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Objective:Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco. Study Design:Retrospective chart review. Setting:Urban tertiary care public hospital in San Francisco. Subjects and Methods:We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes. Results:We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5. Conclusion:DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.

Little is known about dissemination and implementation in safety net settings. The authors conducted a literature review of innovation/implementation studies in US safety net health care settings between 2008 and 2017. Each article was coded for (1) intervention characteristics, (2) implementation stage, (3) internal versus external ownership, and (4) prespecified implementation outcomes (eg, acceptability and fidelity). Twenty studies were identified; the majority were implemented within community clinics or integrated safety net systems (15 articles), most involved care process improvements (13 articles), and most were internally developed (13 articles). The internally developed innovations reported fewer barriers to acceptability among staff/providers, higher leadership involvement and organizational alignment, greater amounts of customization to the local setting, and better sustainment. Future work should harness the high levels of alignment and acceptability in implementation research within safety net settings, with an eye toward maintaining fidelity to facilitate dissemination across sites.

Despite the increasing focus within public health on the social determinants of health and 'structural approaches' over the past three decades, controversy remains regarding the field's relative emphasis on the behaviors of individuals versus the organization of societies when explaining why some are healthy and others are not. This research seeks to clarify how authoritative sources within public health instruction frame the relationship among behavior, society, and health by identifying common themes within social and behavioral science textbooks assigned within MPH programs located primarily in the US. Textbook analysis was informed by a modified grounded theory approach and is situated broadly within the critical discourse analysis tradition. Common themes include: the primacy of behavior to health outcomes; the purpose of public health theory is explaining behavior and informing behavior change; social and individual factors influence health behaviors; and ecological approaches are necessary for behavior change. Notable divergences from these themes are also discussed. These findings suggest a continuing need to think critically about how health, behavior, and society are framed within public health instruction specifically and within the field of public health more broadly. We close by considering the relevance of social theories of health inequality and structural competency to these discussions. [ABSTRACT FROM AUTHOR]

Purpose: School-based health centers (SBHCs) have traditionally been concentrated in urban centers but have increasingly moved to rural and suburban settings. Adolescents living outside urban centers continue to experience barriers accessing contraceptives and reproductive health care. SBHCs are well positioned to reduce these barriers since they often offer convenient, in-school reproductive health care services. We describe the experiences of adolescents and emerging adults as they navigate access to contraceptives at SBHCs and nonschool locations in nonurban, low-income communities. Method: We interviewed 30 sexually active individuals aged 15 to 21 living in rural and suburban communities in Colorado where high school SBHCs were recently introduced. Participants reflected on their experiences with or without in-school access to sexual and reproductive health services. Results: Overall, young people supported within-school access to contraceptives, citing convenience, low cost, and greater confidentiality and privacy compared with out-of-school providers, particularly in rural areas. At the same time, findings point to the need for SBHCs to overcome adolescents' and emerging adults' misunderstanding of age requirements to access confidential contraceptive services and their remaining concerns around confidentiality in the school setting. Conclusions: Our results indicate that SBHCs in low-income rural and suburban areas provide essential contraceptive services that young people access and value. Policy makers in nonurban communities should look to the SBHC model to reduce barriers for young people accessing reproductive health care, and health care providers should work to ensure confidentiality and to correct misinformation about their right to access contraceptive services. [ABSTRACT FROM AUTHOR]

Although U.S. cities are expanding "anti-homeless" legislation – such as laws against public sleeping or use of shelter – there is little research on the public health consequences. Officials argue that laws forbidding public sleeping, and other forms of behavioral supervision, are "tough love" strategies to compel people experiencing homelessness to improve their health by leaving the streets and using services. To test these claims and understand the public health implications of "quality of life" laws enforced against the homeless, this paper reports on a community-based participatory research survey of 484 individuals experiencing homelessness in Denver, Colorado. Results indicate that respondents have worse sleep habits and mental health outcomes when worried about police contact; people seek isolated sleeping locations to avoid police contact, resulting in more assault; and individuals are more at risk of exposure to weather-related hazards if they have been instructed to quit using shelter. This evidence contradicts the "tough love" defense of the criminalization of homelessness, as the health and wellbeing of people experiencing homelessness is worsened through "quality of life" policing. Results from this survey have been used by community partners and local policymakers to successfully advance district court arguments that anti-homeless legislation in Denver, Colorado is unconstitutional. [ABSTRACT FROM AUTHOR]