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Article ; Online: Individual and Community Engagement in Response to Environmental Challenges Experienced in Four Low-Income Urban Neighborhoods

Michelle L. Kaiser / Michelle D. Hand / Erica K. Pence

International Journal of Environmental Research and Public Health, Vol 17, Iss 6, p

2020 Volume 1831

Abstract: Low-income urban communities, and the individuals that live within them, continue to face disproportionate interconnected social, economic, and environmental challenges related to their built, natural, and social environments. The aim of our ... ...

Abstract	Low-income urban communities, and the individuals that live within them, continue to face disproportionate interconnected social, economic, and environmental challenges related to their built, natural, and social environments. The aim of our phenomenological research study was to elevate the experiences of residents living in low-income urban neighborhoods in terms of their communities’ environmental challenges. Our objectives were to (1) identify challenges across neighborhoods, (2) identify ways individuals and communities are addressing those challenges, and (3) assess the individual and collective efficacy and engagement of communities to lead environmental improvements in neighborhoods. This study brings forward the voices that are often ignored or misunderstood in these communities and uses an ecological-social perspective. We conducted focus groups (N = 68) in four low-income urban neighborhoods across two Ohio cities in the United States. Participants described five key challenges in their communities: Pollution, abandoned buildings with associated crime, low food access and health concerns, trash and illegal dumping, and lack of trees. We assessed engagement and efficacy using two frameworks focused on individual and community readiness to engage in and lead community change. Policymakers should acknowledge the valuable contributions and leadership capacity of residents in low-income communities to implement environmental initiatives.
Keywords	urban environment ; pollution ; eco-social ; environmental justice ; individual efficacy ; community engagement ; built environment ; focus groups ; Medicine ; R
Subject code	360
Language	English
Publishing date	2020-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Preliminary engagement of a patient advisory board of African American community members with type 2 diabetes in a peer-led medication adherence intervention

Olayinka O. Shiyanbola / Betty L. Kaiser / Gay R. Thomas / Adati Tarfa

Research Involvement and Engagement, Vol 7, Iss 1, Pp 1-

2021 Volume 9

Abstract: Abstract Background The Peers Supporting Health Literacy, Self-efficacy, Self-Advocacy, and Adherence (Peers LEAD) program is a culturally tailored educational-behavioral 8-week intervention that addressed psychosocial and sociocultural barriers to ... ...

Abstract	Abstract Background The Peers Supporting Health Literacy, Self-efficacy, Self-Advocacy, and Adherence (Peers LEAD) program is a culturally tailored educational-behavioral 8-week intervention that addressed psychosocial and sociocultural barriers to diabetes medication adherence in African Americans. A brief 3-week version of the Peers LEAD intervention used a community engagement approach to examine the feasibility and acceptability of the intervention amongst patient stakeholders. Main body African Americans who were adherent to their diabetes medicines were paired with those who were non-adherent to their medicines. Together, they participated in the group and phone-based medication adherence intervention. Input from this brief intervention was important for the design of the remainder weeks of the 8-week program. The intervention targeted negative beliefs about diabetes, use of diabetes medicines, and offering culturally tailored peer support to improve medication adherence in African Americans. To receive input in the development and implementation of the program, we worked with community advisors and a peer ambassador board of African Americans who were adherent to their diabetes medicines. The peer ambassador board and community advisors reviewed intervention materials to ensure they were understandable and appropriate for the community. As well, they provided feedback on the process for intervention delivery. Conclusion The active engagement of the peer ambassador board and community advisors led to a revised intervention process and materials for a medication adherence program for African Americans with type 2 diabetes.
Keywords	Community engagement ; African Americans ; Diabetes ; Medication adherence ; Health equity ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	360 ; 796
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability

Taryn Vian / Rachel M. Fong / Jeanette L. Kaiser / Misheck Bwalya / Viviane I.R. Sakanga / Thandiwe Ngoma / Nancy A. Scott

International Journal of Health Policy and Management, Vol 11, Iss 2, Pp 160-

Lessons From Zambia

2022 Volume 172

Abstract: BackgroundCommunity-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case ... ...

Abstract	BackgroundCommunity-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members.MethodsWe applied a principally qualitative design using observation and analysis of written documentation of public meetings to answer our research question: how do governance committees enact inward transparency and demonstrate accountability to their communities. The analysis measured participation and stakeholder representation at public meetings, the types and purposes of accountability sought by community members as evidenced by questions asked of the governance committee, and responsiveness of the governance committee to issues raised at public meetings.ResultsPublic meetings were attended by 6 out of 7 possible stakeholder groups, and reports were generally transparent. Stakeholders asked probing questions focused mainly on financial performance. Governance committee members were responsive to questions raised by participants, with 59% of answers rated as fully or mostly responsive (showing understanding of and answering the question). Six of the 10 sites held elections to re-elect or replace governance committee members. Only 2 sites reached the target set by local stakeholder committees of 50% female membership, down from 3 at formation. To further improve transparency and accountability, community governance committees need to engage in advance preparation of reports, and should consult with stakeholders on broader measures for performance assessment. Despite receiving ...
Keywords	governance ; transparency ; democratic ; community-based ; maternity waiting homes ; Public aspects of medicine ; RA1-1270
Subject code	320
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Seascape ecology in the vicinity of a Blake Ridge cold seep

Kellie Johnson / Avery Taylor / Annika Socha / Ellie Barkyoumb / Koichi Nakamura / Carl L. Kaiser / Christopher R. German / Dana R. Yoerger / Cindy Lee Van Dover

Frontiers in Marine Science, Vol

2023 Volume 10

Abstract: Systematic surveys of the distribution of epibenthic megafaunal species relative to one another and to environmental variables in the deep sea can lead to inferences and testable hypotheses regarding factors that influence their distributions. Here we ... ...

Abstract	Systematic surveys of the distribution of epibenthic megafaunal species relative to one another and to environmental variables in the deep sea can lead to inferences and testable hypotheses regarding factors that influence their distributions. Here we use a seascape approach to provide insight into the character and spatial extent of the influence of a chemosynthetic seep on the distribution of epibenthic megafauna and the nature of transition zones (ecotones). Faunal distributions were determined from georeferenced images of the seabed collected during a systematic survey (~ 400 m x 400 m) by the Autonomous Underwater Vehicle Sentry in the vicinity of a newly discovered methane bubble plume on the Blake Ridge Diapir. The survey area was found to include both seep and non-seep habitats. The sphere of influence of seep productivity on the surrounding benthic megafaunal assemblage was limited—on the order of 10’s of meters—based on ecotone analysis. Small but detectable redox anomalies in the water column (5 m above bottom) in the study area occurred on a similar horizontal scale. Distributions of background megafaunal taxa were non-random for many morphotypes and included both positive and negative associations between morphotypes and the seep habitat. Subtle variations in depth (<6 m) correlated with distributions of seep-associated vesicomyid clams, which occupy shallow depressions in the seabed. The seep habitat itself, comprising a patchy mosaic of megafaunal sub-communities (e.g., clam bed, mussel bed, background soft-sediment bathyal taxa) and transition zones, was at least as diverse as the surrounding non-seep habitat and contributes seep endemic morphotypes to regional biodiversity. While seep productivity may support prey fields for deep-diving beaked whales, any relationship between the seeps and whale feeding areas remains intriguing speculation. Like many other regions of the deep sea, Blake Ridge South has accumulated marine litter, including litter likely originating from scientific endeavors. ...
Keywords	Blake Ridge seep ; cooccurrence ; network analysis ; ecotone ; species distributions ; sphere of influence ; Science ; Q ; General. Including nature conservation ; geographical distribution ; QH1-199.5
Subject code	333
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A cost description of the setup costs of community-owned maternity waiting homes in rural Zambia

Allison Juntunen / Nancy A. Scott / Jeanette L. Kaiser / Taryn Vian / Thandiwe Ngoma / Kaluba K. Mataka / Misheck Bwalya / Viviane Sakanga / David Kalaba / Godfrey Biemba / Peter C. Rockers / Davidson H. Hamer / Lawrence C. Long

PLOS Global Public Health, Vol 3, Iss

2023 Volume 4

Abstract: Maternity waiting homes (MWHs) are one strategy to improve access to skilled obstetric care in low resource settings such as Zambia. The Maternity Homes Access in Zambia project built 10 MWHs at rural health centers in Zambia for women awaiting delivery ... ...

Abstract	Maternity waiting homes (MWHs) are one strategy to improve access to skilled obstetric care in low resource settings such as Zambia. The Maternity Homes Access in Zambia project built 10 MWHs at rural health centers in Zambia for women awaiting delivery and postnatal care (PNC) visits. The objective of this paper is to summarize the costs associated with setup of 10 MWHs, including infrastructure, furnishing, stakeholder engagement, and activities to build the capacity of local communities to govern MWHs. We do not present operational costs after setup was complete. We used a retrospective, top-down program costing approach. We reviewed study documentation to compile planned and actual costs by site. All costs were annuitized using a 3% discount rate and organized by cost categories: (1) Capital: infrastructure and furnishing, and (2) Installation: capacity building activities and stakeholder engagement. We assumed lifespans of 30 years for infrastructure; 5 years for furnishings; and 3 years for installation activities. Annuitized costs were used to estimate cost per night stayed and per visit for delivery and PNC-related stays. We also modeled theoretical utilization and cost scenarios. The average setup cost of one MWH was $85,284 (capital: 76%; installation: 24%). Annuitized setup cost per MWH was USD$12,516 per year. At an observed occupancy rate of 39%, setup cost per visit to the MWH was USD$70, while setup cost per night stayed was USD$6. The cost of stakeholder engagement activities was underbudgeted by half at the beginning of this project.This analysis serves as a planning resource for governments and implementers that are considering MWHs as a component of their overall maternal and child health strategy. Planning considerations should include the annuitized cost, value of capacity building and stakeholder engagement, and that cost per bed night and visit are dependent upon utilization.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	690
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Midlife vulnerability and food insecurity

Lisa M Soederberg Miller / Daniel J Tancredi / Lucia L Kaiser / Jeffrey T Tseng

PLoS ONE, Vol 15, Iss 7, p e

Findings from low-income adults in the US National Health Interview Survey.

2020 Volume 0233029

Abstract: Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn ... ...

Abstract	Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. Methods Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. Results Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. Conclusions Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Explaining Racial Inequality in Food Security in Columbus, Ohio

Keumseok Koh / Michelle L. Kaiser / Glennon Sweeney / Karima Samadi / Ayaz Hyder

International Journal of Environmental Research and Public Health, Vol 17, Iss 5488, p

A Blinder–Oaxaca Decomposition Analysis

2020 Volume 5488

Abstract: Food insecurity is a leading public health challenge in the United States. In Columbus, Ohio, as in many American cities, there exists a great disparity between Black and White households in relation to food insecurity. This study investigates the degree ...

Abstract	Food insecurity is a leading public health challenge in the United States. In Columbus, Ohio, as in many American cities, there exists a great disparity between Black and White households in relation to food insecurity. This study investigates the degree to which this gap can be attributed to differences in food shopping behavior, neighborhood perception, and socioeconomic characteristics. A Blinder–Oaxaca decomposition method is used to analyze a household survey dataset collected in 2014. We find a 34.2 percent point difference in food security between White and Black households. Variables related to food shopping behavior, neighborhood perception, and socioeconomic characteristics explain 13.8 percent, 11.6 percent, and 63.1 percent of the difference, respectively. These independent variables combined can explain 68.2 percent of the food security gap between White and Black households. Most of this is attributable to socioeconomic variables. Sense of friendship in neighborhood, use of private vehicles, and satisfaction of neighborhood food environment also partially contribute to the food security gap.
Keywords	food security ; food insecurity ; race ; inequalities ; Blinder–Oaxaca decomposition ; Medicine ; R
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Trends in maternal mental health during the COVID-19 pandemic–evidence from Zambia

Irene Falgas-Bague / Thandiwe Thembo / Jeanette L. Kaiser / Davidson H. Hamer / Nancy A. Scott / Thandiwe Ngoma / Ravi Paul / Allison Juntunen / Peter C. Rockers / Günther Fink

PLoS ONE, Vol 18, Iss

2023 Volume 2

Abstract: The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such ... ...

Abstract	The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic. We examined the prevalence of mental health distress among a cohort of 1105 mothers using the World Health Organization’s Self-Reporting Questionnaire (SRQ-20) before the onset of the COVID-19 pandemic in August 2019 and after the first two infection waves in October-November 2021. Our primary outcome was mental health distress, defined as SRQ-20 score above 7. We analyzed social, economic and family level characteristics as factors modifying to the COVID-19 induced changes in the mental health status. At baseline, 22.5% of women were in mental health distress. The odds of mental health distress among women increased marginally over the first two waves of the pandemic (aOR1.22, CI 0.99–1.49). Women under age 30, with lower educational background, with less than three children, and those living in Eastern Province (compared to Southern Province) of Zambia, were found to be at highest risk of mental health deterioration during the pandemic. Our findings suggest that the prevalence of mental health distress is high in this population and has further worsened during COVID-19 pandemic. Public health interventions targeting mothers’ mental health in low resource settings may want to particularly focus on young mothers with limited educational attainment.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Trends in maternal mental health during the COVID-19 pandemic-evidence from Zambia.

Irene Falgas-Bague / Thandiwe Thembo / Jeanette L Kaiser / Davidson H Hamer / Nancy A Scott / Thandiwe Ngoma / Ravi Paul / Allison Juntunen / Peter C Rockers / Günther Fink

PLoS ONE, Vol 18, Iss 2, p e

2023 Volume 0281091

Abstract	The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic. We examined the prevalence of mental health distress among a cohort of 1105 mothers using the World Health Organization's Self-Reporting Questionnaire (SRQ-20) before the onset of the COVID-19 pandemic in August 2019 and after the first two infection waves in October-November 2021. Our primary outcome was mental health distress, defined as SRQ-20 score above 7. We analyzed social, economic and family level characteristics as factors modifying to the COVID-19 induced changes in the mental health status. At baseline, 22.5% of women were in mental health distress. The odds of mental health distress among women increased marginally over the first two waves of the pandemic (aOR1.22, CI 0.99-1.49). Women under age 30, with lower educational background, with less than three children, and those living in Eastern Province (compared to Southern Province) of Zambia, were found to be at highest risk of mental health deterioration during the pandemic. Our findings suggest that the prevalence of mental health distress is high in this population and has further worsened during COVID-19 pandemic. Public health interventions targeting mothers' mental health in low resource settings may want to particularly focus on young mothers with limited educational attainment.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa—a multiphase optimization strategy (MOST) approach using a fractional factorial design

Lauren Jennings / Rebecca L. West / Nafisa Halim / Jeanette L. Kaiser / Marya Gwadz / William B. MacLeod / Allen L. Gifford / Jessica E. Haberer / Catherine Orrell / Lora L. Sabin

Trials, Vol 24, Iss 1, Pp 1-

2023 Volume 13

Abstract: Abstract Background South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard ... ...

Abstract	Abstract Background South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. Methods We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an ...
Keywords	HIV ; Antiretrovirals ; Medication adherence ; Electronic adherence monitoring ; Behavior change ; MOST framework ; Medicine (General) ; R5-920
Subject code	310
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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