Development and validation of statewide survey-based measures of livability in Connecticut.

Livability, or how a place and its systems (e.g., housing, transportation) supports the ability to lead a livable life, is a determinant of health. There is a lack of standard, validated measures to assess livability in the US. This study employed factor analytic methods to create measures of livability in Connecticut using data from the DataHaven Community Wellbeing Survey (DCWS) (n = 32,262). Results identified a 3-factor model (safety, opportunity, and infrastructure) as the best fit, explaining 69% of the variance in survey items. Newly created livability measures had high internal consistency, in addition to high convergent validity with other area-level measures.

The Influence of Housing Status and Food Insecurity on a Behavioral HIV/STI Prevention Intervention for Black Women under Community Supervision in New York City: A Moderation Analysis.

Black women in community supervision programs (CSPs) are disproportionately affected by HIV and other sexually transmitted infections (STIs). A randomized controlled trial of a group intervention titled Empowering African-American Women on the Road to Health (E-WORTH) demonstrated effectiveness in reducing sexual risk behaviors and STI incidence among Black women in CSPs. This secondary analysis aimed to assess the moderating effects of housing status and food security on E-WORTH effectiveness in reducing sexual risk behaviors and cumulative incidence of STIs over a 12-month period which were found significant in the original trial among a sample of 351 Black women in CSPs in New York City who use drugs and/or engage in binge drinking who reported engaging in HIV risk behaviors or testing positive for HIV. We examined the moderating effects of housing stability, housing independence, and food insecurity on reducing cumulative STI incidence and number of unprotected sex acts using mixed-effects negative binomial regression and logistic regression models that controlled for age, high school education, employment status, and marital status. Findings indicate that the intervention effect was moderated by housing stability, but not housing independence or food security. Compared to the control group, E-WORTH participants who were housing insecure had 63% fewer acts of condomless sex. Our findings highlight the importance of interventions designed for women in CSPs that account for upstream determinants of health and include service linkages to basic needs provisions. Further research is needed to unpack the cumulative impacts of multiple experiences of poverty faced by this population.

Characteristics of drug-involved black women under community supervision; implications for retention in HIV clinical trials and healthcare.

This study examined retention and its relationship to mental health, substance use, and social determinants of health in a randomized clinical trial of a behavioral HIV/sexually transmitted infection prevention intervention with drug-involved Black women (N = 348) under community supervision programs in New York City. Using secondary analysis, we used logistic models to test the association between factors related to mental health, substance use, and social determinants of health and follow-up assessment completion (three, six, and 12 months). Participants who were diagnosed with schizophrenia had lower odds of retention. Participants who misused prescription opiates during their lifetime or food insecure in the past 90 days had higher odds of retention throughout the intervention.

Investigating the measurement properties of livability: a scoping review.

Connecting evidence-based public health recommendations to livability, a popular and relatable construct, can increase the policy relevance of research to improve community design. However, there are many different definitions and conceptualizations of livability and little consensus about its measurement. Improved measurement, including standardization, is needed to increase understanding of livability's influence on health and to facilitate comparisons across contexts. This study sought to review existing livability measures, how they were created, and evidence regarding their reliability and validity. A scoping review of three databases (PubMed, Google Scholar, and Web of Science) identified 744 eligible studies. After screening, 24 studies, 15 from the original search and 9 through backward citation searches, were included in the review. Most studies were carried out in an urban context. There was minimal consensus across studies on the conceptualization of livability. However, measure domains and indicators overlapped significantly. While the process used to validate the measures varied, most studies reported high levels of reliability and found that livability was correlated with similar measures (e.g. place satisfaction, neighborhood safety, and sense of place) and self-reported health and wellbeing. Further research is needed to develop parsimonious, standardized measures of livability in order to create and sustain livable communities worldwide.

Sustainability and Equity in Urban Development (S&EUD): A Content Analysis of "Bright Spots" from the Accelerating City Equity (ACE) Project.

Sustainable and equitable urban development (S&EUD) is vital to promote healthy lives and well-being for all ages. Recognizing equity as core to urban development is essential to ensure that cities are inclusive, safe, resilient, and sustainable. The aim of this study was to identify and assess the elements of equity and sustainability in exemplary bright spots using the ACE Framework and the United Nations' 5 Ps of Sustainable Development. A content analysis process was performed to identify initial case studies, obtain bright spot information, and select final case studies. The exemplary bright spots selected were assessed for drivers of equity and the five pillars of sustainability. Results showed that equity and sustainability have become key considerations in urban development work. Numerous effective strategies and outcomes identified in the exemplary bright spots could be replicated in other contexts.

A Call for a Transformative Public Health Training: The Necessity of Abolition.

The societal distrust of public health alongside the complex, intersecting, and large public health crises of today and our future requires a transformation of the education of the next generation of public health leaders. The field of public health's goals of health equity for all cannot be advanced until our field interrogates and resists the prison industrial complex (PIC), which maintains White supremacy and (re)produces health inequities. As current and former public health students, we propose incorporating abolition of the PIC as a political vision, structural and power analysis, and organizing strategy into the public health curriculum. We highlight gaps in the public health curriculum and the existing similarities between stated goals of abolition and public health. We propose calls to action for individuals, faculty, and schools of public health to interrogate the carceral nature of public health and work toward contributing to the positive project of an abolitionist future.

"Creating communities that care:" reflections from community leaders on Livability Academy, a neighborhood quality-of-life training program in Philadelphia.

"What does livability mean to us? Creating communities that care." This reflective praxis think-piece was a collective effort by graduates of the Livability Academy program, a community leadership program hosted in eastern North Philadelphia. Program participants worked in teams to implement programs to improve neighborhood quality of life, as those involved in implementing Livability Academy collaborated to strengthen the bottom-up, asset-based, network-driven model. Our reflections on successes and areas for improvement can strengthen future cohorts of Livability Academy and keep us connected to continue making our neighborhoods more livable.

Exploring Residents' Perceptions of Neighborhood Development and Revitalization for Active Living Opportunities.

INTRODUCTION: Community fears of gentrification have created concerns about building active living infrastructure in neighborhoods with low-income populations. However, little empirical research exists related to these concerns. This work describes characteristics of residents who reported 1) concerns about increased cost of living caused by neighborhood development and 2) support for infrastructural improvements even if the changes lead to a higher cost of living. METHODS: Data on concerns about or support for transportation-related and land use-related improvements and sociodemographic characteristics were obtained from the 2018 SummerStyles survey, an online panel survey conducted on a nationwide sample of US adults (n = 3,782). Descriptive statistics characterized the sample, and χ2 tests examined associations among variables. RESULTS: Overall, 19.1% of study respondents agreed that development had caused concerns about higher cost of living. Approximately half (50.7%) supported neighborhood changes for active living opportunities even if they lead to higher costs of living. Prevalences of both concern and support were higher among respondents who were younger and who had higher levels of education than their counterparts. Support did not differ between racial or ethnic groups, but concern was reported more often by Hispanic/Latino (28.9%) and other non-Hispanic (including multiracial) respondents (25.5%) than by non-Hispanic White respondents (15.6%). Respondents who reported concerns were more likely to express support (65.3%) than respondents who did not report concerns (47.3%). CONCLUSION: The study showed that that low-income, racial, or ethnic minority populations support environmental changes to improve active living despite cost of living concerns associated with community revitalization.

Provider perceptions of availability, accessibility, and adequacy of health and behavioral services for Latino immigrants in Philadelphia: a qualitative study.

OBJECTIVE: Latino populations in the United States are disproportionately affected by substance use, HIV/AIDS, violence, and mental health issues (SAVAME). A growing body of evidence demonstrates the syndemic nature of SAVAME and the need for integrated strategies to reduce their impact. This study sought to understand the network of SAVAME services for Latino immigrants in Philadelphia to inform future interventions for SAVAME prevention and mitigation. METHODOLOGY: Key informant interviews (N = 30) were conducted with providers working in Latino-serving organizations providing SAVAME services. Interviews were analyzed using thematic coding and grounded theory. RESULTS: Latino-serving providers perceived a large need for, and important limitations in the availability, accessibility, and adequacy of SAVAME services for Latino immigrants. Gaps were seen as especially acute for mental health and substance use services, partly because of insufficient funding for these services. Latino immigrants' lack of health insurance, immigration status, limited English proficiency (LEP), stigma surrounding SAVAME issues, and limited knowledge of available services were identified as significant barriers preventing access to services. Providers noted that scarcity of well-trained, culturally competent, and ethnically concordant providers reduced the adequacy of SAVAME services for Latino immigrant clients. The small size, low levels of infrastructure, and limited capacity were reported as additional factors limiting the ability of many Latino-serving organizations to adopt a syndemic approach in the prevention and treatment of SAVAME services. CONCLUSIONS: The results call for changes in the structure of funding streams and communitywide strategies to foster collaboration across SAVAME providers working with Latino immigrant clients.

Analysis of Network Characteristics to Assess Community Capacity of Latino-Serving Organizations in Philadelphia.

Latino immigrants are disproportionately impacted by substance use, HIV/AIDS, domestic violence, and mental health (SAVAME). The burden of these syndemic conditions is influenced by limited access to health and social services to prevent and treat these conditions. The syndemic nature of these factors necessitates an integrated, coordinated approach to address them simultaneously. We analyzed characteristics of Latino-serving organizations in Philadelphia, PA, that provide SAVAME-related health and/or social services, and their interorganizational collaborations to meet the needs of Philadelphia's Latino communities. We surveyed Latino-serving organizations (N=43) identified through existing resource directories and key informants. Network analyses identified patterns and density of collaborative ties (i.e., referrals, administrative, or planning/advocacy) across organizations and characterized these ties by type of service. Density (expressed as percent of all possible ties) revealed a higher referral rate (40%) than administrative (29%) or planning (26%) coordination. Network sociograms display clusters of providers by geography. Examination of bonding (within-group) ties revealed comparable perceptions of high value among both South/Center Philadelphia (57%) and in North Philadelphia providers (56%), but bridging (between-group) ties suggest lower levels of high-value perceptions (24%). No evident clustering by type of service based on syndemic factor was observed. Density of bridging across types of providers was highest for referrals (38%) followed by planning (23%) and administrative coordination (20%). Interventions to promote collaboration between providers should focus on facilitating administrative and planning collaborations that leverage existing capacity of the network. Given the syndemic nature of these conditions, greater collaboration between providers of complementing SAVAME services is imperative.

Provider Perspectives on Latino Immigrants' Access to Resources for Syndemic Health Issues.

INTRODUCTION: Latino immigrants to the United States experience disproportionate impacts from the syndemic formed by substance abuse, violence victimization, HIV/AIDS, and mental health (SAVAME). This study characterizes resource access for Latino immigrants living in Philadelphia, as perceived by staff at Latino-serving organizations. METHODS: An online cross-sectional survey of staff at key Latino-serving Philadelphia organizations assessed access to their organization and citywide access to each type of service (substance use, HIV/AIDS, domestic violence [DV], and mental health) for Latino immigrants. Descriptive statistics for organizational access indicators and citywide access scores across four syndemic domains (availability, accessibility, adequacy, and quality) and by syndemic condition were computed. RESULTS: Organizational access and citywide access across HIV/AIDS (mean = 1.94, SD = 0.83), mental health (mean = 1.37, SD = 0.95), substance use (mean = 1.11, SD = 0.74), and DV (mean = 1.49, SD = 0.97) services were perceived as far from optimal. Domain scores were highest for accessibility (mean = 1.66, SD = 1.03), followed by quality (mean = 1.44, SD = 0.79), availability (mean = 1.41, SD = .81), and adequacy (mean = 1.24, SD = .75). CONCLUSION: Based on findings from a survey of staff working at Latino-serving organizations, this study highlights the lack of support and resources for Latino immigrants, in particular those related to mental health and substance use. Programs and interventions are needed to improve service delivery in Latino immigrant communities.

A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study.

BACKGROUND: Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. METHODS: Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. RESULTS: From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches' flexibility and willingness to work with the family's schedule. Acceptability themes suggest providing actionable strategies tailored to the family's context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. CONCLUSIONS: RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.

Assessing the reliability and validity of direct observation and traffic camera streams to measure helmet and motorcycle use.

There is a need to develop motorcycle helmet surveillance approaches that are less labour intensive than direct observation (DO), which is the commonly recommended but never formally validated approach, particularly in developing settings. This study sought to assess public traffic camera feeds as an alternative to DO, in addition to the reliability of DO under field conditions. DO had high inter-rater reliability, κ=0.88 and 0.84, respectively, for cycle type and helmet type, which reinforces its use as a gold standard. However, traffic camera-based data collection was found to be unreliable, with κ=0.46 and 0.53 for cycle type and helmet type. When bicycles, motorcycles and scooters were classified based on traffic camera streams, only 68.4% of classifications concurred with those made via DO. Given the current technology, helmet surveillance via traffic camera streams is infeasible, and there remains a need for innovative traffic safety surveillance approaches in low-income urban settings.