Community-based Practice Research Articles

Partnering with recovery community centers to build recovery capital by improving access to reproductive health.

People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80-95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender-based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. This initiative is the merging of best practices in recovery and community-based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contraception and pregnancy tests. Considering recent policies limiting access to reproductive health, innovative community-based solutions are needed to engage and empower people who can get pregnant or are pregnant while in active drug use and in recovery. Providing low barrier reproductive health items by people with lived experience with SUD can serve as a valuable harm reduction model and improve recovery capital. This is the first study to propose a methodology and context to implement a community-based study merging best practices in recovery with those in reproductive health with the potential to improve recovery capital and maternal/child health trajectories for people with SUD.

Effect of an Australian community-based caseload midwifery group practice service on maternal and neonatal outcomes for women from a refugee background

BackgroundWomen from a refugee background who resettle in high-income countries experience poorer perinatal outcomes in comparison to women from host countries. There is a paucity of research on how best to improve these outcomes. AimTo report on the effectiveness of an Australian Refugee Midwifery Group Practice service on perinatal outcomes. MethodsWe used inverse probability of treatment weighting to balance confounders and calculate treatment effect and compare maternal and neonatal outcomes for women from a refugee background who received Refugee Midwifery Group Practice care (n = 625), to those receiving standard care (n = 634) at a large tertiary hospital (1 January 2016–31 December 2019). Prespecified primary outcomes included: proportion of women attending ≥ 5 antenatal visits, preterm birth (<37 weeks), spontaneous onset of labour, epidural analgesia in the first stage of labour, normal birth (term, spontaneous onset, vertex, spontaneous vaginal birth, no epidural, no episiotomy), and exclusively breast-feeding at discharge. FindingsWomen who received Refugee Midwifery Group Practice care were more likely to have spontaneous onset of labour (adjusted odds ratio 2·20, 95% CI 1·71–2·82; p < 0·0001), normal birth (1·55, 1·23–1·95; p < 0·0001), and less likely to use epidural analgesia (0·67, 0·50–0·89; p = 0·0067) and have a preterm baby (0·60, 0·36–0·99; p = 0·047). There was no difference between groups in women attending ≥ 5 antenatal visits and exclusive breastfeeding at discharge from hospital. DiscussionA Refugee Midwifery Group Practice is feasible and clinically effective. ConclusionSimilar services could potentially improve outcomes for women from a refugee background who resettle in high-income countries.

IRONMAN: A Novel International Registry of Men With Advanced Prostate Cancer.

To describe a newly established international registry recruiting diverse patients with advanced prostate cancer across academic and community practices to address unmet needs in this population. Initiated in 2017, IRONMAN (International Registry for Men with Advanced Prostate Cancer) is a prospective cohort of patients with advanced prostate cancer. The study will enroll 5,000 patients with metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC), recruited from Australia, the Bahamas, Barbados, Brazil, Canada, Ireland, Jamaica, Kenya, Nigeria, Norway, South Africa, Spain, Sweden, Switzerland, the United Kingdom, and the United States. The study is collecting datatypes to study variation in care and treatment of advanced prostate cancer across countries and across academic, community-based, and government practices with a focus on clinical outcomes, patient-reported outcomes, epidemiologic data, biologic subtypes, and clinician questionnaires. Through July 2022, 2,682 eligible patients were enrolled in 11 of 12 active countries. Sixty-six percent of patients have mHSPC, and 34% have CRPC. On the basis of self-report, 11% of patients are Black and 9% are Hispanic. Five Veterans Affairs Medical Centers are enrolling patients. Globally, 23% of patients report being veterans of military service. To our knowledge, this is the first international cohort of people newly diagnosed with advanced prostate cancer designed to describe variations in patient management, experiences, and outcomes. IRONMAN aims to identify optimal treatment sequences to improve survival, understand patient-reported outcomes, and explore novel biomarkers to understand treatment resistance mechanisms. Insights from IRONMAN will inform and guide future clinical management of people with mHSPC and CRPC. This cohort study will provide real-world evidence to facilitate a better understanding of the survivorship of people with advanced prostate cancer.

Accommodating hearing loss in outpatient physician offices in the U.S.

BackgroundApproximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients’ safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. ObjectiveExamine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. MethodsWe surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. ResultsAmong the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. ConclusionsMore than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.

Care during ART scale-up: surviving the HIV epidemic in Ethiopia

Over the last decades, there has been a worldwide rise of new technologies for controlling the HIV epidemic by expanding antiretroviral medicines. This article examines how the pharmaceutical-driven model of public health, which emerged as a byproduct of antiretroviral treatment (ART) scale-up in Ethiopia, interplayed with local forms of actions, engagements, and voices through which suffering inflicted by the epidemic was cared for. Through the eyes of an Ethiopian woman with HIV, this article illustrates how the increasing emphasis on ART facilitated the defunding of some community-based care practices. Moreover, it rendered the realities of precarious life with HIV invisible in the landscape of therapeutic citizenship. However, for Ethiopians, ART scale-up unfolded amid multiple forms of HIV care practices and relationships that endured stigma, alienation, and uncertainty before and after ART. The experience of surviving the HIV epidemic in Ethiopia provides a vital premise upon which claims of meaningful care are made, and ways to otherwise develop healthcare actions and engagements are sought.

Care Aesthetics, Coronavirus and Everyday Life

The article outlines the concept of care aesthetics and then uses it to examine different responses to the coronavirus pandemic. The ambition is to provide a language and approach to everyday community-based practices that values them as caring and artistic, without necessarily determining whether they are first and foremost one or the other. The article outlines the origins of care aesthetics as a response to the field of feminist care ethics and then examines how it links to theories of the everyday and everyday aesthetics. Community responses to the pandemic are examined through this lens, to reveal the blurred boundaries between acts of care and arts-led programmes. Examples of community cooking, theatre companies transforming their venues and community arts interventions are discussed to demonstrate how attention to the sensory practices of caring solidarity might be enhanced.

S1531 How Type of Office Visit Influences Attitudes and Preferences for Telemedicine

Introduction: The COVID-19 pandemic caused significant changes in delivery of healthcare. Telemedicine emerged as a popular option. Numerous studies demonstrate a favorable opinion of telemedicine from patient and physician perspectives. What factors make it more efficient and effective? This study explores how type of office visit impacts attitudes towards telemedicine and affects patient’s preferences for future visits. Methods: Surveys were delivered by mail or in person to 1,100 randomly selected patients of Sierra Nevada Gastroenterology, a community-based practice in Grass Valley, CA. Each patient (pt) had a telemedicine visit (TMV) from April 2020-October 2021. Three hundred twenty surveys were returned completed. Surveys contained a 5-point Likert scale set of questions rating the quality, communication, compassion, thoroughness and convenience of TMV. In person visits (IPV) were then directly compared to TMV for the same qualities. Demographics were recorded (Table 1). Surveys were separated into 3 categories based on type of visit: new complaint (NC), follow-up of existing problem (FU), procedure-related visit (PRV). Statistical analysis and chi-square test were used to determine statistical significance. Results: Quality, communication, thoroughness and compassion during TMV rated high with Likert scores of 4.3-4.7 (5 = strongly agree) for all groups. Comparing the 3 groups (NC, FU, PRV) with chi-square testing, no statistical difference in ratings was seen. FU pts had the highest Likert scores in all categories. Pts with new complaints preferred IPV over TMV for quality, communication, thoroughness and compassion, which was rated statistically significantly higher (P < 0.05). TMV was favored for convenience in all groups with highest ranking in FU pts (73%). Conclusion: This study showed type of office visit did not affect satisfaction or ratings of TMV. However, type of visit did reveal preferences for either IPV or TMV. Pts with NC preferred IPV and felt compassion is important and delivered more effectively in person. This suggests non-verbal communication such as body language, facial expression and tone is conveyed more effectively in person than over phone or video calls. FU or PRV pts rated TMV as more convenient and preferable over IPV for future visits, suggesting that pts with stable or less acute problems prioritize convenience over other factors when selecting type of visit. Further studies are needed to determine what other factors will influence and improve quality of TMV. Table 1. - New Complaint * (n=220) Follow-up Visit (n=45) Procedure Related Visit **(n=55) Gender Male/Female 113/107 21/24 17/38 Age < 39 years old 10 4 2 40-49 11 3 4 50-59 47 10 10 60-69 69 8 13 70-79 70 16 20 80+ 12 3 6 Ethnicity White 194 41 48 Black 1 0 1 Hispanic 9 3 0 Asian 7 1 3 Other 3 0 0 *New complaints include abdominal pain, change in bowels, heartburn, nausea or vomiting, liver problems or inflammatory bowel disease.**Procedure Related Visit focused primarily on setting up scope (e.g., screening for colon cancer, surveillance of polyps or Barrett's).

CLL-449 Patterns of Treatment and Prognostic Testing Among Black Patients With Chronic Lymphocytic Leukemia (CLL): Results From informCLL, a Prospective, Observational Registry

To evaluate real-world treatment patterns and prognostic biomarker testing in Black patients with CLL enrolled in informCLL. informCLL, a US-based, prospective, observation registry, enrolled patients who initiated FDA-approved treatment for CLL/SLL (October 2015 - June 2019). Baseline characteristics, FISH testing rates, and patterns of treatment were summarized by lines of therapy (LOT). Of 1462 enrolled patients, 106 (7%) were Black. Black patients were predominantly enrolled in the South (69%) and from community-based practices (87%). Compared with the overall registry population, Black patients were younger (median age 66 years vs 71 years), had higher proportions with ECOG status ≥1 (65% vs 53%) and Rai stage III-IV (64% vs 51%), and similar time from diagnosis to treatment on registry (median 40 months vs 41 months) but shorter time from diagnosis to first-line treatment (median 7 months vs 19 months). FISH testing rates were similar (25% vs 28%). In a multivariate analysis (performed in overall registry population), baseline factors associated with FISH testing were shorter time from diagnosis to treatment, better ECOG status, earlier LOT (first-line), community practice setting, and a prior malignancy (p<0.05 for all); race was not a predictive factor. As observed in the overall population, ibrutinib was the most frequent treatment among Black patients in first-line (50%) and R/R (67%) settings, followed by chemoimmunotherapy (first-line, 43%; R/R, 15%). In the first-line cohort, ibrutinib use generally increased over time (2016, 31%; 2017, 57%; 2018, 63%; 2019, 55%) while chemoimmunotherapy use persisted (56%, 36%, 38%, and 36%, respectively). In R/R patients, ibrutinib use decreased over time while chemoimmunotherapy remained consistent. In informCLL, Black patients with CLL tended to be younger, with worse ECOG status, more advanced disease, and shorter time to first-line therapy than the overall registry population. Black patients may need close monitoring of disease status as they will tend to require initial CLL therapy more rapidly than other patients. Although ibrutinib was the most common treatment in Black patients, chemoimmunotherapy use remained persistent. Prognostic testing rates were suboptimal in Black patients, similar to the overall population. ©2022 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2022 ASCO Annual Meeting. All rights reserved.

A Collaborative Experiment in Building Anti-Carceral Pedagogies

The authors outline their development of an abolitionist and anti-carceral syllabus, to be shared as a “model in process” for relational learning and activism. The article provides a number of resources intended as community knowledge building and the development of applied and community-based practices.

An Intersectional Analysis of the Recruitment and Participation of Second-Generation African Canadian Adolescent Girls in a Community Basketball Program in Ottawa, Canada

Guided by the experiences and perspectives of sport practitioners, in this paper, an intersectional lens was used to examine age, gender, race, socioeconomic status, and religion and how they relate to the recruitment and participation of second-generation, low-income, African Canadian, Black Muslim, and Christian adolescent girls in a community-based basketball program in Ottawa, Canada. Semistructured interviews were conducted with 11 program coordinators and coaches involved in the City of Ottawa Community Centre Basketball League (CCBL), and reflexive thematic analysis of the data was engaged. The findings were threefold: (a) CCBL coordinators and coaches recognize the importance of representation to enhancing their support to program users; (b) CCBL coaches and coordinators make efforts to build trust with and increase buy-in from first-generation immigrant parents to improve girls’ program participation; and (c) CCBL coaches and coordinators make religious accommodations in response to the needs of Muslim and Christian program users. The findings illustrated that community-based sport programs serving second-generation African Canadian adolescent girls in low-income communities require multifaceted program and outreach strategies that consider the intersecting social experiences of participants to improve recruitment and participation. To conclude, policy and program design and implementation strategies to support the creation of inclusive, equity-driven community-based sport practices were proposed.

S895 Predicting Potential Candidacy for IBD Research Trials Using Integrated Data Science Modeling in Community-Based GI Practices

S895 Predicting Potential Candidacy for IBD Research Trials Using Integrated Data Science Modeling in Community-Based GI Practices

Buprenorphine Initiation in the Era of High-potency Synthetic Opioids: A Call for Community-based Participatory Research to Help Learning Health Systems Provide Precision Medicine for Opioid Use Disorder.

High-potency synthetic opioids and adulterants have saturated the US opioid supply, heightening risk to people who use drugs and creating challenges to buprenorphine initiation. As buprenorphine is an essential component of a response to the opioid crisis, a robust evidence base is urgently needed. Rapid research, in partnership with people who use drugs and using community-based participatory research practices to ensure trust, shared goals, and an absence of adverse consequences, should be conducted to help identify the factors associated with successful and failed inductions. Among factors to be considered include detailed assessment of substances used, amount of substances used, time between last use and buprenorphine induction, withdrawal severity at time of buprenorphine induction, dose of buprenorphine, impact of buprenorphine on withdrawal severity, and perhaps even genotypic information. Successful conduct of these efforts in learning health systems can help us move toward precision medicine for opioid use disorder.

Career Mentoring Surgical Trainees in a Competitive Marketplace

Resident trainees in Canadian Otolaryngology–Head &amp; Neck Surgery (OHNS) programs have cited job prospects as the biggest stressor they face. Increased numbers of residency training positions combined with decreased employment opportunities have worsened competition for surgical positions. The purpose of this inquiry was to explore gaps in resident career planning and examine how leadership can prepare graduating residents to optimize employability. This mixed-methods prospective study was completed in two phases. A combination of online surveys and two focus group sessions were used to gather information from academic and clinical staff surgeons, resident trainees, and administrative leadership. Eleven of the potential 12 resident participants responded to the initial survey, seven of the 13 staff surgeons, and one administrative leader. Each of the resident and staff focus groups had five participants. This comprehensive inquiry led to the development of a conceptual framework describing domains of concern important to OHNS residents. Themes included lack of career mentoring, complex systemic limitations, inadequacy of exposure to community-based surgical practice, and a potentially stifling organizational culture. OHNS residents face significant stress regarding potential employability following residency. Solutions to address concerns must be collaborative in nature and begin with the existing leadership structure.

EP08.02-043 The Current State of Biomarker Testing in Lung Cancer as Seen by Health Care Providers

Comprehensive biomarker testing, defined as a biomarker test that looks at the entire genome, or set of genes, and/or proteins in a person’s tumor to determine if there are changes that could be related to the person’s cancer and inform treatment for people diagnosed with metastatic non-small cell lung cancer (mNSCLC) with adenocarcinoma histology. Despite recent advancements and better implementation of testing and precision medicine, it has been documented for years that in community-based practices, people diagnosed with lung cancer are less likely to receive comprehensive biomarker testing and instead favor testing for one or two genes (Gutierrez et al, 2017).

Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic.

The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic. An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making. Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P &lt; .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P &lt; .001), and salary (19.7% vs 7.0%; P &lt; .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes. Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.

The same, only different: Using physician billing data from four provincial payment systems to describe family physician practice patterns in Canada.

ObjectivesIn Canada physician payment systems and associated billing data vary across provinces. We used linked billing data to develop comparable measures of family physician (FP) service volume, continuity, and comprehensiveness in each of four provinces, with the goal of describing changing patterns over time, relevant to workforce planning policy. ApproachWe accessed linked population and physician registry data, vital statistics, physician billing data, hospital and emergency department records, and (where available) laboratory and prescription drug records in four Canadian provinces from 1996/7 to 2017/8. We tracked changes in primary care physician service volume (patient visits), continuity, and comprehensiveness over two decades, and explored the impacts of career stage and graduation cohort on patterns observed. We also quantified changes in the volume of services that required FP coordination, review, administration, and/or follow-up, reporting changes in service volume per-capita, per community-based family physician and per physician visit. ResultsVisit volume and continuity per provider fell over time in the four provinces examined. Visits increased with years in practice until mid-to-late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume, continuity, or comprehensiveness of care. Over this time period, the number of FPs per-capita has grown, but the number in comprehensive, community-based practice has remained constant. While primary care visits have declined, the number of prescriptions, lab tests, emergency department visits, and specialist visits per capita have all increased. When expressed per community-based FP, and particularly per community-based FP patient visit, the increases in workload range from 36.1% for lab tests to 55.0% for ED follow-up. Increases in service volume are greatest among patients ages 80 and older, a rapidly-growing population segment. ConclusionLinked data capturing changes in practice patterns and workload suggest that even with an increasing per-capita supply of family physicians, additional resources will be needed to ensure all patients can access comprehensive primary care. Information on the various roles family physicians fill and demographic change will strengthen workforce planning.

Medical Care Needs of Laundromat Users in San Antonio, Texas: A Potentially Unique Setting for Health Interventions.

Innovative community-based public-private partnerships are forming to address health needs of underserved communities. This study partnered with laundromats in San Antonio, Texas to understand the health and healthcare needs of laundromat users as a possible underserved population. A total of 193 laundromat users across eight laundromats participated in a survey based on the Texas Behavioral Risk Factor Surveillance System (BRFSS) that asked about health status, access to care, vaccinations, and use of preventive healthcare services. Responses were compared to population estimates from Bexar County and the state of Texas. Results showed that over half of the sample of laundromat users were female, racial/ethnic minorities, living at poverty level, and did not have health insurance coverage. Compared to county and state population estimates, laundromat users were significantly more likely to report poor health and physical impairment; and were less likely to have a primary care provider, to have received a routine medical checkup in the past year, and to have been tested for HIV. Laundromat users were also less likely to receive some gender-specific preventive healthcare screenings such as pap smears and mammograms for women, and prostate exams for men than county or state population estimates. In the laundromat sample, 78% expressed interest in receiving healthcare services on-site at laundromats. Together, these findings suggest laundromats may be a unique setting for healthcare intervention to reach undeserved, racial/ethnic minority communities. Pilot programs that target this setting are needed to explore this opportunity to deliver community-based public health practice.

Social Enterprise in Action: A Study of Indigenous Community-based Enterprise in Rural Areas to End Poverty in All its Form (Irodori Leaf-Business Kamikatsu, Japan and Ikat Woven-Business Pringgasela Lombok, Indonesia)

Rural-based social innovation is increasingly receiving attention in most developing countries. Community-based entrepreneurship is an essential instrument for realizing the potential among marginal and deprived communities isolated from the mainstream economy and is important in bringing social upliftment. Community empowerment helps in eradicating poverty, especially in rural areas since the households can create their welfare based on the local resource. Community-based enterprises usually evolve in a geographical region with the business being set up, owned, and controlled by the local community with a focus on self-supporting jobs. The present research analyzes the community-based enterprise practice as one of the forms of social innovation and identifies its critical success factors. The research uses qualitative methods and case studies. Data were collected through in-depth interviews and observation. Research result indicates that initiators forming groups and collaborating with other parties to support product commercialization will scale up the community-based practice. Local government policy interventions in the form of financial and technical support become leverage for community-based enterprise activities so that all community members are self-employed and economically independent.&#x0D; Keywords: social enterprise, community-based entrepreneurship, sustainable development goals

Editorial introductions

Editorial introductions

Improving the Health of the Nation Through Transdisciplinary Community Engagement

This article chronicles how three land-grant universities and one non-land-grant university medical center have transformed to meet the needs of people where they live, work, learn, and play. In this article, we first get a glimpse of how an institutional commitment to community engagement and supportive administrative structures are advancing community-based public health practice at Oregon State University. Next, we learn how Texas A&amp;M’s AgriLife Extension Service is using community data to focus on the most pressing needs of the state’s 254 counties. We then examine how Mississippi State University is working to address the shortage of health care professionals in its state by introducing young people to health careers and encouraging medical students to practice in the state. Finally, we learn how the University of New Mexico Medical Center and New Mexico State University are using the tried-and-true principles of cooperative extension to address the state population’s health needs through Health Extension Rural Offices.