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Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City

Jiang, Nan; Thorpe, Lorna; Kaplan, Sue; Shelley, Donna
Background: To assess residents' attitudes towards the United States (U.S.) Department of Housing and Urban Development's new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority's capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.
PMID: 30241291
ISSN: 1660-4601
CID: 3301172

Time to Track Health Outcomes of Smoke-Free Multiunit Housing

Thorpe, Lorna E; Feinberg, Alexis M; Elbel, Brian; Gordon, Terry; Kaplan, Sue A; Wyka, Katarzyna; Athens, Jessica; Shelley, Donna
PMID: 29246676
ISSN: 1873-2607
CID: 2907832

A Pilot Community Health Worker Program in Subsidized Housing: The Health + Housing Project

Freeman,Amy L; Li, Tianying; Kaplan, Sue A; Ellen, Ingrid Gould; Young, Ashley; Rubin, Diane; Gourevitch, Marc; Doran, Kelly M
ORIGINAL:0012804
ISSN: 1936-007x
CID: 3206142

Unpacking Partnership, Engagement, and Collaboration Research to Inform Implementation Strategies Development: Theoretical Frameworks and Emerging Methodologies

Huang, Keng-Yen; Kwon, Simona C; Cheng, Sabrina; Kamboukos, Dimitra; Shelley, Donna; Brotman, Laurie M; Kaplan, Sue A; Olugbenga, Ogedegbe; Hoagwood, Kimberly
Background: Partnership, engagement, and collaboration (PEC) are critical factors in dissemination and implementation (D&I) research. Despite a growing recognition that incorporating PEC strategies in D&I research is likely to increase the relevance, feasibility, impacts, and of evidence-based interventions or practices (EBIs, EBPs), conceptual frameworks and methodologies to guide the development and testing of PEC strategies in D&I research are lacking. To address this methodological gap, a review was conducted to summarize what we know, what we think we know, and what we need to know about PEC to inform D&I research. Methods: A cross-field scoping review, drawing upon a broad range of PEC related literature in health, was conducted. Publications reviewed focused on factors influencing PEC, and processes, mechanisms and strategies for promoting effective PEC. The review was conducted separately for three forms of partnerships that are commonly used in D&I research: (1) consumer-provider or patient-implementer partnership; (2) delivery system or implementation team partnership; and (3) sustainment/support or interagency/community partnership. A total of 39 studies, of which 21 were review articles, were selected for an in-depth review. Results: Across three forms of partnerships, four domains (cognitive, interpersonal/affective, behavioral, and contextual domains) were consistently identified as factors and strategies for promoting PEC. Depending on the stage (preparation or execution) and purpose of the partnership (regulating performance or managing maintenance), certain PEC strategies are more or less relevant. Recent developments of PEC frameworks, such as Partnership Stage of Change and multiple dynamic processes, provide more comprehensive conceptual explanations for PEC mechanisms, which can better guide PEC strategies selection and integration in D&I research. Conclusions: This review contributes to D&I knowledge by identifying critical domain factors, processes, or mechanisms, and key strategies for PEC, and offers a multi-level PEC framework for future research to build the evidence base. However, more research is needed to test PEC mechanisms.
PMCID:6050404
PMID: 30050895
ISSN: 2296-2565
CID: 3216112

Content analysis of targeted food and beverage advertisements in a Chinese-American neighbourhood

Bragg, Marie A; Pageot, Yrvane K; Hernandez-Villarreal, Olivia; Kaplan, Sue A; Kwon, Simona C
OBJECTIVES: The current descriptive study aimed to: (i) quantify the number and type of advertisements (ads) located in a Chinese-American neighbourhood in a large, urban city; and (ii) catalogue the targeted marketing themes used in the food/beverage ads. DESIGN: Ten pairs of trained research assistants photographed all outdoor ads in a 0.6 mile2 (1.6 km2) area where more than 60.0 % of residents identify as Chinese American. We used content analysis to assess the marketing themes of ads, including references to: Asian cultures; health; various languages; children; food or beverage type (e.g. sugar-sweetened soda). SETTING: Lower East Side, a neighbourhood located in the borough of Manhattan in New York City, USA. SUBJECTS: Ads (n 1366) in the designated neighbourhood. RESULTS: Food/beverage ads were the largest ad category (29.7 %, n 407), followed by services (e.g. mobile phone services; 21.0 %, n 288). Sixty-seven per cent (66.9 %) of beverages featured were sugar-sweetened, and 50.8 % of food ads promoted fast food. Fifty-five per cent (54.9 %) of food/beverage ads targeted Asian Americans through language, ethnicity of person(s) in the ad or inclusion of culturally relevant images. Fifty per cent (50.2 %) of ads were associated with local/small brands. CONCLUSIONS: Food/beverage marketing practices are known to promote unhealthy food and beverage products. Research shows that increased exposure leads to excessive short-term consumption among consumers and influences children's food preferences and purchase requests. Given the frequency of racially targeted ads for unhealthy products in the current study and increasing rates of obesity-related diseases among Asian Americans, research and policies should address the implications of food and beverage ads on health.
PMCID:5586044
PMID: 28587693
ISSN: 1475-2727
CID: 2660262

Testing the use of practice facilitation in a cluster randomized stepped-wedge design trial to improve adherence to cardiovascular disease prevention guidelines: HealthyHearts NYC

Shelley, Donna R; Ogedegbe, Gbenga; Anane, Sheila; Wu, Winfred Y; Goldfeld, Keith; Gold, Heather T; Kaplan, Sue; Berry, Carolyn
BACKGROUND: HealthyHearts NYC (HHNYC) will evaluate the effectiveness of practice facilitation as a quality improvement strategy for implementing the Million Hearts' ABCS treatment guidelines for reducing cardiovascular disease (CVD) among high-risk patients who receive care in primary care practices in New York City. ABCS refers to (A) aspirin in high-risk individuals; (B) blood pressure control; (C) cholesterol management; and (S) smoking cessation. The long-term goal is to create a robust infrastructure for implementing and disseminating evidence-based practice guidelines (EBPG) in primary care practices. METHODS/DESIGN: We are using a stepped-wedge cluster randomized controlled trial design to evaluate the implementation process and the impact of practice facilitation (PF) versus usual care on ABCS outcomes in 250 small primary care practices. Randomization is at the practice site level, all of which begin as part of the control condition. The intervention consists of one year of PF that includes a combination of one-on-one onsite visits and shared learning across practice sites. PFs will focus on helping sites implement evidence-based components of patient-centered medical home (PCMH) and the chronic care model (CCM), which include decision support, provider feedback, self-management tools and resources, and linkages to community-based services. DISCUSSION: We hypothesize that practice facilitation will result in superior clinical outcomes compared to usual care; that the effects of practice facilitation will be mediated by greater adoption of system changes in accord with PCMH and CCM; and that there will be increased adaptive reserve and change capacity. TRIAL REGISTRATION: NCT02646488.
PMCID:4932668
PMID: 27377404
ISSN: 1748-5908
CID: 2178972

"When you walk in the rain, you get wet": A Qualitative Study of Ghanaian Immigrants' Perspective on the Epidemiological Paradox

Kaplan, Sue A; Ahmed, Ramatu; Musah, Adam
This study sought to understand the perceptions of Ghanaian immigrants of the health status and health trajectory of their community. We conducted focus groups and interviews with 63 primarily Ghanaian immigrants living in New York City. Nearly all participants observed that Ghanaians are generally healthy when they arrive in the US, but that their health declines over time. Participants identified four causes of this perceived deterioration: changes in health behaviors, increased stress, environmental exposures, and barriers to health care. Participants see themselves as being at risk for many health problems resulting from changes in lifestyle that follow immigration. Although some vulnerabilities are unique to their experience as immigrants, many of the risk factors they described are the same as those that affect other residents in the communities in which they live.
PMID: 23881531
ISSN: 1557-1912
CID: 1448172

Moving to patient reported collection of race and ethnicity data: implementation and impact in ten hospitals

Berry, Carolyn; Kaplan, Sue A; Mijanovich, Tod; Mayer, Andrea
PURPOSE: The purpose of this paper is to examine the feasibility of collecting standardized, patient reported race and ethnicity (RE) data in hospitals, and to assess the impact on data quality and utility. DESIGN/METHODOLOGY/APPROACH: Part of a larger evaluation that included a comprehensive assessment. Sites documented RE data collection procedures before and after program implementation. Primary data collected through qualitative interviewing with key respondents in ten hospitals to assess implementation. Nine hospitals provided RE data on the same patients before and after implementation new data collection procedures were implemented to assess impact. FINDINGS: Implementation went smoothly in nine of ten hospitals and had substantial effects on the hospital staff awareness on the potential for disparities within their hospitals. New procedures had minimal impact on characterization of readmitted patients. PRACTICAL IMPLICATIONS: This study demonstrated that it is feasible for staff in a diverse group of hospitals to implement systematic, internally standardized methods to collect self-reported RE data from patients. ORIGINALITY/VALUE: Although this study found little impact patients' demographic characterizations, other benefits included greater awareness of and attention to disparities, uncovering small pockets of minorities, and dramatically increased RE data use in quality improvement efforts.
PMID: 25076602
ISSN: 0952-6862
CID: 1930622

The perception of stress and its impact on health in poor communities

Kaplan, Sue A; Madden, Vivienne Patricia; Mijanovich, Todor; Purcaro, Ellenrita
With the increased understanding of the relationship between stress and disease, the role of stress in explaining persistent disparities in health outcomes has received growing attention. One body of research has focused on allostatic load-the "wear and tear" that results from chronic or excessive activation of the stress response. Other research has looked at the link between stress and health behaviors. In this study, we conducted 7 focus groups with a total of 56 people to understand how people living in Highbridge, South Bronx, New York, a low income community with poor health outcomes, perceive stress and its relationship to health. Focus group participants described a direct causal pathway between stress and poor health as well as an indirect pathway through health behaviors, including uncontrolled eating, sleep deprivation, substance abuse, smoking, violence and aggression, and withdrawal and inactivity. Participants articulated a number of theories about why stress leads to these unhealthy behaviors, including self-medication, adaptive behavior, discounting the future, depletion of willpower, and competing priorities. Their nuanced understanding of the link between stress and health elucidates the mechanisms and pathways by which stress may result in disparities in health outcomes and create challenges in changing health behaviors in poor communities like the South Bronx.
PMID: 22806256
ISSN: 0094-5145
CID: 213232

Symptomatic and urodynamic responses in patients with reduced or no seminal emission during silodosin treatment for LUTS and BPH

Roehrborn, C G; Kaplan, S A; Lepor, H; Volinn, W
Data from phase 3 studies (NCT00224107, NCT00224120) of silodosin for treatment of BPH symptoms were analyzed to examine the relationship between treatment efficacy and occurrence of abnormal ejaculation. Men aged >/=50 years with International Prostate Symptom Scores (IPSS) >/=13 and peak urinary flow rates (Qmax) of 4-15 ml s(-1) received placebo or silodosin 8 mg once daily for 12 weeks. Silodosin-treated patients were stratified by absence or presence of 'retrograde ejaculation' (RE). Groups were compared using analysis of covariance (for change from baseline) and responder analyses. Of the 466 patients receiving silodosin, 131 (28%) reported RE and 335 (72%) did not; 4 of the 457 patients receiving placebo (0.9%) reported RE. Most RE events in silodosin-treated patients (110/134; 82%) were reported as 'orgasm with absence of seminal emission.' Silodosin-treated patients with (+) and without (-) RE showed significant improvement in IPSS, Qmax and quality of life versus placebo (P<0.02). RE+ patients versus RE- patients experienced numerically greater improvement, but differences were not statistically significant (P>0.05). For RE+ patients, the odds of achieving improvement of >/=3 points in IPSS and >/=3 ml s(-1) in Qmax by study end were 1.75 times those for RE- patients (P=0.0127). Absence of seminal emission may predict superior treatment efficacy of silodosin in individual patients.
PMCID:3094762
PMID: 21135869
ISSN: 1365-7852
CID: 854162