Florida Community Research Articles

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways.The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time.During this period,students hadremote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc.,San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year wasreduced to five weeks to allow for timely graduation.The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkshiphas traditionally beenan eight-week-long rotation.Other clerkships that varied from six to eight weeks were similarly reduced to five weeks.We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care.A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation.We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68,p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there waslimited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship.These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education.If another pandemic were to arise, the durationof differentclerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.

Exploring Workplace Incivility and Bullying in Healthcare Workers in a South Florida Community Hospital

Introduction: Workplace incivility and bullying are concerning issues in healthcare with detrimental consequences for healthcare workers (HCW) and healthcare organizations. Organizational leaders’ recognition of incivility/bullying within healthcare organizations, and their sources, is imperative to prevent and/or address issues by creating “zero tolerance” work environments. The purpose of this cross-sectional, descriptive study was to explore HCWs’ experiences with incivility and bullying at a South Florida community hospital. Methods: A convenience sample of HCWs at a South Florida community hospital were recruited to voluntarily complete the Nursing Incivility Scale. Results: A sample of 325 HCWs responded to the survey. The results showed general incivility as the highest source across all HCWs, with certified nursing assistants having the highest level of incivility across all sources (general, nurse, supervisor, physician, and patients). Correlative analysis showed statistically significant relationships between several sources of incivility (general, supervisor, physician, and patient; r = .250 to .390) for those reporting past experiences with incivility/bullying, and healthcare role and physician incivility (r = -.224). Independent t tests and one-way ANOVA showed statistically significant differences. Of note, compared to other HCW roles, registered nurses reported physicians as their highest source of incivility. Discussion: Workplace incivility/bullying is a serious issue in healthcare across all disciplines and roles, requiring healthcare organization leaders’ awareness and subsequent interventions to prevent and address its occurrence. The results of this study provide necessary insight for hospital organization leaders as they endeavor to create and nurture “zero tolerance” work environments. Keywords: workplace incivility, workplace bullying, workplace violence, zero tolerance

The effects of fire, climate, and species composition on longleaf pine stand structure and growth rates across diverse natural communities in Florida

The longleaf pine (Pinus palustris) savanna is an endangered ecosystem within a global biodiversity hotspot. However, most studies of longleaf habitats have not considered their distinct structure and function among unique communities, which are critical for developing appropriate management strategies. We aim to assess how differences in climate, fire, and species composition interact and relate to longleaf pine densities and growth rates in distinct communities. We surveyed longleaf pine stand structure (density by size and age classes) and estimated growth rates using 516 tree cores across 5 community types (69 plots, each ≤ 160 m2). Surveys covered the range of longleaf pine in Florida, USA, including the southernmost extent of the species range, and included all communities where longleaf are dominant (sandhill, upland pine, and mesic, wet, and scrubby flatwoods). We used an NMDS ordination to classify communities by species composition. We used linear mixed-effects models to examine the effect of community type on longleaf pine density and growth rates and then used recursive partitioning and regression tree analyses to identify how climate, fire, and species composition affect density and growth rates. We found that stand structure and species composition were different across communities, with upland pine being the most species rich and having the highest density of mature trees, whereas growth rates were not statistically different across communities. Across communities, unique interactions between climate, fire, and species composition, resulted in differences in stand structure and growth rates. In general, tree and grass stage densities were best predicted by species composition and fire rather than by climate, whereas growth rates were best predicted by climate. Having included the southernmost extent of longleafs range we show that longleaf growth rates increased with higher temperatures, but this effect is reversed in dry conditions. Our results suggest that longleaf growth rates across its range will be more sensitive to current and future climate change than longleaf population density. Furthermore, while controlling competition from hardwoods has been a focus of longleaf restoration, our results suggest that species that facilitate longleaf establishment may be equally important in restoring and managing these habitats. Managers should design and apply regional and community specific plans that take into account relationships between fire and associated species composition under a changing climate, which will influence strand structure and tree growth differently in different communities.

Evaluation of Chemotherapy-Induced Myelosuppression in Patients with Extensive-Stage Small Cell Lung Cancer Treated with Trilaciclib: Retrospective Analysis of Florida Community Oncology Practices

Evaluation of Chemotherapy-Induced Myelosuppression in Patients with Extensive-Stage Small Cell Lung Cancer Treated with Trilaciclib: Retrospective Analysis of Florida Community Oncology Practices

Exploration of Multilevel Barriers and Strategies That Affected Early COVID-19 Vaccination and Testing in Rural Latino Communities in Southwest Florida.

The COVID-19 pandemic has disproportionately impacted multiple racial and ethnic minority groups, including Latinos residing in rural communities. Low rates of vaccination and testing combined with social determinants of health have contributed significantly to this disparate impact. Given the needs and constraints unique to rural Latino migrant and immigrant communities, this qualitative study examined multilevel barriers and strategies that affect COVID-19 vaccination and testing uptake among these communities in southwest Florida. Four focus groups (n = 25) were conducted between March and April 2021 with various key stakeholders, including rural Latino community members, local leaders, and community health workers (‘Promotoras de Salud’). Themes that aligned with barriers to COVID-19 vaccination and testing included fear, lack of control, misinformation, lack of accessibility, and institutional/policy issues; themes that aligned with strategies to improve COVID-19 vaccination and testing uptake included faith, taking care of self, and community and family resilience. Recommendations for improving future pandemic responses for rural Latino communities include incorporating multiple levels of intervention, such as consideration of the role of the family, involving trusted community members, and ensuring the development and implementation of fair and consistent policies.

The Treatment of COVID-19 With Monoclonal Antibody Therapy: Patient-Reported Outcomes.

ObjectiveThere have been many efforts to research and produce treatment modalities for COVID-19. Monoclonal antibodies have been one of the effective treatments since their approval by the US Food and Drug Administration (FDA) under emergency use authorization (EUA) in 2020. This study surveyed COVID-19 patients about their disease course and experience with monoclonal antibody treatment.MethodsPatients who received monoclonal antibody treatment between February 12, 2021, and June 2, 2021, at a South Florida community hospital were enrolled in the study. This included patients over 18 years of age with a confirmed positive COVID-19 test result, with mild to moderate symptoms within 10 days of onset and identified as high risk for progression to severe disease. There were no exclusion criteria. After 30 days, patients were followed up via a structured telephone survey regarding subsequent emergency department (ED) visits for worsening COVID-19 symptoms, need for oxygenation, intubation, and death. Secondary outcomes were adverse effects and patient perceptions.ResultsAmong the 119 patients who received monoclonal antibodies during the established time frame, 93 (78.1%) consented to participate in the telephone survey. Of these, 11.8% had a subsequent visit to the ED for worsening COVID-19 symptoms, 6.5% required oxygen, and 2.2% were admitted to the intensive care unit (ICU). There were no reported intubations or deaths. The vast majority (91.4%) would recommend monoclonal antibody treatment to others.ConclusionPatients who received monoclonal antibody therapy had low rates of subsequent ED visits and rarely required oxygen or ICU admission. The majority of patients would recommend treatment with monoclonal antibodies to others.

COVID-19, science, vaccines and family in a multi origin Latinx population in South Florida.

During the Spring of 2021 in Miami-Dade County, four virtual focus groups were held with 31 participants from four diverse local Latinx communities as part of the Florida Community Engagement Alliance (FL-CEAL) Against COVID-19 Disparities project. The main objective was to explore attitudes about COVID-19 information and prevention strategies among South Florida's diverse Latinx populations, across a broad geographical area. The study used a semi-structured focus group qualitative design and chose participants from four well established Latinx neighborhoods. Participants were mostly women, diversity was strong with birth regions including the Caribbean, North, Central and South America. Though a third (n = 11) were born in the United States, almost all (n = 28) reported speaking Spanish at home. Three themes and six subthemes were identified to underscore Latinx attitudes toward COVID-19 vaccine uptake or hesitancy. These were: (1) Attitudes regarding vaccine intake; (2) Sources of Information; and (3) Science Education. The degree to which each of these themes exercised influence on vaccine intake or hesitancy varied. The multi origin Latinx participation in the focus groups strengthened findings by broadening representation and discussion. In the end and despite the various national origins, all participants indicated receiving most of their information on COVID-19 related topics from their family, physicians, social networks, and some form of media.

Snowbirds and snowflakes: Mobility and aging across the Canada‐United States border

Changes brought about by globalization such as the growth of the travel industry and increasing interconnectivity between places have opened up new lifestyle options for Canadian retirees. Commonly called “snowbirds,” thousands of Canadian retirees choose to spend their winters in warm destinations outside Canada, with most going to localities in the southern United States. Most snowbirds visit the same place every year and spend many years going back and forth between Canada and their chosen winter destination. Drawing on insights from both life‐course theory and the new mobilities paradigm, this paper considers how the cross‐border snowbird phenomenon links to wider processes related to aging. Qualitative interviews were conducted with retirees wintering in various communities in southern Florida. The findings of the study highlight the importance of understanding both aging and mobility as processes that intersect in variable ways over time to influence new geographies of aging.

Assessing the Impact of Demographic Factors on Presenting Conditions or Complaints Among Internal Medicine Patients in an Underserved Population in Central Florida.

Background and objectivePatients’ demographics (race, age, gender, and ethnicity) have been determined to affect patients’ health status. It has been established that chronic disease prevalence varies by race, age, gender, and ethnicity; however, not much is known about how these demographic factors influence presenting conditions or complaints within a student-run clinic (SRC). This study aimed to investigate how demographic factors in the Apopka community in Florida determine what internal medicine (IM) conditions or complaints patients present with at a student-run free clinic.MethodsElectronic medical record (EMR) data for adult patients seen at the clinic from February 2019 to February 2020 were reviewed to collect information on patient demographics, IM presenting conditions or complaints, and body mass index (BMI). Binary logistic regressions were employed to investigate the relationship between demographic factors and presenting conditions or complaints.ResultsThe majority of the patients were female (62.2%), with an almost equal representation of Hispanic (50.3%) and non-Hispanic individuals. About half of the patients visiting the clinic were either overweight or obese. Of the 167 patients, the average age was 44.17 and 44.32 years for males and females respectively. The most common presenting conditions or complaints included cardiac conditions (25.07%), diabetes (9.64%), gastric pain (9.21%), and upper respiratory infection (URI)/allergies (6.15%). Cardiac conditions were further broken down into hypertension (18.94%), dyslipidemia (3.94%), and palpitations (2.19%). Patient age was a contributing factor to the incidence of diabetes (p=0.002), hypertension (p<0.0001), and cardiovascular conditions excluding hypertension (p=0.021). There was a significant relationship between obesity and diabetes (p=0.036) and hypertension (p=<0.001).ConclusionSRCs can make use of the information obtained from this study to advocate for coverage of medications to treat diabetes and hypertension in this undocumented population to prevent morbidity rates. We believe our findings can also provide guidance in terms of instituting screening programs for these illnesses among the broader population and SRCs with different patient makeups.

Application of machine learning algorithms for localized syringe services program policy implementation – Florida, 2017

Background People who inject drugs (PWID) are at an amplified vulnerability for experiencing a multitude of harms related to their substance use, including viral (e.g. HIV, Hepatitis C) and bacterial infections (e.g. endocarditis). Implementation of evidence-based interventions, such as syringe services programs (SSPs), remains imperative, particularly in locations at an increased risk of HIV outbreaks. This study aims to identify communities in Florida that are high-priority locations for SSP implementation by examining state-level data related to the substance use and overdose crises. Methods State-level surveillance data were aggregated at the ZIP Code Tabulation Area (ZCTA) (n = 983) for 2017. We used confirmed cases of acute HCV infection as a proxy of injection drug use. Least Absolute Selection and Shrinkage Operator (LASSO) regression was used to develop a machine learning model to identify significant indicators of acute HCV infection and high-priority areas for SSP implementation due to their increased vulnerability to an HIV outbreak. Results The final model retained three variables of importance: (1) the number of drug-associated skin and soft tissue infection hospitalizations, (2) the number of chronic HCV infections in people aged 18–39, and 3) the number of drug-associated endocarditis hospitalizations. High-priority SSP implementation locations were identified in both urban and rural communities outside of current Ending the HIV Epidemic counties. Conclusion SSPs are long researched, safe, and effective evidence-based programs that offer a variety of services that reduce disease transmission and assist with combating the overdose crisis. Opportunities to increase services in needed regions across the state now exist in Florida as supported by the expansion of the Infectious Disease Elimination Act of 2019. This study provides details where potential areas of concern may be and highlights regions where future evidence-based harm reduction programs, such as SSPs, would be useful to reduce opioid overdoses and disease transmission among PWID. Key messages The rate of acute HCV in Florida in 2017 was 1.9 per 100,000, nearly twice the national average. Serious injection related infections among PWID are significant indicators of acute HCV infection. High-priority SSP implementation locations in Florida were identified in both urban and rural communities, including those outside of current Ending the HIV Epidemic counties.

P147 Comparing Communities Based on Population Density to Inform Meal Kit Intervention Recruitment of Families with Low Income

<h3>Background</h3> Best practice for community-based interventions includes partnering with community stakeholders for study design, implementation, and evaluation. Successful recruitment of families with low income into these studies requires an understanding of community characteristics, potential barriers to participation, and recruitment strategies. Local stakeholder advisory committees are critical for this process as community needs and residents differ. <h3>Objective</h3> To compare stakeholder perceptions of community characteristics and suggested recruitment strategies for participation in a healthy meal kit intervention for families with low income for three Florida communities (rural, suburban, and urban) with a high prevalence of food insecurity. <h3>Study Design, Setting, Participants</h3> Community stakeholders, referred by established partners, from rural (n = 10), suburban (n = 9), and urban (n = 10) neighborhoods participated in six semi-structured focus groups and completed a demographic survey. <h3>Measurable Outcome/Analysis</h3> Meetings were audio-recorded, transcribed verbatim, coded, and categorized by two researchers to identify common themes. Perceived community characteristics and suggested recruitment strategies were compared using cross-tab analysis. <h3>Results</h3> Stakeholders (11 male, 17 female, 1 preferred not to answer) were 50.2 ± 12.9 years old, primarily non-Hispanic (89.7%) and white (65.5%). All stakeholders work in their respective communities and resided (n = 9) there for an average of 35.3 ± 21.0 years. Most (62.1%) had never purchased a meal kit. A similar community characteristic theme across all three groups was financial instability, although both rural and urban participants identified difficulty accessing fresh fruits and vegetables (F&V). Suburban and urban participants described their communities as diverse in age, culture, and/or spoken languages. Rural and urban stakeholders discussed local initiatives to increase fresh F&V access while suburban and urban stakeholders highlighted intracommunity partnerships. Recruitment strategies were more similar than not. All stakeholders suggested connecting with media outlets, schools, and faith-based and community organizations. Rural and urban stakeholders suggested presentations on the study. Suburban stakeholders suggested partnering with government agencies. <h3>Conclusions</h3> Community-specific nuances should be considered when recruiting for a healthy, community-based meal kit intervention intended to increase access to healthy foods for families with low income. <h3>Funding</h3> Walmart Foundation

The Effects of Lifestyle on COVID-19 Vaccine Hesitancy in the United States: An Analysis of Market Segmentation.

The aim of this study is to correlate lifestyle characteristics to COVID-19 vaccination rates at the U.S. County level and provide where and when COVID-19 vaccination impacted different households. We grouped counties by their dominant LifeMode, and the mean vaccination rates per LifeMode are calculated. A 95% confidence interval for both the mean and median vaccination rate for each LifeMode is generated. The limits of this interval were compared to the nationwide statistics to determine whether each LifeMode’s vaccine uptake differs significantly from the nationwide average. We used Environmental Systems Research Institute Inc. (ESRI) Tapestry LifeModes data that are collected at the U.S. household level through geodemographic segmentation typically used for marketing purposes. High risk Lifestyle segments and their locations are clearly the areas in the U.S. where the public might benefit from a COVID-19 vaccine. We then used logistic regression analysis to predict vaccination rates using ESRI’s tapestry segmentation and other demographic variables. Our findings demonstrate that vaccine uptake appears to be highest in the urban corridors of the Northeast and the West Coast and in the retirement communities of Arizona and Florida and lowest in the rural areas of the Great Plains and Southeast. Looking closely at other parts of the West such as the Dakotas and Montana, counties that contain Native American reservations have higher vaccination rates. Racial/ethnic minorities also adopt the vaccine at higher rates. The most effective predictor of vaccination hesitancy was Republican voting habits, with Republican counties less likely to take the vaccine. The other predictors in order of importance were college education, minority race/ethnicity, median income, and median age. Our approach correlating lifestyle characteristics to COVID-19 vaccination rate at the U.S. County level provided unique insights into where and when COVID-19 vaccination impacted different households. The results suggest that prevention and control policies can be implemented to those specific households.

Advancing a hyperlocal approach to community engagement in climate adaptation: Results from a South Florida pilot study in two communities

With increasing urgency of local and regional climate adaptation, there is a growing need for governments to identify and respond effectively to the concerns of communities they serve and to align investments. We designed and piloted a novel hyperlocal method for urban adaptation planning combining two social science tools that have been widely but separately used to foster community engagement and strategize solutions. Our not-for-profit community partners facilitated multi-session online workshops with participants from two communities in South Florida with whom they have well-established relationships and in which socio-economic conditions and climate risks represent notable vulnerabilities. The workshops first employed photovoice to elicit individual narratives about climate change impacts; participants then followed a design thinking protocol to critically evaluate the leading concerns they identified and propose adaptation solutions. Geospatial mapping and data tools were provided for participants to gain additional tools and further knowledge. Local planning and resilience officials attended some or all of the workshops as observers and interlocutors, dialoguing with participants. Comparative analysis revealed differences in risk awareness and primary concerns between communities, and further demonstrated that concerns and solutions proposed by members of at-risk neighborhoods do not always align with geospatial data that often drives infrastructure adaptation planning in the region, suggesting that more widespread use of community engaged methods could enhance government climate adaptation responses for local communities.

Accelerating sea-level rise and the fate of mangrove plant communities in South Florida, U.S.A.

Analysis of four South Florida tide gauges, with records ranging from 27 to 116 yrs., indicate the average rate of sea-level rise has accelerated from 3.9 mm yr−1 (1900–2021) to 6.5 mm yr−1 (2000−2021), and 9.4 mm yr−1 over the past decade. Future rates are forecast to accelerate over the duration of this century. A predictive conceptual framework (model) was developed in which the resilience of South Florida mangrove plant communities is solely a function of the rate of sea-level rise and vertical sediment accumulation. The model was verified using historical (e.g., 1900–2021) and recent (e.g., 2000–2021) sediment accumulation rate data derived using three different methodological approaches. Results indicate by 2040–2050 South Florida mangrove plant communities, already subjected to the destabilizing effects of accelerating sea-level rise for decades, will begin a widespread conversion to estuarine conditions. This will initially trigger the formation and expansion of inundation ponds, as is already occurring in the study area. By the end of this century, most mangrove forested areas will be submerged. The loss of other coastal wetlands (e.g., brackish marsh) is also likely because their rates of sediment accumulation are lower than mangrove. The findings of this study are consistent with other resilience projections that have been conducted in South Florida and at the global scale. Several knowledge gaps were identified which must be filled to improve confidence in subsequent forecasts and the outcome of mitigation efforts undertaken to enhance resilience. These include the lack of (1) sediment accumulation data representative of transitional and freshwater wetlands, (2) a robust understanding of post-depositional processes (e.g., compaction) that can compromise resilience through shallow (~1 m) subsidence, and (3) recent sediment accumulation data necessary to determine how South Florida coastal wetlands have responded to a sustained acceleration in the rate of sea-level rise over the last decade.

International Medical Graduates and practice rates in underserved communities in Florida

International Medical Graduates and practice rates in underserved communities in Florida

Leveraging Informal Learning Pedagogies to Empower Coastal Communities for Disaster Preparedness

With the increasing frequency and intensity of hurricanes, people and communities within hurricane-prone zones are often overwhelmed and lack effective preparedness in terms of social connectivity critical for making proactive decisions to survive anticipated disasters. Disaster management agencies traditionally share preparedness guidelines through formal educational and other public media channels (such as academic institutions, articles, and the Federal Emergency Management Agency, etc.) only. However, such formal modalities seldom consider the socio-economic status, cultural background, diversity, and education level of communities. Consequently, vulnerable communities are challenged by poor inclusive accessibility, lack of receptiveness, and responsiveness. An Informal Learning Pedagogy (ILP) for hurricane preparedness can be a practical solution to disseminate knowledge on preparedness and hurricane impacts at the community level through nurturing enthusiasm to learn from one another within the community setting, which causes ripple effects that are more profound within a diverse community. This approach would effectively support educating more people about hurricane preparedness. The main objectives of this study are: 1) to assess the hurricane preparedness awareness of people living in a hurricane-prone coastal community in South Florida, United States; 2) to investigate the applicability of adopting novel ILP mechanisms for a disaster-prone community and; 3) analyze and plan for the development of online community-centered hurricane preparedness training with a primary focus on preparedness, warning, evacuation, and early recovery. Developing training modules focused on disaster preparedness through informal learning environments depends on incorporating actual community requirements, which reflect audience-centered needs as part of enhancing the resilience capacity of coastal communities. As such, in this study, an online questionnaire survey focusing on the validation of the research hypothesis was designed and conducted among South Florida residents. The survey data results indicated that participation in disaster-preparedness training through informal modalities highly depends on the length of an individual’s stay in a disaster-prone zone, anticipated benefits of disaster education, and the availability of online training. This research study contributes to the disaster preparedness and response bodies of knowledge by identifying informal ways of communicating hazard preparedness knowledge to advance the resilience capacities in disaster-prone communities.

Patient acceptance of HIV rapid testing in the dental care setting

ABSTRACT Dental settings are untapped venues to identify patients with undiagnosed HIV who may otherwise lack testing opportunities. Perceived lack of patient acceptance has been a significant barrier limiting dentists’ willingness to offer HIV testing. This study implemented rapid HIV testing in dental settings located in an HIV prevalent region to evaluate patient acceptance. Two South Florida community health centers implemented routine oral rapid HIV testing as part of clinical practice, followed by exit interviews with patients immediately after to determine patient acceptance. The binary primary outcome was patient’s acceptance of the rapid HIV test. Multivariable logistic regression assessed associations between patient characteristics and acceptance. Overall acceptance by dental patients (N = 600) was 84.5%. Patients who were more likely to participate in other medical screenings in dental settings were more than twice as likely to accept the test compared to those who were neutral/less likely (OR: 2.373; 95% CI: 1.406–4.004). Study findings highlight the high patient acceptance of HIV testing in dental settings. Widespread implementation of such testing will require an expanded societal view of the traditional role of the dentist that will embrace the potentially valuable role of dentistry in preventive health screenings and population health.

Abstract 240: Leveraging Health Equity Data To Drive Public Health And Health Care Practice, 2010-2020

Objectives: Increasing the understanding of the variety of data sources around health equity that are available and how to use these data to drive public health and health care practice is critical to address inequities and improve health outcomes. The social determinants of health (SDOH), factors related to where people live, work, play, and age, are strongly tied to health outcomes. Primary and secondary SDOH can be used to understand the context of the issues faced at the individual and community levels and can help inform appropriate interventions and support the connection to available resources. Methods: The Heath Equity Profile, available from the public facing Florida Community Health Assessment Resource Toolset (FLHealthCHARTS) website, contains over 150 indicators at the county-level related to demographics, income and employment, housing, education, risk behaviors, access to care, access to food, and various health outcomes, including prevalence, incidence, morbidity, and mortality. The indicators contained in the Health Equity Profile were used to identify counties with the largest SDOH disparities and largest burden of poor health outcomes for several initiatives focused on increasing community-clinical linkages and leveraging cross-sector partnerships to address health outcomes. Findings: Public health initiatives focused on hypertension, diabetes, and heart disease have leveraged the data contained in the Health Equity Profile to select geographic areas for implementation. Using these data, interventions were able to be deployed in areas with the greatest need and opportunity to benefit. Understanding the conditions under which individuals live is critical to the successful implementation of both public health and health care improvement efforts. Various data sources are widely available that can provide additional context and guidance for the development of tailored interventions to improve individual and population health.

Factors Influencing Healthcare Utilization Among Patients at Three Free Clinics.

Despite improvements in healthcare for uninsured persons, health disparities remain. We surveyed patients at three free clinics in an urban Florida community to better understand the factors that influence where they seek healthcare. Survey questions were developed based on factors previously demonstrated to affect healthcare utilization. A focus group validated the instrument. Patients self-administered written surveys over a 6-week period at three free clinics, including a student-run free clinic (SRFC). Results were compiled and analyzed using Chi-square and Fisher-Freeman-Halton Exact tests, Kruskal-Wallis test, Mann-Whitney U test, and Spearman's rho, as appropriate. Odds ratios were calculated for significant findings (p < 0.05). Patients completed 323 surveys. Free clinic visit frequency was positively related to female gender, Hispanic ethnicity, higher income, and poorer health. Black race was related to less frequent visits. Visit frequency differed among the clinic sites. Patients attending a SRFC were more likely to utilize another clinic. Patient satisfaction was not related to visit frequency. Seeking care at other clinics was related to employment. Emergency room utilization was positively related to male gender. Patients listed proximity and ability to receive care not offered at the free clinic as the primary reasons for seeking care at another clinic. In this sample, free clinic utilization was related to demographic and community factors. Free clinics should consider these factors when designing their care delivery. SRFC's should further evaluate how they function in the safety net.

149 Understanding vaccine hesitancy among underserved communities in South Florida – an effort by the Florida Community-Engaged Research Alliance Against COVID-19 in Disproportionately Affected Communities (FL-CEAL) to address vaccine uptake disparities in the COVID-19 pandemic.

OBJECTIVES/GOALS: The goal of this project is to understand vaccine hesitancy and barriers to COVID-19 vaccine uptake among underserved communities in South Florida, to promote vaccine awareness, and to tailor education and communication based on the findings, in partnership with local community-based organizations. METHODS/STUDY POPULATION: By partnering with local community organizations, leaders, faith groups, and other trusted sources, the FL-CEAL teams will conduct a nationally developed CEAL survey in minority communities in South Florida to understand vaccine hesitancy and barriers, conduct outreach activities such as webinars and virtual townhalls to address hesitancy and promote vaccine uptake, and develop and disseminate educational materials and social media communications based on findings. The communities in South Florida include the Latinx farm working community, Latinx sexual/gender minorities, and Haitian and Black populations in South Florida. RESULTS/ANTICIPATED RESULTS: Early findings have indicated that hesitancy drivers vary among specific communities, while lack of trust is an overall barrier. Over 100 outreach activities have been conducted, including events with subject matter experts and community partners addressing vaccines. A credit-earning Community Health Worker (CHW) curriculum on COVID vaccine hesitancy was created in partnership with the Miami CTSI and the Florida CHW Coalition and has been delivered to over 200 Florida CHWs. The training focuses on evidence-informed best practices for CHWs to increase vaccine acceptance. At least 350 surveys will be conducted to understand beliefs and concerns around COVID-19 vaccines, and tailor education materials and communication strategies. DISCUSSION/SIGNIFICANCE: The FL-CEAL Alliance has successfully leveraged their ongoing state-wide effort at addressing COVID-19 disparities to focus on COVID vaccine hesitancy in minority communities and leveraged data and findings to inform community-specific approaches in addressing some of those barriers.