COVID-19: An opportunity to engage African Americans and women in research on cardiovascular disease.

INTRODUCTION: African Americans (AA) have been disproportionately affected with the COVID-19 disease experiencing 30%-60% of the deaths, while only making up 13% of the US population. Early data suggest that pregnant women and those with cardiovascular disease (CVD) may experience worse outcomes with severe coronavirus infection. There is an urgent need to incorporate AA and female perspectives into the design of research on the CVD complications related to COVID-19. OBJECTIVES: The goal of this project was to incorporate perspectives of AA and female patients in developing research priorities and AN agenda related to COVID-19. Objectives included: (a) develop a strong, research-ready partnership capable of executing PCOR, (b) creation of a research agenda and a set of priorities on racial/sex-specific CVD disparities in COVID-19 which reflects the perspectives of AA's and women; (c) long-term objective is creation of a set of research questions suitable for clinical research using the AHA Registry. METHODS: The project used principles of active and adult learning within the framework of capacity building to build a strong, patient-centered vision of research needs. Different methods of obtaining patient input were used to identify questions suitable for research using the America Heart Association COVID-19 CVD Quality Improvement Registry: focus groups and town halls to identify concerns and interests vis-à-vis CVD and COVID research; narrative medicine methods collected compelling real-life, COVID-19 health stories; a research advisory council reviewed and prioritized research questions. RESULTS: Outcomes include a replicable method of obtaining patient-oriented input into the creation of a research agenda and a set of research priorities for COVID-19. Outputs include the establishment of a research advisory council and stakeholder training using the PCORI funded, PORTAL program resources; a catalogue of patient generated narratives on COVID-19 experiences in the voice of AAs and women, and a set of research questions suitable for research using the AHA Registry. CONCLUSION: The project created a research ready stakeholder network, ready to develop a research agenda about COVID-19.

Collective Efficacy as a Key Context in Neighborhood Support for Urban Youth.

Neighborhood context, including the physical and social environment, has been implicated as important contributors to positive youth development. A transactional approach to neighborhood asserts that place and people are mutually constitutive; negative perceptions of place are intrinsically bound with negative portrayals of stigmatized groups, including youth. Adult perceptions of neighborhood youth may contribute to an increased sense of alienation and youth antisocial behavior. This study uses street-intercept interviews with adults (N = 408) to examine the relationship between neighborhood conditions and adult support for neighborhood youth. A path model was used to examine the direct and indirect relationship of neighborhood constructs (safety, aesthetic quality, and walkability) on adult support for neighborhood youth. Neighborhood aesthetic quality and the walking environment were directly associated with adult support for youth, whereas perceived safety was indirectly associated. Collective efficacy partially explained these relationships. Findings support theorized relationships between people and places; improvements to neighborhood physical environment may directly impact resident adults' perceptions of neighborhood young people.

Social cognitions, distress, and leadership self-efficacy: associations with aggression for high-risk minority youth.

Urban ethnic minority youth are often exposed to high levels of aggression and violence. As such, many aggression intervention programs that have been designed with suburban nonethnic minority youth have been used or slightly adapted in order to try and meet the needs of high-risk urban youth. The current study contributes to the literature base by examining how well a range of social-cognitive, emotional distress and victimization, and prosocial factors are related to youth aggression in a sample of urban youth. This study utilized data gathered from 109 9- to 15-year-old youth (36.7% male; 84.4% African American) and their parents or caregivers. A series of hierarchical multiple regressions were fit predicting youth aggression from social-cognitive variables, victimization and distress, and prosocial variables, controlling for youth gender and age. Each set of variables explained a significant and unique amount of the variance in youth aggressive behavior. The full model including all predictors accounted for 41% of the variance in aggression. Models suggest that youth with stronger beliefs supportive of violence, youth who experience more overt victimization, and youth who experience greater distress in overtly aggressive situations are likely to be more aggressive. In contrast, youth with higher self-esteem and youth who endorse greater leadership efficacy are likely to be less aggressive. Contrary to hypotheses, hostile attributional bias and knowledge of social information processing, experience of relational victimization, distress in relationally aggressive situations, and community engagement were not associated with aggression. Our study is one of the first to address these important questions for low-income, predominately ethnic minority urban youth, and it has clear implications for adapting aggression prevention programs to be culturally sensitive for urban African American youth.

Developing measures of community-relevant outcomes for violence prevention programs: a community-based participatory research approach to measurement.

Community-Based Participatory Research is a research paradigm that encourages community participation in designing and implementing evaluation research, though the actual outcome measures usually reflect the "external" academic researchers' view of program effect and the policy-makers' needs for decision-making. This paper describes a replicable process by which existing standardized psychometric scales commonly used in youth-related intervention programs were modified to measure indicators of program success defined by community partners. This study utilizes a secondary analysis of data gathered in the context of a community-based youth violence prevention program. Data were retooled into new measures developed using items from the Alabama Parenting Questionnaire, the Hare Area Specific Self-Esteem Scale, and the Youth Asset Survey. These measures evaluated two community-defined outcome indicators, "More Parental Involvement" and "Showing Kids Love." Results showed that existing scale items can be re-organized to create measures of community-defined outcomes that are psychometrically reliable and valid. Results also show that the community definitions of parent or parenting caregivers exemplified by the two indicators are similar to how these constructs have been defined in previous research, but they are not synonymous. There are nuanced differences that are important and worthy of better understanding, in part through better measurement.

Methods for linking community views to measureable outcomes in a youth violence prevention program.

BACKGROUND: All parties in community-academic partnerships have a vested interest prevention program success. Markers of success that reflect community's experiences of programmatic prevention success are not always measurable, but critically speak to community-defined needs. OBJECTIVE: The purpose of this manuscript was to (1) describe our systematic process for linking locally relevant community views (community-defined indicators) to measurable outcomes in the context of a youth violence prevention program and (2) discuss lessons learned, next steps, and recommendations for others trying to replicate a similar process. METHODS: A research team composed of both academic and community researchers conducted a systematic process of matching community-defined indicators of youth violence prevention programmatic success to standardized youth survey items being administered in the course of a program evaluation. The research team of three community partners and five academic partners considered 43 community-defined indicators and 208 items from the youth surveys being utilized within the context of a community-based aggression prevention program. At the end of the matching process, 92 youth survey items were identified and agreed upon as potential matches to 11 of the community-defined indicators. CONCLUSIONS: We applied rigorous action steps to match community-defined indicators to survey data collected in the youth violence prevention intervention. We learned important lessons that inform recommendations for others interested in such endeavors. The process used to derive and assess community-defined indicators of success emphasized the principles of community-based participatory research (CBPR) and use of existing and available data to reduce participant burden.

Locating and communicating with at-risk populations about emergency preparedness: the vulnerable populations outreach model.

Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.

If you ask them, will they come? Predictors of quarantine compliance during a hypothetical avian influenza pandemic: results from a statewide survey.

BACKGROUND: An influenza pandemic, such as that of the H1N1 virus, raises questions about how to respond effectively to a lethal outbreak. Most plans have focused on minimizing impact by containing the virus through quarantine, but quarantine has not been used widely in the United States and little is known about what would be the public's response. The purpose of this study was to investigate factors that influence an individual's decision to comply with a hypothetical avian influenza quarantine order. METHODS: A total of 1204 adult Pennsylvania residents participated in a random digit dial telephone sample. The residents were interviewed regarding their attitudes about and knowledge of avian influenza and about compliance with quarantine orders, including staying at home or traveling to a government-designated facility. RESULTS: Analysis of variance showed differences among demographic groups in willingness to comply with quarantine orders, with women and individuals not presently employed more willing to stay at home or to travel to a government-designated facility if ordered. Those who did not regularly attend religious services were significantly less willing than those who did attend regularly to comply with any type of quarantine order. Regression analysis indicated that demographic variables, overall knowledge of avian influenza, attitudes about its severity, and the belief that the respondent and/or his or her significant other(s) may contract it were predictive. CONCLUSIONS: The results of this study can provide health planners and policy makers with information for improving their efforts to conduct a quarantine successfully, including crafting messages and targeting information to certain groups of people to communicate risk about the epidemic.

Access impediments to health care and social services between Anglophone and Francophone African immigrants living in Philadelphia with respect to HIV/AIDS.

OBJECTIVES: To describe the social and cultural differences between Anglophone and Francophone African immigrants which define the impediments that Francophone African immigrants face trying to access health and human services in Philadelphia, Pennsylvania. METHODS: Surveys and personal interviews were administered to participants in social events, community meetings, and health centers. A Chi-squared analysis was used to contrast the communities. RESULTS: Francophone Africans demonstrated less acculturation, education, English fluency, and more legal documentation problems, and thus face greater challenges accessing health care. Anglophone Africans had a higher level of acculturation, fewer language problems, and perceived fewer barriers in accessing health care than Francophone Africans. CONCLUSIONS: Educating new immigrants, through a more culturally sensitive infectious disease treatment and prevention program, is integral to achieving a higher access and utilization rates of available services; especially in recent Francophone immigrants. A larger study is needed to extend the findings to other cities where immigrants with similar backgrounds or acculturation issues reside.

Translating community-specified indicators of program success into measurable outcomes.

BACKGROUND: Community participatory research encourages community involvement in early stages of program development and implementation, but sustainability is dependent on continued community interest and participation. While locally measured outcomes may not be generalizable, evaluations that demonstrate progress on community-specified markers of success can demonstrate a community's return on investment. The purpose of this study was to outline a process whereby community-identified indicators of successful violence prevention were translated into measurable variables. METHODS: Focus groups were conducted with key groups within identified neighborhoods experiencing high rates of violence in a large metropolitan area in the northeast United States. FINDINGS: From these groups, 40 indicators of successful violence prevention programs were expressed by the participants. Of these, 45 percent were matched to existing datasets with relevant variables. Datasets were then reviewed for accessibility. Feasibility of actually obtaining and analyzing data was tested by demonstrating the association between a "translated indicator" and a traditional indicator of violence. Greening data from Landsat satellite were correlated with shootings and mapped over target neighborhoods. CONCLUSIONS: Results indicate that it is possible to develop measurable community-specific indicators for evaluation of youth violence prevention programs and that these indicators have the potential for being generalizable across communities.

Disaster preparedness of households with special needs in southeastern Pennsylvania.

BACKGROUND: Individuals with disabilities are disproportionately vulnerable in evacuation emergencies, and they face numerous challenges accessing resources for response and recovery. PURPOSE: The aim of this study was to compare the preparedness behaviors of households with and without special-needs members. METHODS: A random-digit-dial telephone survey was conducted of 501 adults in southeastern Pennsylvania in 2008. The survey instrument gathered data on sociodemographic characteristics, disability status/functional limitations, and preparedness behaviors related to an evacuation emergency. Analyses were conducted in 2009 and included multiple logistic regressions. Data were weighted to correct for unequal probabilities of selection and response. RESULTS: Nineteen percent (n=95) of respondents reported living in a household in which someone had a transportation-related special need requiring assistance in case of an emergency. Households with a special-needs member had greater odds of having arranged a place to meet (OR=2.2; 95% CI=1.26, 3.88); located a shelter (OR=1.8; 95% CI=1.05, 3.24); or packed a bag (OR=1.8; 95% CI=1.02, 3.21). No significant differences were identified with respect to awareness of evacuation routes, purchasing of food and water, or creation of an emergency plan to guide evacuation decision-making. CONCLUSIONS: Despite both greater vulnerability to disaster and numerous messages by governmental and nongovernmental organizations, households with special-needs members are not more likely to engage in time-consuming preparedness behaviors such as planning and buying. Understanding the motivations and behaviors of special-needs groups is critical to designing informed risk-communication messages and interventions to bolster the preparedness of the most vulnerable populations.

Factors associated with zidovudine receipt and prenatal care among HIV-infected pregnant women in New Jersey.

Despite reductions in perinatal HIV transmission, cases continue to occur. To determine factors associated with zidovudine (ZDV) receipt among HIV-infected pregnant women we merged three data sets for women in New Jersey in 1995-1997, identifying 395 HIV-infected pregnant women. Half received two arms of ZDV prophylaxis. Attendance at five or more prenatal visits was the strongest independent factor related to ZDV receipt (OR 6.37, 95% CI 3.84, 10.57). Half (49.0%) had limited prenatal care. AIDS diagnosis, race/ethnicity, and drug use were also independently related to ZDV receipt. Post hoc analysis revealed that being unmarried, Black, multiparous, having no insurance, and illegal drug use were associated with limited prenatal care. Although the U.S. has seen reductions in HIV perinatal transmission, our research showed that HIV-infected women who did not get prenatal care were less likely to receive two arms of ZDV prophylaxis. A wide public health net that brings all women into care is necessary to reduce perinatal transmission further.

Mapping perceptions related to acceptance of smallpox vaccination by hospital emergency room personnel.

Emergency department personnel would be first responders in the event of a bioterror smallpox outbreak, yet few were willing to be vaccinated during the 2002 federal campaign. To better understand vaccination concerns, perceptual mapping methods were used to create multidimensional models of how emergency department personnel (N= 73) in the Philadelphia area perceive the risks and benefits of smallpox vaccination under 4 levels of threat: (1) today; (2) if another terrorist attack happened anywhere in the U.S.; (3) if a smallpox attack happened somewhere in the U.S.; (4) if a smallpox attack happened locally. The perceptual maps show significant shifts in factors that are important for motivating respondents to accept vaccination under increasingly higher levels of threat. In the today scenario, endorsement of vaccination from a credible source, such as a major hospital in the area, was a very important factor (mean =7.10 on a 0-10 scale).However, endorsement was not as important under the 2 higher levels of threat. Under these conditions, respondents'sense of wanting to help in a disaster emerged as an important element the closer the hypothetical attack was to the respondent,ranging in importance from 3.87 under the least threat to 7.35 under the greatest threat scenario. The perceptual maps yield information that would assist planners in designing more effective risk communication strategies tailored to particular audiences and levels of threat. Such communications are important to prepare for a smallpox event or other uncertain outbreak, where it is essential to rapidly vaccinate a critical mass of healthcare workers.

Breast cancer early detection among Chinese women in the Philadelphia area.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death among Chinese American women. Previous studies identified disparities in breast cancer screening between Asian and Caucasian women. This study describes breast cancer awareness, attitudes, and knowledge, as well as barriers and facilitators of early detection among Chinese women in Philadelphia. METHODS: A cross-sectional, translated survey was conducted among a convenience sample of 111 Chinese women from the greater Philadelphia area. Data were analyzed using descriptive statistics to describe participant experiences and attitudes, and Pearson correlation coefficients, chi-square tests, and multiple regressions were used to identify significant predictors of breast cancer screenings. RESULTS: Of respondents, 53.2% had ever performed breast self-examination (BSE). Among women aged >or=40, 53.6% had ever had clinical breast examination (CBE), and 71.1% had ever had mammogram. Knowledge (p < 0.001) and self-efficacy (p = 0.001) predicted BSE ever performance. Having a doctor as information source of CBE (p = 0.001) and belief in family history as a risk factor of breast cancer (p = 0.002) were significant predictors of having ever had a CBE. Having a doctor as information source of mammogram (p = 0.002) was the only significant predictor of having ever had mammogram screening. CONCLUSIONS: This study laid a foundation for developing culturally sensitive breast cancer education and screening programs for Chinese women in the Philadelphia area. Recommendations include a call for physician education to improve breast cancer screening rates in this population.

The value template process: a participatory evaluation method for community health partnerships.

This article presents the results of a pilot implementation of an evaluation process designed to help community health collaboratives obtain relevant information for planning and evaluation. The Value Template Process assists collaboratives to identify performance and impact indicators that are meaningful and measurable with accessible data. The process also encourages communication and engagement in assessment among collaborative members. The pilot study demonstrated that the process's underlying assumptions of social capital were valid and that the process was feasible and useful to the community health collaborative.

Knowledge, attitudes, and predictors of advance directive discussions of registered nurses.

The purpose of this study was to describe nurses' knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses' comfort and that developing interventions to further nurses' confidence in their discussion skills may increase advance directive discussions.

Correlates of clinical preventive practices among internal medicine residents.

BACKGROUND: Healthy People: 2010 calls for improvement in the delivery of clinical preventive services. Physicians value preventive services, yet their rates of prevention consistently fall below recommendations. This study examines the relationship between personal characteristics of internal medicine residents and their clinical prevention practices in an outpatient setting. METHODS: Participants were 56 of 80 physicians (70%) in an internal medicine residency program in New Jersey. Personal characteristics (i.e., demographics, specialty orientation, attitudes toward prevention, and personal health behaviors) of the residents were collected via a self-administered survey. A 12-month retrospective chart review of 184 new doctor-patient encounters was performed to determine rates of clinical preventive services. RESULTS: Clinical preventive services were performed at varying rates, and differential practices specific to the patient's gender and/or age were detected for several services. Multiple regression revealed four significant predictors of overall prevention practice: clinic site, international medical graduates, generalist orientation, and self perceived health status (R(2) = 0.32). Predictors of health promotion counseling were clinic site, international medical graduates, and generalist orientation (R(2) = 0.30). CONCLUSIONS: While personal characteristics such as self-rated health and generalist orientation were associated with preventive practices, factors related to the office environment were also associated with increased delivery of clinical preventive services. Prevention-oriented office systems, such as "Put Prevention Into Practice," should be worthwhile considerations to increase delivery of preventive services.

Implications of evidence-based practice for community health.

Evidence-based practice, developed in clinical medicine, is being applied to community health programs. Barriers to implementation of evidence-based practice noted in clinical medicine are likely to exist in community health settings and may be complicated by the nature of community health programs. These barriers include accessibility and availability of relevant data, social and political considerations of program decision-making, and conflicting expectations for evaluation research. This paper discusses barriers to both amassing evidence for practice and using evidence for decision-making in community health. The potentialfor conflict between practice goals set by evidence-based thinking and those set by community health organizations is also discussed. Implications for evaluations of community health programs are raised and recommendations for improving access to and use of evaluation information are made.

Pneumococcal vaccination in pennsylvania nursing homes: factors associated with vaccination level.

OBJECTIVES: To determine the levels of knowledge and beliefs about pneumococcal disease and the pneumococcal polysaccharide vaccine (PPV), the level of PPV use, PPV-related practices, and factors associated with PPV use in Pennsylvania's nursing homes. DESIGN/SETTING: A 68-item, cross-sectional survey of Nursing Directors at a random sample of PA nursing homes (291) was conducted between April and June 1999. Survey results and facility characteristics were used to describe vaccination practices, estimate the vaccination level and determine through bivariate analysis, associations between vaccination level and facility characteristics and practices. RESULTS: Respondents are knowledgeable about PPV and recommendations for its use but less knowledgeable about financial reimbursement. Pneumonia is believed to be a serious threat to nursing home residents; PPV is thought to be important, effective, cost-effective, and safe for use in nursing homes. The estimated PPV rate is 49%, and vaccination practices are variable. Factors associated with higher vaccination level include: knowledge of financial reimbursement, strong belief in the importance of vaccinating residents and the effectiveness of the vaccine, practices related to policies, assessment, consent and orders, and organizational factors of size, ownership, average length of stay, and identification of a staff "vaccine advocate." CONCLUSION: Staff members are knowledgeable about the vaccine and believe it should be used in nursing homes. Efforts aimed at improving vaccination rates should concentrate on examples of effective vaccination programs and practices rather than basic information about the vaccine. Development of institutional policies, which guide vaccination practice and institutionalize the use of automated patient management systems that prompt staff to assess vaccination status and order vaccination, could have considerable impact in meeting the recommendation for vaccination of nursing home residents.