Journal of Public Health Management and Practice最新文献

Objective: The purpose of this study was to examine the implementation and effectiveness of a novel pediatric food navigation program through a structured, comprehensive evaluation using the RE-AIM framework.

Design and participants: Data were collected from October 2021 through August 2022 for 166 pediatric patients and their families who were screened as food insecure or high-risk for food insecurity and were referred to this pilot food resource navigation program (FRNP). A total of 88 patients' guardians consented to participate in this FRNP, receiving initial service connection. Participants were contacted via telephone by trained navigators within this health system to assess food security status across three time points (baseline, follow-up 1 [1- <3 months], and follow-up 2 [3-6 months]) and facilitate connection to appropriate community-based resources related to food assistance.

Results: In this sample, we had an overrepresentation of Hispanic patients and an underrepresentation of Non-Hispanic Black and White patients relative to the available clinic population. Patients participating in the navigation program showed incremental shifts toward food security from baseline to two follow-up points. Integration within primary care was supported by physician champions across participating clinics and alignment with systemwide, updated universal screening guidelines to support projected increases in families requiring connecting to assistance programs. Through this evaluation, a comprehensive list of community-based food resource programs related to food assistance was integrated into electronic documentation for navigators to alleviate navigator burden and sustain the effect of this FRNP's implementation.

Conclusions: These findings may be used to inform expansion of current programming efforts within this FRNP and to clarify process evaluations of broader health system-based programming. Further research, building on the findings of this pilot study, is needed to examine the longitudinal, causal effect of FRNPs in pediatric food security and long-term health outcomes for replication across health systems nationwide.

Context: In fiscal year 2019, the Department of Health and Human Services (DHHS) received an appropriation from Congress specifically to update guidelines for investigating community cancer concerns. This resulted in the DHHS directing the Centers for Disease Control and Prevention (CDC) to fulfill this responsibility.

Program: The CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) provide guidance to state, tribal, local, and territorial (STLT) health departments and play important roles in supporting STLT programs in addressing community cancer concerns.

Implementation: The updated guidelines offer enhancements addressing limitations and challenges regarding the process for investigating cancer clusters as expressed by STLT programs responsible for responding to inquiries and by communities impacted by unusual patterns of cancer. Additionally, the updated guidelines offer new tools and approaches associated with scientific advancements. Issues associated with improving communications and community engagement were a priority. Details in the updated guidelines provide suggestions for building and maintaining trust; provide resources via additional tools, templates, and methodology to facilitate sharing of information; provide suggestions for identifying agency and community points of contacts; and provide suggestions for establishing a community advisory committee.

Conclusion: Enhancements to the previous guidelines were included to address advancements in statistical approaches and methods for understanding exposure pathways and also to respond to limitations described in the previous guidelines. Furthermore, these enhancements ensure communities have a voice in the process and offer methods to enhance transparency throughout the investigative process. Ultimately, the 2022 Guidelines are designed to ensure that community engagement, community input, and communication remains paramount to the process of assessing unusual patterns of cancer and environmental concerns.

Context: In the early stages of the COVID-19 pandemic in New York City, individuals who tested positive, exposed contacts, and their families faced significant challenges in accessing essential resources for successful quarantine and isolation. These resources included alternative housing, food access, grocery delivery, missed wage assistance, transportation for household members, medical care, and more.

Program: The City University of New York (CUNY) Recovery Corps emerged as an innovative virtual resource navigation service to connect New Yorkers to essential resources and later to vaccinations, treatment, and services for Long COVID. The program prioritized reaching people living in underserved and under-resourced neighborhoods. Over 3 years, it made a substantial impact, reaching 374 728 New Yorkers and connecting 135 147 to crucial resources.

Implementation: Implementing a successful virtual navigation center amidst a global pandemic posed unique challenges. It required well-established systems to provide services, manage staff, build community, and both assure and improve service quality.

Evaluation: Continuous quality assurance and process improvement efforts resulted in a nearly 10-point increase in successful client-resource connections program-wide, with individual navigators showing improvements of up to 20%. Staff-led initiatives, such as population-specific resource guides and incentive awards, boosted morale and cohesion. Providing continuous professional development opportunities and requested training including trauma-informed care, self-care, and strategies for managing grief contributed to staff retention and improved client interactions.

Discussion: The CUNY Recovery Corps provides a blueprint for setting up navigation services for emergency response and supporting health and social services. The current paper delves into the intensive quality improvement efforts, program management infrastructure, and staff support that made this program a success. By applying these lessons on establishing and maintaining a virtual call center prioritizing the client's well-being and staff strengths, policymakers and social service leaders can effectively address various health and social service needs proactively rather than rebuilding after each disaster.

Introduction: Employees are often placed within an organization based on their respective roles or duties, which can lead to vertical and horizontal organizational silos. Organizational silos may restrict information, resources, and stymie progress and innovation. This analysis presents a framework to mitigate silos and overcome communication barriers within an organization by increasing collaboration.

Methods: The project team examined results from the Centers for Disease Control and Prevention (CDC), the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) 2020 Employee Viewpoint Survey Results and conducted 19 key informant discussions with NCCDPHP employees. Participants were asked to provide feedback on (1) understanding silos in the workplace and (2) best practices for reducing silos and fostering collaboration. A thematic analysis was conducted to understand organizational silos, the motivation to reduce silos, and identify best practices and strategies.

Results: Respondents felt that siloing exists at the division and branch levels; however, 95% of respondents were motivated to reduce silos. Fifty-eight percent of respondents identified that institutional factors such as the organizational structure (n = 8) and red tape/bureaucracy (n = 3) contribute to siloing. Additional behaviors and actions that perpetuate silos were identified, and efforts to reduce silos were categorized to propose a model: Framework to Foster Collaboration for improving organizational collaborative efforts.

Discussion and conclusion: Key themes included inclusion, shared goals and vision, bi-directional communication, and relationship building and developing trust as critical elements for improving collaboration and creating synergy across teams in efforts to reduce silos in the workplace.

Context: Population health rankings can be a catalyst for the improvement of health by drawing attention to areas in need of relative improvement and summarizing complex information in a manner understood by almost everyone. However, ranks also have unintended consequences, such as being interpreted as "hard truths," where variations may not be significant. There is a need to improve communication about uncertainty in ranks, with accurate interpretation. The most common solutions discussed in the literature have included modeling approaches to minimize statistical noise or borrow strength from covariates. However, the use of complex models can limit communication and implementation, especially for broad audiences.

Objectives: Explore data-informed grouping (cluster analysis) as an easier-to-understand, empirical technique to account for rank imprecision that can be effectively communicated both numerically and visually.

Design: Cluster analysis, specifically k-means clustering with Wasserstein (earth mover's) distance, was explored as an approach to identify natural and meaningful groupings and gaps in the data distribution for the County Health Rankings' (CHR) health outcomes ranks.

Setting: County-level health outcomes from the 2022 CHR.

Participants: 3082 counties that were ranked in the 2022 CHR.

Main outcome measure: Data-informed health groups.

Results: Cluster analysis identified 30 health groupings among counties nationwide, with cluster size ranging from 9 to 184 counties. On average, states had 16 identified clusters, ranging from 3 in Delaware and Hawaii to 27 in Virginia. Number of clusters per state was associated with number of counties per state and population of the state. The method helped address many of the issues that arise from providing rank estimates alone.

Conclusions: Public health practitioners can use this information to understand uncertainty in ranks, visualize distances between county ranks, have context around which counties are not meaningfully different from one another, and compare county performance to peer counties.

This pilot study explores the utilization of the Overdose Detection Mapping Application Program (ODMAP) as a tool for enhancing collaboration between the public health and public safety sectors to address the overdose epidemic in the United States. Through qualitative interviews with ODMAP users, key themes emerged, including the role of data sharing in facilitating collaboration, challenges posed by divergent data privacy standards, and the need for clearer guidance on cross-sector data sharing. Findings highlight ODMAP's potential to integrate data for targeted interventions at individual and population levels. Future research directions include overcoming data sharing barriers, strategically utilizing data across sectors, and rigorously evaluating the impact of cross-sector partnerships on overdose morbidity and mortality. Overall, this study underscores the importance of ODMAP in fostering coordinated responses to the overdose crisis and provides valuable insights for improving overdose surveillance and intervention efforts.

The North Carolina Medical Society (NCMS) and American Medical Association (AMA) collaborated to support diabetes prevention efforts in North Carolina (NC) with a physician champion initiative focused on tracking and increasing referrals to the National Diabetes Prevention Program (DPP). Three focus areas to effectively engage and utilize physician champions included: (1) self-adoption within their practice, (2) engagement and outreach with other healthcare leaders, and (3) influence to peers and colleagues. Six NC physician champions were selected to support the work from January 2020 to January 2023. This resulted in increased outreach to physicians about Diabetes Free NC , increased materials/education for physicians on prediabetes identification and management, and 1943 referrals to the National DPP. This work can be further translated and applied to other states to aid prevention efforts. Physician champions' expertise coupled with adequate resources can allow them to play a key role in chronic disease prevention and management.

Context: Tobacco usage accounts for one of the most preventable causes of death.

Objective: This study aimed to explore mechanisms linking cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents.

Design, setting, and participants: This was a cross-sectional study conducted among 6 urban secondary schools. A pretested and validated self-administered questionnaire was used. Data analysis for structural equation modeling was done using SMART-PLS v3.2.8.

Main outcome measure: The main outcome measure was to determine the direct and indirect effects of cigarette pack factors, point-of-sale marketing, and individual factors (psychological reactant trait) to predict smoking intention among school-going adolescents in a theory-based model.

Results: A total of 386 adolescents fulfilling the inclusion criteria participated. Pictorial warning message reactance (β = .153, P  ≤ .001), pack receptivity of conventional pack (β = .297, P  = .004), and psychological reactant trait (β = .174, P  ≤ .001) were positively related to smoking intention. Pictorial warning negative affect (β = -.153, P  = .001) was negatively related to smoking intention. The psychological reactant trait was positively related to message reactance (β = .340, P  ≤ .001). However, recall exposure to point-of-sale marketing and pack appraisal of conventional pack was not positively related to smoking intention (β = .038, P  = .22 and β = -.026, P  = .39, respectively). Pictorial warning message reactance also positively mediates the relationship between psychological reactant trait and smoking intention (β = 0.05, p = .001). The model has strong predictive power.

Conclusion: In conclusion, cigarette pack factors and psychological reactant traits are essential in predicting smoking intention. Hence, policymakers should consider these factors in developing smoking policies.

Objective: In April 2020, the US Centers for Disease Control and Prevention (CDC) recommended community masking to prevent the transmission of SARS-CoV-2. Since then, a total of 39 US states and DC issued mask mandates. Despite CDC recommendations and supporting evidence that masking reduces COVID-19 community transmission, from January to June 20, 2021 states lifted their mask mandates for all individuals. This study examined the association between lifting state-issued mask mandates and mask-wearing behavior in 2021.

Design: We estimated a difference-in-difference model, comparing changes in the likelihood for individuals to wear a mask in states that lifted their mask mandate relative to states that kept their mandates in place between February and June of 2021.

Setting: Individuals were surveyed from across the United States.

Participants: We used masking behavior data collected by the Porter Novelli View 360 + national surveys (N = 3459), and data from state-issued mask mandates obtained by CDC and the University of Nevada, Las Vegas.

Main outcomes: The outcome variable of interest was self-reported mask use during the 30 days prior to the survey data collection.

Results: In the overall population, lifting mask mandates did not significantly influence mask-wearing behavior. Mask wearing did significantly decrease in response to the lifting of mask mandates among individuals living in rural counties and individuals who had not yet decided whether they would receive a COVID-19 vaccine.

Conclusion: Policies around COVID-19 behavioral mitigation, specifically amongst those unsure about vaccination and in rural areas, may help reduce the transmission of COVID-19 and other respiratory viruses, especially in communities with low vaccination rates.