Perceptions of the Zika Virus, Contraceptive Access, and Motivation to Participate in the Zika Contraception Access Network Program: Qualitative Analysis of Focusgroup Discussions with Puerto Rican Women.

OBJECTIVE: During the 2016-2017 Zika virus outbreak in Puerto Rico, the Zika Contraception Access Network (Z-CAN) provided client-centered contraceptive counseling and access to the full range of reversible contraceptive methods at no cost to prevent unintended pregnancies and thereby to reduce Zika-related birth outcomes. METHODS: To understand how Puerto Rican women's perceptions of the Zika virus affected contraceptive decisions and assess how they heard about the Z-CAN program and what influenced their participation, or lack thereof, 24 focus-group discussions were conducted among women of reproductive age who did and did not participate in Z-CAN. RESULTS: Women who participated in the discussions often had heard about Z-CAN from their physician or friends; non-participants had heard about Z-CAN from Facebook or friends. Women expressed satisfaction on finding a Z-CAN clinic and valued the same-day provision of contraceptives. When a preferred contraceptive method or a first appointment was not readily available, women reconsidered accessing the program. Women's perceptions and trust of reproductive healthcare providers, their engagement in social networks, and their ability to choose a contraceptive method that best meets their needs can influence participation in contraception-access programs. CONCLUSION: Focus groups can be used to understand women's knowledge of the Zika virus, barriers and facilitators to contraception access, and motivations for participation in the Z-CAN program.

Addressing Adolescent Substance Abuse and Risky Sexual Health Behaviors via Youth-Led Initiatives: A Review of the Teens Linked to Care Pilot Program.

The Teens Linked to Care (TLC) pilot program utilized a youth-led integrated strategy to prevent substance use and risky sexual behavior among school-attending youth at disproportionate risk, including sexual and gender minority youth (SGMY). The program developed a framework to address human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), teen pregnancy, and high-risk substance use within schools. Strategies included education, primary prevention, and early detection screening. High schools in two rural counties served as pilot sites and successfully implemented strategies to encourage youth to engage in healthier sexual practices and avoid harmful substance use. An evaluation of TLC demonstrated its effectiveness in developing youth-friendly resources, promoting connectedness, and building resiliency among students and staff. This program used the results of two iterations of the Youth Risk Behavior Survey (YRBS) to understand the situations of youth, including SGMY. YRBS results helped tailor program activities for SGMY populations. By focusing on education, access to care, and supportive environments, schools can utilize the TLC model to combat youth substance abuse and risky sexual practices.

The CDC Foundation's COVID-19 emergency response pilot project: a case study in knowledge brokering for older adults and caregivers.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) public health emergency has disproportionately affected older adults and their caregivers, requiring evidence-based and coordinated efforts to meet their health and social needs. This paper describes the role of the CDC Foundation as a knowledge broker working with public health partners to rapidly meet the unmet health, social, and other needs of older adults and caregivers during the COVID-19 pandemic. Type of program or service: Qualitative case study using the Role Model for Knowledge Brokering framework to describe a project that translated public health research into practice during the COVID-19 pandemic response. METHODS: This case study documents the experiences of a US-based foundation serving as a knowledge broker, carrying out three roles: establishing research partnerships to study unmet health, social, and other needs of older adults and caregivers during COVID-19; coordinating with partners to identify evidence-based strategies; and rapidly implementing four emergency response pilot projects. RESULTS: The emergency response pilot projects created included: an online resource library - -SearchFindHelp.org - of public health programs and resources for organisations serving older adults and caregivers; digital literacy training for older adults and caregivers; multicultural caregiver tools to serve rural and Asian American and Pacific Islander older adults; and a grant program to expand local, direct services for older adults. SearchFindHelp.org had 46 781 new users and 101 908 total views from June 2021-March 2023. Older adults and caregivers who participated in digital literacy training from May-September 2021 were more likely to find health resources online and schedule and attend an online doctor's visit. A paid media campaign in December 2021 was launched to raise awareness of multicultural caregiver tools. Ten community organisations expanded direct, local services for older adults. LESSONS LEARNT: This project highlights the valuable role a foundation can play as a knowledge broker in rapidly translating research into practice during a public health emergency response, to address emerging community needs.

Building Global Health Systems Capacity During COVID-19 to Improve Vaccination Access and Reduce Hesitancy: Case Studies in Zambia and Tanzania.

During the COVID-19 pandemic, the CDC Foundation collaborated with implementing partners in Zambia and Tanzania to address challenges related to vaccination access and hesitancy through strategic partnership, technical assistance, and community engagement. These efforts were successful in fostering collaborations among community partners and health authorities and actively engaging the ministries of health. This article describes 2 case studies from Zambia and Tanzania involving different strategies to build health system capacity through projects that improved vaccination access and reduced hesitancy. Such projects illustrate how efforts that strengthen public health and healthcare systems have further positive implications for building localized response systems through context-tailored approaches and building capacity of local healthcare workers. The case studies are examples of public health emergency response projects that successfully increased vaccination access and reduced hesitancy in local communities by rapidly implementing projects to strengthen health system capacity and resilience.

Community Perspectives on Contraception in the Context of Zika Virus in American Samoa and the Commonwealth of the Northern Mariana Islands.

The prevention of unintended pregnancy was identified as a primary prevention strategy to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak. The Centers for Disease Control and Prevention in partnership with local health agencies conducted formative research to guide the development of culturally appropriate messages and materials to increase awareness of the prevention of unintended pregnancy as a strategy to decrease Zika-related adverse outcomes in American Samoa and the Commonwealth of the Northern Mariana Islands (CNMI). Nine focus groups (N=71) were conducted with women and men aged 18-44 years living in American Samoa and CNMI. Semi-structured interview guides were used to explore participants' knowledge and perceptions of Zika, family planning, and contraception; barriers and facilitators to access contraception and use; and information sources and contraception decision-making. Trained staff from local organizations co-moderated each focus group. Thematic analysis was conducted with NVivo 10. Participants had mixed knowledge about Zika virus and its relation to pregnancy and birth defects. Women and men had varied knowledge of the full range of contraceptive methods available in their jurisdiction and identified barriers to contraceptive access. Social factors including stigma, gender roles, and religion often deterred participants from accessing contraceptive services. Participants highlighted the need for culturally appropriate and clear messaging about contraceptive methods. Results demonstrate the feasibility of conducting formative research as an effective strategy for understanding community perspectives on unintended pregnancy prevention in the context of the Zika virus outbreak to develop health communication materials.

K-12, college/university, and mass shootings: similarities and differences.

In a 2003 study, we examined five antecedents of school shootings - a history of rejection, acute rejection experience, history of psychological problems, fascination with death or violence, and fascination with guns. In three studies, the current project examined the role of these factors in 57 K-12 shootings, 24 college/university shootings, and 77 mass shootings that occurred since the original study. Over half of all shooters had a history of psychological problems. More K-12 shooters than college or mass shooters displayed a history of rejection. However, more mass than school shooters had experienced an acute rejection, such as a workplace firing. The characteristics identified in the original study appeared as common antecedent conditions of not only K-12 shootings but college/university and mass shootings as well. These results identify problems that can be addressed to minimize the occurrence of school and mass shootings.

The Act of Listening Well: Improving Communication Skills through Bibliotherapy.

Health professions education programs have the ability to educate future healthcare professionals on the technical aspects of medicine and physical function, yet it is difficult to provide students with the skills to effectively communicate with patients. Communication is a critical competency for all healthcare professionals, and it is well-documented that patient-provider communication is an important factor in affecting patient views and care outcomes. In this essay, a program of bibliotherapy, or reading therapy, is explored as a means to teach health professions students to effectively and compassionately communicate with patients. The experience of serving as a bibliotherapist enables students to create bonds that increase empathy and understanding of patient perspectives.