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Examine the appeal of a virtual avatar-led nutrition education program among youth-serving community partners in North Carolina. We surveyed community partners using the Diffusion of Innovation Theory constructs of relative advantage, compatibility, and complexity. Logistic regression evaluated the appeal and likelihood of the program's future use. Community partners (n = 100) agreed that the program was an innovative (87%) and convenient (85%) way for youth and parents to learn about nutrition. Partners who perceived the program as a relative advantage to current programs had significantly higher odds of future use intention (P = 0.005). Those who found it compatible with organizational and personal values had significantly higher odds of future use (P < 0.001). A nutrition education virtual avatar program is of interest to youth-engaged community partners. Future research examining the potential integration of this type of program within community organizations is warranted. [ABSTRACT FROM AUTHOR]

Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs. To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders. A qualitative study using in-depth interviews between March 2021 and July 2021. Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed. Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting. Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success. Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises. [ABSTRACT FROM AUTHOR]

To describe and analyze how Extension nutrition educators in one state system transitioned from primarily face-to-face to virtual nutrition education programming. This exploratory case study gathered data through nutrition educator interviews, virtual program delivery guides, and nutrition educators' program impact statements. Southeastern State Extension system in late 2022. The sample included 15 participant interviews, multiple virtual program delivery guides, and 43 program impact summaries. The use of Cultural Historical Activity Theory as a framework to explore educators' learning process with virtual program delivery and how this learning influenced community nutrition program delivery choices. Qualitative data was analyzed with ATLAS.ti using a priori coding. Two key findings emerged from the data: educators were more likely to deliver programs in a virtual setting when the programs aligned with their values and skills, and educators preferred flexible program curricula and delivery guides because it allowed them to address their community's specific needs. Educators plan to continue to deliver certain community nutrition programs virtually. Future research is needed to explore additional perspectives on virtual delivery, such as program participants and state program managers. [ABSTRACT FROM AUTHOR]

Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes. We used 2016–2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (N = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis. The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, −0.008; 95% confidence interval, −0.011 to −0.005), and by 5.2% (mean indirect effect, −0.013; 95% confidence interval, −0.017 to −0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals. A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities. [ABSTRACT FROM AUTHOR]

This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes. Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method. Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss. A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants. [ABSTRACT FROM AUTHOR]

The Community Helpers Programme (CHP) is a peer-helping programme providing youth and young adults with tools to support their peers to problem solve and seek mental health and suicide prevention support. This study aims to evaluate the effectiveness of the provincial programme (primary outcomes = knowledge, self-efficacy; secondary outcome = awareness of stigma) and describe the experience of participants, coordinators, and others. The mixed methods evaluation included a longitudinal panel design outcome evaluation along with follow-up interviews. A series of three surveys collecting participant characteristics, knowledge, self-efficacy, and awareness of stigma at pre-training (T0), post-training (T1), and six-months follow-up (T2) were conducted. Mean group scores were calculated for completers (T0 and T1 completers and T0, T1, and T2 completers). Friedman tests were conducted to assess change over time and follow-up Wilcoxon Signed Rank tests determined the significance of changes in scores between each timepoint. Content analysis was conducted on qualitative data. Participants' knowledge of mental health, suicide, and available supports along with self-efficacy increased from T0 to T1, and declined at T2. Awareness of stigma was high at all timepoints. Themes from the qualitative analysis included skill and knowledge development facilitators (e.g., consideration of learner needs, passionate coordinators, engaged learning approaches), sustaining community helper connectedness (e.g., helpers' network, awareness of and communication with local resources), and role and impact of CHP (e.g., addressing stigma, success stories). This evaluation demonstrated that CHP was effective and offered feedback on experiences, including suggestions on CHP strengths and aspects to explore. [ABSTRACT FROM AUTHOR]

To ensure access to effective levonorgestrel (LNG) emergency contraception (EC), pharmacies must keep medication in stock or available for quick delivery, and pharmacists must be knowledgeable about sales restrictions and the therapeutic window for EC. We conducted a mystery caller study to assess LNG EC availability and information accuracy provided by staff in West Virginia community pharmacies. A female research team member posed as a 16-year-old caller to ask pharmacy staff questions about whether LNG EC was in stock, the requirements for purchase, and when it should be taken for effectiveness. Data were analyzed with SPSS using the Pearson's χ2 test to determine if there was a relationship between pharmacy type and response accuracy to our questions about point-of-sale requirements and timing for effectiveness for LNG EC. Of the 506 pharmacies in the sample, 275 (54.3%) were chain pharmacies and 231 (45.7%) were independent. Overall, chain pharmacies provided significantly more accurate answers than independent pharmacies on all point-of-sale requirements. Regarding timing for effectiveness, 49.2% of all pharmacies provided an accurate response (62.9% for chain pharmacies vs. 32.9% for independent pharmacies). Overall, availability and accuracy regarding LNG EC were poor in West Virginia pharmacies. Pharmacists, particularly those at independent pharmacies serving rural communities, are in a critical and powerful position to influence community health by providing accurate and timely information and access to all contraceptive options, including LNG EC. [ABSTRACT FROM AUTHOR]

The prevalence of mental health conditions in pediatric patients in the United States is approximately 15%. Concerningly, nearly half go untreated, with lower treatment rates among children of color. Collaborative care can increase access to care and has an emerging evidence base for pediatrics. We present retrospective results from a collaborative care program that accepted referrals for a variety of conditions. Pediatric patients seen in an academic, urban collaborative care program from July 2019 to December 2021 were tracked in a registry. Demographics, presenting problem(s), symptoms, treatment, and discharge dispositions were examined. Descriptive data were analyzed, including changes in reported symptoms via paired t -tests. Three hundred nineteen patients were seen. Racial and ethnic diversity in our clinic's population was similar to that of the surrounding community, with half belonging to a minoritized racial or ethnic group. Symptom comparisons demonstrated clinically and statistically significant improvements from intake to discharge. Collaborative care can improve access to care and outcomes for a diverse pediatric population. Our clinic served racial and ethnic patient populations that were representative of the demographics of the metropolitan area. Further study is necessary to determine if collaborative care increases access for these underserved groups. [ABSTRACT FROM AUTHOR]

The article focuses on the incorporation of financial coaching into pediatric primary care, presenting a feasible and acceptable hybrid model within an urban academic center. Topics include the background of financial instability's impact on health, the innovative approach of integrating financial coaching into pediatric care, and the positive outcomes, with 88 present enrollment and 49 present engagement in coaching.

The article focuses on "The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change." Topics include the implementation of community-participatory approaches for policy, systems, and environmental change; the role of nutrition in promoting environmental health; and the impact of community-based social services on individual and family well-being.

We evaluated the impact of a College Focused Rapid Rehousing (CFRRH) program on food security, food assistance, and nutrition habits. In California, as 11-19% of college students experience homelessness and 41-50% are food insecure, the state invested in the development of CFRRH programs. CFRRH is broadly based on the Housing First model: an intervention that provides access to housing that is not conditional upon additional treatment requirements. Since basic needs insecurities often coexist, evaluation of the impacts of a housing intervention on other insecurities, such as food insecurity, is needed. CFRRH students in 2 community colleges and 8, 4-year universities in California participated in the evaluation. CFRRH is a university-community partnership that provides housing subsidies, housing support, and basic needs case management for college students experiencing homelessness. Survey data were collected at baseline (n=181) and follow up (n=60) from program participants to assess food security, food assistance, and food purchasing, preparation, and consumption habits. Interviews (n=40) were conducted to assess participant's perceptions of the program's impact on their eating habits. Approximately 74% of participants reported very low or low food security at baseline with no significant differences at follow up. There was no change in receiving assistance applying for CalFresh or visiting the campus food pantry by time in the program. Students moderately agreed that the CFRRH program allowed them to purchase healthier foods (mean 3.8, SD 1.0), cook more at home (mean 3.8; SD 1.19), and consume a healthier diet (mean 3.5; SD 1.14). In interviews, some highlighted that while in the program they ate healthier meals and reported improved food storage and kitchen access. CFRRH had a modest impact on participant cooking and diet. As no significant change was seen in food security or in accessing food resources, more attention could be paid to providing food security resources in CFRRH. Kaiser Family Foundation, Angel Foundation, Kresge Foundation [ABSTRACT FROM AUTHOR]

To determine the efficacy of The Happy Kitchen/La Cocina Alegre® (THK/LCA) program to improve nutrition outcomes of low-income Texans. The THK/LCA program draws from established health promotion and nutrition education models, including the Social-Ecological Model, the Health Belief Model, and Social Cognitive Theory. Additionally, this culturally sustaining education program incorporates insights from scholars like Drs. Gloria Ladson-Billings, Django Paris, and H. Samy Alim. Central to the curriculum is the Hispanic tradition of sobremesa, emphasizing connections and information sharing around the table after a meal. THK/LCA primarily aims to serve low-income Texans facing systemic barriers to food access. THK/LCA classes are held in community spaces like libraries, health clinics, and schools, and recruitment is conducted in collaboration with community organizations. The service population is defined as individuals or families with income less than 185% of the poverty line or who live in an area designated as low-income/low-access by USDA's Food Access Research Atlas. THK/LCA is a community-engaged, peer-facilitated, interactive 6-week cooking and nutrition class series that emphasizes the selection and preparation of fresh, nutritious, and economical foods in alignment with traditional foodways. Pre-, post-, and 3-month follow-up surveys were administered to obtain information on program completion, meals provided, changes in fruit and vegetable intake, nutrition knowledge, cooking skills, and home-cooked meal preparation. Counts and percentages were determined using Tableau data analysis software. Three hundred and sixty-five Texans participated in THK/LCA classes, with 196 participants completing all 6 classes in a series. The equivalent of 4,851 meals were provided to participants. Most participants reported increases in fruit and vegetable consumption (80%), nutrition knowledge (89%), cooking skills (86%), and cooking more meals at home (80%). THK/LCA has demonstrated success in improving access to fresh and nutritious foods among low-income people living in Texas. Next steps will include an evaluation of program expansion efforts. None [ABSTRACT FROM AUTHOR]

Food insecurity is a significant problem on college campuses. Community gardens are a potential solution and have additional benefits such as the promotion of sustainable thoughts and actions, improvement of mental wellness, and even increased academic performance, without the same level of stigma associated with other interventions such as food pantries. To develop an instrument to assess behavioral capability, expectations, value expectancies, self-efficacy, collective efficacy, and likelihood to volunteer among students regarding a campus-based, community garden. This cross-sectional study was conducted at a Mid-western, private university using a convenience sampling of students. Instrument items were developed using the Social Cognitive Theory, and the survey was administered online. Internal consistency of the subscales was analyzed using Cronbach's alpha. Descriptive statistics were used to report demographics and interest level of participants. Of the 209 respondents, 60% were women and ages ranged 18-43 years (M= 20.46 + 2.67). The internal consistency reliability of the subscales for behavioral capability, expectations, expectancies, and likelihood to volunteer were excellent (ɑ=.90,.90,.93,.92, respectively). Self-efficacy and collective efficacy were only 1 item each so reliability was not analyzed. Of respondents, 70% (n=190) felt confident in their ability to contribute to the garden, and 85% (n=190) felt confident students could work together to contribute. Seventy percent (n=189) also reported they would be likely to volunteer in the garden, and 75% (n=188) would be likely to use the produce grown. This instrument was determined to be reliable among this population. Other institutions may also find this survey useful to determine interest in a campus-based community garden. None [ABSTRACT FROM AUTHOR]

Substance use disorder (SUD), overdose, and drug use-related crime continue to increase in the U.S. Pre-arrest diversion-to-treatment programs may decrease crime recidivism and overdose deaths. We assessed the impact of a community-wide diversion-to-treatment initiative on crime, incarceration, and overdose. This article reports on the prospective evaluation of a law enforcement-led, pre-arrest diversion-to-treatment program on crime, incarceration, and overdose deaths compared between participants who did not engage (non-engaged; n = 103), engaged but did not complete (non-completers; n = 60) and completed (completers; n = 100) the program. Participants included 263 adults apprehended by police officers for low-level, drug use-related crimes between September 1, 2017 and August 31, 2020. The program offered eligible persons participation in a six-month program consisting of a clinical assessment, referral to addiction treatment services based on each individual's needs, connection to recovery peer support, and treatment engagement monitoring. Completers had their initial criminal charges 'voided,' while non-engaged and non-Completer participants had their original charges filed with local prosecutors. The project collected participant-level data on arrests and incarceration within 12 months before and 12 months after program enrollment and data on fatal overdose within 12 months after program enrollment. Logistic regression predicted outcomes using baseline demographics (sex, age, race, housing status) and pre-index crime arrest and incarceration indices as covariates. After accounting for baseline demographics and pre-enrollment arrest/incarceration history, logistic regression models found that the non-engaged and the non-Completer groups were more likely than completers to be arrested (odds ratios [ORs]: 3.9 [95 % CI, 2.0–7.7] and 3.6 [95 % CI, 1.7–7.5], respectively) and incarcerated (ORs: 10.3 [95 % CI, 5.0–20.8] and 21.0 [95 % CI, 7.9–55.7], respectively) during the 12-month follow-up. Rates of overdose deaths during the 12-month follow-up were greatest in non-engaged (6/103, 5.8 %) and non-Completer (2/60, 3.3 %) groups; completers had the lowest rate (2/100, 2.0 %), with all deaths occurring after completion of the six-month treatment/monitoring program. Collaboration between law enforcement, clinicians, researchers, and the broader community to divert adults who commit a low-level, drug use-related crime from criminal prosecution to addiction treatment may effectively reduce crime recidivism, incarceration, and overdose deaths. • Pre-arrest diversion-to-treatment programs that focus on long-term treatment may reduce crime recidivism and overdose deaths • Program completion was associated with a lower likelihood of arrest or incarceration within 12 months after the index crime • Within 12 months of the index crime, 5.8% of Non-Engaged, 3.3% of Non-Completers, and 2.0% of Completers had a fatal overdose [ABSTRACT FROM AUTHOR]

The ongoing overdose crisis in Canada has prompted efforts to increase access to a "safer supply" of prescribed alternatives to the unregulated drug supply. While safer supply programs predominantly distribute hydromorphone tablets, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada offers a range of prescribed alternatives, including fentanyl patches. However, little is known about the effectiveness of fentanyl patches as safer supply. Drawing on the perspectives and experiences of program participants, we sought to qualitatively evaluate the effectiveness of the SAFER fentanyl patch program in meeting its intended aims, including reducing risk of overdose by decreasing reliance on the unregulated drug supply. As part of a larger mixed-methods evaluation of SAFER, semi-structured qualitative interviews were conducted with 17 fentanyl patch program participants between February 2022 and April 2023. Thematic analysis of interview data focused on program engagement, experiences, impacts, and challenges. The flexible program structure, including lack of need for daily dispensation, the extended missed dose protocol, and community pharmacy patch distribution fostered engagement and enhanced autonomy. Improved management of withdrawal symptoms and cravings due to steady transdermal dosing led to reduced unregulated drug use and overdose risk. Participants also experienced economic benefits and improvements in overall health and quality of life. However, skin irritation and patch adhesion issues were key barriers to program retention. Our findings demonstrate the value of including fentanyl patch safer supply in the substance use continuum of care and offer insights for innovations in delivery of this intervention. [ABSTRACT FROM AUTHOR]

Place-based policing is effective, but the police do not have all the tools needed to solve complex crime problems and certain policing strategies may increase the risk of disparate impacts to members of marginalized communities. However, local governments—acting in their role as a "super-controller," can incentivize and support the natural crime-control system of place managers, handlers, and guardians to act to prevent crime at hot spots, whether or not the police are involved. This paper examines a body of evidence from 44 studies on the effectiveness of local government-led and initiated non-police interventions at crime hot spots, finding that local governments can successfully capitalize on the concentration of crime at hot spots and direct its myriad non-police resources to help prevent crime from occurring at these places. The paper concludes with three themes that have both practical and research implications for local governments as super-controllers at crime hot spots: 1) support systematic hot spot problem-solving, 2) examine the threshold of effective deterrence, and 3) ensure rigorous evaluation. • Place-based policing is effective, but there are limits to the police's ability to solve complex problems. • Local governments can prevent crime by acting as a 'super-controller', supporting the natural system of controllers. • We found place-based strategies initiated by local governments are effective across multiple domains of crime prevention. • Programs should support systematic problem-solving, consider the threshold of deterrence, and ensure rigorous evaluation. [ABSTRACT FROM AUTHOR]

This study aims to create a stigma reduction framework for stuttering in the local context of Québec, Canada using the Participative Concept Mapping Approach (PCMA), focusing on both self and societal stigma. Employing a mixed-methods approach, this study engaged 17 experts—people who stutter, clinicians and health innovation specialists—in PCMA workshops. Via diverse steps, including generation, sorting and rating of ideas in response to the focus prompt, "To effectively address stuttering (self-)stigma, an intervention should..." these sessions led to a framework depicted in visual maps, then refined into actionable principles through qualitative analysis. Mixed-methods data analysis used the open-source R-CMap software to generate visual maps illustrating the relationships among ideas as well as importance and feasibility ratings. The collaborative workshops identified 95 ideas in response to the focus prompt, reunited in 7 clusters, evolving into 16 principles to mitigate stuttering stigma and self-stigma. At the therapy level, these principles emphasize personalized therapy, thorough assessments, stigma-free therapeutic environment, empowerment, and the importance of group inclusivity and educating the relational circles. Societally, they advocate for initiatives such as improved educational outreach, empathy enhancement, and better representation. This dual approach targets individual experiences and societal views on stuttering, stressing the need for an all-encompassing intervention framework. The findings demonstrate PCMA's usefulness in crafting local, culturally sensitive, tailored interventions for stigma reduction. The study emphasizes the necessity of holistic approaches that address individual experiences and societal perceptions, offering a model to conduct similar exercises in diverse local settings. • The participatory method PCMA is used to map a stigma reduction framework. • 17 experts unite in Québec to tackle stuttering stigma via PCMA mixed methods. • PCMA has the potential to help develop tailored stigma community interventions. • Cultural insight's role in stigma reduction is explored. • PCMA's wider use in stigma research is discussed. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is the commonest sexually transmitted infection. It has over 200 genotypes which, depending on the site of infection and type of virus, can give rise to cancers or warts. HPV infection is a prerequisite for cervical cancer and is associated to varying degrees with other anogenital cancers and, increasingly, with cancers of the oropharynx. It is also associated with anogenital warts which, while not life threatening, cause considerable morbidity. HPV vaccines have been available since 2006 and by mid-2021 have been introduced into over 110 countries. Trials and real world data have shown them to be safe and highly effective at preventing infection with HPV and anogenital warts. Data are also accumulating showing impressive reductions in cervical cancer. In UK, HPV vaccine mainly offered to girls and boys aged 12–13 years in a school-based programme. Uptake is generally high, but inequalities persist and there are concerns about the impact of a recent significant decline in uptake due to school closures arising from the COVID pandemic. HPV vaccine programmes have been significantly impacted by vaccine hesitancy in some countries, but experience in the Republic of Ireland and Denmark has shown that with involvement of the community, this can be successfully addressed. Modelling estimates that, by 2058, the vaccine will have prevented over 64,000 HPV-related cervical cancers and almost 50,000 other HPV-related cancers. The introduction of a vaccine containing nine HPV strains will further increase the number of cancers prevented. This short article outlines how HPV vaccination in adolescence is helping prevent serious illness in adult life. [ABSTRACT FROM AUTHOR]

Background Uganda has achieved a considerable reduction in childhood stunting over the past 2 decades, although accelerated action will be needed to achieve 2030 targets. Objectives This study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda. Methods This mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a scoping literature review; 2) quantitative data analyses, including Oaxaca–Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national- and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives. Results Stunting prevalence declined by 14% points from 2000 to 2016, although geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z -scores (HAZs) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women's empowerment, cultural norms, water and sanitation, dietary intake/diversity, and reduced childhood illness as important. The 2011 Uganda Nutrition Action Plan was an essential multisectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors. Conclusions Uganda's success in stunting reduction was multifactorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated, and rural populations along with high-burden districts. [ABSTRACT FROM AUTHOR]

Housing is a pressing problem worldwide and a key determinant of health and wellbeing. The right to adequate housing, as a pillar of the right to an adequate standard of living, means more than a roof to live under. Adequate means the dwelling must fulfill material functions and psychosocial functions, thus contributing to dwellers health and wellbeing. Social housing policies aim to fulfill the right to housing, but frequently fail in fulfilling the right to it being adequate. This study capitalizes on the implementation of a national urban regeneration program in two social housing villas in central Chile (one in Santiago, in the central valley, the other in Viña del Mar, a coastal city) to run a natural experiment assessing the impact of dwelling renovation on several dimensions of perceived habitability and housing satisfaction among the -mostly female-household homemakers. We use 5 waves of survey data collected with a step-wedge design to estimate the association between a time-varying exposure status (the intervention) and 7 binary outcomes for habitability and 5 for housing dissatisfaction, including overall housing satisfaction. We use Poisson regression models with robust variance and a random intercept at the respondent level. At baseline, reports of poor habitability and dissatisfaction across all features were markedly high, the highest levels of dissatisfaction being with acoustic insulation and dwelling size in both villas, and with indoor temperature in Santiago. The intervention resulted in statistically significant and markedly large improvements in reported habitability and dissatisfaction relative to those housing components targeted by the intervention, as well as with overall dwelling satisfaction in both study cases. Implications are, first, that the policy response to quantitative housing deficits must not overlook housing quality; second, that housing renovation appears as a promising intervention for qualitative housing crises; third, that while improvements in habitability and satisfaction are specific to the interventions in place, overall housing satisfaction can improve in more limited, tailored, dwelling renovation interventions. Social housing renovation in Latin America appears as a promising intervention to improve quality of life among the urban poor dwellers and reduce inequalities in health related to housing conditions. • Study of reported habitability and housing satisfaction among urban poor homemakers. • First longitudinal assessment of formal social housing renovation in Latin America. • Housing renovation can positively impact quality of life and wellbeing. • Results stress the need to addressing the qualitative housing crisis. • General satisfaction improved in all cases, despite different interventions. [ABSTRACT FROM AUTHOR]

To explore whether a student arts curriculum and campaign can increase awareness and interest in SNAP at a community college with high levels of food insecurity. A participatory community arts approach was used to engage the student body. Community college students, faculty, and staff Social scientists interviewed (in English, Spanish and Arabic) students experiencing food insecurity about experiences of food security and how food connects to their identity and foodways. These transcripts were anonymized and shared with students enrolled in multiple art classes, who created art in response. The art and testimony excerpts were shared in an original 'zine, in the school's galleries, at events, on a website, and enlarged as window murals. In all places where the art and testimonies were presented, information about SNAP enrollment was presented. Mutiple languages, cultures, and foodways were represented throughout. An online survey in English, Spanish and Arabic was emailed to the entire student body immediately following the intervention. T-tests comparing those who were engaged in the program and those who were not, and descriptive statistics for those engaged are presented. In the post-intervention survey (N=413), 69.5% of (in-person) students engaged with at least one project element (eg, 'zine, event, etc.). Compared with those who did not engage with the project, engaged students were significantly more likely to have heard of SNAP (p =.026), to know about changes college student SNAP eligibility (p=.001), and to say they would seek out information about SNAP in the future (p=.004). Among those who engaged, 68.7% said they have a deeper understanding of food insecurity, 62.1% reported a better understanding of SNAP, and 57.1% felt that their own struggles were represented. Art can be an effective way to engage audiences around stories about varied foodways and lived experience of food insecurity while increasing awareness of and interest in SNAP. Robert Wood Johnson Foundation [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of Shop Smart Tennessee (SSTN) in engaging small food retailers in promoting healthy food items and impacting consumer purchasing Research has shown the food retail environment, including accessibility and affordability of foods, is an important component of dietary choices. As a strategy to increase consumers' ability and motivation to purchase healthier foods, food retail work is a critical component of a multipronged approach to address chronic disease prevention (CDC, 2014). Using the Theory of Planned Behavior and reciprocal determinism, SSTN works with small food retailers - mostly rural - to implement strategies to encourage healthy food choices. Additionally, by engaging consumers, SSTN seeks to increase demand of healthier foods such as low-calorie beverages, whole grains, lean proteins, and fruit. Target audiences included small food retailers and shoppers of SNAP/EBT accepting stores in low-income census tracts from 2021-2023. SSTN is an eight-week SNAP-Ed food retail program designed to encourage consumers to make healthy food selections. SSTN uses weekly taste testing, educational materials, behavioral economics approaches, and social media to achieve program goals. Additionally, SSTN educators work with retailers to implement store environmental changes and stocking enhancements designed to promote healthy choices. Evaluation data were collected through a standardized store assessment conducted at the start of the intervention, post-intervention retailer interviews, and paper surveys distributed to consumers during final sessions. Since 2021, SSTN has been implemented in 31 stores reaching over 9,100 consumers. 370 adults completed surveys. Fifty-six percent (n=209) of respondents reported they purchased promoted foods as a result of the in-store taste testings. Twenty store managers completed surveys. During program delivery, 40% (n=8) managers started stocking new healthy items and 42% (n=9) increased their stock of current healthy items. SSTN effectively engaged food retailers and positively impacted consumer demand for healthier foods demonstrating the ability of small food retail interventions to benefit both customers and store owners. Supplemental Nutrition Assistance Program - Education [ABSTRACT FROM AUTHOR]

ANGELS (Agriculture & Nutrition for Girls while Encouraging Leadership & STEM Enrichment) is a program for female adolescents from communities of color aiming to increase interest in STEM-education and careers with experiential agricultural and nutrition activities. To test the acceptability of the ANGELS pilot program. Program staff implemented ANGELS as a quasi-experimental, treatment-only pilot over 6 weeks in summer 2023 on a university campus in Southeast, Tennessee. Each week of the full-day programming had a different STEM-related theme (eg, agriculture, nutrition, leadership). All participants were 6-8th grade female adolescents from communities of color. Acceptability measures included weekly participant process evaluations (11-items) that explored opportunities for programmatic improvement and participant satisfaction and engagement; pre/post program evaluations (38-items) that explored interest in STEM content and careers; and post-intervention ripple effect mapping focus groups to explore participant perceptions of the impact of the ANGELS Program on themselves, their families, and their communities. Descriptive statistics were calculated for process evaluations and paired samples t tests examined differences in pre/post program evaluations. An inductive analytical framework was applied to qualitative evaluation data and code frequencies were calculated to inform direct content analysis. Most participants were retained throughout the pilot (n=15/16). Participants reported a mean score of 3.4/5 (±0.62) on the 8-item engagement scale (α=0.66). Although not significant, data from pre/post-intervention showed increases in "interest in math content" (3.89±1.46 vs. 4.09±1.36, respectively) on 7-point Likert-type scale; "perceptions of being in an environment supportive of science careers" (3.16±0.52 vs. 3.25±0.50, respectively) on a 5-point Likert scale; and "intent to pursue STEM-related education" (3.15±0.33 vs. 3.23±0.35, respectively) on a 5-point Likert scale. Participants perceived that learning about nutrition and food security were the most important takeaways. Participants indicated acceptability of ANGELS pilot; however, larger scale studies are needed to measure program effectiveness. Exploring the ANGELS program model as an avenue to address lack of nutrition practitioners from racial/ethnic minority groups is warranted. NIFA [ABSTRACT FROM AUTHOR]

Enhance healthy eating behaviors through collaboration. Dairy Council of California's (DCC) Let's Eat Healthy (LEH) initiative applied the social ecological model to develop an LEH community fostering healthy eating through multiple influence levels. Agencies, Health Professionals, Students, Families, Educators The LEH framework has three strategic goals: nutrition security, nutrition education, and collaboration addressing actions for individual, community, organizational, and environmental levels. LEH champions conduct community nutrition interventions, with opportunities to learn together and integrate actions advancing nutrition education and equity; valuing milk and dairy foods as part of healthy eating patterns. To ignite the initiative, DCC convened an inaugural LEH Summit; launched the LEH website with curated resources; and spearheaded annual leadership recognition programs, grants, and Community of Practices (COP) webinars. The following metrics were used: web traffic, online engagement, summit registrations, post-event survey, community grants mid-point/end-year reports, and COP registrations and pre/post surveys. The website had 46,488 visits with 39,733 unique visitors who were identified as 13,811 community Members and 3,872 LEH Champions. The Summit was attended by 90 leaders, experts, and supporters from diverse entities and professions. One hundred percent of respondents found LEH valuable for collaboration and advancing nutrition in their communities. Eighty-seven percent gained partnership opportunities with 57% identifying specific activities. Seven community grant partnerships were established. Their 414 events/activities reached 61,403 (children K-12, educators, families, and community) through student workshops, culinary training, family-centered nutrition and food literacy programs, and Junior Farmer programs docent and teacher training. LEH has laid a strong foundation for enhancing collaborative objectives which will deepen through ongoing and future activities. The webpage, Summit, and COPs provide avenues to engage LEH champions and foster collaboration for nutrition education and security, incorporating milk and dairy foods into these efforts. Community grants are instrumental in expanding local reach and diverse partnerships. Dairy Council of California [ABSTRACT FROM AUTHOR]

The Georgia Department of Human Services, Division of Family and Children Services (DHS/DFCS) implemented various community-based initiatives to involve community in informing its SNAP-Ed programs. In 2023 the Georgia SNAP-Ed Community Advisory Board (CAB) provided guidance on selecting and funding trusted community-based organizations (CBOs) to facilitate community listening sessions (CLS) across the state. The goal of the CLS was to garner guidance on the needs and opportunities to improve nutrition education and community change approaches in communities with little or no existing SNAP-Ed programming. DHS/DFCS, Center for Wellness and Nutrition (CWN) and the CAB identified CBOs to conduct localized CLS in priority communities. Each CBO aimed to recruit up to 30 SNAP-Ed eligible adults. State and community-level SNAP-Ed and chronic disease data was shared with participants to solicit ideas. Participants were asked to brainstorm the strengths and challenges related to supporting healthy eating and physical activity as well as solutions that might help people overcome these challenges and live healthier lifestyles. CLS participants discussed their communities in small groups and then voted on the solutions they would like to prioritize for their community. Microsoft Excel was used to summarize the strengths, challenges, and solutions data and identify themes for each host site and aggregated for the state of Georgia. Priority solutions were quantified and used to make recommendations for Georgia programming. Participants voted to prioritize the following recommendations: prioritize expanding programming to rural communities in Georgia, consider establishing cross-sector partnerships to increase access to grocery stores and safe physical activity opportunities, increase access to fresh produce through community gardens or by working with existing grocery stores and retailers, and provide more opportunities for authentic community engagement. The results of these CLS are being used by the Georgia SNAP-Ed CAB to prioritize and fund projects that reflect the needs elevated by the community members that participated. Supplemental Nutrition Assistance Program - Education [ABSTRACT FROM AUTHOR]

• Despite Latine immigrant youth being considered a vulnerable population who experience a heightened prevalence of psychological stress attributed to post-migration experiences, Latine immigrant youth reported having a positive attitude towards mental health. • Despite logistical barriers that contribute to utilizing fewer healthcare services and not knowing how to navigate the healthcare system, Latine immigrant youth reported having positive attitudes towards mental health services, especially when these services are community-based. • Latine immigrant youth reported having positive experiences with culturally sensitive youth programs that promote psychological well-being while integrating into the United States. Latine immigrant youth, in general, report logistical barriers that contribute to utilizing fewer healthcare services and not knowing how to navigate the healthcare system. In addition to underutilizing healthcare services, Latine immigrant youth also report higher levels of negative attitudes toward mental health when compared to non-Latine immigrant youth. However, little is still known regarding factors that impact these attitudes toward Latine immigrant youth, as well as the community support efforts that are available to this specific group. Using a semi-structured interview with 12 Latine immigrant youth, this study explored (1) the attitudes towards mental health, (2) attitudes towards mental health services, (3) and the experiences of participating in a local community-based program for Latine immigrant youth. Results found that most participants held positive attitudes toward mental health, and all participants described positive attitudes toward mental health services. In addition, all participants reported having positive experiences with a culturally sensitive youth program that promotes psychological well-being while integrating into the United States. They noted that it had benefited them socially, culturally, and psychologically. Given the rise of Latine immigrant youth in the U.S. and the stigma surrounding mental health attitudes, it is crucial to continue to explore this area to serve Latine immigrant youth better and connect them to the mental health services they may need. Also, it is important to have community programs, such as this one, that support and meet Latine immigrant youth's needs. [ABSTRACT FROM AUTHOR]

• Supportive housing can be combined with wraparound supports for teen families. • Collaborative partnerships are key to offering teen families supportive housing. • Supportive housing needs to balance structure with trauma-informed responsivity. Providing support to address the systemic barriers that teen families face is a logical step toward improving their health and well-being. One area where teen families face multiple obstacles is accessing safe, secure, affordable housing. This paper describes a unique, innovative model of supportive housing developed in combination with wraparound supports, provided to teen parents in Edmonton, Canada. As part of a larger community-based participatory research and evaluation project, we draw on qualitative data to describe the supportive wraparound housing model that was developed. In particular, we conducted individual interviews and focus groups with a total of 27 staff members from the partner agencies, who provided information about the Successful Families program model. Analysis of interview data resulted in five broad categories that have resonated with our community and academic team as a way to conceptualize and share the work of the program. Categories, which are described in terms of associated subcategories, include: Community, Partnership, Program Principles and Values, Successful Families Program Structures, and Skill and Knowledge Development. Through this work, we aim to promote awareness of considerations for service providers seeking to implement similar services, and expand the limited knowledge base regarding methods for supporting the diverse needs of teen families. [ABSTRACT FROM AUTHOR]

• PEM-CY assesses the participation of children/young people. • PEM-CY assesses the environment of children/young people. • PEM-CY Brazil version presents good internal consistency. • PEM-CY Brazil version presents good construct validity (known-group validity). • PEM-CY-Brazil will contribute to the rehabilitation process focused on participation. Participation of children with disabilities is an indicator of social inclusion, health, and well-being, and its evaluation needs to be included in the clinical practice of rehabilitation professionals. To investigate the measurement properties of the Participation and Environment Measure - Children and Youth Brazilian version (PEM-CY Brazil). We used the PEM-CY to evaluate participation and environment of children with and without disabilities in the home, school, and community settings. Based on COSMIN guidelines, we analyzed two measurement properties: internal consistency for all domains using Cronbach's alpha; and construct (known-groups) validity, i.e., the degree to which instrument scores identify differences between groups. T-tests, Mann-Whitney, or Chi-square tests compared children with and without disabilities. 101 Brazilian children (mean age=9.31 years) with (n = 62) and without (n = 39) disabilities were included. Internal consistency ranged from appropriate (0.70) to excellent (0.95) for all domains in all settings, except for Resources in the environment of the home setting (0.53). Regarding construct validity, PEM-CY participation scores were significantly different between groups in most domains. Children with disabilities were significantly less involved and participated in a smaller number of activities in all settings, in comparison to those without disabilities. The PEM-CY scores in all settings of the environment were significantly higher in the group of children without disabilities. Preliminary support was provided for the internal consistency and construct (known-groups) validity of the PEM-CY Brazil to measure participation and the environment in the Brazilian context. The PEM-CY can therefore be used by rehabilitation professionals in Brazil. [ABSTRACT FROM AUTHOR]

Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults. Longitudinal, observational study. Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score–matching scheme. After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio. Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67). This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities. [ABSTRACT FROM AUTHOR]

• Most studies compared care leavers to their peers in the overall population, rather than to at-risk non-residential care youth. • Compared with youth in the community, youth in care were significantly less likely to report having a mentor. • Meaningful adult figures were found vital for at-risk youth in care and in their natural environments. • Facilities should ensure stable mentoring to achieve effective mentoring relationships. In this study, we explored the protective and promotive factors (e.g., life skills, hope, and mentoring relationships) among at-risk youth in the community in comparison to those in residential care. Our aim was to understand the mechanisms contributing to their resilience. The participants consisted of 373 at-risk adolescents aged 16–19, either placed in out-of-home care or living with their biological parents and receiving community-based treatment in Israel. The results revealed notable differences between youth in residential care and those in the community. Specifically, participants in residential care were significantly less likely to report having a mentor and showed lower levels of life skills. Through multi-group structural equation modeling (SEM), we uncovered that life skills played a mediating role in connecting youths' mentoring relationships with their hope within both groups. The discussion suggests the importance of considering both contextual and personal factors as integral components of intervention programs. This approach is applicable to both care settings and community programs designed for at-risk youth. [ABSTRACT FROM AUTHOR]

To refine a measure of home cooking quality (defined as the usage level of practices with the potential to influence the nutrient content of prepared foods) and conduct a construct validation of the revised tool, the Healthy Cooking Questionnaire 2 (HCQ2). Two validation approaches are described: (1) a community science approach used to refine and validate Healthy Cooking Questionnaire (HCQ) constructs, and (2) responses to the revised HCQ (HCQ2) in a sample of Amazon Mechanical Turk (MTurk) workers to determine questionnaire comprehension. The Community Scientist Program at the University of Texas MD Anderson Cancer Center facilitated discussion groups to refine the HCQ questions and validate constructs. MTurk workers were subsequently recruited to complete the refined survey so that comprehension and associations with demographic variables could be explored. Ten community scientists participated in the refinement of the HCQ. The revised tool (HCQ2) was completed by 267 adult US-based MTurk workers. Demographics, HCQ concepts, HCQ2, Self-Reported Questionnaire Comprehension. Comprehension items were examined using descriptive statistics. Exploratory analysis the relationships between cooking quality and demographic characteristics, meal type, cooking frequency, as well as patterns of food preparation behavior was conducted on the MTurk sample The HCQ was refined through activities and consensus-building. MTurk responses to the HCQ2 indicated high comprehension and significant differences in cooking quality scores by demographic factors. This study refined and validated a self-report measure of cooking quality. Cooking quality measures offer critical evaluation methods for culinary programs. [ABSTRACT FROM AUTHOR]

To examine temporal associations between participation in a community-based intervention targeting sugary drink intake and sleep outcomes among children. Data are from an ethnically diverse sample of 100 children aged 9–12 years from 2 Massachusetts Boys and Girls Club (BGC) sites who participated in a pilot-site randomized trial (usual BGC programming plus H 2 GO! intervention vs usual BGC programming). Secondary outcomes of the trial (sleep duration and adequate sleep duration [≥ 9 h/night] were assessed via a self-report survey at baseline, 2 months, and 6 months. Generalized linear and logistic regression models estimated intervention effects associated with outcomes. The intervention was associated with increased sleep duration (β = 0.74; 95% confidence interval, 0.03–1.45) and higher odds of adequate sleep (odds ratio, 2.47; 95% confidence interval, 1.06–5.74) at 2 months. Sleep did not differ by treatment condition at 6 months. This community-based sugary drink intake intervention may be a potential avenue to improve child sleep outcomes in the short term. [ABSTRACT FROM AUTHOR]

Growing inequalities, austerity public funding, and the COVID-19 pandemic have contributed to heightened interest in mobilising the assets and resources within communities to support health and well-being. We aimed to identify the type of actions or initiatives by food retail stores intended to support local communities and contribute to well-being. A Scoping Review. A scoping review was conducted in Scopus, Web of Science, and of grey literature to identify the extent of study of food retail stores in supporting community well-being, types and outcomes recorded from community-oriented actions. Data extraction included: population targeted, the content of initiative/action, outcomes recorded and key insights. Studies were grouped into broad categories relating to their actions and objectives. Actions were associated with either strengthening communities or public health prevention or promotion. Few studies reported clearly on impact, and most accounts of impact on well-being and broader community outcomes were narrative accounts rather than objectively measured. Although rigorous capture of outcomes was absent, there were consistent themes around partnership and community insights that are relevant to the development and implementation of future actions in communities. This is an under-researched area that may nevertheless hold potential to support the broader public health effort in communities. To provide clear recommendations for specific investments, there is merit in identifying a subset of health and well-being outcomes most likely to be associated with food retailer community actions in order to assess and capture impact in future. We propose that the theoretical underpinning associated with asset-based approaches, which take account of context and community conditions, would be a useful framework for future study. [ABSTRACT FROM AUTHOR]

To examine whether the decrease in very low food security (VLFS) observed in California shortly after California's coronavirus disease (COVID-19) shutdown remained throughout Federal Fiscal Year (FFY) 2020. To investigate associations among unemployment, Supplemental Nutrition Assistance Program (SNAP) enrollment, and VLFS across FFY 2020. Telephone interview responses from mothers from randomly sampled households from low-income areas throughout California to the 6-item US Department of Agriculture Food Security Survey Module identified VLFS families. Logistic regression examined VLFS rates before vs after California's COVID-19 shutdown, with race/ethnicity, age, and education as covariates. Pearson correlations were calculated for unemployment, SNAP enrollment, and VLFS. Most (66.4%) of the 2,682 mothers were Latina. VLFS declined from 19.3% before to 14.5% after California's COVID-19 shutdown (adjusted odds ratio, 0.705; P = 0.002). The correlation for unemployment and SNAP household participation was 0.854 (P = 0.007), and for SNAP participation and VLFS was −0.869 (P = 0.005). Publicly-funded assistance programs may lower food insecurity, even during a time of increased economic hardship. Examining the specific factors responsible for the observed decline in VLFS has merit. Whether VLFS remains below the rate observed before California's COVID-19 shutdown is worthy of ongoing study. [ABSTRACT FROM AUTHOR]

To evaluate the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents. Children aged 7–12 years with autism and their parent participated in 6 weekly sessions. Recruitment, intervention, and data collection took place in a community health center in an urban area. Of the 50 referred participants, 38% attended the first classes, and 26% completed the program. Families and staff expressed satisfaction; parents reported increased physical activity, fruit, and vegetable intake in their children. Parents also desired continued learning and individualized recommendations. Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism. As many children with autism battle with obesity, the findings from this pilot provide important insight into supporting these families and can further inform the development of evidence-based practices currently lacking for children with autism and their families. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a fruit and vegetable prescription program on diabetes and cardiovascular risk outcomes. Single-arm pre-post study. Primary care clinic in a community-based hospital. Adults with type 2 diabetes (n = 97), aged > 18 years, with hemoglobin A1c (HbA1c) ≥ 7.0%, and a body mass index (BMI) of ≥ 25 kg/m2. Over 7 months, participants received monthly group-based diabetes self-management education (DSME) and monthly vouchers ($28–$140/month) redeemable for fruits and vegetables at local markets. Biomarker changes (HbA1c, BMI, and blood pressure) were assessed with paired t tests. Voucher distribution and redemption were tracked, and voucher redemption rates were calculated. Linear mixed-effect regression models tested associations between biomarkers, voucher redemption rates, and participant characteristics. There was a −1.3% (P < 0.001) postprogram change in HbA1c. Reduced HbA1c was associated with higher voucher redemption rates (P = 0.032) and a change in diabetes medications (P = 0.003). There were no associations with BMI, but blood pressure was positively associated with voucher redemption. Fruit and vegetable prescription programs may improve diabetes outcomes by incentivizing DSME uptake and retention. Future randomized trials are warranted to identify strategies to improve DSME engagement and voucher redemption rates and assess mechanisms through which these programs influence health outcomes. [ABSTRACT FROM AUTHOR]

Can the United States dramatically reduce the number of its children living in poverty? This article summarizes key conclusions of the report issued by National Academies of Sciences, Engineering and Medicine's Committee on Building an Agenda to Reduce the Number of Children in Poverty by Half in 10 Years. These conclusions focus on the causal evidence linking poverty reduction and child well-being as well as a host of policy and program ideas directed toward poverty reduction. The Committee found that packages of work-oriented and income support program are able to simultaneously reduce child poverty and increase the number of adult workers in low-income families. Costs of these policies are also considered. [ABSTRACT FROM AUTHOR]

Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing – affordability, stability, quality, and neighborhood – and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity. [ABSTRACT FROM AUTHOR]

Although they are an increasing share of the US child population (26% in 2020) and have much higher poverty rates than children in nonimmigrant families (20.9% vs 9.9%), children in immigrant families have much more restricted access to the social safety net, which can lead to increased economic hardship and health and developmental risks. More than 90% of children in immigrant families are US citizens, but they are excluded from the safety net due to restrictions that affect their parents and other family members. Exclusions that affect children in immigrant families include restricted categorical eligibility based on immigrant status, stricter income eligibility, reduced benefit levels, high administrative burden, and interactions with immigration policy such as public charge. These exclusions limit the ability of both existing and enhanced social programs to reduce child poverty among this population. Results derived from the Transfer Income Model simulations for the National Academy of Sciences, Engineering and Medicine's 2019 report A Roadmap to Reducing Child Poverty show that the poverty-reducing effects of potential enhancements to three main antipoverty programs result in unequal poverty reduction effects by family citizenship/immigration status with disproportionate negative effects on Hispanic children, 54% of whom live in immigrant families. Policy principles to improve equitable access and poverty-reduction effects of social programs for children in immigrant families include basing eligibility and benefit levels on the developmental, health and nutrition needs of the child instead of the immigration status of other family members, reducing administrative burden, and eliminating the link between immigration policy and access to the safety net. [ABSTRACT FROM AUTHOR]

If ZIP code is more important than genetic code in determining one's health and opportunities, how can pediatricians enable healthy and opportunity-rich environments for all children? This paper introduces a broad network of organizations, policies, and financial resources that are working to improve ZIP codes by tackling poverty at the neighborhood level. The mission-driven US community development sector began with the War on Poverty in the 1960s and 70s and comprises a network of finance, real estate, and community-based organizations working together to overturn decades of racially motivated disinvestment, revitalize persistently marginalized, low-income communities, and enhance the lives of the people who live in them. Across the country, thousands of community development corporations, community development financial institutions, affordable housing developers, and regulated for-profit banks together invest over $300 billion annually in affordable housing, childcare and early learning facilities, recreation centers, community clinics, grocery stores, small businesses, and financial services for low-income families and neighborhoods. We present successful examples of community development efforts targeting child health and opportunity and highlight opportunities for pediatricians to advise, collaborate, and partner in order to accelerate and maximize the impact of billions of dollars invested in support of healthier neighborhoods where all children can grow and thrive. [ABSTRACT FROM AUTHOR]

This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. This was a systematic review and meta-analysis. A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = −2.90 mm Hg, 95% confidence interval [95% CI]: −3.63, −2.16), diastolic blood pressure (WMD = −2.21 mm Hg, 95% CI: −3.12, −1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = −8.88 mg/dl, 95% CI: −12.84, −4.92), triglycerides (WMD = −8.40 mg/dl, 95% CI: −12.10, −4.70), total cholesterol (WMD = −2.96 mg/dl, 95% CI: −3.10, −2.81) and fasting blood glucose (WMD = −2.06 mg/dl, 95% CI: −3.02, −1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments. [ABSTRACT FROM AUTHOR]

The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). We conducted participant observation and in-depth interviews June–December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. TLC guests and staff described an atmosphere where radical hospitality—welcoming guests with extraordinary warmth, generosity, and unconditional acceptance—was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe. [ABSTRACT FROM AUTHOR]

Deaths caused by alcohol are increasing in England and 80 % of people with alcohol use disorders (AUDs) are not in treatment. The Blue Light approach (Alcohol Change UK) is an initiative to support people with AUDs who are not in treatment. This study aimed to tailor the Blue Light approach (combined with alcohol identification and alcohol brief interventions [ABI] training) for police officers and homeless service staff in North West England, and to qualitatively evaluate the feasibility and acceptability of the training. The Blue Light approach was tailored using co-production activities, based on Transdisciplinary Action Research. Full-day and half-day training sessions were delivered to the police (full-day N = 14, half-day N = 54) and homeless service staff (full-day N = 11, half-day N = 32), in local police stations and online (four half-day sessions). Semi-structured interviews (N = 23) were conducted to evaluate implementation and integration, analysing the qualitative data in line with Normalisation Process Theory. Four themes were identified, each with two to three sub-themes, reflecting: (i) the importance of training for working practice, (ii) implementation of the interventions, (iii) changes to relationships within and between organizations, and (iv) recommendations for further changes to the training. Differences in findings across the organizations (police versus homeless services) and by training type attended (full-day versus half-day, in-person versus online) are presented. There is evidence to suggest that the training has provided worthwhile knowledge and intervention techniques that can become embedded into working practices. Nevertheless, structural barriers were apparent, primarily within the police service, with clear disparities between recognising the value of the training and what is achievable in practice, given the competing demands. • Co-production activities were used to tailor the existing Blue Light training. • The training was delivered to police and homeless service staff. • The implementation and integration of the training were qualitatively assessed. • The themes show that the interventions can be embedded into working practices. • Barriers to implementing interventions were clear within the police service. [ABSTRACT FROM AUTHOR]

A growing proportion of Medicare home health (HH) patients are "community-entry," meaning referred to HH without a preceding hospitalization. We sought to identify factors that predict community-entry HH use among older adults to provide foundational information regarding care needs and circumstances that may prompt community-entry HH referral. Nationally representative cohort study. Health and Retirement Study (HRS) respondents who were aged ≥65 years, community-living, and enrolled in Medicare between 2012 and 2018 (n = 11,425 unique individuals providing 27,026 two-year observation periods). HRS data were linked with standardized HH patient assessments. Community-entry HH utilization was defined as incurring one or more HH episode with no preceding hospitalization or institutional post-acute care stay (determined via assessment item indicating institutional care within 14 days of HH admission) within 2 years of HRS interview. Weighted, multivariable logistic regression was used to model community-entry HH use as a function of individual, social support, and community characteristics. The overall rate of community-entry HH utilization across observation periods was 13.4%. Older adults had higher odds of community-entry HH use if they were Medicaid enrolled [adjusted odds ratio (aOR) = 1.49, P =.001], had fair or poor overall health (aOR = 1.48, P <.001), 3+ activities of daily living limitations (aOR = 1.47, P =.007), and had fallen in the past 2 years (aOR = 1.43, P <.001). Compared with those receiving no caregiver help, individuals were more likely to use community-entry HH if they received family or unpaid help only (aOR = 1.81, P <.001), both family and paid help (aOR = 2.79, P <.001), or paid help only (aOR: 3.46, P <.001). Findings indicate that community-entry HH serves a population with long-term care needs and coexisting clinical complexity, making this an important setting to provide skilled care and prevent avoidable health care utilization. Results highlight the need for ongoing monitoring of community-entry HH accessibility as this service is a key component of home-based care for a high-need subpopulation. [ABSTRACT FROM AUTHOR]

The international consensus in support of universal health coverage (UHC), though commendable, thus far lacks a clear mechanism to finance and deliver accessible and effective basic healthcare to the two billion rural residents and informal workers of low- and lower-middle-income countries (LLMICs). Importantly, the two preferred financing modes for UHC, general tax revenue and social health insurance, are often infeasible for LLMICs. We identify from historical examples a community-based model that we argue shows promise as a solution to this problem. This model, which we call Cooperative Healthcare (CH), is characterized by community-based risk-pooling and governance and prioritizes primary care. CH leverages communities' existing social capital, such that even those for whom the private benefit of enrolling in a CH scheme is outweighed by the cost may choose to enroll (given sufficient social capital). For CH to be scalable, it needs to demonstrate that it can organize delivery of accessible and reasonable-quality primary healthcare that people value, with management accountable to the communities themselves through structures that people trust, combined with government legitimacy. Once LLMICs with CH programs have industrialized sufficiently to make universal social health insurance feasible, CH schemes can be rolled into such universal programs. We defend cooperative healthcare's suitability for this bridging role and urge LLMIC governments to launch experiments testing it out, with careful adaptation to local conditions. [ABSTRACT FROM AUTHOR]

To describe New Jersey residents' relative priorities for the allocation of tax revenue generated by recreational cannabis sales. We aim to assess preferences for public health initiatives, including drug treatment, compared to a range of alternatives, including traditional policing, especially within the social and demographic groupings of people generally most impacted by punitive drug enforcement policies. We collected population-representative survey data four months post-implementation of recreational cannabis sales in New Jersey (N = 1,006). We gauge respondents' top preferences for the allocation of new revenue generated by the legal cannabis market. Using multinomial logistic regression, we assess how various demographic and political factors shape public support for devoting revenue toward public health initiatives. While priorities are mixed within the sample, we find more general support for funding community-based initiatives in public health, housing, and education than for funding police, courts, and prisons. Among Black residents, the largest proportion chose investments in affordable housing. Regression analysis reveals political orientation as having the most consistent association with expressed preferences, with Republicans favoring investments in traditional law enforcement priorities over other potential funding domains. Recreational cannabis legalization is occurring at a rapid pace, yet important context, including how the tax revenue could be invested in communities, remains unclear. Insight into current public opinion on funding priorities suggests a desire for investment in fundamental societal institutions, including education and public health, rather than the punitive enforcement mechanisms that have defined cannabis policy for many decades. [ABSTRACT FROM AUTHOR]