A Qualitative Exploration of Spanish-Speaking Latina Women's Experiences Participating in WIC Before and During the COVID-19 Pandemic.

BACKGROUND: More than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas' experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. OBJECTIVE: This study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic-related policy changes made to the WIC program. DESIGN: Qualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. PARTICIPANTS/SETTING: Study participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. ANALYSIS: All interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. RESULTS: Perceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. CONCLUSIONS: Concerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women's experiences with WIC.

Special Supplemental Nutrition Program for Women, Infants, and Children Participant Grocery Store Purchases during the COVID-19 Pandemic in North Carolina.

Background: Families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) experienced barriers to accessing healthy food during the COVID-19 pandemic, but we do not yet understand how WIC participant food purchases shifted during the pandemic. Objectives: We aimed to describe the association between the initial shock of the pandemic in March 2020 and WIC shoppers' food purchases and changes in purchases before and during the pandemic at a top grocery chain and examine differences in these relationships by duration of WIC use. Methods: We used longitudinal food transaction data from WIC shoppers (n = 2,989,116 shopper-month observations from 175,081 unique WIC shoppers) from 496 stores in a top grocery store chain in North Carolina between October 2019 and May 2021. We used an interrupted time series design to describe the following: 1) the relationship between the initial shock of the pandemic and WIC shopper food purchases and 2) differences in purchases before and during the pandemic. To assess differences in purchases between shoppers consistently using WIC electronic benefit transfer (EBT) cards and shoppers starting or stopping WIC EBT use during the pandemic, we used models stratified by WIC group. Primary outcomes were share (%) of total calories purchased from fruits, vegetables, nuts, and legumes (FV), processed foods, and sugar-sweetened beverages (SSBs). Results: We observed small decreases in the share of total calories from FV (-0.4%) and small increases in the share of calories from processed food (1.1%) and SSBs (0.5%) purchased at this retailer when comparing the pre and post March 2020 periods. Compared with shoppers that started or stopped using WIC benefits during the pandemic, shoppers that used WIC benefits consistently had slightly higher FV and lower processed food and SSB purchases at this retailer. Conclusions: Future studies should examine whether additional supports for nutrient-dense food choices may be needed for families with low incomes in public health emergencies.

Evidence-Based Performance Indicators of Positive Inpatient Experiences.

GOAL: Patient experiences affect the competitiveness and financial viability of a hospital. The purpose of this research was to ascertain the factors that contribute to positive inpatient experiences by using empirical evidence from national databases and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. METHODS: Data were assembled from four publicly available U.S. government datasets. The HCAHPS national survey responses (n = 2,472) were based on four consecutive quarters of patient surveys. Measures of clinical complications obtained from the Centers for Medicare & Medicaid Services were used to assess hospital quality. Social determinants of health were incorporated into the analysis by including data from the Social Vulnerability Index as well as zip code-level information from the Office of Policy Development and Research. PRINCIPAL FINDINGS: The study results show that hospital quietness, nurse communication, and care transition positively affected patient experience ratings and the patient's likelihood to recommend the hospital. In addition, findings show that hospital cleanliness positively influenced patient experience ratings. However, hospital cleanliness had little impact on the likelihood of a patient's recommending the hospital, and staff responsiveness had a negligible impact on both patient experience ratings and the likelihood to recommend the hospital. The results also revealed that hospitals with better clinical outcomes received better patient experience ratings and recommendation scores, whereas hospitals that serve more vulnerable populations received worse patient experience ratings and recommendation scores. PRACTICAL APPLICATIONS: Findings from this research demonstrate that managing the physical surroundings by providing a clean and quiet environment, providing relationship-centered care through interactions with medical personnel, and working to engage patients in their health as they transition out of care contributed to positive inpatient experiences.

Analyzing the impact of agricultural BMPs on stream nutrient load and biotic health in the Susquehanna-Chemung basin of New York.

Despite the widespread use of agricultural best management practices (BMPs) to reduce watershed scale nutrient loads, there remain few studies that use directly observed data - instead of models - to evaluate BMP effectiveness at the watershed scale. In this study, we make use of extensive ambient water quality data, stream biotic health data, and BMP implementation data within the New York State portion of the Chesapeake Bay watershed to assess the role of BMPs on reducing nutrient loads and modifying biotic health in major rivers. The specific BMPs considered were riparian buffers and nutrient management planning. A simple mass balance approach was used to evaluate the role of wastewater treatment plant nutrient reductions, agricultural land use changes, and these two agricultural BMPs in matching observed downward trends in nutrient load. In the Eastern nontidal network (NTN) catchment - where BMPs have been more widely reported - the mass balance model suggested a small but discernible contribution of BMPs in matching the observed downward trend in total phosphorus. Contrastingly, BMP implementations did not show clear contributions towards total nitrogen reductions in the Eastern NTN catchment nor for the total nitrogen and phosphorus in the Western NTN catchment, where BMP implementation data are more limited. Assessment of the relationship between stream biotic health and BMP implementation using regression models found limited connection between extent of BMP implementation and biotic health. In this case, however, spatiotemporal mismatches between the datasets and the relatively stable biotic health, typically of moderate to good quality even before BMP implementation, may reflect the need for better monitoring design to assess BMP effects at the subwatershed scale. Additional studies, perhaps using citizen scientists, may be able to provide more suitable data within the existing frameworks of the long-term surveys. Given the preponderance of studies that rely only on modeling to understand nutrient loading reductions achieved by implementation of BMPs, it is essential to continue to collect empirical data to meaningfully evaluate whether there are actual measurable changes due to BMPs.

Monitoring Green Sea Turtles in the San Gabriel River of Southern California.

Effective conservation of endangered species relies on the characterization of habitat use and tracking of long-term population trends, which can be especially challenging for marine species that migrate long distances and utilize a diversity of habitats throughout their lives. Since 2012, citizen science volunteers at the Aquarium of the Pacific in Long Beach, California, have been monitoring an urban population of East Pacific green sea turtles (Chelonia mydas) that resides near the mouth of the San Gabriel River (SGR) in Southern California, USA, in order to gain insights about how the population uses this area. Here, we collate and analyze nine years of citizen science data, including observed sightings collected across 10 observation stations. Our results confirm that green sea turtles are frequently present around warm water effluent from power plants, similar to research results reported for other locations in the eastern Pacific Ocean. Importantly, observational data also show notable green sea turtle activity around the outfalls for a small wetland habitat bordering the SGR, highlighting the importance of wetland ecosystems as a key habitat and foraging area for this threatened population. Finally, our results showcase the benefits of using citizen science to monitor sea turtle populations in easily accessible nearshore habitats.

"I Think That's the Most Beneficial Change That WIC Has Made in a Really Long Time": Perceptions and Awareness of an Increase in the WIC Cash Value Benefit.

During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.

Developing a watershed screening tool to estimate relative contribution of phosphorus to guide management planning.

To support the development of clean water plans, as required by the federal Clean Water Act 303(d) program, the New York State Department of Environmental Conservation (DEC) developed the Loading Estimator of Nutrient Sources (LENS) tool. DEC has prioritized clean water planning for fresh waterbodies experiencing negative impacts due to excessive phosphorus levels. LENS, an Excel based tool, combines several simple steady state models into a single screening tool that may be used to estimate the relative contribution of phosphorus sources within a watershed, waterbody response, and recovery potential of a waterbody. To validate that LENS results are reasonable approximations, LENS loading estimates were statistically compared with loading estimates from more complex watershed models that were used to develop existing clean water plans using simple linear regressions. For this comparison, DEC selected a variety of completed models that have modeled watershed phosphorus loads with different land use compositions and loading from both point and nonpoint sources. This analysis shows that LENS performs reasonably well at estimating the relative loading from a range of source sectors, though cannot replace more robust watershed models. DEC has used LENS to prioritize waterbodies for clean water plans and to guide management actions in watersheds where data is lacking to support more complex modeling efforts. Future expansions of LENS may include modifying the tool to estimate other pollutants (i.e. nitrogen), add the ability to account for internal loading of nutrients within waterbodies; and estimate the contribution of nutrients from groundwater.

An Evaluation of Syndromic Surveillance-Related Practices Among Selected State and Local Health Agencies.

CONTEXT: Syndromic surveillance consists of the systematic collection and use of near real-time data about health-related events for situational awareness and public health action. As syndromic surveillance programs continue to adopt new technologies and expand, it is valuable to evaluate these syndromic surveillance systems and practices to ensure that they meet public health needs. OBJECTIVE: This assessment's aim is to provide recent information about syndromic surveillance systems and practice characteristics among a group of state and local health departments. DESIGN/SETTING: Information was obtained between November 2017 and June 2018 through a telephone survey using an Office of Management and Budget-approved standardized data collection tool. Participants were syndromic surveillance staff from each of 31 state and local health departments participating in the National Syndromic Surveillance Program funded by the Centers for Disease Control and Prevention. Questions included jurisdictional experience, data sources and analysis systems used, syndromic system data processing characteristics, data quality verification procedures, and surveillance activities conducted with syndromic data. MEASURES: Practice-specific information such as types of systems and data sources used for syndromic surveillance, data quality monitoring, and uses of data for public health situational awareness (eg, investigating occurrences of or trends in diseases). RESULTS: The survey analysis revealed a wide range of experiences with syndromic surveillance. Participants reported the receipt of data daily or more frequently. Emergency department data were the primary data source; however, other data sources are being integrated into these systems. All health departments routinely monitored data quality. Syndromes of highest priority across the respondents for health events monitoring were influenza-like illness and drug-related syndromes. However, a wide variety of syndromes were reported as priorities across the health departments. CONCLUSION: Overall, syndromic surveillance was relevantly integrated into the public health surveillance infrastructure. The near real-time nature of the data and its flexibility to monitor different types of health-related issues make it especially useful for public health practitioners. Despite these advances, syndromic surveillance capacity, locally and nationally, must continue to evolve and progress should be monitored to ensure that syndromic surveillance systems and data are optimally able to meet jurisdictional needs.

Lessons Learned From a Centers for Disease Control and Prevention Virtual Partner Services Technical Assistance Pilot Project to Respond to a Local Syphilis Outbreak.

ABSTRACT: A virtual partner services technical assistance (TA) project was piloted with the Minnesota Department of Health to address an ongoing syphilis outbreak. The TA reduced the health department's disease intervention specialist workload, achieved partner services outcomes comparable with in-person methods, and identified lessons learned to replicate with other jurisdictions.

Self-care agency and self-care practice in youth workers reduces burnout risk and improves compassion satisfaction.

INTRODUCTION AND AIMS: Youth work specialises in helping vulnerable young people face life challenges during critical stages of their development. It is a complex and demanding role and factors influencing occupational stress in youth workers are rarely investigated. This study examined whether youth alcohol and other drug workers with greater compassion satisfaction, self-care practice and self-care agency experienced different rates of occupational stress including burnout and secondary traumatic stress. DESIGN AND METHODS: A convenience sample of 258 Australian youth alcohol and other drug workers completed an online questionnaire battery. A four-stage data analysis was conducted utilising multivariate analysis of variance, bivariate correlations, linear multiple regression models and mediation modelling. RESULTS: Burnout and secondary traumatic stress exhibited moderate negative correlations with compassion satisfaction, self-care practice and the different forms of self-care agency. Further, a decrease in lacking power for self-care, a form of self-care agency, was the strongest contributor to both burnout and secondary traumatic stress. Support was found for a mediation pathway whereby self-care agency led to greater self-care practice, which in turn increased compassion satisfaction, lowering burnout and secondary traumatic stress. DISCUSSION AND CONCLUSIONS: The findings suggest that it would be beneficial for self-care agency to be a key focus of youth worker training and professional development programs.

Incidence and Prevalence of Pediatric Eosinophilic Esophagitis in Utah Based on a 5-Year Population-Based Study.

BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is often detected in children and is considered to be a rare disease, with prevalence values reported to be below 60 cases per 100,000 persons. To determine whether the incidence of EoE in children in Utah exceeds estimates from regional reports, we calculated incidence and prevalence values over a 5-year period. METHODS: Using consensus guidelines for the diagnosis of EoE, we reviewed pathology records from the Intermountain Healthcare pathology database, from July 1, 2011 through June 31, 2016. We collected data on 10,619 pediatric patients with available esophageal biopsy results, and identified cases of esophageal eosinophilia (>14 eosinophils in a high-power microscopy field in an endoscopic biopsy). An EoE case required the presence of esophageal eosinophilia, symptoms of esophageal dysfunction, and the absence of co-morbid conditions that may cause esophageal eosinophilia. Annual pediatric EoE incidence and prevalence values were calculated per 100,000 children, based on averaged pediatric population estimates from census figures of Utah in 2010 and 2016. RESULTS: We identified 1281 unique pediatric patients who met criteria for esophageal eosinophilia. Of those, 1060 patients met criteria for newly diagnosed EoE. Over the 5-year period studied, the average annual pediatric EoE incidence in Utah was 24 cases per 100,000 children. The prevalence in year 5 of the study was 118 cases per 100,000 children. CONCLUSION: In a population-based study of children in Utah, we found the incidence and prevalence of pediatric EoE to be higher than previously reported. This could be due to the prominence of EoE risk factors in this region, as well as Utah's searchable medical record system that allows for reliable case ascertainment. Further studies of this type could increase disease awareness, prompting early referral to pediatric gastroenterologists and trials to strengthen evidence-based, algorithmic approaches to EoE diagnosis and treatment in children.

Substance use by same sex attracted young people: Prevalence, perceptions and homophobia.

INTRODUCTION AND AIMS: Research highlights that lesbian, gay, bisexual and transgender (LGBT) people use alcohol and drugs (AOD) more than heterosexual people; however, the incidence of AOD use by LGBT youth is less understood. The purpose of the current study was to ascertain AOD prevalence rates for LGBT youth compared with the Australian youth population; perceptions of AOD use within the LGBT community; and the impact of homophobia on AOD use. DESIGN AND METHODS: The study surveyed a cross-sectional sample of LGBT youth (13-24 years) (n = 161) who attended a LGBT festival in Brisbane, Australia, in 2012. The Alcohol Use Disorders Identification Test-Consumption, Fagerström Test for Nicotine Dependence and Drug Check Assessment Tool were utilised to examine patterns of AOD use, with items developed to explore perceptions of AOD use and homophobia. RESULTS: AOD use was common among the LGBT sample, with higher prevalence rates compared with the general Australian youth population (2010 National Drug Strategy Household Survey). AOD use by under 18-year-olds, and gender diverse youth was markedly higher. The majority misperceived AOD use to be the same in the LGBT and heterosexual communities. Those who believed homophobia impacted on AOD use were significantly more likely to use AOD. DISCUSSION AND CONCLUSIONS: The higher prevalence of AOD use strongly suggests the need for AOD agencies to better respond to LGBT youth by not only screening sexuality and gender identity but also exploring young people's perceptions of AOD use in the LGBT community and their experiences of homophobia in order to provide effective AOD clinical treatment.

Asbestosis in Louisiana: a descriptive review and demographic analysis of hospitalizations for abestosis, 1999-2009.

Asbestosis is a debilitating, chronic, lung disease with no known treatment and most commonly occurs among workers in certain occupational settings. As a condition highly associated with occupational exposure, its incidence has been affected by changes in industry standards. In particular, the bans on both production and new uses of asbestos fibers put in place during the past 20 to 30 years have significantly reduced occupational exposures. Despite these restrictions, asbestos can still be found in many products. Louisiana has more facilities that produce, process, or use asbestos than any other state in the US. Health outcomes associated with asbestos exposure include asbestosis, mesothelioma, and lung cancer. To evaluate the impact of asbestos exposure on Louisiana residents, Louisiana Hospital Inpatient Discharge Data (LAHIDD) from 1999-2009 was analyzed. Results indicate that asbestosis hospitalizations have remained steady over the 11-year period with approximately 295 cases per year. White males have the highest rates, and cases are clustered geographically. Overall, Louisiana's rate is significantly greater than the US rate (p < 0.0001).