Under-resourced Communities Research Articles

Exploring Global Arts Movements and Their Impact on Health Education

This review investigates the intersection between global art movements and health education, exploring how art can play a transformative role in promoting health awareness and education, particularly in under-resourced communities. Drawing on philosophical theories of creativity, behavior change, and real-world case studies, this research highlights how arts initiatives have contributed to public health awareness and education. The paper addresses the integration of arts in health education, the challenges faced, and the opportunities for creating a more holistic approach to health promotion. The review concludes by emphasizing the importance of cross-disciplinary partnerships to further integrate arts into health education for a more profound global impact. Keywords: Global arts movements, Health education, Public health, Arts initiatives, Social change.

Examining Disparities in PFAS Plasma Concentrations: Impact of Drinking Water Contamination, Food Access, Proximity to Industrial Facilities and Superfund Sites.

Most of the US population is exposed to per- and polyfluorinated substances (PFAS) through various environmental media and these sources of PFAS exposure coupled with disproportionate co-localization of PFAS-polluting facilities in under-resourced communities may exacerbate disparities in PFAS-associated health risks. We leveraged two cohorts in Southern California with 8 PFAS concentrations measured in plasma. We obtained PFAS water testing data from the Third Unregulated Contaminant Monitoring Rule and state monitoring data, census tract-level information on food access using the Food Access Research Atlas, the location of Superfund sites on the National Priorities List, and data on facilities known to release PFAS pollutants. These data were then spatially linked to the participants' home addresses. In the first cohort, we found that detections of PFOS, PFOA, and PFHxS in drinking water were associated with 1.54 ng/mL (95% CI: 0.77, 2.32), 0.47 ng/mL (0.25, 0.68), and 1.16 ng/mL (0.62, 1.71) increase in plasma PFOS, PFOA, and PFHxS. The presence of Superfund sites was associated with higher plasma concentrations of PFOS, PFHxS, PFPeS, and PFHpS (betas [95% CIs]: 0.96 [0.21, 1.71], 0.9 [0.22, 1.58], 0.04 [0.02, 0.06] and 0.05 [0.02, 0.09], respectively). Each additional PFAS-polluting facility present in the neighborhood was associated with a 0.9 ng/mL (0.03, 0.15) increase in the concentration of PFOS. In the other cohort, we found that the presence of Superfund sites was associated with higher plasma PFDA, PFHpS, PFOS (betas [95% CIs]: 0.03 [0.01, 0.06], 0.05 [0.01, 0.09], and 1.96 [0.31, 3.62]). Neighborhood low access to food was associated with a 2.51 ng/mL (0.7, 4.31) increase in plasma PFOS, 0.6 ng/mL (0.16, 1.06) increase in plasma PFOA and 0.06 (0.02, 0.1) increase in plasma PFHpS. Reducing sources of PFAS exposure in under-resourced neighborhoods may help reduce disparities in human exposure levels.

Ain’t Gonna Let Nobody Turn Me Around: A Principals Fight Against Traditional Educator Pathways to Staff an Underperforming School in the Rural South

Marcus, a young principal hired to turn around an underperforming school in the rural South, struggles to stabilize the school’s current staffing challenges. Throughout the case study, Marcus navigates recruiting and retaining teachers; however, he also creates an innovative partnership that enables him to train prospective teachers on his campus. The purpose of this case study is to encourage school leaders to pursue non-traditional solutions to staffing. This case also benefits graduate students in education policy, principalship preparation, and educational administration. Further, this case benefits leaders struggling to staff schools in under-resourced communities like the ones in the rural South.

Vaccine Beliefs Among Uninsured People Receiving Care at Free Clinics.

Misinformation and vaccination hesitancy contribute to disparities in vaccination rates, particularly in under-resourced communities. This study aims to investigate perceptions and factors influencing vaccination decisions at free clinics serving diverse, under-resourced communities. Surveys were conducted across eight free clinics in the Greater Sacramento area, targeting uninsured or underinsured individuals. Information on demographics, sources of vaccine information, access to vaccines, vaccine perceptions, and vaccination decisions as pertaining to influenza and COVID-19 were collected on Qualtrics software. Chi-square and t-tests were used to analyze associations between demographics and vaccination rates. Among 109 participants (24-82 years old), vaccination rates were found to be higher than the county average, with notable demographic variations. Contrary to initial hypotheses, men had higher vaccination rates than women, and recent immigrants exhibited higher vaccination rates than more long-term U.S. residents. A higher number of participants regarded the COVID-19 vaccine as effective than as safe, while the reverse was true for the influenza vaccine. Healthcare providers were the most trusted and influential sources for vaccine information, followed by government agencies, and then family and friends. Answers to hypothetical vaccine scenarios elicited assessments on risks and benefits. The study provides insight into the dynamics of vaccine hesitancy and factors that play into the decision-making process in under-resourced communities, underscoring the role of trust in healthcare providers. These findings are vital for tailoring community outreach strategies to create trust, address barriers, and enhance vaccine uptake within free community clinics.

Disparities in Salmonellosis Incidence for US Counties with Different Social Determinants of Health Profiles Are Also Mediated by Extreme Weather: A Counterfactual Analysis of Laboratory Enteric Disease Surveillance (LEDS) Data From 1997 to 2019

Understanding disparities in salmonellosis burden is critical for developing effective, equitable prevention programs. Past efforts to characterize disparities were limited in scope and by the analytical methods available when the study was conducted. We aim to address this gap by identifying disparities in salmonellosis incidence between counties with different determinants of health (DOH) profiles. Using national U.S. Laboratory-based Enteric Disease Surveillance (LEDS) data for 1997–2019, age-adjusted county-level salmonellosis incidence/100,000 persons was calculated and linked to publicly available DOH data. We used hurdle counterfactual random forests (CFRFs) to quantify, for each DOH, the risk that (i) ≥1 versus no cases were reported by a county, and (ii) when ≥1 case was reported, whether a high (≥16 cases/100,000 persons) or low incidence (≥1 & <4 cases/100,000 persons) was reported. Risk in both models was significantly associated with demographic DOH, suggesting a disparity between counties with different demographic profiles. Risk was also significantly associated with food, healthcare, physical, and socioeconomic environment. The risk was generally greater for counties with more negative food resources, and for under-resourced counties (e.g., fewer healthcare and social services, fewer grocery stores). Risk was also significantly higher if any extreme weather event occurred. The study also found that underreporting and underascertainment appeared to result in underestimation of salmonellosis incidence in economically marginalized and under-resourced communities. Overall, our analyses indicated that, regardless of other county characteristics, extreme weather was associated with increased salmonellosis incidence, and that certain communities were differentially disadvantaged toward a higher incidence. This information can facilitate the development of community-specific prevention efforts.

Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life.

Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.

An Introduction to Operation Save Jamaica

Operation Save Jamaica (OSJ) is on a mission to bring about transformation to communities and holds the perspective that, in order for Jamaica to realize its 2030 vision; to be the place of choice to live, work, raise a family, do business, and retire, our under-resourced communities, especially those that are called “garrison” communities, must be transformed.

Fresh Takes!! the Impact of Receiving Fresh Food Boxes on the Health and Well-being of Individuals living With Diabetes and Prediabetes in Under-resourced Communities in the South Bronx

Fresh Takes!! the Impact of Receiving Fresh Food Boxes on the Health and Well-being of Individuals living With Diabetes and Prediabetes in Under-resourced Communities in the South Bronx

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement.

Reading together often with infants and young children strengthens their relationships with parents/caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents/caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading beginning at birth and continuing at least through kindergarten as a strategy for supporting parents/caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create a nurturing and stimulating home environment. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children, but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."

Abstract B063: A community-based organization, health equity uplift and growth alliance for triple negative breast cancer and metastatic breast cancer in young women

Abstract Background: Triple Negative Breast Cancer (TNBC) and Metastatic Breast Cancer (MBC) disproportionately affect the Black, indigenous, and people of color (BIPOC) community as well as younger women. Breast cancer (BC) is the leading cause of cancer-related deaths in women less than 40 years old, and survival rates for young women with BC remain lower than for their older counterparts. While more effective treatments and progress in genomic and genetic testing have improved survival of those affected by BC, not everyone has benefited from these advances. Methods: In early 2023, Tigerlily Foundation issued a request for proposal for community-driven initiatives to educate and support young BIPOC women at risk or living with TNBC or MBC in under resourced communities. Fifteen applications were received by Tigerlily over a 6-week period, and 5 community-based organizations (CBOs) in under-resourced metropolitan areas were recommended for $20,000 each in funding by an independent review panel. Tigerlily met with CBO leaders 3 times between May 2023-April 2024 to share experiences, lessons learned and successes. Results: The community- based organization health equity uplift and growth (CBO HUG) alliance resulted in patients and caregivers with increased awareness regarding BC stage, type, and equitable care standards. Approximately, 620 CBO led programs were held over 12 months, where 15,419 BIPOC community members were reached, and 340 community members were referred for screening or health services in partnership with CBOs, Tigerlily’s ANGEL Advocates (Peer Navigators) and NCI Cancer Center Leadership. Programs generally fell into 19 program types, e.g., game nights, radio podcasts, and programs in connection with mobile mammogram units. Twelve Tigerlily ANGEL advocates participated by sharing Tigerlily resources and their stories, providing educational material, facilitating discussion groups, and co-designing content and evaluation instruments. Evaluation reports identified over 40 actionable and notable practices. These practices are categorized by those that worked well and those that need improvement, as noted by CBO leadership and/or ANGEL advocates. Conclusions: The CBO HUG Alliance education and capacity building initiative fostered solutions and bolstered community-based organizations in under-resourced communities. This program leveraged peer navigation and culturally sensitive programming to help young BIPOC persons optimize their health. CBO leaders provided local expertise and community-driven solutions which are at the core of Tigerlily’s commitment to uplift others by listening, learning, leveraging what we learned, and letting the community lead. Next steps include sustained co-curation of tailored content to support empowerment of priority populations. Citation Format: Jeanne M. Regnante, Mandi L. Pratt-Chapman, Belinda Paulicin, Amy Leader, Virginia Leach, LaToya A. Cooper, Sue Steele, Maimah Karmo. A community-based organization, health equity uplift and growth alliance for triple negative breast cancer and metastatic breast cancer in young women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B063.

Integrative Neuro-social cognitive Strategy Programme for Instilling REcovery (INSPIRE): a community-based cognitive remediation trial-study procotol

BackgroundAdults with schizophrenia experience a range of neurocognitive problems that affect their daily functioning. Evidence for the efficacy of cognitive remediation in schizophrenia has been established, but its implementation in under-resourced community-based settings is less well-studied. In recent years, interventions have also focused on the strategy-learning approach in favor of drill-and-practice. Moreover, there is an increasing recognition to address social cognition and negative symptoms alongside neurocognition.This study attempts to carry out cognitive remediation in a community mental health setting. The Neuropsychological and Educational Approach to Remediation (NEAR) is used as the cognitive remediation intervention. Neurocognitive and social cognitive games will be introduced during the computer-assisted cognitive exercises sessions. In addition, the instructional technique will foster the use of metacognition and cognitive strategies. Moreover, metamotivation training will be the focus of some bridging sessions to enhance motivation to engage in goal-directed learning behaviors.The aims of the study are to 1) investigate the effects of cognitive remediation on neurocognition, social cognition and functional outcomes of participants with schizophrenia/schizoaffective disorders in community mental health settings; and 2) explore the mediators for change (eg: metamotivation, metacognition and negative symptoms) in cognitive performance and functional outcomes.MethodsThis randomized controlled trial will be conducted in three Singapore Anglican Community Services (SACS) centers, where standard psychiatric rehabilitation is delivered. Participants who are randomized to the experimental arm will receive cognitive remediation and psychiatric rehabilitation, while those randomized to the control arm will receive standard psychiatric rehabilitation only. Cognitive remediation is carried out three times a week for 12 weeks. It consists of computer-assisted cognitive exercises, as well as bridging groups to aid transfer of learning to daily living. Baseline, post-intervention and eight-week follow-up measurements will be collected. Group by time differences in cognitive performance, negative symptoms, metamotivation, metacognition, functioning and recovery will be analyzed across the three time points. Mediators for improvement in cognitive performance and functioning will also be explored.DiscussionFindings of this research will add to the body of knowledge about the key therapeutic ingredients within a strategy-based cognitive remediation program and improve its implementation within under-resourced community settings.Trial registrationThis study has been registered with ClinicalTrials.gov (ID: NCT06286202). Date of registration: 29 February 2024. Date of last update: 21 May 2024.

Remembering Lost Lives and Collective Healing from Trauma: Homicides, Incarceration, and Pain-Driven Advocacy in the Jane and Finch Community

This article serves as a vessel for knowledge mobilization and activism as research, intertwining remembrance of lost lives and communal healing by sharing collective pain amongst the authors and bolstering mutual support. Guided by personal encounters with violence including death, homicides, and incarceration, four authors comprising a teacher, social worker, and two community activists, unveil their 20-year+ advocacy journey in the Jane and Finch community in Toronto, Canada including their involvement with programs and services through the non-profit organization Youth Association for Academics, Athletics, and Character Education (YAAACE). The pain and suffering are shared as symptoms of systemic trauma inflicted on the community and how the trauma is perpetuated through institutional neglect for racialized under-resourced communities. The conversations are examined through an intersectional and Critical Race Theory lens, centering life experiences associated with trauma and systemic violence. Lived experiences and emotions are shared as valuable data through duoethnography as a methodology, emphasizing how inspiration is harnessed from the pain and trauma to guide community advocacy. Effective coping and healing strategies are outlined from various vantage points. Overall, the article contributes to filling in the research gap by centering racialized personal narratives in the Canadian context, offering nuanced lessons for integrating research and activism, and showcasing tangible ways to support the needs of youth and families through community-oriented, trauma-informed approaches.

Expanding ACES in child and family service systems: Incorporating context and resilience

The Adverse Childhood Experiences (ACEs) framework has been instrumental in illustrating the profound and long-term impact of early-life stressors in the developmental trajectories of children and families and well-being of our communities. However, despite its groundbreaking contributions, the ACEs framework predominately adopts a deficit-oriented lens, focusing on risk factors while often neglecting the protective and positive experiences children and families also experience. In the United States, communities that have been historically marginalized, including racial and ethnic minorities, are disproportionately impacted by ACEs due to systemic inequities and historical injustices, leading to persistent sociodemographic health and social disparities. Recent advances to the ACEs framework argue that the traditional ACEs model inadequately addresses the broader socio-structural, political, and economic contexts that influence adversity, including living in under-resourced communities, ongoing community violence and poor access to service systems. As a result, child, and family service systems (CFSS) may fail to consider how socio-structural factors, may potentially reinforce disparities in service access, delivery, and outcomes. This paper discusses the limitations of the traditional ACEs framework and advocates for a more comprehensive approach that incorporates socio-ecological and strengths-based perspectives like the Social Determinants of Health Framework and the Protective and Compensatory Experiences (PACEs) Framework. By shifting towards this holistic perspective, researchers and practitioners alike can better understand the interplay of systemic inequalities and socio-structural conditions in shaping ACEs exposure and outcomes, and, therefore, inform more effective practices, policies and services that can address both the immediate impact and root causes of adversity.

Evaluating patient experience with a surgical navigation program for under-resourced patients

BackgroundThis study aimed to characterize patient satisfaction with navigators and surgical care accessed through a novel navigation program for under-resourced communities. MethodsPSN-I and PSQ-18 questionnaires assessed satisfaction with navigators and care, respectively. Primary outcomes were PSN-I and PSQ-18 scores. Secondary analyses tested associations between satisfaction and patient factors and between PSN-I and PSQ-18 scores. ResultsOf 294 patients contacted, 88 (29.9 ​%) responded. Most were Hispanic/Latinx (76.1 ​%), Spanish-speaking (71.5 ​%), and uninsured (85.2 ​%). Participants were highly satisfied with navigators (mean 38.5, SD 7.6; max. 45) and most care domains except Financial Aspects (mean 3.2, SD 1.0; max. 5) and Accessibility/Convenience (mean 3.5, SD 0.6; max. 5). Higher navigator satisfaction was associated with post-consultation need for surgery (coeff. 5.6, 95 ​% CI[0.9, 10.3]) and increased the odds of care satisfaction (OR 1.1, 95 ​% CI[1.0, 1.2]). ConclusionsPatients are satisfied with navigation services—a previously unstudied aspect of this unique surgical equity program.

Hope Against Hope

Inspired by the writings of adolescents in a community-based organization, we utilize a critical poetic inquiry methodology to examine how they express the spatial, temporal, and relational boundaries of the pathways among adolescence, adultification, and adulthood through poetic expression. Through Anzaldúa’s (1999) framework of nepantla, an in-between space that serves to interlace the past, present, reality, and imagination for adolescents, we find that students (a) navigate and identify family dynamics, (b) negotiate tensions of adultification, and (c) recognize and push against social inequities. This article illuminates how youth in under-resourced communities negotiate, imagine, and realize possibilities for their futures.

Standardizing and Improving Primary Care-Based Electronic Developmental Screening for Young Children in Federally Qualified Health Center Clinics

ObjectivesMany barriers to implementation of developmental screening in primary care exist, especially for children from under-resourced communities. Developmental screening is vital to early detection of developmental delay and autism spectrum disorder, and early intervention (EI) referral. This study sought to examine whether implementation of a standardized clinical workflow using electronic screening tools improved both rates of developmental screening, and the number of children identified at risk for developmental delay, in a federally qualified health center (FQHC).MethodsA retrospective study was conducted at an academic-affiliated FQHC. Electronic versions of the Ages and Stages Questionnaire 3 (ASQ-3) and Modified Checklist in Autism for Toddlers Revised (M-CHAT-R) were implemented at well-child visits. New clinical workflow training on developmental screening and EI referral was provided. Chi-square and Fisher’s Exact analyses were conducted.ResultsASQ-3 screening rates increased from 62.7 to 73.6% pre- to post-intervention. Post-intervention, there was a significant decrease in paper screens (p < .001), and a significant increase in the percentage of children with ASQ-3 results in the below cutoff range from 14.7 to 18.2% (p < .002). M-CHAT-R screening rates increased from 56.4 to 59.4% pre- to post-intervention. Post-intervention, there was a significant increase in electronic screens (p < .001).Conclusions for PracticeImplementation of electronic screening tools improved universal developmental screening in a FQHC. To decrease barriers in under-resourced communities, the use of electronic tools may decrease the rate of screening error seen with paper screening and have the potential to better identify children at risk for developmental delay.

The Interrater Reliability of a Coding System for Measuring Mental Health Professionals’ Decisions and Actions

ABSTRACT Objective The clinical decisions and actions of evidence-based practice in psychology (EBPP) are largely underspecified and poorly understood, in part due to the lack of measurement methods. We tested the reliability of a behavioral coding system that characterizes a flow of interrelated activities that includes problem detection and prioritization, intervention selection and implementation, and review of intervention integrity and impact. Method The context included two publicly funded youth mental health service organizations located in geographically distinct and underresourced communities in the U.S. where service inequities are common. We sampled 84 digitally recorded and transcribed supervision events that included a sample of professionals who were mostly women (93.02%) and BIPOC (86.04%) whose self-reported race/ethnicity matched the youth populations they served. We coded these events for activities (e.g., considering) and their predicate content (i.e., problems or practices) and examined reliability of these codes applied to excerpts (i.e., small contiguous units of dialogue) as well as to complete events. Results Interrater reliability estimates showed that, overall, coders reliably rated the occurrence and extensiveness of activities and content. Excerpt coding was generally more reliable than event coding. However, mathematical aggregation of excerpt coding offered a superior method for estimating event codes reliably, reducing individual subjectivity while providing event level synthesis of activities that are grounded in excerpt level details. Conclusions The assessment of clinical decisions and actions has the potential to unpack the black box of EBPP, with different methods best suited to different research questions and resource considerations.

Using mid-upper arm circumference z -score measurement to support youth malnutrition screening as part of a global sports and wellness program and improve access to nutrition care.

Historically, mid-upper arm circumference (MUAC) has been instrumental to identifying malnutrition in children under 5 years living in resource restricted settings. Less attention is directed to at-risk, school-aged youth. Updated and validated pediatric age- and gender-specific MUAC growth curves expand malnutrition screening opportunities (2 months-18 years) including overweight/obesity. An innovative partnership was created to integrate MUAC z-score measurement trainings and screenings in the Real Madrid Foundation's (RMF) Social Sports Schools (S3) program, which provide sports and wellness programming to under-resourced communities. This work aimed to investigate the feasibility of leveraging non-healthcare professionals (non-HCPs) to identify malnutrition risk as part of RMF S3. This global, two-part program on malnutrition risk identification included training adult facilitators and screening children attending RMF S3. RMF facilitators were trained with didactic lectures on malnutrition, and practical hands-on learning of proper MUAC z-score tape measurement. Aggregate data on facilitators and the number of times to correctly administer the MUAC z-tape were recorded. Aggregate data on child malnutrition risk screenings were collected. Nine countries participated representing Europe, Pacific Asia, Africa, Latin America, and North America. In total, 143 RMF facilitators were trained, and 318 children were screened across 11 sites. More than half of facilitators were male (56%, n = 80), and majority were coaches (41.3%, n = 59), followed by staff (25.2%, n = 36), and volunteers (16.1%, n = 23). Facilitator attempts ranged from 1 to 4 times for proper MUAC z-score administration with mean 2.12 (± 0.86). There were no significant differences for attempts among RMF facilitator types (p = 0.10). Sixteen percent (n = 51) of children screened were recommended for HCP referral, with concentrations in Pacific Asia (68%, n = 35), Latin America (24%, n = 12), and Africa (8%, n = 4). Findings from our sample demonstrate that integration of MUAC z-score based malnutrition risk screening within community sports and wellness programming among non-HCPs is feasible, and that some regions with less frequent access to routine health care may experience greater benefit from these programs. Equipping non-HCP facilitators in community sports and wellness programs with training on malnutrition screening provides a means to meet under-resourced families where they live to begin conversations around malnutrition risk with the hope of establishing additional pathways to care.

Infectious disease responses to human climate change adaptations.

Many recent studies have examined the impact of predicted changes in temperature and precipitation patterns on infectious diseases under different greenhouse gas emissions scenarios. But these emissions scenarios symbolize more than altered temperature and precipitation regimes; they also represent differing levels of change in energy, transportation, and food production at a global scale to reduce the effects of climate change. The ways humans respond to climate change, either through adaptation or mitigation, have underappreciated, yet hugely impactful effects on infectious disease transmission, often in complex and sometimes nonintuitive ways. Thus, in addition to investigating the direct effects of climate changes on infectious diseases, it is critical to consider how human preventative measures and adaptations to climate change will alter the environments and hosts that support pathogens. Here, we consider the ways that human responses to climate change will likely impact disease risk in both positive and negative ways. We evaluate the evidence for these impacts based on the available data, and identify research directions needed to address climate change while minimizing externalities associated with infectious disease, especially for vulnerable communities. We identify several different human adaptations to climate change that are likely to affect infectious disease risk independently of the effects of climate change itself. We categorize these changes into adaptation strategies to secure access to water, food, and shelter, and mitigation strategies to decrease greenhouse gas emissions. We recognize that adaptation strategies are more likely to have infectious disease consequences for under-resourced communities, and call attention to the need for socio-ecological studies to connect human behavioral responses to climate change and their impacts on infectious disease. Understanding these effects is crucial as climate change intensifies and the global community builds momentum to slow these changes and reduce their impacts on human health, economic productivity, and political stability.

Breast Radiation Therapy Survivorship and Cancer Support Groups: an Opportunity for Community Engagement and Education Through the Addressing Breast Cancer Dermatologic Side Effects (ABCDEs) Program.

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths in women in the USA. To serve under-insured breast cancer patients in South Texas, we designed a patient education program to improve health literacy of secondary dermatologic changes after completing radiation therapy.A needs assessment survey was distributed to better understand the patients' stage of treatment, experiences with radiation-induced dermatologic side effects, and over-the-counter skin products and home remedies used.Of the 33 patients that participated in this program, nearly all patients (93.94%, n = 31) are either currently undergoing treatment or have completed treatment. Of the 31 individuals, 74.19% of patients (n = 23) have completed treatment at least 9-12months ago, 22.58% (n = 7) are currently receiving chemotherapy, and 3.23% (n = 1) are currently undergoing radiation therapy. Among the dermatologic side effects, patients experienced changes to skin color, redness, and burns/burning sensation at the greatest severity. The top products used by survey participants were prescription-strength topical corticosteroids (65.63%) followed by oral analgesics (28.13%) and compression sleeves (25.00%). Aloe vera (15.63%) was the most used complementary and alternative therapeutic treatment. By surveying experiences of radiation-induced dermatologic side effects in predominantly under-resourced and minority communities, we can better tailor patient education programs to reflect patients' experiences. Overall, this program can enhance clinicians' insight on under-resourced patient experiences to improve health literacy and dispel common misconceptions surrounding breast cancer treatment, management, and survivorship.