Community-based Strategies Research Articles

Harm reduction techniques among cisgender gay, bisexual, and queer men using anabolic androgenic steroids: a qualitative study

BackgroundAnabolic androgenic steroids (AAS) are synthetic forms of testosterone frequently used as performance enhancing drugs among gay, bisexual, and queer (GBQ) men. Despite widespread use, associated harms, and the likely existence of an AAS use disorder, there is no medical consensus on standards of care for people who use AAS, with most medical providers focusing exclusively on abstinence. Individuals using AAS have developed community-based harm reduction strategies to mitigate these harms.MethodsThis paper is a sub-analysis of qualitative data obtained through semi-structured interviews with GBQ men using AAS for 8 or more weeks recruited through convenience and snowball sampling from clinical sites and LGBTQ + venues in New York City as well as through social media. Interviews were coded with themes developed using reflexive thematic analysis. Data related to harm reduction techniques were then re-analyzed through a prevention strategies framework lens of primary, secondary, and tertiary harm prevention.ResultsThematic saturation was reached at twelve interviews in the primary analysis, with men reporting frequent use of multiple harm reduction techniques. For primary prevention, men avoided oral steroids and simultaneous substance use, tried to obtain AAS from reputable sources, used “cycling” to dose steroids, and practiced sterile injection techniques. Secondary prevention methods included patient-directed lab testing for hematocrit, liver and kidney function, cholesterol, prostate specific antigen, testosterone, and self-performed blood pressure checks. Tertiary prevention included donating blood and the use of medications without a prescription, including aromatase inhibitors, selective estrogen receptor blockers, aspirin, statins, angiotensin receptor blockers, clomiphene, and human chorionic gonadotropin.ConclusionsDespite many GBQ men experiencing harms from anabolic androgenic steroids, community members have often sought harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS.

The Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: a feasibility and acceptability study

BackgroundA dementia diagnosis can lead to a decline in cognitive, social, and physical health, but people with dementia can live meaningful lives and participate actively in society with psychosocial support. This single-arm, non-randomised feasibility study explored the feasibility and acceptability of a Comprehensive REsilience-building psychoSocial intervenTion (CREST) for people with dementia, their caregivers, General Practitioners (GPs), and the public.MethodsNine people with dementia and their primary caregivers living in the community (n = 9 dyads) completed the CREST intervention which had three components (cognitive stimulation therapy [CST], physical exercise, and dementia education). Quantitative secondary outcomes were assessed at baseline and following the 15-week intervention; qualitative interviews were conducted during and post-intervention. All study components were assessed against pre-defined criteria, to determine the feasibility of conducting a future definitive trial.ResultsRecruitment of people with dementia and their caregiver was a significant challenge and led to considerable delays to the onset and conduct of the intervention. Only 13% of eligible GP practices agreed to assist in recruitment and achieved a 6% enrolment rate; a community-based recruitment strategy proved more effective, yielding a 29% enrolment rate. However, once recruited, participants maintained high attendance and adherence to the content of each component with average adherence rates of 98% for CST, exercise sessions and caregiver education. Adherence to secondary exercise measures was lower, with home exercise diary completion at 37% and Fitbit wear adherence at 80% during the day and 67% at night. The people with dementia felt their concentration and fitness had improved over the 15-week intervention and particularly enjoyed the social aspects (e.g. group classes, exercising with partners from the community). Caregivers felt they had better knowledge and understanding following their education component and reported that the social aspects (interacting and sharing experiences with each other) were important. Overall, participants reported that the three components of the intervention were feasible and acceptable. In addition, the quantitative measures and health economic tools employed were feasible. However, the secondary elements of the exercise component (recording home exercise diaries and Fitbit use) were not considered feasible. Overall, pre-defined criteria for progression to a definitive intervention were fulfilled in terms of acceptability, retention and fidelity but not recruitment.ConclusionWhile overall, the CREST intervention was feasible and acceptable to participants, significant difficulties with recruitment of people with dementia and their caregiver through GP practices impacted the viability of delivering the intervention. Recruitment through community-based groups proved a more feasible option and further work is needed to overcome barriers to recruiting this cohort before a larger-scale trial can be conducted.Trial registrationISRCTN25294519.

What factors influence women's empowerment in Ethiopia? A multilevel analysis of Ethiopia's demographic and health survey data

BackgroundWomen's empowerment has been a global priority, as countries can achieve significant growth and economic development by empowering women. Understanding the individual and community-level factors that influence women's empowerment is crucial for policymakers to develop effective policies and to improve women's empowerment.MethodA community-based cross-sectional survey was conducted in 11 administrative regions of Ethiopia. The analysis included a weighted sample of 7,108 married women of reproductive age (15–49 years) from the 2,016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to examine the individual and community-level factors associated with women's empowerment. In the final model, significant variables were identified using a p-value of <0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI).ResultsThe overall magnitude of women's empowerment was 23.7% (95% CI: 22.7–24.7). Only 30.9% of women reported participating in household decision-making, and 32.5% disagreed with all the reasons justifying wife-beating. At individual-level, factors positively associated with women's empowerment included secondary (AOR: 2.72 (1.77–4.23), and higher (AOR: 3.65 (1.81–7.34) education. However, belonging to the Muslim religion was negatively associated with women's empowerment (AOR: 0.63 (0.47–0.85). At the community level, wealthy communities were positively associated with women's empowerment (AOR: 1.60 (1.05–2.44). Conversely, residing in rural areas (AOR: 0.49 (0.29–0.83), and living in the Afar (AOR: 0.35 (0.17–0.70), Amhara (AOR: 0.45 (0.26–0.79), Oromia (AOR: 0.43 (0.26–0.73), South Nation Nationalities, and Peoples (SNNP) (AOR: 0.42 (0.24–0.75), and Gambella (AOR: 0.36 (0.20–0.66) regional states were negatively associated with women's empowerment.ConclusionThe overall magnitude of women's empowerment in this study was low. Factors that positively influenced empowerment included attending secondary and higher education, as well as residing in communities with higher wealth status. On the other hand, being Muslim, residing in rural areas, and living in the Afar, Amhara, Oromia, SNNPR, Gambella, and Tigray regions were negatively associated with women's empowerment. As a result, the government of Ethiopia needs to design community-based women's empowerment strategies and involve women in income-generation activities that improve their participation in household decision-making to empower them.

Educating lifestyle modification to diabetic patients

The burden of non-communicable diseases (NCDs) is steadily increasing, making them a major health concern. Diabetes mellitus (DM) is one of the major non-communicable diseases that affects the public health and the community. DM is a chronic, complex disease that requires multi-factor risk reduction strategies apart from its maintaining blood glucose level. One of the community-based strategy is to educate diabetic patients about life style modifications. Keeping that as a guideline, a nurse-led intervention was carried out to ring about a change in life style in these patients. About 60 diabetic patients with equal number of control subjects were taken for the pilot study. Data were collected through interviews with a semi-structured questionnaire before (pre-test) and after nurse-led intervention (post-test) The data were analyzed using descriptive and inferential statistics; the calculated data were tabulated and graphed. The results of the study show that diabetic patients included in the study have improved their knowledge of life style modification. The community nurse intervention improved their perspective and understood the importance of life style medication (from 16.19 to 24.98%). This was tested using the student paired t test. Outcome of the test before the intervention showed significant change. Pre-test value was (53.97%) and the post-test intervention was 83.27%. The effect of such intervention was influenced the age, gender, education, and family structure. The intervention was found to be more effective in male patients of the age group 30-40 years with educational background and stable family structure having a joint family. The awareness created by nurse led intervention is effective and is significant taking age, sex, education level and the family structure. The pilot study indicates that further studies may be carried out in the community with general population and then specifically in patients with diabetes.

Improving racial/ethnic health equity and naloxone access among people at risk for opioid overdose: A simulation modeling analysis of community-based naloxone distribution strategies in Massachusetts, United States.

During the COVID-19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community-based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs. Individual-based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity-focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups). Massachusetts, United States. People at risk of OOD. Annual number and rate of OODs, total healthcare costs of increasing naloxone availability. Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity-focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved. An equity-focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy.

Association Between Diet and Mental Health Outcomes in a Sample of 13,887 Adolescents in Canada.

The high prevalence of mental disorders among adolescents calls for community-based and population-level prevention strategies. Diet is an important intervention target for primary prevention of mental disorders among adolescents. We used data from a large longitudinal study of Canadian adolescents (aged 14-18 y) to examine prospective associations between diet and mental health outcomes. We estimated the effect of diet (ie, consumption of vegetables and fruit and sugar-sweetened beverages [SSBs]) at baseline on depressive symptoms, anxiety symptoms, and psychological well-being (measured by the Center for Epidemiologic Studies Depression Scale-Revised, Generalized Anxiety Disorder 7 scale, and Flourishing Scale, respectively) and at 1-year follow-up in a sample of 13,887 Canadian secondary school students who participated in the 2017-2018 and 2018-2019 cycles of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary (COMPASS) behavior study. We applied linear mixed-effects methods informed by a directed acyclic graph. Sensitivity analyses assessed the robustness of the effect estimates to unmeasured confounding variables. Baseline SSB consumption was associated with greater severity of depressive (β = 0.04; 95% CI, 0.01-0.06) and anxiety (β = 0.02; 95% CI, 0-0.05) symptoms, particularly among male students, and poorer psychological well-being (β = -0.03; 95% CI, -0.05 to -0.01) at follow-up. Baseline vegetables and fruit consumption was positively associated with psychological well-being (β = 0.06; 95% CI, 0.03-0.10) but not other mental health outcomes at follow-up. Our results support the notion that diet should be part of comprehensive mental health prevention and promotion interventions to reduce the prevalence of mental health disorders among adolescents.

Betel Quid Use and Tuberculosis Transmission: A Neglected Focus Area for Tuberculosis Control in Low- and Middle-Income Countries.

Habitual betel quid consumption and spitting contribute to tuberculosis (TB) transmission due to direct exposure to pathogens, immunosuppression, and social contact. Despite betel quid being classified as a group 1 human carcinogen and a high prevalence of betel quid consumption in patients with TB, there exists a knowledge gap in the relationship between quid use and TB, which presents as a neglected opportunity to address the global burden of TB in low- and middle-income countries. Understanding such a knowledge gap is crucial when taking measures at various levels, including research prioritization, behavior change communication, and legislation to address the availability and access of quid products, coupled with community-based interventional strategies. This article thus presents empirical evidence on quid use and its effects on TB spread and identifies feasible, applicable changes required at various levels to curtail the spread of TB among betel quid users.

A Pilot Feasibility Study of Delivering a Quit & Win Tobacco-Free Contest in Community Mental Health Programs.

Quit & Win contests are a community-based tobacco cessation strategy that has demonstrated success in supporting tobacco cessation efforts in the general population. However, such contests have not been implemented and evaluated among people living with mental illnesses (MIs). This pilot study aimed to evaluate the feasibility of implementing Quit & Win contests in terms of program delivery, engagement, and cessation outcomes among people with MIs. A single-group posttest design to evaluate the feasibility of Quit & Win contests conducted at three community mental health programs. Flyers introducing the contest were posted at study sites 2 weeks prior to recruitment. Recruitment occurred on 2 days over a 2-week period. Eligible participants received a pamphlet with information about tobacco treatment resources. At the follow-up, postsurveys and expired CO levels were obtained. Participants (N = 28) were mostly male, Non-Hispanic White, with a high school or higher education, unemployed, and 46.4% had a primary substance use disorder diagnosis. Among those who engaged in the program, seven (25.0%) returned for the follow-up, of which three (42.9%) successfully stopped cigarette use. Four (57.1%) described using nicotine replacement therapy in their attempt to stop using cigarettes. Challenges to cessation included difficulty finding available tobacco treatment programs, limited access to treatment medications, and experiencing nicotine withdrawal symptoms. Our findings suggest the feasibility of Quit & Win interventions in community mental health settings. Further efforts are required to enhance recruitment, engagement, and retention, and to support access to community-based tobacco treatment resources.

Assessment of Practices on Purchase of Packaged Foods and Utilization Patterns of Food Labels among Adults in Puducherry

Abstract Background: There is an increase in the manufacture and consumption of prepackaged foods as a result of widespread urbanization, long working time, and adaption to a sedentary lifestyle. The majority of these prepackaged foods contain food labels. Food labeling is a community-based strategy that informs customers about a food’s nutritional composition, empowering them to choose healthier foods. To assess the practices on the purchase of packaged foods and utilization patterns of food labels among adults in Puducherry. Material and Methods: A cross-sectional survey in the field practice area of a private medical college at Puducherry was carried out for two months including adults residing for > 6 months in selected villages/wards. A sample size of 460 with a multistage sampling technique was considered. Data collection using a semi-structured questionnaire incorporated into Epi-collect software and was analyzed using SPSS16. Ethical clearance was obtained from Institutional Ethical Committee. Written informed consent was sought from participants. Results: Around 271 (58.91%) and 189 (41.08%) respondents were residing in urban and rural regions, respectively. Purchase of packages was seen in 297 (64.57%) people. Only one-fourth of the subjects had the practice of reading the food labels, with urban residents having a better practice when compared with rural population (P value < 0.05). Conclusion: The study reveals a low level of utilization pattern of food labels among consumers of packaged food products. The findings of this study would be helpful for concerned authorities in creating and improving awareness among consumers and ensuring that their usability is improved.

Anthropogenic effects and ecosystem services of tropical highland forests in Ethiopia

Despite the significant direct and indirect benefits that forests, particularly tropical highland forests, provide to local communities, they are facing severe degradation primarily due to population growth and rapid land-use changes. This has made it difficult for policymakers to effectively manage these forests due to a lack of comprehensive current forest research data. Therefore, the primary objective of this study was to examine the anthropogenic impacts on forest ecosystems and the ecosystem services (11ecosystem services,ESs) they provide, as well as to understand local perspectives on management of natural forests. For collecting disturbance indicators and other environmental data, 12 transect lines by 150 meter interval between each of the two consecutive parallel transects and 40 quadrats (20 m x 20 m size each) by 100 m interval were laid out in 145 ha total forest land size of the five study sites of three districts. However, for questionnaire-based data, 266 respondents were participated. As revealed in the results, the majority of households (about 78 %) relied on mixed farming and had ≤ 1 ha of land with 5.6 average family size. Besides, 74.3 % of the households used forest products for cooking food and getting energy to their homes due to little or no electricity, or other energy sources in rural communities. Nearly 85 % of the households also obtained timber from natural forests. Tree cutting, grazing, cultivation, and fires were the major anthropogenic factors leading to deforestation and loss of ecosystem services and biodiversity of the studied forest ecosystems. Disturbance assessment indicated that almost all forest patches, excluding one in the eastern subregion of the study area, were severely impacted. This suggests a widespread degradation of Ethiopia's forests. However, various ESs, mainly regulating and habitat services, followed by provisioning ones, were delivered from these sites. Hence, soil erosion controlling, flood protecting, and soil fertility regulating services were some of the most services provided by the forests. Likewise, being shelter and nursery sites for biota were the other most important habitat service. The raw materials including grass for fodder, medicinal plants, timber, fuel wood, and water for livestock watering and domestic uses were the major provisioning services provided. Thus, more than 93 % of the households had a great interest for the protection and continuity of the present forest patches in the future. Briefly, despite being heavily degraded due to anthropogenic factors, these natural forests still provided various ecological, social, and economic services to the local people; thereby the people were interested in protecting and conserving them. Thus, for restoring degraded forest areas of the zone, community-based participatory conservation strategies were recommended.

A Systematic Review of Resilience in At-Risk Youth for Psychotic Disorders: An Analysis of Protective and Risk Factors from Recent Literature.

Psychotic disorders in youth pose significant challenges for mental health services, necessitating a detailed understanding of the interplay between risk factors and resilience. This systematic review aimed to assess how resilience factors might buffer the adverse effects of risk factors on the development of psychosis among youth, thereby informing targeted interventions. Studies were selected based on criteria including a focus on individuals aged up to 25 years old at risk for psychosis, the examination of both risk factors and resilience, and the use of validated instruments for measuring outcomes. Literature searches were conducted across several databases, such as PubMed, Scopus, and Web of Science. Data extraction emphasized odds ratios (ORs) and hazard ratios (HRs) for risk factors, including familial, developmental, and socio-environmental influences. The review included and analyzed nine studies, encompassing a diverse sample of 140,972 participants. Significant findings indicate that highly supportive familial and community environments significantly reduce the risk of psychosis onset. For instance, children with strong family support and engagement in structured activities demonstrated a 40% lower incidence of developing psychotic symptoms [p < 0.05]. Furthermore, the presence of neurobehavioral deficits, such as impaired verbal memory and attention, emerged as significant predictors of psychosis, with these children exhibiting a threefold increase in risk compared to their peers [OR = 3.2, 95% CI: 2.1-4.8, p < 0.01]. Resilience factors play a critical role in mitigating the impact of psychosocial and neurobiological risks in the development of psychosis among youths. Interventions enhancing resilience could potentially alter the trajectory of psychosis development, emphasizing the need for early and targeted psychosocial interventions to support at-risk populations. This study underscores the importance of fostering resilience through both individual-focused and community-based strategies to prevent the onset of psychotic disorders in vulnerable young populations.

Communities of Practice: A Strategy for Re-engaging Out-of-School Youth by Nurturing Prospects and Fostering Connections

This research focuses on the potential of the Communities of Practice (CoPs) that might be utilized to bring back the out-of-school youth (OSY) to formal schooling. Even with the attempts to increase enrollment in schools, some of the Filipino youths still have no access to education, and still have difficult life struggles that include loss of jobs and social exclusion. This study discusses the experience and issues with which OSY encounter in CoPs and comprises the valuable prospects for them further. The exploratory research question of the study depicts the experiences of OSY within CoPs in terms of the sense of belonging, social connectedness, and perceived upcoming possibilities. It also narrows down challenges like; they lack financial capital, or have lack of access to services. Subjects of the study were selected within the area of Barangay Nagtenga, Sta. Cruz, Ilocos Sur. Participants and observations were obtained through interviews, and fundamental trends such as isolation, restricted social relationships, and low earnings were identified. From the study, there is a recommended plan on how to bring about the CoPs that focus on the learning from peers, skills enhancement, and community activities for the enhancement of OSY. This research clearly brings out the significance that can be achieved through community-Based strategies in re-engaging and promoting out-of-school youth.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

Colorectal Cancer Outcomes: A Comparative Review of Resource-Limited Settings in Low- and Middle-Income Countries and Rural America.

Background/Objectives: Colorectal cancer remains a significant global health challenge, particularly in resource-limited settings where patient-centered outcomes following surgery are often suboptimal. Although more prevalent in low- and middle-income countries (LMICs), segments of the United States have similarly limited healthcare resources, resulting in stark inequities even within close geographic proximity. Methods: This review compares and contrasts colorectal cancer outcomes in LMICs with those in resource-constrained communities in rural America, utilizing an established implementation science framework to identify key determinants of practice for delivering high-quality colorectal cancer care. Results: Barriers and innovative, community-based strategies aimed at improving patient-centered outcomes for colorectal cancer patients in low resource settings are identified. We explore innovative approaches and community-based strategies aimed at improving patient-centered outcomes, highlighting the newly developed colorectal surgery fellowship in Sub-Saharan Africa as a model of innovation in this field. Conclusions: By exploring these diverse contexts, this paper proposes actionable solutions and strategies to enhance surgical care of colorectal cancer and patient outcomes, ultimately aiming to inform global health practices, inspire collaboration between LMIC and rural communities, and improve care delivery across various resource settings.

Examining the Impact of Simultaneous Alcohol and Cannabis Use on Alcohol Consumption and Consequences: Protocol for an Observational Ambulatory Assessment Study in Young Adults.

There is significant conflicting evidence as to how using cannabis while drinking alcohol (ie, simultaneous alcohol and cannabis use) impacts alcohol volume consumed, patterns of drinking, and alcohol-related consequences. The impact of simultaneous use on drinking outcomes may be influenced by several within-person (eg, contextual) and between-person (individual) factors. This study was designed to examine naturalistic patterns of alcohol and cannabis use to understand how simultaneous use may impact drinking outcomes. The primary aims were to understand the following: (1) if simultaneous use is associated with increased alcohol consumption and riskier patterns of drinking,(2) if simultaneous use leads to increased alcohol consequences, and(3) how contextual circumstances moderate the impact of simultaneous use on consumption and consequences. Data collection involves a 28-day ambulatory assessment protocol in which a sample of non-treatment-seeking young adults who report simultaneous use of alcohol and cannabis complete ecological momentary assessments (random, event-contingent, and time-contingent surveys) of alcohol and cannabis use, contexts, motives, and consequences on their personal smartphones while continuously wearing an alcohol biosensor bracelet. Participants also complete a baseline assessment, brief internet-based check-in on day 14, and a final session on day 28. Community-based recruitment strategies (eg, social media and flyers) were used to enroll 95 participants to obtain a target sample of 80, accounting for attrition. Recruitment and data collection began in May 2021 and continued through June 2024. Initial results for primary aims are expected in October 2024. As of March 2024, the project had recruited 118 eligible participants, of whom 94 (79.7%) completed the study, exceeding initial projections for the study time frame. Remaining recruitment will provide the capacity to probe cross-level interactions that were not initially statistically powered. Strengths of the project include rigorous data collection, good retention and compliance rates, faster-than-expected enrollment procedures, use of a novel alcohol biosensor, and successful adaptation of recruitment and data collection procedures during the COVID-19 pandemic. This is the first investigation to assess the key momentary predictors and outcomes of simultaneous use as well as self-reported and objective (via alcohol biosensor) measures of alcohol consumption and patterns. The results of this study will inform prevention efforts and studies of individuals who use cannabis who are engaged in alcohol treatment. DERR1-10.2196/58685.

The Test and Protect Program: A Data-Driven, Community-Engaged Approach to COVID-19 Testing Site Localization.

As the COVID-19 pandemic progressed, reliable, accessible, and equitable community-based testing strategies were sought that did not flood already overburdened hospitals and emergency departments. In Hamilton County, Ohio, home to~800 000 people across urban, suburban, and rural areas, we sought to develop and optimize an accessible, equitable county-wide COVID-19 testing program. Using Coronavirus Aid, Relief, and Economic Security Act funding, multidisciplinary, multiorganization partners created the test and protect program to deliver safe, reliable testing in neighborhoods and organizations needing it most. Our approach involved: (1) use of geospatial analytics to identify testing locations positioned to optimize access; (2) community engagement to ensure sites were in trusted places; and (3) tracking of data over time to facilitate ongoing improvement. Between August 2020 and December 2021, more than 65 000 tests were completed for nearly 46 000 individuals at community-based testing sites. These methods could have application beyond COVID-19 and our region.

“You Never Know Who’s Gonna Be Next”: The Role of Community Violence Intervention Workers in Responding to Homicides and Survivor Support

The racial and spatial concentration of homicides coupled with the low levels of protection, safety, and accountability afforded to surviving family, friends, and community members raises the question of who is capable of accompanying impacted individuals and negotiating safety in the aftermath of violent death. Community Violence Intervention (CVI) workers are a growing professional field of indigenous peacemakers who lead community-based efforts to both prevent and intervene violence. The current study presents original, novel research engaging CVI workers’ experiences responding to homicides to prevent retaliation and support survivors and how persistently responding to violent death in their community impacts their wellbeing. This exploratory study involved 35 in-depth, qualitative interviews with CVI workers and their supervisors in Chicago, IL. Thematic analysis indicates they are “first among first responders” and are critical information intermediaries to designate appropriate violence prevention and intervention strategies. CVI workers also experience traumatic grief, largely associated by their relationship and proximity to homicide victims. The implications highlight the distinctive contributions of CVI workers in formulating more comprehensive, community-based post-homicide strategies aimed at supporting marginalized survivors and communities disproportionately affected by violence.

Vaccine coverage and timeliness among children of adolescent mothers: A community-based study in the Eastern Cape, South Africa

BackgroundChildren born to adolescent mothers are more vulnerable to infant mortality and morbidity than those born to adult mothers. HIV-exposed children have lower antibody protection against vaccine-preventable diseases at birth compared to unexposed children. In South Africa, 17 % of adolescent girls aged 15–19 years are mothers, yet vaccination coverage and timeliness among their children is underreported. MethodsThis study estimated age-appropriate vaccination coverage and timeliness among children (n = 1080) of adolescent mothers (n = 1015) in the Eastern Cape, South Africa. Mother-child dyads were recruited through healthcare and community-based sampling strategies. Vaccination data were abstracted from 1013 home-based child health records (2017–2019). Coverage is reported for Diphtheria-Tetanus-Pertussis 3rd dose (DTP3), under-1 vaccination among children over 12 months (n = 613) and measles 2nd dose (MCV2) among children over 24 months (n = 382) using proportions with 95 % confidence intervals (95 %CI). Timeliness is defined as receiving each vaccination within 4 weeks of recommended age. Findings are disaggregated by maternal HIV-status. ResultsOverall, 27.3 % of adolescent mothers were living with HIV. Coverage of DTP3 was 85.6 % (95 %CI: 82.6–88.3 %), under-1 coverage was 53.2 % (95 %CI: 49.1–57.2 %), and MCV2 coverage was 62.3 % (95 %CI: 57.2–67.2 %). Vaccination coverage was lower among children of adolescent mothers living with HIV (AMLHIV) than unexposed children (DTP3 80.3 % vs 88.2 % p-value: 0.01; under-1 46.5 % vs 56.4 % p-value: 0.02; MCV2 55.4 % vs 67.1 % p-value: 0.02). Timeliness of vaccinations declined over time from 98.0 % at birth, 70.7 % at 14 weeks, 71.9 % at 9 months and 37.3 % at 18 months. ConclusionVaccination coverage among children of adolescent mothers in the Eastern Cape are below national targets. Children of AMLHIV had lower coverage than HIV-unexposed children. Further research is needed to identify risk factors associated with incomplete and delayed vaccinations among this group, particularly among HIV-exposed children. Enhanced vaccination campaigns may be required for children of adolescent mothers.

Exploring Ubuntu-Based Research Methodologies in Southern African Bantu People's Embodied Movements: Ethical Considerations, Community-Based Strategies, and Philosophy

Exploring Ubuntu-Based Research Methodologies in Southern African Bantu People's Embodied Movements: Ethical Considerations, Community-Based Strategies, and Philosophy

Effectiveness and implementation of decentralized, community- and primary care-based strategies in promoting hepatitis B testing uptake: a systematic review and meta-analysis

Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking. We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components. 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference=27.9% [95% Confidence Interval=3.4-52.4], I2=99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness. HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets. Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.