Carin Molchan

Geographic disparities threaten equitable access for children to health-promoting safe green spaces, and quality early education in the communities in which they live and grow. To address gaps in the field, we integrated the fields of developmental psychology, public health, and environmental science to examine, at the population level, associations between the environmental burden, socioeconomic vulnerability, and kindergarten readiness in a diverse urban county. Three administrative datasets were integrated through an early childhood data sharing research partnership in Miami-Dade County. The Bruner Child Raising Vulnerability Index, the five domains of the Environmental Burden module from the Environmental Justice Index, and public school kindergarten readiness scores were aggregated at the census tract level. Analysis of variance and multiple regression analyses found associations between socioeconomic vulnerability and race/ethnicity. The socioeconomic vulnerability levels were highest in census tracts with a higher percentage of Black residents, compared to all other races/ethnicities. Areas of greater social vulnerability had lower kindergarten readiness and a higher environmental burden. A higher environmental burden predicted lower kindergarten readiness scores above and beyond race/ethnicity and socioeconomic vulnerability. The findings advance our understanding of global challenges to sustainable healthy child development, such as the persistence of a disproportionate environmental burden and inequitable access to resources such as green spaces and early education programs. The present study results can inform community health improvement plans to reduce risk exposures and promote greater access to positive environmental and educational resources for all children.

The narrative is framed within the context of ways that public health interventions balance the rights of individuals and community when related to infectious diseases. This central example is from a community-based HIV testing program in an area with high HIV prevalence. We describe a breach of confidentiality resulting from an involuntary disclosure of a participant’s HIV status. This breach of confidentiality occurs within a family. The narrative considers the respective rights of individuals and community members related to disclosure of HIV status and pays attention to how roles (e.g., health care worker, sexual partner) influence decisions regarding disclosure of someone’s HIV status. There were clear testing program guidelines for how, when, and where to disclose HIV status of household members. Standard operating procedures and careful training were meant to protect data confidentiality and privacy of patients. In practice, things were messier and less clear. The narrative describes how this confidentiality breach occurred, what was done to ensure the participant was safe after the fact and ways to amend the breach on a systems level.