Background/Purpose: People with chronic disease have increased risk for adverse health outcomes resulting from infectious disease outbreaks, underscoring the enhanced need for outbreak preparedness in this population. Simultaneously, individuals with chronic disease may face greater barriers to preparedness. We assessed preparedness factors comparing U.S. adults with and without chronic disease.

Methods: In May 2023, we conducted a demographically and geographically balanced national online panel survey of 4,543 adults in the United States. We assessed key aspects of outbreak preparedness outlined in national guidelines, including resource availability and knowledge/abilities related to preventing disease transmission. We used logistic regression models adjusted for age, sex, education, income, ethnicity, and race to compare preparedness measures based on chronic disease status.

Results: Fifty-four percent of survey respondents reported having a chronic disease. Similarly high percentages of adults with and without chronic disease reported having knowledge and abilities related to handwashing, wearing of masks, vaccination, and social distancing to prevent infectious disease spread. However, adults with chronic disease were less likely to report high levels of overall household preparedness (OR 0.75 (95% CI: 0.60-0.94)). Adults with chronic disease reported being less able to use high efficiency air conditioning filters (OR 0.78 (95% CI: 0.65-0.93)), create financial savings (OR 0.61 (95% CI: 0.50-0.76)), store food (OR 0.57 (95% CI: 0.44-0.75)), or store needed medication (OR 0.64 (95% CI: 0.47-0.86)) for an emergency, compared to healthy adults.

Conclusions: Adults with chronic disease may face higher barriers to household preparedness for infectious disease outbreaks when compared to healthy adults.

Standard data collection for immunizations do not collect gender and sexuality in Washington State, leaving the LGBTQ+ communities hidden from analysis. In 2022, we conducted a Rapid Community Assessment using the CDC’s toolkit to learn about COVID-19 and flu vaccination attitudes and experiences among LGBTQ+ communities in Pierce County, WA.

We developed a stakeholder-approved facilitator guide for listening sessions. Community stakeholders recruited participants and facilitators. Facilitators were trained on trauma-informed facilitation techniques. Listening sessions were then conducted in-person and virtually.

During the first series of listening sessions, participants from the LGBTQ+ community said that the community viewed the vaccine as being overall beneficial. They said it was a way to return to activities such as work or socialization and many said they received the vaccine to protect others.

The second series of focus groups centered on the trans community. These participants described specific ways their trans identity intersected with the previous themes. Participants said misgendering, transphobia, and lack of trans representation in institutions are all barriers to vaccination and other primary care activities. Other barriers showed the intersection between trans identity and themes from the initial focus groups.

Both series viewed community-based organizations as trusted sources for information and healthcare services even when the government or healthcare providers were not.

To improve the medical culture for LGBTQ patients, we partnered with an existing program that hosts up-to-date health information for providers. This site shares community voices, gathers LGBTQ resources, and connects providers and residents to local community-based organizations.

Introduction

The Project on Government Oversight and Department of Investigations found deaths and injuries during incarceration are underreported. The objective was to describe and compare injury characteristics and outcomes among patients transported to four level I-II trauma centers from prison by race.

Methods

This retrospective cohort study included adult traumatic injuries (1/1/15-7/15/22) admitted to four level I-II trauma centers (CO, TX, KS) transported from prison. Injury characteristics and mortality were compared by race: non-Hispanic (NH-) White, NH-Black, or Hispanic. Significance was set at α<0.01.

Results

Among 47,710 traumatic injuries, 73% were NH-White (n=34,727), 6% were NH-Black (n=2,967), and 21% were Hispanic (n=10,016); 181 were transported from prison. There was a disproportionately higher rate of NH-Black [14% (n=25)], and Hispanic [25% (n=45)] patients than NH-White patients [61% (n=111)], p<0.0001, of trauma patients transported from prison.

Among patients transported from prison, there were no significant differences in the transportation mode: 84% were transported via ambulance (80% NH-Black, 80% Hispanic, 87% NH-White, p=0.51), 6% via police (8% NH-Black, 11% Hispanic, 3% NH-White, p=0.09), 3% via flight (0% NH-Black, 2% Hispanic, 5% NH-White), and 7% had an unknown mode of transportation (12% NH-Black, 7% Hispanic, 6% NH-White, 0.73).

Among patients transported from prison, there was a trend towards more assaults among NH-Black patients (64%) than Hispanic (44%) and NH-White patients (38%), p=0.07. NH-White patients (19%) had injuries caused by self-harm more often than Hispanic (11%) and NH-Black patients (0%), p=0.03; other injury causes were comparable by race. NH-Black (24.0%) and NH-White patients (21%) transported from prison suffered penetrating trauma more often than Hispanic counterparts (9%), but the difference was not significant (p=0.27). Among patients transported from prison, NH-Black patients (48%) suffered skull fractures more often than Hispanic (36%), or NH-White patients (24%), p=0.04, other diagnoses were comparable. NH-Black patients tested positive for opiates (16%), more often than Hispanic (9%) and NH-White patients (4%), p=0.01, other drug results were similar. The median hospital length of stay was significantly longer for NH-White patients (3 days) than NH-Black patients (2 days) and Hispanic patients (1 day), p=0.0002. Intensive care unit admission was similar between groups, p=0.34. Mortality rates among trauma patients transported from prison was similar by race (4% NH-Black, 2% Hispanic, 5% NH-White, p=0.87). Among the seven deaths of patients transported from prison, 42% were caused by assault, 42% were self-harm injuries and 14% had an unknown cause.

This study was limited to prison injuries transferred to the participating hospitals; injuries treated at prison, or deaths in prison, were not included. Further details on the injury cause were not available.

Conclusions

NH-Black and Hispanic patients were transported from prison for traumatic injuries more often than NH-White patients. NH-White patients transported from prison committed self-harm more often than their NH-Black or Hispanic counterparts. Assault was the most common cause of prison injury transports, affecting NH-Black patients most often. The most common causes of death among patients transported from prison were falls and self-harm. This information can guide policies to reduce preventable traumatic injuries and deaths during incarceration.

Background/Purpose

In the United States, law enforcement are often the first on scene when a traumatic injury occurs and are frequently charged with determining the need for paramedics/emergency medical services (EMS), and/or providing medical care prior to paramedics’ arrival. Despite the significant public health implications, the scope of law enforcement's roles and responsibilities in the prehospital setting are largely regional, defined by the municipalities within which they operate. Little is known about the impact of police presence and activities at the scene for injured patients, including for low-income and/or communities of color. We aim to evaluate the available evidence on the role law enforcement plays in the prehospital setting.

Methods

A scoping review was performed to identify studies evaluating prehospital transport of injured patients and the role of police. We devised a unique search strategy composed of terms that fall into three categories: police, healthcare, and disparities. We applied this search strategy to several databases. All English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion.

Results/Outcomes

Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Two mechanisms were identified whereby police interact with patients in the prehospital setting and can have the potential to influence transport times: on-scene practices (e.g. scene clearance) and police transport. On-scene practices such as scene clearance have been observed to increase transport times in several studies, though no studies show outcomes data for patients after arrival to the hospital. Police transport of patients prior to EMS arrival may have the potential to decrease transport times. We also identified a paucity of research evaluating disparities within transport times and differential impacts of police presence according to race/ethnicity, socioeconomic status, and neighborhood effects.

Conclusions

This scoping review suggests that police involvement may impact time to medical care through scene clearance and police transport protocols. There is a critical need to investigate how scene clearance and other law enforcement practices impact public health, particularly as it pertains to injured patients, and how associated outcomes vary by patient and community demographics. Further, patient experiences of police must guide future policy goals and implementation.

Background

The Ohio EMS Incident Reporting System (EMSIRS) collects data on all EMS runs completed by agencies in the state of Ohio. The Ohio Trauma Registry (OTR) collects data on traumatic injuries reported by Ohio hospitals. This analysis identifies important variables for data linkage and establishes an algorithm for linking EMSIRS and OTR data.

Methods

2019 and 2020 data were pulled from EMSIRS and OTR. The incident county, incident zip code, patient’s gender, patient’s date of birth, destination hospital, and destination hospital arrival date were identified as record linkage variables. EMSIRS and OTR records with noted EMS or law enforcement transport to a hospital were kept in the analysis. EMSIRS data were further subset to those with identified injuries. Records with incomplete record linkage variables were deleted from both datasets. OTR and EMSIRS data were de-duplicated using the linkage variables. EMSIRS data were de-duplicated to only include one record that was submitted by the transporting agency as required. EMSIRS and OTR data were then merged using the linkage variables.

Results

In 2019, there were 181,935 injury-related records in EMSIRS and 37,917 records in OTR with noted EMS or law enforcement transport to a hospital. After eliminating records with incomplete data, there were 170,650 EMSIRS and 34,581 OTR records. After de-duplication, there were 170,367 EMSIRS and 34,560 OTR records. Data linkage yielded 17,877 records, comprising 9.8% of the EMSIRS records and 47.1% of OTR records. In 2020, there were 167,458 injury-related records in EMSIRS and 42,919 records in OTR with noted EMS or law enforcement transport. After eliminating incomplete data, there were 156,998 EMSIRS and 39,413 OTR records. After de-duplication, there were 156,622 EMSIRS and 39,384 OTR records. Data linkage yielded 20,644 records, comprising 12.3% of the EMSIRS records and 48.1% of OTR records.

Conclusions

The data linkage algorithm linked 47.1% - 48.1% of OTR data with EMSIRS, representing 9.8% - 12.3% of the EMS data. The disparate percentages can be attributed to differences in data system denominators and data collection methods. Data completeness is vital to maximizing linkage between data systems. Establishing a successful data linkage protocol between Ohio EMS and hospital trauma data allows the state to analyze the continuum of care for EMS patients who are transported to hospitals with traumatic injuries, providing stakeholders with insight for future treatment planning and EMS agency-hospital collaborative efforts.

Background: Globally, there is a significant unmet need for the rapidly growing burden of Non Communicable Diseases (NCDs). The continuous management and integration of different specializations required for NCD management are not built into health system processes in a way that delivers adequate NCD care in a meaningful way. The World Health Organization (WHO) developed the Package of Essential Noncommunicable Disease Interventions (PEN) to improve the provision of NCD services. In recognition of this, Wellness Centers (WCs) were created in Ghana to provide the needed response for NCD management. This study explores how Wellness centres provided long term treatment and integrated care for a health system that was originally built to treat one-off disease conditions.

Objectives: This study explores the services provided, reach and influence of the Wellness Centers on integration and continuity of care for people living with NCDs.

Methods: An exploratory qualitative study was conducted with health professionals (n=) and clients (n=25) of Wellness Centres in two district hospitals and one regional hospital in a deprived region of Ghana where NCDs are on the rise. The data was analysed thematically.

Results: The WC provided both preventive and therapeutic services to clients. The centres provide consultations, counselling, referrals, and medication. The centres had dedicated clinic days for hypertension and diabetes. Clients seen in a ranked order were mainly people living with hypertension, diabetes, ART, asthma, HIV/AIDS, hyperlipidaemia, cardiac conditions, stroke and sickle cell. Each facility reported about 300 registered clients. Daily, about 50 to 70 clients were seen. To provide integrated services, clients were linked with the OPD department, pharmacy, nutrition, laboratory, consultation room/doctor, physiotherapy, and counselling. Some clients reported a longitudinal relationship with a single identifiable provider and compliance with follow-up visits. However, lack of drugs, long waiting time at referred centres, cost of service and hope for cure were factors that limited effectiveness of the Wellness centre. Also Wellness centres struggled to sustain continuity of care because some participants did not accept a long term prognosis of their conditions.

Background: During the COVID-19 outbreak in Louisville, KY, Essential Needs Program (ENP) provided supplemental services to help residents complete their isolation or quarantine (I/Q) without entering public spaces. ENP provided food, household and hygiene products, coordinated prescription deliveries and Medication Assisted Treatment (MAT) for opioid use disorders, and temporary isolation housing away from household members. We aimed to (1) explore the usefulness of ENP services among priority groups and understand barriers for completing I/Q period (2) develop a context-specific framework grounded in experiences of resident consumers to help create equitable preparedness infrastructure.

Methods: The ENP evaluation employed a mixed-methods approach to describe lessons learned from NP consumers who requested to receive ENP services between April 2020 and June 2022 in Louisville, Kentucky. The consumers responded to multiple questions in four domains to assess: (1) quality and timely delivery of services received on a 6-point Likert scale, (2) perceived barriers to staying in I/Q, (3) adequacy of services received, (4) the extent of changes in protective practices among the study groups. Qualitative open-ended questions were also incorporated in most domains. The primary outcome was the self-reported successful completion of the I/Q period, as directed by public health recommendations. Standard established principles of analytic induction such as concrete coding and constant comparative methods were utilized to analyze qualitative responses.

Results: Online survey links were distributed via SMS text messages among 8,898 unique consumer phone numbers and 817 completed surveys were received. When asked whether ENP was able to help participants complete I/Q period, 56% of respondents agreed. 46% of respondents reported ENP services significantly reduced their need to leave I/Q, while 15% thought their need was somewhat reduced. 50% of the respondents with disabilities thought ENP greatly reduced their need to leave I/Q. When asked, the 19.5% respondents who reported leaving I/Q specified reasons such as food and durable goods shortage; lack of childcare; work requirements; lack of help from family or friends; and family or friend-related emergencies. The burden was particularly hard on families with children and households with more than two individuals. However, 35% of the overall respondents reported an increase in preventive practices due to a COVID-19 infection.

Conclusion: Survey respondents reported a heightened sense of shared responsibility and adapting protective measures after testing positive. Therefore, integrating enhanced messaging and health education to this subset of individuals and across public health infrastructure may help decrease the community’s spread of communicable diseases. For better adherence to I/Q policies and the success of supplemental services like ENP, the scope of food and household items should include items more appropriate for households with children. However, to more fully represent social world complexity, virtual in-person interviews with ENP consumers (N=20) will be completed between May-June 2023.

Public Health Implications: Creating local evidence may impart knowledge about the current systemic barriers to creating an equitable and sustainable infrastructure-driven recovery process for at-risk populations of Louisville, KY.

Background/Purpose: Home fires are among the greatest disaster threats to American families, killing on average 2,500 people per year in the United States. To address this issue, the Red Cross launched the Home Fire Campaign (HFC) in 2014 with the support of Federal Emergency Management Agency Fire Prevention and Safety grant funding. The HFC aims to build the capacity of at-risk households to respond effectively to home fires and other disasters by conducting smoke alarm installation in-home visits and assisting households in developing fire escape plans. Since 2015, NORC at the University of Chicago (NORC) has conducted an annual evaluation of the HFC to understand the impact of the program on household fire safety and prevention practices.

Methods: Currently in their eighth year, NORC has fielded an annual survey to a sample of intervention participants to understand their fire safety knowledge and behaviors, satisfaction with HFC services, and demographic information. NORC has also employed various other methods to evaluate the impact of the HFC program including fielding a survey to a comparison group every other year and conducting a case study of a community highly saturated with HFC services. Most recently in 2022, NORC conducted a study to evaluate the Red Cross Home Fire Risk Map and explore differences between households in the United States that are classified as “high-risk” or “low-risk” for experiencing a home fire and suffering more severe consequences following a home fire.

Results/Outcomes: Through the evaluation of the Home Fire Risk Map, NORC found that homes in “high-risk” areas more frequently reported having zero smoke alarms and have had more frequent and more severe experiences with home fires. 32 percent of high-risk group respondents reported having experienced a home fire, compared to 23 percent of the low-risk group. Through the HFC evaluation, NORC has consistently found that intervention households have more smoke alarms in their homes than comparison households and are more likely to have an escape plan in the event of a home fire. The average total number of smoke alarms reported in intervention households in 2020 was 3.8 compared to 2.8 in the comparison group. In the case study of a highly saturated community, NORC found that households that did not receive an in-home visit experienced more frequent home fires that led to property and content loss of over two times greater than households that did receive an in-home visit.

Conclusions: Conducting in-home visits to install smoke alarms and teach household members about fire safety and prevention practices is a valuable tool to reduce home fires in the United States. The Red Fire Home Fire Risk Map can help partners and program implementers accurately identify areas to target for home fire reduction interventions. Finally, the Red Cross Home Fire Campaign is effective at reaching at-risk households and in increasing household members’ preparedness to respond to a home fire.

Firearms are the leading cause of death for Black men ages 15-34 and the second leading cause of death for Latino men in the same age range; reducing rates of gun carrying in this population is critical. Prosocial messaging through youth voice on personal social media platforms holds great potential for reducing gun carrying among young men in social circles where gun carrying is common practice. The Choices program is a group of young men of color, ages 13-24, that meets weekly to share a meal and build community as they identify positive, protective factors around self-development and success, name and work to address challenges and risk factors in the lives of participants, and cover topics such as: roadblocks, discipline, housing, transportation, silencing the [distracting/negative] voices, creating a safety plan, controlling anger, living space budgets, goalsetting, and financial management. Given the social media influence of this group within circles that have relatively high rates of carrying, participants of the Choices program engage in and promote prosocial behaviors within their spheres of influence, as gun carrying neither increases perceptions of interpersonal safety nor decreases overall risk of victimization among urban youth who carry. The Choices program harnesses the power of prosocial messaging to discourage gun carrying among immediate social circles of this group of young men.

Prosocial, positive influence is supported by the literature, as messaging within a close prosocial frame, especially messaging that encourages friends to “protect your loved ones,” positively influences behavior. Through weekly meetings with a Health Behavior Coach, a Social Media Expert, the Program Lead of the Choices Program, participants learn about the theory that substantiates the impact of prosocial messaging while also increasing technical skill and strategy across popular social media platforms. Through their own creativity and voice, participants transform this messaging into personal social media posts that discourage gun carrying among friends and within social spheres of influence. This group builds community with one another through shared, collaborative positive engagement, learns marketing and communications strategies and skills, and is introduced to data collection and tracking as a professional skillset. Analysis involves discussion of variable measures of effectiveness of posts through the assessment of style, content, and varied posting schedules. Finally, through pre-post surveys for program participants and an anonymous post-campaign survey regarding gun carrying habits posted by participants in their social media channels, participants engage in a conversation regarding positive uses of social media, perceived and demonstrated effects of a campaign such as this, and next steps in this or other realms of positive influence through prosocial media engagement. With an average of 400 social media contacts per youth participant, this project is estimated to reach 8,000+ individuals.