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Coastal communities along the U.S. Gulf of Mexico have been profoundly shaped by environmental health (EH) threats, reflecting the region's history of natural and technological disasters, as well as ongoing issues of environmental degradation and pollution. The Vietnamese American community in the state of Mississippi is vulnerable to EH threats, but there is limited research on their risk perceptions. Understanding perceptions of risk and responsibility is important to manage EH risks and promote community resilience. This community-based participatory research study characterizes Vietnamese American perceptions of EH risks, sources of information, and responsibility in coastal Mississippi. Five focus groups were conducted in 2016 and 2017 in Biloxi, Mississippi with Vietnamese Americans working in the seafood industry (n=24) and mothers of children under the age of 18 (n=25). Findings related to participants' concerns with air quality, drinking water quality, and the 2010 Deepwater Horizon oil spill are interpreted using Boholm's relational theory of risk. Unreliable access to healthcare and limited English proficiency constrain participants from acting on their environmental health risk relationships. A community-based organization in Biloxi that works with Vietnamese Americans plays an important role in addressing risk in this population.

It is critical to evaluate community health worker (CHW) programs to maximize effectiveness. However, there is little consensus, and structure, for how to evaluate such programs.The purpose of this study was to develop a flexible framework for evaluating components of CHW programs in community and clinical settings.Semistructured interviews were conducted with CHWs and their supervisors to determine evaluation categories for the framework. A survey was then administered to pilot the framework at federally qualified health centers and community-based organizations with existing CHW programs.Eighteen federally qualified health centers and community-based organizations in Louisiana, Mississippi, Alabama, and Florida.Participants consisted of 23 CHWs and 19 CHW supervisors.Interview participants directly informed the development of an evaluation framework for CHW programs. The framework consists of 7 evaluation categories: client relations, intraorganizational relations, interorganizational relations, capacity development, program effectiveness, cost-efficiency, and sustainability. Survey respondents specified best practices for program implementation for each evaluation category. Recommendations for CHW program evaluation include tailoring evaluation efforts and data collection methods to program context, using mixed-methods approaches for collecting evaluation data, and streamlining evaluation efforts with an organization's existing evaluation systems.The evaluation framework is a flexible and practical model for collecting information needed for monitoring and evaluating CHW programs. By relying on practitioners' perspectives, this study contributes to an evidence base for implementing and evaluating CHW programs.

IntroductionAs of November 2021, COVID-19 has killed more than 5 million people globally, including over 750 000 in the USA. Apart from corticosteroids, most available therapeutic options are at best marginally efficient in reducing disease severity and are extremely expensive. The systematic investigation of clinically approved drugs is a priority to determine what does mitigate disease severity. Oestradiol (E2) and progesterone (P4) produce a state of anti-inflammatory immune responses and immune tolerance, and enhanced antibody production. The goal of this trial is to evaluate the efficacy of a short E2 and P4 therapy, in addition to standard of care (SOC), in mitigating disease severity in COVID-19 hospitalised patients.Methods and analysisPhase 2, randomised, double blind, placebo-controlled, single-centre trial. Patients hospitalised for confirmed COVID-19, with scores 3–5 on the 9-point WHO ordinal scale are randomised between two arms: (1) Oestradiol cypionate intramuscular (IM) and micronised progesterone oral (PO), in addition to SOC, and (2) placebo, in addition to SOC. The primary outcome is the proportion of patients improving to scores 1 or 2 on the WHO scale through day 28. Secondary outcomes include length of hospital stay, duration of mechanical ventilation, cause of death, readmission rates, change in inflammatory biomarkers between admission and occurrence of primary endpoint, and adverse events. Study sample size will be up to 120 participants. The trial is currently recruiting subjects.Ethics and disseminationThe sponsor of this study is the Center of Excellence in Sex-Based Biology & Medicine at Tulane University, New Orleans, Louisiana, USA. Ethical approval was obtained from the Tulane institutional review board on 14 May 2021. The study was reviewed by the US Food and Drug Administration and granted Investigational New Drug #152 499. Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT04865029; Pre-results.

Community health workers (CHWs) are recognized for bridging communities and health care systems; yet, there is limited discussion of CHWs' roles as organizational actors within and outside clinics. Individual semistructured interviews (n = 21) were conducted in 4 Gulf Coast states with CHWs and supervisors to examine the bridging function of CHWs from a community health center's perspective. Results highlight that CHWs can function as gatekeepers and ambassadors who extend the clinics' reach in the community, enhance patient access to resources, and improve organizational efficiency. This study demonstrates the value that CHWs can bring for clients and clinics as organizational actors.

Standard evaluation practice in public health remains limited to evaluative measures linked to individual projects, even if multiple interrelated projects are working toward a common impact. Enterprise evaluation seeks to fill this policy gap by focusing on cross-sector coordination and ongoing reflection in evaluation. We provide an overview of the enterprise evaluation framework and its 3 stages: collective creation, individual data collection, and collective analysis. We illustrate the application of enterprise evaluation to the Gulf Region Health Outreach Program, 4 integrated projects that aimed to strengthen health care in Louisiana, Mississippi, Alabama, and the Florida Panhandle after the Deepwater Horizon oil spill. Shared commitment to sustainability and strong leadership were critical to Gulf Region Health Outreach Program's success in enterprise evaluation. Enterprise evaluation provides an important opportunity for funding agencies and public health initiatives to evaluate the impact of interrelated projects in a more holistic and multiscalar manner than traditional siloed approaches to evaluation.

Context Community health workers (CHWs) are an increasingly viable component of the American health system. While organizations may be interested in incorporating CHWs into the health care workforce, there are challenges to doing so. Objective This study characterizes the successes and lessons learned from implementing new CHW programs in clinical and community-based settings in 4 US Gulf states. Design Semistructured interviews were conducted with CHWs and their supervisors. Setting Interviews were conducted with participants in 16 community-based organizations and federally qualified health centers located in coastal counties and parishes of Louisiana, Florida, Alabama, and Mississippi. Participants Study participants consisted of 22 CHWs and 17 CHW supervisors. Results Although most challenges and strategies were reported by participants working in both clinical and community-based settings, some were workplace-specific. Participants from predominantly clinical settings described the importance of strengthening organizational cohesion and coordination, whereas participants from community-based participants discussed the need for specialized training for CHWs. In both work environments, participants indicated that CHW functioning was constrained by limited organizational resources, difficulty accessing the client population, and limited knowledge regarding the CHW's scope of practice. Strategies to improve CHW functioning in both settings included investing in local partnerships, streamlining resources, prioritizing strong communication and outreach, and establishing explicit operating procedures. The majority of participants noted that challenges lessened over time. Conclusions Evaluating successes and lessons learned in CHW work is critical to maximize CHWs' abilities to address clients' health needs and promote health in underserved communities. This study provides important insights into how to successfully integrate CHWs into the public health workforce.

Environmental health literacy (EHL) involves understanding and using environmental information to make decisions about health. This study developed a validated survey instrument with four scales for assessing media-specific (i.e., air, food, water) and general EHL. The four scales were created as follows: 1) item generation: environmental health scientists and statisticians developed an initial set of items in three domains: knowledge, attitudes, and behaviors, 2) item review: items were reviewed for face validity, 3) validation: 174 public health students, the exploratory sample, and 98 community members, the test sample, validated the scales. The scales&rsquo, factor structure was based on exploratory factor analysis (EFA) and model fit was assessed through confirmatory factor analysis (CFA). For each scale, the final EFA resulted in an independent three-factor solution for knowledge, attitudes, and behaviors. Good fit for the three-factor structure was observed. Model fit for CFA was generally confirmed with fit indices. The scales showed internal consistency with Cronbach&rsquo, s alpha from 0.63 to 0.70. The 42-item instrument represents an important contribution towards assessing EHL and is designed to enable meaningful engagement between researchers and community members about environmental health. The intended outcome is sustained community&ndash, academic partnerships benefiting research design, implementation, translation, dissemination, and community action.

Climate change adaptation is increasingly considered an urgent priority for policy action. Billions of dollars have been pledged for adaptation finance, with many donor agencies requiring that adaptation is distinct from baseline development. However, practitioners and academics continue to question what adaptation looks like on the ground, especially in a developing country. This study examines the current framing of planned adaptation amidst low socioeconomic development and considers the practical implications of this framing for adaptation planning. Three overarching approaches to planned adaptation in a developing country context emerged in a systematic review of 30 peer-reviewed articles published between 2010 and 2015, including: (1) technocratic risk management, which treats adaptation as additional to development, (2) pro-poor vulnerability reduction, which acknowledges the ability of conventional development to foster and act as adaptation, and (3) sustainable adaptation, which suggests that adaptation should only be integrated into a type of development that is socially and environmentally sustainable. Over half of ‘sustainable adaptation’ articles in this review took a critical adaptation approach, drawing primarily from political ecology and postdevelopment studies, and emphasizing the malleability of adaptation. The reviewed articles highlight how the different framings of the relationship between adaptation and development result in diverse and sometimes contradictory messages regarding adaptation design, implementation, funding, monitoring, and evaluation. This review illustrates the need to continually interrogate the multiple framings of adaptation and development and to foster a pragmatic and pluralistic dialogue regarding planned adaptation and transformative change in developing countries. WIREs Clim Change 2016, 7:707–726. doi: 10.1002/wcc.416 This article is categorized under: Vulnerability and Adaptation to Climate Change > Learning from Cases and Analogies Climate and Development > Knowledge and Action in Development

Objectives. To establish a validated, standardized set of core competencies for community health workers (CHWs) and a linked workforce framework. Methods. We conducted a review of the literature on CHW competency development (August 2015), completed a structured analysis of literature sources to develop a workforce framework, convened an expert panel to review the framework and write measurable competencies, and validated the competencies (August 2017) by using a 5-point Likert scale survey with 58 participants in person in Biloxi, Mississippi, and electronically across the United States. Results. The workforce framework delineates 3 categories of CHWs based upon training, workplace, and scope of practice. Each of the 27 competencies was validated with a mean of less than 3 (range = 1.12–2.27) and a simple majority of participants rated all competencies as “extremely important” or “very important.” Conclusions. Writing measurable competencies and linking the competencies to a workforce framework are significant advances for CHW workforce development. Public Health Implications. The standardized core competencies and workforce framework are important for addressing health disparities and maximizing CHW effectiveness.

Community‐based adaptation (CBA) has emerged over the last decade as an approach to empowering communities to plan for and cope with the impacts of climate change. While such approaches have been widely advocated, few have critically examined the tensions and challenges that CBA brings. Responding to this gap, this article critically examines the use of CBA approaches with Inuit communities in Canada. We suggest that CBA holds significant promise to make adaptation research more democratic and responsive to local needs, providing a basis for developing locally appropriate adaptations based on local/indigenous and Western knowledge. Yet, we argue that CBA is not a panacea, and its common portrayal as such obscures its limitations, nuances, and challenges. Indeed, if uncritically adopted, CBA can potentially lead to maladaptation, may be inappropriate in some instances, can legitimize outside intervention and control, and may further marginalize communities. We identify responsibilities for researchers engaging in CBA work to manage these challenges, emphasizing the centrality of how knowledge is generated, the need for project flexibility and openness to change, and the importance of ensuring partnerships between researchers and communities are transparent. Researchers also need to be realistic about what CBA can achieve, and should not assume that research has a positive role to play in community adaptation just because it utilizes participatory approaches. WIREs Clim Change 2016, 7:175–191. doi: 10.1002/wcc.376 For further resources related to this article, please visit the WIREs website.

Arctic regions are experiencing the most rapid climate change globally and adaptation has been identified as a priority across scales. Anticipatory planning to adapt to the impacts of climate change usually follows a number of steps: assess current and future vulnerability, identify potential adaptations, prioritize options, implement prioritized options, and monitor and evaluate implementation . While most of these steps are well documented, there has been limited examination of the process of adaptation prioritization in Arctic communities. In this paper, we build upon existing tools and propose a framework for prioritizing adaptation options and guiding decision-making for implementation in Arctic regions. Using four adaptation performance criteria (timescale, equity, sustainability and total costs) to evaluate options through a multi-criteria decision analysis coupled with a network centric approach, our Adaptation Prioritization Framework promotes a participatory approach for adaptation prioritization and planning. We illustrate application of the framework using a hypothetical example from the territory of Nunavut in the Canadian Arctic.

Climate change presents substantial risks to the health of Indigenous peoples. Research is needed to inform health policy and practice for managing risks, with community based adaptation (CBA) emerging as one approach to conducting research to support such efforts. Few, if any, studies however, have critically examined the application of CBA in a health or Indigenous peoples context. We examine the strengths, challenges, and opportunities of health-related CBA research in Indigenous community settings, drawing on the experiences of the multi-nation interdisciplinary Indigenous Health Adaptation to Climate Change (IHACC) project. Data collection was guided by a framework developed to evaluate CBA projects. Semi-structured interviews (n = 114) and focus groups (n = 23, 177 participants) were conducted with faculty-based researchers, institutional partners, community members, students, and trainees involved in the IHACC project in Canada, Uganda, and Peru. Results illustrate the importance of CBA in co-generating knowledge on climate-health vulnerability and adaptation options, capacity building, and informing decision choices. There are also significant challenges of conducting CBA which can have unintended negative consequences, with results emphasizing the importance of managing the tension between health research and tangible and immediate benefits; developing a working architecture for collective impact, including team building, identification of common goals, and meaningful engagement of knowledge users; and the need to continuously monitor and evaluate progress. CBA holds significant promise in a health adaptation context, but only in the ‘right’ circumstances, where considerable time is spent developing the work with partners.

Context Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. Program This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. Implementation The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. Evaluation The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. Discussion This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

Institution-oriented, top-down and community-oriented, bottom-up stakeholder approaches are evaluated for their ability to enable or constrain the implementation of adaptation in developing nations. A systematic review approach is used evaluate the project performance of 18 adaptation projects by three of the Global Environment Facility's (GEF) adaptation programmes (the Strategic Priority for Adaptation (SPA), the Special Climate Change Fund (SCCF), and the National Adaptation Programs of Action (NAPA)) according to effectiveness, efficiency, equity, legitimacy, flexibility, sustainability, and replicability. The ten SPA projects reviewed performed highest overall, especially with regards to efficiency, legitimacy, and replicability. The five SCCF projects performed the highest in equity, flexibility, and sustainability, and the three NAPA-related projects were the highest-performing projects with regards to effectiveness. A comparison of top-down and bottom-up approaches revealed that community stakehol...

This paper conducts a systematic realist review to examine how market engagement interacts with vulnerability to food insecurity after a climatic hazard event, focusing on rural areas of the developing world. It examines who is able to engage in the market after a climatic hazard and the barriers and opportunities that this engagement presents to food security. In the review, households were less able to effectively engage in the market to maintain food security when they had limited pre-hazard resources and/or were unable to mobilize these resources due to the biophysical and socioeconomic context following the climatic event. It is important to consider the volition behind market engagement after a climatic hazard and the consequences of using the market to maintain food security.

Background: Current literature emphasizes the need to implement informed consent according to indigenous principles and worldviews. However, few studies explicitly address how informed consent can be effectively and appropriately obtained in indigenous communities in accordance with research ethics guidelines. Methods: This article uses participatory rural appraisal methods to identify and characterize community preferences for informed consent in two indigenous communities in the Peruvian Amazon, using Canadian federal research regulations and McGill University's Research Ethics Board as a case study to examine where institutional ethics guidelines constrain or support culturally appropriate notions of informed consent. Results: The study emphasizes the importance of tailoring informed consent procedures to community circumstances. Although both communities in this case study are located in the Peruvian Amazon, there were important distinctions between them, such as gender dynamics and social structure, which profoundly affected informed consent procedures. It is also important to consider the balance of collectivism and individualism at a community level in order to determine the role of individual and community consent. Conclusion: Research ethics guidelines generally allow for this contextualized approach. However, regulations still have the potential to constrain indigenous informed consent due to content requirements for informed consent forms, limited flexibility for modifications in the field, and requirements for individual consent.