An Academic-Health Department Community Partnership to Expand Disease Investigation and Contact Tracing Capacity and Efficiency During the COVID-19 Pandemic.

Disease investigation and contact tracing are long-standing public health strategies used to control the spread of infectious disease. Throughout the COVID-19 pandemic, health departments across the country have lacked the internal workforce capacity and technology needed to efficiently isolate positive cases and quarantine close contacts to slow the spread of SARS-CoV-2. This article describes an innovative disease investigation and contact tracing program developed through a formalized community partnership between a local county health department and local university. This innovative new program added 108 contact tracers to the county's public health workforce, as well as enabled these contact tracers to work remotely using a call center app and secure cloud-based platform to manage the county's caseload of cases and contacts. An overview of the requirements needed to develop this program (eg, hiring, health data security protocols, data source management), as well as lessons learned is discussed.

Adoption, Sustainability, and Dissemination of Chronic Disease Prevention Policies in Community-Based Organizations.

Introduction. Despite increasing interest in structural (policy, systems, and environmental) changes to improve health, little attention has focused on the adoption, implementation, sustainability, and potential for dissemination of these changes among local community-based organizations. Method. A mixed methods approach was used for this process evaluation. Representatives of nine community-based organizations were surveyed using closed-ended questions and in-depth qualitative interviews to describe 32 policy changes. Diffusion of Innovation theory was used to inform the development of survey questions and the interview guide. Results. Policies adopted by local community-based organizations concerned types of food/beverages provided to staff/clients, methods to encourage physical activity, breastfeeding support, and tobacco control. The majority of the policies were either fully (66%) or partially (31%) implemented 1 year after their initial adoption. In general, participants somewhat/strongly agreed that policies had characteristics that predict sustainability/diffusion (relative advantage, compatibility, complexity, trialability, observability). In-depth interview responses described a generally smooth process for policy adoption and high levels of optimism for continued sustainability but revealed few efforts to disseminate the policies beyond the original organization. Conclusions. Structural changes in community-based organizations are a valuable tool for encouraging healthy changes in communities and have great potential to be adopted, sustained, and diffused.

Baseline assessment of a potassium iodide distribution for nuclear power plant emergencies in the Canadian-United States border region.

OBJECTIVE: This study sought to evaluate resident demographics and resident understanding of the proper use of potassium iodide (KI) pills as a countermeasure in the event of a nuclear power plant emergency. We also described expected behaviors of community members in the event of a nuclear accident. DESIGN: The study design utilized a cross-sectional survey with a validated written questionnaire. Subjects, Participants: The study subjects were Canadian residents living within the primary emergency planning zone of the Fermi 2 nuclear power reactor. There was a 77 percent participation rate (n = 180) in Amherst Point and 61 percent for Bois Blanc Island (commonly referred to as Bob-Lo Island) (n = 57). MAIN OUTCOME MEASURE(S): The primary study outcome measures were the number of knowledge-based questions survey respondents correctly answered about proper KI use (Ksum) and various behavior-based survey questions in the context of the extended parallel process model (EPPM). RESULTS: Overall, we found that residents in general had a very low overall comprehension of proper KI use. We found that most resident demographics (eg, age, gender) did not significantly impact their knowledge of proper KI use but did find that households with children under 13 years of age tended to have higher comprehension scores than households without young children. Most residents reported that if they thought they were exposed to radiation they would go to the hospital or call 911 and few residents knew their evacuation routes, few were aware of the emergency siren, none knew where the reception center was located, and most did not have an emergency kit in their home. The majority of the survey respondents did indicate that they would evacuate if told to do so by their government. CONCLUSIONS: Public health outreach is crucial for KI distribution programs because of the overall low pre-existing comprehension in communities. Also, hospitals and 911 must be prepared to deal with higher volume of residents seeking help should an accident occur.

Emergency Preparedness Plans and Perceptions Among a Sample of United States Childcare Providers.

OBJECTIVES: Children are at increased risk for experiencing negative physical and mental health outcomes as a result of disasters. Millions of children spend their days in childcare centers or in residential family childcare settings. The purpose of this study was to describe childcare providers' perceived levels of preparedness capabilities and to assess differences in levels of perceived preparedness between different types of childcare providers. METHODS: A national convenience sample of childcare center administrators and residential family childcare administrators completed a brief online survey about their preparedness efforts. RESULTS: Overall, there were few differences in preparedness between childcare centers and residential family childcare providers. However, childcare centers were more likely to report that they had written plans (94.47%) than residential family childcare providers (83.73%) were (χ12=15.62; P<.001). Both types of providers were more likely to report being very prepared/prepared for fires (91.31%) than they were for any other type of emergency (flooding, active shooter, etc.; 45.08% to 79.34%). CONCLUSIONS: Future work should assess how childcare providers respond to and recover from emergencies, as well as explore the types of resources childcare providers need in order to feel comfortable caring for children during such emergency situations. (Disaster Med Public Health Preparedness. 2019;13:704-708).

The Perceived Role of Direct Support Professionals in the Health Promotion Efforts of Adults With Developmental Disabilities Receiving Support Services.

Direct support professionals (DSPs) play a large social role in the lives of people with developmental disabilities (DD) and have the potential to influence their health behaviors. Six qualitative focus groups ( n = 48) were conducted with DD community agency administrators, DSPs, family members and adults with DD to better understand the perceived role of DSPs in the health promotion efforts of those with DD. Findings from this study suggest that DSPs experience several barriers when trying to promote the health of those with DD, one of which is fear of violating the rights of people with DD. Future work should identify ways to overcome the barriers experienced by DSPs, so that they can better assist people with DD with health promotion efforts.

Smoking behaviors of adults with developmental disabilities and their direct support professional providers.

BACKGROUND: People with developmental disabilities are not immune from the addictive effects and poor health outcomes associated with cigarette use. Direct support professionals often play a large role in the social environments of people with developmental disabilities and the literature suggests that one's environment can influence behavior. OBJECTIVES: To examine the relationship between the smoking behaviors of people with developmental disabilities and their direct support professional providers. Two exploratory aims of the study were to assess how direct support professionals facilitate smoking behaviors and to describe the use of home smoking policies. METHODS: The Ohio Department of Disabilities' online provider search database was used to randomly select participants. A total of 398 direct support professionals completed an online survey about smoking. Direct support professionals served as proxy reporters for the smoking behaviors of those with developmental disabilities. Descriptive statistics were calculated and Chi-Square tests were used. RESULTS: Findings suggest that there was no significant relationship (χ12 = 0.300, p = 0.584) between the current smoking behaviors of people with developmental disabilities and their direct support providers. Direct support professionals were most likely to facilitate smoking behaviors by allowing people with developmental disabilities to smoke in front of them and waiting for them to finish smoking before moving on to a new activity. Approximately 46% of people with developmental disabilities were reported to have some type of home smoking policy. CONCLUSIONS: Future research is needed to better understand the reasons why people with developmental disabilities initially start smoking and continue to smoke.

Delivering Person-Centered Care: Important Preferences for Recipients of Long-term Services and Supports.

OBJECTIVES: Although assessing individual consumer preferences are an important first step in providing person-centered care, the purpose of this study was to identify the top 10 shared preferences that are important to a majority of consumers receiving long-term services and supports. DESIGN: A cross-sectional survey design was used. SETTING AND PARTICIPANTS: Preference assessment interviews were conducted with 255 nursing home (NH) residents and 528 older adults receiving home and community-based services (HCBS). MEASUREMENTS: The Preferences for Everyday Living Inventory (PELI) was used to collect consumer preference information. Two versions of the PELI were used-the PELI-NH for NH residents and the PELI-HC for clients receiving HCBS and analysis focused on 41 shared items between the 2 versions. All respondents answered PELI questions independently and rated the importance of psychosocial preference items on a scale from not at all to a lot/very important. RESULTS: Ten preferences were shared as being important or very important by NH residents and older adults receiving HCBS. Most notably, more than 90% of respondents in each group rated "having regular contact with family" as an important priority. Having privacy, choices about what to eat, when to bathe, and activity options also were important preferences for a majority (77%-93%) in both settings. CONCLUSION: Providers seeking to incorporate preference-based care can utilize study results as a foundation to incorporating important preferences into the care delivery process at the organizational level across care settings. For example, assessing all consumers on this core set of 10 shared preferences can assist with relationship building, transitions in care, and quality improvement. However, preferences with aggregate low-rated levels of importance in this study should not be discredited or eliminated. It is important for providers to understand the unique preference inventory of each older adult, which can then be targeted toward meeting goals for preference fulfillment. This can aid in bringing preferences into practice to improve the quality of care and quality of life to best meet the psychosocial needs of each person.

Dietary and physical activity behaviors of adults with developmental disabilities and their direct support professional providers.

BACKGROUND: People with developmental disabilities lead more sedentary lifestyles, consume poorer diets, as well as have higher rates of chronic conditions such as diabetes and heart disease when compared to members of the general population. Direct support professionals play a large social role in the lives of their clients with developmental disabilities, and thus have the ability to influence the health behaviors of their clients. OBJECTIVES: The overall purpose of this study was to examine the relationship between the dietary and physical activity behaviors of direct support professionals and their clients with developmental disabilities, as well as to assess how direct support professionals facilitate the health behaviors of their clients. METHODS: A statewide random sample of direct support professionals (n = 398) completed an online survey about their own dietary/physical activity behaviors and these same health behaviors of their adult clients with developmental disabilities. Pearson/Spearman correlations were used to examine the relationship between the health behaviors of direct support professionals and their clients with developmental disabilities. RESULTS: Small-to-moderate correlations (ρ or r = 0.127-0.333) between direct support professionals' and clients' behaviors existed for all dietary and physical activity health behaviors except for participation in some sort of moderate-to-vigorous physical activity each week (ρ = 0.098, p = 0.06). CONCLUSIONS: Direct support professionals appear to play a role in the dietary/physical activity behaviors of their clients; however, future research on this topic should also include other key members of the social networks of adults with developmental disabilities such as family members, roommates, and day-habilitation providers.

Obesity Prevention Practices and Policies in Child Care Settings Enrolled and Not Enrolled in the Child and Adult Care Food Program.

Objectives The United States Department of Agriculture's Child and Adult Care Food Program (CACFP) provides meals and snacks to low-income children in child care. This study compared nutrition and physical activity practices and policies as well as the overall nutrition and physical activity environments in a sample of CACFP and non-CACFP child care settings. Methods A random stratified sample of 350 child care settings in a large Midwestern city and its suburbs, was mailed a survey on obesity prevention practices and policies concerning menu offerings, feeding practices, nutrition and physical activity education, activity levels, training, and screen time. Completed surveys were obtained from 229 of 309 eligible child care settings (74.1 % response rate). Chi square tests were used to compare practices and policies in CACFP and non-CACFP sites. Poisson and negative binomial regression were used to examine associations between CACFP and total number of practices and policies. Results Sixty-nine percent of child care settings reported CACFP participation. A significantly higher proportion of CACFP sites reported offering whole grain foods daily and that providers always eat the same foods that are offered to the children. CACFP sites had 1.1 times as many supportive nutrition practices as non-CACFP sites. CACFP participation was not associated with written policies or physical activity practices. Conclusions for Practice There is room for improvement across nutrition and physical activity practices and policies. In addition to food reimbursement, CACFP participation may help promote child care environments that support healthy nutrition; however, additional training and education outreach activities may be needed.

Mother-child communication about sexual health, HPV and cervical cancer among antenatal clinic attendees in Johannesburg, South Africa.

Parent-child communication about sexual health is considered an effective strategy for encouraging safe sexual practices among youth. This study used a brief survey to examine mother-child communication among 86 antenatal clinic attendees in Johannesburg, South Africa. Eighty-five percent of mothers reported having enough information to discuss HIV/AIDS prevention with their children, while only 36% reported having enough information to discuss HPV/cervical cancer prevention. Thirty-seven percent of mothers who reported being comfortable discussing HIV/sexual health with their child actually discussed these topics with their child; while 58% of mothers who reported being comfortable did not discuss HIV/sexual health with their child. Future research and program planning efforts should focus on identifying the best strategies to educate South African mothers on HPV and cervical cancer, so that mothers can effectively communicate their knowledge about these topics to their children.

An analysis of key stakeholders' attitudes and beliefs about barriers and facilitating factors in the development of a cervical cancer prevention program in South Africa.

Cervical cancer is the leading cause of cancer related deaths among women. Each year there are approximately 250,000 deaths; most of which occurred in Sub-Saharan Africa, South Asia, and Latin America. The purpose of this report is to examine key stakeholders experience and knowledge of HPV and cervical cancer, examine their experiences with the current cervical cancer screening and treatment policy, and identify barriers and facilitating factors to vaccine implementation and uptake. Fifteen indepth interviews were conducted with key stakeholders in Cape Town and Johannesburg, South Africa. The interviews revealed several key findings including: 1) knowledge about HPV and cervical cancer varied across participants, 2) knowledge about cervical cancer was also mixed while knowledge about the relationship between HPV and cervical cancer was low among participants. Our findings indicate that key stakeholders are concerned about women's health and wellbeing. In addition, they believe that the government, families, and the media need to play a prominent role in prevention efforts.