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Objectives. This study evaluated how high versus low-intensity community wellness coaching and health behaviors were associated with changes in depression screen results over one year. Methods. This was an analysis of secondary data collected in a 12-month obesity-related community health worker (CHW) program for 485 Utah women of color. Depression screen (Patient Health Questionnaire-2 score ³3) and self-reported fruit/vegetable consumption and physical activity (FV/PA) were recorded quarterly. Associations between FV/PA and changes in depression screen over time were evaluated in multivariable models. Results. Positive depression screen prevalence declined over 12 months (21.7% to 9.5%) with no difference between study arms. Overall, FV ³5 times/day (AOR=1.5; 95% CI 1.0–2.2), any PA (AOR=3.1; 95% CI 1.5–6.4), and muscle strengthening activities (AOR=1.13; 95% CI 1.01–1.26) were associated with improved depression screen results over time. Conclusion. These results indicate value in addressing and evaluating depression in obesity-related interventions in underserved communities.

This study assesses the sociodemographic facilitators and barriers to human papillomavirus (HPV) vaccination for diverse teens in a region with low HPV vaccination rates. In this community-based participatory research study, we surveyed adult family members of teens aged 11-17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Salt Lake City, Utah. Bivariate analyses assessed associations between sociodemographic characteristics and, respectively, HPV vaccine receipt and intentions for vaccination. Barriers to vaccination were also investigated. Only 20% of participants had vaccinated at least one of their children with at least one dose of the HPV vaccine. HPV vaccination was significantly related to caregiver age ( =0.035), race/ethnicity ( =0.001), educational attainment ( =0.006), annual household income ( =0.0454), years in the United States ( =0.023), and caregiver parent birthplace ( =0.008). Among caregivers with unvaccinated children, intention to vaccinate was significantly related to race/ethnicity ( =0.048 for daughters; =0.003 for sons), caregiver parent birthplace ( =0.023 for sons), health insurance coverage ( =0.028 for daughters; =0.047 for sons), and type of health insurance coverage ( =0.008 for sons). The most frequently cited barriers to HPV vaccination were lack of knowledge about the HPV vaccine, costs, side effects, and child not being sexually active. Our results show substantially lower HPV vaccine coverage than both national and state rates, signaling the urgent need for multipronged HPV vaccination interventions within these communities; strategies are discussed.

Abstract The COVID-19 pandemic has exacerbated disparities in mental health treatment for people of color in the USA. Meeting the needs of those most burdened by this disparity will require swift and tactical action in partnership with these communities. The purpose of this paper is to describe how a community-based participatory research approach was employed to assess the priorities and needs of four communities of color (African immigrant, Hispanic/Latino, Black/African American, and Pacific Islander) in a major U.S. city. A brief quantitative survey devised jointly by community leaders and the research team was deployed to community members (N = 59) in the fall of 2020. The most endorsed mental health issues across the communities were excessive worry (51%) and stress regarding COVID-19, racism, and immigration policies (49%). The most endorsed physical health concerns included sleep difficulties (44%), headaches, and backaches (each 39%). Physical symptoms predicted the endorsement of a mental health issue above and beyond COVID-19–related hardships, multiplying the odds of reporting an issue by 1.73 per physical health concern endorsed. Based on these findings, the community-research team conceptualized and proposed an evidence-based, effectiveness-implementation hybrid type-2 intervention approach for chronic worry and daily stress. This paper highlights detail on how the community-research team arrived at the proposed multilevel intervention that addresses community-stated barriers to mental health treatment (e.g., preferring trusted health workers to deliver emotional health treatments) and considers the burden of the additional stressful context of COVID-19. Lay Summary Diverse community members and university researchers collaborated on the development of an equitable intervention approach for community members’ mental health needs.

Background Disparities in sleep duration are a modifiable contributor to increased risk for cardiometabolic disorders in communities of color. We examined the prevalence of short sleep duration and interest in improving sleep among a multi-ethnic sample of women participating in a culturally tailored wellness coaching program and discussed steps to engage communities in sleep health interventions. Methods Secondary analysis of data from a randomized trial were used. The wellness coaching trial utilized a Community-Based Participatory Research (CBPR) approach. Data were from the baseline survey and baseline wellness coaching notes. Short sleep duration was defined as < 7 h of self-reported sleep. Participants were prompted to set a goal related to healthy eating/physical activity and had the opportunity to set another goal on any topic of interest. Those who set a goal related to improving sleep or who discussed a desire to improve sleep during coaching were classified as having an interest in sleep improvement. Analyses utilized multivariable models to evaluate factors contributing to short sleep and interest in sleep improvement. We present our process of discussing results with community leaders and health workers. Results A total of 485 women of color participated in the study. Among these, 199 (41%) reported short sleep duration. In adjusted models, Blacks/African Americans and Native Hawaiians/Pacific Islanders had higher odds of reporting < 7 h of sleep than Hispanics/Latinas. Depression symptoms and self-reported stress management scores were significantly associated with short sleep duration. Interest in sleep improvement was noted in the wellness coaching notes of 52 women (10.7%); sleep was the most common focus of goals not related to healthy eating/physical activity. African Immigrants/Refugees and African Americans were less likely to report interest in sleep improvement. Community leaders and health workers reported lack of awareness of the role of sleep in health and discussed challenges to obtaining adequate sleep in their communities. Conclusion Despite the high prevalence of short sleep duration, interest in sleep improvement was generally low. This study highlights a discrepancy between need and interest, and our process of community engagement, which can inform intervention development for addressing sleep duration among diverse women.

ObjectiveTo investigate: (1) patient and family experiences with healthcare and the intensive care unit (ICU); (2) experiences during their critical illness; (3) communication and decision making during critical illness; (4) feelings about the ICU experience; (5) impact of the critical illness on their lives; and (6) concerns about their future after the ICU.DesignFour semistructured focus group interviews with former ICU patients and family members.SettingsMulticultural community group and local hospitals containing medical/surgical ICUs.ParticipantsPatients and family who experienced a critical illness within the previous 10 years.InterventionsNone.Measurements and main resultsFour separate focus groups each lasting a maximum of 150 min and consisting of a total of 21 participants were held. Focus groups were conducted using a semistructured script including six topics relating to the experience of critical illness that facilitated deduction and the sorting of data by thematic analysis into five predominant themes. The five main themes that emerged from the data were: (1) personalised stories of the critical illness; (2) communication and shared decision making, (3) adjustment to life after critical illness, (4) trust towards clinical team and relevance of cultural beliefs and (5) end-of-life decision making. Across themes, we observed a misalignment between the medical system and patient and family values and priorities.ConclusionsThe experience of critical illness of a diverse group of patients and families can remain vivid for years after ICU discharge. The identified themes reflect the strength of memory of such pivotal experiences and the importance of a narrative around those experiences. Clinicians need to be aware of the lasting effects of critical illness has on patients and families.

Objective: Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider.Methods: Using logistic regression and data from a community-based participatory study, we estimated the relative likelihood that an African immigrant woman would have a regular health care provider com­pared with an African American woman.Results: Immigrant status remains a power­ful predictor of whether a woman had a regular health care provider after control­ling for covariates. African immigrants were 73% less likely to have a regular health care provider than were otherwise similar African American women.Conclusion: Expanding health care educational efforts for immigrants may be warranted. Future research should examine how cultural beliefs and time in residence influence health care utilization among US immigrants. Ethn Dis. 2019;29(2):253-260; doi:10.18865/ed.29.2.253

Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N = 228). Ninenty-three of these participants also participated in ten focus groups conducted in three languages. Descriptive statistics and Fishers’ Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born = 50% vs US-born = 30%, p < 0.05; medium acculturation = 60% vs high acculturation = 26%, p = 0.01), while greater proportions of US-born participants reported media sources (49% vs foreign-born = 29%, p < 0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p < 0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.

Current sources of publicly available human papillomavirus (HPV) information may not adequately meet the needs of diverse families. This study sought to describe associations between sociodemographic and acculturation factors, and sources of HPV information among diverse parents and caregivers. Community organizations purposively recruited participants from African American, African refugee, Hispanic/Latino, American Indian, and Native Hawaiian and Pacific Islander communities for a 21-item survey (N=228). 93 of these participants also participated in 10 focus groups conducted in three languages. Descriptive statistics and Fishers’ Exact Test for Count Data were produced and triangulated with focus group data to provide additional context. Overall, HPV vaccine awareness and knowledge in the five communities was low. This study found that a greater proportion of lower-acculturated participants had heard of HPV through personal networks (foreign-born=50% vs US-born=30%, p<0.05; medium acculturation=60% vs high acculturation=26%, p=0.01), while greater proportions of US-born participants reported media sources (49% vs foreign-born=29%, p<0.05). Across communities, healthcare system sources were described as important and preferred sources of HPV information. Hearing about the HPV vaccine from healthcare settings was significantly associated with increased accuracy in HPV vaccine knowledge (p<0.05). Communities described a need for more in-depth information about the HPV vaccine, and culturally and linguistically appropriate educational materials. Culturally-competent delivery of HPV information through the healthcare system sources may be important in improving knowledge and acceptability of the HPV vaccine among diverse families.