Addressing the physician-scientist pipeline: Strategies to integrate research into clinical training programs
Introduction Physician-scientists are critical members of the biomedical workforce. Thecombination of rigorous scientific training and clinical skills uniquely positions them tobridge clinical needs with investigational pursuits by identifying important clinical questionsthat drive basic discoveries and translating those into therapeutics that improve patientoutcomes. The impact of physician-scientists on biomedical science has been profound.Indeed, the recipients of the 2019 Nobel Prize in Physiology or Medicine, William Kaelin Jr.,Gregg Semenza, and Peter Ratcliffe, are all physician-scientists. Furthermore, physician-scientists have been well represented as Nobel laureates (including Frederick Banting, CarlCori, Earl Sutherland, Alfred Gilman, Michael Brown, Joseph Goldstein, Bernardo Houssay,Edwin Krebs, Peter Agre, Harold Varmus, Robert Lefkowitz, Brian Kobilka, and RalphSteinman, to name a few). Yet, as the need for novel therapies has grown, the number ofphysician-scientists has declined (1). The reasons for this decline are numerous, includinglength and cost of clinical training, declining funding opportunities, reduced visibility ofphysician-scientist role models, and compensation disparities between academic andprivate practice careers. Residency, fellowship training, and entry into faculty — importantentry points for budding physician-scientists and a period of continuity for those who wish tobuild on their earlier research experiences — are critical junctures where attrition occursalong the physician-scientist training timeline (2–5).
Youth involvement in food preparation practices at home: A multi-method exploration of Latinx youth experiences and perspectives
Youth are frequently involved in preparing meals for themselves and family members. Latinx youth may be more likely to be involved in food preparation compared to youth from other ethnic backgrounds. Involvement in food preparation has been linked to various positive health outcomes, such as better diet quality and higher self-esteem. However, little is known about how youth come to be involved in food preparation at home. In addition, previous research has failed to explore the perspectives of youth regarding their role in food preparation. The objective of the present study was to qualitatively explore the food preparation practices of youth from im/migrant Latinx families. A multi-method study consisting of participatory focus groups embedded within an ethnographic fieldwork period was conducted. Participatory focus groups with Latinx youth featured inclusive discussions and participatory techniques, such as draw-write-tell activities, photo-elicitation activities, a decision-making chart activity, and listing activities. Twenty-three youths ages 9–17 years participated in this study. A thematic analysis uncovered themes related to gender norm expectations, specific cooking skills bound by age and food type, and food preparation as an important household contribution. Findings illustrate the diverse experiences of Latinx youth in food preparation. The investigation of youth involvement in food preparation in the home environment may identify potential targets for obesity prevention and dietary health promotion.
Air pollution and green consumption of consumers in China’s urban areas: a norm activation perspective
This study aims to explore how consumers’ psychological factors affect their pro-environment purchasing behavior in a smog-ridden city. Based on the Protective Action Decision Model and Heuristic–Systematic Model, this study proposed a model to investigate consumers’ decision-making process in purchasing green anti-smog products. It also provided new empirical evidence for the role of personal norms on consumers’ green consumption behavior by examining the differences between two groups of consumers (i.e., green and non-green) through a multi-group path analysis. The predictions were tested using a questionnaire survey of 1,124 participants living in the Beijing–Tianjin–Hebei region of China. Results indicated that product knowledge, smog knowledge, risk perception, and systematic processing positively affected consumers’ purchase intention. In addition, the significant differences of consumers with various personal norms in purchase decision-making were found in the current study. In the green group, product knowledge positively affected consumers’ risk perceptions and systematic processing intentions. Information seeking increased their purchase intentions. However, these relationships were not significant in the non-green group. This study contributes to the existing literature by linking consumers’ protective behaviors with green consumption and providing a comprehensive model for predicting consumers’ purchase decisions.
A Qualitative Study of Intimate Partner Violence and Employment Instability
Maintaining employment while suffering from intimate partner violence (IPV) is extremely difficult given the direct and indirect ways abusers disrupt work. The current qualitative study seeks to strategically fill a gap in knowledge regarding survivors’ employment instability and gain insight toward creating more supportive workplaces for survivors. Women (N = 19) receiving services for IPV at a Midwest U.S. agency were interviewed about their experiences of employment instability, workplace disruptions (including via technology), and their perceptions of policies and practices that employers use to support employees experiencing abuse. Specifically, the study asks four research questions to address gaps in literature: (a) What are the employment instability experiences of survivors related to IPV, including attendance, hours, and job loss? (b) What are survivors’ experiences of workplace disruptions, including with technology? (c) What formal employer policies and practices related to IPV are survivors familiar with? and (d) What workplace supports do IPV survivors perceive to be helpful or harmful? Findings uniquely contribute to existing literature by revealing employment instability among mothers, highlighting the use of technology to disrupt survivors’ work, and determining existing policies and procedures that workplaces use to address IPV. Implications for advocates working with survivors as well as employer and state policymakers are discussed.
Intimate Partner Violence in India: Abuse in India’s Empowered Action Group States
Married women in India experience intimate partner violence (IPV) at alarming rates. This study explores regional differences in Indian women’s physical IPV experiences by looking at the effect of living in eight Empowered Action Group (EAG) states. It is hypothesized that women in EAG states will be more likely to have experienced physical IPV than women living outside EAG states. A sample of 65,587 women was selected from the 2005-2006 India National Family Health Survey (NFHS-3). Counter to our hypothesis, logistic regression results show that living in an EAG state decreases likelihood of physical IPV in the past 12 months.
Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness
Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14–25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH’s engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.
Relationships Between Parenting and Dangerous Substance Use Behaviors Among Youth Experiencing Homelessness
Objective: Understanding patterns of dangerous and illicit substance use among young parents who are homeless may provide insight into how best to support this highly vulnerable group and their children. This study examines the relationship between having a biological child and drug use among youth experiencing homelessness. Method: We used 4 waves of cross-sectional data from 1,010 youths ages 14–26 at 3 drop-in agencies serving youth experiencing homeless in Los Angeles, CA. Among participants, 23.8% of males and 28.9% of females had a biological child. We conducted multivariate logistic regression models for males and females on 4 substance use behaviors in the past month: binge drinking, using hard/illicit drugs, prescription drug misuse, and injection drug use. Results: Fathers had greater odds of hard drug use, prescription drug misuse, and injection drug use than males without children. There was no significant relationship between having a child and any of the four substance use behaviors for females. Conclusions: Findings suggest that having a child is not associated with higher risk of dangerous or illicit substance use for females. Results highlight the need to proactively engage young males in pregnancy prevention, parenting programs, and substance use treatment and prevention.
Consideration of Heterogeneity in a Meta-analysis of Latino Sexual Health Interventions
Latino adolescents are disproportionately affected by teenage pregnancy, sexually transmitted infections, and HIV, persistent sexual and reproductive health (SRH) disparities that represent a national public health concern. Despite progress nationally, Latina adolescents continue to exhibit above-average teenage pregnancy, birth, and repeat birth rates.1 Particularly concerning are the 17% increase in reportable sexually transmitted infections among 10- to 19-year-old Latino adolescents since 2014 and the 6% rise in new HIV diagnoses among 13- to 19-year-old Latino adolescents between 2016 and 2017 alone.2–4 Given these statistics, research is needed to strengthen the evidence on programs to reduce Latino adolescent SRH disparities.
#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign
Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago’s PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.
Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group
Objectives: Lack of clarity on the definition of “patient engagement” has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of “patient engagement in research.” Methods: A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. Results: Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: “patient-centered” (30.5%), “patient engagement” (15.5%), and “patient participation” (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of “patient engagement,” the most common themes were “active process,” “patient involvement,” and “patient as participant.” In the research setting, the top themes were “patient as partner,” “patient involvement,” and “active process”; these did not appear in the top 3 themes of nonresearch definitions. Conclusion: Distinct themes are associated with the term “patient engagement” and with engagement in the “research” setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of “patient engagement in research.”
Putting Quality Metrics in Context: A Novel Index Approach to Measuring Inpatient Utilization
To determine the preliminary feasibility and reliability of a novel health plan‐level quality index reflecting multiple aspects of inpatient utilization currently measured by separate quality metrics. Analysis of three Healthcare Effectiveness Data and Information Set (HEDIS) measures: Acute Hospital Utilization (AHU), Hospitalizations for Potentially Preventable Conditions (HPC), and Plan All‐Cause Readmissions (PCR). Proportion of plans able to report these measures were examined within and between measurement years. Individual measure performance was scored on the observed‐to‐expected (O/E) ratio: O/E = 1 “as expected” (score of 0), O/E < 1 “better than expected” (score of +1), and O/E > 1 “worse than expected” (score of ‐1). Measure scores were summed to create an index (‐3 to +3). Performance variation was examined. Index unidimensionality and reliability were evaluated using coefficient omega (total and hierarchical) and explained common variance (ECV). Medicare Advantage (MA) plans reporting HEDIS in measurement years (MY) 2017 (505 plans) and 2018 (525 plans). To align reporting strata across the three metrics, analysis was restricted to beneficiaries age 65 and older. A majority of plans were able to report measures in both MY2017 and MY2018 (AHU: 67.0%, HPC: 65.7%, PCR: 60.7%). In MY2018, 71.4% of plans reported all three measures. The strongest correlation in O/E ratios was observed between AHU and HPC (Pearson: 0.29, Spearman: 0.64), the weakest between AHU and PCR (Pearson: 0.19, Spearman: 0.17). A moderate correlation was observed between PCR and HPC (Pearson: 0.31, Spearman: 0.36). “Better than expected” (+1) was the most common measure‐level score on AHU (48.0%) and HPC (51.4%). “As expected” (0) was the most common score (58.5%) on PCR. The most common index score was +2 (25.1%), and mean score was 0.3. HPC performance scores were most likely to contribute to an increased index score (52.4% of cases), and AHU performance was most likely to contribute to a decreased index score (42.1% of cases). PCR performance was as likely to increase (20.5%) as decrease (21.1%) the index score. When the original O/E ratio for each measure was retained, moderate‐to‐good reliability was observed. Omega hierarchical approached the minimum 0.50 threshold (0.49), and ECV met the 0.85 threshold for unidimensionality. Omega hierarchical decreased significantly (0.33), and ECV no longer achieved the 0.85 threshold when the composite was scored as an ordinal index (‐3 to +3). A composite inpatient utilization index is feasible and demonstrates meaningful variation. Index‐style scoring is useful for visualization and identification of trends; however, composite reliability is achieved only when original O/E ratios are maintained. Alternative scoring approaches should be examined. Inpatient utilization is a primary driver of health care costs and critical target for quality improvement. Current health plan accountability metrics focus on different components of utilization separately and may miss the relationships between them. Interventions to improve one metric may overlap into another, while over‐focusing on one aspect in isolation may lead to perverse incentives (eg, keeping total hospitalizations high to make readmission rates appear low). The proposed composite approach provides a more complete representation of inpatient care, improving transparency and accountability.
Prevalence of Intestinal Parasites in a Low-Income Texas Community
Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth’s unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.
Young transgender women survivors of intimate partner violence: A latent class analysis of protective processes
The Effect of Mentoring on School Attendance and Academic Outcomes: A Randomized Evaluation of the Check & Connect Program
Chronic absenteeism in early grades has been found to be predictive of high school dropout, but little is known about effective solutions to reduce absenteeism. Researchers conducted a randomized evaluation of Check & Connect (C&C), a school-based mentoring program, to evaluate its impact on school attendance and academic outcomes. The study was conducted in Chicago Public Schools (CPS) from 2011-2015. For students who began the program in grades 5-7, the program decreased student absences and caused participating students to fail fewer courses. However, there were no measurable effects of participating in the program for students who began the program in grades 1-4.
Financial Instability in the Earned Income Tax Credit Program: Can Advanced Periodic Payments Ameliorate Systemic Stressors?
The Earned Income Tax Credit (EITC) serves more than 26 million U.S. tax filers every year. The EITC is distributed annually at tax time; however, past research suggests that lump-sum disbursements leave households with a lack of funds to deal with financial emergencies throughout the year. Drawing upon the data from a pilot program conducted in 2014–2015 in Chicago, this study analyzes how advanced periodic payments help mitigate financial instability for EITC recipients. Interview participants relate that advanced periodic payments result in a reduction in perceived stress, lower levels of debt, fewer unpaid bills, and the ability to engage youth in extracurricular activities. The findings provide a unique perspective on the ways in which low-income households cope with financial instability and stress and suggest that payment frequency options can play a small but important role in the way in which the EITC operates as a support mechanism.
Accountable policing: Policies to advance the personal safety of Black boys and young men (Race and Opportunity Lab Brief Report No. 3)
The policies and practices that perpetuate the continual, unjust murder of Black males by the nation’s law-enforcement professionals have gone unchanged for far too long. While this pattern is most dangerous for Black men (Ross, 2015), the consequences of this system reach communities far and wide. HomeGrown StL is issuing this Brief Report to provide local, state, and federal policymakers with concrete, evidence-based policy recommendations for building an equitable, transparent, and ac- countable public-safety approach that will serve and protect all U.S. residents, not just a select few. Our review of local, state, and federal law-enforcement policies demonstrates that, although a handful have been implemented to reduce police violence, evidence-based solutions have been neglected in favor of ineffective approaches or of complete inaction. It is time for policymakers, especially leaders in the St. Louis region, to acknowledge their responsibility for putting an end to this abhorrent injustice.
Exposure to community-based violence on social media among black male emerging adults involved with the criminal justice system
The prevalence of community-based violence (CBV) exposure among black American male emerging adults ages 18 to 25 with a history of involvement with the criminal justice system is a major public health concern. Although exposure (whether as victim or witness) to CBV is linked with negative outcomes, empirical research examining black men’s negative emotional responses to seeing videos of real-life incidents of CBV on social media is scant. To address these identified concerns and make recommendations for future research, the present study examines the relationship between seeing videos of CBV on social media and three types of negative emotional responses (that is, feeling sad, angry, and fearful) prior to incarceration among a sample of 101 black men detained in a midwestern jail. Social media use and seeing videos of CBV on social media were moderately high for study participants. Seeing a video involving police violence was significantly associated with an increase in the odds of feeling sad, angry, and fearful. Social media research is an emerging area that has the potential to advance our understanding of the impact of seeing social media videos of police violence on the well-being of black men and factors that mediate or moderate this relationship.
A Meta-Analysis of Acculturation and Enculturation: Bilinear, Multidimensional, and Context-Dependent Processes
Acculturation and enculturation are currently conceptualized as bilinear, multidimensional, and context-dependent cultural socialization processes (Yoon et al., 2013). Yet, this conceptualization requires further specification and empirical evidence. Our work is timely given the downward shift in productivity of traditional acculturation research and the need for a new direction. We examined the constructs and processes of acculturation and enculturation by meta-analytically synthesizing the findings of 255 publications (343 independent samples). In support of a bilinear (vs. unilinear) conceptualization, we found that acculturation and enculturation were only slightly associated with each other, r = −.18. In support of multidimensionality and context-dependency, their relationship varied by dimension (e.g., nonsignificant association of mainstream and ethnic identities vs. significant associations in other dimensions), geographic region, and race. Additionally, acculturation and enculturation rates/patterns varied by dimension; extrinsic changes (e.g., behavior) proceeded faster than intrinsic changes (e.g., values, identity). We discuss a direction for future research and implications for practice, advocacy, and education/training.
Using the Life Story Book With Mentally Alert Residents of Nursing Homes
Depression and lack of meaning in life (MIL) are common among residents of nursing homes (NHs) and contribute to a reduction in overall health and well-being. Life Story Book (LSB), a reminiscence intervention, is designed to provide a person with the opportunity to review their past and capture their life stories and photographs into a book. LSB has demonstrated positive outcomes for residents of NHs with dementia, yet little is known for residents without dementia. A switching replication design was used to examine the effects of LSB among 21 mentally alert residents from two NHs (NH-A and NH-B) in Houston, Texas. Participants in NH-A received three weeks of the LSB intervention, while NH-B received three weeks of care-as-usual; the intervention was then switched. The GDS-12R and the MIL questionnaire (MLQ) were used to measure depressive symptoms and MIL respectively. Participants from NH-A (n =11) and NH-B (n = 10) had a mean age of 75 years (SD =11.34); 81% female; 52% non-Hispanic white and 33% African American. Results from a one-way MANCOVA found no statistically significant difference on the GDS-12R and MLQ (F(3, 14) = 2.50, p = .102; Wilks’ Lambda = .652; η2 = .35). Further analyses comparing the pre-intervention and post-intervention scores for the entire sample (N =21) found a significant reduction in depressive symptoms (M = 2.67; SD = 2.52) and (M =1.67, SD = 2.29); (t (20) = 2.21, p = 0.039). The potential benefits of LSB for mentally alert residents of NHs warrants further research.
Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting
Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.