Low-income Populations Research Articles

Impactos Socioambientais em Assentamentos Urbanos Informais

Aim – Analyze, critically, the environmental licensing process of informal urban settlements, seeking to improve the instrument in a context of climate change. Methodology - This is a qualitative approach in which the documentary research method was used in environmental licensing processes of informal urban land subdivisions in the Federal District. Originality/relevance - There is a scarcity of studies investigating licensing in informal urban settlements. Considering that environmental licensing is required for activities that may cause socio-environmental damage and aims to mitigate or compensate for such damage, research that empirically evaluates the application of the instrument should be encouraged. Results - In general, environmental licensing in informal urban settlements has not been efficient, mitigation measures are not complied with, monitoring is unsatisfactory, there is a lack of indicators to measure urban environmental quality, and there is a lack of analysis of technological alternatives that consider climate projections and nature-based solutions. Theoretical/methodological contributions: Research on environmental licensing processes for informal urban settlements for low-income (ARIS) and high-income populations (ARINE) has contributed to complement the global literature, focused on investigating the mining and energy sectors. Comparative research on informal urban land subdivision in other socioeconomic contexts is recommended. Social and environmental contributions - Low-income settlements in ARIS are more vulnerable to socio-environmental risks and climate change than settlements in ARINE, requiring greater attention from managers to reduce this vulnerability.

Relationship Between Radiation Oncology Department National Institutes of Health Funding and Institutional Community Inclusion/Investment

PURPOSE Disparities in health care access and funding allocation persist among racial minorities and low-income populations. Radiation oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. METHODS Radiation oncology departments awarded NIH funding from 2019 to 2021 were studied using the 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity to assess the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding. RESULTS Twenty-two radiation oncology departments were analyzed in this study. A significant positive correlation was identified between the NIH research funding these departments received and their institutional rankings for overall community benefit (tau = 0.38; P < .034). Additionally, there was a trend toward significance for the relationship between NIH funding and institutional rankings for community investment spending (tau = 0.497; P < .053). No significant correlation was observed for other variables, including institutional rankings for charity care spending, Medicaid as a portion of patient revenue or services provided to patients from minoritized groups, low-income backgrounds, or those with lower levels of education. CONCLUSION Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit (measured by spending on financial assistance, community investment, and Medicaid). This suggests that departments receiving NIH funding may be incentivized to allocate resources toward initiatives aimed at improving community health outcomes extending beyond direct patient care.

The present and future of road Financing: Leveraging knowledge from the tolling industry to implement road-usage charge programs in the u.s

Historically, transportation funding in the United States has been supported primarily by motor fuel taxes. In recent years, revenues from fuel taxes have been shrinking. In response to the revenue shortfalls, many states have launched pilots or full-scale programs of road-usage charge (RUC) as an alternative to motor fuel taxes for transportation funding. Some of the challenges facing RUC is the cost of implementation compared to traditional motor fuel taxes, operational complexities, and the equity concerns (Caltrans, 2017). To address these challenges, states are looking to leverage existing vehicle-level pricing programs, such as road tolling, to learn about synergies between RUC and tolling. In this paper, we conducted semi-structured interviews with experts from tolling programs across the U.S. to identify areas of overlap between tolling and RUC. We built upon the interview findings by conducting a multi-criteria decision analysis (MCDA) to evaluate how well the state-level RUC pilots and programs can integrate with tolling systems. Our results demonstrate that there are numerous mutual benefits of a RUC-tolling integration. Both the tolling industry and RUC implementations can benefit from the increased scale of operations and the spur of technical innovations, which would reduce administrative costs. RUC programs can also learn from the tolling industry to address data privacy and security issues. In terms of policy and program designs of RUC, it is essential to design RUC rates which are equitable by considering the financial burdens on low-income populations and ensuring access to the system for the unbanked and underbanked populations.

Value for Money Modeling for Scaling up Nature-Based Solutions for Improving Integrated Water Resources Management and Enhanced Water Security in Pakistan

This paper is about the Value for Money (VfM) analysis conducted for the Water Resource Accountability (WRAP) Project, which comprehensively evaluates the project’s economic efficiency, effectiveness, equity, and overall impact. The WRAP implements to undertake demonstrations of Nature-based Solutions (NbS), including Ecosystem-based Adaptation (EbA) interventions that will improve water security and governance, build resilience to climate change of communities at the target sites in Gilgit-Baltistan (GB) and Khyber Pakhtunkhwa (KP), and enable the government and relevant stakeholders to implement and replicate NbS in Pakistan for building climate change resilience. The Paper is based on primary and secondary data collected using a well-structured interview schedule, focus group discussion, and other verified reports. The excel-based model was used for analysis, and a step-by-step and structured framework was used to conduct a VfM assessment. VFM estimates showed a favorable BCR across various interventions, with standout results like the Gabion check weirs and protection bunds (Gabion Bund) intervention achieving an impressive BCR of 3.50. These findings reaffirm the project’s ability to deliver substantial benefits while efficiently utilizing resources, making it a prudent investment in water resource management and natur- based solutions. WRAP’s equity analysis promotes inclusivity and fairness, particularly among vulnerable populations. While the project made significant strides in involving women in water-efficient practices, there is room for enhancing inclusiveness for lower-income and disabled populations. Recommendations emphasize setting specified targets for various populace categories to bolster the project’s social impact further.

Academic Essay On Equitable Access To Mental Health Services In Brazil

Equitable access to mental health services in Brazil faces complex and interconnected challenges. Among the main issues are regional inequalities, socioeconomic barriers, and the stigma associated with mental disorders. Regional inequality results in significant differences in the quality and availability of mental health services between urban and rural areas. While large cities such as São Paulo and Rio de Janeiro have advanced infrastructure and qualified professionals, rural areas and urban outskirts suffer from a lack of resources and professionals, limiting access to necessary care. Socioeconomic barriers also play a crucial role. Low-income populations face additional difficulties, such as lack of transportation and inadequate health insurance, which restrict access to mental health services. The lack of information and the stigmatization of mental disorders worsen the situation, discouraging individuals from seeking treatment due to fear of discrimination and prejudice. To address these challenges, it is essential to adopt integrated strategies. Expanding mental health infrastructure in underserved areas and creating integrated care networks are fundamental. Public policies should reduce socioeconomic inequalities by providing financial support and improving transportation. Awareness campaigns about mental health can overcome informational barriers and stigma. Continuous training of health professionals and community participation are also crucial to ensure inclusive and locally adapted care. With a coordinated effort, it is possible to promote more just and comprehensive access to mental health services in Brazil.

Unbalanced burden is escalating: Urban inequality landscape under sudden shocks?

Sudden and unforeseen events, notably the COVID-19 pandemic has underscored and exacerbated pre-existing urban inequalities. These disruptions have disproportionately affected the most vulnerable sectors of society, thereby further aggravating existing inequalities. Addressing these inequality issues requires systematic research into academic community's response to significant global disturbances. Therefore, we have integrated bibliometric analysis with meta-analysis (quantitatively combines research results from systematic reviews) techniques, culminating in a research framework based on KNIME software (a software for creating data applications and services) and Python programming. Noteworthy for its open-source nature, scalability, and reproducibility, this framework tries to decode the developmental patterns and response characteristics of urban inequality research under sudden shocks. Additionally, it seeks to clarify its causal pathways, predict the emergence of new or strengthened inequalities, and provide effective suggestions to promote inclusive and sustainable urban development. Our findings indicate that the COVID-19 has exacerbated the existing urban inequality, attracting widespread attention in fields such as society and public health. Issues of fairness and justice of human health, resource allocation, urban resilience and vulnerability have become hot topics around COVID-19 related urban inequalities. Simultaneously, the sudden shocks have led to disparities in research areas and themes. Social, economic, and urban planning are the main drivers behind urban inequality, and particularly affecting vulnerable groups, including low-income populations and those living in remote regions. Before and after the COVID-19, the average global urban inequality are 0.57 and 0.61, respectively. Inequality issues are particularly severe in Africa and countries such as Afghanistan, Pakistan, and India. The pandemic changed the focus of urban inequality to health and social issues, worsening inequality performance in these regions and deepening global gaps. Additionally, countries with high urban inequality are more prone to large-scale outbreaks and higher mortality rates. To this end, we advocate academia for in-depth research and comprehensive evaluation, focusing on vulnerable groups, providing integrated policy recommendations, supporting interdisciplinary exchanges and cooperation, and committing to find long-term sustainable solutions. These efforts aim to propose more comprehensive and reasonable solutions to alleviate and address complex urban inequality issues under sudden shocks.

Unveiling environmental justice in two US cities through greenspace accessibility and visible greenness exposure

Uneven access to greenspaces or visible greenness is an environmental justice (EJ) issue. In this paper, we use a social equity lens to develop geospatial models that measure convenient walking access to urban greenspaces such as parks and street-level green exposure en route to greenspaces. We utilized earth science, geospatial, and demographic datasets to develop two models—Greenspace Accessibility and Visible Greenness Exposure—and applied them in Camden and Jersey City, USA, two communities experiencing environmental injustices. Modeling results show that greenspace accessibility is a concern in both cities, with Jersey City experiencing more prominent disparities. We observed significant positive relationships in Camden between greenspace accessibility and two EJ variables: Black segregation and Hispanic segregation. Most streets in both cities have poor greenness exposure, although Jersey City faces higher inequality compared to Camden. We also observed significant negative relationships in Jersey City between street-level greenness exposure and low-income populations. We conclude the paper by explaining the implications of our findings for greenspace planning and policymaking.

Assessing the Impact of SNAP-Ed: A Comprehensive Evaluation Framework for Healthy Living Promotion in the United States

The Supplemental Nutrition Assistance Program Education (SNAP-Ed) plays a crucial role in promoting healthy food choices and physically active lifestyles among low-income populations. This article proposes a comprehensive evaluation framework for SNAP-Ed initiatives to assess the program's reach, implementation, outcomes, and cost-effectiveness. The framework incorporates key components such as needs assessment, process evaluation, outcome evaluation, and economic evaluation. By integrating various data sources and methods, the proposed framework enables a holistic understanding of the program's strengths, challenges, and opportunities for improvement. It emphasizes the importance of rigorous evaluation methods to measure the impact of SNAP-Ed interventions on nutrition knowledge, attitudes, behaviors, and overall health outcomes. The framework aims to provide a structured approach for SNAP-Ed Implementing Agencies to demonstrate the program's effectiveness and guide decision-making for continuous improvement.

Role of Health Insurance Policies in Access to Healthcare Services in Bangladesh

Purpose: To aim of the study was to analyze the role of health insurance policies in access to healthcare services in Bangladesh. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The role of health insurance policies in Bangladesh is crucial in improving access to healthcare services, particularly for low-income populations. Health insurance has been found to reduce the financial barriers to accessing care, leading to increased utilization of essential health services. However, challenges such as limited coverage, awareness, and administrative inefficiencies persist, hindering the full potential of these policies. Expanding and refining health insurance schemes could significantly enhance healthcare accessibility and reduce out-of-pocket expenditures, ultimately contributing to better health outcomes across the country. Unique Contribution to Theory, Practice and Policy: The health belief model (HBM), the theory of planned behavior (TPB) & Andersen’s behavioral model of health services may be used to anchor future studies on the role of health insurance policies in access to healthcare services in Bangladesh. Health insurance providers should develop targeted outreach and education programs to inform underserved populations about available health insurance options and their benefits. Policymakers should consider implementing universal health insurance coverage mandates to ensure that all individuals, regardless of socioeconomic status, have access to healthcare services.

Impact of health policy changes on population health

Recent health policy changes have had a profound impact on population health, reflecting diverse approaches and outcomes across different regions. The affordable care act (ACA) in the United States expanded healthcare coverage, improving access to preventive services and chronic disease management. Despite these advancements, disparities in health outcomes persist, particularly among minority and low-income populations. In Europe, universal healthcare systems like those in Germany and the Netherlands have achieved near-universal coverage and high public satisfaction. However, socioeconomic inequalities continue to influence health outcomes, necessitating policies that address broader social determinants of health. Low- and middle-income countries (LMICs) have implemented universal health coverage (UHC) initiatives, such as Thailand's UHC scheme and Rwanda's community-based health insurance. These reforms have led to significant improvements in maternal and child health, reduced out-of-pocket expenditures, and increased healthcare utilization among the poor. However, disparities between urban and rural populations remain a challenge, underscoring the need for comprehensive strategies that strengthen healthcare systems and infrastructure. Future directions for health policy improvement include addressing health disparities, integrating technology, and promoting preventive care. Community-based interventions and cultural competency training for healthcare providers can reduce disparities and enhance patient satisfaction. The integration of telemedicine, electronic health records, and health information exchanges can improve care coordination and access to services, although equitable access to digital health tools is essential. Emphasizing preventive care through increased funding, incentivizing providers, and raising public awareness can significantly reduce the burden of chronic diseases. Engaging patients in their healthcare decisions and promoting shared decision-making fosters a collaborative and effective healthcare environment. Policymakers must adopt comprehensive and adaptable strategies to address persistent disparities, integrate technology, and promote preventive care, ultimately leading to more equitable and effective health outcomes for diverse populations.

Outpatient ATG-free hematopoietic transplantation for aplastic anemia in limited-resource environments offers excellent results: Data from a single LATAM center

ObjectiveTo document the results of outpatient hematopoietic stem cell transplantation (HSCT) from the peripheral blood (PB) of sibling donors without anti-thymocyte globulin (ATG) in the conditioning regimen. Material and methodsPatients from a low-income population with severe AA who received a PB, unmanipulated sibling HLA-identical HSCT between 2000 and 2020 at a single institution were studied. Survival was the primary outcome. ResultsForty-one transplants were performed. Time between diagnosis and transplant was five months (1–104). Median age was 37 (range, 4–61) years; 25 (61 %) recipients were males and 32 (78 %) had treatment failure, 9 (22 %) have not received treatment. ATG was administered in 5 (12.2 %) cases; the graft source was PB in 38 (92.7 %) transplants. Twenty-six (63.4 %) transplants were carried out in the outpatient setting. Infections developed in 14 (34.1 %) patients. Primary graft failure (GF) occurred in 3 (7.3 %) patients. The 15-year OS was 81 %, EFS was 77.4 %. Patients with high pre-HSCT transfusion burden had lower OS (p = 0.035) and EFS (p = 0.026). Previous treatment failure and age were not associated with lower OS (p = 0.115, p = 0.069) or EFS (p = 0.088, p = 0.5, respectively). ConclusionsHLA-identical T-cell replete outpatient HSCT from the PB of sibling donors for AA patients using ATG-free conditioning offers excellent long-term survival.

Food insecurity amongst asylum seekers and people without status in Israel

BackgroundThe COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19.MethodsA multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed.ResultsFour hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05–1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts.ConclusionIn conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.

Economic and Social Impact Assessment of Chronic Diseases Among the Low-Income Population in Southern Punjab, Pakistan

Economic and Social Impact Assessment of Chronic Diseases Among the Low-Income Population in Southern Punjab, Pakistan

Cienciometric Analysis of Scientific Production on Hydatidosis/Echinococcosis in Latin America

Abstract Introduction: Hydatidosis/cystic echinococcosis (CE) is considered a neglected disease due to its preventive nature and impact on low-income populations. In Latin America, there is a high incidence, and in the high Andean regions, it is considered an endemic disease. The objective of this study was to quantify and analyze the scientific production of hydatidosis/echinococcosis through a bibliometric analysis in Latin America up to 2022. Methods: A bibliometric analysis study was conducted based on the scientific production of CE in the SCOPUS database until 2022 in Latin American countries. Information was collected through a systematic search. Frequencies and percentages were used to summarize the variables captured in the final database. Results: Scientific production showed growth over the years, with Argentina, Uruguay, and Chile having the highest production. In addition, there has been a trending use of the term “neglected disease” since 2018. The most cited articles were primarily narrative reviews, book chapters, and original articles in that order. Only 27% of the studies were funded by an institution in Latin America. Conclusion: Scientific production in Latin America regarding CE is on the rise, especially in countries with high incidence rates. Furthermore, these countries demonstrate a significant network of international collaboration.

Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study.

Introduction Traumatic brain injuries (TBI) in recent years have proved to be a significant public health problem, with potentially life-changing consequences for the individual and their family. Alcohol consumption is a regular, well-documented problem among persons sustaining TBIdue to road traffic accidents and accidental falls. The primary objective of this study was to find out the correlation between the Glasgow Coma Scale (GCS) score and CT brain findings among mild TBI patients under acute alcohol intoxication and determine if early CT-brain is indicated in this group. Methods A prospective observational study was conducted involving 111 alcohol-intoxicated patients with mild head injuries admitted to the surgical wards of Thanjavur Medical College Hospitalover a period of three months. The Glasgow Coma Scale was used to assess the patient'sneurological status and determine the severity of the brain injury. A semi-structured CT-brain findings chart and a severity of alcohol intoxication objective-based scoring system were developed and validated by experts. Descriptive statistics tools such as frequency, percentage, and mean were used, along with inferential statistics tools like the Chi-squared test, Fisher exact test, and Pearson's correlation coefficient test. Results The study findings showed that the comparison of GCS with early CT-brain was significant at a p-value of 0.012, and a negative correlation (r=-0.253) was found between GCS and CT-brain findings. A comparison of CT-brain findings with the severity of alcohol intoxication was non-significant at a p-value of 0.433. Conclusions Early CT-brain in intoxicated mild TBI patients may have a positive impact on early diagnosis and management, even in centers with limited resources catering to low-income population groups. The results of our short-term study show that early CT-Brain picks up lesions and helps initiate early management while it is up to the attending physician to keep in mind an adverse cost-benefit ratio in overuse of hospital resources and misdiagnosis leading to undertreatment causing long-term sequelae and morbidity before prescribing early CT-brain in this cohort of patients.

Accessibility to the winter cycling network in Montréal: A transport equity diagnosis

Recent studies have demonstrated the importance of a well-maintained and safe bicycle network to increase winter cycling. However, inequities in the access to cycling infrastructure in winter have not been documented yet. Based on the concept of equity in transport, this research aims to fill the gap and assess whether inequities are exacerbated during winter in the city of Montréal, Canada. The distance to the nearest cycling network section and kilometres of cycling network with 2.5 km and 5 km were computed in GIS. Two types of statistical analysis were then conducted to assess potential inequities for four population groups: weighted t-tests and seemingly unrelated regression (SUR) models. Our results demonstrate that the winter cycling network is more concentrated in central neighbourhoods and that accessibility issues are increasing in winter. Visible minorities face the most lack of accessibility, compared to the rest of the population. People under the age of 15 and over the age of 65 years old are also in unequal situations, while the low-income population has better access to winter cycling infrastructure than other groups. Our results innovate by incorporating measures of accessibility to the winter cycling network into the assessment of transport inequities.

Climate Justice Implications of Natech Disasters: Excess Contaminant Releases during Hurricanes on the Texas Gulf Coast.

Extreme weather events are becoming more severe due to climate change, increasing the risk of contaminant releases from hazardous sites disproportionately located in low-income communities of color. We evaluated contaminant releases during Hurricanes Rita, Ike, and Harvey in Texas and used regression models to estimate associations between neighborhood racial/ethnic composition and residential proximity to hurricane-related contaminant releases. Two-to-three times as many excess releases were reported during hurricanes compared to business-as-usual periods. Petrochemical manufacturing and refineries were responsible for most air emissions events. Multivariable models revealed sociodemographic disparities in likelihood of releases; compared to neighborhoods near regulated facilities without a release, a one-percent increase in Hispanic residents was associated with a 5 and 10% increase in the likelihood of an air emissions event downwind and within 2 km during Hurricanes Rita and Ike (odds ratio and 95% credible interval= 1.05 [1.00, 1.13], combined model) and Harvey (1.10 [1.00, 1.23]), respectively. Higher percentages of renters (1.07 [1.03, 1.11], combined Rita and Ike model) and rates of poverty (1.06 [1.01, 1.12], Harvey model) were associated with a higher likelihood of a release to land or water, while the percentage of Black residents (0.94 [0.89, 1.00], Harvey model) was associated with a slightly lower likelihood. Population density was consistently associated with a decreased likelihood of a contaminant release to air, land, or water. Our findings highlight social inequalities in the risks posed by natural-technological disasters that disproportionately impact Hispanic, renter, low-income, and rural populations.

Exploring Patterns and Disparities in E-Consult Referrals: An Analysis of Patient and Community Factors in Colorado Health Care.

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.

Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

IntroductionColorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings. MethodsA multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45–75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment. ResultsThe primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings. ConclusionsThis study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities. Trial RegistrationNCT05714644

Connecting With Shosho: Assessing the Role of Grandmothers in a Low-Income Population in Nairobi, Kenya

Connecting With Shosho: Assessing the Role of Grandmothers in a Low-Income Population in Nairobi, Kenya