Health Outreach Research Articles

Variation in State-Level Mammography Use, 2012 and 2020.

Mammography is a screening tool for early detection of breast cancer. Uptake in screening use in states can be influenced by Medicaid coverage and eligibility policies, public health outreach efforts, and the Centers for Disease Control and Prevention-funded National Breast and Cervical Cancer Early Detection Program. We described state-specific mammography use in 2020 and changes as compared with 2012. We estimated the proportion of women aged ≥40 years who reported receiving a mammogram in the past 2 years, by age group, state, and demographic and socioeconomic characteristics, using 2020 Behavioral Risk Factor Surveillance System data. We also compared 2020 state estimates with 2012 estimates. The proportion of women aged 50-74 years who received a mammogram in the past 2 years was 78.1% (95% CI, 77.4%-78.8%) in 2020. Across measures of socioeconomic status, mammography use was generally lower among women who did not have health insurance (52.0%; 95% CI, 48.3%-55.6%) than among those who did (79.9%; 95% CI, 79.3%-80.6%) and among those who had a usual source of care (49.4%; 95% CI, 46.1%-52.7%) than among those who did not (81.0%; 95% CI, 80.4%-81.7%). Among women aged 50-74 years, mammography use varied across states, from a low of 65.2% (95% CI, 61.4%-69.0%) in Wyoming to a high of 86.1% (95% CI, 83.8%-88.3%) in Massachusetts. Four states had significant increases in mammography use from 2012 to 2020, and 8 states had significant declines. Mammography use varied widely among states. Use of evidence-based interventions tailored to the needs of local populations and communities may help close gaps in the use of mammography.

Learning from health system actor and caregiver experiences in Ghana and Nepal to strengthen growth monitoring and promotion.

Globally, growth monitoring and promotion (GMP) of infants and young children is a fundamental component of routine preventive child health care; however, programs have experienced varying degrees of quality and success with enduring challenges. The objective of this study was to describe implementation of GMP (growth monitoring, growth promotion, data use, and implementation challenges) in two countries, Ghana and Nepal, to identify key actions to strengthen GMP programs. We conducted semi-structured key informant interviews with national and sub-national government officials (n = 24), health workers and volunteers (n = 40), and caregivers (n = 34). We conducted direct structured observations at health facilities (n = 10) and outreach clinics (n = 10) to complement information from interviews. We coded and analyzed interview notes for themes related to GMP implementation. Health workers in Ghana (e.g., community health nurses) and Nepal (e.g., auxiliary nurse midwives) had the knowledge and skills to assess and analyze growth based on weight measurement. However, health workers in Ghana centered growth promotion on the growth trend (weight-for-age over time), whereas health workers in Nepal based growth promotion on measurement from one point in time to determine whether a child was underweight. Overlapping challenges included health worker time and workload. Both countries tracked growth-monitoring data systematically; however, there was variation in growth monitoring data use. This study shows that GMP programs may not always focus on the growth trend for early detection of growth faltering and preventive actions. Several factors contribute to this deviation from the intended goal of GMP. To overcome them, countries need to invest in both service delivery (e.g., decision-making algorithm) and demand generation efforts (e.g., integrate with responsive care and early learning).

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

Global medical mission with surgical education objectives: a quality report regarding sustainability in an affiliated hospital in Quito, Ecuador

This report seeks to describe the logistics, outcomes, and push toward building a sustainable model for global surgical missions as viewed through the lens of Northwell Health’s 2020 Surgical Mission composed of both operations and international education. The Northwell-Quito 2020 medical mission to Ecuador was envisioned and successfully executed to help achieve Northwell Health’s goal of becoming a globally recognized leader in high-quality, socially conscious health care, and health education. A Northwell-sponsored team of 30 employees and community volunteers partnered with Hospital Padre Carollo, Fundación Tierra Nueva, and the Ecuadorian Ministry of Public Health to provide surgical services to the indigent and underserved of Quito, Ecuador from January 19 to January 24, 2020. During this mission, a total of 127 patients were evaluated, which included preoperative evaluations, operations, as well as postoperative follow-up from prior missions’ surgical interventions. Of the 56 patients scheduled for surgery, 53 operations were performed, including 30 adult and 23 pediatric procedures. No major complications occurred, and all patients were recovering appropriately at the postoperative evaluation on January 24, 2020. Northwell team members provided didactic and practical training for Ecuadorian health care providers, residents, and students to fulfill the educational mission of providing sustainable perioperative care. For the first time, Northwell’s Center for Global Health partnered with Universidad de San Francisco in Quito to organize a Global Health Week focused on the development of research, education, and mental health outreach and partnerships seeking toward building a sustainable model inclusive of logistics alongside international and cross-cultural care.

COVID‐19 vaccine hesitancy: The synergistic effect of anxiety and proactive coping

AbstractBackgroundThis study sought to identify cognitive and behavioral predictors of COVID‐19 vaccine hesitancy. Specifically, this study examined the effect of anxiety about developing COVID‐19 and proactive coping behavior on the likelihood of reporting COVID‐19 vaccine hesitancy in a sample of adults living in the United States.MethodsAn online survey of proactive coping strategies, anxiety related to developing COVID‐19, and vaccine hesitancy was administered in October 2020 to 534 adults aged 21–79‐years old. Age, gender, race, self‐rated health, years of education, COVID‐19 knowledge, and perceived constraints were included as covariates.ResultsOver half of the study participants (56.7%) were COVID‐19 vaccine hesitant. People who were less anxious about developing COVID‐19 were more likely to be vaccine hesitant. A statistically significant COVID‐19 anxiety × proactive coping interaction showed the odds of vaccine hesitancy was highest among individuals with low anxiety about developing COVID‐19 and high proactive coping, whereas vaccine hesitancy was lowest among individuals with high COVID‐19 anxiety and high proactive coping.ConclusionResults support a future‐oriented approach to public health outreach efforts regarding COVID‐19 vaccines. Improvement of proactive coping skills and emphasis on the likelihood of contracting COVID‐19 may be more effective in increasing vaccine uptake than simply restating scientific facts regarding safety or efficacy.

Oral Antiviral Therapy Utilization Among Adults with Recent COVID-19 in the United States.

This is the first study, to our knowledge, to assess uptake of oral antiviral treatment (OAV) for COVID-19 in the US and assess whether it is reaching recommended groups. The study evaluated uptake among persons of all ages, with emphasis on utilization among individuals ages 65 + who comprise 75% of all COVID-19 deaths. To maximize public health outreach and benefit, we sought to understand reasons for use and non-use of OAV among individuals 65 + with at least mild COVID-19 symptoms. Data were collected from phase 3.5 of the US Census Household Pulse Survey, during three 2022 time periods: June 1-13, June 29-July 11, and July 27-August 8. Respondents (n = 12,299) were ages 18 + with active or resolved COVID-19 within the last 4weeks of their survey participation. Comparisons of demographic variables were made for OAV uptake using the chi-square test of independence. A logistic regression was conducted to identify characteristics of participants independently associated with receipt of an OAV. Comparisons were made with chi-square testing, between those ages 65 + with at least mild symptoms who endorsed one of a number of specific reasons for not using OAV. Utilization was low-17.9% of all respondents, 20.5% of respondents ages 50-64, and 33.9% of respondents 65years and older received guideline-concordant treatment for their infection. Receipt did not differ by income or sex. The average response across the three phases was 5.4%. Most common reasons for not receiving treatment included having minimal symptoms, not thinking that they needed treatment, and not receiving a recommendation from their healthcare provider. A minority of increased-risk US residents have accessed early therapy for COVID-19 despite being made available without cost. Responses suggest that efforts to improve patient and provider knowledge could improve utilization to mitigate future COVID-19 hospitalizations.

Automated Text Messaging During COVID-19: Patient Feedback to Increase Adoption.

Automated text messaging interventions can effectively improve self-care and were used to support the U.S. Veterans Health Administration's (VHA) public health outreach during the COVID pandemic. Currently, significant gaps exist in knowledge about VHA patients' texting protocol preferences that may impact user receptivity, engagement, and effectiveness. This study qualitatively evaluated patient suggestions to improve two VHA Covid-related texting interventions and preferences for future text message protocols.We reviewed cross-sectional type-written survey responses from patients receiving either the "Coronavirus Precautions" or the "Coping During COVID" multi-week text protocols. Two team members independently and inductively coded all responses allowing for an upward abstraction of qualitative data.Nine hundred five patients (72.8% male) responded to the open-response item questions targeted by this research. An item that sought feedback to improve protocol acceptability generated thirteen distinct descriptive categories (inter-rater reliability 83.5%). Codable feedback showed, for example, that patients desired to manipulate message frequency and to have a more sophisticated interaction with messages. Patients' suggestions for future automated text messaging protocols yielded nine distinct topic areas.Patients offered suggestions that may impact receptivity and engagement of future automated text message protocols, particularly as they relate to outreach during a public health crisis. In addition, patients offered specific topics they would like to see in future text message protocols. We discuss how the findings can be used to increase engagement in current and post-pandemic public health interventions.

Nutrition and Health Programming and Outreach in Grocery Retail Settings: A Community Coalition in Action.

Grocery stores can provide a conducive environment for interventions targeting healthy eating and access to health services, particularly in low-income communities. A wide array of organizations deliver nutrition and related programs in community settings, but rarely in a coordinated fashion. Collaboration of local health promotion organizations with grocery stores could increase consumers' access to and selection of healthy foods and related services. This evaluation of the In-Store Programming and Outreach Coalition (IPOC) uses thematic analysis of first-person accounts from coalition members. To our knowledge, this is the first study of such a coalition. We present perspectives from six stakeholders about the IPOC strengths, challenges, and recommendations for strengthening the delivery of in-store interventions. Themes identified include partnership, increased client reach and cross-referrals, conflicting work schedules, leadership, and recommendations to identify coalition leaders and expand services to other grocery stores. We conclude that grocery stores can offer a suitable setting for programming and community outreach through coalitions.

Feasibility of a Community-Based, Online, Peer-Supported Spinal Cord Injury Self-management Intervention: Protocol for a Pilot Wait-Listed Randomized Trial

People with spinal cord injury (SCI) report feeling unprepared to manage their disability upon discharge to the community. This situation is exacerbated when they return to settings where self-management support and resources are sparse, thus increasing the risk of costly secondary conditions and rehospitalizations. These factors make a compelling case for implementing innovative community-based SCI self-management programs that empower and engage individuals with SCI. Using a community-engaged research (CEnR) approach, we developed a peer-supported SCI self-management intervention, known as PHOENIX (Peer-supported Health Outreach, Education, and Information Exchange), which integrates online educational content and support from peer navigators (PNs) through telehealth, to promote health and community participation after SCI. The objective of this pilot study is to evaluate the feasibility and acceptability of PHOENIX and the study design, and to obtain estimates of the variability of relevant outcome measures. We conducted a pilot randomized waitlist-controlled trial (n=30) in collaboration with the South Carolina Spinal Cord Injury Association (SCSCIA), our long-standing community-based nonprofit organization research partner. We recruited 4 PNs through our SCSCIA collaboration using its existing network of trained peer mentors. Our study design supported comparison of the following 2 randomly assigned groups: PHOENIX intervention group and waitlist enhanced usual care (EUC) group. The PHOENIX intervention was administered online by PNs over 16 weeks through scheduled "video visits." The EUC group participated in the study for 16 weeks with usual community services and no navigation, and received 4 monthly newsletters from the SCSCIA on a variety of SCI-relevant topics. At the end of the waitlist period, the waitlist EUC group received the full PHOENIX intervention. Measures of feasibility included PN and participant recruitment and retention, PN workload, protocol adherence, and incidence of technical issues. We conducted qualitative interviews with participants and PNs to evaluate the acceptability of PHOENIX and the study design. Outcome measures, including community participation, quality of life, and the occurrence and subjective impact of medically serious secondary conditions and rehospitalizations, were assessed at baseline after randomization and at subsequent time points to allow between-group comparisons. PN hiring and training were completed in August 2018. Recruitment began in November 2018. A total of 30 participants were recruited across South Carolina, and 28 participants completed follow-up by August 2020. An analysis of the results is being finalized, and the results are expected to be published in 2023. This study will provide valuable information to guide future research seeking to address unmet self-management needs and improve outcomes in individuals with SCI. Feasibility findings of this study will provide evidence from CEnR guided by people with SCI and SCI service providers to inform further development, testing, and dissemination of effective and scalable self-management strategies for people with SCI. RR1-10.2196/42688.

Is maternal anemia among tribal women being neglected? A study from Southern Rajasthan.

Poor birth outcomes have been linked to maternal anemia. Tribal women are at higher risk of malnutrition and disease due to sociocultural barriers and poor educational status. The data on the prevalence of maternal anemia and its associated factors among pregnant tribal women are limited. A community-based cross-sectional study was conducted among 429 pregnant tribal women for maternal anemia from August 2021 to June 2022. A structured questionnaire was employed to collect sociodemographic data. The prevalence of anemia was 85.7%, with a mean hemoglobin level of 9.21 ± 1.3 g/dL. On applying WHO 2011 anemia criteria for pregnant women, 25.0% had mild anemia, 73.4% had moderate anemia, and 1.6% had severe anemia. The significant factors associated with anemic condition were household condition, monthly income, and husband's occupation. The higher prevalence of anemia among pregnant tribal women is alarming that necessitates a rethinking of health infrastructure and outreach in tribal dominant areas.

Program logic of a mental health outreach service for socially anxious youth

Youth mental health is a major concern both in Australia and internationally. Identifying at-risk young people is a core service priority. This report describes a “Youth Social Inclusion Program” developed in Australia to assist young people identified as having social difficulties that prevent them linking into formal mental health services. This report describes the Australian service context and uses the “program explication” methodology to document: the program activities, therapeutic processes, and underpinning evidence for the benefits of this service. Program explication is a consulting method designed to assist services to identify and review implicit program logic assumptions against evaluation literature. We demonstrate the application of this method in exploring the assumptions and evidence for the Youth Social Inclusion Program, targeting outreach to socially anxious young people in Australia. The Youth Social Inclusion Program involved seven logically consistent activities. Our literature search revealed moderate evidence for the expected benefits of the activities. This practice-based design drew on several theoretical perspectives. Given that the program logic has been established, we outline a proposal for further evaluation.

Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India.

Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. This was a cross-sectional descriptive mixed-methods study. Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.

Coping with the 2022 infant formula shortage

To estimate the proportion of US consumers who sought formula during the shortage, what coping mechanisms they used, and public support for formula policies, we conducted an online survey of approximately 1,000 US consumers in August 2022 via Qualtrics. Approximately 35% of consumers attempted to purchase formula during the shortage, for their own household or on behalf of someone else, and the most common coping mechanisms were focused on searching different outlets (e.g., multiple stores, online). During the shortage public health agencies published recommendations for consumers – some were highly utilized (e.g., searching multiple stores), however, some were utilized less frequently (e.g., brand switching, breastfeeding). Additionally, despite warnings, some consumers still attempted to make their own formula. Understanding what coping mechanisms were and were not utilized, and their related risks has important implications for improving public health outreach in the future. Finally, we find considerable public support for regulation to ensure adequate supply of formula in the future, in particular regulation allowing imported formula and increased government involvement in the number of firms producing formula.

Targeted education and outreach to neighbors of homes with high gross alpha radioactivity in domestic well water

Gross alpha, a measurement of radioactivity in drinking water, is the most frequent laboratory test to exceed primary drinking water standards among wells tested under the New Jersey Private Well Testing Act (NJ PWTA). Certain geological factors prevalent in New Jersey (NJ) are primarily responsible for the presence of radioactivity in private well drinking water and thus, many of the estimated one million private well users in NJ may be at-risk of water contamination from naturally occurring radionuclides. Neighbor-based private well outreach methodology was utilized to identify high risk wells in both northern and southern NJ regions and offer free private well testing for radionuclides. Previously tested wells with gross alpha exceeding or equal to 3.7 becquerels per liter (Bq L-1; 100 pCi/L) were selected (n = 49) to identify neighbors (n = 406) within 152.4 m (500 feet). Invitation letters were mailed to selected neighbors and some of the previously tested high wells (n = 12) offering free water sampling for the following parameters: gross alpha (48-hour rapid test), combined radium-226 and radium-228 (Ra-226 + Ra-228), uranium-238 (U-238), radon-222 (Rn-222) and iron. Overall, 70 neighbors and 5 high PWTA wells participated in this free water testing opportunity. For neighboring wells, gross alpha results revealed 47 (67.1%) wells exceeding the gross alpha MCL of 0.555 Bq L-1 (15 pCi/L) mainly due to radium activity in the raw/untreated water. Of those with water treatment (n = 62), 12 (19.4%) treated water samples exceeded the gross alpha MCL. Targeting neighbors of known highly radioactive wells for private well testing is an effective public health outreach method and can also provide useful insight of regional contaminant variations.

Harmful Algal Bloom Exposures Self-reported to Poison Centers in the United States, May-October 2019.

The National Poison Data System (NPDS) comprises self-reported information from people who call US poison center hotlines. NPDS data have proven to be important in identifying emerging public health threats. We used NPDS to examine records of people who had self-reported exposure to harmful algal blooms (HABs). Participating poison centers then contacted people who had called their centers from May through October 2019 about their HAB exposure to ask about exposure route, symptoms, health care follow-up, and awareness of possible risks of exposure. Of 55 callers who agreed to participate, 47 (85%) reported exposure to HABs while swimming or bathing in HAB-contaminated water. Nine callers reported health symptoms from being near waters contaminated with HABs, suggesting potential exposure via aerosolized toxins. Symptoms varied by the reported routes of exposure; the most commonly reported symptoms were gastrointestinal and respiratory. More public and health care provider education and outreach are needed to improve the understanding of HAB-related risks, to address ways to prevent HAB-related illnesses, and to describe appropriate support when exposures occur.

Invited Commentary on Stoehr J et al: The Personal Impact of Involvement in International Global Health Outreach: A National Survey of Former Operation Smile Student Volunteers

During my years working in Kenya and Ethiopia, I used to warn keen short-term volunteers that, as much as they came motivated by a sincere desire to help African patients, the only real impact they could expect was on themselves - they will leave changed, and what they will receive will outweigh anything they could give. It was a tough and sobering statement, yet essential for addressing the inherent savorism that characterized - and still does - so much of global surgical care.

The Personal Impact of Involvement in International Global Health Outreach: A National Survey of Former Operation Smile Student Volunteers

BackgroundHumanitarian surgical organizations such as Operation Smile provide global health opportunities for students and medical trainees. Prior studies have shown a positive benefit for medical trainees. This study aimed to determine if the international global health experiences of young student volunteers impact their career choices as adults. MethodsA survey was sent to adults who were involved with Operation Smile as students. The survey elicited information about their mission trip experience, education, career, and current volunteer and leadership activities. Data were summarized with descriptive statistics and qualitative analysis. Results114 prior volunteers responded. The majority participated in leadership conferences (n = 110), mission trips (n = 109), and student clubs (n = 101) while in high school. Many graduated from college (n = 113, 99%) and completed post-graduate degrees (n = 47, 41%). The most highly represented occupational industry was healthcare (n = 30, 26%), including physicians and medical trainees (n = 9), dentists (n = 5), and other healthcare providers (n = 5). Three-fourths reported that their volunteer experience impacted their career choice, and half reported that their experience allowed them to connect with career mentors. Their experience was associated with the development of leadership skills, including public speaking, self-confidence, and empathy, and increased awareness of cleft conditions, health disparities, and other cultures. Ninety-six percent continued to volunteer. Narrative responses revealed that the volunteer experiences impacted their inter- and intrapersonal development into adulthood. ConclusionsParticipation in a global health organization as a student may encourage a long-term commitment to leadership and volunteerism and foster interest in a healthcare career. These opportunities also encourage development of cultural competency and interpersonal skills. Level of evidenceIII, Cross-Sectional Study.

Hepatitis C Virus Screening among Baby Boomers: The Positive Benefits of Health Education and Outreach during the COVID-19 Pandemic.

In 2019, 2020, and 2021, Sendero Health Plans, an ACA health insurance company, implemented Hepatitis C Virus (HCV) health education and outreach screening campaigns. Chi-square goodness-of-fit and tests of independence were performed to assess and compare the uptake of HCV screening among baby boomers in 2019, 2020, and 2021. In 2019, 2020, and 2021, 17.9% (308/1,718), 10.9% (93/852), and 8.5% (37/435) of eligible members were screened, respectively. Individuals were more likely to be screened for HCV in 2019 than in 2020 and 2021 (p < 0.0001). In 2019, 2020, and 2021, 39.9%, 26.9%, and 48.6% of annual screenings occurred during the health campaign months, respectively. Annual HCV screening rates were lower during the COVID-19 pandemic period than in the pre-pandemic cohort. However, screening rates during the months of outreach and education contributed to nearly 50% of annual screenings in the pandemic year 2021, thus representing a positive impact on preventive screening uptake despite the pandemic. Missed screening opportunities affect HCV transmission, diagnosis, and treatment. Yet, health education and outreach continue to work, even during a pandemic.

Data Corroboration of The Catastrophic Chernobyl Tragedy Using Arc-Length Estimate Conjecture

Nuclear power is perhaps one of the biggest keys to empowerment for any country. In fact, nuclear power has been the backbone of the international superpowers like the US and USSR since the 20th Century. Alongside its merits, nuclear power carried some demerits propping on it. One of the biggest amongst all was the Chernobyl nuclear cataclysm that occurred on the 26’th April 1986. Within hours of the explosion, nuclear radiation blanketed the whole city of Pripyat, Ukraine. In this paper, we have developed a notion namely “Arc-Length Estimate Conjecture” to detect anomaly, and fairness in data sets. If an anomaly is found, the Arc Length Estimate Conjecture is capable of dissecting the anomality in magnitudical terms. Further we have analyzed the Radiation that emerged from the Chernobyl Catastrophe by looking at the concentration of radioactive elements that were measured from different parts of the world. We have considered the elements I131 and Cs134 as elements of utmost importance and have tried to verify the data put forward by USSR regarding the radiation emission level of these radio actives. social-circles, and non-religious students. The results of this study and related studies to follow will be used to inform improvements to mental health counseling and outreach to at- risk individuals at universities across the United States.

Comparing experiences with mental health issues to perceptions of their prevalence: A study of Duke University undergraduates

Mental illness affects all populations but has disproportionately affected college students in the recent past. Universities provide a unique setting in which students often live away from their families and must make an effort to stay socially engaged. While plenty of research on mental health has been conducted on children and adults, the field is lacking in research on college-aged individuals. The present study identifies the frequency of symptoms of depression and anxiety among the Duke University undergraduate community, as well as demographic factors that are correlated with these symptoms. The data were obtained through a survey asking students about their experiences with well-established symptoms of Major Depressive Disorder and Generalized Anxiety Disorder. The data indicate that students at Duke University experience symptoms of depression and anxiety at a higher rate compared to the average 18-29 year old person in the United States. Other findings include a greater prevalence of mental illness symptoms among low-income students, students with small social-circles, and non-religious students. The results of this study and related studies to follow will be used to inform improvements to mental health counseling and outreach to at-risk individuals at universities across the United States.