A Systematic Approach to Translating Evidence into Practice to Reduce Infant Mortality.

Purpose To provide recommendations for improving rates of infant mortality in a U.S. southeastern city using a collective impact approach. Description A convening organization and its academic partner devised a systematic process involving national experts and local stakeholders. Assessment A panel of infant mortality experts reached consensus on eight recommendations and three key overarching principles. Local stakeholder groups advanced four recommendations, of which three aligned closely with expert panel recommendations: (1) increasing access to, and use of 17-alpha hydroxyprogesterone caproate (17P); (2) reshaping housing policy using a health lens, and (3) supporting pre-conception health, intra-conception health and family planning. Conclusion The dynamic process of recommendation development occurred within a larger collective impact framework and can be used to shape a community-based approach to infant mortality. Other communities interested in improving rates of infant mortality or tackling other challenging public health issues could engage in a similar process.

Psychiatric Medication, African Americans and the Paradox of Mistrust.

OBJECTIVES: To examine race differences in how generalized mistrust, mistrust in physicians, and mistrust in psychiatric medication shape the willingness to utilize psychiatric medication. METHODS: Data was used from two waves (1998 and 2006) of the U.S. General Social Survey a representative sample of non-institutionalized Americans. We analyzed data for 343 African American and 1,920 white adults, ages 18-89. The data included measures of the respondents' willingness to utilize psychiatric medication as well as measures of generalized mistrust, mistrust in physicians, and mistrust in psychiatric medication. We employed ordinary least squares regression to test whether these three forms of mistrust reduce the black-white gap in psychiatric drug usage and whether race moderates the association between any type of mistrust and the willingness to endorse psychiatric medication utilization. RESULTS: Mistrust in physicians and psychiatric medication is related to less willingness to utilize psychiatric medicines for both African Americans and whites; however, paradoxically, these forms of mistrust decrease psychiatric drug usage more steeply for whites. CONCLUSIONS: The pattern of findings in this study suggests that trust or low levels of mistrust, rather than high levels of mistrust, actually maintains the black-white difference in the use of psychiatric medication.