The First Steps to Building Research Collaborative Using Strength-Based Assessments and GIS Maps with a Sample of Community-Based Organizations in the Bronx, NY.

Introduction: Community-based participatory research (CBPR) is one of the most effective strategies for conceptualizing, developing, and executing programs or interventions that address health disparities in community settings. The City University of New York (CUNY)'s Institute for Health Equity (CIHE) focuses on the social determinants that affect the physical and mental health of New York City's poor and underserved. Methods: This study utilized a modified Strengths, Weaknesses, Opportunities, and Threats (SWOT) tool as a strength-based assessment (SBA) to evaluate community-based organization (CBO)'s Areas for Growth (SWOT-SBA). This approach was used to identify CBOs' strengths, prospects, and priorities to address the Bronx's health disparities. Furthermore, this study collected descriptive information on CBO's catchment areas, services provided, and population served to create interactive and static maps and contingency tables using the Arch-GIS software. Results: This study was the first step to building CIHE Healthy-Bronx Research Collaborative to address the Bronx's health disparities. The results indicate that Hunts Point and Longwood Community Districts are the most served by CBOs. The SWOT-SBA suggests that CBOs' engagement through "appreciative inquiry" to conduct a CBPR has the most promise for a successful partnership between CBOs, research partners, and local stakeholders. Conclusion: This analysis suggests that CBOs center their resources to function as a leader in the Bronx and have identified the need to expand services during the pandemic. Findings from this study suggest that CBOs want to collaborate in CBPR initiatives.

National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017-2022.

BACKGROUND: Any form of racism in healthcare is an unacceptable barrier to receiving equitable and quality care, further contributing to health disparities among populations. For these reasons, it is critical to have a better understanding on the amount of research and scientific advances of funded projects aimed at racism in healthcare. An examination of the distribution of R-series funded research by the National Institutes of Health (NIH) on racism in healthcare during a 5-year fiscal year (FY) period (2017-2022) was conducted by the study team. METHODS: This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) for research project grants awarded on racism and healthcare during the FYs of 2017 to 2022. The number of R-series NIH funded projects on racism in healthcare were examined, including the abstract and public health relevance statement, number of publications, spending category, fiscal start and end dates, total amount of funding each year, funding agency/center(s), and type of funding opportunity announcements. Descriptive statistics were performed on the data by the research team. RESULTS: There were a total of 93 R-series grants funded during the FYs of 2017 to 2022. Most of the grants were R01s (77.4%); focused primarily on racism at the system-wide level (68.8%), and on patients (64.5%); the largest racial and ethnic minority group reported were African/American/Black (20.4%); and close to 40% did not report race or ethnicity. None of the grants focused in internalized racism, which is at the individual -level. From the FYs of 2017 to 2022, 0.07% of all NIH research funding was awarded to racism in healthcare. CONCLUSION: The findings of this study showed the need for continued funding and of the need of more research on racism in healthcare, that potentially can reduce health disparities and inequities.

Lessons to Build an Educational Model for Higher Education Institutions Defined as Anchor Institutions to Tackle Public Health Crises: A Pilot Study on COVID-19 Vaccine Hesitancy Among Faculty and Students in Hebert L. College in the Bronx, NY.

Coronavirus disease 2019 exacerbated health inequities in Bronx Communities. This study explored vaccine hesitancy among a random sample of faculty and students from Hebert Lehman College. Findings suggest faculty are largely vaccinated (87%), while 59% of students are unvaccinated. Significant gaps in information were found related to safety and complications. This suggests universities need to adopt an educational model with a multipronged social support strategy to gain students' trust and a greater sense of belonging.

COVID-19 exacerbó las desigualdades de salud en el Bronx. Herbert Lehman College, es uno de los campos del sistema de la ciudad de New York ubicado en el Bronx, con más del 60% de los estudiantes residiendo en el Bronx. En este estudio, se recolectó una muestra aleatoria de estudiantes y profesores de Lehman para entender la predisposición y resistencia a recibir la vacuna contra el COVID-19. Los resultados sugieren que la mayoría de los profesores reportan están vacunados, mientras que solo el 59% de los estudiantes reportan estar vacunados. Se encontraron lagunas significativas de información relacionadas con seguridad y complicaciones. Este estudio sugiere que las universidades necesitan adoptar un modelo educacional con estrategias de apoyo social múltiple para obtener confianza estudiantil y un mayor sentido de pertenencia.

Disparities in violent fatal injury among racial and ethnic minorities, 2009-2019: a portfolio analysis of United States-National Institutes of Health.

The excess mortality burden due to violent fatal injuries is an urgent public health issue for adolescents and young adults, especially those from racial and ethnic minority populations. We examined the research portfolio of the United States National Institutes of Health (NIH) related to violent fatal injuries between 2009 and 2019 to focus on adolescents and young adults from NIH-designated populations experiencing health disparities and to identify trends and research gaps. We analyzed funded projects by populations covered, geographic location of the study population, type of research (etiology, intervention, methodology), type of determinants, and publications generated. In 10 years, NIH funded 17 grants that produced 90 publications. Researchers used socioecological frameworks most to study violent crime, except in rural locations. Research gaps include the direct impact of violent crime among those victimized and health care (the least studied determinant) and premature mortality disparities caused by hate crimes.

Longitudinal trends (2011-2020) of premature mortality and years of potential life loss (YPLL) and associated covariates of the 62 New York State counties.

BACKGROUND: New York State (NYS) is the 27th largest state and the 4th most populous state in the U.S., with close to 20 million people in 62 counties. Territories with diverse populations present the best opportunity to study health outcomes and associated covariates, and how these differ across different populations and groups. The County Health Ranking and Roadmaps (CHR&R) ranks counties by linking the population's characteristics and health outcomes and contextual factors in a synchronic approach. METHODS: The goal of this study is to analyze the longitudinal trends in NYS counties of age-adjusted premature mortality rate and years of potential life loss rate (YPLL) from 2011-2020 using (CHR&R) data to identify similarities and trends among the counties of the state. This study used a weighted mixed regression model to analyze the longitudinal trend in health outcomes as a function of the time-varying covariates and clustered the 62 counties according to the trend over time in the covariates. RESULTS: Four clusters of counties were identified. Cluster 1, which represents 33 of the 62 counties in NYS, contains the most rural counties and the least racially and ethnically diverse counties. Clusters 2 and 3 mirror each other in most covariates and Cluster 4 is comprised of 3 counties (Bronx, Kings/Brooklyn, Queens) representing the most urban and racial and ethnic diverse counties in the state. CONCLUSION: The analysis clustered counties according to the longitudinal trends of the covariates, and by doing so identified clusters of counties that shared similar trends among the covariates, to later examine trends in the health outcomes through a regression model. The strength of this approach lies in the predictive feature of what is to come for the counties by understanding the covariates and setting prevention goals.

Using Economic Evaluation to Hasten Health Equity.

Achieving health equity has proven elusive for two reasons. First, most research has focused on changing the behavior of individuals; however, policies that address socioeconomic factors or change the context to facilitate healthy decisions tend to be more effective. Second, health disparity science and evidence are not consistently used to guide policy makers, even those seeking health equity. In this perspective, we discuss economic evaluation tools that researchers can use to assist decision-makers in conducting research or evaluating policy: self-reported health-related quality of life surveys and cost-benefit analysis evaluations informed with willingness to pay research and analyses.

NIH Portfolio of Unintentional Injury Research Among Racial and Ethnic Minority Children: Current Landscape and Future Opportunities.

Unintentional injuries (UIs) caused by accidental suffocation, burns, drowning, falls, poisoning, and motor vehicle accidents are the leading causes of morbidity and mortality among children (Dellinger and Gilchrist. Am J Lifestyle Med; 2017). Notable racial and ethnic disparities exist in accidental suffocation among infants and in motor vehicle injuries (MVI) among youth. The purpose of this study is to examine the National Institutes of Health's funded research projects addressing UIs, using a socioecological framework, and to determine whether funded projects align with key priorities for unintentional injuries among racial and ethnic minorities as identified by the research community. Between 2011 and 2018, a total of 130 grants that examined UIs were identified, thirty-four of which focused on UI research among children. Of those 34 grants, eight focused on UIs among racial and ethnic minority children. The analyses suggest four areas of opportunities, where more research is needed to (1) prevent accidental suffocation among American Indians and Alaska Natives; (2) strengthen the role of the health care sector to prevent UIs; (3) promote the use of an integrative multilevel social ecological approach to characterize UIs and help shape interventions; and (4) promote the collection and dissemination of local injury-specific data to develop interventions in community settings. Identifying gaps and opportunities for reducing the health burden of UI among racial and ethnic minorities can inform prevention efforts and guide the development of interventions that target these populations.

Inadequate Data Limit the Analysis of Health Disparities and Causes: A Call for Research on Youth Interpersonal Violence.

Interpersonal violence among racial and ethnic minority youth is of great concern in health disparity research. Child maltreatment (CM), adolescent dating abuse (ADA), sexual abuse, and polyvictimization are key forms of interpersonal violence that require surveillance and national epidemiological data. However, national data systems and published evidence do not depict this health burden for all racial and ethnic populations. Prevalence and incidence rates for American Indians, Eskimo, and Asian youth are absent from most estimates. This commentary provides a brief overview of the gaps in the literature and offers suggestions for addressing these gaps.

The impact of nursing students on the health-related quality of life and perceived social support of a rural population in Ecuador: effects of a service-based learning course.

BACKGROUND: Students seeking degrees in healthcare in Ecuador participate in community improvement projects and provide free health services under the supervision of faculty health professionals. The aim of this study is to determine the impact of a community-based intervention delivered by nursing students on health-related quality of life (HRQoL) and perceived social support of a rural population in Ecuador. METHODS: A quasi-experimental non-equivalent control group design study was conducted in two rural communities in Tumbaco, Ecuador. Families from one rural community were invited to participate in the intervention, receiving 8 weekly home visits from nursing students. Families from a neighboring community were similarly recruited as wait-list controls. One member of each family was consented into the study; the final sample included 43 intervention participants and 55 control participants. HRQoL and perceived social support were assessed before and after the intervention in both groups. The SF-12 was used to measure HRQoL, including eight domain scores and two composite scores, and the Interpersonal Support Evaluation List was used as an indicator of perceived social support. Difference-in-differences (DD) analyses were conducted to mitigate the effects of any baseline differences in the non- equivalent control group design. RESULTS: When compared to the control group, the intervention group realized significant improvements in the physical component summary score of the SF-12 (4.20, p < 0.05) and the physical function domain of the SF-12 (4.92, p < 0.05). There were no statistically significant differences for any other components of the SF-12 or in the measure of perceived social support. CONCLUSIONS: Nursing students completing their rural service rotation have the potential to improve the health-related quality of life of rural residents in Ecuador. Future research should continue to examine the impact of service-based learning on recipient populations.

Developing local health policy: Profiling needs and opportunities in the Municipality of Quito, Ecuador.

We describe the steps taken and analysis applied in developing a local health policy agenda for the city of Quito, in Ecuador. In 2014, the Health Commissioner's Office of the Municipality of Quito analyzed the city's epidemiological health profiles, social determinants of health, the legal authority of the Municipality, and relevant literature to understand the city's health burden and develop a Ten-Year Health Plan (2015-2025). Results revealed that Quito's population suffered from noncommunicable chronic diseases (diabetes and hypertension) and identified the primary risk factors (poor nutrition, physical inactivity, and resulting overweight or obesity). Other common conditions included respiratory diseases, mental health conditions, deaths and injuries from motor vehicles, violence, and physical insecurity. The plan emphasized health promotion and disease prevention with the aim of transforming citizens' health perceptions with their active participation by fostering public and private intersectoral commitment to improve the quality of life of the population .

How much are Ecuadorians Willing to Pay to Reduce Maternal Mortality? Results from a Pilot Study on Contingent Valuation.

CONTEXT: There is an established association between the provision of health care services and maternal mortality. In Ecuador, little is known if the societal value is greater than the resources expended in preventive medicine. AIMS: The purpose of this research is to investigate Ecuadorians' willingness to pay to prevent maternal death and disabilities due to complications of care during childbirth in the context of universal coverage. METHODS AND MATERIALS: The study elicited a "contingent" market on morbidity and mortality outcomes, specific to Ecuador's epidemiologic profiles between a hypothetical market that included a 50% reduction in the risk of maternal mortality from 100 to 50 per 100,000, and a market that included a 50% reduction in the risk of maternal morbidity from 4,000 to 2,000 per 100,000. RESULTS: The average amount participants are willing to pay (WTP) to prevent maternal mortality in the context of universal coverage, was $176 a year (95% CI=$172, $179). The unadjusted mean WTP for a reduction in the maternal morbidity risk was $135 (95% CI=$132, $139). Translated into Value of statistical Life, participant´s from this study valued the prevention of one statistical maternal death at USD $352,000. CONCLUSION: Results suggest that the costs of maternal care do not outweigh the benefit of prevention, and that Ecuadorians are willing to pay a significant amount to reduce the risk of maternal mortality. GLOBAL HEALTH IMPLICATIONS: Reduction of maternal mortality will remain an important global developmental goal in the upcoming years. Having a monetary approximation on the value of these losses may have important implications in the allotting financial and technical resources to reduce it.

The longitudinal effect of drug use on productivity status of nonmetropolitan african american young adults.

The purpose of this study was to investigate the longitudinal effect of marijuana and heavy alcohol use on the productivity status of nonmetropolitan African American young adults. This analysis was based on secondary data from the Family and Community Health Study. For alcohol, the study evaluated the effects on productivity status for individuals with heavy alcohol use trajectories from adolescence into young adulthood while marijuana effects were evaluated during the period when adolescents are more likely to have initiated usage (14-16 years of age). Productivity status was measured when study participants were between 18 and 21 years, for both alcohol and marijuana. Multivariate logistic regression models were used to test the association between subjects' drug use and productivity. Bivariate analysis of the effects of marijuana use indicate that marijuana users by age 16 are 35% less likely to be productive at age 21 than those who have not initiated marijuana use (p < .005). After controlling for individual, community, and family factors, the multivariate logistic models for alcohol and marijuana use suggest that early adolescence drug use (marijuana and heavy alcohol use) do not have an impact on productivity status during early adulthood. Analyzing and understanding the different drug use trajectories in relation to a productivity outcome is important for policies and research geared to preventing drug use and in identifying its relation with micro- and macro-level labor market outcomes.

The economic burden of intimate partner violence in ecuador: setting the agenda for future research and violence prevention policies.

INTRODUCTION: Intimate partner violence (IPV) is a widespread social structural problem that affects a great proportion of Ecuadorian women. IPV is a sexually, psychologically, or physically coercive act against an adult or adolescent woman by a current or former intimate partner. Not-for-profit groups in Ecuador report that 70% of women experience 1 of the forms of IPV sometime during their lifetime, but population-based surveys suggest that 41% of Ecuadorian women are exposed to emotional violence, 31% physical violence, and 12% sexual violence by their spouse or partner over their lifetime. Despite the high prevalence, the response of the Ecuadorian government has been insufficient to reduce the number of victims and to provide adequate legal and health services for the prevention and treatment of IPV. Given the power of economic data to influence policy making, the goal of this study is to produce the first estimate of the economic impact of IPV in Ecuador and to identify the policy paths in which these estimates would have the greatest impact for Ecuador. METHODS: Using a bottom-up method for estimating the economic burden of IPV and a national prevalence of IPV based on a population-based survey in the 2003-2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 United States (U.S.) currency rate. RESULTS: Based on a prevalence of 255,267 women who were victims of IPV in the 2003-2004 year, the total economic burden is estimated at approximately $109 million adjusted to the 2012 the U.S. currency rate. The largest cost category contributing to the economic burden was the costs of healthcare services to treat injuries associated with IPV events. CONCLUSION: The asymmetry between the economic burden of IPV and the amount of government resources devoted to IPV prevention efforts suggests the need for a greater role to be played by the government and other factors in society in the area of IPV prevention.