Applying Community-Based Participatory Research Partnership Principles to Public Health Practice-Based Research Networks

With real-world relevance and translatability as important goals, applied methodological approaches have arisen along the participatory continuum that value context and empower stakeholders to partner actively with academics throughout the research process. Community-based participatory research (CBPR) provides the gold standard for equitable, partnered research in traditional communities. Practice-based research networks (PBRNs) also have developed, coalescing communities of practice and of academics to identify, study, and answer practice-relevant questions. To optimize PBRN potential for expanding scientific knowledge, while bridging divides across knowledge production, dissemination, and implementation, we elucidate how PBRN partnerships can be strengthened by applying CBPR principles to build and maintain research collaboratives that empower practice partners. Examining the applicability of CBPR partnership principles to public health (PH) PBRNs, we conclude that PH-PBRNs can serve as authentic, sustainable CBPR partnerships, ensuring the co-production of new knowledge, while also improving and expanding the implementation and impact of research findings in real-world settings.ECU Open Access Publishing Support Fun

Editorial Comment: Changing the Rules in Vaccine Coverage for Vulnerable Populations

Increasing life expectancy through decreasing vaccine preventable deaths is a hallmark of modern public health in the United States (1). Two federal vaccine programs help insure coverage for vulnerable populations. The Vaccines for Children (VFC) Program provides vaccines to eligible children[1] at no cost, removing financial barriers to vaccinations. Close to half of US children and 30 percent of adolescents are vaccinated through the VFC program yearly (2). The federal Section 317 Immunization Grant Program (Section 317) complements VFC by supporting the national immunization infrastructure, primarily immunization workforce, delivery systems, and emergency response, as well as by providing vaccines for non-VFC eligible financially vulnerable populations

Hospital clusters of invasive Group B Streptococcal disease: A systematic review.

OBJECTIVES: To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals. METHODS: Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297. RESULTS: Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset (<7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant (n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. CONCLUSIONS: Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics

Use of the County Health Rankings by Local Health Departments in Florida, 2010 - 2011

This paper describes how local health departments (LHDs) in Florida used the County Health Rankings over the first two years of their release (2010 – 2011). We surveyed LHD leadership to describe if, how and to what extent the Rankings were used by Florida’s 67 LHDs to improve the health of their communities and describe changes in use from the 2010 to the 2011 release. Our results indicate substantial use of the Rankings by Florida’s LHDs, particularly as applied to community health assessments, staff education, as a starting point for examining other indicators and databases, and in grant applications. From 2010 to 2011, we found significant increases in LHD use of the Rankings to build broad multisectoral community involvement in the solution of community health problems. However, media engagement with the Rankings appears to have decreased with time. A primary implication for public health practice is the apparent utility of the Rankings as a tool for community organizing around public health issues and communicating the multifactorial nature of health

Factors Driving Local Health Department’s Collaboration with Other Organizations in the Provision of Personal Healthcare Services

Background: Recent work has highlighted the necessity of integrating primary care services and public health to improve quality and reduce the cost of healthcare. Research Objectives: To describe levels of partnership between local health departments (LHD) and other organizations in the community in the provision of personal healthcare services; and to assess LHD organizational characteristics and community factors that contribute to partnerships. Data Sets and Sources: Data were drawn from the 2013 NACCHO Profile Study (Module 1) and the Area Health Resource File. A total of 490 LHDs responded to Module 1, where LHDs were asked to describe the level of partnership for selected programs including three personal healthcare services—Maternal and Child Health (MCH), communicable/infectious disease control, and chronic disease prevention. The five levels of partnership were measured on an ordinal level from “not involved”, “networking”, “coordinating”, “cooperating”, to “collaborating”, with “collaborating” as the highest level of partnership. The level of partnership in these three personal healthcare services were the outcomes examined in this analysis. Covariates included both LHD organizational and community factors. Study Design: This is a cross-sectional study, based on secondary data from multiple sources, linked at the LHD as a unit of observation. Analysis: Three ordinal logistic regression models were run to assess factors associated with higher levels of partnership in the three personal healthcare programs. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study’s survey design. Principal Findings:Overall, proportions of LHDs at the five levels of partnership—not involved, networking, coordinating, cooperating , and collaborating—for MCH were 11.8%, 12.4%, 28.3%, 24.9%, and 22.6%; for infectious disease control were 8.1%, 3.9%, 27.6%, 31.8%, and 28.9%; for chronic disease prevention were 10.4%, 14.2%, 37.7%, 21.2%, and 16.5%, respectively The proportion of LHDs engaged in collaboration, the highest level of partnership, increased with LHD jurisdiction population size. For MCH, 14.1% of LHDs with =500,000 people reported collaboration (p=500,000 reported collaboration with other organizations in the community (p Conclusion: Level of partnership varied across LHDs of different jurisdiction population sizes. And the level of partnership was highest for infectious disease control, and the lowest in chronic disease prevention. Implications for Public Health Practice and Policy: Factors that might promote LHD’s collaboration in the provision of personal health care services include having a public health physician on staff, higher per capita expenditure, and conducting a community health assessment

A Tool to Cost Environmental Health Services in North Carolina Local Health Departments

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services. Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and finance managers. LHDs (n=15) received technical support to estimate costs for fiscal year 2012. Results: The tool contained the following sections: Agency/Respondent Information, Service Counts, Direct Labor Costs, Direct Non-Labor Costs, and Indirect/Overhead Costs. The time required to complete the tool ranged from 2 to 12 hours (median = 4). Implications: LHDs typically did not track costs by program area, nor did they acknowledge indirect costs or costs absorbed by the county. Nonetheless, this costing tool is one of the first to estimate costs associated with environmental health programs at the LHD level and has important implications for practitioners and researchers, particularly when these limitations are recognized

A possible dose–response association between distance to farmers’ markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

Background: The association between farmers’ market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by fruit and vegetable consumption. Methods: In 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a crosssectional survey among 263 farmers’ market customers (199 provided complete address data) and conducted farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI. Results: Those who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption. Conclusions: More work should be done to understand factors within farmers’ markets that encourage fruit and vegetable purchases.ECU Open Access Publishing Support Fun

Local Health Departments’ Costs of Providing Environmental Health Services

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services. Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure. Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per service provided. In a second step, total costs are decomposed into key components, including direct and indirect costs. Both data collection and analysis were conducted in 2014. Results: For the LHDs examined in this report, median cost per service amounted to $145 for food and lodging and$82 for onsite water. Service costs, however, varied widely across agencies. Decomposition showed that direct labor costs represented more than 80% of total costs. Other direct costs accounted for 10% to 15% of total costs, while indirect costs represented 5% to 6% of total costs. Implications: The finding that labor costs represent a majority of the total costs of service provision has important implications for public health practitioners. Perhaps most importantly, for the purpose of costing public health services, estimation procedures may be simplified by focusing primarily on the cost of labor required to provide any given service

LHDs\u27 Implementation and Evaluation of Strategies to Target Psychological, Mental Health, and Other Behavioral Healthcare Needs of the Underserved Population

Background: Underserved subgroups face barriers when accessing behavioral healthcare. Local health departments (LHDs) are charged with “linking people to needed personal health services and assure the provision of healthcare when otherwise unavailable”. Research Objectives: 1) To assess the extent to which LHDs implement and evaluate strategies to target the behavioral healthcare needs for the underserved populations; 2) To identify factors that are associated with these undertakings. Datasets and Sources: Data were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials The Module 2 questionnaire of the Profile contained question about strategies used by LHDs to target the behavioral healthcare needs of the underserved populations (N=505). Study Design: Cross-sectional, quantitative survey. Analysis: Factors associated with assuring access to behavioral health services were examined by using logistic regression analyses. Descriptive statistics were also computed. To account for complex survey design, we used SVY routine in Stata 11. Principal Findings: About 30% of LHDs implemented or evaluated strategies to target the behavioral healthcare needs of underserved populations in their jurisdiction. Our multivariate analysis indicates that LHDs with city/multicity jurisdiction (AOR=0.16, 95% CI: 0.04-0.77), centralized governance (AOR=0.12, 95% CI: 0.02-0.85), and those located in the South Region (AOR=.0.25, 95% CI: 0.08-0.14) or the West Region (AOR=.0.36, 95% CI: 0.14-0.94) were less likely to have targeted the behavioral healthcare needs of the underserved. LHDs with higher per capita expenditures (AOR=1.85, 95% CI: 1.00-3.42), or those with greater number of activities to address health disparities (AOR=1.27, 95% CI: 1.08-1.49) had higher odds of having targeted the behavioral healthcare needs of the underserved. Conclusion: Extent to which the LHDs implemented or evaluated strategies to target the behavioral healthcare needs of the underserved populations varied by centralization of governance, the degree to which LHDs were well-funded, health disparities reduction activities, geographic region, and jurisdiction type. Implications for Public Health: Policy and practice focus on mental health issues in under-served populations is ever more critical, given the low proportion of LHDs targeting behavioral health needs, and the increased vulnerability of underserved population emanating from recent financial crises