Alicia L. Salvatore, DRPH, MPH

Director of Community Engaged Research

Publications

Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children
Early Care and Education Teacher's Role in Obesity Prevention and Healthy Development of Young American Indian Children
Kracht CL, Sisson SB, Walker D, Kerr K, Stephens L, Anderson A, Seward J, Weedn AE, Cheney M, Copeland K, Salvatore AL, Jacob A, Key M, Dennison M, Tallbear C, Horm D

J Transcult Nurs 2019 01;30(1):75-85

PMID: 29998791

Abstract

INTRODUCTION">The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health.</Abstr: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children's health.

METHODOLOGY">Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged.</Abstr: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged.

RESULTS">Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior.</Abstr: Teachers felt that nutrition and physical activity were important to children's health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child's behavior.

DISCUSSION">Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.</Abstr: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

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Engaging Community Health Workers and Social Care Staff as Social First Responders during the COVID-19 Crisis
Engaging Community Health Workers and Social Care Staff as Social First Responders during the COVID-19 Crisis
Salvatore AL, Ortiz J, Booker E, , Katurakes N, Moore CC, Johnson CPA, Mapp AM, Waad A, Axe ML

Dela J Public Health 2020 Jul;6(2):92-95

PMID: 34467118

Abstract

In this public health practice vignette, we describe an ongoing community and system intervention to identify and address social determinants of health and related needs experienced by ChristianaCare patients and the greater community during the Coronavirus pandemic. This intervention, being conducted by the ChristianaCare Office of Health Equity, in partnership with ChristianaCare's embedded research institute, the Value Institute, and the Community Outreach and Education division of the Helen F. Graham Cancer Center and Research Institute, engages more than 25 community health workers, health Guides, Latinx health promoters and other social care staff as social first responders during the COVID-19 crisis. These experienced front-line social care staff screen patients and community members for social needs; make referrals to agencies and organizations for needed assistance (e.g., food, housing, financial assistance); assess people's understanding of COVID-19 and preventive measures; provide education about COVID-19; and, connect patients and community members to COVID-19 testing and any relevant clinical services. While this ongoing intervention is under evaluation, we share here some preliminary lessons-learned and discuss the critical role that social first responders can play in reducing the growing adverse social and health impacts of COVID-19 across the state of Delaware.
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HPV vaccination and Native Americans: protocol for a systematic review of factors associated with HPV vaccine uptake among American Indians and Alaska Natives in the USA
HPV vaccination and Native Americans: protocol for a systematic review of factors associated with HPV vaccine uptake among American Indians and Alaska Natives in the USA
Gopalani SV, Sedani AE, Janitz AE, Clifton SC, Stoner J, Peck J, Comiford A, Salvatore AL, Campbell J

BMJ Open 2020 09;10(9):e035658

PMID: 32895265

Abstract

INTRODUCTION">The nine-valent human papillomavirus (HPV) vaccine could prevent an estimated 92% of the cancers attributable to HPV types targeted by the vaccine. However, uptake of the HPV vaccine among American Indian and Alaska Native (AI/AN) adolescents has been low. AI/ANs also bear a disproportionate burden of cervical and other HPV-associated cancers. Increasing HPV vaccination rates is a national priority, but reviews and national surveys on HPV vaccination factors are lacking for the AI/AN population. The objective of this systematic review is to assess factors associated with HPV vaccination among AI/ANs in the USA.</Abstr: The nine-valent human papillomavirus (HPV) vaccine could prevent an estimated 92% of the cancers attributable to HPV types targeted by the vaccine. However, uptake of the HPV vaccine among American Indian and Alaska Native (AI/AN) adolescents has been low. AI/ANs also bear a disproportionate burden of cervical and other HPV-associated cancers. Increasing HPV vaccination rates is a national priority, but reviews and national surveys on HPV vaccination factors are lacking for the AI/AN population. The objective of this systematic review is to assess factors associated with HPV vaccination among AI/ANs in the USA.

METHODS AND ANALYSIS">A systematic review is proposed to synthesise the current literature on HPV vaccination factors in AI/ANs from 1 July 2006 until 30 September 2019. As applicable, controlled vocabulary terms, keywords and special features (eg, limits, explode and focus) will be incorporated into database searches. To maximise the identification of relevant studies, citation indexes and databases that index dissertations, preprints and grey literature are included. Studies will be screened and selected independently in two stages. In stage 1, titles and abstracts will be screened. In stage 2, full-text articles will be screened and selected. A data extraction form and quality assessment tool will be piloted, revised and implemented. If available, measures of frequency and association will be presented. A narrative synthesis of the included studies will also be undertaken and reported.</Abstr: A systematic review is proposed to synthesise the current literature on HPV vaccination factors in AI/ANs from 1 July 2006 until 30 September 2019. As applicable, controlled vocabulary terms, keywords and special features (eg, limits, explode and focus) will be incorporated into database searches. To maximise the identification of relevant studies, citation indexes and databases that index dissertations, preprints and grey literature are included. Studies will be screened and selected independently in two stages. In stage 1, titles and abstracts will be screened. In stage 2, full-text articles will be screened and selected. A data extraction form and quality assessment tool will be piloted, revised and implemented. If available, measures of frequency and association will be presented. A narrative synthesis of the included studies will also be undertaken and reported.

ETHICS AND DISSEMINATION">As our review will use publicly available data and publications, an Institutional Review Board review will not be required. We will disseminate the findings from this review through peer-reviewed publication(s) and conference presentation(s).</Abstr: As our review will use publicly available data and publications, an Institutional Review Board review will not be required. We will disseminate the findings from this review through peer-reviewed publication(s) and conference presentation(s).

POTENTIAL AMENDMENTS">In the event of amendments to the protocol, we will provide the date, rationale, and description of the change for each amendment.</Abstr: In the event of amendments to the protocol, we will provide the date, rationale, and description of the change for each amendment.

PROSPERO REGISTRATION NUMBER">CRD42020156865.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInfo: CRD42020156865.

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Impact of a Healthy Retail Intervention on Fruits and Vegetables and Total Sales in Tribally Owned Convenience Stores: Findings From the THRIVE Study
Impact of a Healthy Retail Intervention on Fruits and Vegetables and Total Sales in Tribally Owned Convenience Stores: Findings From the THRIVE Study
Williams MB, Wang W, Taniguchi T, Salvatore AL, Groover WK, Wetherill M, Love C, Cannady T, Grammar M, Standridge J, Fox J, Jernigan VBB

Health Promot Pract 2021 11;22(6):796-805

PMID: 32912007

Abstract

BACKGROUND">Healthy retail interventions are a recommended intervention strategy to address diet-related diseases, such as obesity and diabetes; however, retail managers are concerned about their bottom line. This study's aim was to assess the impact of a healthy retail intervention on fruits and vegetables (FV) sales, as well as total sales, in tribally owned convenience stores where grocery stores are scarce.</Abstr: Healthy retail interventions are a recommended intervention strategy to address diet-related diseases, such as obesity and diabetes; however, retail managers are concerned about their bottom line. This study's aim was to assess the impact of a healthy retail intervention on fruits and vegetables (FV) sales, as well as total sales, in tribally owned convenience stores where grocery stores are scarce.

METHOD">We analyzed weekly sales data over the first 6 months of a healthy retail intervention. We assessed the proportion of sales from two FV baskets. The FV basket included all fresh, canned, and dried FV sold at stores; while the fruits, vegetables, and salads (FVS) basket included all FV items as well as all salads sold. We compared mean weekly sales rates in intervention and control stores over the 6-month period using generalized estimating equations models to account for repeated measures.</Abstr: We analyzed weekly sales data over the first 6 months of a healthy retail intervention. We assessed the proportion of sales from two FV baskets. The FV basket included all fresh, canned, and dried FV sold at stores; while the fruits, vegetables, and salads (FVS) basket included all FV items as well as all salads sold. We compared mean weekly sales rates in intervention and control stores over the 6-month period using generalized estimating equations models to account for repeated measures.

RESULTS">Mean weekly FV basket sales rates were higher in intervention stores than control stores in both Nations. Mean weekly FVS baskets sales were significantly higher in intervention stores than control stores in one Nation and were higher, but not statistically significant, in intervention stores in the other Nation. Total sales remained steady throughout the intervention period.</Abstr: Mean weekly FV basket sales rates were higher in intervention stores than control stores in both Nations. Mean weekly FVS baskets sales were significantly higher in intervention stores than control stores in one Nation and were higher, but not statistically significant, in intervention stores in the other Nation. Total sales remained steady throughout the intervention period.

CONCLUSIONS">The THRIVE (Tribal Health and Resilience in Vulnerable Environments) intervention increased FV sales without negatively affecting total sales. Policy and Practice Implications. Healthy retail interventions in tribal convenience stores, where many Native Americans living in rural areas shop due to scarcity of grocery stores, could improve diet-related disparities without reducing total sales.</Abstr: The THRIVE (Tribal Health and Resilience in Vulnerable Environments) intervention increased FV sales without negatively affecting total sales. . Healthy retail interventions in tribal convenience stores, where many Native Americans living in rural areas shop due to scarcity of grocery stores, could improve diet-related disparities without reducing total sales.

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Facilitators and challenges in the adoption of a virtual nurse visit in the home health setting
Facilitators and challenges in the adoption of a virtual nurse visit in the home health setting
Birkhoff SD, McCulloh Nair J, Bald K, Frankum T, Sanchez SR, Salvatore AL

Home Health Care Serv Q ;40(2):105-120

PMID: 33779522

Abstract

The COVID-19 pandemic created an opportunity to incorporate nurse-led virtual home care visits into heart failure patients' plan of care. As a supplemental nurse visit to traditional in-person home visits, the Virtual Nurse Visit (VNV) service was deployed using Zoom teleconferencing technology enabling telehealth nurses to remotely communicate, assess, and educate their patients. This mixed methods study explored heart failure patients' abilities, experience, and satisfaction to use and adopt a virtual nurse visit. Sociodemographic, semi-structured interview questions, and the System Usability Scale data were collected. Thirty-four participants completed the study. Over half of participants perceived the VNV usable and four qualitative themes emerged: perceived safety during COVID-19, preferences for care delivery, user experiences and challenges, and satisfaction with the VNV service. Findings from this study builds the science around telehealth that will inform future studies examining this type of nurse-led virtual visit and subsequent patient outcomes.
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The effect of the food environment on fresh produce served in family child care homes
The effect of the food environment on fresh produce served in family child care homes
Fortin-Miller SA, Grantham CE, Campbell JE, Salvatore AL, Hoffman LA, Sisson SB

Nutr Health 2021 Dec;27(4):381-386

PMID: 33781117

Abstract

BACKGROUND: Higher produce consumption in childhood decreases risks of short- and long-term malnutrition, obesity, and disease. Children in early care programs, including family child care homes (FCCHs), receive 50-67% of daily nutrition while in care. Procuring nutritious foods requires grocer access, which is absent in food deserts (FDs).

AIM: To determine if FCCH food environment (FE) impacted distance to grocers and amount of fresh produce served.

METHODS: Using a cross-sectional design, Modified Retail Food Environment Index scores determined census tract FD status. FCCH and grocer addresses were geocoded and distance to the nearest grocers was calculated. Fresh produce was observed during two lunches.

RESULTS: FE did not influence distance to grocers or fresh produce served. Non-desert FCCHs tended to serve fresh produce more frequently. The amount of fresh produce served was overall low.

CONCLUSION: Further studies are warranted to inform policies aimed to reduce provider barriers regarding service of fresh produce.

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Community Health Improvement Plans: An Analysis of Approaches Used by Local Health Departments
Community Health Improvement Plans: An Analysis of Approaches Used by Local Health Departments
Carroll LD, Wetherill MS, Teasdale TA, Salvatore AL

J Public Health Manag Pract ;28(1):E291-E298

PMID: 33797504

Abstract

CONTEXT: The Public Health Accreditation Board requires accredited local health departments (LHDs) to complete community health improvement plans (CHIPs). Evidence suggests that participatory planning frameworks, cross-sector collaboration, social determinants of health (SDOHs), and steering organizations are integral to effective public health planning. However, little is known about the degree to which LHDs incorporate these aspects during the CHIP process.

OBJECTIVES: To describe the use of planning methods, SDOHs, cross-sector partnerships, and steering organizations during the CHIP development process among nationally accredited LHDs and to identify whether LHD jurisdictional size or region is associated with differences in use.

DESIGN: The most recent CHIPs from 93% of all nationally accredited LHDs (n = 195) were qualitatively reviewed and numerically coded for each of the planning components to calculate frequency and degree of use. Differences in use of each component by LHDs' jurisdictional size and region were tested using the chi-square test.

MAIN OUTCOME MEASURE: Use of CHIP planning frameworks, SDOH inclusion, cross-sector partnerships, and steering organizations.

RESULTS: One-half of LHDs (53%) reported use of Mobilizing for Action through Planning and Partnerships, but nearly one-fourth of LHDs did not use any planning framework. LHDs with a large jurisdictional size (>500 000) were significantly more likely to include SDOHs to a high degree than LHDs with mid- (100 000-499 999) to small- (<99 999) jurisdictional size (P < .01). Similarly, large LHDs were more likely to include cross-sector partners except for the category community members, which were rarely (10%) included. Mid-sized LHDs were more likely to lead the CHIP steering committee (61%) than small (29%) and large (9%) LHDs (P < .01). Differences in use of the 4 components by region were less significant.

CONCLUSIONS: Jurisdictional size, rather than region, was more strongly associated with LHD approaches to CHIP development. More studies are needed to determine how differences influence CHIP implementation and impact.

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Creating a Nonprofit Spin-Off to Implement a Community Health Improvement Plan: A Case Study of a Midsize Health Department in the Midwest
Creating a Nonprofit Spin-Off to Implement a Community Health Improvement Plan: A Case Study of a Midsize Health Department in the Midwest
Carroll LD, Wetherill MS, Rogers M, Teasdale TA, Salvatore AL

J Public Health Manag Pract 2021 May;():

PMID: 34016903

Abstract

A common problem faced by local health departments is engaging cross-sector stakeholders to achieve shared community goals. Community engagement is critical for effective Community Health Improvement Plan (CHIP) development and implementation, while also being a standard for health department accreditation. This case study describes one city-county health department's development of a nonprofit arm to act as a catalyst for connecting community leaders to identify and collaboratively address community health goals. First, we describe our process to develop a nonprofit entity and strategically recruit community members to comprise the founding board of directors. Then, we describe methods employed by the nonprofit to create a community action plan in response to identified community health needs and how we incentivized progress. We evaluated our process using a mixed-methods approach and conclude that a nonprofit arm of a health department can be a novel strategy for effectively engaging community stakeholders to advance community health.
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Testing a holistic conceptual framework for early childhood teacher well-being
Testing a holistic conceptual framework for early childhood teacher well-being
Kwon KA, Ford TG, Jeon L, Malek-Lasater A, Ellis N, Randall K, Kile M, Salvatore AL

J Sch Psychol 2021 06;86():178-197

PMID: 34051913

Abstract

Using a holistic conceptualization of teacher well-being in concert with the Job Demands and Resources (JD-R) framework, our interdisciplinary study examined associations among various job demands and resources and whole teacher well-being (i.e., professional, psychological, and physical well-being) in early care and education settings. First, we investigated direct associations of job demands and resources with teachers' professional well-being. Second, we tested two models of potential mediation for the relationship of job demands and resources to well-being using structural equation modeling techniques: (a) that psychological and physical well-being mediate the relationship between demands, resources, and professional well-being; and (b) that professional well-being mediates the relationship between demands, resources, and psychological and physical well-being. Although our sample of early childhood teachers (n = 262) reported high levels of professional well-being (i.e., work commitment, self-efficacy), a substantial number of them experienced challenges in both psychological (e.g., perceived stress, depressive symptoms) and physical (e.g., ergonomic pain) well-being. As expected, teachers' work-related stressors and work resources (positive work climate, quality of the physical environment) were directly associated with teachers' professional well-being. Contrary to our expectations, however, instrumental resources (i.e, wages, health insurance) did not predict any aspects of teachers' professional well-being. Our data only supported the first of the two tested mediation hypotheses (i.e., that psychological and physical well-being mediated the associations between working conditions and professional well-being), but with one caveat: physical well-being preceded psychological well-being in mediating the associations. These results advance our understanding of the challenges present in the early childhood workforce and have implications for policies and programs to improve teacher working conditions and well-being.
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Family Child Care Providers' Nutrition Practices and Policies: Happy Healthy Homes
Family Child Care Providers' Nutrition Practices and Policies: Happy Healthy Homes
Patel SM, Sisson SB, Stephens HA, Williams BD, Hoffman LA, Salvatore AL

J Nutr Educ Behav 2021 Dec;53(12):1066-1071

PMID: 34635431

Abstract

OBJECTIVE: Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies.

METHODS: Cross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05).

RESULTS: Confidence and barriers were significantly correlated (r(47) = -0.4, P = 0.004). Independent variables explained 36% of practices (r = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted.

CONCLUSIONS AND IMPLICATIONS: Provider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.

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