Nila Uthirasamy

This Practice Report describes our development of disability-inclusive public health courses. People with disabilities are designated as a “population with health disparities” by the National Institute on Minority Health and Health Disparities. Integrating disability-inclusive principles and approaches is an essential aspect of addressing barriers to population health and facilitating equitable public health practice among this population. Yet, public health professionals often receive minimal or no training on disability. To develop disability-inclusive public health training within our area of focus (developmental disabilities), we relied on input from key informants (N = 11) with expertise in disability advocacy, public policy, and public health practice and education. Thematic analysis with an “immersion and crystallization” process was used to produce 7 “Guiding Principles” for our work. Public health researchers and educators should consider building upon these emergent principles when developing disability-inclusive public health educational resources.

Background and Objective: Since cardiovascular health (CVH) precedes cardiovascular disease (CVD) outcomes, our study examines associations between state-level structural racism and CVH among Black and White participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Design and Participants: A cross-sectional analysis of baseline REGARDS data, a national prospective cohort of 30,239 Black and White adults, 45+ years, enrolled from 2003 to 2007 and followed for 15+ years. Main Measures: CVH, the primary outcome, was operationalized using Life’s Essential 8 (LE8)–physical activity, BMI, blood pressure, diet, cholesterol, smoking, glucose, sleep—with each component scored 0–100 and composite scores categorized as poor (< 50), intermediate (50–79), ideal (≥ 80). State-level structural racism measures (dichotomized at the median), created using the 2000 U.S. Census, Vera Institute, U.S. Census Current Population Survey, included Black:White ratios (B:W) for jail incarceration, residential segregation, economic status, education, employment, and health insurance. Participants with > 7 LE8 components and complete structural racism measures were included. All analyses were race-stratified. Ordinal logistic regression models were used to estimate associations and calculate adjusted proportional odds ratios and 95% confidence intervals. Key Results: In total, 24,811 participants were included. Average LE8 scores were significantly lower among Black than White participants (56 vs. 64; p < 0.001). Among Black participants, higher odds of low CVH were observed in states with greater structural racism: high B:W unemployment (OR = 1.41, 95% CI 1.23–1.61), residential segregation (1.39, 1.26–1.53), education (1.37, 1.20–1.56), poverty (1.22, 1.11–1.35), uninsured status (1.12, 1.02–1.22). White adults in high structural racism states also had higher odds of low CVH for unemployment (1.16, 1.04–1.29), segregation (1.22, 1.13–1.30), education (1.12, 1.03–1.21). Conclusions: Black participants in high structural racism states were at increased risk of poor CVH across measures of structural racism. White residents of these states were also at increased risk of poor CVH for fewer measures. Policy addressing structural factors like segregation and unemployment may help reduce Black–White CVH inequities.

Background: Early childhood interventions can simultaneously promote positive health and early language experiences, but implementation and health equity often receive insufficient attention during the development process. Objective: We apply a health equity lens to refine and pilot-test a family literacy and wellness program designed for Latino dual language learners (DLLs) entering kindergarten and their caregivers. Methods: In collaboration with a parent and community advisory board, we refined an 8-week family literacy and wellness program and conducted a pilot randomized controlled trial (RCT) with a waitlist control. The program, specifically designed by our interprofessional team for Latino DLLs, uses health topics (ie, nutrition, physical activity, sleep, and social-emotional development) to (1) introduce foundational language and literacy skills to children; (2) empower families to engage in health and home literacy activities using a strengths-based approach; and (3) encourage maintenance of families’ home language. We assessed reach by collecting sociodemographic information; attendance and acceptability using a parent survey; and preliminary effects on home literacy activities through a validated parent-report instrument (StimQ₂ quantity, quality, content, and concepts subdomains) and on child literacy skills using investigator-developed assessments. We analyzed quantitative data using descriptive statistics and regression analyses. Results: Parents and community advisors informed the program content. A total of 32 parent-child dyads were enrolled in the pilot RCT. All parents identified as Latino, and half had not completed high school, indicating that we reached the intended audience. Parents rated the program as highly acceptable, and 23 (72%) participants attended at least half of the sessions. After participation, group 1 had higher StimQ₂ quality scores (effect size 0.99, P=.02) and higher quantity scores (effect size 1.01, P=.04) compared with group 2. Conclusions: Similar interprofessional collaborations may be a promising strategy to promote equity in early language experiences for Latino DLLs and their families.

Ready and Healthy for Kindergarten is a Spanish/English multilingual family involvement program that is grounded in sociocultural and family literacy theories since it focuses on health and literacy development. The program’s development reflects a collaborative partnership of teachers, pediatricians, families, and an advisory board of multilingual parents dedicated to preparing preschoolers and their families for kindergarten. Health themes are presented to introduce foundational literacy and social-emotional skills, and the program comprises eight one-hour virtual sessions intended to engage both children and their families through active participation in learning. The program highlights how parents, educators, and pediatricians can come together to align their expertise and impact family knowledge around child development needs. With this strong collaboration when designing and implementing the Ready and Healthy for Kindergarten program, we were able to successfully provide guidance and support for families, which helped them to establish routines that promote health and well-being, along with some literacy skills.