Addressing Trauma-Informed Principles in Public Health through Training and Practice.

The increasing prevalence of traumatic events requires our public health workforce to be knowledgeable about ways trauma influences population and individual health. There is a gap in student training about the various ways that traumatic events affect their capacity to perform public health work and the communities they serve. While other human services disciplines explicitly use trauma-informed terminology and concepts in student training, references to trauma-informed approaches are more implicit in public health curricula. This study examined trauma-informed principles and related terminology for use in public health coursework in the context of a community-wide water contamination public health crisis in Flint, Michigan, USA. We addressed the principles of trauma-informed approaches across key competency areas common to USA public health accredited programs, including discussion to support student understanding of the principle in action. Using trauma-informed language (1) enhances our capacity to name and respond empathetically in traumatized communities, (2) provides guiding principles for less community-engaged efforts, and (3) fosters stronger relationships for more community-engaged initiatives by providing areas of accountability for unintended consequences throughout the program's development and implementation processes. Rising public health professionals equipped with knowledge of trauma-informed approaches can more intentionally minimize unintended negative consequences of public health initiatives.

Ableism and Contours of the Attitudinal Environment as Identified by Adults with Long-Term Physical Disabilities: A Qualitative Study.

Adults with physical disabilities experience a continuum of enabling and disabling attitudes in the environment. This study identified where adults with physical disabilities experience the attitudinal environment, the continuum of those attitudes, and how they impact emotional and psychological health and well-being. Focus groups and interviews were conducted in 2019 and 2020 with adults with physical disabilities in southeastern Michigan in the United States. Participants discussed environmental factors that impact healthy aging. From an initial thematic coding of narratives, the attitudinal environment was identified. Transcripts were recoded and analyzed focusing on societal attitudes. Qualitative analyses revealed that participants did not experience societal attitudes as simply positive or negative, and that the contexts in which these attitudes were expressed were not limited to interpersonal interactions. Rather, these attitudes were also experienced in the built environment and through social institutions and organizations and their programs, systems, and structures that provide or deny needed accommodations, resources, and support. The spectrum of overlapping attitudes that participants articulated ranged from understanding and supportive, to not understanding, to being viewed and treated as less than human. Societal structures reflect and influence societal attitudes and have material consequences on the lives of adults with physical disabilities.

"We're Still Here": A Photovoice Study of Mothers' Perspectives 6 Years after the Flint Michigan Water Contamination Event.

Purpose: This study explored the lived experiences of pregnant and parenting women after the water contamination event in Flint, Michigan (Flint Water Contamination Event [FWCE]), by helping them visualize their everyday challenges, assets, and family health concerns. Methods: The photovoice methodology was utilized in this study. Individual participants met with researchers to discuss their photos using the SHOWeD method. Researchers analyzed the photographs, accompanying narratives, and discussion session transcripts using descriptive coding and thematic analysis. Results: Data analysis revealed five themes: (1) having a healthy pregnancy and well children is a central concern in everyday life, (2) children serve as social and practical resources for family, (3) meeting children's need for safe water is a significant concern, (4) the community and its households battle to get safe affordable water, and (5) there are resources available in the community to support mothers. Conclusion: While much information is still being collected and published in the aftermath of the FWCE, this study was the first to use the photovoice method to allow pregnant and parenting women to express their concerns about how the FWCE continues to affect the health and care of their families.

Online engagement and cognitive function among older adults.

AIM: Social engagement is known to serve an important role in cognitive health, but there has been limited information on the role of online engagement. The present study aimed to identify the benefits of different online activities for the cognitive function of older adults. METHODS: Data came from the National Health and Aging Trend Study, Round I-V (2011-2015), with >8000 respondents from Medicare beneficiaries. Cognitive function was measured by the Clock Drawing Test and immediate 10-word recall. The respondents were also asked if they carried out any of the online activities listed. RESULTS: Some online activities, such as email, texting and seeking medical information, can reduce the risk of cognitive decline. Whereas contacting a medical provider using online can increase the risk of cognitive decline. CONCLUSIONS: Given the findings, the development of new technologies for online social engagement needs to be one of the priorities for researchers and policymakers in the field of aging and dementia. Geriatr Gerontol Int 2019; 19: 918-923.

Influences of asthma on reported health indicators and access to health care among children.

BACKGROUND: Studies on the influences of pediatric asthma on health and access to health care were conducted in limited geographic areas or age groups. OBJECTIVE: To investigate associations of asthma with health, use of medical care, mental health or educational services, activity limitations, problems in paying bills, and frustrations in obtaining health care among children in the United States. Caregivers reported children's conditions. METHODS: Logistic regression models were adjusted for sociodemographic factors in the nationally representative 2011/2012 National Survey of Children's Health. RESULTS: Of the 91,116 children 0 to 17 years old, 14.6% had reported asthma. Of children 0 to 17 years old with asthma, 21.2% were non-Hispanic black. Of children 0 to 17 years old without asthma, 12.2% were non-Hispanic black. In children 0 to 17 years old, compared with children without asthma, children with asthma had an increased odds to have reported fair or poor health, receive more medical care, mental health, and educational services than usual, have activity limitations, have medical bills that the family had problems paying (odds ratio 1.5, 95% confidence interval 1.3-1.7), and have caregivers who were frustrated in obtaining care (odds ratio 1.5, 95% confidence interval 1.2-1.7). The odds ratios for the associations between asthma and all outcomes were higher in the 0- to 5-year-old compared with the 6- to 17-year-old group. CONCLUSION: When adjusting for sociodemographic variables, caregivers have problems paying bills and obtaining health care services for their child. To develop age-appropriate interventions, more research is needed to understand why families have difficulties accessing health care.

Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial.

CONTEXT: African American adolescent girls are at high risk for human immunodeficiency virus (HIV) infection, but interventions specifically designed for this population have not reduced HIV risk behaviors. OBJECTIVE: To evaluate the efficacy of an intervention to reduce sexual risk behaviors, sexually transmitted diseases (STDs), and pregnancy and enhance mediators of HIV-preventive behaviors. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of 522 sexually experienced African American girls aged 14 to 18 years screened from December 1996 through April 1999 at 4 community health agencies. Participants completed a self-administered questionnaire and an interview, demonstrated condom application skills, and provided specimens for STD testing. Outcome assessments were made at 6- and 12-month follow-up. INTERVENTION: All participants received four 4-hour group sessions. The intervention emphasized ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison condition emphasized exercise and nutrition. MAIN OUTCOME MEASURES: The primary outcome measure was consistent condom use, defined as condom use during every episode of vaginal intercourse; other outcome measures were sexual behaviors, observed condom application skills, incident STD infection, self-reported pregnancy, and mediators of HIV-preventive behaviors. RESULTS: Relative to the comparison condition, participants in the intervention reported using condoms more consistently in the 30 days preceding the 6-month assessment (unadjusted analysis, intervention, 75.3% vs comparison, 58.2%) and the 12-month assessment (unadjusted analysis, intervention, 73.3% vs comparison, 56.5%) and over the entire 12-month period (adjusted odds ratio, 2.01; 95% confidence interval [CI], 1.28-3.17; P =.003). Participants in the intervention reported using condoms more consistently in the 6 months preceding the 6-month assessment (unadjusted analysis, intervention, 61.3% vs comparison, 42.6%), at the 12-month assessment (unadjusted analysis, intervention, 58.1% vs comparison, 45.3%), and over the entire 12-month period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.50; P<.001). Using generalized estimating equation analyses over the 12-month follow-up, adolescents in the intervention were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, and more likely to apply condoms to sex partners and had better condom application skills, a higher percentage of condom-protected sex acts, fewer unprotected vaginal sex acts, and higher scores on measures of mediators. Promising effects were also observed for chlamydia infections and self-reported pregnancy. CONCLUSION: Interventions for African American adolescent girls that are gender-tailored and culturally congruent can enhance HIV-preventive behaviors, skills, and mediators and may reduce pregnancy and chlamydia infection.