CD08-001 Abstracts
1 R18 DP001542-01 - Environmental and Policy Changes to support Physical Activity: Translation of Evidence Based Approaches within African American Communities
BAKER, ELIZABETH A
DESCRIPTION (provided by applicant): The goal of this project is to translate and implement an evidence-based strategy for a racial and ethnic minority community, defined as African American in St. Louis, MO, and assess the factors that hinder or facilitate the translation (i.e. adoption, adaptation and implementation) of these strategies. The proposed project aims to expand an existing inter-disciplinary partnership and work with this partnership to translate and implement evidence-based strategies adapted for the St. Louis context and population. The Community Action Plan for this project will include four steps: 1) identifying relevant stakeholders and partners and expanding the current partnership, 2) providing technical assistance workshops based on the needs of the partnership, 3) sharing assessment data on disparities in physical activity behavior and in access to physical activity opportunities and 4) adopting and implementing evidence-based strategies adapted for the St. Louis context and population. A comprehensive evaluation will be conducted several times throughout the project to assess the intra- and inter-organizational characteristics and the partnerships’ capacity to work together and to identify strengths and challenges in the process of adapting and implementing the strategies. The evaluation will estimate and report the potential translatability and public health impact of the implemented strategies by measuring a variety of translation determinants (e.g. feasibility, fidelity, adaptability, economic cost, cultural context). As part of the summative evaluation, the project team will monitor community environments and residents’ behaviors before and after specific strategies are implemented to document whether the implemented strategy increased physical activity behavior. Data from the qualitative and quantitative assessments will be triangulated and compared to existing theories of dissemination, adoption, adaptation and implementation of evidence-based interventions. An in-depth case study approach will be used to disseminate the lessons learned to other communities and practitioners.
1 R18 MN000003-01 - Addressing Mental Health Services Disparities for Ethnically Diverse Children
EIRALDI, RICARDO
DESCRIPTION (provided by applicant): The proposed study is in response to a Program Announcement entitled, Elimination of Health Disparities through Translation Research (R18). The purpose of the study is to adapt evidence-based interventions for use in urban schools with large numbers of low-income Latino students. The interventions will be delivered within a family-centered system for the delivery of mental health services for children that has the potential to be self- sustaining over time. The interventions, which are based on SW-PBS methodology, would address a range of behavioral disorders and concomitant peer difficulties experienced by children at school and at home. The study will take place in two public schools (K through 5th and K through 8th) in an urban area with high concentrations of low-income Latino families. Data will be collected simultaneously on three ongoing aspects of the project: (a) Development of a data collection system; (b) Improvement of key school systems; (c) Protocol modification and implementation. The proposed study is designed to reach all children attending the participating schools. Aims of the study are: (1) To develop a data collection system for SW-PBS that is useful, efficient, and acceptable; (2) To build the capacity of the school system to support the implementation of SW-PBS; (3) To identify components of SW-PBS primary and secondary tier interventions that need adaptation; (4) To determine the feasibility of implementing SW-PBS interventions in two under-resourced schools; (5) To assess acceptability of Tier 1 and Tier 2 interventions (uptake); and (6) To estimate the health outcome associated with the implementation of the SW-PBS package. Evidence-based intervention packages will be identified and modified based on focus groups, follow-up interviews and brief surveys with 93 parents and 60 teachers. Tier 1 interventions will be implemented first on 1,027 students. Children who do not respond to Tier 1 interventions will be assigned to one or more interventions for Tier 2 or they will be assessed and referred for treatment in the community. It is expected that 154 children will receive Tier 2 interventions in the school and that 63 parents of children in Tier 2 will receive parental skills training at a community center. The proposed study is the result of a partnership between researchers, experts in school-wide positive behavior support (SW-PBS), teaching staff, school administrators, parents/caregivers and community mental health workers. The study addresses a specific goal of Healthy People 2010--reducing or eliminating mental health services disparities among ethnically diverse children. The study may contribute to the development of an efficient and effective system for the delivery of mental health services to low-income, inner-city children and families. Data obtained for this study may contribute to a better understanding of factors that facilitate the adaptation and implementation of evidence-based interventions in under-resourced urban schools. The adapted evidence-based interventions described in this proposal are likely to contribute to a reduction in mental health services disparities among urban ethnically-diverse children. The proposal may also increase research interest in the effectiveness of school-wide positive behavior support (SW-PBS) interventions in under-resourced urban schools.
1 R18 MN000004-01 - Chronic Illness & Minor Depression: Community and CDSMP
GONZALES, JUNIUS
DESCRIPTION (provided by applicant): Minor depression alone and its co-occurrence with chronic diseases are under- recognized, under-treated and understudied. This proposed study uses theoretically driven mixed methodologies to understand key barriers and facilitators for the successful translation of an evidence-based intervention (EBI) - chronic disease self management programs (CDSMP) - into community settings for underserved Latinos who suffer from minor depression and co- occurring chronic disease. We have chosen CDSMP because of its strong evidence base and its ability to be delivered by lay health workers in various settings and reduce health disparities. New data show that minor depression exerts large costs, increases mortality when present in cardiac disease, and is not responsive to most interventions that are effective for major depression. This proposed study is aligned with CDC's performance goal to support prevention research to develop sustainable and transferable community-based behavioral interventions. We propose to partner with two community partners - Hispanic Service Council and Familia Sana and use ongoing funded community-based participatory research (CBPR) efforts for a three-phase study. This partnership will drive the understanding of important barriers and facilitators that need to be addressed for the successful adaptation of this EBI - that is, to make it contextually relevant, keep it effective and meet primary stakeholder’s needs. In Hillsborough County area where we wish to do this work, the Latino population is over 20% and huge gaps in general and mental health services exist. The specific aims of this project are to: identify key stakeholder perspectives on multi- dimensional barriers and facilitators to the adoption of CDSMP into community settings; employ mixed methods to adapt CDSMP to best address those priority needs; and test the feasibility of implementing the adapted CDSMP using a lagged intervention design with outcome measurements over months, to estimate intervention parameters in preparation for a future large scale cross-county implementation study. This research is exceptionally relevant to public health because it seeks to improve health and functioning outcomes in a poor minority population that suffers from an important, highly prevalent and disabling condition - minor depression that co-occurs with chronic diseases - using community engagement for the adaptation, implementation and sustainability of an EBI.
1 R18 DD000457-01 - Family Planning & Preconception HIV testing
HOCK-LONG, LINDA E
DESCRIPTION (provided by applicant): Family Planning & Preconception HIV Testing Recent Centers for Disease Control and Prevention human immunodeficiency virus (HIV) testing and preconception health recommendations call for the provision of routine, universal HIV screening for women of reproductive age. Although limited, evidence suggests that up to 50% of pregnant women with HIV infection in the US are initially detected via prenatal screening. While this detection rate illustrates the relative success of efforts to promote prenatal screening, it also points to a critical gap in preconception screening practices, as unawareness of infection status at time of conception represents an important "missed opportunity" for early detection. Federal Title X Family Planning Program grantees, such as the applicant organization, are uniquely positioned to deliver routine preconception HIV testing services to a racially and ethnically diverse, and primarily low-income, patient population. Yet, efforts to elevate routine preconception HIV screening to the status of a core family planning service have met with mixed success at best. Given the critical role that health care providers play in institutionalizing practice guidelines and influencing patient receptivity to services, we hypothesize that the integration of a brief, evidence-based counseling model could effect positive changes in both provider and patient preconception testing behaviors. Thus, we propose to adapt the health care provider delivered Options risk reduction intervention, which is based on the Information-Motivation- Behavioral Skills model of HIV prevention and uses Motivational Interviewing techniques to deliver risk reduction messages. The specific aims of the proposed study are to: 1. Conduct formative research with family planning providers and patients to understand the prevalence of preconception-based HIV testing among patients, to determine how often providers offer HIV testing to their patients, and to identify the informational, motivational, and behavioral skills facilitators of and barriers to HIV testing. 2. Modify the content of the Options intervention to ensure that it targets deficits, and capitalizes on strengths, in information, motivation and behavioral skills, relative to preconception-based HIV testing; We will use various quantitative (survey) and qualitative (focus group, free list, semi-structured interview) methodologies. We will also explore patient receptivity to preconception HIV testing and the extent to which environmental-level factors impede or facilitate HIV service delivery. The proposed study will then: 3. Conduct a pilot study to assess the feasibility of translating the adapted intervention into family planning settings; 4. Assess the potential effect of the adapted intervention on preconception-based HIV testing uptake in family planning settings. 5. Examine the extent to which the effects of the adapted intervention are moderated by individual (e.g., provider, patient) and contextual (e.g., clinic environment) factors. We hypothesize that: a) family planning providers delivering services at intervention site clinics will show improvement in their routine preconception HIV testing intentions and b) rates of preconception HIV testing will be higher at intervention site family planning clinics when compared to clinics with continuing standard of care. To support attainment of the study aims, Deborah Cornman, PhD, a key member of the University of Connecticut's Center for Health, Intervention, and Prevention team that developed Options, will serve as a co-investigator, and a Community Advisory Board that includes Title X family planning provider and patient representatives will provide guidance in all phases of the proposed study. In addition, two clinicians who have successfully integrated family planning services at their respective Philadelphia HIV clinics will serve as clinical consultants. The intervention content and evaluation will be documented as a replication manual. Integration of the intervention at family planning agencies nationwide will promote routine preconception testing for HIV as the gateway to treatment, care, and prevention for women of reproductive age.
1 R18 PS001155-01 - Culturally Responsive Translation of RESPECT with Native Communities
KAUFMAN, CAROL E
DESCRIPTION (provided by applicant): We propose to assess the translatability of an HIV/STD prevention intervention called RESPECT among American Indian and Alaska Native (AI/AN) youth. RESPECT has been shown to be efficacious in reducing sexual risk behaviors and the incidence of sexually transmitted diseases (STDs) in public STD clinics among ethnically and racially heterogeneous heterosexual adult (ages15-39) populations. Such findings hold great promise for AI/ANs, a group that shoulders 2-4 times the level of STDs nationally. In fact, 11 of the 12 service areas of the Indian Health Service (IHS) show rates of Chlamydia trachomatis (Chlamydia) higher than the US average, with 3 of these service areas at levels 5-6 times higher. AI/AN adolescents ages 15-19 bear a disproportionate share of most STDs, comprising 34% and 28% of all Chlamydia and Neisseria gonorrhea (gonorrhea) cases, respectively, reported in IHS services areas. This is due to a number of factors. Like other adolescents, AI/AN youth have increased biological vulnerability, face transportation limitations (especially in reservation or Village settings where distances are great), and are reluctant to use services designed for adults. Those in rural or reservation settings are especially concerned about receiving confidential care in their often small and close-knit communities. Finally, AI/AN youth experience higher levels of sexual risk behaviors compared to others in their age group nationally. The Centers for Disease Control and Prevention (CDC) have recognized this problem, and recently initiated an effort to implement school-based Chlamydia screening in AI/AN communities. As noted by the CDC in that effort, STD screening at AI/school clinics also provides a critical point of prevention through counseling; RESPECT, a proven HIV/STD prevention intervention, was recommended as a model. As yet, however, no research on the viability, or external validity, of RESPECT in AI/AN communities exists. At the same time, little dissemination research exists to delineate the factors and processes in AI/AN communities which might facilitate the widespread use of any evidence-based intervention, let alone one that may incur particular resistance because of stigma and values surrounding sexual activity. We need to know about the external validity and the dissemination processes in AI/AN communities if we are to address effectively the daunting disparities in HIV/STDs and sexual risk-taking among youth. To do this, we propose the following: [1] With tribal partnerships, regional alliances, and national collaboration, we will use the Theory of Diffusion of Innovations to guide the development of a dissemination plan for RESPECT with AI/AN communities; [2] using the RE-AIM framework of enhancing external validity, we will implement the RESPECT intervention in school-based clinics in a specific AI community; and [3] evaluate the potential diffusion of RESPECT based on the results of [1] and [2].
1 R18 CE001479-01 - Implementing SafeCare to Prevent Child Maltreatment in Underserved Populations: A study of training models
LUTZKER, JOHN
DESCRIPTION (provided by applicant): This study will examine the impact of enhanced versus standard training for trainers and coaches in the implementation of a train-the-trainer (TTT) approach of the SafeCare parenting program. The research study will be layered on a training contract being developed between NSTRC and the Georgia Department of Human Resources to provide SafeCare training to DHR staff. With funds provided by the research grant, we will increase the number of DHR trainers and coaches trained by NSTRC as DHR begins statewide implementation of SafeCare. We will randomly assign half of trainees to the standard training model of training, and half to an enhanced model of training. The standard training model includes workshop training, practice, and in-vivo skill demonstration. The enhanced training model will consist of the standard training plus coaching or consultation from NSTRC trainers for up to six months. NSTRC trainers will work with trainers and coaches assigned to the enhanced model by observing them and providing feedback on their performance to ensure training and coaching is delivered with fidelity and competence. The primary outcomes of the study are fidelity- and competence- related measures for trainers and coaches and the home visitors they train/coach, and engagement measures for the families served. The primary analyses will focus on understanding whether the enhanced training model results in (1) greater fidelity and more competent provision of services for trainers, coaches, and home visitors, and (2) greater engagement and retention of families. We will also examine how a variety of individual and organizational characteristics influence fidelity and competence, alone or in combination with training. Finally, because of the increased cost of the enhanced training model, we will conduct an economic analysis to calculate the incremental benefits in fidelity, competence, and engagement/retention afforded by the more costly enhanced training. PUBLIC HEALTH RELEVANCE: Successful prevention and intervention of child maltreatment requires the implementation of evidence-based practices in child welfare systems and prevention programs. Reducing disparities requires a focus on implementation of evidence-based programs for problems that disproportionately affect vulnerable populations, and attention to how those populations receive those programs. As the state of Georgia begins a statewide rollout of the SafeCare parent training program, this study will compare two training models for SafeCare(R) with regard to how they influence trainer and coach fidelity and competence, and provider fidelity and competence and client engagement.
1 R18 EH000348-01 - Reducing Social Disparities of Heatwave Impacts in a Changing Climate
O'NEILL, MARIE SYLVIA
DESCRIPTION (provided by applicant): Climate change is projected to increase the frequency and intensity of heatwaves, and heat is already one of the principal weather-related causes of mortality in the U.S. Heat affects certain populations disproportionately, including African Americans, Latinos, city-dwellers, diabetics, the elderly and the poor. The contribution of heatwaves to social disparities in health is an important target for translational research since several preventive interventions exist. Heatwave health warning systems (HHWS), heat island mitigation through tree planting and other measures, and other programs administered by local governments are evidence-based interventions that improve quality of life, foster environmental sustainability, and protect public health during heatwaves. With increasing evidence for accelerated climate change, wider implementation of these programs is needed. This project aims to provide insights into how HHWS and other evidence- based interventions can be translated to other settings to better protect public health and reduce social disparities, thus fostering their more widespread and effective adoption. A multi-disciplinary team, with expertise in epidemiology, sociology, health education, statistics, meteorology, applied public health, and local action and governance, will conduct a mixed-method study in four U.S. cities (Detroit, MI; New York, NY; Philadelphia, PA; and Phoenix, AZ). These cities are at varying stages in implementing HHWS and climate change adaptation programs and include diverse populations with documented racial/ethnic and socio-economic disparities in heat exposure and heat-related health effects. Using qualitative methodology, semi-structured interviews will be undertaken with main stakeholders in the four cities: potential target populations (city residents, predominantly older and of diverse racial/ethnic backgrounds) and implementers of these interventions (government officials representing public health, weather, social and environmental services, among others). The interviews will assess the factors that inhibit or facilitate the translation of the evidence-based interventions. Using quantitative methods, the team will use state-of-the-art epidemiology and meteorology methods to evaluate the triggers of HHWS interventions, investigating ways to make translation of current interventions more effective and easier to understand for the user groups, and communicating specific impacts on population subgroups. This effort will address the availability, reliability and ease of interpretation of HHWS systems by public health officials and the media. We will analyze historical data (1989-2000) in the four cities, comparing daily weather parameters (temperature and heat indices and air mass types) and the degree to which they differ in their associations with excess daily mortality by population group, accounting for air pollution. Through the community action plan, recommendations from the evaluation of results will be shared with relevant authorities from a range of U.S. communities and the public so these research findings will be translated into practice to help achieve the goal of eliminating social disparities in health. PUBLIC HEALTH RELEVANCE: Relevance: Heat exposure can cause illness and death, and heatwaves are increasing in frequency because of global climate change. This research will explore how to better translate evidence-based interventions intended to reduce social disparities in the health impacts of heatwaves (e.g. heatwave health warning systems, tree planting and modifications to the built environment) to other settings. The goal is to encourage the widespread adoption of effective local programs to prevent illness and save lives during heatwaves.
1 R18 DP001566-01 - THE FLU-FOBT Program: Translation of an Evidence-based Colorectal Cancer Screening
POTTER, MICHAEL B
DESCRIPTION (provided by applicant): Colorectal cancer screening (CRCS) saves lives, but screening rates remain low, especially among ethnic minorities and others who get medical care in safety net clinical settings. In these settings the primary CRCS option for average risk patients is annual home fecal occult blood testing (FOBT), a test that has been shown in several studies to reduce colorectal cancer mortality. Offering FOBT during nurse-run annual influenza vaccination clinics at San Francisco General Hospital has been shown to increase CRCS rates. Specific Aims: We propose to (1) adapt the “FLU-FOBT Program” for primary care clinics that provide influenza vaccines but do not run dedicated annual influenza clinics; (2) study the efficacy of the adapted “FLUFOBT Program” in safety net primary care clinics; (3) study its robustness as a practical intervention to increase CRCS in these settings, and (4) develop tools and materials for dissemination of the adapted FLUFOBT Program as a practical approach to reduce CRCS disparities in other clinical settings in the safety net. Methods: In Phase 1 (Year 1), we will adapt the FLU-FOBT Program as a primary care intervention at Chinatown Public Health Clinic (CPHC) in San Francisco. The CPHC nursing staff will offer influenza vaccination to all adults over age 50 who present for primary care during the 2008-9 influenza vaccination season. Patients who accept influenza vaccine will be assessed for CRCS eligibility and offered FOBT by the nurse if due. In Phase 2 (Year 2), we will determine the efficacy of this intervention in a time-randomized trial in 6 other safety net primary care clinics in San Francisco that serve a diverse, multi-ethnic population. The intervention will consist of exposure to the FLU-FOBT Program, and the comparison group will be usual care in which influenza vaccination will be offered without CRCS. The primary outcome will be the proportion of primary care clinic attendees who are initially due for CRCS and become up to date after the intervention, within the intervention and usual care arms of the study. The robustness of the FLUFOBT Program as a practical intervention for “real world” clinical settings will be determined using the RE-AIM criteria (reach, effectiveness, adoption, implementation, maintenance). In Phase 3 (Year 3), we will complete the analyses of efficacy and robustness and develop tools for further dissemination and implementation to other primary care settings where FOBT remains the primary screening strategy for average risk adults. Public Health Relevance: If successful and widely disseminated, the “FLU-FOBT Program” could increase access to CRCS for millions of Americans. More generally, this research could serve as a model strategy to develop, translate, and implement an evidence-based intervention to promote health and prevent disease in primary care settings where health disparities persist.
1 R18 OH009579-01 - Reducing Pesticide Exposure in Farmworker Families: Research to Practice
QUANDT, SARA A
DESCRIPTION (provided by applicant): Migrant and seasonal farm workers and their families are exposed to pesticides through occupational and para- occupational pathways. This population of contingent workers, largely born in Latin America, experiences a disproportionate level of pesticide exposure, relative to the rest of the US population. Research has established the health hazards of such exposure. Children and women are at special risk for adverse health outcomes, and may have significant risks due to their roles in the home, residence near treated fields, and use of pesticides in substandard housing. This proposed demonstration project builds on over ten years of community-based participatory research (CBPR) conducted by a university-community partnership which has produced an effective lay health advisor intervention to reduce pesticide exposure among Latino farm workers and among their families. The goal of this project is to move an effective culturally- and educationally- appropriate pesticide safety intervention for farm worker families into public health practice. The specific aims are: (1) to implement a demonstration project translating an effective intervention to reduce pesticide exposure among families of Latino farm workers to a broader public health context; (2) to evaluate the potential translatability and public health impact of this pesticide exposure intervention; and (3) to disseminate the program through public health programs at the local, regional and national levels. The content of the intervention includes six general modules using active learning methods supported by materials designed for low-literacy adults. These modules address routes of pesticide exposure, procedures for keeping agricultural pesticides from entering the home, methods for removing pesticides from the home, using residential integrated pest management rather than pesticides to control pests, and methods to convince others to change behaviors. A seventh module addresses pesticide safety during pregnancy. Ten lay health advisors (promotoras de salud) will be placed with six collaborating community public health agencies in a 13 county area of eastern North Carolina. Promotoras will recruit farm worker families with at least one child under 12 and provide pesticide health and safety training, using a curriculum previously demonstrated to change knowledge of and behaviors toward pesticides. Liaisons from the community agencies will assist promotoras in locating farm worker families from their clientele and in carrying out the program. Pre- and post intervention interviews will measure knowledge and behavior. Guided by a logic model, the program evaluation will focus on short term outcomes (increased individual knowledge about pesticide safety; greater mastery of specific behaviors to reduce pesticide exposure; increased the capacity of local public health agencies to prevent pesticide-related illnesses) and longer term outcomes (reductions in pesticide-related illnesses and the diffusion of this program into the broader network of public health agencies). The potential translatability and public health impact of the intervention will be assessed. PUBLIC HEALTH RELEVANCE: This project will provide an effective, educationally- and culturally-appropriate pesticide safety program to families of Latino migrant and seasonal farm workers. Because pesticide exposure has long-term health effects on children and adults, this program can result in decreases in the neurological, cancer, and developmental defects that have been associated with exposure.
1 R18 EH000349-01 - Reducing Asthma Disparities: The Baltimore City Healthy Homes Initiative
SHEA, MADELEINE A
DESCRIPTION (provided by applicant): "Reducing Asthma Disparities: The Baltimore City Healthy Homes Initiative" (RAD) will reduce racial disparities in asthma morbidity in Baltimore by providing an evidence- based healthy homes intervention to the families of 250 Baltimore Public School students aged 4-18 who have persistent asthma. The RAD Initiative is a translation research project, adapting the effective Seattle-King County (SKC) model. The SKC Healthy Homes program has significantly reduced asthma symptom days and urgent health service usage (Krieger et al., 2005). We will enhance the SKC intervention to address risks specific to Baltimore through: 1) maternal depression screening and referrals, 2) strengthened rodent reduction measures, 3) lead poisoning prevention, 4) additional injury prevention, 5) motivational interviewing to reduce environmental tobacco smoke, and 6) recruitment through the schools. This translation research will compare and contrast the intervention costs, medical costs, home environmental health outcomes and children's asthma-related health outcomes in 250 intervention children and a comparable group of 250 non-intervention Medicaid enrolled children with persistent asthma. The RAD Initiative will be lead by the Baltimore City Health Department's Healthy Homes Division, whose mission is to improve the health of children and their families by reducing housing hazards tied to asthma, lead exposure, and injuries. In addition to helping the BCHD achieve its long-term goal of reducing asthma disparities, the RAD Initiative's specific aims include, first, disseminating project findings broadly to city, state, and national stakeholders through a Baltimore community conference, student-produced video, journal articles, community and conference presentations, and web-based information and materials. Second, the RAD Initiative will identify mechanisms by which the program can be sustained over time and scaled up to address the needs of all at-risk Baltimore families of children with asthma. Third, the RAD Initiative aims to use a coordinated, public-private partnership approach to extend the reach of healthy homes home visiting programs. The RAD Initiative represents the alliance of two universities, two city agencies, the state, Baltimore City's congressional delegation, a youth-focused social action organization, an asthma coalition, and a coalition of African-American charities. PUBLIC HEALTH RELEVANCE: Project Narrative By adapting the Seattle King County Healthy Homes approach to the Baltimore environment and new research findings, we aim to reduce disparities related to childhood asthma, lead poisoning, and injuries. Baltimore's unsafe housing is harmful to the city's most vulnerable residents. Our "Reducing Asthma Disparities" Initiative will demonstrate a new systems approach to diffusing an effective intervention to reach underserved families with children with chronic asthma to significantly reduce health disparities in Baltimore.
1 R18 OH009574-01 - More than Training: Workers' Rights Centers Empowering Hazard Awareness/ Response
SOKAS, ROSEMARY K
DESCRIPTION (provided by applicant): Immigrant workers are one-third more likely to suffer fatal occupational traumatic injuries than U.S. workers as a whole, and are more likely to be engaged in contingent or informal work. Workers’ centers have emerged to address worker needs. Workers using these centers have expressed strong interests in training, often characterize themselves as independent contractors rather than day laborers, and engage in direct action or group action and file complaints to government agencies, suggesting strong self-efficacy. While work hazards are a concern, few centers address them. Occupational safety and health training programs have been associated with reduced injury claims outcomes and increased hazard identification and remediation when offered in the context of union support. The goal of this proposal is to translate a modified OSHA 10-hour hazard awareness training intervention developed by a worker center serving Latino day laborers in New Jersey that uses a small group, rights-based, problem-solving approach and includes hands- on practice with equipment. The project will be conducted in partnership with workers’ centers, university- based educators, and a national network of workers’ centers. Thirty worker members from each of two Chicago worker centers will be recruited to assume leadership roles in health and safety targeting construction. One third will participate in a two-day weekend program conducted by a New Jersey team of worker and OSHA certified trainers, after which each worker will be issued an OSHA 10-hour card. Subsequent training for the remaining two-thirds of the worker leaders will be offered by the Chicago partners, with New Jersey partners observing and debriefing. Trainee evaluation will be conducted using previously developed knowledge, attitude, self-reported practice and injury outcome measures with a crossover control study design and mixed qualitative/ quantitative methods assessing outcome effects and fidelity of transfer. During year 2, Chicago partners will continue to train locally and will serve as the hub for outreach to teams from 6 additional Midwest worker centers through a national network of workers’ centers that will also train national staff during this time, and will engage partners in regional training centers and universities to replicate the outreach effort. During year 3, existing training programs will continue, and an additional 12 centers will be recruited through the national network for participation. The project will measure changes in existing interventions, such as OSHA referral and direct action, over the course of the project, and will track centers adopting the approach; workers trained, and sampled markers of impact. PUBLIC HEALTH RELEVANCE: This project will use existing construction hazard awareness training materials and methods to provide occupational safety and health training programs to Latino immigrant day laborers working primarily in the construction sector through a problem-solving, peer-educator approach. A national network of 20 worker center training sites will provide the context for subsequent hazard identification and remediation by the trained workers and other center members, as well as through referrals to OSHA.
1 R18 DP001570-01 - Dissemination of a Smoking Quitline to the Underserved
VIDRINE, JENNIFER IRVIN
DESCRIPTION (provided by applicant): The proposed study forges a link between Emory University Rollins School of Public Health and New Birth Missionary Baptist Church in metropolitan Atlanta, Georgia. The study aims are: (1) to adapt the evidence-based SISTA HIV intervention for African-American women by applying the ADAPT-ITT model to develop an adapted faith-based HIV intervention; (2) to assess the acceptability of the adapted faith-based HIV intervention by administering an acceptability survey to the community advisory board and pilot attendants; (3) to assess the efficacy of the faith-based adapted HIV intervention by demonstrating a reduction in unprotected sexual intercourse and mediators of safer sex over the 6-month follow-up period comparable to young adult women in the original SiSTA HIV intervention; (4) to enhance adoption of the faith-based adapted HIV intervention by training African-American females, 18 - 29 years of age from each of the six New Birth Affiliate Churches (N = 50 women total) to implement the faith-based adapted SISTA HIV Intervention; (5) to enhance diffusion of the faith-based adapted HIV intervention by having each of the 50 trainers implement the intervention to five to ten women in the target population attending New Birth Affiliate Churches; (6) to assess fidelity to the faith-base adapted HIV intervention among the 50 trainers by having them complete a Session Adherence form after every workshop administered and (7) to determine the economic feasibility of implementing the faith-based adapted HIV intervention by assessing the cost to implement this intervention.
1 R18 EH000355-01 - Chicago Westside Partnership for Children's Asthma Initiative (CWPC-AI)
WHITMAN, STEVEN
DESCRIPTION (provided by applicant): Asthma is one condition that disproportionately affects poor and minority children living in inner-city neighborhoods. African American children have some of the highest rates documented, and Chicago has been shown to be among the hardest hit cities. The proposed project, the Chicago Westside Partnership for Children's Asthma Initiative (CWPC-AI), aims to translate the Seattle-King County Healthy Homes (SKCHH) environmental intervention model into one that is culturally appropriate and effective for children with poorly controlled asthma living in the poor, African American Westside Chicago community of North Lawndale. A collaborative approach drawing on the strengths of several partners and incorporating full and meaningful participation by the community will be utilized. The initiative builds on the experiences of the Sinai Urban Health Institute (SUHI) and Sinai Children's Hospital (SCH) in conducting and evaluating home-based pediatric asthma interventions utilizing Community Health Workers (CHW). The Metropolitan Tenant's Organization (MTO) will provide support in training CHWs to conduct a thorough environmental assessment, and to work with families in modifying the home environment and behaviors in a way that will reduce exposure to asthma triggers. An MTO Housing Advocate will handle environmental situations beyond the expertise of the CHW. The initiative will also partner with SUHI's Breathing Freedom program, a North Lawndale community-based smoking cessation program, to reduce secondhand smoke exposure among children who have asthma. Attorneys working for Health & Disability Advocates (HDA) will provide pro bono assistance in resolving housing and other issues requiring legal intervention. The Sinai Community Institute (SCI) and Chicago Asthma Consortium (CAC) will build upon their strong community connections in assembling a Community Advisory Committee, which will be instrumental in guiding the intervention process and in developing key relationships necessary in ensuring the success of the initiative. Our goal is to enroll 360 children into CWPC-AI over an 18-month recruitment period, with the intention of completing the entire 12-month intervention with 250 (70%) of the enrolled participants. CHWs will make 5-6 home visits over the course of the intervention, during which they will comprehensively educate the family on asthma and its proper management, focusing heavily on both improving medical management (e.g., recognizing and reacting appropriately to asthma symptoms, medication techniques, etc.) and reducing exposure to home triggers. Referrals to MTO and HDA will be made as necessary. Evaluation activities will focus on documenting the process of the intervention and the associated outcomes (effectiveness). Monitoring of the process is particularly important as it will allow for an assessment of the intervention's translatability, documenting the successes and challenges of implementing the program within the target community, and paving the way for the translation of the initiative to other populations. Qualitative methods will supplement quantitative data collection in better documenting issues related to translatability, assessing both community strengths which facilitate implementation and challenges that impede upon it, and the process of addressing any barriers. One of the specific aims of the project is to significantly impact asthma-related measures of morbidity, urgent health resource utilization and quality of life. Therefore, progress will be monitored towards 2 primary goals (to decrease asthma-related morbidity and to improve quality of life) and 3 intermediate goals (to decrease the number of asthma triggers in the home environment, to improve asthma-related knowledge of the child's primary caregiver and to improve the caregiver's self-efficacy to properly manage asthma). In all instances, a pre-post study design will be utilized, with each participant serving as his/her own historical control. The study has more than adequate power to detect effect sizes that are clinically meaningful. Substantial attention will be paid to matters of fidelity, uptake and other issues that will influence translatability. Throughout, we will operate with the explicit goal of being able to sustain this project after the initial funding has expired. The community, Community Advisory Committee, and all partnering agencies, will work collaboratively to ensure that the approach and its effects are sustained. Through this collaborative approach and implementation of an evidence-based intervention it is believed that CWPC-AI will significantly impact asthma health disparities, ultimately helping to close the gap. PUBLIC HEALTH RELEVANCE: African American children have been shown to have some of the highest rates of asthma documented, and Chicago has been demonstrated to be among the hardest hit cities. The Sinai Urban Health Institute (SUHI) and Sinai Children's Hospital (SCH) have sought to improve asthma management among inner-city children with asthma by providing individualized education in several interventions and published their results. The Chicago Westside Partnership for Children's Asthma Initiative (CWPC-AI), is an effort of translational intervention for pediatric asthma employing the Seattle-King County Healthy Homes model, an established intervention for pediatric asthma, as our foundation; and responding to two of the priority areas set forth in the FOA by the National Center for Environmental Health: (1) Healthy Homes and Communities - research to translate evidence-based interventions to address disparities in health outcomes related to environmental conditions in the home and/or communities; (2) Asthma - patient/guardian attitudes toward use of inhaled corticosteroids.
1 R18 PS001157-01 - Elimination of Health Disparities through Translation Research
WINGOOD, GINA MARIA
DESCRIPTION (provided by applicant): The proposed study forges a link between Emory University Rollins School of Public Health and New Birth Missionary Baptist Church in metropolitan Atlanta, Georgia. The study aims are: (1) to adapt the evidence-based SISTA HIV intervention for African-American women by applying the ADAPT-ITT model to develop an adapted faith-based HIV intervention; (2) to assess the acceptability of the adapted faith-based HIV intervention by administering an acceptability survey to the community advisory board and pilot attendants; (3) to assess the efficacy of the faith-based adapted HIV intervention by demonstrating a reduction in unprotected sexual intercourse and mediators of safer sex over the 6-month follow-up period comparable to young adult women in the original SiSTA HIV intervention; (4) to enhance adoption of the faith-based adapted HIV intervention by training African-American females, 18 - 29 years of age from each of the six New Birth Affiliate Churches (N = 50 women total) to implement the faith-based adapted SISTA HIV Intervention; (5) to enhance diffusion of the faith-based adapted HIV intervention by having each of the 50 trainers implement the intervention to five to ten women in the target population attending New Birth Affiliate Churches; (6) to assess fidelity to the faith-base adapted HIV intervention among the 50 trainers by having them complete a Session Adherence form after every workshop administered and (7) to determine the economic feasibility of implementing the faith-based adapted HIV intervention by assessing the cost to implement this intervention.
* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.
Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.
Page last modified: October 20, 2008
Content source: Office of the Chief Science Officer (OCSO)
