A Place-Based Community Health Worker Program: Feasibility and Early Outcomes, New York City, 2015

Introduction: This study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes. Methods: This intervention was informed by a mixed-method needs assessment performed December 2014–January 2015 (representative telephone survey, n¼1,663; six focus groups, n¼55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February–December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/ clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity). Results: At the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p¼0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p¼0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up. Conclusions: Housing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes

Reconciling Religious Identity And Reproductive Practices: The Church And Contraception In Poland

Background and objectiveAfter the fall of state socialism in Poland in 1989, a Catholic-nationalist government assumed power. The new political power of the Catholic Church resulted in severe restrictions on family planning (FP) services. Yet, Poland\u27s fertility rate declined sharply, suggesting that women are controlling their fertility despite restrictions. This study examined the Church\u27s influence on women\u27s contraceptive decisions, and how women reconcile religious teachings with their contraceptive use. Methods We conducted a mixed-methods study, including a cross-sectional survey and qualitative interviews, in Gdańsk, Poland with sexually active women aged 1840. The quantitative sample included 418 respondents; the qualitative sample included 49 respondents. Results Despite restrictions on FP services, modern contraceptive use among our sample was 56, up from 19 in 1991. Catholicism played a relatively small role in respondents\u27 contraceptive decisions; though 94.2 of respondents were Catholic, 79 reported that the Church had little or no influence on reproductive decisions. Women\u27s explanations for how they reconcile their reproductive practices with Catholicism included using elements of religion to support contraceptive use, prioritising responsibility for family and financial considerations over the Church\u27s prohibitions, and challenging the Church\u27s credibility in FP matters. Conclusions Our findings underscore women\u27s struggles under post-socialist reproductive policies that limit FP access. Despite religious, political, and economic obstacles, contraceptive use has increased dramatically, indicating that FP is a high priority for women in Poland. Policies should respond to women\u27s needs. Comprehensive, state-sponsored FP and sex education are urgently needed and the state should legitimise such services. © 2010 European Society of Contraception and Reproductive Health

Food shopping behaviors of residents in two Bronx neighborhoods

Background: Numerous researchers have documented associations between neighborhood food environments and residents’ diets. However, few quantitative studies have examined the food shopping behaviors of residents in low-income neighborhoods, including the types of stores patronized and frequency of visits. This study presents findings on the food shopping behaviors of residents in the Bronx neighborhoods of West Farms and Fordham. Methods: Street-intercept surveys were conducted in spring 2012 with residents of West Farms and Fordham as part of a broader program evaluation. The survey included questions on general food shopping behaviors including visits to neighborhood bodegas (corner stores) and supermarkets, mode of transportation to the supermarket most commonly frequented, and the primary source for purchases of fruits and vegetables. Results: The survey was conducted with 505 respondents. The sample was 59% Hispanic and 34% black, with a median age of 45 years. Thirty-four percent of respondents had less than a high school education, 30% were high school graduates or had their GED, and 36% had attended some college. Almost all respondents (97%) shopped at supermarkets in their neighborhood; 84% usually shopped at a supermarket within their neighborhood, and 16% usually shopped at a supermarket outside of their neighborhood. Most respondents (95%) shopped at bodegas in their neighborhood, and 65% did so once per day or more. Conclusions: Residents of these neighborhoods have high exposure to local food stores, with the vast majority of respondents shopping at neighborhood supermarkets and bodegas and almost 2 in 3 respondents going to bodegas every day. These findings demonstrate the important role of supermarkets and bodegas in local residents’ shopping patterns and support the inclusion of these stores in efforts to create food environments that support and promote healthy eating

Food shopping behaviors of residents in two Bronx neighborhoods

<strong>Background: </strong>Numerous researchers have documented associations between neighborhood food environments and residents’ diets. However, few quantitative studies have examined the food shopping behaviors of residents in low-income neighborhoods, including the types of stores patronized and frequency of visits. This study presents findings on the food shopping behaviors of residents in the Bronx neighborhoods of West Farms and Fordham.<br> <strong>Methods: </strong>Street-intercept surveys were conducted in spring 2012 with residents of West Farms and Fordham as part of a broader program evaluation. The survey included questions on general food shopping behaviors including visits to neighborhood bodegas (corner stores) and supermarkets, mode of transportation to the supermarket most commonly frequented, and the primary source for purchases of fruits and vegetables.<br> <strong>Results: </strong>The survey was conducted with 505 respondents. The sample was 59% Hispanic and 34% black, with a median age of 45 years. Thirty-four percent of respondents had less than a high school education, 30% were high school graduates or had their GED, and 36% had attended some college. Almost all respondents (97%) shopped at supermarkets in their neighborhood; 84% usually shopped at a supermarket within their neighborhood, and 16% usually shopped at a supermarket outside of their neighborhood. Most respondents (95%) shopped at bodegas in their neighborhood, and 65% did so once per day or more.<br> <strong>Conclusions: </strong>Residents of these neighborhoods have high exposure to local food stores, with the vast majority of respondents shopping at neighborhood supermarkets and bodegas and almost 2 in 3 respondents going to bodegas every day. These findings demonstrate the important role of supermarkets and bodegas in local residents’ shopping patterns and support the inclusion of these stores in efforts to create food environments that support and promote healthy eating

Evaluation of the New York City Green Carts program

Access to fresh fruits and vegetables is a concern, particularly among low-income populations. Mobile vending is one strategy to expand produce availability and access to increase consumption. In 2008, New York City launched a mobile vending initiative, Green Carts. We report on the evaluation. Three waves of cross-sectional observational surveys of produce availability, variety, and quality were conducted during the summers of 2008, 2009, and 2011 in a stratified random sample of stores and carts comparing establishments in Green Cart neighborhoods (n = 13) with comparison neighborhoods (n = 3). Bivariate analyses for availability, variety, and quality comparing Green Cart and comparison neighborhoods were presented across years, and logistic and negative binomial regressions were used to test whether fruit and vegetable availability, variety, and quality increased in Green Cart compared with comparison neighborhoods, adjusting for clustering and neighborhood demographics. Establishments selling fruits and vegetables in Green Cart neighborhoods increased between 2008 and 2011 (50% to 69%, p &lt;0.0001); there was no comparable increase in comparison neighborhoods. Establishments selling more than 10 fruits and vegetables types increased from 31% to 38% (p = 0.0414) in Green Cart neighborhoods; there was no change in comparison neighborhoods. Produce quality was high among comparison establishments, with 95% and 94% meeting the quality threshold in 2008 and 2011, while declining in Green Cart neighborhood establishments from 96% to 88% (p &lt; 0.0001). Sustained produce availability was found in Green Cart neighborhoods between 2008–2011. Green Carts are one strategy contributing to improving produce access among New Yorkers

Resident Experiences With a Place-Based Collaboration to Address Health and Social Inequities: A Survey of Visitors to the East Harlem Neighborhood Health Action Center

In 2016 and 2017, the New York City Department of Health and Mental Hygiene established Neighborhood Health Action Centers (Action Centers) in disinvested communities of color as part of a place-based model to advance health equity. This model includes co-located partners, a referral and linkage system, and community space and programming. In 2018, we surveyed visitors to the East Harlem Action Center to provide a more comprehensive understanding of visitors' experiences. The survey was administered in English, Spanish, and Mandarin. Respondents were racially diverse and predominantly residents of East Harlem. The majority had been to the East Harlem Action Center previously. Most agreed that the main service provider for their visit made them feel comfortable, treated them with respect, spoke in a way that was easy to understand, and that they received the highest quality of service. A little more than half of returning visitors reported engaging with more than one Action Center program in the last 6 months. Twenty-one percent of respondents reported receiving at least one referral at the Action Center. Two thirds were aware that the Action Center offered a number of programs and services and half were aware that referrals were available. Additional visits to the Action Center were associated with increased likelihood of engaging with more than one program and awareness of the availability of programs and referral services. Findings suggest that most visitors surveyed had positive experiences, and more can be done to promote the Action Center and the variety of services it offers

Disruption of Healthcare in New York City During the COVID-19 Pandemic: Findings From Residents Living in North and Central Brooklyn, the South Bronx, and East and Central Harlem

Introduction: The COVID-19 pandemic has disproportionately affected some New York City (NYC) neighborhoods that primarily consist of Black, Indigenous, and Latinx residents. In comparison to the rest of NYC, these neighborhoods experienced high hospitalization and COVID-related death rates, which has been attributed to a longstanding history of structural racism and disinvestment. While stay-at-home orders were implemented to reduce the spread of COVID-19, this may have also affected access and utilization of non-COVID related healthcare services. This study aims to assess the prevalence of and reasons for the disruption of non-COVID related healthcare services during the first 18 months of the pandemic. Methods: From September 30, 2021 to November 4, 2021, the NYC Health Department administered the COVID-19 Community Recovery Survey to a subset of residents who were part of the NYC Health Panel a probability-based survey panel. This cross-sectional survey, which included closed and open-ended questions, was either self-administered online or completed via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese. Descriptive statistics were used to summarize responses and unweighted, weighted, age-adjusted percentages, and 95% Confidence Intervals (CIs) were calculated. Results: With a response rate of 30.3% (N = 1358), more than half of participants (54%) reported disruption to either routine physical healthcare or mental health services. Concern about getting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Concern about getting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges. Conclusions: Due to the pandemic, some disruption to healthcare was expected. However, most study participants either avoided or experienced a delay in healthcare. The delay of non-COVID related healthcare throughout the pandemic may result in the further widening of the health inequity gap among NYC residents dealing with a higher chronic disease burden before the start of the COVID-19 pandemic in March 2020. Findings from this study can support equitable COVID-19 recovery, and guide efforts with health promotion

Building a Culture of Health at the Neighborhood Level Through Governance Councils

To explore facilitators and barriers to developing and sustaining collaboration among New York City Department of Health and Mental Hygiene's Neighborhood Health Action Centers and co-located partners, who share information and decision-making through a Governance Council structure of representative members. Semi-structured interviews were conducted in 2018 with 43 Governance Council members across the three Action Centers of East Harlem (13), Tremont (15), and Brownsville (15), New York City. Governance Council members identified collaboration through information- and resource-sharing, consistent meetings and continuous communication as valuable for fostering a culture of health in their communities. Immediate benefits included building relationships, increased access to resources, and increased reach and access to community members. Challenges included difficulty building community trust, insufficient advertisement of services, and navigation of government bureaucracy. The Governance Councils forged collaborative relationships among local government, community-based organizations and clinical providers to improve health and well-being in their neighborhoods. Sharing space, resources and information is feasible with a movement towards shared leadership and decision-making. This may result in community-driven and tailored solutions to historical inequities. In shared leadership models, some internal reform by Government partners may be required