Philadelphia Community Research Articles

Xylazine’s Impacts on the Community in Philadelphia: Perspectives of People Who Use Opioids and Harm Reduction Workers

Background Xylazine is in 99% of the fentanyl supply in Philadelphia, PA and is on the rise throughout the United States. Perspectives about this emerging crisis among people who use opioids (PWUO) and harm reduction workers are lacking. Methods We conducted focus groups with PWUO and harm reduction workers in Philadelphia, PA. Discussions focused on xylazine’s impact on PWUO. Transcripts were coded for thematic analysis. Results Themes across focus groups included xylazine withdrawal, wounds, safety concerns, and overdose response implications. Participants emphasized extreme xylazine withdrawal and the difficulty of withdrawal management. Groups explored potential roles of first responders in addressing xylazine-related wounds. PWUO were receptive to receiving help, but many harm reduction workers expressed reservations about partnering with police. Discussion Results underscore the impact of xylazine withdrawal on PWUO. Emerging information on withdrawal management should be shared among care providers to identify optimal protocols. Safety-planning with PWUO should be explored, but structural interventions are imperative. While there may be a role for first responders in delivering harm reduction interventions, it is important to recognize historical harms by first responders against PWUO.

Developing a city-wide, community-engaged cancer disparities research agenda.

In response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clinical cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered. Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship, and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3's Stakeholder Advisory Committee. Stakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: communication between patients, providers, and caregivers; education that reaches patients and community members with tailored and targeted information; navigation that assists people in finding and accessing the right cancer screening or treatment option for them; and representation that diversifies the workforce in clinics, cancer centers, and research offices. A community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians.

An implementation evaluation of a sports-based health intervention for underrepresented middle school youth in Philadelphia.

Multicomponent, community-based programs aiming to improve health behaviors in youth are needed but can be challenging to implement. Research is needed to better understand the factors that facilitate and inhibit effective implementation of these programs especially for youth at increased risk of health disparities. This study aimed to identify and explore the implementation determinants and outcomes of a multicomponent health intervention conducted from 2021 to 2022 for middle school students living in underserved communities in Philadelphia, PA, USA. Mixed methods approaches, including self-report surveys and semi-structured qualitative interviews, were administered to 18 members of the implementation staff at the end of the program, including coaches (n = 7), assistant coaches (n = 2), school champions (n = 6), administrative leaders (n = 2), and a school district administrator (n = 1). Survey and interview questions were guided by the Consolidated Framework for Implementation Research (CFIR), and interviews were thematically coded following transcription based on 26 CFIR constructs. Innovation source, evidence strength and quality, cosmopolitanism, and the personal attributes of individuals were key constructs associated with implementation effectiveness. Data revealed three multidimensional themes that highlighted broader challenges influencing implementation: (i) broad consensus, different interpretations, (ii) staffing challenges, and (iii) continuity is key. The need for the program was clearly recognized and overall belief in the purpose of the intervention was strong among key program staff and administration. However, issues including limited engagement with training, staffing turnover, and the rotational programming design hindered implementation. Future projects aiming to implement multicomponent after-school time interventions must ensure a consistent vision among partners and continuity in program delivery.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19.

Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake. The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted. Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents. Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

Book review: The Sanctuary City: Immigrant, Refugee, and Receiving Communities in Postindustrial Philadelphia

Book review: The Sanctuary City: Immigrant, Refugee, and Receiving Communities in Postindustrial Philadelphia

Dismantling Barriers to Hepatitis B and Delta Screening, Prevention, and Linkage to Care among the PWUD Community in Philadelphia.

The prevalence of hepatitis B and delta viruses (HBV/HDV) among people who use drugs (PWUD) remains largely unknown. In the context of one Philadelphia-based harm reduction organization (HRO), this study aimed to assess HBV/HDV prevalence and facilitate linkage to care. Participants completed a demographic HBV/HDV risk factor survey and were screened for HBV and reflexively for HDV if positive for HBV surface antigen or isolated core antibody. Fisher's exact tests and regression were used to understand relationships between risks and HBV blood markers. Of the 498 participants, 126 (25.3%) did not have hepatitis B immunity, 52.6% had been vaccinated against HBV, and 17.9% had recovered from a past infection. Eleven (2.2%) participants tested positive for isolated HBV core antibody, 10 (2.0%) for HBV surface antigen, and one (0.2%) for HDV antibody. History of incarceration was associated with current HBV infection, while transactional sex and experience of homelessness were predictive of previous exposure. This study found high rates of current and past HBV infection, and a 10% HBV/HDV co-infection rate. Despite availability of vaccine, one quarter of participants remained vulnerable to infection. Findings demonstrate the need to improve low-threshold HBV/HDV screening, vaccination, and linkage to care among PWUD. The study also identified gaps in the HBV/HDV care cascade, including lack of point-of-care diagnostics and lack of support for HROs to provide HBV services.

Assessing and Improving Data Integrity in Web-Based Surveys: Comparison of Fraud Detection Systems in a COVID-19 Study.

Web-based surveys increase access to study participation and improve opportunities to reach diverse populations. However, web-based surveys are vulnerable to data quality threats, including fraudulent entries from automated bots and duplicative submissions. Widely used proprietary tools to identify fraud offer little transparency about the methods used, effectiveness, or representativeness of resulting data sets. Robust, reproducible, and context-specific methods of accurately detecting fraudulent responses are needed to ensure integrity and maximize the value of web-based survey research. This study aims to describe a multilayered fraud detection system implemented in a large web-based survey about COVID-19 attitudes, beliefs, and behaviors; examine the agreement between this fraud detection system and a proprietary fraud detection system; and compare the resulting study samples from each of the 2 fraud detection methods. The PhillyCEAL Common Survey is a cross-sectional web-based survey that remotely enrolled residents ages 13 years and older to assess how the COVID-19 pandemic impacted individuals, neighborhoods, and communities in Philadelphia, Pennsylvania. Two fraud detection methods are described and compared: (1) a multilayer fraud detection strategy developed by the research team that combined automated validation of response data and real-time verification of study entries by study personnel and (2) the proprietary fraud detection system used by the Qualtrics (Qualtrics) survey platform. Descriptive statistics were computed for the full sample and for responses classified as valid by 2 different fraud detection methods, and classification tables were created to assess agreement between the methods. The impact of fraud detection methods on the distribution of vaccine confidence by racial or ethnic group was assessed. Of 7950 completed surveys, our multilayer fraud detection system identified 3228 (40.60%) cases as valid, while the Qualtrics fraud detection system identified 4389 (55.21%) cases as valid. The 2 methods showed only "fair" or "minimal" agreement in their classifications (κ=0.25; 95% CI 0.23-0.27). The choice of fraud detection method impacted the distribution of vaccine confidence by racial or ethnic group. The selection of a fraud detection method can affect the study's sample composition. The findings of this study, while not conclusive, suggest that a multilayered approach to fraud detection that includes conservative use of automated fraud detection and integration of human review of entries tailored to the study's specific context and its participants may be warranted for future survey research.

Identifying and Addressing Barriers to Screening Mammography in a Medically Underserved Community

Rationale and ObjectivesBreast cancer mortality is 40% higher for Black women compared to White women. This study seeks to assess knowledge of breast cancer screening recommendations and identify barriers to risk assessment and mammographic screening among a medically underserved, low-income, predominantly Black community in West Philadelphia. Materials and MethodsDuring a free mobile mammography screening event, women were offered surveys to assess perceptions of and barriers to breast cancer risk assessment and screening. Among those who subsequently underwent mobile screening, health insurance and time to additional diagnostic imaging and biopsy, when relevant, were retrospectively collected. Results233 women completed surveys (mean age 54±13 years). Ninety-three percent of respondents identified as Black. The most frequently cited barrier to screening mammography was cost and/or lack of insurance coverage (30%). Women under 50 reported more barriers to screening compared to older women. Among those recalled from screening and recommended to undergo biopsy, there was a trend toward longer delays between screening and biopsy among those without a PCP (median 45 days, IQR 25–53) compared to those with a PCP (median 24 days, IQR 16–29) (p=0.072). ConclusionIn a study of a medically underserved community of primarily Black patients, barriers to breast cancer risk assessment, screening, and diagnosis were identified by self-report and by documented care delays. While free mobile mammography initiatives that bring medical professionals into communities can help mitigate barriers to screening, strategies for navigation and coordination of follow-up are critical to promote timely diagnostic resolution for all patients.

Characterizing Lung Cancer Burden Among Asian-American Communities in Philadelphia.

Lung cancer (LC) is the leading cause of cancer death among Asian-Americans. However, there are differences in LC incidence and mortality among Asian racial subgroups. The objective of this study was to describe LC burden and disparities among race/ethnic groups (White, Black, Asian, and Hispanic) across US census tracts (CT) in Philadelphia using the Pennsylvania Cancer Registry dataset (N=11,865). ArcGIS Pro was used to geocode patient addresses to the CT level for linkage to US Census data. Despite being diagnosed more frequently with advanced-stage lung cancer compared with other race and ethnic groups in Philadelphia, Asian patients were most likely to be alive at the time of data receipt. Among Asian subgroups, Korean patients were the oldest (median age 75, p=0.024). Although not statistically different, distant stage disease was the most prevalent among Asian Indian (77.8%) and Korean (73.7%) and the least prevalent among Chinese patients (49.5%). LC was the cause of death for 77.8% of Asian Indian, 63.2% of Korean, 52.9% of other Asian, 48.5% of Chinese, and 47.5% of Vietnamese patients. CTs where Asian individuals were concentrated had lower socioeconomic status and greater tobacco retailer density compared to the entire city. Compared to all of Philadelphia, heavily Asian CTs experienced a greater age-standardized LC incidence (1.48 vs. 1.42) but lower age-standardized LC mortality (1.13 vs. 1.22). Our study suggests that LC disparities exist among Asian subgroups, with Asian Indian and Korean Philadelphians most likely to present with advanced disease. Additional studies are needed to investigate LC among high-risk racial and ethnic groups, including Asian subgroups.

Community stakeholders, communicative geography, and the urban policy process

ABSTRACT We situate this paper within the geographies of policy, and we draw from the Discipline of Planning to conceptualize policy analysis as a communicative act. Blending such ideas with geographical concepts leads us to a place ontology, which recognizes that the policymaker’s life world is rooted in place and thus influences how that person makes professional decisions. We explore these concepts via in-depth, in-person interviews with 15 non-profit/community stakeholders in an exceptionally poor and environmentally distressed community in Philadelphia (USA). Our data provide insight into a subset of the policy-making community, while our results advance understanding of how policy analysis is conducted. This paper demonstrates that the current public policy process ignores an important feature of analysis (i.e., place ontology) – especially when studying a distressed community for which existing methods of analysis may be poorly suited – while simultaneously providing guidance on how to correct this deficiency.

Identifying and addressing barriers to screening mammography in a medically underserved community.

e18685 Background: Breast cancer mortality is 41% higher for Black women than for Non-Hispanic White women. This difference is partly due to disparities in access to high quality screening and timeliness of follow-up of abnormal mammographic findings. This study aimed to identify barriers to mammographic screening and follow-up among a medically underserved, low-income, predominantly Black community in West Philadelphia during a free community screening initiative. Methods: Free breast cancer screening was provided for eligible, average-risk members of the community via a mobile mammography unit for two weeks in June 2022. This initiative was situated as part of a larger, multidisciplinary cancer screening fair that was organized by a collaborative of faculty and staff from our academic hospital and community volunteers. Women attending the fair were offered surveys on access to breast cancer screening. For those who subsequently underwent mobile mammographic screening, health insurance and time to follow-up testing, if needed, were collected from the electronic medical record. Results: 233 women completed surveys (mean age 54±13 years). Among respondents, 93% identified as Black, and 82% reported having a PCP. Of those with a PCP, 55% reported having previously had a breast physical exam, and 56% had been counseled on their personal breast cancer risk. 49% were advised to begin screening by age 40, while the remainder were either counseled to begin at an older age, or were not advised on when to initiate screening. 74% of the cohort endorsed at least one barrier to screening mammography. The most frequently cited barrier was cost and/or lack of insurance coverage (30%), followed by time limitations due to work schedule (21%), fear/anxiety of screening results (20%), fear/anxiety of pain or discomfort (20%), and difficulties with scheduling (19%). Of 181 women who underwent mobile screening mammography, 24 (13%) received a BIRADS 0 assessment, and 11 (6%) went on to undergo breast biopsy. There was a trend toward longer delays between screening and biopsy for women who did not have a PCP (median 45 days, IQR 31–52) compared to those who did (median 24 days, IQR 16–29) (p = 0.072). Three patients who received BIRADS 0 assessments have not yet followed up, all of whom lack health insurance. Conclusions: In this cohort of women from a predominantly Black, medically-underserved community, significant logistical barriers to mammography and follow-up were identified both by self-report and by documented delays in care. Free mobile mammography initiatives that bring medical professionals into the community can help address these barriers, while also providing education and personalized risk assessment. Importantly, sustained engagement is necessary to ensure appropriate follow-up for women found to have additional care needs after screening and is area of future growth for our program.

Soil contamination in community gardens of Philadelphia and Pittsburgh, Pennsylvania.

Community gardens have been seen sprouting up in and around urban settings such as Philadelphia and Pittsburgh over the past several decades. Due to the long histories of industrial activities and urbanization, these soils in urban regions may be at a high risk for various contaminants such as metals and metalloids. Using inductively coupled plasma mass spectrometry (ICP-MS), we measured 7 elements (lead (Pb), zinc (Zn), copper (Cu), vanadium (V), cadmium (Cd), nickel (Ni), and arsenic (As)) in soil samples collected from a total of 21 community gardens in Philadelphia City, Philadelphia suburban areas, and Pittsburgh City during September and October 2021. We found that the city areas in Philadelphia and Pittsburgh had higher elemental concentrations in community garden soils compared to the suburbs. We found that all elements except vanadium were below the Pennsylvania Department of Environmental Protection (PADEP) guidelines. When compared to more stringent Canadian Council of Ministers of the Environment (CCME) guidelines of a maximum of 140mg/kg of lead in the soil, 36% percent of Philadelphia community gardens, 60% of Pittsburgh gardens, and 20% of the Philadelphia suburb gardens exceeded the CCME guideline. In Philadelphiacity, generally, elemental concentrations exhibited a negative trend with increasing distance to historical smelter locations, although a significant correlation was observed for only zinc. We found that the soil from the raised beds had lower concentrations of lead and arsenic, but many of the samples from the raised beds had higher concentrations of zinc, copper, vanadium, and nickel. This discrepancy in raised beds is most likely attributed to these elements being actively deposited in the soil from present day sources such as vehicles on the road and active industrial sites. Understanding and recognizing such variations of these contaminants in community gardens are essential to understanding how industrial legacies and modern pollution continue to put urban communities at a disproportionate risk of health impacts.

Assessment of heavy metal contamination in soil and produce of Philadelphia community gardens

ABSTRACT Urban and ex-urban residents have been increasingly utilizing community gardens to supplement their diets, foster relationships with neighbors and learn new skills. Soils in urban-region community gardens, however, can be detrimental to human health if contaminated with metals. In this study, the soils of 20 Philadelphia-region community gardens (and produce from 6 gardens) were analyzed for heavy metal content (As, Cd, Cr, Co, Cu, Ni, Pb) to assess bioavailability, determine relationships with environmental and demographic variables and compare with published safe limits. About 58% of soil samples and 86% of produce samples were above their respective safe lead level. Metal concentrations in garden produce differed between produce types, with the highest concentrations of As, Cr, Co and Cu found in root and leafy vegetables and the lowest concentrations found in fruiting vegetables. Philadelphia-region community gardeners are exposed to unsafe levels of metals both from the soil and from consumed produce.

Opposing Innovations: Race and Reform in the West Philadelphia Community Free School, 1969–1978

AbstractThis article uses oral history, archival material, and published primary sources to examine the competing conceptions of “innovation” at work in the creation and operation of the West Philadelphia Community Free School (WPCFS) from 1969 to 1978. One of the longest-running initiatives in the School District of Philadelphia's experimental Office of Innovative Programs, the WPCFS stood at the crossroads of conflicting imperatives for “innovation.” These included: (1) institutional interests in advancing “humanizing” pedagogy; (2) Black activists’ interests in operating a community-controlled school for students of color in West Philadelphia; and (3) teachers’ interests in balancing their commitments to “humanizing” instruction and a surrounding community with different educational priorities. We highlight two instances where the frictions between these uses of “innovation” became pronounced in the WPCFS—debates over “free time” and the 1973 teachers’ strike. These incidents clarify how the burden of reconciling opposing innovations fell unevenly on the teachers and community members—often in ways that pitted the groups against one another—and exacerbated raced and classed inequalities in the school and district. While the account focuses on the 1960–1970s, we suggest that the WPCFS is relevant for us today, offering insights for the present into the longer discursive history of “innovation” as a lever for school reform, and into its impacts on educational equity.

Beyond a Lush Life: Representation and Performativity at America's [Only] Queer Jazz Festival

Beyond a Lush Life: Representation and Performativity at America's [Only] Queer Jazz Festival

Multi-variable assessment of green stormwater infrastructure planning across a city landscape: Incorporating social, environmental, built-environment, and maintenance vulnerabilities

Green stormwater infrastructure (GSI) is an increasingly popular tool to meet federal water regulations for stormwater quality and quantity, while assuaging urban flooding. While cities across the United States implement GSI into their planning processes, they are also potentially affecting the local communities that are receiving these GSI through social, ecological, physical, and economic impacts. Flooding is impacting urban communities by damaging homes and infrastructure, degrading ecosystems, and exacerbating social inequities. In the planning process, there is an acute need for the consideration of the equitable distribution of GSI in addition to technical and engineering needs. This study examines multiple aspects of vulnerability to local flooding impacts—social, environmental, and infrastructural—across a city landscape to identify those communities that have a greater need for GSI. Given the city of Philadelphia is a leader in GSI implementation in the United States, we use it as our research setting where we create citywide, multifaceted vulnerability indices that account for the spatial distribution of social, built environment, and maintenance vulnerabilities to flooding events. In addition to these indices, a GSI type decision table was created to suggest more equitable placements of different GSI types based on their maintenance needs and expected co-benefits. The results of this study reveal unequal distribution of social and built-environment vulnerabilities in the city at the Census block group scale, with high social vulnerability consistently spread across the central, southwest, and northwest neighborhoods of Philadelphia. Potential areas of severe GSI maintenance impacts appear to be concentrated in the downtown neighborhoods, while overall vulnerability appears elevated throughout the downtown and northwest neighborhoods. These results indicate that some communities in Philadelphia are highly vulnerable and should be prioritized for GSI implementation. In addition, the type of GSI implemented should be optimized to address the specific vulnerability impacts in different areas. A multifaceted vulnerability approach to planning can be applied in multiple areas of climate adaptation equity, with future studies continuing to update and add more dimensions of vulnerability where and when applicable.

No Scholars in the West

Seeking knowledge from scholars is an imperative for Salafis. But what does that mean for Salafis in the West who deny that there are any scholars among them? Since the 1960s, Western Muslims have been taking advantage of the scholarships available for Islamic studies programs in Saudi Arabia. A steady stream of students has gone, studied with leading Salafi scholars in the heart of the Muslim world, and returned home to promulgate Salafi teachings and lead their communities. Why do none of these former students count as scholars? If they are not scholars, then what is the nature of their role as local leaders? To answer these questions, this study looks closely at the predominantly African American Salafi affiliate community in Philadelphia. The arguments here contribute to a growing body of literature on global Salafism and specifically studies of so-called Madkhalī communities tied to the Islamic University of Medina. Primary fieldwork from 2010 to 2013 and interviews as recent as 2021 inform the conclusion that this community’s pattern of knowledge transmission perpetuates and even celebrates the continual reliance of Philadelphia’s Salafis on scholars abroad.

Christian healthcare in medically underserved North Philadelphia

With an unfortunate number of underserved communities throughout the world, it would be remiss to overlook the prevalence of ones located right in the backyards of America. Most residents of these communities suffer disproportionately from health disparities. They are often lower income, non-white residents of dense and diverse urban neighborhoods, like ones located in North Philadelphia. Since 1989, a health center, Esperanza, has been dedicated to serving the members of the North Philadelphia community through an intentional and faith-based approach. Today, its director, Susan Post, has continued to carry out the mission of Esperanza through efforts that highlight purposeful proximity.

The Art of Friendship: Solidifying Resettled Communities in Philadelphia

Written by two unlikely friends, this article discusses a project, Friends, Peace, and Sanctuary (FPS), that brought together professional book artists and recently resettled families from Syria and Iraq to co-create works together over the course of two years, and culminated in a series of exhibitions in Swarthmore, Philadelphia, and New York. Friendship and building intercultural relationships was at the heart of FPS, which we argue exemplifies the ways in which community-based, socially engaged art can function as a pathway to peace and social justice in local communities. The project, which formally ended in 2019, has had ripple effects in the resettled community of Philadelphia, and project collaborators continue to work closely together to promote peace in the City through arts and culture initiatives.

Developing and Delivering a Comprehensive Vaccine COVID-19 Program: RapidVax

RapidVax was developed in January 2021 to provide COVID-19 vaccination across Temple University’s College of Public Health (CPH). The scale-up phase of the project was an inter-professional effort to develop specific messaging about COVID-19 vaccination and delivered vaccination to communities in Philadelphia, esepcially vaccine-hesitant individuals and marginalized groups with limiteded access to health services. Emphasizing community engagement, evidenced-based message designs, and vaccine delivery, RapidVax has resulted in 1,542 individuals within the CPH and Temple, 2,685 of the general public vaccinated, of which approximately 74.9% were people of color and 16% were homeless (total doses given to date is 7,445). RapidVax, as an interprofessional collaboration between nursing, social work, pharmacy, and public health practitioners, is a promising model to deliver vaccination and decrease disparities.