Do health education initiatives assist socioeconomically disadvantaged populations? : a systematic review and meta-analyses

Background: Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. Methods: We pre-registered the study on Open Science Framework https://osf.io/ek5yg/. We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. Results: We identified 8618 unique records, 96 met our criteria for inclusion – involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09–0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05–0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. Conclusions: Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health

Changing Physical Activity Behavior with Continuous Glucose Monitoring: A Dissertation

Up to 60% of individuals with type 2 diabetes (T2DM) do not participate in regular physical activity (PA) despite the known benefits. To encourage these individuals to increase PA behavior, this study tested the feasibility and implementation of a nurse-directed counseling intervention using continuous glucose monitoring system (CGMS). The study used a framework derived from self-efficacy theory to 1) compare changes in self-efficacy, BP and activity counts between participants receiving CGMS counseling and standard T2DM counseling, 2) examine relationships between PA self-efficacy and BP and activity counts, 3) evaluate recruitment, retention, and screening strategies, and 4) assess instrument reliability and utility. Adults (N=52) with T2DM (non-insulin requiring, inactive) were randomized to intervention (n=27) or control groups (n=25). Both groups received 90 minutes of diabetes education with a follow-up phone call at 4 weeks. The intervention group also received feedback on their own CGMS graphs and a role model\u27s graph depicting PA related reductions in glucose levels. PA benefits/barriers were discussed and goals were set. Outcomes were recorded at 1 and 8 weeks. Participants were older (57±14 years), predominantly (90%) white, about half (52%) female, and had diabetes for 8±7 years. Relative to the control group, participants receiving the intervention had higher self-efficacy scores at 8 weeks, indicating more confidence in sticking to a PA program. Their light/sedentary activity minutes decreased significantly and moderate activity minutes increased significantly; systolic BP, A1c and BMI decreased significantly. Only self-efficacy for Sticking to it was positively associated with moderate activity. The most successful recruitment media was multiple newspaper press releases. Most referrals came from endocrinology physicians. Of 231 study volunteers, 106 did not meet the criterion of A1c≥7.5%. These data suggest that CGMS feedback is feasible for counseling individuals with T2DM to improve PA and may improve risk factors for diabetes-related complications. Newspaper press releases are effective for recruiting participants with T2DM. Less restrictive inclusion criteria in a larger study may allow more participation by sedentary individuals with T2DM but may reduce effect size. CGMS was well tolerated and its data aided diabetes-related teaching

Identifying and reducing lead exposure associated with the use of cultural practices in southern Nevada Hispanic communities

Despite large amounts of national data on lead and childhood lead poisoning, the status of childhood lead exposure in Nevada as a result of the use of cultural practices in the Hispanic population is unknown. The influx of immigrant Hispanic populations to Nevada, their low education level, the high number of them who are living in poverty present an increased risk for children to be exposed to lead through the use of imported consumables, home remedies and alternative medicine (i.e., healers/ sobadores). A 61-question survey collected data from Hispanics over 18 years of age who have or take care of children six years or under. Results from the study demonstrated a significant relationship exists in the proportion of children who had reported to suffer from empacho and from a stomach illness, χ2 (1, N = 189) = 29.024, p \u3c .001). Children who had empacho were more than 2.1 times as likely to also suffer from a stomach illness. A total 8.5% of respondents whose children suffered from empacho also used Azarcón, a folk remedy containing a high percentage of lead, LR (1, N = 190) =12.044, p = .001). A significant relationship exists between suffering from empacho and using a curandera/sobadora, χ2 (1, N = 192) = 26.91, p \u3c .001). Individuals who reported their iv children as suffering from empacho were 11.6 times more likely to use a curandera/sobadora than those who did not report having empacho. Foreign born Hispanics were more knowledgeable and 2.8 times more likely to believe their child had a high chance of getting elevated blood lead levels as compared to U.S. born respondents, χ2 (1, N = 212) = 3.814, p = .051. These results were inconclusive but should be explored further. On the other hand, they had less knowledge than their counterparts regarding the cost for getting child tested for lead, χ2 (1, N = 212) = 7.7, p = .006 and the time needed for treatment of elevated blood lead levels, χ2 (1, N = 212) = 3.4, p = .066. Foreign born Hispanics were almost 2.6 times as likely to believe treatment for elevated BLLs would take too much spare time and 4 times more likely to believe the lead test would be too expensive. There was a significant relationship between country of origin and language, with 96.6% of foreign born Hispanics and 35.4% U.S. born respondents choosing Spanish as their preferred language for prevention messages, LR (1, N = 208) = 62.8, p \u3c .001. Language is an indicator of the degree individuals have acculturated to American society (i.e., the process whereby one group contributes more to the flow of cultural elements than the other, much weaker one). Language may also influence how these individuals respond to health promotion and behavior change campaigns and the type of media they choose. A lead prevention campaign to be developed will incorporate language, folk traditions and the importance of the nuclear and expanded family to be thoroughly involved in preventing their children from being exposed to lead through folk remedies, folk healers and other items identified in this study

Investing in The Health and Well-Being of Young Adults

This report was prepared to assist federal, state, and local policy makers and program leaders, as well as employers, nonprofit organizations, and other community partners, in developing and enhancing policies and programs to improve young adults' health, safety, and well-being. The report also suggests priorities for research to inform policy and programs for young adults.Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large

Robert Wood Johnson Foundation - 2005 Annual Report: A Tree in the Storm -- Philanthropy and the Health of the Public

Contains president's message, program information, grantee profiles, grants list, financial statements, and an assessment of the public health system after Hurricane Katrina

2023 Medical Student Research Day Abstracts

Medical student research day is designed to highlight the breadth of research and scholarly activity that medical students have accomplished during their education at The GW School of Medicine and Health Sciences. All medical students are invited to present research regardless of the area of focus. Abstract submissions represent a broad range of research interests and disciplines, including basic and translational science, clinical research, health policy and public health research, and education-related research

Socioecological Determinants of Obesity Among Hispanic Parents/Child Caregivers in Aurora, Illinois

Obesity has increased during the past 30 years in the United States. Obese adults and children are at risk for cardiovascular disease, diabetes, hypertension, and comorbidities. Parents and child caregivers play key roles in the decisions of family health. Studies exploring sociodemographic and socioecological factors associated with obesity among U.S. Hispanic parents and child caregivers are lacking. Guided by the socioecological model, this study examined the following factors: gender; acculturation; dietary intake of fat, sugar, fruits, and vegetables; and role as food purchaser/food preparer that influenced obesity. A 3-paper-based survey, consisting of a demographic survey, the Block Fat-Sugar-Fruit-Vegetable Screener and the Bidimensional Acculturation Scale for Hispanics (BAS), was used to collect data. The volunteer sample of 165 Hispanic parents/child caregivers residing in Aurora, Illinois, was recruited using venue-based sampling. Point-biserial correlations, chi-square, and multiple logistic regression were performed to test 10 hypotheses. Acculturation, as measured by the BAS non-Hispanic domain scores, was a significant predictor of obesity. Obesity increased 1.737 times with every 1 unit increase in acculturation BAS non-Hispanic domain scores. Multiple regression results showed that developing obesity was 2.46 times lower in males compared with females in the overall sample. These findings could be used to promote positive social change by influencing the development of culturally congruent obesity prevention, management, and treatment programs produced by educators and health professionals specifically targeting obesity among Hispanic women, which could further increase the overall well-being and longevity of Hispanic families in Aurora, Illinois, and beyond

Approaches to enhance interpretability and meaningful use of big data in population health practice and research

While many public health and medical studies use big data, the potential for big data to further population health has yet to be fully realized. Because of the complexities associated with the storage, processing, analysis, and interpretation of these data, few research findings from big data have been translated into practice. Using small area estimation synthetic data and electronic health record (EHR) data, the overall goal of this dissertation research was to characterize health-related exposures with an explicit focus on meaningful data interpretability. In our first aim, we used regression models linked to population microdata to respond to high-priority needs articulated by our community partners in New Bedford, MA. We identified census tracts with an elevated percentage of high-risk subpopulations (e.g., lower rates of exercise, higher rates of diabetes), information our community partners used to prioritize funding opportunities and intervention programs. In our second and third aims, we scrutinized EHR data on children seen at Boston Medical Center (Boston, MA), New England’s largest safety-net hospital, from 2013 through 2017 and uncovered racial/ethnic disparities in asthma severity and residential mobility using logistic regression. We built upon a validated asthma computable phenotype to create a computable phenotype for asthma severity that is based in clinical asthma guidelines. We found that children for whom severity could be ascertained from these EHR data were less likely to be Hispanic and that Black children were less likely to have lung function testing data present. Lastly, we constructed contextualized residential mobility and immobility metrics using EHR address data and the Child Opportunity Index 2.0, identified opportunities and challenges EHR address data present to study this topic, and found significant racial/ethnic disparities in access to neighborhood opportunity. Our findings highlighted the perpetuation of residence in low opportunity areas among non-White children. The main challenge of this dissertation, to work within the limitations inherent to big data to extract meaningful knowledge from these data and by linking to external datasets, turned out to be an opportunity to engage in solutions-oriented research and do work that, to quote Aristotle, “…is greater than the sum of its parts”. Through strategies ranging from engaging with community partners to examining who and what data are captured (and not captured) in EHR health and address data, this dissertation demonstrated potential ways to leverage big data sources to further public health and health equity

A PHENOMENOLOGICAL INVESTIGATION OF TIME TO PRESENTATION, DIAGNOSIS, AND TREATMENT FOR INDIANA FARMERS WITH PROSTATE CANCER AND MEASUREMENTS OF TRADITIONAL MASCULINITY IDEOLOGY

Thesis (Ph.D.) - Indiana University, School of Public Health, 2020Introduction: The most common and second-deadliest cancer in the U.S. for men is prostate cancer (PCa). Extensive research shows that farmers have higher PCa incidence and mortality than nonfarmers. This study aims to better understand U.S. farmers’ increased risk of PCa by exploring care-seeking behaviors and masculinities in Indiana farmers with a history of PCa. Methods: Eleven farmers with a PCa history completed a questionnaire about their traditional masculinity beliefs and an interview focused on their PCa experiences, from signs and symptoms to after treatment. Interview questions were based on three theories, and the questionnaire was the 21-item Male Role Norms Inventory-Short Form (MRNI-SF). Results: MRNI-SF results showed farmers endorsed traditional masculine norms. Specifically, they agreed with avoiding femininity, having negative attitudes towards sexual minorities, being self-reliant through mechanical skills, toughness, and sex being important. Farmers did not endorse men being dominant nor with men restricting emotions. Seven themes described farmers’ PCa experiences: the body was an occasional guide for detection, routine checkups were the primary method of suspicion, PSA-testing was a powerful predictor, biopsy was somewhat of a bugaboo, diagnosis put psychological health on display, healthcare professional characteristics and others’ experiences reigned paramount in treatment decisions, and treatments invoked physical concerns and side effects. Discussion: Farmers did not agree with men always dominating and restricting emotions, which does not reflect previous studies. More research is suggested utilizing the MRNI-SF with larger populations of farmers. Based on the themes, increased somatic awareness is suggested for farmers, as well as continued routine checkups and PSA-testing. Farmers also require improved health education and resources to prepare for a PCa biopsy, to cope with a diagnosis, to make treatment decisions, and to manage treatment symptoms