Ecology, Wicked Problems, and the Context of Community Interventions

2019 ◽  
Vol 46 (2) ◽  
pp. 204-212
Author(s):  
Edison J. Trickett
Keyword(s):  
Public Health ◽  
Community Intervention ◽  
Wicked Problems ◽  
Community Research ◽  
Community Interventions ◽  
Ecological Processes ◽  
Intervention Process ◽  
Ecological Metaphor ◽  
Five Cs ◽  
Over Time

The concept of ecology has, over time, become increasingly important as a frame for conducting community interventions. While multiple ecological frameworks have been proposed both within and outside public health, most have drawn on Bronfenbrenner’s work and the concern with multiple levels of the ecological context. The present article presents an ecological metaphor for community intervention developed in community psychology over the past 50 years. This perspective was specifically developed to conduct community research and intervention in the spirit of community development. The article begins with a brief discussion of social problems as “wicked problems” defying preordained and prescribed solutions. It then organizes the presentation of the ecological metaphor around five Cs that, together, provide an overview of the main points of the perspective: contextualist philosophy of science, community as a multilevel concept, culture and diversity as critical community-defining concepts, collaboration as a fundamental part of the ecology of intervention, and commitment (to community over time). Each of these five Cs adds to an appreciation of the differing aspects of the community intervention process as an ecological enterprise. Embedded in the five Cs are four ecological processes drawn from field biology that are metaphorically useful in providing a cognitive map for understanding community and assessing community impact: interdependence, cycling of resources, adaptation, and succession. Together, this ecological perspective both reflects and differs from extant perspectives in public health and, as such, is intended to contribute to furthering ecological thinking and acting more generally in community interventions.

scholarly journals Helping Young Men Thrive: Positive Youth Development and Men’s Health

2009 ◽  
Vol 3 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Dzung X. Vo ◽  
M. Jane Park
Keyword(s):  
Gender Differences ◽  
Youth Development ◽  
Positive Youth Development ◽  
Community Intervention ◽  
Young Men ◽  
Positive Development ◽  
Community Interventions ◽  
Positive Outcomes ◽  
Healthy Development ◽  
Five Cs

Positive youth development (PYD) is a strong and growing field that complements the traditional problem-focused view of youth, and describes and promotes the healthy development and positive outcomes of young people. The PYD perspective can be applied in clinical and community intervention settings. Frameworks such as the “Five Cs” and the Search Institute’s developmental assets model have guided researchers and practitioners in better understanding the process of PYD and the effectiveness of community interventions to promote PYD. The PYD literature lacks a coherent guiding framework to describe gender differences in positive development, which in turn could guide community and clinical interventions designed to help young men thrive.

scholarly journals Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Barbara Tempalski ◽  
Leslie D. Williams ◽  
Brooke S. West ◽  
Hannah L. F. Cooper ◽  
Stephanie Beane ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Resource Availability ◽  
People Who Inject Drugs ◽  
Census Data ◽  
Poverty Rate ◽  
Community Action ◽  
Historical Change ◽  
Treatment Coverage ◽  
Over Time

Abstract Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.

scholarly journals Increasing Voluntary Public Health Reporting to the NHSN Antimicrobial Use Option

2020 ◽  
Vol 41 (S1) ◽  
pp. s296-s297
Author(s):  
Heather Dubendris ◽  
Amy Webb ◽  
Melinda Neuhauser ◽  
Arjun Srinivasan ◽  
Wendy Wise ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Stewardship ◽  
Self Report ◽  
Antimicrobial Use ◽  
Health Departments ◽  
Public Health Reporting ◽  
Use Stage ◽  
Education And Development ◽  
Health Registry ◽  
Over Time

Background: The CDC NHSN launched the Antimicrobial Use Option in 2011. The Antimicrobial Use Option allows users to implement risk-adjusted antimicrobial use benchmarking within- and between- facilities using the standardized antimicrobial administration ratio (SAAR) and to evaluate use over time. The SAAR can be used for public health surveillance and to guide an organization’s stewardship or quality improvement efforts. Methods: Antimicrobial Use Option enrollment grew through partner engagement, targeted education, and development of data benchmarking. We analyze enrollment over time and discuss key drivers of participation. Results: Initial 2011 Antimicrobial Use Option enrollment efforts awarded grant Funding: to 4 health departments. These health departments partnered with hospitals, which encouraged vendors to build infrastructure for electronic antimicrobial use reporting. CDC supported vendors through outreach and education. In 2012, with CDC support, Veterans’ Affairs (VA) Informatics, Decision-Enhancement, and Analytic Sciences Center and partners began implementation of Antimicrobial Use Option reporting and validation of submitted data. These early efforts led to enrollment of 64 facilities by 2014 (Fig. 1). As awareness of the antimicrobial use option grew, we focused on facility engagement and development of benchmark metrics. A second round of grant Funding: in 2015 supported submission to the Antimicrobial Use Option from additional facilities by Funding: a vendor, a healthcare system, and an antimicrobial stewardship network. In 2015, CMS recognized the Antimicrobial Use Option as a choice for public health registry reporting under Meaningful Use Stage 3, resulting in an increase in participating hospitals. Antimicrobial Use Option enrollment increased in 2015 (n = 120), coinciding with national prioritization of antimicrobial stewardship. In 2016, the SAAR, was released in NHSN. We leveraged the SAAR to encourage participation from additional facilities and began quarterly calls to encourage continued participation from existing users. In 2016, the Department of Defense began submitting data to the Antimicrobial Use Option, resulting in 207 facilities enrolled in 2016, which grew to 616 in 2017. As of November 2019, 12 vendors self-report submission capabilities and 1,470 facilities, of ~6,800 active NHSN participants, are enrolled in the Antimicrobial Use Option. Two states have passed requirements regulating Antimicrobial Use Option reporting with Tennessee’s requirement going into effect in 2021. Conclusions: The Antimicrobial Use Option offers evidence that collaboration with partners, and leveraging of benchmarking metrics available to a national surveillance system can lead to increased voluntary participation in surveillance of high-priority public health data. Moving forward, we will continue expanding analytic capabilities and partner engagement.Funding: NoneDisclosures: None

Health Disparities and the Law: Wrongs in Search of a Right

2003 ◽  
Vol 29 (2-3) ◽  
pp. 363-380
Author(s):  
Mary Anne Bobinski
Keyword(s):  
Public Health ◽  
Health Planning ◽  
Healthy People ◽  
Public Action ◽  
Traditional Health ◽  
Obesity And Diabetes ◽  
Wide Range ◽  
State Coercion ◽  
Healthy People 2010 ◽  
Over Time

Healthy People 2010 provides our Nation with the wide range of public health opportunities that exist in the first decade of the 21st century. With 467 objectives in 28 focus areas, Healthy People 2010 will be a tremendously valuable asset … . Healthy People 2010 reflects the very best in public health planning—it is comprehensive, it was created by a broad coalition of experts from many sectors, it has been designed to measure progress over time, and, most important, it clearly lays out a series of objectives to bring better health to all people in this country.The current responses to the traditional health perils … have been weakened. At the same time, it seems to this outsider as though the entire public health establishment is united around the proposition that massive public action should be taken to deal with the new “epidemics,” such as obesity and diabetes … . But the use of the term “epidemic” is just the wrong way to think about this issue. There are no noncommunicable epidemics … . Yet the designation [of] obesity as a public health epidemic is designed to signal that state coercion is appropriate … .

scholarly journals SARS-CoV-2 shifting transmission dynamics and hidden reservoirs potentially limit efficacy of public health interventions in Italy

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Marta Giovanetti ◽  
Eleonora Cella ◽  
Francesca Benedetti ◽  
Brittany Rife Magalis ◽  
Vagner Fonseca ◽  
...  
Keyword(s):  
Public Health ◽  
Epidemiological Data ◽  
Health Interventions ◽  
Transmission Dynamics ◽  
Public Health Interventions ◽  
Viral Spread ◽  
Three Phase ◽  
Phylodynamic Analysis ◽  
Epidemic Wave ◽  
Over Time

AbstractWe investigated SARS-CoV-2 transmission dynamics in Italy, one of the countries hit hardest by the pandemic, using phylodynamic analysis of viral genetic and epidemiological data. We observed the co-circulation of multiple SARS-CoV-2 lineages over time, which were linked to multiple importations and characterized by large transmission clusters concomitant with a high number of infections. Subsequent implementation of a three-phase nationwide lockdown strategy greatly reduced infection numbers and hospitalizations. Yet we present evidence of sustained viral spread among sporadic clusters acting as “hidden reservoirs” during summer 2020. Mathematical modelling shows that increased mobility among residents eventually catalyzed the coalescence of such clusters, thus driving up the number of infections and initiating a new epidemic wave. Our results suggest that the efficacy of public health interventions is, ultimately, limited by the size and structure of epidemic reservoirs, which may warrant prioritization during vaccine deployment.

Multiple Outbreaks of Gastroenteritis That Were Associated with 16 Funerals and a Unique Caterer and Spanned 6 Days, 2011, Québec, Canada

2013 ◽  
Vol 76 (9) ◽  
pp. 1582-1589 ◽  
Author(s):  
COLETTE GAULIN ◽  
SOULYVANE NGUON ◽  
MARIE-ANDREE LEBLANC ◽  
DANIELLE RAMSAY ◽  
SOPHIE ROY
Keyword(s):  
Public Health ◽  
Food Samples ◽  
Viral Gastroenteritis ◽  
Epidemiological Investigation ◽  
Food Handlers ◽  
Duration Of Symptoms ◽  
Causative Agents ◽  
Stool Samples ◽  
The Mean ◽  
Over Time

In January 2011, multiple acute gastroenteritis outbreaks that spanned many days and were related to attendance at funerals were reported to public health units in Quebec. An epidemiological investigation was initiated to identify the source of the contamination and to explain the extent of the contamination over time. Thirty-one cohorts of individuals attended different funerals held between 14 and 19 January. All attendees were served a cold buffet made by the same caterer. Of these 31 cohorts, 16 (with a total of about 800 people) contained individuals who reported being ill after the funeral. Symptoms were mainly diarrhea (89 to 94% of individuals), vomiting (63 to 90%,) and fever (26 to 39%), with a median incubation period of 29 to 33 h and a median duration of symptoms of 24 to 33 h, suggesting norovirus-like infection. Among the 16 cohorts, 3 were selected for cohort studies. Among those three cohorts, the mean illness rate was 68%. Associations were found between those who fell ill and those who had consumed pasta salad (relative risk [RR] = 2.4; P = 0.0022) and ham sandwiches (RR = 1.8; P = 0.0096). No food handlers reported being sick. No stool samples were provided by individuals who became ill. Environmental and food samples were all negative for causative agents. Although the causative agent was not clearly identified, this investigation raised many concerns about the importance of preventing foodborne transmission of viral gastroenteritis and generated some recommendations for management of similar outbreaks.

Arguments used by proponents and opponents in Brazil’s regulatory discussions of e-cigarettes and heated tobacco products

2021 ◽  
pp. tobaccocontrol-2021-056628
Author(s):  
Mônica Nunes-Rubinstein ◽  
Teresa Leão
Keyword(s):  
Public Health ◽  
Content Analysis ◽  
Cigarette Smoking ◽  
Health Risks ◽  
Regulatory Agency ◽  
Economic Consequences ◽  
The Other ◽  
Tobacco Products ◽  
The Right ◽  
Over Time

ObjectivesTo identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019.MethodsWe conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request.ResultsThe arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the ‘health’ theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used.ConclusionsThose that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.

scholarly journals What is Communicable? Unaccounted Injuries and “Catching” Diabetes in an Illegible Epidemic

2019 ◽  
Vol 34 (4) ◽  
Author(s):  
Amy Moran-Thomas
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Disease Transmission ◽  
Communicable Disease ◽  
Treatment Access ◽  
Infectious Disease Transmission ◽  
The World ◽  
Historically Situated ◽  
Over Time ◽  
Non Communicable Disease

Long-accepted models of causality cast diseases into the binary of either “contagious” or “non-communicable,” typically with institutional resources focused primarily on interrupting infectious disease transmission. But in southern Belize, as in much of the world today, epidemic diabetes has become a leading cause of death and a notorious contributor to organ failure and amputated limbs. This ethnographic essay follows caregivers’ and families’ work to survive in-between public health categories, and asks what responses a bifurcated model of infectious versus non-communicable disease structures or incapacitates in practice. It proposes an alternative focus on diabetes as a “para-communicable” condition—materially transmitted as bodies and ecologies intimately shape each other over time, with unequal and compounding effects for historically situated groups of people. The article closes by querying how communicability relates to community, and why it matters to reframe narratives about contributing causalities in relation to struggles for treatment access.

scholarly journals Quantifying the relationship between lockdowns, mobility, and effective reproduction number (Rt) during the COVID-19 pandemic in the Greater Toronto Area

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Dainton ◽  
Alexander Hay
Keyword(s):  
Public Health ◽  
Secular Trend ◽  
Reproduction Number ◽  
Time Lag ◽  
Correlation Coefficients ◽  
Greater Toronto Area ◽  
Global Mobility ◽  
The Relationship ◽  
Second Wave ◽  
Over Time

Abstract Background The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting. Objective We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada. Methods Weekly effective reproduction number (Rt) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of Rt over time. We calculated Pearson correlation coefficients between GMI and Rt for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days. Results In all PHUs except Toronto, the most rapid decline in Rt occurred in the first 2 weeks of the first province-wide lockdown, and this was followed by a slight trend to increased Rt as restrictions decreased. This trend reversed in all PHUs between September 6th and October 10th after which Rt decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and Rt were significant (p < 0.01) in all PHUs 14 days after lockdown, indicating moderate to high correlation between decreased mobility and decreased viral reproduction rates, and reflecting that the incubation period brings in a time-lag effect of human mobility on Rt. In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown. Conclusions The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing Rt over time.

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