Background: This project aimed to understand the impact of long-COVID on Vaccine Equity and Access Program (VEAP) communities and conduct an environmental scan of national organizations and government entities to determine available information, resources, and support. VEAP funds 90 community-based organizations (CBOs) to develop and implement health communication and community engagement strategies to increase COVID-19 and influenza vaccine confidence and acceptance in racial and ethnic communities. Methods: A two-part environmental scan was conducted over 3-months. Part one scanned the websites of 50 state health departments (SHD) and 24 national-level organizations (NLO) for accessible information on long-COVID. Part two determined whether these organizations provided information, resources, or activities to communities. A quantitative survey was conducted with VEAP-funded CBOs to measure knowledge of long-COVID and assess the impact of long-COVID on their VEAP work. Results: 30% of SHD discussed long-COVID, 22% provided resources, and 12% provided activities to individuals and communities. 8 NLOs mention long-COVID on their websites; five provided resources, and three provided activities. The survey received 32 responses; 72% of CBOs reported having heard of long-COVID. 66% understood the symptoms of long covid and its impact on communities. The primary sources for information and resources were the CDC, Google, and SHD. 50% of CBOs reported long-COVID having a moderate to significant impact on their VEAP work. While all CBOs reported long-COVID impacting communities, less than half provide support services. Conclusion: This scan indicates a need for accessible information, resources, and visibility of long-COVID on a national, state, and local level.

Background:

To address the low levels of physical activity and feelings of isolation during the COVID-19 pandemic within McLennan County, the Live Well Waco Coalition developed and launched a free, eight week walking program called Let’s Walk Waco (LWW) in 2021. LWW was modeled by existing evidence-based programs. The coalition used constructs of each program to form a community-specific intervention.

Methods:

Using the plan–do–study–act (PDSA) model, improvements were identified to increase program participation in year 2 of LWW. This included increased marketing campaigns, additional incentives, social support, and a kickoff event.

Results:

Participation in the program grew by 83% from 2021 (170) to 2022 (310). The total number of miles walked increased from 18,129.64 miles in 2021 to 32,368.37 miles in 2022, an increase of 78.5%. This program also provided incentives for those who completed the program. Incentives were donated by the community and increased 233.3% from 2021 to 2022.

Conclusions:

Due to scarce county level data and resources, the PDSA model allows for a micro level view to increase program capacity by adapting to changing community needs. During the planning of year 2, lessons from year 1 were discussed and implemented, including increasing capacity and funding. Growth can be attributed to using the PDSA model and more coalition involvement. This model can be implemented at small to midsize health departments to improve physical activity of the community.

Keywords:

Physical Activity, Health Education, Program Retention, Health Promotion

Citation:

McLennan, Texas. County Health Rankings & Roadmaps. Accessed March 30, 2023. https://www.countyhealthrankings.org/explore-health-rankings/texas/mclennan?year=2023

Issue: Crisis and emergency risk communication (CERC) frameworks have been used to promote public participation in COVID-19 mitigation efforts, but equitable implementation depends on reaching those who have been disproportionately affected by COVID-19 disparities. African American, Hispanic, immigrant and refugee populations have experienced disproportionate COVID-19 incidence, hospitalizations, and deaths due to pandemic-associated environmental and socioeconomic factors framed by structural racism.

Description: In March 2020, a Community Based Participatory Research partnership in Southeast Minnesota adopted CERC framework to address COVID-19 prevention, testing, and socioeconomic impacts within health disparity groups. Through the introduction of a novel bidirectional CERC framework, the partnership was able to collaborate with Communication Leaders (CLs) and their social networks to refine messages, leverage resources, and advise policy makers.

Lessons Learned: Given the success in reaching patients, high acceptability, feasibility, perceived efficacy, and sustainability of this program, the idea to create a web-based toolkit that could be utilized by other organizations as a resource to assist with building community partnerships and implementing successful CERC programs was born. Stakeholders who implemented the bidirectional CERC framework are currently engaged in a phased, participatory process to develop a web-based toolkit for populations at risk for health disparities from pandemics and other infectious disease outbreaks with a go live date of August 2023.

Recommendations: It is hoped that this toolkit can be incorporated into current and future pandemic preparedness policies for community engagement to ultimately narrow the gap in health disparities seen in populations at risk.

Background: California is particularly vulnerable to devastating effects of wildfires given its decades-long drought, population density, and the Santa Ana winds. While the wildfire hazard is well-documented in California, our purpose was to analyze individual-level characteristics that affect subgroups’ resilience in the aftermath of wildfires, which would help inform targeted, community-based interventions.

Methods: To assess the risk associated with California wildfires, we constructed a social vulnerability and wildfire risk index for census tracts in 2019 using principal component analysis (PCA). Additionally, ArcGIS Pro was used to conduct a hotspot analysis of CA tracts vulnerable to wildfires.

Results: In our PCA, 3 components together explained 65% of the variance in the data. PCA was effective in developing composite factors across climate, clinical, social vulnerability, and environmental justice dimensions. In our hot spot analysis, we anticipate the clustering of poor clinical outcomes where there is a greater amount of acres burned and air pollution attributed to wildfires.

Conclusion: Our results indicate that when communities have coexisting social, economic, and environmental burdens, they are most vulnerable to poor health outcomes and low adaptive capacity upon exposure to wildfires. In our index, less than a high school education, poverty, unemployment, housing burden, children under 10 years old, asthma ED visits, and AMI ED visits were highly correlated with each other. Moreover, greater educational attainment, employment, income, and low housing burden may be protective factors. Our index and hotspot analysis have broad implications for California government officials and policymakers during wildfire preparedness and resource allocation.

Background:

According to the CDC, 50% of unintended pregnancies in the United States (US) are associated with incorrect use of contraception. Emergency contraception (EC) is a vital resource for women who may fail other contraceptive options. Community pharmacists, one of the most accessible healthcare professionals, have a significant opportunity to make interventions and influence public health outcomes. However, there is limited established guidance on the community pharmacist’s role in EC care in the US.

Methods:

One electronic database (PubMed) was searched in October 2022 using a combination of keywords and Medical Subject Headings (MeSH) Emergency Contraception and Pharmacists to identify the articles. The inclusion criteria were studies published from 2010 to present regarding the pharmacist’s role in EC in the US.

Results:

Considering 9 in 10 Americans live within 5 miles of a community pharmacy, pharmacists are well positioned to provide EC education. The literature review focused on studies conducted with community pharmacists because they interact with the patient regarding usage, side effects, effectiveness, and availability of EC. One characteristic of the identified studies showed areas of improvement for counseling. Another common theme was that pharmacists focus on levonorgestrel treatment, even though other EC options exist.

Conclusions:

The limited number of articles highlights necessity for further research on the community pharmacist's role in EC care. Thus, pharmacists could benefit from additional training and education on providing EC. In addition, further studies are needed to evaluate how the involvement of community pharmacists in reproductive care can positively impact public health outcomes.

Background: Despite declines, teen birth rates in the US continue to outpace other developed countries, with teens in rural communities at higher risk for early pregnancy and parenthood. A Community Based Participatory Research was implemented in two rural counties to understand the experiences of teen pregnancy and parenthood among rural communities.

Method: 110 semi-structured interviews were conducted with current/former teen parents, parents of teenagers, social service and healthcare providers, school officials, and community stakeholders. Interviews were transcribed verbatim and analyzed using Atlas.ti following the six steps thematic analysis process.

Results: Two Opposing yet mutually endorsed perspectives within community surrounding teen pregnancy were identified: (1) teen pregnancy/parenthood is accepted but considered unacceptable and (2) teen pregnancy/parenthood is disappointing but also celebrated by families. Theme 1: Participants described that perceptions of teen pregnancy/parenthood have shifted across generations and became contradictory. Although pregnancy/parenthood are highly stigmatized experiences for teens, participants describe the growing acceptance within their communities. An example: “Yeah, it’s a baby boom. Teen pregnancy is more acceptable now than when I was pregnant as a teenager...” Theme 2: Participants described being disappointed with the prevalence of teen pregnancy/parenthood in their community, but also how families often celebrate these births. An example: "...the parents of these teenagers are happy about like, they're excited to have grand babies earlier on...”

Conclusion: Community perceptions about teen pregnancy and parenthood in rural communities present both a challenge and opportunities for prevention efforts. Strategies that uphold rural community values yet emphasizing delay in early parenthood needed.

Issues: Approximately 12% of Florida residents are without health insurance and 4% are undocumented. Community health fairs connect these populations with healthcare resources.

Description: Medical students volunteer as patient navigators at student-run community health fairs through the community service organization of a Florida medical school. Based on test results and clinical assessments at the health fairs, patients are stratified as high-risk, moderate-risk, or low-risk. Patients in the high-risk group are contacted more frequently to expedite their navigation. Navigators then help patients identify healthcare resources according to their health needs (e.g., free clinics or subsidized health insurance).

Lessons Learned: During 2021-2022, our organization collaborated with community partners to conduct seven health fairs. Over 600 patients participated in health screenings at these fairs. 82 (14%) high-risk and 128 (21%) moderate-risk patients participated in our navigation program. In the high-risk group, navigators successfully reached 64% of patients, either through text, phone, or email, 79% of whom achieved a navigation goal (e.g., primary care physician appointment). In the moderate-risk group, 39% of patients were reached, 82% of whom achieved a navigation goal. To improve patient contact, we added a Google Voice phone number, which allowed patients to directly reach out to navigators, creating an avenue to address patients’ questions via closed-loop communication.

Recommendations: Patient navigation programs can assist underserved groups by connecting patients to healthcare resources. Risk-stratification and two-way communication help to ensure that higher risk patients are connected to these resources efficiently.

Background

The traditional approach to care for dementia patients with comorbidities has led to fragmented care, contributed to polypharmacy, and often is not aligned with patients' preferences. Goal-directed care has been shown to increase patient and caregiver satisfaction, improve quality of life, and reduce costs.

Methods

This study utilized qualitative data collected as part of a larger cross-sectional, mixed methods study which aimed to understand areas of fit and disconnect between clinic-based care plans and goals and priorities of care for dementia patients with comorbidities at Grady Hospital outpatient geriatric clinic. The sample includes 19 dyads of patients with varying stages of dementia and their caregivers. Each visit consisted of a standardized geriatric assessment, and a semi-structured, dyadic qualitative interview to assess goals and preferences. Clinic visits concluded with the creation of a revised care plan that considered the dyad’s goals and preferences.

Results

Patient participants (n=19) were 89% female, 100% African American; 58% had a diagnosis of Alzheimer’s disease and the average stage of dementia was moderate. While thematic analysis of transcripts is ongoing, preliminary findings indicate that all dyads prioritize maintaining independence, reducing hospitalization, and having support from social services to reduce caregiving burden. Nearly all dyads found the physician-led discussion of goals and preferences cathartic.

Conclusion

This study suggests that eliciting patient and caregiver goals and preferences could benefit overall quality of care for this patient population. Furthermore, this study has the potential to inform future patient-centered dementia care initiatives for patients in underserved African American populations.

ISSUE:

There are thousands of disasters (natural, man-made, and technological) of public health significance annually. Emergency Departments in the United States receive around 130 million visits per year (CDC, 2020). The number of climate-related disasters has tripled in the last 30 years (Oxfam, 2022). In the face of these increasing disasters, low-income and minority communities are disproportionately at-risk.

DESCRIPTION:

The American Red Cross Los Angeles Region hosted an annual READYteens Program every summer from 2019 to 2022 to train youth and young adults (YAYA), approximately aged 15-20, in the areas of disaster preparedness, response, and recovery. The primary curriculum included preparedness education, Incident Command System (ICS), emergency communications, medical response (BLS, FAST, First Aid), search & rescue (triage, fire safety), active shooter, psychological first aid, sheltering & feeding, and fundraising.

LESSONS LEARNED:

As of Summer 2022, we trained 400+ students in Los Angeles County from diverse zip codes and schools free-of-charge both remotely and in-person. We designed a best practices framework for training YAYA who are most susceptible to various disasters due to geographic location, socioeconomic status, and/or environmental discrimination by local, state, and/or federal government. This serves as a model for public health workforce development to expand health equity and reduce burden of disasters.

RECOMMENDATIONS:

The following steps will focus on expanding the program nationally through American Red Cross networks, community organizations, and student groups. We will work with public health and community education leaders to develop a sustainable training model with specific feeders into the public health workforce.