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It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The Association advocates the use of qualified registered dietitians (RDs) to assess and evaluate the need for nutrition care according to each person's individual medical condition, needs, desires, and rights. Dietetic technicians, registered, provide support to RDs in the assessment and implementation of individualized nutrition care. Individual rights and freedom of choice are important components of the assessment process. An RD must assess each older adult's risks vs benefits for therapeutic diets. Older adults select housing options that provide a range of services from minimal assistance to 24-hour skilled nursing care. Food is an important part of any living arrangement and an essential component for quality of life. A therapeutic diet that limits seasoning options and food choices can lead to poor food and fluid intake, resulting in undernutrition and negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The expansion of health care communities creates a multitude of options for RDs and dietetic technicians, registered, to promote the role of good food and nutrition in the overall quality of life for the older adults they serve.

As with other national disasters, epidemics, and pandemics, the novel coronavirus SARS-CoV-2 (COVID-19) pandemic has highlighted health disparities in Black communities in the USA. Healthcare providers, community activists, politicians, members of faith-based organizations, professional athletes, and Black families are asking crucial questions about why Black and Brown people are disproportionately infected by, and dying from, the COVID-19. Evidence in healthcare and social sciences literature demonstrates that historically, systemic racism and injustices play a large role in the health and well-being of Blacks living in the USA. For decades, the National Black Nurses Association has been on the forefront, engaging our people using a collaborative community-based practice model. The healthcare goal in the USA should center on health protection, promotion, and prevention, moving toward a wellness model and away from treatment of illnesses that contribute to healthcare waste. Finally, awareness of social determinants of health has taken center stage, demonstrating how laws, policies, and practice affect health outcomes and the well-being of Black and Brown communities. In order to address social determinants of health and healthcare inequity, the National Black Nurses Association has called for an increase in the number of Black registered nurses and licensed vocational and practical nurses. The healthcare goal in the USA should center on health protection, promotion, and preventions moving toward a wellness model and away from treatment of illnesses that contributes to healthcare waste.

The Association of State and Territorial Directors of Nursing vision for emergency preparedness is that every community, family, and individual will have a comprehensive emergency preparedness plan that minimizes the consequences of disasters and emergencies, and enables communities, families, and individuals to respond and recover. This position paper provides national and state policy guidance during emergencies to all public health nurses in the United States and its Territories. Public health nurses bring critical experience to each phase of a disaster: mitigation, preparedness, response, and recovery. Public health nurses strive to achieve individual competencies so that they may better collaborate with others and contribute to emergency preparedness and response. Twelve Emergency Preparedness Competencies are listed in this position paper that will assist public health nurses with disaster prevention, planning, response, recovery, drills, exercises, and training. This position paper will be useful in clarifying the expertise that public health nurses can contribute to teams that serve to protect the health and safety of communities against disaster threats and realities. [ABSTRACT FROM AUTHOR]

Background: The United States is increasingly recognizing period product insecurity, insufficient access to menstrual products and limited private spaces for managing menstruation due to financial constraints, as an issue impacting the well-being and dignity of Americans. One strategy to address period product insecurity has been distributing free period products via period supply banks. The outcomes of period product distribution outside the school setting are absent from the literature. Objectives: This study, a formative evaluation of the free period product distribution efforts of the Alliance for Period Supplies, aims to identify (1) characteristics of individuals receiving products from period supply banks and their experiences of period product insecurity and (2) health and social outcomes experienced by recipients of free period products. Design: Survey data collection occurred at two points: baseline and one-year follow-up. All study participants provided verbal consent. Methods: Between Fall 2018 and Spring 2020, 1863 baseline and 80 follow-up surveys were administered. Participants received free period products for themselves and/or a household member from one of 20 participating Alliance for Period Supplies period supply banks directly or from one of their 64 partner agencies. Results: At baseline, 72.4% of participants had to choose between buying period products and another basic need. One year after accessing a period supply bank, 36.3% of participants reported this experience (p = 0.018). Participants reported at baseline, on average, 7.8 days in the past year of avoiding seeing others, canceling appointments, or skipping work or school because they did not have access to period products. At follow-up, this was reduced to 1.2 days, on average, t (68) = 2.214, p < 0.05. Conclusion: Period supply banks play an essential role in facilitating access to period products and the resulting benefits. Our study highlights the need for sustainable, well-funded policies and interventions to address period product insecurity effectively in society. Plain Language Summary: How people in the United States benefit when they get free period products from a period supply bank Why we did this study: In the United States, many individuals cannot afford to buy period supplies and the other stuff they need to live. Period supply banks want to help by giving them free period products. Researchers do not know if getting free period products is helpful for individuals. What we wanted to learn: The Alliance for Period Supplies is a membership program for period supply banks. We wanted to learn about the individuals who get free period products and whether getting them was helpful. What we did: For a year, starting in Fall 2018, we asked 1863 individuals to fill out paper surveys. A year later, we asked 80 of those same individuals to fill out a second survey. We asked participants to take the survey if they got free period products from a period supply bank for themselves or someone they live with. Individuals only participated in the study if they told us they wanted to. What we learned: Individuals who cannot afford period products must navigate difficult decisions between purchasing products or choosing other basic needs. Providing free products through a period supply bank has lessened the burden on these individuals, reducing the number who had to choose. Individuals unable to afford period products may sometimes opt out of going places they want to go for pleasure or miss important events, like work or school, because they do not have period products. Getting free period products has eased these challenges, letting individuals participate more fully in activities and engagements without worry about period products. Why is this important: Period supply banks are essential places where individuals receive free period products. The period supply banks need more individuals, including our government, to donate period supplies or money to buy them so they can help more individuals. [ABSTRACT FROM AUTHOR]

Aim: To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). Background: Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. Design: Qualitative study using focus groups. Methods: Data were obtained from 12 focus groups and one in‐depth interview conducted in Baltimore, MD among HIV‐negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18–24, 25–34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. Results: Most identified as homosexual/gay/same gender‐loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. Discussion: Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. Impact to Nursing Practice: Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices–such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future. [ABSTRACT FROM AUTHOR]

Background: Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.Methods: This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS.Results: Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.Conclusions: This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research. [ABSTRACT FROM AUTHOR]

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed. [ABSTRACT FROM AUTHOR]

Racism is part of the foundation of U.S. society and institutions, yet few studies in community psychology or organizational studies have examined how racism affects organizations. This paper proposes a conceptual framework of institutional racism, which describes how, in spite of professional standards and ethics, racism functions within organizations to adversely affect the quality of services, the organizational climate, and staff job satisfaction and morale. Grounded in systems theory and organizational empowerment, the framework is based on data that describe how racism was made manifest in a county public health department. The findings highlight the importance of understanding how organizations are influenced by external forces and can negatively affect clients, communities, and their own staff members.

This paper extends and further validates the quality-of-life/community-healthcare model and measures developed by Rahtz and Sirgy (2000). The quality of life (QOL) model is based on the theoretical notion that community residents' satisfaction with healthcare services available within their community affects community quality of life and life satisfaction. This study extends the model and, in keeping with past research, posits that the bottom-up spillover from community QOL to life satisfaction is greater for those individuals with low personal health satisfaction, lower income, and old age. Data were collected from 1094 community residents in the East-Coast area of the United States. The results provide good support of the new model. Managerial implications and applications for the new model are discussed.

Purpose: Few international comparisons of health services are performed using microlevel data. Using such data, this paper compares the need for and receipt of assistance with activities of daily living (ADLs) in comparable samples in the United States and Sweden, a country with a universal system of community-based services. Design and Methods: Data from national surveys of community residents completed at approximately the same time in each nation are used to create comparable measures of need and assistance. Descriptive and logistic regression analyses compare need and assistance patterns across the nations and identify individual factors that explain receipt of assistance and unmet needs. Results: Our results indicate that a simple story of greater use of paid formal services in Sweden and more unpaid informal use in the United States masks a more complex relationship. Assistance with ADLs seems to be more targeted in Sweden; narrow differences in assistance widen considerably when the analysis is limited to those reporting need. Implications: Although these two different health systems result in similar levels of overall ADL assistance, a detailed microlevel comparison reveals key distinctions. Further microlevel comparisons of access, cost, and quality in cross-national data can further aid our understanding of the consequences of health policy.

Aims: To identify the barriers and facilitators to healthcare for people without documentation status. Design: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Methods: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social‐ecological model. Data Sources: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. Results: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti‐immigrant rhetoric) and policy‐related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety‐net clinics and supportive federal policies emerged as key facilitators. Conclusion: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. Impact: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. Reporting Method: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Patient or Public Contribution: No patient or public contribution was needed. Trial and Protocol Registration: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289). [ABSTRACT FROM AUTHOR]

Background: Global health research partnerships, which promote the exchange of ideas, knowledge and expertise across countries, are considered key to addressing complex challenges facing health systems. Yet, many studies report inequalities in these partnerships, particularly in those between high and low-and-middle-income countries (LMICs). Objective: This paper examines global research collaborations on community health worker (CHW) programmes, specifically analysing the structures of authorship teams and networks in publications reporting research on CHW programmes in low-income countries (LICs). Methods: A sub-set of 206 indexed journal articles reporting on CHW programmes in LICs was purposefully selected from a prior review of research authorship on CHW programmes in all LMICs over a five year period (2012–2016). Data on country and primary organisational affiliation and number of publications for all individual authors, programme area (e.g. maternal child health) and total citations per paper were extracted and coded in excel spreadsheets. Data were then exported and analysed in Stata/ICV.14 and Gephi. Results: The 206 papers were authored by 1045 authors from 299 institutions, based in 43 countries. Half (50.1%) the authors came from LIC-based institutions, 43.8% from high-income country (HIC) institutions, 2.9% from middle-income country (MIC) institutions and 3.2% had different first affiliations in different publications. Authors based in the USA (302) and UK (68) accounted for just over a third (35.4%) of all authors. Partnership patterns revealed a primary mode of North–South collaboration with authors from the US, and to a lesser extent the UK, playing central bridging roles between institutions. Strong network clusters of multiple-affiliated authors were evident in research on MCH and HIV/TB aspects of CHW programmes. Conclusion: Knowledge production on CHW programmes in LICs flows predominantly through a pool of connected HIC authors and North–South collaborations. There is a need for strategies harnessing more diverse, including South–South, forms of partnership. [ABSTRACT FROM AUTHOR]

Public libraries in the United States (U.S.) are important sources of health information. Immigrants comprise a large portion of the U.S. population, and research suggests that public libraries help immigrants adjust to life in a new country. Public libraries help immigrants access information directly related to health and provide programs that have indirect impacts on health outcomes, including learning a new language and forging social ties. The purpose of this paper was to examine perspectives from librarians related to interactions with immigrant patrons and how their library supports them in this role. Public librarians (n = 205) from two selected U.S. states completed an online survey focusing on how comfortable they were in helping immigrants with inquiries related to health and the role of the public library in supporting librarians in this endeavor. Respondents generally reported high levels of comfort interacting with immigrants, although there was limited interaction on potentially sensitive topics (i.e., immigration, health). Library staff perceived that libraries overall were not effective in meeting the needs of immigrant populations and that librarians were infrequently offered professional training related to cultural competency and diversity. The findings echo previous studies that demonstrate the need for professional development to ensure that librarians are aware of library resources available to assist immigrant patrons. Findings from this study suggest opportunities for public health professionals and public librarians to collaborate to ensure the provision of reliable resources, health information, and referrals to community-based services. [ABSTRACT FROM AUTHOR]

Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) are the greatest predictors of one's health status. There are clear SDOH disparities present in the United States, many of which have been especially evident during the COVID pandemic. SDOH have become a greater focus of payers, including Centers for Medicare & Medicaid Services (CMS). CMS has updated the reimbursement structure of Medicare and Medicaid to incentivize more SDOH-related interventions. Providers are also growing increasingly attentive to the SDOH needs of their patients, but often are unable to sufficiently address them outside of care settings. The combination of increased SDOH funding with inefficient mechanisms to meet patients' SDOH needs has led to the emergence of the for-profit SDOH industry. The purpose of this paper was to investigate the industry and identify its size, scope, and future implications. The authors conducted an analysis of for-profit SDOH companies using a third-party industry research platform. A collection of 58 companies was identified with $2.4 billion in funding and a total valuation of over $18.5 billion as of July, 2021. Two literature searches were conducted to support strategy recommendations for critically evaluating SDOH outcomes from these companies, and to determine the downstream effects they will have on community-based organizations also working to improve SDOH. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the 'program theory' of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need. [ABSTRACT FROM AUTHOR]

Background: In the United States chronic illnesses have become a way of life for multiple generations – they are the number one cause of death and disability (accounting for more than 70% of deaths), 60% of American adults have at least one chronic disease, and 40% have multiple chronic conditions. Although multiple factors contribute to the growth in chronic disease prevalence, a major factor has been overreliance on health care systems for promoting health and preventing disease. Large health care systems are ill equipped for this role since they are designed to detect, treat, and manage disease, not to promote health or address the underlying causes of disease. Methods: Improving health outcomes in the U.S. will require implementing broad‐based prevention strategies combining biological, behavioral, and societal variables that move beyond clinical care. According to community medicine, clinical care alone cannot create, support, or maintain health. Rather, health can only ensue from combining clinical care with epidemiology and community organization, because health is a social outcome resulting from a combination of clinical science, collective responsibility, and informed social action. Results: During the past 20 years, our team has developed an operational community medicine approach known as community health science. Our model provides a simple framework for integrating clinical care, population health, and community organization, using community‐based participatory research (CBPR) practices for developing place‐based initiatives. In the present paper, we present a brief overview of the model and describe its evolution, applications, and outcomes in two major urban environments. Conclusion: The paper demonstrates means for integrating the social determinants of health into collaborative place‐based approaches, for aligning community assets and reducing health disparities. It concludes by discussing how asset‐based community development can promote social connectivity and improve health, and how our approach reflects the emerging national consensus on the importance of place‐based population system change. [ABSTRACT FROM AUTHOR]

Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients. [ABSTRACT FROM AUTHOR]

Introduction: Tooth decay remains the most prevalent chronic disease in children and adults, even though it is largely preventable. Studies show that mothers' oral and overall health is linked to children's oral health and pregnancy outcomes. This paper examines achievements during the last 20 years, assesses current challenges, and discusses future priorities. Oral health status: Data show a modest improvement in children's oral health during the last 20 years; however, tooth decay still affects more than half of adolescents. According to national survey data, about 26% of working-age adults had untreated tooth decay. Overall, significant oral health disparities by race/ethnicity and income persist. Dental service utilization: The annual dental visit rate for children in the 2015 Medical Expenditure Panel Survey was 48%. Among children enrolled in Medicaid, dental visit rates increased from 18% in 1993 to nearly 50% in 2018. About 46% of women are estimated to receive teeth cleaning during pregnancy. Over the years, race or ethnicity and income-level differences in dental visits observed in the early 2000s have narrowed substantially in children but not among pregnant women. Discussion: Many effective interventions are available at the community and individual levels but are underutilized. Lack of integration of oral health into the overall health care system and programs, community conditions, poverty, and limited health literacy make it difficult for families to engage in healthy habits, use preventive interventions, and access treatment promptly. Conclusion: To further improve oral health, policy and system reforms are needed to address the factors mentioned above. Therefore, we urge the federal Maternal and Child Health Bureau to take steps to convene a workshop to develop a framework for future actions. Significance: What is already known on this subject? Existing publications discuss the extent to which women, children, and adolescents experience oral health problems, effective policies and programs, and the need to integrate oral health care into the overall health care system. What does this study add? This manuscript provides a historical perspective on efforts and progress made to address the causes of high oral disease rates, unmet oral health treatment needs, and profound oral health disparities. It also discusses challenges that four major programs have encountered in working to achieve better oral health outcomes. In addition, it makes recommendations for improving oral health and calls for a national workshop to develop a framework for future actions. [ABSTRACT FROM AUTHOR]

The aim of this paper is to review the roles that community pharmacists in the United States (US) can play to support public health measures during the current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic (COVID-19). Community pharmacists in the US are highly visible and accessible to the public and have long been regarded as a source for immunization services as well as other public health activities. In the US, the scope of pharmacy practice continues to expand and incorporate various health services on a state-by-state level. For the purposes of this article, a PubMed literature search was undertaken to identify published articles on SARS-CoV-2, COVID-19, pharmacist- and pharmacy-based immunization and other public health care activities in the US in order to identify and discuss roles that community pharmacists can play during this pandemic including as vaccinators, screeners and testers. In conclusion, community pharmacists are knowledgeable and capable providers of public health services and are easily accessible and well regarded by the public. The incorporation of community pharmacists into this nation's COVID-19 pandemic response plan can help aid recovery efforts in the US. [ABSTRACT FROM AUTHOR]

The Rio Grande Valley of Texas has an exceptionally high number of COVID-19 cases and case fatality rate. The region makes up only 3% of the Texas population but, as of April 2021, accounted for 9% of the state's COVID-19 deaths. Additionally, during the summer of 2020, the Rio Grande Valley had one of the highest per capita infection rates in the United States. This paper explores the social-ecological elements that impact health-seeking behaviors in this community using interviews conducted with healthcare personnel and nonprofit leaders in the Rio Grande Valley between 2019 and 2020. Using this data, we found that anti-immigrant rhetoric has increased levels of fear among immigrants and mixed-status families, which has made them less willing to access healthcare. Additionally, we found that changes in the public charge rule has led to a decreasing number of children accessing government-provided health insurance. Our findings suggest that these outcomes likely contributed to the severity of the COVID-19 outbreak in the Rio Grande Valley.

Syringe service programs (SSP) increasingly serve rural areas of the United States, yet little is known about access and perceived need for their services. Objectives: This paper presents the HIV and viral hepatitis prevention, testing, and treatment, and, substance use disorder treatment and overdose prevention services offered at three SSPs and which services their clients accessed. Across the three SSPs, 45 clients (people who inject drugs [PWID]), 11 staff, and five stakeholders were interviewed. Results: Most clients (n = 34) reported accessing SSP services weekly and primarily for sterile syringes and injection-related supplies. All clients reported testing for HIV at least once, though concern for acquiring or transmitting HIV was divided between some or no concern. Most clients (n = 43) reported testing for hepatitis C virus (HCV). Concern for acquiring or transmitting HCV was also mixed. Vaccination for hepatitis A and/or B teetered around half (HAV: n = 23) to a third (HBV: n = 15). Most clients (n = 43) knew where to access the overdose countering medication, Narcan. Feelings about substance use treatment options varied, yet most felt not enough were available. Of note, not all assessed services were offered by the sampled SSPs. Conclusions/Importance: The findings help us understand PWIDs' rationale regarding services accessed and preference for particular services. The need for some services was not perceived by those at risk for the illness the services addressed. Discussing risk and providing tailored education is important when providing SSP services to rural residing PWIDs. [ABSTRACT FROM AUTHOR]

Introduction: Australian rural and remote areas are faced with the double burden of an ageing population paired with inequitable access to health resources due to the paradigm of major city centred health care. This complicates fall management within this space. Paramedics are a registered health profession, which provides mobile, equitable health care. However, this resource is not being effectively utilised in rural and remote areas where primary care access barriers may cause patient needs to go unmet. Objective: To describe the existing literature and describe the international scope of current paramedicine practice in the out‐of‐hospital management of falls amongst older adults in rural and remote settings. Design: Joanna Briggs Institute scoping review methodology was employed. CINAHL (EBSCO), MEDLINE (Ovid), EMBASE (Ovid), SCOPUS (Elsevier), Google Scholar and These Global were searched and Australian, New Zealand and the UK ambulance service guidelines were sought. Findings: Two records met inclusion criteria. Currently, rural and remote paramedic fall management involves preventative health promotion through patient education, population‐based screening and referrals. Discussion: The use of paramedics to screen at‐risk populations and refer is vital, as many rural adults had screened positive to fall risks and other unmet needs. There is poor recollection of physically printed education material and low acceptance of further in‐home assessments following paramedic departure. Conclusion: This scoping review has highlighted a significant knowledge gap on this topic. Further research is needed to effectively utilise paramedicine within areas where access to primary care is not possible to achieve downstream, risk reducing care in the home. [ABSTRACT FROM AUTHOR]

Objectives: To use network analysis in order to evaluate the effectiveness of interorganizational networks in implementing policy, systems, and environmental interventions for cardiovascular disease prevention throughout the United States., Methods: Evaluators conducted an interorganizational network (ION) survey to examine information sharing and joint planning within organizational relationships in 15 community-based cardiovascular disease prevention partnership networks. Density and betweenness centrality scores at the node- and network-level were calculated for each partnership network using UCINET© network analysis software. Common data patterns were then extracted using a multiple case study format., Results: Network density scores ranged from 0.50 to 1.00 (M = 0.84, SD = 0.14) for information sharing and 0.43-1.00 (M = 0.77, SD = 0.15) for joint planning. Centralization indices ranged from 0.00 to 0.11 (M = 0.04, SD = 0.03), and 0.00-0.17 (M = 0.06, SD = 0.05), respectively. Overall, 73.33 % of communities were successful in meeting their partnership goals., Conclusions: When planning and implementing interorganizational networks, high betweenness centrality and more hierarchically structured networks were identified as the most salient partnership characteristics to programmatic success. The network findings were triangulated with previously published qualitative data to provide context. These findings provide valuable insight on how national networks can be designed and leveraged to implement systematic community health projects., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

To provide medical and social services to underserved communities, many health care organizations across the United States have expanded the role of emergency medical services to include mobile integrated health and community paramedicine (MIH-CP). Although MIH-CP programs differ in structure and setting, many share the common goal of improving health through home-based, patient-centered care management models. Ideally, these innovative programs reduce use of health care services, including 911 (US emergency system) calls and emergency department visits. In 2018 a large, urban academic medical center partnered with the city's fire department to establish an MIH-CP program to support patients as they transition in their first 30 days at home after hospitalization. Prior to launch, a multidisciplinary team developed a logic model to guide development, implementation, and evaluation of this complex and innovative program. This paper describes the team's structured process for developing a logic model. It also describes key components of the initial logic model and the Transitional Health Support program structure, as well as subsequent revisions to both. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature. [ABSTRACT FROM AUTHOR]

The US opioid epidemic is national in scope, but many local solutions have been shown to have efficacy. Many nonprofit hospitals have the resources and infrastructure to lead these community-based efforts, but there is evidence that some organizations are not adopting opioid services as part of their community benefit requirements to assess and address critical community health needs. This paper assesses why hospitals do not address opioid abuse after completing a community health needs assessment. For a 20% random sample of nonprofit hospitals, a unique data set was constructed of hospital efforts to address opioid abuse using the most recent publicly available community health needs assessments and implementation strategies adopted by hospitals (calendar years 2015, 2016, 2017, or 2018). Multinomial logistic regression was used to assess the relationship between 5 different reasons hospitals cited for not addressing opioid abuse and both hospital and community characteristics. Results indicate that opioid abuse was not addressed by 32% (143) of hospitals in their formal implementation strategies. State community benefit laws, county overdose level, county poverty rate, hospital region, and hospital system membership all were significantly related to the reasons hospitals cited for not addressing opioid abuse as part of their community health engagement. Hospitals in communities with significant substance abuse needs and few institutional resources may need support to address opioid misuse and adopt treatment and harm reduction initiatives. Policies that support hospital–public health partnerships may be especially important to assist hospitals to address nonmedical or behavioral health needs in their communities. [ABSTRACT FROM AUTHOR]

Background: Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities., Methods: The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice., Discussion: The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection., Trial Registration: This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018.

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing. [ABSTRACT FROM AUTHOR]

The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers. [ABSTRACT FROM AUTHOR]

The widespread adoption of science-based prevention requires local infrastructures for prevention service delivery. Communities That Care (CTC) is a tested prevention service delivery system that enables a local coalition of community stakeholders to use a science-based approach to prevention and improve the behavioral health of young people. This paper uses data from the Community Youth Development Study (CYDS), a community-randomized trial of CTC, to examine the extent to which better internal team functioning of CTC coalitions increases the community-wide adoption of science-based prevention within 12 communities, relative to 12 matched comparison communities. Specifically, this paper examines the potential of both a direct relationship between coalition functioning and the community-wide adoption of science-based prevention and a direct relationship between functioning and the coalition capacities that ultimately enable the adoption of science-based prevention. Findings indicate no evidence of a direct relationship between four dimensions of coalition functioning and the community-wide adoption of a science-based approach to prevention, but suggest a relationship between coalition functioning and coalition capacities (building new member skills and establishing external linkages with existing community organizations) that enable science-based prevention. [ABSTRACT FROM AUTHOR]

African Americans experience higher incidence and prevalence of Alzheimer's disease (AD). Yet, they continue to be underrepresented in AD research, limiting the ability to generalize findings to the increasingly diverse US population. To reduce AD disparities, targeted efforts are needed to increase the representation of African Americans in AD research. This mini review identified evidence-based strategies that increased research participation among older African Americans. Four recruitment strategies emerged from eight published peer-reviewed studies that directly evaluated the effectiveness of strategies aimed at increasing the number of African American participants in Alzheimer's research. The strategies include community outreach and education, face-to-face discussions, remote access, and referral and partnership with local organizations. Across different locations, these strategies increased the number of African Americans enrolled into AD research, the number of people that signed up to donate their brains for AD research upon death, and the knowledge and perception of AD in the communities. Targeted efforts are effective in increasing AD research participation among older African Americans, especially when combined with approaches that emphasize transparency and mutual trust and involve the community as stakeholders in the research process. [ABSTRACT FROM AUTHOR]

Background: Efforts in the USA during the 21st century to stem the ever-rising tide of suicide and risk-related premature deaths, such as those caused by drug intoxications, have failed. Based primarily on identifying individuals with heightened risk nearing the precipice of death, these initiatives face fundamental obstacles that cannot be overcome readily., Objective: This paper describes the step-by-step development of a comprehensive public health approach that seeks to integrate at the community level an array of programmatic efforts, which address upstream (distal) risk factors to alter life trajectories while also involving health systems and clinical providers who care for vulnerable, distressed individuals, many of whom have attempted suicide., Conclusion: Preventing suicide and related self-injury morbidity and mortality, and their antecedents, will require a systemic approach that builds on a societal commitment to save lives and collective actions that bring together diverse communities, service organisations, healthcare providers and governmental agencies and political leaders. This will require frank, data-based appraisals of burden that drive planning, programme development and implementation, rigorous evaluation and a willingness to try-fail-and-try-again until the tide has been turned., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This paper presents a simple model to guide the efficient allocation of resources in community programs to detect and treat hypertension. We model such programs as n-component series systems, where each stage must function in sequence in order for the system as a whole to operate. The model differs from standard series reliability models in that, if a component fails, costs at subsequent stages are not incurred. This "pay-as-you-go" aspect implies that widespread screening is inefficient, and that resources could be better spent ensuring continued treatment of identified hypertensives. Calculations based on actual programs suggest that an optimal allocation of a fixed budget could increase significantly the number of hypertensives controlled, by about 40 percent in our example. This conclusion is robust under all but the most pessimistic assumptions. [ABSTRACT FROM AUTHOR]

In 2000, the American PT Association (APTA) published its Vision statement advocating for DA (DA) to PT. This narrative review of the literature aims to identify the current state of DA in the United States (US) and compare that status to the US Military. Initial PubMed search in the English language with keywords physical therapy (PT), physiotherapy, DA, self-referral, and primary contact from the year 2000 onwards with subsequent focused searches using keywords DA/self-referral/primary contact of physical therapists/physiotherapists on outcomes/autonomous practice/economic impact/patient satisfaction yielded 103 applicable studies on the topic. This paper excluded 40 international articles to focus on US military and civilian research. Current literature supports Physical Therapists (PTs) in an initial contact role based on patient safety, satisfaction, access to care, efficiency, healthcare utilization, and potential cost savings. Despite its success in the US Military, DA to PT in the US civilians remains limited and incomplete. PTs still await unrestricted DA and privileges associated with autonomous practice including the ability to order imaging and prescribe some medications. [ABSTRACT FROM AUTHOR]

Abstract In 2017, we traveled to Cuba to learn about the nation's approach to health care. Despite being a developing nation, Cuba boasts health care indicators that are comparable to those of the United States and other developed nations. Emphasizing prevention and proactive care, the Cuban health care system provides lessons to inform future U.S. health care reform efforts in order to contain medical costs while providing quality care. Visiting with Cuban health care professionals over the course of eight days, and interviewing American physicians who were trained in Cuba but practice in the U.S. this paper provides an overview of key differences in primary health care in Cuba and primary care practice in the U.S. Our work has three main themes: how Cuban medicine approaches primary health care, the importance of medical curriculum in establishing these priorities, and the prioritization of the clinical encounter over technologically-advanced interventions. [ABSTRACT FROM AUTHOR]

The article discusses the paper titled "Economic stabilization of the family: The standard of living" by Harry L. Lurie that was presented at the 5th Annual Meeting of the National Conference of Social Work in Memphis, Tennessee on May 2 to 9, 1928. It mentions the issues to consider in analysing poverty in terms of standards of living and sources of income. It also explores the development of the Chicago Standard Budget by social agencies in Illinois to govern the assistance to poor families.

During the 1960s, cities across the United States erupted with rioting. Subsequent inquiries into its sources revealed long-simmering discontent with systemic deprivation and exploitation in the country's most racially segregated and resource-scarce neighborhoods. Urban medical centers were not exempt from this anger. They were standing symbols of maldistribution, cordoned off to those without sufficient economic means of access. In this article, I examine the travails of the world-famous and prestigious Cleveland Clinic after the 1966 riot in the Hough neighborhood on the East Side of Cleveland, Ohio. After years of unbridled expansion, fueled by federal urban renewal efforts, the riots caught the Clinic's leadership off guard, forcing it to rethink the long-standing insularity between itself and its neighbors. The riots were central to the Clinic's programmatic reorientation, but the concessions only went so far, especially as the political foment from the riots dissipated in the years afterward. The Cleveland experience is part of a larger—and still ongoing—debate on social obligations of medical centers, "town–gown" relations between research institutions and their neighbors, and the role of protest in catalyzing community health reform. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the key evaluation components for a set of community-wide teen pregnancy prevention initiatives. We first describe the performance measures selected to assess progress toward meeting short-term objectives on the reach and quality of implementation of evidence-based teen pregnancy prevention interventions and adolescent reproductive health services. Next, we describe an evaluation that will compare teen birth rates in intervention communities relative to synthetic control communities. Synthetic controls are developed via a data-driven technique that constructs control communities by combining information from a pool of communities that are similar to the intervention community. Finally, we share lessons learned thus far in the evaluation of the project, with a focus on those lessons that may be valuable for local communities evaluating efforts to reduce teen pregnancy., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use., Methods: This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending. The costs of covering up to 20 hours of personal care services a week were estimated using MCBS population counts, participation assumptions based on the literature, and financing design parameters., Results: A targeted HCBS benefit could be added to Medicare and financed with income-related cost sharing ranging from 5% to 50%, a premium paid by Medicare beneficiaries of approximately $42 a month, and payroll taxes estimated at around 0.4% of earnings on employers and employees., Conclusions: Adoption of an HCBS benefit in Medicare would improve financial protection for beneficiaries with physical and/or cognitive impairment and provide the financing for health organizations to better integrate medical and social services. ICOs and delivery models of care emphasizing care at home would improve accessibility of care and avoid costly institutionalization; additionally, it would also reduce beneficiary reliance on Medicaid.

The U.S.-México border is a dynamic region that is medically underserved, with vulnerable populations, living with pressing health and social conditions, high uninsured rates, high rates of migration, inequitable health conditions, and a high rate of poverty. The United States-México Border Health Commission was established to serve as a mechanism to assist in addressing the evolving health issues, among those residing in this large border region. One of the Commission's roles is to train and support promotores de salud' efforts, which enhances the quality of life of U.S.-México border residents. Promotores de salud (the U.S.-México term used for community health workers) have long worked as essential members in U.S.-México border communities, serving in diverse roles. Information shared here describes some key roles, as it pertains to promotores de salud as vital members in the provision of health information, support, and resources to community members along the U.S.-México border. The purpose of this paper is to share best practices on the various essential roles of promotores de salud, as identified by the U.S.-México Border Health Commission, in the U.S.-México border. These best practices help reinforce the purpose of promotores de saluds' work and support the need to continue developing these key individuals for the critical work they perform within their border communities. [ABSTRACT FROM AUTHOR]

In predominately immigrant neighborhoods, the nuances of immigrant life in the ethnic enclave have important, yet underappreciated impact on community health. The complexities of immigrant experiences are essential to unpacking and addressing the impact of acculturative processes on observed racial, ethnic, and class-based health disparities in the United States. These insights because they are largely unexplored are best captured qualitatively through academic-community research partnership. We established the participatory mixed method Little Village participatory community health assessment (CHA) to explore community health in an ethnic enclave. In this paper, we share findings from our qualitative component exploring: how do Residents in a Predominately Immigrant Neighborhood Perceive Community Health Needs and Assets in Little Village. Three major themes emerged: rich, health promoting community assets inherent in the ethnic enclave; cumulative chronic stress impacting the mental health of families and intra-familial strain; and, work and occupation as important but underappreciated community health determinants in an immigrant neighborhood. These nuanced findings enhanced our community health assessment and contributed to the development of two additional tailored CHA methods, a community member-administered Community Health Survey, and an oral history component that provided deeper insight on the community’s health needs and assets, and a focus for action on work as a social determinant of health at the community level. Conducting trusted community-driven health assessments that are adaptive and flexible to capture authentic needs and assets are critical, given health consequences of the new anti-immigrant rhetoric and growing socio-political tensions and fear in immigrant neighborhoods in the United States. [ABSTRACT FROM AUTHOR]