Alana Rosenberg

Implementation of a Diabetes Prevention Program in Public Housing Communities

OBJECTIVE The purpose of this study was to describe the process of implementing a diabetes prevention program provided by homecare nurses to residents of public housing communities. DESIGN AND SAMPLE A cluster randomization pilot study was conducted comparing enhanced standard care (2 interactive classes on diabetes prevention) to a diabetes prevention program (7 interactive classes and behavioral support). The sample (n = 67) was primarily female (79%), nonwhite (76%), unpartnered (83%), with a mean age of 40 years, and an average of 3 children. Mixed methods were used to evaluate the implementation process. MEASURES Data were collected on attendance, attrition, and protocol implementation. Interviews were conducted with nurses and community health workers who assisted with program implementation. RESULTS Homecare nurses were able to implement a diabetes prevention program in public housing communities, with a protocol implementation of 83% across classes and groups. Attendance was suboptimal with 60% for the enhanced standard care group and 54% for the diabetes prevention group. Nurses and community health workers were resourceful and positive about program implementation. CONCLUSION Linking existing resources, such as a homecare agency with a public housing community, is one approach to disseminate diabetes prevention programs.

Navigating Limited and Uncertain Access to Subsidized Housing After Prison

Abstract An emerging literature has documented the challenges that formerly incarcerated individuals face in securing stable housing. Given the increasingly unaffordable rental market, rental subsidies represent an important and understudied source of stable housing for this population. The existing literature has described substantial discretion and a varied policy landscape that determine former prisoners’ access to housing subsidies, or subsidized housing spaces that are leased to members of their social and family networks. Less is known about how former prisoners themselves interpret and navigate this limited and uncertain access to subsidized housing. Drawing on data from repeated qualitative interviews with 44 former prisoners, we describe the creative and often labor-intensive strategies that participants employed to navigate discretion and better position themselves for subsidized housing that was in high demand, but also largely out of reach. Our findings also illustrate the potential costs associated with these strategies for both participants and members of their social and family networks.

Comparing Black and White Drug Offenders: Implications for Racial Disparities in Criminal Justice and Reentry Policy and Programming

Despite knowledge of racial bias for drug-related criminal justice involvement and its collateral consequences, we know less about differences between Black and White drug offenders. We compare 243 Black and White non-violent drug offenders in New Haven, Connecticut, for demographic characteristics, substance use, and reentry services accessed. Blacks were significantly more likely to have sales and possession charges; significantly more likely to prefer marijuana, a less addictive drug; and significantly less likely to report having severe drug problems. For both races, drug treatment was the most common service accessed through supervision. These comparisons suggest different reasons for committing drug-related crimes and, thus, different reentry programming needs. Although drug treatment is critical for all who need it, for racial justice, we must also intervene to address other needs of offenders, such as poverty alleviation and employment opportunities.

Mass incarceration, race inequality, and health: Expanding concepts and assessing impacts on well-being

We explore race differences in how individuals experience mass incarceration, as well as in mass incarcerations impacts on measures of well-being that are recognized as major social determinants of health. We draw on baseline data from a sample of 302 men and women recently released from prison/jail or placed directly onto probation in New Haven, Connecticut (CT) for drug related offenses and followed at 6-month intervals for two years (2011-2014). We describe race differences in experiences of mass incarceration and in its impacts on well-being; and we conduct mediation analyses to analyze relationships among race, mass incarceration, and well-being. Blacks reported fewer adult convictions than whites, but an average of 2.5 more adult incarcerations. Blacks were more likely to have been incarcerated as a juvenile, spent time in a juvenile facility and in an adult facility as a juvenile, been on parole, and experienced multiple forms of surveillance. Whites were more likely to report being caught by the police doing something illegal but let go. Blacks were more likely to report any impact of incarceration on education, and dropping out of school, leaving a job, leaving their longest job, and becoming estranged from a family member due to incarceration. Whites were more likely to avoid getting needed health or social services for fear of arrest. Overall, Blacks reported a larger number of impacts of criminal justice involvement on well-being than whites. Number of adult incarcerations and of surveillance types, and being incarcerated as a juvenile, each mediated the relationship among race, mass incarceration, and well-being. Though more research is necessary, experiences of mass incarceration appear to vary by race and these differences, in turn, have implications for interventions aimed at addressing the impacts of mass incarceration on health and well-being.

A taxonomy and cultural analysis of intra-hospital patient transfers

Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff.

Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service

Objective: Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. Method: We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4 h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24 h of admission, including RRT activation, care escalation to intensive care, or in‐hospital mortality. Results: A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4 h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non‐boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in‐hospital death, within 24 h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non‐boarding patients (1.91% vs. 1.91%, p = 0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p = 0.003). Conclusion: Within the first 24 h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding.

Dual Incarceration and Condom Use in Committed Relationships

Incarceration fractures relationship ties and has been associated with unprotected sex. Relationships where both individuals have a history of incarceration (dual incarceration) may face even greater disruption and involve more unprotected sex than relationships where only one individual has been incarcerated. We sought to determine whether dual incarceration is associated with condom use, and whether this association varies by relationship type. Data come from 499 sexual partnerships reported by 210 individuals with a history of incarceration. We used generalized estimating equations to examine whether dual incarceration was associated with condom use after controlling for individual and relationship characteristics. Interaction terms between dual incarceration and relationship commitment were also examined. Among currently committed relationships, dual incarceration was associated with inconsistent condom use (AOR: 4.33; 95% CI 1.02, 18.45). Dual incarceration did not affect condom use in never committed relationships. Reducing incarcerations may positively impact committed relationships and subsequently decrease HIV-related risk.ResumenEl encarcelamiento fractura los lazos relacionales y ha sido asociado con relaciones sexuales sin protección. Es posible que las relaciones en las que ambos individuos tienen una historia de encarcelamiento (encarcelamiento dual) enfrenten aún mayor disrupción e involucren más sexo sin protección que las relaciones en las que sólo un individuo ha sido encarcelado. Nuestro objetivo fue determinar si el encarcelamiento dual está asociado con el uso de condón, y si esta asociación varía según el tipo de relación. Los datos provienen de 499 relaciones sexuales reportadas por 210 individuos con historia de encarcelamiento. Usamos ecuaciones de estimación generalizadas para examinar si el encarcelamiento dual estaba asociado con el uso de condón luego de controlar por características individuales y de la relación. También analizamos los términos de interacción entre el encarcelamiento dual y el compromiso en la relación. En relaciones comprometidas en el presente, el encarcelamiento dual estaba asociado con uso inconsistente del condón (AOR: 4.33; IC 95%: 1.02, 18.45). En relaciones nunca comprometidas, el encarcelamiento dual no afectó el uso de condón. Reducir el encarcelamiento puede tener un impacto positivo en relaciones comprometidas y, consecuentemente, reducir el riesgo de VIH.