Community-wide Interventions Research Articles

Striking Decrease of Enteroviral Meningitis in Children During the COVID-19 Pandemic.

We report the unprecedented complete absence of pediatric enteroviral meningitis in 2020 in the area of Bern, Switzerland. Presumably an unintended effect of coronavirus disease 2019 public health measures, this finding highlights the potential of community-wide nonpharmaceutical interventions for controlling the circulation of a major pediatric pathogen, which is mainly transmitted by the fecal–oral route.

Impact of a community-wide combination HIV prevention intervention on knowledge of HIV status among adolescents.

Objective:To determine the impact of a community-wide combination HIV-prevention package (PopART Intervention) that includes universal testing and treatment (UTT) on knowledge of HIV status, among adolescents aged 15--19 years.Design:The HPTN 071 (PopART) for Youth (P-ART-Y) study was nested within HPTN 071 (PopART), a three-arm, cluster-randomized trial conducted from 2013 through 2018 in 21 communities in Zambia and South Africa. Communities were randomly assigned to arm A (combination prevention intervention with universal ART), arm B (prevention intervention with ART provided according to local guidelines), or arm C (standard-of-care).Methods:Knowledge of HIV status was measured using data collected during the third round of the PopART intervention in arms A and B (October 2016 to December 2017) and by conducting a cross-sectional survey (August to November 2017) in arm C communities to provide comparative data. The survey was conducted among ∼200 randomly selected adolescents in each community. We used linear regression of the 21 community-level values to make comparisons among trial arms.Results:Knowledge of HIV status was 78.2% (23 544/30 089) in arm A and 76.0% (24 417/32 148) in arm B communities, compared with 32.9% (698/2120) in arm C communities. Knowledge of HIV status varied by country, triplet, sex, and age. The adjusted mean difference was 42.3% between arm A with arm C, 95% CI 28.1–56.6, P less than 0.001 and 40.4% between arm B with arm C, 95% CI 24.6–56.2, P < 0.001).Conclusion:Implementation of a community-wide combination HIV-prevention package that includes UTT substantially enhanced knowledge of HIV status among adolescents.

The Happy Campaign: Assessing the Effects of a Community-Wide Intervention on Older Adults Living in Public Housing

In the field of developmental psychology, the Stress-and-Coping model (Lazarus & Folkman, 1984) posits that individual differences in biological, psychological, and social risk and protective factors serve to increase or buffer the impact of stressful experiences on psychological well-being later in life. Importantly, research suggests that residents of public housing generally experience more risk factors than elders at large (Rabins, et al. 1996). The present study examines the impact of a programmatic intervention, The Happy Campaign, on individuals living in public housing in a small Midwestern city (aged 51-90 years; Mage= 63.3 years; SDage= 8.6 years). Goals of the Happy Campaign were to improve residents’ coping skills and increase perceived support. Results demonstrated significant improvement in key aspects of well-being post-intervention; these included significant increases in exercise (p = .04), self-reported health (p = .01), as well as decreases in negative affect (p= .008). Data also show a moderate increase in residents’ hope post-intervention (p = .06). Although future research is needed to account for confounding variables that arose in conducting research in this community setting, these data provide preliminary evidence that a broad-based, environmental intervention may offset the myriad risks faced by particularly vulnerable elders, and even augment well-being.

Social distancing as a strategy to prevent respiratory virus infections.

Social distancing as a strategy to prevent respiratory virus infections.

Do multicomponent community-wide interventions that include mass media, individual counseling, and organizational partnership components increase physical activity?

Do multicomponent community-wide interventions that include mass media, individual counseling, and organizational partnership components increase physical activity?

Long-term effects of a toddler-focused caries prevention programme among Northwestern US tribal children: The TOTS-to-Tweens study.

We sought to determine whether American Indian tribe-based interventions that successfully prevented toddler dental caries in a 2005 cohort study (the Toddler Overweight and Tooth Decay Prevention Study, or TOTS) influenced the prevalence of dental caries in children ages 11 to 13 in the same communities ten years later (the TOTS-to-Tweens study). We recruited original TOTS participants and conducted school- and community-based dental screenings at tribal communities that received family plus community-wide interventions (F+CW), community interventions only (CW) or were control communities. We also enrolled children who did not participate in TOTS, but were exposed to CW interventions or to the control environment. Trained clinicians examined children's teeth and recorded whether each tooth was decayed, missing or filled (DMFT). We calculated DMFT scores for each child and evaluated differences in DMFT incidence rate ratios (IRR) and components of DMFT by intervention group. We observed lower age- and sex-adjusted DMFT scores among F+CW children (a mean of 2.1 DMFT; 95% confidence interval [CI]: 1.4-2.7) and among CW children (2.2; 95% CI: 1.9-2.6), than control children (3.0; 95% CI: 2.3-3.7). The F+CW group had 32% lower DMFT scores than control children (IRR=0.68; 95% CI: 0.46-1.01), and CW children had 26% lower DMFT scores than control (IRR=0.74; 95% CI: 0.55-1.00). The proportion of children with filled teeth was higher in control than intervention communities (37.9% in F+CW, 47.1% in CW, and 67.1% in control, P=.002). Our findings suggest modest yet significant long-term effects of interventions that prevented toddler dental caries on the DMFT scores of tweens evaluated ten years later. Further study of effective interventions and their sustainability is clearly warranted among tribal children, who remain at high risk for dental caries.

Population strategy for promoting physical activity.

Physical inactivity is a globally prevalent phenomenon even though the health benefits of physical activity are well-known. The development of population strategies that effectively promote physical activity is necessary to reduce the individual and social burden of physical inactivity. Quality evidence informing strategies to promote physical activity at scale, however, is limited. Among cluster randomized trials examining the effectiveness of multistrategic, community-wide interventions aimed at promoting physical activity, only 1 trial (the COMMUNICATE study) successfully achieved a population-level increase in physical activity. This trial adopted social marketing techniques and network intervention (eg, word of mouth) in close collaboration with the target population (community residents). Although most previous studies ended their interventions within 1 to 3 years, the COMMUNICATE study took 5 years to achieve a population-level increase in physical activity. These findings suggest the need for a more focused approach (1 behavior at a time) as a basic marketing principle. Promoting physical activity at scale is a tough challenge but not impossible. Sophisticated approaches are necessary.

The State of Experimental Research on Community Interventions to Reduce Greenhouse Gas Emissions—A Systematic Review

This paper reviews research on community efforts to reduce greenhouse gas emissions. We conducted a systematic search of the relevant literature, and supplemented our findings with an analysis of review papers previously published on the topic. The results indicate that there have been no peer-reviewed experimental evaluations of community-wide interventions to reduce greenhouse gases involving electricity, refrigeration, or food. The lack of findings limits the conclusions which can be made about the efficacy of these efforts. As a result, we are not accumulating effective interventions, and some communities may be implementing strategies that are not effective. We advocate for the funding of experimental evaluations of multi-sector community interventions to reduce greenhouse gas emissions. Such interventions would attempt to engage every sector of the community in identifying and implementing policies and practices to reduce emissions. Comprehensive multi-sector interventions are likely to have synergistic effects, such that the total impact is greater than the sum of the impact of the individual components. We describe the value of interrupted time-series designs as an alternative to randomized trials, because these designs confer particular advantages for the evaluation of strategies in entire communities.

Unpalatable food for thought: Let marketing research guide effective public obesity interventions.

The prevalence of obesity is growing unabatedly despite the considerable efforts directed at the problem. Although abundant research has contributed to our understanding of the multifactorial causes of obesity, there is less attention to research that is relevant for guiding social marketers, public health professionals and policymakers in delivering public health interventions for countering and/or preventing the problem of obesity. This review offers six points for identifying and developing research relevant for guiding community-wide obesity interventions based on the idea that an applied marketing research perspective offers a better model for identifying effective interventions than more theoretical academic research. Specifically, the research guiding public health and social marketing interventions needs to (1) provide information on ultimate outcomes (weight, health and unintended consequences) more than intermediate outcomes (beliefs, attitudes and behaviour), (2) report on observations collected over the longer term, (3) use natural settings (even at a cost of internal validity), (4) endeavour to overcome observer-effects, (5) report effect sizes (rather than statistical significance) and (6) use moderator analyses to capture variation in how a population responds to interventions.

Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation

Community randomised trials have had mixed success in implementing combination prevention strategies that diagnose 90% of people living with HIV, initiate and retain on antiretroviral therapy (ART) 90% of those diagnosed, and achieve viral load suppression in 90% of those on ART (90-90-90). The Bukoba Combination Prevention Evaluation (BCPE) aimed to achieve 90-90-90 in Bukoba Municipal Council, Tanzania, by scaling up new HIV testing, linkage, and retention interventions. We did population-based, cross-sectional surveys before and after our community-wide intervention in Bukoba-a mixed urban and rural council of approximately 150 000 residents located on the western shore of Lake Victoria in Tanzania. BCPE interventions were implemented in 11 government-supported health-care facilities throughout Bukoba from Oct 1, 2014, to March 31, 2017, when national ART-eligibility guidelines expanded from CD4 counts of less than 350 cells per μL (Oct 1, 2014-Dec 31, 2015) and 500 or less cells per μL (Jan 1, 2016-Sept 30, 2016) to any CD4 cell count (test and treat, Oct 1, 2016-March 31, 2017). We used pre-intervention (Nov 4, 2013-Jan 25, 2014) and post-intervention (June 21, 2017-Sept 20, 2017) population-based household surveys to assess population prevalence of undiagnosed HIV infection and ART coverage, and progress towards 90-90-90, among residents aged 18-49 years. During the 2·5-year intervention, BCPE did 133 695 HIV tests, diagnosed and linked 3918 people living with HIV to HIV care at 11 Bukoba facilities, and returned to HIV care 604 patients who had stopped care. 4795 and 5067 residents aged 18-49 years participated in pre-intervention and post-intervention surveys. HIV prevalence before and after the intervention was similar: pre-intervention 8·9% (95% CI 7·5-10·4); post-intervention 8·4% (6·9-9·9). Prevalence of undiagnosed HIV infection decreased from 4·7% to 2·0% (prevalence ratio 0·42, 95% CI 0·31-0·57), and current ART use among all people living with HIV increased from 32·2% to 70·9% (2·20, 1·82-2·66) overall, 23·0% to 62·1% among men (2·70, 1·84-3·96), and 16·7% to 64·4% among people aged 18-29 years (3·87, 2·54-5·89). Of 436 and 435 people living with HIV aged 18-49 years who participated in pre-intervention and post-intervention surveys, previous HIV diagnosis increased from 47·4% (41·3-53·4) to 76·2% (71·8-80·6), ART use among diagnosed people living with HIV increased from 68·0% (60·9-75·2) to 93·1% (90·2-96·0), and viral load suppression of those on ART increased from 88·7% (83·6-93·8) to 91·3% (88·6-94·1). BCPE findings suggest scaling up recommended HIV testing, linkage, and retention interventions can help reduce prevalence of undiagnosed HIV infection, increase ART use among all people living with HIV, and make substantial progress towards achieving 90-90-90 in a relatively short period. BCPE facility-based testing and linkage interventions are undergoing national scale up to help achieve 90-90-90 in Tanzania. US Presidents' Emergency Plan for AIDS Relief.

Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country

This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term community-wide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1–5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term.Registration: This study is registered at IRCT, a WHO primary registry (https://irct.ir). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1.

Understanding socio-cultural influences on food intake in relation to overweight and obesity in a rural indigenous community of Fiji Islands.

Obesity and non-communicable diseases (NCDs) are largely preventable by understanding the connection between socio-cultural knowledge, yet intervention effectiveness may hinder changes in lifestyles and behaviours in Indigenous health. This study performed to understand the social and cultural components, which contribute to obesity in rural areas of the Indigenous Fijian. This study is a Community-Based Participatory Research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data were analysed using descriptive thematic analysis. Food intake was associated with socio-cultural, economic, political and physical environmental factors. Participants reveal previous health promotion programs did not incorporate the cultural values, cultural competence beliefs and traditional ways of rural Indigenous Fijian community. The health care providers and policymakers need to be involved in recognising iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. SO WHAT?: Community-wide lifestyle interventions, conceptual approaches based on communal perceptions of the problem at hand can also be the basis for future research on identifying socio-cultural factors, for example, the community and family support that can help shape behaviours.

Spatial distribution of people diagnosed with tuberculosis through routine and active case finding: a community-based study in Kampala, Uganda

BackgroundRoutine tuberculosis (TB) notifications are geographically heterogeneous, but their utility in predicting the location of undiagnosed TB cases is unclear. We aimed to identify small-scale geographic areas with high TB notification rates based on routinely collected data and to evaluate whether these areas have a correspondingly high rate of undiagnosed prevalent TB.MethodsWe used routinely collected data to identify geographic areas with high TB notification rates and evaluated the extent to which these areas correlated with the location of undiagnosed cases during a subsequent community-wide active case finding intervention in Kampala, Uganda. We first enrolled all adults who lived within 35 contiguous zones and were diagnosed through routine care at four local TB Diagnosis and Treatment Units. We calculated average monthly TB notification rates in each zone and defined geographic areas of “high risk” as zones that constituted the 20% of the population with highest notification rates. We compared the observed proportion of TB notifications among residents of these high-risk zones to the expected proportion, using simulated estimates based on population size and random variation alone. We then evaluated the extent to which these high-risk zones identified areas with high burdens of undiagnosed TB during a subsequent community-based active case finding campaign using a chi-square test.ResultsWe enrolled 45 adults diagnosed with TB through routine practices and who lived within the study area (estimated population of 49 527). Eighteen zones reported no TB cases in the 9-month period; among the remaining zones, monthly TB notification rates ranged from 3.9 to 39.4 per 100 000 population. The five zones with the highest notification rates constituted 62% (95% CI: 47–75%) of TB cases and 22% of the population–significantly higher than would be expected if population size and random chance were the only determinants of zone-to-zone variation (48%, 95% simulation interval: 40–59%). These five high-risk zones accounted for 42% (95% CI: 34–51%) of the 128 cases detected during the subsequent community-based case finding intervention, which was significantly higher than the 22% expected by chance (P < 0.001) but lower than the 62% of cases notified from those zones during the pre-intervention period (P = 0.02).ConclusionsThere is substantial heterogeneity in routine TB notification rates at the zone level. Using facility-based TB notification rates to prioritize high-yield areas for active case finding could double the yield of such case-finding interventions.

Impact of changing road infrastructure on children's active travel: A multi-methods study from Auckland, New Zealand

IntroductionBuilt environment infrastructure that supports active travel may help increase rates of children's active travel to school. Knowledge gaps exist in terms of how small-to-medium scale, school-focused infrastructural changes might impact children's active school travel and associated variables along the pathway to behaviour change. The aim was to work with a regional transport agency to evaluate the impact of infrastructural changes in a school neighbourhood. MethodsChildren in school years 5–8 and their parents/caregivers from two schools involved in a school travel intervention were invited to participate. The study area was identified in partnership with Auckland Transport (responsible for delivering all intervention elements). Children completed a geographic informations systems survey that captured behaviours and neighbourhood perceptions. Parents completed a telephone interview to measure neighbourhood perceptions and reasons for school travel mode. Tube counters and video cameras were used to measure traffic speeds and volume, and counts of pedestrians and cyclists, respectively. Baseline measures were taken in 2015 (traffic data) and from May-July 2016 (all other measures), infrastructural works were delivered from November 2016 to May 2017, and follow-up measures were repeated in May-June 2018. ResultsAt baseline, 123 children and 88 parents participated. At follow-up, 152 children and 91 parents participated. Reductions in traffic speeds but increases in traffic volumes were observed post the intervention. Positive and negative shifts in child and parent neighbourhood perspectives were observed. Distance to school, convenience, and traffic saftey concerns were raised as key factors of importance by parents and children. Overall, rates of car use for the school trip increased, while video observation showed an increase in pedestrians. ConclusionsReversing declines in active travel may require more intensive, community-wide interventions that substantially improve neighbourhood safety and perceptions of safety. Longer term follow-up may be necessary to understand the true effect of the intervention.

Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey.

BackgroundThe mental health consequences of the coronavirus disease (COVID-19) pandemic, community-wide interventions, and social media use during a pandemic are unclear. The first and most draconian interventions have been implemented in Wuhan, China, and these countermeasures have been increasingly deployed by countries around the world.ObjectiveThe aim of this study was to examine risk factors, including the use of social media, for probable anxiety and depression in the community and among health professionals in the epicenter, Wuhan, China.MethodsWe conducted an online survey via WeChat, the most widely used social media platform in China, which was administered to 1577 community-based adults and 214 health professionals in Wuhan. Probable anxiety and probable depression were assessed by the validated Generalized Anxiety Disorder-2 (cutoff ≥3) and Patient Health Questionnaire-2 (cutoff ≥3), respectively. A multivariable logistic regression analysis was used to examine factors associated with probable anxiety and probable depression.ResultsOf the 1577 community-based adults, about one-fifth of respondents reported probable anxiety (n=376, 23.84%, 95% CI 21.8-26.0) and probable depression (n=303, 19.21%, 95% CI 17.3-21.2). Similarly, of the 214 health professionals, about one-fifth of surveyed health professionals reported probable anxiety (n=47, 22.0%, 95% CI 16.6-28.1) or probable depression (n=41, 19.2%, 95% CI 14.1-25.1). Around one-third of community-based adults and health professionals spent ≥2 hours daily on COVID-19 news via social media. Close contact with individuals with COVID-19 and spending ≥2 hours daily on COVID-19 news via social media were associated with probable anxiety and depression in community-based adults. Social support was associated with less probable anxiety and depression in both health professionals and community-based adults.ConclusionsThe internet could be harnessed for telemedicine and restoring daily routines, yet caution is warranted toward spending excessive time searching for COVID-19 news on social media given the infodemic and emotional contagion through online social networks. Online platforms may be used to monitor the toll of the pandemic on mental health.

Awareness of the term "frailty" and its correlates among older adults living in a metropolitan area

Objectives This study aimed to examine the awareness of the term "frailty" and its correlates among older adults living in a Japanese metropolitan area.Methods We used baseline and 2-year follow-up data from a community-wide intervention on preventing frailty in Ota City, Tokyo. In July 2016, we conducted a self-administered questionnaire survey via mail to investigate the lifestyle and health status of 15,500 non-disabled residents aged 65-84 years from all 18 districts. In July 2018, we investigated the awareness of the term "frailty" in the same sample using a different questionnaire, and 10,228 people (4,977 men and 5,251 women) were included in the analyses. In addition, 9,069 people (4,347 men and 4,722 women) who responded to both 2016 and 2018 surveys were analyzed for correlates of awareness of the term "frailty." We categorized the responses "I know the meaning" or "I have heard of it but do not know the meaning" as awareness of the term. Decision tree and multilevel Poisson regression analyses were performed to examine the association of the following with awareness of "frailty": age, marital status, living situation, education, equivalent income, body mass index, number of chronic diseases, alcohol consumption, smoking status, Dietary Variety Score (DVS), and presence or absence of lower back and knee pains, depressive mood, exercise habits, social activity, social isolation, and frailty.Results Awareness of the term "frailty" was estimated as 20.1% in total (15.5% in men and 24.3% in women). The subgroup with the highest "frailty" awareness was women who exercised, were socially active, and had a DVS of 4 or more (awareness of 36.3%). Significant independent correlates of "frailty" awareness were age (as per year: multivariate-adjusted prevalence ratio=1.03, [95% confidence interval=1.02-1.04]), sex (women: 1.35 [1.21-1.51]), educational attainment (high school: 1.27 [1.11-1.45], higher than junior college/vocational schools: 1.47 [1.28-1.70]), equivalent income (more than 2.5 million yen/year: 1.12 [1.01-1.25]), exercise habits (presence: 1.26 [1.11-1.43]), DVS (6 points or more: 1.37 [1.21-1.55]), social activity (presence: 1.33 [1.20-1.49]), social isolation (presence: 0.75 [0.67-0.85]), and frailty (presence: 0.72 [0.62-0.84]).Conclusions Although many policies refer to "frailty," the level of awareness of the term among older adults was low. Older adults, especially women, who had higher socioeconomic status, better exercise and dietary habits, and stronger social connections, were significantly more aware of the term. In contrast, individuals who were socially isolated and/or frail did not know the term. Thus, it is crucial to develop specific measures to promote frailty prevention among high-risk individuals.

Steps toward community health promotion: Application of transtheoretical model to predict stage transition regarding smoking

BACKGROUND:Recently, the Iranian Ministry of Health estimated about 750,000 deaths are attributed smoking complications. The aim of this study was to apply the transtheoretical model (TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural factors regarding smoking cessation.METHODS:This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran. A total number of 562 participants selected by multistage sampling. They were asked about stages of change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an orderly sequence of changes in smoking behavior that people progress through according to the TTM. Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months), contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop smoking within 1 month), action (quit smoking for <6 months), maintenance (stopped smoking for 6 months or more), and termination (will never smoke again). Data were analyzed using tests such as Chi-square, Kruskal–Wallis, and logistic regression by SPSS 11.5.RESULTS:About 18% and 19% of people in this study were regular hookah and cigarette smokers, respectively. There was significant difference between cigarette smoking and sex (P < 0.001) and marital status (P = 0.01). There was a statistically significant difference between stages of change in men and women from the point of cigarette smoking (P < 0.001). Male sex, hookah smoking, and alcohol abuse were predictors of PC, and age was the only predictor of termination stage for cigarette smoking. Sex did not have any role in hookah smoking.CONCLUSION:Targeted education based on gender and marital status warrant attention. Community-wide education and interventions such as increasing the price of cigarettes are desired.

PSYCHOMETRIC PROPERTIES OF THE OLDER ADULT TECHNOPHOBIA SCALE AND SMARTPHONE CHALLENGE TASK

Older adults are especially prone to anxiety if they are unable to keep pace with technological advances and are generally more technophobic than their younger counterparts. Older adults tend to limit their use of technology, if not avoid it altogether, such as using a smartphone for calls and text messages only, while eschewing more advanced functions. Currently, there is no measure of technophobia in older adults that captures fears and concerns about the use of these up-to-date technological tools. The purpose of this investigation was to evaluate the psychometric properties of a new scale of technophobia and corresponding smartphone challenge task in a sample of older adults. Community-dwelling older adults (N = 42, 81.0% female, Mage = 77.3) completed the following: the Older Adult Smartphone Challenge Task (OASCT), Older Adults’ Technophobia Scale (OATS), Older Adult Social Anxiety Scale, Computer Anxiety Rating Scale, and the IPIP Five Factor Personality Domains. Preliminary data indicate good internal consistency for the OATS (α = .87) and the OASCT (α = .86). The OASCT was negatively correlated with age, computer anxiety, and OATS anxiety/avoidance scores, but positively correlated with education. The OATS scores were positively correlated with social anxiety, social avoidance, and computer anxiety, but negatively correlated with extraversion. To keep pace with the contemporary world, older adults must achieve a level of comfort with the use of technological devices. Administering the OASCT and OATS could be a valuable first step in identifying older adults with technology-related deficits and anxiety for individual and/or community-wide intervention.

Effect of a media intervention on hepatitis B screening among Vietnamese Americans

ABSTRACT Objective: There is a lack of controlled studies of community-wide interventions to increase screening for hepatitis B (HBV) among Asian Americans, particularly Vietnamese Americans, who disproportionately suffer from HBV-related illnesses. The objective of our study was to develop, implement, and evaluate the effectiveness of a media campaign to promote HBV screening among Vietnamese Americans. Design: We designed and implemented a three-year media campaign promoting HBV screening among Vietnamese Americans. Evaluation consisted of cross-sectional pre- and post-intervention population-based telephone surveys of Vietnamese Americans adults age 18–64 who spoke English or Vietnamese and lived in the Northern California (intervention) or Greater Washington, D.C. (comparison) communities in 2007 or 2011. Statistical analysis was completed in 2012. The main outcome was self-report of HBV testing, defined as participants answering ‘Yes’ to the question: ‘Have you ever had a blood test to check for hepatitis B?’ Results: The sample sizes at pre- and post-intervention were 1,704 and 1,666, respectively. Both communities reported increased exposure to HBV-related booklets, radio and television advertisements, and websites. Only the intervention community reported increased exposure to newspaper elements. HBV screening increased in both communities (intervention: 65.3% to 73.1%, p < 0.01, comparison: 57.7% to 66.0%, p < 0.01). In multivariable analyses, there was no intervention effect. In both communities, exposure to media elements (Odds Ratio 1.26 [95% Confidence Interval: 1.21, 1.31] for each additional element) was significantly associated with screening. Conclusions: Among Vietnamese Americans in 2 large communities, HBV screening rates were sub-optimal. Screening increased in both the intensive media intervention and comparison communities, and exposure to HBV-related media messages was associated with increased screening. Efforts to address HBV screening among Vietnamese Americans should include mass media messaging.

Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months.

One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.