CONTEXT:Maternal and infant morbidity and mortality remain high in the United States, and improving quality of clinical care is one strategy to improve outcomes. Perinatal Quality Collaboratives (PQCs) are statewide networks of teams working to improve maternal and infant health by supporting quality improvement (QI) initiatives. PQCs execute deliberate activities to support implementation of QI; implementation outcomes can be used to measure the execution of these activities. OBJECTIVE:To examine PQC implementation outcomes to better understand implementation achievements. DESIGN:We adapted Proctor et al.'s implementation outcomes framework to measure implementation outcomes using standardized annual PQC performance measures. SETTING:US, October 2023 through September 2024. PARTICIPANTS:Thirty-six Centers for Disease Control and Prevention-supported PQCs. INTERVENTION:Developed implementation outcome definitions relevant for the standard PQC programmatic model and mapped outcomes to performance measures, assessing the execution of PQC activities. Descriptive PQC-reported data were summarized as counts and percentages. MAIN OUTCOME MEASURE:Implementation outcomes (adoption, appropriateness, feasibility, fidelity, penetration, and sustainability). RESULTS:PQCs reported moderate adoption, with an average of 67% of births in a state occurring in birthing hospitals that participated in PQC QI initiatives. PQCs also reported moderate appropriateness; among birthing hospitals serving populations most likely to experience adverse health outcomes, 67% participated with their PQC. An average of 85% of participating birthing hospitals submitted data to their PQC as required for QI initiatives (feasibility), and PQCs averaged 75% or higher on all fidelity measures (trainings, webinars, learning products, and convenings). For penetration, fewer than 50% of PQCs engaged in activities with community-based organizations, although 56% engaged with community members and 83% with patients/families. Most (78%) participating hospitals made lasting system changes (sustainability). CONCLUSIONS:Findings suggest that PQCs implement QI initiatives with high feasibility, fidelity, and sustainability, moderate adoption and appropriateness, and varied penetration. Understanding PQC implementation outcomes can highlight areas of success and identify areas for PQC improvement.
CONTEXT:Child nutrition (CN) professionals must meet ongoing United States Department of Agriculture (USDA) nutrition standards and professional training requirements, yet national evidence on priority training topics and preferred delivery formats across roles is limited. OBJECTIVE:To identify high priority training needs and preferred delivery modes among School Nutrition (SN) and Child and Adult Care Food Program (CACFP) professionals nationwide. DESIGN:Cross sectional, web-based survey. SETTING:United States; survey distributed through the Institute of Child Nutrition national contact database (emails sent November 7 to December 5, 2023). PARTICIPANTS:A total of 777 CN professionals including SN management/other staff, SN frontline staff/workers, and CACFP professionals. INTERVENTION IF APPLICABLE:Not applicable. MAIN OUTCOME MEASURES:Respondents selected high-need training topics to complete within the next 2 years and indicated preferred delivery mode (in-person live, live virtual, or self-paced online) for each selected topic. RESULTS:Training priorities and delivery preferences differed by role and topic. SN management/other respondents most often preferred in-person live training for operational and complex topics such as food production (17.8%) and program management (17.6%), while live virtual training was most frequently preferred for special diets (19.0%). Self-paced online formats were most frequently preferred for compliance-oriented topics including civil rights (23.1%) and food safety/Hazard Analysis and Critical Control Point (22.2%). SN frontline staff/workers most often preferred self-paced online training for USDA meal pattern requirements (26.6%) and civil rights (22.9%), and live virtual training for special diets (17.4%). CACFP professionals most often preferred self-paced online training for USDA meal pattern requirements (30.7%) and health and safety (29.1%), with live virtual training commonly preferred for administration/paperwork (24.4%) and special diets (24.4%). CONCLUSIONS:CN professionals report role and topic-specific training needs and distinct delivery preferences, supporting flexible, differentiated training pathways (eg, in-person for hands on operations; self-paced online for standardized compliance content) to strengthen implementation of USDA standards.
OBJECTIVE:The objective of this analysis was to evaluate community-based naloxone access in Rhode Island by demographics and distribution methodology, with a health equity lens. DESIGN:The analysis used self-reported demographic and distribution information from individuals receiving naloxone from community-based agencies in 2024. SETTING:Rhode Island. PARTICIPANTS:Individuals who received a naloxone kit from community-based agencies in Rhode Island. No personally identifiable individual level data were collected or used. MAIN OUTCOME MEASURES:Demographic information of individuals receiving intranasal naloxone from community-based agencies was examined by distribution methods, which include naloxone received in-person (fixed distribution site and mobile outreach) versus mail-delivered naloxone and by distance traveled to receive naloxone. RESULTS:In 2024, most individuals received naloxone via in-person distribution (91.3%), with the most interactions through mobile outreach (51.8%), and received naloxone within 10 miles of their residence ZIP code (91.3%). Individuals living in rural areas, those identifying as woman or a gender minority, and those under 25 more commonly received naloxone via mail delivery or further from their residence. CONCLUSIONS:This analysis demonstrates that varied naloxone distribution methods reach diverse populations. Methods for naloxone receipt can be used to expand naloxone distribution to specific populations.
BACKGROUND:Dental fluorosis is a developmental disturbance of dental enamel caused by successive exposures to high fluoride concentrations during tooth development. Approximately 65% of India's rural population is directly exposed to fluoride-related health problems, according to a report from UNICEF. OBJECTIVE:To perform a scientometric analysis of dental fluorosis research in India with a focus on mapping research trends, geographic distribution, collaborative networks, and thematic key insights, while reviewing and comparing the reported prevalence and associated risk factors from the literature. RESEARCH DESIGN:A descriptive scientometric study was conducted to evaluate the research landscape on dental fluorosis in India. Articles were retrieved from databases such as "PubMed, Scopus, EBSCO-HOST" and analyzed using tools like VOS viewer and R software to map the geographic distribution, keyword patterns, year-wise trend, and co-authorship networks. In addition, reported prevalence and risk factors are evaluated and reviewed. FINDINGS:The analysis expressed a rising trend in dental fluorosis research, with higher concentrations of studies in fewer parts of India. Common keywords concentrated more on fluoride exposure and its epidemiology, where co-authorship networks indicated limited interinstitutional collaboration. Reviewed studies demonstrated varying prevalence rates across India and associated risk factors, which showed inconsistency throughout the derived studies. IMPLICATIONS:This scientometric overview refers to an increasing but unbalanced base of dental fluorosis studies in India. It forms the basis of identifying gaps in the field of research and directing further studies to aid in the reduction of fluorosis prevalence in India.
The reemergence of infectious diseases, such as measles, in the United States has placed significant strain on state, local, tribal, and territorial health departments to respond and contain the spread of disease. The actions by health departments have spanned a wide range of outbreak preparedness and response initiatives, with some health departments excelling in their approaches while others work to build capacity despite resource constraints. To strengthen outbreak preparedness and response, the Johns Hopkins Center for Outbreak Response Innovation convened a national Community of Practice series in 2025, bringing together 115 participants from 40 health departments. Presentations emphasized the importance of interdisciplinary collaboration, system adaptability, and continuous learning to enhance outbreak response capacity. This series underscored that sustainable improvements in public health practice rely on bridging academic research and operational realities through shared learning networks, ensuring that technical innovations translate into effective and scalable disease response strategies nationwide.
CONTEXT:Disasters can triple the risk of food insecurity for vulnerable households, with effects lasting years beyond the initial shock. In North Carolina, where hurricanes are frequent, local organizations face growing pressure to support communities with limited resources and fragmented information systems. OBJECTIVE:This study aimed to identify data and information gaps faced by organizations addressing disaster food insecurity and the tools they use to record, access, and share data and information. DESIGN:A qualitative, exploratory study combining semi-structured interviews and workshops with organizational representatives engaged in disaster food security governance. SETTING:Coastal North Carolina, specifically New Hanover and Pender Counties, both highly affected by hurricanes and with active food policy and disaster response networks. PARTICIPANTS:Representatives from 18 organizations, including nonprofits, governmental agencies, food banks, pantries, and other community actors involved in food security and disaster response. MAIN OUTCOME MEASURES:Organizational experiences and perceived needs related to data, information access, and communication tools for disaster food insecurity response. RESULTS:Two central themes emerged: (1) data and information are often functionally inaccessible, that is, mismatched to organizations' needs, poorly formatted, or incomplete and (2) there is a need for reliable and suitable data and information tools to coordinate action within an organization and across diverse organizations during and after disasters. Respondents emphasized the need for integrated, user-friendly, low-barrier geospatial information systems that enable real-time data exchange and collaboration, particularly for smaller nonprofits with limited capacity. CONCLUSIONS:Effective disaster food security governance requires practical tools that synthesize and share relevant data across organizational boundaries. Investing in integrated information platforms and low-barrier communication systems can strengthen coordination, reduce duplication of services, and improve food security outcomes after disasters. These findings underscore the importance of supporting nonprofits and cross-sector coalitions with accessible data resources to enhance preparedness and response in hurricane-prone regions.
CONTEXT:The first COVID-19 case in Massachusetts was identified in January 2020, marking the start of an unprecedented pandemic that resulted in more than 20,000 deaths statewide. In response, Massachusetts rapidly developed and launched the Community Tracing Collaborative (CTC), the nation's first large-scale statewide contact tracing support system. PROGRAM:Beginning in April 2020, the CTC, an entirely virtual operation, recruited and trained more than 4000 lay staff to conduct outreach to COVID-19 cases and contacts. CTC services included case investigation and contact tracing; referral for social supports such as food and other resources; outbreak investigation and response; and referrals for testing and treatment. EVALUATION:We conducted a cohort analysis of COVID-19 cases and close contacts referred to the CTC, as well as contacts identified by CTC staff during tracing activities, between May 1, 2020, and October 31, 2021. We calculated the proportions of cases and contacts with successful initial interviews and, among those, successful completion of isolation or quarantine. RESULTS:During the study period, the CTC supported 551,797 cases and 304,928 contacts. Among individuals served, 8.6% identified as Black, 22.0% as Hispanic, 50.8% as female, and 11.6% as non-English speaking. Overall, 79.3% had a successful initial interview outcome, and among these, 72.6% successfully completed isolation or quarantine. CONCLUSIONS:The CTC demonstrated that a large-scale, integrated case investigation and contact tracing program with embedded supportive services can be rapidly deployed and sustained, even in an unprecedented public health emergency.
The Texas Birth Defects Epidemiology and Surveillance Branch routinely requests facility discharge lists across the state of Texas to capture potential cases in the registry following established surveillance processes. Electronic case reporting (eCR) was implemented for birth defects surveillance in 2023. Electronic initial case reports (eICRs) are triggered in near time, permitting timely notification of potential birth defect cases. The purpose of the present evaluation was to determine case ascertainment of critical congenital heart defects in Texas across 2 data sources, a facility discharge list, and the eCR data for the same facility. Results indicate a more complete capture of potential diagnoses in the eCR data, although not all eCR-identified diagnoses were confirmed via medical chart abstraction or within the eICR. Thus, although eCR is a timelier, and potentially more complete source for potential case/diagnosis identification, it is not currently a viable source for diagnosis confirmation.
CONTEXT:During the early COVID-19 vaccine rollout, large disparities in uptake emerged across income and insurance groups, despite the vaccine being made available at no cost to recipients. Medicaid, as the largest public insurance program for low-income adults, was positioned to play a key role in supporting equitable COVID-19 vaccination uptake. However, administrative burden (AB) and fragmented enrolment processes may have inhibited participation. OBJECTIVE:To estimate the relationship between Medicaid coverage and COVID-19 vaccine uptake among low-income adults, and assess whether differences in access or engagement underlie observed disparities. DESIGN:Cross-sectional analysis of individual-level survey data using entropy balancing and robustness checks including instrumental variables. SETTING AND PARTICIPANTS:Adults aged 18-64 with household income below 200% of the federal poverty level, drawn from the US Census Household Pulse Survey (January-September 2021). MAIN OUTCOME MEASURES:Self-reported receipt of at least 1 COVID-19 vaccine dose or reported intention to vaccinate. RESULTS:After balancing observed covariates across insurance groups, Medicaid coverage was associated with a 3.4 percentage point increase in vaccine uptake compared with being uninsured, but a 6.9 percentage point gap remained relative to private insurance. Additional analyses suggest unobserved barriers may further depress vaccine uptake among those insured through Medicaid. These disparities seem driven in part by administrative burden (AB): Medicaid recipients facing more complex enrolment systems were less likely to use available vaccination services, underscoring how program design can shape downstream health behaviors even postenrolment. CONCLUSIONS:AB and access fragmentation likely contributed to lower COVID-19 vaccination rates among Medicaid enrollees, even when vaccines were free and insurance was nominally available. Addressing these policy-mediated barriers may improve equity in vaccination uptake among low-income adults in future public health interventions.
CONTEXT:Examining earnings trends among local health department (LHD) employees has been difficult because of the scarcity of longitudinal data at the individual employee level. Previous research has relied on repeated cross-sectional data sets to investigate earnings patterns, but only longitudinal data enable a nuanced analysis of how earnings evolve over time. OBJECTIVES:To analyze trends in earnings among LHD employees in Ohio between 2019 and 2024. DESIGN:This study analyzed annual financial reports from 52 LHDs in Ohio, serving approximately 60% of the state's population. The data set included individual earnings data for 2557 employees in 2019 and 2929 employees in 2024, with a subset of 1051 tracked across both years. Both cross-sectional and longitudinal analyses were conducted to examine earnings trends based on employees' tenure within their positions. RESULTS:In Ohio, LHD employees' actual annual earnings rose from $67,492 in 2019 to $81,681 in 2024, but inflation-adjusted earnings declined by 1 percent, indicating a loss of purchasing power during this period of high inflation. Employees continuously employed at the same LHD saw greater salary growth, with inflation-adjusted earnings increasing by 9 percent over 5 years, unlike the overall trend. Employees who joined after 2019 made 7% less in inflation-adjusted dollars than those who left before 2024. CONCLUSION:By leveraging individual-level, longitudinal data, this study demonstrates that earnings trajectories differ substantially depending on employees' working trajectory. Overall stagnation in earnings observed in cross-sectional analyses is driven, in part, by workforce turnover. Employees who remained in their positions benefited from sustained wage growth, whereas those who left or were newly hired tended to earn less in real terms. Findings suggest that retention may be a mechanism through which employees realize earnings growth.
ABSTRACT:Osteoarthritis affects 33.2 million US adults and drives substantial primary care utilization. Despite evidence supporting nonpharmacologic interventions, implementation remains challenging due to limited clinical-community coordination. We conducted a project in which we used existing evidence and developed an integrated primary care and community implementation framework for comprehensive osteoarthritis management through (1) landscape assessment; (2) expert panel input; (3) design sessions; and (4) iterative consultation. The resulting "Public Health Framework for Collaborative Osteoarthritis Management and Wellbeing" integrates existing clinical practice guidelines, electronic health record screening tools, structured referral pathways, and Community Care Hubs that coordinate access to evidence-based programs and social resources. This approach could serve as a model for managing other chronic conditions requiring clinical-community integration.
CONTEXT:Persistent workforce shortages have challenged the public health workforce. During COVID-19 response, the federal government launched Public Health AmeriCorps (PHA) to embed AmeriCorps members in public health systems. Minnesota Public Health Corps (MNPHC), a PHA initiative, focused on placing members in Minnesota public health agencies to strengthen capacity. OBJECTIVE:The objective of this study was to strengthen the evidence base for public health workforce development by evaluating the relationship between MNPHC participation on members' "career capital," and subdomains of "Knowing How," "Knowing Why," and "Knowing Whom," through a mixed-methods approach, addressing a key gap in program evaluation and guiding future strategies. DESIGN:Single-group, pre-post observational, explanatory mixed-methods design. SETTING:Public health agencies with at least one MNPHC member. PARTICIPANTS:MNPHC members. MAIN OUTCOME MEASURES:Career capital. RESULTS:Participants demonstrated significant gains in overall career capital (scale of 1-7) after service, with mean scores increasing from 5.4 preservice to 6.1 postservice (P < .001). In the "Knowing How" domain (scale of 1-7), scores rose from a preservice mean of 5.4-6.1 postservice (P < .001), supported by 2237 qualitative references from 94 members. The "Knowing Why" domain (scale of 1-7) showed an increase from 5.6 to 6.1 (P < .001), with 315 qualitative references from 74 members. In the "Knowing Whom" domain (scale of 1-7), scores improved from 5.2 to 5.9 (P < .001), with 171 qualitative references from 65 members. CONCLUSIONS:Quantitative results showed a difference in members' career capital from preservice to postservice; the qualitative data support and contextualize the quantitative findings. An integrated interpretation supports an inference that participants' career development was both statistically and experientially significant, with applied skill-building acting as a potential driver of broader gains.
ABSTRACT:This study examined how state and local parks and recreation funding relates to county-level access to exercise opportunities, physical inactivity, and obesity, and how these associations differed in metropolitan versus nonmetropolitan areas. A cross-sectional analysis of all US counties (n = 3142) linked 2021 Census expenditure data with 2021 County Health Rankings measures. Generalized estimating equations assessed associations between expenditures and each outcome. Results showed that parks and recreation spending accounted for an average of 1.1% of state-local budgets (range: 0.4%-2.5%). Each 1% increase in expenditures was associated with significantly greater access to exercise opportunities and lower rates of physical inactivity and obesity. Such associations were strongest in metropolitan counties. In conclusion, increased investment in parks and recreation may improve community access to active environments and reduce physical inactivity and obesity. Future research should explore parks and recreation funding allocations in more detail and across a broader range of health outcomes.
CONTEXT:The COVID-19 pandemic disrupted health care access and exacerbated social needs, but fragmented data limit coordinated responses across health and social systems. OBJECTIVE:To assess changes in health care and social service utilization before, during, and after the onset of COVID-19 using an integrated data set, and examine whether social service utilization was associated with recovery period health care utilization and mortality. DESIGN:Retrospective longitudinal study using difference-in-differences analysis. SETTING:An integrated health system and local social service agencies in Mecklenburg County, North Carolina. PARTICIPANTS:In total, 28,258 adult patients attending a safety-net community clinic from September 2018 to August 2021 with 3 distinct periods: Baseline/Prepandemic (September 1, 2018-August 31, 2019), Pandemic (September 1, 2019-August 31, 2020), and Recovery (September 1, 2020-August 31, 2021). MAIN OUTCOME MEASURES:Monthly health care utilization (clinic visits, emergency department [ED] visits with hospitalization, ED visits discharged home) and social service utilization (food assistance, housing/shelter, or emergency financial aid). RESULTS:Clinic visits declined by approximately 30% from January to April 2020 relative to baseline/prepandemic levels, with a 19% reduction in new chronic condition diagnoses, then rebounded by late 2020. ED visits declined early in the Pandemic period but later shifted toward higher acuity: admissions increased from 11.4% during Baseline/Prepandemic to 13.2% during Recovery, while treat-and-release visits remained below baseline/prepandemic. Social service utilization rose steadily from 33.7% during Baseline/Prepandemic to 36.4% during the Pandemic period and 39.3% during Recovery, largely driven by food assistance (32%-37.6%). In adjusted analyses, social service utilization during the Pandemic period was associated with higher odds of clinic visits and lower odds of mortality during Recovery. CONCLUSIONS:Health care utilization initially declined but normalized by 2021, while social service utilization rose and remained elevated, signaling persistent community needs. Integrated data showed these patterns, demonstrating that social services may mitigate adverse outcomes. Findings underscore the importance of sustaining safety nets and integrated data infrastructure to inform resilient public health responses.
CONTEXT:The association between preemption of local youth tobacco access laws and cigarette purchases remain uncertain, particularly considering existing state/local tobacco laws. OBJECTIVE:To assess state preemption and local laws related to youth access to tobacco in relation to cigarette purchases and expenditures from 2004-2021 and explore differential impacts among sociodemographic subpopulations, particularly communities with more youth. DESIGN:Longitudinal. SETTING:The United States. PARTICIPANTS:Two thousand nine hundred forty-two counties. METHODS:Data on state youth access preemption and state smoke-free, cigarette taxes, and licensing laws (CDC's STATE system); local youth access laws (American Nonsmokers' Rights Foundation); county-level cigarette purchases and expenditures (NielsenIQ Consumer Panel); and sociodemographics (American Community Survey) were obtained. Multilevel linear models examined the associations between state preemption and local laws related to youth access and county-level cigarette purchases and expenditures, controlling for state smoke-free, taxation, and licensing laws, county-level sociodemographics, and state as a fixed effect. Analyses assessed interactions between preemption and sociodemographic subgroups. RESULTS:Greater state smoke-free law coverage (Purchases: ß = -102 980, P < .001; Expenditures: ß = -143 617, P < .001) and higher cigarette taxes (Purchases: ß = -530 968, P < .001; Expenditures: ß = -783 441, P < .001) were associated with fewer purchases and lower expenditures; neither preemption nor local laws were associated. However, interactions were found between preemption law status and percentage of residents younger than 18 years (Purchases: ß = 5 477 332, P < .001; Expenditures: ß = 15 400 000, P = .01), such that there were greater purchases and expenditures in counties with more youth residents, but the increases were steeper in counties in states with (vs. without) preemption on youth access. CONCLUSIONS:While smoke-free laws and cigarette taxes remain strongly associated with fewer cigarette purchasing, state preemption may be linked to disproportionately higher purchasing in counties with larger youth populations. Policies limiting preemption and strengthening local authority, alongside comprehensive state measures, may complement comprehensive state tobacco control measures in communities with larger youth populations.
CONTEXT:Community Health Workers (CHWs) are increasingly involved in genomics-related communication and research engagement, yet few genomics training programs are tailored to their roles, learning needs, or community contexts. OBJECTIVE:To refine and build consensus on the content, structure, and applicability of the PaRtnEring to build understanding oF gEnomics Responsibly (PREFER) CHW Genomics Research Education Program using a multiround Delphi process. DESIGN:A 3-round Delphi study incorporating quantitative ratings and qualitative feedback to evaluate and revise curriculum modules and activities. SETTING:Five CHW partner training sites across the Southeastern United States. PARTICIPANTS:Twenty-four individuals, including CHWs, CHW trainers, and genetics content experts. CHWs and CHW trainers comprised 83% of the panel. INTERVENTION:An iterative refinement of a 10-module genomics education curriculum covering topics such as Genetics 101, Family History, Genetic Counseling and Testing, CHW Roles, Genetics Research, Ethical/Legal/Social Issues, and Communicating About Genomics. MAIN OUTCOME MEASURES:Clarity of learning objectives, use of adult learning theory, anticipated knowledge gain, and appropriateness of module-specific workbook activities, assessed using the Kirkpatrick Model and predefined consensus threshold of ≥75% agreement. RESULTS:In Round 1, Genetics 101 and CHW Roles scored below the 75% consensus threshold. Round 2 focus groups identified needs for simplified scientific content, strengthened integration of CHW roles, and expanded real-world examples. In Round 3, 18 full assessments showed improved agreement across modules, although gaps remained in adult learning integration for selected modules. The final curriculum achieved consensus on clarity and anticipated knowledge gain across all modules. CONCLUSIONS:The Delphi process effectively refined the PREFER curriculum and ensured alignment with CHW needs. CHWs played a central role throughout development, directly shaping content, structure, and cultural relevance. The resulting curriculum offers a feasible, community-aligned approach to building CHW capacity in genomics communication and research engagement.
OBJECTIVE:To describe the Air and Army National Guard's (NG) role during the COVID-19 pandemic. METHODS:Qualitative interviews were conducted with Air and Army National Guard (NG) medical service members and state and local health department (HD) staff who partnered with the NG during the pandemic. To ensure geographic and political diversity, participants were recruited from each of the 10 FEMA regions, including Republican, Democratic, and Swing states. FINDINGS:From August 2023 to April 2024, 20 semistructured interviews were conducted across 10 states. Respondents described partnerships between states and the NG for medical and nonmedical support including COVID-19 testing, vaccination, medical supply distribution, and vulnerable population assistance. Respondents described an overall positive perception of the NG partnership and identified best practices to prepare for future emergencies. CONCLUSIONS:The NG served as a force multiplier to increase the capacity of HDs. States that had previously trained with the NG were better prepared to collaborate during the response. POLICY IMPLICATIONS:This study highlights the essential assistance the NG provides to HDs during a public health emergency and provides best practices for future partnerships.
CONTEXT:The COVID-19 pandemic exacerbated long-standing health inequities, especially among racial and ethnic minority populations and individuals with chronic conditions. Efforts to mitigate these disparities are often hindered by fragmented data systems that separate health care and social service data. Integrated Data Systems (IDS) offer a promising cross-sector solution to link patient-level data for more targeted interventions. PROGRAM:We established a partnership between a nonprofit health system and a university-based IDS, the Charlotte Regional Data Trust, to link electronic health records with social service data on food, housing, and employment for a cohort of underserved patients in Mecklenburg County, North Carolina. This case report describes the governance framework and technical infrastructure used to develop a replicable data-sharing model. IMPLEMENTATION:Over 24 months, we executed key agreements including an Enterprise Memorandum of Understanding (EMOU), Business Associate Agreement (BAA), and Data Sharing Agreement (DSA) and secured institutional approvals. A probabilistic matching algorithm linked clinical and social service data, and the final dataset was deidentified before analysis. EVALUATION:The integrated dataset includes 28 258 patients with 36 months of clinical and social service data, including 12 months prepandemic and 24 months during the pandemic. Linkage was successful for 41% of patients with at least 1 social service record. Social service engagement, particularly food assistance, increased over time, whereas health care utilization patterns fluctuated. These linked data provide critical insights into how social needs and clinical outcomes intersect across crisis and recovery phases. DISCUSSION:This project demonstrates the feasibility of IDS-based cross-sector integration in a real-world setting. Key lessons include the value of legal infrastructure, institutional trust, and governance structures. Findings support the use of IDS to guide care coordination, advance health access, and build preparedness for future public health and disaster recovery challenges.
CONTEXT:Participatory methods facilitate end-user engagement with research and rely on strategies that successfully recruit community participants. An innovation tournament successfully crowdsourced ideas for the implementation of long-acting, injectable preexposure prophylaxis among sexual minority men (SMM) in Chicago. Evaluation of the success of recruitment strategies will provide insights on this community-facing participatory approach. OBJECTIVE:This work evaluated the reach and cost of the recruitment strategies deployed during the innovation tournament. DESIGN:Advertisement methods involved (1) physical (eg, flyers), (2) digital (eg, social media), and (3) in-person (eg, tabling). Recruitment locations were informed by partner organizations, and geospatial distribution of HIV prevalence and key population demographics. QR codes and URLs were developed for each advertisement type and location to enable systematic tracking of the source of ideas. Descriptive statistics were calculated. SETTING:Chicago, Illinois. PARTICIPANTS:Participants for the innovation tournament included community members in Chicago (≥13 year old). Recruitment strived to engage SMM, particularly Black and Latino individuals. Individuals involved in recruitment efforts included the research team, graphic designer, and community-based partners. MAIN OUTCOME MEASURES:Reach was defined as the number of ideas submitted in the tournament. Cost was calculated from administrative data. RESULTS:Seventy-three ideas were submitted from 5 recruitment locations (eg, sexually transmitted infection clinics) and from relevant key populations (eg, 60% Chicago residents and sexual minorities). Physical advertisements on public transportation yielded the greatest number of submissions (31%). The digital advertisements from community-based organization listserv/emails produced the ideas with the highest scores, whereas advertisements on public transportation generated ideas with the lowest scores. Cost-effectiveness varied across locations. Public transportation had the highest costs per submission, whereas digital advertising incurred the lowest costs. CONCLUSIONS:This work can inform future recruitment efforts to maximize the success of participatory research within the community. Findings provide insight into cost-effective recruitment strategies that yield high reach.
