Health Promotion Practice最新文献

To address complex problems like health disparities, public health interventions have become increasingly ''complex''-engaging multisector partners and communities at multiple ecological levels. Complex interventions are intentionally flexible, making them challenging to evaluate with predetermined measures. While innovative evaluation methods tailored to complex interventions have been developed, there is a need for practical guidance to enhance capacity within public health. This article describes the qualitative FIND (Frame, Identify, Narrow, Do) evaluation process for a complex, community-engaged health equity intervention. Illustrative examples and take-away tools are provided. The FIND process is sensitive to complexity, involving ongoing data collection that helps guide implementation. The evaluator is embedded within the project team, facilitating frequent, direct interaction between the evaluator and those whose roles position them to hear or see happenings with the on-the-ground implementation in real time. The FIND process includes (a) developing a flexible framework for determining relevant processes and outcomes, (b) identifying important project events, (c) narrowing in on the most impactful events, and (d) making decisions informed by data. Using the FIND process, the project team learned about significant project events that would have been missed without a complexity-sensitive approach. Having the evaluator embedded within the project team, rather than as an independent entity, was crucial for understanding and utilizing on-the-ground developments in an evolving intervention. There is a need for more practical guidance to build capacity for evaluating complex public health interventions, including strategies for communicating with stakeholders about approaches that diverge from traditional scientific norms.

Purpose. Lung cancer is the leading cause of cancer death, with most cases attributable to cigarette smoking. Many communities within the lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) umbrella have high rates of smoking, but focused lung cancer prevention is limited. Our objective was to utilize a community-based participatory research (CBPR) approach to guide the development of a program focused on lung cancer prevention in LGBTQ+ elders. Methods. Through community partnerships, we recruited participants who self-identified as LGBTQ+ and were eligible for lung cancer screening (LCS) to participate in semi-structured qualitative discussions with complementary surveys. Qualitative guides were developed to collect data on determinants of smoking cessation and LCS and to elicit feedback on interventions to support lung cancer prevention through a tailored approach to patient navigation. Qualitative data were analyzed using rapid templated analysis to elucidate themes. Results. The 21 enrolled participants had diverse sexual and gender identities and 57% were of minoritized race/ethnicity. Most (81%) had experience with smoking cessation but few (10%) had undergone LCS. Overall themes suggest interest in personalized (to individuals), tailored (to the LGBTQ+ community) and integrated longitudinal programs to support lung cancer prevention. Themes suggest strong endorsement of focused messaging to LGBTQ+ persons and reducing stigma related to LGBTQ+ identity and smoking. Conclusions. Themes highlight the need for integrated tobacco and LCS programming which can provide longitudinal support, and ideally, center community settings and peer support. This formative work will be utilized to adapt a patient navigation program to assist screen-eligible LGBTQ+ elders.

Introduction: We examined youth and young adult access to flavored vaping products following New York's (NY's) flavored vaping product sales restriction in 2020.

Method: In 2021, we conducted an online survey (N = 493) and focus groups (N = 33) with NY youth and young adults who vaped in the past year (ages 15-24). We summarize findings and use logistic regression to assess associations with access to flavored vaping products.

Results: Most youth and young adults who vaped in the past year (64%) had obtained flavored vaping products. Among them, 49% purchased in a store, 47% got them from social sources, and 11% bought online. Focus group participants reported restricted products were available on store shelves or behind the counter. Those under age 21 were less likely to buy flavored vaping products in store than those aged 21-24, but age was unrelated to online purchases. Focus group participants reported websites did not require age verification, or they found ways to circumvent it. Most believed buying flavored vaping products was easy (77%) and had gotten easier or stayed the same in the past year (70%).

Discussion: Most NY youth and young adults who vaped in the past year obtained flavored vaping products and found it easy to buy them after the statewide sales restriction, suggesting that implementation has not occurred as intended. Findings also raise questions about retailer compliance and highlight enforcement challenges with online purchases. Continued retailer education and enforcement efforts, including for online sales, may help flavored vaping product sales restrictions achieve intended outcomes.

The COVID-19 pandemic and its related economic challenges exacerbated food insecurity across New York State (NYS). Approximately one third of New York City residents reported use of emergency food services in the pandemic's first year and, in 2021, approximately 1 in 10 NYS residents was food insecure, with rates among Hispanic and Black New Yorkers more than double that of White residents. Although these numbers have decreased following the acute phase of the pandemic, disparities by race and ethnicity persist and use of emergency food services remain elevated for New Yorkers born outside of the United States. Despite this, few policies and interventions that aim to improve the charitable and emergency food systems focus on the cultural relevance and appropriateness of foods provided. In 2022, researchers conducted 12 interviews with key stakeholders from organizations and institutions providing food distribution services to culturally diverse New Yorkers to understand barriers and facilitators related to providing culturally appropriate foods and elicit lessons learned and recommendations to inform future programs and policies. Findings from this study indicate that organizations serving diverse communities recognize the importance of providing culturally appropriate food services and make efforts to tailor these services accordingly. However, they face challenges that limit their capacity to offer foods consistent with the dietary needs and preferences of their clients. Additional funding, policies, and support are needed to improve the availability of culturally inclusive food distribution services within the emergency and charitable food systems.

Our collaboration to strengthen applied practice in public health training between two public universities in New Mexico has offered us insight into the types of institutional, administrative, and programmatic support beneficial for navigating work with limited resources and varying geographic considerations. We share some lessons from this burgeoning partnership between University of New Mexico's (UNM) College of Population Health and New Mexico State University's (NMSU) Department of Public Health Sciences which began in 2022. The main areas of learning focus on exchanging resources to extend relationships with fieldwork sites and site supervisors, engage and support students in their planning and implementation of their fieldwork, and identify institutional resources to maintain and grow programmatic quality. Implications from this work include efforts to reinforce the public health workforce pipeline, especially to ensure the participation and success of students from underrepresented backgrounds.

Water justice-equitable, reliable access to clean, sufficient water, and the knowledge and mechanisms related to its management-is a key global social justice and environmental issue. Cape Town, South Africa, is an important context to explore water justice due to its 2018 water crisis. Water scarcity intersects with other issues, including health disparities, food insecurity, and gender inequity, in turn requiring citizen engagement in water-related issues and knowledge sharing to produce sustainable, contextually relevant solutions. The arts are powerful tools for citizen engagement and knowledge sharing and translation in research, as well as social and environmental action. In this Resources, Frameworks, and Perspectives article, we outline the methods and lessons learned from developing Confluency, an arts-based exhibit and resource that aimed to generate and share knowledge on water justice issues between academics, practitioners, artists, and activists in Canada and South Africa. We detail the methods used to develop the Confluency exhibit and resource, including preparing the art exhibit framework, facilitating art workshops, designing interactive stations, and implementing the interactive art exhibit. Lessons learned are shared from implementing Confluency in diverse South African and Canadian settings. These case studies signal that the methodological approaches used in designing and implementing this exhibit and resource hold promise for providing opportunities to reflect on, and learn about, global and local water justice issues. This resource could be expanded to engage communities in research, policy, and practices regarding water justice in other diverse global settings to advance health, equity, and rights.

The first Ebola Virus Disease (EVD) cases in the 2021 Ebola outbreak were reported by the Democratic Republic of the Congo (DRC) Ministry of Health in February. However, 1 week later, the Guinea Ministry of Health reported its first EVD outbreak since April 2016. U.S. Centers for Disease Control (CDC) in-country operational and workforce capacity were built during the 2014-2016 Ebola outbreak response in West Africa and leveraged during the 2021 EVD outbreaks. During the 2014-2016 West Africa response and the 2021 EVD outbreaks, capacity and capability improvements in laboratory systems, risk communication, surveillance, epidemiology, infection prevention, and control were needed for a successful response. The overarching goal of CDC's operational and workforce capacity improvements was to strengthen countries' abilities to prevent, detect, and respond to outbreaks quickly. The Ebola outbreaks are examples of enhanced public health interventions where CDC has contributed as a partner with in-country ministries of health to save lives and control disease outbreaks. Lessons learned from the recent Ebola outbreaks indicate that a capacity-building approach has the potential application to other public health emergencies and contributes to strengthening global health security.

University wellness programs often employ health campaigns to promote awareness and engagement in health behaviors. However, with limited resources, it is challenging to develop and test health campaign materials in a timely manner. The Design Thinking Approach (DTA) provides a promising strategy for developing materials in a quicker, less expensive way compared to traditional methods. This pilot study examined the feasibility and short-term impact of implementing the DTA to develop a self-care campaign at a university to reach students on campus. University peer health educators and staff completed a 5-session DTA workshop to learn how to apply the DTA to develop and test a self-care campaign. Feasibility of the approach was conducted by having workshop participants rate the acceptability and practicality of the process. To examine the short-term impact, the self-care campaign was compared to an existing mental health campaign. Results from the feasibility analysis indicated that the participants responded well to the approach and found it to be overall beneficial. Results also revealed that the self-care campaign had a greater number of event attendees compared to the existing mental health campaign. However, the reach on social media was similar, but slightly higher, for the existing mental health campaign. No significant difference in perceived effectiveness score was found. Results provide evidence for the potential for the DTA to be a feasible and efficient tool for testing health campaign ideas. However, more extensive testing is needed to understand its impact long-term and which feedback methods (e.g., interviews and surveys) are most useful.

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce. Public health staff from 13 local authorities participated in semi-structured telephone interviews using questions informed by a conceptual framework composed of five previously defined levels of political commitment: rhetorical, institutional, operational, embedded, and system-wide. Thematic analysis showed that public health officers secured a political commitment by framing childhood obesity in line with existing priorities to build support among councillors in a position to advocate for the issue. Public health officers also engaged with multiple stakeholders, gathering data and insights to develop operational and embedded commitment. The study shows that effective health promotion practice requires a skilled and committed public health workforce, acting as policy entrepreneurs to secure system-wide political commitment in local government by proactively navigating local governance and policy processes, to build in opportunities for feedback and accountability.

Compared to other age groups, 18- to 25-year olds (young adults) are more likely to engage in heavy alcohol use and inconsistent contraceptive use, increasing their susceptibility to sexually transmitted infections (STIs) and unintended pregnancy. The Studying Alcohol and Related Risks (STARR) intervention was efficacious in reducing young adult alcohol-related risky sexual behavior, including reducing the number of casual sexual partners and alcohol use prior to sex. We conducted a qualitative study to guide the adaptation of the STARR intervention to include additional content on contraceptive use and prepare for dissemination of the intervention to a community audience. We conducted 10 focus groups with young adults (n = 16) and semistructured interviews with local community stakeholders (n = 12) to examine: (a) intervention characteristics, such as compatibility, adaptability, and design and packaging and (b) dissemination and communication channels. Focus groups and interviews were audio-recorded, transcribed, and thematically analyzed. Participants found the proposed intervention acceptable and highlighted the need to promote STI prevention among young adults. Participants viewed text-based interventions as accessible and effective. Key considerations included developing personalized messages from credible sources, using gender-inclusive language, and sending messages at strategic timepoints. Social media (Instagram, Twitter, Snapchat, TikTok), events, and campus resources were described as avenues to create awareness and disseminate information about the proposed intervention. Findings demonstrate the need for innovative and tailored young adult health programs that incorporate multilevel dissemination strategies. This study highlights the need for implementation activities that will improve the adoption and dissemination of evidence-based programs, particularly among young adults.