Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic.

Objective: Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods: We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results: Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion: This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.

The impact of sodium reduction on overall nutrient content in Child and Adult Care Food Program meals.

OBJECTIVE: To understand the impact of Na reduction on the nutrient content of Child and Adult Care Food Program (CACFP) meals served through At-Risk Afterschool Meals (ARASM) without compromising the nutritional quality of the meals served. DESIGN: Sodium Reduction in Communities Program (SRCP) partnered with a CACFP ARASM programme from October 2016 to September 2021. We assessed changes in Healthy Eating Index 2015 (HEI-2015) food component scores and macro- and micronutrients using cross-sectional nutrient analyses of October 2016 and 2020 menus. SETTING: ARASM programme sites in Indianapolis, IN, USA. PARTICIPANTS: October 2016 and 2020 menus from one CACFP ARASM programme. INTERVENTION: Na reduction strategies included implementing food service guidelines, modifying meal components, changing procurement practices and facilitating environmental changes to promote lower Na items. RESULTS: From baseline in 2016 to 2020, fifteen meal components were impacted by the intervention, which impacted 17 (85 %) meals included in the analysis. Average Na per meal reduced significantly between 2016 (837·9 mg) and 2020 (627·9 mg) (P = 0·002). Between 2016 and 2020, there were significant increases in whole grains (P = 0·003) and total vegetables (P < 0·001) and significant reductions in refined grains (P = 0·001) and Na (P = 0·02), all per 1000 kcal served. CONCLUSIONS: This study demonstrates that Na content can be reduced in CACFP meals without compromising the nutritional quality of meals served. Future studies are needed to identify feasible best practices and policies to reduce Na content in the CACFP meal pattern.

Supporting Health Equity Through Data-Driven Decision-Making: A Local Health Department Response to COVID-19.

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197-S200. https://doi.org/10.2105/AJPH.2021.306421).

Sodium Reduction in Distributive Meals Through Speed-Scratch Cooking.

PURPOSE AND OBJECTIVES: Through the Centers for Disease Control and Prevention's Sodium Reduction in Communities Program, the Marion County Public Health Department and partners implemented sodium reduction strategies in distributive meal programs (ie, low- or no-cost meals available to under-resourced populations) to meet the long-term goal of reducing the burden of sodium-related chronic disease among adults aged 60 or older. The purpose of our study was to evaluate results from the first 2 years of the program, which modified recipes to reduce overall sodium levels through speed-scratch cooking (combining prepared food products with those made from scratch). INTERVENTION APPROACH: We modified recipes to reduce sodium content in 2 potato products served frequently as side dishes in distributive programs for older adults for congregate meals - those provided to groups in a community setting - and home-delivered meals. EVALUATION METHODS: We compared average sodium content of a 3-month menu cycle between 2 program years, the costs and consumer acceptance of recipe modifications, and consumer perceptions of product changes. Primary data included a nutrient analysis and key informant interviews. RESULTS: Approximately 2,000 distributive meal clients of CICOA Aging and In-Home Solutions were served reduced-sodium potato dishes over the 2 years of the intervention. From year 1 to year 2, the sodium content of scalloped potatoes was reduced by 65%, and the sodium content of mashed potatoes was reduced by 87%. Client acceptance of the modified recipes met the target threshold of a mean Likert-scale score of 3.75 out of 5.0, and the combined cost savings for both potato dishes was 45 cents per serving. Key informants noted the themes of economics of cost and labor, knowledge of how to identify reduced sodium options, and quality of the replacement food as essential factors for recipe modification. IMPLICATIONS FOR PUBLIC HEALTH: Using speed-scratch recipe modification for 2 potato dishes significantly reduced the sodium content of distributive meals for older adults. Speed-scratch recipe modification can be used as a tool to improve the nutritional value of meals and reduce the chronic disease burden of high-risk populations.

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.

PROBLEM STATEMENT AND SIGNIFICANCE: Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? METHODS: A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. RESULTS: Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. IMPLICATIONS FOR PRACTICE: This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.