FORWARD: Building a Model to Hold Schools of Public Health Accountable for Antiracism Work.

Schools of public health have increasingly adopted programs, praxis, and competencies for antiracist work. Fighting Oppression, Racism and White Supremacy through Action, Research and Discourse (FORWARD) was founded to accelerate antiracist work at the Columbia University Mailman School of Public Health in New York City. Seven action corps reporting to an accountability cabinet were established with 183 participants. FORWARD achieved progress across five core pillars. We describe how an iterative, dynamic structure and explicit framework for accountability can guide future antiracism work. (Am J Public Health. 2023;113(10):1086-1088. https://doi.org/10.2105/AJPH.2023.307356).

Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents.

Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.

Increasing student engagement with course content in graduate public health education: A pilot randomized trial of behavioral nudges.

Digital advances in the learning space have changed the contours of student engagement as well as how it is measured. Learning management systems and other learning technologies now provide information about student behaviors with course materials in the form of learning analytics. In the context of a large, integrated and interdisciplinary Core curriculum course in a graduate school of public health, this study undertook a pilot randomized controlled trial testing the effect of providing a "behavioral nudge" in the form of digital images containing specific information derived from learning analytics about past student behaviors and performance. The study found that student engagement varied significantly from week to week, but nudges linking coursework completion to assessment grade performance did not significantly change student engagement. While the a priori hypotheses of this pilot trial were not upheld, this study yielded significant findings that can guide future efforts to increase student engagement. Future work should include a robust qualitative assessment of student motivations, testing of nudges that tap into these motivations and a richer examination of student learning behaviors over time using stochastic analyses of data from the learning management system.

Needs Assessment of Integrative Health Services at School-Based Health Centers.

Objective: The purpose of this needs assessment was to hear about adolescents' experience with and interest in accessing integrative health services (IHS) at their school-based health centers (SBHCs) so that future education and service offerings could be better informed. Subjects: We surveyed 373 9th to 12th graders, of mostly low-income and minority status, who were enrolled as patients at 6 SBHCs in New York City, New York. Verbal consent was obtained prior to their completing a survey on provided mobile devices. Design: The 35-item anonymous survey asked about adolescents' health goals, familiarity and experience with 14 different integrative health modalities and interest in learning about and accessing these modalities. Results: Among all patients, the most common health goal was improving sleep (65%). Before completing the needs assessment survey, almost all patients (98%) had heard of at least 1 integrative health modality and 69% had ever used any modality. On average, patients were interested in learning more about 7.6 of the modalities and were significantly more interested in learning about each modality from trained professionals than from trained peers or by themselves. Conclusions: Improving sleep was a central health goal for SBHC patients. The majority expressed interest in receiving information on massage, meditation and yoga from trained health professionals, and they wanted access to these modalities at their SBHCs. SBHCs are in a unique position of power in which they can bring desired, cost-effective integrative health modalities to marginalized students. Future efforts should expand provider training to support education on and delivery of these modalities and evaluation of their effectiveness at SBHCs.

Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders.

OBJECTIVES: Functional abdominal pain disorders (FAPD) affect approximately 13.5% of children. Pharmacotherapy is often ineffective, leaving providers, and families seeking adjunctive therapies. Auriculotherapy provides treatment for pain and other symptoms, without a defined protocol for FAPD. A handheld point-finder device measuring transdermal electrical current determines active acupoints, with a higher current indicating a more active acupoint. Our objectives were to determine auricular acupoint (AA) activity in FAPD and to assess participants' attitudes towards auriculotherapy. METHODS: This is a prospective double-blind study evaluating the electrodermal activity of AAs in pediatric-aged female participants with FAPD compared to healthy controls (HC). Participants completed surveys regarding demographics and interest in auriculotherapy. The electrodermal assessment evaluated 20 AAs per ear using a point-finder device. Each AA current measurement was analyzed by average relative rank and median, with a median current measurement ≥50 µA considered active. RESULTS: We enrolled 46 female participants, 22 FAPD (mean age 15.8 years) and 24 HC (mean age 15.4 years). In FAPD, 12 of 40 AAs were active, of which only six were also active in HC. Comparison of median current and average ranking between participants demonstrated consistency. In the post-assessment survey, 86.4% of FAPD expressed interest in receiving auricular acupressure and 68.2% would travel to the clinic solely for treatment. CONCLUSIONS: Based on electrodermal measurements, we propose a treatment protocol using auriculotherapy for FAPD symptom-management. We demonstrated there is considerable patient interest in auriculotherapy. Further studies are needed to confirm the findings in a larger sample size and validate the efficacy of this treatment protocol.

Primary care providers' responses to pregnancy intention screening challenges: community-based participatory research at an urban community health centre.

BACKGROUND: Incorporating pregnancy intention screening into primary care to address unmet preconception and contraception needs may improve delivery of family planning services. A notable research gap exists regarding providers' experiences conducting this screening in primary care. OBJECTIVE: To explore primary care providers' perceived challenges in conducting pregnancy intention screening with women of reproductive age and to identify strategies to discuss this in primary care settings. METHODS: This qualitative study emerged from a 2017 community-based participatory research project. We conducted semi-structured, in-depth interviews with 10 primary care providers who care for women of reproductive age at an urban federally qualified health centre. Analysis consisted of interview debriefing, transcript coding and content analysis with the Community Advisory Board. RESULTS: Across departments, respondents acknowledged difficulties conducting pregnancy intention screening and identified strategies for working with patients' individual readiness to discuss pregnancy intention. Strategies included: linking patients' health concerns with sexual and reproductive health, applying a shared decision-making model to all patient-provider interactions, practicing goal setting and motivational interviewing, fostering non-judgmental relationships and introducing pregnancy intention in one visit but following up at later times when more relevant for patients. CONCLUSIONS: Opportunities exist for health centres to address pregnancy intention screening challenges, such as implementing routine screening and waiting room tools to foster provider and patient agency and sharing best practices with providers across departments by facilitating comprehensive training and periodic check-ins. Exploring providers' experiences may assist health centres in improving pregnancy intention screening in the primary care setting.

Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ2, p < .001). In the last academic year, 45.5% conducted no medical provider trainings, and 54.5% conducted no general staff trainings on providing care for LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

Adapting the Get Yourself Tested Campaign to Reach Black and Latino Sexual-Minority Youth.

BACKGROUND: Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population. METHOD: This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design. RESULTS: During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth.

Assessing the Impact of School-Based Health Centers on Academic Achievement and College Preparation Efforts: Using Propensity Score Matching to Assess School-Level Data in California.

This study examines the association between school-based health center (SBHC) presence and school-wide measures of academic achievement and college preparation efforts. Publicly available educational and demographic data from 810 California public high schools were linked to a list of schools with an SBHC. Propensity score matching, a method to reduce bias inherent in nonrandomized control studies, was used to select comparison schools. Regression analyses, controlling for proportion of English-language learners, were conducted for each outcome including proportion of students participating in three College Board exams, graduation rates, and meeting university graduation requirements. Findings suggest that SBHC presence is positively associated with college preparation outcomes but not with academic achievement outcomes (graduation rates or meeting state graduation requirements). Future research must examine underlying mechanisms supporting this association, such as school connectedness. Additional research should explore the role that SBHC staff could have in supporting college preparation efforts.

Improving contraceptive choice: fidelity of implementation and the gap between effectiveness and efficacy.

Interventions to reduce unintended pregnancy through improved contraceptive use are a public health priority. A comprehensive process evaluation of a contraceptive assessment module intervention with demonstrated efficacy was undertaken. The 12-month process evaluation goal was to describe the extent to which the intervention was implemented as intended over time, and to identify programmatic adjustments to improve implementation fidelity. Quantitative and qualitative methods included staff surveys, electronic health record data, usage monitoring, and observations. Fidelity of implementation was low overall (<10% of eligible patients completed the entire module [dose received]). Although a midcourse correction making the module available in clinical areas led to increased dose delivered (23% vs. 30%, chi-square test p = .006), dose received did not increase significantly after this adjustment. Contextual factors including competing organizational and staff priorities and staff buy-in limited the level of implementation and precluded adoption of some strategies such as adjusting patient flow. Using a process evaluation framework enabled the research team to identify and address complexities inherent in effectiveness studies and facilitated the alignment of program and context.

Emotional Freedom Techniques (EFT) Tapping for Pediatric Emergency Department Staff During the COVID-19 Pandemic: Evaluation of a Pilot Intervention.

Objective: Emergency-department (ED) staff may experience psychologic distress due to the stressful nature of their work. The COVID-19 pandemic exacerbated this distress. Emotional Freedom Techniques (EFT) tapping, a somatic psychophysiologic intervention combining vibratory acupressure with elements of cognitive-behavioral and exposure therapies, can reduce psychologic distress. This study tested the short-term effect of 10-minute EFT tapping on the psychologic distress of pediatric ED staff responding to COVID-19. Materials and Methods: During the COVID-19 pandemic, diverse staff in the pediatric ED of a New York City teaching hospital participated in this single-group study. A licensed creative arts therapist led participants in 10-minute EFT tapping sessions. A self-report questionnaire with 7 items based on the Trauma Exposure Response framework was administered immediately pre- and postintervention. Standardized mean differences between both timepoints were calculated. Results: There were statistically significant reductions for 6 of the 7 items studied, including stress (3.32-2.14), obsessive and intrusive thoughts (2.50-1.85), feelings of pressure (3.20-2.17), loneliness (1.84-1.44), and emotional and physical pain (2.28-1.70); all P < 0.001. No significant changes in professional satisfaction were reported following the intervention. Conclusions: Despite the limitations of a single-arm study design, a 10-minute brief EFT tapping session was a promising way to reduce short-term psychologic distress in pediatric ED health care workers. Future studies, including rigorous randomized controlled trials, are needed to evaluate the effectiveness of brief EFT tapping interventions in other settings.

The role of school-based health centers in providing long-active reversible contraceptive care to adolescents in New York City.

Long-acting reversible contraceptives (LARCs) are effective contraceptive methods for adolescents. This study describes the initiation and continuation of LARC care to adolescents at school-based health centers (SBHCs) during the COVID-19 pandemic. Participants received contraceptive care in New York City SBHCs from April 2021-June 2022. LARC initiation, LARC discontinuation, and total contraceptive visits were measured monthly. During the study period, the SBHCs provided 1,303 contraceptive visits, including 77 LARC initiations. Among LARC initiations, six-month continuation probability was 79.3 % (95 %CI: 69.0-91.1). SBHCs play an important role in providing adolescents contraceptive services, particularly LARC care, when other health care systems are disrupted.

Class III obesity and unwanted pregnancy among women with live births in New York City, 2004-2007.

Obesity is associated with numerous adverse health effects for pregnant women and their newborns. Unintended pregnancy is associated with suboptimal prenatal health behaviors and adverse birth outcomes. While research has suggested a link between obesity and unintended pregnancy, the evidence has been contradictory. Research has not focused on women at the highest level of obesity, Class III (body mass index ≥40). Pregnancy Risk Assessment Monitoring System data for 4,161 women in New York City with a live birth from 2004 to 2007 and complete data on pregnancy intention, height, and weight were examined. The primary outcome, having a live birth that resulted from an unwanted pregnancy (not wanted at that time or at any time in the future), was compared across 6 groups of pre-pregnancy body mass index (BMI). Logistic regression models adjusting for sociodemographic factors and stressors during pregnancy were conducted. The proportion of women reporting their pregnancy was unwanted increased with increasing BMI level to a high of 24 % among women with Class III obesity. After adjustment for confounding sociodemographic factors, women classified as Class III obese were significantly more likely than women with normal BMI to report an unwanted pregnancy [AOR = 2.81 (95 % CI: 1.41-5.60)]; this relationship held after adjusting for stressors during pregnancy. No significant association was found for women of other BMI groups. Previous analyses may have masked a relationship between BMI and unwanted pregnancy among women with Class III obesity. Further research exploring underlying mechanisms which are amenable to intervention is of critical public health importance.

Effects of a Mentoring Program for Black, Indigenous, and People of Color and First-Generation Public Health Students.

OBJECTIVES: Among graduate public health students, Black, Indigenous, and other people of color (BIPOC; including Latinx, Asian, Middle Eastern and North African, Native Hawaiian and Pacific Islander, and multiracial) experience educational and personal challenges that require institutional support and reform. The objective of this study was to evaluate the effects of an antiracist mentorship program on the sense of belonging and overall experience among BIPOC and first-generation students at Columbia University Mailman School of Public Health in New York City. METHODS: We used 2 data sources to retrospectively evaluate experiences of BIPOC and first-generation graduate students: the 2021 Mentoring of Students and Igniting Community (MOSAIC) Student Survey (n = 39), which collected data on experiences of students who participated in the MOSAIC program, and the 2016-2020 Graduate Exit Surveys (n = 1222), which collected data on graduating students' experiences, satisfaction, and perspectives on diversity, equity, and inclusion. A difference-in-difference analysis compared overall experience, public health career preparedness, quality of life, and department satisfaction among all students before (2016-2018) and after (2019-2020) implementation of the MOSAIC program. RESULTS: Satisfaction among graduate students attributable to the MOSAIC program introduced in 2019 increased by about 25%. Compared with students who had not been exposed to MOSAIC, students exposed to MOSAIC had a 25% positive difference (P = .003) in overall graduate school experience, a 28% difference (P < .001) in quality of life, and a 10% difference (P = .001) in satisfaction with their departments. CONCLUSION: Mentorship for BIPOC and first-generation public health graduate students offers an effective strategy to improve student experiences and satisfaction with graduate departments and, ultimately, may help students meet educational and professional goals.

Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value?

INTRODUCTION: This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. METHOD: Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. RESULTS: Survey respondents (n = 45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n = 15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. DISCUSSION: Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.

'Our mind could be our biggest challenge': A qualitative analysis of urban adolescents' sleep experiences and opportunities for mind-body integrative health approaches to improve sleep.

Objective: To inform the development of a combined sleep and mind-body integrative health (MBIH) intervention, we explored urban adolescents' sleep experiences and perceptions of MBIH techniques. Methods: We conducted eight focus groups with school-based health center patients in New York City, exploring sleep experiences; mindfulness, body awareness, tapping, acupressure, and self-hypnosis; and intervention delivery preferences. We recorded, transcribed, and analyzed the discussions applying methods from grounded theory. Results: Participants (n = 25) were ages 14-17, predominantly female (64%), Latino (60%), and Black (40%). Participants reported social, physical, and internal sleep barriers, but had limited success implementing sleep improvement strategies. Participants viewed MBIH techniques positively, noted audio-guided techniques' accessibility, and were intrigued by less-familiar techniques. Preferences varied around domains of intervention delivery. Conclusion: Results underscore the need for adolescent-informed interventions offering sleep improvement strategies. Participants' interest and willingness to engage in MBIH techniques present an opportunity for practitioners to develop and deliver sleep interventions incorporating MBIH components to urban adolescents. Varied intervention preferences highlight the need to be adaptable to adolescents' lived experiences, comfort levels, and learning styles. Innovation: This study elucidates the perspectives of underrepresented adolescents whose perspectives on MBIH have rarely been explored, an important first step in developing tailored interventions.

Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review.

Sexual, reproductive, and maternal health (SRMH) care in the US is highly politicized, with restrictions that impede immigrant women's health. This review describes SRMH outcomes among immigrant women accessing publicly-funded services. We examined articles published from December 2007 to August 2020 in PubMed, PsycINFO, and Web of Science databases, following PRISMA guidelines. Included articles (n = 9) consisted of predominantly Latina immigrant samples. The majority included a subsample of women classified as vulnerable due to low income, low educational attainment, and/or documentation status. Our search strategy included a range of SRMH outcomes; however, the majority of articles focused on prenatal care (PNC). Over half of the articles revealed that underserved immigrant women with access to Medicaid/CHIP during expansion had higher rates of PNC adequacy compared to those without access. There is a need for more research on the impact of publicly-funded services other than Medicaid on outcomes beyond PNC.

Providing Contraceptive Health Services to Adolescents and Young Adults by Telemedicine: A Scoping Review of Patient and Provider Perspectives.

OBJECTIVE: The objective of this scoping review is to synthesize and identify gaps in existing research on accessibility of telemedicine-delivered contraceptive health services to female adolescents and young adults (AYAs) and acceptability of these services to AYA patients and their medical providers. METHODS: We searched the PubMed, Scopus, Embase, and CINAHL databases to extract relevant studies on telemedicine and provision of contraceptive services among non-institutionalized, non-chronically ill female AYAs, ages 10 through 24 years. RESULTS: We screened 154 articles, and 6 articles representing 5 studies met the full inclusion criteria. Three studies assessed telemedicine acceptability and accessibility from the perspective of providers, and 3 described patients' perceived accessibility and acceptability of a theoretical telemedicine visit. No studies directly assessed AYA patients' satisfaction with actual telemedicine visits for contraceptive services. Providers viewed telemedicine-delivered sexual and reproductive health (SRH) services as acceptable to themselves and AYA patients. Most AYAs reported that they would use telemedicine for SRH services, although they would prefer in-person care. All articles identified concerns about privacy and confidentiality as a barrier to SRH telemedicine care. CONCLUSIONS: Telemedicine-delivered contraceptive health services for AYAs were perceived as acceptable and accessible by providers and by most AYA patients, although patients reported a preference for in-person care. However, none of these findings are based on patients' actual experiences with SRH telemedicine. Further research is needed to directly assess the accessibility and acceptability of telemedicine-delivered contraceptive health services for female AYA patients.

Comprehensive sexuality education for fraternity-affiliated undergraduates: a pilot program to improve sexual and reproductive health knowledge, attitudes, and communication.

Objective: Comprehensive sexuality education (CSE) allows for informed and healthy decisions. College students often lack understanding of sexual and reproductive health (SRH). Conversations and Pizza (CAP), an interactive curriculum, was designed to address gaps in CSE and improve SRH outcomes. Participants: 66 fraternity affiliated undergraduate students. Methods: A six-session intervention discussed gender norms, biology, consent, harassment, and bystander intervention. Pre- and post-quantitative surveys assessed attitudes and behaviors; plus-delta format was used for qualitative feedback. Results: Qualitative data reflected engagement. Post-intervention, multiple measures improved (McNemar p < 0.05): perceived self-efficacy in consent and peer norms (4/8 measures), bystander intervention (5/6), and awareness of harassment (2/5). Participants reported more conversations with partners (pregnancy and STI prevention, 50% to 75%); human papillomavirus (HPV) vaccination receipt increased (60% to 93%, McNemar p < 0.001). Conclusion: Reproductive health outcomes improved in this pilot, laying the groundwork for continued testing. CAP is a successful pilot program that can be evaluated for a variety of groups and formats.