Papers by robert fullilove
JAMA: The Journal of the American Medical Association, 1992
Journal of Community Health
Structural Interventions for HIV Prevention
Given the vast potential to intervene in prison settings, this chapter provides the background an... more Given the vast potential to intervene in prison settings, this chapter provides the background and a corresponding case study as to how structural-level approaches might be used to prevent HIV acquisition/transmission in prison settings. A peer-based model that empowers inmates to be the change agents is described. The chapter offers a compelling case that peer education programs created, managed, and administered by incarcerated persons have significant and often unrecognized potential. It begins with an overview of HIV in US prisons, followed by a description of peer education programs and HIV prevention and World AIDS Day in Prison using three correctional facilities as examples. Implications and conclusions close out the chapter.
Digital Innovation for Healthcare in COVID-19 Pandemic: Strategies and Solutions, 2022
Pedagogy in Health Promotion, 2021
A public health workforce that reflects the increasing diversity of the U.S. population is critic... more A public health workforce that reflects the increasing diversity of the U.S. population is critical for health promotion and to eliminate persistent health disparities. Academic institutions must provide appropriate education and training to increase diversity in public health professions to improve efforts to provide culturally competent care and programs in the most vulnerable communities. Reaching into the existing talent pool of diverse candidates at the undergraduate level is a promising avenue for building a pipeline to advanced training and professional careers in the field of public health. The Summer Public Health Scholars Program (SPHSP) at the Columbia University Irving Medical Center (CUIMC) is a 10-week summer internship program with a mission to increase knowledge and interest in public health and biomedical sciences. Funded by the Centers for Disease Control and Prevention’s (CDC) Undergraduate Public Health Summer Programs, sponsored by the CDC’s Office of Minority H...
The Integration Debate, 2009
Racism: Science & Tools for the Public Health Professional, 2019
TP49. TP049 COVID: ARDS AND ICU MANAGEMENT, 2021
RATIONALE: Communities of color are bearing a disproportionate burden of coronavirus disease 2019... more RATIONALE: Communities of color are bearing a disproportionate burden of coronavirus disease 2019 (COVID-19) morbidity and mortality. Social determinants of health have resulted in higher prevalence and severity of COVID-19 among minority groups. Published work on COVID-19 disparities has focused on higher transmission, hospitalization, and mortality risk among people of color, but studies on disparities in the post-acute care setting are scarce. Our aim was to identify socioeconomic disparities in health resource utilization after hospital discharge. METHODS: This was a retrospective study. We identified adult patients who were hospitalized at CUIMC or the Allen Hospital from March 1st through April 30th 2020, had a positive RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), developed severe hypoxemic respiratory failure requiring invasive mechanical ventilation, and were successfully discharged from the hospital without need for ventilator support. Patients who received a tracheostomy and were weaned off the ventilator prior to discharge were included. Exclusion criteria included transfer from or to another institution, prior tracheostomy, in-hospital death, and discharge with a ventilator. RESULTS: We identified 195 patients meeting inclusion criteria. The median age was 59 (IQR 47-67), and 135 (66.5%) were men. There were 25 (12.8%) patients who were uninsured and 116 (59.5%) patients who had public insurance. There were 121 (62%) Hispanic, 34 (17%) Black, and 18 (9%) White patients. Uninsured patients within our cohort were more likely to be Hispanic and Spanish-speaking (p=0.027;p<0.001, respectively). Uninsured patients were also more likely to be discharged to home (p<0.001) than to a rehabilitation facility. 8.8% of patients were readmitted to CUIMC within 30 days and 41.5% saw a medical provider at CUIMC within 30 days of discharge. Insurance status did not predict 30-day re-hospitalization or completion of outpatient follow-up, although our study was underpowered to answer these questions. CONCLUSION: Our study demonstrated that race/ethnicity and primary language are associated with insurance status with Hispanic and Spanish-speaking patients being more likely to be uninsured. Uninsured patients were more likely to be discharged home after hospitalization, rather than to facility for further care and rehabilitation. We did not demonstrate any short-term differences in 30-day re-hospitalization rates or follow-up visits but we suspect socioeconomic disparities represent a significant barrier to adequate follow-up care in the long term. We plan to investigate this further with longitudinal follow-up and survey data.
Asian American Journal of Psychology, 2020
American Journal of Public Health, 2020
Both authors contributed to the conceptualization of the article, article writing, and discussion... more Both authors contributed to the conceptualization of the article, article writing, and discussions of its substance. N. C. Huang wrote the draft. S. C. Hu revised the article and added important intellectual content. ACKNOWLEDGMENTS We would like to give our sincere thanks to Stella Yu, PhD, for her invitation and English edits. We also express our appreciation to Health Promotion Administration, Ministry of Health and Welfare in Taiwan, and all members in Taiwan Alliance for Healthy Cities.
Journal of General Internal Medicine, 2020
Oxford Medicine Online, 2017
This chapter discusses the unique impact that social disadvantage in general and the criminal jus... more This chapter discusses the unique impact that social disadvantage in general and the criminal justice systems in the United States in particular have on the conditions that drive the HIV/AIDS epidemic in this country. HIV/AIDS is classified as an important racial/ethnic health disparity because residents of marginalized black and Hispanic communities are overrepresented among persons living with HIV/AIDS in the United States. Members of black and Hispanic communities are also overrepresented in the criminal justice; in terms of the epidemic, approximately one out of seven persons living with HIV/AIDS will pass through a U.S. correctional facility in any given year. A history of incarceration is associated with poor treatment outcomes for HIV illness. Improving the quality of HIV care in correctional facilities and in the communities to which incarcerated persons will return is imperative, as is effective interventions in incarcerated populations and communities. Having AIDS activist...
Clinical Obesity, 2016
As of 2012 a large proportion of children and adults in the United States were considered obese, ... more As of 2012 a large proportion of children and adults in the United States were considered obese, increasing their risk of a number of health problems associated with obesity, including acute injuries such as lower extremity fractures and chronic diseases like diabetes (1–3). There are various biological explanations for why people become obese, including genetics, positive energy imbalances and environmental chemical exposures (4–6). Unfortunately, these biological explanations of obesity do not encompass the chronic diseases that are associated with overweight and obesity, including type 2 diabetes (T2D), heart disease, cancer and others (5,7,8). When researchers write about obesity, they rarely limit their writings to body weight alone, frequently including these chronic conditions in their analyses despite the fact that said conditions are clinically distinct from both overweight and obesity (8–14). In order to reconcile biological theories about obesity with the chronic conditions researchers frequently associate with obesity, obesity might best be interpreted as a syndemic. A syndemic is defined as, ‘...two or more epidemics... interacting synergistically and contributing, as a result of their interaction, to excess burden of disease in a population’, and refers specifically to the health consequences of the ways in which such diseases interact (15). One of the primary initial uses of the syndemics approach was to help public health professionals understand the relationship between human immunodeficiency virus (HIV) and tuberculosis (TB), two infectious diseases that can produce a larger disease burden than the burden produced by the individual diseases when they co-occur. The syndemics approach would benefit obesity research and clinical practice in a number of ways. Primary among these benefits is that such an approach would allow researchers to more thoroughly interrogate relationships between obesity, its related conditions and social and structural factors, similar to the way that the syndemics approach has been recommended for use in analyses of the relationship between social factors, including poverty and race, and HIV (16). Consider as an example the relationship between an individuals’ neighbourhood of residence and their weight status. Both street-tree density and homicide rates have been correlated with higher obesity prevalence among pre-school-aged children, indicating that both social and structural factors can have an impact on childhood obesity (17). A similar correlational relationship has been found between recreational trails, crime and obesity among children of all ages (18). Systematic reviews have found correlations between neighbourhood design and obesity among adults (19). This area of obesity research appears ideal for the syndemics approach, as such an approach can specifically reflect the influence of the social and structural environment and its impact on disease processes and aetiology, and by doing so, help clarify methodological approaches to these contributors to obesity. This enhanced understanding could then inform clinical practice by providing practitioners better insight into how and why obesity occurs in both individuals and populations, improving clinicians understanding of obesity and their ability to effectively advise their patients. The syndemics approach to obesity would also help provide a theoretical justification for the way that many researchers currently approach obesity. This current approach often includes chronic conditions associated with obesity, including diabetes, cardiovascular disease (CVD), cancer and myriad others. For example, Wang et al.
The Western journal of medicine, 1992
To examine the actual and potential spread of human immunodeficiency virus (HIV) from an acquired... more To examine the actual and potential spread of human immunodeficiency virus (HIV) from an acquired immunodeficiency syndrome (AIDS) epicenter to surrounding neighborhoods, we studied the prevalence of the viral infection and AIDS risk behaviors from 1988 to 1989 in a representative sample of unmarried whites, African Americans, and Hispanics living in San Francisco. We surveyed 1,770 single men and women aged 20 to 44 years (a 64% response rate) in a random household sample drawn from 3 neighborhoods of varying geographic and cultural proximity to the Castro District where the San Francisco epidemic began. Of 1,369 with blood tests, 69 (5%) had HIV antibodies; all but 5 of these reported either homosexual activity (32% HIV-positive; 95% confidence interval [CI] = 23%, 41%), injection drug use (5% HIV-positive; CI = 1%, 14%), or both (59% HIV-positive; CI 42%, 74%). Homosexual activity was more common among white men than among African-American or Hispanic men, but the proportion of t...
Journal of the National Medical Association, 1991
This study examines the impact of race and psychiatric symptomatology on the treatment of black p... more This study examines the impact of race and psychiatric symptomatology on the treatment of black patients with acquired immunodeficiency syndrome (AIDS). The study consisted of two parts: 1) focused group discussions with AIDS health professionals, and 2) a retrospective chart review of 44 hospitalized AIDS patients. The group discussions revealed that there are specific gaps in mental health services for all AIDS patients and that psychiatric and medical services must be delivered in an ethnically sensitive manner to be effective with black patients. The chart review revealed no statistically significant difference between black and white patients in terms of prevalence of psychiatric symptoms. The results of this study suggest that ethnically sensitive psychiatric diagnosis and treatment may have important clinical implications in the long-term management of black patients with AIDS.
The year 2011 marks the thirtieth year that we have acknowledged the existence of an infectious d... more The year 2011 marks the thirtieth year that we have acknowledged the existence of an infectious disease crisis in our midst. On June 5, 1981, an article appeared in the Morbidity and Mortality Weekly Report (MMWR)—a publication of the U.S. Centers for Disease Control—that presented the cases of five homosexually active gay men with Pneumocystis carinii pneumonia at three different hospitals in Los Angeles. This condition was, at that moment in our history, sufficiently rare that it occasioned both comment and publication. The authors speculated about the possibility that this pneumonia was the result of suppressed immune system function as well as the possibility that a homosexual lifestyle was responsible for exposing five men who did not know each other to the same set of conditions that occasioned a problem with their immune systems. From that point on, a succession of observations and publications would confirm the existence of an infectious disease epidemic that was generating ...
PubMed, May 1, 1997
Self-organized criticality offers more than a descriptive model or a doomsday forecast. We have t... more Self-organized criticality offers more than a descriptive model or a doomsday forecast. We have tried to suggest that it is a paradigm for understanding the interconnections between apparently complex processes. At best, it suggests a method for finding the pressure points that can be used to bring unstable systems of public health services into greater levels of stability. The model enjoins us to understand that our goal is not to achieve equilibrium--that perfect match between the demand for health services and its delivery--but rather stability (or, more precisely, metastability). As is true of the sandpile, our systems of public health are constantly evolving. If we are correct, then the mechanism driving this ostensibly complex pattern of change and growth reflects the existence of simpler and, hopefully, more manageable processes. By monitoring these processes, it may be increasingly possible to adapt to change and even manage it effectively.
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Papers by robert fullilove