Health Impact Research Articles

Assessing Direct and Spillover Effects of Intervention Packages in Network-randomized Studies.

Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component on the overall package effectiveness can improve intervention delivery. We adapted an approach to evaluate the effects of a time-varying intervention package in a network-randomized study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts average potential outcomes if a person was not exposed to themselves under intervention in the network versus no intervention in a control network. We estimated the effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using marginal structural models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors. There were 560 participants with at least one follow-up visit, 48% of whom were randomized to the intervention, and 1,598 participant visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (rate ratio = 0.61; 95% confidence interval = 0.43, 0.87). These methods will be useful for evaluating intervention packages in studies with network features.

Development of a protocol for using geo-trackers to identify zoonotic enteric pathogen transmission pathways in a pilot study in Kenya

Abstract Humans and animals can be exposed to fecally-transmitted pathogens in both private and public domain environments. Animals may also acquire pathogen infections from these two environments and transmit them to humans through different pathways. Evidence on how often and where interactions occur between the two environments could improve the effectiveness of public health programs for preventing zoonotic disease transmission and response to disease outbreaks. This study aimed to develop a protocol for using geo-trackers to measure the spatial-temporal movement and interaction between animals and children in households and public areas in low- and middle-income categories of urban neighbourhoods in Kenya. It also aimed to identify opportunities and challenges for the scale-up of these methods’ for surveillance of other zoonotic diseases of public health significance. One commercial geo-tracker device with the best technological performance and usability that met pre-defined criteria for the study context was identified. Community engagement meetings were then conducted to gather input on a proposed study protocol. Afterwards, infants and animals were geo-tracked in 10 households in urban informal settlements of Kibera and Jericho, Nairobi over two consecutive weeks with iterative improvements to protocols. The effectiveness of the geo-tracking exercise was evaluated through in-depth interviews with Community Health Volunteers (CHVs) and infant caregivers. Animal and infant behaviour and battery reliability of the geo-trackers were also monitored; and observed opportunities and challenges in implementing the protocol during the exercise were documented. Community members were receptive and accepted the use of geo-trackers on animals and children. In pilot testing, there was no change of behaviour from 10 infants tracked. Discomfort was observed for up to 30 min after the placement for some of the seven animals tracked, but the animals quickly adjusted. The battery for all geo-tracker devices lasted for the 24-h geo-tracking period. Some caregivers and CHVs were concerned whether the geo-trackers could record personal information. It was shown that geo-tracker devices can be successfully deployed to study animal-child interactions and movement in different categories of urban neighbourhoods. Recommendations have been made on the lessons learnt from the study to help scientists who would use geo-trackers for future community-based human and animal research. One Health impact statement Assessing human and animal risks of acquiring enteric infections from environmental contamination, or contributing to pathogen contamination of the environment requires understanding spatial-temporal patterns of human and animal movement between private households and the community. Movement of domestic animals is relevant for understanding household-community spatial patterns of pathogen transmission because animal ownership and contact with humans is common, and free-roaming animals carrying enteric pathogens can spread diverse faecal pathogens between environments. The community-based participatory research approach of this study evaluated implementation feasibility from the lens of technical usability and reliability of geo-tracking devices, as well as social acceptability and ethics related to using such devices for the community-based study of human and animal subjects in urban settings. Evidence and recommendations from this study will be useful to anyone interested in understanding human-animal-environment interactions and their contributions to infectious disease transmission.

An open pilot trial of a behavioural intervention to reduce violence by young adults with early psychosis receiving treatment in an early intervention services setting: A protocol.

Despite the public health impact of violence among young adults with psychosis, behavioural interventions to reduce the risk of engaging in violence remain rare. For young adults with early psychosis, cognitive behavioural therapy (CBT)-based psychotherapy has efficacy in reducing impairment and improving functioning. However, no CBT-based intervention to reduce violence has been formally adapted for young adults with early psychosis. This protocol outlines the first clinical trial of a behavioural intervention to reduce violence for young adults with early psychosis. This study is set in an early intervention services (EIS) setting and seeks to adapt and pilot Psychological Intervention for Complex PTSD and Schizophrenia-Spectrum Disorder (PICASSO), a CBT-based intervention, through an iterative process utilizing mixed-methods assessments. All research will occur at OnTrackNY, the largest EIS program in the United States. This study will consist of an open pilot trial, with four EIS clinicians delivering the intervention to one to two EIS participants per round. In this mixed-methods study, both quantitative measures (acceptability, feasibility and hypothesized mediators of target outcome collected on a weekly basis) and qualitative interviews (with EIS clinicians at weeks 4, 8 and 12) will be conducted. Transcripts will be analyzed using thematic content analysis. Two to three rounds of iterative modifications are anticipated (n = 10-16 EIS participants total). Recruitment began in February 2024 and is expected to continue over a 9-12-month period. Because violent behaviour causes interpersonal disruptions such as incarceration and increased caregiver burden, an innovative intervention to reduce violence risk could have broader health impact for this vulnerable population. Adapting the PICASSO intervention to the EIS setting will optimize its acceptability and feasibility by the intended target population.

Climate change education: exploring knowledge, attitudes, and practices of medical students in a Turkish medical school

ABSTRACT Climate change presents a significant health challenge, emphasizing the need for resilient healthcare systems. This study aimed to explore medical students’ knowledge, attitudes, and practices regarding the climate-health link and their curriculum preferences. Conducted from March to June 2023 at the Medical School of Bahçeşehir University, Turkiye, the cross-sectional study utilized an online questionnaire covering demographic data and climate change-related inquiries. Participation was open to all medical students without class-based distinctions. The response rate was 53.6%, with 439 medical students included (average age: 21.8 years). The majority (74.5%) acknowledged human-induced climate change, with over 87% expressing concerns about its impact on health. Nearly 70% emphasized the importance of physicians understanding climate change’s health effects, while 45.8% perceived a lack of information in their medical education. Most students (70.0%) supported integrating climate change’s health effects into medical education, rating its importance at 7.1 on a scale of 0 to 10. Preferences included electives, team-based learning, case-based learning, problem-based learning, clinical practice in climate-sensitive diseases, and theoretical courses on climate change in basic medical sciences. This study underscores the growing awareness among medical students regarding climate change’s health impact and the need for climate-integrated medical education, emphasizing its importance in preparing future physicians for climate-related health challenges and resilient healthcare systems.

Estimating potentially preventable ambient PM2.5-attributable adult deaths by improving air quality in Nepal

Air pollution is an important global environmental health risk factor, with many Asian countries experiencing alarming levels in recent decades. Nepal, a South Asian country, has been facing severe degradation in air quality in recent years, where data are scarce on the health impact of air pollution, especially at sub-national levels. In this study, we investigated ambient fine particulate matter (PM2.5)-attributable adult (≥25 years) premature mortality in Nepal, analyzed its long-term trend, and estimated potentially preventable adult mortality under different improved air quality scenarios defined using the World Health Organization's (WHO) interim targets (IT) and the air quality goal (AQG). Leveraging an open-source high-resolution PM2.5 dataset and an age-specific population dataset, we employed the Global Exposure Mortality Model to estimate mean and 95% confidence intervals of PM2.5-attributable adult mortality using Monte Carlo simulations. We estimated the country-level NCD + LRI (non-communicable diseases and lower respiratory infections) adult deaths attributable to PM2.5 exposure as 48881 (95% CI: 37175−61470), and the PM2.5-attributable NCD + LRI adult mortality rate as 267 (95% CI: 203−335) per 100000 in 2019. The adult mortality burden consistently increased during 2000–2019. Moreover, improving air quality to the WHO ITs and AQG could prevent an estimated 9690 (95% CI: 7698−11812) to 39419 (95% CI: 30311−49277) premature adult deaths across the country in 2019. Our findings suggest that the adult mortality burden due to air pollution in Nepal is substantial, which offers an opportunity to prevent a considerable number of premature adult deaths by mitigating air pollution in the country.

Perceptions of Tobacco Price Policy among Students from Sapienza University of Rome: Can This Policy Mitigate Smoking Addiction and Its Health Impacts?

Tobacco use is one of the main risk factors for non-communicable diseases. Avoiding youth initiation and treating addiction are fundamental public health issues to ensure better health. Among tobacco control policies, increasing tobacco price is the single most effective intervention. It reduces tobacco consumption, especially among youths, while representing a government financing source. This study aimed to assess the agreement with the proposal of a one-euro increase in tobacco price earmarked to health issues among students at Sapienza University. Two convenience samples were surveyed, five years apart, on World No Tobacco Days. Smoking habits, agreement with the proposal and reasons for it were collected. Results from the 208 questionnaires (107 in 2014, 101 in 2019) showed 46.6% of agreement with the proposal (53.3% in 2014, 39.2% in 2019, p = 0.044). Main predictive factor for agreement was being a non-smoker (OR = 6.33 p < 0.001), main reason (64.8%) was it could trigger smokers to quit or reduce consumption. Several factors might have influenced this finding, including the introduction of novel tobacco products and their increased advertisement on social media. In 2024, European Union is planning to update the Tobacco Taxation Directive which could greatly contribute to the reduction of non-communicable diseases and premature deaths.

Risk-based public health impact assessment for drinking water contamination emergencies

Chemical spills in surface waters pose a significant threat to public health and the environment. This study investigates the public health impacts associated with organic chemical spill emergencies and explores timely countermeasures deployable by drinking water facilities. Using a dynamic model of a typical multi-sourced New England drinking water treatment facility and its distribution network, this study assesses the impacts of various countermeasure deployment scenarios, including source switching, enhanced coagulation via poly‑aluminum chloride (PACl), addition of powdered activated carbon (PAC), and temporary system shutdown. This study reveals that the deployment of multiple countermeasures yields the most significant reduction in total public health impacts, regardless of the demand and supply availability. With the combination PAC deployed first with other countermeasures proving to be the most effective strategies, followed by the combination of facility shutdowns. By understanding the potential public health impacts and evaluating the effectiveness of countermeasures, authorities can develop proactive plans, secure additional funding, and enhance their capacity to mitigate the consequences of such events. These insights contribute to safeguarding public health and improving the resilience of drinking water systems in the face of the ever-growing threat of chemical spills.

Oral health-related quality of life in implant-supported rehabilitations: a prospective single-center observational cohort study

BackgroundOral Health-Related Quality of Life (OHRQoL) is a comprehensive concept covering daily comfort, self-esteem, and satisfaction with oral health, including functional, psychological, and social aspects, as well as pain experiences. Despite abundant research on OHRQoL related to oral diseases and hygiene, there is limited data on how patients perceive changes after implant-prosthetic rehabilitation. This study aimed to evaluate OHRQoL and aesthetic perception using OHIP-14 and VAS scales respectively, before (baseline-TB), during (provisional prostheses-TP), and after (definitive prostheses-TD) implant-prosthetic rehabilitation. It also explored the impact of biological sex, substitution numbers, and aesthetic interventions on OHRQoL and VAS scores, along with changes in OHIP-14 domains.MethodsA longitudinal prospective single-center observational cohort study was conducted with patients requiring implant-prosthetic rehabilitation. Quality of life relating to dental implants was assessed through the Italian version of Oral Health Impact Profile-14 (IOHIP-14), which has a summary score from 14 to 70. Patients’ perceived aesthetic was analyzed through a VAS scale from 0 to 100. Generalized Linear Mixed Effect Models, Linear Mixed Effect Models, and Friedman test analyzed patient responses.Results99 patients (35 males, 64 females) aged 61–74, receiving various prosthetic interventions, were enrolled. Both provisional and definitive prosthetic interventions significantly decreased the odds of a worse quality of life compared to baseline, with odds ratios of 0.04 and 0.01 respectively. VAS scores increased significantly after both interventions, with estimated increases of 30.44 and 51.97 points respectively. Patient-level variability was notable, with an Intraclass Correlation Coefficient (ICC) of 0.43. While biological sex, substitution numbers, and aesthetic interventions didn’t significantly affect VAS scores, OHRQoL domains showed significant changes post-intervention.ConclusionsThese findings support the effectiveness of implant-prosthetic interventions in improving the quality of life and perceived aesthetics of patients undergoing oral rehabilitation. They have important implications for clinical practice, highlighting the importance of individualized treatment approaches to optimize patient outcomes and satisfaction in oral health care.

Introducing the Occupational Health and Safety Potential Midpoint Impact Indicator in Social Life Cycle Assessment

Occupational health and safety (OSH) is crucial for sustainable development, recognized by corporations, the European Union, and Sustainable Development Goals. This study introduces a characterization model for OSH in the social life cycle assessment (S-LCA) to support the quantification of OHS along product supply chains and sustainable decision making. The characterization model aims to provide a practical approach for assessing OHS at the product level with actual working hours or recommends a secondary approach with monetary data, when working hours are unavailable, to calculate the Occupational Health and Safety Potential (OHSP). The developed model was tested in a theoretical case study on shirt production in Europe and globally. The case study shows that the European shirt value chain resulted in higher OHSP values than the global shirt values chain. In addition, the model shows which life cycle stages and organizations highly contributed to the OHSP results. In both approaches, the shirt production stage contributed highly. Differences in results emerged based on the calculation approach, underscoring the model’s versatility, because increasing the complexity of calculating the CFs with monetary values will affect the results based on sectorial monetary output. Additionally, the study mentions benefits to the operationalization of social impact assessment and limitations when the developed characterized model is employed. Last, this study aids in offering a tool for organizations to meet the demands of the new Corporate Sustainability Reporting Directive by quantifying and publicizing OHS data.

The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients.

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort. Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14). Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect. Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression. Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Bleaching efficacy of in-office dental bleaching with different application protocols: a single-blind randomized controlled trial.

This randomized controlled trial aimed to evaluate the equivalence in the color change, adverse effects, self-perception (AS) and the impact on oral condition (IO) of participants submitted to different application protocols of in-office dental bleaching. 165 participants were bleached with a 35% hydrogen peroxide gel (Total Blanc Office One-Step, DFL), according to the following protocols: (1) 2 applications of 20-min each (2 × 20min); (2) 1 × 40-min and; (3) 1 × 30-min. The color change was evaluated with the Vita Easyshade spectrophotometer, Vita Classical and Vita Bleachedguide scales. The intensity and risk of tooth sensitivity (TS) and gingival irritation (GI) were recorded using a 0-10 visual analogue scale (VAS). AS and IO was assessed before and after the bleaching procedure using the Orofacial Aesthetic Scale and Oral Health Impact Profile-14, respectively. Equivalent color change were observed (p < 0.001), with no significant difference between groups. The group 2 × 20min presented the highest risk of TS (76%, 95% CI 63 to 85), compared to the 1 × 30min (p < 0.04). The intensity of TS and GI and the risk of GI was similar between groups (p > 0.31). Irrespectively of the group (p = 0.32), significant improvements were observed for all items of AS and IO after bleaching (p < 0.02). The 1 × 30min protocol produced equivalent color change to the other bleaching protocols with reduced risk of TS and shorter application time. A more simplified application regimen of a single application of 30min yields effective bleaching and patient satisfaction while minimizing undesirable side effects and improving patient satisfaction.

Care seeking for childhood illnesses in rural Mtwara, south-east Tanzania: a mixed methods study.

Care seeking was assessed in preparation for a study of the health impact of novel design houses in rural Mtwara, Tanzania. A total of 578 residents of 60 villages participated in this mixed-methods study from April to August 2020. Among them, 550 participated in a healthcare-seeking survey, 17 in in-depth interviews and 28 in key informant interviews. The decision to seek care was based on symptom severity (95.4% [370]). Caregivers first visited non-allopathic healthcare providers or were treated at home, which led to delays in seeking care at healthcare facilities. More than one-third (36.0% [140]) of respondents took >12 h seeking care at healthcare facilities. The majority (73.0% [282]) visited healthcare facilities, whereas around one-fifth (21.0% [80]) sought care at drug stores. Treatment costs deterred respondents from visiting healthcare facilities (61.4% [338]). Only 10 (3.6%) of the households surveyed reported that they were covered by health insurance. Quality of care, related to institutional factors, impacts timely care seeking for childhood illnesses in Mtwara, Tanzania. Ensuring accessibility of facilities is therefore not sufficient.

Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders

BackgroundChronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders’ support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation.MethodsQualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis.FindingsNineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed.InterpretationStakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.

Assessing public health implications of free trade agreements: The comprehensive and progressive Trans‐Pacific Partnership Agreement

AbstractIn 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans‐Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well‐being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five‐step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross‐sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision‐makers to prepare for the CPTPP in Wales using an evidence‐informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

Particulate Matter Pollution and Health Impacts in Six North African Countries

This paper addresses the issue of outdoor particulate matter pollution in six North African countries-Algeria, Egypt, Libya, Morocco, Sudan, and Tunisia. Major particulate matter sources include various industries and transportation systems, dust storms, and sandstorms. It has been shown that there is a need to increase public awareness and participation and enhance capacities regarding ground-based monitoring of particulate matter, using satellite data, and assessing the health impacts of exposure to particulate matter. There is also a need for improved legislation and better governance regarding its implementation and enforcement. If possible, examples of potential impacts of particulate matter pollution on the Gross National Product (GNP) for various economic and health sectors will be reported. As outdoor particulate matter pollution is one of the major sources of loss to the GNP, air quality management needs to be strengthened.

Abstract PO1-09-10: County-level Social Vulnerability and Survival among Women with Inflammatory Breast Cancer

Abstract Purpose: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a poor overall prognosis compared to other forms of breast cancer. Advances in treatment have contributed to improvement in IBC survival rates in recent years, yet disparities in outcomes persist. It is unclear whether social determinants of health impact IBC prognosis independent of access to quality cancer care. Thus, the aim of this study was to examine whether the US county-level social vulnerability index (SVI) was associated with IBC stage at diagnosis and overall survival (OS) among women with IBC treated at a single institution. Methods: Patients enrolled in the IBC registry at Dana-Farber Cancer Institute (DFCI) were included in this study. We linked participant’s residential zip codes to the 2020 CDC’s county-level SVI, which is calculated from 15 social determinants of health attributes from the American Community Survey including socioeconomic status, household composition, language and minority status, and housing and transportation factors. The SVI value reflects the percentile of counties in the nation that are less vulnerable than the county of interest. We assessed associations between SVI and stage at diagnosis using t-tests. Kaplan-Meier curves and log-rank tests were used to assess survival across SVI quartiles based on distribution (1st [least vulnerable] and 4th [most vulnerable]). Using hierarchical logistic regression models and Cox proportional hazards models with mixed effects incorporating cluster-specific random effects that modify the baseline hazard function, we assessed whether SVI is associated with the presence of de novo metastatic disease and OS in IBC. Results: A total of 586 women (86% White) enrolled in the IBC registry at DFCI between 1986 and 2021 were included in this study. Of these, 69.1% had stage III and 30.9% had de novo metastatic disease. 280 deaths occurred in the study population over a mean follow-up of 4.1 years. SVI for the counties where study participants resided ranged from 2.6% to 95.8% (median=34.2%). The mean SVI did not significantly differ according to stage at diagnosis (41.6% in non-metastatic and 40.8% in metastatic at presentation; p=0.70). OS did not significantly differ across SVI quartiles (p-value=0.63). In the age-adjusted models, the SVI was not associated with the presence of de novo metastatic disease (odds ratio (OR (95% CI)=0.99 (0.84, 1.16)) or OS (HR (95% CI)=0.79 (0.46, 1.33). Conclusions: Our findings that residing in socially vulnerable US counties is not associated with the presence of de novo metastatic disease or IBC survival among a subset of women accessing high-quality cancer care suggest that improving access to quality cancer care may overcome underlying socioeconomic factors that contribute to disparities in IBC outcomes. Future studies are needed to confirm these findings in other settings. Citation Format: Kelly Hirko, Elizabeth Troll, Sean Ryan, Faina Nakhlis, Jennifer Bellon, Olga Kantor, Christina Minami, Eren Yeh, Ilana Schlam, Laura Warren, Caroline Block, Susan Schumer, Filipa Lynce. County-level Social Vulnerability and Survival among Women with Inflammatory Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-10.

Abstract PO2-09-10: Addressing Breast Cancer Disparities: Co-Creating Digital Interventions with Patients, Navigators &amp; the Community to Address Social Determinants of Health in the Memphis Statistical Area

Abstract Background: The Memphis Statistical Area, which covers counties in Arkansas, Mississippi, and Tennessee, leads in disparities in mortality rates between Black breast cancer patients compared to White counterparts1. Urban Health Education &amp; Support Services (UHESS), in partnership with RabbleHealth, and West Cancer Center &amp; Research Institute (WCCRI), initiated a solutions-oriented, community-based scalable initiative in January 2023 to measurably address social determinants of health (SDOH), which often drive cancer inequities that disproportionately impact individuals of marginalized communities. By leveraging a community-driven, co-creation sustainable approach, the team sought to measurably improve breast cancer equality utilizing digital enablement and the knowledge of local breast cancer survivors and leading healthcare professionals, including navigators. Methods: A four-phase approach was leveraged to 1. improve access to locally available breast cancer services in communities that are traditionally underserved and 2. measure the public health impact against root causes of breast inequities (i.e., care pathway metrics), and 3. create a repeatable, scalable model to expand to other underserved communities. In Phase 1, UHESS leveraged the Mid-South Regional Breast Cancer Coalition, which convenes ten local breast cancer patient advocacy organizations, to recruit focus groups for co-creation throughout all phases of the initiative. The working group consisted of eight representatives from a variety of Memphis-based cancer organizations, faith-based organizations, navigator programs, and WCCRI. This phase centered around establishing trust with the local patient advocacy community. In Phase 2, an initial patient survey was circulated to identify key resources that reduce health inequities and barriers to access. Human-centered design facilitators supported a series of Listen &amp; Learn workshops with patients to convey root causes of gaps in access to relevant services and with navigators to understand professional needs of navigators and scale the ability improve patient access to resources. To co-create a solution, facilitated patient and navigator workshops were held in Phase 3 to gather patient-centric user experience and design enhancements for a digital patient engagement app. These requirements as well as navigator-defined metrics needs were digitized and organized by SDoH. Phase 4, the Deploy &amp; Measure phase, will begin in September of 2023 and the community-based deployment model focuses on three drivers including: (a) embedding within navigator workflow, (b) activating faith-based organizations, and (c) leveraging societies. Health equity performance data will be analyzed weekly to rapidly target those ZIP codes with the greatest need. Results: Co-design efforts included over 50 members of the Greater Memphis community and final initiative results will be presented at the meeting. Planning for further research regarding community impact and model scalability is already underway. Conclusion: By leveraging a community-driven, co-creation sustainable approach, this model enables a better way to measurably improve breast cancer equality utilizing digital enablement and the knowledge of local breast cancer survivors and leading healthcare professionals, including navigators. Initiative Funding Acknowledgements: Gilead Life Sciences &amp; Blue Cross Blue Shield of Tennessee Foundation 1. Vidal G, Bursac Z, Miranda-Carboni G, White-Means S, Starlard-Davenport A. Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee. Cancer Med. 2017 Jul;6(7):1776-1786. doi: 10.1002/cam4.1117. Epub 2017 Jun 14. PMID: 28612435; PMCID: PMC5504313. Citation Format: Gregory Vidal, Stacey Tinianov, Aubrey Kelly, Andrea Curry, Carla Baker. Addressing Breast Cancer Disparities: Co-Creating Digital Interventions with Patients, Navigators &amp; the Community to Address Social Determinants of Health in the Memphis Statistical Area [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-10.

Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps.

This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.

Health impact assessment of the surface water pollution in China

China suffers from severe surface water pollution. Health impact assessment could provide a novel and quantifiable metric for the health burden attributed to surface water pollution. This study establishes a health impact assessment method for surface water pollution based on classic frameworks, integrating the multi-pollutant city water quality index (CWQI), informative epidemiological findings, and benchmark public health information. A relative risk level assignment approach is proposed based on the CWQI, innovatively addressing the challenge in surface water-human exposure risk assessment. A case study assesses the surface water pollution-related health impact in 336 Chinese cities. The results show (1) between 2015 and 2022, total health impact decreased from 3980.42 thousand disability-adjusted life years (DALYs) (95 % Confidence Interval: 3242.67–4339.29) to 3260.10 thousand DALYs (95 % CI: 2475.88–3641.35), measured by total cancer. (2) The annual average health impacts of oesophageal, stomach, colorectal, gallbladder, and pancreatic cancers added up to 2621.20 thousand DALYs (95 % CI: 2095.58–3091.10), revealing the significant health impact of surface water pollution on digestive cancer. (3) In 2022, health impacts in the Beijing-Tianjin-Hebei and surroundings, the Yangtze River Delta, and the middle reaches of the Yangtze River added up to 1893.06 thousand DALYs (95 % CI: 1471.82–2097.88), showing a regional aggregating trend. (4) Surface water pollution control has been the primary driving factor to health impact improvement, contributing −3.49 % to the health impact change from 2015 to 2022. It is the first city-level health impact map for China's surface water pollution. The methods and findings will support the water management policymaking in China and other countries suffering from water pollution.

Adjuvanted Vaccine to Prevent Respiratory Syncytial Virus in Adults Ages 60 Years and Older

Respiratory syncytial virus (RSV) is a prevalent cause of acute lower respiratory tract illness that disproportionately affects older adults, young children, and infants, which can lead to hospitalizations and death. The health impact on the elderly and infants accentuates the need for effective preventive strategies. Arexvy is the first approved vaccine to prevent lower respiratory tract illness caused by RSV in older adults ages 60 and older. It contains recombinant respiratory syncytial virus glycoprotein F stabilized in the prefusion conformation. Arexvy offers approximately 83% protection in adults and appears to maintain effectiveness for up to two RSV seasons. The vaccine was generally well tolerated in clinical trials, with the most frequently observed and reported adverse events being mild to moderate injection site pain, fatigue, myalgia, headache, and arthralgia. This article includes a description of Arexvy, the target population, contraindications, side effects, and clinical implications when considering the use of this vaccine.