The four stages of neighborhood trust: Classic grounded theory.

INTRODUCTION: Neighborhoods are often overlooked as a determinant of health. Among recent research, the focus on "place-based effects," due to prolonged residential environmental exposure, has been of particular interest. These studies' purpose is to identify and examine how a healthy neighborhood is intentionally created to describe a transferable process-driven theory. METHOD: A classic grounded theory approach was used in these studies. Data sources include individual in-depth interviews, historical documents, and a member-checking focus group, collected over 3-years. RESULTS: Analysis generated the Four Stages of Neighborhood Trust Model, which is nested within the context of perceived neighborhood safety. The theory outlines a social process of four stages of neighborhood trust: (a) rules-based agreements, (b) shared values, (c) cooperation, and (d) neighborhood belonging. CONCLUSIONS: We present the development of a process-driven theory that may be useful for public health nurses as they engage neighborhoods in health promotion activities. The stage of trust development will aid the nurse in identifying what is needed to move to the next stage in a healthy neighborhood process.

How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources.

PURPOSE: The National Institute of Health's All of Us Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the All of Us Research Program using the only proxy measure currently available in the dataset. METHODS: Currently, the All of Us Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas. Using the All of Us Controlled Tier Dataset v6, we compared sociodemographic and health characteristics of All of Us rural participants identified via this proxy to rural US residents from nationally representative data sources using chi-squared tests. RESULTS: 3.1% of 160,880 All of Us participants were rural, compared to 15%-20% of US residents based on commonly accepted rural definitions. Proportionally more rural All of Us participants reported fair or poor health status, history of cancer, and history of heart disease (P<.01). CONCLUSIONS: The All of Us measure may capture a subset of underserved participants who live in rural areas and experience health care access barriers due to distance. Researchers who use this proxy measure to characterize rurality should interpret their findings with caution due to differences in population and health characteristics using this proxy measure rural compared to other commonly used rural definitions.

Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach.

Background: Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan. Methods: We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected. Results: The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data. Conclusions: These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan.

Using Photovoice to Explore Determinants of Health among Homeless and Unstably Housed Women.

The lived experiences of homeless and unstably housed women, including their health-related priorities, are understudied in smaller metropolitan and rural communities. In this study, we partnered with a day center for women who experience homelessness in Spokane, Washington. We used Photovoice, a community-based participatory action research method, to explore the health-related concerns, needs, and behavior of women who are homeless or unstably housed. Participant-generated photographs and group interview data were analyzed using thematic analysis. Three themes were generated: "These are my supports", "I'm trying to make my health better", and "[My] choices are very limited". The themes illustrated individual, interpersonal, community, and societal strengths and vulnerabilities aligned with the social ecological model. Participants demonstrated resourcefulness, creativity, and hope as they strived toward health improvement. Trauma-informed, strengths-based approaches that respect the autonomy of homeless and unstably housed women and that amplify their voices are needed to minimize power imbalances in research, policy, and practice. This includes an imperative for healthcare and social work programs to ready graduates to deliver effective, empathic services by increasing their knowledge of social determinants of health and of the stigma faced by marginalized communities. Moreover, collaborating with these communities when designing, implementing, and evaluating services is critical.

Language access research for community health: provider perspectives on language access techniques and the role of communication technology.

BACKGROUND: In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). METHODS: Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. RESULTS: Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. CONCLUSIONS: Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP.

Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019.

BACKGROUND: Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. METHODS: Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. RESULTS: Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. DISCUSSION: To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.

Flexible Resources Key to Neighborhood Resilience for Children: A Scoping Review.

Neighborhoods have been the focus of health researchers seeking to develop upstream strategies to mitigate downstream disease development. In recent years, neighborhoods have become a primary target in efforts to promote health and resilience following deleterious social conditions such as the climate crisis, extreme weather events, the global pandemic, and supply chain disruptions. Children are often the most vulnerable populations after experiencing unexpected shocks. To examine and describe conceptually the construct of Neighborhood Resilience, we conducted a comprehensive scoping review using the terms ("resilience" or "resiliency" or "resilient") AND ("neighborhood"), utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases, to assess overall neighborhood themes that impact resilience. A total of 57 articles were extracted that met inclusion criteria. Extracted characteristics included study purpose, country of origin, key findings, environmental protective/risk factors. The analysis revealed a positive relationship between neighborhood resource density, neighborhood resiliency, and individual resiliency. This study reports the finding for studies with a population focus of pre-school age and school age children (1.5-18 years of age). Broadly, we identified that the primary goals regarding neighborhood resilience for childhood can be conceptualized as all activities and resources that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred. This goal conceptually encompasses antecedents that increase protective factors and reduces risk factors for children and their families. This comprehensive look at the literature showed that a neighborhood's ability to build, promote, and maintain resiliency is often largely dependent on the flexible resources (i.e., knowledge, money, power, prestige, and beneficial social connections) that are available.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Compassion and Trauma: Occupational Health Experiences of Certified Medical Interpreters in Five U.S. States.

Medical interpreters play a vital role in fostering understanding and ensuring safety and transparency in healthcare for patients with non-English language preference. Limited research describes work-related experiences of medical interpreters. The purpose of this research was to explore perceptions of occupational health and safety among medical interpreters. A structured, online survey was administered to all certified medical interpreters in Hawaii, New York, New Jersey, California, and Texas. Participants described occupational experiences as an interpreter via an open-ended question. Responses were coded using qualitative thematic analysis. Response text was reviewed, a codebook of descriptive themes developed, and data thematically coded and summarized. Of 981 potential participants, 199 responded (20.3% response rate). Four main themes were identified: Professionalism and Role, Work-Related Challenges, Approaches to Mitigate Vicarious Trauma, and The Rewarding Nature of the Job. Respondents described compassion fatigue, vicarious trauma, intentional emotional distancing from clients, and loneliness. Respondents identified needs for workplace support to ensure professionalism and safeguard interpreter safety. Medical interpreters appreciate their work, yet face challenges, including compassion fatigue and vicarious trauma. Employers and healthcare institutions should support the occupational and emotional needs of medical interpreters as a vital member of the healthcare team.

Effect of RISE Bundle implementation on school adoption of a student-centered return-to-learn program in Washington state.

BACKGROUND: Appropriate concussion care in school is vital for full recovery, but school return-to-learn (RTL) programs are lacking and vary in quality. Establishing student-centered RTL programs may reduce disparities in RTL care. OBJECTIVE: To examine the effect of RISE Bundle (Return to Learn Implementation Bundle for Schools) implementation on high school adoption of a student-centered RTL program. METHODS: A convenience sample of fourteen (4 rural and 10 urban) small and large Washington (WA) State public high schools were enrolled in a stepped-wedge study with baseline, end of study, and monthly measures over the 2021-2022 academic year. Schools identified an RTL champion who led RISE Bundle implementation in 6-week steps. Concussion knowledge and impact of RTL program on concussion care were examined. RESULTS: Ten schools (71.4%) successfully completed RISE Bundle implementation and established a functional RTL program. Self-reported concussion knowledge from RTL Champions increased post intervention. Establishing RTL programs facilitated provision of tailored accommodations, and perceived variation and inequities in RTL care were reduced. CONCLUSION: RISE Bundle implementation proved feasible, supported the establishment of a functional RTL program, and perceived to reduce disparities in concussion care in rural and urban WA State public high schools of varying sizes.

Suspected Suicidal Cannabis Exposures Reported to US Poison Centers, 2009-2021.

This cross-sectional study examines case characteristics of suicidal cannabis exposures reported to US poison centers before vs during the COVID-19 pandemic.

Instrument Evaluation: Attitudes Toward Older Adults and Intent to Work in Geriatrics.

ABSTRACT: Despite the increasing demand for nurses in geriatrics, interest lags in working with older adults. The Carolina Opinions on the Care of Older Adults instrument assesses attitudes toward older adults, with one subscale assessing intention to work with older adults. The instrument was used in a pretest/posttest study with prelicensure students enrolled in a gerontological nursing course. Posttest scores showed an improvement in attitudes toward older adults. The geriatric career choice subscale showed no pretest/posttest changes. The Carolina Opinions on the Care of Older Adults instrument is a suitable measure to assess changes in attitudes and intention to work with older adults.

Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools.

INTRODUCTION: The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services. METHODS: A weighted, nationally representative sample of U.S. public schools from the 2017-2018 School Survey on Crime and Safety was used. Schools reported the provision of diagnostic mental health assessments and/or treatment as well as factors that limited the provision of mental health services. Availability of mental health services and factors limiting service provision were examined across rurality, adjusting for school enrollment and grade level. The analysis was conducted in December 2021. RESULTS: Half (51.2%) of schools reported providing mental health assessments, and 38.3% reported providing treatment. After adjusting for enrollment and grade level, rural schools were 19% less likely, town schools were 21% less likely, and suburban schools were 11% less likely to report providing mental health assessments than city schools. Only suburban schools were less likely than city schools to provide mental health treatment (incidence rate ratio=0.85; 95% CI=0.72, 1.00). Factors limiting the provision of services included inadequate access to professionals (70.9%) and inadequate funding (77.0%), which were most common among rural schools. CONCLUSIONS: Significant inequities in school-based mental health services exist outside of urban areas.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research.

BACKGROUND: Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. METHODS: This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. RESULTS: The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. CONCLUSIONS: The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

Synthetic cannabinoid poisonings and access to the legal cannabis market: findings from US national poison centre data 2016-2019.

AIM: To investigate trends in synthetic cannabinoid exposures reported to United States (US) poison control centres, and their association with status of state cannabis legalisation. METHODS: A retrospective study of National Poison Data System (NPDS) data from 2016 to 2019 identified and associated synthetic poisoning reports with annual state cannabis law and market status. State status was categorised as restrictive (cannabis illegal or limited medical legalisation), medical (allowing THC-containing medical cannabis use) and permissive (allowing non-medical use of THC-containing cannabis by adults). We categorised a subset of states with permissive policies by their implementation of legal adult possession/use and opening retail markets, on a quarterly basis. Mixed-effects Poisson regression models assessed synthetic exposures associated with legal status, first among all states using annual counts, and then among states that implemented permissive law alone using quarterly counts. RESULTS: A total of 7600 exposures were reported during the study period. Overall, reported synthetic exposures declined over time. Most reported exposures (64.8%) required medical attention, and 61 deaths were documented. State implementation of medical cannabis law was associated with 13% fewer reported annual exposures. Adoption of permissive state cannabis policy was independently and significantly associated with 37% lower reported annual synthetic exposures, relative to restrictive policies (IRR: 0.63, 95% CI: 0.50-0.79). Among states with permissive law during the period, implementation of legal adult possession/use was associated with 22% fewer reported quarterly exposures. Opening of retail markets was associated with 36% fewer reported exposures, relative to states with medical cannabis only. CONCLUSIONS: Adoption of permissive cannabis law was associated with significant reductions in reported synthetic cannabinoid exposures. More permissive cannabis law may have the unintended benefit of reducing both motivation and harms associated with use of synthetic cannabis products.

System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State.

Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.

Trazodone Prescribing for Children With Attention Deficit Hyperactivity Disorder on Medicaid in Oregon.

OBJECTIVE: To examine trazodone prescribing to Medicaid-insured children with a diagnosis of attention deficit hyperactivity disorder (ADHD) from 2012 to 2016 for patient-level factors, including coexisting diagnoses associated with trazodone prescriptions. METHODS: A retrospective cohort study used de-identified claims data from the Oregon Health Authority to analyze associations, frequency, and likelihood of new trazodone fills. RESULTS: A total of 16,547 trazodone prescriptions were identified, representing 8.4% (n = 2,705) of 32,134 children. Most were filled for children ages 10 years and older. Children with ADHD were predominantly male (70.7%); however, more female children had a filled trazodone prescription compared with males (10.1% vs 7.7%). Female and male children with a filled trazodone prescription shared common diagnoses in the top 10 rank, although episodic mood disorders, such as bipolar disorder (International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 296) were only noted for female children. Female children were significantly older at the time of the first filled trazodone prescription (12.5 years; 95% CI, 12.3-12.7) compared with male children (12.0 years; 95% CI, 11.8-12.1). Modified Poisson regression models found children with ADHD and a filled trazodone prescription were 3 times more likely to have a sleep-related diagnosis as their most common diagnosis (excluding ADHD), compared with those of the same age and sex without a trazodone prescription (RR, 2.94; 95% CI, 2.44-3.54). CONCLUSIONS: Children with ADHD are prescribed trazodone off label and for conditions with no national guidelines or clinical evidence of efficacy. Female children on Medicaid may be prescribed trazodone for concurrent mental health conditions, and further research is warranted regarding potential correlates.

Language Assistance Services in Nonfederally Funded Safety-Net Medical Clinics in the United States.

Background: In the United States, nonfederally funded safety-net clinics provide health care services to underserved populations, including patients with limited English proficiency. Unlike clinics that receive federal funding, which requires provision of qualified interpreters, these clinics are not required to provide such services. Objective: The aim of this study was to describe the types of language assistance services used by safety-net clinics and their approaches to medical interpreter training for volunteers and staff. Methods: A survey was administered by mail and email to nonfederally funded medical safety-net clinics identified from publicly available directories. The survey collected information on clinic characteristics, interpreter modalities used, and interpreter training and could be completed on paper or online. Results: Among 859 eligible clinics, 216 completed the survey (24% response rate). Few clinics reported timely access to professional interpreter services in-person (18.5%), by phone (23%), or by video (7%), while 80% of clinics used ad hoc family member or friend to interpret and 53% used ad hoc child to interpreter. Seventy-eight percent of clinics reported using bilingual staff, providers, and/or volunteers. Staff/volunteer training was provided by 22 clinics (11%). Conclusion: Most safety-net clinics relied upon ad hoc interpreters, contrary to best practices. Use of ad hoc interpreters can lead to errors in interpretation, contributing to inequities in quality of health care services. Future efforts should identify economical strategies to improve access to qualified interpreter services at nonfederally funded safety-net clinics.