Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature.

OBJECTIVE: To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE: An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA: Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION: The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS: Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS: Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION: Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.

Systematic Review of Variables Related to Instruction in Augmentative and Alternative Communication Implementation: Group and Single-Case Design.

PURPOSE: This article provides a systematic review and analysis of group and single-case studies addressing augmentative and alternative communication (AAC) intervention with school-aged persons having autism spectrum disorder (ASD) and/or intellectual/developmental disabilities resulting in complex communication needs (CCNs). Specifically, we examined participant characteristics in group-design studies reporting AAC intervention outcomes and how these compared to those reported in single-case experimental designs (SCEDs). In addition, we compared the status of intervention features reported in group and SCED studies with respect to instructional strategies utilized. PARTICIPANTS: Participants included school-aged individuals with CCNs who also experienced ASD or ASD with an intellectual delay who utilized aided or unaided AAC. METHOD: A systematic review using descriptive statistics and effect sizes was implemented. RESULTS: Findings revealed that participant features such as race, ethnicity, and home language continue to be underreported in both SCED and group-design studies. Participants in SCED investigations more frequently used multiple communication modes when compared to participants in group studies. The status of pivotal skills such as imitation was sparsely reported in both types of studies. With respect to instructional features, group-design studies were more apt to utilize clinical rather than educational or home settings when compared with SCED studies. In addition, SCED studies were more apt to utilize instructional methods that closely adhered to instructional features more typically characterized as being associated with behavioral approaches. CONCLUSION: The authors discuss future research needs, practice implications, and a more detailed specification of treatment intensity parameters for future research.

Urban policy interventions to reduce traffic-related emissions and air pollution: A systematic evidence map.

BACKGROUND: Urban areas are hot spots for human exposure to air pollution, which originates in large part from traffic. As the urban population continues to grow, a greater number of people risk exposure to traffic-related air pollution (TRAP) and its adverse, costly health effects. In many cities, there is a need and scope for air quality improvements through targeted policy interventions, which continue to grow including rapidly changing technologies. OBJECTIVE: This systematic evidence map (SEM) examines and characterizes peer-reviewed evidence on urban-level policy interventions aimed at reducing traffic emissions and/or TRAP from on-road mobile sources, thus potentially reducing human exposures and adverse health effects and producing various co-benefits. METHODS: This SEM follows a previously peer-reviewed and published protocol with minor deviations, explicitly outlined here. Articles indexed in Public Affairs Index, TRID, Medline and Embase were searched, limited to English, published between January 1, 2000, and June 1, 2020. Covidence was used to screen articles based on previously developed eligibility criteria. Data for included articles was extracted and manually documented into an Excel database. Data visualizations were created in Tableau. RESULTS: We identified 7528 unique articles from database searches and included 376 unique articles in the final SEM. There were 58 unique policy interventions, and a total of 1,139 unique policy scenarios, comprising these interventions and different combinations thereof. The policy interventions fell under 6 overarching policy categories: 1) pricing, 2) land use, 3) infrastructure, 4) behavioral, 5) technology, and 6) management, standards, and services, with the latter being the most studied. For geographic location, 463 policy scenarios were studied in Europe, followed by 355 in Asia, 206 in North America, 57 in South America, 10 in Africa, and 7 in Australia. Alternative fuel technology was the most frequently studied intervention (271 times), followed by vehicle emission regulation (134 times). The least frequently studied interventions were vehicle ownership taxes, and studded tire regulations, studied once each. A mere 3 % of studies addressed all elements of the full-chain-traffic emissions, TRAP, exposures, and health. The evidence recorded for each unique policy scenario is hosted in an open-access, query-able Excel database, and a complementary interactive visualization tool. We showcase how users can find more about the effectiveness of the 1,139 included policy scenarios in reducing, increasing, having mixed or no effect on traffic emissions and/or TRAP. CONCLUSION: This is the first peer-reviewed SEM to compile international evidence on urban-level policy interventions to reduce traffic emissions and/or TRAP in the context of human exposure and health effects. We also documented reported enablers, barriers, and co-benefits. The open-access Excel database and interactive visualization tool can be valuable resources for practitioners, policymakers, and researchers. Future updates to this work are recommended. PROTOCOL REGISTRATION: Sanchez, K.A., Foster, M., Nieuwenhuijsen, M.J., May, A.D., Ramani, T., Zietsman, J. and Khreis, H., 2020. Urban policy interventions to reduce traffic emissions and traffic-related air pollution: Protocol for a systematic evidence map. Environment international, 142, p.105826.

Participant characteristics predicting communication outcomes in AAC implementation for individuals with ASD and IDD: a systematic review and meta-analysis.

This meta-analysis examined communication outcomes in single-case design studies of augmentative and alternative communication (AAC) interventions and their relationship to participant characteristics. Variables addressed included chronological age, pre-intervention communication mode, productive repertoire, and pre-intervention imitation skills. Investigators identified 114 single-case design studies that implemented AAC interventions with school-aged individuals with autism spectrum disorder and/or intellectual disability. Two complementary effect size indices, Tau(AB) and the log response ratio, were applied to synthesize findings. Both indices showed positive effects on average, but also exhibited a high degree of heterogeneity. Moderator analyses detected few differences in effectiveness when comparing across diagnoses, age, the number and type of communication modes, participant's productive repertoires, and imitation skills to intervention. A PRISMA-compliant abstract is available: https://bit.ly/30BzbLv.

Facilitators and Barriers When Conducting Adult Health Programs Within the African American Church: A Systematic Review.

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level.

PET-CR as a potential surrogate endpoint in untreated DLBCL: meta-analysis and implications for clinical trial design.

This study's focus is the association of end-of-therapy (EOT) PET results with progression-free (PFS) and overall survival (OS) in patients with diffuse large B-cell lymphoma receiving first-line chemoimmunotherapy. We develop a Bayesian hierarchical model for predicting PFS and OS from EOT PET-complete response (PET-CR) using a literature-based meta-analysis of 20 treatment arms and a substudy of 4 treatment arms in 3 clinical trials for which we have patient-level data. The PET-CR rate in our substudy was 72%. The modeled estimates for hazard ratio (PET-CR/non-PET-CR) were 0.13 for PFS (95% CI 0.10, 0.16) and 0.10 for OS (CI 0.07, 0.12). Hazard ratios varied little by patient subtype and were confirmed by the overall meta-analysis. We link these findings to designing future clinical trials and show how our model can be used in adapting the sample size of a trial to accumulating results regarding treatment benefits on PET-CR and a survival endpoint.

Systemic review of genetic and epigenetic factors underlying differential toxicity to environmental lead (Pb) exposure.

Lead (Pb) poisoning is a major public health concern in environmental justice communities of the USA and in many developing countries. There is no identified safety threshold for lead in blood, as low-level Pb exposures can lead to severe toxicity in highly susceptible individuals and late onset of diseases from early-life exposure. However, identifying "susceptibility genes" or "early exposure biomarkers" remains challenging in human populations. There is a considerable variation in susceptibility to harmful effects from Pb exposure in the general population, likely due to the complex interplay of genetic and/or epigenetic factors. This systematic review summarizes current state of knowledge on the role of genetic and epigenetic factors in determining individual susceptibility in response to environmental Pb exposure in humans and rodents. Although a number of common genetic and epigenetic factors have been identified, the reviewed studies, which link these factors to various adverse health outcomes following Pb exposure, have provided somewhat inconsistent evidence of main health effects. Acknowledging the compelling need for new approaches could guide us to better characterize individual responses, predict potential adverse outcomes, and identify accurate and usable biomarkers for Pb exposure to improve mitigation therapies to reduce future adverse health outcomes of Pb exposure.

Medicolegal death investigator workplace safety hazards: A scoping review of the literature.

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on-scene and follow-up activities, a scoping review was conducted to document known occupational safety risks and health-related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty-five articles met inclusion criteria, which included seventeen survey-mixed method designs, two systematic reviews, five quasi-experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies.

A 10-year systematic review of theory-driven approaches to increasing catch-up HPV vaccination rates among young adult males in colleges/university settings.

OBJECTIVE: To describe rates and identify factors associated with human papillomavirus (HPV) vaccination among young adult males in college/university settings. METHODS: Study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched for empirical studies published between 2009 and 2019 and focused on predictors for HPV vaccine uptake. Studies' methodological quality scores ranged between 12 and 23 points. RESULTS: Five hundred and ninety eight titles/abstracts and 154 full-text articles were screened. Eighteen studies were included for final analysis. Results depicted participants' attitude, perceived susceptibility, severity, benefits, and barriers in receiving HPV vaccine. Many participants did not perceive themselves to be susceptible to HPV infection, and barriers to receiving HPV vaccine outweighed benefits. HPV knowledge and vaccination rates were relatively low among respondents. CONCLUSION: Prevention campaigns that increase knowledge, promote positive attitudes, change perception of susceptibility, and address barriers may result in higher HPV vaccination rates among males in college/university settings.

Family Health History-Based Interventions: A Systematic Review of the Literature.

CONTEXT: National efforts have advocated for the need to deliver family health history-based interventions to the lay public for more than a decade. Yet, the numbers, characteristics, and outcomes of such interventions are unknown. This first-of-its-kind systematic literature review examines the characteristics and effectiveness of the existing family health history-based interventions. EVIDENCE ACQUISITION: The research team systematically searched peer-reviewed articles published between January 2003 and July 2020 in MEDLINE, Embase, CINAHL, and Google Scholar. EVIDENCE SYNTHESIS: A total of 35 articles met the inclusion criteria. These studies assessed various behaviors, including family health history collection/communication with family members, family health history communication with healthcare providers, healthy diet adoption, physical activity level, uptake of medical screenings and genetic tests, and being proactive in healthcare matters. The average methodologic quality score of the studies was 9.9 (SD=1.6) of a theoretical range from 2 to 16. CONCLUSIONS: Many family health history-based interventions exist to examine a variety of behaviors. Yet, there is room for improvement in methodology because few studies used a randomized or quasi-experimental design. In addition, most included studies did not report objective or longer-term outcome data to examine the effectiveness of family health history-based interventions.

Characterizing baseline legacy chemical contamination in urban estuaries for disaster-research through systematic evidence mapping: A case study.

Natural disasters such as floods and hurricanes impact urbanized estuarine environments. Some impacts pose potential environmental and public health risks because of legacy or emerging chemical contamination. However, characterizing the baseline spatial and temporal distribution of environmental chemical contamination before disasters remains a challenge. To address this gap, we propose using systematic evidence mapping (SEM) in order to comprehensively integrate available data from diverse sources. We demonstrate this approach is useful for tracking and clarifying legacy chemical contamination reporting in an urban estuary system. We conducted a systematic search of peer-reviewed articles, government monitoring data, and grey literature. Inclusion/exclusion criteria are used as defined by a Condition, Context, Population (CoCoPop) statement for literature from 1990 to 2019. Most of the peer-reviewed articles reported dioxins/furans or mercury within the Houston Ship Channel (HSC); there was limited reporting of other organics and metals. In contrast, monitoring data from two agencies included 89-280 individual chemicals on a near-annual basis. Regionally, peer-reviewed articles tended to record metals in Lower Galveston Bay (GB) but organics in the HSC, while the agency databases spanned a wider spatial range in GB/HSC. This SEM has shown that chemical data from peer-reviewed and grey literature articles are sparse and inconsistent. Even with inclusion of government monitoring data, full spatial and temporal distributions of baseline levels of legacy chemicals are difficult to determine. There is thus a need to expand the chemical, spatial, and temporal coverage of sampling and environmental data reporting in GB/HSC.

Securing a sustainable and fit-for-purpose UK health and care workforce.

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

Application of the navigation guide systematic review methodology to evaluate prenatal exposure to particulate matter air pollution and infant birth weight.

Low birth weight is an important risk factor for many co-morbidities both in early life as well as in adulthood. Numerous studies report associations between prenatal exposure to particulate matter (PM) air pollution and low birth weight. Previous systematic reviews and meta-analyses report varying effect sizes and significant heterogeneity between studies, but did not systematically evaluate the quality of individual studies or the overall body of evidence. We conducted a new systematic review to determine how prenatal exposure to PM2.5, PM10, and coarse PM (PM2.5-10) by trimester and across pregnancy affects infant birth weight. Using the Navigation Guide methodology, we developed and applied a systematic review protocol [CRD42017058805] that included a comprehensive search of the epidemiological literature, risk of bias (ROB) determination, meta-analysis, and evidence evaluation, all using pre-established criteria. In total, 53 studies met our inclusion criteria, which included evaluation of birth weight as a continuous variable. For PM2.5 and PM10, we restricted meta-analyses to studies determined overall as "low" or "probably low" ROB; none of the studies evaluating coarse PM were rated as "low" or "probably low" risk of bias, so all studies were used. For PM2.5, we observed that for every 10 µg/m3 increase in exposure to PM2.5 in the 2nd or 3rd trimester, respectively, there was an associated 5.69 g decrease (I2: 68%, 95% CI: -10.58, -0.79) or 10.67 g decrease in birth weight (I2: 84%, 95% CI: -20.91, -0.43). Over the entire pregnancy, for every 10 µg/m3 increase in PM2.5 exposure, there was an associated 27.55 g decrease in birth weight (I2: 94%, 95% CI: -48.45, -6.65). However, the quality of evidence for PM2.5 was rated as "low" due to imprecision and/or unexplained heterogeneity among different studies. For PM10, we observed that for every 10 µg/m3 increase in exposure in the 3rd trimester or the entire pregnancy, there was a 6.57 g decrease (I2: 0%, 95% CI: -10.66, -2.48) or 8.65 g decrease in birth weight (I2: 84%, 95% CI: -16.83, -0.48), respectively. The quality of evidence for PM10 was rated as "moderate," as heterogeneity was either absent or could be explained. The quality of evidence for coarse PM was rated as very low/low (for risk of bias and imprecision). Overall, while evidence for PM2.5 and course PM was inadequate primarily due to heterogeneity and risk of bias, respectively, our results support the existence of an inverse association between prenatal PM10 exposure and low birth weight.

Frequent emergency department use in the paediatric population: A systematic literature review.

OBJECTIVE: We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. METHODS: We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. RESULTS: Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. CONCLUSIONS: Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.

A Scoping Review of Bikeability Assessment Methods.

Bicycling holds promise as a healthy and sustainable means of transportation and physical activity. Despite the growing interest in community-based environmental approaches to promoting physical activity, bikeability has received relatively little attention. This paper provides a scoping review of the instruments developed to measure bikeability along with practice-based analyses of the tools related to user expertise, estimated cost, and required time to implement. The review summarizes the literature, identifies research gaps, and informs stakeholders with articles from EBSCO and transportation databases published after 2003 when the previous bikeability instrument review paper was published. Data extraction included the tool name, data collection method, study location, data collection scale, type of measure, and description. Two reviewers independently reviewed articles included in the full text review, and the inter-rater agreement exceeded 90%. The database search yielded 388 unique articles, and 17 met the inclusion/exclusion criteria. Most of the studies, 11 of 17, were applied to settings outside of the U.S. Five studies employed a self-report survey, and five studies examined bikeability using geospatial data, like GIS. Seven studies used a direct observation audit tool-one specifically using a mobile app and another using virtual observation techniques with Google Street View. Bikeability tools are useful for assessing communities and their supports for bicycling. Our primary finding is that advances in technology over the past two decades have driven innovative and useful methodologies, in a variety of disciplines, for assessing the environment, but more consensus is needed to provide a universal definition of bikeability.

Intergenerational communities: A systematic literature review of intergenerational interactions and older adults' health-related outcomes.

RATIONALE: Population aging is a major societal challenge that the US and many other countries are facing. The roles of intergenerational interactions are being increasingly recognized as important factors influencing health and well-being of older adults and other generations. OBJECTIVE: This systematic review paper provides a critical assessment of the current state of knowledge about the impacts of intergenerational activities on older adults' health-related outcomes. METHODS: Literature searches were conducted in October 2019 within MEDLINE, SocIndex, APA PsycInfo, and CINAHL Complete, using a pre-developed list of relevant keywords. Identified papers were reviewed and selected based on the following eligibility criteria: (1) older adults aged 50 or over as the study population, (2) nonfamily member intergenerational interactions as independent variables, (3) older adults' health-related outcomes as dependent variables, and (4) empirical and quantitative studies performed in the US and written in English. A total of 24 out of 22,674 identified articles met these eligibility criteria. RESULTS: All of the 24 studies focused on evaluating intergenerational programs and their intervention effects. No studies addressed community or environmental interventions/effects. Program-based intergenerational interactions showed positive associations with older adults' physical health, psychosocial health (e.g. reduced depression), cognitive function, social relationships, and well-being/quality of life. Moreover, engagement in intergenerational activities was linked with increased physical and social activities. CONCLUSIONS: This review showed solid evidence supporting the significance of program-based interventions in promoting intergenerational activities and associated health benefits. Significant knowledge gaps are also found resulting from the lack of studies examining the roles of physical environmental interventions/factors, diverse types of intergenerational interactions, and location-driven activities. Such studies can contribute to a better understanding of the specific attributes, both program-based and place-based supports, of the community environment that can promote intergenerational interactions and healthy aging in place.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis.

BACKGROUND: African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS: In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS: Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS: Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.

Patients' and providers' perspectives on sexual health discussion in the United States: A scoping review.

OBJECTIVES: The objective of this scoping review was to explore patients' and providers' perspectives on sexual health communication. METHODS: A literature search was conducted in three databases, Medline (OVID), CINAHL (Ebsco), and PsycINFO (Ebsco) covering January 1, 2000-May 12, 2020. A coding sheet with a list of questions was created in Qualtrics to extract information from each article. RESULTS: Thirty-three (33) studies were included in this review. The findings indicated that 1) the current sexual health discussion does not meet the needs of the patients; and 2) patients and providers hold uniquely different perspectives on the importance of the discussion, the responsibility of conversation initiation, and the comfort level of the discussion. CONCLUSIONS: There remains a significant gap between providers' perceptions and patients' needs regarding sexual health discussion. More efforts should be made to promote the necessary sexual health communication. PRACTICE IMPLICATIONS: Providers should initiate the discussion when necessary because it is very likely that patients welcome the discussion. Medical education and training should incorporate sexual health into its curricula to enhance health care professionals' abilities in addressing sexual health issues. Providers should model a sense of openness and comfort in conversation to encourage patients to discuss sexual health.

Urban policy interventions to reduce traffic emissions and traffic-related air pollution: Protocol for a systematic evidence map.

INTRODUCTION: Cities are the world's engines of economic growth, innovation, and social change, but they are also hot spots for human exposure to air pollution, mainly originating from road traffic. As the urban population continues to grow, a greater quantity of people risk exposure to traffic-related air pollution (TRAP), and therefore also risk adverse health effects. In many cities, there is scope for further improvement in air quality through targeted urban policy interventions. The objective of this protocol is to detail the methods that will be used for a systematic evidence map (SEM) which will identify and characterize the evidence on policy interventions that can be implemented at the urban-level to reduce traffic emissions and/or TRAP from on-road mobile sources, thus reducing human exposures and adverse health impacts. METHODS: Articles will be searched for and selected based on a predetermined search strategy and eligibility criteria. A variety of databases will be searched for relevant articles published in English between January 1, 2000 and June 1, 2020 to encompass the interdisciplinary nature of this SEM, and articles will be stored and screened using Rayyan QCRI. Predetermined study characteristics will be extracted and coded from included studies in a Microsoft Excel sheet, which will serve as an open access, interactive database, and two authors will review the coded data for consistency. The database will be queryable, and various interactive charts, graphs, and maps will be created using Tableau Public for data visualization. The results of the evidence mapping will be detailed via narrative summary. CONCLUSION: This protocol serves to increase transparency of the SEM methods and provides an example for researchers pursuing future SEMs.