Hospital-Based Community Gardens as a Strategic Partner in Addressing Community Health Needs.

As part of community health needs assessments, US nonprofit hospitals are identifying a high prevalence of chronic diseases associated with poor diets. Institutions have responded by establishing nutrition-related initiatives such as farmers' markets and community gardens. There is public health value in demonstrating how these partnerships can help hospitals address identified community health needs. Here we describe diverse strategies undertaken by a hospital-based community garden at Penn State Milton S. Hershey Medical Center, explore implications for US hospitals, and provide implementation guidance. (Am J Public Health. 2023;113(9):939-942. https://doi.org/10.2105/AJPH.2023.307336).

Strategies to Help Health Care Organizations Execute Their Food System Leadership Responsibilities.

Food systems influence environmental sustainability and health. The fact that our current food production and distribution practices neither support nor promote planetary or human health raises ethical concerns. Since health organizations offer food to patients, community members, and employees, they are situated at key intersections among food systems, agricultural policies and practices, and public health. This article considers the nature and scope of health care organizations' local food system leadership responsibilities and describes how health care organizations' food practices can help improve health outcomes and motivate equity.

The bystander effect: Impact of rural hospital closures on the operations and financial well-being of surrounding healthcare institutions.

INTRODUCTION: There is presently a rural hospital shortage in the United States with 180 closures since 2005 and hundreds of institutions in financial peril. Although the hospital closure phenomenon is well-established, less is known about the spillover impact on the operations and financial wellbeing of surrounding hospitals. This preliminary study quantified how discrete rural hospital closures impact institutions in their regional proximity, finding a significant increase in inpatient admissions and emergency department visits for these "bystander hospitals". METHODS: Using a repository of rural hospital closures collected by the UNC Sheps Center for Health Services Research, we identified closures over the past 15 years. Criteria for inclusion were hospitals that had been fully closed between 2005-2016 and with >25-bed capacity. We then designated surrounding hospitals within a 30-mile radius of each closed hospital as "bystander hospitals." We examined the average rate-of-change for inpatient admissions and emergency department visits in surrounding hospitals both two years before and after relevant hospital closures. RESULTS: We identified 53 hospital closures and 93 bystander hospitals meeting our criteria during the study period. With respect to geographic distribution, 66% of closures were in the Southern US, including 21% in Appalachia. Average emergency department visits increased by 3.59% two years prior to a hospital's closure; however, at two years post-closure the average rate of increase rose to 10.22% (F (4,47) = 2.77, p = 0.0375). Average bystander hospital admissions fell by 5.73% in the two years preceding the hospital closure but increased 1.17% in the two years after (F (4,46) = 3.05, p = 0.0259). CONCLUSION: These findings predict a daunting future for rural healthcare. While previous literature has described the acute effects hospital closures have on communities, this study suggests a significant spillover effect on hospitals within the geographic region and a cyclical process at play in the rural healthcare sector. In the absence of significant public health assistance in regions affected by closures, poor health outcomes, including "diseases of despair," are likely to continue proliferating, disproportionately affecting the most vulnerable. In the COVID-19 era, it will be especially necessary to focus on hospital closures given increased risk of maintaining solvency due to delayed and deferred care atop already tight margins.

Bisexual Women's Invisibility in Health Care.

Invisibility of racial and ethnic inequity in clinical research means many important features of disease etiology and symptom presentation are often unaccounted for. Similarly, binary (ie, gay or straight) definitions of sexuality render bisexual women's experiences invisible, and this invisibility has 2 important consequences for minority groups' members' health, which this article considers.

Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study.

BACKGROUND AND OBJECTIVE: Increasing mortality and decreasing life expectancy in the USA are largely attributable to accidental overdose, alcohol-related disease and suicide. These 'deaths of despair' often follow years of morbidity, yet little is known about trends in the clinical recognition of 'diseases of despair'. The objective of this study is to characterise rates of clinically documented diseases of despair over the last decade and identify sociodemographic risk factors. DESIGN: Retrospective study using a healthcare claims database with 10 years of follow-up. SETTING: Participants resided nationwide but were concentrated in US states disproportionately affected by deaths of despair, including Pennsylvania, West Virginia and Delaware. PARTICIPANTS: Cohort included 12 144 252 participants, with no restriction by age or gender. OUTCOME MEASURES: Diseases of despair were defined as diagnoses related to alcohol misuse, substance misuse and suicide ideation/behaviours. A lookback period was used to identify incident diagnoses. Annual and all-time incidence/prevalence estimates were computed, along with risk for current diagnosis and patterns of comorbidity. RESULTS: 515 830 participants received a disease of despair diagnosis (58.5% male, median 36 years). From 2009 to 2018, the prevalence of alcohol-related, substance-related and suicide-related diagnoses respectively increased by 37%, 94%, and 170%. Ages 55-74 had the largest increase in alcohol/substance-related diagnoses (59% and 172%). Ages <18 had the largest increase in suicide-related diagnoses (287%). Overall, odds for current-year diagnosis were higher among men (adjusted OR (AOR) 1.49, 95% CI 1.47 to 1.51), and among those with Affordable Care Act or Medicare coverage relative to commercial coverage (AOR 1.30, 1.24 to 1.37; AOR 1.51, 1.46 to 1.55). CONCLUSIONS: Increasing clinical rates of disease of despair diagnoses largely mirror broader societal trends in mortality. While the opioid crisis remains a top public health priority, parallel rises in alcohol-related diagnoses and suicidality must be concurrently addressed. Findings suggest opportunities for healthcare systems and providers to deploy targeted prevention to mitigate the progression of morbidities towards mortality.

Growing Healthy Hearts: Gardening Program Feasibility in a Hospital-Based Community Garden.

OBJECTIVE: To assess feasibility in terms of acceptability, demand, and participant willingness to engage in gardening activities during an intervention delivered at a hospital-based community garden for patients at risk for cardiovascular disease (CVD). METHODS: In a pre-post study design, 15 adults with ≥1 CVD risk factor attended 5 education sessions over 12 weeks, tended garden beds, and completed questionnaires related to program acceptability and future gardening intentions. Interviews were used to identify areas for programmatic improvement. RESULTS: Most participants rated the intervention as good or excellent (93%), and 73% indicated that it was likely that they would garden next season. Areas for programmatic improvement included creating opportunities for group discussion, providing online materials, and offering more cooking and gardening content. CONCLUSIONS AND IMPLICATIONS: Gardening as an intervention for adult patients with CVD risk factors is feasible. Assessment of the effect of gardening on health outcomes and dietary intake is warranted.

"Prevention Produce": Integrating Medical Student Mentorship into a Fruit and Vegetable Prescription Program for At-Risk Patients.

INTRODUCTION: Fruit and vegetable prescription (FVRx) programs provide increased access to produce to food-insecure, at-risk populations, yet many lack the educational and social components to support long-term disease prevention. OBJECTIVES: To address these barriers, students at Penn State College of Medicine designed "Prevention Produce"-a modified FVRx program that integrated a community-based, month-long educational curriculum-and undertook preliminary evaluation. METHODS: Nine families deemed by clinicians as at risk of chronic disease and food insecurity received weekly $40 "prescriptions" for produce at partnering farmers markets. Participants were paired with medical student mentors who delivered weekly nutrition education modules and assisted in produce shopping. Preprogram and postprogram surveys were administered, categorizing perceptions and practices of healthy eating. All participants were interviewed by phone 3 years later to assess long-term impact. Medical students provided written reflections via online survey. RESULTS: Postprogram fruit and vegetable consumption increased, and more patients expressed efforts to include produce in every meal. More participants strongly agreed that fruits and vegetables prevented chronic diseases. In reflective interviews, participants praised the program's ease of use, mentor-patient relationship, and increased access to produce. Student mentors expressed gratitude for one-on-one interaction and felt empowered to learn and deliver nutrition education. CONCLUSION: Integration of an FVRx program with education, mentorship, and community-based focus may increase produce consumption and improve opinions about healthy eating. This program serves as a model for integrating preventive strategies within larger health care systems. Additionally, the model can facilitate early clinical interventions that may benefit medical trainees' professional development.

Interest in Using Workplace Energy Expenditure Devices Among Primary Care Patients.

BACKGROUND: Workplace energy expenditure devices (WEEDs), such as bicycle desks and treadmill desks, can contribute to weight gain prevention and disease risk-reduction. Little is known about the extent to which adults with diverse health risk factors are interested in using WEEDs. METHODS: Primary care patients aged 18 to 65 years at 2 outpatient clinics in Central Pennsylvania completed a cross-sectional survey in April, 2014 to assess interest in using "a small pedaling device under the desk" and "walking on a treadmill with a desk attached" if these options were provided at no cost. Demographic and health risk factors were also assessed. Multiple logistic regression analyses were used to examine the associations of demographic and health risk factors with interest in using WEEDs. RESULTS: Among 240 patients, 106 (44.2%) reported interest in using WEEDs. Of these 106 patients, interest in using a bicycle desk (91.5%) was higher than interest in using a treadmill desk (65.1%), P < .001. Females were more likely than males to be interested in using a bicycle desk, and patients aged 18 to 44 years were more likely than those aged 45 to 65 years to be interested in using a treadmill desk. CONCLUSIONS: Results suggest that diverse patient populations may have interest in using WEEDs. Promoting use of WEEDs in primary care practices could help meet national standards for providing comprehensive, patient-centered care.

A Growing Opportunity: Community Gardens Affiliated with US Hospitals and Academic Health Centers.

BACKGROUND: Community gardens can reduce public health disparities through promoting physical activity and healthy eating, growing food for underserved populations, and accelerating healing from injury or disease. Despite their potential to contribute to comprehensive patient care, no prior studies have investigated the prevalence of community gardens affiliated with US healthcare institutions, and the demographic characteristics of communities served by these gardens. METHODS: In 2013, national community garden databases, scientific abstracts, and public search engines (e.g., Google Scholar) were used to identify gardens. Outcomes included the prevalence of hospital-based community gardens by US regions, and demographic characteristics (age, race/ethnicity, education, household income, and obesity rates) of communities served by gardens. RESULTS: There were 110 healthcare-based gardens, with 39 in the Midwest, 25 in the South, 24 in the Northeast, and 22 in the West. Compared to US population averages, communities served by healthcare-based gardens had similar demographic characteristics, but significantly lower rates of obesity (27% versus 34%, p < .001). CONCLUSIONS: Healthcare-based gardens are located in regions that are demographically representative of the US population, and are associated with lower rates of obesity in communities they serve.

Feasibility of utilising an all-volunteer workforce as a disruptive innovation for the US obesity epidemic.

OBJECTIVES: As the prevalence of obesity in US adults continues to increase, addressing weight control will require an effective, lower-cost intervention. A model for delivering free peer-to-peer counselling has the potential to create a paradigm shift in the way weight and other chronic illnesses are addressed in the US. The objective of this study is to understand the potential for utilising successful peer volunteers as counsellors in weight control programmes and as a possible intervention strategy to address the global obesity epidemic in a cost-effective manner. STUDY DESIGN: This cross-sectional study surveyed a nationwide panel of US adults (n=806) in 2010. METHODS: We created survey items to identify participant interest in three specific types of weight control programmes: a free programme led by successful peers, a paid programme led by successful peers and a programme led by trained paid professionals. Statistical analysis was conducted in 2011. Logistic regression was used to adjust for the effect of potential confounders on participant interest in different weight control programmes and willingness to volunteer. RESULTS: More than three times as many subjects (27.4% vs. 8.3%) were interested in the free peer-led programme versus the expert-led paid option. Of participants who had ever had successful weight loss, 15% were interested in volunteering to help others lose weight. CONCLUSIONS: Individuals appear to be willing to both attend and conduct peer volunteer-led weight control groups. Further research is necessary to develop and test interventions to assess the effectiveness of such interventions.

Characterizing customers at medical center farmers' markets.

Approximately 100 farmers' markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010 and October 2011 at three medical centers in different geographic regions of the US (Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center) were conducted. Markets reported serving 180-2,000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n = 585) across markets were similar in sociodemographic characteristics--most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers' markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers' markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.

'Shooting at the sun god Apollo': the Apollonian-Dionysian balance of the TimeSlips Storytelling Project.

In The Birth of Tragedy, Friedrich Nietzsche celebrated the dueling forces of reason and emotion as personified by the ancient Greek gods Apollo and Dionysus. A subtle Apollonian-Dionysian balance can be observed in TimeSlips, a group-based creative storytelling activity developed in the 1990s and increasingly used in dementia care settings worldwide. This article explains how the Apollonion-Dionysian aspects of TimeSlips are beneficial not only for persons with dementia, but also for their carers. Narrative data from medical students at Penn State College of Medicine who participated in TimeSlips at a local retirement community are shared.

Public health potential of farmers' markets on medical center campuses: a case study from Penn State Milton S. Hershey Medical Center.

There are currently 7175 farmers' markets in the United States, and these organizations are increasingly viewed as one facet of the solution to national health problems. There has been a recent trend toward establishing markets on medical center campuses, and such partnerships can augment a medical center's ability to serve community health. However, to our knowledge no studies have described the emergence of a market at a medical center, the barriers and challenges such an initiative has faced, or the nature of programming it may foster. We provide a qualitative description of the process of starting a seasonal, once-a-week, producers-only market at the Pennsylvania State Hershey Medical Center, and we call for greater public health attention to these emerging community spaces.

Marketplace of memory: what the brain fitness technology industry says about us and how we can do better.

In the therapeutic void created by over 20 failed Alzheimer's disease drugs during the past decade, a new marketplace of "brain fitness" technology products has emerged. Ranging from video games and computer software to mobile phone apps and hand-held devices, these commercial products promise to maintain and enhance the memory, concentration, visual and spatial skills, verbal recall, and executive functions of individual users. It is instructive to view these products as sociocultural objects deeply imbued with the values and ideologies of our age; consequently, this article offers a critique of the brain fitness technology marketplace while identifying limitations in the capacity of commercial products to realistically improve cognitive health. A broader conception of brain health is presented, going beyond the reductionism of the commercial brain fitness marketplace and asking how our most proximate relationships and local communities can play a role in supporting cognitive and psychosocial well-being. This vision is grounded in recent experiences at The Intergenerational School in Cleveland, OH, a multigenerational community-oriented learning environment that is implementing brain fitness technology in novel ways.