Community-level Interventions Research Articles

Leveraging Key Informant Interviews to Inform Intervention Development: The Greater Lawndale Healthy Work Project.

The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL). We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development. We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention. Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient. Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity.

Multi-omics analysis of a fecal microbiota transplantation trial identifies novel aspects of acute graft-versus-host disease pathogenesis.

Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic hematopoietic cell transplantation (alloHCT) associated with gut microbiota disruptions. However, whether therapeutic microbiota modulation prevents aGVHD is unknown. We conducted a randomized, placebo-controlled trial of third-party fecal microbiota transplantation (FMT) administered at the peak of microbiota injury in 100 patients with acute myeloid leukemia receiving induction chemotherapy and alloHCT recipients. Despite improvements in microbiome diversity, expansion of commensals, and shrinkage of potential pathogens, aGVHD occurred more frequently after FMT than placebo. Although this unexpected finding could be explained by clinical differences between the two arms, we asked whether a microbiota explanation might be also present. To this end, we performed multi-omics analysis of pre- and post-intervention gut microbiome and serum metabolome. We found that post-intervention expansion of Faecalibacterium, a commensal genus with gut-protective and anti-inflammatory properties under homeostatic conditions, predicted a higher risk for aGVHD. Faecalibacterium expansion occurred predominantly after FMT and was due to engraftment of unique donor taxa, suggesting that donor Faecalibacterium-derived antigens might have stimulated allogeneic immune cells. Faecalibacterium and ursodeoxycholic acid (an anti-inflammatory secondary bile acid) were negatively correlated, offering an alternative mechanistic explanation. In conclusion, we demonstrate context dependence of microbiota effects where a normally beneficial bacteria may become detrimental in disease. While FMT is a broad, community-level intervention, it may need precision engineering in ecologically complex settings where multiple perturbations (e.g. antibiotics, intestinal damage, alloimmunity) are concurrently in effect.

Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association.

Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment. We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions. One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations. The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.

Population mental health science: Guiding principles and initial agenda.

A recent American Psychological Association Summit provided an urgent call to transform psychological science and practice away from a solely individual-level focus to become accountable for population-level impact on health and mental health. A population focus ensures the mental health of all children, adolescents, and adults and the elimination of inequities across groups. Science must guide three components of this transformation. First, effective individual-level interventions must be scaled up to the population level using principles from implementation science, investing in novel intervention delivery systems (e.g., online, mobile application, text, interactive voice response, and machine learning-based), harnessing the strength of diverse providers, and forging culturally informed adaptations. Second, policy-driven community-level interventions must be innovated and tested, such as public efforts to promote physical activity, public policies to support families in early life, and regulation of corporal punishment in schools. Third, transformation is needed to create a new system of universal primary care for mental health, based on models such as Family Connects, Triple P, PROmoting School-community-university Partnerships to Enhance Resilience, Communities That Care, and the Early Childhood Collaborative of the Pittsburgh Study. This new system must incorporate valid measurement, universal screening, and a community-based infrastructure for service delivery. Addressing tasks ahead, including scientific creativity and discovery, rigorous evaluation, and community accountability, will lead to a comprehensive strategic plan to shape the emergent field of public mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An enhanced cross-sectional HIV incidence estimator that incorporates prior HIV test results.

Incidence estimation of HIV infection can be performed using recent infection testing algorithm (RITA) results from a cross-sectional sample. This allows practitioners to understand population trends in the HIV epidemic without having to perform longitudinal follow-up on a cohort of individuals. The utility of the approach is limited by its precision, driven by the (low) sensitivity of the RITA at identifying recent infection. By utilizing results of previous HIV tests that individuals may have taken, we consider an enhanced RITA with increased sensitivity (and specificity). We use it to propose an enhanced estimator for incidence estimation. We prove the theoretical properties of the enhanced estimator and illustrate its numerical performance in simulation studies. We apply the estimator to data from a cluster-randomized trial to study the effect of community-level HIV interventions on HIV incidence. We demonstrate that the enhanced estimator provides a more precise estimate of HIV incidence compared to the standard estimator.

Interfaces of ‘being healthy and being Ill’: how is health being perceived by individuals with non-communicable chronic conditions?

BackgroundAccommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual’s perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question ‘how do individuals with non-communicable chronic conditions perceive their health as healthy or ill’?.MethodsThis study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling.ResultsThe participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care.ConclusionsDue to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual’s health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.

Challenges in Evaluating a Community-Level Intervention to Address Root Causes of Youth Violence.

Violence disproportionately impacts Black American youth, representing a major health disparity. Addressing the possible root causes of structural inequities to reduce violence may increase the impact of prevention strategies. However, efforts to evaluate the impact of such interventions pose numerous methodological challenges, particularly around selecting an effective evaluation design to detect change at the community level, with adequate power and sampling, and appropriate constructs and measurement strategies. We propose a multiple baseline experimental design to evaluate the impact of a community-level youth violence and suicidality prevention strategy. A multiple baseline experimental design with multiple community units balances the need for scientific rigor with practical and values-based considerations. It includes randomization and plausible counterfactuals without requiring large samples or placing some communities in the position of not receiving the intervention. Considerations related to the conceptualization of the logic model, mechanisms of change, and health disparity outcomes informed the development of the measurement strategy. The strengths and weaknesses of a multiple baseline experimental design are discussed in comparison to versions of randomized clinical trials. Future health disparity intervention evaluation research will benefit from (1) building a shared sense of urgent public need to promote health; (2) respecting the validity of values- and partnership-based decision-making; and (3) promoting community-based and systems-level partnerships in scientific grant funding. The described study has been registered prospectively at clinicaltrials.gov, Protocol Record 21-454.

Parental Knowledge, Beliefs, Practices, and Barriers Related to Children's Bladder Health in the School Environment.

Pediatric lower urinary tract symptoms (LUTS) are a set of common childhood problems. Community-level interventions that target behavioral change among children with LUTS can improve symptoms outside of the clinic environment. Parents, navigating the home and school environments, are key in supporting healthy bladder behaviors. Thus, we asked parents about their perceptions and barriers related to pediatric bladder health. English-speaking parents (n = 30) of children ages 5-10 years with and without LUTS were interviewed. Transcripts were coded iteratively by two independent coders using deductive and inductive approaches that emphasized consensus coding and peer debriefing. Ninety-three percent of participants were women, 50% were 30-39 years old, and 60% held a graduate degree. Parents identified school-, classroom-, and child-based barriers to bladder health. These included the bathroom environment, restrictive policies for bathroom use, and anxiety on how and when to use the bathroom. Addressing school-, classroom-, and child-based barriers is necessary to promote healthy bladder habits among children in the school environment and beyond. Recommended school-based interventions include bathroom use and sanitation policies that support students' voiding needs, teachers' professional development, and school readiness initiatives. Limitations include participation of English-speaking parents only.

Cultivating a “Feminine” Surgical Culture: Lessons from Indonesia

Background: Despite a growing number of female physicians, most practicing surgeons in the U.S. are still men. By contrast, Indonesia has achieved notable gender parity among surgeons, with the number of women practicing as plastic surgeons projected to soon surpass men. Achieving more female representation in plastic surgery is important for delivering high-quality care, especially in the face of physician shortages and high burnout. Methods: This survey study was conducted at the 26th Annual Scientific Meeting of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons (InaPRAS) in Manado, Indonesia, during August 2023. Respondents were asked about their perceptions of plastic surgery, mentorship, career motivations, and caregiving responsibilities. Responses were scored using a 3-point Likert scale of agreement to statements (Disagree, Neutral, Agree); χ2 and Fischer’s exact test were performed to assess differences in responses by gender. Results: In this validated survey of 175 plastic surgeon trainees and attendings, there were no significant difference between genders in the perception and roles of mentorship in preparing for a career in plastic surgery. Respondents for both genders espoused optimistic views on work-life balance items, including time for family and friends and flexibility of work schedules. Conclusion: Indonesia can serve as a model for encouraging greater gender parity in plastic surgery. Community-level interventions such as family leave policies, childcare provisions, and initiatives to promote an inclusive culture will create a more supportive workplace to increase women’s representation in plastic surgery in the United States and around the world.

The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal.

Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016-2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.

The Loud Silent Side of Single Parenthood in Europe: Health and Socio-Economic Circumstances from a Gender Perspective

AbstractLone parenthood is one of the multiple accepted family types that make up today’s societies. In Europe, 3.2% of total households were single adults with children in 2019. Understanding the socioeconomic and demographic transformations that have led to the relatively high rates of single-parent families have attracted the attention and concern of researchers and policy makers. This study contributes to the literature by exploring trends in and predictors of health outcomes, lifestyle factors (obesity, smoking and alcohol) and social support among single-parent families and cohabiting couples in 20 European countries. To do so, microdata from the European Health Interview Survey-EHIS (2013–2015 and 2018–2020) is used. Running multivariate logistic regressions, we estimate the impact of individual factors associated with single parents’ health status, lifestyle factors and social support, adjusting by demographic characteristics and stressors. Our analysis suggests that both single mothers and fathers are left behind in several respects compared to their couple counterparts: lower education levels, lower income and worse economic conditions, worse physical health, and poorer social support relationships. Differences in health status, lifestyle factors and social support between single and couple parents, both mothers and fathers could be associated with the unequal distribution of demographic and stress factors found in this article. Understanding these characteristics of single-parent families could enable the establishment of community-level interventions to mitigate the adverse effects of lone parenthood and their children.

"We don't separate out these things. Everything is related": Partnerships with Indigenous Communities to Design, Implement, and Evaluate Multilevel Interventions to Reduce Health Disparities.

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

A Qualitative Study of the Meaning of Food and Religious Identity

ObjectiveTo identify common themes of the meaning of food among people who identify with a specific religious tradition, particularly focusing on potential applications for nutrition education and professional practice at multiple levels of the Social-Ecological Model. DesignVirtual and in-person focus groups were used to collect qualitative data. SettingA midsized city in eastern Washington State. ParticipantsNine focus groups (n = 35), each representing a distinct religious congregation. Phenomenon of InterestMeaning of food in the context of religion. AnalysisQualitative, reflexive thematic analysis using web-based software to organize data. ResultsFour key themes were identified that applied to both of the overarching focus group topic areas (general and religious): (1) food fosters connection, (2) food influences health, (3) relationships with food are complicated, and (4) food choices reflect values. Subthemes were specific to topic areas. In religious contexts, the meaning of food was more likely understood at a community level in addition to individual and relational levels of the Social-Ecological Model. Conclusions and ImplicationsAcknowledgment and consideration of the religious identities of patients and clients may provide greater opportunities for community connection, which may have potential implications for community-level nutrition interventions.

The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities.

Despite having the same underlying genetic etiology, individuals with the same syndromic form of intellectual developmental disability (IDD) show a large degree of interindividual differences in cognition and IQ. Research indicates that up to 80% of the variation in IQ scores among individuals with syndromic IDDs is attributable to nongenetic effects, including social-environmental factors. In this narrative review, we summarize evidence of the influence that factors related to economic stability (focused on due to its prevalence in existing literature) have on IQ in individuals with syndromic IDDs. We also highlight the pathways through which economic stability is hypothesized to impact cognitive development and drive individual differences in IQ among individuals with syndromic IDDs. We also identify broader social-environmental factors (e.g., social determinants of health) that warrant consideration in future research, but that have not yet been explored in syndromic IDDs. We conclude by making recommendations to address the urgent need for further research into other salient factors associated with heterogeneity in IQ. These recommendations ultimately may shape individual- and community-level interventions and may inform systems-level public policy efforts to promote the cognitive development of and improve the lived experiences of individuals with syndromic IDDs.

Smart cities and communities in the GCC region: from top-down city development to more local approaches

City planners are seeking ways to incorporate human-centric urban projects that combine smart technology, good infrastructure and people’s perception as well as their participation. Smart city developments are increasingly being applied to smaller scales at which communities can co-design hard infrastructure and the resulting services. Experiences from city projects at this level have produced a plethora of designs, challenges and success factors, particularly from cases in countries with long legacies in city development. In the Gulf Cooperation Council region, young cities and new planned cities house the bulk of the population and face environmental challenges related to urban segregation, urban sprawl and large consumption footprints. The political-economy of this region in terms of central urban planning and government-led economic development offers valuable insights on the limits and challenges in implementing projects related to smart and connected communities (SCC). SCC as a label for smart urban interventions towards more connectedness between hard and soft (human-related) infrastructure can provide opportunities for participatory and sustainable urban planning in the region. This paper analyzes the role of community-level interventions within the smart city policies of Gulf countries. It shows that only few local-level projects exist, while the barriers to large-scale SCC initiatives are related to demographics, community characteristics, technological sophistication, lack of conducive regulations, and the prevalence of central urban planning. The success of local smart city approaches in the Gulf is dependent on public leadership in terms of clearing obstacles, designing broader strategies, and expanding projects to include the residential sector. Considering the potential of SCC projects to enhance the transition to sustainability in the predominantly urban Gulf societies, broader engagement of local governments, utilities, and community-level developers can result in tangible benefits in terms of more sustainable, smart and tailored local services.

Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study

BackgroundCommunities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility.MethodsThis study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.ResultsState-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.ConclusionWe identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

Identifying research gaps in climate-related mental health outcomes in North America and Europe: a qualitative framework analysis

BackgroundClimate change and mental health outcomes are two of the most pressing global crises. Despite the increasing global mental health burden, climate-related mental health outcomes research is nascent and isolated, with substantial gaps across regions and disciplines. Connecting Climate Minds is a global initiative connecting researchers, experts, and people with lived experience of adverse mental health outcomes to identify regional research needs and create a community to support improved climate-related mental health outcomes. MethodsWe focused on North America and Europe as part of the global Connecting Climate Minds effort, using semi-structured interviews, focus groups, regional dialogues (ie, discussions between experts in climate health, planetary health, human health, and mental health and with lived experience to discuss the climate threats most affecting their communities, their effects on mental health, and opportunities for action), and a literature review to identify crucial research gaps in climate change and mental health. We collected insights into priorities when addressing mental health outcomes related to climate change in Europe and North America; requirements for effective research, policy, and practice; and encouraging collaboration from a diverse community that included experts, researchers, practitioners from multiple disciplines, indigenous groups, and youth representatives. We used a qualitative framework analysis to identify consensus priorities. FindingsSeveral themes emerged regarding research gaps. First, research into the effects of climate change on mental health is needed (eg, how pre-existing mental health outcomes are affected by climate disaster events, risk factors and protective factors, the effects of climate action or inaction on mental health, and economic costs). Second, investigating connections between climate-related mental health outcomes and Indigenous and other cultural practices (eg, the effects of climate change on Indigenous peoples and practices, cultural variations in mental health responses, and the effectiveness of integrating Indigenous and cultural knowledge into mental health interventions). Third, mixed-methods research is needed to explore the relationships between climate change, global and national economies, and governance and their associations with mental health outcomes. Fourth, evaluating social and cultural connectedness in mental health outcomes and climate change, community-level interventions, and the effectiveness of climate-education programmes that incorporate mental health considerations are research priorities. Finally, understanding how emerging technology can be used to understand climate-related mental health outcomes and use of technology to collect, analyse, and respond to population health data (with ethical considerations). InterpretationConnecting Climate Minds aims to psychologically equip people in Europe and North America to navigate the challenges of a changing climate. Climate-related mental health experts in should collaborate and encourage research and action that are proactive, community-led, and accessible. FundingImperial College London, the Wellcome Trust, and the Planetary Health Alliance via Harvard University.

Examination of community-level interventions addressing early childhood obesity in Los Angeles County

ObjectiveTo help inform decisions regarding the equitable implementation of obesity interventions, we examined whether interventions were equitably reaching the most vulnerable communities, identified communities that received fewer interventions than expected, and estimated the effect of ‘dose’ of interventions on obesity prevalence. MethodsWe created a database to identify and characterize obesity-related interventions implemented in Los Angeles County from 2005 to 2015 linked to community-level sociodemographic and obesity prevalence data. We ran generalized linear models with a Gamma distribution and log link to determine if interventions were directed toward vulnerable communities and to identify communities that received fewer interventions than expected. We ran fixed-effects models to estimate the association between obesity prevalence and intervention strategy count among preschool-aged children enrolled in the Special Supplemental Nutrition Assistance Program for Women Infants and Children. ResultsWe found that interventions targeted vulnerable communities with high poverty rates and percentages of minority residents. The small cluster of communities that received fewer interventions than expected tended to have poor socioeconomic profiles. Communities which received more intervention strategies saw greater declines in obesity prevalence (β = -0.023; 95 % CI: −0.031, −0.016). ConclusionsIt is important to determine if interventions are equitably reaching vulnerable populations as resources to tackle childhood obesity become available. Evaluating the population impact of multiple interventions implemented simultaneously presents methodological challenges in measuring intervention dose and identifying cost-effective strategies. Addressing these challenges must be an important research priority as community-wide interventions involve multiple intervention strategies to reduce health disparities.

Abstract 797: Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients

Abstract Background: Living in deprived or rural neighborhoods can negatively influence individual health through various mechanisms, including limited access to care due to scarce resources, medical facilities, or health professionals. Prior ecological studies have shown an association between living in rural or disadvantaged areas and higher cancer morbidity or mortality, but research on the association between neighborhood of residence and cancer patients’ healthcare utilization, health status, or quality of life has been limited. Method: We used survey and electronic health records data on cancer patients aged ≥18 years (N=16,606) from All of US Controlled Tier Dataset v7 (summer 2017-July 1, 2022). Area deprivation index (ADI) was based on six items, including 3-digit zip code-level median household income, proportions of high school graduation, vacant housing, recipients of public assistance income, and individual without health insurance or with incomes below the poverty level. Rural-urban status was defined at the 3-digit zip code-level as urban (100% urban), mostly urban (≥50%-<100% urban), and rural (>50% rural). Logistic regression models were used to estimate the association between ADI or rurality and health care utilization (general doctor, specialist, mental health, or nurse practitioner/physical assistant [NP/PA] visits) or health outcome (fair/poor physical and mental health status, quality of life), controlling for various covariates. Results: Cancer patients living in the most deprived areas (ADI 5th quintile) were less likely to have general doctor visits (OR=0.73; 95% CI=0.54-0.85), NA/PA visits (OR=0.87; 95% CI=0.77-0.99), or mental health professional visits (OR=0.85; 95% CI=0.74-0.98), and more likely to have fair or poor quality of life (OR=1.31; 95% CI=1.06-1.62), compared to those living in the least deprived areas (ADI 1st quintile), controlling for all covariates. Similarly, rural cancer patients were less likely to have general doctor visits (OR=0.58; 95% CI=0.42-0.79) or mental health professional visits (OR=0.53; 95% CI=0.41-0.67), and more likely to have fair/poor physical health (OR=1.27; 95% CI=1.03-1.57), compared with urban cancer patients. However, rural cancer patients were more likely to have NA/PA visits (OR=1.29; 95% CI=1.04-1.58) and less likely to have fair/poor mental health (OR=0.66; 95% CI=0.48-0.92). Cancer patients in mostly urban areas showed similar patterns to those in rural areas but the magnitudes of associations were smaller. Conclusions: In this study, cancer patients living in deprived or rural areas were less likely to have general doctor or mental health professional visits and more likely to have poor physical health compared to patients in the least deprived or urban area. Community-level interventions in deprived or rural areas are required to mitigate disparities in healthcare and health among cancer patients. Citation Format: Hyunjung Lee, Dongjun Lee, Ding Quan Ng, Daniel Wiese, Ahmedin Jemal, Farhad Islami. Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients [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 797.

Abstract P198: Developing a Practical, Evidence-Based Framework for Evaluating Community Nutrition Security Interventions

Introduction: Addressing nutrition insecurity at a population level is complex and requires changing policies, systems, and environments. The American Heart Association (AHA) has identified 17 research informed systemic interventions that have the potential to increase nutrition security over time. These interventions can be leveraged individually or together based on community needs and assets. Evaluating these interventions is essential for understanding impact, improving implementation, and allocating resources to effective strategies. This project sought to establish a pragmatic yet rigorous framework for evaluating the health impact of these strategies in communities across the United States. Hypothesis: We assessed the hypothesis that we could evaluate community nutrition security interventions by using program records, secondary data sources, and judicious use of primary data collection. Methods: Researchers reviewed details from the AHA's community impact database detailing 188 research informed nutrition security projects in communities across 29 states and the District of Columbia. Impacts were assessed for reach of intervention and strength of evidence to determine relative population dose of interventions. Seven interventions were determined to be ‘high dose,’ and researchers identified community and proximal outcomes for three high-dose interventions where the AHA is typically the catalyst that is leading and influencing work with community partners. Researchers reviewed 11 national databases to identify existing community-level data aggregated at the county, city, zip code, or census track that may be associated with the three high dose impact opportunities. Researchers then reviewed the evidence-based literature associated with proximal outcomes - organizational, environmental, policy, or individual/household changes - that have been documented in research studies in association with the three high dose interventions. Using the insight from both reviews, researchers were able to develop a model evaluation framework for assessing the impact of community level interventions over time. Results: Researchers were able to identify 17 proximal outcomes and two community level outcomes with evidence associated with the three high dose interventions. Conclusion: Demonstrating the impact of community level nutrition security interventions is challenging given the complexity of the environments in which they are implemented and the limitations of evaluation resources. This approach prioritizes high dose evidence-based interventions and then leverages existing community level datasets and organizational measures to assess impact. It provides a framework for other organizations to prioritize specific systemic interventions to evaluate and further informs the evidence base for future interventions.