Maintaining and Improving Virtual Call Centers for Public Health: The CUNY Recovery Corps Experience.

CONTEXT: In the early stages of the COVID-19 pandemic in New York City, individuals who tested positive, exposed contacts, and their families faced significant challenges in accessing essential resources for successful quarantine and isolation. These resources included alternative housing, food access, grocery delivery, missed wage assistance, transportation for household members, medical care, and more. PROGRAM: The City University of New York (CUNY) Recovery Corps emerged as an innovative virtual resource navigation service to connect New Yorkers to essential resources and later to vaccinations, treatment, and services for Long COVID. The program prioritized reaching people living in underserved and under-resourced neighborhoods. Over 3 years, it made a substantial impact, reaching 374 728 New Yorkers and connecting 135 147 to crucial resources. IMPLEMENTATION: Implementing a successful virtual navigation center amidst a global pandemic posed unique challenges. It required well-established systems to provide services, manage staff, build community, and both assure and improve service quality. EVALUATION: Continuous quality assurance and process improvement efforts resulted in a nearly 10-point increase in successful client-resource connections program-wide, with individual navigators showing improvements of up to 20%. Staff-led initiatives, such as population-specific resource guides and incentive awards, boosted morale and cohesion. Providing continuous professional development opportunities and requested training including trauma-informed care, self-care, and strategies for managing grief contributed to staff retention and improved client interactions. DISCUSSION: The CUNY Recovery Corps provides a blueprint for setting up navigation services for emergency response and supporting health and social services. The current paper delves into the intensive quality improvement efforts, program management infrastructure, and staff support that made this program a success. By applying these lessons on establishing and maintaining a virtual call center prioritizing the client's well-being and staff strengths, policymakers and social service leaders can effectively address various health and social service needs proactively rather than rebuilding after each disaster.

Clinical pharmacokinetics of atropine oral gel formulation in healthy volunteers.

Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and psychological manifestations. Providers commonly prescribe atropine eye drops for topical administration to the oral mucosa, as an off-label treatment to manage sialorrhea. However, the off-label use of atropine eye drops can be associated with medication and dosing errors and systemic side effects. To address these limitations of treatment, we developed a mucoadhesive topical oral gel formulation of atropine as an alternative route to off-label administration of atropine eye drops. In this clinical pharmacokinetic (PK) study, we evaluated the safety and PK of atropine gel (0.01% w/w) formulation after single-dose administration to the oral mucosa in 10 healthy volunteers. The PK data showed that after topical administration to the oral mucosa, atropine followed a two-compartment PK profile. The maximum plasma concentration and area under the curve extrapolated to infinite time were 0.14 ng/mL and 0.74 h·ng·mL-1 , respectively. The absorption rate constant calculated by the compartmental analysis was 0.4 h-1 . Safety parameters, such as heart rate, blood pressure, and oxygen saturation, did not significantly change before and after administration of the gel formulation, and no adverse events were observed in all participants who received atropine gel. These data indicate that atropine gel formulation has a satisfactory PK profile, is well-tolerated at the dose studied, and can be further considered for clinical development as a drug product to treat sialorrhea.

Comparison of Current Attitudes Toward COVID-19 Vaccination in New York City and the US Nationally.

COVID-19 vaccination has resulted in decreased hospitalization and mortality, particularly among those who have received a booster. As new effective pharmaceutical treatments are now available and requirements for non-pharmaceutical interventions (e.g. masking) are relaxed, perceptions of the risk and health consequences of SARS-CoV-2 infection have decreased, risking potential resurgence. This June 2022 cross-sectional comparative study of representative samples in New York City (NYC, n = 2500) and the United States (US, n = 1000) aimed to assess differences in reported vaccine acceptance as well as attitudes toward vaccination mandates and new COVID-19 information and treatments. NYC respondents reported higher COVID-19 vaccine acceptance and support for vaccine mandate than U.S. respondents, yet lower acceptance for the booster dose. Nearly one-third of both NYC and U.S. respondents reported paying less attention to COVID-19 vaccine information than a year earlier, suggesting health communicators may need innovation and creativity to reach those with waning attention to COVID-19-related information.

The Need for Systems Approaches for Precision Communications in Public Health.

A major challenge in communicating health-related information is the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. To date, public health communications approaches have often not adequately accounted for the complexities of these systems to the degree necessary to have maximum impact. The virality of COVID-19 misinformation and disinformation has brought to light the need to consider these system complexities more extensively. Unaided, it is difficult for humans to see and fully understand complex systems. Luckily, there are a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. Using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.

Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019.

Importance: Patients with chronic pain often receive long-term opioid therapy (LOT), which places them at risk of opioid use disorder and overdose. This presents the need for alternative or companion treatments; however, few studies on the association of medical cannabis (MC) with reducing opioid dosages exist. Objective: To assess changes in opioid dosages among patients receiving MC for longer duration compared with shorter duration. Design, Setting, and Participants: This cohort study of New York State Prescription Monitoring Program data from 2017 to 2019 included patients receiving MC for chronic pain while also receiving opioid treatment. Of these, patients receiving LOT prior to receiving MC were selected. Individuals were studied for 8 months after starting MC. Data were analyzed from November 2021 to February 2022. Exposures: Selected patients were divided into 2 groups based on the duration of receiving MC: the nonexposure group received MC for 30 days or fewer, and the exposure group received MC for more than 30 days. Main Outcomes and Measures: The main outcome was opioid dosage, measured by mean daily morphine milligram equivalent (MME). Analyses were conducted for 3 strata by opioid dosage prior to receiving MC: MME less than 50, MME of 50 to less than 90, and MME of 90 or greater. Results: A total of 8165 patients were included, with 4041 (median [IQR] age, 57 [47-65] years; 2376 [58.8%] female) in the exposure group and 4124 (median [IQR] age, 54 (44-62) years; 2370 [57.5%] female) in the nonexposure group. Median (IQR) baseline MMEs for the exposure vs nonexposure groups were 30.0 (20.0-40.0) vs 30.0 (20.0-40.0) in the lowest stratum, 60.0 (60.0-70.0) vs 60.0 (60.0-90.0) in the middle stratum, and 150.0 (100.0-216.2) vs 135.0 (100.0-218.0) in the highest stratum. During follow-up, significantly greater reductions in opioid dosage were observed among the exposure group. A dose-response association of patients' opioid dosage at baseline was observed with the differences in the monthly MME reductions between exposure and nonexposure groups, with a difference of -1.52 (95% CI, -1.67 to -1.37) MME for the lowest stratum, -3.24 (95% CI, -3.61 to -2.87) MME for the middle stratum, and -9.33 (95% CI, -9.89 to -8.77) MME for the highest stratum. The daily MME for the last month of the follow-up period among patients receiving longer MC was reduced by 48% in the lowest stratum, 47% in the middle stratum, and 51% in the highest stratum compared with the baseline dosages. Among individuals in the nonexposure group, daily MME was reduced by only 4% in the lowest stratum, 9% in the middle stratum, and 14% in the highest stratum. Conclusions and Relevance: In this cohort study of patients receiving LOT, receiving MC for a longer duration was associated with reductions in opioid dosages, which may lower their risk of opioid-related morbidity and mortality.

Covid-19 Vaccine Effectiveness in New York State.

BACKGROUND: Population-based data from the United States on the effectiveness of the three coronavirus disease 2019 (Covid-19) vaccines currently authorized by the Food and Drug Administration are limited. Whether declines in effectiveness are due to waning immunity, the B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or other causes is unknown. METHODS: We used data for 8,690,825 adults in New York State to assess the effectiveness of the BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines against laboratory-confirmed Covid-19 and hospitalization with Covid-19 (i.e., Covid-19 diagnosed at or after admission). We compared cohorts defined according to vaccine product received, age, and month of full vaccination with age-specific unvaccinated cohorts by linking statewide testing, hospital, and vaccine registry databases. We assessed vaccine effectiveness against Covid-19 from May 1 through September 3, 2021, and against hospitalization with Covid-19 from May 1 through August 31, 2021. RESULTS: There were 150,865 cases of Covid-19 and 14,477 hospitalizations with Covid-19. During the week of May 1, 2021, when the delta variant made up 1.8% of the circulating variants, the median vaccine effectiveness against Covid-19 was 91.3% (range, 84.1 to 97.0) for BNT162b2, 96.9% (range, 93.7 to 98.0) for mRNA-1273, and 86.6% (range, 77.8 to 89.7) for Ad26.COV2.S. Subsequently, effectiveness declined contemporaneously in all cohorts, from a median of 93.4% (range, 77.8 to 98.0) during the week of May 1 to a nadir of 73.5% (range, 13.8 to 90.0) around July 10, when the prevalence of the delta variant was 85.3%. By the week of August 28, when the prevalence of the delta variant was 99.6%, the effectiveness was 74.2% (range, 63.4 to 86.8). Effectiveness against hospitalization with Covid-19 among adults 18 to 64 years of age remained almost exclusively greater than 86%, with no apparent time trend. Effectiveness declined from May through August among persons 65 years of age or older who had received BNT162b2 (from 94.8 to 88.6%) or mRNA-1273 (from 97.1 to 93.7%). The effectiveness of Ad26.COV2.S was lower than that of the other vaccines, with no trend observed over time (range, 80.0 to 90.6%). CONCLUSIONS: The effectiveness of the three vaccines against Covid-19 declined after the delta variant became predominant. The effectiveness against hospitalization remained high, with modest declines limited to BNT162b2 and mRNA-1273 recipients 65 years of age or older.

New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status - New York, May 3-July 25, 2021.

Data from randomized clinical trials and real-world observational studies show that all three COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration* are safe and highly effective for preventing COVID-19-related serious illness, hospitalization, and death (1,2). Studies of vaccine effectiveness (VE) for preventing new infections and hospitalizations attributable to SARS-CoV-2, the virus that causes COVID-19), particularly as the B.1.617.2 (Delta) variant has become predominant, are limited in the United States (3). In this study, the New York State Department of Health linked statewide immunization, laboratory testing, and hospitalization databases for New York to estimate rates of new laboratory-confirmed COVID-19 cases and hospitalizations by vaccination status among adults, as well as corresponding VE for full vaccination in the population, across all three authorized vaccine products. During May 3-July 25, 2021, the overall age-adjusted VE against new COVID-19 cases for all adults declined from 91.8% to 75.0%. During the same period, the overall age-adjusted VE against hospitalization was relatively stable, ranging from 89.5% to 95.1%. Currently authorized vaccines have high effectiveness against COVID-19 hospitalization, but effectiveness against new cases appears to have declined in recent months, coinciding with the Delta variant's increase from <2% to >80% in the U.S. region that includes New York and relaxation of masking and physical distancing recommendations. To reduce new COVID-19 cases and hospitalizations, these findings support the implementation of a layered approach centered on vaccination, as well as other prevention strategies such as masking and physical distancing.

New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status - New York, May 3-July 25, 2021.

Data from randomized clinical trials and real-world observational studies show that all three COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration* are safe and highly effective for preventing COVID-19-related serious illness, hospitalization, and death (1,2). Studies of vaccine effectiveness (VE) for preventing new infections and hospitalizations attributable to SARS-CoV-2, the virus that causes COVID-19), particularly as the B.1.617.2 (Delta) variant has become predominant, are limited in the United States (3). In this study, the New York State Department of Health linked statewide immunization, laboratory testing, and hospitalization databases for New York to estimate rates of new laboratory-confirmed COVID-19 cases and hospitalizations by vaccination status among adults, as well as corresponding VE for full vaccination in the population, across all three authorized vaccine products. During May 3-July 25, 2021, the overall age-adjusted VE against new COVID-19 cases for all adults declined from 91.7% to 79.8%. During the same period, the overall age-adjusted VE against hospitalization was relatively stable, ranging from 91.9% to 95.3%. Currently authorized vaccines have high effectiveness against COVID-19 hospitalization, but effectiveness against new cases appears to have declined in recent months, coinciding with the Delta variant's increase from <2% to >80% in the U.S. region that includes New York and relaxation of masking and physical distancing recommendations. To reduce new COVID-19 cases and hospitalizations, these findings support the implementation of a layered approach centered on vaccination, as well as other prevention strategies such as masking and physical distancing.

Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York.

PURPOSE: New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS: We conducted a statewide seroprevalence study in a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first poststratification weighting and then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing the number of diagnoses by the number of estimated infection-experienced adults. RESULTS: Based on 1887 of 15,101 (12.5%) reactive results, estimated cumulative incidence through March 29 was 14.0% (95% confidence interval [CI]: 13.3%-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City 22.7% (95% CI: 21.5%-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, P < .0001). An estimated 8.9% (95% CI: 8.4%-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults aged 55 years or older (11.3%, 95% CI: 10.4%-12.2%). CONCLUSIONS: From the largest U.S. serosurvey to date, we estimated >2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained less than herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.

Peeling lead paint turns into poisonous dust. Guess where it ends up? A media campaign to prevent childhood lead poisoning in New York City.

Successful public health media campaigns promote messages, increase awareness, engage the public, and encourage behavior change. Between 2004 and 2006, the Lead Poisoning Prevention Program of the New York City Department of Health and Mental Hygiene conducted a media campaign grounded in social learning theory and the social marketing model to increase parents' awareness of childhood lead poisoning, ways to protect their children, and property owners' legal responsibility to fix peeling lead paint safely, and increase awareness of regulatory changes and encourage enforcement of New York City's Local Law 1 of 2004. Campaign materials were focus group tested and the campaign was refined annually. The campaign ran city-wide and in targeted high-risk neighborhoods. Neighborhoods and media venue (bus, train, kiosk, and store) changed annually, based on population risk factors and venue availability. Exposure to the campaign, campaign-related knowledge, and behavior were assessed using pre- and postcampaign street intercept surveys. Results showed that campaign reached the targeted population, and had an impact on knowledge of lead poisoning prevention measures as evidenced by increased knowledge of lead paint exposures sources in one year and increased knowledge of preventive behaviors in another year; these improvements were observed for both genders and most ethnic, primary language, educational attainment, and age groups in each year. Lessons learned indicate that well-targeted media campaigns, designed with audience participation, can reach parents through various venues, and improve key knowledge areas. Evaluation challenges faced include high levels of knowledge at baseline, competing media messages, and balancing between program needs and evaluation design.

The health care home model: primary health care meeting public health goals.

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.

I used to cry every day: a model of the family process of managing displacement.

Community displacing events, natural or human made, are increasing in frequency. By the end of 2009, over 36 million people were known to be displaced worldwide. Displacement is a traumatic experience with significant short- and long-term health consequences. The losses and costs associated with displacement-social connections, employment, property, and economic capital-are felt not only by the displaced individuals but also the communities they have left behind, and the communities that receive displaced individuals. Many researchers have explored the link between health and reduced social, cultural, and economic capital. Most of the displacement literature focuses on the effect of displacement on the displaced individual; however, many families move as a group. In this study, we examined the family process of managing displacement and its associated capital losses by conducting interviews with 20 families. We found that families undergo a four-phase process of displacement: antecedent, uprooting, transition, and resettlement. The losses families experience impact the health and well-being of individuals, families, and communities. The degree to which the displacement process ends successfully, or ends at all, can be affected by efforts to both create connections within the new communities and rebuild economic and social capital.

Ryan White CARE Act Title IV programs: a preliminary characterization of benefits and costs.

Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990 to address the unmet health needs of persons living with HIV (PLWH) by funding primary healthcare and support services to enhance access to and retention in care. The CARE Act was amended and reauthorized in 1996 and in 2000, and again in December 2006. As originally enacted, the CARE Act was a compromise across a wide political divide. A structure was established that distributed Ryan White CARE Act (RWCA) funds through five federal titles, with different parameters set for each title. Some funds were placed under federal control, while others were controlled locally and distributed to cities and states. Some funds were earmarked for specific services or populations, such as medications; others could be assigned according to a community's priorities. Title IV, the section of the RWCA dedicated to serving women, children, youth, and families who are infected with and affected by HIV/AIDS, is unique, even given the diversity of the other titles. The Title IV program was first implemented in 1988 as the Pediatric AIDS Demonstration Program. It became part of the CARE Act in 1994, and its purpose was expanded at that time to create better links between medical and support services. Although it is the smallest of the titles, with less than 4 percent of the RWCA budget, it may have the broadest mission: providing medical, logistical, psychosocial, and developmental care not just to persons living with the virus, but to entire families. In addition to its focus on this target population, Title IV is unique in its recognition of the need for, and historic support of, comprehensive systems of care to improve, expand, and coordinate service delivery, HIV-prevention efforts, and clinical research. Title IV was excluded from a 10 percent administrative cap on administrative expenses, which enables its funded programs to accomplish this mission. As of 2003, Title IV supported 74 family projects in 34 states (including Puerto Rico, the District of Columbia, and the Virgin Islands), which was a 28 percent increase in funded grantees and a 35 percent increase in participating states since 1999. However, the program's expansion was not matched with a comparable examination of its impact. Rather, the U.S. Health Resources and Services Administration (HRSA), the agency responsible for administering the RWCA, has focussed its evaluation interests on developing goals to use in evaluating its overall RWCA program and in evaluating shorter-term demonstration projects that have more-limited goals. Previous assessments of HIV/AIDS provider networks have examined the following: The process of network development and the determinants of successful implementation, The feasibility of collecting data from network providers, and The mechanisms of agency collaboration and care coordination at the provider level. Only recently has HRSA begun work on developing theoretical frameworks that are useful in exploring the relationships between network characteristics, participating providers, and clients' health and psychosocial outcomes. An examination of Title IV projects is appropriate for a number of reasons. No systematic study of the program has been published to date. Knowledge of the organization of Title IV projects, as well as the services they provide, will improve policy makers' understanding of the range and importance of the strategies that Title IV programs use to meet the needs of the populations they serve. Moreover, as the demand for RWCA funding grows, Title IV projects could offer a model for the efficient deployment of scarce resources.