Publications

PURPOSE: Understand the cost of delivering existing community-based, no cost to participant, aerobic dance and yoga classes in an underserved, racial and ethnic minority community in the Midwest.

DESIGN: Pilot 4-month observational, descriptive, cost analysis of community fitness classes.

SETTING: Community-wide, group-based, fitness classes online, and in parks and community centers in traditionally Black neighborhoods in Kansas City.

PARTICIPANTS: Participants (N = 1428) were recruited from underserved, racial and ethnic minority areas of Kansas City, Missouri.

INTERVENTION: Aerobic dance and yoga classes were provided free of charge to all residents of Kansas City, Missouri online and in-person. Each class was approximately 1 hour, with a warmup and cooldown. All classes were delivered by African American women.

METHODS: Descriptive statistics of the costs for the program are presented. Cost per metabolic equivalents (MET) were calculated. Independent samples t-tests were conducted to examine differences between aerobic dance and yoga cost per MET.

RESULTS: The total program costs were $10,759.88 USD, with 1428 participants attending 82 classes over the 4-month intervention. The cost per MET was $1.67, $1.11, and $0.74/MET-hour/session/attendee for low, moderate, and high-intensity aerobic dance, respectively, and $3.02/MET-hour/session/attendee for yoga. Aerobic dance had a significantly lower cost per MET than yoga (t = 13.6, P < .001, t = 47.6, P < .001, t = 92.8, P < .001, for low, moderate, and high-intensity, respectively).

CONCLUSIONS: Delivering community-based, physical activity interventions in racial and ethnic minority communities is a potential way to increase physical activity. The costs of group-based fitness classes are similar to other physical activity interventions. Further research needs to be conducted on the costs to increase physical activity of traditionally underserved populations who suffer from higher rates of inactivity and comorbidities.

OBJECTIVE: To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030.

METHODS: Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons.

RESULTS: Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96).

CONCLUSIONS: Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines.

LEVEL OF EVIDENCE: N/A Laryngoscope, 2023.

OBJECTIVE: Community Health Improvement Plans (CHIPs) are a foundational public health practice conducted by every accredited health department in the United States. Community Health Improvement Plans may impact community-wide physical activity (PA) by implementing large-scale interventions. However, no studies have evaluated whether, or how, CHIP goals focusing on increasing PA are implemented. This study aims to understand CHIP PA goals, implementation strategies, and implementation outcomes of CHIP nationally.

DESIGN: This study was a cross-sectional online survey of CHIP implementation.

SETTING: A random sample of accredited local health departments nationally.

PARTICIPANTS: Local health departments (N = 44) were invited to participate in this study.

MAIN OUTCOME MEASURES: Constructs from Proctor's Model of Implementation Research and implementation strategies were the main outcomes assessed.

RESULTS: Most CHIPs included PA goals (72.7%). Goals most commonly focused on changing built environment and infrastructure (25.9%), increasing education and awareness (22.2%), increasing PA programming (18.5%), and partnering with health care (18.5%). Common implementation strategies used were designing and evaluating their CHIPs (72.7%) and developing relationships with stakeholders (72.7%). Respondents reported that CHIPS were able to be adopted, acceptable for the community, and feasible. Community Health Improvement Plans were also reported to be safe, yet respondents reported effectiveness lower than other constructs. Participants reported that individual-level PA was unlikely to change due to their CHIP (mean = 3.39, SD = 1.12).

CONCLUSIONS: Overall, it seems that communities are choosing easily adopted, appropriate, feasible, and safe interventions that may be less effective over those that may produce large-scale improvement in PA behavior. Future research needs to be conducted on the process of CHIP implementation and the potential long-term outcomes. Community Health Improvement Plans may serve as a powerful tool to improve population health if implemented effectively.

BACKGROUND: Ending the HIV epidemic requires additional healthcare and public health workers who are competent in HIV prevention and treatment. The National HIV Curriculum was developed to increase competency in HIV among healthcare workers in the US.

OBJECTIVES: The purpose of the current study was to examine the impact of implementing the National HIV Curriculum (NHC) for nursing and public health students.

DESIGN: This study employed a single-arm, cohort intervention design.

SETTING: This study was conducted at large, public university in the Midwestern United States of America in a state noted for high HIV transmission.

PARTICIPANTS: Undergraduate nursing, graduate nursing, and undergraduate public health students participated in this study.

METHODS: An online survey of nursing and public health students was conducted following implementation of the NHC at a large, public university in the Midwest. Students were assessed on knowledge and interest of HIV using a bootstrapped paired-samples t-test approach.

RESULTS: Participants (N = 175) were enrolled in the undergraduate nursing program (n = 72, 41.14 %), graduate nursing (n = 37, 21.14 %) public health (n = 37, 21.14 %), medicine (n = 10, 5.71 %), and biological, biomedical, and health sciences discipline (n = 19, 10.86 %). Overall, results suggest a consistent gain in knowledge of working with individuals living with HIV of 1.42 points (on a 4-point scale). About half (47.43 %) of all students increased interest to work with individuals living with HIV in the future.

CONCLUSION: The NHC increased knowledge and interest in students across a broad range of nursing, public health, medicine, and other disciplines. This study suggests that universities can integrate the curriculum across undergraduate and graduate programs. Students at varying degree levels may benefit from the NHC. Future longitudinal studies should be conducted on the career choices of those students exposed to the NHC.

PURPOSE: The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers' nutrition behaviors.

DESIGN: One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO.

INTERVENTION: Weekly delivery of free produce via a mobile market over 12 weeks.

MEASURES: A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks.

ANALYSIS: Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks.

RESULTS: More youth reported consuming fresh fruit (73.8% to 83.3%; χ2 = 7.76, P = .005) and vegetables (66.4% to 71.3%; χ2 = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ2= 6.33, P = .012) and sports drinks (41.8% to 38.2%; χ2= 12.32, P < .001) from baseline to follow-up.

CONCLUSIONS: A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents.

BACKGROUND: Sexually transmitted infection rates continue to increase across the US, further developing health disparities and economic burdens of disease, especially as migration occurs. In this study, we aim to assess the relationship between STI rates and population-level variables from 2008 to 2017 at the county level in Missouri.

METHODS: Two data sources were used: STI rates of chlamydia, gonorrhea, syphilis, HIV reported to Missouri DHSS and ACS 1-year county population estimates. Linear regression models and ANOVA tests were conducted in SPSS for each STI from year-to-year and 2008-2017. Covariates included in the analyzes were county-level income, employment rate, race, ethnicity, age, and percent poverty. Further, Akaike Information Criterion tests were performed to indicate the best predictor models and averaged standardized beta values.

RESULTS: Significant relationships among STI rates and population growth were identified. Chlamydia, syphilis, and HIV were positively associated with population growth from 2008 to 2017 (β = 0.15; β = 0.01; β = 0.05, respectively). Gonorrhea was negatively associated with population growth (β = - 0.02) but positively associated with unemployment rates (β = 0.01) highlighting the need to address population growth, as well as other variables in a population.

CONCLUSIONS: There seems to be a positive relationship among population change and rates of STIs. As populations change, rates of STIs change. Moving forward, quantitative work should be conducted in various states and the nation to understand this relationship in different contexts. Future studies should be qualitative word focused on county health departments and community health improvement plans. Lastly, public policy should be implemented to buffer the impact of migration on health outcomes.

BACKGROUND: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population.

OBJECTIVE: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research.

METHODS: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable.

RESULTS: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022.

CONCLUSIONS: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37126.

PURPOSE: Physical inactivity among adolescents in the United States continues to be a pervasive and growing problem, especially among low income and adolescents of color. Physical literacy is important for adolescents to engage in physical activity. However, few studies have assessed physical literacy among marginalized populations. The purpose of this study is to describe levels of physical literacy among marginalized adolescents in a Midwest City.

METHODS: Data were collected from 169 participants (85 adolescents and 84 parents). Adolescents included in the study were from 4 Kansas City (Missouri) public schools. Univariate statistics were calculated for 3 physical literacy domains (PLAYinventory, PLAYself, and PLAYparent). To assess for differences among groups, the authors conducted a single-factor analysis of variance (1-way analysis of variance).

RESULTS: The sample (N = 169) was primarily Hispanic (48.2% adolescents and 42.9% parents). Sedentary behaviors were self-reported as the highest overall activities adolescents participated in within the past 12 months. The mean physical literacy score for this sample was 71.9 among adolescent reported and 72.7 among parent reported. Analysis of variance of racial and ethnic groups for PLAYself and PLAYparent assessments showed no significant difference in values. Compared with other subscales of both the PLAYparent and PLAYself instrument, parents and adolescents showed a lack of confidence in adolescent's ability to be active in the 4 environments (land, water, ice, and snow).

CONCLUSION: Physical literacy is shown to be important in maintaining physical activity throughout life; given this, it is important to understand how to increase confidence of seasonal specific skills in marginalized adolescents.

BACKGROUND: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19).

OBJECTIVE: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest.

METHODS: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software.

RESULTS: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day.

CONCLUSIONS: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted.

Housing and employment are key factors in the health and wellbeing of persons living with HIV (PLWH) in the United States. Approximately 14% of low-income PLWH report housing instability or temporary housing, and up to 70% report being unemployed. The purpose of this study was to examine the outcomes of an intervention to improve housing and employment for PLWH in the Midwest. Participants (N = 87) were recruited from the Kansas City metropolitan area to participate in a one-year intervention to improve housing and employment. All individuals were living with HIV and were not stably housed, fully employed, nor fully engaged in HIV medical care. A series of generalized estimating equations were conducted using client-level longitudinal data to examine how housing, employment, viral load, and retention in care changed over time. Housing improved from baseline to follow-up, with more individuals reporting having stable housing (OR = 23.5; p < 0.001). Employment also improved from baseline to follow-up, with more individuals reporting full-time employment (OR = 1.9; p < 0.001). Viral suppression improved from baseline to follow-up, with more individuals being virally suppressed (OR = 1.6; p < 0.05). Retention in care did not change significantly from baseline to follow-up (OR = 0.820; p = 0.370). Client navigation seems to be a promising intervention to improve housing and employment for PLWH in the Midwest. Additional research is needed on the impact of service coordination on client-level outcomes. Future studies should be conducted on the scalability of client navigation interventions to improve the lives of low-income, underserved PLWH.