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58096 A community-academic partnership to implement DASH diet and social/behavioral interventions in congregate meal settings to reduce hypertension among seniors aging in place
- Kimberly S. Vasquez, Adam Qureshi, Andrea Ronning, Moufdi Naji, Cameron Coffran, Clewert Sylvester, Glenis George-Alexander, Dacia Vasquez, Teeto Ezeonu, Chamanara Khalida, Victor Baez, William Dionne, Sharon Tobias, Debra Diaz, Caroline S. Jiang, Roger Vaughan, Barry S. Coller, Jonathan N. Tobin, Dozene Guishard, Rhonda G. Kost
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 30 March 2021, p. 76
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ABSTRACT IMPACT: Our implementation model translates two evidence-based nutritional and behavioral interventions to lower blood pressure, into a community-based intervention program for seniors receiving congregate meals. OBJECTIVES/GOALS: The Rockefeller University, Clinical Directors Network, and Carter Burden Network received an Administration for Community Living Nutrition Innovation grant to test whether implementation of DASH-concordant meals and health education programs together lower blood pressure among seniors aging in place. METHODS/STUDY POPULATION: n=200, >60 yr, >4 meals/week at CBN; engagement of seniors/stakeholders in planning and conduct; Advisory Committee to facilitate dissemination; menus aligned with Dietary Approaches to Stop Hypertension (DASH) and NYC Department for the Aging nutritional guidelines; interactive sessions for education in nutrition, BP management, medication adherence. Training in use of automated daily home BP monitors (Omron 20). Validated surveys at M0, M1, M3, M6. Taste preference and cost assessed through Meal Satisfaction (Likert scale) and Plate Waste measures. Primary Outcome: Change in Systolic BP (SBP) at Month 1; change in %BP controlled. Secondary: validated cognitive, behavioral, nutritional measures (SF-12, PQH-2), economics; staff/client satisfaction, trends and significant associations. RESULTS/ANTICIPATED RESULTS: n=94, x2 age =73 +/- 8 years, 65% female, 50% White, 32% Black/African American, 4% Asian, 1% American Indian, Alaskan Native, 13% Other, 32% Latino/a, 43% with income <$20,000. Mean SBP at Baseline was 137.87 +18.8 mmHg (range 98-191). Menus were adapted to provide 20% daily DASH requirements at breakfast, 50% at lunch. Participants attended classes in nutrition and medication management and were provided with and trained to use an automated home BP monitor. Meal satisfaction scores dipped briefly then met or exceed pre-DASH levels. Home BP data was downloaded every 2-4 weeks with social/behavioral support. The COVID-19 closures interfered with BP outcome data collection and meal service ceased. Primary outcome: x2 change in SBP at Month 1 = -4.41 mmHg + 18 (n=61) (p=0.713). Significant associations will be reported. DISCUSSION/SIGNIFICANCE OF FINDINGS: Our community-academic research partnership implemented the DASH diet in congregate-meal settings to address uncontrolled hypertension in seniors. COVID-19 interrupted the study, but encouraging trends were observed that may inform refinement to this community-based health intervention for seniors.
Using attendance data for social network analysis of a community-engaged research partnership
- Kimberly S. Vasquez, Shirshendu Chatterjee, Chamanara Khalida, Dena Moftah, Brianna D’Orazio, Andrea Leinberger-Jabari, Jonathan N. Tobin, Rhonda G. Kost
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 21 December 2020, e75
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Background:
The Rockefeller University Center for Clinical and Translational Science (RU-CCTS) and Clinical Directors Network (CDN), a Practice-Based Research Network (PBRN), fostered a community–academic research partnership involving Community Health Center (CHCs) clinicians, laboratory scientists, clinical researchers, community, and patient partners. From 2011 to 2018, the partnership designed and completed Community-Associated Methicillin-Resistant Staphylococcus Aureus Project (CAMP1), an observational study funded by the National Center for Advancing Translational Sciences (NCATS), and CAMP2, a Comparative Effectiveness Research Study funded by the Patient-Centered Outcomes Research Institute (PCORI). We conducted a social network analysis (SNA) to characterize this Community-Engaged Research (CEnR) partnership.
Methods:Projects incorporated principles of Community-Based Participatory Research (CAMP1/2) and PCORI engagement rubrics (CAMP2). Meetings were designed to be highly interactive, facilitate co-learning, share governance, and incentivize ongoing engagement. Meeting attendance formed the raw dataset enriched by stakeholder roles and affiliations. We used SNA software (Gephi) to form networks for four project periods, characterize network attributes (density, degree, centrality, vulnerability), and create sociograms. Polynomial regression models were used to study stakeholder interactions.
Results:Forty-seven progress meetings engaged 141 stakeholders, fulfilling 7 roles, and affiliated with 28 organizations (6 types). Network size, density, and interactions across organizations increased over time. Interactions between Community Members or Recruiters/Community Health Workers and almost every other role increased significantly across CAMP2 (P < 0.005); Community Members’ centrality to the network increased over time.
Conclusions:In a partnership with a highly interactive meeting model, SNA using operational attendance data afforded a view of stakeholder interactions that realized the engagement goals of the partnership.
4114 A Community/Academic Partnership to Implement Nutritional and Social/Behavioral Interventions to reduce Hypertension among Seniors Aging in Place
- Kimberly Vasquez, Andrea Ronning, Moufdi Naji, Glenis George-Alexander, Clewert Sylvester, Cameron Coffran, Teeto Ezeonu, Chamanara Khalida, Jonathan N. Tobin, Dozene Guishard, Rhonda G Kost
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, p. 76
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OBJECTIVES/GOALS: The Rockefeller University CCTS, Clinical Directors Network (CDN), and Carter Burden Network (CBN) received a DHHS-Administration for Community Living Nutrition Innovation grant to test whether implementation of DASH-concordant meals and a program to enhance self-efficacy, could lower blood pressure among seniors aging in place. METHODS/STUDY POPULATION: CEnR-Nav model to engage stakeholders, enroll seniors age >60 yr., eating 4 meals a week at 2 CBN congregate meal sites; Advisory Committee to facilitate dissemination; menus aligned with Dietary Approaches to Stop Hypertension (DASH) and New York City Department for the Aging (DFTA) nutritional guidelines; interactive sessions for education (nutrition, blood pressure, medication adherence); Omron 10 home BP devices for daily home monitoring. Plate Waste and Meal Satisfaction (Likert scale) to assess taste preference and cost impact. Outcomes: Primary: Change in Systolic BP at Month 1; change in percent with controlled blood pressure. Secondary: change in validated measures of cognitive (e.g. SF-12, PHQ-2), behavioral (Home BP monitoring), nutritional (food frequency) variables, satisfaction, costs. RESULTS/ANTICIPATED RESULTS: Menu alignment required multiple iterations. Plate Waste and Menu Satisfaction tools were developed. Site 1 enrollment began June 2019; educational sessions and home BP monitors and training were provided. Baseline mean blood pressure (Site 1) was 138/79 +20.5; (range: 7% hypertensive crisis, 36% stage 2 hypertension, 22% stage 1 hypertension, 22% elevated, and 13% normal). DASH-aligned meals began October 2019; Meal satisfaction declined briefly, chefs adjusted menus, and meal satisfaction rose to pre-intervention levels. Site 2 enrollment is ongoing; dietary intervention will start in 2020. Primary outcome data (change in BP) will be complete in March 2020. Secondary outcome data on social and behavioral impact of the interventions will also be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: We leveraged our community-academic research partnership to conduct research addressing uncontrolled hypertension, an urgent unmet health need among seniors. The DASH Implementation Study can inform the broader aging services and healthcare community of the potential for congregate nutrition programs to improve cardiovascular health outcomes.
4391 Big data analysis of adolescent obesity, pregnancy and kidney function
- Dana Bielopolski, Neha Singh, Caroline Jiang, Robert Bruce MacArthur, Kimberly Vasquez, Dena Moftah, Rhonda G Kost, Jonathan N. Tobin
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, p. 43
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OBJECTIVES/GOALS:
1. Examine the associations among BMI and markers of cardiometabolic risk, including blood pressure, lipids and blood glucose.
2. Assess prevalence of kidney function deterioration, identified as hyperfiltration and moderately increased albuminuria (MIA), in obese compared to normal weight adolescents.
METHODS/STUDY POPULATION: De-identified electronic health records (EHR) data were extracted for female adolescents, aged 12-21 years, and their offspring through 24 months, who received health care services (Jan 2012 to Dec 2016) in NYC from 12 academic health centers and community health centers that are part of PCORnet NYC Clinical Data Research Network (NYC-CDRN). Data were analyzed using SAS (version 3.2.5). Patient characteristics overall and for study subgroups were examined using standard summary statistics. Trends in cardio-renal variables were examined by BMI groups coded according to NHANES as underweight, normal weight, overweight or obese. Multiple linear regression analyses will control for covariates. RESULTS/ANTICIPATED RESULTS: Data from 651,066 adolescent females ages 12-21 were retrieved. Analysis was performed on a subset of 202,214 unique patients (26% white, 15% black, 12.9% Latina) for whom there was complete data for BMI and blood pressure. Distribution of BMI was 6% underweight, 59% normal weight, 19% overweight, and 17% obese. There were significant differences in mean systolic (SBP, mean±SD mmHg: 102±12, 108±11, 112±12, 116±12) and diastolic blood pressure (DBP, mean±SD mmHg: 62±10, 66±8, 68±8.9, 70±9) across the four BMI groups with an increasing trend (p-values<0.0001). We will examine renal function trends, and whether these cardio-renal differences persist when controlling for age, race and ethnicity. DISCUSSION/SIGNIFICANCE OF IMPACT: Although SBP/DBP means were within normal limits across BMI groups, significant increasing trends suggest that women in higher BMI groups may be at increased risk for hypertension and potentially for renal dysfunction. We will examine contributions of race/ ethnicity and age to these associations.
Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning
- Joshua M. Tobin, William D. Ramos, Joel Greenshields, Stephanie Dickinson, Joseph W. Rossano, Peter G. Wernicki, David Markenson, Kimberly Vellano, Bryan McNally, CARES Surveillance Group
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- Journal:
- Prehospital and Disaster Medicine / Volume 35 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 January 2020, pp. 141-147
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- April 2020
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Introduction:
The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.
Hypothesis/Problem:The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.
Methods:The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).
Results:Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10–6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01–2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86–2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91–1.84; P = .157).
Conclusion:In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.
3310 A Community-Academic Partnership to Understand the Association Among Health Status and Senior Services Utilization to Improve Nutrition and Blood Pressure Control for Low Income Seniors Aging in Place
- Kimberly Vasquez, Dozene Guishard, Rina Desai, Moufd Naji, Caroline Jiang, Andrea Ronning, Glenis George-Alexander, Onassis Castillo Ceballo, Jackie Berman, Jonathan N. Tobin, Rhonda G Kost
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, pp. 79-80
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OBJECTIVES/SPECIFIC AIMS: The Rockefeller University Center for Clinical and Translational Science (RU-CCTS), Clinical Directors Network (CDN), and Carter Burden Network (CBN), a multi-site senior services organization serving East Harlem, NY, formed a community-academic research partnership to characterize the health of the CBN seniors (many who are racial/ethnic minorities, low-income, and suffering from multiple chronic conditions) and to explore the use and associations of a measure of overall health status and frailty in this population. A simple validated measure of health status could standardize and streamline community-based translational research to study the impact of CBN’s services on health outcomes. The CCTS-funded Pilot Project aims to: 1) Engage CBN seniors and stakeholders in priority-setting, joint protocol development, research conduct, analysis and dissemination; 2) Characterize the health status of the CBN seniors using validated measures; 3) Establish an electronic database infrastructure for current and future research; 4) Understand how health and senior activities information can be used to implement programs to improve senior health and well-being. METHODS/STUDY POPULATION: 1) We used Community Engaged Research Navigation (CEnR-Nav) methods to facilitate partnership development, and to engage CBN seniors and stakeholders in each step of the research; 2) Research staff conducted recruitment, informed consent, and physical assessments (e.g., pulse, blood pressure, BMI); and administered validated surveys to collect health status information. 3) Data were captured on a REDCap-based platform. The primary outcome, frailty, was measured by the validated Short Physical Performance Battery (SPPB). 4) Secondary outcomes include the association of use of services/activities with the primary outcome. Research participants consented to sharing of their health, demographic and services utilization data compiled by CBN staff and the NYC Department for the Aging (DFTA). DFTA provided comparison datasets of de-identified health and demographic data for clients attending other NYC DFTA-funded senior centers. RESULTS/ANTICIPATED RESULTS: 1) 43 residents and stakeholders engaged in partnership-building, study design and implementation. 2) 218 participants from two senior centers were enrolled. Mean age, 68 ± 11 years; 58% Hispanic; 33% African American, 23% White, 1% Asian, 18% Unknown, 17% Other; 69% reported <$20000 annual income; 40% had not completed high school; 30% scored as moderately or severely frail; 83% were overweight or obese; and 33% reported a history of diabetes. 84% had uncontrolled high blood pressure; many participants were previously aware of their hypertension diagnosis. 3) A REDcap database was developed to store historical and prospective data. 4) Across frailty categories, there was a significant difference in utilization of non-meal (p = 0.0237) and meal services (p = 0.0127) and there was an inverse proportional relationship between the number of meal and non-meal visits, and frailty. Additional associations among health status measures (e.g., SPPB, demographics, biological measures: pulse, blood pressure, BMI; psychosocial and nutritional scales) and CBN service utilization (i.e., meals vs. non-meals activities) will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: We developed a community-academic research partnership, infrastructure and capacity, built through our Community-Engaged (CEnR-Nav) model, to conduct a pilot study characterizing the health status and services utilization of low-income minority seniors. Our pilot study identified an urgent health priority, uncontrolled hypertension in 84% of CBN’s seniors. We then leveraged the team’s expertise and CBN’s meal services program to develop a research proposal for external funding to conduct a community-based multi-component intervention study. Replacement of a typical Western diet with the Dietary Approaches to Stop Hypertension (DASH) diet has been proven to reduce blood pressure in hypertensive and normotensive individuals in as little as 14 days, yet effective implementation has been lacking, and it is relatively untested in community-living seniors who receive their meals in settings such as CBN. We are also exploring mechanistic questions that relate to blood pressure control, such as the impact of the DASH diet on inflammation, which may lead to a better understanding of the underlying mechanism of action of the DASH diet. Our community partner, CBN, was awarded the DHHS-ACL nutrition innovation grant to conduct this 2-year study with CDN and RU-CCTS. The resulting study developed out of the community engaged pilot study represents a unique combination of community-centered care, within an implementation science framework (with embedded mechanistic measures under development). This is an example of the novel, full-spectrum approach to translational research that the RU-CCTS/CDN Community Engaged Research Core has been developing over the last decade. The research to characterize CBN clients’ health status is now being extended to address cardiovascular health by way of intervening on diet quality and food insecurity, a key component of the social determinants of health, in partnership with agencies outside of the healthcare delivery system. The outcomes of the DASH Diet implementation study will also serve to inform the broader aging service provider network and the healthcare community about the impact of senior center congregate meal composition and services on health outcomes.
2229 A community-academic translational research and learning collaborative to evaluate the associations among biological, social, and nutritional status for adolescent women and their babies using electronic health records (EHR) data
- Jonathan Tobin, Amanda Cheng, Caroline S. Jiang, Mireille McLean, Peter R. Holt, Dena Moftah, Rhonda G. Kost, Kimberly S. Vasquez, Daryl L. Wieland, Peter S. Bernstein, Siobhan Dolan, Mayer Sagy, Abbe Kirsch, Michael Zinaman, Elizabeth DuBois, Barry Kohn, William Pagano, Gilles Bergeron, Megan Bourassa, Stephanie Morgan, Judd Anderman, Shwu H. Kwek, Julie Wilcox, Jan L. Breslow
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, pp. 77-78
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OBJECTIVES/SPECIFIC AIMS: To build a multisite de-identified database of female adolescents, aged 12–21 years (January 2011–December 2012), and their subsequent offspring through 24 months of age from electronic health records (EHRs) provided by participating Community Health. METHODS/STUDY POPULATION: We created a community-academic partnership that included New York City Community Health Centers (n=4) and Hospitals (n=4), The Rockefeller University, The Sackler Institute for Nutrition Science and Clinical Directors Network (CDN). We used the Community-Engaged Research Navigation model to establish a multisite de-identified database extracted from EHRs of female adolescents aged 12–21 years (January 2011–December 2012) and their offspring through 24 months of age. These patients received their primary care between 2011 and 2015. Clinical data were used to explore possible associations among specific measures. We focused on the preconception, prenatal, postnatal periods, including pediatric visits up to 24 months of age. RESULTS/ANTICIPATED RESULTS: The analysis included all female adolescents (n=122,556) and a subset of pregnant adolescents with offspring data available (n=2917). Patients were mostly from the Bronx; 43% of all adolescent females were overweight (22%) or obese (21%) and showed higher systolic and diastolic blood pressure, blood glucose levels, hemoglobin A1c, total cholesterol, and triglycerides levels compared with normal-weight adolescent females (p<0.05). This analysis was also performed looking at the nonpregnant females and the pregnant females separately. Overall, the pregnant females were older (mean age=18.3) compared with the nonpregnant females (mean age=16.5), there was a higher percentage of Hispanics among the pregnant females (58%) compared with the nonpregnant females (43.9%). There was a statistically significant association between the BMI status of mothers and infants’ birth weight, with underweight/normal-weight mothers having more low birth weight (LBW) babies and overweight/obese mothers having more large babies. The odds of having a LBW baby was 0.61 (95% CI: 0.41, 0.89) lower in obese compared with normal-weight adolescent mothers. The risk of having a preterm birth before 37 weeks was found to be neutral in obese compared with normal-weight adolescent mothers (OR=0.81, 95% CI: 0.53, 1.25). Preliminary associations are similar to those reported in the published literature. DISCUSSION/SIGNIFICANCE OF IMPACT: This EHR database uses available measures from routine clinical care as a “rapid assay” to explore potential associations, and may be more useful to detect the presence and direction of associations than the magnitude of effects. This partnership has engaged community clinicians, laboratory, and clinical investigators, and funders in study design and analysis, as demonstrated by the collaborative development and testing of hypotheses relevant to service delivery. Furthermore, this research and learning collaborative is examining strategies to enhance clinical workflow and data quality as well as underlying biological mechanisms. The feasibility of scaling-up these methods facilitates studying similar populations in different Health Systems, advancing point-of-care studies of natural history and comparative effectiveness research to identify service gaps, evaluate effective interventions, and enhance clinical and data quality improvement.
2324 A community-academic partnership to understand the correlates of successful aging in place (year 2)
- Kimberly Vasquez, Dozene Guishard, William Dionne, Alexandra Jurenko, Caroline Jiang, Cameron Coffran, Andrea Ronning, Glenis George-Alexander, Cynthia Mofunanya, Onassis C. Ceballo, Lisa Tsatsas, Barry S. Coller, Jonathan N. Tobin, Rhonda G. Kost
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- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, pp. 63-64
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OBJECTIVES/SPECIFIC AIMS: Objective: The Rockefeller University Center for Clinical and Translational Science (RU-CCTS), Clinical Directors Network (CDN), and Carter Burden Network (CBN), a multisite senior services organization serving East Harlem, NY, formed a community-academic partnership to examine the use of a simple validated surrogate measure of overall health status and frailty in this population. Many CBN seniors are racial/ethnic minorities, low-income, and suffer from multiple chronic conditions, depression and food insecurity. Multiple biological, musculoskeletal, psychosocial and nutritional factors contribute to frailty, which has been defined variously in senior health outcomes research. The CTSA-funded Pilot Project aims to: (1) Engage CBN seniors and stakeholders in priority-setting, joint protocol development, research conduct, analysis, and dissemination; (2) Characterize the health status of the CBN seniors using validated measures; (3) Establish database infrastructure for current and future research; (4) Understand how health and senior activities information can be used to create programs to improve senior health. METHODS/STUDY POPULATION: Methods: (1) CEnR-Navigation, a collaborative program/process that consists of semistructured meetings and activities facilitated by expert Navigators, was used for partnership development and to engage Carter Burden seniors to refine priorities and research questions, provide feedback on study design and conduct, and analyze and disseminate results. (2) Standard physical measurements and validated survey instruments were used to collect health information; target enrollment is 240 seniors across 2 sites (1 hosted within a subsidized housing facility and Social Model Adult Day Program). (3) A REDCap-based platform was designed for data capture and import. Individual attendance at senior activities for the prior year was extracted from existing records. The primary outcome is frailty, as measured by validated walk/balance tests (Short Physical Performance Battery). Secondary outcomes include measures of engagement, and association of use of services/activities with the primary outcome. RESULTS/ANTICIPATED RESULTS: (1) In total, 29 residents and 14 other stakeholders engaged in partnership-building, study design and implementation. (2) From May to November 2017, 98 participants were enrolled from site 1 (a residential site). Enrollment at site 2 (a senior center), begun in November, is projected for February completion. Characteristics of site 1 participants: median age=63.6 years; Hispanic, 44.90% (44); White, 13.89% (10), Black, 62.50% (45); Asian, 4.17% (3); American Indian or Alaskan Native, 2.78% (2), and Other, 16.67% (12). Educational attainment: 51.04% (49) had not completed high school; 19.79% (19) were high school graduates; 18.75% (18) completed some college, and 10.42% (10) were college graduates. For the 85 participants reporting annual income: 64.71% (55) reported <$10,000; 28.24% (24) reported $10,000–$15,000; 7.06% (6) were among the ranges from $15,000 to $50,000. The average body mass index (BMI) was 30, which is obese. For 83.67% (82) of site 1 participants, the BMI was in the range of overweight or obese. Half of participants (49) reported health literacy barriers in the Single Item Health Literacy Survey. Demographics and Frailty assessments (walk and balance tests) for participants enrolled at both sites will be reported. (3) Activity participation data for July 2016–November 2017 were recovered for 507 sessions at site 1 and are being analyzed. DISCUSSION/SIGNIFICANCE OF IMPACT: Here we report progress in developing a sustainable community-academic partnership, infrastructure and research capacity with the CBN senior services organization, and characterizing this at-risk population, of whom 71% have a high school education or less, 93% live in extreme poverty, and 84% are overweight or obese. A simple validated frailty measure in seniors will enable the acceleration of community-based translational research addressing senior health, and examine changes in this measure in relationship to the utilization of senior services.
2080 Implementing and evaluating an evidence-based intervention from the intensive care unit (ICU) setting into primary care using promotoras to reduce CA-MRSA recurrence and household transmission
- Brianna M. D’Orazio, Jonathan N. Tobin, Rhonda G. Kost, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria P. de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw W. Hassen, Franco Barsanti, Satoko Kanahara, Regina Hammock, Rosalee Nguyen, Mark Trezia, Trang Gisler, Herminia de Lencastre, Alexander Tomasz, Barry S. Coller
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- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 71
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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.
2528: A community-academic partnership to understand the correlates of successful aging in place
- Rhonda G. Kost, Rhonda G. Kost, Kimberly Vasquez, Dozene Guishard, William Dionne, Caroline Jiang, Cameron Coffran, Andrea Ronning, Glenis George-Alexander, Barry S. Coller, Jonathan N. Tobin
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 82
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OBJECTIVES/SPECIFIC AIMS: The Rockefeller University-Center for Clinical and Translational Science and Clinical Directors Network (RU-CCTS/CDN) community-academic-partnership engaged with Carter Burden Center for the Aging (CBCA), a multisite senior community services organization serving Upper Eastside and East Harlem, NY, to develop community-engaged research. Many seniors served by CBCA are racial/ethnic minorities, live in poverty, suffer from multiple chronic conditions, depression, and food insecurity; there is no simple measure routinely used to characterize the health/health risks of program participants. Multiple biological, musculoskeletal, psychosocial and nutritional factors collectively contribute to frailty a construct that is variously defined, and has been used as a surrogate or predictor for health outcomes. Aim 1: We will engage seniors, CBCA leadership, New York City Department for the Aging, staff and other stakeholders in research priority-setting, joint protocol writing, research conduct, analysis and dissemination to cultivate a population of elder stakeholders interested in designing and participating in this and future research. Aim 2: We will characterize the health status of the resident and nonresident populations by collecting data across 3 sessions to include validated cardio-metabolic, musculoskeletal, chronic condition prevalence, quality of life, psychosocial, and nutritional assessments. METHODS/STUDY POPULATION: Stakeholders will be engaged through the process of Community Engaged Research Navigation and a series of meetings and exercises to refine priorities and research design, co-write the protocol, provide feedback on conduct, analyze and disseminate results of the project. RESULTS/ANTICIPATED RESULTS: Outcomes will include rates of participation and retention in assessments and engagement activities, themes from qualitative research, contributions to study design, placement of aims on the T0-T48 spectrum, social network analysis, classification of engagement on the spectrum of Community-based Participatory Research (CBPR) and partnership assessment. The primary outcome is frailty (6-minute walk test); We will examine associations among these measures with services utilization data captured electronically by CBCA. A key deliverable of this project will be a REDCap data capture platform that integrates and displays these measures that will be sustainable for CBCA. DISCUSSION/SIGNIFICANCE OF IMPACT: This practice-based research partnership will allow us to extract, replicate and extend the lessons learned about engaging stakeholders in generating hypotheses, operationalizing research, collecting and analyzing data, and disseminating results. The collaboration is built around generating and testing rigorous clinical an health services hypotheses that are derived from real-world practice-based needs and also incorporate basic science measures to embed and examine mechanistic hypotheses. Testing a simple to implement validated surrogate frailty measure will accelerate progress on evidence-based practices to test interventions that enhance healthy aging and serve as a model for future similar partnerships to form a network for community-based senior research. This work aligns with the RU-CCTS grant Hub Research goal to engage populations across the life span, including hard-to-reach and underserved populations, such as minority seniors.
2421: Patient and household member colonization and environmental contamination with Staphylococcus aureus in a comparative effectiveness study of home-based interventions to reduce CA-MRSA recurrence and household transmission
- Jonathan N. Tobin, Rhonda G. Kost, Brianna M. D’Orazio, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria Pardos de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw Worku Hassen, Tracie Urba
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- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 77
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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are commonly seen in primary care, with recurrence rates that range from 16% to 43%, and present significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to develop and evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence of CA-MRSA in patients presenting to primary care with SSTIs and transmission within their households. This presentation will examine associations between wound microbiology, clinical presentation, and housing characteristics, including housing density and household surfaces contamination. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 3 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants will be randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention (based on the REDUCE MRSA trial) or usual care. The highly engaged stakeholder team finalized the intervention protocol, developed and implemented CHW and clinician training, and developed an online health portal application for data management and exchange. RESULTS/ANTICIPATED RESULTS: We have collected 923 isolates from 237 individuals, including 240 wound culture isolates and 683 surveillance culture isolates (nares, axilla, groin). MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively; 59.5% with MRSA+ wound culture had 1 or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had 1 or more MSSA+ surveillance culture. Of those with MRSA or MSSA infections, 70% of subjects were male, with an average age of 37.9 (SD=15.9 y). The most frequent sites of infection were the leg (20%), axilla (18%), buttock (17%), and abdomen/torso (12%). There was no association between the location and type of infection (MRSA/MSSA) (p-value=0.09). The kitchen floor (14.05%) and bedroom floor (14%) were the most common surfaces contaminated with MRSA. These were also the most common surfaces contaminated with MSSA, which was recovered from 10.2% and 9.1% of kitchen floors and bedroom floors, respectively. For individuals with an MRSA or MSSA wound infection, there was an average number of 3.2 (SD=1.6) co-residents per household, and 36.5% of household members were colonized with either MRSA or MSSA. There is no association between household density (number of co-residents) and type of infection (MRSA/MSSA) (Fisher’s p-values=0.171 and 0.371, respectively). In households of participants with MSSA wound infections, the number of colonized sites is positively associated with the level of household MSSA contamination (p=0.027). Further analyses will examine the associations between molecular subtypes, wound location, household surface contamination and household member colonization and infection. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the patient-level and environmental-level factors associated with SSTI recurrence, surface contamination and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators to implementation of home visits by CHWs in underserved populations, and aims to strengthen the evidence base for implementation of strategies to identify and reduce household reservoirs and then control SSTI recurrence and household transmission.
3 - Characteristics of Gang Members
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
- Published online:
- 23 July 2009
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- 23 December 2002, pp 32-55
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Summary
To begin our study of gang membership, we examine the prevalence and duration of gang membership for the total sample of the Rochester Youth Development Study and for its major demographic subgroups, compare gang members and nonmembers in terms of delinquent behavior, and then assess the proportionate contribution of gang members to the overall volume of crime.
The Prevalence of Gang Membership
Ever Prevalence
The prevalence of being a gang member at any point up to Wave 9, which essentially covers the high school years, is 30.9% of the total sample (Table 3.1). Thus, although most (69.1%) in this urban sample were not gang members, gang membership is not rare.
This prevalence rate is rather high when comparisons are made with results in other studies. For example, Klein (1971) estimated that in the four geographical areas covered by his study only about 6% of the gang-age youths in those areas were actually gang members. A similar approach, with similar results, has been used by other field researchers – for example, Moore (1978) and Vigil (1988). In a survey of eighth graders in 11 American cities, Esbensen and Winfree (1998) found that 11.8% of the respondents were gang members. Our estimate, based on a measure of lifetime prevalence rather than a point estimate or annual rate, highlights the importance of looking at gang membership as a trajectory that unfolds with age.
7 - Gangs, Guns, and Crime
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 122-139
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the previous analysis indicates that gang membership facilitates a broad range of delinquent behaviors including violence, drug use, and drug sales. When boys join gangs their delinquency increases and when they leave gangs their delinquency decreases. Here we focus on a related form of illegal behavior: owning and carrying illegal firearms. In particular, we are interested in the interplay between gang membership and patterns of owning and carrying guns. There are three general analytic questions. First, do gangs recruit those who carry illegal guns prior to gang membership, does gang membership enhance gun carrying, or are both processes at work? Second, do former gang members continue carrying guns as a result of their gang experience? Finally, what is the joint impact of gang membership and gun involvement on delinquency, drug use, and drug sales? Because research has shown that illegal gun carriers are more active in criminal activity (Lizotte et al., 2000) and that gang members show higher levels of criminal activity (Chapter 6), we hypothesize that gang members who also carry guns will have higher levels of criminal activity than one would predict from either factor alone. We conduct all these analyses for two types of illegal gun carriers: those who carry illegal guns but do not own them, and those who carry illegal guns that they own. The distinction is important, especially at these ages and especially for gang members.
4 - The Antecedents of Gang Membership
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 56-76
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having provided a description of gang members by examining their demographic characteristics, we now extend this description considerably by identifying risk factors for gang membership. After examining how antecedent characteristics and attributes affect the likelihood that an individual will join a gang, we examine the ability of these same risk factors to distinguish transient from stable gang members. Following these bivariate analyses, we turn to multivariate models and examine how experiencing multiple risk affects the odds of joining a street gang.
A Risk Factor Approach
Risk factors are “individual or environmental hazards that increase an individual's vulnerability to negative developmental outcomes” (Small and Luster, 1994: 182; see also Farrington, 2000; Werner and Smith, 1982). Consistent with the multidimensionality of the life-course approach, risk factor models assume that there are multiple, and often overlapping, risk factors in an individual's background that lead to adverse outcomes. In the terms of developmental psychopathology, outcomes are characterized by equifinality, or multiple pathways to the same outcome (Cicchetti and Rogosch, 1996). Furthermore, this approach assumes that cumulative risk, that is, risk that occurs in many different life domains, is most strongly related to adversity (Werner and Smith, 1982).
Identifying risk factors, especially those that occur early in the life course, has several theoretical and practical advantages (Farrington, 2000). Theoretically, identifying factors that increase risk suggests fruitful areas for exploration in more formal causal analyses. It also helps in isolating variables that mediate or translate increased vulnerability into actually experiencing the outcome.
6 - Gangs as a Facilitating Context for Delinquent Behavior
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 96-121
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Up to this point the analysis has focused on the antecedents of gang membership, examining risk factors for and causal processes associated with joining a gang. Now we examine whether membership in a juvenile street gang alters the short-term behavior patterns and the long-term life-course development of gang members. The first set of issues we address concerns the extent to which the gang actually facilitates various forms of deviant behavior.
In Chapter 3 we demonstrated that gang members in Rochester have significantly higher rates of delinquency than nonmembers. This finding confirms results from earlier observational studies (Hagedorn, 1998; Klein, 1971; Miller, 1966; Moore, 1978; Taylor, 1990), from studies using official data (Cohen, 1969; Klein et al., 1986; Maxson and Klein, 1990), and from those using survey techniques (Fagan, 1989, 1990; Fagan et al., 1986; Short and Strodtbeck, 1965; Tracy, 1979). We also demonstrated that gang members account for a disproportionate share of the crime problem relative to their representation in the general population. Because gangs clearly connote groups that have a deviant or criminal orientation, a strong relationship between gang membership and high rates of involvement in delinquency and drug use is hardly surprising. What these studies do not identify, however, are the social processes that bring about the association between gang membership and higher rates of delinquency. As Fagan has noted, “it is uncertain whether the differences reflect the positive correlation between group crime and violence, features of the gang itself, or the state of social controls in the inner cities where gangs are most evident” (1990: 186).
9 - Long-Term Consequences of Gang Membership
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 163-180
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gangs have a powerful, contemporaneous effect on the lives of the adolescents who become involved with them. It is also reasonable to expect that gang membership will have long-term consequences as well, interfering with the normal course of adolescent development and affecting the transition to adult roles and statuses. Although reasonable, there has been surprisingly little research conducted in this area. As early as 1971 Klein commented that “Though the need is great, there has been no careful study of gang members as they move on into adult status” (1971: 136), a view more recently advanced by Hagedorn (1998) and by Decker and Lauritsen (1996). In this chapter we examine whether adolescent involvement in street gangs has long-term consequences in such important developmental areas as family formation, parenthood, and employment. We begin by introducing basic concepts from the life-course perspective to guide the analysis.
Life-Course Perspective
The life-course perspective recognizes that as people age they enter and move along various trajectories. Trajectories are age-graded patterns of development with respect to major social institutions such as family, school, and work. They capture the long view of development, “linking social and psychological states over a substantial portion of the life span” (Elder, 1997: 955). Short-term changes in the life course, including movement into and out of trajectories, are referred to as transitions.
One of the most volatile stages of human development occurs as individuals move from adolescence to adulthood.
2 - Research Procedures: The Sample and the Data
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 11-31
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to examine the origins and aftermath of membership in juvenile street gangs, we rely on data from the Rochester Youth Development Study, an ongoing, longitudinal investigation of antisocial behavior. This study, which began in 1986 with funding from the Office of Juvenile Justice and Delinquency Prevention, focused on the causes and correlates of serious, violent, and chronic delinquency. The study of gangs is just one aspect of this broader research initiative, but one that is very central to the core aims of the study. In this chapter we introduce the reader to the design of the Rochester study and describe the study's sample and measures, especially as they focus on issues related to gangs and gang membership.
The Rochester Youth Development Study
The Rochester Youth Development Study follows a panel of juveniles from their early teenage years through their early adult years. Figure 2.1 depicts the overall research design of the study. To date, we have collected 12 waves of data spanning the ages of 13 through 22.
Each subject and a primary caretaker (in the vast majority of cases this is the biological mother) were interviewed at six-month intervals from the spring of 1988 until the spring of 1992. After a two-year gap in data collection, annual interviews began in 1994. By the end of Wave 12 in the spring of 1997, we had reinterviewed 846 of the initial 1,000 subjects in the study, a retention rate of 85%.
5 - The Origins of Gang Membership
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 77-95
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the results of the risk factor analyses are descriptively informative, but they are also theoretically limited. A risk factor approach provides a somewhat atomized view of gang members that is focused on individual variables; it fails to identify the causal processes by which more distal variables lead to more proximal variables and how they, in turn, lead to outcomes of interest. Indeed, as Farrington has noted, “a major problem with the risk factor prevention paradigm is to determine which risk factors are causes and which are merely markers or correlated with causes. It is also important to establish processes or developmental pathways that intervene between risk factors and outcomes, and to bridge the gap between risk factor research and more complex explanatory theories” (2000: 7). In this chapter we begin to address the general topic of identifying the causes of gang membership. The central question is, Why do some youths join street gangs while others manage to avoid the lure of the gang?
We address this question using two complementary approaches. The first approach is more qualitative and is based on the perceptions of the gang members. We asked them why they joined the gang and these open-ended responses provide information on their perceptions of the more immediate influences that led to their decision. The second approach is based in the tradition of causal modeling.
About the Authors
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp xv-xvi
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Appendix B: Prevalence of Gang Membership
- Terence P. Thornberry, State University of New York, Albany, Marvin D. Krohn, State University of New York, Albany, Alan J. Lizotte, State University of New York, Albany, Carolyn A. Smith, State University of New York, Albany, Kimberly Tobin, Westfield State College, Massachusetts
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- Gangs and Delinquency in Developmental Perspective
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- 23 July 2009
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- 23 December 2002, pp 210-211
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