Purpose: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural‐urban differences in mortality‐related outcomes within comparable levels of deprivation. Methods: Rural‐urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural‐urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Findings: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. Conclusions: This study noted a differential effect in mortality‐related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.

The impetus for the recognition of the need for legal partners in healthcare came from Boston City Hospital in 1993. The hospital provided care to the largest uninsured and underinsured population in the New England states. The pediatric patients were noted by Dr. Barry Zuckerman to have difficulty in recovering from medical illnesses. He linked their inability to improve their health to poor housing, food insecurity, and basic social determinants of health. His hiring of a part-time lawyer led to a national movement for the development of medical-legal partnerships. The American Bar Association, the National Center for Medical-Legal Partnerships at George Washington University in Washington, DC and the American Academy of Pediatrics formed the first national medical-legal partnership in 2007. Joint resolutions were passed for members to become partners with the other professional colleagues to “address the legal and social issues affecting patient health and well-being.” The American Bar Association resolution led to the creation of the Medical-Legal Partnership Pro Bono Project. In 2015, the East Tennessee State University College of Nursing nurse-led community health center was awarded a small grant from the National Nurse Centers Consortium to participate in the development of a medical-legal partnership. The health center is staffed by Nurse Practitioners who provide health care for the underserved in northeast Tennessee. The patients are diverse and include homeless, migrants, residents of public housing, uninsured, and underinsured. Partnering with the Tennessee Justice Center in Nashville, Tennessee, the nurse-led medical legal partnership improved lives of pediatric patients, adults, pregnant women across the state, and advocacy rights for those who cannot speak for themselves.

No description available.

South Africa has the highest global burden of HIV/AIDS with over 7.9 million people living with HIV/AIDS. Women and girls bear a disproportionate burden of the disease, which is potentially driven by low levels of correct HIV knowledge and high levels of gender-based violence. Our study aimed to determine the factors that influence uptake of HIV testing among reproductive aged women between 15-49 years in South Africa. Data from the 2016 (N=8514) iteration of the Demographic and Health Survey was utilized. Our outcome variable was HIV testing (yes/no) and our predictor variables were age at first sex, highest educational level, marital status, and recent condom use. We conducted descriptive statistics, chi-square analysis and T-test for our categorical and continuous variables (age at first sex), respectively. We further conducted multiple logistic regression to determine predictors of HIV testing. Frequencies, mean age at first sex, p-values, odds ratios, and 95% confidence intervals with alpha set to 0.05 were reported. Of 6489 women included in the final analysis, 5915 (91.15%) of women had ever been tested for HIV, 4964 (76.50%) and 746 (11.50%) had secondary and higher education as their highest educational level The mean age at first sex for women who had ever tested for HIV was 17.55 + 2732.7 years compared to 17.17 + 3119.7 years for women who had never tested for HIV (P<0.0001). The majority of respondents were never married (N=3415,52.63%) and 1746 women (26.91%) were married. Women who used condom during the last sex were 2883 (44.43%) compared to 3606 (55.57%) women who did not. The relationship between marital status and HIV testing (P=0.0009) and condom use and HIV testing (P=0.0471) were all statistically significant. After adjusting for confounders, we found that women with primary education had a 44.4% decrease in the odds of HIV testing and women with no education had a 61% decrease, compared to women to women who had secondary education (OR = 0.556, CI= 0.429-0.719, P<0.0001), (OR = 0.394, CI= 0.251-0.620, p<0.0001)., Women who had higher education had a 46% increase in the odds of HIV testing compared to women who had secondary education (OR = 1.460, CI= 1.049-2.033, P=0.0249). Being married and living with partner were associated with a 59.6% and 90% increase in the odds of having been tested HIV (OR = 1.596, CI= 1.276-1.996, P<0.0001) and (OR = 1.907, CI= 1.441-2.524, P<0.0001) compared to women who had never been married. No longer living together/separated was associated with a 4.5 times higher odds of HIV testing (OR = 4.491, CI= 1.826-11.045, P=0.0011) among women compared to never been married. Age at first sex was not significantly associated with HIV testing in the final model (OR = 1.028, CI= 0.995-1.062, P= 0.1020). Our study suggests the need to increase basic education up to secondary level and beyond among women in South Africa to increase uptake of HIV testing and reduce the burden of HIV/AIDS.

Interventions that promote alternative income generation (AIG) to address social determinants of health are associated with increased household income and improved health outcomes. Organizations have used beekeeping to address poverty and other development goals with mixed outcomes. Beekeeping presents a viable option to promote AIG. Organizations increase their risk of failing to achieve positive outcomes when beekeeping interventions are inadequate. This project aims to develop an organizational assessment tool that measures organizational position in relation to evidence-based factors for income generation and improved quality of life among global beekeepers. The assessment is organized into seven domains that correspond with PRECEDE-PROCEED and may be a useful iterative diagnosis, evaluation, and monitoring tool. The instrument was developed through a literature review and adapted to PRECEDE-PROCEED to include organizational, ecological, and evaluation factors. The instrument was pretested among content experts and revised before being administered to BEECause Gambia (BCG). BEECause’s mission is to reduce poverty and promote pollinator and honeybee populations. The assessment results were analyzed to propose recommendations to BCG to consider in future strategic planning processes. The pretest included a survey and cognitive interviews to identify and revise problematic statements. Pretest survey statements were evaluated using a five-point Likert scale. Scores £ 3 directly informed the cognitive interview protocol, which allowed respondents to explicate their feedback and concerns. Interview results were analyzed for trends between respondents and corroborated against evidence-based factors. Statements were revised to consider optimal domain alignment, content validity, and meaningfulness. The revised survey included seven domains, 49 statements and one open-ended response. BEECause’s overall assessment score was 4.1. By domain their scores were 4.1 in design, 4.1 in implementation, 4.2 in predisposing factors, 3.1 in enabling factors, 3.8 in reinforcing factors, 4.2 in impact, and 5.0 in outcomes. Domain and statement scores underwent SWOT analysis. Scores ³ 4 were considered strengths. Scores < 4 were considered weaknesses, opportunities, and threats. The assessment resulted in three recommendations to BCG including 1) build financial security, 2) build stakeholder confidence, and 3) address enabling and reinforcing factors. This project may serve as a model for public health efforts in AIG.

BACKGROUND: This work serves as a cases study for the findings of the Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-Making (3-D Commission). The dissertation assessed public views of what matters for health, the degree of incorporation of SDoH in Covid-19 decision-making, and the mental health consequences of SDoH disruptions in diverse contexts using multiple data sources. METHODS: An online survey collected relevant individual-level data from Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States using RIWI—a professional global survey platform that uses a patented Random Domain Intercept Technology™ (RDIT™). National-level data retrieved included Covid-19 policy data from the Oxford Covid-19 Government Response Tracker (OxCGRT) and data from the International Labour Organization (ILO) on the informal labor sector. All data were used in descriptive and multivariable regression analyses. RESULTS: Of 8,754 respondents, 56.2% (95% CI: 55.1%, 57.2%) ranked healthcare as the most important determinant of health. Politics was the determinant with the greatest absolute difference between what respondents considered matters for health versus what they perceived decision-makers think matters for health. Overall, more restrictive Covid-19 stay-at-home orders were associated with a higher burden of SDoH disruptions while more expansive income support policies were associated with a lower burden of disruptions. The lowest two income quintile in all countries reported the highest burden of employment insecurity, financial insecurity, and food/supplies insecurity. The income gradient of SDoH disruptions persisted after controlling for government income support policies. Experiencing Covid-19 SDoH disruptions was then associated with a higher burden of both depression symptoms and probable post-traumatic stress disorder (PTSD). The prevalence of probable PTSD was about three times higher among people who experienced at least one Covid-19 SDoH disruption compared to those who did not experience a disruption. CONCLUSION: This research showcases the need for more investment in communication efforts around the importance of SDoH both to the general public and decision-makers. Moreover, SDoH disruptions and their association with adverse mental health outcomes during the Covid-19 pandemic highlight the lack of consideration for SDoH in the design and implementation of policies. Countries in different contexts would benefit from implementing the 3-D Commission principles and recommendations to ensure that decision-making on health is guided by equity and informed by data on SDoH. / 2024-08-30T00:00:00Z

Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.

Studies have indicated that the prevalence of mental health disorders among refugees has increased. The social capital and socioeconomic status of the host country are believed to influence the development and maintenance of mental health. This study aims to generate knowledge about the factors that affect adult refugees’ mental illness in Sweden and inquires as to the activities in the labor market for preventing mental illness among adult refugees in Sweden. This study was conducted using a scoping review method. The author analyzed 14 articles, and the results revealed that refugees are more prone to experiencing mental health problems, such as depression and anxiety, than native-born Swedes. This study revealed that the social capital and socioeconomic status of the host country may influence the development and maintenance of adult refugees’ mental health.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

No description available.