Community Health

Correction to: No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016 The article No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016, written by Mohsin Ali and Marsha D. Williams, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 02 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 13 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Building Community Partnerships: The Role of Schools of Public Health

A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in Utah Abstract In the United States, Latinos are more likely to be uninsured and diagnosed with later stage cancer than non-Hispanic whites. Promotoras (lay health educators) help improve cancer knowledge and facilitate access to cancer screenings. We tested a promotora led workplace-based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino employees in service or manual labor jobs. Latinos 18 and older from Salt Lake County, Utah were enrolled from January 2015 to February 2016. N = 265 completed pre- and post-intervention surveys that measured knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Demographic, economic, and cancer factors of participants who completed the intervention were compared to those who were incomplete. Changes in knowledge and adherence were calculated using McNemar's tests. Logistic regression compared outcomes by select demographic, economic and cancer factors. More participants were older, spoke Non-English languages, were single/widow(er)s, worked part-time, and had an immediate family member with cancer compared to those who did not complete the study (all p < 0.05). Knowledge of the age to begin cancer screenings increased significantly from baseline to follow-up for cervical (65.1–77.7%), breast (67.2–81.7%), and colorectal cancer (49.8–80.7%), all p ≤ 0.001. Knowledge of the frequency of cervical (34.0–46.5%) and colorectal (72.1–84.5%) screening increased from baseline to follow-up, both p < 0.001. Adherence to fecal immunochemical tests (FIT) for colorectal cancer increased from baseline to follow-up (13.8–56.9%, p < 0.001). Promotora led workplace-based interventions can strengthen community capacity for educating and supporting Latino employees in preventing breast, cervical, and colorectal cancer.

Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007–2015 Abstract Sugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007–2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0–5 years old, 1.05 (95% CI 0.90, 1.21) among children 6–12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach.

A Mixed-Methods Assessment of a Peer-Enforced Tobacco- and Smoke-Free Policy at a Large Urban University Abstract The study aims to evaluate the enforcement, opinions, and effectiveness of the University of South Florida's tobacco free policy one year following implementation. By assessing readiness to change and using geographic information system (GIS) mapping this study sought to introduce a unique and effective way of evaluating college tobacco free policies. A cross-sectional survey was administered to students, faculty, and staff to assess knowledge of policy and resources, tobacco use observations, stage change regarding policy enforcement, self-efficacy to enforce, and policy impact on perceived campus tobacco use (n = 5242). Additionally, using ArcGIS Collector (in: ESRI, ArcGIS desktop: release 10, Environmental Systems Research Institute, Redlands, 2011) volunteers collected geospatial data on tobacco use continuing to occur on campus following policy implementation. Overall there was moderate knowledge of the current policy and low beliefs for policy enforcement. Majority of respondents were not approaching violators to remind them of the policy and did not plan to do so in the future. There were statistically significant differences between smokers and non-smokers as well as between students and faculty and staff. The mapping of observed violations revealed continued tobacco use on campus with 158 data points. From both the geospatial results as well as the survey findings, the current policy is ineffective in reducing tobacco use across campus. With rapidly increasing numbers of smoke and tobacco free universities, new and innovative evaluation tools are needed so institution leaders can efficiently evaluate their implementation.

A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases Abstract Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases—PubMed, EMBASE, and CINAHL—along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.

Awareness and Knowledge of Human Papilloma Virus and Cervical Cancer in Women with High Pap Uptake Abstract This cross-sectional study explored knowledge, awareness, and health practices surrounding cervical cancer prevention and screening. Patients (n = 129) were recruited from three community clinics of underserved populations in Dallas, Texas. Women between ages 18–65 were surveyed using a self-administered questionnaire to evaluate their knowledge, awareness, and attitudes related to pap tests, human papilloma virus (HPV), HPV vaccines, and cervical cancer. Most women reported having a pap test in the past 3–5 years (86.6%). Over half knew that there was an increased risk of cervical cancer with an HPV infection, abnormal pap test, or both (52%). However, less than half of women knew the purpose of a pap test (40%), the purpose of the HPV vaccine (48%), or the transmission mode of HPV (25%). Over half of participants first heard about a pap test from a doctor (60%), about one quarter from their mother (24%), and less than a quarter from others (16%). More than half of women were aware of HPV (55%), while less than half were aware of the HPV vaccine (48%). Overall, we found that while most women had a high uptake of pap tests, they had low knowledge of the purpose of a pap test, the HPV vaccine, and transmission mode of HPV. They also had low awareness of HPV and the HPV vaccine. Given that almost all cases of cervical cancer are due to HPV infection, future studies should aim to further explore the gap between knowledge and awareness of HPV and pap uptake.

Birth Certificate Validity and the Impact on Primary Cesarean Section Quality Measure in New York State Abstract In New York (NY), birth certificate data are routinely used for assessing quality of care and health outcomes such as primary cesarean section (PCS) rates. However rare events are often underreported. This study compared birth certificates to medical records, and examined the impact of underreporting on risk adjustment variables for PCS. We conducted an internal validation study using a random sample of 702 NY births in 2009. Sensitivity and positive predictive value (PPV) of rare events reported on birth certificates were determined using abstracted and matched medical records as the gold standard. To assess the impact, we calculated PCS odds ratios for variables in the risk-adjustment model before and after correcting for measurement error. The sensitivity and PPV of birth certificate data elements including those in the PCS risk model varied from 0 to 100. After correction for measurement error, PCS odds ratios increased for most variables. For example, the PCS odds ratio for those with no prior live births was 3.03 (95% CI 2.94, 3.13), but after correction of measurement error increased to 3.46 (95% CI 3.22, 3.67). A composite negative event variable including abruptio placenta, eclampsia, or infection was the only variable that decreased after correction and was no longer significant (uncorrected OR 3.06, 95% CI 2.86, 3.29; corrected OR 1.42, 95% CI 0.79, 2.59). Underreporting on birth certificates remains concerning and impacts the risk adjustment for quality measures. Without improved data validity, health plans' quality metrics do not fully account for patient case-mix.

Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern Ethiopia Abstract Healthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories, etc in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management. A facility based cross-sectional study design was applied on 400 health workers. All public health institutions inside Jigjiga town were included and the study participants were randomly selected from each health facility. Data were collected using pre-tested and self administered questionnaire. The collected data was analyzed using SPSS version 20. Multivariable logistic regression model was used to identify factors associated with knowledge and practice of health workers. Out of those involved in this study, 47.7% and 42.3% of respondents had good knowledge and good practice on healthcare waste management, respectively. Health workers in the age group of 35–44 years, nurses, midwifes, medical laboratory, were significantly associated with knowledge of health workers. On the other hand, only educational status was significantly associated with practice. In this study, both knowledge and practice of health workers about healthcare waste management was poor. To enhance both the knowledge and practice of health workers, on job training is recommended.

No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016 Abstract Mystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases.