Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations.

Objective: To describe the process of engaging community, caregiver, and youth partners in codeveloping an intervention to promote equitable uptake of the COVID-19 vaccine in non-Hispanic Black (Black) and Hispanic youth who experience higher rates of COVID-19 transmission, morbidity, and mortality but were less likely to receive the COVID-19 vaccine. Methods: A team of 11 Black and Hispanic community partners was assembled to codevelop intervention strategies with our interdisciplinary research team. We used a mixed-methods crowdsourcing approach with Black and Hispanic youth (n=15) and caregivers of Black and Hispanic youth (n=20) who had not yet been vaccinated against COVID-19, recruited from primary care clinics, to elicit perspectives on the acceptability of these intervention strategies. Results: We codeveloped five strategies: (1) community-tailored handouts and posters, (2) videos featuring local youth, (3) family-centered language to offer vaccines in the primary care clinic, (4) communication-skills training for primary care providers, and (5) use of community health workers to counsel families about the vaccine. The majority (56-96.9%) of youth and caregivers rated each of these strategies as acceptable, especially because they addressed common concerns and facilitated shared decision-making. Conclusions: Engaging community and family partners led to the co-development of culturally- and locally-tailored strategies to promote dialogue and shared decision-making about the COVID-19 vaccine. This process can be used to codevelop interventions to address other forms of public health disparities. Policy Implications: Intervention strategies that promote dialogues with trusted healthcare providers and support shared decision-making are acceptable strategies to promote COVID-19 vaccine uptake among youth from historically underserved communities. Stakeholder-engaged methods may also help in the development of interventions to address other forms of health disparities.

From the national to the local: Issues of trust and a model for community-academic-engagement.

Inequities in health and health care in the United States have persisted for decades, and the impacts on equity from the COVID-19 pandemic were no exception. In addition to the disproportionate burden of the disease across various populations, the pandemic posed several challenges, which exacerbated these existing inequities. This has undoubtedly contributed to deeply rooted public mistrust in medical research and healthcare delivery, particularly among historically and structurally oppressed populations. In the summer of 2020, given the series of social injustices posed by the pandemic and highly publicized incidents of police brutality, notably the murder of George Floyd, the Association of American Medical Colleges (AAMC) enlisted the help of a national collaborative, the AAMC Collaborative for Health Equity: Act, Research, Generate Evidence (CHARGE) to establish a three-way partnership that would gather and prioritize community perspectives and lived experiences from multiple regions across the US on the role of academic medicals centers (AMCs) in advancing health and social justice. Given physical gathering constraints posed by the pandemic, virtual interviews were conducted with 30 racially and ethnically diverse community members across the country who expressed their views on how medical education, clinical care, and research could or did impact their health experiences. These interviews were framed within the context of the relationship between historically oppressed groups and the COVID-19 vaccine clinical trials underway. From the three-way partnership formed with the AAMC, AAMC CHARGE participants, and 30 community members from racially and ethnically diverse groups, qualitative methods provided lived experiences supporting other literature on the lack of trust between oppressed communities and AMCs. This led to the development of the Principles of Trustworthiness (PoT) Toolkit, which features ten principles inspired by community members' insights into how AMCs can demonstrate they are worthy of their community's trust. In the end, the three-way partnership serves as a successful model for other national medical and health organizations to establish community engaged processes that elicit and prioritize lived experiences describing relationships between AMCs and oppressed communities.

The Benefits of Physician Training Programs for Rural Communities: Lessons Learned from the Teaching Health Center Graduate Medical Education Program.

Rural communities disproportionately face preventable chronic diseases and death from treatable conditions. Health workforce shortages contribute to limited health care access and health disparities. Efforts to address workforce shortages have included establishing graduate medical education programs with the goal of recruiting and retaining physicians in the communities in which they train. However, rural communities face a number of challenges in developing and maintaining successful residency programs, including concerns over financial sustainability and the integration of resident trainees into existing clinical practices. Despite these challenges, rural communities are increasingly interested in investing in residency programs; those that are successful see additional benefits in workforce recruitment, access, and quality of care that have immediate and direct impact on the health of rural communities. This commentary examines the challenges and benefits of rural residency programs, drawing from lessons learned from the Health Resources and Services Administration's Teaching Health Center Graduate Medical Education program.

Risk factors of hypertension and correlates of blood pressure and mean arterial pressure among patients receiving health exams at the Preventive Medicine Clinic, King Chulalongkorn Memorial Hospital, Thailand.

OBJECTIVE: The purpose of the present cross-sectional study was to determine the relevance of several risk factors for hypertension in a Thai population. MATERIAL AND METHOD: The authors used multiple linear regression to identify factors that influenced systolic blood pressure(SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) in a study of 1,398 patients. RESULTS: Hypertensive risk factors were similar among men and women. Increased age, body mass index (BMI), and low educational attainment, were statistically significant risk factors for hypertension in men. For example, overweight men (BMI = 25.0-29.9 kg/m2) were 1.88 times more likely to be hypertensive (OR = 1.88, 95%CI = 1.02-3.47) as compared with men who had a normal BMI (20.0-24.9 kg/m2). Obese men (> or = 30.0 kg/m2) had an increased risk, but this association was not significant (OR = 1.40, 95%CI = 0.34-5.69). Similar risk factors were identified among women. Overweight women had a 1.74-increased risk for hypertension (OR = 1.74, 95%CI = 1.13-2.69). The corresponding risk was increased 3-fold among obese women (OR = 3.05, 95%CI = 1.76-5.29). Among men, age and BMI were positively associated with increased SBP, DBP and MAP Men > or = 60 years of age had an increase in SBP (beta = 18.89, p < 0.001), DBP (beta = 5.53, p < 0.001), and MAP (beta = 9.89, p < 0.001) values as compared with the referent group (< 40 years). Similar associations were noted among women. CONCLUSION: Hypertension risk factors observed in this Thai population are similar to those found in Western populations. Prospective studies are needed to evaluate rigorously causal relationships between risk factors and hypertension.