Jessica Haughton

Introduction: This study explored factors associated with sugar-sweetened beverage (SSB) and water consumption among adults in a small community in rural Mexico. Methods: We conducted a cross-sectional survey using door-to-door sampling in an unincorporated community. Measures included self-reported consumption of beverages, personal preference, behavioral, and social environmental factors. Hierarchical multivariate linear regression models tested associations between social environmental factors and beverage consumption. Results: Participants ( n = 89) reported consuming high amounts of sugar-sweetened beverages, averaging 29.9 oz (884.2 mL) per day. Daily water intake was approximately 33.9 oz (1002.5 mL) per day. Personal preference (β = 1.58; 95% CI 1.20, 2.04), behavioral (β = 1.38; 95% CI 1.10, 1.74), and social environmental factors (β = 1.38; 95% CI 1.02, 1.86) were associated with greater daily consumption of SSBs. Conclusions: Adults reported consuming high amounts of SSBs and low amounts of water. These behaviors correlated with personal preference, behavioral, and social environmental factors. A multidimensional approach that considers personal, behavioral, and social environmental factors could reduce SSB consumption and improve health outcomes in rural Mexican communities.

Objective: The Community Health Worker Institute (CHWI) addresses health-related social needs (HRSNs) by integrating Community Health Workers (CHWs) into patient care. This study explores the barriers and facilitators to HRSN referrals and the integration of CHWs within clinical teams. Methods: Qualitative interviews were conducted with CHWs, CHWI program staff, and clinicians from ambulatory care clinics. Semi-structured interviews, guided by the Consolidated Framework for Implementation Research, were audio-recorded, transcribed, and analyzed using rapid qualitative methods. Results: Preliminary findings found that while clinicians support the CHWI and referral program, time constraints during patient visits likely hinder effective screenings and referrals. CHWs are seen as valuable advocates but continue to face challenges due to confusion about their clinical role from patients and clinicians. Hierarchical power dynamics seen between providers and CHWs likely contribute to this confusion. Clinics with strong leadership, clear role delineation, and clinical site preparation appear to have better CHW integration. Conclusion: CHWs play a crucial role in addressing HRSNs, but their integration into clinical teams requires overcoming logistical and educational challenges. These findings offer insights for improving the HRSN referral process and integrating CHWs into healthcare systems.

Maternal mortality ratios (MMR) in sub-Saharan Africa remain the highest in the world, despite vast improvements made in other regions [1]. In 2020, the World Health Organization (WHO) developed Sustainable Developmental Goal (SDG) Target 3.1 to reduce the global MMR to less than 70 deaths per 100 000 live births in the next 10 years [2]. […]

Previous research has demonstrated that social determinants of health are drivers of medical utilization, cost, and health outcomes. In this study, we compared the mean annual total cost to deliver health services per patient by health-related social need (HRSN) status and total HRSNs using linear regression and ANOVA, respectively. Patients with ≥1 HRSN (n = 8409) yielded $1772 higher annual costs compared to patients without HRSNs (n = 34 775) (P < .0001). Compared to patients without HRSNs, delivering care to patients with 1 HRSN (n = 4222) cost $1689 (P < .0001) more and to patients with ≥2 HRSN (n = 4187) cost $1856 (P < .0001) more per year.

There are significant concerns that COVID-19-related disruptions in routine health care will reverse the gains made over the past 2 decades in reducing maternal and under-5 mortality in low- and middle-income countries. The objective of this study was to examine the extent of disruptions in community-based maternal and child health services and explore community perceptions and experiences with health care use in the year following the start of the COVID-19 pandemic in one district in northern Togo, West Africa. This study included analysis of multiple types of data including: (1) routine health management information system data from 18 public sector health centers, (2) programmatic data collected through an integrated health center- and community-based primary care program at 5 health centers, and (3) semi-structured interviews with health center managers, community health workers (CHWs), and community members at those 5 health centers. We found only short-term declines in service utilization coinciding with the COVID-19 pandemic and no decline in the delivery of community-based care by CHWs. Qualitative data were consistent with the quantitative results, reporting sustained use of health-care services. Multilevel factors related to the continued provision of care during the COVID-19 pandemic included regular and clear communication from CHWs as trusted community sources, risk minimization at the health-center level, continued provision of community-based care by CHWs, and collaboration between community leaders and health-care workers to limit COVID-19 transmission. Findings demonstrate resiliency of an integrated primary care system when equipped with an adequately trained, supervised, and supplied health workforce, implementation of infection prevention and control measures, communication by trusted community sources, and adaptations to health-care delivery that enable the continued provision of care.

Global rates of child mortality have significantly declined since 1990 with continued progress made towards the Sustainable Development Goal (SDG) target of less than 25 under-five deaths per 1000 live births by 2030 [1]. Several low- and middle-income countries (LMICs), however, are expected to fall short of this target due to disparities in managing preventable […]