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Effects of lead exposure on blood pressure
Monica Bastos Paoliello, PhD
State University of Londrina
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Inequalities in Health Service Use among Former Inmates: Implications for Race/ Ethnic Health Disparities
Kathryn M. Nowotny, PhD
University of Miami
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The Center for Substance Use and HIV/AIDS Research on Latinos in the United States, an NIMHD Exploratory Center of Excellence that is housed under CRUSADA, was awarded supplemental funds for projects which aim to address some of the critical medical and mental needs confronting residents of the country of Haiti and the Haitian community in Miami-Dade after the devastating earthquake of January 13, 2010.
Public Health Relevance: This initiative will provide much needed aid in addressing some of the short- and long-term health needs of residents of Haiti and the Haitian community in Miami, Florida. It will also provide critical infrastructure to support a sustainable long-term recovery from the earthquake both in Haiti and in the Miami Haitian community.
Principal Investigator: Nazife Emel Ganapati
The term "emotional labor" was originally coined by the sociologist Arlie Hochschild in her seminal study entitled The Managed Heart: Commercialization of Human Feeling (1983). Although some ambiguity persists regarding the term, emotional labor broadly refers to work that requires a worker to regulate his/her experienced emotions and to visually display professionally desired emotions during interpersonal transactions at work (e.g., face-to-face or voice-to-voice). Emotional regulation could take the form of (a) surface actingâ€” displaying the appropriate emotions without actually feeling them (faking or putting on a faÃ§ade as if the emotions are felt inside); or (b) deep actingâ€”displaying the appropriate emotions by modifying the inner feelings (still faking but in good faith to seem authentic to the intended audience) (Hochschild 1983). Scholars from a diverse array of disciplines have written on emotional labor since the beginning of the 1980s, highlighting its importance in the lives of health care professionals (Larson and Yao 2005;), teachers (Constanti & Gibbs 2004), police officers (van Gelderen et al. 2007), bank tellers (Rupp, McCance, Spencer & Sonntag 2008), and Disneyland ride operators (Van Maanen & Kunda 1989), just to name a few.
Although demand for emotional labor is perhaps at its highest in times of disasters, there is a lack of studies on emotional labor involved with disaster relief and early recovery workers. Even more scarce are studies that compare the emotional labor of disaster relief and early recovery workers who are native to the impacted region with that of members of the international aid community. Existing studies on disaster relief and early recovery workers mostly focus on their mental health status, including the prevalence of anger among them, their experience of distress and symptoms of posttraumatic stress disorder (PTSD) (e.g., Evans et al. 2009, Long, Meyer and Jacobs 2007), and their use of mental health services (Elhai et al. 2006, Katz et al. 2006). Some studies concerning disaster relief and early recovery workers identify their use of substances (e.g., Simons et al. 2005) and their support needs (Bjerneld et al. 2004, Hearns and Deeny 2007, Tomczyk et al. 2008).
In order to address the above mentioned gap in the literature, the proposed study will seek to answer the following questions: What are the differences between the perceptions of Haitian and international disaster relief and early recovery workers on emotional labor experienced in response to the recent Haitian earthquake? What kind of professional skills (including emotional regulation) do members of these groups find are necessary to deal with disaster victims on the ground during disaster response and in the early recovery period? What are the immediate and long-term consequences of emotional labor for disaster relief and early recovery workers (e.g., in terms of PTSD, substance use)?
We will use a convenience sample of 80 disaster relief and early recovery workers who served on the ground after the January 12th Haitian earthquake. Half of these will be Haitian government officials (e.g., from local and national levels) while the other half will be international disaster relief and early recovery workers (e.g., members of the medical profession, search and rescue teams, U.S. troops). We will mainly recruit the study participants from government offices and the field offices of international aid agencies (e.g., Red Cross, Partners in Health) in Haiti. Additional participants will be recruited from the offices of search and rescue teams based in the U.S. (e.g., in Florida, Virginia and California) that have responded to the earthquake but have returned home after completing their missions. The interviews will be face-to-face and semi-structured, conducted in Haitian KreyÃ²l, French, or English in places convenient to the participants. Each interview will be audio-recorded with the informed consent of participants. The data will be transcribed using a predetermined protocol to capture the participants' perceptions word-for-word. In addition to the interviews, we will engage in participant observation in the disaster zone to better understand how disaster relief and early recovery workers emotionally deal with disaster victims in their face-to-face interactions. Furthermore, data from secondary sources such as Haitian and international newspapers will be analyzed to study the representation of such workers' emotional work in the media. We will analyze the qualitative data collected from the interviews, participant observation, and review of secondary sources using ATLAS.ti and quantitative data using SPSS.
There is a need to conduct the proposed study as it will allow for capturing time-sensitive perishable data on the emotional work of disaster relief and early recovery among workers in a disaster zone. These workers need to address not only such issues as search, rescue, medical aid, and debris removal in disaster zones but also handle disaster victims who may be emotionally traumatized. They are expected to understand disaster victims' emotional tones and adopt certain demeanors in response to these tones, projecting a caring, tolerant, and empathic image. We expect that the findings of the study will help such workers better understand the emotional aspects of their work in disaster zones and provide them with basic guidelines on how to manage emotions in their day-to-day interactions with disaster victims during response and early recovery periods. The study will also inform researchers who specialize in disaster management, public health, public management, and human resource management by exposing them to the highly demanding emotional work undertaken by such workers and to the influence of culture on emotional labor. Lastly, a better understanding of such workers' emotional work in the aftermath of disasters will help ensure the success of disaster relief and early recovery programs undertaken by national governments and international aid agencies.
Principal Investigator: Richard Beaulaurier
The earthquake disaster has exposed deep problems and issues in delivering social and health services in Haiti as well as to members of the Haitian Diaspora living in South Florida, a community that is expected to experience greater stress as its numbers swell to include new arrivals displaced by the earthquake. Neither government nor indigenous nonprofit or nongovernmental organizations (NPOs and NGOs) in Haiti has the capacity to provide health, mental health, nutrition, crisis counseling and other services that are taken for granted in more developed economies. This problem is exacerbated in the current crisis. In South Florida, nonprofits catering to the Haitian population that were already overwhelmed trying to meet the needs of the Diaspora community are now grappling with additional needs for delivery of concrete services, emotional trauma resulting from the conditions for loved ones in the home country, mounting or facilitating disaster relief efforts, and an expected influx of refugees.
There are a number of Haitian Service Agencies (HSA) in the Miami area. On the positive side, these organizations have the contacts, experience, linguistic and cultural competencies to identify problems and provide a number of concrete and direct services to the Haitian community. At the same time, most of these agencies are small, understaffed (particularly with professional staff), underfunded and increasingly called on to stretch resources and expertise to deal with a range and scope of difficulties that would challenge the most highly developed service agencies. In the Miami area, HSAs are in immediate need of organizational and fiscal supports in order to expand the range and scope of their services to serve the needs of Haitians during this crisis and in the months and years to come.
The Florida International University School of Social Work (FIUSSW) has faculty skilled in all aspects of organizational development and community organization. These professionals are highly capable and qualified to assess and diagnose problems in developing service delivery agencies and networks, complete assessments to aid in identifying areas of greatest need, deliver services and organize self- help efforts. Moreover, they possess extensive experience in program development and creation, and formative evaluation and have used these skills to fine-tune program efforts and to conduct projects and research in the local Haitian community.
For this effort, the FIUSSW will partner with the Human Services Coalition (HSC). HSC has a long standing relationship with the FIUSSW. FIUSSW faculty have served on the board of directors of HSC, and a number of HSC staff have served as field practicum instructors in the FIUSSW. HSC specializes in capacity building for organizations, in particular for small community-based organizations that cater to minority and hard-to-serve populations. HSC has provided such organizational supports for 15 years and is well-recognized and respected for its collaboration and networking in the Haitian service community and beyond. HSC works in partnership with over 50 organizations, including many that focus on the needs of the Haitian population. Currently, HSC is playing a lead role in organizing a network of service providers around relief to local Haitian residents through www.crisiscommons.org. HSC is ideally suited to serve as practice partner working directly with area nonprofits.
Operation Help Haiti at Home (O3H), will build capacity of the area nonprofits vital to relief efforts stemming from the Haiti earthquake. Specifically, the program will include organizational assessment, support and evaluation, to demonstrate benefit to participating organizations and the constituents they serve. FIU and HSC will work together to accomplish program goals. FIUSSW Professor Richard Beaulaurier will serve as principal investigator and evaluator. HSC will provide capacity building services and include FIU faculty as needed.
Specific program components include:
Inventory of area Haitian Service Organizations: We will use a combination of existing sources and key informant contacts to identify organizations that provide mental health, health, material support and other forms of assistance to members of the Miami-Dade Haitian community. These will include Haitian multi-service and neighborhood centers, traditional health and social service centers with capability in Haitian Creole (Kreyol), as well as those within the borders of Miami's Little Haiti neighborhood, and Haitian neighborhoods in the Homestead area (south Miami-Dade County). Existing sources include Switchboard of Miami (local Helpline); a resource guide being developed by the Jay Weiss Center at the University of Miami (to be completed by March 1, 2010); agencies identified in Dr. Beaulaurier's previous research in the Haitian community; agencies being convened by Miami-Dade County Commissioner Barbara Jordan; and agencies already identified by HSC. Key informants will include directors of prominent Haitian service organizations, such as Sant-La neighborhood center, Haitian Women of Miami, Center for Haitian Studies, Haitian American Foundation; City of Miami Neighborhood Enhancement Team (in Little Haiti); Pierre Touissant Center; Notre Dame Catholic Church, and others.
Outreach will be facilitated by extensive networks that already exist in the Haitian community in Miami- Dade. HSC has longstanding contacts with the centers above, which have access to Haitian media (radio, television and print). Project staff will also make direct calls to agencies to apprise them of the availability of services and to set up interviews with directors.
Assessment interviews with interested organizational directors will be conducted by Dr. Beaulaurier and HSC staff to assess educational and consultation needs. Interviews will be semi-structured, and inquire about the need for the range of technical and consultation supports that HSC and FIUSSW are able to offer.
Delivery of technical support will proceed by matching needs assessed during the interviews with directors, with the supportive services and consultation opportunities available through HSC. It is also anticipated that consultation and educational experiences, as well as the formative evaluation process, may result in the identification of additional needs for support.
HSC will be primarily responsible for delivery of technical support services, calling on FIUSSW staff where appropriate. Technical support and capacity building will be organized around three foci: operational success, mission success and community success. Services will range from basic back-office services (fiscal, human resource, technology), to demonstrating effectiveness (evaluation, fundraising and communications/marketing), to developing interagency collaborations, service networks and leadership. HSC has considerable experience delivering such services. Twenty nonprofits have already received total management support (fiscal sponsorship) from HSC, and over 100 have received other capacity building services through education and consultation.
We anticipate that 10-15 organizations from Miami-Dade and Broward counties will participate in the program, receiving a range of education and consultation services over a 12 month period that will relate directly to their ability to provide health and human services to Haitian and Haitian American constituents including relocation and assimilation support, application assistance for economic benefits, financial and crisis counseling, child placement, case management, community and economic development such as microfinance and matched savings.
Capacity building services may take three forms: 1) Seminars on (a) program operations (e.g. bookkeeping, record keeping, human resource management, information technology); (b) accomplishing mission (media coverage, social marketing, fundraising and evaluation); and (c) achieving broader community impact (relief-related funding and policies). 2) Consultation to develop individual implementation plans that incorporate mission and community impact service components including coalition building, networks, business and community engagement. 3) Direct management services, including fiscal sponsorship, outsourced human resource management, information technology. HSC has a long history of providing these services to organizations that do not have the capability to provide them in house. This may be particularly important for small HSAs that are experiencing increases in demand for services, and may also be necessary for agencies that receive disaster related funding to temporarily expand their services.
Efforts will focus on strengthening organizational effectiveness in three areas: operations, achievement of mission, and community impact. Operations enhancements focus on improving efficiency and accountability. These are of critical importance as agencies are called on to do more with the same resources, as well as to upgrade their capabilities to allow them to be viable candidates for service expansion, as resources become available. Operations supports include:
Mission-related supports will serve to increase organizational visibility, financial viability and sustainability. These are especially important for at least two reasons. First, many HSAs are in a relatively early stage of development. Second, as is typical of ethnic service organizations, leadership and staff have generally favored cultural competence and commitment to the Haitian community sometimes at the cost of managerial and program development skills (Perlmutter, 1988; Stepick, et al., 1999). While HSAs require supports to enhance their ability to serve their communities during the current crisis, they will also need supports to help them sustain their efforts once media attention shifts. Such supports include:
Dr. Beaulaurier, in conjunction with HSA staff and HSC staff, will aid in the development of a formative evaluation process specifically tailored to the kind of consultation, service or training utilized by the HSA. This approach focuses on gathering and analyzing data that can be used to fine-tune activities so that they are maximally useful to agencies and their clients (Patton, 1986). While it is not possible to specify specific design components of such an evaluation in advance, they will generally combine qualitative methods and quantitative management information. Dr. Beaulaurier has a strong background in both of these areas.
Organizations will be supported to improve internal practices, increase delivery of services to the target population, and increase participation in community collaboration. Specifically, we expect 80% of participating organizations (10 to 15) to demonstrate increases in at least one measure for each of the three program components in which they participate: operations, mission, and community impact. Targets for operations mission and impact will be developed jointly be O3H staff and staff of HSAs. Once programs have been established and running, follow up interviews with executive directors and key informants (see above) will assess overall performance of the program to determine any needs for further support. These interviews will be conducted by Dr. Beaulaurier or O3H staff trained by him. We will also conduct five follow up with focus groups, each with approximately eight current or former recipients of services of the agencies with which we have worked. Focus groups will be conducted by the Research Assistant in English or Kreyol, audio recorded and transcribed for subsequent analysis. Translation issues will be handled using a procedure that Dr. Beaulaurier developed for a prior NIJ funded study.
The purpose of interviews will be to assess (a) overall quality of the services provided by O3H; the degree to which there remain unmet needs related to the disaster in Haiti, and (c) identification of "lessons learned" from this approach to providing support for HSAs.
Data collected from assessment, formative evaluation and follow-up activities will be analyzed by Dr. Beaulaurier and HSC staff. Much of the research design will emerge from a fitting process between consultation and educational needs of the HSAs and the services HSC provides. We anticipate that ATLAS.ti and SPSS software packages will aid in the analysis of qualitative and quantitative data respectively. Data will be analyzed with the objective of (a) producing feedback to HSAs; (b) developing papers, presentations and reports on approaches that appear particularly effective, as well as documenting those that were less so; and (c) serve as pilot data and analyses that can be used to apply for subsequent NIH funding to conduct research on the most effective approaches to providing supports to HSAs, and to serve as a guide for research into supports for other minority serving health and social service agencies.
Principal Investigator: Marilys Randolph
Co-Investigators: Denis Brunt, Leonard Elbaum, Anahid Kulwicki
Preliminary reports from the World Health Organization following the major earthquake in Haiti on January 12, 2010 indicate significant damage inflicted to the critical infrastructures in the country including basic utilities, transportation, communication and health (1). In the aftermath of this event in Port-Au-Prince, the challenges for first responders in the health community were overwhelming. Traumatic amputations are the "signature" injuries, as in the absence of crucial health and disaster management infrastructures, complications from crush injuries were treated mostly by surgical amputations. The large number of amputations performed on children and adults is unprecedented in a country where post-amputation care and rehabilitation are practically non-existent (2-4). Haiti lacks both the personnel and technology to provide shortand long-term rehabilitation services, including the fabrication of prostheses. In addition, amputees will have to learn to cope with the difficulties of returning to work given the constant challenges of navigating architectural barriers and the geographic terrain, as well as with social rejection as a result of being disabled. Recent newspaper articles (see attached exhibits) highlight both the extensive amputee rehabilitation challenges that now face the country and the social impact of disability following amputation.
In 2007, 47% of the population in Haiti lacked access to basic health care. The majority of the population used traditional medicine and received very limited basic health care at hospitals or clinics. In Port- Au-Prince and other areas, hospitals and clinic facilities were unable to provide basic services because of infrastructural deficiencies (1). The earthquake of January 12, 2010 further contributed to the collapse of an already weak health system. Although current reports estimate the numbers of casualties and survivors, there is no documentation of the characteristics, the number and severity of the traumatic and emergency amputations performed nor the likely resultant post-amputation complications.
In studies performed by the United States Armed Forces, traumatic- and combat-related amputations were associated with frequent complications, thus delaying rehabilitation and limiting functional outcomes (4). In Haiti, it is likely that without basic post-operative care, amputees will suffer wound infections, contractures and other deformities of their residual limbs that will delay or negatively impact prosthetic fitting. The United States Army's Amputee Patient Care Program, using a multidisciplinary team approach addressing both the psychosocial and physical issues that impact rehabilitation and reintegration into society, has produced positive outcomes (6). In the context of Haiti, the post-operative assessment, immediate mobilization, prevention of complications, pre-prosthetic assessments, and assessment of psychosocial issues will be key components in the rehabilitation of amputees, young and old.
In this immediate period after the quake, many questions remain unanswered: What are the sociodemographic characteristics of amputees in Haiti following the earthquake? What is the best approach to assist these amputees to return to work within their environment as contributing members of society? What is the optimal prosthetic design that would be adaptable to the local environment and available resources? Data must be collected about the amputees to develop a comprehensive health care intervention model to meet the specific challenges in Haiti. It is unclear how an amputation in Haiti will affect a Haitian person's ability to return to work, attend school, or engage in daily activities. Barriers to rehabilitation include social, cultural, financial, geographic, and environmental factors. To understand how amputees perceive their disabilities and how they are viewed by society is essential to the pathway of rehabilitation and complete recovery. The data from this study will help establish an informed post-amputation program of rehabilitation, as well as provide immediate health services to address pre-prosthetic and mobility needs of the amputees.
The short-term goal of the project is to help establish a rehabilitation program for amputees at three selected community-based sites in Haiti. The long-term goal is to develop, implement, and evaluate a culturally and linguistically competent rehabilitation program that is tailored to the needs of the amputees in Haiti who have undergone traumatic and/or surgical amputation as a result of the recent earthquake. Services will include pre-prosthetic assessments, the application of prosthetic devices and technologies required for prosthesis fabrication, fitting and maintenance as well as physical rehabilitation. It is anticipated that the protocol developed through the present funding will help (1) implement pre-prosthetic assessments, (2) determine risks for post-amputation complications, and (3) implement interventions to assist 150 amputees to improve mobility and readiness for prostheses. This program will train local health professionals and paraprofessionals to do the above. The model developed will help in rapidly employing future assistance with similar tragedies, including timely rehabilitative health outcomes.
The specific aims of this study are as follows:
The proposed study intends to collect data and provide care for 150 amputees who present at one of three clinical centers for medical care in Haiti. Study personnel will include six Haitian employees of the three clinical centers (two at each site) as team leaders, three Haitians trained as physical therapy (PT) technicians, and one Haitian hired as project coordinator. The proposed sites are in Port-Au-Prince, Leogane and St. Marc. The focus of the study will be on individuals 18 years and older with a plan to involve children in a larger project in the future. The plan for implementing and evaluating the intervention will be as follows:
Month 1: Three partnering agencies will be identified, the participant recruitment plan will be actuated, and Institutional Review Board (IRB) approval will be obtained. Additionally, the research methods, data collection measures, and data collection instrument will be finalized. Recruiting and training the Haitian coordinator and personnel to administer the data collection instruments and train Haitian PT technicians to evaluate a patient's status with respect to prosthetic fitting will be completed.
Months 2-3: Data collection at three centers will be completed. Two Haitian employees at each center will be responsible for data collection. It is anticipated that each employee will complete interviews on 25 patients during Month 2 (total of 150 patients across the three centers). PT technicians will complete assessments and interventions for the 150 amputees.
Month 4: Qualitative and quantitative data will be analyzed. A model for intervention will be developed. Results will be shared with the community-based organizations, and a report will be sent to the funding agency. Manuscripts will be submitted for publication in appropriate journals.
The Principal Investigator, Dr. Marilys Randolph, will identify and recruit local partners. She will also interview potential Haitian coordinator and team leaders in the three selected sites. In addition, other local Haitian personnel will be identified who will receive training from the project team to provide care and rehabilitation of the amputees in that region (Specific Aim 2). Each center will have a Haitian team leader whose role is to oversee the provision of amputee services and data collection. It will be the responsibility of these team leaders to collect socio-demographic and health status data on the patients with amputations who participate in the study, including the amputee's gender and age, limb amputated, level of amputation, health status, post-amputation complications, and pre-prosthetic mobility. FIU graduate students will assist in data analysis (Specific Aim 1). It is unclear how an amputation in Haiti will affect a person's ability to return to day-to-day activities, find new work, or attend school. To understand how amputees perceive their disabilities and how they are viewed by society is essential to the pathway of rehabilitation and complete recovery (Specific Aim 3). Culturally tailored interview schedules in Creole, prepared for Haitian patients with the assistance of a translator, will be administered to amputee survivors to assess their perceptions of their disabilities, functional health patterns, and mental health (5-7). Local health care workers and Creole-speaking physical therapy and nursing students from FIU will conduct the interviews.
Participants will receive payments for their contributions to the study. Investigators will then develop a culturally competent and linguistically appropriate rehabilitation program to assist amputees with work re-entry, improved mobility, readiness for prosthesis and attain more complete recoveries (5-7). The investigators will train PT technicians to do physical assessments of amputees. One PT technician will be assigned to each center. The exam will include the status of post-amputation complications and the status of the residual limb, joint range of motion (ROM), mobility and strength. These data will provide information on the patient's readiness for prosthetic fitting (Specific Aim 4). These technicians will be assisted by Creole-speaking physical therapy students from FIU. From this assessment, an immediate intervention plan will be developed to provide pre-prosthetic care and train local Haitians within the community agencies to provide this care.
Evaluation will include both qualitative and quantitative measures. Socio-demographic and health status data will be compiled and analyzed to determine the needs of the amputee population and to develop an evidence-based amputee rehabilitation program. Qualitative data analysis will document the perceptions of the amputees regarding their levels of disability secondary to recent limb amputation. Qualitative and physical data (health and functional status, residual limb characteristics, mobility, strength, ROM, sensation, and presence of phantom limb) will be compiled, analyzed and used to develop culturally competent, linguistically appropriate interventions to meet their needs. It is anticipated that the methodology and interventions developed in the proposed project will help establish a methodology and best practice model that can be rapidly employed to assist with similar tragedies to attain optimum health outcomes in future crises situations.
Principal Investigator: Juan Acuna
The Haitian community in Miami-Dade has been affected in a myriad of ways by the recent catastrophic earthquake in Haiti. Given the close proximity to Haiti and the historic migratory patterns between Haiti and South Florida, the consequences of the aftermath of the earthquake are likely to have both short- and longterm impacts on South Florida and its Haitian population. It is anticipated that the need and demand for health care services for residents of Miami's Little Haiti community will intensify.
As a result of the recent earthquake and subsequent events in Haiti, Florida International University's Herbert Wertheim College of Medicine (WCOM) is proposing to incorporate the Little Haiti community into its WCOM NeighborhoodHelp program. NeighborhoodHelp is a novel component of the medical school's curriculum that focuses on the influences of social determinants of health addressed at the level of households through visitation by medical and other healthcare students. Interdisciplinary teams of FIU students are assigned to track and monitor the health of families residing in communities of need. Each team, consisting of a medical student plus students from social work, nursing, and public health, works with one to two households.
NeighborhoodHelp represents a new vision for advancing access to health care for minority and underserved populations and a new model of medical education in which medical and other healthcare students are immersed in the communities they serve. The program is based on transdisciplinary collaborations, grass roots community partnerships, and governmental institutions of the targeted neighborhoods. NeighborhoodHELP is participatory at the levels of collection of data and generation of information (community participatory research), creation of community capacity to address their own healthrelated issues (community participatory needs assessment, assets mapping, and program generation. As part of the engagement of medical and other healthcare students, NeighborHoodHelp plans to evaluate the longterm impact of the healthcare students' work with families in designated neighborhoods on the communities' social determinants of health.
Currently, NeighborhoodHelp is being implemented in the geographic area of North Miami Dade. The initial stage consisted of conducting a population-based survey of 2,200 households to document the influence of social determinants on health status of individuals and families living in these medically underserved and racially and culturally diverse neighborhoods. The door-to-door survey started in October 2009 and has now collected 60% of the sample. Thus far, the response rate is 80%; we expect data collection to be completed by the end of March 2010. Results from these community assessments will be used to: 1) provide information for the engagement of the healthcare students with the community, 2) provide a baseline for ongoing assessment of the impact of the health care students' work on the community's social, and health status, and 3) inform the development of treatments and interventions targeting health disparities in the selected communities. Implementation of NeighborhoodHelp in Little Haiti will heighten awareness of the unique healthcare needs of this community in the aftermath of this disaster and direct much-needed healthcare resources to this medically underserved community.
Miami-Dade is a demographically diverse community that includes large immigrant populations from throughout the Americas. Haitians and Haitian Americans constitute one of the large subgroups of immigrants in Miami-Dade; with "Little Haiti" occupying a well defined geographical area. In this application, we propose the first phase of a permanent and long-term plan to expand the NeighborhoodHelp program to Little Haiti. Specifically, funds are requested to conduct a population-based survey of 2,200 households in the Little Haiti community.
The specific aims of this study are as follows:
We propose to apply the know-how developed in the current community participatory survey being conducted in North Miami Dade. In addition to providing the neighborhood-level data needed for the incorporation of the Little Haiti area into the HeighborhoodHelp training program of the WCOM, the results will inform the development of evidence-based programs for the Haitian population.
Sample Size and sampling methodology: The sampling frame is the primary list of households that will be assembled and used to randomly select our population-based sample. The complete area was mapped with parcel data using ArcGIS and housing and public records databases. Single and duplex family homes will be kept after filtering by records that indicate parcel purpose, industrial, and business parcels. In case of doubt, high resolution imagery will be used to identify the nature of specific parcels. Using the survey topics that were selected, and establishing estimated prevalence for those health characteristics, the intended level of detection by the survey, and the level of error tolerated, a sample size of 1780 households has been obtained as the sample to study the relationships and associations of interest. Due to estimated non-participation at the level of 30% (based on the local experience with the current survey in the neighboring area), and a 20% error between the parcel data and household data (even though the error was minimized by excluding industrial and businesses from the parcel sampling frame), the total sample was estimated at 2200 surveyed households.
Field activities: Community members from north Miami (near the area of Little Haiti) have been recruited and trained. Community members from Little Haiti will be added to the team (28 interviewers now), trained by the PI (J.Acuna) and paired with experience interviewers to survey the area door-to-door. These community interviewers will be assessed for their reliability by having them conduct practice interviews with reinterviews of a sample of their interviews. As in our current survey, community interviewers will, if found necessary in the initial testing, be accompanied by experienced interviewers to ensure reliability.
Socio-demographic and health status data will be compiled and analyzed to determine the conditions and needs of the population and the community. This information will be used for the training and engagement of the health care students within the community. The data will constitute a pre-engagement community-level baseline assessment of the health status of the Little Haiti area. Post-engagement assessments will be conducted after six months and one year in order to evaluate the impact of the NeighborhoodHelp training program on the community. Additionally, analyses of the baseline survey will be conducted by The FIU NIMHD Center of Excellence Research on U.S Latino AIDS/HIV and Drug Abuse (CRUSADA) and WCOM research teams to inform the development of prevention and treatment programs focusing on reducing health disparities in the Little Haiti population.
The proposed study will provide the data base for the development of a socially responsive medical school program that will have as its primary mission to form an equitable partnership with an urban minority neighborhood including little Haiti which one of the poorest and most underserved Communities in Miami-Dade County. The focus of this partnership will be to support development of a long-term initiative that may help to close the gap on health disparities in this community and that will provide short-, mid-, and long-term mitigation efforts, thus improving prevention strategies and the overall health status of the residents. These linkages will be developed using an innovative transdisciplinary approach and with partnering communities at multiple levels and systems.
This study provides an opportunity to collect much needed information on past conditions before the disaster (by recollection), what specific risk factors have the greatest impact on the daily living conditions of Little Haiti residents now after the disaster, and will provide the opportunity for longer term monitoring of this community for relief efforts. The results obtained will inform the development of community-based strategies and policies to restructure health and social services and to develop a community based medical program focused on post-disaster determinants of the health status of patients and communities. In particular, the results will immediately aid in the short- and long-term recovery of Haitian individuals and families directly affected by the Haitian earthquake. Consequently, the medical training model developed as the result of this study will result in cutting edge health practitioner relief programs in this community where current services and medical students will be equal partners with social workers, nurses, lawyers, and community based organizations (churches, housing advocates to name but a few to address their patient's health and social needs).
This proposal aims to recruit a random sample of 2200 households in the Little Haiti-Miami area. This area is composed by minority population (according to census information, about 95% of the households are minority population, mostly from Caribbean (Haitian) descent). Most of the population in the community included is considered a minority as described (Caribbean, African American, Hispanics, very few Asians, and other ethnic groups) . The inclusion of the minority groups will be determined by the proportion already present in the community, as the method of sampling chosen is a random selection.
Women and Children are to be part of the survey in the same manner. As the unit of analysis will be the household, women and children included will be included as part of the household to be surveyed, or visited. No special effort will be done to include any particular women or children subsets.