Community Coalitions Research Articles

Learning collective care to support young climate justice advocates

Young people mitigate their climate distress, develop their efficacy, and contribute to the effectiveness of climate movements through activism. However, they are often excluded from adult-led climate movements and exposed to a number of risks when they do participate. In this context, this participatory action research study draws on multiple care theories to offer collective care praxis through which adults and young people might co-create more care-full and safe climate justice movements capable of supporting, sustaining, and sharing power with young people. The study examines how 13 young and three adult co-researchers learned about and applied collective care through a youth climate justice training program in Western Australia. The program enabled young people to engage with climate emotions, identify care practices, and map support networks. Furthermore, the study developed three practices for adult-led climate movements engaging with young people: Responding to intersectionality with active solidarity, child safeguarding, and building care-full community coalitions. We conclude that a collective care praxis offers organisers and activists in all their diversities an opportunity to prefigure more care-full and just climate movements.

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

Abstract 816: Implementation of a community-based multi-component cancer screening intervention supported by a cross-sector community coalition

Abstract It is widely agreed that screening and early detection of cancer saves lives. However, disparities exist in those who received routine screenings and variability in clinic screening protocol. Working with community-based clinics on quality improvement as well as systematically screening all eligible patients can result in increased equity in screening and thus early detection. Be Well Communities™ is MD Anderson’s place-based approach for cancer prevention and control, working with communities to promote wellness and address modifiable risk factors for cancer. The first several years of the initiative in Baytown focused on healthy eating and active living interventions for cancer prevention, over time the community’s trust and appetite increased which allowed for additional and more traditional cancer prevention interventions (e.g., human papilloma virus vaccination, screening). In this project, three evidence-based interventions for cancer screening were implemented in collaboration with Chambers Health, a local FQHC in Baytown, Texas, to work toward addressing the disparities in screening outcomes experienced by community residents. Chambers Health compliance rates have increased since the beginning of the Cancer Screening Navigation program, supported by Be Well Communities. Two full-time patient navigators are supported to facilitate increased screening through patient education, increased clinic compliance and development of standard operating procedures for navigation related operations. In addition, one full-time Outreach Coordinator is supported to engage with patients and provide education on cancer screenings. Compared to 2022, there was a 39% increase in colon cancer screening compliance rates, a 25% increase in cervical cancer screening compliance rates, and a 47% increase in breast cancer screening compliance rates. Compliance refers to any patient who is up-to-date in their cancer screenings. The Be Well Communities team supported Chambers Health through funding, technical assistance, and capacity building. They were then able to provide culturally relevant and high-quality care to enhance community capacity to address low rates of cancer screening in Baytown. Furthermore, Chambers Health has since integrated the patient navigators and Outreach Coordinator into their operational budget, a notable systems change for the organization and demonstration of commitment to the project and continued clinic quality improvement and more so dedication to the patients served. Citation Format: Ruth Rechis, Mayra Aquino, Haley Gardiner, Blanca Puga, Michael T. Walsh. Implementation of a community-based multi-component cancer screening intervention supported by a cross-sector community coalition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 816.

Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial

Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC)-3.20 [95% C.I.-4.43,-1.98]) and toward MOUD (AMC-0.33 [95% C.I.-0.56,-0.09]) than stakeholders in Wait-list Control communities (AMC-0.18 [95% C.I.-1.38, 1.02], p=0.0007 and AMC 0.11 [95% C.I.-0.09, 0.31], p=0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC-0.59 [95% CI,-0.87,-0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p=0.18). The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. US National Institute on Drug Abuse.

An Approach to Enhancing Medication Treatment for Opioid Use Disorder in the HEALing Communities Study.

The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) aims to test the effectiveness of the Communities That HEAL intervention in decreasing opioid overdose deaths in 67 communities across four U.S. states. This intervention enlists a collaborative team of researchers, academic experts, and community coalitions to select and implement interventions from a menu of evidence-based practices, including medications for opioid use disorder (MOUD). The HCS's New York team developed an integrated network systems (INS) approach with a mapping tool to coach coalitions in the selection of strategies to enhance medication treatment. With the INS approach, community coalitions develop a map of service delivery venues in their local county to better engage people with medication treatment wherever this need arises. The map is structured around core services that can provide maintenance MOUD and satellite services, which include all settings where people with opioid use disorder are encountered and can be identified, possibly given medication, and referred to core programs for ongoing MOUD care. This article describes the rationale for the INS mapping tool, with a discussion framed by the consolidated framework for implementation research, and provides a case example of its application.

Using effective community coalitions to prevent mental and behavioral disorders on a national scale

This paper describes how knowledge from life-course research and community intervention studies can be integrated within community coalition models to inform a feasible national plan to measurably prevent and reduce mental and behavioral disorders. In many nations, including Australia, mental and behavioral disorders are increasing in child and youth populations, forewarning of increased future disorders. There is limited evidence that treatment interventions can turn the tide. However, we argue here that universal (whole population) and selective (group targeted) preventative interventions are feasible, effective, and cost-effective for reducing child and adolescent mental and behavioral disorders. Modifiable risk factors (causal or associational predictors) and protective factors (risk modifiers) have been identified across diverse settings (e.g., family, school, and community). As no single factor is solely responsible for the development of child and adolescent mental and behavioral disorders, a multi-factor intervention approach is required. Given communities vary in their profile of child and adolescent mental and behavioral disorders, and local risk and protective influences, tailoring prevention strategies to community conditions is essential. We present here the ‘Communities That Care’ model as a feasible community coalition training approach, scalable to cost-effectively prevent and reduce child and adolescent mental and behavioral disorders across large populations. The Communities That Care model comprises five phases that sequentially prepare and formalize a community coalition, assist a needs assessment, strategically planned implementation, and evaluation. Australian evaluations demonstrate that municipal completion of the model achieves youth-reported improvements in substance use, behavior problems and risk and protective factors. Archival data analyses associate municipal completion with annual reductions of above 8 % per annum in child and adolescent injury hospitalization and in reduced police reports of youth crime (5 % pa) and violence (2 % pa). Despite its excellent credentials, the Communities That Care model is presently under-utilized for the prevention of mental and behavioral disorders. To immediately reduce the crisis of increasing child and adolescent mental and behavioral disorders, we advocate for increased funding for the national implementation and evaluation of community coalition models, with a requirement that alternative models should be evaluated against current best-practice as incorporated in the Communities That Care model.

COVID-19 impacts on youth and young adult workforce development programs: A local perspective

In the United States in 2020, an estimated 12.6% of individuals ages 16 to 24 were disconnected from education and employment – up from 10.7% in 2019. While the Workforce Innovation and Opportunity Act of 2014 authorizes several youth-focused workforce development programs that target services toward disconnected youth, COVID-19 and ensuing mitigation measures exposed structural inequities in access to educational systems, workplace environments, and employment opportunities. This qualitative study examines the impact of COVID-19 on five local youth and young adult (YYA) workforce development programs, providers, and YYA participants in an urban county in Texas. Study participants included 12 youth-serving staff representing 5 programs, and 7 YYA representing 1 program. Semi-structured interview protocols guided three focus groups and four individual interviews. Data were analyzed in Dedoose by three researchers using thematic analysis. Impacts on programs included amplified recruitment and retention challenges related to safety protocols, disrupted interagency connections, access to technology, and YYAs competing priorities. Impacts on providers included changes in work-life balance and perceived organizational support, self-efficacy, and job satisfaction. Impacts on YYA included disruptions to education and employment, increases in (a) the need for mental health services, (b) unstable and/or unsafe living situations, (c) availability of resources like food and housing assistance, and a decrease in access to critical resources like transportation and government IDs. Recommendations include planning for flexibility in performance requirements for future crises, building a community coalition to target barriers to participation in these programs, and providing access to YYA mental health services within programs.

Police chief calls for community and “open minds”

The police chief of Newtown, Ohio credits the open minds of all four “pillars” involved in fighting the opioid crisis in a 16% reduction of overdose deaths last year. In an exclusive interview with ADAW this month, Chief Thomas W. Synan Jr. attributed the success to a robust community coalition that in the past few years has “connected all the pieces and built a continuing care model.”

The Evaluation of Equity-Focused Community Coalitions: A Review of the Empirical Literature

Conducting evaluation and research with community coalitions involved in health equity initiatives is inherently complex. In this paper we provide a review and synthesis of the empirical literature on the evaluation of equity-focused community coalitions. We explore issues, challenges, and barriers experienced by evaluators, as well as techniques and approaches that were considered beneficial. Our review identified 11 peer reviewed articles, from which we identified seven overlapping themes: (1) framing equity in the evaluation process, (2) use of multiple theoretical frameworks, (3) use of systems-focused approaches, (4) strategic use of intersectoral partnerships and collaborations, (5) intentional communication and building trusting relationships, (6) challenges dedicating purposeful time to the work, and (7) issues of cultural and contextual clarity and responsiveness. Our findings point to a significant focus on context, history, learning, communication, relationships, and power. The cultural complexity and historical scope of each context, diversity of stakeholders, and enormity of the systemic issues involved, shape and challenge the evaluation and research process in fundamental ways, requiring a creative and kinetic thinking -- a shifting from methodological certainty to an acknowledged uncertainty, where mixing, blending and the innovative use of approaches and theories becomes a way of moving beyond the colonizing past.

Autumn in New York: The Case of Long-Term Care Facilities in the "Safe Staffing" Lawsuit With Less Staffing But Similar COVID-19 Outcomes.

In 2022, 239 New York state long-term care facilities (LTCFs) challenged a "Safe Staffing" law in court. Our study compares LTCFs involved and not involved in the lawsuit, testing for differences in staffing measures and resident outcomes during the first year of the coronavirus disease 2019 (COVID-19) pandemic. New York LTCF-level data were obtained from the Centers for Medicare and Medicaid Services 2019 organization and 2020 COVID-19 data files. These data were then linked to data from the Long-Term Care Community Coalition, which identified the LTCFs involved in the "Safe Staffing" lawsuit. We first tested for differences in reported 2019 staffing levels by lawsuit involvement. Second, we specified "Doubly Robust" regression models to test if lawsuit involvement was associated with differences in resident COVID-19 infections, COVID-19 deaths, and overall mortality. LTCFs involved in the lawsuit reported lower staff ratings and fewer staffing hours compared to LTCFs not involved in the lawsuit. Despite finding higher rates of admissions with COVID-19 in LTCFs involved in the lawsuit, we did not find that COVID-19 infections, COVID-19 deaths, or overall mortality differed by lawsuit involvement. LTCFs involved in the lawsuit were deemed by policymakers as reducing staff, earning excess profits, and placing residents at risk. While these LTCFs reported lower staffing levels, we observed no differences in resident outcomes during the first year of the COVID-19 pandemic. Researchers and policymakers should develop more nuanced perspectives concerning the relationship among LTCF staffing, outcomes, and organizational profitability.

Schools and Juvenile Treatment Drug Courts: A Case Study on Treatment Access through Collaboration and Advocacy

Abstract Adolescent substance use is typically addressed from the perspectives of school personnel (e.g., teachers, school counselors, social workers, and resource officers) who interact daily with students in school settings. Consequences of adolescent substance use in the schools may include suspension or expulsion and possible legal involvement. However, many adolescents do not have access to evidence-based treatment to address drug and alcohol use. Services are often not available or fragmented, resulting in poor compliance with treatment and inadequate treatment outcomes for youth. Cross-sector collaboration among schools, community behavioral health agencies, and juvenile court service units offers an opportunity to improve access to care and efficiency in delivering care to adolescents with drug and alcohol problems. Illuminated through a single case study, embedded substance use treatment in schools through partnerships with the court service unit and community behavioral health providers can increase access to care. Counselors and social workers play a key role in advocating for joint efforts to increase service access and improve treatment outcomes. Advocacy efforts may include participation and leadership in community coalitions, training and consultation in evidence-based practices, and seamless communication across all organizations that serve youth with substance use disorders.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness.

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Lessons learned from community engagement regarding phylodynamic research with molecular HIV surveillance data.

The widespread implementation of molecular HIV surveillance (MHS) has resulted in an increased discussion about the ethical, human rights and public health implications of MHS. We narrate our process of pausing our research that uses data collected through MHS in response to these growing concerns and summarize the key lessons we learned through conversations with community members. The original study aimed to describe HIV transmission patterns by age and race/ethnicity among men who have sex with men in King County, Washington, by applying probabilistic phylodynamic modelling methods to HIV-1 pol gene sequences collected through MHS. In September 2020, we paused the publication of this research to conduct community engagement: we held two public-facing online presentations, met with a national community coalition that included representatives of networks of people living with HIV, and invited two members of this coalition to provide feedback on our manuscript. During each of these meetings, we shared a brief presentation of our methods and findings and explicitly solicited feedback on the perceived public health benefit and potential harm of our analyses and results. Some community concerns about MHS in public health practice also apply to research using MHS data, namely those related to informed consent, inference of transmission directionality and criminalization. Other critiques were specific to our research study and included feedback about the use of phylogenetic analyses to study assortativity by race/ethnicity and the importance of considering the broader context of stigma and structural racism. We ultimately decided the potential harms of publishing our study-perpetuating racialized stigma about men who have sex with men and eroding the trust between phylogenetics researchers and communities of people living with HIV-outweighed the potential benefits. HIV phylogenetics research using data collected through MHS data is a powerful scientific technology with the potential to benefit and harm communities of people living with HIV. Addressing criminalization and including people living with HIV in decision-making processes have the potential to meaningfully address community concerns and strengthen the ethical justification for using MHS data in both research and public health practice. We close with specific opportunities for action and advocacy by researchers.

A Qualitative Study of Health Equity's Role in Community Coalition Development.

Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)-a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities' needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.

Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review

BackgroundThere are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.ObjectiveTo inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.MethodsA realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening.ResultsWe included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the “reach” of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered.ConclusionRealist reviews can help guide the development of locally adapted primary health care interventions.

An Urgent Need for School-Based Diversion Programs for Adolescent Substance Use: A Statewide Survey of School Personnel

PurposeThere has been growing interest in reserving punishment as a last resort to address substance use in schools. However, there is significant variability in adoption of alternative approaches. This study reported school personnel's perceptions of diversion programs, identified characteristics of schools/districts that currently have diversion programs, and defined barriers of implementation of diversion programs. MethodsOne hundred fifty six school stakeholders from Massachusetts' K-12 schools, including district administrators, principals and vice principals, school resource officers, guidance counselors, and nurses, completed a web-based survey in May–June 2020. Participants were recruited through e-mail distributed via professional listservs, direct school outreach, and community coalitions. The web survey queried beliefs, attitudes, and actions that schools take regarding substance use infractions as well as perceived barriers to implementing diversion programs. ResultsParticipants endorsed strong beliefs that punishment was an appropriate school response for student substance use, particularly for nontobacco-related infractions. Despite these personal beliefs, diversion programs were rated as more effective but less commonly used than punitive approaches (37% of respondents reported having diversion programs in their schools/districts vs. 85% used punitive approaches) (p < .03). Punishment was more likely to be used to respond to cannabis, alcohol, and other substances compared to tobacco (p < .02). Primary barriers of implementing diversion programs included funding, staff training, and parental support. DiscussionBased on school personnel perceptions, these findings lend further support for a transition away from punishment and toward more restorative alternatives. However, barriers to sustainability and equity were identified that warrant consideration when implementing diversion programs.

Colorectal Cancer Knowledge and Screening Change in African Americans: Implementation Phase Results of the EPICS Cluster RCT

African Americans are disproportionately affected by mortality risk for colorectal cancer. This study aimed to determine the most effective educational approach of 4 study arms that enhances the likelihood of pursuing subsequent colorectal cancer screening, and to identify the associated factors. Age-eligible adults (N=2,877) were recruited to participate in a cluster randomized control dissemination and intervention implementation trial titled Educational Program to Increase Colorectal Cancer Screening. The project began in May 2012 and ended in March 2017 (the implementation phase lasted 36 months). Educational sessions were conducted through 16 community coalitions that were randomized into 1 of 4 conditions: website access (to facilitator training materials and toolkits) without technical assistance, website access with technical assistance, in-person training (provided by research staff and website access) without technical assistance, and in-person training with technical assistance. A follow-up to determine participant CRC screening was conducted 3 months later. Compared with the website access with technical assistance intervention group, 2 groups, in-person training with technical assistance and without technical assistance, indicated significantly higher odds for obtaining colorectal cancer screening (OR=1.31; 95% CI=1.04, 1.64; p=0.02 and OR=1.35; 95% CI=1.07, 1.71; p=0.01, respectively). Though sociodemographic factors were not significantly associated with pursuing subsequent colorectal cancer screening, the postintervention cancer knowledge increased significantly among the study participants. The importance of in-person interactions, local coalitions, and community contexts may play a key role for successfully increasing colorectal cancer screening rates among African Americans as reflected through this study. The integration of telehealth and use of other virtual technologies to engage the public in research have increased since the COVID-19 pandemic and should be assessed to determine their impact on the degree to which in-person interventions are significantly more effective when compared with solely web-assisted ones. The study is registered at www.clinicaltrials.gov NCT01805622.

Development and Implementation of a GIS-Based Active Route Visualization Tool to Facilitate Equitable Planning for Walking and Cycling Routes in Small Communities

Active transportation modes such as walking and bicycling have demonstrated several benefits for health, the environment, the economy, and road safety. However, the transportation planning process in rural areas rarely incorporates this mode of transportation. In fact, many small and rural towns lack the resources, experience, and capabilities to conduct detailed modeling of active transportation. In response, this research developed an Active Route Visualization (ARV) Tool to support planning and decision making in small cities and rural towns. By incorporating a modified three-step modeling process that used active trip rates developed from the 2017 National Household Travel Survey, the ARV Tool provided a map that highlighted the daily volumes of active travel in the community and ranked the roadway segments that had greater potential to support walking and bicycling. This research demonstrated application of the ARV Tool in the city of Atmore, AL. Implementation of the tool was valuable in this rural city as it supported a community coalition effort in partnership with the Alabama Cooperative Extension System to promote active transportation. In this process, the community coalition reviewed and discussed the ARV Tool outputs and provided invaluable local knowledge and feedback that were incorporated into the action plans. Small and rural towns can benefit from an easy-to-use, practical, and data-driven tool that provides insights to initiate discussions to identify priorities and opportunities for active transportation.

Community-Centered Assessment to Inform Pandemic Response in Georgia (US).

The Georgia Community Engagement Alliance (CEAL) Against COVID-19 Disparities Project conducts community-engaged research and outreach to address misinformation and mistrust, to promote inclusion of diverse racial and ethnic populations in clinical trials and increase testing and vaccination uptake. Guided by its Community Coalition Board, The GEORGIA CEAL Survey was administered among Black and Latinx Georgia 18 years and older to learn about community knowledge, perceptions, understandings, and behaviors regarding COVID-19 testing and vaccines. Survey dissemination occurred using survey links generated through Qualtrics and disseminated among board members and other statewide networks. Characteristics of focus counties were (a) highest proportion of 18 years and older Black and Latinx residents; (b) lowest COVID-19 testing rates; and (c) highest SVI values. The final sample included 2082 surveyed respondents. The majority of participants were men (57.1%) and Latinx (62.8%). Approximately half of the sample was aged 18-30 (49.2%); the mean age of the sample was 33.2 years (SD = 9.0), ranging from 18 to 82 years of age. Trusted sources of COVID-19 information that significantly predicted the likelihood of vaccination included their doctor/health care provider (p-value: 0.0054), a clinic (p-value: 0.006), and university hospitals (p-value: 0.0024). Latinx/non-Latinx, Blacks vs. Latinx, Whites were significantly less likely to get tested and/or vaccinated. Non-Latinx, Blacks had higher mean knowledge scores than Latinx, Whites (12.1 vs. 10.9, p < 0.001) and Latinx, Blacks (12.1 vs. 9.6, respectively, p < 0.001). The mean knowledge score was significantly lower in men compared to women (10.3 vs. 11.0, p = 0.001), in those who had been previously tested for COVID-19 compared to those who had never been tested (10.5 vs. 11.5, respectively, p = 0.005), and in those who did not receive any dose of vaccination compared to those who were fully vaccinated (10.0 vs. 11.0, respectively, p < 0.001). These data provide a benchmark for future comparisons of the trajectory of public attitudes and practices related to the COVID-19 pandemic. They also point to the importance of tailoring communication strategies to specific cultural, racial, and ethnic groups to ensure that community-specific barriers to and determinants of health-seeking behaviors are appropriately addressed.