A Clinical-Community Partnership to Address Food Insecurity and Reduce Emergency Department Utilization Among Medicaid-Insured Patients in North Carolina.

Context: Socioeconomic risk factors have the greatest impact on overall health trajectory. Patients with Medicaid insurance are more likely to experience food insecurity, in addition to poor health and increased health care utilization. Targeted food and produce prescription programs can reduce food insecurity, but sustainable implementation is challenging and evidence demonstrating the impact on clinical utilization outcomes is lacking.

An equity-focused approach to improving access to COVID-19 vaccination using mobile health clinics.

This article describes the implementation of an equity-focused strategy to increase the uptake of COVID-19 vaccination among communities of color and in traditionally underserved geographic areas using mobile health clinics (MHCs). The MHC Vaccination Program was implemented through a large integrated healthcare system in North Carolina using a grassroots development and engagement strategy along with a robust model for data-informed decision support to prioritize vulnerable communities. Several valuable lessons from this work can replicated for future outreach initiatives and community-based programming: •Health systems can no longer operate under the assumption that community members will come to them, particularly those experiencing compounding social and economic challenges.

Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality.

Objective: To examine the role of race/ethnicity and social determinants of health on COVID-19 care and outcomes for patients within a healthcare system that provided virtual hospital care.

Methods: This retrospective cohort study included 12,956 adults who received care for COVID-19 within an integrated healthcare system between 3/1/2020 and 8/31/2020. Multinomial models were used to examine associations between race/ethnicity, insurance, neighborhood deprivation measured by Area Deprivation Index (ADI), and outcomes of interest.

Residential Segregation and Emergency Department Utilization Among an Underserved Urban Emergency Department Sample in North Carolina.

Residential segregation is a spatial manifestation of structural racism. Racial disparities in emergency department (ED) utilization mirror social inequity in the larger community. We evaluated associations between residential segregation and ED utilization in a community with known disparities and geographically concentrated social and health risk.

A Replicable, Solution-Focused Approach to Cross-Sector Data Sharing for Evaluation of Community Violence Prevention Programming.

Context: Community violence is a public health problem that erodes social infrastructure. Structural racism contributes to the disparate concentration of violence in communities of color. In Mecklenburg County, North Carolina, increasing trends in community violence show racial and geographic disparities that emphasize the need for cross-sector, data-driven approaches to program and policy change.

Racial/Ethnic Disparities in Health Care Setting Choice for Adults Seeking Severe Acute Respiratory Syndrome Coronavirus 2 Testing.

Objectives: Equitable access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing is important for reducing disparities. We sought to examine differences in the health care setting choice for SARS-CoV-2 testing by race/ethnicity and insurance. Options included traditional health care settings and mobile testing units (MTUs) targeting communities experiencing disproportionately high coronavirus disease 2019 (COVID-19) rates.

Social and demographic characteristics of frequent or high-charge emergency department users: A quantile regression application.

Objective: Heavy users of the emergency department (ED) are a heterogeneous population. Few studies have captured the social and demographic complexity of patients with the largest burden of ED use. Our objective was to model associations between social and demographic patient characteristics and quantiles of the distributions of ED use, defined as frequent and high-charge.

Development, Implementation, and Results from a COVID-19 Messaging Campaign to Promote Health Care Seeking Behaviors Among Community Clinic Patients.

Care-delays can further exacerbate racial and ethnic health disparities in novel coronavirus disease 2019 (COVID-19) related complications. The purpose of our study was to describe and evaluate a Patient Engagement Messaging campaign (PEM campaign) promoting health care seeking behaviors among community and rural clinic patients in North Carolina. Text and voice messages were delivered over 3-weeks.

Using cloud-based, open-source technology to evaluate, improve, and rapidly disseminate community-based intervention data.

Building Uplifted Families (BUF) is a cross-sector community initiative to improve health and economic disparities in Charlotte, North Carolina. A formative evaluation strategy was used to support iterative process improvement and collaborative engagement of cross-sector partners. To address challenges with electronic data collection through REDCap Cloud, we developed the BUF Rapid Dissemination (BUF-RD) model, a multistage data governance system supplemented by open-source technologies, such as: Stage 1) data collection; Stage 2) data integration and analysis; and Stage 3) dissemination.

Effectiveness of a Playground Intervention for Antisocial, Prosocial, and Physical Activity Behaviors.

Background: We examined the effectiveness of Peaceful Playgrounds™ (P2) to decrease antisocial behaviors (ASB) while increasing physical activity (PA) and prosocial behaviors (PSB) in elementary school children.

Methods: A longitudinal, cluster-randomized design was employed in 4 elementary school playgrounds where students (third to fifth) from 2 intervention and 2 control schools were observed during recess periods. The intervention included environmental changes (eg, marked surfaces) and student education.

Addressing obesity with pediatric patients and their families in a primary care office.

Pediatric obesity is a prevalent condition that has devastating health consequences for children. If left untreated, it can result in adult obesity and related chronic health conditions. Special considerations need to be made for treatment in the pediatric population including an adjustment of treatment goals (weight maintenance vs weight loss) and treatment methodologies.

Bicycling policy indirectly associated with overweight/obesity.

Background: Policies to enhance bicycling are correlated with health outcomes. Research has yet to provide an adequate, empirically derived explanation for this finding.

Purpose: To examine a comprehensive model of a pathway potentially linking bicycle policies to overweight/obesity.

Playground Safety is Associated With Playground, Park, and Neighborhood Characteristics.

Background: More than 200,000 children each year are treated at emergency departments for injuries occurring on playgrounds. Empirically derived data are needed to elucidate factors associated with playground safety and reduce injury rates.

Objective: Determine if neighborhood, park and playground characteristics are significantly associated with playground safety.

Relations between perceptions of environmental features and physical activity.

Studies have examined associations between environmental features and physical activity, but there has been no exploration of adult perceptions about the influence environmental features have on physical activity. This study assessed associations between perceptions of environmental features and physical activity. 305 women and 229 men (18-91 years of age) were interviewed in their homes.

Community development corporations could potentially improve research on causal associations between environmental features and physical activity.

Background: Community development corporations (CDC) are worldwide entities that create environments facilitating physical activity. At the same time, researchers face challenges conducting cost-effective, longitudinal studies on how environmental changes affect physical activity.

Objective: To provide evidence suggesting that CDC initiatives could potentially be integrated into a research framework for examining the influence of environmental improvements on physical activity.

Outcomes from an urban pediatric obesity program targeting minority youth: the Healthy Hawks program.

Background: The aim of this study was to describe the outcomes of a family-based behavioral group treatment program with a group of urban, minority, low-income families.

Methods: Two hundred and ten families enrolled in a 12-week family-based behavioral group treatment program for pediatric obesity. The program was offered in English and in Spanish and targeted the enrollment of low-income highly diverse youth and families.