Racial and Ethnic (In)equity in Development of Power Through Place-Based Initiatives.

: Place-based initiatives (PBIs) invest in a geographic area and often build community power to improve well-being. However, there can be differences in results for different groups within a community. : In six communities, we measured differences in "power to" by race/ethnicity at two points for the first phase of the PBI Healthy Places North Carolina (HPNC) using five indicators: (1) representation in network of actors collaborating to improve health, (2) leadership attributes, (3) perceived change in attributes due to HPNC, (4) network centrality, and (5) perceived change in network ties due to HPNC.

SEED: A novel web-based data visualization platform to visualize, communicate, and explore social, environmental, and equity drivers of health.

Multisector stakeholders, including, community-based organizations, health systems, researchers, policymakers, and commerce, increasingly seek to address health inequities that persist due to structural racism. They require accessible tools to visualize and quantify the prevalence of social drivers of health (SDOH) and correlate them with health to facilitate dialog and action. We developed and deployed a web-based data visualization platform to make health and SDOH data available to the community.

Routine Hearing Screening for Older Adults in Primary Care: Insights of Patients and Clinic Personnel.

Background And Objectives: Hearing loss frequently goes undiagnosed and untreated, with serious sequelae. Hearing screening facilitates diagnosis and treatment but is not routinely conducted in primary care. This study addresses the attitudes and insights of patients and primary care clinic personnel relative to the routinization of hearing screening in primary care for older adults.

A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement.

Objectives: The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults.

A Community-engaged Approach to Research Translation: The CIPHERS Project.

Problem: Translating research to support practice is becoming a more prominent goal in the scientific community. However, further innovation and research is needed on effective approaches to this endeavor.

Purpose: This case study describes an approach that combines the insights of diffusion of innovation theory with the philosophy and practices of community engagement.

Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention.

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health.

Research translation: A pathway for health inequity.

In a context of social inequity, research translation naturally furthers health inequity. As Fundamental Cause Theory (FCT) explains-and an associated empirical literature illustrates-those with more resources benefit earlier and more from scientific innovation than those with fewer resources. Therefore, research translation of its own course creates and widens health disparities based on socioeconomic status and race/ethnicity.

LATIN-19: A Grassroots Coalition to Mitigate the Effect of COVID-19 on the Latinx Community in North Carolina.

Background: Social inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities.

A pragmatic clinical trial of hearing screening in primary care clinics: cost-effectiveness of hearing screening.

Background: Hearing loss is a high prevalence condition among older adults, is associated with higher-than-average risk for poor health outcomes and quality of life, and is a public health concern to individuals, families, communities, professionals, governments, and policy makers. Although low-cost hearing screening (HS) is widely available, most older adults are not asked about hearing during health care visits. A promising approach to addressing unmet needs in hearing health care is HS in primary care (PC) clinics; most PC providers (PCPs) do not inquire about hearing loss.

Perceived Benefits of Training Clinicians in Community Engagement for a Leadership Development Program.

Background And Objectives: Community engagement (CE), including community-engaged research, is a critical tool for improving the health of patients and communities, but is not taught in most medical curricula, and is even rarer in leadership training for practicing clinicians. With the growth of value-based care and increasing concern for health equity, we need to turn our attention to the benefits of working with communities to improve health and health care. The objective of this brief report is to increase understanding of the perceived benefits of CE training for primary care clinicians, specifically those already working.

Eviction as a Disruptive Factor in Health Care Utilization: Impact on Hospital Readmissions and No-show Rates.

Background: Residential eviction is a component of housing instability that negatively affects physical and mental health, but the effect of eviction on health care utilization, specifically hospital readmissions and outpatient no-show rates, is not known.

Methods: We conducted a retrospective review of health care utilization of individuals evicted from public housing between January 2013 and December 2017, investigating hospital readmissions and no-show rates one year before and after eviction.

Results: 131 individuals who had been evicted had one year of data pre-and post-eviction.

Comparative implementation-effectiveness of three strategies to perform hearing screening among older adults in primary care clinics: study design and protocol.

Background: The burden of hearing loss among older adults could be mitigated with appropriate care. This study compares implementation of three hearing screening strategies in primary care, and examines the reliability and validity of patient self-assessment, primary care providers (PCP) and diagnostic audiologists in the identification of 'red flag' conditions (those conditions that may require medical consultation and/or intervention).

Methods: Six primary care practices will implement one of three screening strategies (2 practices per strategy) with 660 patients (220 per strategy) ages 65-75 years with no history of hearing aid use or diagnosis of hearing loss.

Community and Stakeholder Engagement.

Improving population health in a sustainable way requires collaboration within the medical community and also working through partnerships among multiple community and societal stakeholders. One example of stakeholder engagement is engagement of the community whose health will be affected. Stakeholder engagement has benefits for the quality, sustainability, and impact of population health research and interventions.

What Is Population Health?

This article defines population health as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. Attention to social and environmental, as well as medical, determinants of health is essential.

Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention.

Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs.

Increasing Stroke Knowledge and Decreasing Stroke Risk in a Latino Immigrant Population.

Stroke knowledge is poor and stroke risk is growing for the U.S. Latino immigrant population.

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department.

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.

Integrating Registered Dietitian Nutritionists Into Primary Care Practices to Work With Children With Overweight.

Despite increased reimbursement for registered dietitian nutritionists (RDNs), few studies have assessed the potential of integrating them into primary care clinics to support pediatric weight management. To assess the feasibility and effectiveness of this approach, RDNs were introduced into 8 primary care practices in North Carolina. This mixed-methods study combined (1) interviews and focus groups with RDNs and clinic personnel, (2) comparison of change in body mass index (BMI) z-score in study practices to change in historical comparison groups, and (3) analysis of behavior and BMI change for RDN utilizers.

Place-Based Initiatives to Improve Health in Disadvantaged Communities: Cross-Sector Characteristics and Networks of Local Actors in North Carolina.

Objectives: To examine the leadership attributes and collaborative connections of local actors from the health sector and those outside the health sector in a major place-based health initiative.

Methods: We used survey data from 340 individuals in 4 Healthy Places North Carolina counties from 2014 to assess the leadership attributes (awareness, attitudes, and capacity) and network connections of local actors by their organizational sector.

Results: Respondents' leadership attributes-scored on 5-point Likert scales-were similar across Healthy Places North Carolina counties.

Use of the 5 As for Teen Alcohol Use.

Clinical guidelines recommend addressing adolescent alcohol use in primary care; the 5 As (Ask, Advise, Assess, Assist, Arrange) may be a useful model for intervention. We audio-recorded 540 visits with 49 physicians and adolescents, compared alcohol disclosure rates in the encounter with those in a survey, and analyzed conversations for use of the 5 As and their relation to adolescent reports of drinking 3 months after the encounter. When physicians asked clear, nonleading questions, drinkers were more likely to disclose alcohol use ( P = .

The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea.

Objectives: Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase.

Methods: Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761).