Supporting Rural Community Emergency Planning, Response, and Recovery.

When rural communities are faced with an emergency or disaster, their capacity to support the response is often exceeded. The NORC Walsh Center for Rural Health Analysis and the Rural Health Information Hub (RHIhub) developed the Rural Emergency Preparedness and Response Toolkit (the Toolkit) to support rural communities with disaster planning, response, and recovery. The Toolkit provides information drawn from literature, subject matter experts, and case studies and shares key considerations for emergency preparedness. This article highlights the development of and key insights from the Toolkit, including preparedness frameworks, population considerations, plan and assessment examples, and funding support. Investing in emergency preparedness is vital for rural communities and this Toolkit offers strategies and best practices for each phase of a disaster.

Experiences of Technology-Facilitated Abuse Among Sexual and Gender Minorities.

Technology-facilitated abuse (TFA) against sexual and gender minority (SGM) adults is a serious though understudied issue. Few studies have examined the types, extent, and perpetrators of TFA against SGMs, and those that have analyzed any of these phenomena have mostly done so with samples of youths. This article offers results of a nationally representative survey on experiences of TFA among a sample of 2,752 U.S. adults aged 18 to 35 years, including 504 SGMs. The prevalence and types of TFA against SGMs were examined using a 27-item inventory capturing six general types of TFA, including surveillance, cyber-interference/communications, reputational harm, monitoring/tracking, fraud, and controlling/limiting access. Respondents could also indicate their relationship to the perpetrator. Results revealed significant differences in the prevalence, types, and perpetrators of TFA against SMGs (compared to non-SGMs), such that SGMs experienced greater levels of TFA victimization, were more likely to be victimized by perpetrators who were not intimate or ex-intimate partners, and were more likely to experience all forms of TFA, except for monitoring/tracking. No significant differences were found for general experiences of TFA victimization between cisgender and non-cisgender individuals or between sexual minority males and sexual minority females. Results thus show that although SGMs and non-SGMs experience similar types of TFA, SGMs experience TFA at higher rates. These findings provide a vital foundation for future work on TFA victimization among SGMs and offer insights for policy and practice, particularly for practitioners and clinicians working with SGMs. Findings indicate a potential need for greater access to health care, victim services, technological support, and legal aid for SGMs due to their increased risk of TFA victimization.

How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity.

INTRODUCTION: Healthy People establishes national goals and specific measurable objectives to improve the health and well-being of the nation. An overarching goal of Healthy People 2030 is to "eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all." To inform Healthy People 2030 health equity and health disparities content and products, the US Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with NORC at the University of Chicago, conducted a review of peer-reviewed and gray literature to examine how health equity is defined, conceptualized, and measured by public health professionals. METHODS: We reviewed (1) peer-reviewed literature, (2) HHS and other public health organization Web sites, and (3) state and territorial health department plans. We also conducted targeted searches of the gray literature to identify tools and recommendations for measuring health equity. RESULTS: While definitions of health equity identified in the scan varied, they often addressed similar concepts, including "highest level of health for all people," "opportunity for all," and "absence of disparities." Measuring health equity is challenging; however, strategies to measure and track progress toward health equity have emerged. There are a range of tools and resources that have the potential to help decision makers address health equity, such as health impact assessments, community health improvement plans, and adapting a Health in All Policies approach. Tools that visualize health equity data also support data-driven decision making. DISCUSSION: Using similar language when discussing health equity will help align and advance efforts to improve health and well-being for all. Healthy People objectives, measures, and targets can help public health professionals advance health equity in their work. HHS ODPHP continues to develop Healthy People tools and resources to support public health professionals as they work with cross-sector partners to achieve health equity.

Prevalence of Adverse Childhood Experiences (ACEs) and associated health risks and risk behaviors among young women and men in Honduras.

BACKGROUND: Adverse Childhood Experiences (ACEs) are potentially traumatic childhood events associated with negative health outcomes. Limited data on ACEs exists from low- and middle-income countries (LMICs). No ACEs studies have been done in Honduras. OBJECTIVE: This study assessed the prevalence of ACEs in Honduras and associated health risks and risk behaviors among young adults. PARTICIPANTS AND SETTING: Data from the 2017 Honduras Violence Against Children and Youth Survey (VACS) were used. Analyses were restricted to participants ages 18-24 years (n = 2701). METHODS: This study uses nationally representative VACS data to estimate the weighted prevalence of ACEs (physical, emotional, and sexual violence; witnessing violence; parental migration). Logistic regression analyses assessed the relationship between individual ACEs, cumulative ACEs, and health risks and risk behaviors (psychological distress; suicide ideation or self-harm; binge drinking; smoking; drug use; STIs; early pregnancy). Chi-square tests examined differences by sex. RESULTS: An estimated 77 % of 18-24 year olds in Honduras experienced at least 1 ACE and 39 % experienced 3+ ACEs. Women experienced significantly more sexual, emotional, and physical violence compared to men. Compared to youth with no ACEs, those with 1-2 ACEs and 3+ ACEs had 1.8 and 2.8 increased odds for psychological distress, 2.3 and 6.4 increased odds for suicidal ideation and self-harm, and 1.7 and 1.9 increased odds for smoking, respectively, adjusting for age, education, and food insecurity. Physical violence victimization and witnessing violence in the community were associated with increased odds of all health risks and risk behaviors. CONCLUSIONS: The high prevalence of ACEs and associated negative health risks and risk behaviors in this population support the need for prevention and early intervention for ACEs.

Healthcare needs and utilization patterns of sex-trafficked youth: Missed opportunities at a children's hospital.

BACKGROUND: Domestic minor sex-trafficked (DMST) youth experience profound medical and mental health consequences. This retrospective study reviewed healthcare utilization patterns and documented individualized risk factors of sex-trafficked youth in the 5 years prior to presenting to a healthcare setting. The primary aim of this study was to examine healthcare utilization patterns among DMST youth with the goal of determining opportunities for earlier identification within the healthcare system. METHODS: A chart review was conducted of all patients <18 years old referred for suspected or confirmed sex trafficking to a child and adolescent protection centre (CAPC) in an urban, academic children's hospital in Washington, DC from January 1, 2006 to March 1, 2017. Patients were seen by a child abuse pediatrician or a trauma-informed social worker in an inpatient, outpatient, or emergency department setting. Demographics and medical, psychiatric, and social history were abstracted from encounters within the hospital's healthcare system along with provider concern for DMST up to 5 years prior to their initial CAPC visit. Descriptive statistics were performed. RESULTS: Thirty-nine patients were identified with a mean age of 14.6 years (SD = 1.7). Ninety percent (n = 35/39) of patients were seen in the healthcare system within the 5 years prior to their initial CAPC visit, totaling 191 encounters. Of the visits, 57% (n = 108/191) occurred in the emergency department. The most common chief complaints for encounters were psychiatric (21%, n = 41/191). Less than half of the youth, 43%, had any documented provider concern for sex trafficking in their medical record prior to identification as DMST. CONCLUSION: Most of this cohort was previously evaluated within the healthcare system. However, there was limited provider documentation of concern for DMST despite the presence of risk factors. Provider recognition of youth at risk for DMST is crucial for providing care for youth.

Featured counter-trafficking program: The CAREs clinic, a primary care medical home for commercially exploited youth.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes a medical home model of care to serve the complex medical and mental health needs of commercially sexually exploited youth. Located in Washington D.C., US, it provides coordinated ongoing primary, mental health, and reproductive health care in a trauma-informed manner. Serving 62 youth during its first year, the medical home has begun to improve access to high-quality healthcare to a very vulnerable population.

Perceptions of Health Care Transition Care Coordination in Patients With Chronic Illness.

OBJECTIVES: Expert consensus jointly authored in 2011 by the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians supports the use of health care transition (HCT) care coordination (CC). Although gaps in care are addressed in these practice-based implementation recommendations, such recommendations have never undergone rigorous assessment. We assessed the effectiveness of implementation on quality of chronic illness care and CC during HCT for adolescents and young adults. METHODS: Adolescents and young adults with special health care needs were enrolled in a randomized HCT CC intervention. Intervention participants received HCT CC as outlined in the 2011 clinical report. Perceptions of chronic illness care quality and CC were assessed at 0, 6, and 12 months. RESULTS: Intervention participants had a Patient Assessment of Chronic Illness Care score at 12 months of 3.6 vs 3.3 compared with participants in the control group (P = .01). Intervention participants had higher average scores for patient activation (3.7 vs 3.4; P = .01), problem solving (3.8 vs 3.4; P = .02), and coordination/follow-up (3.0 vs 2.5; P < .01). The Client Perceptions of Coordination Questionnaire revealed that intervention participants had 2.5 times increased odds to endorse mostly or always receiving the services they thought they needed and had 2.4 times increased odds to have talked to their provider about future care (P < .01). CONCLUSIONS: Implementing recommended HCT CC practices improved patient or patient caregiver perception of quality of chronic illness care and CC especially among the most complex patients.