Individual-level Interventions Research Articles

Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence

BackgroundWe describe the rationale and study design for “TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN),” a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma.DesignTRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome.DiscussionResults from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence.Trial registrationClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries.

Recommendations on Social Determinants of Health in Neurologic Disease.

Social determinants of health (SDOH) are increasingly recognized as important drivers of inequities in neurologic disease and outcomes. However, our understanding of the biopsychosocial mechanisms by which SDOH affect neurologic disease remains in its infancy. The most robust epidemiologic research has been on the associations between education, schooling, and place-based social determinants on cognition, dementia, and cerebrovascular disease later in life. Further research is needed to more deeply understand the complex interplay of SDOH on neurologic disease. Few SDOH screening tools have been validated in populations with neurologic disease. In addition, comparison across studies and populations is hampered by lack of standardized common data elements. Experiences of populations historically underrepresented in research should be centered in future research studies, and changes should be made in recruitment expectations and measurement choices. For research on inequities, it is critical to support and incentivize institutional infrastructure to foster meaningful engagement with populations affected by research. Finally, it remains to be seen whether individual-level health or behavioral interventions or place-level, systemic or policy interventions to reduce population burden will be most effective in reducing inequities in neurologic disease and outcomes. Although numerous clinical trials have focused on addressing downstream SDOH such as health literacy and health behaviors (e.g., medication adherence, physical activity, diet), few have addressed upstream, structural determinants which may have a more profound impact on addressing inequities in neurologic disease. Ultimately, further research is needed to determine which specific SDOH should be targeted and how, when, and by whom they should be addressed to improve neurologic outcomes.

Understanding parents uncertainty sources and management strategies while caring for a child diagnosed with a hematologic cancer

RationaleParents of a child or adolescent (CA) or young adult (YA) diagnosed with a hematologic cancer often face uncertainty. Managing uncertainty is critical to reduce the psychosocial burden of illness-related stressors. ObjectiveThis study sought to identify: 1) sources of uncertainty among parents of a child diagnosed with a hematologic cancer, 2) strategies used by parents to manage uncertainty, and 3) clinicians' responses to parents' online information-seeking approach to managing uncertainty. MethodsParents of CAs/YAs diagnosed with a hematologic cancer within the past 1–18 months and living in the U.S. participated in an in-depth, semi-structured phone interview (n = 20). Data were analyzed thematically. ResultsParents reported uncertainty about treatment (options, efficacy, and side effects or risks) and uncertainty about the future (recurrence, whether worry would subside, and how to approach the child's future). Parents managed uncertainty by seeking information online, talking to clinicians, and joining support groups. Clinicians' responses to online information-seeking were described as supportive and unsupportive. ConclusionParents described struggling with uncertainty across the cancer continuum (from primary treatment to survivorship). Parents' psychosocial health may benefit from individual and systems level interventions that help address and manage uncertainty, especially interventions focusing on parent caregiver-clinician communication.

Community- and individual-level correlates of HIV incidence in HPTN 071 (PopART).

Universal HIV testing and treatment aims to identify all people living with HIV and offer them treatment, decreasing the number of individuals with unsuppressed HIV and thus reducing HIV transmission. Longitudinal follow-up of individuals with and without HIV in a cluster-randomized trial of communities allowed for the examination of community- and individual-level measures of HIV risk and HIV incidence. HPTN 071 (PopART) was a three-arm cluster-randomized trial conducted between 2013 and 2018 that evaluated the use of two combination HIV prevention strategies implemented at the community level to reduce HIV incidence compared to the standard of care. The trial, conducted in 21 communities in Zambia and South Africa, measured HIV incidence over 36 months in a population cohort of ∼2000 randomly selected adults per community aged 18-44. Multilevel models were used to assess the association between HIV incidence and community- and individual-level socio-demographic and behavioural risk factors, as well as prevalence of detectable virus (PDV) defined as the estimated proportion of the community with unsuppressed viral load. Overall HIV incidence was 1.49/100 person-years. Communities with less financial wealth and communities with more individuals reporting having sex partners outside of the community or two or more sexual partners had higher HIV incidence. PDV at 2 years of study was 6.8% and was strongly associated with HIV incidence: for every 50% relative reduction in community PDV, there was a 49% (95% confidence interval [CI]: 37%-58%, p < 0.001) relative decrease in HIV incidence. At the individual level; socio-economic status, AUDIT score, medical male circumcision and certain sexual behaviours were associated with HIV risk. Using data from the PopART randomized trial, we found several associations of HIV incidence with community-level measures reflecting the sexual behaviour and socio-economic make-up of each community. We also found a strong association between community PDV and HIV incidence supporting the use of PDV as a tool for monitoring progress in controlling the epidemic. Lastly, we found significant individual-level factors of HIV risk that are generally consistent with previous HIV epidemiological research. These results have the potential to identify high high-incidence communities, inform structural-level interventions, and optimize individual-level interventions for HIV prevention. ClinicalTrials.gov number, NCT01900977, HPTN 071 [PopArt].

Oral Health Intervention During Pregnancy: A Systematic Review

Background: Oral health during pregnancy is essential regarding its long-term and shortterm effects on maternal and child health. Objective: This study aimed to investigate the strategies and methods used in oral health promotion interventions during pregnancy. Also, it is tried to determine the extent to which environmental barriers and socio-economic factors, in addition to individual factors, have been considered in the design of these interventions. Methods: The data were extracted from Pub-Med, Web of Science, and Scopus databases by searching the published papers before November 2019. The search terms consisted of pregnancy, oral health promotion, health education, and preventive health services, resulting in 2772 records. The inclusion criteria were pregnant women as a target group; study design with randomized (controlled) trials; implementing a minimum of one health promotion intervention; and studying the outcomes including knowledge, attitudes, dental cleaning behaviors, and clinical examinations. On the other hand, the articles only focused on the infant’s oral health were excluded. Results: A total of 20 articles were included in this study. The subject of most reviewed studies was the individual-level interventions using various methods, including lectures, role-playing, group discussion, one-on-one counseling, skill-based education, commercials on the video-sharing website, and using social networks. Few studies (n = 4) provided screening and referring to dental services, prophylaxis, nonsurgical therapy, and initial periodontal treatment. Only one study focused on socio- economic factors, including cost and location of dental services and involvement of prenatal care providers. Conclusion: According to ecological approaches, maintenance of outcomes needs addressing multilevel determinants. However, based on the results, a few oral health interventions during pregnancy included environmental/policy-level factors in addition to individual factors. Hence, interventions with different strategies that consider multiple determinants are needed.

Suicide Prevention: A Must-Do Task

Suicide prevention requires a comprehensive and multi-dimensional approach that addresses the interplay of individual, social, and environmental factors contributing to suicidal behavior. How to prevent it is crucial and is a must-do task. It is critical to examine individual-level interventions such as mental health screenings and access to mental health services, as well as population-level strategies including awareness campaigns and public policy initiatives. Consequently, it is essential to emphasize the significance of fostering community support, strengthening protective factors, and promoting resilience to counteract suicide risk. Additionally, the role of education, stigma reduction, and collaboration between various stakeholders in implementing effective suicide prevention programs also play a pivotal part in it.

Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action.

It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing. Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist-facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy. Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate. Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these. An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.

Between Resilience and Agency: A Systematic Review of Protective Factors and Positive Experiences of LGBTQ+ Students.

A negative school climate resulting from homophobic and transphobic bias and discrimination is associated with poor well-being and mental health among LGBTQ+ youth. However, protective factors and mechanisms may buffer against the impact of stigmatization. Drawing on the socio-ecological model, minority stress theory, and positive youth development and agency perspectives, we carried out a systematic review of research focusing on factors that can promote the well-being of LGBTQ+ students in educational settings, outlining the primary outcomes from studies published between 2012 and 2022. The PRISMA protocol was used for this review, and 64 articles were scrutinized. The results of the thematic analysis revealed that both external factors (school-inclusive policies and extracurricular activities; social support from school, family, and the community; and school connectedness) and internal factors (psychosocial characteristics and personal agency) promote positive school experiences, such as the exploration of sexual and gender identities in a safe environment. The present findings highlight the need for inclusive school policies and strategies and individual-level interventions that target the well-being and positive mental health outcomes of sexual and gender minority students.

The many "costs" of transportation: Examining what cancer caregivers experience as transportation obstacles.

Transportation has been identified as a specific source of burden for cancer caregivers. This study examined cancer caregivers' subjective experiences and objectives costs associated with transportation over a 6-month period of providing end-of-life care to a family member or friend. This was a multi-site longitudinal, prospective cohort study that followed 223 caregiver-patient dyads. Data were collected using biweekly, semi-structured interviews for up to 6 months and collection of all caregiving related receipts. Interviews were coded and analyzed using a comparative, iterative analysis and actual out of pockets costs were described using descriptive statistics. Over the 6-month study period most caregivers (n = 143; 74%) discussed transportation at one or more timepoints. Average biweekly transportations costs to caregivers were $43.6. Caregivers described (n = 56; 39%) multiple direct and indirect costs of transportation, and 58% (n = 84) discussed the need for transportations services or assistance at the institutional level. Caregivers described the multifaceted costs of transportation they experienced which are in line with previous work. Alongside descriptions of direct costs, caregivers described key opportunity costs, such as personal and work time forgone to transporting patients. Caregivers also made suggestions for institutional and/or civic based solutions to facilitate reliable modes of transportation, rather than individual-level intervention.

Addressing HIV vulnerability and promoting resilience among heterosexual Black men and communities in Ontario, Canada: A concept-mapping approach

We used concept-mapping methods to gain insights into promising HIV prevention intervention strategies from the collective experience of heterosexual Black men (HBM) in four cities of Ontario. We engaged 60 HBM in online group concept-mapping sessions. First, we held a brainstorming session where the HBM generated 226 statements anonymously on strategies to reduce HIV vulnerabilities. The statements were condensed to 123. Second, the HBM ( n = 45) sorted the 123 statements into self-created categories. Third, the HBM rated the strategy statements by importance ( n = 45) and feasibility ( n = 41). Finally, cluster analysis and multidimensional scaling were used to describe data patterns. The statements cluster tagged “family and individual level interventions” had the highest mean rating in importance (4.061) and feasibility (3.610). The policy interventions cluster solution was rated second highest in importance (IR = 4.058) and the sixth in feasibility (FR = 3.413). Other cluster solutions ratings were addressing racism (third highest in importance [IR = 4.030] and fourth highest in feasibility [FR = 3.514]); healthcare, research, and economic opportunities (fourth highest in importance [IR = 4.018] and third highest in feasibility [FR = 3.526]); sexual health awareness strategies (fifth highest in importance [IR = 3.993] and highest in feasibility [FR = 3.611]) and sex/HIV education (sixth highest in importance [IR = 3.975] and fifth highest in feasibility [FR = 3.442]); and individual and community empowerment (lowest in importance [IR = 3.846] and lowest in feasibility [FR = 3.375]). Intergenerational (family and individual), policy, and anti-racism interventions are the top three priority strategies for HIV prevention and care for HBM and communities in Ontario.

Do individual-level interventions focusing attention on or away from stress experience help reduce occupational stress in healthcare workers?

Do individual-level interventions focusing attention on or away from stress experience help reduce occupational stress in healthcare workers?

Countering Misinformation

Abstract: Developing effective interventions to counter misinformation is an urgent goal, but it also presents conceptual, empirical, and practical difficulties, compounded by the fact that misinformation research is in its infancy. This paper provides researchers and policymakers with an overview of which individual-level interventions are likely to influence the spread of, susceptibility to, or impact of misinformation. We review the evidence for the effectiveness of four categories of interventions: boosting (psychological inoculation, critical thinking, and media and information literacy); nudging (accuracy primes and social norms nudges); debunking (fact-checking); and automated content labeling. In each area, we assess the empirical evidence, key gaps in knowledge, and practical considerations. We conclude with a series of recommendations for policymakers and tech companies to ensure a comprehensive approach to tackling misinformation.

The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics.

Independent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics. A population-based study (Olmsted County, Minnesota, USA). Older adults (age 65+ years) with no prior history of NHP. Electronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden. Among 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1years). At baseline date, median age was 73years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI. This study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.

Examining the relationship between negative social exchange and suicidal ideation: the role of thwarted interpersonal needs

PurposeSuicidal ideation (SI) is a serious public health concern among youth and young adults in the USA. It is critical to evaluate potential risk and protective factors associated with SI among young adults to develop prevention strategies that target novel mechanistic outcomes.Design/methodology/approachThis study sought to evaluate the association between negative social exchange (NSE) and SI via the framework of the interpersonal theory of suicide. Participants were a diverse sample of N = 243 college students, with a mean age of 19.98 years (SD = 3.15). Participants were predominantly female (68.3%) and Hispanic/Latinx (39.5%), white (21.4%) or multiracial/multiethnic (24.3%). Participants completed survey measures to assess each of the constructs of interest.FindingsResults indicated a significant indirect effect from NSE to SI via perceived burdensomeness, but not thwarted belongingness.Originality/valueWhile individual-level interventions target emotional reactivity and managing emotional responses, larger public health–focused interventions on campus may wish to target reductions in NSE on campus. Future work should evaluate these associations using longitudinal study designs to further evaluate the statistical models.

Investigating the role of perceived ingroup and outgroup colourism on body image and wellbeing among Black, Asian, and other racialised/ethnic minority groups living in the UK

Colourism is a form of prejudice and discrimination based on skin shade, disadvantaging people of colour with darker skin. This study investigates the relationship between perceived colourism, body image, and psychological wellbeing, considering perceived colourism from the ingroup (people of the same racialised group) and the outgroup (white people). A total of 516 Black, Asian, and other racialised/ethnic minority adults living in the UK (56.8 % women) completed an online survey. Using structural equation modelling, we tested a theoretically informed model: ingroup and outgroup colourism were predictors, body image and psychological distress were outcomes, and skin shade satisfaction and surveillance were hypothesised mediators. The model provided a good fit to the data. Ingroup colourism was related to lower skin shade satisfaction and higher skin shade surveillance, which in turn related to worse body image and greater psychological distress. Outgroup colourism was related to higher skin shade surveillance, which in turn was associated with worse body image. Outgroup colourism was directly associated with greater psychological distress. Results showed perceived colourism was associated with worse body image and psychological distress among people of colour in the UK. Therefore, colourism should be considered in the development of societal-, community-, and individual-level body image interventions.

Individual and Community-Level Risk Factors for Giardiasis in Children under Five Years of Age in Pakistan: A Prospective Multi-Regional Study.

This study aimed to estimate the prevalence of Giardia lamblia infection and identify associated risk factors at both individual and community levels in a pediatric population in different agroecological zones of Khyber Pakhtunkhwa, Pakistan. A community-based cross-sectional study was conducted from March to December 2022. Using stratified sampling, 1026 households were recruited from nine agroecological zones. Stool samples were collected from 1026 children up to the age of five years and processed for detection of Giardia using a commercial ELISA kit. Data on potential risk factors were collected using a pre-structured questionnaire. A multivariable logistic regression model was used to identify risk factors associated with giardiasis. The study found that the prevalence of giardiasis in the study area was 3.31%. Children aged 13-24 months were found to be at higher risk for giardiasis. Illiterate mothers and fathers attending daycare institutions/kindergartens, mothers not practicing hand washing during critical times, households with companion animals, and homes where stray dogs/cats enter were identified as predictors of giardiasis at the individual level. Children living in sub-mountain valleys use un-piped water, inadequate domestic water storage vessels, drink un-boiled or unfiltered water, live near rubbish heaps or un-paved streets/pathways, and have unimproved latrine facilities were identified as risk factors of giardiasis at the community level. The study highlights the need for integrated intervention approaches at both individual and community levels to reduce the incidence of giardiasis in Khyber Pakhtunkhwa, Pakistan. Interventions aimed at promoting behavioral change and providing safe and adequate water sources, combined with individual-level interventions such as hand washing and awareness of giardiasis prevention methods, would be critical to addressing this health concern. Inter-sectoral collaboration between the health sector and other sectors would also be necessary to achieve meaningful progress in reducing the incidence of giardiasis in resource-limited areas.

Epidemiological impact of public health interventions against diabetes in Qatar: mathematical modeling analyses.

To predict the epidemiological impact of specific, and primarily structural public health interventions that address lifestyle, dietary, and commuting behaviors of Qataris as well as subsidies and legislation to reduce type 2 diabetes mellitus (T2DM) burden among Qataris. A deterministic population-based mathematical model was used to investigate the impact of public health interventions on the epidemiology of T2DM among Qataris aged 20-79 years, which is the age range typically used by the International Diabetes Federation for adults. The study evaluated the impact of interventions up to 2050, a three-decade time horizon, to allow for the long-term effects of different types of interventions to materialize. The impact of each intervention was evaluated by comparing the predicted T2DM incidence and prevalence with the intervention to a counterfactual scenario without intervention. The model was parameterized using representative data and stratified by sex, age, T2DM risk factors, T2DM status, and intervention status. All intervention scenarios had an appreciable impact on reducing T2DM incidence and prevalence. A lifestyle management intervention approach, specifically applied to those who are categorized as obese and ≥35 years old, averted 9.5% of new T2DM cases by 2050. An active commuting intervention approach, specifically increasing cycling and walking, averted 8.5% of new T2DM cases by 2050. Enhancing consumption of healthy diets including fruits and vegetables, specifically a workplace intervention involving dietary modifications and an educational intervention, averted 23.2% of new T2DM cases by 2050. A subsidy and legislative intervention approach, implementing subsidies on fruits and vegetables and taxation on sugar-sweetened beverages, averted 7.4% of new T2DM cases by 2050. A least to most optimistic combination of interventions averted 22.8-46.9% of new T2DM cases by 2050, respectively. Implementing a combination of individual-level and structural public health interventions is critical to prevent T2DM onset and to slow the growing T2DM epidemic in Qatar.

Effects Of Smoking On Hair Loss

Hair loss, also known as alopecia can be caused by avariety of factors like hormonal changes, medicalconditions, medications, nutritional deficiency stressand also smoking .The underlying biological mechanismthat may link smoking to hair loss are not yet fullyunderstood, but it is thought that smoking has anegative impact on blood supply to hair follicles.Significant association between smokers having ahigher risk of developing hair loss compared to nonsmokers. Furthermore the study also shows a positivecorrelation between smoking and male pattern baldnesswhich is a common type of hair loss in men. Themanagement and prevention of hair loss fromsmoking require various level of intervention. Individuallevel intervention like abstaining from smoking,increasing awareness among youth regarding theeffects of smoking. Similar recommendations on thecommunity level and country level like bandingcigarettes, taxation of tobacco products, smokingcessation program like camping and nicotinereplacement therapy.

Individual-level interventions for reducing occupational stress in healthcare workers.

Individual-level interventions for reducing occupational stress in healthcare workers.

Underlying Factors that Contributed to Job Stress in an Organisation

Job stress is a significant issue in many organisations, with potential negative impacts on employees’ well-being, productivity, and job satisfaction. This study reviews the causes, and effects related to job stress in terms of an organisational context. Causes of job stress may include workload, role conflict, poor working conditions, lack of control, poor relationships with colleagues or supervisors, job insecurity, lack of recognition or rewards, and poor work-life balance. Negative effects of job stress can manifest as physical symptoms, psychological symptoms, and behavioural symptoms, with implications for both the employees and organisations. Interventions for addressing job stress may include individual-level interventions, organisational-level interventions, or a combination of both. Future research could assist in addressing these limitations and provide a more nuanced understanding of job stress and its impacts. In conclusion, job stress is a critical issue, whereby organisations should address to promote employees’ well-being and productivity. Moreover, effective interventions are available to assist in achieving this goal.