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Objectives: To describe the use of a Theory of Change to meaningfully engage community members from or support underserved communities in two National Institutes of Health-funded implementation science projects aimed at promoting equitable access to COVID-19 testing and vaccination for underserved communities., Study Setting: Both projects focused on Latino, Black, and immigrant and refugee communities in South/Central San Diego and/or individuals accessing care at a federally qualified health center near the US/Mexico border during December 2020-April 2021., Study Design: By using a participatory action research design, Community Advisory Boards (CABs) were established for each project with 11 and 22 members. CAB members included community organizers, promotores de salud (community health workers), clinic providers and administrators, and public health researchers. The CABs were guided through a seven-session Theory of Change process, focused on identifying necessary conditions that must exist to eliminate COVID-19 disparities along with specified actions to create those conditions and a blueprint for assessing the impact of those actions., Data Collection: Each session lasted 2 h hosted virtually and was augmented by interactive web-based activities. There was a live interpreter who facilitated the participation of Spanish-speaking CAB members. A Theory of Change for each project was completed in approximately 4 months., Principal Findings: Nine necessary conditions were identified related to (1) accessible and available services; (2) culturally and linguistically competent programming; (3) investment in trusted community and faith leaders; (4) social safety nets to provide ancillary services. Corresponding actions to create these conditions and measures to indicate success in creating these conditions were operationalized by the CAB., Conclusions: While resource-intensive, a CAB-led Theory of Change process yielded a rich opportunity to engage diverse groups that typically are not invited to inform these processes., (© 2022 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Background: Meaningful community engagement is instrumental to effective implementation and sustainment of equitable public health interventions. Significant resources are necessary to ensure that community engagement takes place in culturally sensitive, trusted ways that optimize positive public health outcomes. However, the types and costs of resources best suited to enable meaningful community engagement in implementation research are not well-documented. This study's objectives are (1) to describe a pragmatic method for systematically tracking and documenting resources utilized for community engagement activities, (2) report resources across phases of implementation research, and (3) provide recommendations for planning and budgeting for community engagement in health equity implementation research., Methods: Community engagement partners completed a tracking log of their person-hours for community engagement activities across three phases of community engagement (startup, early, maintenance) in two implementation research projects to promote equity in COVID-19 testing and vaccination for underserved communities. Both projects completed a six-session Theory of Change (i.e., a facilitated group discussion about current and desired conditions that culminated with a set of priorities for strategic change making) over 4 months with respective Community Advisory Boards (CAB) that included community organizers, promotores, federally qualified health center providers and administrators, and public health researchers. The reported person-hours that facilitated community member engagement were documented and summarized within and across project phases., Results: For both projects, the startup phase required the highest number of person-hours ( M = 60), followed by the maintenance ( M = 53) and early phase ( M = 47). Within the startup phase, a total of 5 community engagement activities occurred with identifying and inviting CAB members incurring the greatest number of person-hours ( M = 19). Within the early phase, a total of 11 community engagement activities occurred with coordinating and leading live interpretation (Spanish) during CAB sessions incurring the greatest number of person-hours ( M = 10). The maintenance phase included 11 community engagement activities with time dedicated to written translation of CAB materials into Spanish incurring the greatest number of person-hours ( M = 10)., Conclusions: Study findings indicate that the most significant investment of resources is required in the startup period. Needed resources decreased, albeit with a greater diversity of activities, in later phases of community engagement with Spanish language translation requiring most in the later stage of the study. This study contributes to the community engagement and implementation science literature by providing a pragmatic tracking and measurement approach and recommendations for planning for and assessing costs to facilitate meaningful community engagement in public health implementation research., Competing Interests: Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Urban community gardens have increased in prevalence as a means to generate fresh fruits and vegetables, including in areas lacking access to healthy food options. However, urban soils may have high levels of toxic heavy metals, including lead and cadmium and the metalloid arsenic, which can lead to severe health risks. In this study, fruit and vegetable samples grown at an urban community garden in southeastern San Diego, the Ocean View Growing Grounds, were sampled repeatedly over a four-year time period in order to measure potential contamination of toxic heavy metals and metalloids and to develop solutions for this problem. Metal nutrient, heavy metal, and metalloid concentrations were monitored in the leaf and fruit tissues of fruit trees over the sampling period. Several of the fruit trees showed uptake of lead in the leaf samples, with Black Mission fig measuring 0.843-1.531 mg/kg dry weight and Mexican Lime measuring 1.103-1.522 mg/kg dry weight over the sampling period. Vegetables that were grown directly in the ground at this community garden and surrounding areas showed arsenic, 0.80 + 0.073 mg/kg dry weight for Swiss chard, and lead, 0.84 ± 0.404 mg/kg dry weight for strawberries, in their edible tissues. The subsequent introduction of raised beds with uncontaminated soil is described, which eliminated any detectable heavy metal or metalloid contamination in these crops during the monitoring period. Recommendations for facilitating the monitoring of edible tissues and for reducing risk are discussed, including introduction of raised beds and collaborations with local universities and research groups., Competing Interests: The authors declare no conflict of interest associated with the work described in this manuscript., (© 2020 The Authors. Plant Direct published by American Society of Plant Biologists and the Society for Experimental Biology and John Wiley & Sons Ltd.)

Dramatic changes taking place locally, regionally, globally, demand that we rethink strategies to improve public health, especially in disadvantaged communities where the cumulative impacts of toxicant exposure and other environmental and social stressors are most damaging. The emergent field of Sustainability Science, including a new bioregionalism for the 21st Century, is giving rise to promising place-based (territorially rooted) approaches. Embedded in this bioregional approach is an integrated planning framework (IPF) that enables people to map and develop plans and strategies that cut across various scales (e.g. from regional to citywide to neighborhood scale) and various topical areas (e.g. urban land use planning, water resource planning, food systems planning and "green infrastructure" planning) with the specific intent of reducing the impacts of toxicants to public health and the natural environment. This paper describes a case of bioregionally inspired integrated planning in San Diego, California (USA). The paper highlights food-water-energy linkages and the importance of "rooted" community-university partnerships and knowledge-action collaboratives in creating healthy and just bioregions.