Community Stakeholders Research Articles

Integrating Stakeholder Priorities for the Optimization of Care of the Preterm Infant in a Safety-Net NICU.

This study aimed to engage clinical and community stakeholders to create a prioritization matrix of interventions to reduce neonatal brain injury and improve neurodevelopmental outcomes. We collaborated with our community partner to establish a Lived Experience Advisory Group (LEAG). Faculty performed a literature review to identify neonatal neuroprotective interventions; additional priorities from the LEAG were also included. Project leaders scored and presented intervention bundles for impact. Stakeholder priorities for value/feasibility were obtained via questionnaire. Mean values were incorporated into a prioritization matrix. Themes from discussions with LEAG members included the role of the neonatal intensive care unit (NICU) parent, the experience of trauma, shared decision-making, communication and trust with the health care team, and bias in medical care. Five interventions were placed in the highest priority quadrant of the prioritization matrix: thermoregulation, maternal antepartum steroids, delayed cord clamping, optimized oxygen delivery, and optimized glucose regulation. It is feasible to incorporate community and parent values into clinically oriented neuroprotective intervention bundles for preterm infants. This clinical-community collaboration is vital to ensure that our project objectives meet the needs and priorities of the population it is intended to serve. · Including input from parent advisory groups supports interventions that meet the needs of families.. · Collaboration between clinical and community stakeholders can improve neuroprotective and neurodevelopmental strategies.. · Incorporation of clinical interventions into a prioritization matrix improves resource utilization.. · Five perinatal interventions were ranked highly for impact and feasibility in the prioritization matrix..

Practices of Good Governance in Budhanilkantha Municipality: Local Government Initiatives

This article explores good governance practices and public service delivery by elected representatives and administrative staff in Budhanilkantha Municipality, Nepal. It examines local government initiatives and emphasizes key principles of good governance such as accountability, transparency, justice, and participation. This study employs a mixed-methods approach, incorporating surveys and interviews, to assess key governance indicators, including transparency, accountability, public participation, and service delivery. Likewise, a stratified sampling method was used to select 120 respondents from all wards of Budhanilkantha Municipality. The findings provide a comprehensive overview of governance practices in the Municipality, highlighting strengths and improvement areas. While awareness of governance principles is generally high, challenges such as limited public participation, delayed public service delivery, and varying levels of transparency persist. The research underscores the importance of citizen engagement and the proactive implementation of good governance mechanisms to foster trust, enhance service delivery, and support sustainable local development. The insights derived from this case study offer valuable guidance for policymakers, practitioners, and community stakeholders seeking to strengthen governance frameworks at the local level.

Eksplorasi Sejarah, Arsitektur, dan Konservasi Candi Tebing Tegallinggah sebagai Warisan Budaya di Gianyar, Bali

The objective of this research is to critically evaluate the historical significance, architectural features, and conservation techniques associated with the Tegalinggah Cliff Temple, a major cultural heritage site in Gianyar, Bali. The inquiry used a qualitative research technique, collecting primary data through field observations and interviews with historians, local community stakeholders, and conservation specialists, supported with secondary material from relevant academic literature. Data was analyzed using qualitative descriptive approaches, supplemented by focus group discussions, to offer a thorough knowledge of the temple's historical background, architectural elements, and contemporary conservation efforts. The research results show that, despite Tegalinggah Cliff Temple's historical and architectural significance, it faces serious preservation issues such as natural degradation and limited community participation. The report emphasizes the importance of enhanced local engagement and the establishment of stronger conservation management structures to protect the site. In conclusion, the Tegalinggah Cliff Temple is an important cultural asset that requires increased preservation measures to maintain the long-term protection and development of Balinese cultural heritage.

Enhancing the Public-Private-Community Partnerships in the Banana Value Chain in Mutasa District, Zimbabwe

The paradigm shift from the New Public Administration to the New Public Governance underlines the significance of multi-stakeholder collaborations in attending to complex societal challenges. In this vein, Public-Private-Community Partnerships are a feasible mechanism for enhancing the banana value chain in Mutasa District of Zimbabwe. Bananas are extensively eaten fruits in the world with smallholder farmers playing a vital role in production, particularly in developing nations like Zimbabwe. Yet smallholder farmers’ economic returns in the banana value chain are a cause of concern. Thus, this study focuses on enhancing Public-Private-Community Partnerships in the smallholder banana value chain. A concurrent mixed methods research design allowed for both objectivity and detailed analysis. The target population comprised public, private, and community stakeholders in the banana value chain. The multiplicity of stakeholders motivated a mixture of quota, purposive, and snowball sampling techniques to ensure representation. Questionnaires, in-depth interviews, and focus group discussions were the data collection methods. There was descriptive analysis of quantitative data, while qualitative data were analyzed thematically, and related findings were grouped together. Public-Private-Community Partnerships are attractive because they reduce information asymmetry, enhance transparency, ensure fairness in pricing, facilitate risk sharing, increase productivity, and enhance value addition. Public-Private-Community Partnerships are not “magic bullets”, necessitating attention to their potential deficits, which include power imbalances, conflicts of interest among partners, and challenges associated with ensuring active participation by diverse stakeholder groups. Pathways for strengthening Public-Private-Community Partnerships include consensus building, clear definition of partners’ roles, fair sharing of risks and benefits, monitoring and evaluation, selection of competent actors, and farmer capacity building. Effective Public-Private-Community Partnerships facilitate active participation among the public, private, and community actors along the entire value chain.

Audit Committees in South Africa in Terms of the Companies Act 71 of 2008: Policy Rationale, Role and Contribution of Audit Committees towards Financial Reporting

In recent times the world's business community has seen an overwhelming surge of serious corporate governance and financial reporting scandals in both the private and the public sectors. These governance collapses happened despite the fact that the majority of these companies have audit committees. This article critically examines the provisions of the Companies Act 71 of 2008 relating to the establishment and maintenance of audit committees in South African companies. The focus is particularly on the policy rationale, and the role and contribution of audit committees towards financial reporting in South Africa. The purpose is to demonstrate that audit committees play a key role in the production of dependable financial statements and reports for the benefit of the company's stakeholder community. This article highlights the relationship between the effectiveness of audit committees and good corporate governance, as well as accurate financial reporting. In other words, where there is a more effective audit committee, there is a high likelihood of accurate and dependable financial statements and other financial reports.

Exploring the Role of Artificial Intelligence in Achieving a Net Zero Carbon Economy in Emerging Economies: A Combination of PLS-SEM and fsQCA Approaches to Digital Inclusion and Climate Resilience

In this paper, we examine the role of artificial intelligence (AI) in sovereignty and carbon neutrality, emphasizing digital inclusion and climate-resilient AI strategies for emerging markets. Considering the previous studies on AI for carbon neutrality and digital inclusion for climate research along with technology policy frameworks as a guide, this paper undertakes Partial Least Squares Structural Equation Modelling (PLS-SEM) with AI strategies and carbon neutrality outcomes. At the same time, fuzzy-set Qualitative Comparative Analysis (fsQCA) is used to reveal different configurations leading to achieving climate resilience. The model covers various aspects of AI-enabled policy, including technology adoption, policy frameworks, digital literacy, and public engagement. Survey data were collected from key stakeholders in climate policy, technology sectors, and local communities using a structured survey to understand their attitudes towards negative emissions technologies from prominent experts in emerging countries like Vietnam, Italy, Malaysia, and Greece. PLS-SEM results reveal the importance of AI in developing carbon neutrality, a critical AI strategic dimension (Data analytics capability and policy support). Some aspects of the fsQCA findings present heterogeneous outcomes, highlighting complex combinations of digital inclusion, AI adoption, and climate resilience which are industry-specific. This study would further enrich the literature concerning climate strategies by exploring AI, digital inclusion, and carbon neutrality interactions. Theoretically, practical and enriching suggestions for future research are derived to help AI intelligence infuse sustainable climate actions.

Memorias I° Jornada de Investigación de la Escuela de Ciencias Agrarias de la Universidad Nacional, Costa Rica (ECA-UNA)

The School of Agricultural Sciences (ECA) of the National University plays a crucial role in the generation, dissemination, and transfer of knowledge to society. Through its diverse programs, projects, laboratories, and academic activities, ECA addresses various strategic areas related to the management of agricultural resources, innovation in sustainable production systems, genetic improvement, and food security. As an academic unit, we are aware of the importance of disseminating and sharing the results of the main research conducted within the School. This is achieved by creating spaces to showcase the wide range of projects ECA undertakes to different stakeholders, including students, academics, producers, and the general public. The aim of these spaces is to foster multidisciplinary approaches that generate a positive impact in the search for solutions to the major challenges facing the agricultural sector, both nationally and regionally. In this context, the School of Agricultural Sciences organizes the 1st Research Conference as a key platform to present the main research conducted by this academic unit. This event seeks to share experiences with the entire university community and other stakeholders in the agricultural sector, fostering an enriching and collaborative dialogue. The realization of this event underscores the importance of joining efforts to promote innovation and sustainability in the agricultural sector, essential elements for the economic and social development of our country.

'Taking it one day at a time' and 'Reaching back out to help someone': How transgender women living with HIV and community stakeholders navigate violence, oppression, and health through coping and advocacy.

Transgender women living with HIV face intersectional oppression resulting in consequences for their mental and physical health. Interventions are needed that center the voices of transgender women living with HIV (TWLWH) and community stakeholders engrossed in work on behalf of the transgender community through advocacy and/or work roles. Through a partnership with a trans led and focused program of a community-based health organization and an academic partner, from October 2020 through October 2021, TWLWH and community stakeholders participated in qualitative interviews on trauma, violence, mental health struggles, HIV stigma, gender discrimination, health behaviors (e.g., medication adherence), and their thoughts and recommendations for a proposed intervention. Using a virtual platform (i.e., Zoom or phone) TWLWH and stakeholders were administered a demographics survey via Research Electronic Data Capture (REDCap) and completed individual interviews that were audio recorded. These interviews were analyzed using thematic content analysis. All TWLWH and 50% of stakeholders were Black. Qualitative findings highlighted the magnitude of violence, stigma, and discrimination faced by TWLWH and the mental, physical, and economic consequences. Also highlighted were the adaptive strategies TWLWH are utilizing to cope, ways in which invested stakeholders (many of lived expertise) are showing up for women, and acceptability and valuable insights for a proposed intervention. TWLWH are navigating a hostile society and multilevel interventions (at the structural, community, interpersonal, and individual levels) centering their voices and those invested in advocating for the community are needed to address the sequelae of oppression they face.

Increasing Access to Palliative Care in Cameroon: Progress, Gaps, and Recommendations.

Access to palliative care is an urgent global need. Countries with the greatest palliative care needs have limited access. In Cameroon, demand for palliative care is growing due to the rising incidence of life-limiting conditions. Identifying available palliative care services and programs could provide an understanding of access gaps and inform future roadmaps for palliative care development in the country. We aim to map available palliative care services, identify gaps and inform recommendations to promote early access to palliative care in Cameroon. We undertook a literature review of articles reporting any aspects of palliative care in Cameroon. We searched Embase, MEDLINE, Scopus, PsycINFO, CINAHL, PubMed and gray literature. Data were analyzed thematically using the World Health Organization model for the assessment of palliative care development. We identified 41 articles reporting 21 organizations with some form of palliative care services such as clinical services, education, advocacy and research. These were led mostly by individual health care providers or private and faith-based organizations. Major palliative care initiatives included training in the form of workshops, and adult and pediatric outpatient, in-patient and community-based palliative care. There were few reports of oral morphine production, community engagement, advocacy and palliative care research. Progress in palliative care development was reported in five regions of Cameroon over the last two decades. Findings suggest the need for an intersectoral approach including government, community, and health care stakeholders to achieve sustainable palliative care. This could potentially ensure equitable access to palliative care in Cameroon.

Substance Use Service Utilization and Barriers to Access Among Homeless Veterans: A Scoping Review

The high prevalence of military veteran substance use (SU) when compared to their nonveteran counterparts has been described as an urgent public health issue. The commonality of severe mental and physical health comorbidities in this population affects their ability to recover and relates to the onset and maintenance of homelessness. While veteran-targeted housing and SU interventions exist, they are being underutilized. This scoping review synthesizes published peer-reviewed articles from 1990 to 2021 at the intersections of housing, substance abuse, and service utilization by homeless veterans. Qualitative thematic analysis of 119 retained peer-reviewed articles revealed five key themes: (1) the association between SU and housing stability, (2) gendered comparisons with service needs and provision, (3) consideration for comorbidities, (4) social support and relationship-centered interventions, and (5) barriers to health care services. This review offers a series of concerns, outcomes, and recommendations that might be valuable for practitioners, health care providers, and community stakeholders when implementing or re-evaluating new or existing homeless veteran treatment programs.

Barriers and facilitators encountered by healthcare providers when supporting individuals with SCI to change their bowel care

Background Individuals with spinal cord injury (SCI) are dissatisfied with their bowel care, but 71% have not changed their care for at least 5 years. Recently, individuals with SCI expressed a need for knowledge about bowel care options. Healthcare providers (HCP) play a crucial role in supporting bowel care changes. Objective We aimed to understand the barriers and facilitators HCP face when discussing changes in bowel care with individuals with SCI. Methods Semi-structured interviews were conducted with HCP in partnership with Spinal Cord Injury British Columbia and key community stakeholders. Barriers and facilitators were extracted, deductively coded using the Theoretical Domains Framework, then inductively analysed for themes. Results Themes highlighted that effective bowel care requires diverse knowledge from a multidisciplinary team. Lack of time to prioritise bowel care and limited healthcare resources were barriers to improving care, which may be augmented through regular bowel care review of both medical and person-centered priorities. Facilitators were accessible and tailored knowledge sharing of care options, complemented by peer support. Conclusion This study highlights the need for targeted interventions that reduce barriers and enhance facilitators to changing care routines, supporting individuals with SCI to change bowel care when needed, and improving quality of life.

Examining Community Preferences for Adaption and Dissemination of an Efficacious Brief Intervention on Alcohol Use and Sexual Behavior

Compared to other age groups, 18- to 25-year olds (young adults) are more likely to engage in heavy alcohol use and inconsistent contraceptive use, increasing their susceptibility to sexually transmitted infections (STIs) and unintended pregnancy. The Studying Alcohol and Related Risks (STARR) intervention was efficacious in reducing young adult alcohol-related risky sexual behavior, including reducing the number of casual sexual partners and alcohol use prior to sex. We conducted a qualitative study to guide the adaptation of the STARR intervention to include additional content on contraceptive use and prepare for dissemination of the intervention to a community audience. We conducted 10 focus groups with young adults (n = 16) and semistructured interviews with local community stakeholders (n = 12) to examine: (a) intervention characteristics, such as compatibility, adaptability, and design and packaging and (b) dissemination and communication channels. Focus groups and interviews were audio-recorded, transcribed, and thematically analyzed. Participants found the proposed intervention acceptable and highlighted the need to promote STI prevention among young adults. Participants viewed text-based interventions as accessible and effective. Key considerations included developing personalized messages from credible sources, using gender-inclusive language, and sending messages at strategic timepoints. Social media (Instagram, Twitter, Snapchat, TikTok), events, and campus resources were described as avenues to create awareness and disseminate information about the proposed intervention. Findings demonstrate the need for innovative and tailored young adult health programs that incorporate multilevel dissemination strategies. This study highlights the need for implementation activities that will improve the adoption and dissemination of evidence-based programs, particularly among young adults.

The gift of health promotion in a celebration: A descriptive observational study of community baby showers on YouTube

Introduction: Although community baby showers have persisted as a global health promotion practice for infants and their families over the past decades, to date there is no study that has evaluated coverage and engagement of community baby showers across social media as a rising global health communication medium in this contemporary digital era. It follows that the goal of this study sought to fill this gap by examining the existing state of coverage for community baby showers on social media utilizing view count as an engagement metric. Methods: In this cross-sectional, descriptive and observational study, we conducted a content analysis of the top 100 most widely viewed videos populated on YouTube at one conceptual point in time that covered community baby showers. to determine the most prevalent sources, formats, and content represented across this sample of videos. Results: Many of the videos were published by nongovernmental / organizational sources (n=86) and among them, the majority were in the form of news reports (n=59). Content across these videos presented a diversity of community stakeholders and entities involved in the development and implementation of community baby showers, many which were both for-profit and non-profit organizations (n=72). There was substantial coverage of a wide range of resources and services for prenatal and postnatal care delineated across all of the videos in this sample. Several videos (n=39) covered increased support building for families of infants. Notably, these videos cumulatively generated a low number of views (N=73,036) which yields clinical, educational, and public health implications. Conclusion: Recommendations to partner with news organizations and utilize content that generated greater viewership as facilitators in increasing capacity to reach, engagement and impact of community baby showers are presented to optimize infant health outcomes, reduce infant mortality, and heighten access to resources and support for infants and their families worldwide.

Empirical Reality versus Theoretical Framework: Street-Level Bureaucrats' Behavior in Driver's License Services at Pinrang Police Resort, Indonesia

This study investigates the behavioral dynamics of street-level bureaucrats (SLBs) in the driver's license (SIM) service at the Pinrang Resort Police (Polres Pinrang) in Indonesia, juxtaposing empirical findings with Michael Lipsky's seminal theory of street-level bureaucracy. Employing a qualitative phenomenological methodology, the research seeks to elucidate the influence of working conditions on SLBs' behavioral patterns and the consequent impact on public service quality. Data were collected through semi-structured interviews with SLBs and service recipients, non-participant observations, and document analysis, then subjected to iterative thematic analysis using interactive model. The findings reveal notable divergences from Lipsky's theoretical propositions. SLBs at Polres Pinrang encounter reduced ambiguity in policy objectives and performance evaluation, attributable to effective communication channels, comprehensive standard operating procedures, and a robust performance appraisal system. Despite resource limitations and escalating service demands, SLBs exhibit adaptability in delivering responsive services through access rationing strategies, task routinization, and collaborative partnerships with interdepartmental units and community stakeholders. Contrary to the nonvoluntary client interactions posited by Lipsky, SLB-SIM applicant engagements are characterized by enhanced humanization and responsiveness. Nevertheless, Lipsky's theoretical insights maintain relevance in the broader landscape of public service provision. The study underscores the criticality of striking a balance between procedural adherence and client-centric responsiveness to optimize service quality.

Evaluating public health vending machine rollout and utilization in criminal-legal settings

IntroductionHarm reduction resources for people who are involved in the criminal-legal system should be easily accessible. The Rhode Island Department of Corrections (DOC) used funding from a state opioid stewardship fund created through the Rhode Island Opioid Stewardship Act (legislation passed in 2019) to implement five custom-designed vending machines for community corrections offices and state awaiting trial carceral facilities. The vending machines provide resources for overdose prevention, infection prevention, basic needs, and nicotine replacement therapy (NRT). We aim to describe the development and rollout of the vending machines and present data about items taken most frequently by setting. MethodsResearch and design experts, with DOC and community stakeholders, developed and tailored the public-facing design of the vending machines. Before implementation, the researchers from the development team conducted meetings with staff at each location to discuss harm reduction and their role in addressing the opioid crisis in this high-risk population. The machines were manufactured in 2022 and installed in early 2023 (dates varied by location). The community support and advocacy organization tracks and maintains inventory (items taken and replaced) by month. No individual-level client data is collected. ResultsThere were 3720 items dispensed from May 2022 to February 2024 across five locations. Overall, hygiene kits were the most frequently accessed item (28.3 %, n = 1051), followed by NRT (19.0 %, n = 706) and ponchos (16.6 %, n = 616). The fentanyl tests (n = 230), wound care kits (n = 248), resource guide (n = 253), naloxone (n = 221), and safer sex kits (n = 218) each made up between 5.9 % and 6.8 % of items accessed. The pregnancy test was the least accessed at 4.8 % (n = 177). There were statistically significant differences in the monthly number of items distributed by location for the basic needs items, excluding NRT, with 39 items per month at the three Probation/Parole locations compared to 21 per month for the two DOC facilities. ConclusionsThe utilization patterns demonstrate the demand for basic supplies and support related to harm reduction. Monitoring and summarizing utilization ensures that the vending machines remain useful to the community and facilitates transparency and communication with stakeholders.

Organic Community Leadership: An Integrated Perspective

Community, characterised by reciprocity and mutuality, represents one of the fundamental bases upon which society is built. Community leadership is a distinct leadership style that refers to civic-minded individuals who voluntarily and organically self-organise and devote their efforts towards leading issues of importance within their communities. This organic community leadership is a ‘collective relational phenomenon’ that is favoured in dynamic environments; the voluntary action of people within a community can help tackle community challenges at scale, with speed, and result in grassroot innovations. Despite its positive role in society, community leadership faces additional challenges to leadership in organisational settings, including understanding the spatial boundaries of a domain which spans different social fields, fostering linkages among groups where there is no formal authorisation, being receptive to varying ideologies, capabilities, and divergent viewpoints to foster collaboration, and managing unequal power distribution and divergent political agendas. The above opportunities and challenges posed by community leadership has meant that the past few decades have seen growing attention placed on the study of community leadership. Gaps remain in the body of knowledge in supporting the effective execution of community leadership. Authors argue that the leadership literature remains fragmented, many leadership frameworks/models remain agnostic of context, and there is a need for improved understanding of where and by whom leadership is enacted. Most studies to date concentrate on discrete aspects of the community leadership sphere. A more integrated perspective on organic community leadership is needed. Based on a SLR, this paper presents an integrated framework for organic community leadership. The framework emphasises human agency and fostering the collective efficacy of a broad coalition of community stakeholders to work towards a common purpose. It recognises the legitimisation process of emerging leaders and key leader behavioural considerations, framed within the context of fostering an appropriate environment for community cohesion, collaboration, and action. Thus, this paper takes a step towards providing a more holistic stance on the community leadership phenomenon.

Outcomes of Community-Friendly Schools in Hong Kong

Amid growing competition and evolving demands, schools must rethink their roles in addressing the needs of various stakeholders. Community-friendly schools in Hong Kong, which integrate community resources to help students understand and contribute to social issues, not only facilitate students’ engagement in learning activities and their learning attitudes but also positively impact students’ willingness to serve the community and the school’s reputation. This research adopted both qualitative and quantitative methods, utilizing questionnaires and interviews as data-gathering instruments. The sample included students, teachers, and community stakeholders for the questionnaires, while interviews were conducted with a smaller group, consisting of participants from each of these groups. The performance of these schools was assessed in terms of their impact on students' understanding of the community, willingness to serve, and school reputation. These aspects were evaluated through three tiers of community-friendly schools: community learning activities, activities in cooperation with community organizations, and community services organized by the school. The data analysis employed descriptive statistics, analysis of variance, and linear regression models to highlight the significant impacts of these institutions. Key findings revealed that community-friendly schools significantly boosted student engagement in community activities, deepening their understanding of social issues and fostering a stronger sense of civic responsibility. Students' involvement in these programs was strongly linked to a deeper understanding of the community and a greater willingness to serve. These initiatives also positively impacted the school's reputation, as stakeholders perceived these schools as fostering meaningful community connections and shared responsibility.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

Identifying pragmatic solutions to reduce cigarette smoking prevalence in Indigenous North Americans: A sequential exploratory mixed-methods study protocol.

American Indians and Alaska Natives (AI/AN) have the highest prevalence of cigarette smoking of any race or ethnicity in the United States. Efforts to address smoking prevalence in this population have not historically targeted maintenance of smoking cessation, or behaviors associated with pregnancy. Recent longitudinal cohort studies have identified maintenance of cessation and pregnancy as potential opportunities to address smoking in AI/AN people. To promote success in achieving sustained smoking cessation in AI/AN people, we propose a community engaged sequential exploratory mixed-methods study focused on identifying pragmatic elements of cessation interventions. A discovery sample of 45 AI/AN people will be included in the qualitative study in one of two arms consisting of small groups or one-on-one interviews to develop elements of cessation interventions for evaluation in a discrete choice experiment survey. These one-on-one interviews will characterize the key drivers of smoking relapse and unique experiences of smoking during pregnancy. An additional, independent small group will consist of counselors who engage in smoking cessation counseling. A larger-scale survey will be administered to an AI/AN cohort from Olmsted County, Minnesota (n = 898). Elements of successful interventions will be used to inform a smoking cessation intervention pilot study. Community stakeholders have informed the methods outlined in this protocol, and there is a longitudinal engagement plan for the duration of study. We outline the methods to understand optimal strategies to promote sustained cigarette smoking cessation and cessation during pregnancy in AI/AN people. This study is critical to inform a pilot intervention aimed at reducing smoking prevalence in AI/AN people.

Exploring Climate Change Adaptations for Cultural Heritage: The ADAPT Framework

Abstract There is an urgent need for climate change–informed decision-making and adaptation actions for cultural heritage. Challenges arise in incorporating and balancing multiple considerations, including robust understandings of climate change vulnerability, the objectives of current management paradigms, the need for meaningful engagement, the risk of maladaptation, and constrained resources to implement. We offer a conceptual framework and guide to integrate climate science and cultural heritage management to produce a range of adaptation actions for cultural heritage, categorized as Acclimate, Dislocate, Abandon, Protect, and Tell the Story (ADAPT) approaches. The ADAPT framework is intended to aid archaeologists and other cultural heritage managers in developing and evaluating possible adaptation actions that directly respond to findings from climate change vulnerability assessments, critically integrating management postures and constraints, and coproducing climate change adaptations with Indigenous rightsholders and community stakeholders.