Community-based Approaches For Prevention Research Articles

An Estimation of the Non-pharmaceutical Interventions Efficacy through Awareness to Reduce the COVID-19 Disease Burden

The World Health Organization (WHO) has declared the outbreak of COVID-19 a public health emergency of global concern. When this pandemic-potential virus arises, community-based prevention approaches are perhaps the most readily available measures to support and dissuade communities from spreading the virus. In this rapid review, I followed the Search, Appraisal, Synthesis, and Analysis (SALSA) approach and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for an accurate evaluation of the content of literature in the system of non-pharmaceutical interventions (NPIs). As a result, 39 literature from a total of 315 searches were included in this study. Numerous NPIs were instantaneously introduced globally. Results indicated that physical distancing steps involve isolation of ill people, contact tracing, quarantine of exposed individuals, closures at school and in the workplace, and a combination of these approaches may be successful strategies to minimize infection transmission. Nevertheless, owing mainly to empirical and computer modeling research, the importance of such proof was comparatively small. Therefore, when designing a pandemic strategy, the authorities of local government units (LGUs) must recognize that each group is distinct and effective mitigation strategies will differ based on the level of community transmission, characteristics, implementation capacity, potential behavior and impacts, including most vulnerable populations to severe disease, and their socio-economic conditions. The introduction of mitigation measures is key to supporting community emergency plans. These plans will provide additional authority and coordination available for public health emergency response initiatives.

A Community-Based Prevention Approach: Examples from the Field

The issue of child maltreatment is complex and requires community-based solutions to ensure the well-being of children and families. The prevention of maltreatment, both primary and secondary, involves a unique understanding of community context and individual’s behavior as it relates to society. It is important to promote practice principles believed to mitigate stressors that could lead to child maltreatment and overall, to support improved outcomes for children and families. These principles include building the capacity of communities to offer locally based services and supports that address the unique needs of children and families, and strengthen parental capacity to protect and provide for their children. However, the prevention of child abuse is not just about services, but about embracing and changing norms—those community and individual beliefs and expectations about how we should behave, and the understanding that there is knowledge to be gained from the community that individuals come from. This article presents examples from a nation-wide, federally funded program that strengthens families and prevents child maltreatment through community-based solutions that embrace social norms and promote collaboration and coordination across related efforts at the state and local level.

Identity management and sense of belonging to gay community among young rural Thai same-sex attracted men: implications for HIV prevention and treatment

Young Thai men who have sex with men continue to have high HIV prevalence and incidence in spite of much investment in community-based prevention approaches. To make HIV services more appropriate for same-sex attracted young men in Thailand, it needs to be considered how target groups view themselves and manage their identities. This paper derives from a qualitative study of 25 same-sex attracted rural young Thai men. It identifies five tactics men employed to manage the discrepancy between their preferences and parental/societal expectations regarding gender and sexuality, and discusses how the young men viewed themselves in the wider context of Thai society, including whether they felt part of a separate gay community. Participants usually did not adopt a gay social identity and were reluctant to join in gay community activities beyond dating. Hence, they would likely experience barriers in accessing gay community-based HIV services. HIV services targeting young same-sex attracted Thai men need to be diversified if they are to be more inclusive, appropriate and effective.

Using a “genomics tool” to develop disease prevention strategy in a low-income setting: lessons from the podoconiosis research project

Genomics research is making significant contributions to our understanding of the biology and treatment of several human diseases. With varying degrees of success, genomics has also contributed to the development of new diagnostic tools and prevention strategies in the public health settings (Brand et al. 2008). A high proportion of diseases with significant public health impact occur due to the interplay between genetic and environmental factors. In this regard, conducting genomics research on diseases with strong environmental determinants is useful not only to identify genetic causes but also to improve public health approaches that aim to modify environmental risk factors (Agurs-Collins et al. 2008; Burke et al. 2010). Genomics research may contribute to the latter by presenting evidence for stratifying targeted population by level of genetic risk. This risk stratification approach has the potential to refine disease prevention strategies by more effectively targeting individuals differentially affected by the disease (Khoury et al. 2005). Moreover, given that most common complex diseases have both genetic and environmental components, community health interventions that utilize information from both risk factors promise to have higher impact (Morabia and Costanza 2005). Family health history (FHH) is the most commonly applied genomics/genetics tool in the stratification of disease risk at community level. FHH of a disease is a composite indicator of the effects of factors such as genetics, environment, culture, behavior, and the complex interplay between these factors in families. It is a “low tech” but powerful community health genomics tool for risk prediction and stratification, disease prevention and control, and health promotion (Yoon et al. 2002). For example, a study showed that 86 % of early strokes aggregated in 11 % of families, and 72 % of all early chronic heart disease cases clustered in only 14 % of families (Williams et al. 2001), demonstrating the efficiency of FHH in predicting disease risk (Scheuner 2003). Moreover, a randomized clinical trial showed effectiveness of family-oriented education and behavioral interventions. Individuals that received preventive messages tailored to an individual's familial risk had more compliance to the recommendations than those that received standard prevention messages (Ruffin et al. 2011). Despite existing knowledge gaps, the important role of the FHH tool for clinical and primary health practice was reflected in the National Institutes of Health's Consensus Development Program (http://consensus.nih.gov/2009/familyhistory.htm). Importantly, FHH offers unique values for disease prevention in low-income countries for several reasons including the fact that it is well proven, free, and is readily available to all persons (Guttmacher et al. 2004). However, there is paucity of practical evidence on applicability of FHH for informing disease prevention programs in low-income countries, particularly in Africa. The aim of this article is to describe a practical lesson gained from epidemiologic and genetic studies in Ethiopia that informed community-based prevention approaches for targeting children at high risk for podoconiosis. First, we provide a brief description of podoconiosis and the resource challenges of prevention in endemic communities. Second, we review evidence for the role of genetic and environmental risk factors for podoconiosis, and the usefulness of FHH as a “genomics tool” capturing both risk factors for identification of high risk individuals and resource targeting. Third, we discuss an experience from a pedigree study and a community-based genomics research project that demonstrated the scientific basis and feasibility of FHH. Fourth, we highlight the practical application of this approach by the local community-oriented organization in developing a model podoconiosis prevention program that targets children at high risk. Finally, we point out a strategic direction that can be implemented at primary health care facilities in Ethiopia for systematizing and scaling up the implementation of FHH to speed up elimination of podoconiosis.

The ultimate measures of health.

Assessing public health progress involves measuring what is important. Until now, such measurements have largely entailed disease surveillance or special reports that summarize disease trends, presented by race/ethnicity or some other variable.1–3 Such efforts have advanced critical understanding of our disease status as a nation. But individual health ultimately reflects not just the singular influence of biology, but also the complex constellation of many other dimensions. Future assessment efforts must begin to measure and track those social determinants4,5 so that we can measure what is ultimate, not merely what is important. Health arises not just from a doctor's office, but also from our homes, jobs, schools, communities, and places of worship—in short, where we live, labor, learn, play, and pray.5–9 All of these conditions determine whether we can fully be healthy, defined by the World Health Organization as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”10 While some Americans meet this standard, far too many fall short. Disturbingly, many cannot reach their full potential because of unnatural causes linked to economic, social, or environmental disadvantage.11 Such situations limit opportunities for good health choices. Addressing these health disparities requires first a better understanding of measures representing social, economic, educational, environmental, policy-oriented, cultural, and even spiritual dimensions of health. Recently, the Institute of Medicine (IOM) report For the Public's Health: The Role of Measurement in Action and Accountability reaffirmed the urgency of addressing the underlying factors that contribute to poor health, not just disease outcome data.6 The IOM recommended changes in the process, tools, and approaches used to gather information about social and environmental determinants, including a standardized core set of health outcome indicators and indicators of community health. Such improved data collection and measurement frameworks will help assess and provide clear accountability needed from both government and multisector partners responsible for understanding, monitoring, and improving population health. Also, the recently unveiled goals and objectives of Healthy People 2020 for the first time have identified the social determinants as one of its 42 topic areas.7 In joining time-honored topic areas such as tobacco use and immunization, social determinants outcomes over the next decade move us closer to assessing the foundations of health, not just disease. While the precise metrics are still under discussion, areas under consideration include those related to education, employment, income, housing, family and social support, community safety, and characteristics of the built environment. Such measures have already received some attention from the County Health Rankings,12 a collaboration of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute, as well as from the most recent IOM report on the Leading Health Indicators.13 Changing what we measure can lead to new directions in how we act. Indeed, the time-honored core public health function of assessment catalyzes two others: assurance and policy.14 In 21st century public health, we understand that health is too important to be left to the health sector alone. Indeed, we need a broad social determinants approach—that is, health in all policies—that involves a multisector approach and collaboration with a host of nontraditional partners. Doing so will allow more people a true opportunity for better health choices—and help make the healthy choice the easier choice. Recently, the U.S. Department of Health and Human Services (HHS) has stressed such a multidisciplinary approach through its HHS Action Plan to Reduce Racial and Ethnic Health Disparities.15 By capitalizing on community-based prevention approaches and other opportunities to transform health care embedded in the Affordable Care Act,16 the HHS Action Plan offers an opportunity to eliminate disparities and improve public health quality in its broadest sense.17 We also need to communicate the social determinants of health, a term still largely confined to academic circles, in ways that better resonate with the general public. RWJF has committed to finding a common language that expands national views about where health starts, not just where diseases end.18 RWJF suggests messages such as “your neighborhood or job shouldn't be hazardous to your health,” and, “all Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of income, education, or ethnic background.” In short, we are all interdependent and interconnected, and we all have promises to keep. The classic 1988 IOM report The Future of Public Health defines the essence of our field as “fulfilling society's interest in assuring conditions in which people can be healthy.”14 Beginning to assess and address those conditions through a social determinants approach opens the door to innovative ways of improving public health. Measuring what is ultimate, as well as what is important, will surely move our country closer to the day when every person has the opportunity to reach his or her highest attainable standard of health.

Using multilevel, multisource needs assessment data for planning community interventions.

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010-Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos.

The Better Beginnings, Better Futures Project: A Universal, Comprehensive, Community-Based Prevention Approach for Primary School Children and Their Families

Evaluated a community-based, universal project designed to prevent emotional and behavioral problems and promote general development in young children, while also attempting to improve family and neighborhood characteristics, to link effectively with existing services, and to involve local residents in project development and implementation. The research involved 554 4-year-old children and their families living in 3 disadvantaged neighborhoods in Ontario, Canada. Longitudinal analyses of changes over the first 5 years of project operation indicated significant improvements in children's and parents' social-emotional functioning and physical health, parenting behaviors, and neighborhood and school characteristics. The findings from the Better Beginnings, Better Futures Project are encouraging and provide unique evidence for the extent to which a universal, comprehensive, community-based prevention strategy can promote the longer term development of young children, their families, and their neighborhoods.

The staying power of sexually transmitted diseases

Sexually transmitted diseases (STDs) not only have staying power but also appear to be on the increase. Emerging laboratory technologies and improving epidemiological methods have identified more than 25 organisms transmitted by intimate human sexual contact. Based on global serological evidence even more incurable viral infections are transmitted each year via the sexual route. The consequences of these infections remain devastating. However the problem is seen in the collation of multiple microepidemics spread among sexually active individuals who themselves choose sex partners with specific social networks. In this article these microepidemics are examined by considering several interconnected themes. Transmission dynamics suggest that the probability of infecting a susceptible partner can be reduced by promoting use of barrier methods and safer sex practices and the duration of infectiousness can be reduced by early diagnosis and curative treatment. In the context of sexual networks the role of core groups and bridge populations in sustaining the spread of STDs is emphasized. Human rights should be strengthened so as to maximize the effect of individually oriented clinical STD control services and community-based prevention approaches. In addition technical innovations will also help control STDs which consequently will further underscore the importance of human behavior.

Developing and Implementing Interventions in Community Settings

SUMMARY This paper describes the needs of youth at high risk of future drag use and an intervention approach which responds to those needs by utilizing community settings. The paper begins by discussing the merits of community-based drug abuse prevention. Next, the paper reviews the background and nature of drag use among youth who are at inordinately high risk for using and encountering problems associated with drags. Against that backdrop, the authors offer an approach to intervening with high-risk youth to prevent drug use and its attendant problems. The community-based preventive intervention approach includes relevant theory, applicable principles and specific strategies. Results from community-based prevention interventions are next discussed. Finally, the authors summarize the strengths and limitations of a community-based prevention approach offered to combat problems of drag use among high-risk youth.

Risk factors for initiation of drug use among young males in southwest China.

To identify risk factors for drug use among young males in southwest China a cross-sectional survey and a non-concurrent cohort study were conducted. Demographic, behavioral and drug-use information was collected from young males aged 18-29 years. The non-concurrent cohort included the period 1 January 1991 to 1 August 1994. A total of 1548 subjects were interviewed. The cumulative incidence increased between 1991 and 1993. Multivariate analysis identified the following significant risk factors for drug use: being divorced/widowed/separated, having been encouraged by friends/others to try drugs, smoking cigarettes, belonging to the Jingpo ethnic group, and having a family member who used drugs in 1991. More than 6 years of education was a protective factor for drug use. Drug use in the community was associated with having been encouraged by friends or others to try drugs (71%), to smoking cigarettes (50%), and to belonging to the Jingpo group (24%). The results are consistent with community based prevention approaches which should be studied carefully because of the unique cultural and epidemiological situation in China.