Sarah E. Brewer

School-based asthma programs have reduced asthma disparities for low-income and racial/ethnic minority children in urban settings, including Latinx families. However, rural parent perspectives have not yet been incorporated into these programs. To inform implementation of our Better Asthma Control for Kids (BACK) program in rural Colorado, we sought to understand the barriers and facilitators to asthma management in rural settings for Latinx and non-Latinx families. Between June and September 2022, interviews with Latinx and non-Latinx caregivers of children with asthma in rural Colorado explored barriers and facilitators to pediatric asthma management, including self-management practices, cultural beliefs, and interest in BACK. Interviews were coded and analyzed for thematic domains of commonalities and unique experiences by ethnicity/language spoken. We interviewed 22 caregivers (68% Latinx, 45% Spanish-speaking) living in two rural regions of Colorado. Barriers across caregivers included three themes: (a) Rural families experience challenges accessing asthma care due to transportation challenges and limited health care availability. (b) Families have common knowledge, language, and cultural gaps that lead to misperceptions of asthma. Latinx caregivers, who often struggled to understand why their child had asthma, leading to limited diagnosis acceptance and obstacles to self-management. (c) Rural caregivers desire tailored education to address asthma knowledge gaps and were interested in school-based asthma programs like BACK. The novel barriers to pediatric asthma management identified among rural non-Latinx and Latinx families will guide tailoring of BACK to enhance its impact—other programs seeking to improve asthma disparities in rural and Latinx communities should consider these barriers.

Background: Public health messaging often falls short of the needs of underserved and minority communities, missing the mark on translating information that captures cultural, linguistic, or community relevance to influence health behaviors. Rapid community translation (rapid-CT) is an adaptation of the Boot Camp Translational method for community engagement in translating medical evidence into community health promotion messages and interventions. This paper describes the dissemination of materials from a rapid-CT of messages promoting COVID-19 vaccination among children and adults, boosters, and Long COVID messages. Methods: This project engaged five disproportionately impacted Colorado communities: urban and rural Latino/a/x, urban Black/African American, rural African immigrant, and urban American Indian/Alaska Native communities to conduct three cycles of about 6 week each of rapid-CT over 2021–2022. Each cycle of rapid-CT was led by 2 trained facilitators, usually one academic and one community partner. The process involved: (1) determining the role of partners and fostering partnerships; (2) describing the innovation, rationale, and evidence; (3) identifying the intended audience, message, timing, and format for dissemination; (4) selecting the communication and distribution channels; (5) identifying barriers and facilitators to dissemination, and (6) evaluating and refining the dissemination process. Dissemination was examined via tracking spreadsheet and impact was examined through surveys (recollection of seeing the materials, attitudes about COVID vaccinations, and vaccine status) and team de-briefing. Results: We engaged 126 unique community members and 15 facilitators. Within each cycle, rapid-CT communities co-created distinctive campaigns including messages, materials, and dissemination strategies. Each rapid-CT group identified anticipated and actual barriers and facilitators to the dissemination of messages and materials. Each group also demonstrated impact with metrics ranging from views of online videos or marketing materials to distributions of items promoting the message (e.g., 1,000 stickers distributed), although capacity to assess impact was a varied and the changing evidence and related to COVID-19 vaccination presented challenges. Conclusion: Rapid-CT was effective for engaging communities in co-creating distinct messages and communication strategies tailored to their community's needs and populations. Rapid-CT is well-suited to message creation for dynamic public health emergencies. Future use of Rapid-CT should set clear expectations for time commitment of community partner and establish prospective evaluation plans in addition to community-developed plans.

Background: Refugees face barriers to accessing healthcare despite provision of short-term services after arrival. Limited access to sustained primary care may lead to increased emergency department (ED) utilization and little is known regarding how refugee children access emergency care. Objective: To compare the proportion of ED claims and median level of service (LOS) between refugee children and general population controls in a statewide claims database. Methods: We conducted a retrospective cohort study of medical claims for patients aged 0 to 18 years old in a statewide claims database from 2014–2019. Refugee claims were identified using deterministic linkage of children with known refugee status. Procedure and diagnosis ICD9/10, Healthcare Common Procedure Coding System, and Current Procedural Terminology codes were obtained from the statewide database to indicate type of claim (ED vs outpatient) and LOS. Demographics were extracted from a data warehouse. Primary outcome was the number of ED claims per 1000 combined ED and outpatient claims. LOS was measured as a proxy for ED visit complexity. We compared demographics, frequency of claims, and median LOS using chi-square. Results: There were 5,590,808 total claims with 1,235,476 ED claims. Median number of ED claims per individual patient was the same between groups, however the proportion of claims related to an ED visit was significantly higher in the refugee population than the general population controls (244 vs 221, p = 0.001). Median LOS for ED claims was Level 3 (99283) and there was no difference between groups. Conclusion: Proportion of ED claims was higher in a refugee population compared to controls with no differences in LOS, indicating higher ED utilization among refugees for all acuity levels. Further study is needed to determine if healthcare disparities account for this difference and if population specific services may support the care of the refugee children.

The lack of a cohesive, stakeholder-informed refugee health research agenda has been a barrier to promoting, funding, and conducting health research with refugee populations in North America. A cross-sectional study was conducted among individuals working in refugee health in North America (N = 93) to describe major domains within the field of refugee health research and to develop refugee health research priorities. Open-ended survey questions included: (1) What research topics specific to refugee research would you like to see in an international research agenda? (2) Please describe current and important gaps that you believe exist in refugee research and why? Overarching themes focused on the need for the development of research partnerships with refugee communities that are intentional, effective, and driven by the needs of refugee communities. The survey also identified a need for best practices in creating sustainable, community-based research partnerships (effective models and evidence-based strategies) that translate across 12 domains. The refugee health research priorities for North America described in this manuscript should continue to be modified over time as political, economic, social, and medical contexts change.

Purpose: To understand motivators, concerns, and factors associated with COVID-19 vaccine initiation for adults in five racial/ethnic communities across Colorado. Methods: Community-based data collectors surveyed participants from five Colorado communities (urban and rural Latina/o/x, urban Black, rural African American immigrant, and urban American Indian) about vaccine attitudes, intentions, and uptake from September to December 2021. Bivariate and multivariable logistic regression models were used to examine factors associated with the primary outcome of COVID-19 vaccine “initiation.” Results: Most participants (71.1%) reported having initiated COVID-19 vaccination; vaccine series completion was 65.1%. Both motivators and concerns about COVID-19 vaccines were prevalent. Vaccine hesitancy (OR: 0.41, 95% CI:0.32–0.53; p < .001) and low perceptions of COVID-19 vaccination social norms (OR: 0.48, 95% CI:0.27–0.84; p = .01) were associated with vaccine initiation. Conclusion: Despite the limitation of a moderate sample size, our findings support the need for further interventions to increase vaccination against COVID-19 by reducing vaccine hesitancy and improving perceived social norms of vaccination in underserved Colorado communities. Implications: To improve trust in vaccines and promote vaccine uptake, community messaging should be tailored to vaccination motivators and concerns and demonstrate COVID-19 vaccination as the community default.

Providing communities with COVID-19 vaccination information is essential for optimizing equitable vaccine uptake. Using rapid community translation, adapted from Boot Camp Translation, five community teams transcreated COVID-19 vaccination campaigns. Transcreated messaging incorporated community attitudes, culture, and experiences. Using rapid community translation for the promotion of COVID-19 vaccination demonstrates a successful approach to engaging communities most affected by the pandemic to develop messages that reflect community values, assets, and needs, especially when time is of the essence. (Am J Public Health. 2024;114(S1):S50–S54. https://doi.org/10.2105/AJPH.2023.307456 )