Water safe Worcester: student-led drowning prevention in an adolescent underserved population.

Adolescents aged 15 to 19 years have the second highest fatal drowning rate of any age group, second only to toddlers aged 12 to 36 months. This risk is amplified in black, indigenous, and people of color (BIPOC), and those of low socioeconomic status. Worcester, MA is a diverse city with over 40% of residents identifying as BIPOC and 20% living below the poverty line. The city has multiple natural bodies of water available for recreation, putting Worcester residents, particularly adolescents, at high risk of drowning. It is known that swimming lessons provided to adolescents significantly improve their swimming skills, however many programs are tailored to young children and are not appropriate for adolescents. Students from the University of Massachusetts T.H. Chan Medical School (UMass Chan), in collaboration with community partners, developed a water safety and swim education program tailored to Worcester adolescents as a means for an age-appropriate swim experience and education, community engagement, and injury prevention. Water Safe Worcester (WSW) was established as a city-wide injury prevention program that included swim lessons offered by medical students at the Central Community Branch YMCA in Worcester, MA. Instructors included UMass Chan medical students, graduate students, and staff. Adolescent YMCA members were invited to participate in lessons free of charge. Lessons were 90 min and emphasized a 3-fold approach: (1) expand knowledge of water safety and what to do in an emergency, (2) increase swimming skills, and (3) reduce fear of water. The overall attendance for the 2023 spring and summer sessions offered was 73 students, including multiple swimmers who attended more than one session. A total of 12 volunteers participated, which included 9 first-year medical students, one PhD student, one research assistant, and one surgery resident from UMass Chan. WSW demonstrated promising outcomes during its swim education classes, suggesting that WSW is a successful model to promote water safety, reduce the risk of drowning, and expand access to life-saving skills to Worcester's at-risk adolescents. This program serves as a critical step toward health equity while also providing an avenue for public health and injury prevention exposure for medical students.

Closing the Digital Divide in Interventions for Substance Use Disorder.

Digital health interventions are exploding in today's medical practice and have tremendous potential to support the treatment of substance use disorders (SUD). Developers and healthcare providers alike must be cognizant of the potential for digital interventions to exacerbate existing inequities in SUD treatment, particularly as they relate to Social Determinants of Health (SDoH). To explore this evolving area of study, this manuscript will review the existing concepts of the digital divide and digital inequities, and the role SDoH play as drivers of digital inequities. We will then explore how the data used and modeling strategies can create bias in digital health tools for SUD. Finally, we will discuss potential solutions and future directions to bridge these gaps including smartphone ownership, Wi-Fi access, digital literacy, and mitigation of historical, algorithmic, and measurement bias. Thoughtful design of digital interventions is quintessential to reduce the risk of bias, decrease the digital divide, and create equitable health outcomes for individuals with SUD.

A Structural Competency Framework for Emergency Medicine Research: Results from a Scoping Review and Consensus Conference.

INTRODUCTION: The application of structural competency and structural vulnerability to emergency medicine (EM) research has not been previously described despite EM researchers routinely engaging structurally vulnerable populations. The purpose of this study was to conduct a scoping review and consensus-building process to develop a structurally competent research approach and operational framework relevant to EM research. METHODS: We conducted a scoping review focused on structural competency and structural vulnerability. Results of the review informed the development of a structural competency research framework that was presented throughout a multi-step consensus process culminating in the 2021 Society for Academic Emergency Medicine Consensus Conference. Feedback to the framework was incorporated throughout the conference. RESULTS: The scoping review produced 291 articles with 123 articles relevant to EM research. All 123 articles underwent full-text review and data extraction following a standardized data extraction form. Most of the articles acknowledged or described structures that lead to inequities with a variety of methodological approaches used to operationalize structural competency and/or structural vulnerability. The framework developed aligned with components of the research process, drawing upon methodologies from studies included in the scoping review. CONCLUSION: The framework developed provides a starting point for EM researchers seeking to understand, acknowledge, and incorporate structural competency into EM research. By incorporating components of the framework, researchers may enhance their ability to address social, historical, political, and economic forces that lead to health inequities, reframing drivers of inequities away from individual factors and focusing on structural factors.