Under-resourced Communities Research Articles

Longitudinal Trajectories of Identity Formation and Resilience Development in Adolescents Living in Under-Resourced Communities

Identity and resilience are critical during adolescence, especially when facing contextual challenges. This longitudinal study explored the trajectories of identity and resilience in adolescents (n = 546; MAge = 16.22) living in an under-resourced South African community. Associations between identity and resilience were analyzed across three time points using repeated measures ANOVA’s. The dimensions of identity did not vary substantially across time, but resilience scores fluctuated significantly. Participants with high resilience showed a substantial decrease in Exploration in Depth over time, while participants with low resilience showed an increase. The findings provide insights into how to foster resilience in adolescents living in under-resourced communities.

Thriving Against All Odds: Identity Resilience Experiences of South African Adolescents Living in Under-Resourced Contexts

A resilient identity can buffer against the harmful effects of living in contexts of adversity. This study explored the identity resilience experiences of South African adolescents living in under-resourced communities. Focus group discussions with fifty-four participants (MAge=17.85) were analyzed using reflexive thematic analysis. Participants emphasized the centrality of their sense of self as they navigate through life’s challenges. Personal agency and a resilient mindset played an important role in overcoming adversity. Participants found strength in healthy connections (with families, schools, and religious communities). Interventions to enhance the well-being of adolescents in under-resourced communities should consider personal resources and social structures.

Clinical Outcomes of Rural Patients with Diabetes Treated by ECHO-Trained Providers Versus an Academic Medical Center.

Despite clinical practice guidelines prioritizing cardiorenal risk reduction, national trends in diabetes outcomes, particularly in rural communities, do not mirror the benefits seen in clinical trials with emerging therapeutics and technologies. Project ECHO supports implementation of guidelines in under-resourced areas through virtual communities of practice, sharing of best practices, and case-based learning. We hypothesized that diabetes outcomes of patients treated by ECHO-trained primary care providers (PCPs) would be similar to those of patients treated by specialists at an academic medical center. Specialists from the University of New Mexico (UNM) launched a weekly diabetes ECHO program to mentor dyads consisting of a PCP and community health worker at ten rural clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the UNM Diabetes Comprehensive Care Center (DCCC). Eligible participants included adults with type 1 diabetes, type 2 diabetes on insulin, or diabetes of either type with A1c > 9%. The primary outcome was change from baseline in A1c in the ECHO and DCCC cohorts. Secondary outcomes included changes in body mass index (BMI), blood pressure, cholesterol, and urine albumin to creatinine ratio (UACR). Compared to the DCCC cohort (n = 151), patients in the ECHO cohort (n = 856) experienced greater A1c reduction (-1.2% vs -0.6%; p = 0.02 for difference in difference). BMI decreased in the Endo ECHO cohort and increased in the DCCC cohort (-0.2 vs. +1.3 kg/m2; p = 0.003 for difference in difference). Diastolic blood pressure declined in the Endo ECHO cohort only. Improvements of similar magnitude were observed in low-density lipoprotein cholesterol in both groups. UACR remained stable in both groups. ECHO may be a suitable intervention for improving diabetes outcomes in rural, under-resourced communities with limited access to a specialist.

Communities of practice and the elevation of urban elementary teacher discourse about critical pedagogy of place

Children who live in under-resourced communities and attend under-resourced schools deserve access to high-quality teachers and educational opportunities to support their success and well-being. This study emerged from a professional development (PD) for urban teachers working in such schools, to expand educational opportunities for elementary students through outdoor science teaching. Engaging frameworks of communities of practice (CoP) and critical pedagogy of place (CPP), this critical ethnographic study investigates how urban elementary teachers engage in discourse about critical issues of place. Additionally, the investigation seeks to understand how a CoP supports such discourse. The primary data for this study were multiple sets of researcher field notes collected from participant teachers during virtual spring and in-person summer PD. Over the course of the PD, participants shifted from viewing their outdoor teaching spaces with a deficit perspective to an asset-focused one. As they visited one another’s teaching sites, the CoP the teachers were a part of created opportunity for discourse about social justice linked to issues of place within their particular school neighborhoods. The ability of urban elementary teachers to connect social justice to issues of place and to the teaching of science has implications for countering the injustice that characterizes many urban communities in the USA and elsewhere.

Student choice and barriers to physical activity in Latino boys in the REACH after-school program

ABSTRACT Background After-school programs (ASP) provide safe and enjoyable setting for youth to participate in sports and physical activities (PA). The flexibility in the structure of ASPs can facilitate non-traditional approaches to teaching PA which consider the context of the community, students’ backgrounds, and focuses on positive youth development. REACH takes a non-traditional approach that aims to provide youth in under-resourced communities with a safe space for PA and learning through a sport-centered curriculum. Purpose The objective was to highlight the perspectives of Latino boys regarding their lived experiences in an after-school soccer and literacy program in a diverse urban school. The research questions were: (a) what are the lived experiences of young boys in a year-long after-school program in a diverse urban setting? (b) What opportunities did REACH provide that helped the young boys negotiate barriers to being physically active? Method Twenty-three Latino boys participated in the REACH after-school sessions over a school year. Four pre-service teachers facilitated soccer sessions at REACH. Data were collected through boys’ weekly journals across 28 weeks and interviews with ten boys at the end of the year. Coaches’ reflexive journals were used to triangulate the data. Data were independently coded using constant comparison and analyzed following a collaborative qualitative analysis procedure. Trustworthiness included triangulation of data, negative cases checks, multiple coders, and peer-debriefing. Results The results presented in this article are part of a larger year-long mixed-methods curriculum intervention. Two themes are presented to represent the perspectives of the boys in participating in REACH. In the first theme, we discuss student choice that was expressed in the way youth chose to participate in REACH and engage in PA during out-of-school hours. The second theme presents the students’ identifying the barriers they face to being physically active and the ways REACH provided a space for them to reflect on those barriers. Discussion Students’ choice was expressed in participants’ engagement in physical activities and sports in and outside of REACH and as a fundamental aspect that enhanced enjoyment in the program. Thus, participating in the program led students to enhance their physical activity enjoyment in and out of the program as well as learn about life skills through sport. With a focus on positive youth development, discussions and journaling in REACH encouraged the boys to reflect on life skills that focused on character and the development of positive relationships. Participants described varied barriers they faced to being physically active in and out of schools. REACH provided a safe space where participants could talk about and develop awareness about aspects of their community such as violence. Conclusion REACH provided a safe space for students to be active, learn sports skills, and engage in interest-based activities. The safe space provided in REACH also encouraged Latino boys to reflect on the barriers to being physically active outside of the program with the intent of possibly transferring what was learned in the program to their lives. Having a choice was a fundamental aspect to enhancing the boys’ enjoyment in REACH.

The feasibility of the PicPecc application as an mHealth tool: Reflections from South African children

Background: Access to technology (and data) through mobile health (mHealth) can alleviate some of the challenges children experience in accessing healthcare services. However, the South African context is unique with children living in under-resourced and rural communities, with limited transport, long commute times to reach clinics, and poor access to technology. Therefore, even though mHealth tools can be beneficial, researchers need to determine the feasibility of such an application for the South African context.Aim: The study focussed on determining the feasibility of the PicPecc application (app) (an mHealth tool) in South Africa for children requiring mental health support.Setting: The study included 20 children between the age of 7 years and 18 years in different mainstream schools and a special school.Methods: A qualitative research design was used to conduct structured interviews with children, either via an online meeting (e.g., Google Meet) or in a natural setting (in the child’s school or home context).Results: The data were analysed and themes were identified according to five dimensions of access to healthcare and technology, namely acceptability, availability, accessibility, affordability, and accommodation.Conclusion: This study found that the PicPecc app is promising for implementation in the South African clinical setting. Participants reported various advantages when utilising the app to self-report health symptoms and thus considered it feasible for implementation in the South African context.Contribution: The study highlights important considerations for the implementation of mHealth technologies in the South African context.

Challenges and Implications for Substance Use and Mental Healthcare Among Under-Resourced Women in the COVID-19 Era.

The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes towardit, and its impact on substance use and treatment access. A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive analyses summarized the data. Participants faced various challenges during the pandemic. Many reported increased substance use, especially alcohol, opioids, benzodiazepines, and nicotine. Mental health stability was negatively affected, exacerbating existing disorders and limiting mental healthcare access.A majority (56.1%) reported that their chronic mental health disorder was less stable during the pandemic. Twenty (30.3%) participants reported that they had been diagnosed with a new mental health disorder since the pandemic, and 28.8% reported that it was harder for them to access mental healthcare during the pandemic. Job loss, housing instability, and financial strain were prevalent. Half (n=33, 50%) received a COVID-19 vaccine dose, while 27.3% (n=18) declined vaccination due to knowledge gaps and religious beliefs. The majority (n=41, 62.1%) worried about securing basic needs such as groceries and medication, with 64.6% (n=42) expressing a desire to cope using alcohol or drugs. This study expands upon previous research by examining the effect of the COVID-19 pandemic on mental health in the context of substance use disorder treatment. Unlike previous data, which focused solely on substance use behaviors, our study delves into the impact of the pandemic on co-occurring mental health disorders. Findings underscore the need for gender-responsive and culturally appropriate SUD treatment. Vaccine hesitancy, as reflected in the study, necessitates more effective, tailored evidence-based informational campaigns. Efforts must focus on enhancing mental healthcare access, reducing stigma, and supporting individuals with co-occurring conditions amidst this evolving COVID-19 health crisis.

Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum.

New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students' transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.

Nurturing care assets for food security: a community asset mapping approach

BackgroundZip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk.MethodsFour steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist.ResultsWe identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk.ConclusionsThe quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets.

Holistic Review in Family Medicine Residency Programs: A CERA Study.

Interest in using holistic review for residency recruitment as a strategy to improve the diversity of the physician workforce has increased. However, no data are published on the prevalence of holistic review in the selection process for family medicine residency programs. We designed this study to assess programs' knowledge, skills, and attitudes; prevalence; barriers to implementation; and program characteristics associated with the use of holistic review. Data for this study were elicited as part of a 2023 survey conducted by the Council of Academic Family Medicine Educational Research Alliance. The nationwide, web-based survey was sent to 739 family medicine residency program directors. A total of 309 program directors completed the holistic review portion of the survey. Programs that understood and agreed with holistic review used it more in their selection process. Holistic review was more common in programs with higher rates of residents, faculty, and patients that are underrepresented in medicine. Barriers to holistic review utilization were increased number of applicants, increased resources associated with holistic review, and lack of consensus on the holistic review approach. The holistic review process is an area of growing interest to diversify the physician workforce, especially among residencies caring for underresourced communities. Further discussions on the specific scoring rubrics of family medicine residency programs that use holistic review are needed and could help programs that are facing barriers. Widespread use of holistic review to diversify the physician workforce has the potential to improve patient care access and health.

Developing a Community-Based Exercise and Physical Programme for Runners With Patellofemoral Pain in Under-Resourced Communities: A Delphi Study

Background: Patellofemoral pain (PFP) is a multifactorial condition that is highly prevalent among recreational runners. Poor homeostasis between load and runner's capacity is the main cause of PFP. A low-cost and community-based intervention is needed to address the rehabilitation needs of runners in under-resourced communities. Purpose: To develop a community-based exercise and physical programme for runners with PFP in under-resourced communities. Method: This study used a Delphi method that included sports experts (physicians, physiotherapists, biokineticists, podiatrists, and sports therapists) who consented to participate. Delphi included three rounds of iterations to attain consensus among experts. Experts reached a consensus by rating PFP programme items using the 5-point Likert scale. Results: Ten experts participated. There were more males ( n = 6) than females ( n = 4). Participants were aged between 36 and 55 years ( n = 5) and had 16-20 years of clinical experience ( n = 5). Delphi process yielded an exercise and physical intervention, which included the following 10 recommended strategies: hip muscle training, quadriceps muscle training, general lower limb and trunk strengthening, use of appropriate running shoes, and use of prefabricated in-shoe foot orthosis, tissue mobilisation, patellar taping/bracing, education, flexibility exercises, addressing external loads, and addressing nonphysical internal loads. Conclusions: A consensus was reached for a suitable exercise and physical programme for runners in under-resourced communities. A follow-up implementation study is, therefore, recommended.

Design of a Mobile App Interface That Engages Community Members in a Food System Pilot Study.

Supermarkets are scarce in many under-resourced urban communities, and small independently owned retail stores often carry few fresh or healthy items. The Baltimore Urban food Distribution (BUD) mobile application (app) was previously developed to address supply-side challenges in moving healthy foods from local suppliers to retailers. In-app opportunities for consumers to indicate demand for these foods are crucial, but remain absent. We sought to understand community members' perspectives on the overall role, function and features of a proposed consumer-engagement module (BUDConnect) to expand the BUD app. A series of initial high-fidelity wireframe mockups were developed based on formative research. In-depth interviews (n = 20) were conducted and thematically analyzed using ATLAS.ti Web. Participants revealed a desire for real-time crowd-sourced information to navigate their food environments safely and effectively, functionality to help build community and social networks among store owners and their customers, opportunities to share positive reviews and ratings of store quality and offerings, and interoperability with existing apps. Rewards and referral systems resulting in the discounted purchasing of promoted healthy items were suggested to increase adoption and sustained app use. Wireframe mockups were further refined for future development and integration into the BUD app, the program and policy implications of which are discussed.

Identification of factors associated with opioid-related and hepatitis C virus-related hospitalisations at the ZIP code area level in the USA: an ecological and modelling study

Opioid overdose and related diseases remain a growing public health crisis in the USA. Identifying sociostructural and other contextual factors associated with adverse health outcomes is needed to improve prediction models to inform policy and interventions. We aimed to identify high-risk communities for targeted delivery of screening and prevention interventions for opioid use disorder and hepatitis C virus (HCV). In this ecological and modelling study, we fit mixed-effects negative binomial regression models to identify factors associated with, and predict, opioid-related and HCV-related hospitalisations for ZIP code tabulation areas (ZCTAs) in South Carolina, USA. All individuals aged 18 years or older living in South Carolina from Jan 1, 2016, to Dec 31, 2021, were included. Data on opioid-related and HCV-related hospitalisations, as well as data on additional individual-level variables, were collected from medical claims records, which were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic and socioeconomic variables were obtained from the United States Census Bureau (American Community Survey, 2021) with additional structural health-care barrier data obtained from South Carolina's Center for Rural and Primary Health Care, and the American Hospital Directory. Between Jan 1, 2016, and Dec 31, 2021, 41 691 individuals were hospitalised for opioid misuse and 26 860 were hospitalised for HCV. There were a median of 80 (IQR 24-213) opioid-related hospitalisations and 61 (21-196) HCV-related hospitalisations per ZCTA. A standard deviation increase in ZCTA-level uninsured rate (relative risk 1·24 [95% CI 1·17-1·31]), poverty rate (1·24 [1·17-1·31]), mortality (1·18 [1·12-1·25]), and social vulnerability index (1·17 [1·10-1·24]) was significantly associated with increased combined opioid-related and HCV-related hospitalisation rates. A standard deviation increase in ZCTA-level income (0·79 [0·75-0·84]) and unemployment rate (0·87 [0·82-0·93]) was significantly associated with decreased combined opioid-related and HCV-related hospitalisations. Using 2016-20 hospitalisations as training data, our models predicted ZCTA-level opioid-related hospitalisations in 2021 with a median of 80·4% (IQR 66·8-91·1) accuracy and HCV-related hospitalisations in 2021 with a median of 75·2% (61·2-87·7) accuracy. Several underserved high-risk ZCTAs were identified for delivery of targeted interventions. Our results suggest that individuals from economically disadvantaged and medically under-resourced communities are more likely to have an opioid-related or HCV-related hospitalisation. In conjunction with hospitalisation forecasts, our results could be used to identify and prioritise high-risk, underserved communities for delivery of field-level interventions. South Carolina Center for Rural and Primary Healthcare, National Institute on Drug Abuse, and National Library of Medicine.

The Benefits of Informal Learning Garnered Through Participation in the Curriculum and Community Environmental Restoration Science (STEM + Computer Science) Project

The Curriculum and Community Environmental Restoration Science (STEM + Computer Science) Project has several goals, with its primary focus on connecting the students of New York City with the enormous potential of restoring New York Harbor to its former self. Through the collaboration of numerous partners representing all of the facets of the city to the marginalized students living in hundreds of under-resourced communities, out-of-school experiences such as participation in the annual Science Symposium and the environmental fieldwork conducted along the shores of New York Harbor flourished. The CCERS STEM + C Project enables the merging of these entities for the good of its participants and the enormous benefit to the environment's restoration. This study consists of student surveys administered to and completed by 513 students attending schools throughout New York City's five boroughs. Of those who responded to the ethnicity section of the survey, 43.7% represent minority students. Data indicated a significant increase in STEM motivation by the CCERS STEM + C participating students, particularly those who identify as members of the under-represented minority group.

Assessing the Progress toward a Water-Efficient Economy in the United States from 1985 to 2015.

United Nations Sustainable Development Goal 6 tackles the long-neglected economic dimension of water utilization by monitoring nations' water use efficiency (WUE). However, it is imperative to emphasize the need for consistent spatial-temporal subnational WUE estimates, rather than relying solely on recent national trends, which can obscure crucial water use concerns and improvement opportunities. Here, a time series analysis of national, state, and sectoral (e.g., industrial, service, and agriculture) WUE from 1980 to 2015 was developed by compiling the most comprehensive and disaggregated water and economic data from 3243 US counties and 50 US states. The US total WUE increased by 181% from 16.2 (1985) to 45.6 USD/m3 (2015), driven by service sector WUE enhancements. The increased industry and service WUEs in most states were more strongly correlated with decreased per capita water withdrawal than with economic growth. Simultaneously, reductions in agriculture WUE were observed in 18 states potentially because of the complicated interaction of diverse factors specific to local communities. Expanding WUE gaps between affluent and less affluent states, and persisting WUE gaps between water-abundant andwater-scarce states highlight the need to advance policies to support under-resourced communities in effective water planning and water pricing for advancing equitable development.

Abstract PO5-12-01: Characteristics of Patients Served by Participants in a Survivorship Navigator Learning Collaborative

Abstract Patient navigation is demonstrated to be a successful model for improving breast cancer screening and early detection, particularly for women in under-resourced communities. The effectiveness of this model has not yet been explored in cancer survivorship. Our research assesses the feasibility of community-based patient navigation after a breast cancer diagnosis. This analysis focuses on the role of patient navigators in providing community-based peer support for women living with breast cancer. We conducted an analysis of data from the Breast Cancer Survivorship Patient Navigator Virtual Learning Collaborative (VLC), a case-based, iterative, virtual training program designed to increase capacity of community-based patient navigators to support women diagnosed with breast cancer. Navigators participated in a 14-week practice-based curriculum focused on improving community support for breast cancer survivors. Each session included a brief lecture followed by a case presentation by a participant. Lecture topics include Breast Cancer 101, Psychosocial support, Treatment options, Clinical trials, Sexual Health, Palliative Care, Genetic Testing, and Trauma. All participants were asked to present at least one de-identified case for discussion, using an 55-item case presentation template. The template included data on patient demographics, diagnosis, treatment, and support. To encourage active learning, navigators were encouraged to present challenging cases for discussion focused on identifying solutions and providing peer support. This analysis focuses on the characteristics of patients presented by community navigators from January 2021 to May 2023. A total of 92 de-identified patient cases were presented by 71 patient navigators and community health workers. (Table 1) The majority of patients were diagnosed within 12 months (62%), with early stage (Stages I-III) disease (78%), and were in active treatment or had not yet started treatment (67%). More than half of the cases had tumors that were HR+ (54%) and nearly half were HER2- (43%); 9% of cases were triple negative and 9% were triple positive. Tumor characteristics were not reported for 27% of cases. Individuals diagnosed with metastatic breast cancer (MBC) compared with those diagnosed with early stage disease were more likely to be Black (59% v 39%), single (56% v 31%), not currently employed (100% v 46%), younger (average age 52 v 55 years old) and insured through Medicaid (56% v 17%) Individuals living with MBC relied more heavily on professional support compared to those diagnosed with early stage disease. The majority of MBC patients relied on the clinical care team (67%) and friends and family (67%) for support, with a large number also receiving support from faith-based organizations (56%), compared to those with early stage disease who relied on friends and family (90%) and the clinical care team (54%). Both groups relied on navigators (33% v 35%) and social workers (44% v 34%), while those with MBC relied more frequently on paid caregivers (44% v 3%), disability services (22% v 6%). The data indicates that individuals with MBC had more unmet needs, including practical support (55% v 33%) and disability (55% v 14%). Supportive care needs vary considerably based on stage of diagnosis, while community-based supportive services are often designed to meet the needs of those diagnosed with early stage disease. Community-based survivorship navigators more readily engage with patients with early stage disease who are newly diagnosed or in active treatment. Individuals with MBC have fewer community-based resources and are less likely to connect with a community-based navigator. Data from our Breast Cancer Survivorship Patient Navigator VLC points to the potential to identify gaps in community-based survivorship care. Future research should focus on expanding the reach of community navigators and ensuring community-based support for patients across all stages. Table 1 Demographics of Patients Presented at VLC Citation Format: Tamara Hamlish, Talia Holzman Castetllands. Characteristics of Patients Served by Participants in a Survivorship Navigator Learning Collaborative [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-01.

Racial (In)Equity in South Los Angeles-Community Centered Experiences with COVID-19 Syndemics.

To analyze community experiences involving COVID-19 vaccination access and equity in Black and Latina/o/x communities within South Los Angeles, using a socioecological framework. We conducted four virtual focus groups (n = 33 total participants) in 2021, with Black and Latina/o/x community members, community leaders, and community-based providers in South Los Angeles, a region highly impacted by the COVID-19 pandemic. We used a grounded theory approach to guide the analysis and generate data shaped by participant perspectives. Participants across groups consistently emphasized medical mistrust, fear/skepticism, misinformation, accessibility, and feelings of pressure and blame as factors influencing COVID-19 vaccination decisions. The need to address pandemic-related socioeconomic hardships in underresourced communities was equally highlighted. Findings show that building trust, providing tailored information, and continued investment into diversity and equity initiatives can support Black and Latino/a/x communities in making informed health decisions. Community-centered support services should address the economic, social, and structural impact of the pandemic on vulnerable communities. Furthermore, public health and policy efforts must prioritize funding to equip social and health care systems with infrastructure investment in racial and ethnic minority communities.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review

ObjectiveTo compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries.DesignA realist review.Data sourcesEmbase, PubMed, Dimensions ai and Google Scholar.SettingHigh-income...

Anxiety and Depression Prevalence in Free Clinic Patients

Background: Disparities in mental health services are often observed in under-resourced low-income communities, which are at an increased risk for compromised mental health. By surveying patients at JayDoc Free Clinic, a student-run free clinic (SRFC) in Kansas City, Kansas, this study sought to as-sess the prevalence of depression and anxiety and compare screening outcomes among various de-mographic groups seeking safety-net care.Methods: From May through November 2022, patients aged 12 and older were offered a Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and demographic survey. Demo-graphic variables included household income, gender, insurance status, and race and ethnicity. GAD-7 and PHQ-9 questionnaire scores were categorized into minimal, mild, moderate, or severe catego-ries. Relationships between demographic variables and scores on screening questionnaires were an-alyzed using multivariable analyses, with linear regression and analysis of variance one-way tests for significance (p-value <0.05).Results: Of 232 participants who consented to the study, 222 completed the GAD-7 and 228 com-pleted the PHQ-9. In comparison to 2019 United States national data, the percentage of respondents experiencing anxiety and depression was greater across all severity classifications. Approximately 18.1% reported symptoms of moderate to severe anxiety and 21.5% reported symptoms of moderate to severe depression, compared to national distributions of 6.1% and 7%, respectively. Of 232 participants, 54 completed the demographic survey. There was no correlation between PHQ-9 scores or GAD-7 scores and gender, household income, insurance status.Conclusion: While no association was identified between screening outcomes and demographic var-iables, the findings that the prevalence of anxiety and depression at JayDoc SRFC is greater than na-tional rates reaffirm the need for accessible mental health services for patients receiving care at SRFCs. This study provides insight into the status of mental health in an SRFC patient population and discusses mental health screening implementation at SRFCs.