In Philadelphia there are racial disparities in health outcomes during the perinatal period, such that Black infants and their parents experience a disproportionately higher burden of poor outcomes compared to their White counterparts. These excess risks are driven at least in part by high rates of poverty and other manifestations of structural racism. The provision of guaranteed income (GI) or unconditional cash payments during and after pregnancy, is a bold and evidence-based approach to advancing equity in financial security and health. The objective of this protocol paper is to describe the community-centered approach to the design of (a) the Philly Joy Bank (PJB), a perinatal GI program in Philadelphia, and (b) the evaluation of PJB's impact. PJB was conceived by an established coalition of community partners through a collective impact model. Decisions related to the design and implementation of PJB are made through a consensus building process that centers the voices of Lived Experience Experts (i.e., Black birthing people in Philadelphia). Congruent with the community-driven design of PJB, the evaluation of the impact of PJB is grounded in the principles of community-based participatory research and is co-designed by the community. The study purpose is to assess the feasibility and acceptability of PJB (Aim 1); to examine whether and how GI affects ability to meet basic needs and parental stress (Aim 2); and to explore the impact of PJB on parental mental health and the preliminary impact on infant prematurity (low birthweight and preterm birth) (Aim 3). Descriptive statistics, mixed effects regression analyses, and participatory qualitative analysis approaches will be used to achieve study aims. GI is a promising upstream structural intervention to address persistent health inequities during the perinatal period: a critical period of the life course. Understanding if and how GI improves health for birthing people and their infants can inform implementation and policy to advance health equity.
The variation of the phase-separation temperature, Tc, in lenses was studied during the postnatal development of three genetically different mouse strains: Swiss-Webster, Philly, and the (Swiss-Webster x Philly)F1 hybrid. The general behavior of Tc during early postnatal development has two stages: in stage I, Tc increased to a maximum and then, in stage II, Tc decreased. Philly mice are a strain that develops hereditary cataracts about 36 days following birth. In F1 hybrids of Philly and Swiss-Webster mice, cataracts appeared about 49 days following birth, approximately equal to 13 days later in development than in the Philly mice. In the Philly and hybrid mice, stage I and stage II were followed by stage III in which Tc reached a minimum value and then increased toward body temperature. The values of Tc at birth, the slope of the increase during stage I, and the maximum Tc were characteristic for each mouse strain. These results establish that the behavior of the temperature of the phase separation Tc in mouse lens is linked to the genetic strain of the mice and that the value of Tc at birth is an early indicator of lenses that will develop cataracts and lenses that will develop normally.
Place-based initiatives attempt to reduce persistent health inequities through multisectoral, cross-system collaborations incorporating multiple interventions targeted at varying levels from individuals to systems. Evaluations of these initiatives may be thought of as part of the community change process itself with a focus on real-time learning and accountability. We described the design, implementation, challenges, and initial results of an evaluation of the West Philly Promise Neighborhood, which is a comprehensive, child-focused place-based initiative in Philadelphia, Pennsylvania. Priorities for the evaluation were to build processes for and a culture of ongoing data collection, monitoring, and communication, with a focus on transparency, accountability, and data democratization; establish systems to collect data at multiple levels, with a focus on multiple uses of the data and future sustainability; and adhere to grant requirements on data collection and reporting. Data collection activities included the compilation of neighborhood-level indicators; the implementation of a program-tracking system; administrative data linkage; and neighborhood, school, and organizational surveys. Baseline results pointed to existing strengths in the neighborhood, such as the overwhelming majority of caregivers reporting that they read to their young children (86.9%), while other indicators showed areas of need for additional supports and were programmatic focuses for the initiative (e.g., about one-quarter of young children were not engaged in an early childhood education setting). Results were communicated in multiple formats. Challenges included aligning timelines, the measurement of relationship-building and other process-focused outcomes, data and technology limitations, and administrative and legal barriers. Evaluation approaches and funding models that acknowledge the importance of capacity-building processes and allow the development and measurement of population-level outcomes in a realistic timeframe are critical for measuring the success of place-based approaches.
An altered beta B2-crystallin is synthesized in the lens of the Philly mouse. This beta B2 has a more acidic isoelectric point than the beta B2 that is isolated from normal mouse lens. The altered beta B2 is immunologically reactive with antibody to the amino terminal of the beta B2-crystallin, but appears to be present in only very small quantities in the Philly lens. When the soluble proteins are isolated from the Philly lens and chromatographed by gel exclusion chromatography, the beta B2 can be found primarily in the heavy molecular weight fraction. Some immunoreactive material was also found throughout the higher molecular weight beta-crystallin region, beta H, and the lower molecular weight region, beta L. These results would indicate that the altered beta B2-crystallin in the Philly lens can interact with the other beta-crystallins in the lens; however, interactions of the beta B2-crystallin with the other proteins of the lens may cause rapid aggregation of the cellular proteins leading to the formation of the heavy molecular weight material. The increased number of these aggregates may eventually lead to the cataract formation in the Philly mouse.
Inequity in access to urban greenspaces might contribute to health disparities in the USA via multiple pathways. Academic medical centres can promote health equity in their surrounding communities by partnering with community organisations to improve greenspace access in urban environments. Academic medical centres are also uniquely positioned to advance health-equity leadership among the next generation of doctors through medical-education initiatives; of particular importance is that medical professionals are involved in advocating for the expansion of greenspace access due to its direct relationship with human health and wellness. Furthermore, by focusing educational, research, and service endeavours on addressing the most important health issues within their communities, institutions could allocate some of their resources towards community greening as a form of preventive health investment. This Personal View describes our medical-student-led pilot project Philadelphia Towards Racial and Environmental Equity (Philly TREEs) at the Perelman School of Medicine (University of Pennsylvania, Philadelphia, PA, USA), which aims to improve tree equity and community wellness in Philadelphia. We highlight this project to show how academic medical institutions can help cities to achieve urban tree-canopy goals in an equitable way through community partnership and address disparities in the environment and in health.
We evaluated whether Philly Food Bucks, a bonus incentive program at farmers markets, is associated with increased fruit and vegetable consumption and Supplemental Nutrition Assistance Program (SNAP) sales at farmers markets in low-income areas. A convenience sample of 662 customers at 22 farmers markets in low-income neighborhoods in Philadelphia, Pennsylvania, was surveyed via face-to-face interviews. Questions addressed shopping characteristics, self-reported change in fruit and vegetable consumption, whether customers tried new fruits or vegetables, use of Philly Food Bucks, and demographic information. Market-level SNAP sales and Philly Food Bucks redemption data were also collected to monitor sales patterns. Philly Food Bucks users were significantly more likely than nonusers to report increasing fruit and vegetable consumption (OR, 2.4; 95% CI, 1.6-3.7; P < .001) and to report trying new fruits or vegetables (OR 1.8; 95% CI, 1.2-2.7; P = .006). At the market level, average SNAP sales more than doubled at farmers markets in low-income areas in the first 2 years of the Philly Food Bucks program. At the city's largest farmers market in a low-income area, the program was associated with an almost 5-fold higher increase in annual SNAP sales compared with baseline. Results from this study demonstrate that a bonus incentive program tied to SNAP was associated with self-reported increases in fruit and vegetable consumption and increased SNAP sales at participating farmers markets in low-income communities. More research is warranted to evaluate the long-term impact of bonus incentives on farmers market use, dietary behaviors, and health outcomes.
The beta-crystallin basic principal polypeptide (beta Bp) appears to be altered in the lens of the Philly mouse and may be the main defect in this hereditary cataract. Northern blot analysis showed that an mRNA encoding for beta Bp is present in the Philly mouse lens, but normal beta Bp could not be detected. Instead, a different protein related to beta Bp has been observed. Western blot analysis with antibodies against specific beta Bp peptide sequences showed that the Philly protein shares the same amino-terminal residue as beta Bp but lacks a part of the carboxyl-terminal half of normal beta Bp. The altered protein is slightly smaller than beta Bp and has a more acidic isoelectric point by two-dimensional gel electrophoresis. It also lacks the property of heat stability characteristic of normal beta Bp. The mapping of the alteration in beta Bp may give insight into the nature of the heat stability of this protein as well as some indication of the structural components that are necessary to maintain optical clarity in the lens.
This work describes a demonstration/research project to implement and evaluate community-developed, community-based strategies that address childhood lead poisoning. The project will increase knowledge of childhood lead poisoning as an environmental health risk, as well as hazard, exposure, and outcome surveillance for lead as an environmental agent. At the end of the second year of this study the data indicate increased knowledge about lead poisoning and that more children are being tested for lead poisoning in the experimental census tracts (CTs), when compared with the control CTs, with lower lead levels.
Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. Results showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30-day SSB consumption frequency decreased (b = -34.8, 95% CI, -67.7 to -1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites. Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
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In 2019, an explosion at the Philadelphia Energy Solutions Refinery, one of the largest urban oil refineries in the U.S., led to its shuttering and transition into redevelopment. Local fenceline communities, previously impacted by refinery operations, expressed concern about air toxics, particularly benzene, released during the decommissioning process. To monitor volatile organic compounds (VOCs), including benzene, in fenceline communities, we created THRIVEair, a partnership between environmental justice organization Philly Thrive and Drexel University scientists. Key goals of the project included community-responsive air monitoring, data democratization, and timely report-back of results. Through an action-reflection-action approach, we co-designed a one-year VOC monitoring campaign from June 2023-June 2024, and data dissemination products, including fact sheets, Teach-Ins, and a public website. We monitored 37 VOCs using one-week integrated samples collected using passive thermal desorption tubes. Nine stationary sites were monitored weekly, and 11 additional sites were monitored on a rotating basis for two one-week sessions in summer and winter. On average, we found that benzene concentrations were relatively low over the one-year monitoring period (mean for stationary sites: 1.32 μg/m3, range = 0.30 - 9.04 μg/m3), though spatial and temporal variability were evident. Through the air monitoring campaign design and implementation process, THRIVEair supported Philly Thrive's goal of establishing an air monitoring network in neighborhoods impacted by the former refinery. By providing publicly available air quality data, THRIVEair results can be leveraged in Philly Thrive's advocacy efforts.
Approximately 25% of sexually transmitted infections (STIs) in Philadelphia involve teens and birth rates among underserved youth is more than double the national average. Proud Teens of Philly (PTOP), a community-based youth-oriented sexual-health education program, aims to mitigate disparities among underserved youth, including Latino/Hispanic and Black youth. This study assessed the impact of PTOP on sexual-health education and behaviors among Philadelphia youth. Participants were recruited from schools, churches, and community-based organizations, to attend eight one-hour-long virtual synchronous sessions. Evidence-based sexual-health curricula, Positive Potential and Making Proud Choices, were administered to 650 Philadelphia students aged 12-18 during the 2021-2022 academic year. Pre- and post-surveys were administered electronically to collect data on demographics, sexual attitudes, HIV/STI knowledge, contraception knowledge and access, confidence in consent and condom use, and life skills. Paired t-tests comparing pre- and post-survey responses were conducted. Participants demonstrated significant improvement in knowledge (t = 10.48, p < 0.0001) regarding STI transmission, HIV pre-exposure prophylaxis, and birth control. They felt more prepared to reject unprotected sex (t = 4.81, p < 0.0001) and better understood the efficacy of condoms. PTOP curricula increased exposure to alternative forms of contraception. In addition, students gained valuable skills in communication, goal setting, and emotion management. Engagement in a comprehensive sexual-health education program can significantly improve STI knowledge, sexual attitudes, and consent among underserved youth populations. Increased knowledge and emotion management empower teens to make safer choices, potentially limiting engagement in and adverse outcomes of risky sexual behaviors. Future studies should explore longitudinal impacts of youth-oriented sexual-health educational programs.
Universal School Meals (USM) serve as a first line of defense for students facing hunger in marginalized communities. Despite this, school meal uptake remains low across the district due to several barriers in the inner and outer school setting. Community- and school-led interventions and strategies are an underutilized approach for enhancing USM implementation and student uptake but may yield a more sustainable impact on addressing food insecurity. The aims of this study are to 1) engage in a structured implementation mapping process with a diverse array of school and district representatives grounded in implementation science and health equity frameworks, and 2) understand the key constraints and supports of implementation mapping from the lens of policy implementers and recipients. We recruited 4 schools (2 intervention, 2 waitlist) to engage in the mapping process. Meetings covered tasks 1-4: steps 1) needs assessment, 2) identify target objectives, 3) select strategies for enhancement, and 4) prepare an implementation plan over 4-5 planning meetings in partnership with school food service, students, parents, and teachers, and administrators of each school. Transcripts were deductively coded using the Exploration, Preparation, Implementation and Sustainment (EPIS) and Getting to Equity (GTE) frameworks and inductively by the research team. We engaged 19 participants across the 2 intervention schools (3 teachers, 2 food service, 2 parents, 2 administrators, 10 students). Data from the mapping meetings were primarily coded to Culture from the EPIS framework and Increase Healthy Options from the GTE framework. Code relations analysis between both frameworks highlighted factors such as school and district operations and social drivers of health among school communities impacting equitable USM implementation. Thematic coding yielded four primary themes: Infrastructure/Material Barriers, Communication, Stigma & Social Drivers, and Autonomy & Decision Making. These themes highlight the facilitators and barriers to implementation, mapping, and changing school meals on a systems level. Engaging school and district partners is an essential step for building lasting changes in the health of underrepresented communities. We successfully engaged a group of representatives to facilitate implementation mapping and implementation strategy development. This is one example of how community-partnered research can be leveraged to potentially facilitate change in school systems. ClinicalTrials.gov, NCT06579079, Registered on 07082024.
Black families often address police interaction safety with a conversation known as "The Talk." Previous academic literature centering the physician's perspective has proposed pediatrician involvement in anticipatory guidance on this topic. This study explores the views of Black teenage male individuals and their caregivers on pediatricians discussing safe police interactions as part of routine guidance and seeks to identify key factors for facilitating these discussions. Semistructured interviews were conducted individually with Black male individuals aged 13 to 18 years and their caregivers. Participants were recruited from primary care well visits at an academic institution in west Philadelphia, Pennsylvania. Interviews were conducted virtually, recorded, and transcribed for analysis. Themes were validated by randomly selected participants of the study. A total of 47 participants, including 20 youth-caregiver dyads, completed interviews. Participants supported pediatrician involvement in anticipatory guidance for teenagers about navigating police encounters, emphasizing that conversations should seek to improve youth safety and reduce fear during police encounters. Interviewees felt that racial concordance with pediatricians was not essential if the discussion was compassionate and culturally sensitive. Caregivers expressed a desire to align pediatrician guidance with family teaching and child's social and cognitive development. Participants preferred one-on-one conversations with pediatricians to enhance receptivity. Black teenage male individuals and their caregivers are open to pediatricians discussing police interactions as part of anticipatory guidance, emphasizing a tailored, sensitive approach. Further research is needed to investigate the perspectives of Black non-male youth and other populations disproportionately impacted by police violence.
Antibody therapies can remove amyloid plaques from the brain and slow cognitive decline in people with Alzheimer's disease who are mildly impaired. These drugs are now being evaluated in participants who are cognitively unimpaired but positive for a biomarker of Alzheimer's disease for their safety, tolerability, disease-modifying and cognitive preserving effects, and ability to avert the onset of cognitive impairment. If these studies are successful, and the drugs get regulatory approval, they could accelerate the evaluation and approval of related Alzheimer's disease-modifying treatments in people who are unimpaired with or without a biomarker of the disease. Preclinical Alzheimer's disease therapies that modify the underlying disease in people who are unimpaired with a biomarker of Alzheimer's disease and primary prevention therapies that avert the onset of amyloid plaques in those with a negative test have the potential to substantially prevent ensuing biological and clinical manifestations of Alzheimer's disease. In this Policy View, we assess the challenges and opportunities that trials of these drug treatments will bring, and consider the blood tests, cognitive assessments, and post-marketing strategies needed to enable the approval, affordability, health-care insurance coverage, and equitable use. Our recommendations are intended for consideration in the USA, and relevant refinement in other countries.
Social media is crucial for health promotion in Philadelphia, where youth face high rates of teen births and STIs. Proud Teens of Philly (PTOP), linked to Temple University's Center for Asian Health, uses its Youth Advisory Board (YAB) to engage 13-18-year-olds in outreach and content creation on Instagram and YouTube Shorts. The YAB's eight members educate peers on consent, relationships, and STI prevention. A qualitative survey rated the CBPR approach highly, scoring 4.66 out of 5. We emphasized inclusive, interactive content. Establishing privacy protocols remains essential.
Formative research is an important component of health communication campaign development. Rapid message testing approaches are useful for testing new messaging quickly and efficiently during public health emergencies, such as COVID-19, when guidance and recommendations are rapidly changing. Wiki surveys simultaneously collect quantitative message testing data and qualitative feedback on potential social media campaign messages. Philly CEAL used wiki surveys to test messages about COVID-19 vaccinations for dissemination on social media. A cross-sectional survey of Philadelphia residents (N = 199) was conducted between January and March 2023. Wiki surveys were used to assess the perceived effectiveness of messages promoting the updated COVID-19 booster and child vaccination. In each wiki survey, participants were presented with two messages and asked to select the one that they perceived as most effective. Participants could alternatively select "can't decide" or submit their own message. A score estimating the probability of selection was calculated for each message. Participant-generated messages were routinely reviewed and incorporated into the message pool. Participants cast a total of 32,281 votes on messages seeded by the research team (n = 20) and participants (n = 43). The highest scoring messages were those that were generated by participants and spoke to getting your child vaccinated to protect them against serious illness and getting the booster to protect your health and that of your community. These messages were incorporated into social media posts disseminated by Philly CEAL's social media accounts. Wiki surveys are a feasible and efficient method of rapid message testing for social media campaigns.
Increasing numbers of adolescents with gender dysphoria start gonadotropin-releasing hormone agonists to halt puberty, minimizing psychological distress. The uncertainty of long-term effects of this medication, and the subsequent likelihood of accessing gender-affirming hormone treatment, highlights the importance of fertility preservation before starting hormone treatment. We investigated the take-up, hormonal profile, and sperm quality in adolescents undergoing fertility preservation via cryopreservation by masturbation or surgical sperm retrieval, before starting hormonal therapy. Data were prospectively maintained from a tertiary UK-based hospital. A total of 122 people <19 years, mean age 15.2 ± 1.7 years, referred by gender clinics and general practitioners, were included in this cohort study. Participants were counseled for fertility preservation, and serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels were recorded before providing semen samples. Masturbation semen samples were classified as normal (>15 mil/mL), oligozoospermia (1-15 mil/mL), cryptozoospermia (<1 mil/mL), or azoospermia. If the sample was insufficient or the person was unwilling to masturbate, surgical sperm retrieval was offered in a stepwise manner using electroejaculation, testicular sperm extraction (TESE) ± microdissection testicular sperm extraction (mTESE). Quality of semen produced by participants, via masturbation or surgical sperm retrieval, was analyzed to determine if it was good enough to cryopreserve for future fertility use. Of 122 participants, 23 (19%) declined sample storage. In the masturbation group (average age, 16.3 years), 78 people produced 106 samples. Of 106 samples, 86 were stored-43.7% were normospermic, 35.9% oligozoospermic, 8.7% cryptozoospermic, and 11.7% azoospermic. Overall, semen parameters varied but were generally abnormal, illustrated by only 43.7% of the masturbation samples produced being normospermic. For surgical sperm retrieval subjects (average age, 15.2 years), electroejaculation was successful in 4 of 21 people, whereas the rest proceeded with TESE/mTESE. Encouragingly, 16 of 21 subjects had an average of 5 vials stored, and all participants had a testosterone level >8 nmol/L. Semen parameters in this subcohort were poor but possibly adequate for intracytoplasmic sperm injection. In this large database of transgender girls referred for fertility preservation in the United Kingdom, fertility preservation is possible, even with those unwilling to masturbate. Long-term data are required to check the health of these gametes, observing live birth rates using these preserved gametes.