Programs and Communities

Opioid use disorder (OUD) is a chronic, complex health condition that continues to be a growing problem in the general population, and this increase is paralleled in pregnant women. Pregnancy is a time when women with OUD may be ready to begin a journey of recovery. OUD has both maternal and fetal implications. The safest way to begin recovery during pregnancy is with the initiation of either buprenorphine or methadone to prevent symptoms of withdrawal which can increase risk of fetal harm.

Both medications have the added benefit of being safe to use during lactation. There is a minimal amount of either medication that is found in breastmilk. Breastfeeding during medication assisted recovery (MAR) is linked both to improved maternal and neonatal outcomes, and improved bonding. Often women who are engaged in MAR are unaware of the benefits of breastfeeding initiation and exclusivity. Mothers may perceive breastfeeding as a danger to their baby based on misinformation and bias. Initiation of individualized and nonjudgmental breastfeeding education to women beginning an inpatient MAR program can improve maternal understanding of the benefits of exclusive breastfeeding and increase intention to exclusively breastfeed.

Routine cervical cancer screening has significantly decreased the mortality rate of cervical cancer. Today, cervical cancer predominantly affects those who are rarely or never screened. Government programs are in place to provide cervical cancer screening at little to no cost, yet screening rates remain suboptimal.

This project evaluated an evidence-based intervention to increase cervical cancer screening among underserved women in a federally qualified health center (FQHC). Female patients ages 21 to 65 years without history of hysterectomy (n=1,710) were sent reminders to their phones through the electronic health record (EHR). The message included educational material about the screening process and an announcement regarding government aid for free or reduced cost screening.

The number of patients who made an appointment after receiving the message was assessed two months later. In total, 156 responses were collected, and 28 patients made an appointment for screening. The most frequently observed category of Ethnicity was Hispanic/Latina (n = 24, 86%). The most frequently observed category of Insurance was Title X (n = 13, 46%). The observations for Age had an average of 41.04 (SD = 9.93). Using an EHR communication function to send motivational reminders has shown some promise for increasing cervical cancer screening, thereby reducing cervical cancer mortality among the underserved.

Pregnancy is a specific time in a woman’s life filled with complex changes in health, including the oral cavity. During this time, dental and perinatal care teams can be influential in helping women initiate and maintain essential habits to improve health and prevent adverse outcomes. There is research evidence that dental providers are reluctant to treat dental problems during pregnancy. Barriers to practice identified by dentists include lack of education, time, financial constraints, and concern for the safety treating pregnant women. Factors that facilitate dental care for pregnant women include purposeful assessment, referrals from prenatal providers, and continuing education for dental team members.

Multiple organizations recommend the treatment of oral health conditions during pregnancy to promote health and prevent pregnancy complications. In order to promote community-based partnerships in a healthcare system, dentists are encouraged to develop an intentional plan to increase collaboration with other members of the women’s healthcare team. Prior to developing a system wide intervention to improve access to dental care during pregnancy, dental team members were surveyed to identify barriers and facilitators which promote or hinder care in their practice. The data acquired will be used to inform the design and implementation of an intervention to specifically meet the needs of patients and providers in that system.

Women in recovery from substance use disorders (SUD) face significant barriers to achieving reproductive well-being (RWB) and disproportionately experience unintended pregnancy. Unintended pregnancy can have serious consequences in this population. Equity-informed approaches promote the integration of reproductive health care (RHC) with recovery programs to improve both access to and quality of RHC. Arizona’s largest SUD recovery program, Crossroads, Inc. recently opened an on-site, integrated primary clinic offering RHC. A one-month pilot demonstration of One Key Question (OKQ), a pregnancy desire screening tool, was implemented with fidelity at Crossroads to identify clients with RHC needs and offer care.

IRB exempt status was obtained through Arizona State University. All female-bodied clients aged 18-49 were screened following routine admission assessments. The Institute for Healthcare Improvement Triple Aim model based on Self-Determination Theory and Motivational Interviewing was used to prioritize client autonomy. The client experience of care was measured using an adapted Interpersonal Quality of Family Planning scale. The magnitude of needs and desires were summarized with descriptive statistics. Sixty-three clients were screened with OKQ. Needs were identified in 97% of clients. Of those clients, 98% accepted referrals. Ninety percent of items measuring the client experience of care were rated as “excellent.” OKQ provided an efficient structure for person-centered screening and referral conversations to integrate RHC in a large SUD recovery program with excellent care experiences reported by clients.

The human papillomavirus (HPV) is a sexually transmitted infection (STI) that is associated with several types of cancer and genital warts. No cure exists for those currently infected with HPV, but a vaccine is available that can prevent the virus and development of cancers associated with HPV. Military servicemembers are at a high risk for contracting HPV; it is one of the most common STIs among active duty service members. The health consequences of HPV can impact a servicemember’s military readiness. The HPV vaccine is not required for military servicemembers, but it is offered free of charge. HPV vaccination rates among military service members remain relatively low.

The purpose of this evidence-based project was to increase the level of knowledge about HPV, improve health beliefs regarding HPV, increase HPV vaccine intention, recommendation, and uptake. Using the Health Belief Model as an organizing framework, a population targeted eight-minute education video on HPV and HPV vaccination was developed. It was implemented at an outpatient military treatment facility located in the southwest United States over a 6-week period, to newly reported service members. Participants included 116 military service members aged 18 to 45. A pretest and posttest questionnaire were used to assess the impact of the intervention. HPV level of knowledge increased significantly from pretest to posttest mean scores were 3.00 to 4.39 respectively (p < .001). HPV vaccine intention increased from 62% to 66% (p = .739). HPV vaccine recommendation increased from 62% to 85% (p < .001).

The New Jersey Childhood Obesity Study was designed to provide vital information for planning, implementing, and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland. These five communities are being supported by the Robert Wood Johnson Foundation’s New Jersey Partnership for Healthy Kids program to plan and implement policy and environmental change strategies to prevent childhood obesity. Effective interventions for addressing childhood obesity require community-specific information on

who is most at risk and on contributing factors that can be addressed through tailored interventions that meet the needs of the community. Based on comprehensive research, a series of reports are being prepared for each community to assist in planning effective interventions.

The main components of the study were:

• A household telephone survey of 1700 families with 3–18 year old children,

• De-identified heights and weights measured at public schools,

• Assessment of the food and physical activity environments using objective data.

This report presents the results from the household survey. Reports based on school body mass index (BMI) data and food and physical activity environment data are available at www.cshp.rutgers.edu/childhoodobesity.htm.

The New Jersey Childhood Obesity Study was designed to provide vital information for planning, implementing, and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland. These five communities are being supported by the Robert Wood Johnson Foundation’s New Jersey Partnership for Healthy Kids program to plan and implement policy and environmental change strategies to prevent childhood obesity. Effective interventions for addressing childhood obesity require community-specific information on

who is most at risk and on contributing factors that can be addressed through tailored interventions that meet the needs of the community. Based on comprehensive research, a series of reports are being prepared for each community to assist in planning effective interventions.

The main components of the study were:

• A household telephone survey of 1700 families with 3–18 year old children,

• De-identified heights and weights measured at public schools,

• Assessment of the food and physical activity environments using objective data.

This report presents the results from the household survey. Reports based on school body mass index (BMI) data and food and physical activity environment data are available at www.cshp.rutgers.edu/childhoodobesity.htm.

The maps in this chartbook describe the physical activity environment in Camden in terms of geographic distribution of parks and physical activity facilities. Research shows that people who have access to these facilities are more likely to be physically active.

• The maps in this chartbook were created using physical activity facilities data from a commercial database (lnfoUSA, 2008), data from city departments, as well as information obtained from systematic web searches. The maps present data for the city of Camden and for a 1 mile buffer area around Camden.

• Physical activity centers include private and public facilities which offer physical activity opportunities for children 3-18 years of age.

• Physical activity environment maps are compared with Census 2000 data to visualize accessibility of physical activity opportunities in neighborhoods with different characteristics.

• Poverty level presented in this chartbook are based on the 2000 Federal Poverty Guidelines.

• Crime rates in Camden are presented at the census block group level as relative crime risk (CrimeRisk) obtained from a commercial data source (Applied Geographic Solutions, 2008). CrimeRisk - an index value derived from modeling the relationship between crime rates and demographics data - is expressed as the risk of crime occurring in a specific block group relative to the national average. For this chartbook, data on total CrimeRisk, which includes personal and property crimes, are reported.

The maps in this chartbook describe the physical activity environment in New Brunswick in terms of geographic distribution of parks and physical activity facilities. Research shows that people who have access to these facilities are more likely to be physically active.

• The maps in this chartbook were created using physical activity facilities data from a commercial database (lnfoUSA, 2008), data from city departments, as well as information obtained from systematic web searches. The maps present data for the city of New Brunswick and for a 1 mile buffer area around New Brunswick.

• Physical activity centers include private and public facilities which offer physical activity opportunities for children 3-18 years of age.

• Physical activity environment maps are compared with Census 2000 data to visualize accessibility of physical activity opportunities in neighborhoods with different characteristics.

• Poverty level presented in this chartbook are based on the 2000 Federal Poverty Guidelines.

• Crime rates in New Brunswick are presented at the census block group level as relative crime risk (CrimeRisk) obtained from a commercial data source (Applied Geographic Solutions, 2008). CrimeRisk - an index value derived from modeling the relationship between crime rates and demographics data - is expressed as the risk of crime occurring in a specific block group relative to the national average. For this chartbook, data on total CrimeRisk, which includes personal and property crimes, are reported.