Listening Sessions to Shape the Innovative NIH ComPASS Common Fund Program to Advance Health Equity.

The National Institutes of Health (NIH) recognized the need for a research program to address the underlying structural factors that impact health. To inform the development of the NIH Common Fund Community Partnerships to Advance Science for Society (ComPASS) Program, NIH obtained input through community listening sessions. Through its design, ComPASS recognizes the essential role of community organizations as the lead in addressing persistent structural and social challenges to accelerate progress toward advancing health equity. (Am J Public Health. Published online ahead of print April 18, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307656).

Public Priorities in Women's Health: Analysis of Request for Information Published to Inform "Advancing NIH Research on the Health of Women: A 2021 Conference".

Objectives: To assist with planning a congressionally requested conference on women's health research, the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) invited comments to characterize public concerns related to any or all of the specified public health issues: maternal morbidity and mortality (MMM); stagnant rates of cervical cancer survival; and the growing incidence of chronic debilitating conditions in women (CDCW). This analysis summarizes public priorities in women's health research. Materials and Methods: All comments received in response to a request for information were open coded and a master list of keywords was created, and comments were categorized. Comments addressing CDCW were categorized using a conceptual framework developed by the NIH. Results: Two hundred forty-seven comments were coded and analyzed. One hundred four comments (42%) addressed MMM; 182 comments (73%) discussed CDCW; and 27 comments (10%) addressed cervical cancer. Comments focused on CDCW most frequently addressed female-specific conditions (83%). The 10 most frequently identified keywords in order of frequency from the manual coding were as follows: (1) MMM, (2) racial disparities, (3) access to care, (4) provider training, (5) mental health, (6) Black or African American women, (7) screening, (8) quality of care, (9) time to diagnosis, and (10) social determinants of health. Conclusions: Comments demonstrate a broad range of concerns related to the health of women, including MMM, CDCW, and cervical cancer. A wide array of commenters included patients, advocacy groups, and academic and professional organizations originating from geographically diverse locations. These comments reflect a strong desire from the public to prioritize research on the health of women.

Screen to Save: Results from NCI's Colorectal Cancer Outreach and Screening Initiative to Promote Awareness and Knowledge of Colorectal Cancer in Racial/Ethnic and Rural Populations.

BACKGROUND: The Center to Reduce Cancer Health Disparities (CRCHD), NCI, implemented Screen to Save, NCI's Colorectal Cancer Outreach and Screening Initiative to promote awareness and knowledge of colorectal cancer in racial/ethnic and rural populations. METHODS: The initiative was implemented through CRCHD's National Outreach Network (NON). NON is a national network of Community Health Educators (CHE), aligned with NCI-designated Cancer Centers across the nation. In phases I and II, the CHEs focused on the dissemination of cancer-related information and implementation of evidence-based educational outreach. RESULTS: In total, 3,183 pre/post surveys were obtained from male and female participants, ages 50 to 74 years, during the 347 educational events held in phase I. Results demonstrated all racial/ethnic groups had an increase in colorectal cancer-related knowledge, and each group strongly agreed that the educational event increased the likelihood that they would engage in colorectal cancer-related healthful behaviors (e.g., obtain colorectal cancer screening and increase physical activity). For phase II, Connections to Care, event participants were linked to screening. Eighty-two percent of the participants who obtained colorectal cancer screening during the 3-month follow-up period obtained their screening results. CONCLUSIONS: These results suggest that culturally tailored, standardized educational messaging and data collection tools are key change agents that can serve to inform the effectiveness of educational outreach to advance awareness and knowledge of colorectal cancer. IMPACT: Future initiatives should focus on large-scale national efforts to elucidate effective models of connections to care, related to colorectal cancer screening, follow-up, and treatments that are modifiable to meet community needs.

Education on cancer risk assessment and genetic counseling to address cancer health disparities among racial/ethnic groups and rural populations: Implementing culturally tailored outreach through community health educators.

While significant progress is being made in cancer prevention and treatment, opportunity exists to make a difference for populations bearing an uneven burden of the disease. Research indicates that increased inherited risk and more-aggressive forms of cancer among underserved racial/ethnic (R/E) groups (e.g., African American/Black, American Indian/Alaska Native, Asian, Hispanic/Latino, and Native Hawaiian/Other Pacific Islander) and rural populations may explain the cancer incidence and mortality disparities these populations experience. These racial and ethnic (R/E) categories reflect the standard naming convention for the classification of federal data on race and ethnicity. One method by which progress can be made for these underserved populations is to expand knowledge of, access to, and uptake of two existing and impactful preventive oncology tools-cancer screening and genetic counseling and risk assessment (GCRA). Individuals from these populations who have cancer may benefit by learning about treatment options, risk projections for secondary cancers, and clinical trial participation. Effecting change in community beliefs and behaviors regarding these preventive tools and yielding the aforementioned benefits will see greater success if shepherded by individuals accepted and trusted in the respective communities. This was the charge taken on and embraced by Community Health Educators in the National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities' (CRCHD) National Outreach Network (NON) and U54 Comprehensive Partnerships to Advance Cancer Health Equity (CPACHE) programs. The NCI CRCHD integrated into the work of these CHEs an emphasis on cancer genetic education. As part of their undertaking, NON and CPACHE CHEs detail education and outreach strategies that may be helpful to increase GCRA awareness and uptake in R/E groups and rural populations and, in turn, bring positive change for those with or at risk for heritable cancers.

Cognitive-behavioural therapy for heroin and cocaine use: Ecological momentary assessment of homework simplification and compliance.

OBJECTIVES: The purpose of this study was to evaluate the effects of homework-task difficulty and electronic-diary reminders on written homework completion during cognitive-behavioural therapy (CBT) for addiction. Completion of homework is an important element in CBT that may affect outcome. DESIGN: All participants received all combinations of our two interventions in a factorial 2 × 2 counterbalanced Latin-square design. METHODS: Methadone-maintained cocaine and heroin users were given homework between each of 12 weekly CBT sessions and carried electronic diaries that collected ecological momentary assessment (EMA) data on craving and exposure to drug-use triggers in four 3-week blocks assessing two levels of homework difficulty and prompted and unprompted homework. RESULTS: Neither simplified (picture-based) homework nor electronic reminders increased homework completion. In EMA reports, standard but not simplified homework seemed to buffer the craving that followed environmental exposure to drug cues. EMA recordings before and after the CBT intervention confirmed a decrease over time in craving for cocaine and heroin. CONCLUSIONS: These findings demonstrate the utility of EMA to assess treatment effects. However, the hypothesis that simplified homework would increase compliance was not supported. PRACTITIONER POINTS: Our simplifications of homework assignments for cognitive-behavioural therapy were mostly ineffective, or even counterproductive, perhaps because they did not engage sufficient depth of processing or because they were perceived as too simplistic. Our reminder beeps for homework were mostly ineffective, or even counterproductive, suggesting that mobile electronic interventions for substance-use disorders may need to be more interactive.

Neighborhood environment and urban schoolchildren's risk for being overweight.

PURPOSE: Child and adolescent obesity is increasingly prevalent and predisposes risk for poor physical and psychosocial health. Physical and social factors in the environment, such as neighborhood disorder, may be associated with childhood obesity. This study examines the association between living in a disordered neighborhood and being overweight among a sample of urban schoolchildren. DESIGN: Baseline interview data, including height, weight, and hip circumference, were obtained from 313 elementary school-aged participants in a community-based epidemiologic study. SETTING: The setting was Baltimore, Maryland, a large metropolitan city. SUBJECTS: Subjects were elementary school students ages 8 to 12 years. MEASURES: To assess neighborhood characteristics, independent evaluators conducted objective environmental assessments using the Neighborhood Inventory for Environmental Typology instrument on the block faces (defined as one side of a city block between two intersections) where the children resided. ANALYSIS: Logistic regression models with generalized estimating equations were used to examine the association between neighborhood disorder and children being overweight. RESULTS: Neighborhood disorder showed a trend toward a statistically significant association with being overweight during childhood (odds ratio [OR], 1.03; confidence interval [CI], .99-1.07; p = .07) in the unadjusted model. Gender was significantly associated with being overweight, with female gender increasing the odds of being overweight by 50% in the sample (OR, 1.50; CI, 1.18-1.92; p < .01). After controlling for race, age, and comparative time spent on a sport, multivariable analyses revealed that gender (adjusted odds ratio [AOR], 2.42; CI, 1.63-3.59; p < .01) and neighborhood disorder (AOR, 1.09; CI, 1.03-1.15; p < .01) were associated with being overweight. Further, an examination of interactions revealed girls (AOR, 2.40; CI, 1.65-3.49; p < .01) were more likely to be overweight compared with boys (AOR, 2.20; CI, 1.57-3.11; p < .01) living in neighborhoods with the same level of neighborhood disorder. CONCLUSION: Results suggest neighborhood hazards warrant additional consideration for their potential as obesogenic elements affecting gender-based disparities in weight among urban schoolchildren. Future studies in this area should include longitudinal examinations.

Neighborhood disorder and juvenile drug arrests: a preliminary investigation using the NIfETy instrument.

BACKGROUND: Disordered neighborhood environments are associated with crime, drug use, and poor health outcomes. However, research utilizing objective instruments to characterize the neighborhood environment is lacking. OBJECTIVES: This investigation examines the relationship between objective measures of neighborhood disorder and juvenile drug arrests (JDAs) in an urban locale. METHODS: The neighborhood disorder scale was developed using indicators from the Neighborhood Inventory for Environmental Typology (NIfETy) instrument; a valid and reliable tool that assesses physical and social disorder. Data on 3146 JDAs from 2006 were obtained from the police department. RESULTS: Negative binomial regression models revealed a significant association between neighborhood disorder and the count of JDAs in the neighborhood (ß == .34, p < .001). The relationship between neighborhood disorder and JDAs remained significant after adjusting for percent African-Americans in the neighborhood (ß == .24, p < .001). CONCLUSIONS: This preliminary investigation identified a positive and statistically significant relationship between an objective measure of neighborhood disorder and JDAs. Future investigations should examine strategies to reduce drug-related crime by addressing the larger neighborhood and social context in which drug involvement and crime occurs.

Neighborhood & Family Effects on Learning Motivation among Urban African American Middle School Youth.

Motivational theorists in psychology have moved away from individual-based approaches to socio-cognitive and socio-ecological models to explain student engagement and motivation for learning. Such approaches consider, for example, the influence of family and neighborhood environments as important constructs in youth behavior. In this study, links between neighborhood condition (e.g. external appearance of the blocks nearest to the respondents' home), family dysfunction, and motivation for learning are investigated. Data were obtained from two hundred and sixteen (216) urban African American middle school children enrolled in a substance use prevention intervention. Analytic models show associations between poor neighborhood condition and both family dysfunction and lower learning motivation. Family dysfunction was also found to mediate the effect of neighborhood condition on motivated learning. Neighborhood and family characteristics are important determinants of urban schoolchildren's motivation for learning.

Neighborhood environment and internalizing problems in African American children.

This study examines gender differences in the association between environment and internalizing problems in a sample of predominately African American schoolchildren. Internalizing problems was assessed using the Youth Self Report. Violence and alcohol and other drug (AOD) exposure subscales were created using observational assessments of neighborhood blocks. Logistic regression models were used to assess the relationship between neighborhood environment and internalizing problems. For each AOD item present on the block the odds of internalizing problems among girls increased by 17% (OR = 1.17, CI: 1.01, 1.35, P = 0.039). The relationship was not significant among boys. Violence exposure did not predict internalizing problems in boys or girls. These preliminary findings suggest that primary school-aged girls' emotional well-being is more negatively impacted by deleterious environments. Future investigations will examine the relationship between deleterious neighborhood environments and internalizing problems as the children age into adolescence.

Neighborhood disorder and incarceration history among urban substance users.

This research examines the relationship between neighborhood physical and social disorder and incarceration history among urban drug users. A cohort of 358 African American and White urban drug users completed a clinical interview and psychological assessment that emphasized cognitive and social-behavioral HIV risk factors. The Neighborhood Inventory for Environmental Typology was used to assess indicators of physical and social disorder. After controlling for age, gender, education, and having a place to live, multivariable analyses revealed that living in a neighborhood with moderate or high levels of disorder (odds ratio [OR] = 1.63; 95% confidence interval [CI] = [1.02, 2.59]) and drinking alcohol every day or nearly every day for 3 months or more (OR = 2.03; 95% CI [1.24, 3.31]) were associated with incarceration history. Findings suggest that select characteristics of disadvantaged communities may be important determinants of incarceration vulnerability among urban substance users. Residential improvements hold promise to enhance interventions aimed to reduce incarceration.

Early Sexual Initiation among Urban African American Male Middle School Youth in Baltimore City.

Data regarding the etiology of problem-based child and adolescent outcomes indicates neighborhood socioeconomic status, land use mix, traffic danger, availability of drugs and alcohol and collective socialization are factors that influence or confound behavior among youth in urban areas. With socio-ecological models in mind, this study examined associations between early sexual initiation and neighborhood condition, externalizing behavior, drug use and perceived peer acceptance of drug use. One hundred and fifteen African American male adolescents (ages 11 to 15) enrolled in a randomized control trial provided the data for analysis. Logistic regression models showed older age, perceived peer acceptance of drug use and externalizing behavior were predictors of early sex initiation. Although physical and social hazards as well as resource depletion in urban centers creates increased risk for poor health and social outcomes among adolescents, no neighborhood effects were found in this study. Interventions to delay sexual initiation among urban African American male adolescents may benefit from focus on both socially, and ecologically, relevant influences.

Gender differences in the prevalence and behavioral risk factors of HIV in South African drug users.

South Africa continues to be the global epicenter of HIV infection. Further, extensive gender disparities in HIV infection exist with females four times as likely to be infected with HIV/AIDS as males (UNAIDS, AIDS epidemic update, 2006; WHO, Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections, 2006). A cross-sectional collection of drug users recruited in the Pretoria region of South Africa (N = 385) was used to model HIV infection as a function of sexual risk behaviors and drug use as modified by gender. Receiving money from illicit sources and knowing someone with AIDS were loosely associated with HIV. Gender interactions were observed for age, cocaine use and condom use. Gender stratified analyses revealed that males who used condoms, were younger and tested negative for cocaine use were less likely to test positive for HIV. Findings suggest that males may have more control of risk behaviors and support the need for gender specific prevention strategies.