Insights from Developing and Implementing a Novel School Community Collaborative Model to Promote School Safety.

BACKGROUND: School Resource Officer (SRO) programs do not reduce school violence and increase school discipline. We describe the use of a culturally responsive framework to form a school community collaborative among students, parents, staff, administrators, and law enforcement to reform an SRO program, promote school safety, and reduce punitive measures. METHODS: Members of a participating school district, a local county, and a university collaborated. Adapting an identified culturally responsive model, a racially/ethnically diverse school community co-developed and implemented a School Community Collaborative (SCC) to address a school safety priority (SRO program reform). The main outcomes were SCC model development and implementation, policy change, and school community feedback. RESULTS: Sixteen community members participated in the 5-week SCC with students, staff, law enforcement, and parents. The SCC revised the district's SRO memorandum of understanding (MOU) with law enforcement. Participants reported favorable feedback, and 89% reported the inclusion of diverse voices. CONCLUSIONS: Co-development and implementation of an SCC process with schools were feasible. School SCC participated in a community-engaged evaluation and revision of an MOU.

Provider perceptions of mHealth engagement for low-resourced, safety-net communities.

OBJECTIVE: Evaluate nurses' and other health care professionals' (HCPs) perceptions about implementing mobile health technology (mHealth) in clinical practice to support health care delivery for low-resourced, safety-net communities. DESIGN: Qualitative exploratory study using data collected from focus group sessions. Respondents addressed four topics: (1) technology's role in health care delivery; (2) barriers to incorporating mHealth data in clinical practice; (3) need for mHealth Clinical Practice Guide (CPG); and (4) mHealth's potential to improve health care access for marginalized communities. SAMPLE: Thirty HCPs providing services to community health center patients in Washington State and Washington, DC. MEASUREMENTS: Thematic analysis of qualitative data. RESULTS: Themes included:(1) mHealth's ability to provide customized reminders and data accuracy; (2) patients' mistrust of technology; (3) the possibility of linking community resources to address the social determinants of health;(4) mHealth's potential to improve patient-provider communication. CONCLUSION: Health care professionals support incorporating mHealth inpatient care but suggest that an mHealth CPG would improve its potential for facilitating health care delivery in low-resourced communities.

Technology's role in promoting physical activity and healthy eating in working rural women: A cross-sectional quantitative analysis.

AIMS: This exploratory study evaluated sociodemographic predictors of healthy eating and physical activity (PA) in a sample of working rural women and their access to and interest in using technology for health promotion. SETTINGS AND DESIGN: This study is a cross-sectional quantitative analysis. MATERIALS AND METHODS: A 32-item questionnaire was administered to a convenience sample of N = 60 women, working at a regional healthcare facility in the Pacific Northwest. STATISTICAL ANALYSIS: Descriptive statistics characterized PA and healthy eating, barriers and support for PA and healthy eating, and perceived role of technology for health promotion. Chi-square tests for categorical variables evaluated relationships between PA and healthy eating support with behavioral engagement. RESULTS: Only 23% and 25% followed recommended PA and fruit and vegetable consumption guidelines. Those likely to engage in preventive care had higher income and education. Fewer respondents reported barriers to PA than for healthy eating (47% vs. 57%), and those reporting barriers were likely to have lower income and less than a high-school education. Sixty percent reported social support for PA and only 52% for healthy eating. A significant relationship was evident between PA support and PA engagement (P = 0.015). Eighty-two percent used mobile phones to look up health information and 29% did so daily. Almost two-thirds (62%) reported likelihood of using online health information boards to support healthy eating and 45% for PA. CONCLUSION: Working rural women benefit from PA and healthy eating guidance. Attention to sociodemographic predictors may support a tailored digital healthcare approach to promote wellness in this community.

Physical Activity Support Predicts Safety-Net Patients' Digital Health-Care Engagement: Implications for Patient Care Delivery.

PURPOSE: Assess relationship among health services received and patients' digital health-care engagement. DESIGN: Quantitative cross-sectional survey study. SETTING: Community health centers in Washington state and DC. SAMPLE: N = 164 adult safety-net patients. INTERVENTION: Not applicable. MEASURES: Outcomes were knowledge and use of health apps. Predictors were health service access (access to specialists and health information); health service delivery (healthy eating and physical activity counsel); health service satisfaction; and perceived service value. ANALYSIS: Descriptive and multivariate regression analyses. Odds ratios (OR) reported for 95% confidence interval (CI). RESULTS: Response rate was 35%. Of all, 71% were knowledgeable of smartphone use for wellness and 48% used health apps. Physical activity (PA) counseling predicted knowledge and health apps use. Respondents receiving PA counseling were 2.61 times more likely to be knowledgeable about using smartphones for health promotion (OR = 2.61; P = .047; 95% CI: 1.01-6.73). Respondents receiving PA counseling were 2.89 times more likely to use health apps (OR = 2.89; P = .022; 95% CI: 1.17-7.17). Health information access predicted health apps use; respondents with easy access to general health information were 0.29 times as likely to use health apps (OR = 0.29; P = .043; 95% CI: 0.09-0.96). CONCLUSION: Targeted preventive care support encourages digital health-care engagement. mHealth may supplement health-care needs outside clinics.

Short-Term Outcomes of a Diversity, Equity, and Inclusion Institute for Nursing Faculty.

BACKGROUND: Student populations in the United States are increasingly diverse, prompting the need to make learning environments in schools of nursing more inclusive. Training for faculty is needed to support this work; however, evidence regarding best practices to make classrooms more inclusive is lacking. METHOD: A 3-day Diversity, Equity, and Inclusion (DEI) Institute was developed and conducted to create inclusive learning environments; facilitate crucial conversations on racism and other -isms, especially in the context of nursing and health equity; and practice these skills and develop or transform at least one actual class activity. RESULTS: DEI Institute satisfaction and impact were overwhelmingly positive, and statistically significant increases in DEI-related teaching self-efficacy were observed post-Institute (p values ranging from .0004 to < .0001). CONCLUSION: The DEI Institute is one example of a successful approach that can create inclusive learning environments and address issues related to health equity. [J Nurs Educ. 2019;58(11):633-640.].

Mobile Health Technology Knowledge and Practices Among Patients of Safety-Net Health Systems in Washington State and Washington, DC.

PURPOSE: Mobile health technology (mHealth) can reduce health disparities, but research on the health behaviors of low-income patients is needed. This study evaluates mHealth knowledge and practices of low-resource safety-net patients. METHODS: We administered a 47-item questionnaire to 164 low-income patients accessing services at community health centers in the state of Washington and Washington, DC. Predictor variables included demographic factors: age, race, ethnicity, income. Outcome variables were smartphone knowledge (smartphones as a wellness tool), medical app knowledge (availability of medical-based apps), smartphone practices (ever used smartphones for wellness), health apps practices (ever used health-based apps), and medical apps practices (ever used medical-based apps). Multivariate logistic regression assessed relationships between predictor and outcome variables. RESULTS: Mean age was 35.2 years (median: 34), and study cohort (N=159) consisted of mostly women (68%), white race (36%), and income of <$20,000/year (63%). Outcomes: 71% and 58% reported knowledge of using smartphones for wellness and knowledge of medical apps, respectively; 76% used smartphones for wellness, with adults 50+ years of age significantly less likely than younger adults (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.88-0.99); 48% used health apps, with adults 50+ years of age less likely than younger adults (OR: 0.95, 95% CI: 0.91-0.99) and respondents earning <$20,000/year less likely than higher earners (OR: 3.13, 95% CI: 1.02-9.57); and 58% used medical apps, with Hispanics/Latinos significantly more likely than non-Hispanics/Latinos (OR: 6.38, 95% CI: 1.04-39.02). CONCLUSIONS: Safety-net patients use mobile devices for health promotion. Age and income are important predictive factors, suggesting a more tailored design of the technology is required for broad engagement and health equity.

Anxiety and Depression Mediate the Relationship Between Perceived Workplace Health Support and Presenteeism: A Cross-sectional Analysis.

OBJECTIVE: This study investigates the mediation effect of anxiety and depression on the relationship between perceived health-promoting workplace culture and presenteeism. METHODS: Paper surveys were distributed to 4703 state employees. Variables included symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]); anxiety (General Health Questionnaire-12 [GHQ-12]); perceived workplace support for healthy living and physical activity; and presenteeism (Work Productivity and Activity Impairment Questionnaire). Correlational analyses assessed relationships among culture, mental health, and productivity. RESULTS: Indirect effects of workplace culture on productivity, mediated by anxiety and depression symptoms were significant (P's = 0.002). Healthy living culture and anxiety were significantly associated (r = -0.110, P < 0.01), and anxiety and presenteeism were significantly associated (r = +0.239, P < 0.01). CONCLUSION: Anxiety and depression determine the impact of perceived health promotive workplace culture on employee productivity. The paper highlights importance of health promotive practices targeting employee mental well-being.

Perceived workplace health support is associated with employee productivity.

PURPOSE: To examine the relationship between perceived workplace health support and employee productivity. DESIGN: A quantitative cross-sectional study. SETTING: Washington State agencies. SUBJECTS: A total of 3528 employees from six state agencies were included in this analysis. MEASURES: Perceived workplace health support was assessed by two questions that queried respondents on how often they felt supported by the workplace for healthy living and physical activity. The Work Productivity and Activity Impairment Questionnaire was used to measure health-related absenteeism and presenteeism in the past 7 days. ANALYSIS: Multivariate linear regression was used to estimate the mean differences in productivity by levels of perceived health support. RESULTS: Most participants were between 45 and 64 years of age and were predominantly non-Hispanic white. Presenteeism varied significantly by the level of perceived workplace health support, with those who felt least supported having higher presenteeism than those who felt most supported. The difference in presenteeism by perceived workplace support remained significant in models adjusting for sociodemographic and health characteristics (mean difference: 7.1% for support for healthy living, 95% confidence interval: 3.7%, 10.4%; 4.3% for support for physical activity, 95% confidence interval: 1.7%, 6.8%). Absenteeism was not associated with perceived workplace health support. CONCLUSION: Higher perceived workplace health support is independently associated with higher work productivity. Employers may see productivity benefit from wellness programs through improved perceptions of workplace health support.

Psychological distress after a positive fecal occult blood test result among members of an integrated healthcare delivery system.

BACKGROUND: Colorectal cancer screening (CRCS) reduces morbidity and mortality; however, the positive benefits might be partially offset by long-term distress following positive screening results. We examined relationships among colorectal cancer-specific worry and situational anxiety after positive fecal occult blood tests [FOBT (+)] compared with receipt of negative results. METHODS: Of note, 2,260 eligible members of Group Health, an integrated healthcare delivery system, completed baseline surveys and received FOBT screening kits, with 1,467 members returning the kits. We matched FOBT (+) patients (n = 55) 1:2 on age and sex with FOBT (-) respondents (n = 110). Both groups completed follow-up surveys at 7 to 14 days and 4 months after screening. We assessed situational anxiety (State-Trait Anxiety Inventory, STAI), colorectal cancer worry frequency, and mood disturbance. RESULTS: Mean age was 59 years, and majority were women (62%) and White (89%). After adjusting for age, sex, and baseline worry, at 7 to 14 days after screening, the FOBT (+) group was 3.82 [95% confidence interval (CI), 1.09-13.43] times more likely to report colorectal cancer-related mood disturbances and significantly higher mean STAI scores than the FOBT (-) group (mean = 38.8 vs. 30.9; P = 0.007). At 4-month posttest, mood disturbances and situational anxiety seemed to drop to baseline levels for FOBT (+). No colon cancer worry frequency was observed. CONCLUSIONS: FOBT (+) results are associated with short-term situational anxiety and colorectal cancer-specific mood disturbances. IMPACT: Distress from FOBT (+) results declined to near-baseline levels by 4 months. Additional studies are needed to clarify the relationship between long-term distress and follow-up colonoscopy.

Uptake and positive predictive value of fecal occult blood tests: A randomized controlled trial.

OBJECTIVE: The aim of this study is to compare the uptake of three mailed high-sensitivity fecal occult blood tests (FOBTs). METHODS: We conducted a parallel 3-arm randomized controlled trial in an integrated healthcare delivery system in Washington State. From January 2010 through February 2011, automated data were used to identify potentially eligible patients aged 50-74 due for colorectal cancer screening. Participants were mailed one of three FOBT kits (1-sample OC-Auto® fecal immunochemical test [FIT], 2-sample InSure® FIT, or 3-sample guaiac Hemoccult SENSA®), instructions, and a postage-paid return envelope. We performed a modified intent-to-treat analysis with return of any FOBT within 6 months of randomization as the primary outcome. RESULTS: Of the 9922 people invited, 2873 returned surveys, 2263 were randomized, and 2234 were analyzed. FOBTs were returned by 1431 participants. At 6 months post-randomization, the proportions screened by any FOBT were 0.69 (95% confidence interval [CI] 0.66-0.72) for the OC-Auto arm, 0.64 (95% CI: 0.61-0.68) for the InSure arm, and 0.61 (95% CI: 0.58-0.65) for the Hemoccult SENSA arm (P<0.001 for any difference). Pairwise comparisons showed significant differences between the OC-Auto group and each of the other groups after correction for multiple comparisons. CONCLUSION: Uptake of mailed FOBT kits varies by kit type.

Increasing evidence-based workplace health promotion best practices in small and low-wage companies, Mason County, Washington, 2009.

INTRODUCTION: Modifiable health risk behaviors such as physical inactivity, unhealthy eating, and tobacco use are linked to the most common chronic diseases, and chronic diseases contribute to 70% of deaths in the United States. Health risk behaviors can be reduced by helping small workplaces implement evidence-based workplace health promotion programs. The American Cancer Society's HealthLinks is a workplace health promotion program that targets 3 modifiable health risk behaviors: physical inactivity, unhealthy eating, and tobacco use. We evaluated employers' implementation of HealthLinks in small workplaces. METHODS: We targeted Mason County, Washington, a rural low-income community with elevated obesity and smoking rates. We conducted baseline assessments of workplaces' implementation of program, policy, and communication best practices targeting the health risk behaviors. We offered tailored recommendations of best practices to improve priority health behaviors and helped workplaces implement HealthLinks. At 6 months postintervention, we assessed changes in best practices implementation and employers' attitude about HealthLinks. RESULTS: Twenty-three workplaces participated in the program. From baseline to follow-up, we observed significant increases in the implementation of physical activity programs (29% to 51%, P = .02), health behavior policy (40% to 46%, P = .047), and health information communication (40% to 81%, P = .001). Employers favorably rated HealthLinks' appeal, relevance, and future utility. CONCLUSION: When offered resources and support, small and low-wage workplaces increased implementation of evidence-based workplace health promotion best practices designed to reduce modifiable health risk behaviors associated with chronic diseases. Results also suggest that HealthLinks might be a sustainable program for small workplaces with limited resources.

Nonparticipation in a population-based trial to increase colorectal cancer screening.

BACKGROUND: Many trials have tested different strategies to increase colorectal cancer (CRC) screening. Few describe whether participants are representative of the population from which they are recruited. PURPOSE: To determine risk factors related to nonparticipation among patients enrolled in an integrated health plan and not up to date for CRC testing, in a trial to increase screening rates. METHODS: Between July 2008 and October 2009, a total of 15,000 adults aged 50-74 years from 21 clinics in Washington State who were due for CRC screening were contacted. Nonparticipants were defined as English-speaking patients who did not engage in the call or refused participation while still potentially eligible. Log-binomial regression models were used to estimate the relative risk of nonparticipation. Analyses were completed between October 2010 and June 2011. RESULTS: Patients who were nonwhite, had less education, used tobacco, had less continuity of care, and had lower rates of preventive care and cancer screening were more likely to be nonparticipants. Patients reporting never having received any type of CRC testing or screening were also more likely not to participate (62% of nonparticipants vs 46% of participants; adjusted RR=1.58, 95% CI=1.47, 1.70). Reasons for refusal included costs, risks of procedures, and not wanting their medical records reviewed. CONCLUSIONS: Patients eligible for but not participating in the trial were more likely to be from minority socioeconomic and racial groups and had behaviors that can negatively affect cancer outcomes. Additional efforts are needed to recruit patients who need CRC screening the most. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov NCT 00697047.

Fall prevention knowledge, attitude, and practices of community stakeholders and older adults.

We assessed knowledge, attitude, and provision of recommended fall prevention (FP) practices by employees of senior-serving organization and participation in FP practices by at-risk elders. The Washington State Department of Health administered structured telephone surveys to 50 employees and 101 elders in Washington State. Only 38% of employees felt "very knowledgeable" about FP, and a majority of their organizations did not regularly offer FP services. Almost half (48%) of seniors sustained a fall within the past 12 months; however, one-third perceived falling to be among their least important health concerns, and most had minimal working knowledge of proven FP practices. Seniors who perceived avoiding falls as important to their well-being were more likely to participate in practices about which they had the least knowledge (risk assessment, medication management). Increased awareness and availability of FP services might help engage older adults in FP practices and reduce the adverse effects of falls.

Evaluating the relationships among psychological distress, executive cognitive function and economic factors on mammography use in unaffected African American women at risk for breast cancer.

OBJECTIVE: Psychological distress impairs the cognitive function involved in planning and decision-making (executive cognitive function), and hinders engagement in health promoting behaviors. This study examined the relationship among distress, executive cognitive function (ECF) and mammography use in African American women at risk for breast cancer. DESIGN: A cross-sectional sample of mammography screening adherers (n = 44) and non-adherers (n = 16) completed measures of psychological distress (Brief Symptom Inventory) and executive cognitive function, (Wisconsin Card Sort Task and Stroop Color Word Test). RESULTS: More than one-quarter of the high-risk sample had high levels of distress. Distress scores explained 12% of the variance in two ECF components (abstract concept formation and cognitive flexibility), suggesting a significant relationship between psychological distress and cognitive function. Distress scores and ECF measures did not predict mammography use; employment status emerged as the strongest predictor of mammography screening (OR = 4.36, 95% CI: 1.18-16.07). CONCLUSION: Elevated psychological distress is evident in high-risk African American women and appears to have an effect on the cognitive function involved in behavioral regulation and planning. Results also support the role of socioeconomic status as a significant predictor of mammography use.

Predicting regular breast cancer screening in African-American women with a family history of breast cancer.

OBJECTIVE: To evaluate the impact of socioeconomic, personal and affective factors on regular breast cancer screening in at-risk African-American women. METHODS: The study was a cross-sectional analysis assessing socioeconomic and affective predictors of breast cancer screening practices. Unaffected African-American women ages 40-64 with a family history of breast cancer were recruited from community settings. The main outcome measures were recent mammography, regular mammography and regular breast self-examinations. RESULTS: The majority of women reported having a recent mammogram (73%) and yearly mammograms (71%). More than half (56%) reported monthly breast self-examinations (BSEs). Available health insurance and risk perception had significant independent associations with regular mammography screening so that women having a mammogram every 6-12 months were more likely to have health insurance [odds ratio (OR)=4.99, 95% confidence interval (CI): 1.05-23.52], and women not engaged in regular screenings were less likely to perceive future breast cancer risk (OR=0.10, 95% CI: 0.01-0.96). Access to regular healthcare had a significant independent association with recent mammography so that women having a mammogram in the past 12 months were more likely to have access to regular healthcare (OR=6.59, 95% CI: 1.01-42.79). CONCLUSIONS: A significant majority of this subset of African-American women engage in repeat mammography screenings with cognitive and economic factors predicting noncompliance. Additional research with repeat mammography users is required so that regular screening practices can be encouraged among all at-risk women.