Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Meehan A[original query] |
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Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019
Meehan AA , Milazzo KE , Bien M , Nall SK , Vickery KD , Mosites E , Barocas JA . BMC Public Health 2024 24 (1) 1159 BACKGROUND: The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along orders), but little is known about the impact of involuntary displacement on health. The purpose of this study was to investigate the association between broadly defined experiences of involuntary displacement and self-reported health conditions among people experiencing homelessness. METHODS: We used logistic regression models to generate odds ratios using publicly available data from a cross-sectional sample of people experiencing homelessness in Denver, Colorado, during September 2018-February 2019. Hosmer-Lemeshow Goodness of Fit tests were used to assess model fit. RESULTS: Among 397 people experiencing homelessness, involuntary displacement was significantly associated with self-reported infectious diseases (adjusted odds ratio (aOR) 2.09, 95% CI 1.27, 3.41), substance and alcohol use (aOR 2.83; 95% CI 1.70, 4.73), climate-related conditions (aOR 2.27; 95% CI 1.35, 3.83), and worsening mental health (aOR 2.00; 95% CI 1.24, 3.24) after controlling for potential confounders. No statistically significant associations were identified between involuntary displacement and injuries, musculoskeletal issues, chronic conditions, and chronic mental and emotional issues. CONCLUSIONS: This research quantifies the association between involuntary displacement and multiple infectious and non-infectious health outcomes. While city officials attempt to grapple with increasing unsheltered homelessness, it is important to understand what harms are occurring that are associated with current policies. Our research adds to the growing body of literature that involuntary displacement is a harmful response to unsheltered homelessness. Alternative approaches focused on connections to housing and social services should be prioritized. |
Health belief model to assess Mpox knowledge, attitudes, and practices among residents and staff, cook county jail, Illinois, USA, July-August 2022
Hassan R , Meehan AA , Hughes S , Beeson A , Spencer H , Howard J , Tietje L , Richardson M , Schultz A , Zawitz C , Ghinai I , Hagan LM . Emerg Infect Dis 2024 30 (13) S49-s55 In summer 2022, a case of mpox was confirmed in a resident at the Cook County Jail (CCJ) in Chicago, Illinois, USA. We conducted in-depth interviews with CCJ residents and staff to assess mpox knowledge, attitudes, and practices; hygiene and cleaning practices; and risk behaviors. We characterized findings by using health belief model constructs. CCJ residents and staff perceived increased mpox susceptibility but were unsure about infection severity; they were motivated to protect themselves but reported limited mpox knowledge as a barrier and desired clear communication to inform preventive actions. Residents expressed low self-efficacy to protect themselves because of contextual factors, including perceived limited access to cleaning, disinfecting, and hygiene items. Our findings suggest correctional facilities can support disease prevention by providing actionable and tailored messages; educating residents and staff about risk and vaccination options; and ensuring access to and training for hygiene, cleaning, and disinfecting supplies. |
Lessons learned from COVID-19 response in correctional and detention facilities
Waddell C , Meehan A , Schoonveld M , Kaplan Z , Bien M , Bailey C , Mosites E , Hagan LM . Emerg Infect Dis 2024 30 (13) S5-s12 The COVID-19 pandemic disproportionately affected persons held in and working in correctional and detention facilities, causing facilities' traditional priorities to shift when healthcare and public health needs temporarily drove many aspects of operations. During July-August 2022, we interviewed members of health departments and criminal justice organizations to document lessons learned from the COVID-19 response in correctional settings. Participants valued enhanced partnerships, flexibility, and innovation, as well as real-time data and corrections-specific public health guidance. Challenges included cross-sector collaborations, population density, scarcity of equipment and supplies, and mental health. Most participants reported improved relationships between criminal justice and public health organizations during the pandemic. Lessons from COVID-19 can be applied to everyday public health preparedness and emergency response in correctional facilities by ensuring representation of correctional health in public health strategy and practice and providing timely, data-driven, and partner-informed guidance tailored to correctional environments when public health needs arise. |
Infectious diseases among people experiencing homelessness: A systematic review of the literature in the United States and Canada, 2003-2022
Waddell CJ , Saldana CS , Schoonveld MM , Meehan AA , Lin CK , Butler JC , Mosites E . Public Health Rep 2024 333549241228525 Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness. |
Considerations for defining homelessness in public health data collection
Meehan AA , Waddell CJ , Marx GE , Clarke KEN , Bratcher A , Montgomery MP , Marcus R , Ramirez V , Mosites E . Public Health Rep 2023 333549231215850 Public health problems cannot be addressed without timely and accurate data. However, data that provide insight into populations that may be at disproportionate risk for disease, including people experiencing homelessness, are insufficiently captured. Although the associations between homelessness and disease have been well documented,1-6 data on housing status are not universally or consistently collected in routine public health data.7 Improving collection of data on housing status in public health data collection efforts is necessary to address health disparities among people experiencing homelessness and advance health equity research and practice. | Collecting data related to homelessness and disease is complicated for several reasons, but one of the most salient reasons is that defining homelessness is challenging. Several federal agencies use their own definitions to identify people who might be eligible for assistance programs, creating confusion about which definition should be used for public health purposes. In addition, definitions of homelessness at federal agencies have changed over time, further complicating the collection of homelessness data. The US Department of Housing and Urban Development (HUD) defines homelessness as lacking a fixed, regular, and adequate nighttime residence8; this definition includes both people with a primary nighttime residence of a public or private place not meant for human habitation (eg, cars, parks, public spaces, abandoned buildings) and people residing in temporary shelters (eg, emergency homeless shelter, transitional housing). The US Department of Education (DOE) uses a broader lens, defining homelessness to include school-aged children whose housing situation meets the HUD criteria for homelessness while also including those who share housing with other people by doubling up or couch surfing; those who live in motels, hotels, or trailer parks; and those who are abandoned at hospitals.9 |
Compendium of measures to prevent disease associated with animals in public settings, 2023
Daly RF , Mathewson AA , Pride KR , Ireland MJ , Bailey SJ , Beck K , Benedict K , Calico M , Hairgrove T , Meehan T , Olsen C , Schaefbauer S , Stapleton S . J Am Vet Med Assoc 2023 261 (12) 1887-1894 Opportunities for the public to interact with animals in public settings such as petting zoos, fairs, and farm visits can be valuable learning and entertainment experiences. However, zoonotic disease transmission from healthy animals on exhibit and their environments, as well as injuries and other health problems, may result from these interactions if steps are not taken to minimize risks. The 2023 Compendium of Measures to Prevent Disease Associated with Animals in Public Settings provides background about these potential risks and updates recommendations for reducing those risks. Enteric zoonotic disease risks from animal contact in public settings include Shiga toxin–producing Escherichia coli infections, cryptosporidiosis, and campylobacteriosis. These infections occur when pathogens are accidentally ingested by individuals following direct contact with animals or contaminated objects. Zoonotic influenza infections can occur in a similar manner or through aerosols generated from infected animals. Other infectious diseases, parasitic infections, bites, and other injuries are also possible hazards in these settings. Inadequate handwashing and facility design flaws are frequent contributors to these risks, especially on farms or temporary exhibits not specifically designed for public use. Venues should provide sufficient handwashing stations and establish clearly defined animal contact areas. Operators should educate visitors about potential disease and injury risks, steps necessary to minimize exposure, and the importance of handwashing after the visit. Additionally, operators and visitors alike should realize that certain individuals are at heightened risk for zoonotic infections. Signs, handouts, and other educational materials are publicly available in a toolkit that accompanies the compendium. © 2023 American Veterinary Medical Association. All rights reserved. |
Barriers to COVID-19 prevention measures among people experiencing homelessness with substance use disorder or serious mental illness
Meehan AA , Jeffers A , Barker J , Ray CM , Laws RL , Fields VL , Miedema SS , Cha S , Cassell CH , DiPietro B , Cary M , Yang M , McLendon H , Marcus R , Mosites E . J Prev (2022) 2023 44 (6) 663-678 People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health problems related to substance use disorder (SUD) and severe mental illness (SMI) may have created additional challenges for PEH to practice prevention measures like mask wearing, physical distancing, handwashing, and quarantine and isolation. The study objective was to understand the perceived barriers PEH face regarding COVID-19 non-pharmaceutical prevention strategies and identify recommendations for overcoming barriers. From August-October 2020, qualitative phone interviews with 50 purposively selected behavioral health professionals across the United States serving PEH with SUD or SMI were conducted. Professionals described that PEH faced barriers to prevention that were structural (e.g., access to necessary resources), behavioral (related to SUD or SMI), or related to the priority of other needs. Recommendations to overcome these barriers included providing free prevention resources (e.g., masks and hand sanitizer), providing education about importance of prevention strategies, and prioritizing access to stable housing. Interviews took place before COVID-19 vaccines were available, so barriers to vaccination are not included in this paper. Findings can help support tailored approaches during COVID-19 and future public health threats. |
Strengthening public health capacity to address infectious diseases: Lessons from 3 Centers of Excellence in Public Health and Homelessness
Bien MB , Whitton A , Meehan A , Thornhill L , Ellis K , Leopold J , Borne D , Vickery KD , Imbert E , Twohey-Jacobs L , Perez KA , Mosites E . J Public Health Manag Pract 2023 29 (6) 775-779 People experiencing homelessness are disproportionately affected by infectious diseases and often face barriers to receiving appropriate medical treatment. Responding to the needs of people experiencing homelessness requires state and local health departments to integrate information sources and coordinate multisector efforts. From 2021 to 2023, the CDC Foundation, in cooperation with the Centers for Disease Control and Prevention, established pilot Centers of Excellence in Public Health and Homelessness in Seattle, Washington; San Francisco, California; and the state of Minnesota. These centers strengthened their capacity to address the needs of people experiencing homelessness by supporting cross-sector partnerships, assessing the interoperability of data systems, prioritizing infectious disease needs, and identifying health disparities. These programs demonstrated that health departments are heterogeneous entities with differing resources and priorities. They also showed the importance of employing dedicated public health staff focused on homelessness, establishing diverse partnerships and the need for support from local leaders to address homelessness. |
Previous health care experiences' influence on health care perceptions among residents of six homeless shelters in Seattle, Washington, July-October 2021
Meehan AA , Cox SN , Thuo NB , Rogers JH , Link AC , Martinez MA , Lo NK , Manns BJ , Rolfes MA , Chow EJ , Chu HY , Mosites E , Al Achkar M . J Patient Cent Res Rev 2023 10 (3) 111-120 PURPOSE: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care. METHODS: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July-October 2021. All residents (age ≥18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose. RESULTS: Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination. CONCLUSIONS: Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes. |
Population-level health effects of involuntary displacement of people experiencing unsheltered homelessness who inject drugs in US cities
Barocas JA , Nall SK , Axelrath S , Pladsen C , Boyer A , Kral AH , Meehan AA , Savinkina A , Peery D , Bien M , Agnew-Brune C , Goldshear J , Chiang J , Linas BP , Gonsalves G , Bluthenthal RN , Mosites E . JAMA 2023 329 (17) 1478-1486 IMPORTANCE: At least 500 000 people in the US experience homelessness nightly. More than 30% of people experiencing homelessness also have a substance use disorder. Involuntary displacement is a common practice in responding to unsheltered people experiencing homelessness. Understanding the health implications of displacement (eg, "sweeps," "clearings," "cleanups") is important, especially as they relate to key substance use disorder outcomes. OBJECTIVE: To estimate the long-term health effects of involuntary displacement of people experiencing homelessness who inject drugs in 23 US cities. DESIGN, SETTING, AND PARTICIPANTS: A closed cohort microsimulation model that simulates the natural history of injection drug use and health outcomes among people experiencing homelessness who inject drugs in 23 US cities. The model was populated with city-level data from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance system and published data to make representative cohorts of people experiencing homelessness who inject drugs in those cities. MAIN OUTCOMES AND MEASURES: Projected outcomes included overdose mortality, serious injection-related infections and mortality related to serious injection-related infections, hospitalizations, initiations of medications for opioid use disorder, and life-years lived over a 10-year period for 2 scenarios: "no displacement" and "continual involuntary displacement." The population-attributable fraction of continual displacement to mortality was estimated among this population. RESULTS: Models estimated between 974 and 2175 additional overdose deaths per 10 000 people experiencing homelessness at 10 years in scenarios in which people experiencing homelessness who inject drugs were continually involuntarily displaced compared with no displacement. Between 611 and 1360 additional people experiencing homelessness who inject drugs per 10 000 people were estimated to be hospitalized with continual involuntary displacement, and there will be an estimated 3140 to 8812 fewer initiations of medications for opioid use disorder per 10 000 people. Continual involuntary displacement may contribute to between 15.6% and 24.4% of additional deaths among unsheltered people experiencing homelessness who inject drugs over a 10-year period. CONCLUSION AND RELEVANCE: Involuntary displacement of people experiencing homelessness may substantially increase drug-related morbidity and mortality. These findings have implications for the practice of involuntary displacement, as well as policies such as access to housing and supportive services, that could mitigate these harms. |
Factors that influence compliance for referral from primary care to hospital for maternal and neonatal complications in Bosaso, Somalia: a qualitative study
Morris CN , Meehan K , Had H , Barasa SO , Zainul H , Hynes M , Amsalu R . BMJ Open 2023 13 (4) e070036 OBJECTIVES: To estimate referral compliance and examine factors that influence decisions to comply with referral for newborn and maternal complications in Bosaso, Somalia. SETTING: Bosaso, Somalia, is a large port city that hosts a large proportion of internally displaced persons. The study was conducted at the only four primary health centres offering 24/7 delivery services and the only public referral hospital in Bosaso. PARTICIPANTS: All pregnant women who sought care at four primary centres and were referred to the hospital for maternal complications or mothers whose newborns were referred for neonatal complications were approached for enrolment from September to December 2019. In-depth interviews (IDIs) of 54 women and 14 healthcare workers (HCWs) were conducted. OUTCOME MEASURES: This study examined timely referral compliance from the primary centre to the hospital. IDIs were analysed for a priori themes investigating the decision-making process and experience of care for maternal and newborn referrals. RESULTS: Overall, 94% (n=51/54) of those who were referred, 39 maternal and 12 newborns, complied with the referral and arrived at the hospital within 24 hours. Of the three that did not comply, two delivered on the way, and one cited lack of money as the reason for noncompliance. Four themes emerged: trust in medical authority, cost of transportation and care, quality of care, and communications. The factors that facilitated compliance were the availability of transportation, family support, concern for health, and trust in medical authority. HCWs raised the importance of considering the maternal-newborn dyad throughout the referral process, and the need for official standard operating procedures for referrals including communications between the primary care and the hospital. CONCLUSIONS: High compliance for referral from primary to hospital care for maternal and newborn complications was observed in Bosaso, Somalia. Costs associated with transportation and care at the hospital need attention to motivate compliance. |
Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021.
Cox SN , Rogers JH , Thuo NB , Meehan A , Link AC , Lo NK , Manns BJ , Chow EJ , Al Achkar M , Hughes JP , Rolfes MA , Mosites E , Chu HY . Vaccine X 2022 12 100232 INTRODUCTION: Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. METHODS: We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. RESULTS: From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3% (n=53) when recalling attitudes in March 2020 to 74.4% (n=87) as of August 2021, and was similar among residents and staff. Many participants (43.6%, n=51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7% (n=16) changed back and forth, 10.3% (n=12) became more hesitant, and 32.5% (n=38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n=116), we found a 57.2% increase in vaccine acceptability (RR 1.57; 95% CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. CONCLUSIONS: Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917. |
Impact of Social Isolation during the COVID-19 Pandemic on Mental Health, Substance Use, and Homelessness: Qualitative Interviews with Behavioral Health Providers.
Jeffers A , Meehan AA , Barker J , Asher A , Montgomery MP , Bautista G , Ray CM , Laws RL , Fields VL , Radhakrishnan L , Cha S , Christensen A , Dupervil B , Verlenden JV , Cassell CH , Boyer A , DiPietro B , Cary M , Yang M , Mosites E , Marcus R . Int J Environ Res Public Health 2022 19 (19) The United States is experiencing a syndemic of homelessness, substance use disorder, and mental health conditions, which has been further exacerbated by the COVID-19 pandemic. Although it is expected that mitigation strategies will curb community transmission of COVID-19, the unintended consequences of social isolation on mental health and substance use are a growing public health concern. Awareness of changing mental health and substance use treatment needs due to the pandemic is critical to understanding what additional services and support are needed during and post-pandemic, particularly among people experiencing homelessness who have pre-existing serious mental illness or substance use disorder. To evaluate these effects and support our understanding of mental health and substance use outcomes of the COVID-19 pandemic, we conducted a qualitative study where behavioral health providers serving people experiencing homelessness described the impact of COVID-19 among their clients throughout the United States. Behavioral health providers shared that experiencing social isolation worsened mental health conditions and caused some people to return to substance use and fatally overdose. However, some changes initiated during the pandemic resulted in positive outcomes, such as increased client willingness to discuss mental health topics. Our findings provide additional evidence that the social isolation experienced during the pandemic has been detrimental to mental health and substance use outcomes, especially for people experiencing homelessness. |
Monkeypox case investigation - Cook County Jail, Chicago, Illinois, July-August 2022
Hagan LM , Beeson A , Hughes S , Hassan R , Tietje L , Meehan AA , Spencer H , Turner J , Richardson M , Howard J , Schultz A , Ali S , Butler MM , Arce Garza D , Morgan CN , Kling C , Baird N , Townsend MB , Carson WC , Lowe D , Wynn NT , Black SR , Kerins JL , Rafinski J , Defuniak A , Auguston P , Mosites E , Ghinai I , Zawitz C . MMWR Morb Mortal Wkly Rep 2022 71 (40) 1271-1277 Knowledge about monkeypox transmission risk in congregate settings is limited. In July 2022, the Chicago Department of Public Health (CDPH) confirmed a case of monkeypox in a person detained in Cook County Jail (CCJ) in Chicago, Illinois. This case was the first identified in a correctional setting in the United States and reported to CDC during the 2022 multinational monkeypox outbreak. CDPH collaborated with CCJ, the Illinois Department of Public Health (IDPH), and CDC to evaluate transmission risk within the facility. Fifty-seven residents were classified as having intermediate-risk exposures to the patient with monkeypox during the 7-day interval between the patient's symptom onset and his isolation. (Intermediate-risk exposure was defined as potentially being within 6 ft of the patient with monkeypox for a total of ≥3 hours cumulatively, without wearing a surgical mask or respirator, or potentially having contact between their own intact skin or clothing and the skin lesions or body fluids from the patient or with materials that were in contact with the patient's skin lesions or body fluids.) No secondary cases were identified among a subset of 62% of these potentially exposed residents who received symptom monitoring, serologic testing, or both. Thirteen residents accepted postexposure prophylaxis (PEP), with higher acceptance among those who were offered counseling individually or in small groups than among those who were offered PEP together in a large group. Monkeypox virus (MPXV) DNA, but no viable virus, was detected on one surface in a dormitory where the patient had been housed with other residents before he was isolated. Although monkeypox transmission might be limited in similar congregate settings in the absence of higher-risk exposures, congregate facilities should maintain recommended infection control practices in response to monkeypox cases, including placing the person with monkeypox in medical isolation and promptly and thoroughly cleaning and disinfecting spaces where the person has spent time. In addition, officials should provide information to residents and staff members about monkeypox symptoms and transmission modes, facilitate confidential monkeypox risk and symptom disclosure and prompt medical evaluation for symptoms that are reported, and provide PEP counseling in a private setting. |
COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021.
Meehan AA , Aarvig K , Kashani M , Whitton A , Mosites E . J Public Health Manag Pract 2022 28 (6) 693-701 CONTEXT: Understanding COVID-19 vaccine acceptability among people experiencing homelessness is critical to improve vaccine coverage during the COVID-19 pandemic. Little is known about COVID-19 vaccine acceptability people experiencing unsheltered homelessness (PEUH). OBJECTIVE: To identify and describe motivators for receiving a COVID-19 vaccine and reasons for hesitancy, information sources utilized and trusted for vaccine decision making, logistical barriers to receiving vaccination, and what might increase comfortability to receive a COVID-19 vaccination among PEUH. DESIGN: Cross-sectional survey design, implemented from March to June 2021. SETTING: Two US cities: Las Vegas and Nevada (urban), and Orlando, Florida (suburban). PARTICIPANTS: People experiencing predominantly unsheltered homelessness accessing handwashing stations and other wrap-around social services at program sites managed by Clean the World Foundation. MAIN OUTCOME MEASURES: The main outcome measures assessed included survey responses about current vaccine receipt (if participants have already received one or more doses of a COVID-19 vaccine), intention to receive a COVID-19 vaccine if not already received, motivators for receiving or wanting to receive a vaccine, reasons for hesitancy or uncertainty about receiving a vaccine, sources of information regarding COVID-19 vaccines, and actual or anticipated logistical barriers or challenges to receiving COVID-19 vaccines. RESULTS: Among 864 participants, 465 (53.8%) were classified as "vaccine accepting," and 399 were classified "vaccine hesitant or undecided." The primary motivator to be vaccinated was to protect their health (212, 45.6%). Hesitant or undecided participants reported that vaccines were too new (269, 67.4%) or they needed more information (223, 55.9%) and were more likely to receive information from social media than accepting participants (80.0% vs 58.3%, P < .001). Logistical barriers to vaccination included distance to vaccination locations (85, 21.3%), lack of transportation (79, 19.8%), and limited time (64, 16%). CONCLUSIONS: Vaccination efforts to reach PEUH should consider how information and logistical needs may be addressed. |
Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021.
Meehan AA , Thomas I , Horter L , Schoonveld M , Carmichael AE , Kashani M , Valencia D , Mosites E . JAMA Netw Open 2022 5 (8) e2227248 IMPORTANCE: A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH. OBJECTIVE: To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments. MAIN OUTCOMES AND MEASURES: The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas. RESULTS: Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population. CONCLUSIONS AND RELEVANCE: These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making. |
Behavioral Health Providers' Experience with Changes in Services for People Experiencing Homelessness During COVID-19, USA, August-October 2020.
Marcus R , Meehan AA , Jeffers A , Cassell CH , Barker J , Montgomery MP , Dupervil B , Henry A , Cha S , Venkatappa T , DiPietro B , Boyer A , Radhakrishnan L , Laws RL , Fields VL , Cary M , Yang M , Davis M , Bautista GJ , Christensen A , Barranco L , McLendon H , Mosites E . J Behav Health Serv Res 2022 49 (4) 470-486 The COVID-19 pandemic caused disruptions in behavioral health services (BHS), essential for people experiencing homelessness (PEH). BHS changes created barriers to care and opportunities for innovative strategies for reaching PEH. The authors conducted 50 qualitative interviews with behavioral health providers in the USA during August-October 2020 to explore their observations of BHS changes for PEH. Interviews were transcribed and entered into MAXQDA for analysis and to identify salient themes. The largest impact from COVID-19 was the closure or limited hours for BHS and homeless shelters due to mandated "stay-at-home" orders or staff working remotely leading to a disconnection in services and housing linkages. Most providers initiated telehealth services for clients, yielding positive outcomes. Implications for BHS are the need for long-term strategies, such as advances in communication technology to support BHS and homeless services and to ensure the needs of underserved populations are met during public health emergencies. |
Preventing childhood adversity through economic support and social norm strategies
Ottley PG , Barranco LS , Freire KE , Meehan AA , Shiver AJ , Lumpkin CD , Gervin DW , Holmes GM . Am J Prev Med 2022 62 S16-s23 Through the Essentials for Childhood program, the Centers for Disease Control and Prevention funds 7 state health departments (states) to address the urgent public health problem of adverse childhood experiences and child abuse and neglect, in particular. Through interviews and document reviews, the paper highlights the early implementation of 2 primary prevention strategies from the Centers for Disease Control and Prevention's child abuse and neglect technical package with the greatest potential for broad public health impact to prevent adverse childhood experiences-strengthening economic supports and changing social norms. States are focused on advancing family-friendly work policies such as paid family and medical leave, livable wage policies, flexible and consistent work schedules, as well as programs and policies that strengthen household financial security such as increasing access to Earned Income Tax Credit. In addition, states are launching campaigns that focus on reframing the way people think about child abuse and neglect and who is responsible for preventing it. State-level activities such as establishing a diverse coalition of partners, program champions, and state action planning have helped to leverage and align resources needed to implement, evaluate, and sustain programs. States are working to increase awareness and commitment to multisector efforts that reduce adverse childhood experiences and promote safe, stable, nurturing relationships and environments for children. Early learning from this funding opportunity indicates that using a public health approach, states are well positioned to implement comprehensive, primary prevention strategies and approaches to ensure population-level impact for preventing child abuse and neglect and other adverse childhood experience. |
Public Health Lessons Learned in Responding to COVID-19 Among People Experiencing Homelessness in the United States.
Mosites E , Harrison B , Montgomery MP , Meehan AA , Leopold J , Barranco L , Schwerzler L , Carmichael AE , Clarke KEN , Butler JC . Public Health Rep 2022 137 (4) 333549221083643 Homelessness is a serious public health issue. The number of people experiencing homelessness (PEH) has been increasing since 2016; on a single night in January 2020, an estimated 580 000 people were experiencing homelessness in the United States, more than 225 000 of whom were unsheltered (ie, having a primary nighttime location that is not designated as a regular sleeping accommodation, such as on the streets or in abandoned buildings, vehicles, or encampments). 1 Compared with the general US population, PEH experience elevated rates of infectious and noninfectious disease and face 3 to 10 times higher mortality rates.2,3 In the United States, non-Hispanic Black people were 3.5 times more likely than non-Hispanic White people to experience homelessness. 4 American Indian/Alaska Native people also have disproportionately high rates of homelessness compared with non-Hispanic White people. 5 |
Clinic- and Community-Based SARS-CoV-2 Testing Among People Experiencing Homelessness in the United States, March-November 2020.
Berner L , Meehan A , Kenkel J , Montgomery M , Fields V , Henry A , Boyer A , Mosites E , Vickery KD . Public Health Rep 2022 137 (4) 333549221086514 OBJECTIVE: SARS-CoV-2 testing is a critical component of preventing the spread of COVID-19. In the United States, people experiencing homelessness (PEH) have accessed testing at health clinics, such as those provided through Health Care for the Homeless (HCH) clinics or through community-based testing events at homeless service sites or encampments. We describe data on SARS-CoV-2 testing among PEH in US clinic- and community-based settings from March through November 2020. METHODS: We conducted a descriptive analysis of data from HCH clinics and community testing events. We used a standardized survey to request data from HCH clinics. We developed and made publicly available an online data entry portal to collect data from community-based organizations that provided testing for PEH. We assessed positivity rates across clinics and community service sites serving PEH and used generalized linear mixed models to account for clustering. RESULTS: Thirty-seven HCH clinics reported providing 280 410 tests; 3.2% (n = 8880) had positive results (range, 1.6%-4.9%). By race, positivity rates were highest among people who identified as >1 race (11.6%; P < .001). During the reporting period, 22 states reported 287 community testing events and 14 116 tests; 7.1% (n = 1004) had positive results. Among facility types, day shelters (380 of 2697; 14.1%) and inpatient drug/alcohol rehabilitation facilities (32 of 251; 12.7%) reported the highest positivity rates. CONCLUSIONS: While HCH clinic data provided results for a larger number of patients, community-based testing data showed higher positivity rates. Clinic data demonstrated racial disparities in positivity. Community-based testing data provided information about SARS-CoV-2 transmission settings. Although these data provide information about testing, standard surveillance systems are needed to better understand the incidence of disease among PEH. |
Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness - Six U.S. Jurisdictions, December 2020-August 2021.
Montgomery MP , Meehan AA , Cooper A , Toews KA , Ghinai I , Schroeter MK , Gibbs R , Rehman N , Stylianou KS , Yeh D , Thomas-Campbell N , Washington NC , Brosnan HK , Chang AH , Gomih A , Ngo C , Vickery KD , Harrison B , Winkelman TNA , Gerstenfeld A , Zeilinger L , Mosites E . MMWR Morb Mortal Wkly Rep 2021 70 (48) 1676-1678 COVID-19 outbreaks have been reported in homeless shelters across the United States (1). Many persons experiencing homelessness are older adults or persons with underlying medical conditions, placing them at increased risk for severe COVID-19–associated illness. The proportion of persons experiencing homelessness who are fully vaccinated against COVID-19 in the United States is currently unknown. Many persons experiencing homelessness express a willingness to receive the COVID-19 vaccine (2,3). |
COVID-19 Vaccine Acceptability Among Clients and Staff of Homeless Shelters in Detroit, Michigan, February 2021.
Meehan AA , Yeh M , Gardner A , DeFoe TL , Garcia A , Vander Kelen P , Montgomery MP , Tippins AE , Carmichael AE , Gibbs Chw R , Caidi H , Mosites E , Rehman N . Health Promot Pract 2021 23 (1) 15248399211049202 Understanding COVID-19 vaccine acceptability among clients and staff of homeless shelters can inform public health efforts focused on communicating with and educating this population about COVID-19 vaccines and thus improve vaccine uptake. The objective of this study was to assess COVID-19 vaccine acceptability and uptake among people in homeless shelters in Detroit, Michigan. A cross-sectional study was conducted from February 9 to 23, 2021. Seventeen homeless shelters were surveyed: seven male-only, three male/female, and seven women and family shelters. All clients and staff aged ≥18 years and able to complete a verbal survey in English or with a translator were eligible to participate; of the 168 individuals approached, 26 declined, leaving a total sample of 106 clients and 36 staff participating in the study. The median client and staff ages were 44 and 54 years, respectively. Most participants (>80%) identified as non-Hispanic Black or African American. Sixty-one (57.5%) clients and 27 (75.5%) staff had already received or planned to receive a COVID-19 vaccination. Twelve (11.3%) clients and four (11.1%) staff were unsure, and 33 (31.1%) clients and five (13.9%) staff did not plan to get vaccinated. Reasons for hesitancy were concerns over side effects (29 clients [64.4%] and seven staff [77.8%]) and unknown long-term health impacts (26 clients [57.8%] and six staff [66.7%]). More than half of the clients had already received or planned to receive the vaccine. Continuing efforts such as vaccine education for hesitant clients and staff and having accessible vaccine events for this population may improve acceptability and uptake. |
Priorities and indicators for economic evaluation of built environment interventions to promote physical activity
Cradock AL , Buchner D , Zaganjor H , Thomas JV , Sallis JF , Rose K , Meehan L , Lawson M , Lavinghouze R , Fenton M , Devlin HM , Carlson SA , Bhattacharya T , Fulton JE . J Phys Act Health 2021 18 (9) 1-9 BACKGROUND: Built environment approaches to promoting physical activity can provide economic value to communities. How best to assess this value is uncertain. This study engaged experts to identify a set of key economic indicators useful for evaluation, research, and public health practice. METHODS: Using a modified Delphi process, a multidisciplinary group of experts participated in (1) one of 5 discussion groups (n = 21 experts), (2) a 2-day facilitated workshop (n = 19 experts), and/or (3) online surveys (n = 16 experts). RESULTS: Experts identified 73 economic indicators, then used a 5-point scale to rate them on 3 properties: measurement quality, feasibility of use by a community, and influence on community decision making. Twenty-four indicators were highly rated (≥3.9 on all properties). The 10 highest-rated "key" indicators were walkability score, residential vacancy rate, housing affordability, property tax revenue, retail sales per square foot, number of small businesses, vehicle miles traveled per capita, employment, air quality, and life expectancy. CONCLUSION: This study identified key economic indicators that could characterize the economic value of built environment approaches to promoting physical activity. Additional work could demonstrate the validity, feasibility, and usefulness of these key indicators, in particular to inform decisions about community design. |
Rapid point-of-care CD4 testing at mobile units and linkage to HIV care: an evaluation of community-based mobile HIV testing services in South Africa
Sloot R , Glenshaw MT , van Niekerk M , Meehan SA . BMC Public Health 2020 20 (1) 528 BACKGROUND: Mobile HIV testing services (HTS) are effective at reaching undiagnosed people living with HIV. However, linkage to HIV care from mobile HTS is often poor, ranging from 10 to 60%. Point-of-care (POC) CD4 testing has shown to increase retention in health facilities, but little evidence exists about their use in mobile HTS. This study assessed the feasibility of POC CD4 test implementation and investigated linkage to HIV care among clients accepting a POC test at community-based mobile HTS. METHODS: This retrospective study used routinely collected data from clients who utilized community-based mobile HTS in the City of Cape Town Metropolitan district, South Africa between December 2014 and September 2016. A POC CD4 test was offered to all clients with an HIV positive diagnosis during this period, and a CD4 cell count was provided to clients accepting a POC CD4 test. Random effects logistic regression was used to assess factors associated with POC CD4 test uptake and self-reported linkage to care among clients accepting a POC test. Models were adjusted for sex, age, previous HIV test done, tuberculosis status and year of HIV diagnosis. RESULTS: One thousand three hundred twenty-five of Thirty-nine thousand seven hundred ninety clients utilizing mobile HTS tested HIV positive (3%). 51% (679/1325) accepted a POC test. The age group with the highest proportion accepting a POC test was 50+ years (60%). Females were less likely to accept a POC test than males (odds ratio = 0.7, 95%CI = 0.6-0.8). Median CD4 count was 429 cells/μl (interquartile range = 290-584). Among 679 clients who accepted a POC CD4 test, 491 (72%) linked to HIV care. CD4 cell count was not associated with linkage to care. CONCLUSION: Our findings suggest that mobile HTS can identify early HIV infection, and show that a high proportion of clients with a POC test result linked to care. Future research should assess factors associated with POC test acceptance and assess the impact of POC CD4 testing in comparison to alternative strategies to engage HIV positive people in care. |
Effectiveness of clinical training on improving essential newborn care practices in Bossaso, Somalia: a pre and postintervention study
Amsalu R , Morris CN , Hynes M , Had HJ , Seriki JA , Meehan K , Ayella S , Barasa SO , Couture A , Myers A , Gebru B . BMC Pediatr 2020 20 (1) 215 BACKGROUND: Increasingly, neonatal mortality is concentrated in settings of conflict and political instability. To promote evidence-based practices, an interagency collaboration developed the Newborn Health in Humanitarian Settings: Field Guide. The essential newborn care component of the Field Guide was operationalized with the use of an intervention package encompassing the training of health workers, newborn kit provisions and the installation of a newborn register. METHODS: We conducted a quasi-experimental prepost study to test the effectiveness of the intervention package on the composite outcome of essential newborn care from August 2016 to December 2018 in Bossaso, Somalia. Data from the observation of essential newborn care practices, evaluation of providers' knowledge and skills, postnatal interviews, and qualitative information were analyzed. Differences in two-proportion z-tests were used to estimate change in essential newborn care practices. A generalized estimating equation was applied to account for clustering of practice at the health facility level. RESULTS: Among the 690 pregnant women in labor who sought care at the health facilities, 89.9% (n = 620) were eligible for inclusion, 84.7% (n = 525) were enrolled, and newborn outcomes were ascertained in 79.8% (n = 419). Providers' knowledge improved from pre to posttraining, with a mean difference in score of + 11.9% (95% CI: 7.2, 16.6, p-value < 0.001) and from posttraining to 18-months after training with a mean difference of + 10.9% (95% CI: 4.7, 17.0, p-value < 0.001). The proportion of newborns who received two or more essential newborn care practices (skin-to-skin contact, early breastfeeding, and dry cord care) improved from 19.9% (95% CI: 4.9, 39.7) to 94.7% (95% CI: 87.7, 100.0). In the adjusted model that accounted for clustering at health facilities, the odds of receiving two or more essential newborn practices was 64.5 (95% CI: 15.8, 262.6, p-value < 0.001) postintervention compared to preintervention. Predischarge education offered to mothers on breastfeeding 16.5% (95% CI: 11.8, 21.1) vs 44.2% (95% CI: 38.2, 50.3) and newborn illness danger signs 9.1% (95% CI: 5.4, 12.7) vs 5.0% (95% CI: 2.4, 7.7) remained suboptimal. CONCLUSIONS: The intervention package was feasible and effective in improving essential newborn care. Knowledge and skills gained after training were mostly retained at the 18-month follow-up. |
Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo
Hynes M , Meehan K , Meyers J , Mashukano Maneno L , Hulland E . Reprod Health Matters 2017 25 (51) 1-11 Providing quality health care services in humanitarian settings is challenging due to population displacement, lack of qualified staff and supervisory oversight, and disruption of supply chains. This study explored whether a participatory quality improvement (QI) intervention could be used in a protracted conflict setting to improve facility-based maternal and newborn care. A longitudinal quasi-experimental design was used to examine delivery of maternal and newborn care components at 12 health facilities in eastern Democratic Republic of Congo. Study facilities were split into two groups, with both groups receiving an initial "standard" intervention of clinical training. The "enhanced" intervention group then applied a QI methodology, which involved QI teams in each facility, supported by coaches, testing small changes to improve care. This paper presents findings on two of the study outcomes: delivery of active management of the third stage of labour (AMTSL) and essential newborn care (ENC). We measured AMTSL and ENC through exit interviews with post-partum women and matched partographs at baseline and endline over a 9-month period. Using generalised equation estimation models, the enhanced intervention group showed a greater rate of change than the control group for AMTSL (aOR 3.47, 95% CI: 1.17-10.23) and ENC (OR: 49.62, 95% CI: 2.79-888.28), and achieved 100% ENC completion at endline. This is one of the first studies where this QI methodology has been used in a protracted conflict setting. A method where health staff take ownership of improving care is of even greater value in a humanitarian context where external resources and support are scarce. |
Integrating health and transportation in Nashville, Tennessee, USA: From policy to projects
Meehan LA , Whitfield GP . J Transp Health 2017 4 325-33 The Nashville Area Metropolitan Planning Organization (MPO) is among the first MPOs in the United States to recognize the interplay of transportation and public health, particularly regarding physical activity, air pollution, and traffic crashes. The Nashville MPO has taken a multifaceted approach to simultaneously improve the transportation system, quality of life, and health status of the region's population. The purpose of this paper is to describe the multiple programs and projects that the MPO has undertaken to this end, so that other cities might learn from Nashville's example.The MPO's strategy comprised six processes. First, the MPO conducted the Regional Bicycle and Pedestrian Study in 2009 and 2014 that established priority issues to be addressed by bicycle and pedestrian projects in Regional Transportation Plans. Second, the MPO responded to public opinion by adopting new transportation policies in the 2035 and 2040 Regional Transportation Plans, including increasing bicycle and pedestrian options and expanding public transit. Third, the MPO created scoring criteria for proposed roadway projects that prioritized health impacts. Fourth, the MPO reserved funding for projects selected under the new criteria and established a new funding program, the Active Transportation Program. Fifth, the MPO conducted the Middle Tennessee Transportation and Health Study, one of the first regional studies in the nation linking transportation and health. Finally, the MPO implemented the Integrated Transport and Health Impact Model which predicts and monetizes population-level health impacts of shifting the population towards active transportation modes.Recent inventories of bicycle and pedestrian infrastructure suggest these interrelated processes are increasing opportunities for walking, bicycling, and public transit use in the region. Further, each of these projects has contributed to a growing appreciation in the region of the links between transportation and health, and continued evaluation efforts can determine if transportation behaviors and health outcomes are changing. |
The integrated transport and health impact modeling tool in Nashville, Tennessee, USA: implementation steps and lessons learned
Whitfield GP , Meehan LA , Maizlish N , Wendel AM . J Transp Health 2016 5 172-181 The Integrated Transport and Health Impact Model (ITHIM) is a comprehensive tool that estimates the hypothetical health effects of transportation mode shifts through changes to physical activity, air pollution, and injuries. The purpose of this paper is to describe the implementation of ITHIM in greater Nashville, Tennessee (USA), describe important lessons learned, and serve as an implementation guide for other practitioners and researchers interested in running ITHIM. As might be expected in other metropolitan areas in the US, not all the required calibration data was available locally. We utilized data from local, state, and federal sources to fulfill the 14 ITHIM calibration items, which include disease burdens, travel habits, physical activity participation, air pollution levels, and traffic injuries and fatalities. Three scenarios were developed that modeled stepwise increases in walking and bicycling, and one that modeled reductions in car travel. Cost savings estimates were calculated by scaling national-level, disease-specific direct treatment costs and indirect lost productivity costs to the greater Nashville population of approximately 1.5 million. Implementation required approximately one year of intermittent, part-time work. Across the range of scenarios, results suggested that 24-123 deaths per year could be averted in the region through a 1-5% reduction in the burden of several chronic diseases. This translated into $10-$63 million in estimated direct and indirect cost savings per year. Implementing ITHIM in greater Nashville has provided local decision makers with important information on the potential health effects of transportation choices. Other jurisdictions interested in ITHIM might find the Nashville example as a useful guide to streamline the effort required to calibrate and run the model. © 2016. |
DELTA PREP: building capacity to meet the public health urgency of intimate partner violence
Mercy JA , Freire KE . Health Educ Behav 2015 42 (4) 433-5 We are social animals, and the quality of our relationships with each other lies at the heart of our health and well-being. The relationships we have with our spouses and domestic partners are perhaps among the most central in shaping our lives. Violence with our partners, of course, severely undermines and, in many cases, can destroy these relationships so important to our health and well-being. Unfortunately, intimate partner violence (IPV) is all too common. In 2011, over 1 in 5 women and 1 in 7 of men had experienced severe physical violence by an intimate partner sometime in their lifetime (Breiding et al., 2014). In addition, almost 1 in 10 women and 1 in 200 men had been raped by an intimate partner in their lifetime. These statistics, however, only tell part of the problem. The women, men, and children exposed to IPV are vulnerable to a broad range of public health problems and risk behaviors including, for example, depression, anxiety, posttraumatic stress disorder, sexually transmitted infections (including HIV), chronic pain, gastrointestinal disorders, cardiovascular disease, stroke, smoking, binge drinking, and HIV risk factors (Breiding, Black, & Ryan, 2008). Because of its prevalence and many health impacts, IPV must be considered an urgent public health problem deserving the same level of attention and investment we give to problems of similar magnitude and impact. | Given the urgency of addressing IPV and an associated increase in the demand for evidence-based IPV prevention innovations, building an infrastructure that can more effectively move innovations from research to action is increasingly important. This infrastructure requires attention to the capacity of state and local organizations to be successful in scaling up effective programs with fidelity (Flaspohler, Meehan, Maras, & Keller, 2012; Wandersman et al., 2008). It also requires a reach beyond traditional health agencies to partners with deep experience and expertise in IPV and social action. The four articles in this focus section describe the DELTA PREP Project, an initiative to build infrastructure to support IPV prevention and accelerate prevention efforts within 19 states through state domestic violence coalitions. The project (2008-2012) was initiated through a partnership between the Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention, state domestic violence coalitions, the CDC Foundation, and the Robert Wood Johnson Foundation, which provided funding for the project. |
A 10-year review of the Centers for Disease Control and Prevention's Heads Up initiatives: bringing concussion awareness to the forefront
Sarmiento K , Hoffman R , Dmitrovsky Z , Lee R . J Safety Res 2014 50 143-7 Children and adolescents are at increased risk for concussions, a type of mild traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or body that can change the way the brain normally works. While most children and adolescents no longer experience symptoms within two weeks of the injury, some—especially those who have a history of concussions—may have symptoms that last for months or even longer (Eisenberg, Andrea, Meehan, & Mannix, 2013). Concussions need to be addressed correctly to help reduce the risk for short- or long-term health problems that can affect a child’s or adolescent’s thinking, learning, behavior, and/or emotions (Brosseau-Lachaine, Gagnon, Forget, & Faubert, 2008; McClincy, Lovell, Pardini, Collins, & Spore, 2006; Moser, Schatz, & Jordan, 2005; Schatz, Moser, Covassin, & Karpf, 2011). | To help address this public health concern, the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000) charged the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control to implement a public information campaign to broaden public awareness of the health consequences of TBI. In response, CDC developed and launched the Heads Up concussion education campaign. Over the last 10 years, CDC’s Heads Up campaign has grown into a cohesive suite of educational initiatives that share a common goal: to help protect children and adolescents from concussions and other serious brain injuries by raising awareness, enhancing knowledge, and informing action to improve prevention, recognition, and response to concussions. Each CDC Heads Up initiative fulfills these goals by (1) translating the latest concussion science into educational products tailored specifically for the target audiences, and (2) working with partner organizations to disseminate and integrate concussion educational materials and messages into their existing systems and programs. This report describes the process CDC employed to develop and carry out the Heads Up campaign. |
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