Increasing Food Access: Evaluation of a Food Buying Club in Philadelphia

Introduction: Children living in food insecure homes are at higher risk of developing a variety of negative health outcomes, including cardiovascular disease, obesity, and cognitive, emotional and behavioral problems. In order to combat these outcomes, Mercy Neighborhood Ministries of Philadelphia (MNMOP) established a Food Buying Club to increase accessibility and affordability of fresh produce. However, the satisfaction with this program among participants needs to be determined in order to strengthen the program. Objective: The objective of this quality improvement study was to evaluate parental satisfaction with the MNMOP program, specifically regarding produce options, cost, and variety. Methods: An online survey was emailed to the participants of the July distribution. Satisfaction with the overall program, food variety, food quality, and cost was assessed. Reasons for joining the program, barriers to joining, and suggestions for future changes were also assessed. The survey was adapted to an open-ended format for in-person interviews. 37 in-person interviews were conducted during the October distribution. Results: 4 participants completed the online survey. Participants rated high satisfaction with the quality, variety, and cost of the produce. No barriers to joining were noted. Suggestions for change included better advertising of the program and making the packages larger. Interview analysis is pending. Conclusion: While awaiting further analysis, the Food Buying Club should increase advertising in the community because the fresh produce appears to be satisfactory among participants. However, the small sample size limits these conclusions. Future analysis should include a larger sample and information about motives for both joining and continuing to purchase from the program

Parks and shootings in Philadelphia from 2005-2015: A proximity analysis

Introduction: Urban green space exposure has been negatively correlated with mortality, and positively correlated with mood, attention, and physical activity; however, the relationship between urban green space, violence, and crime is still a topic of contention. The Philadelphia Horticultural Society found significant reductions in gun assaults and gun robberies in greened lots vs. ungreened lots. It is unclear whether or not there is a protective effect of parks overall for shootings in Philadelphia. Methods: In order to explore the relationship between green space and shootings in Philadelphia, we compiled data from 2005-2015 police reports to map out where shootings and drug related crimes were occurring using ArcGIS. We then conducted proximity analyses between shootings, poverty level, and drug related crimes within 600 feet of a park and a 600-1200 feet of a park. Results: Using Philadelphia neighborhoods as the unit of analysis, we found the ratio of shootings within 600 ft. of a park and ratio of shootings in the neighborhood per 100,000 people was positively correlated when controlling for drug related crimes and poverty (t=2.26, p=.059). Similarly, with a buffer range of 600-1200 ft. of a park, there was a positive correlation between shootings near the park and overall shootings in the neighborhood (t=5.70, p=.001). Conclusion: Though our proximity analysis, which controlled for poverty levels and drug crimes, we found that parks are not protective for shootings in Philadelphia. However, future studies will need to determine whether or not there is a difference between greened parks and ungreened lots

Understanding the Attitudes and Perceptions Towards Lung Cancer Screening Amongst United States Veterans: A Qualitative Study

Introduction: Lung cancer is the leading cause of cancer mortality in the United States, with this rate disproportionately affecting the veteran population. Despite USPSTF recommendations, screening rates are low and underutilized. The purpose of this study is to understand veterans’ knowledge, attitudes and beliefs surrounding lung cancer and lung cancer screening to better address barriers to screening. Methods: Five interviews were conducted with veteran community members, and three were conducted with key informants for a current total of eight interviews. Key informants included Philadelphia community leaders who work with veterans. Interviews explored lung cancer screening knowledge, motivating factors and barriers to care, tobacco use, and potential educational strategies. Interviews were transcribed and coded through NVivo Pro 12 for direct content analysis. Results: Analysis revealed a lack of knowledge and awareness surrounding lung cancer screening amongst veterans. Cancer screening beliefs echoed themes of fatalism and personal experience. Multiple barriers to care were identified, including lack of concern, fear, and patient navigation. Despite these barriers, interviewees believed that screening is necessary. Smoking is highly prevalent in this community due to social, cultural, and habitual factors. Potential educational strategies include group classes with both medical providers and lung cancer survivors. Conclusion: This study provides insight into understanding veterans’ knowledge and beliefs surrounding lung cancer screening. Understanding these values are important in addressing barriers to care and reducing the disproportionate lung cancer burden. In the future, this knowledge can be utilized to facilitate the development of culturally and linguistically appropriate educational programs and materials

Perspectives of Asian/Pacific Islanders on Lung Cancer Screening in Philadelphia: A Qualitative Study

Introduction: Even though rates of smoking, the leading cause of cancer, are lower in Asian/Pacific Islanders (API), the rates of lung cancer deaths are still one of the highest compared to those of other minority groups in the US. However, little is known about the beliefs and attitudes that influence lung cancer screening behaviors of APIs. Objective: The objective of this study is to better understand the current beliefs, attitudes, and knowledge of APIs in Philadelphia towards lung cancer and lung cancer screening. Methods: Six in-depth interviews were conducted with key informants, who all had extensive experience working with the Asian community in Philadelphia. The content of interviews included the interviewee’s knowledge of the attitudes and beliefs about lung cancer and lung cancer screening held by the API community. Motivational factors, barriers to screening, and effective educational/communication strategies were also assessed. Content analysis was used to analyze the qualitative data. Results: A majority of the participants felt that fatalism, no concept of preventive care, and not wanting to know a bad diagnosis were strong beliefs associated with lung cancer screenings that are held by the API community. Work, cost, language, fear, and a lack of knowledge were identified as barriers to lung cancer screenings, while family and doctors’ recommendation were identified as motivational factors. Conclusion: Culturally and linguistically appropriate education programs and materials in the future need to address these specific barriers, include basic information about and risk factors for lung cancer, and target messaging towards family to encourage lung cancer screening for APIs at risk

Assessing Food Quality and Regulations at Homeless Shelters in Philadelphia

Introduction: Nutritional diseases such as hypertension, diabetes, and cholesterol disorders are particularly high among individuals experiencing homelessness in comparison to the general United States population, leading the propagation of chronic health conditions and overuse of expensive healthcare resources. In addition, the food served in homeless shelters is the main source of nutrition for those living in these shelters, most notably when there is no option for food storage available. Despite the disproportionate prevalence of nutrition-related diseases among the homeless population, there is limited research on the quality of the food provided in homeless shelters and there are few policies to regulate the food being served. Methods: This exploratory study assesses and compares the quality of food provided as well as the nutritional policies that have been implemented in Philadelphia homeless shelters and nonprofit organizations that care for individuals experiencing homelessness. This study also assesses how food is obtained, prepared, and distributed. Leadership and staff members from Philadelphia homeless shelters are interviewed about food quality, food-related procedures, and food policies at the shelter. Responses from the interview are coded by performing a content analysis. Results: Five staff members from different homeless shelters were interviewed. A content analysis performed by two researchers revealed food quality at shelters to be ____. Barriers to improving food quality included _____. __ shelters had food-related policies that improved the quality of food served, including ____. Conclusion: The assumed data suggests that the nutritional quality of food at the shelters is generally poor and that shelter leadership cites similar barriers to improving nutritional quality as those in prior studies. In addition, shelter leadership offered few policies in place to improve the nutritional quality of food, whereas the nonprofit organizations had policies that allow for higher nutritional quality of food. Results provide insight into nutrition initiatives that have been successful among shelters, and future studies should examine the efficacy of these policies

Health Needs of Philadelphia’s Latinos through Photovoice

Introduction: The Patient Protection and Affordable Care Act requires non-profit hospitals to complete a Community Health Needs Assessment (CHNA) every three years that provides insight into the health and social needs of the community served and develop a plan to address priority needs. Community engagement and collaborative participation are essential to the process. For the 2019 CHNA, Thomas Jefferson University Hospitals is conducting a more in-depth assessment of the Philadelphia Latino community in North Philadelphia in order to better understand the specific issues faced by this population. Objective: To conduct a CHNA in North Philadelphia’s Latino community that identifies priority health and social needs and opportunities for addressing these issues through input from the community. Also, to empower the community to address the identified needs. Methods: Interviews with key community stakeholders suggested that using Photovoice methodology for the CHNA would transcend language barriers and give voice to those who otherwise go unheard. Up to 50 youth will be recruited to participate in 3 Photovoice projects in North Philadelphia. Youths will be instructed to take photographs that address the questions “What in your community helps you to be healthy?” and “What prevents you from being healthy?”. Photos will be discussed individually and in groups using the SHOWeD process. Thematic analysis and prioritization will be used to identify key issues and strategies to advocate for change. Results: Results are pending. Conclusions: Yet to be determined. The community’s desire to complete Photovoice from the child’s perspective emphasizes importance of future health and implies that kids are more aware of community health issues

Quality Improvement Study of Behavioral Health Resources Access in 19121 and 19132

Introduction: Children who have experienced four or more ACES (adverse childhood events) are shown to have negative mental health outcomes. Adolescents living in the Philadelphia zip codes 19121 and 19132 have higher ACE scores. This makes it necessary for adolescent providers to screen for behavioral health issues in their patients and refer out to appropriate resources. Objective: The purpose of this quality improvement study is to see what current barriers exist relating to physician referral and access to behavioral health resources for their patients. Methods: A guide of behavioral health resources available to adolescents in 19121 and 19132 was made for this assessment. The next step will be to interview adolescent care providers in this community about the processes used in identifying behavioral health issues and resources if needed. Specific primary care sites will be contacted to identify appropriate providers interested in participating in an interview. The interviews will be used to collect information regarding the provider’s process of behavioral health screening and referral. Common themes and barriers will be identified. Results: The behavioral health resource guide will be given to providers interviewed in the hopes of easing access to resources. I am currently waiting on getting approved as IRB-exempt before beginning interviews. Conclusion: It is expected that potential barriers to access will include long wait times for patients, insurances not being accepted, and unawareness of current resources available. Accessibility to behavioral health resources would need to be improved for adolescent patients to receive appropriate mental healthcare

Identifying the Health Needs of the East North Philadelphia Latino Youth via PhotoVoice

Introduction: The East North Philadelphia community contains the city’s largest Latino population, most of whom are of Puerto Rican and Dominican descent. This community in particular has unique health needs compared to the rest of the city of Philadelphia, with rates of diabetes (22.9%), asthma (28.6%), and poverty (45.5%) exceeding the national and city averages. Documenting the perceived needs of the children living here regarding their built environment will provide insight into the problems onto which the community at large needs to focus. This study aims to determine the priority needs of the community and to empower the youth to engage with and advocate for their community through photography. Methods: “PhotoVoice” projects were completed with adolescent Latino community members throughout 5 zip codes to survey the self-identified needs of the community regarding their collective health. Interviewers asked participants “what about [their] community helps or hurts their health?”, and the responses were transcribed and coded by multiple researchers to insure inter-rater reliability. Results: A thematic analysis was completed by both participants and researchers, which resulted in a list of top needs, most notably “Mental Health”, “Trauma, Safety and Violence”, “Built Environment”, and “Health Education and Health Behavior”. Conclusion: This data will be used in future advocacy work to help alleviate the burdens described by the East North Philadelphia Latino youth community