Targeting Outreach Research Articles

Contributing Factors to Delays in COVID-19-Related Hospitalization Among Latinx and Spanish-Speaking Patients/Factores Que Contribuyen a Retrasos en Hospitalizaciones Relacionadas con COVID-19 Entre Pacientes Latinos e Hispano-Hablantes.

Latinx populations have been more heavily impacted by the COVID-19 pandemic than the general population of the US, including higher rates of hospitalization due to COVID-19 in eastern Massachusetts. We conducted a qualitative study to better understand the experiences of Latinx and Spanish-speaking patients who had clinically significant COVID-19 in the early months of the pandemic. Thirteen qualitative, semistructured, phone interviews were conducted between December 2020 and April 2021 with Latinx and Spanish-speaking patients who had experienced clinically significant COVID-19 in the metro-north Boston area. Interviews were recorded and transcribed in their original languages. An a priori code tree was developed which was later iteratively revised based on emerging themes. Transcripts were thematically analyzed. Participants discussed their overall experiences contracting the COVID-19 infection, as well as their experiences with the disease and with being hospitalized and the months after in recovery. Family and social networks were a common support, both emotional and financial. Although they survived the disease, hospitalization had serious impacts on the mental and physical health of participants, including the remnants of trauma from hospitalization itself. Latinx and Spanish-speaking patients in eastern Massachusetts had specific experiences in the early months of the COVID-19 pandemic that were shaped by their living conditions and culture. It is important for health care professionals to understand these experiences so that they can design appropriate medical interventions as well as target outreach efforts that are culturally appropriate. Finally, serious attention should be paid to the mental health-related consequences of hospitalization and policies that can alleviate them.

Modeling the value of an emergency department influenza vaccination program

BackgroundSeasonal influenza continues to present a significant annual burden as the vaccination rate in the United States is 51.8%. Emergency Department (ED) based influenza programs have been successfully implemented and improve vaccine uptake, reduce incidence and costs, and improve outcomes. ObjectiveTo develop a predictive model to assess preventable influenza cases, hospitalizations, fatalities, and incremental cost avoidance based on the unvaccinated population. MethodsA retrospective cohort of ED encounters limited to Medicare and Medicaid populations was performed across 14 tertiary care hospital EDs and six freestanding EDs for 2020. The total number of unvaccinated individuals was identified to determine the potential impact of an ED vaccination campaign. The average cost and loss per inpatient stay was identified from prior industry Medicare benchmark data and was utilized to extrapolate Medicaid losses. Results from published cost-effectiveness studies identified the vaccination thresholds to prevent one additional case of influenza, one additional hospitalization, and one additional fatality. ResultsA total of 39,463 unvaccinated individuals were identified, with 14,064 classified as Medicare, and 25,379 classified as Medicaid. Assuming a 95% target outreach, 90% medical eligibility, and 70% acceptance rate, 414 influenza cases would be prevented (266 Medicaid, 148 Medicare), 28 hospitalizations would be prevented (18 Medicaid, 10 Medicare), and eight deaths would be prevented (5 Medicaid, 3 Medicare). Accordingly, a reduction in admissions would prevent $409,360 in total inpatient medical costs and $36,232 in losses to healthcare systems. ConclusionAn ED-based influenza vaccination program would have a measurable impact on patient influenza disease burden and associated medical expenditures.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

A Recipe for Madness: Parenthood in the Era of Covid-19.

ObjectivesThis article seeks to understand the economic, mental health, and political impacts on American parents in the era of Covid‐19.MethodsWe draw on survey data from a diverse national sample collected in September 2020 and employ multivariate analysis to explore how Covid‐19 has uniquely affected the attitudes and life experiences of American parents.ResultsWe find that Covid‐19 has been unusually burdensome for parents as they are more likely to have experienced negative physical and mental health outcomes and suffer more negative financial impacts. Despite the challenges parents face, they also remain cautious about in‐person school and vaccinations. Although mothers have been the focus of much news coverage, we find that both mothers and fathers have been similarly and negatively impacted by Covid‐19.ConclusionAmerican parents are suffering at distinctively high levels during this pandemic. In order to recover, policymakers will need to target outreach and support tailored to the needs and issues facing parents.

A mobile health-facilitated behavioural intervention for community health workers improves exclusive breastfeeding and early infant HIV diagnosis in India: a cluster randomized trial.

IntroductionIndia’s national AIDS Control Organization implemented World Health Organization’s option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services.MethodsA cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models.ResultsOf 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC.ConclusionsThe COMBIND intervention was easily integrated into India’s existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes.

Assessing Hereditary Colorectal Cancer Referral Patterns to a Tertiary Care Center: A Novel Approach Using Geographic Information System Mapping.

Patients and their family members with hereditary colorectal cancer require longitudinal follow-up that is best achieved through a dedicated program with a registry. However, referrals for these conditions remain poor. Geographic information systems technology is a novel method to evaluate geographic variation in multiple realms but is being used more in health care. The purpose of this study was to evaluate referral patterns with geographic information systems technology to better target efforts for improving overall referrals. We hypothesized that marked variation would exist as to the geospatial locations of referrals and that gastroenterologists would be the dominant referral source. This was a retrospective cross-sectional study. The study was conducted at Vanderbilt University Medical Center. The hereditary colorectal cancer registry was queried from June 2007 to August 2016 for demographics, distance to center, genetic mutations, and the specialty of the referring providers. Geospatial data on both patient and referring specialist were collected. We analyzed patient and referral data with geographic information systems technology to look for gaps and patterns. A total of 676 patients were entered into the registry during this period. Fifty-six percent were women, and the median age was 50 years (interquartile range, 42-60 y). The median distance from the center was 60 miles (interquartile range, 22-120 miles), and 31% carried an identified germline mutation. Gastroenterology represented the overall largest source of referrals and, when broken down by syndrome, they represented the top referral specialty for familial adenomatous polyposis. Surgeons were the largest referral source for Lynch syndrome. The study was limited by covariates in the database. Our hereditary colorectal cancer registry serves a large geographic area, with the largest group of referrals coming from gastroenterologists. Performing this analysis with geographic information systems technology mapping allowed us to identify clustering of patients and providers throughout the region as well as gaps. This information will help to target outreach and distribution of educational materials for providers and their patients to increase registry enrollment. See Video Abstract at http://links.lww.com/DCR/A950.

Unmarried Mothers' Postnatal School Enrollment: The Role and Intersection of Demographic and Socioeconomic Characteristics

ABSTRACTDrawing from a theoretical model of educational decisions and intersectionality theory, this study examined demographic, socioeconomic, and public assistance characteristics that influence unmarried mothers' postnatal enrollment. Using the Fragile Families and Child Wellbeing Study (FFCWS), binomial and multinomial regression techniques were used to examine unmarried mothers' enrollment in their child's first 9 years. Results showed unmarried mothers' educational commitment coupled with the influence of race and class indicate that they need additional opportunities to optimize their educations and job opportunities. Targeting outreach and enrollment assistance to underrepresented groups can reduce social-origin inequalities. Important directions for future research include understanding unmarried mothers' rationale for school enrollment and considering how race and class work in combination to support or deter enrollment.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota.

We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Applying innovative approaches for reaching men who have sex with men and female sex workers in the Democratic Republic of Congo.

In the Democratic Republic of Congo (DRC), men who have sex with men (MSM) and female sex workers (FSW) have the highest HIV prevalence but have the least access to services due to their marginalization within Congolese society. The Projet Intégré de VIH/SIDA au Congo (ProVIC) aims to reduce the risk and impact of HIV in the DRC through community- and facility-based prevention, counseling and testing, and treatment strategies aimed at high-risk populations, including MSM and FSW. To more effectively meet the needs of key populations, ProVIC tailored the existing interventions to better suit MSM and FSW by offering mobile counseling and rapid HIV testing services at night in MSM and FSW "hotspots," targeting outreach to and mobilizing key populations through social networks of MSM and FSW peer educators and recruiters, and referring MSM and FSW who test HIV positive to "friendly" clinics. Through these approaches, ProVIC was able to reach 2,621 MSM and 12,746 FSW with targeted prevention messaging in 2013 and provide testing and counseling services to 4,366 MSM and 21,033 FSW from October 2012 to June 2014. By applying innovative adaptations geared toward key populations, ProVIC has been able to better reach MSM and FSW in the DRC. ProVIC's targeted interventions for MSM and FSW provide promising examples of programming that can be used to meet the HIV prevention and testing needs of key populations and improve referrals for care and treatment, particularly in complex and unstable settings similar to the DRC.

California agritourism operations and their economic potential are growing

More than 2.4 million visitors participated in agritourism at California farms and ranches in 2008. They stayed at guest ranches in the foothills, picked peaches in the Sacramento Valley, played in corn mazes up and down the state, shopped at on-farm produce stands along the coast, held weddings in fields and vineyards from coast to mountains, and experienced myriad other agriculture-related tourism activities. The UC Small Farm Program conducted the first statewide economic survey of California agritourism operators to better understand their goals, needs and economic outlook. University researchers from several other states provided input and sample data from state surveys conducted between 2000 and 2007. This information will help to target outreach and address current and emerging challenges.

Abstract B7: High-resolution geospatial mapping tools to reduce breast cancer-related disparities

Abstract Background: Breast cancer mortality is significantly higher in pre-menopausal African American women than in age-matched Caucasian women (38.4 vs. 23.0 deaths/100,000). Durham County has one of the highest rates of breast cancer death for African American women in the State of North Carolina (47.2 deaths/100,000 versus 26.5/100,000 for Caucasian women), with rates in North Carolina well higher than national averages. The causes of these disparities are complex, but likely include lack of access to care, cultural norms regarding preventive screening, and the high frequency of clinically aggressive triple-negative breast cancer in African American women. Survival rates for pre-menopausal African American women with triple negative breast cancer are extremely poor, with only 14% of women alive five years after diagnosis. Our outreach studies provide evidence that one key to reducing breast cancer death is to identify high-risk women before (rather than after) women present with invasive breast cancer. However, there are many barriers to identifying breast cancer risk in African American women, including cultural barriers, education, mistrust, and hesitancy to participate in clinical trials. Hypothesis: High-resolution geospatial analysis can be used to 1) identify neighborhoods with a high incidence of early onset breast cancer in African American women, 2) target outreach services, and 3) rapidly tracking response to community partnered interventions. Methods: We used high-resolution geospatial mapping to develop point density maps of: 1) family history of breast cancer; 2) invasive breast cancer; 3) pre-cancer; and 4) mammography, for all women, Caucasian women, and African American women. We evaluated women of all ages and women <50 years of age. Point density is an aggregation method used to show the magnitude of points per unit area. For all women, the ratio of the incidence of pre-breast cancer versus invasive cancer was roughly 1:1. However, the ratio for African American women under the age of 50 was 1:8, demonstrating that women <50 were presenting to the health system with invasive breast cancer (rather than pre-cancerous changes). Women <50 underwent mammography, but our preliminary data suggest that African American women under 50 primarily underwent mammography only when presenting with breast symptoms. Conclusion: High-resolution geospatial mapping allowed us to 1) identify Durham neighborhoods with the highest incidence and rate of young African American women with early onset breast cancer and 2) demonstrated that African American women under the age of 50 were only undergoing mammography when presenting with a breast mass. We are currently using geospatial mapping to target Navigator sponsored community education and provide free breast screening through neighborhood community centers and free clinics. Geospatial mapping will be used to track the effectiveness of our community partnered interventions. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B7.

Landowner motivations for watershed restoration: lessons from five watersheds

Collaborative watershed management initiatives have increased tremendously over the past decade. One of the critical questions for these initiatives is how to influence private land management practices to improve watershed health. This article researches landowner motivations and preferences for watershed restoration efforts in five watersheds in Western Oregon. Based on a survey of 446 landowners and 80 personal interviews, the research revealed that landowner perspectives vary by socio-economic, cultural, and land use characteristics. They are strongly motivated by a concern for future generations and interpersonal influence is particularly important. Finances, time, and unfamiliarity were all significant barriers to the adoption of conservation practices. The findings also revealed considerable variation among landowners as to their trusted sources of information and preferred outreach methods. Beyond the findings in Oregon, the research suggests that watershed initiatives need to understand landowner characteristics and motivating factors to better promote watershed restoration and target outreach efforts.

RESIDENTIAL STATUS AND HIV RISK BEHAVIORS AMONG PUERTO RICAN DRUG INJECTORS IN NEW YORK AND PUERTO RICO*

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p <. 001), and more New York IDUs lived in their own home (30% vs. 14%, p <. 001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Speed, sex, gay men, and HIV: ecological and community perspectives.

Fifteen years into the HIV/AIDS epidemic, a great deal is now known about the different populations impacted by the disease, including those affected directly or indirectly by drug use. Anthropology has played a critical role in assisting with this task by identifying hidden populations, developing new methodological approaches, and targeting outreach efforts. In spite of this considerable body of ethnographic knowledge, men who have sex with other men (i.e., MSM, or gay and bisexual men) who use drugs have not received the same research attention as other drug users, despite the fact that they represent nearly one-fifth of AIDS cases in the U.S. with injection drug histories. In response to the alarming increase in HIV seroprevalence among this population, this ethnographic project provides preliminary data about those who are at dual risk for HIV through both homosexual behavior and injection drug use.