Characterizing household emergency preparedness levels for natural disasters during the COVID-19 pandemic: United States, 2020-2021.

INTRODUCTION: It is vital that households are prepared for a natural disaster to help mitigate potential negative impacts. Our goal was to characterize United States household preparedness on a national level to guide next steps to better prepare for and respond to disasters during the COVID-19 pandemic. METHODS: We added 10 questions to the existing Porter Novelli's ConsumerStyles surveys in fall 2020 (N = 4,548) and spring 2021 (N = 6,455) to examine factors that contribute to overall household preparedness levels. RESULTS: Being married (odds ratio (OR), 1.2), having children in the home (OR, 1.5), and having a household income of $150,000 or more (OR, 1.2) are all associated with increased preparedness levels. Those in the Northeast are least likely to be prepared (OR, 0.8). Persons living in mobile homes, Recreational Vehicles, boats, or vans are half as likely to have preparedness plans compared to those living in single family homes (OR, 0.6). CONCLUSIONS: As a nation, there is much work to be done in terms of preparedness to reach performance measure targets of 80 percent. These data can help inform response planning and the updating of communication resources such as websites, fact sheets, and other materials to reach a wide audience of disaster epidemiologists, emergency managers, and the public.

Developing a management and finance training for future public health leaders.

Public health leaders are increasingly being asked to address adaptive challenges in the context of finite and often limited resources. Budgets and their associated resources create the financial framework within which public health agencies and organizations must operate. Yet, many public health professionals expected to undertake roles requiring this foundational knowledge and skills are not trained in the fundamentals of public finance and are ill-equipped for managing and monitoring funds. Graduate courses in schools of public health most often are focused on health care management and finance or private sector finance. To meet the needs of future public health leaders, it is critical that academic content builds capacity in management and finance focused on public health practice. This paper describes the development of a Doctor of Public Health program management and finance course designed to prepare future public health leaders. The course aims to build the knowledge and skills of doctoral-level students to recognize the inherent challenges of public health finance and the importance of cultivating and managing resources to improve public health practice and achieve strategic public health goals.

Applying a Health Equity Lens to Evaluate and Inform Policy.

Health disparities have persisted despite decades of efforts to eliminate them at the national, regional, state and local levels. Policies have been a driving force in creating and exacerbating health disparities, but they can also play a major role in eliminating disparities. Research evidence and input from affected community-level stakeholders are critical components of evidence-based health policy that will advance health equity. The Transdisciplinary Collaborative Center (TCC) for Health Disparities Research at Morehouse School of Medicine consists of five subprojects focused on studying and informing health equity policy related to maternal-child health, mental health, health information technology, diabetes, and leadership/workforce development. This article describes a "health equity lens" as defined, operationalized and applied by the TCC to inform health policy development, implementation, and analysis. Prioritizing health equity in laws and organizational policies provides an upstream foundation for ensuring that the laws are implemented at the midstream and downstream levels to advance health equity.

Addressing Health Disparities in Adults with Developmental Disabilities.

Adults with developmental disabilities are a growing population that experiences significant health disparities due to unmet health care and social needs. Few standardized health care guidelines are available or broadly accepted as best practices for this population. The Adult Disability Medical Healthcare (ADMH) is a community-based clinic that provides a unique multidisciplinary team-based approach to addressing the social and health care needs of adults with developmental disabilities within the framework of a Patient Centered Medical Home model. ADMH is developing the necessary research infrastructure and obtaining input from individuals with developmental disabilities, their families, and community stakeholders and is performing foundational analysis to inform the development of guidelines for evidence-based best practices for the care of adults with developmental disabilities. This will set the stage for future research evaluating the impact of these guidelines on health outcomes and the reduction of health disparities in this population. This commentary highlights a process for development of evidence-based guidelines and best practices for care of adults with developmental disabilities.

Health Policy Training for Health Equity Leaders.

Health professional training programs increasingly recognize the importance of health policy training. Despite integration of this training into health professional education, there have been limited published studies about health policy training and few studies that meaningfully measure and evaluate learner outcomes. The Satcher Health Leadership Institute at Morehouse School of Medicine developed a multidisciplinary, post-doctoral, health policy fellowship program in 2009, uniquely focused at the intersections of health policy, health equity, and leadership development. The program curriculum was intentionally designed with desired learner outcomes, aligning training and learner experiences with these outcomes, and meaningfully capturing and measuring outcomes in program evaluation. We present our training approach as well as results from an alumni survey assessing learner outcomes one to five years post fellowship completion. To our knowledge, this is the first study that evaluates the longitudinal impact of health policy training on the career trajectories of program graduates. We believe this offers a number of opportunities for replication and translation across health professional training programs.

Curriculum Mapping and Needs Assessment to Inform the Training of Health Policy Leaders.

Purpose: To identify synergies and gaps in knowledge, skills, and attributes identified by health policy leaders and create a summary measure of congruence with the Health Policy Leadership Fellowship Program curriculum. Methods: We mapped the Health Policy Leadership Fellowship Program curriculum to the most highly ranked knowledge, skills, and attributes identified through the Health Policy Leaders' Training Needs Assessment survey. Results: Overall, the Health Policy curricular elements had the highest percentage of congruence with the needs assessment Knowledge elements (>60%). The lowest levels of congruence (<30%) occurred most frequently within the Attribute elements. Conclusions: Mapping an existing program's content and elements to needs perceptions from professionals practicing in the field may help to both inform and evaluate an existing program's ability to attract and meet the needs of target learners. While needs assessments have traditionally been used to help develop programs, this study also demonstrates their application as a process evaluation tool when mapped to existing programs' curricular elements.

Correlates of Combination Antiretroviral Adherence Among Recently Diagnosed Older HIV-Infected Adults Between 50 and 64 years.

Optimal adherence to combination antiretroviral therapy is essential to the health of older people living with HIV (PLWH), however, the literature on adherence and aging is limited. Using Medicaid data from 29 states (N = 5177), we explored correlates of optimal adherence among older PLWH. The prevalence of optimal adherence was low (32 %) in this study. Males were more adherent than females (APR = 1.11, 95 % CI 1.02-1.21, P = 0.0127); persons with three or more co-morbidities (APR = 0.67, 95 % CI 0.60-0.74, P < 0.001), two co-morbidities (APR = 0.86, 95 % CI 0.75-0.98, P = 0.0319) and one co-morbidity (APR = 0.82, 95 % CI 0.73-0.92, P = 0.0008) were less adherent than those without any co-morbidity; and residents of rural areas (APR = 0.90, 95 % CI 0.63-0.98, P = 0.0385) and small metropolitan areas (APR = 0.82, 95 % CI 0.72-0.94, P = 0.0032) were less adherent than residents of large metropolitan areas. There were no racial differences in optimal adherence. Targeted interventions that provide adherence support, case management, and peer navigation services may be of benefit in achieving optimal adherence in this population.

Health Policy Training: A Review of the Literature.

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach.

Racial/Ethnic Disparities in Mental Health Service Utilization among Youth Participating in Negative Externalizing Behaviors.

PURPOSES: Racial/ethnic differences in mental health service utilization were examined among youth who reported participating in negative externalizing behaviors. METHODS: The study utilized merged data from the 2007-2010 National Survey on Drug Use and Health (NSDUH) to examine differences in utilization of inpatient or outpatient mental health services not related to substance or alcohol use by White, Black and Hispanic youth who reported engaging in negative externalizing behaviors ("acting out"). Differences in service utilization in these groups were assessed using logistic regression models. RESULTS: Race/ethnicity was a significant predictor of outpatient mental health service use. Black and Hispanic children were less likely to use outpatient services. Inpatient service use decreased with increasing income. Parental presence in the household increased the likelihood of outpatient service use for minorities. CONCLUSION: Racial/ethnic minority youth in the United States continue to use outpatient mental health services at lower rates. This may lead to high prevalence of untreated negative externalizing behaviors among minority adolescent groups and, in turn, lead to use of inpatient services from systems such as juvenile justice and foster care. Such severe treatment alternatives can be prevented if timely and culturally tailored outpatient intervention is provided.

The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.

OBJECTIVES: We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). METHODS: We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). RESULTS: Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. CONCLUSIONS: Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.

The new invincibles: HIV screening among older adults in the U.S.

BACKGROUND: Thirteen percent of the U.S. population is ages 65 and older, a number projected to reach 20% by 2030. By 2015, 50% of Human Immunodeficiency Virus (HIV)-infected individuals in the U.S. are expected to be ages 50 and older. Current Centers for Disease Control and Prevention guidelines recommend "opt-out" HIV screening for individuals ages 13-64. The purpose of this study was to assess the occurrence and barriers to HIV screening in older adults, and to evaluate the rationale for expanding routine HIV screening to this population. METHODS: The study used 2009 National Health Interview Survey (NHIS) data. A total of 12,366 (unweighted) adults, ages 50 and older, participated in the adult section of the NHIS and answered questions on the HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis components. Associations between HIV screening, socio-demographic variables, and knowledge of HIV-related disease were examined using logistic regression models. RESULTS: The HIV screening rate within this population was 25.4%. Race had no statistically significant effect. Low risk perception of HIV exposure (84.1%) accounted for low likelihood of planned screening (3.5%) within 12 months post survey. A routine medical check-up was the single most common reason for HIV screening (37.6%), with only about half (52.7%) of the tests suggested by a health care provider. CONCLUSION: It is imperative that practices and policies are developed and implemented to increase HIV awareness and screening in the older adult population. Increased health care provider awareness of the importance of HIV screening, especially for those 65 and older, is critical. Health policies and clinical guidelines should be revised to promote and support screening of all adults.

Developing health leaders to combat sexual health disparities.

Health disparities, including sexual health disparities, remain pervasive in our society. The Satcher Health Leadership Institute at Morehouse School of Medicine, through its Sexual Health Scholars and Health Policy Leadership Fellowship Programs, is preparing the next generation of health leaders with the necessary knowledge and skills to combat health disparities.