Contemporary Public Health Research Articles

Improvement in Symptoms of Depression and Anxiety and Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity Following the Implementation of a Multidisciplinary Personalized Lifestyle Intervention Program.

Background/Objectives: Childhood obesity is one of the most challenging contemporary public health problems. Children and adolescents with obesity experience multiple psychosocial difficulties, such as low self-esteem, depression, anxiety, and behavioral problems, which persist for a long time. The aim of the study was to assess the effect of a multidisciplinary personalized lifestyle intervention for depressive and anxiety symptoms, as evaluated by psychometric questionnaires, and their effect and association with cardiometabolic parameters in children and adolescents with overweight and obesity before and after the intervention. Methods: Six hundred and eleven (n = 611) children and adolescents (mean age ± SE: 10.39 ± 0.10 years; 51.5% females, 46.6% pubertal) were studied prospectively. Subjects were classified as being obese (50.2%), overweight (33.5%), or having a normal BMI (16.2%) according to IOTF criteria. All participants entered a 1-year lifestyle intervention program; laboratory investigations were obtained at the beginning and end of the study and two psychometric questionnaires were completed, the CDI and SCARED, which evaluate symptoms of depression and anxiety, respectively. Results: Following the lifestyle intervention, a significant decrease was noted in anxiety scores in all subjects and in depression scores in youth with obesity, as well as in adolescents with obesity, while females displayed a reduced response to the intervention. Insulin resistance and metabolic syndrome parameters, cortisol, PRL, and LH concentrations were positive predictors for depressive and anxiety symptoms. Conclusions: The implementation of a multidisciplinary personalized lifestyle intervention program in the management of childhood obesity is associated with a significant decrease in cardiometabolic and psychosocial comorbidities in children with and without excess adiposity. The improvement in mental health is likely mediated by an improvement in energy metabolism with subsequent improvement in neuroinflammation owing to lifestyle changes.

Truncated VZV gE Induces High-Titer Neutralizing Antibodies in Mice.

Backgrounds: A contemporary public health challenge is the increase in the prevalence rates of herpes zoster (HZ) worldwide. Methods: In this work, the gE gene structure was analyzed using bioinformatics techniques, and three plasmids of varying lengths, tgE537, tgE200, and tgE350, were expressed in Chinese hamster ovary (CHO) cells. These proteins were used to immunize BALB/c mice with Al/CpG adjuvant; ELISPOT and FCM were used to evaluate cellular immunity; and ELISA, VZV microneutralization, and FAMA assays were performed to detect antibody titers. Results: Target protein concentrations of 1.8 mg/mL for tgE537, 0.15 mg/mL for tgE200 and 0.65 mg/mL for tgE350 were effectively produced. The ability of the three protein segments to stimulate CD4+ and CD8+ T cells, as well as to cause lymphocytes to secrete IFN-γ and IL-4, did not significantly differ from one another. Both tgE537 and tgE350 were capable of generating VZV-specific antibodies and neutralizing antibodies, while tgE350 had the highest neutralizing antibody titer (4388). There was no equivalent humoral immune response induced by tgE200. Conclusions: The results of this investigation provide the groundwork for the creation of HZ recombinant vaccines using truncated proteins as antigens.

Metformin – the old drug with new therapeutic possibilities

Original Article, Pol J Public Health, Vol. 134 (2024): 47-51 Paulina Oleksa, Kacper Jasiński, Daria Żuraw, Mateusz Sobczyk, Monika Żybowska, Anna Rzewuska-Fijałkowska, Karolina Haczkur-Pawłowska, Piotr Więsyk Students’ Scientific Society at the Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland Introduction. Metformin is an oral antidiabetic drug from the biguanide group, popularly referred as an aspirin of the 21st century. The therapeutic targets of metformin are expanding. It is characterized by antineoplastic, immunoregulatory, anti-aging and neuroprotective properties. We aimed to evaluate the pleiotropic effects of metformin, taking into account its different mechanisms, efficacy and safety in contemporary public health challenges. Material and methods. We conducted the literature review from 2014 to 2024 using the PubMed and Google Scholar. Results. Metformin, depending on the cancer and its stage, enhances the cancer treatment effects, prevents the drug resistance, lengthens overall time of survival, reduces the risk of recurrence. In the Parkinson’s disease, Alzheimer’s disease and depression metformin can even increase the risk of their occurrence, especially in high doses. Such doses predispose to the cobalamin deficiency, affecting the functioning of the nervous system. Metformin was effective in seizure control of epilepsy. It has positive impact on the course of some autoimmunological diseases. Among diabetics treatment, outcomes of COVID-19 and tuberculosis could be improved by metformin. Conclusions. Metformin is pluripotential drug. Possibilities of adjuvant metformin therapy are very promising, but it cannot be recommended as standard treatment. This issue requires further investigation, preferentially randomized controlled trials on the bigger research samples. Keywords: metformin and therapy, metformin and treatment, metformin and advances.

Complex Pathophysiology of Acute Kidney Injury (AKI) in Aging: Epigenetic Regulation, Matrix Remodeling, and the Healing Effects of H2S.

The kidney is an essential excretory organ that works as a filter of toxins and metabolic by-products of the human body and maintains osmotic pressure throughout life. The kidney undergoes several physiological, morphological, and structural changes with age. As life expectancy in humans increases, cell senescence in renal aging is a growing challenge. Identifying age-related kidney disorders and their cause is one of the contemporary public health challenges. While the structural abnormalities to the extracellular matrix (ECM) occur, in part, due to changes in MMPs, EMMPRIN, and Meprin-A, a variety of epigenetic modifiers, such as DNA methylation, histone alterations, changes in small non-coding RNA, and microRNA (miRNA) expressions are proven to play pivotal roles in renal pathology. An aged kidney is vulnerable to acute injury due to ischemia-reperfusion, toxic medications, altered matrix proteins, systemic hemodynamics, etc., non-coding RNA and miRNAs play an important role in renal homeostasis, and alterations of their expressions can be considered as a good marker for AKI. Other epigenetic changes, such as histone modifications and DNA methylation, are also evident in AKI pathophysiology. The endogenous production of gaseous molecule hydrogen sulfide (H2S) was documented in the early 1980s, but its ameliorative effects, especially on kidney injury, still need further research to understand its molecular mode of action in detail. H2S donors heal fibrotic kidney tissues, attenuate oxidative stress, apoptosis, inflammation, and GFR, and also modulate the renin-angiotensin-aldosterone system (RAAS). In this review, we discuss the complex pathophysiological interplay in AKI and its available treatments along with future perspectives. The basic role of H2S in the kidney has been summarized, and recent references and knowledge gaps are also addressed. Finally, the healing effects of H2S in AKI are described with special emphasis on epigenetic regulation and matrix remodeling.

Syndemic Connections: Overdose Death Crisis, Gender-Based Violence and COVID-19

This article will use syndemic theory to identify and analyze overlapping health and social conditions, focusing specifically on how gender-based violence is systemically interconnected with contemporary public health issues. The overdose death crisis that continues to afflict Canadian populations is not an isolated health issue. Across Canada, it is intertwined with mental health, HIV/AIDS, COVID-19 and structural violence—the chronic and systemic disadvantages affecting those living in poverty and oppressive circumstances. Opioid use is an often-avoidant coping strategy for many experiencing the effects of trauma, relentless fear, pain, ill health and social exclusion. In particular, Indigenous and non-Indigenous women’s experiences with opioid addiction are entangled with encounters with gender based-violence, poverty and chronic ailments within structurally imposed processes and stressors shaped by a history of colonialism, ruptured lifeways and Western ways of knowing and doing, leading to disproportionate harms and occurrences of illness. While biomedical models of comorbidity and mortality approach substance misuse, gender-based violence and major infectious diseases such as HIV/AIDS and COVID-19 as distinct yet compounding realities, this article argues that these conditions are synergistically interrelated via the critical/reflexive lens of syndemic frameworks. Through secondary research using academic, media and policy sources from the past decade in Canada, complemented by prior ethnographic research, the synergistic connections among opioid addiction, gender-based violence and the effects of the COVID pandemic on diverse women will be shown to be driven by socio-structural determinants of health including poverty, intergenerational trauma, the legacy of colonialism and Western optics. Together, they embody a contemporary Canadian syndemic necessitating coordinated responses.

Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations.

The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development.

Pylore Krishnaier Rajagopalan: Pioneer in Kyasanur Forest Disease Research and His Contributions to Zoonotic Disease Studies.

Pylore Krishnaier Rajagopalan was a distinguished public health expert who made significant breakthroughs in the research of Kyasanur forest disease (KFD), a prevalent tick-borne viral ailment in South India. His extensive research on KFD provided vital insights into the impact of the disease on public health and considerably advanced our knowledge of it. Rajagopalan's work also encompasses the study of zoonotic diseases, where he made substantial contributions to our understanding of their epidemiology and control. His research on KFD was instrumental in comprehending the disease transmission dynamics, clinical manifestations, and control strategies, resulting in improved management practices in regions where the disease is endemic. Rajagopalan's contributions have had a long-lasting impact on public health practices, as his work has influenced both scientific research and public health policies. The enduring effects of his work can be observed in the enhanced disease surveillance, outbreak response, and comprehension of zoonotic disease dynamics, which will continue to inform contemporary public health practices.

Mapping Public Health Nursing competencies: A comparative document analysis of competency frameworks and practice standards in the USA and Ireland.

The Public Health Nursing discipline plays a crucial role in promoting sustainable health services. The establishment of competency frameworks and practice standards pertaining to Public Health Nursing has emerged as a cornerstone for guiding practice, education, and research. This study aimed to identify contemporary Public Health Nursing competency frameworks and practice standards and establish a robust list of competency domains. This will inform a subsequent phase of this project that will conduct a review of recent scholarly literature to discern prevailing research trends and delineate strategic directives and research priorities for the discipline. A systematic search of three databases and a grey literature search was undertaken by incorporating keywords to identify existing Public Health Nursing-specific competency frameworks and practice standards. Through screening and selection based on our inclusion criteria, three documents were analyzed. A comprehensive document analysis was conducted to generate a unified domain list and associated descriptors. Three competency-based frameworks and practice standards emanating from two countries, the United States of America and the Republic of Ireland met the inclusion criteria. The document analysis identified 16 individual domains. There was consistent evidence of similarity across the three documents. There were minimal divergences featured within the frameworks which are discussed and compelling justifications for inclusion as universal domains are provided. This document analysis has generated a list of 16 common Public Health Nursing competency domains which will be utilized in phase two of this project as a foundational framework for the purpose of analyzing research trends, influencing research priorities, and enhancing the focal areas for future research agendas within the discipline.

How racism plays out in contemporary public health practice (commentary)

How racism plays out in contemporary public health practice (commentary)

Epidemiological, clinical characteristics and the association between influenza vaccination, oseltamivir treatment, and complications in children with seasonal influenza

Influenza, a historical and contemporary public health challenge, is an acute respiratory infection caused mainly by influenza A or B viruses. This descriptive case series describes 194 children treated for seasonal influenza at the Department of Pediatrics, 103 Military Hospital, Vietnam Military Medical University, from May 2022 to May 2023. Influenza primarily occurred during winter and early spring, peaking in December and January, 57.2% were aged 12-60 months, boys. Vaccination coverage was limited (36.3%), especially post-COVID-19. Complications were seen in 75.3% of the cases, including febrile seizures (42.3%), bronchopneumonia (40.2%), respiratory failure (8.2%), acute myocarditis, influenza-associated encephalopathy, and septic shock. The study reveals bacterial coinfections, affected 20% of the cases, mainly by Streptococcus pneumoniae and S. aureus, and atypical bacteria Mycoplasma pneumoniae. Non-vaccinated children faced significantly higher risks of complications, oseltamivir within 48 hours reducing the risks of complications. Influenza predominantly affects 12-60 month-olds, males, and peaks annually in winter. Severe conditions stem from bacterial coinfections, emphasizing the importance of vaccination and prompt antiviral treatment to mitigate complications. The study highlights a critical need for increased vaccination, especially in the post-COVID-19 era, to manage influenza in children effectively.

Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment.

Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners. The aim of this study was to investigate the impact of communicating uncertainty about COVID-19-related threats and solutions on individuals' risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions. A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses. Individuals were more susceptible to believing false COVID-19-related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals' perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention. Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals' cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public's expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis.

DOCTRINE OF EPIDEMIOLOGY IN AYURVEDA

Epidemiology, the essential aspect of community medicine, is pivotal in understanding and controlling health-related states or events in populations. The Concept of Epidemiology and its principles in Ayurveda, apart from Janapadodwamsa, is a lesser-explored domain. Employing an advanced epidemiological model encompassing Time (Kala), Environment (Desha), Host (Purusha), and Causative factors (Nidanas), including Aharaja, Viharaja, Manaika, and Agantuja factors along with modes of transmission and factors influencing human health in Ayurveda, the analysis unravel the hidden doctrine of Epidemiology in Ayurveda. This study is a modest attempt to understand the epidemiological concepts mentioned in Ayurveda, shedding light on their potential contributions to contemporary public health understanding and programme planning.

Bridging gaps: Transforming dental public health training for modern job market demands.

To create optimal oral and overall community health, dental public health (DPH) specialists must be competent and appropriately skilled to deal with contemporary and emergent public health issues. This study aims to evaluate the current job market demands related to the DPH profession and suggest contemporary skills and qualities that would enable DPH professionals to address emerging issues more effectively in their field. A multimethod qualitative study was conducted involving two distinct groups: employers and potential employees. Interviews of stakeholders (employers)representing different job market domains, and a surveywas administered to recent DPH residency graduates (employees). Qualitative analysis was applied to the data collected. Employers identified the following skills as crucial for future DPH employees: proficiency in care delivery systems, health informatics, clinical training, leadership, and professional and grant writing skills. Many employers assumed the presence of a clinical component in the residency program. DPH residency graduates emphasized that the most significant barrier to securing positions is the lack of clinical experience within the residency program. This research highlights skills currently valued by the DPH job market and proposes that DPH specialty training may consider revising its curriculum to include these skills. Implementing such updates would ensure that graduates are well equipped and competitive, thus significantly contributing to the broader objective of attaining optimal oral health and overall well-being of the community.

Modulation of neural circuits by melatonin in neurodegenerative and neuropsychiatric disorders.

Neurodegenerative and neuropsychiatric disorders are two broad categories of neurological disorders characterized by progressive impairments in movement and cognitive functions within the central and peripheral nervous systems, and have emerged as a significant cause of mortality. Oxidative stress, neuroinflammation, and neurotransmitter imbalances are recognized as prominent pathogenic factors contributing to cognitive deficits and neurobehavioral anomalies. Consequently, preventing neurodegenerative and neuropsychiatric diseases has surfaced as a pivotal challenge in contemporary public health. This review explores the investigation of neurodegenerative and neuropsychiatric disorders using both synthetic and natural bioactive compounds. A central focus lies on melatonin, a neuroregulatory hormone secreted by the pineal gland in response to light-dark cycles. Melatonin, an amphiphilic molecule, assumes multifaceted roles, including scavenging free radicals, modulating energy metabolism, and synchronizing circadian rhythms. Noteworthy for its robust antioxidant and antiapoptotic properties, melatonin exhibits diverse neuroprotective effects. The inherent attributes of melatonin position it as a potential key player in the pathophysiology of neurological disorders. Preclinical and clinical studies have demonstrated melatonin's efficacy in alleviating neuropathological symptoms across neurodegenerative and neuropsychiatric conditions (depression, schizophrenia, bipolar disorder, and autism spectrum disorder). The documented neuroprotective prowess of melatonin introduces novel therapeutic avenues for addressing neurodegenerative and psychiatric disorders. This comprehensive review encompasses many of melatonin's applications in treating diverse brain disorders. Despite the strides made, realizing melatonin's full neuroprotective potential necessitates further rigorous clinical investigations. By unravelling the extended neuroprotective benefits of melatonin, future studies promise to deepen our understanding and augment the therapeutic implications against neurological deficits.

H10N5 and H3N2 Outbreak 2024: The First-Ever Co-Infection With Influenza A Viruses Has Been Culpable for the Contemporary Public Health Crisis.

H10N5 and H3N2 Outbreak 2024: The First-Ever Co-Infection With Influenza A Viruses Has Been Culpable for the Contemporary Public Health Crisis.

How Communities of Practice Generate Knowledge Translation Outcomes to Support Public Health Issues: A Realist Synthesis

Communities of practice in health settings often serve to address contemporary public health issues by sharing knowledge and experiences about accelerating implementations and innovative solutions. Because there are gaps between the practical application of communities of practice and the scientific knowledge about their effectiveness, this realist synthesis aimed to identify how and why members of communities of practice translate the shared knowledge and apply it in their daily practice. In a six‐step process, this realist synthesis included a scoping review that led to an initial theory map (Step 1), followed by searches (Step 2), appraisal (Step 3), extracts and organisation (Step 4), and analysis and synthesis (Step 5). These steps organised the literature into context–mechanism–outcome configurations that guided the development of a realist framework that can support research and practice (Step 6). We identified three key ways in which knowledge translation may occur: (1) Members bring (new) knowledge to their parent organisation; (2) members change the (daily) practice in their parent organisation; and (3) members improve health outcomes through systemic changes. We found that an initial outcome of knowledge sharing within the community of practice is conditional to achieving outcomes of knowledge translation outside the community of practice. This knowledge sharing within the community of practice is more likely to occur in a structured and trusted environment where members feel safe, as well as where members recognise individual and organisational benefits from participation. To achieve knowledge translation outside the community of practice, support from the parent organisation becomes important, alongside learning and developing confidence to implement the knowledge. The synthesis of the different contexts that potentially trigger mechanisms that lead to desired outcomes provides insight into how best to inform community of practice initiators and facilitators about supporting effective public health responses.

The long term effect of renal denervation on ambulatory blood pressure in obese patients with resistant hypertension: A systematic review and meta-analysis of randomized control trials

The global surge in obesity is emerging as a significant contemporary public health challenge, linked with an elevated occurrence of cardiovascular risks like hypertension. Obesity exacerbates the complexity of managing resistant hypertension, as it not only increases the prevalence of hypertension but also contributes to medication resistance. Renal denervation (RDN) stands as a potential approach to address resistant hypertension (RH). A systematic search was conducted through PubMed, Science Direct, and Cochrane Library selecting RCT studies until August 2023. The RCTs showed the long term effect of renal denervation on ambulatory blood pressure in individuals with both obesity and resistant hypertension. Meta-analysis was conducted using Review Manager 5.4 software. There were 9 included RCTs with total 1056 resistant hypertensive patients. Meta-analysis of the difference in changes in ambulatory systolic blood pressure was performed in nine available studies. Renal denervation showed significant ambulatory systolic blood pressure reduction (Mean Difference [MD]: -2.30; 95% CI: -4.34, -0.27; p = 0.03) and non-significant ambulatory diastolic blood pressure reduction (Mean Difference [MD]: -1.07; 95% CI: -2.94, 0.8; p = 0.26). RDN could be an additional treatment for resistant hypertension patients. RDN is not recommended to be performed routinely and not recommended for patients with secondary hypertension or eGFR less than 30 mL/min/1.73 m2.

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness

ObjectiveLoneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others. MethodsStudy One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide. ResultsStudy One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision. ConclusionA communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection. InnovationThis study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.

Streetwork at the crossroads: An evaluation of a street gang outreach intervention and holistic appraisal of the research evidence

AbstractSpurred by the success of public health violence interventions, and accelerated by policy pressure to reduce violence without exacerbating overpolicing and mass incarceration, streetwork programs—those that provide anti‐violence services by neighborhood‐based workers who perform their work beyond the walls of parochial institutions—have positioned themselves as the most important non–law‐enforcement violence prevention option available to urban policy makers. Yet despite their importance, the state of the field seems difficult to interpret for academics and practitioners alike. In this article, we make several contributions that bring forth new findings and deliver new perspectives on streetwork as a violence reduction strategy. First, we offer an extended analytic review of the streetwork evaluation literature that connects the study of contemporary public health violence interventions to a preceding tradition of criminologically inspired streetwork studies. Second, we present the results of an impact evaluation of StreetSafe Boston (SSB)—a multiyear streetwork intervention that served 20 Boston gangs. We find that the SSB intervention had no detectable effect on violence among the gangs that it served. We conclude by offering a framework for understanding a field at multiple crossroads: past and present, proclaimed successes and failures, help and harm.