Interorganizational collaboration in a trauma-informed community: A network analysis of cohesion and change.

Strengthening interorganizational collaboration is critical to mitigate the impact of adverse childhood experiences (ACEs) and improve community health. We examined change in interorganizational collaboration around ACEs within Peace4Tarpon's network and investigated factors influencing collaboration. We conducted a community-wide social network analysis among 32 trauma-informed organizations in 2016 and 2018, using network analysis methods to examine interorganizational cohesion (density, transitivity, triad census) over time, and multiple regression quadratic assignment procedure to investigate factors influencing collaboration. Network cohesion measures indicated small increases in collaboration level and greater network cohesion over time. Conducting ACEs screenings was a significant factor (b = 0.237; p < 0.01) predicting likelihood of interorganizational collaboration in 2016. No assessed ACEs practices predicted collaboration in 2018, suggesting variables assessed predicted a small proportion of variance in collaboration change. Results provide a foundation for understanding how ACEs/trauma-informed practices influence collaboration and highlight implications of interorganizational collaboration. Peace4Tarpon's 2-year progress provides insights for other trauma-informed communities.

Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model.

Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.

The Perceived Effectiveness of Various Forms of Feedback on the Acquisition of Technical Skills by Advanced Learners in Simulation-Based Health Professions Education.

Simulation-based health professions education (SBHPE) is a valuable approach for healthcare professionals to develop and refine technical skills in a safe environment. Feedback plays a crucial role in the acquisition of these skills, but little research has explored the effectiveness of augmented (knowledge of results (KR) and knowledge of performance (KP) versus intrinsic feedback types for advanced learners. Therefore, this study aimed to determine what type of feedback is perceived to be most effective by advanced learners when acquiring complex technical skills in SBHPE. The study followed the test and evaluated phases of the design-based research (DBR) framework. A total of 23 advanced care paramedics (ACPs) participated in the study and received feedback in the form of KR, KP, and intrinsic feedback while using the intraosseous (IO) access simulator. Participants completed a survey to evaluate their learning experience and rank the perceived effectiveness of each feedback type. The results of this study indicated that KP was perceived as the most effective type of feedback and KR was perceived as the least effective feedback, with intrinsic feedback being in the middle. This work provides insights into the use of augmented and intrinsic feedback for advanced learners in an SBHPE environment, but future work to assess the actual learning effects of these types of feedback is needed.

Defining the Nature of Augmented Feedback for Learning Intraosseous Access Skills in Simulation-Based Health Professions Education.

In the field of health professions education, acquiring technical skills involves three stages: 1) receiving instructions, 2) engaging in practice, and 3) receiving feedback. Simulation serves as a valuable tool that encompasses all three stages, enhancing the effectiveness of health professions education. This work focuses on feedback, which can be categorized as intrinsic (perceived by the learner through their senses) or augmented (provided by an external perspective). Augmented feedback can take the form of knowledge of results (information regarding the outcome) or knowledge of performance (information about the actions leading to the outcome). The overall objective of this work was to evaluate the perceived efficacy of these types of feedback in learning technical skills using a simulation, specifically an intraosseous access simulator, among advanced care paramedics. The primary focus of this article and the initial step towards achieving the aforementioned objective of this work was to determine the possible knowledge of results and knowledge of performance that paramedic facilitators could offer to advanced care paramedics during the use of an existing intraosseous access simulator. This research was conducted following the design-based research framework, employing a combination of design thinking and Delphi methods to generate a comprehensive list of augmented feedback, in both the form of knowledge of results and knowledge of performance, that can be provided to advanced care paramedics while learning intraosseous access skills through a simulator. The design thinking session was carried out to generate an initial inventory of augmented feedback, which was then refined through two rounds of Delphi consensus-building with paramedic experts. This process resulted in an eight-step list of feedback for knowledge of results and knowledge of performance that can be delivered to advanced care paramedics by paramedic facilitators using an intraosseous access simulator.

A scoping review: the psychosocial barriers that exist for people with vulvodynia.

BACKGROUND: Vulvodynia, including generalized vulvodynia and vestibulodynia, affects at least 8% to 16% of people with a vulva and may have a negative impact on one's quality of life, psychological health, interpersonal relationships, and individual behaviors. AIM: The aim of this scoping review is to synthesize and analyze the emerging literature of vulvodynia research while determining what psychosocial barriers exist for people with vulvodynia. METHODS: A rigorous literature search was completed in 6 databases: PubMed, CINAHL, Embase, Web of Science, APA PsycInfo, and Academic Search Premier. Key terms and subject headings, including Medical Subject Headings, were used to systematically search these databases. Two reviewers were utilized to assess the reference list and reduce bias. OUTCOMES: A total of 671 articles were discovered during the search, which was narrowed down to 73 that included at least 1 psychosocial barrier that patients experience in the United States and Canada. RESULTS: The findings of the literature search revealed the various psychosocial barriers that patients commonly face: pain, anxiety, depression, catastrophization, fear, lack of self-efficacy, low desire and arousal, negative body image, stigma, distress, posttraumatic stress disorder, child maltreatment and abuse, mistrust, invalidation and isolation, low levels of self-compassion, negative partner support, low relationship satisfaction, lack of physical affection, emotional regulation, and avoidance and lack of approach goals. In addition to psychosocial barriers, structural determinants and environmental barriers-such as delayed diagnosis, low health literacy, cost, transportation, and racial disparities-adversely affected individuals with vulvodynia. CLINICAL IMPLICATIONS: This review should serve as a guide for researchers, medical providers, and program developers to understand all the barriers that patients may face. STRENGTHS AND LIMITATIONS: This review comprehensively highlights existing psychological barriers while promoting structural and environmental barriers that people with vulvodynia face. More research and greater emphasis on the underlying physical conditions that contribute to vulvodynia are needed to effectively educate providers and patients on vulvar pain conditions. CONCLUSIONS: This scoping review highlights the numerous barriers faced by patients with vulvodynia and serves to improve education for patients and providers to achieve earlier diagnoses and better patient outcomes.

Integrating a Video Game Recording Into a Qualitative Research Methods Course to Overcome COVID-19 Barriers to Teaching: Qualitative Analysis.

BACKGROUND: Because of the COVID-19 pandemic, a doctoral-level public health qualitative research methods course was moved to a web-based format. One module originally required students to conduct in-person observations within the community, but the curriculum was adapted using a web-based video game exercise. OBJECTIVE: This study sought to evaluate students' perceptions of this adaptation and determine whether the new pilot format successfully met the module's original learning objectives. METHODS: Recorded footage of a video game session was used for students to observe, take field notes, and compare the results. Qualitative methods were used to evaluate student feedback on the curriculum and determine whether the original learning objectives were met. Data were analyzed using a directed content analysis. RESULTS: The findings demonstrate that all the learning objectives of this adapted qualitative observational research assignment using a web-based video game exercise were successfully met; namely, the students learned how to compare and contrast the observational notes of peers and to evaluate how personal bias and environmental factors can affect qualitative data collection. The assignment was also positively received by the students. CONCLUSIONS: The results align with the constructivist learning theory and other successful COVID-19 implementations. Our study demonstrates that the learning objectives of a qualitative observational assignment can be addressed given that there are proper forethought and delivery when the assignment is adapted to a web-based context using a video game exercise.

Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences.

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.

What does community resilience mean in the context of trauma-informed communities? A scoping review.

Several communities are implementing trauma-informed, community-level approaches focused on addressing/preventing adverse childhood experiences (ACEs), yet most community resilience definitions from published articles are based on acute traumas. This scoping review aims to determine how community resilience is defined and operationalized within the context of chronic/complex traumas. METHODS: We performed a rigorous, comprehensive literature search using multiple databases. RESULTS: The 38 included articles addressed multiple types of chronic traumas, including historical trauma, poverty, minority stress, mass incarceration, and ACEs. A variety of definitions of community resilience were cited, several of which stressed the ability to thrive despite risk factors and the safety and wellbeing of residents. Few articles operationalized community resilience within the context of ACEs, suggesting significant gaps in the literature. CONCLUSION: This review can serve as an important building block to develop expanded definitions of community resilience for chronic traumas and assist communities in promoting community-wide responses to ACEs.

Organizational partnerships for a trauma-informed community: A community-wide social network study.

We investigated whether Peace4Tarpon's trauma-responsive community capacity activities led to greater collaboration among community partners. We conducted longitudinal social network analysis (SNA) among organizations within Peace4Tarpon's network in 2016 and 2018 to capture cooperation around adverse childhood experiences-related topics. We examined network structure, cohesion, organizational collaboration, and associations between centrality and organizational practices. Peace4Tarpon's network included diverse sectors, with a group of organizations forming the network core and collaborating over time. The network displayed a small increase in cohesion, more cross-sector collaboration, and less heterophily over time. We found a significant difference between the mean betweenness centralities of organizations who assessed resilience and those who did not in the 2018 average union network. This is one of the first studies using SNA to investigate a trauma-informed community network. Findings from this type of analysis may assist community organizations in strengthening outreach and strategically engaging organizations within a trauma-informed network.

Implementation of a teacher-led mindfulness program in a low-income pre- and early-elementary school as part of a trauma-responsive, resilience-building community initiative.

Children living in disadvantaged communities experience higher rates of adverse childhood experiences (ACEs) which can lead to poor health outcomes. Mindfulness has been shown to help individuals who are exposed to cumulative stress build resilience and psychological well-being. This pilot study aimed to determine teachers' perceptions of a 6-week school-based, teacher-led mindfulness program in a Gainesville, Florida pre- and early elementary low-income school. The program was conducted as part of a trauma-responsive, resilient community initiative. Teachers were trained on a set of mindfulness skills and were asked to lead practices for 10-15 min per day, 3 or more times per week for 6 weeks. Teachers completed qualitative interviews to determine their perceptions of the program. A total of eight teachers participated, with 124 students receiving the program. Teachers reported high impressions of the program and that students were calmer and more relaxed as a result of the program. Training teachers to deliver mindfulness practices as part of their normal classroom activities is realistic, easily adaptable, and can lead to adoption of a community-wide mindfulness framework. Diffusing mindfulness programs more broadly as part of a preventive, trauma-responsive community has the potential to lessen the effects of ACEs.

Maternal Cotinine Levels and Red Blood Cell Folate Concentrations in the Periconceptual Period.

OBJECTIVES: Studies have examined the association between tobacco use and folate levels in pregnancy, yet few have assessed this relation using objective and accurate measures of both smoking and folate. In this study, we evaluated the association between maternal cotinine levels and periconceptional red blood cell (RBC) folic acid reserves in a cohort of low-income pregnant mothers. METHODS: Smoking information, based on salivary cotinine, a highly sensitive and specific tobacco smoke exposure biomarker, was used. Furthermore, folate was assessed using RBC folate, an indicator of long-term folate storage. Participants were early to mid-trimester pregnant women who received antenatal care between 2011 and 2015 at the Genesis Clinic of Tampa (Florida). A total of 496 women were enrolled in the study. Associations between smoking status/maternal salivary cotinine concentrations, sociodemographic factors, and folate concentrations were investigated using Tobit regression analyses. RESULTS: The mean folate level of the participants was 718.3 ± 183.2 ng/mL, and only 2 (0.4%) participants were deficient in folate. We observed no significant difference in folate levels by smoking status. In contrast, salivary cotinine levels were significantly associated with decreased RBC folate concentrations (ß -11.43, standard error 5.45, P = 0.032). Prepregnancy maternal body mass index, gestational age, stress, and depression also were associated with folate levels. CONCLUSIONS: Low RBC folate is associated with perinatal factors, including high maternal cotinine levels, body mass index, stress, and depression. The effect of low folate levels among smokers cannot be overemphasized, considering that tobacco products not only reduce folate levels but also decrease the bioutilization of folate.

Racism, Psycho-Social Stress, and Health-related Quality of Life.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress.

Phenotypes of fetal macrosomia and risk of stillbirth among term deliveries over the previous four decades.

OBJECTIVES: To evaluate the association between macrosomia and stillbirth over the previous four decades and to determine the consistency of the relationship. METHODS: This was a population-based retrospective cohort study using United States Natality and Fetal Death Data from 1982 to 2017 and restricted to the gestational age range of 37-41 weeks inclusive. Macrosomia was defined as birthweight ≥4000 g and subdivided into its grades as previously recommended: grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g). We calculated temporal trends of stillbirth among fetuses with macrosomia over the years using joinpoint regression. We generated odds ratios from adjusted binomial logistic regression models to examine the association between macrosomia and risk of stillbirth stratified by grades using normal-weight infants (2500-3999 g) as referent. RESULTS: Within the fetal macrosomia group, the rate of stillbirth declined from 2.04/1000 in 1982 to 1.05/1000 by the end of the study period (2017), representing a drop of about 48.5%. For the normal-weight fetuses, stillbirth rate declined from 1.95/1000 to 0.83/1000, equivalent to a decline of 57.4%. Macrosomia was significantly associated with elevated risk for stillbirth: grade 2 (OR = 1.27; 95% CI = 1.22-1.32) and grade 3 (OR = 5.97; 95% CI = 5.69-6.22). CONCLUSIONS: Fetal macrosomia is a significant risk factor for fetal demise with the worst intrauterine survival observed among those classified as grade 3. Fetal macrosomia is a heterogeneous rather than a homogeneous entity in terms of risk profiles, and this needs to be considered in future policy guidelines.

Protective Factors Using the Life Course Perspective in Maternal and Child Health.

The life course perspective (LCP), a valuable theoretical framework for investigating racial disparities in birth outcomes, examines the cumulative exposure of risk and protective factors throughout the life span. Although risk and protective exposures are equally vital to health, most studies have focused solely on the risk factor exposures faced by vulnerable populations. In clear contrast to the traditional public health approach, which emphasizes a deficit model, strengths-based approaches focus on protective factors and fostering resilience. These approaches view communities as valuable assets that have the capacity to fully engage themselves and their residents to achieve optimal health. Participatory action research methods are well suited to apply a strengths-based approach to understand health disparities. Our study aimed to explore maternal and child health protective factors from community residents' perspective. A group of researchers, including active members in the community with a long history of grassroots development work, conducted ten community-based participatory focus groups with community residents in Tampa, FL, using the LCP framework. A total of 78 residents participated in ten focus groups. Perceived protective factors during pregnancy included self-esteem, spirituality, pregnancy support, good nutrition, prenatal care, and community resources. Protective factors for non-pregnant women were self-esteem, spirituality, social support, health literacy, community support and community resources, and societal factors. For children and adolescents, relevant protective factors were self-esteem, positive role models, nutrition and physical activity, and community support. The identified factors are community assets or strengths that mitigate or eliminate maternal and child health risks in families and communities residing in low-income neighborhoods, which must be considered in developing effective maternal and child health interventions.

Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971-2017.

PURPOSE: Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28-42 weeks inclusive. METHODS: This was a retrospective cohort study covering the period 1971-2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000-4499 g), Grade 2 (4500-4999 g) and Grade 3 (≥ 5000 g). RESULTS: A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain. CONCLUSION: This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.

Effects of Maternal Carbohydrate and Fat Intake on Fetal Telomere Length.

OBJECTIVES: Telomere length can be affected by dietary factors in adults. We investigated the association between maternal carbohydrate and fat intake during pregnancy and telomere length in neonatal cord blood leukocytes. We hypothesized that high fat consumption and high carbohydrate consumption would be associated with shortened fetal telomere length. METHODS: We collected umbilical cord blood at delivery from women admitted for labor and delivery in a university hospital (N = 62) and extracted genomic DNA using quantitative polymerase chain reaction. We quantified telomere length using the telomere-to-single copy gene ratio method (T:S ratio). High carbohydrate intake was defined as consumption of >175 g/day and high fat intake as >35 g/day. We performed generalized linear regression modeling and bootstrap statistical analyses to derive precise estimates of association. RESULTS: Of the 62 maternal-fetal dyads included in this study, 79% were classified as high carbohydrate consumers and 37% were classified as high fat consumers. High fat consumption had a significant negative effect on T:S ratio (P < 0.05). Although high carbohydrate consumption was associated with a decreased T:S ratio, this relation did not attain statistical significance. CONCLUSIONS: To our knowledge, this study is the first evidence of an association between maternal high fat consumption and shortened fetal telomere length. These findings could enhance our understanding of the role of maternal diet in fetal programming.

Evidence of altered brain regulatory gene expression in tobacco-exposed fetuses.

AIM: We sought to determine the association between prenatal smoking status and expression of fetal brain regulatory genes. METHODS: At delivery, we collected information from parturient women on prenatal smoking habits and analyzed salivary cotinine levels. We obtained neonatal umbilical cord blood and extracted total RNA. We then employed the quantitative polymerase chain reaction (QPCR) analyses and the comparative CT method to calculate the relative gene expression of selected fetal brain regulatory genes responsible for (1) brain growth (brain-derived neutrotrophic factor, BDNF), (2) myelination (proteolipidic protein 1, PLP1 and myelin basic protein, MBP), and (3) neuronal migration and cell-cell interactions during fetal brain development or RLN. The χ2-test, analysis of variance (ANOVA), and the Grubb test were used to evaluate the relationship between prenatal smoking status and relative gene expression levels. Further analysis using bootstrapping was performed to assess the precision of our estimates. RESULTS: Of the 39 maternal-infant dyads included in this study, 25.6% were non-smokers, 43.6% were passive smokers and 30.8% were active smokers. The results showed down-regulation of the selected fetal brain regulatory genes among active smokers. CONCLUSIONS: These findings represent preliminary evidence in humans that intrauterine tobacco exposure impacts fetal brain programming. Future studies are warranted to examine whether our findings represent potential mechanisms through which adverse childhood/adult-onset cognitive and behavioral outcomes that have been previously linked to intrauterine exposure occur.

Exploring the Life Course Perspective in Maternal and Child Health through Community-Based Participatory Focus Groups: Social Risks Assessment.

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Association Between Maternal-Perceived Psychological Stress and Fetal Telomere Length.

OBJECTIVE: Our study aimed to investigate the association between maternal-perceived psychological stress and fetal telomere length. METHODS: We recruited women in labor upon hospital delivery admission. Based on responses to the Perceived Stress Scale, we categorized participants as having "high," "normal," or "low" perceived stress. We collected umbilical cord blood samples (N = 71) and isolated genomic DNA from cord blood leukocytes using quantitative polymerase chain reaction. We used a ratio of relative telomere length derived by telomere-to-single-copy gene ratio (T/S ratio). We applied analysis of variance and bootstrapping statistical procedures. RESULTS: Sixteen (22.5%) women were classified as having low perceived stress, 42 (59.2%) were classified as having normal perceived stress, and 13 (18.3%) were classified as having high perceived stress. Fetal telomere length differed significantly across the three stress groups in a dose-response pattern (T/S ratio of those with low perceived stress was greater than those with normal perceived stress, which was greater than those with high perceived stress [P < 0.05]). CONCLUSIONS: Our findings support our hypothesis that maternal-perceived psychological stress during pregnancy is associated with shorter fetal telomere length and suggest maternal stress as a possible marker for early intrauterine programming for accelerated chromosomal aging.