Search

While health care-associated financial burdens among uninsured individuals are well described, few studies have systematically characterized the array of financial and logistical complications faced by insured individuals with low household incomes. In this mixed methods paper, we conducted 6 focus groups with a total of 55 residents and analyzed programmatic administrative records to characterize the specific financial and logistic barriers faced by residents living in public housing in East and Central Harlem, New York City (NYC). Participants included individuals who enrolled in a municipal community health worker (CHW) program designed to close equity gaps in health and social outcomes. Dedicated health advocates (HAs) were explicitly paired with CHWs to provide health insurance and health care navigational assistance. We describe the needs of 150 residents with reported financial barriers to care, as well as the navigational and advocacy strategies taken by HAs to address them. Finally, we outline state-level policy recommendations to help ameliorate the problems experienced by participants. The model of paired CHW–HAs may be helpful in addressing financial barriers for insured populations with low household income and reducing health disparities in other communities. [ABSTRACT FROM AUTHOR]

Purpose: This study discusses the creation of an online, asynchronous presentation to educate adolescents about prevention of noise-induced hearing loss (NIHL) through interprofessional collaborations and electronic service-learning (eSL) during the COVID-19 pandemic. Method: The Hearing Education and Research (HEAR) presentation, which included activities and videos to educate a group of ethnically diverse adolescents (n = 100) on NIHL, was created by 11 doctor of audiology (AuD) students through online collaborations toward course-related eSL requirements. Adolescents responded to a baseline survey to assess hearing health–related behaviors prior to reviewing the presentation. A postprogram survey was administered 1 week after the presentation to assess change in knowledge and attitudes toward NIHL prevention. Online collaborations with schoolteachers helped with project implementation. Postreflection papers written by AuD students regarding the eSL activities were analyzed. Lastly, suggestions from a focus group of educators were included that highlight the role of interprofessional collaborations to enhance school-based hearing conservation opportunities. Results: The HEAR presentation resulted in changes in knowledge about NIHL among the adolescents. Postreflection papers by the AuD students indicated that the eSL activity served as a high-impact pedagogical assignment, especially during the academic challenges of the pandemic. Feedback from a focus group of schoolteachers helped outline ideas for future implementation of sustainable hearing conservation programs in school settings. Conclusion: The pilot data collected in this study serve as a proof of concept for future hearing conservation projects in school-based settings via interprofessional collaborations and by engaging university students via eSL. [ABSTRACT FROM AUTHOR]

Home health aides and home care agencies, who operate in a high work stress environment under normal conditions, were placed under extraordinary demands during the COVID-19 pandemic. In this paper, we examine the unfolding effort at one agency in New York City to offer phone-based support calls to aides. We used a qualitative, single case study design involving semi-structured interviews with call staff and agency leaders (n = 9) and analysis of one year of thematic notes from the calls. We found that the calls resulted in multidirectional communication between agency staff and aides, an increased sense of empathy among staff, and a greater integration of aides into the agency's overall infrastructure. We explore how these calls might contribute to aide retention, worker voice, and mental health. We note the facilitators and barriers to implementing this type of job-based support to help other agencies that may be considering similar models. [ABSTRACT FROM AUTHOR]

Objective: The Buffalo, New York region is one of the leading refugee resettlement areas in the country, settling 94% of African refugees in 2014. However, little is known about their health beliefs, particularly regarding sexual health and HIV. This study's purpose was to describe HIV attitudes and beliefs in a sample of African refugee women, a population that is increasingly present in the country, yet seldom represented in the literature. Design: A convenience sample of 101 African refugee women were recruited via snowball technique in Buffalo, New York. Data were collected from July 2017–July 2018, via paper-pen survey, and were analyzed using descriptive statistics. Results: Participants had low levels of education, but high HIV screening rates. Inconsistencies between knowledge of HIV acquisition and behaviors relating to HIV positive individuals may indicate HIV stigma among the population. Conclusion: Novel strategies geared towards educational levels and societal norms to educate African refugee women about HIV are urgently needed. [ABSTRACT FROM AUTHOR]

Take-home naloxone (THN) is provided to non-medically trained people to reverse potential opioid overdoses. There is an increasing range of effective intramuscular (IM) and intranasal (IN) naloxone devices and this paper explores the types preferred by people who use opioids, using consumer behaviour literature to interpret the findings. Data derive from two unconnected qualitative studies involving audio-recorded semi-structured interviews. Study 1 was conducted in the United States (n = 21 users of non-medical/illicit opioids). Study 2 was conducted in Australia (n = 42 users of non-medical/illicit or prescribed opioids). Most participants preferred IN naloxone. Preferences were based on the ease, speed, safety and comfort of each device and underpinned by accounts of overdose revivals as being very rushed and frightening situations. Preferences related to complex interactions between the naloxone device ('product'); the knowledge, skills, experience and attitudes of the lay responder ('consumer'), and when, where and how naloxone was to be used ('usage situation'). THN programs should offer choice of device when possible and nasal naloxone if resources permit. Asking people which devices they prefer and why and treating them as valued consumers of naloxone products can generate insights that improve future naloxone technology and increase THN uptake and usage. [ABSTRACT FROM AUTHOR]

Participatory research methodologies have expanded the opportunities for critical, emancipatory and democratic health and social work research. However, their practical application in research with vulnerable participants has historically been challenging due to ethical, practical and theoretical concerns. Individuals who are homeless are typically seen as 'hard-to-reach', transient, 'hidden' and even chaotic participant populations. Unsurprisingly, examples of the use of innovative participatory research techniques with those groups have been relatively scarce. This paper aimed to address this gap by discussing the application of one such technique – the mobile phone diary in research with multiply disadvantaged homeless adults. Diary methods are situated within the qualitative research on health, illness and social marginality, and the enhanced capabilities of the mobile phone diary are highlighted. The author illustrates the application of the mobile phone diary in his participatory research on the everyday life narratives of adults with serious mental illness (SMI) who were homeless. The process of designing the mobile phone diary is detailed. Following this, participant testimonies of their use of the mobile phone diary are presented. They demonstrate the participatory and inclusive nature, as well as the cathartic and empowering potential, of this technique. The methodological contributions and challenges and the theoretical generativity of the mobile phone diary method are discussed. The mobile phone diary is a feasible approach for eliciting evocative, contextualised and nuanced accounts of the lived experience of homelessness, social isolation, coping and recovery. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs. [ABSTRACT FROM AUTHOR]

This paper describes incidental exposure to alcohol in advertisements on buses in Manhattan, New York City. From April to July 2019, researchers observed advertisements on all bus lines in Manhattan and coded the content of these advertisements, including the kinds of products and services advertised and whether alcoholic beverages or images were present. Despite a ban on direct alcohol beverage advertising within the Metropolitan Transit Authority in 2017 (and expanded in 2019), almost one in five of the 136 advertisements observed (n = 25) included incidental exposure to images of alcohol portrayed in a favorable way and/or associated with well-known movie stars and television personalities. Advertisements on city buses are unlike any other, as they traverse the city streets and create considerable exposure to residents, including youth. This study demonstrates that banning advertisements for alcohol will not necessarily restrict favorable images containing alcohol and that youth continue to be exposed to these images. [ABSTRACT FROM AUTHOR]

The information literacy (IL) assessment program at Manhattan College in Riverdale, New York, instituted in 2014–2015, evaluates students' information literacy capabilities as demonstrated in their written coursework, their test performance, and their comments on library instruction sessions. Both instruction and assessment are closely linked to five learning objectives, and five years' assessment results have led to significant changes in the IL instruction program. This paper presents key concepts in IL assessment; highlights the importance of evidence-based measures (that is, direct assessment of cognitive outcomes); describes Manhattan College's three assessment methods, with guidelines for the reporting of results; discusses sampling difficulties and related statistical issues; describes the changes in IL instruction undertaken in response to the results ("closing the loop"); and reviews additional assessment methods that can help demonstrate the impact of IL instruction on broader educational outcomes. [ABSTRACT FROM AUTHOR]

This paper draws data from a 5-year ethnographic study of young multilingual (Mixteco/Spanish/English) children in their early childhood classrooms. In this paper, we focus on two of the children and their distinctive paths as they develop language and literacy. Using a sociocultural and multimodal theoretical framework we examine how these two children participate in and negotiate a balanced literacy curriculum. [ABSTRACT FROM PUBLISHER]

Community health workers (CHWs) are uniquely positioned to improve health outcomes in immigrant communities; however, research on appropriate metrics for evaluating CHW attributes and mechanisms of effectiveness are limited. The objective of this paper is to characterize CHW attributes and pathways of action using adapted measures, develop a scale using these measures, and explore how findings can inform future CHW research and practice. The study analyzed pre- and post-intervention group data from one quasi-experimental and three randomized controlled-design parent trials assessing the impact of CHW-led group and individual health coaching on various health outcomes in four New York City immigrant communities. We conducted descriptive, bi-variate and principal components analysis to develop a 13-item scale assessing CHW attributes, roles, and pathways of action. The sample included 437 individuals completing the intervention arm of a CHW study. We found CHWs were reported to affect change through a number of mechanisms and participants expressed substantial communal concordance with the CHWs in terms of country of birth, language, and culture. Principal components analysis with promax rotation identified 13 items with three factors and high Cronbach's alphas: 1) valued interpersonal attributes of the CHW (alpha=0.784); 2) CHW as a bridge to health and non-health resources (alpha=0.857); and 3) providing accessibility beyond health providers (alpha=0.904). Socio-demographic characteristics and differences in CHW pathways of action were identified by community. Study findings can guide improved selection and training of CHWs. Further, measures identified in the principal components analysis can be used to guide future CHW evaluation efforts. [ABSTRACT FROM AUTHOR]

There are particular conditions that may optimize the effects of drinking-water interventions on body weight change and risk of obesity. Strategic planning to create and sustain conditions for optimal effects of drinking water may maximize the impact of school-based interventions to reduce childhood obesity. This paper proposes questions about the target population, type of diet and activity level that will be maintained during the intervention, and planned intervention message(s). The proposed questions are motivated by conditions associated with significant effects of drinking water in randomized controlled trials. They are discussed in relation to conditions underlying the recently successful school-based drinking-water intervention in New York City. If conditions allow, school-based drinking-water interventions have the potential to efficiently benefit millions of children worldwide, who are at risk of becoming obese. [ABSTRACT FROM AUTHOR]

Background: The paper examines the role of community-based participatory research (CBPR) within the context of social justice literature and practice. Methods: Two CBPR case studies addressing health inequities related to Type 2 Diabetes and Cardiovascular disease were selected from a national cross-site study assessing effective academic-community research partnerships. One CBPR partnership works with African Americans in rural Pemiscot County, Missouri and the other CBPR partnership works with African American and Latinos in urban South Bronx, New York City. Data collection included semi-structured key informant interviews and focus groups. Analysis focused on partnerships' context/ history and their use of multiple justice-oriented strategies to achieve systemic and policy changes in order to address social determinants of health in their communities. Results: Community context and history shaped each partnership's strategies to address social determinants. Four social justice approaches (identity/recognition, procedural, distributive, and structural justice) used by both partnerships were identified. These social justice approaches were employed to address underlying causes of inequitable distribution of resources and power structures, while remaining within a scientific research framework. Conclusion: CBPR can bridge the role of science with civic engagement and political participation, empowering community members to become political agents who integrate evidence into their social justice organizing strategies. [ABSTRACT FROM AUTHOR]

Background Current electrocardiographic and echocardiographic measurements in heart failure (HF) do not take into account the complex interplay between electrical activation and local wall motion. The utilization of novel technologies to better characterize cardiac electromechanical behavior may lead to improved response rates with cardiac resynchronization therapy (CRT). Electromechanical wave imaging (EWI) is a noninvasive ultrasound-based technique that uses the transient deformations of the myocardium to track the intrinsic EW that precedes myocardial contraction. In this paper, we investigate the performance and reproducibility of EWI in the assessment of HF patients and CRT. Methods EWI acquisitions were obtained in five healthy controls and 16 HF patients with and without CRT pacing. Responders (n = 8) and nonresponders (n = 8) to CRT were identified retrospectively on the basis of left ventricular (LV) reverse remodeling. Electromechanical activation maps were obtained in all patients and used to compute a quantitative parameter describing the mean LV lateral wall activation time (LWAT). Results Mean LWAT was increased by 52.1 ms in HF patients in native rhythm compared to controls (P < 0.01). For all HF patients, CRT pacing initiated a different electromechanical activation sequence. Responders exhibited a 56.4-ms ± 28.9-ms reduction in LWAT with CRT pacing (P < 0.01), while nonresponders showed no significant change. Conclusion In this initial feasibility study, EWI was capable of characterizing local cardiac electromechanical behavior as it pertains to HF and CRT response. Activation sequences obtained with EWI allow for quantification of LV lateral wall electromechanical activation, thus providing a novel method for CRT assessment. [ABSTRACT FROM AUTHOR]

Research is fundamental to the advancement of medicine and critical to identifying the most optimal therapies unique to particular societies. This is easily observed through the dynamics associated with pharmacology, surgical technique and the medical equipment used today versus short years ago. Advancements in knowledge synthesis and reporting guidelines enhance the quality, scope and applicability of results; thus, improving health science and clinical practice and advancing health policy. While advancements are critical to the progression of optimal health care, the high cost associated with these endeavors cannot be ignored. Research fundamentally needs to be evaluated to identify the most efficient methods of evaluation. The primary objective of this paper is to look at a specific research methodology when applied to the area of clinical research, especially extracorporeal circulation and its prognosis for the future. [ABSTRACT FROM AUTHOR]

In order to connect with families and influence treatment trajectories, outreach materials should address cultural perceptions of the condition, its causes, and post-diagnostic care. This paper describes the cultural adaptation and translation of the Autism Speaks First 100 Days Kit into Korean for the purpose of improving autism spectrum disorder (ASD) diagnosis, assessment, and interventions. The goal of this study is to describe a methodology for future cross-cultural adaptations and translations of outreach materials on ASD, using the Autism Speaks First 100 Days Kit as an exemplar. The research involved two stages of qualitative interviews: unstructured individual and group interviews with 19 Korean child health and education professionals in Queens, NY, followed by structured cultural consensus modeling interviews with 23 Korean mothers, with and without children with ASD, in Queens, NY and the greater Washington, DC area. We conclude that a systematic approach to cultural translation of outreach materials is feasible. Cultural consensus modeling yielded information about numerous barriers to care, had a demonstrable effect on the translation of the kit, and was efficient when employed with coherent segments of a relatively homogeneous population and focused on a single condition. [ABSTRACT FROM AUTHOR]

Objective To examine the validity and reliability of a questionnaire administered with an audience response system (ARS). Design Cross-sectional study. Setting Two New York City public elementary schools. Participants Fourth- and fifth-grade students. Main Outcome Measures A Food, Health, and Choices questionnaire (FHC-Q) assessed energy balance-related behaviors (EBRBs) including intake of fruits and vegetables, sugar-sweetened beverages, processed packaged snacks, and fast food; physical activity; recreational screen time; and associated psychosocial determinants (≥ 3 questions/outcome scale). Previously validated reference instruments were used for relative validation. The ARS format was compared with a paper-and-pencil format. All measures were administered in a classroom setting. Analysis Pearson correlation coefficients between the reference instruments and the FHC-Q were calculated. Internal consistency reliabilities were evaluated with Cronbach α. Spearman rank correlation, intra-class correlation, and percent agreement were used for test-retest reliability between paper-and-pencil and ARS, and between 2 ARS FHC-Q administrations. Results Correlations for EBRBs with reference instruments ranged from 0.38 to 0.61 ( P < .01). Cronbach α ranged from .77 to .92 for EBRBs and .74 to .90 for psychosocial determinants. Test-retest reliability correlations ranged from 0.36 to 0.87 ( P < .001). Agreement for knowledge questions ranged from 69.8% to 84.8%. Conclusions and Implications The ARS FHC-Q has acceptable validity and reliability for collecting data on EBRBs and associated psychosocial determinants for upper-elementary students. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) constitute 60% of the approximately 5 million people in the U.S. infected with hepatitis C virus (HCV). Treatment of PWID is complex due to addiction, mental illness, poverty, homelessness, lack of positive social support, poor adherence-related skills, low motivation and knowledge, and poor access to and trust in the health care system. New direct-acting antiviral medications are available for HCV with high cure rates and few side effects. The life expectancy and economic benefits of new HCV treatments will not be realized unless we determine optimal models of care for the majority of HCV-infected patients. The purpose of this study is to evaluate the effectiveness of directly observed therapy and group treatment compared with self-administered individual treatment in a large, urban opioid agonist therapy clinic setting in the Bronx, New York.Methods/design: In this randomized controlled trial 150 PWID with chronic HCV were recruited from opioid agonist treatment (OAT) clinics and randomized to one of three models of onsite HCV treatment in OAT: 1) modified directly observed therapy; 2) group treatment; or 3) control - self-administered individual treatment. Participants were age 18 or older, HCV genotype 1, English or Spanish speaking, treatment naïve (or treatment experienced after 12/3/14), willing to receive HCV treatment onsite, receiving methadone or buprenorphine at the medication window at least once per week, and able to provide informed consent. Outcomes of interest include adherence (as measured by self-report and electronic blister packs), HCV treatment completion, sustained virologic response, drug resistance, and cost-effectiveness.Discussion: This paper describes the design and rationale of a randomized controlled trial comparing three models of care for HCV therapy delivered in an opioid agonist treatment program. Our trial will be critical to rigorously identify models of care that result in high adherence and cure rates. Use of blister pack technology will help us determine the role of adherence in successful cure of HCV. Moreover, the trial methodology outlined here can serve as a template for the development of future programs and studies among HCV-infected drug users receiving opioid agonist therapy, as well as the cost-effectiveness of such programs.Trial Registration: This trial was registered with ClinicalTrials.gov ( NCT01857245 ). Trial registration was obtained prospectively on May 20th, 2013. [ABSTRACT FROM AUTHOR]