This chapter describes the public health landscape shaped by interactions between LGBTQ+ adolescents and media. In doing so, it integrates public health and media studies perspectives to describe the current state of knowledge about media as a site of production of health, culture, and capital that shapes the environment of health equity surrounding LGBTQ+ adolescents. It contextualizes public health research in the history of US media production and an examination of key dynamics characterizing LGBTQ+ adolescents’ interactions with social media.

Introduction

In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults.

Methods

We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire – Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively.

Results

Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: −0.63; 95% CI: −0.99 to −0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: −0.74; 95% CI: −1.24 to −0.25).

Discussion

Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.

Objective

Inadequate diversity in clinical trials is widely recognized as a significant contributing factor to health disparities experienced by racial/ethnic minorities and other diverse populations in the US. To address this in a scalable way, we sought to develop a web tool that could help enhance underserved minority participation in clinical research.

Methods

We used our research literacy support flashcard tool as the initial prototype for human-centered design and usability testing of the web tool Health for All in public library settings. After forming partnerships with leadership from Chicago Public Libraries (CPL), local medical libraries, and the Chicago Department of Public Health, we conducted seven iterative design sessions with focus groups of library patrons and library staff from six CPL branches serving underserved communities followed by two rounds of usability testing and website modification.

Results

Based on the qualitative research findings from Design Sessions 1–7, we enacted the design decision of a website that was a hybrid of fact-filled and vignette (personal stories) paper prototypes divided into 4 modules (trust, diversity, healthy volunteers, pros/cons), each with their own outcome metrics. The website was thus constructed, and navigation issues identified in two rounds of usability testing by library patrons were addressed through further website modification, followed by the launch of a beta version of a hybridized single-scrolling and guided module prototype to allow further development with website analytics.

Conclusions

We report the development of Health for All, a website designed to enhance racial/ethnic minority participation in clinical trials by imparting research literacy, mitigating distrust engendered by longstanding racism and discrimination, and providing connections to clinical trials recruiting participants.

This thesis explores the meaning and implications of a ritual view of communication in the field of public health. This thesis uses the budding field of precision medicine to frame arguments and discoveries, referring back to the Precision Medicine Initiative in chapter introductions, conclusions, and illustrative examples throughout. The introduction presents the script for an interactive online live stream performance summarizing this thesis. Chapter 1 highlights the dominance of a transmission view of communication in public health, which tends to focus on top-down transfer of knowledge from experts to general audiences. This chapter highlights the limitations of such a view, especially when it comes to meeting the needs of medically underserved communities. This chapter highlights the gaps that a ritual view of communication could fill in public health research and practice.

Chapter 2 further examines what a ritual view of communication entails in public health, and how to conceive of it in relation to participatory research frameworks. This chapter closes with the design of a conversational tool to help academic-community partnerships employ a ritual view of communication on a project-level scale. Chapter 3 describes the development of "A People's Guide" community engagement program, employing a ritual view of communication to reconfigure the social roles and power dynamics in public health community engagement. This community engagement program uses workshops and interviews with members of medically underserved communities to publish a zine, which is then the basis of conversation in academic journal club workshops. This chapter uses a developmental evaluation framework to inform the program development process and suggest next steps that can be taken to develop this program further.

Overall, this thesis employs a combination of theory, applied media practices, educational field work, and design to highlight the opportunities that a ritual view of communication presents to advance health equity.

Objective

An informed, timely referral from a generalist practitioner has the potential to facilitate care for a patient seeking an abortion. However it is unclear what barriers, if any, generalist practitioners perceive in this process. The objective of this study was to qualitatively characterize abortion referral patterns among generalist practitioners.

Study design

We conducted individual interviews with generalist practitioners practicing at Northwestern Medicine, encompassing four hospitals across the greater Chicago metropolitan area. The interview guide focused on abortion-related topics including: referral patterns, attitudes about providing referrals, and specifics of the abortion referral process. We analyzed the data for content and themes using an inductive approach.

Results

We completed 37 interviews. Practitioners in all fields and practice sites were willing to provide abortion referrals. Practitioners perceived barriers in the referral process, with a lack of knowledge chief among them. Further, practitioners saw abortion referrals as more burdensome than other specialty referrals.

Conclusion

Generalist practitioners are willing to provide abortion referrals, but perceive multiple barriers in the abortion referral process. Generalist practitioners can help to ensure their patients receive timely and quality abortion care if they feel prepared and empowered to assist with these referrals.

Context

This qualitative study explores generalist health care providers’ perceptions of Planned Parenthood in relation to their own practice in an integrated health care system. This study addresses a gap in the literature around perceptions of Planned Parenthood among health care providers in the increasingly common context of integrated health care systems.

Methods:Providers were recruited at 4 hospitals in a Chicago-area integrated health care system. Semi-structured interviews were conducted with 37 generalist providers. Interview transcripts were analyzed with an inductive, constant comparative approach.

Results

We found key themes around providers’ perceptions of Planned Parenthood in their abortion referral process: perceptions of Planned Parenthood as a uniform, collective abortion provider; perceptions of Planned Parenthood as a recognizable name associated with abortion; working around provider-level knowledge barriers; working around patient-level cost barriers; minimally facilitated referrals; and referrals to unnamed/unknown providers.

Conclusions

Our findings shed light on Planned Parenthood clinics’ unique role in family planning referrals. While Planned Parenthood clinic sites differ in their availability of services, most providers focused on Planned Parenthood overall as a fallback option for abortion referrals. These findings suggest the need to empower generalist providers with comprehensive information about local family planning resources. These findings also highlight an opportunity for integrated health systems to work more closely with Planned Parenthood locations their providers may refer to.

Background

Community-based organizations (CBOs) are critical channels for the delivery of health promotion programs. Much of their influence comes from the relationships they have with community members and other key stakeholders and they may be able to harness the power of social media tools to develop and maintain these relationships. There are limited data describing if and how CBOs are using social media. This study assesses the extent to which CBOs engaged in health promotion use popular social media channels, the types of content typically shared, and the extent to which the interactive aspects of social media tools are utilized.

Methods

We assessed the social media presence and patterns of usage of CBOs engaged in health promotion in Boston, Lawrence, and Worcester, Massachusetts. We coded content on three popular channels: Facebook, Twitter, and YouTube. We used content analysis techniques to quantitatively summarize posts, tweets, and videos on these channels, respectively. For each organization, we coded all content put forth by the CBO on the three channels in a 30-day window. Two coders were trained and conducted the coding. Data were collected between November 2011 and January 2012.

Results

A total of 166 organizations were included in our census. We found that 42% of organizations used at least one of the channels of interest. Across the three channels, organization promotion was the most common theme for content (66% of posts, 63% of tweets, and 93% of videos included this content). Most organizations updated Facebook and Twitter content at rates close to recommended frequencies. We found limited interaction/engagement with audience members.

Conclusions

Much of the use of social media tools appeared to be uni-directional, a flow of information from the organization to the audience. By better leveraging opportunities for interaction and user engagement, these organizations can reap greater benefits from the non-trivial investment required to use social media well. Future research should assess links between use patterns and organizational characteristics, staff perspectives, and audience engagement.