Health Promotion Practice最新文献

Black youth and rural adolescents are two groups who experience asthma disparities. Racism and discrimination in health care likely lead to group-based (systems-level) medical mistrust for some adolescents. Group-based medical mistrust, one pathway by which racism drives health inequities, is associated with poorer outcomes for patients with chronic conditions. Despite its potential importance in adolescent asthma, previous research has not considered group-based medical mistrust in this population. To fill this gap, we characterize group-based medical mistrust among rural adolescents with poorly controlled asthma, examining demographic differences. We analyzed baseline data from a school-based clinical trial in which 164 adolescents (mean age = 16.3; 76.2% Black) completed the Group-Based Medical Mistrust Scale (GBMMS). Using linear regression, we tested associations with race, gender, and age, controlling for recent medical visits and insurance status. The total GBMMS mean score was 2.3 (SD = 1.22); subscale scores ranged from 2.3 to 2.4. Black adolescents reported significantly higher total GBMMS scores (β = .45, p = .003) and significantly higher scores on two GBMMS subscales: suspicion of health care providers (β = .56, p = .007) and lack of support from health care providers (β = .36, p = .007). Gender and age were not associated with GBMMS scores. Health care providers need to consider medical mistrust and its role in their clinical care. Together with their institutions, health care providers and researchers should work toward changing systems that perpetuate racism to build trust as a means of reducing asthma disparities among adolescents.

People who use drugs (PWUD) face stigmatizing treatment and substandard care during all stages of their health care journey, including in the prehospital setting by Emergency Medical Services (EMS) providers. Drawing on the professional and lived experience of the authors, we have developed a training with an intended audience of Emergency Medical Technicians (EMTs) and Paramedics in Massachusetts that will orient them to harm reduction philosophy. The training is delivered online through an asynchronous platform housed at Boston University School of Public Health and centers around several themes including the impact of fentanyl on the drug supply, the role of harm reduction in mitigating the impacts of drug criminalization, and ensuring that EMS providers have access to tools and best practices for improving overdose response, pain management, documentation, and respectful language. The training has been approved for Massachusetts Office of Emergency Medical Services (OEMS) continuing education credit and will be offered for free. We plan to evaluate changes in participant knowledge and attitudes and overall acceptability of the training among EMS providers in Massachusetts.

Seven of the top ten leading causes of death in the United States are due to chronic diseases and treating these accounts for 86 percent of our nation's health care costs. The workplace offers an environment to implement chronic disease prevention strategies, such as worksite wellness programs, due to the large amount of time spent at the worksite daily by employees. As a result of COVID-19, many organizations began to change their workdays (i.e., working from home). This research sought to understand what, if any, implications the COVID-19 epidemic had on worksite wellness programming. Semistructured interviews were employed and recorded via Zoom conferencing to gather qualitative data. Four themes were identified: (a) relationship building among remote employees, (b) creativity in how to carry out program components, (c) increased physical activity and work-life balance, and (d) increased knowledge of health issues and mental health resources. Both challenges and successes were reported within themes. The main finding from this research indicates a mostly positive experience for worksite wellness programs during the COVID-19 epidemic. Many organizations have continued nontraditional work environments and the lessons learned from this study can both encourage and provide ideas for how to create and continue a worksite wellness program outside of the normal face-to-face working environment.

Introduction: Early Head Start (EHS) and Head Start (HS) staff comprise a large segment of the public sector workforce and experience numerous risk and chronic factors for medical conditions or symptoms. Few health and wellness workplace interventions, however, specifically focus on EHS/HS staff.

Methods: A train-the-trainer (TTT) approach was used to build capacity among directors and staff from 57 EHS/HS programs on how to strategically plan and implement a health promoting worksite program focusing on improving nutrition and physical activity practices among EHS/HS staff. Baseline and 3-month post-training questionnaires assessed EHS/HS staff changes on knowledge and practices related to nutrition and physical activity. Paired t-tests or chi² statistics assessed changes in questionnaire responses over time.

Results: 1,363 staff from 57 programs completed baseline and follow-up surveys. Staff had high knowledge regarding healthful dietary patterns at baseline. Over one-third of staff reported drinking soda with meals and almost 50% identified soda as their most common drink. Roughly one-third of staff also reported no physical activity in the prior week at baseline. Staff demonstrated significant improvements in dietary, nutrition, and physical activity practices. Staff also improved grocery shopping behaviors.

Implications for practice: The TTT approach to disseminate an EHS/HS staff-focused health promotion program, "Eat Healthy, Stay Active!' provides a potentially promising strategy to build upon and disseminate more broadly to reach the over >300,000 EHS/HS staff workforce.

Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.

Introduction. Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips.

The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions.

Through Substance Abuse and Mental Health Services Administration funding, Michigan State University (MSU) Extension partnered with MSU's Family Medicine and Health Department of Northwest Michigan to implement trainings for community members and health care providers to increase awareness and improve prevention efforts addressing opioid use disorder (OUD) in rural areas. We formed the Michigan Substance Use Prevention, Education and Recovery (MiSUPER) project to design and evaluate opioid misuse prevention trainings. A socio-ecological prevention model was an underlying conceptual framework for this project and drove strategies used in trainings, products created, and measurement. The purpose of this study is to determine the effectiveness of one-time online educational training events for rural community members and health care providers on community OUD issues, treatment options, and supports for those in recovery. Between 2020 and 2022, rural participants completed pre- and posttraining, and 30-day follow-up evaluation surveys. We report the demographic characteristics of community (n = 451) and provider (n = 59) participants, self-reported knowledge gained, and overall perceptions of the trainings. Findings show community members' knowledge increased from pre- to posttraining (p < .001) and was maintained at 3 months, while providers' knowledge was unchanged over time. Posttraining, community participants felt more comfortable speaking about addiction with family and friends (p < .001), and providers had better knowledge of local resources for patients who could not afford opioid misuse treatments (p < .05). All participants reported gaining knowledge of community resources for opioid misuse prevention, treatment, and recovery (p < .01). Opioid misuse prevention trainings may be most effective when adapted to leverage local resources.

Health-related social needs (HRSNs), like unstable housing, inability to afford utilities, food insecurity, unreliable transportation, and lack of personal safety, profoundly affect people's health and well-being. Between 2017 and 2022, awardees of the Accountable Health Communities Model (AHC) addressed the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services. Using and sharing HRSN data between clinical and community partners was a critical component of these efforts. This article shares findings from focus groups and interviews with 19 AHC awardees and seven of their partners. It explores the following:1. Whether sharing HRSN data with clinical partners informed clinical care2. Successes and challenges related to sharing data with community-based organizations (CBOs) and clinical partners3. How awardees collected and used HRSN data to advance health equityHalf of awardees interviewed documented HRSNs in electronic health records and shared aggregated HRSN data with CBOs. HRSN data enabled some clinicians to adjust patient care, although most were uncertain about how to do so. Participants described how sharing HRSN data with communities informs program and funding priorities to improve equity. However, CBOs noted that they had limited incentive to participate in data-sharing platforms. Our work highlights opportunities to provide guidance to clinicians on how to use HRSN screening results in care, standardize HRSN screening results in electronic health records, and co-create data-sharing initiatives with CBOs and patients to ensure meaningful participation.

Background. Behavior change has been a critical factor in slowing the spread of COVID-19. In South Africa where infection rates are high, research is needed on the protective behaviors adopted by youth who have low infection rates but are carriers of the virus. Aims. The purpose of this study is to (1) identify the protective behaviors young people adopted during the pandemic and (2) to estimate the probability of positive behavior change by demographic and socioeconomic characteristics. Methods. The study uses data from the South African National Income Dynamics-Coronavirus Rapid Mobile Survey 2020. The sample includes 985 (n) youth aged 15-24 years. The outcome of interest is behavior change due to the Coronavirus. Cross-tabulations and an adjusted binary logistic regression model showing odds ratios, are fit to the data. Results. Not all youth adopted protective behaviors. The most prevalent behaviors adopted include washing hands (67.75%) and staying at home (54.02%). Youth in households with six or more members are more likely to change their behaviors (ORs = 1.67 and 1.64, both p-values < .05). However, youth who do not have access to water to wash hands (OR = 0.71), reside in households with food insecurity (OR = 0.94), and those living in nonformal housing (OR = 0.69) are less likely to adopt behavior change. Conclusion. Due to the socioeconomic inequalities associated with behavior change, there is need for more tailored approaches to address youth living in impoverished households in the country.