A framework and process for community-engaged, mixed-methods cancer needs assessments.

PURPOSE: Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS: We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS: The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION: This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Toward a more expansive and inclusive definition of women's health: A content analysis of Twitter conversations.

To develop a nuanced understanding of women's health on social media, we conducted a content analysis of Twitter data in early 2020, during the early days of the COVID-19 pandemic. Included tweets (N = 1,714) fell into 15 overarching themes. "Politics and Women's Health" was most discussed, demonstrating the politicization of women's health, followed by "Maternal, Reproductive, and Sexual Health." COVID-19 was a crosscutting issue for 12 themes, suggesting widespread effects on women's health. Overall, diverse conversations unfolded on social media, including variation geographically, highlighting the need for a more expansive and inclusive definition of women's health. This work supports further investigation into the role of politics and COVID-19 across women's health domains.

Exploring Characteristics of Academic General Surgery Residency Applicants: A Group Concept-Mapping Approach.

OBJECTIVE: Holistic review, which emphasizes qualitative attributes over objective measures, has been proposed as a method for selecting candidates for surgical residency in order to improve diversity in graduate medical education, and, ultimately, the field of surgery. This study seeks to articulate desirable traits of applicants as a first-step in standardizing the holistic review process. DESIGN: Using Group Concept Mapping, a web-based mixed-methods participatory research methodology, residency selection committee members were asked to 1) list desirable characteristics of applicants, 2) group these into categories, 3) rate their importance to academic/clinical success on a 5-point Likert scale (1 = not at all important, 5 = extremely important), and 4) rate the degree to which each characteristic is feasible to assess on a 3-point Likert scale (1 = not at all feasible, 3 = very feasible). Grouped characteristics submitted to hierarchical cluster analysis depicted committee's consensus about desirable qualities/criteria for applicants. Bivariate scatter-plots and pattern-matching graphics demonstrated which of these criteria were most important and reliably assessed. SETTING: A single academic general surgery residency training program in Western Pennsylvania. PARTICIPANTS: Members of the selection committee for the UPMC General Surgery Residency program who had participated in at least 1 prior cycle of applicant selection. RESULTS: Desirable characteristics of highly qualified applicants into an academic general surgery residency were clustered into domains of 1) scholarly work and research, 2) grades/formal assessments, 3) program fit, 4) behavioral assets, and 5) aspiration. Behavioral assets, which was felt to be the most important to clinical and academic success were considered to be the least feasible to reliably assess. Within this domain, initiative, being self-motivated, intellectual curiosity, work ethic, communication skills, maturity and self-awareness, and thoughtfulness were viewed as most frequently reliably assessed from the application and interview process. CONCLUSIONS: High quality applicants possess several behavioral assets that faculty deem are important to academic and clinical success. Adapting validated metrics for assessing these assets, may provide a solution for addressing subjectivity and other challenges scrutinized by critics of holistic review.

Developing Community-Based Mentorship: Supporting Health Science Training in Historically Marginalized Communities.

Community mentors can play a unique and critical role in developing and supporting graduate and health professional student learning in underresourced community-based settings. These mentors can benefit from extra preparation for a potentially unfamiliar role as teachers about complex social and structural challenges faced by the populations with which they work. Encouraging mentors to recognize and share their valuable expertise while developing their teaching skills can (1) improve mentors' abilities to work effectively with graduate-level and health science students from multiple disciplines, (2) bolster student learning about important historical social and structural determinants of participants' health, and (3) help students understand the broader context within which organizations serving vulnerable populations operate. As such, in one full-time, community-engaged, interdisciplinary practicum program, Bridging the Gaps-Pittsburgh, part of the multiinstitutional Bridging the Gaps Network, a half-day mentor workshop has been required for two decades for new community mentors to develop their capacity to be community-based teachers of largely graduate-level health science students. Additionally, program staff aim to support mentors and connect them to faculty and community resources in a variety of ways. Our model supports the argument that applied learning by health professional students in community settings can be significantly enhanced through building and supporting the capacity of community mentors to act as recognized teachers in areas of community expertise.

Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia.

OBJECTIVE: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. DATA SOURCE: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. STUDY INCLUSION AND EXCLUSION CRITERIA: Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. DATA EXTRACTION: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. DATA SYNTHESIS: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. RESULTS: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. CONCLUSIONS: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.

Understanding Polarizing Community Perspectives on Harm Reduction Strategies: Challenges to Addressing the Opioid Crisis in Appalachian Pennsylvania.

Introduction: Rural communities face barriers to opioid treatment and overdose prevention including concerns about stigma and lack of harm reduction services. Purpose: The aim of this study was to explore community perspectives and understanding of harm reduction approaches to opioid use and overdose in a high-risk Northern Appalachian case community in Pennsylvania. Methods: A small town approximately 10 miles from Pittsburgh was identified as the community with the greatest predicted probabilities of epidemic outbreak using posteriors from spatial models of hospitalizations for opioid use disorders. We interviewed 20 key stakeholders in the case community in using a semi-structured interview guide and analyzed the qualitative data using an inductive grounded theory approach. Results: Our findings illustrate how conflicting perspectives about opioid dependence lay the foundation for the polarizing community perspectives on addressing opioid use and overdose and general disagreement regarding the legitimacy of harm reduction approaches versus abstinence-based recovery plans. Community members shared varying perspectives on multiple aspects of the opioid epidemic, including appropriate strategies, treatment, and overdose prevention methods and how community leaders and organizations should respond. Implications: Opinions, coupled with a general lack of education regarding opioid use and harm reduction options, make it challenging for small communities with limited resources to create comprehensive plans to address the opioid crisis.

Drivers of opioid use in Appalachian Pennsylvania: Cross-cutting social and community-level factors.

BACKGROUND: Four Appalachian states including Pennsylvania (PA) have the highest drug overdose rates in the country, calling for better understanding of the social and economic drivers of opioid use in the region. Using key informant interviews, we explored the social and community drivers of opioid use in a non-urban Appalachian Pennsylvania community. METHODS: In 2017, we conducted qualitative interviews with 20 key stakeholders from a case community selected using the results from quantitative spatial models of hospitalizations for opioid use disorders. In small town located 10 miles outside Pittsburgh, PA, we asked participants to share their perceptions of contextual factors that influence opioid use among residents. We then used qualitative thematic analysis to organize and generate the results. RESULTS: Participants identified several contextual factors that influence opioid use among residents. Three cross-cutting thematic topics emerged: 1) acceptance and denial of use through familial and peer influences, community environments, and social norms; 2) impacts of economic shifts and community leadership on availability of programs and opportunities; and 3) the role of coping within economic disadvantage and social depression. CONCLUSION: Uncovering multi-level, contextual drivers of opioid use can benefit the development of future public health interventions. These results suggest that social and community-level measures of structural deprivation, acceptance and/or denial of the opioid epidemic, community engagement and development, social support, and social depression are important for future research and programmatic efforts in the Appalachian region.

Introduction to the Theme Issue on Dynamics of Health Behavior: Revisiting Systems Science for Population Health.

Systems science can help public health professionals to better understand the complex dynamics between factors affecting health behaviors and outcomes and to identify intervention opportunities. Despite their demonstrated utility in addressing health topics such influenza, tobacco control, and obesity, the associated methods continue to be underutilized by researchers and practitioners addressing health behaviors. This article discusses the growth of systems science methods (e.g., system dynamics, social network analysis, and agent-based modeling) in health research, provides a frame for the articles included in this themed issue, and closes with recommendations for enhancing the future of systems science and health behavior research. We argue that integrating systems sciences methods into health behavior research and practice is essential for improved population health and look forward to supporting the evolution of the field.

Increasing Community Participation in Public Health Research: Applications for Concept Mapping Methodology.

BACKGROUND: Concept mapping builds on other qualitative methods widely used in community-engaged research and community-based participatory research (CBPR) approaches by adding intentional participatory elements to engage stakeholders and increased data collection structure via built-in quantitative elements. OBJECTIVES: This article presents examples of community-based studies using concept mapping to illustrate how public health researchers can use this method to incorporate participatory elements in projects that vary by research objective and degrees of community engagement. METHODS: Drawing from our previous experience, we present four participatory concept mapping projects. These illustrative research examples focus on projects developed by academic-community partnerships, including a hospital-based community needs assessment, the creation of a domestic violence research agenda, the study of trust in community-academic partnerships, and the development of strategies to address breast cancer through a county-level collaborative. CONCLUSIONS: Through the use of illustrative examples, we provide four research-based applications of concept mapping with a variety of community engagement levels. These examples show how the use of concept mapping as a research method allows for the direct participation of community stakeholders to move research agendas forward. Concept mapping generates this forward movement in public health research through the production of visual representations and action-oriented results that promote the ability of stakeholders to have increased ownership in the improvement of health outcomes in their communities.

Two-photon polymerized poly(caprolactone) retinal cell delivery scaffolds and their systemic and retinal biocompatibility.

Cell replacement therapies are often enhanced by utilizing polymer scaffolds to improve retention or direct cell orientation and migration. Obstacles to refinement of such polymer scaffolds often include challenges in controlling the microstructure of biocompatible molecules in three dimensions at cellular scales. Two-photon polymerization of acrylated poly(caprolactone) (PCL) could offer a means of achieving precise microstructural control of a material in a biocompatible platform. In this work, we studied the effect of various formulation and two-photon polymerization parameters on minimum laser power needed to achieve polymerization, resolution, and fidelity to a target 3D model designed to be used for retinal cell replacement. Overall, we found that increasing the concentration of crosslink-able groups decreased polymerization threshold and the size of resolvable features while increasing fidelity of the scaffold to the 3D model. In general, this improvement was achieved by increasing the number of acrylate groups per prepolymer molecule, increasing the acrylated PCL concentration, or decreasing its molecular weight. Resulting two-photon polymerized PCL scaffolds successfully supported human iPSC derived retinal progenitor cells in vitro. Sub-retinal implantation of cell free scaffolds in a porcine model of retinitis pigmentosa did not cause inflammation, infection or local or systemic toxicity after one month. In addition, comprehensive ISO 10993 testing of photopolymerized scaffolds revealed a favorable biocompatibility profile. These results represent an important step towards understanding how two-photon polymerization can be applied to a wide range of biologically compatible chemistries for various biomedical applications. STATEMENT OF SIGNIFICANCE: Inherited retinal degenerative blindness results from the death of light sensing photoreceptor cells. To restore high-acuity vision a photoreceptor cell replacement strategy will likely be necessary. Unfortunately, single cell injection typically results in poor cell survival and integration post-transplantation. Polymeric biomaterial cell delivery scaffolds can be used to promote donor cell viability, control cellular polarity and increase packing density. A challenge faced in this endeavor has been developing methods suitable for generating scaffolds that can be used to deliver stem cell derived photoreceptors in an ordered columnar orientation (i.e., similar to that of the native retina). In this study we combined the biomaterial poly(caprolactone) with two-photon lithography to generate a biocompatible, clinically relevant scaffold suitable for retina cell delivery.

Effect of Molecular Weight and Functionality on Acrylated Poly(caprolactone) for Stereolithography and Biomedical Applications.

Degradable polymers are integral components in many biomedical polymer applications. The ability of these materials to decompose in situ has become a critical component for tissue engineering, allowing scaffolds to guide cell and tissue growth while facilitating gradual regeneration of native tissue. The objective of this work is to understand the role of prepolymer molecular weight and functionality of photocurable poly(caprolactone) (PCL) in determining reaction kinetics, mechanical properties, polymer degradation, biocompatibility, and suitability for stereolithography. PCL, a degradable polymer used in a number of biomedical applications, was functionalized with acrylate groups to enable photopolymerization and three-dimensional printing via stereolithography. PCL prepolymers with different molecular weights and functionalities were studied to understand the role of molecular structure in reaction kinetics, mechanical properties, and degradation rates. The mechanical properties of photocured PCL were dependent on cross-link density and directly related to the molecular weight and functionality of the prepolymers. High-molecular weight, low-functionality PCLDA prepolymers exhibited a lower modulus and a higher strain at break, while low-molecular weight, high-functionality PCLTA prepolymers exhibited a lower strain at break and a higher modulus. Additionally, degradation profiles of cross-linked PCL followed a similar trend, with low cross-link density leading to degradation times up to 2.5 times shorter than those of more highly cross-linked polymers. Furthermore, photopolymerized PCL showed biocompatibility both in vitro and in vivo, causing no observed detrimental effects on seeded murine-induced pluripotent stem cells or when implanted into pig retinas. Finally, the ability to create three-dimensional PCL structures is shown by fabrication of simple structures using digital light projection stereolithography. Low-molecular weight, high-functionality PCLTA prepolymers printed objects with feature sizes near the hardware resolution limit of 50 µm. This work lays the foundation for future work in fabricating microscale PCL structures for a wide range of tissue regeneration applications.

CRISPR-Cas9 genome engineering: Treating inherited retinal degeneration.

Gene correction is a valuable strategy for treating inherited retinal degenerative diseases, a major cause of irreversible blindness worldwide. Single gene defects cause the majority of these retinal dystrophies. Gene augmentation holds great promise if delivered early in the course of the disease, however, many patients carry mutations in genes too large to be packaged into adeno-associated viral vectors and some, when overexpressed via heterologous promoters, induce retinal toxicity. In addition to the aforementioned challenges, some patients have sustained significant photoreceptor cell loss at the time of diagnosis, rendering gene replacement therapy insufficient to treat the disease. These patients will require cell replacement to restore useful vision. Fortunately, the advent of induced pluripotent stem cell and CRISPR-Cas9 gene editing technologies affords researchers and clinicians a powerful means by which to develop strategies to treat patients with inherited retinal dystrophies. In this review we will discuss the current developments in CRISPR-Cas9 gene editing in vivo in animal models and in vitro in patient-derived cells to study and treat inherited retinal degenerative diseases.

First- and second-year gerontology students: Research activities heightened connectedness to learning.

The purpose of this study was to measure 1st- and 2nd-year students' engagement as a result of a qualitative inquiry and field experiences with elders residing in an independent and assisted living retirement community. Undergraduate student research and field experiences are often introduced toward the completion of undergraduate students' academics. The findings suggest discovery and further consideration to implement undergraduate research and field experiences at the beginning of students' academic experiences in gerontology. Outcomes further suggest that early introduction of gerontological research and field experiences may assist in educating students about agism, potentially dissuading personal fears of their aging or apprehensions in working with elders. Optimal student engagement is evidenced through connectedness to learning, understanding of aging concepts through the lens of research, and enhanced learning metaphorically described as a woven gerontological tapestry.

Increases in Network Ties Are Associated With Increased Cohesion Among Intervention Participants.

OBJECTIVE: Many behavior change programs are delivered in group settings to manage implementation costs and to foster support and interactions among group members in order to facilitate behavior change. Understanding the group dynamics that evolve in group settings (e.g., weight management, Alcoholics Anonymous) is important, yet rarely measured. This article examined the relationship between social network ties and group cohesion in a group-based intervention to prevent obesity in children. METHOD: The data reported are process measures from an ongoing community-based randomized controlled trial. A total of 305 parents with a child (3-6 years) at risk of developing obesity were assigned to an intervention that taught parents healthy lifestyles. Parents met weekly for 12 weeks in small consistent groups. Two measures were collected at Weeks 3 and 6: a social network survey (people in the group with whom one discusses healthy lifestyles) and the validated Perceived Cohesion Scale. We used lagged random and fixed effects regression models to analyze the data. RESULTS: Cohesion increased from 6.51 to 6.71 (t= 4.4,p< .01). Network nominations tended to increase over the 3-week period in each network. In the combined discussion and advice network, the number of nominations increased from 1.76 to 1.95 (z= 2.59,p< .01). Cohesion at Week 3 was the strongest predictor of cohesion at Week 6 (b= 0.55,p< .01). Number of new network nominations at Week 6 was positively related to cohesion at Week 6 (b= 0.06,p< .01). In sum, being able to name new network contacts was associated with feelings of cohesion. CONCLUSION: This is the first study to demonstrate how network changes affect perceived group cohesion within a behavioral intervention. Given that many behavioral interventions occur in group settings, intentionally building new social networks could be promising to augment desired outcomes.

A health literate approach to the prevention of childhood overweight and obesity.

OBJECTIVE: To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population. METHODS: Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population. RESULTS: 12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63 ± 0.76, and Fry graph 6.0 ± 0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change. CONCLUSION: The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity. PRACTICE IMPLICATIONS: Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.

An Infection Control Program for a 2009 influenza A H1N1 outbreak in a university-based summer camp.

OBJECTIVES: Describe two 2009-H1N1 influenza outbreaks in university-based summer camps and the implementation of an infection control program. PARTICIPANTS: 7,906 campers across 73 residential camps from May 21-August 2, 2009. METHODS: Influenza-like-illness (ILI) was defined as fever with cough and/or sore throat. Influenza A was identified using PCR or rapid-antigen testing. We implemented an infection control program consisting of education, hand hygiene, disinfection, symptom screening, and ILI case management. RESULTS: An initial ILI cluster involved 60 cases across 3 camps from June 17-July 2. Academic Camp-1 had the most cases (n = 45, 14.9% attack rate); influenza A was identified in 84% of those tested. Despite implementation of an infection control program, a second ILI cluster began on July 12 in Academic Camp-2 (n = 47, 15.0% attack rate). CONCLUSIONS: ILI can spread rapidly in a university-based residential camp. Infection control is an important aspect of the medical response but is challenging to implement.