Instruments for racial health equity: a scoping review of structural racism measurement, 2019-2021.

Progress toward racial health equity cannot be made if we cannot measure its fundamental driver - structural racism. As in other epidemiological studies, the first step is to measure the exposure. But how to measure structural racism is an ongoing debate. To characterize the approaches epidemiologists and other health researchers use to quantitatively measure structural racism, highlight methodological innovations, and identify gaps in the literature, we conducted a scoping review of the peer-reviewed and grey literature published during 2019-2021 to accompany the work of Groos et al. (J Health Dispar Res Pract. 2018;11(2):Article 13), which surveys the scope of structural racism measurement up to 2017. We identified several themes from the recent literature: the current predominant focus on measuring anti-Black racism, using residential segregation as well as other segregation-driven measures as proxies of structural racism, measuring structural racism as spatial exposures, an increasing call by epidemiologists and other health researchers to measure structural racism as a multidimensional, multi-level determinant of health and related innovations, the development of policy databases, the utility of simulated counterfactual approaches in the understanding of how structural racism drive racial health inequities, and the lack of measures of antiracism and limited work on later life effects. Our findings sketch out several future steps to improve the science around structural racism measurements, which is the key to advancing antiracism policies.

Applications of Complex Systems Models to Improve Retail Food Environments for Population Health: A Scoping Review.

Retail food environments (RFEs) are complex systems with important implications for population health. Studying the complexity within RFEs comes with challenges. Complex systems models are computational tools that can help. We performed a systematic scoping review of studies that used complex systems models to study RFEs for population health. We examined the purpose for using the model, RFE features represented, extent to which the complex systems approach was maximized, and quality and transparency of methods employed. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Studies using agent-based modeling, system dynamics, discrete event simulations, networks, hybrid, or microsimulation models were identified from 7 multidisciplinary databases. Fifty-six studies met the inclusion criteria, including 23 microsimulation, 13 agent-based, 10 hybrid, 4 system dynamics, 4 network, and 2 discrete event simulation models. Most studies (n = 45) used models for experimental purposes and evaluated effects of simulated RFE policies and interventions. RFE characteristics simulated in models were diverse, and included the features (e.g., prices) customers encounter when shopping (n = 55), the settings (e.g., restaurants, supermarkets) where customers purchase food and beverages (n = 30), and the actors (e.g., store managers, suppliers) who make decisions that influence RFEs (n = 25). All models incorporated characteristics of complexity (e.g., feedbacks, conceptual representation of multiple levels), but these were captured to varying degrees across model types. The quality of methods was adequate overall; however, few studies engaged stakeholders (n = 10) or provided sufficient transparency to verify the model (n = 12). Complex systems models are increasingly utilized to study RFEs and their contributions to public health. Opportunities to advance the use of these approaches remain, and areas to improve future research are discussed. This comprehensive review provides the first marker of the utility of leveraging these approaches to address RFEs for population health.

Addressing Disparities in Physician Access to Information in Support of Evidence-based Practice.

The purpose of this study is to determine if Minnesota physicians have access to information resources needed to support evidence-based practice (EBP), which supports a culture of safety and patient-centered care. A survey was used to determine Minnesota physicians' need for, and access to, evidence-based clinical information. A total of 877 responses (6.4% response rate) were included in the data analysis. Participants spent 24 min daily seeking answers to clinical questions and averaged 4.41 questions per day that could not be immediately answered. Physicians reported high levels of information needs met (85.8%), though they reported limited access to drug resources, citation databases, systematic reviews, and full-text books and articles. Results also showed use of unreliable sources to support decision-making. A key finding was the extent to which workplace affiliation broadens disparities in information access. National and regional approaches can work to support EBP by reducing the information gap caused by workplace affiliation and other barriers. Further research should be done to identify partnerships, funding, infrastructure, and support to address these gaps.

Combating HIV stigma in low- and middle-income healthcare settings: a scoping review.

INTRODUCTION: Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. METHODS: We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. RESULTS AND DISCUSSION: Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. CONCLUSIONS: Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

Understanding Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women: A Review of the Literature.

PURPOSE OF REVIEW: a)Prostate cancer in sexual and gender minorities is an emerging medical and public health concern. The purpose of this review is to summarize the state of the science on prostate cancer in gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). We undertook a literature review of all publications on this topic through February 2017. With 88 unique papers (83) on prostate cancer in GBM and 5 case reports of prostate cancer in TGW), a small but robust literature has emerged. RECENT FINDINGS: b)The first half of this review critiques the literature to date, identifying gaps in approaches to study. The second half summarizes the key findings in eleven areas. In light of this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men, but they are diagnosed with prostate cancer at about the same rate. SUMMARY: c)Compared to other men, GBM have poorer urinary, bowel, and overall quality-of-life outcomes but better sexual outcomes after treatment; all these findings need more research. Prostate cancer in TGW remains rare and under researched, as the literature is limited to single-case clinical reports.

A qualitative analysis of the information science needs of public health researchers in an academic setting.

OBJECTIVES: The University of Minnesota (UMN) Health Sciences Libraries conducted a needs assessment of public health researchers as part of a multi-institutional study led by Ithaka S+R. The aims of the study were to capture the evolving needs, opportunities, and challenges of public health researchers in the current environment and provide actionable recommendations. This paper reports on the data collected at the UMN site. METHODS: Participants (n=24) were recruited through convenience sampling. One-on-one interviews, held November 2016 to January 2017, were audio-recorded. Qualitative analyses were conducted using NVivo 11 Pro and were based on the principles of grounded theory. RESULTS: The data revealed that a broad range of skill levels among participants (e.g., literature searching) and areas of misunderstanding (e.g., current publishing landscape, open access options). Overall, data management was an afterthought. Few participants were fully aware of the breadth of librarian knowledge and skill sets, although many did express a desire for further skill development in information science. CONCLUSIONS: Libraries can engage more public health researchers by utilizing targeted and individualized marketing regarding services. We can promote open science by educating researchers on publication realities and enhancing our data visualization skills. Libraries might take an institution-wide leadership role on matters of data management and data policy compliance. Finally, as team science emerges as a research priority, we can offer our networking expertise. These support services may reduce the stresses that public health researchers feel in the current research environment.

Somali American female refugees discuss their attitudes toward homosexuality and the gay and lesbian community.

Minnesota is home to the largest population of Somalis in the USA - most arriving as refugees from the civil war in Somalia. As Somali Americans adjust to life in the USA, they are likely to undergo shifts in their belief systems - including changes in their attitudes toward gays and lesbians. We examined the attitudes of 29 Somali American women in the Minneapolis-St. Paul metropolitan area toward homosexuality via face-to-face, semi-structured interviews. Transcripts were translated, transcribed and analysed using an approach informed by grounded theory. Three major themes were identified: (1) Islamic prohibitions against homosexuality; (2) homosexuals exiled to a hidden community; and (3) community members exploring tolerance. Participants' attitudes toward homosexuality were heavily influenced by religious doctrines and cultural contexts. This is the first known study in the USA of Somali American attitudes toward gays and lesbians. As people mass migrate from nations with negative attitudes toward homosexuality to countries with more progressive attitudes toward varied sexual orientations, refugee attitudes about homosexuality will undergo change. Through research and education, we can better understand how to increase tolerance toward and opportunities for visibility among gay and lesbian refugees throughout the diaspora.

Changes in alcohol policies and practices in bars and restaurants after completion of manager-focused responsible service training.

INTRODUCTION AND AIMS: Irresponsible and illegal serving practices at bars and restaurants, such as sales to obviously intoxicated patrons, can lead to various public health harms. Training managers of bars and restaurants in the development and promotion of responsible alcohol policies may help prevent risky and illegal alcohol serving practices. DESIGN AND METHODS: We implemented a training program for managers of bars/restaurants designed to establish and promote responsible beverage service policies/practices. The program included online and in-person components. Bars/restaurants were randomised to intervention (n = 171) and control (n = 163) groups. To assess changes in policies/practices, we surveyed managers prior to and at 1 and 6 months post-training. Logistic regression models assessed changes in policies/practices across time points. RESULTS: The proportion in the intervention group that had written alcohol policies increased from 62% to 95% by 6 months post-training while the control group increased from 65% to 79% (P < 0.05). Similarly, by 6 months post-training 70% of managers in the intervention group reported they had communicated to their staff how to cut off intoxicated patrons, a significant increase from baseline (37%) and from the change observed in the control group (43%-56%). Prevalence of other policies/practices also increased post-training but differences between intervention and control groups were not statistically significant. DISCUSSION AND CONCLUSIONS: Our training program appears to have led to implementation of some policies/practices. Additional studies are needed to determine how training can be combined with other strategies to further improve establishment policies and ultimately reduce alcohol-related harms.

Effects of a Hybrid Online and In-Person Training Program Designed to Reduce Alcohol Sales to Obviously Intoxicated Patrons.

OBJECTIVE: Overservice of alcohol (i.e., selling alcohol to intoxicated patrons) continues to be a problem at bars and restaurants, contributing to serious consequences such as traffic crashes and violence. We developed a training program for managers of bars and restaurants, eARM™, focusing on preventing overservice of alcohol. The program included online and face-to-face components to help create and implement establishment-specific policies. METHOD: We conducted a large, randomized controlled trial in bars and restaurants in one metropolitan area in the midwestern United States to evaluate effects of the eARM program on the likelihood of selling alcohol to obviously intoxicated patrons. Our outcome measure was pseudo-intoxicated purchase attempts-buyers acted out signs of intoxication while attempting to purchase alcohol-conducted at baseline and then at 1 month, 3 months, and 6 months after training. We conducted intention-to-treat analyses on changes in purchase attempts in intervention (n = 171) versus control (n = 163) bars/restaurants using a Time × Condition interaction, as well as planned contrasts between baseline and follow-up purchase attempts. RESULTS: The overall Time × Condition interaction was not statistically significant. At 1 month after training, we observed a 6% relative reduction in likelihood of selling to obviously intoxicated patrons in intervention versus control bars/restaurants. At 3 months after training, this difference widened to a 12% relative reduction; however, at 6 months this difference dissipated. None of these specific contrasts were statistically significant (p = .05). CONCLUSIONS: The observed effects of this enhanced training program are consistent with prior research showing modest initial effects followed by a decay within 6 months of the core training. Unless better training methods are identified, training programs are inadequate as the sole approach to reduce overservice of alcohol.

Attitudes and Practices Regarding Responsible Beverage Service: Focus Group Discussions With Bar and Restaurant Management and Staff.

Staff and management of bars and restaurants are the key players in assuring responsible beverage service (RBS) and preventing the overservice of alcohol to intoxicated patrons. We conducted six focus group discussions ( N = 42) with management and staff from bars and restaurants about RBS. We compared findings from these current discussions to results of focus group discussions conducted in the 1990s. In comparison to the earlier focus group discussions, we found that many managers and staff members had experience with RBS training programs, establishments generally had written alcohol service policies, and managers and staff members perceived greater likelihood of facing consequences from law enforcement for serving underage youth. Managers and servers also expressed greater concern about overservice of alcohol but did not report greater concern about potential legal consequences for overservice of alcohol than participants from the 1990s focus groups. Results of this study can inform training and enforcement approaches to addressing overservice of alcohol.

Developing Internet-based health interventions: a guide for public health researchers and practitioners.

BACKGROUND: Researchers and practitioners interested in developing online health interventions most often rely on Web-based and print resources to guide them through the process of online intervention development. Although useful for understanding many aspects of best practices for website development, missing from these resources are concrete examples of experiences in online intervention development for health apps from the perspective of those conducting online health interventions. OBJECTIVE: This study aims to serve as a series of case studies in the development of online health interventions to provide insights for researchers and practitioners who are considering technology-based interventional or programmatic approaches. METHODS: A convenience sample of six study coordinators and five principal investigators at a large, US-based land grant university were interviewed about the process of developing online interventions in the areas of alcohol policy, adolescent health, medication adherence, and human immunodeficiency virus prevention in transgender persons and in men who have sex with men. Participants were asked questions that broadly addressed each of the four phases of the User-Centered Design Process Map from the US Department of Health and Human Services' Research-Based Web Design & Usability Guidelines. Interviews were audio recorded and transcribed. Qualitative codes were developed using line-by-line open coding for all transcripts, and all transcripts were coded independently by at least 2 authors. Differences among coders were resolved with discussion. RESULTS: We identified the following seven themes: (1) hire a strong (or at least the right) research team, (2) take time to plan before beginning the design process, (3) recognize that vendors and researchers have differing values, objectives, and language, (4) develop a detailed contract, (5) document all decisions and development activities, (6) use a content management system, and (7) allow extra time for testing and debugging your intervention. Each of these areas is discussed in detail, with supporting quotations from principal investigators and study coordinators. CONCLUSIONS: The values held by members of each participating organization involved in the development of the online intervention or program, as well as the objectives that are trying to be met with the website, must be considered. These defined values and objectives should prompt an open and explicit discussion about the scope of work, budget, and other needs from the perspectives of each organization. Because of the complexity of developing online interventions, researchers and practitioners should become familiar with the process and how it may differ from the development and implementation of in-person interventions or programs. To assist with this, the intervention team should consider expanding the team to include experts in computer science or learning technologies, as well as taking advantage of institutional resources that will be needed for successful completion of the project. Finally, we describe the tradeoff between funds available for online intervention or program development and the complexity of the project.