Community-Based Approaches to Reduce Toxins in Housing: Lessons Learned from Working with Diverse Communities

This article will review lessons learned from a community-based participatory research project with Latino and Somali residents in Portland, Oregon. The aim of the Healthy Futures Collaborative (HFC) project was to reduce in-home environmental health hazards associated with childhood respiratory illness and asthma through a process that strengthened social support and civic engagement. Using a community-based approach, the HFC trained community residents as community scientists to ensure local leadership and participation. Results suggest an increase in Somali and Latino residents\u27 knowledge of environmental stressors and changes in behavior that may improve indoor environmental quality. Especially when working with historically marginalized communities, a model that acknowledges power differentials and responds to community-identified priorities is a powerful model for addressing environmental injustices. For example, the project was able to address both behavioral and structural components of housing and poor indoor environmental quality by providing workshops on green cleaning and tenants\u27 rights. Yet, the participatory structure presents unique challenges-including issues of representation and distributive justice-challenges that may be exacerbated in cross-cultural projects with multiple racial/ethnic groups

Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. Objective To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. Data Sources Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. Study Selection Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. Data Extraction and Synthesis Independent data abstraction and study quality rating with dual review. Main Outcomes and Measures Gestational weight–related outcomes; maternal and infant morbidity and mortality; harms. Results Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], −1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, −2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, −1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, −1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, −1.02 kg [95% CI, −1.30 to −0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, −7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, −0.63 kg [95% CI, −1.44 to −0.01]). Data on harms were limited. Conclusions and Relevance Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG

Screening for Unhealthy Drug Use: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE Illicit drug use is among the most common causes of preventable morbidity and mortality in the US. OBJECTIVE To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019. STUDY SELECTION Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use. DATA EXTRACTION AND SYNTHESIS Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drug use and other health, social, and legal outcomes. RESULTS Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95%CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95%CI, 5%to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, –0.49 day in the last 7 days [95%CI, –0.85 to –0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95%CI, 0.59 to 0.82]; ARD, –35%[95%CI, –67%to –3%] and 12 trials, n = 1599; RR, 0.73 [95%CI, 0.62 to 0.85]; ARD, –18%[95%CI, –26%to –10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events. CONCLUSIONS AND RELEVANCE: Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations