Culture of Data 2022

Join Dr. Ninez Ponce for our keynote session on building more resilient public health data systems that are authentic, accessible, and action-oriented. Drawing upon her experience in community-engaged research and in designing data systems that monitor structural racism, Dr. Ponce will lay out a vision for a stronger data system grounded in health equity and will provide recommendations for next steps.

DescriptionThis session includes three presentations about COVID vaccine distribution and equity work across Colorado.

• Presentation 1: Reducing Vaccine Disparities Using a Community-Centered Approach (Ana Brown-Cohen, Tim Wagner; Colorado Access)
• Presentation 2: Leveraging Community Leaders to Increase Vaccination Rates Among Metro Denver’s Latino Populations (Julissa Soto, Julia Mecklenburg; Colorado Access)
• Presentation 3: Authentic Engagement to Reduce COVID-19 Vaccine Hesitancy: Safeguarding Cultural Integrity (Lisa Lucero, Anita Lopez Rodriguez, Charlene Barrientos Ortiz, Montelle M. Taméz; San Luis Valley AHEC and CU Anschutz)

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Full presentation descriptions:
Reducing Vaccine Disparities Using a Community-Centered Approach 
Colorado Access (COA) is the state’s largest Medicaid and CHP provider and services members more likely to experience disparities in COVID-19 vaccination rates. In January 2021, COA strengthened its existing partnership with Immunize Colorado (IC) by joining the Colorado Vaccine Equity Taskforce (CVET) in ensuring that at least 80% of Colorado BIPOC (Black, indigenous, and people of color) adults are fully immunized with the COVID-19 vaccine by the end of 2021. In this effort, the organization leveraged opportunities to make vaccine distribution more equitable through COA’s partnership with trusted community entities already working with BIPOC populations on the ground.

Throughout the Fall of 2021, partnerships between clinical and community organizations were cultivated, including one between STRIDE Community Health Center and Aurora Public Schools (APS) to operate weekly vaccine clinics for community members. APS leads outreach and planning efforts, while STRIDE is responsible for vaccine administration. Colorado Access provided financial resources and data to ensure these efforts were both strategic and effective in reaching students, their families and community members and ensuring access to the COVID-19 vaccine. The organization also partnered with Denver Housing Authority (DHA), Denver Health, and others to implement vaccine sites with the assistance of Denver Health’s mobile vaccine clinic to increase vaccination rates of DHA residents, the majority of which are Health First Colorado (Colorado’s Medicaid Program) members. Additional COA partnerships led to the planning and implementation of a series of vaccination events at local restaurants, parishes, and business, offering evening and weekend hours.

Through individual partnerships, COA instituting a combined method of direct calling and mailers to unvaccinated members of color, yielding a disparity dip from 5.68% in May to 1.54%% in September 2021 within Denver County. This outcome exceeded the state’s goal of a 3% maximum disparity rate in vaccinations between white and BIPOC populations.



Leveraging Community Leaders to Increase Vaccination Rates Among Metro Denver’s Latino Populations
Colorado Access (COA) is the largest Medicaid and CHP provider in the state and services Latino members at relatively high rates. In January 2021, COA joined the Colorado Vaccine Equity Taskforce to leverage its reach and help bridge disparity gaps among its Latino members residing in Adams, Arapahoe, Denver, and Douglas Counties. One of the most effective ways this task was implemented was through the recruitment of a trusted leader from within the targeted communities.

In August 2021, COA partnered with contracted outreach coordinator, Julissa Soto, to combine their leverages and connect with members within the Latino community where they live, work, learn, pray, play, and gather. Soto identified and implemented best practices in health program outreach and information dissemination, particularly assisting Health Departments and other community leaders as they planned and implemented their own vaccination events and Health Equity Clinics. Content included guidance for building COVID-19 vaccine demand within targeted populations and tips for building trust, addressing misinformation, and tailoring messages and materials.

An area of considerable success was meeting members where they prayed. “Vaccine Sunday” was a weekly, culturally specific, faith-based outreach program that targeted various churches attended primarily by Latino community members to promote the COVID-19 vaccine. The program was designed to increase awareness of COVID-19 and its complications, dispel misinformation, and promote vaccine uptake among Latino communities. Between August and December of 2021, Soto has helped conduct 28 Health Equity Clinics, reaching 12,300 churchgoers and leading to the vaccinations of 8,402 members (a 68% success rate). Her work in these communities proved to be so successful, COA has proceeded to extend the contract in hopes to further reduce the vaccination gap through 2022. The partnership’s success has also led to the initiation of efforts that would emulate Soto’s work among other racial groups facing vaccination disparities.



Authentic Engagement to Reduce COVID-19 Vaccine Hesitancy: Safeguarding Cultural Integrity 
We will discuss the CO-CEAL project from the unique points-of-view of the Community Connector, the Community Data Collector, Community Engagement expert staff and from the perspective of project management and academic leadership.

Investing in long-term community relationships, hiring trusted individuals from the community, and providing anti-racism education and training to academic teams, and working within a social justice framework are all necessary components of creating a research infrastructure that truly serves communities. CO-CEAL engaged urban Hispanic and LatinX, rural Hispanic and LatinX, urban African/American, rural African Immigrant and urban American Indian/Alaska Native communities through Community Connectors in each community. Community Connectors and Data Collectors led recruitment of community members for our community survey data collection (goal of 200 surveys from each community) and participation in our 5 Community (Boot Camp) Translations. Community Connectors and other gate keepers leveraged their long-standing community relationships to engage community members rapidly and authentically in a matter of months, where it would have taken years for traditional researchers to accomplish this goal.

This session includes two presentations about how communities have been engaged in data collection and visualization efforts.

• Presentation 1: Assessing Inaccessibility: Involving Community Voices in a Substance Use Dashboard
  (Olivia Leyva, Anne Hill; Pueblo Department of Public Health and Environment)
• Presentation 2: Storytelling as Data: Getting "To the Root" with the Latinx and LGBTQ+ Communities (Audrey Schroer, Janice Stiglich; Boulder County Public Health)

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Full presentation descriptions:
Assessing Inaccessibility: Involving Community Voices in a Substance Use Dashboard
In May 2021, the Pueblo County Partnership for Data (PCPD) project launched a publicly facing dashboard—providing a snapshot of substance use in Pueblo County. After the launch, the data pod—the group responsible for the dashboard’s content-- began revising the visuals to improve accessibility among partners and community residents. Data pod members requested the involvement of community voices, specifically individuals with lived experiences, to review and rethink the dashboard’s content. Step one in doing so was to pilot focus group questions and review of the dashboard with Pueblo Department of Public Health and Environment (PDPHE) employees. At the same time, PDPHE applied and received a grant from NACCHO to improve the health equity of the dashboard. In early 2022, PCPD will facilitate another focus group with peer specialists guided by the NACCHO appointed mentor. With input from these groups, the PCPD data pod will improve the dashboard’s content.

This presentation relates to the conference theme and the objective “Communication and relationship building strategies to increase trust in public health data and/or further action in addressing structural inequities”. Pueblo County, like other socially and economically vulnerable communities, has experienced many hardships because of the COVID-19 pandemic, specifically experiencing a higher overdose call volume and overdose deaths. These unsettling trends are making community leaders take notice. A window of opportunity has emerged to improve the data dashboard’s content with involvement of community voices, to visualize the data with health equity at the forefront, to ensure data transparency, and to work with leadership to use data to make sustainable changes that foster collective action.

This session will benefit attendees by sparking innovation and serving as a model for adaptation. The PCPD project demonstrates a path other communities can replicate or modify to improve the health equity of data collection, dissemination, and visualization.


Storytelling as Data: Getting "To the Root" with the Latinx and LGBTQ+ Communities
Substance use is a complex issue affecting youth and adults in Boulder County. Available health, wellbeing, and criminal justice data point to differences in the substance use experiences of LGBTQ+ and Latinx community members. However, there is limited data available that explicitly focuses on the experiences of LGBTQ+ and Latinx community members related to the strategies to prevent and reduce harm from substance use in Boulder County. The To the Root/A la Raíz project, of Boulder County Public Health, uses a mixed-methods data collection and community led-planning approach to center the experiences and voices of LGBTQ+ and Latinx community members to increase substance use prevention systems created with and for these groups within Boulder County with the goal of reducing youth substance use among Latinx and LGBTQ+ youth in Boulder County. Through the To the Root/A la Raíz project, Boulder County Public Health imagines a new beginning in community-led data collection and planning for Latinx and LGBTQ+ youth and families. Boulder County Public Health staff will share the methods that To the Root/A la Raíz uses to measure health disparities and inequities and promote partnership between community members and public health. Attendees will benefit from this lecture by learning about how research principles from anthropology and epidemiology can be combined with traditional public health planning and grassroots organizing to address health disparities.  

This session includes two presentations about how communities have been engaged in data collection and display efforts.

• Presentation 1: Introducing Health Equity Objectives to Community Partners: Data to Action
  (Dionisia de la Cerda, Ashley Sherrill; CU Anschutz)
• Presentation 2: Assessing Syndromic Surveillance Data Quality During the Pandemic Uncovers Lessons in Health Equity and Access to Care (Jennifer Kret, Yushiuan Chen; Tri-County Health Department)

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Full presentation descriptions:
Introducing Health Equity Objectives to Community Partners: Data to Action 
This lecture presentation will describe to attendees a process for working with a large research team to identify methods to embed inclusivity and health equity (I&E) objectives into existing practice improvement work.  In Colorado, the Practice Innovation Program at the University of Colorado (PIPCO) convenes and staffs the Colorado Health Extension System, a multi-stakeholder cooperative partnership that includes over twenty Practice Transformation Organizations, which include health systems, professional associations, and other groups that provide transformation and quality improvement support for practices and healthcare delivery organizations. PIPCO leads projects with ongoing quality improvement efforts in clinical practices and communities.  

Practice facilitators work directly with practice staff and clinicians to identify and agree on specific and achievable milestones and action steps that aim to address inclusivity and health equity. The milestone activities present a guide for practice facilitators to provide objective steps to build I&E into leadership, data driven quality improvement, team-based care, patient and family engagement, and access to care. The revised milestones guide practice-level activities that translate I&E aims into routine practice actions. This innovative approach supports gathering data and metrics to monitor and measure improvements and identify and address health inequities in clinical practice populations across Colorado.

Working with PIPCO leadership and health equity experts, we implemented this new I&E component into our existing milestone assessment tool. This talk aims to discuss the lessons learned in the early design and implementation process, and what we are learning from the data thus far. 


Assessing Syndromic Surveillance Data Quality During the Pandemic Uncovers Lessons in Health Equity and Access to Care
Colorado Local Syndromic Surveillance collects near-real time data for residents of Adams, Arapahoe, and Douglas counties who visited a participating hospital. These data improve situational awareness and enhance responsiveness to hazardous events and disease outbreaks.

Complete data are essential for identifying disease trends in a pandemic. Missing information can adversely affect downstream meaningful and actionable uses of data for public health monitoring or policy decisions. During the pandemic, total emergency department (ED) visits sharply declined from 8,835 the week of March 8, 2020 to 4,493 the week of April 12, 2020, and then steadily rebounded. During 2021, percentages of missing discharge diagnoses increased from 2.3% (low) to 4.6% (high). Meanwhile, percentages of patients whose discharge disposition indicated leaving against medical advice or discontinued care increased from 1.2% (low) to 4.0% (high). Our hypothesis is that increases in COVID-19 patients overwhelmed EDs and health care systems, causing patients to forgo receiving care for other reasons (e.g., abdominal pain, chest pain, alcohol withdrawal), when experiencing long wait times in EDs.

The presentation will describe trends in ED visits, from October 2019 to December 2021, overall, with missing discharge diagnoses, and those where patients left without receiving care. During 2021, counts of COVID-19-related visits correlated with percentages of missing diagnoses (Correlation=0.710, p<.0001) and numbers of patients leaving the ED (Correlation=0.706, p<.0001). We will also describe characteristics of patients who left without receiving care, including age, sex, race, ethnicity, zip code, and insurance, during 2021 and highlight disparities.

These analyses offer insights to patient healthcare-seeking behaviors during the pandemic and a proxy indicator for access to care. These observations in Syndromic Surveillance will likely appear in hospital discharge data. Looking through a data quality lens is a novel way to identify disparities and health equity trends, as we transition towards recovery and new beginnings.
 

This is a 20-minute, audio-only session. Listen to learn some content while you take a break from the computer screen and take a walk around the block.

The Impact of Data Collection on Access to Health Care Resources among Native American Communities
Bridget Nuechterlein, Cynthia Rice, Christine Velez (CU Denver)

Historically, efforts to address health disparities or improve access to resources based on need has been thwarted by lack of accurate and timely data on health outcomes and needs for the American Indian/Alaska Native (AI/AN) population (Sujata & Warren-Mears, 2019). In our journey to identify the need for substance use disorder treatment for Native American people in Colorado, we began to understand the gaps in national and state level data that lead to inequitable allocation of resources to marginalized communities. Through a qualitative approach that included interviews with Tribal rightsholders and other Tribal health interested parties, we gained perspective and understanding on how the data that state and national data repositories rely on do not accurately reflect the reality for Native American populations. We gained insights concerning the interplay with data sovereignty and learned from communities about what has worked best for them. In this presentation, we aim to share:

1. The impact that colonized data collection methodologies have on the AI/AN populations and the gaps that exist for marginalized communities.
2. Stories on Indigenous data sovereignty.
3. Suggestions on how to set up systems for reflective practice that allow you to challenge colonized data collection and implement more participatory, collaborative, and equitable practices. 

“We are a small population of people because of genocide, no other reason. If you eliminate us in the data, we don’t exist. We don’t exist for the allocation of resources.”
~Abigail Echo-Hawk, Pawnee, Director of the Urban Indian Health Institute and Chief Research Officer of the Seattle Indian Health Board Institute and Chief Research Officer of the Seattle Indian Health Board

This session includes two presentations about how communities have been engaged in data collection and display efforts.

• Presentation 1: Racism is a Risk Factor, not Race: Health Inequities Among Black Youth in Colorado
  (Christine Mulitauopele [CU Anschutz], Emily Fine [CDPHE])
• Presentation 2: From Surviving to Thriving: Understand the Behavioral Health Needs of LGBTQ+ Coloradans (T Schweimler [OMNI Institute], Steven Haden [Envision:You])

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Full presentation descriptions:
Racism is a Risk Factor, not Race: Health Inequities Among Black Youth in Colorado
The purpose of this presentation that will examine results from the 2019 and 2020 Healthy Kids Colorado Survey (HKCS) is to highlight the health inequities that Black young people in Colorado face due to systemic racism and discrimination, as well as to provide some guidance for individual and collective action to dismantle these inequities. For the first time in 2020, questions on experiences with racism were added to the HKCS that allow racism (not race) to be measured as a risk factor for numerous health outcomes. In this analysis, experiences with racism were used as the predictor variable for four protective factors related to school connectedness, safety, and stress management to help draw a more direct correlation to the root cause of health disparities. For Black students and Black Multiracial students, the more racism that was experienced, the greater reduction in odds youth had in experiencing these important protective factors. The results from the HKCS serve as one of many lenses to use to better understand the experiences of young people in Colorado and support efforts to improve equity. By addressing systemic and interpersonal racism, with the intention to eradicate it completely, we can improve upon prevention efforts for Black students experiencing health inequities.


From Surviving to Thriving: Understand the Behavioral Health Needs of LGBTQ+ Coloradans
Although existing research clearly documents the overall prevalence and consequences of behavioral health inequity for LGBTQ+ Coloradans, critical gaps in literature exist. As is the case for many marginalized communities, disparities are widely documented through comparison data points with dominant groups (e.g., white, cis-gender, straight, etc.). These comparisons fail to consider the whole person, factors that support or undermine behavioral health, the strengths and resiliency of communities, as well as the unique and nuanced experiences that lie at intersections of multiple identities.

This session will discuss the development and findings from a statewide survey to explore the behavioral health and wellness of LGBTQ+ Coloradans. The presentation will include: the approach and rationale for identifying key areas of exploration and survey domains to address existing gaps in knowledge and discussion of key findings on the needs and resiliency of Colorado's LGBTQ+ community.

This is an interactive, hands-on skill-building session.

Coloradans Using Data for Change 
Rachele Espiritu and Alina Taniuchi (Change Matrix)

The Colorado Equity Compass (CEC) (www.coequitycompass.org), a project funded by The Colorado Trust, is a data platform that brings to life the experiences of residents in communities across Colorado through community-level health equity indicators and community stories.  

In addition to the social determinants of health data and equity-related tools available on the CEC website, communities are continuing to add their stories and lived experiences. This includes the stories of 20 community organizations who were awarded funds from CEC to support their data storytelling efforts.

In this session, learn how to navigate the CEC platform to find social determinants of health data. Understand the six steps to data storytelling and how the data and stories from the platform can be used to advance community equity work, such as for advocacy and/or grant writing. Bring your unique perspective and share how you would use this data to drive action.

Elevate your community’s experiences by learning how to upload your data and stories to the CEC website. Be a part of a statewide community working together to reduce health disparities by using data and stories.

This session includes two presentations about how data sources have been visualized for use in public health contexts.

• Presentation 1: Measuring and Visualizing Alcohol Outlet Density in Colorado (Julia Stullken, CDPHE)
• Presentation 2: Working with Colorado Prosecutors’ Offices and Community Stakeholders to Develop Data Dashboards and Examine Disparities (Lauren Gase, Jo Beletic; Colorado Evaluation and Action Lab)

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Full presentation descriptions:
Measuring and Visualizing Alcohol Outlet Density in Colorado
Goals/Rationale: The Community Preventive Services Task Force recommends regulating alcohol outlet density (AOD) as a strategy to reduce excessive alcohol consumption. Local and state regulations control distance between alcohol outlets and certain public spaces, such as schools. However, there was not systematic monitoring of AOD in Colorado (CO) prior to 2020.

Methods/Approach: AOD was measured in CO in 2020 using standardized indicators from Measuring Alcohol Outlet Density: A Toolkit for State and Local Surveillance (Mike Fliss). ArcGIS was used for mapping and calculations. Input was solicited from a variety of stakeholders representing different backgrounds to create a dissemination plan that was meaningful to a wide audience. An ESRI StoryMap was created to disseminate AOD in a dynamic and interactive format.

Results/Findings: In 2020, there were 22 retail alcohol outlets per 10,000 CO residents. Rural resort counties generally had higher rates of outlets per 10,000 residents but urban counties and census tracts had higher rates of outlets per square mile, illustrating the importance of interpreting results from different indicators of AOD. The StoryMap is designed to report AOD measurements, educate stakeholders about what AOD is, and provide resources for communities to calculate their own measure of outlet density that are comparable across jurisdictions over time.

Conclusions: The Excessive Alcohol Prevention program at CO Department of Public Health and Environment will continue to monitor AOD and provide technical assistance to stakeholders and partners who are interested in replicating or interpreting AOD measurement. Over time, more data layers can be added to the StoryMap to provide further insight into how AOD affects Coloradans. 



Working with Colorado Prosecutors’ Offices and Community Stakeholders to Develop Data Dashboards and Examine Disparities
Increasingly, prosecutors are expected to take proactive, engaged responses to community problems, reduce disparities in justice outcomes, build greater trust through community engagement, and increase prosecutorial transparency and accountability. This requires robust data-driven prosecutorial work.

This presentation will describe the newly launched Colorado Prosecutorial Dashboards Project, which is working with eight District Attorneys’ offices across the state to develop data dashboards to track progress toward greater efficiency, effectiveness, and fairness. In addition, each office is conducting an analysis of racial/ethnic or economic disparities at points of prosecutorial discretion. This work will help monitor and inform prosecutorial strategies to enhance community well-being.

We will describe major components and lessons learned over the first six months of work which has focused on (a) assessing office capacity and building on strengths; (b) building internal support and cultivating a culture of data-driven decision-making; and (c) engaging community stakeholders and residents to make sure dashboards address their needs and priorities.

In addition to sharing progress and lessons learned, we will invite audience input on opportunities to scale use of the dashboards statewide (the planned second phase for the project). Participants will have an opportunity to receive regular project updates and provide ongoing feedback.

The COVID-19 pandemic has exacerbated existing inequities from healthcare access to education and economic uncertainty; with communities of color experiencing the worst housing, employment, education, and childcare impacts. In this uncertain and distressing environment, the need for community engagement and communication increased greatly to ensure impacted individuals are involved in the design and decisions about the response. However, the pandemic also presented additional challenges in collecting this important data, especially qualitative data. Dr. Djuana Harvell, Director of Special & Innovative Projects of be well Health & Wellness Initiative in Denver, will talk about approaches to community engagement during the pandemic and lessons learned, and how communities can lead efforts and drive change to advance health equity.

This session includes two presentations about maternal and child health outcomes in Utah and Colorado.

• Presentation 1: Health First Colorado Maternity Report (Tamara Keeney, Susanna Snyder; Colorado Department of Health Care Policy & Financing)
• Presentation 2: How Data, Community, and Culture Combine to Support the Wellbeing of Minority Women in Utah (Deepani Jinadasa and Ban Naes; Utah Department of Health)

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Full presentation descriptions:
Health First Colorado Maternity Report 
In 2021, the Colorado Department of Health Care Policy & Financing released a report analyzing data on 2019 Health First Colorado births. The Department analyzed data provided by the Colorado Department of Public Health and the Environment linking the Medicaid ID of the birthing parent with the birth certificate of the newborn. This linking allows for a better understanding of the relationship between health and social risks during pregnancy and the outcomes for both the newborn and birthing parent. Indicators analyzed in this report include timely prenatal care, preterm birth, delivery type, depression screening, diabetes, hypertension, smoking, and homelessness. The analysis is intended for use by partners to inform strategies and targeted interventions in their work to assist the Department in achieving shared goals.

The report focuses on disparities in access to care and outcomes among Health First Colorado members in different racial and ethnic groups. In particular, the report finds that Black and American Indian/Alaska Native pregnant members are at particular risk of gestational and chronic conditions, impacting the outcomes for both the birthing parent and the newborn. The conference presentation will detail efforts underway at the Department to address these disparities, including a newly formed Maternity Advisory Committee (MAC) that provides feedback on the Department’s programming. The MAC is composed of Health First Colorado members who have recently given birth and focuses specifically on members of color.

New for the conference, this presentation will include updated data through 2020 as a preview to the Department’s next installment of the report scheduled to be released in September 2022, including efforts to include qualitative data from our MAC members. The updated data through 2020 will give a glimpse into how the pandemic impacted the overall birth rate among Health First Colorado members, access to care, and outcomes.


How Data, Community, and Culture Combine to Support the Wellbeing of Minority Women in Utah 
This presentation introduces participants to the unique challenges of addressing maternal mortality/morbidity and diabetes disparities in Utah and an innovative research project developed by the Utah Department of Health (UDOH) Office of Health Disparities (OHD) and the University of Utah Wellness Bus. The Embrace Project Study (Embrace) is an intervention that seeks to address health disparities for Native Hawaiian/Pacific Islander (NHPI) women of childbearing age (18–44) by employing and training Community health workers (CHWs) in research methods and grounding the study in the culture and identity of study participants.

In designing Embrace, the OHD reviewed outcomes in women’s health, maternal health, diabetes, and mental health, disaggregating data by race and ethnicity. Health disparities were prominent among women of color, particularly among NHPI women; who face higher severe maternal morbidity (204.3 per 10,000 compared to Utah’s 115 per 10,000), account for 2.8% of maternal deaths compared to 1.1% of live births, and experience higher rates of obesity and diabetes, among other adverse health outcomes.

Embrace contracts CHWs to implement and support the study. CHWs are trained in REDCap, a web application that builds and manages surveys and databases, to collect data from study participants. Along with biometrics measures and health behaviors, Embrace also tracks mental health and self-care status of study participants, which may be the first time this data has been collected from the populations in Utah.

Presenters will emphasize that in the process of advancing health equity, it is crucial to provide actionable race and ethnicity data to decision makers regarding social determinants of health, health disparities, and health equity. Presenters will discuss how to use the health equity mindset as a tool and integrate health equity into programs from inception.

This session includes two presentations about the ways that historical and institutional racism have disproportionately impacted some individuals during the COVID-19 pandemic.

• Presentation 1: Online COVID-19 Vaccine Narratives that Invoke Medical Racism: Understanding Health Mis/Disinformation (Lindsay Diamond; CU Boulder)
• Presentation 2: COVID-19 Diagnoses by Census Tract: CHORDS Data Show the Disparate Impact of the Pandemic on Different Neighborhoods in the Front Range (Guadalupe Solís, Lindsey Whittington; Colorado Health Institute)

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Full presentation descriptions:
Online COVID-19 Vaccine Narratives that Invoke Medical Racism: Understanding Health Mis/Disinformation
Vaccine hesitancy has always been a public health concern, and anti-vaccine campaigns that proliferate disinformation have gained traction across the US in the last 25 years. The demographics of resistance are varied, with health, religious, and, increasingly, political concerns cited as reasons. With the COVID-19 pandemic igniting the fastest development of vaccines to date, mis- and disinformation about them have become inflammatory, with campaigning allegedly including racial targeting. Through a primarily qualitative investigation, we inductively examined a large online vaccine discussion space that invokes references to the unethical Tuskegee Syphilis Study to understand how tactics of racial targeting of Black Americans might appear publicly. We find that such targeting is entangled with a genuine discussion about medical racism and vaccine hesitancy. Across 12 distinct voices that address race, medical racism, and vaccines, we discuss how mis- and disinformation sit alongside accurate information in a “polyvocal” space. This research provides important lessons for public health and advocacy organizations. Medical racism past and present will continue to haunt public health recommendations, and atrocities such as the Tuskegee Syphilis Study need to be ongoingly addressed in public health messaging. Misinformation told as stories is powerful and challenging to undo, particularly when they invoke legitimate tragedies. As such, public health communications today must still address past offenses, even when the events seem to have little connection to the matter at hand. What we see here is part of the ongoing tragedy and impact of the Tuskegee Syphilis Study. To address valid concerns, public health and advocacy groups must attend to the speakers in local communities—even the speakers who have the facts wrong. Health communicators and advocates can look to these amplified voices and conversations to create better, more specific messaging that attends to the nuances of the concerns that arise.


COVID-19 Diagnoses by Census Tract: CHORDS Data Show the Disparate Impact of the Pandemic on Different Neighborhoods in the Front Range 
As COVID-19 spread across the Denver metro area in 2020, neighborhoods with residents who had the lowest levels of educational attainment, the fewest primary English-speakers, and the most people of color were hit hardest. Using census tract-level data from the Colorado Health Observation Regional Data Service (CHORDS), this analysis provided Colorado’s first look at the pandemic’s disparate impacts at a sub-county level.

The analysis used CHORDS data from April 2020 through March. The CHORDS network is a partnership of health care providers and public health researchers that uses anonymized medical records to track health trends by census tract and other demographic measures. The network covers the seven Denver metro-area counties, plus Larimer and Weld. The mapping application built on these data shows an index that compares census tracts to each other in terms of the relative rate of COVID diagnoses.

Our analysis found that in the hardest-hit Front Range neighborhoods, the rate of COVID-19 diagnoses was 10 times greater than in the ones that fared best. The neighborhoods with the highest concentrations of COVID-19 diagnoses often were within a 10-minute drive from areas that largely escaped the pandemic in its first year. The highest diagnosis levels were found in neighborhoods where residents had lower education levels, and neighborhoods with higher concentrations of non-English speakers and people of color. In these areas, systemic factors have historically contributed to disparities and were exacerbated by COVID-19, including crowded housing, inability to telework, and higher barriers to health care and insurance.

By overlaying COVID diagnoses and systemically rooted factors that influence a person’s health, the application showcases how data reveal disparities that exist among different communities and informs strategies to change outcomes.

This session includes one presentation on macro-level trends from the 2020 census and one presentation on a local initiative to help individuals obtain the services they need within their community.

• Presentation 1: Census 2020 Findings for Colorado and What’s Next (Cindy DeGroen, CO Department of Local Affairs)
• Presentation 2: Our Journey of Discovering/Uncovering Data to Information: Building Relationships in Longmont, Colorado to Create a Socio-technical Infrastructure (Donald E Nease Jr. [CU Anschutz], Bruno Sobral [Colorado State University], Kaylee Gordon [CU Anschutz], Dixon Dick [Archethought])

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Full presentation descriptions:
Census 2020 Findings for Colorado and What’s Next
Initial Census 2020 data show a rapidly changing US population not only in its characteristics but also in its geographic shifts. These data reveal critical trends impacting Colorado’s housing, labor force, economy, and service demands for the next few years and decades. This session will provide key findings from Census 2020 for the US and Colorado and discuss the short and long run implications for public health, planners, businesses, and others to help them adapt to the challenges. Additional topics include expected release dates for other variables, a discussion of how the coding of race and ethnicity categories has changed, and how the new disclosure avoidance system protecting all 2020 Census data products will impact the analysis of small areas.


Our Journey of Discovering/Uncovering Data to Information: Building Relationships in Longmont, Colorado to Create a Socio-technical Infrastructure
The web of community service organizations (CBOs) in most communities is a network of overlapping mandates and services. Community members struggle to navigate this web to access and configure their care and the inability to share information among CBOs and those they serve creates unnecessary barriers to care, gaps, and duplication of efforts. As a result, efforts to improve the overall wellbeing of communities is thwarted. Since 2017, we have partnered with the City of Longmont and worked on a socio-technical infrastructure to increase communication and information sharing among social, city, and medical services along with the person accessing said services. Our approach to meet this fragmentation challenge has evolved from one of middleware-enabled data sharing using existing web tools to a novel approach. Our learning journey revealed that we needed to design a system around middleware-based human information sharing that could grow and be self-organizing based on the needs of individual users and CBOs. Over the last year, we convened a Community Steering Board of Longmont residents to help shepherd this work and participate in co-creating this system. The resulting system shifts power to individuals and organizations by permitting them to design, configure their care network, and adapt their access and use of the system to meet their own needs. Communication and information sharing is enabled through messaging templates that are configurable to route information to those in roles and organizations most likely to be able to respond effectively. Those seeking assistance control what and with whom information is shared about themselves, thereby respecting their privacy, while configuring and cultivating their own caring community. As the system is implemented we will continue to learn more about how humans interact and communicate in seeking and providing support and how innovative thinking can produce alternative ways to share information across organizations.

This is a 20-minute, audio-only session. Listen to learn some content while you take a break from the computer screen and take a walk around the block.

Words Matter: How What You Say (And Don’t Say) Influences Wellness 
Manya Chylinski

Difficult life experiences can create stress and trauma, which can make it harder for people to feel engaged with life and work, and can cause them to disconnect, isolate themselves, or feel invisible. As leaders, and as humans, how we talk about stress, trauma, and mental health matters—in helping individuals contextualize their own experiences and then begin to heal. Manya will share how we all benefit when we aren’t afraid to have difficult and nuanced conversations, and discusses the role of communication in aiding recovery and wellness.