Social determinants of health correlations and resource usefulness at a Milwaukee free clinic for uninsured individuals: A cross-sectional study.

Introduction: Addressing social determinants of health (SDOH) is fundamental to improving health outcomes. At a student-run free clinic, we developed a screening process to understand the SDOH needs and resource utilization of Milwaukee's uninsured population. Methods: In this cross-sectional study, we screened adult patients without health insurance (N = 238) for nine traditional SDOH needs as well as their access to dental and mental health care between October 2021 and October 2022. Patients were surveyed at intervals greater than or equal to 30 days. We assessed correlations between SDOH needs and trends in patient-reported resource usefulness. Results: Access to dental care (64.7%) and health insurance (51.3%) were the most frequently endorsed needs. We found significant correlations (P ≤ 0.05) between various SDOH needs. Notably, mental health access needs significantly correlated with dental (r = 0.41; 95% CI = 0.19, 0.63), medications (r = 0.51; 95% CI = 0.30, 0.72), utilities (r = 0.39; 95% CI = 0.17, 0.61), and food insecurity (r = 0.42; 95% CI = 0.19, 0.64). Food-housing (r = 0.55; 95% CI = 0.32, 0.78), housing-medications (r = 0.58; 95% CI = 0.35, 0.81), and medications-food (r = 0.53; 95% CI = 0.32, 0.74) were significantly correlated with each other. Longitudinal assessment of patient-reported usefulness informed changes in the resources offered. Conclusions: Understanding prominent SDOH needs can inform resource offerings and interventions, addressing root causes that burden under-resourced patients. In this study, patient-reported data about resource usefulness prompted the curation of new resources and volunteer roles. This proof-of-concept study shows how longitudinally tracking SDOH needs at low-resource clinics can inform psychosocial resources.

Evaluating Barriers to Opioid Use Disorder Treatment From Patients' Perspectives.

Introduction: Utilizing medications to treat opioid use disorder (MOUD) is both highly effective and unfortunately underutilized in the US health care system. Stigma surrounding substance use disorders, insufficient provider knowledge about substance use disorders and MOUD, and historical lack of physicians with X-waivers to prescribe buprenorphine contribute to this underutilization. Our study aimed to elucidate barriers to accessing MOUD in Milwaukee, Wisconsin. Methods: We conducted semistructured interviews with patients receiving MOUD at a family medicine residency program in Milwaukee, Wisconsin. Interviews were audio-recorded, transcribed verbatim, and analyzed using the qualitative analysis Framework Method. Researchers in our team reviewed transcripts, coding for specific topics of discussion. Coded transcript data were then sorted into a matrix to identify common themes. Results: Interviews with 30 participants showed that motivations to seek treatment appeared self-driven and/or for loved ones. Eighteen patients noted concerns with treatment including treatment denial and efficacy of treatment. Housing instability, experiences with incarceration, insurance, and transportation were common structural barriers to treatment. Conclusions: Primary drivers to seek treatment were patients themselves and/or loved ones. Barriers to care include lack of effective transportation, previous experience with the carceral system, and relative scarcity of clinicians offering MOUD. Future studies may further explore effects of structural inadequacies and biases on MOUD access and quality.

Examining the role of social relationships on health and health behaviors in African American men with prostate cancer: a qualitative analysis.

PURPOSE: Cancer survivor cohort studies document the positive impact of health behaviors on cancer survivorship by influencing quality of life, comorbidity burden, and cancer recurrence. Social networks can be instrumental in supporting health behavior changes. This study used qualitative interviews to explore how social networks may impact health and health behaviors of African American Prostate Cancer Survivors (AAPCS) enrolled in Men Moving Forward (MMF), a lifestyle intervention designed with and for AAPCS. Specifically, we sought to understand how different relationships within social networks influence health and health behaviors, and to identify potential mechanisms for this influence. METHODS: Eighteen men who completed the MMF intervention participated in a semi-structured interview which explored social connections, health and health behaviors, stress, and the cancer experience. Interviews were recorded and transcribed, and thematic analysis was performed by two coders. RESULTS: Participants described robust social networks of friends and family. Four distinct yet overlapping themes were identified that described how relationships influence health and health behaviors among AAPCS: (1) provision of knowledge, (2) health and behavior history, (3) encouragement and support, and (4) shared behavior. CONCLUSIONS: These results provide initial insight into the types of relationships that influence health, and the intersecting and multifaceted mechanisms through which this influence occurs.

Child Anxiety and Depression During the COVID-19 Pandemic and Unmet Mental Health Care Needs.

Child anxiety and depression increased in recent years, while access to health care improved in some ways and worsened in others. The purpose of this study was to understand the prevalence of child anxiety and depression during the COVID-19 pandemic, unmet mental health care need among children with these conditions, and whether disparities exist by race/ethnicity and sex. A cross-sectional secondary data analysis was conducted using the 2021 National Survey of Children's Health (ages 3-17 years, unweighted n = 42,175). Parent/caregiver-reported child anxiety and depression prevalence was greater among non-Hispanic White children than those of other racial/ethnic groups and females compared to males, after adjusting for covariates. Unmet mental health care need among children with anxiety and depression was greater among Hispanic children than those of other racial/ethnic groups, after adjusting for covariates. In conclusion, this study identified a disparity in unmet need between Hispanic children and those of other races and ethnicities. Implications for policy and practice are discussed.

Fight COVID Milwaukee protective behaviors and risk communications associated with the COVID-19 pandemic.

The COVID-19 pandemic has had a major impact on society, causing significant disruptions to everyday life. Risk communication strategies can play an important role in risk management as they allow individuals to prepare for and respond to public health emergencies appropriately. The aim of this study is to investigate public risk behaviors, perceptions of risk and risk communication, and experiences with COVID-19 to better understand the impact of COVID-19 on our community and to better inform public health decisions about communicating and reducing personal risk. Nine virtual focus groups were conducted with 79 residents of Milwaukee County. Audio transcripts of focus group recordings were qualitatively analyzed using MAXQDA. Predominant themes identified include public risk protective behaviors, the emotional toll associated with lockdown measures, and risk communication. Our findings provide a better understanding of how adults, African American and Hispanic groups in particular, viewed the risk communications and protective behaviors associated with COVID-19, how their lives were impacted by the pandemic, and how to effectively communicate public information about personal risk. These findings can help guide risk communication efforts and public health policy interventions for potential infection outbreaks in the future.

Foundations of Community Engagement: A Series for Effective Community-Engaged Research.

Introduction: Medical students lack systematic exposure to community engagement. Community-engaged research (CEnR) is an effective approach to improve community health, and community-engaged physicians are better attuned to the community context of their patients' health and well-being. The Medical College of Wisconsin (MCW) Office of Community Engagement began offering the educational series Foundations of Community Engagement in 2021 to meet this need. Methods: We developed and implemented a four-session series for medical students at MCW and the University of Nebraska Medical Center. A 1-hour session on the foundations of CEnR was held for all learners. Three 1-hour sessions dove deeper into CEnR principles for a self-selected cohort. These small-group sessions involved discussion between faculty and community partners and facilitated small-group discussion. Students completed evaluations after each session. Results: A total of 160 students participated in the introductory session; 36 took part in the follow-up series. Survey response rates varied from 38% to 67% for each session. Overall, 87% of students in all sessions felt their session was worthwhile, with 85% of large-group and 96% of small-group respondents reporting they learned something they would use in their practice or profession. Qualitative responses included appreciation for addressing a curricular gap and desire for more time and more sessions to continue discussions. Discussion: The program was effective at stimulating medical student self-reported gains in skills, attitudes, and future intentions regarding CEnR in an efficient manner. Effective programs that transfer positive CEnR skills and attitudes to future physicians can promote CEnR within academic medicine.

Community focus groups about a COVID-19 individual risk assessment tool: access, understanding and usefulness.

To make informed COVID-19 related decisions, individuals need information about their personal risks and how those risks may vary with specific demographic and health characteristics. The Fight COVID Milwaukee web-based risk assessment tool allows for assessment of COVID-19 mortality risk as a function of personal and neighborhood characteristics. The purpose of this study is to explore public understanding of this risk assessment tool and risk perception through community focus groups. Individuals were recruited from the general adult population in Milwaukee County, Wisconsin, USA, to participate in nine online focus groups where the risk assessment tool was presented for feedback. Three main themes were identified in the focus groups regarding the web-based risk assessment tool: some challenges in accessibility, variable ease of understanding, and personal usefulness but uncertain value for others. This paper explores how members of the community interpret individual risk assessments and life expectancy estimations, and how these vary with age, gender, race/ethnicity, socioeconomic status, and pre-existing comorbidities.

Characterizing rural families' experiences receiving pediatric surgical care: A qualitative study.

PURPOSE: Access to pediatric surgical care is influenced by multiple factors, including proximity to care and financial resources. There is limited understanding regarding the process by which rural children acquire surgical care. We qualitatively explored rural families' experiences seeking surgical care for their children at a major children's hospital. METHODS: Parents or legal guardians ≥18 years of age with children who received general surgical care at a major children's hospital and who lived in rural areas were included. Operative logs from 2020 to 2021 and postoperative clinic visits were used to identify families. Semi-structured interviews explored rural families' experiences receiving surgical care. Interviews were inductively and deductively analyzed to create codes and identify thematic domains. Twelve interviews (with 15 individuals) were conducted before thematic saturation was reached. FINDINGS: Children were predominantly White (92%) and lived a median of 98.3 mi (interquartile range 49.4-147.0 mi) from the hospital. Four thematic domains were identified: (1) Accessing surgical care included difficulties with referral processes and travel/lodging burdens; (2) surgical care processes involved treatment details and provider/hospital expertise; (3) resources for navigating care encompassed families' employment status, financial burden, and technology use; and (4) social support included family situations, emotions and stress, and coping with diagnoses. CONCLUSIONS: Rural families experienced difficulties with obtaining referrals, challenges with travel and employment, and the benefits of technology use. These findings can be applied to the development of tools that can ease challenges faced by rural families whose children require surgical care.

A Description of Theoretical Models for Health Service Utilization: A Scoping Review of the Literature.

Theoretical models to explain health service utilization are numerous and there is no known literature that has synthesized existing models for health service utilization. Systematic searches were conducted in PubMed, MEDLINE, PsychINFO, Scopus, and CINAHL databases from 1960 through May 2021. Literature theorizing models/frameworks for health service utilization were included. Multiple investigators screened citations and full texts. Data extracted included: (1) citation information, (2) purpose of models, and (3) major constructs of models. The search retrieved 6639 citations. A total of 34 articles were eligible for this review. Theoretical models were categorized into 4 thematic domains based on the purpose of the model: (1) generalized health service utilization, (2) health service utilization with respect to specific sociodemographic determinants of health, (3) health service utilization specific to illness or health disciplines, and (4) preventive health services/screenings. There was an increase in models developed over time with a trend toward model development specific to sociodemographic determinants of health, illness, and/or health disciplines. This review cataloged theoretical models for health service utilization by thematic domain to enhance the identification and critical review of existing models. Findings support the notion that theoretical pluralism has been adopted in the field of health service utilization.

The Stacked Community Engagement model: A practical model for developing community-engaged academic medical faculty.

Introduction: There is an increasing recognition of the benefits of sustained community engagement (CE) that accrue to academic health centers and the communities they serve. However, the success and sustainability of CE projects rely on the efforts of individual faculty, learners, and community members, for whom CE efforts are typically added to their professional and personal priorities and responsibilities. This competition for time and resources between priorities and CE can discourage academic medical faculty from participating in CE activities. The Stacked Community Engagement model is proposed to synergize or "stack" responsibilities and goals onto the scaffolding of CE projects. Methods: We examined the literature and expert CE practitioner opinion to identify the challenges faced by community-engaged academic faculty and the key characteristics of CE projects that successfully align and integrate with the priorities of faculty, learners, and community members. We synthesized this information to develop the conceptual Stacked CE model for developing CE academic medical faculty, then illustrated the model in heterogeneous CE programs to explore its generalizability, validity, and robustness. Results: The Stacked CE model, when applied to a specific nutrition education program (The Food Doctors) and outreach program (StreetLife Communities), provided a practical framework for examining the sustained success of a partnership between Medical College of Wisconsin faculty and medical students and the community. Conclusions: The Stacked CE model is a meaningful framework for developing community-engaged academic medical faculty. By identifying overlap and integrating CE into professional activities with intention, CE practitioners can benefit from the deeper connections and sustainability.

Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature.

BACKGROUND: Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles. OBJECTIVE: There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level. SEARCH STRATEGY: Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021. INCLUSION CRITERIA: Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review. DATA EXTRACTION AND ANALYSIS: Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status. RESULTS: A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%). CONCLUSION: This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature. J Integr Med. 2023; 21(2): 159-167.

Navigating misinformation and political polarization of COVID-19: interviews with Milwaukee, Wisconsin county public health officials.

Introduction: The spread of misinformation combined with the political polarization of the COVID-19 vaccine created major challenges for public health officials responding to the COVID pandemic and vaccine roll-out. The challenges public health officials faced when making safety recommendations and promoting the vaccine only exacerbated the already exhausting work conditions they experienced since the start of the pandemic. Combating misinformation while receiving inadequate political support led to burnout for many public health officials. As such, they had to adapt and develop new strategies for increasing vaccine acceptance and decreasing vaccine hesitancies. Method: This study was conducted through qualitative interviews with seven Milwaukee County public health officials. This study aimed to determine how public health officials perceived misinformation and political polarization during the pandemic. Additionally, the study aimed to learn more about strategies county health officials used to combat misinformation while increasing vaccine uptake in their communities. Results: Thematic analysis of the interviews identified three major challenges faced by public health officials in promoting vaccination: dissemination of misinformation in media, political polarization of COVID and its contribution to vaccine acceptance and COVID fatigue, and assessment of the risks associated with disease severity versus vaccine safety considering limited public health resources. Discussion: Learning from public health officials allows us to better understand their perceptions of the extent of local vaccine hesitancies and their advice on how to counteract fears and misinformation and to promote COVID vaccine uptake. Political polarization of COVID and misinformation affected community vaccine acceptance and challenged local public health leadership.

Community focus groups about a COVID-19 individual risk assessment tool: access, understanding and usefulness.

Background : In order to make informed COVID-19 related decisions, individuals need information about their personal risks and how those risks may vary with specific demographic and health characteristics. The Fight COVID MKE web=based risk assessment tool allows for assessment of COVID-19 mortality risk as a function of personal and neighborhood characteristics. The purpose of this study is to explore public understanding of this risk assessment tool and risk perception through community focus groups. Methods : Individuals were recruited from Milwaukee County to participate in nine online focus groups where the risk assessment tool was presented for feedback. Focus group transcripts were then analyzed qualitatively for common themes using MAXQDA. Results : Three main themes were identified in the focus groups regarding the web-based risk assessment tool: access, understanding, and usefulness. Conclusions : This paper explores how members of the community interpret individual risk assessments and life expectancy estimations, and how these vary with age, gender, race/ethnicity, socioeconomic status, and pre-existing comorbidities. Understanding COVID-19 infection and progression rates, and how they vary with a full set of patient-specific characteristics is critical for effective policy and practice responses to the COVID-19 pandemic as well as for future infection outbreaks.

Effects of Telemedicine on Pediatric Clinical Care During COVID-19.

Coronavirus disease 2019 (COVID-19) has provided unprecedented opportunity for the growth of telemedicine in pediatrics. Clinics rapidly expanded their telemedicine capabilities and converted in-person visits to virtual visits to offer patients continued care while limiting infection risks. Although the transition to video visits has several benefits-patient convenience, versatility of care, ease of follow up, and management of chronic conditions-these gains are only available to those who have the requisite technology access and literacy needed to conduct a video visit. The need for technology-dependent care stands to further widen preexisting disparities in access to care for those who cannot use or afford the necessary technology. Our article explores some of these benefits and challenges and reminds us that although telemedicine has proven to have high utility for many patients, there are improvements that must still be made to ensure equitable accessibility and durability of virtual visits. [Pediatr Ann. 2021;50(12):e503-e508.].

CHECK UP: A student-designed model for creating innovative patient education materials that your patients will actually use.

OBJECTIVE: As appointments become more rushed, it is crucial that primary care clinicians consider new and effective ways to provide preventive health education to patients. Currently, patient education is often handouts printed from the electronic medical record system; however, these pieces of paper often do not have the desired impact. Well-established advertising methods reveal that repeated exposure is key in recall and swaying consumer decisions. The Creating Health Education for Constructive Knowledge in Underserved Populations (CHECK UP) Program is a medical student-led program that aims to improve patient recall of health information, health promoting behaviors and health outcomes by applying modified advertising concepts to the delivery of health education. METHODS: Patients were given large magnets containing health education information. These patients were interviewed 3-4 months afterwards to assess use and effectiveness of magnets as a means to provide health education. RESULTS: In total, 25 of the 28 patients given CHECK UP magnets agreed to participate. The majority of participants (23/25) kept the magnets and reported that they, as well as others in their households, see the magnets daily. All 23 participants recalled at least 1 health tip from 1 of the magnets. CONCLUSIONS: The use of non-traditional materials for patient education allowed for repeated exposure and recall of health information. Consideration for modified use of evidence-based advertising and marketing strategies for the delivery of patient education may be an easy and effective way to provide information to patients outside of the clinical setting and promote health behavioral changes.

Geographic variation and risk factors for teenage pregnancy in Uganda.

BACKGROUND: Teenage pregnancy is a global health issue with high rates in sub-Saharan Africa. In Uganda, teenage pregnancy is a public and community health issue. OBJECTIVES: This study hypothesized that there would be regional variations in rates, risk factors and trends of teenage pregnancy in Uganda. METHODS: Data were analyzed from the Uganda Demographic and Health Surveys (UDHS) in 2006 and 2011. The outcome of interest was current pregnancy for females 15 to 19 years of age at the time of the survey. Bivariate analysis was performed for each year to examine the rate and trends of pregnancy by various demographic characteristics. Logistic regression was conducted to assess the association between teenage pregnancy and sociodemographic variables. RESULTS: Uganda's rate of teenage pregnancy increased from 7.3/1000 in 2006 to 8.1/1000 in 2011. The East Central region consistently had the highest rates than other regions. In 2006, teenage pregnancy was significantly associated with being married, living with a partner or separated, as compared to those who were single. Marital and wealth status were also significant predictors of teenage pregnancy based on the 2011 survey. CONCLUSION: The rate of teenage pregnancy in Uganda is high and the trend demonstrated regional variation. Future interventions could focus on regions with high poverty and low education.

More than gangsters and girl scouts: Environmental health perspectives of urban youth.

The purpose of this study was to explore environmental health perspectives among urban youth. A total of 12 focus groups with 64 youth were conducted. Youth defined environmental health in a multidimensional manner which integrated aspects of the physical, social, and built environment and concentrated on the neighborhood context. A theme of environmental health resilience factors and sub-themes of safety, trust, engagement, leadership, and representation were identified and described. A second theme of underlying structural drivers of environmental health with sub-themes of equitable opportunities and power inform environmental health. A conceptual model was developed to guide future environmental health research and action.