Effects of a Faith-Based Obesity Intervention on African American and Latino Adults' Children.

BACKGROUND: Faith-based interventions are promising for promoting healthy behaviors among adults, but their ripple effects on participants' children are unknown. This study is one of the first to assess the effects of a faith-based multilevel obesity intervention on adult participants' children. METHODS: We analyzed quantitative data from a cluster randomized controlled trial with two African American and two Latino churches in South Los Angeles, California, which invited adult participants to enroll one child (5-17 years) in a sub-study. At baseline and 6-7 months follow-up, parents completed a child health survey, which included the family nutrition and physical activity screening tool, and child height and weight were measured (n = 50). RESULTS: Results from linear regression models showed children of intervention participants, compared to control, had significantly better dietary patterns at follow-up. CONCLUSIONS: Findings suggest the health benefits of a faith-based multilevel obesity intervention for adults can extend to children and may help address obesity disparities.

Lessons Learned about Developing Faith and Public Health Partnerships to Address Health Disparities.

Partnerships between public health and faith-based organizations draw on the strengths of both sectors to achieve a shared interest in promoting health and reducing disparities. However, information about implementation of faith and public health partnerships-particularly those involving diverse racial-ethnic groups-is limited. This paper reports on findings from qualitative interviews conducted with 16 public health and congregational leaders around the country as part of the early phase of the development of a faith and public health partnership to address health disparities in Los Angeles, CA. We identified eight themes regarding the barriers and facilitators to building faith and public health partnerships and distilled these into 10 lessons for developing such approaches. These interviews identified that engaging religious organizations often requires building congregational capacity of the congregation to participate in health programs; and that trust is a critically important element of these relationships. Further, trust is closely related to how well each organization involved in the partnership understands their partners' belief structures, approaches to addressing health and well-being and capacities to contribute to the partnership. Tailoring congregational health programs to match the interests, needs and capacity of partners was identified as an important approach to ensuring that the partnership is successful. But, this is complicated by working across multiple faith traditions and the racial-ethnic backgrounds, thus requiring increased and diverse communication strategies on the part of the partnership leadership. These lessons provide important information for faith and public health leaders interested in developing partnered approaches to address health in diverse urban communities.

Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial.

Importance: The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. Objective: To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. Design, Setting, and Participants: This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Intervention: Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Main Outcomes and Measures: Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. Results: High- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). Conclusions and Relevance: The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT04047147.

Lessons From an Implementation Evaluation of a Real-World Multi-City Initiative to Address COVID-19 Vaccination Inequities.

Background: The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color.Purpose: To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles.Design and sample: In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes).Conclusions: Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis.

Continuity of Trust: Health Systems' Role in Advancing Health Equity Beyond the COVID-19 Pandemic.

Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.

The U.S. Equity-First Vaccination Initiative: Impacts and Lessons Learned.

The one-year U.S. Equity-First Vaccination Initiative (EVI), launched in April 2021, aimed to reduce racial inequities in coronavirus disease 2019 (COVID-19) vaccination across five demonstration cities (Baltimore, Chicago, Houston, Newark, and Oakland) and over the longer term strengthen the United States' public health system to achieve more-equitable outcomes. This initiative comprised nearly 100 community-based organizations (CBOs), who led hyper-local work to increase vaccination access and confidence in communities of individuals who identify as Black, Indigenous, and People of Color. In this study, the second of two on the initiative, the authors examine the results of the EVI. They look at the initiative's activities, effects, and challenges, and provide recommendations for how to support and sustain this hyper-local community-led approach and strengthen the public health system in the United States.

The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.

OBJECTIVE: To identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. DATA SOURCES: We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data. STUDY DESIGN: We conducted cross-sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR). DATA COLLECTION: We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of September 18, 2020 through November 5, 2021, and we restricted our analysis to short-term, general hospitals with at least one intensive care unit (ICU) bed. We defined "ICU strain share" as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥ 90%. PRINCIPAL FINDINGS: After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% vs. 22%, p < 0.05) and received greater PRF amounts per bed ($118,864 vs. $92,407, p < 0.05). Having high versus low ICU occupancy relative to pre-pandemic capacity was associated with a modest increase in PRF amounts per bed after adjusting for HRR ($107,319 vs. $96,627, p < 0.05), but there were no statistically significant differences when comparing hospitals with high versus low ICU occupancy relative to contemporaneous capacity. CONCLUSIONS: Hospitals with large Black patient shares experienced greater strain during the pandemic. Although these hospitals received more federal relief, funding was not targeted overall toward hospitals with high ICU occupancy rates.

Feasibility and acceptability of a mobile messaging program within a church-based healthy living intervention for African Americans and Latinos.

Church-based programs can act on multiple levels to improve dietary and physical activity behaviors among African Americans and Latinos. However, the effectiveness of these interventions may be limited due to challenges in reaching all congregants or influencing behavior outside of the church setting. To increase intervention impact, we sent mobile messages (text and email) in English or Spanish to congregants (n = 131) from predominantly African American or Latino churches participating in a multi-level, church-based program. To assess feasibility and acceptability, we collected feedback throughout the 4-month messaging intervention and conducted a process evaluation using the messaging platform. We found that the intervention was feasible to implement and acceptable to a racially ethnically diverse study sample with high obesity and overweight rates. While the process evaluation had some limitations (e.g. low response rate), we conclude that mobile messaging is a promising, feasible addition to church-based programs aiming to improve dietary and physical activity behaviors.

Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.

CONTEXT: Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants as well as the congregation as a whole. However, the extent to which such interventions are developed using a collaborative partnership approach and are effective with diverse racial/ethnic populations is unclear, and these crucial features of well-designed community-based interventions. OBJECTIVE: The present systematic literature review of church-based interventions was conducted to assess their efficacy for addressing obesity across different racial/ethnic groups (eg, African Americans, Latinos). DATA SOURCES AND EXTRACTION: In total, 43 relevant articles were identified using systematic review methods developed by the Center for Disease Control and Prevention (CDC)'s Task Force on Community Preventive Services. The extent to which each intervention was developed using community-based participatory research principles, was tailored to the particular community in question, and involved the church in the study development and implementation were also assessed. DATA ANALYSIS: Although 81% of the studies reported significant results for between- or within-group differences according to the study design, effect sizes were reported or could only be calculated in 56% of cases, and most were small. There was also a lack of diversity among samples (eg, few studies involved Latinos, men, young adults, or children), which limits knowledge about the ability of church-based interventions to reduce the burden of obesity more broadly among vulnerable communities of color. Further, few interventions were multilevel in nature, or incorporated strategies at the church or community level. CONCLUSIONS: Church-based interventions to address obesity will have greater impact if they consider the diversity among populations burdened by this condition and develop programs that are tailored to these different populations (eg, men of color, Latinos). Programs could also benefit from employing multilevel approaches to move the field away from behavioral modifications at the individual level and into a more systems-based framework. However, effect sizes will likely remain small, especially since individuals only spend a limited amount of time in this particular setting.

Eat, Pray, Move: A Pilot Cluster Randomized Controlled Trial of a Multilevel Church-Based Intervention to Address Obesity Among African Americans and Latinos.

PURPOSE: To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes. DESIGN: Cluster randomized controlled trial (pilot). SETTING: Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California. PARTICIPANTS: Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church). INTERVENTION: Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals. MEASURES: Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race-ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status. ANALYSIS: Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes. RESULTS: Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (-0.05 effect sizes; 95% confidence interval [CI] = -0.06 to -0.04), lower BMI (-0.08; 95% CI = -0.11 to -0.05), and healthier diet (-0.09; 95% CI = -0.17 to -0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week. CONCLUSION: Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention.

A Community-Partnered Approach to Developing Church-Based Interventions to Reduce Health Disparities Among African-Americans and Latinos.

Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participatory research (CBPR), focusing on several key issues: (1) the multi-layered governance structure and activities to establish the partnership and identify initial health priority (obesity), (2) characteristics of the congregations recruited to partnership (n = 66), and (3) the lessons learned from participating congregations' past work on obesity that informed the development of a multi-level, multi-component, church-based intervention. Having diverse staff with deep ties in the faith community, both among researchers and the primary community partner agency, was key to recruiting African-American and Latino churches. Involvement by local health department and community health clinic personnel provided technical expertise and support regarding health data and clinical resources. Selecting a health issue-obesity-that affected all subgroups (e.g., African-Americans and Latinos, women and men, children and adults) garnered high enthusiasm among partners, as did including some innovative aspects such as a text/e-mail messaging component and a community mapping exercise to identify issues for advocacy. Funding that allowed for an extensive community engagement and planning process was key to successfully implementing a CBPR approach. Building partnerships through which multiple CBPR initiatives can be done offers efficiencies and sustainability in terms of programmatic activities, though long-term infrastructure grants, institutional support, and non-research funding from local foundations and health systems are likely needed.

An Innovative Network Approach to Coordinating a National Effort to Improve Cardiovascular Health: The Case of Million Hearts.

OBJECTIVE: To assess the structure, content, quality, and quantity of partnerships that developed in response to a national cardiovascular health initiative, Million Hearts. DESIGN: This study used a social network analysis (SNA) approach to assess the Million Hearts initiative network partnerships and identify potential implications for policy and practice. SETTING/PARTICIPANTS: The Million Hearts network comprised a core group of federal and private sector partners that participate in Million Hearts activities and align with initiative priorities. To bound the network for the SNA, we used a list of 58 organizations (74% response rate) from a previously completed qualitative analysis of Million Hearts partnerships. MAIN OUTCOME MEASURES: We used the online PARTNER (Program to Analyze Record and Track Networks to Enhance Relationships-www.partnertool.net) survey to collect data on individual organizational characteristics and relational questions that asked organizations to identify and describe their relationships with other partners in the network. Key SNA measures include network density, centralizations, value, and trust. RESULTS: Our analyses show a network that is decentralized, has strong perceptions of trust and value among its members, and strong agreement on intended outcomes. Interestingly, partners report a desire and ability to contribute resources to Million Hearts; however, the perceptions between partners are that resources are not being contributed at the level they potentially could be. The majority of partners reported that being in the network helped them achieve their goals related to cardiovascular disease prevention. The largest barrier to successful activities within the network was cited as lack of targeted funding and staff to support participation in the network. CONCLUSIONS: The Million Hearts network described in this article is unique in its membership at the national level, agreement on outcomes, its powerful information-sharing abilities that require few resources, and its decentralized structure. We identified strategies that could be implemented to strengthen the network and its activities. By examining a national-level public-private partnership formed to address a public health issue, we can identify ways to strengthen the network and provide a framework for developing other initiatives.

Evaluating Community Partnerships Addressing Community Resilience in Los Angeles, California.

Community resilience has grown in importance in national disaster response and recovery efforts. However, measurement of community resilience, particularly the content and quality of relationships aimed at improving resilience, is lacking. To address this gap, we used a social network survey to measure the number, type, and quality of relationships among organizations participating in 16 coalitions brought together to address community resilience in the Los Angeles Community Disaster Resilience project. These coalitions were randomized to one of two approaches (community resilience or preparedness). Resilience coalitions received training and support to develop these partnerships and implement new activities. Both coalition types received expert facilitation by a public health nurse or community educator. We also measured the activities each coalition engaged in and the extent to which partners participated in these activities at two time points. We found that the community resilience coalitions were initially larger and had lower trust among members than the preparedness communities. Over time, these trust differences dissipated. While both coalitions grew, the resilience community coalitions maintained their size difference throughout the project. We also found differences in the types of activities implemented by the resilience communities; these differences were directly related to the trainings provided. This information is useful to organizations seeking guidance on expanding the network of community-based organizations that participate in community resilience activities.

Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Boston and Massachusetts.

The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. During the first open-enrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, they used federal and state funding to develop navigator programs. Program design differed by location, and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. This article is one in a series designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Each case study was designed to capture nuanced differences in how health departments support these efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. These studies identify compelling models for how state and local health departments can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage moving forward. This article focuses on a case study on Boston and Massachusetts.

Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Illinois.

The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. During the first open-enrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, they used federal and state funding to develop navigator programs. Program design differed by location, and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. This article is one in a series designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Each case study was designed to capture nuanced differences in how health departments support these efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. These studies identify compelling models for how state and local health departments can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage moving forward. This article focuses on a case study on Illinois.

Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Tacoma-Pierce County, Washington.

The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. During the first open-enrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, they used federal and state funding to develop navigator programs. Program design differed by location, and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. This article is one in a series designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Each case study was designed to capture nuanced differences in how health departments support these efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. These studies identify compelling models for how state and local health departments can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage moving forward. This article focuses on a case study on Tacoma-Pierce County, Washington.