Understanding the Perception of Place and Its Impact on Community Violence.

In this article, we explore the responses of 357 African American men between 15- and 24-years old living in four high crime high violence cities to better understand their perception of their environment and its impact on community violence. We focus on study participants' perceptions of their cities, explanations of violence, and their perceived contribution to the level of violence. Respondents describe their cities in grim terms with few opportunities. And, from their perspective, the dangerous environment in which they live necessitates gun possession, potentially perpetuating community violence. Our findings affirm that as with any other public health issue, the perception of place matters in understanding community violence. Further, our findings underscore the importance of seeking and responding to the lived experience of those most likely to be victims and perpetrators of community violence in crafting and implementing interventions.

It Takes a Village: Moving from Unaligned Action to Collective Impact.

For over two decades, violence has been understood as a public health problem. Despite a well-established and applicable public health framework, progress to address the entrenched violence that plagues many cities has been slow. We believe that progress can be effective only if it fully includes those most impacted by the violence. In this article, we describe an initiative to address one aspect of violence plaguing Wilmington: access to and possession of guns. Our initiative is driven by the lived experience of community members, builds on and expands an established collective impact effort to address gun violence, and focuses on the root causes of gun violence.

Considering the Benefits Cliff Embedded in the Relationship between Housing and Health.

This Commentary introduces the reality of the benefits cliff into the housing and health relationship. Improving both housing and health requires addressing the benefits cliff facing extremely low- and low-income people. Those living below the poverty line are at greatest risk of poor, inadequate, and unhealthy living conditions. They are also the group most at risk for losing benefits and economic supports on their journey toward economic self-sufficiency. Addressing the housing crisis in Delaware demands that we recognize the benefits cliff looming on the horizon for extremely low- and low-income families struggling toward self-sufficiency. Effective policies and interventions, at a minimum, need to be informed by the experiences of those struggling to navigate the benefits cliff and achieve economic mobility and need to be integrated across housing, economic benefits, and health care.

Evaluating Veterans Response Teams and Police Interventions on Veterans' Health Care Utilization.

This study examined the effects of veteran-specific cooperative police interventions, including a Veterans Response Team (VRT) and broad collaboration between local police departments and a Veterans Affairs (VA) medical center police department (local-VA police [LVP]), on veterans' health care utilization. Data were analyzed on 241 veterans (51 received VRT and 190 received LVP intervention) in Wilmington, Delaware. Nearly all veterans in the sample were enrolled in VA health care at the time of police intervention. Veterans who received VRT or LVP interventions showed similar increases in use of outpatient and inpatient mental health and substance abuse treatment services, rehabilitation services, ancillary care services, homeless programs, and emergency department/urgent care services after 6 months. These findings suggest the importance of relationship building among local police departments, VA Police, and Veterans Justice Outreach to create pathways to care to ensure that veterans are connected to needed VA health care services.

The Benefits of Community Engaged Research in Creating Place-Based Responses to COVID-19.

Objective: The DSU COVID-19 study aims to understand the response to and impact of COVID-19 in nine underserved communities in Delaware and to inform public health messaging. In this article, we describe our community engaged research approach and discuss the benefits of community engaged research in creating place-based health interventions designed to reduce entrenched health disparities and to respond to emerging or unforeseen health crises. We also highlight the necessity of sustained community engagement in addressing entrenched health disparities most prevalent in underserved communities and in being prepared for emerging and unforeseen health crises. Method: Our study is a longitudinal study comprised of three waves: initial, six months follow-up, and twelve months follow-up. Each wave consists of a structured survey administered on an iPad and a serology test. Through community engaged research techniques, a network of community partners, including trusted community facilities serving as study sites, collaborates on study implementation, data interpretation, and informing public health messaging. Results: The community engaged approach (CEnR) proved effective in recruiting 1,086 study participants from nine underserved communities in Delaware. The research team built a strong, trusting rapport in the communities and served as a resource for accurate information about COVID-19 and vaccinations. Community partners strengthened their research capacity. Collaboratively, researchers and community partners informed public health messaging. Conclusion: The partnerships developed through CEnR allow for place-based tailored health interventions and education. Policy Implications: CEnR continues to be effective in creating mutually beneficial partnerships among researchers, community partners, and community residents. However, CEnR by nature is transactional. Without sustained partnerships with and in underserved communities, we will make little progress in impacting health disparities and will be ill-prepared to respond to emerging or unforeseen health crises. We recommend that population health strategies include sustainable research practice partnerships (RPPs) to increase their impact.

COVID-19 testing in Delaware's underserved communities: demographic and social determinants of testing inequality.

Background: Health experts believe that frequent COVID-19 testing is one of the most important practices for stopping the spread of the COVID-19 virus. Demographic and social factors might play a role in whether a person gets tested for COVID. This present study aimed to investigate (1) the demographic and social factors affecting a person's likelihood of getting tested for COVID-19, and (2) the demographic and social factors related to a positive serology test (i.e., indicating likely past infection). Methods: Data were extracted from a survey conducted in Delaware's underserved communities. Participants were asked to complete a questionnaire about their COVID-19 testing history, and nurses at the study site collected a serology sample from each participant. Results: Our results indicated that Black or Hispanic individuals living in underserved communities had greater odds of having been tested previously for COVID compared to being non-Hispanic White. In addition, our study found that being female, educated, feeling safe in one's neighborhood, being vaccinated against COVID, and being an essential worker increased one's odds of having been previously tested for COVID-19. Regarding the results of the COVID-19 antibody serology tests, our findings revealed that Hispanic respondents were more likely to have a positive serology test compared to non-Hispanic White respondents, indicating that the Hispanic individuals were more likely to contract the virus. Educated individuals were less likely to have a positive serology test compared to the less-educated. Those who expressed hesitancy about getting vaccinated for COVID-19 and identified themselves as essential workers were more likely to have a positive serology test and to have previously contracted the virus. Conclusions: Identifying key factors associated with COVID-19 testing may help establish novel strategies to increase testing rates among vulnerable population. Public health and policy implications are discussed in the article.

COVID-19 Vaccine Hesitancy in Delaware's Underserved Communities.

BACKGROUND AND OBJECTIVE: Vaccine hesitancy may be one of the greatest challenges to conquering the COVID-19 pandemic. Underserved communities across the U.S. have been suffering from the pandemic in unique ways, and vaccine hesitancy may exacerbate or prolong these issues. However, the prevalence of vaccine uptake and hesitancy in these vulnerable populations is unknown. The present study aimed to investigate: (1) prevalence of COVID vaccine uptake and COVID vaccine hesitancy in Delaware's underserved communities; (2) factors (i.e., demographic, socioeconomic characteristics, as well as COVID-related behaviors) associated with vaccine hesitancy; and (3) specific concerns about COVID vaccines. MATERIALS AND METHODS: Data were extracted from a survey conducted in Delaware's underserved communities from March 4, 2021 to May 25, 2021. Logistic regression analyses were used to assess factors associated with vaccine hesitancy. RESULTS: Results from our survey indicated that vaccine uptake is lower in Delaware's underserved communities than Delaware overall and the national average. In addition, a considerable proportion of participants were categorized as vaccine hesitant. We also found that being black increased the likelihood of vaccine hesitancy for the COVID-19 vaccine, which is consistent with prior studies on vaccine hesitancy. Results also indicated that having been tested for COVID in the past decreased the odds of vaccine hesitancy. However, we did not find that demographic or socioeconomic characteristics played a role in vaccine hesitancy in Delaware's underserved communities. CONCLUSION AND RELEVANCE: Our study represents a critial first step in understanding the determinants driving COVID vaccine uptake and hesitancy. Identifying key factors and causes for vaccine hesitancy may help in establishing novel strategies that counteract low vaccination rates in underserved communities.

Integrated nested services: Delaware's experience treating minority substance abusers at risk for HIV or HIV positive.

Treating minority substance abusers at risk of HIV or HIV positive is a critical public health issue. Delaware has achieved success in treating this population through its integrated nested services approach. Through three Center for Substance Abuse funded projects, Delaware has synthesized a number of evidence-based and best practices from the HIV medical treatment, substance abuse treatment and mental health treatment. Evaluation findings show that Project HOPE and Meeting the Challenges are having a positive impact on clients in a number of areas, including medical compliance, physical health, sobriety, employment/income and living situations. Clearly, this approach benefits all stakeholders, including the State of Delaware, local communities, staff and clients.