Iowa Community Research Articles

Community pharmacist encounters with patients displaying suicide warning signs: a cross-sectional survey

BackgroundMental health is a prominent public health issue exacerbated by the coronavirus disease 2019 pandemic. Community pharmacists are positioned to contribute. ObjectivesThis study aimed to describe Iowa community pharmacists’ encounters, confidence, behaviors, and training needs related to patients with suicide warning signs and explore relationships between demographics and previous training with encounter frequency, confidence, and behaviors. MethodsA cross-sectional survey was mailed to a sample of community pharmacists in Iowa. Three contacts were made between May and June 2022 including a prenotification letter, survey with a paid return envelope, and reminder postcard, each with a QR code for optional online completion. The survey included demographics, suicide warning sign encounter types, confidence, suicide prevention behaviors, and suicide prevention training history and needs. Analysis of variance and t tests compared differences between demographics and previous training with encounter frequency, confidence, and behaviors. ResultsThe response rate was 18.3% with 161 survey completions. Pharmacists reported encounters with patients who appeared distressed (96.3%), made concerning statements related to suicide (23.8%), and disclosed suicidal thoughts (8.8%). A minority of pharmacists had asked patients about suicide (21.1%) or referred them to crisis resources in the past year (17.4%). A third had previous suicide prevention training (37.9%), which was associated with higher levels of confidence (P < 0.001) and intervention behaviors (P < 0.05). Respondents expressed interest in training, particularly on intervention and referral. ConclusionsThis sample of community pharmacists encountered patients with suicide warning signs. Providing more pharmacists with training and support in understanding local mental health resources and referrals may increase their confidence and engagement in suicide prevention.

Projected changes in annual maximum discharge for Iowa communities

Understanding the projected changes in annual maximum peak discharge is important to improve resiliency in water resource planning and design at the community level. Currently, much of the literature on climate change impacts focuses on analyses at the regional scale. In this study we use a hydrologic model to evaluate the projected changes in annual maximum peak discharge at the community-level across Iowa under two emission scenarios, Representative Concentration Pathway 4.5 and 8.5 (RCP4.5 and RCP8.5). We utilize climate forcings from global climate models part of the Coupled Model Intercomparison Projected Phase 5 (CMIP5) from 1950 to 2100. Our simulations show a detectable increase in annual maximum discharge for 27% of Iowa’s communities under RCP8.5. However, under RCP4.5 none of the communities are projected to face an increase in annual maximum discharge by the end of the 21st century; furthermore, precipitation intensity under this scenario is not projected to increase in the latter half of the 21st century. Our results point to a larger increase in precipitation intensity and annual maximum discharge under RCP8.5 compared to RCP4.5, especially in the second half of this century. The projected flood peak distributions tend to become statistically different from the historical ones later in the 21st century under RCP8.5 than under RCP4.5. This study provides a basis for analyzing climate change impacts at a local decision-making scale.

The association of forced expiratory volume in one second with occupational exposures in a longitudinal study of adults in a rural community in Iowa.

The Keokuk County Rural Health Study (KCRHS) is a longitudinal population-based study conducted in rural Iowa. A prior analysis of enrollment data identified an association of airflow obstruction with occupational exposures only among cigarette smokers. The current study used spirometry data from all three rounds to investigate whether level of forced expiratory volume in one second (FEV1) and longitudinal change in FEV1 were associated with occupational vapor-gas, dust, and fumes (VGDF) exposures, and whether these associations were modified by smoking. This study sample comprised 1071 adult KCRHS participants with longitudinal data. A job-exposure matrix (JEM) was applied to participants' lifetime work histories to assign exposures to occupational VGDF. Mixed regression models of pre-bronchodilator FEV1 (millimeters, ml) were fit to test for associations with occupational exposures while adjusting for potential confounders. Mineral dust had the most consistent association with change in FEV1, including ever/never ( - 6.3ml/year) and nearly every level of duration, intensity, and cumulative exposure. Because 92% of participants with mineral dust also had organic dust exposure, the results for mineral dust may be due to a combination of the two. An association of FEV1 level with fumes was observed for high intensity ( - 91.4ml) among all participants, and limited to cigarette smokers with results of - 104.6ml ever/never exposed, - 170.3ml high duration, and - 172.4ml high cumulative. The current findings suggest that mineral dust, possibly in combination with organic dust, and fumes exposure, especially among cigarette smokers, were risk factors for adverse FEV1 results.

162 Building a Pandemic-Responsive, Community-Engaged Research Program to Advance Health Equity for Persons with Diabetes

OBJECTIVES/GOALS: Diabetes mellitus and COVID-19 have converged to form a syndemic. Our team sought to identify and respond to the evolving needs of patients and communities affected by diabetes amid the COVID-19 pandemic and to engage community partners and student leaders in the advancement of health equity research and practice in the state of Iowa. METHODS/STUDY POPULATION: A team of faculty, staff, students, and community partners was assembled to facilitate, design, and implement mixed methods research related to diabetes care in collaboration with more than five sites in Eastern and Western Iowa during the pandemic, with a focus on potentially preventable complications such as diabetes-related foot ulcers and amputations in adult patients. Attention was directed towards the experiences of rural residents, persons working in frontline occupations during the pandemic, persons from minoritized racial or ethnic groups, and persons who speak Spanish. RESULTS/ANTICIPATED RESULTS: A semi-structured interview study about diabetes care revealed themes in the experiences of persons with diabetes during the pandemic. A pilot study of an educational tool called the Foot Book among patients and providers demonstrated the potential for use of this tool in health care and community settings to reduce gaps in diabetes foot care. All study materials and activities were offered in English and Spanish. Study results were combined with input from community partners to develop ongoing interventions to improve care in Iowa communities. DISCUSSION/SIGNIFICANCE: Amid the syndemic of COVID-19 and diabetes, urgent action is needed to mitigate health inequities and prevent further acceleration of these inequities. Our team developed a community-engaged, patient-centered, and student-led research program that can respond to the needs of patients and communities in the pandemic era.

Predicting resident satisfaction with public schools in small town Iowa

Estimates of resident satisfaction with public education have great utility in public administration, especially among decision makers in shrinking small communities. But such estimates are typically obtained via surveys, which are costly and often unreliable at high spatial resolutions given low response rates. Our study found that satisfaction with public schools among residents of small communities can be reasonably estimated at the community level using public data. Several models generalized adequately to unseen data—these models typically included the following covariates: state student assessment scores, school reorganizations, net open enrollment, and the cost of educational outcomes relative to neighboring districts. Our findings thus amount to a cost‐effective survey alternative for gauging satisfaction with public schools in small Iowa communities.

The impact of farm animal exposures on Campylobacter jejuni antibody levels in rural agricultural communities of Iowa, USA

BACKGROUND AND AIM: Campylobacter infections transmitted primarily through improperly cooked meat are the leading bacterial cause of diarrhea worldwide. How exposures to farm animals and animal waste (e.g., through occupational contact or residential proximity to animal feeding operations [AFOs]) contribute to infections has been relatively understudied. METHODS: We measured antibodies against Campylobacter jejuni using an enzyme-linked immunosorbent assay in participants from Iowa in the Biomarkers of Exposure and Effect in Agriculture study (n=304 farmers; n=146 non-farming controls from similar communities). Participants self-reported occupational animal contact within the past year. We used a statewide database of permitted AFOs that included animal counts standardized by animal size and manure production to characterize the intensity of AFO exposure within 5km of participants’ residences. We performed linear regressions of log-transformed optical density units (ODs) for immunoglobulin (Ig) A, G, and M antibody levels in relation to occupational animal and low/high AFO exposures, using non-farming controls with low AFO exposure (n=96) as the referent group. We adjusted for age, season, and other potential confounders. We further examined antibody levels by occupational contact with specific animal types. RESULTS: Occupational animal contact was associated with elevated IgA and IgG OD levels in those with low AFO exposure (geometric mean ratio [95% confidence interval]; IgA:1.34[1.07-1.67]; IgG:1.34[1.13-1.57]) as well as those with high AFO exposure (IgA:1.48[1.12-1.95]; IgG:1.34[1.09-1.65]). Antibody levels were higher in farmers raising poultry (IgA:2.20[1.03-4.71]; IgG:2.11[1.35-3.32]), swine (IgA:1.52[1.04-2.22]; IgG:1.50[1.17-1.94]), and dairy cattle (IgG:1.65[1.18-2.31]), particularly for IgG levels in those who reported spending time in poultry (2.29[1.25-4.19]) or swine (1.63[1.25-2.12]) confinements within the past month. We found no significant relationships between occupational animal contact and IgM or AFO exposure alone and any antibody levels. CONCLUSIONS: Occupational animal contact may be a stronger determinant of C. jejuni exposure than residential proximity to AFOs in agricultural communities. KEYWORDS: Campylobacter, animal exposures

Enhancing African American Youth Academic Success

In the state of Iowa, persistent disparities exist between the academic performance of African American youth and the overall student population. Communities in Iowa thus have a critical opportunity to promote academic success among African American youth. With the goal of addressing these disparities in education, we evaluated how best to collaborate with African American residents to build upon the strengths of families and to create new initiatives or modify existing programs to improve educational success. Community leaders, Iowa State University faculty, and university Extension and Outreach staff recruited 45 parents raising African American youth as well as experienced African American educators living in the community. These individuals participated in a series of study circles and action forums and shared their experiences and recommendations for strengthening educational programming for African American youth in the county. Their guidance informed program content, delivery approaches, implementation strategies, and outreach to the African American community in Iowa. Findings may be transferable to other contexts.

Flood risk assessment and quantification at the community and property level in the State of Iowa

Flood risk assessment contributes to identifying at-risk communities and supports mitigation decisions to maximize benefits from the investments. Large-scale risk assessments generate invaluable inputs for prioritizing regions for the distribution of limited resources. High-resolution flood maps and accurate parcel information are critical for flood risk analysis to generate reliable outcomes for planning, preparedness, and decision-making applications. Large-scale damage assessment studies in the United States often utilize the National Structure Inventory (NSI) or HAZUS default dataset, which results in inaccurate risk estimates due to the low geospatial accuracy of these datasets. On the other hand, some studies utilize higher resolution datasets, however they are limited to focus on small scales, for example, a city or a Hydrological United Code (HUC)-12 watershed. In this study, we collected extensive detailed flood maps and parcel datasets for many communities in Iowa to carry out a large-scale flood risk assessment. High-resolution flood maps and the most recent parcel information are collected to ensure the accuracy of risk products. The results indicate that the Eastern Iowa communities are prone to a higher risk of direct flood losses. Our model estimates nearly $10 million in average annualized losses, particularly in large communities in the study region. The study highlights that existing risk products based on FEMA's flood risk output underestimate the flood loss, specifically in highly populated urban communities such as Bettendorf, Cedar Falls, Davenport, Dubuque, and Waterloo. Additionally, we propose a flood risk score methodology for two spatial scales (e.g., HUC-12 watershed, property) to prioritize regions and properties for mitigation purposes. Lastly, the watershed-scale study results are shared through a web-based platform to inform the decision-makers and the public.

Midwives' Perspectives about Vitamin K Prophylaxis Against Vitamin K Deficiency Bleeding of the Newborn.

BackgroundThe American Academy of Pediatrics recommends one intramuscular (IM) vitamin K injection at birth to prevent Vitamin K Deficiency Bleeding of the Newborn (VKDB). Among factors associated with IM vitamin K refusal, investigators have reported an increased frequency of IM vitamin K refusal among parents who select midwife-assisted deliveries. Reasons behind this association are unclear.MethodsTo understand the perspectives of midwives on IM vitamin K prophylaxis and approach to counseling parents using qualitative methodology, we conducted in-depth semi-structured interviews of midwives associated with 3 tertiary academic medical centers and surrounding communities in Connecticut, Iowa and Michigan. We used the grounded theory approach and the constant comparative method until saturation was reached.ResultsWe interviewed 19 white female midwives from different training pathways. Participants who were Certified Nurse Midwives (CNMs) routinely recommended IM vitamin K prophylaxis and Certified Professional Midwives (CPMs) took a more neutral approach. The following 4 themes emerged: (1) Emphasis on an educational approach to counseling that supports parents’ decision-making authority; (2) Low-intervention philosophy in the midwifery model of care attracts certain parents; (3) Need for relationship building between midwives and pediatricians and (4) Opportunities for the future.ConclusionsMidwives in our study perceived that the midwifery model of care, the focus on physiologic birth and prioritizing parents’ decision-making autonomy appears to attract a sub-set of expectant parents with certain belief systems who question interventions such as IM vitamin K prophylaxis. There are opportunities for better collaboration between midwives and pediatricians.

Sex differences in growth in body mass and psychosocial abilities in children in Head Start

ABSTRACT Early childhood is a critical period to intervene for obesity, developmental and behavioural problems. Data from 1065 children in 14 Northeast Iowa Community Action Head Starts (HS) were collected between 2011 and 2018. Body mass index (BMI) and developmental scores were assessed at the beginning of each school year and compared after the first year in HS. Females showed a 3.5% decrease in BMI percentile (F = 2.46, P = .12, = .02), while males increased theirs by 4.4% (F = 7.41, P = .007, = .05). Females showed higher initial passing rates than males on the Brigance (85.9% vs 75.7%, p = .006), self-help (64.7% vs 49.1%, p = .001), but not socio-emotional outcomes. Females in HS showed a slight decrease in BMI, compared to a significant increase in males. Improvements in developmental and behavioural outcomes were similar for both. Further research should determine why such differences occurred.

Collateral Benefits of Evidence-Based Substance Use Prevention Programming During Middle-School on Young Adult Romantic Relationship Functioning.

The quality of romantic relationships formed during early adulthood has critical implications for physical andpsychological wellbeing,futureromantic relationships,and subsequent parenting of the next generation. The present study evaluates the cross-over effects of the PROSPER-delivered adolescent substance use prevention programming on young adult romantic relationship functioning through a long-term developmental cascade of adolescent skills and behaviors, along with subsequent family-of-origin functioning. Prospective, longitudinal, bivariate growth models were used to analyze the effects of the PROSPER-delivered interventions in a sample of 1008 youths living in rural and semi-rural communities in Iowa and Pennsylvania, starting in sixth grade (AgeM = 11.8; 62% female) who were in a steady romantic relationship at the young adult assessment (AgeM = 19.5). Findings indicated a cascading effect through which PROSPER promotes adolescent problem-solving skills during early-to-mid-adolescence; problem-solving skills were associated with better family functioning during mid-adolescence; and family functioning was associated with better romantic relationship quality, indicated by lower levels of relationship violence and more effective relationship problem-solving in young adulthood. PROSPER, which primarily targets adolescent substance misuse and conduct problem prevention, has lasting, collateral effects that benefit young adults in their romantic relationship functioning - which may have further downstream benefits for their own relationships and those of their children (i.e., intergenerational transmission effects). These findings add to the growing body of literature evidencing important cross-over effects of widely disseminated substance use prevention programs delivered during adolescence.

Voluntary Association Participation and White Ethnic Diversity in Rural Iowa Communities

Membership in voluntary associations is of core importance to civil society. In this study, I build on the large literature that focuses on how community racial/ethnic diversity affects individuals’ joining of—and participation within—voluntary associations. The central focus is on White ethnicity or European ancestry, which I analyze using the 2004 Iowa Community Survey and 2000 U.S. Census data. I find that White ethnic diversity is associated with fewer overall memberships and less frequent participation, with differing effects for various large groupings of voluntary organizations. I close our study by discussing the implications of my findings for organizations and the broader community.

Relationships between consultant discipline and specified tree diversity: A case study of two Iowa (USA) communities

Urban forests are valuable assets to a community from multiple perspectives. Diversifying urban forests is a common and important management goal to increase resilience in the face of biotic pests and diseases, climate change, and to increase ecosystem services. Multiple design and engineering consultants develop site plans and specify trees for public and private projects, and consultant disciplines differ in their training plant material selection and diversity. Publicly available site plans from Des Moines (79) and Iowa City, Iowa, USA (70) between 2015–2018 that passed planning and zoning review were analyzed to determine the associations between practitioner disciplinary training and the diversity of specified trees at site, city, and landscape scales. We found that consultant discipline was not related to the alpha diversity of a site until site size was greater than 2.42 ha, then civil engineers were associated with lower tree diversity than other consultants. Landscape architects completed a majority of the project plans (43 %), specified the most trees (62 %), and utilized the most diverse plant palette, including 30 species not used by other consultants. However, landscape architects also frequently specified clonally produced cultivars (62 % of all selections) which may limit genetic diversity at a landscape scale, thus potentially undermining diversification efforts by repeating genotypes. Findings from this study suggest that messages pertaining diversification efforts, plant selection, and reduction of genetic diversity resulting from cultivar specification are important for all consultants, but especially for landscape architects who were responsible for specifying a majority of trees and sites. This case study of two Iowa (USA) communities provides evidence of landscape-scale diversity outcomes associated with consultant discipline and the potential for use of public site plan documents to assess such relationships. Further research is needed to determine if these findings are generalizable to other municipalities or states.

Using social media to navigate changing rural markets: the case of small community retail and service businesses

To help small firms navigate changing rural markets, this study investigated how small businesses use social media to expand their customer and stakeholder networks to sustain their businesses. Focus group interviews with owners of small retail and service businesses were conducted in three selected rural Iowa communities. Our findings indicate that social media is an innovative marketing tool to promote interactive, collaborative, and personalized interactions with customers and stakeholders. These interactions enabled small businesses to attract new customers and foster commitment to the business. In addition, reciprocal relationships with stakeholders leveraged social media content creation and fostered social capital formation. However, social media integration poses challenges for many small businesses, due to operational, economic, infrastructural, legal and regulatory, and psychological factors. Our findings highlight education, legal and regulatory guidelines and policies, tools to measure the effectiveness of social media on marketing, and business assistance and support for small businesses to utilize social media to build customer and other business support networks. Implications support the potential for social media to enhance online interactions for these small firms, leading to the development of social capital, a valuable source of competitive advantage and business sustainability in rural markets.

The Flora of a Mesic Forest Remnant in Iowa's Paleozoic Plateau: Malanaphy Springs State Preserve (Winneshiek County, Iowa)

We present the results of a floristic inventory and qualitative descriptions of the forest communities occurring in Malanaphy Springs State Preserve (MSSP), located in the Paleozoic Plateau of northeastern Iowa. Most of the 25.9-ha preserve is a mature mesic to dry-mesic deciduous forest community occurring on a steep slope adjacent to the Upper Iowa River. The preserve also contains a small floodplain forest as well as a small highly disturbed forest on the upland. We documented 422 plant taxa in our surveys, including 52 non-vascular taxa, 14 seedless vascular taxa, 3 gymnosperms, and 353 angiosperms. Eighty-seven percent of the vascular plant taxa are native, and 21% of the species have an Iowa coefficient of conservatism score of 7 or higher. Five species are listed by the Iowa Department of Natural Resources as endangered, threatened, or of special concern in the state. This survey provides critical baseline data needed to document future changes in the plant communities of MSSP. We conclude that this preserve is an important example of high-quality mesic deciduous forest communities in Iowa. We further conclude that the species diversity of the preserve is threatened by the cumulative impacts of habitat loss, high levels of deer herbivory, invasive species, nitrogen deposition, and climate change and that active management and strategic policy decisions will be needed to preserve native plant species diversity.

COVID‐19 and the Marshallese

<scp>COVID</scp>‐19 and the Marshallese

Trust and White Ethnic Diversity in Small Town Iowa

ABSTRACT Trust is a highly valued social good and scholars have long been interested in what shapes who and how we trust. One line of inquiry within this area has focused on racial/ethnic diversity. In this study, we use the 2004 Iowa Community Survey to focus on European ancestry as a form of white ethnic diversity. We find that white ethnic diversity consistently decreases trust, across several indicators. Our study expands scholars’ understanding of the ethnic landscape of rural America and what such divisions in the United States mean for trust.

Evaluation of a Falls and Fire Safety Program for Community-Dwelling Older Adults.

Remembering When™ (RW) is a falls and fire prevention program delivered by fire service personnel and homecare organizations to help older adults live safely at home for as long as possible. This study evaluated changes in falls prevention and fire safety behaviors and perceptions and social support associated with falls and residential fires among older adults following delivery of the RW program by fire service personnel. In a convenience sample of adults 65 + years residing in five Iowa communities, 70 received the RW program during a home visit and 75 received the RW program in a group presentation followed by a home visit. Baseline and follow-up telephone interviews were conducted to assess changes in falls and fire safety behaviors, perceptions and social support. Changes were assessed using McNemar's exact test and paired sample t-tests. To control for dependence of 26 households with two participants, one participant was randomly selected and included in the analysis (n = 119). The RW program improved falls and residential fire prevention behaviors among older adults. Perceived efficacy to prevent falls increased from baseline (p = 0.047). Perceived susceptibility (p = 0.021) and control of fires (p = 0.000) increased while perceived severity (p = 0.025) and fear of residential fires (p = 0.019) decreased when compared to baseline. The proportion of participants reporting discussing falls with friends and family increased (p < 0.001), and more participants reported discussing fire prevention with healthcare professionals (p = 0.039). Fire service personnel can be effective deliverers of falls prevention information to older adults.

Iowa community pharmacies’ experiences with Medicaid managed care

ObjectivesTo describe Iowa community pharmacies’ experiences and satisfaction with the transition to Medicaid managed care and conduct a qualitative evaluation of the effect of Medicaid managed care on 3 independent community pharmacies. DesignCross-sectional descriptive study. Mixed methods were used: the quantitative phase was a mailed survey and the qualitative phase involved interviews. Setting and participantsThe mail survey was sent to Iowa-registered community pharmacies whose names and addresses were obtained from the Iowa Board of Pharmacy website. Interviews with pharmacists and other pharmacy staff were conducted at 3 Iowa independent community pharmacies. Outcome measuresPharmacy satisfaction and experiences with the Iowa Medicaid managed care program. ResultsThe 265 returned surveys yielded a 27.4% response rate. Eight pharmacists and pharmacy staff were interviewed in the qualitative phase. Mean satisfaction with the Medicaid managed care organizations (MCOs) was 3.1 on a scale of 1-7, with 1 being extremely dissatisfied, and 7 being extremely satisfied. Respondents were most satisfied with the ease of joining the plans’ pharmacy networks (mean = 4.1) and least satisfied with the availability of payment for nondispensing-related services (2.3), plans’ communication with patients (2.7), and plans’ communication with pharmacies (3.0). Pharmacies also reported problems with patients’ access to prescriptions. The MCOs ranked lowest in satisfaction when compared with the largest private payer, the largest Medicare Part D plan, and the previous state-run Medicaid program. The themes that emerged from the interviews were as follows: confusion caused by multiple MCOs, plan-communication challenges, product-coverage challenges, problems related to durable medical equipment, and payment challenges. ConclusionThe transition from a state-run fee-for-service Medicaid program to Medicaid managed care in Iowa created many challenges for community pharmacies. Different procedures and product coverage across the 3 MCOs were particularly problematic.

Monitoring BMI Trends in a Midwest Regional Head Start Population: The Results of a Healthy Lifestyle Intervention.

BackgroundChildhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population.MethodsRetrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed.ResultsData from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t = 1.83, P = .07, d = .10). There were no statistically significant changes in the percent of overweight (Wald χ2 = .50, P = .48) or obese (Wald χ2 = 1.71, P = .19) children between the first and second year.ConclusionThe FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.