Training Community Leaders to Serve as Equal Partners in Research: Penn Community Scholars Program, 2015-2023.

An implementation and effectiveness evaluation of the Community Scholars Program was conducted at the University of Pennsylvania to enhance community capacity to collaborate with academics in mutually beneficial, equitable, and transformative research. Mixed methods were employed using administrative data, surveys, and key informant interviews. Participants expressed high satisfaction, valued interactive learning, and identified areas for improvement. The program increased knowledge and self-confidence in research-related skills and trust in the research process. The program serves as an institutional model to create long-term, mutually beneficial community-academic partnerships. (Am J Public Health. 2024;114(3):284-288. https://doi.org/10.2105/AJPH.2023.307549).

Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries.

BACKGROUND: During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY: Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS: Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION: The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.

Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach.

BACKGROUND: Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites-commonly known as safe injection facilities-in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health. METHODS: We developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood. RESULTS: In Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site's services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered. CONCLUSIONS: Mathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.

Youth Speak Out on School Food Environments.

In Philadelphia, over 40% of youth are overweight or obese. The objective in this assessment was to learn about urban residents' perspectives regarding the local food environment and its impact on eating behaviors. Using photo-elicitation, 20 adolescents reflected on their food environments through photographs and corresponding interviews. Without specific prompting from interviewers, every participant raised concerns about their school food environments, which they commonly found to be unhealthy and unappealing. Participants' responses reflected four themes: (1) mixed reviews regarding the healthfulness of school vending machines, (2) lunch from home versus lunch from school, (3) factors that influenced food choice at school, and (4) critiques of school food environments. Students embraced the photo-elicitation approach as a way to convey their concerns and to suggest opportunities for improvements. School nurses, who are trusted by students and school personnel, are well-positioned to solicit student input and advocate for healthier school food environments.

Perceptions of Nature and Access to Green Space in Four Urban Neighborhoods.

Health benefits have been linked to spending time outdoors in nature and green space. However, there is some evidence of inequities to accessing safe outdoor space, particularly in low-resource communities. The primary aim of this study is to assess attitudes towards nature and use of green space in urban areas. A secondary aim is to describe perceptions of physician-initiated nature prescriptions that target local pediatric populations. We conducted six focus group interviews with 42 residents who were guardians or caretakers of children living in low-resource neighborhoods in Philadelphia, PA. We analyzed interview data using a conventional content analysis approach. Three major themes emerged: (1) perceived benefits of being in nature (physical and mental health benefits), (2) barriers to time spent in nature (unsafe and undesirable conditions of local parks), and (3) desired features of outdoor green spaces (amenities that would increase park use). Additionally, we describe participants' reactions to the idea of a pediatrician-delivered prescription for outdoor green space exposure for a child in their care. Adherence to nature prescriptions programs may hinge on local green space resources, as well as experiential and perceptual barriers and facilitators to nature and park accessibility among caregivers tasked with fulfilling a nature prescription for a child in their care.

Knowledge, perceptions, and behaviors related to salt use among Philadelphia Chinese take-out restaurant owners and chefs.

Most of the sodium Americans consume comes from processed and restaurant foods. An upstream global strategy to promote health is to work with local restaurants to reduce sodium content in their food offerings, while accounting for food taste and economic considerations. In urban communities, Chinese take-out restaurants serve meals with large amounts of sodium and are clustered in low-income, racial/ethnic minority communities with a high prevalence of hypertension. The objective of this study is to assess baseline knowledge, attitudes, and behaviors related to sodium use/consumption among Chinese take-out owners and chefs recruited to participate in the Philadelphia Healthy Chinese Take-Out Initiative. A cross-sectional study of 221 Chinese take-out restaurants was conducted from August 2012 to February 2013. Items measured knowledge, attitudes, and behaviors related to salt use, salt consumption, and health. Most owners/chefs knew that excess sodium consumption contributes to high blood pressure but were less aware of other health effects and of major sources of sodium in the U.S. diet. The majority were willing and able to reduce sodium content in meals if customer demand could be maintained, and they desired training in food preparation, procurement, and marketing. Findings show a need to provide education, strategies, and support to Chinese take-out owners/chefs in preparing low-salt dishes. The results of this and future studies to reduce sodium content in meals by working with restaurant owners and chefs have global health promotion implications.

Improving fruit and vegetable consumption among low-income customers at farmers markets: Philly Food Bucks, Philadelphia, Pennsylvania, 2011.

INTRODUCTION: We evaluated whether Philly Food Bucks, a bonus incentive program at farmers markets, is associated with increased fruit and vegetable consumption and Supplemental Nutrition Assistance Program (SNAP) sales at farmers markets in low-income areas. METHODS: A convenience sample of 662 customers at 22 farmers markets in low-income neighborhoods in Philadelphia, Pennsylvania, was surveyed via face-to-face interviews. Questions addressed shopping characteristics, self-reported change in fruit and vegetable consumption, whether customers tried new fruits or vegetables, use of Philly Food Bucks, and demographic information. Market-level SNAP sales and Philly Food Bucks redemption data were also collected to monitor sales patterns. RESULTS: Philly Food Bucks users were significantly more likely than nonusers to report increasing fruit and vegetable consumption (OR, 2.4; 95% CI, 1.6-3.7; P < .001) and to report trying new fruits or vegetables (OR 1.8; 95% CI, 1.2-2.7; P = .006). At the market level, average SNAP sales more than doubled at farmers markets in low-income areas in the first 2 years of the Philly Food Bucks program. At the city's largest farmers market in a low-income area, the program was associated with an almost 5-fold higher increase in annual SNAP sales compared with baseline. CONCLUSION: Results from this study demonstrate that a bonus incentive program tied to SNAP was associated with self-reported increases in fruit and vegetable consumption and increased SNAP sales at participating farmers markets in low-income communities. More research is warranted to evaluate the long-term impact of bonus incentives on farmers market use, dietary behaviors, and health outcomes.

Community-generated recommendations regarding the urban nutrition and tobacco environments: a photo-elicitation study in Philadelphia.

INTRODUCTION: Overweight, obesity, and tobacco use are major preventable causes of disability, disease, and death. In 2010, 25% of Philadelphia adults smoked, and 66% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health launched Get Healthy Philly, an initiative to improve the city's nutrition, physical activity, and tobacco environments. The objective of this assessment was to identify residents' perspectives on threats to health and opportunities for change in the local food and tobacco environments. METHODS: Participants (N = 48) took photographs to document their concerns regarding Philadelphia's food and tobacco environments and participated in photo-elicitation interviews. We coded photographs and interview transcripts and identified key themes. RESULTS: Participants proposed interventions for nutrition 4 times more often than for tobacco. Participants spontaneously articulated the need for multilevel change consistent with the ecological model of health behavior, including changes to policies (food assistance program provisions to encourage healthful purchases), local and school environments (more healthful corner store inventories and school meals), and individual knowledge and behavior (healthier food purchases). Participants often required interviewer prompting to discuss tobacco, and they suggested interventions including changes in advertising (a local environmental concern) and cigarette taxes (a policy concern). CONCLUSION: Participants were well versed in the relevance to health of nutrition and physical activity and the need for multilevel interventions. Their responses suggested community readiness for change. In contrast, participants' more limited comments regarding tobacco suggested that prevention and control of tobacco use were perceived as less salient public health concerns.

Student public commitment in a school-based diabetes prevention project: impact on physical health and health behavior.

BACKGROUND: As concern about youth obesity continues to mount, there is increasing consideration of widespread policy changes to support improved nutritional and enhanced physical activity offerings in schools. A critical element in the success of such programs may be to involve students as spokespeople for the program. Making such a public commitment to healthy lifestyle program targets (improved nutrition and enhanced physical activity) may potentiate healthy behavior changes among such students and provide a model for their peers. This paper examines whether student's "public commitment"--voluntary participation as a peer communicator or in student-generated media opportunities--in a school-based intervention to prevent diabetes and reduce obesity predicted improved study outcomes including reduced obesity and improved health behaviors. METHODS: Secondary analysis of data from a 3-year randomized controlled trial conducted in 42 middle schools examining the impact of a multi-component school-based program on body mass index (BMI) and student health behaviors. A total of 4603 students were assessed at the beginning of sixth grade and the end of eighth grade. Process evaluation data were collected throughout the course of the intervention. All analyses were adjusted for students' baseline values. For this paper, the students in the schools randomized to receive the intervention were further divided into two groups: those who participated in public commitment activities and those who did not. Students from comparable schools randomized to the assessment condition constituted the control group. RESULTS: We found a lower percentage of obesity (greater than or equal to the 95th percentile for BMI) at the end of the study among the group participating in public commitment activities compared to the control group (21.5% vs. 26.6%, p = 0.02). The difference in obesity rates at the end of the study was even greater among the subgroup of students who were overweight or obese at baseline; 44.6% for the "public commitment" group, versus 53.2% for the control group (p = 0.01). There was no difference in obesity rates between the group not participating in public commitment activities and the control group (26.4% vs. 26.6%). CONCLUSIONS: Participating in public commitment activities during the HEALTHY study may have potentiated the changes promoted by the behavioral, nutrition, and physical activity intervention components. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00458029.