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  • Formerly used defense sites on Unalaska Island, Alaska: Mapping a legacy of environmental pollution

    Jordan‐Ward, Renee; Hippel, Frank A; Schmidt, Jennifer (John Wiley and Sons, 2024-02-14)
    Unalaska Island, Alaska, served as a US military base during World War II. The military installed bases on Unalaska and nearby islands, many of which were built adjacent to Unangan communities. The military used toxic compounds in its operations and left a legacy of pollution that may pose health risks to residents and local wildlife. The goals of this study were to identify hotspots of contamination remaining at Unalaska formerly used defense (FUD) sites, evaluate the risk posed by arsenic, and examine “no US Department of Defense action indicated” (NDAI) status determinations for FUD sites near communities. We compiled soil chemistry data from remediation reports prepared by the US Army Corps of Engineers at 18 FUD sites on and near Unalaska. Nine had past and/or active remediation projects and on-site sampling data. Eight sites did not have sampling data and were characterized as NDAI. One site was listed as closed. For the nine sites with sampling data, we compiled data for 22 contaminants of concern (COC) and compared concentrations to soil cleanup levels for human health (18 AAC 75.341). We mapped contaminant concentrations exceeding these levels to identify hotspots of contamination. We found that concentrations of some of the 22 COC exceeded Alaska cleanup levels despite remediation efforts, including diesel range organics, arsenic, and lead. The highest COC concentrations were at the FUD site adjacent to the City of Unalaska. A quantitative risk assessment for arsenic found that the risk of exposure through drinking water is low. We highlight concerns with NDAI designations and current remedial practices at remote FUD sites located adjacent to communities. Our data suggest the need for further remediation and monitoring efforts on Unalaska for certain contaminants and research to examine potential threats to human and animal health associated with these sites.
  • Engagement with mHealth Alcohol Interventions: User Perspectives on an App or Chatbot-Delivered Program to Reduce Drinking

    Sedotto, Robyn N. M; Edwards, Alexandra E.; Dulin, Partick L.; King, Diane K. (MDPI, 2024-01-02)
    Research suggests participant engagement is a key mediator of mHealth alcohol interventions’ effectiveness in reducing alcohol consumption among users. Understanding the features that promote engagement is critical to maximizing the effectiveness of mHealth-delivered alcohol interventions. The purpose of this study was to identify facilitators and barriers to mHealth alcohol intervention utilization among hazardous-drinking participants who were randomized to use either an app (Step Away) or Artificial Intelligence (AI) chatbot-based intervention for reducing drinking (the Step Away chatbot). We conducted semi-structured interviews from December 2019 to January 2020 with 20 participants who used the app or chatbot for three months, identifying common facilitators and barriers to use. Participants of both interventions reported that tracking their drinking, receiving feedback about their drinking, feeling held accountable, notifications about high-risk drinking times, and reminders to track their drinking promoted continued engagement. Positivity, personalization, gaining insight into their drinking, and daily tips were stronger facilitator themes among bot users, indicating these may be strengths of the AI chatbot-based intervention when compared to a user-directed app. While tracking drinking was a theme among both groups, it was more salient among app users, potentially due to the option to quickly track drinks in the app that was not present with the conversational chatbot. Notification glitches, technology glitches, and difficulty with tracking drinking data were usage barriers for both groups. Lengthy setup processes were a stronger barrier for app users. Repetitiveness of the bot conversation, receipt of non-tailored daily tips, and inability to self-navigate to desired content were reported as barriers by bot users. To maximize engagement with AI interventions, future developers should include tracking to reinforce behavior change self-monitoring and be mindful of repetitive conversations, lengthy setup, and pathways that limit self-directed navigation.
  • Behavioral Health Research and Services FAS Evaluation #38

    Edwards, Alexandra (Behavioral Health Research and Services, 2007-02-07)
  • Behavioral Health Research and Services FAS Evaluation #37

    Edwards, Alexandra (Behavioral Health Research and Services, 2006-08-31)
  • Alaska Multidisciplinary FASD Teams Chart Review Data

    Edwards, Alexandra (Behavioral Health Research and Services, 2005-11-30)
  • Behavioral Health Research and Services FAS Evaluation #32

    Edwards, Alexandra (Behavioral Health Research and Services, 2005-06-30)
  • Matrix Analysis Update of the FASD Teams in the State of Alaska

    Edwards, Alexandra (Behavioral Health Research and Services, 2005-06-30)
  • Behavioral Health Research and Services FAS Evaluation #28

    Edwards, Alexandra (Behavioral Health Research and Services, 2005-02)
  • Behavioral Health Research and Services FAS Evaluation #27

    Edwards, Alexandra (Behavioral Health Research and Services, 2004-09)
  • Fiscal Year 2003 Quarter Two and Three Summary Report of the Alaska Multidisciplinary FASD Diagnostic Team Data

    Edwards, Alexandra (Alaska Comprehensive and Specialized Evaluation Services, 2003-08)
  • Matrix Analysis of Satisfaction Measures Used by the FASD Diagnostic Teams in the State of Alaska

    Edwards, Alexandra (Alaska Comprehensive and Specialized Evaluation Services, 2003-08-25)
  • Matrix Analysis of Assessment Tools Used by the FASD Diagnostic Teams in the State of Alaska

    Edwards, Alexandra (Alaska Comprehensive and Specialized Evaluation Services, 2003-08-25)
  • Matrix Analysis of the Charting Methods Used by the FASD Diagnostic Teams in the State of Alaska

    Edwards, Alexandra (Alaska Comprehensive and Specialized Evaluation Services, 2003-08-25)
  • Fiscal Year 2003 Quarter One Summary Report of the Alaska Multidisciplinary FAS Diagnostic Team Data

    Edwards, Alexandra (Alaska Comprehensive and Specialized Evaluation Services, 2003-02)
  • Summary Report of the Alaska Multidisciplinary FAS Diagnostic Team Data

    Edwards, Alexandra (ACSES, 2002-09)
    This report presents a thorough analysis of the diagnostic data reported by the Alaska Multidisciplinary FAS Diagnostic Teams. Included is a summary of the teams’ data from 1999 through June 2002. The primary purpose of this report is to provide feedback to teams regarding their productivity and outcomes, with an emphasis placed on providing information that will be useful to individual teams, the State Office of FAS, and ultimately the citizens of Alaska. As of the writing of this report, six fully functional diagnostic teams are conducting FASD diagnoses in the state of Alaska, six additional teams are in developmental stages, and two teams have been disbanded. Using the DHSS Office of FAS Diagnostic Team Data Collection Reports, eight of these 14 diagnostic teams submitted 314 completed datasheets. Of these 314 datasheets, two did not include a 4-digit diagnosis and nine were duplicates, leaving a total of 303 usable datasheets. The teams that submitted datasheets and their corresponding number of assessments are as follows: Barrow (one), Bethel (80; one without diagnosis), Bristol Bay (4), Copper Center (18), Fairbanks (11), Kenai/Soldotna (86), Providence Alaska Medical Center (13), and Southcentral Foundation (92; one without diagnosis). Of the 303 individuals for whom diagnoses were submitted, 32 (10.6%) were diagnosed with FAS or atypical FAS.
  • Cataloging of Historical and Current Legislative Decisions, Medical Practices and Agency Policies Regarding FAS

    Edwards, Alexandra (ACSES, 2002-08-05)
    As part of the conditions of funding the statewide Alaska FAS Prevention Project, SAMHSA requested that the project be evaluated by an independent team of evaluators. This evaluation contract was awarded to the Center for Human Development (CHD) at the University of Alaska Anchorage (UAA), with the request that the evaluation be conducted by an interdisciplinary team of evaluators from across the UAA campus. Staff at CHD subsequently selected various professionals from the UAA community to build the Evaluation Team and to divide the work involved in the evaluation of the FAS Prevention Project. The FAS Project Principal Evaluation Team selection began in February 2001 (3rd Quarter of FY 01 of the grant). In August 2001, a comprehensive evaluation plan was submitted to the FAS Advisory Team and State Office of FAS for review and approval. Following submittal of the evaluation plan application to the University of Alaska Institutional Review Board (IRB) and receipt of funding from the state in August 2001, the detailed actions defined in the Diagnostic Evaluation Plan were initiated in October 2001 (2nd Quarter of FY 02 of the grant). The Alaska Comprehensive and Specialized Evaluation Services (ACSES) was one of the groups approached by CHD to participate as a member of the FAS Project Principal Evaluation Team. ACSES was honored to take on the evaluation of diagnosis-related activities, committing to activities to meet five overarching goals. One of these goals was the development of a catalog of historical and current legislative decisions, medical practices, and agency policies regarding FAS and ARBDs in Alaska. This report provides an update on activities and findings about this goal to date.
  • Review of Diagnostic Methods

    Edwards, Alexandra (ACSES, 2002-07-31)
    As part of the conditions of funding the statewide Alaska FAS Prevention Project, SAMHSA requested that the project be evaluated by an independent team of evaluators. This evaluation contract was awarded to the Center for Human Development (CHD) at the University of Alaska Anchorage (UAA), with the request that the evaluation be conducted by an interdisciplinary team of evaluators from across the UAA campus. Staff at CHD subsequently selected various professionals from the UAA community to build the Evaluation Team and to divide the work involved in the evaluation of the FAS Prevention Project. The FAS Project Principal Evaluation Team selection began in February 2001 (3rd Quarter of FY 01 of the grant). In August 2001, a comprehensive evaluation plan was submitted to the FAS Advisory Team and State Office of FAS for review and approval. Following submittal of the evaluation plan application to the University of Alaska Institutional Review Board (IRB) and receipt of funding from the state in August 2001, the detailed actions defined in the Diagnostic Evaluation Plan were initiated in October 2001 (2nd Quarter of FY 02 of the grant). The Alaska Comprehensive and Specialized Evaluation Services (ACSES) was one of the groups approached by CHD to participate as a member of the FAS Project Principal Evaluation Team. ACSES was honored to take on the evaluation of diagnosis-related activities, committing to activities to meet five large goals. One of these goals was the review of FAS diagnostic methods that have been used in Alaska and across the United States. This report provides an update on activities and findings about this goal to date.
  • Adapting adaptive design methods to accelerate adoption of a digital asthma management intervention

    King, Diane K.; Bender, Bruce G.; Cvietusa, Peter J.; Goodrich, Glenn K.; Shoup, Jo Ann (Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA, 2023)
    Investigators conducting translational research in real-world settings may experience changes that create challenges to the successful completion of the trial as well as post-trial adoption and implementation. Adaptive designs support translational research by systematically adapting content and methods to meet the needs of target populations, settings and contexts. This manuscript describes an adaptive implementation research model that provides strategies for changing content, delivery processes, and research methods to correct course when anticipated and unanticipated circumstances occur during a pragmatic trial. The Breathewell Program included two large pragmatic trials of the effectiveness of a digital communication technology intervention to improve symptom management and medication adherence in asthma care. The first trial targeted parents of children with asthma; the second targeted adults with asthma. Adaptations were made iteratively to adjust to dynamic conditions within the healthcare setting, informed by prospectively collected stakeholder input, and were categorized retrospectively by the authors as proactive or reactive. Study outcomes demonstrated improved treatment adherence and clinical efficiency. Kaiser Permanente Colorado, the setting for both studies, adopted the speech recognition intervention into routine care, however, both interventions required numerous adaptations, including changes to target population, intervention content, and internal workflows. Proactive and reactive adaptations assured that both trials were successfully completed. Adaptive research designs will continue to provide an important pathway to move healthcare delivery research into practice while conducting ongoing effectiveness evaluation.
  • 'The park a tree built': Evaluating how a park development project impacted where people play

    Litt, Jill; Hale, James; Burniece, Katherine M.; Ross, Colleen; King, Diane K. (Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA, 2015-12)
    Community parks have achieved recognition as a public health intervention to promote physical activity. This study evaluated changes in population-level physical activity when an undeveloped green space adjacent to transitional housing for refugees was transformed into a recreational park. A prospective, nonrandomized study design used the System of Observing Play and Recreation in Communities (SOPARC) to document the number and activity levels of park users over time, and to compare trends pre- and post-construction. T-tests or tests of medians (when appropriate) were used to compare pre- and post- construction changes in use of non-park and park zones for physical activity and changes in park use by age and gender. Pre- and post-comparisons of people observed using non-park zones (i.e., adjacent streets, alleys and parking lots) and park zones indicated a 38% decrease in energy expended in non- park zones and a 3-fold increase in energy expended within the park (P = 0.002). The majority of park users pre- and post-construction were children, however the proportion of adolescent males observed in vigorous activity increased from 11% to 38% (P = 0.007). Adolescent females and elderly continued to be under-represented in the park. Our findings support an association between creation of accessible outdoor spaces for recreation and improvements in physical activity. Community involvement in park design assured that features included in the park space matched the needs and desires ofthe communities served. Some demographic groups were still under-represented within the park, suggesting a need to develop targeted outreach strategies and programming.

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