87% (444) used HRSN resources. Conclusion An innovative, lighter-touch CQI approach to a second phase of scale-up resulted in sustainment or improvements in most processes and outcomes. Outcomes-oriented CQI measures (family receipt of resources) are an important addition to more traditional process-oriented indicators.
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Affiliation(s)
- MaryCatherine Arbour
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Placidina Fico
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Baraka Floyd
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | | | - Patsy Hampton
- Center for the Study of Social Policy, Washington, D.C., United States
| | - Jennifer Murphy Sims
- Early Intervention Services, UCSF Benioff Children's Hospital, Oakland, CA, United States
| | - Sidney Atwood
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
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Martínez-Alfonso J, Mesas AE, Jimenez-Olivas N, Cabrera-Majada A, Martínez-Vizcaíno V, Díaz-Olalla JM. Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study. Int J Public Health 2022; 67:1605481. [PMID: 36589473 PMCID: PMC9800286 DOI: 10.3389/ijph.2022.1605481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Objective: To analyze whether social deprivation and economic migrant (EM) status influence the risk of being hospitalized with COVID-19. Methods: This was a retrospective follow-up study including all patients older than 18 years attending the Daroca Health Center in Madrid, Spain, diagnosed with COVID-19 during September 2020. Data on EM status and other sociodemographic, lifestyle and comorbidities that could affect the clinical course of the infection were obtained from electronic medical records. Results: Of the 796 patients positive for COVID-19, 44 (5.53%) were hospitalized. No significant differences were observed between those who were hospitalized and those who were not in the mean of social deprivation index or socioeconomic status, but EM status was associated with the risk of being hospitalized (p = 0.028). Logistic regression models showed that years of age (OR = 1.07; 95% CI: 1.04-1.10), EM status (OR = 5.72; 95% CI: 2.56-12.63) and hypertension (OR = 2.22; 95% CI: 1.01-4.85) were the only predictors of hospitalization. Conclusion: Our data support that EM status, rather than economic deprivation, is the socioeconomic factor associated with the probability of hospital admission for COVID-19 in Madrid, Spain.
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Affiliation(s)
| | - Arthur Eumann Mesas
- Universidad de Castilla-La Mancha, Cuenca, Spain,Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil,*Correspondence: Arthur Eumann Mesas,
| | | | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Cuenca, Spain,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Hoven H, Dragano N, Angerer P, Apfelbacher C, Backhaus I, Hoffmann B, Icks A, Wilm S, Fangerau H, Söhner F. Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning. Int J Public Health 2022; 67:1604542. [PMID: 35450128 PMCID: PMC9017774 DOI: 10.3389/ijph.2022.1604542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Since the WHO's "Influenza Pandemic Preparedness Plan" in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning-factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.
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Affiliation(s)
- Hanno Hoven
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Angerer
- Institute of Occupational and Social Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Insa Backhaus
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Hoffmann
- Institute of Occupational and Social Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Heiner Fangerau
- Department of the History, Philosophy, and Ethics of Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felicitas Söhner
- Department of the History, Philosophy, and Ethics of Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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McCabe CF, Wood GC, Franceschelli-Hosterman J, Cochran WJ, Savage JS, Bailey-Davis L. Patient-reported outcome measures can advance population health, but is access to instruments and use equitable? Front Pediatr 2022; 10:892947. [PMID: 36330368 PMCID: PMC9622997 DOI: 10.3389/fped.2022.892947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire. Participants included parent-child dyads who presented at 14 pediatric clinics for regularly scheduled well-child visits (WCV) prior to age 26 months. EHL items include feeding practices, diet, play time, screen exposure, and sleep. Completion was categorized at patient- (i.e., parent-child dyad) and clinic-levels. Parents completed the 15-item EHL in the patient portal before arrival or in the clinic; ninety-three percent of EHL questionnaires were completed in the clinic vs. 7% in the patient portal. High-completers completed EHL for half of WCVs; low-completers completed at least once; and non-completers never completed. Clinics were classified by EHL adoption level (% high completion): High-adoption: >50%; Moderate-adoption: 10%-50%; and Low-adoption: <10%. Individual-level factors had negligible impact on EHL completion within moderate/low EHL adoption sites; high-adoption sites were used to evaluate infant and maternal factors in association with EHL completion using hierarchical logistic regression. Noncompletion of EHL was significantly associated (p < 0.05) with infant use of public insurance (OR = 1.92 [1.42, 2.59]), >1 clinic site for WCV (OR = 1.83 [1.34, 2.50]), non-White birth mother (OR = 1.78 [1.28, 2.47]), and body weight <2,500 grams or gestational age <34 weeks (OR = 1.74 [1.05, 2.90]). The number of WCVs, a proxy for clinic size, was evaluated but was not associated with completion. Findings indicate potential disparities between populations exposed to, completing, and benefitting from these tools.
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Affiliation(s)
- Carolyn F McCabe
- Geisinger Obesity Institute, Danville, PA, United States.,Population Health Sciences, Geisinger, Danville, PA, United States
| | - G Craig Wood
- Geisinger Obesity Institute, Danville, PA, United States
| | - Jennifer Franceschelli-Hosterman
- Geisinger Obesity Institute, Danville, PA, United States.,Nutrition and Weight Management, Geisinger Medical Center, Danville, PA, United States
| | | | - Jennifer S Savage
- Nutritional Sciences, Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Lisa Bailey-Davis
- Geisinger Obesity Institute, Danville, PA, United States.,Population Health Sciences, Geisinger, Danville, PA, United States.,Nutritional Sciences, Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
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Dabravolskaj J, Khan MKA, Veugelers PJ, Maximova K. Mental Health and Wellbeing of 9-12-year-old Children in Northern Canada Before the COVID-19 Pandemic and After the First Lockdown. Int J Public Health 2021; 66:1604219. [PMID: 34539323 PMCID: PMC8441596 DOI: 10.3389/ijph.2021.1604219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Children’s mental health and wellbeing declined during the first COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged settings. We compared mental health and wellbeing of school-aged children observed pre-pandemic in 2018 and after the first lockdown was lifted and schools reopened in Fall 2020. Methods: In 2018, we surveyed 476 grade 4–6 students (9–12 years old) from 11 schools in socioeconomically disadvantaged communities in Northern Canada that participate in a school-based health promotion program targeting healthy lifestyle behaviours and mental wellbeing. In November-December 2020, we surveyed 467 grade 4–6 students in the same schools. The 12 questions in the mental health and wellbeing domain were grouped based on correlation and examined using multivariable logistic regression. Results: There were no notable changes pre-pandemic vs. post-lockdown in responses to each of the 12 questions or any of the sub-groupings. Conclusion: Supporting schools to implement health promotion programs may help mitigate the impact of the pandemic on children’s mental health and wellbeing. The findings align with recent calls for schools to remain open as long as possible during the pandemic response.
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Affiliation(s)
| | - Mohammed K A Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Kousoulis AA, Goldie I. A Visualization of a Socio-Ecological Model for Urban Public Mental Health Approaches. Front Public Health 2021; 9:654011. [PMID: 34055718 PMCID: PMC8158814 DOI: 10.3389/fpubh.2021.654011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
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Raude J, Lecrique JM, Lasbeur L, Leon C, Guignard R, du Roscoät E, Arwidson P. Determinants of Preventive Behaviors in Response to the COVID-19 Pandemic in France: Comparing the Sociocultural, Psychosocial, and Social Cognitive Explanations. Front Psychol 2020; 11:584500. [PMID: 33329241 PMCID: PMC7734102 DOI: 10.3389/fpsyg.2020.584500] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022] Open
Abstract
In absence of effective pharmaceutical treatments, the individual's compliance with a series of behavioral recommendations provided by the public health authorities play a critical role in the control and prevention of SARS-CoV2 infection. However, we still do not know much about the rate and determinants of adoption of the recommended health behaviors. This paper examines the compliance with the main behavioral recommendations, and compares sociocultural, psychosocial, and social cognitive explanations for its variation in the French population. Based on the current literature, these 3 categories of factors were identified as potential determinants of individual differences in the health preventive behaviors. The data used for these analyses are drawn from 2 cross-sectional studies (N = 2,000 in survey 1 and 2,003 in survey 2) conducted after the lockdown and before the peak of the COVID-19 epidemic in France. The participants were drawn from a larger internet consumer panel where recruitment was stratified to generate a socio-demographically representative sample of the French adult population. Overall, the results show a very high rate of compliance with the behavioral recommendations among the participants. A hierarchical regression analysis was then performed to assess the potential explanatory power of these approaches in complying with these recommendations by successively entering sociocultural factors, psychosocial factors, social cognitive factors in the model. Only the inclusion of the cognitive variables substantially increased the explained variance of the self-reported adoption of preventive behaviors (R 2 change = 23% in survey 1 and 2), providing better support for the social cognitive than the sociocultural and psychosocial explanations.
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Affiliation(s)
- Jocelyn Raude
- EHESP School of Public Health, Rennes, France
- Unite des Virus Emergents (UVE: Aix-Marseille Univ – IRD 190 – Inserm 1207 – IHU Mediterranee Infection), Marseille, France
| | | | | | | | | | - Enguerrand du Roscoät
- Santé publique France, Saint Maurice, France
- Laboratoire Parisien de Psychologie Sociale (LAPPS), EA 4386, Université Paris Ouest Nanterre-La Défense, Nanterre, France
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Ruggles L. Frameworks for Community Impact - Community Case Study. Front Public Health 2020; 8:197. [PMID: 32582607 PMCID: PMC7280438 DOI: 10.3389/fpubh.2020.00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Abstract
The Affordable Care Act of 2008 placed specific community health needs assessment and community benefit reporting requirements on US not-for-profit hospitals. The requirements are straightforward, but come with no expectation for synergy between the needs assessment and the community benefit spending, no direction on how to design systems to improve community health, and with surprisingly little accountability for improving health outcomes. With the help of diverse community partners, one Critical Access hospital in rural Vermont has successfully linked the needs assessment with community benefit dollars to address upstream contributors of health. In 2014, Northeastern Vermont Regional Hospital lead the creation of NEK Prosper: Caledonia and Southern Essex Accountable Health Community with a mission to tackle poverty as the ultimate root cause of poor health in the region. This article outlines how a hospital community health needs assessment ignited a change in how community partners worked together, aligned organizational strategies, and overcame industry jargon barriers to create regional system change to improve health. And how that same hospital has used community benefit dollars to accelerate action at the community level.
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Affiliation(s)
- Laural Ruggles
- Northeastern Vermont Regional Hospital, St. Johnbury, VT, United States
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