Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability.

Introduction: Human papillomavirus (HPV) causes 99.7% of cervical cancer cases. Cervical cancer is preventable through early detection via HPV testing. However, the number of women screened for cervical cancer has not increased in the last several years. Lower screening rates among women living in high poverty and social vulnerability areas, Black women, and women with chronic co-morbidities (e.g., type 2 diabetes (T2D)) are associated with their higher cervical cancer mortality rates. When screened, Black women are more likely to be diagnosed at later stages and die from cervical cancer. HPV self-collection decreases barriers to cervical cancer screening and can help lessen disparities among underserved women. This study aimed to examine the acceptability of HPV self-collection among Black women with T2D living in socially vulnerable communities. Methods: Qualitative semi-structured interviews were conducted with 29 Black women with T2D living in communities with high social vulnerability. The Health Belief Model informed the development of the interview guide to gather data on the acceptability of HPV self-collection. Results: Three main themes aligned with the Health Belief Model were identified: (1) HPV self-collection provides a comfortable alternative to in-clinic HPV testing (perceived benefits); (2) HPV self-collection would result in awareness of current HPV status (health motivation); and (3) Women were concerned about collecting their sample accurately (perceived barriers). Discussion/Conclusion: Black women with T2D living in communities with high social vulnerability identified multiple benefits of cervical cancer screening through HPV self-collection. Women are concerned about their ability to collect these samples correctly. Our findings call for future studies focusing on increasing self-efficacy and skills to collect HPV samples among Black women with chronic conditions like T2D who reside in underserved communities with high social vulnerability.

Qualitative Inquiry of African American Female Church Leaders on Facilitators and Barriers of Conducting Adult Health Programs Within African American Churches: A Pilot Study Using a Socioecological Perspective Within the United States.

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding the facilitators and barriers of conducting adult health programs in churches led by female AA pastors/leaders. In addition, research has yet to analyze the effect of policy on these church-based health programs. Thus, this pilot study's objective is to use the socio-ecological model (SEM) as a framework to explore female AA pastors' and church leaders' perspectives, in the U.S., on facilitators and barriers that exist when conducting adult health programs within their congregations. Using snowball sampling to recruit AA female church leaders and pastors (n = 6), semi-structured interviews were conducted with study participants. Data were then transcribed and analyzed using First and Second Cycle coding to identify themes. Nine themes emerged from the data, and after stratifying the themes according to the SEM, this study found that facilitators and barriers exist at the intrapersonal, organizational, community, and policy levels of the SEM. It is important for these factors to be considered to ensure that health programs led by AA women pastors/leaders are successful within AA churches. Study limitations and the need for further research are also noted.

The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data.

BACKGROUND: African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE: The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. METHODS: Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. FINDINGS: Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines' safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. CONCLUSION: Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.

Facilitators and Barriers When Conducting Adult Health Programs Within the African American Church: A Systematic Review.

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level.

COVID-19 and Higher Education: A Qualitative Study on Academic Experiences of African International Students in the Midwest.

COVID-19 pandemic has harshly impacted university students since the outbreak was declared in March 2020. A population impacted the most was international college students due to limited social networks, restrictive employment opportunities, and travel limitations. Despite the increased vulnerability, there has been limited research on the experiences of African-born international students during the pandemic. Using an exploratory qualitative design, this study interviewed 15 African-born international students to understand their experiences during the pandemic. Thematic analysis revealed that the COVID-19 pandemic influenced participants' academic life directly via an abrupt shift to online learning and indirectly through disruptions in an academic work routine, opportunities for networking, and career advancement, resulting in lower academic performance and productivity. These experiences were worsened by other social and regulatory barriers associated with their non-immigrant status. The study findings suggest an increased need for institutional and community support for international students as vulnerable populations during a crisis to promote sustained academic success.

Assessment of Action Plans as a Guide for Equity-Focused Coalition Work.

Collaborative capacity within coalitions is required to promote healthy communities and create systemic change. The purpose of this study was to evaluate the quality of three Tobacco Prevention and Control Coalitions' action plans for their likely ability to address health equity through tobacco cessation efforts. To do this, the Butterfoss State Plan Index was adapted for relevance to community-oriented coalitions, with a focus on health disparities and tobacco control. This study compares three tobacco control coalitions in Texas to quantify their efforts on addressing health disparities through a standardized measurement process. The results of this assessment indicate that there are gaps in existing coalition assessment tools, and action plan norms and requirements, specifically as it pertains to addressing health disparities in a systematic way. Through a systematic analysis of coalition action plans and supporting documents, it is clear that there is a need for more standard inclusion of disparities-focused work within action plans. Community health researchers, coalition members, and coalition funders should consider action plans to be living, iterative documents that are subject to adjustments. Systems-thinking perspective should be used to develop action plans adapted to environmental, community, policy, and other changes. Lessons learned from this study can provide an example of how to incorporate strategies for reducing health disparities within coalition action planning.

Exploration of how emotional social support predicts food insecurity among college students.

Food insecurity has broad detrimental impacts on college students, including failing grades, depression, and social disconnection. Social disconnection is concerning as students often use various support resources to manage food insecurity. Racial disparities in food insecurity are well documented in the literature. The purpose of the current study was to explore the relationship between constructs of emotional support and food insecurity among African American and White students. A validated electronic survey based on the Sense of Support Scale and the U.S. Food Security Scale was utilized for the study. Results indicated that specific constructs of emotional social support were associated with food insecurity (OR: 3.778; p = .011); (OR: -2.116; p = .036). Students who reported strong emotional ties were more likely to experience food insecurity (OR = - 3.837, p = .044). Findings implicate further campus outreach to all students.

Physical Activity and Mental Health Declined during the Time of the COVID-19 Pandemic: A Narrative Literature Review.

(1) Introduction: Mental health (MH) and physical activity (PA) share a bi-directional relationship, but most studies report MH as the outcome. With diminishing pandemic-related MH, this review examines the impact of diminished MH on PA. (2) Methods: This narrative literature review included 19 empirical studies published since the COVID-19 pandemic. Electronic databases such as MEDLINE, PsycINFO, and CINAHL were searched for English language articles in peer-reviewed journals using equivalent index terms: "anxiety", "depression", "stress", "mental health", "exercise", "activity", "COVID-19", "coronavirus", and "2019 pandemic". The search reviewed 187 articles with double-rater reliability using Covidence. A total of 19 articles met the inclusion criteria. (3) Results: MH themes that impacted PA were depression and/or anxiety (n = 17), one of which identified inadequate coping and excessive pandemic stress (n = 2). In addition, women are more likely to suffer diminished MH and reduced PA throughout the pandemic. (4) Conclusion: Current research suggests that individuals with pre-pandemic MH episodes are correlated with more effective coping skills and fewer adverse effects from COVID-19 than expected. As we emerge from this pandemic, equipping all individuals, especially women, with positive coping strategies may accelerate a seamless return to PA.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors.

PURPOSE: Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors. METHODS: Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes. RESULTS: Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being. CONCLUSIONS: Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

Insights into fear: A phenomenological study of Black mothers.

AIM: The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN: A phenomenological approach was used. METHODS: Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS: Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION: Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT: Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.

Narrative Analysis of Childbearing Experiences During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has disrupted health care delivery and services around the world causing rapid changes to maternity care protocols and pregnant women to give birth with tight restrictions and significant uncertainties. There is a gap in evidence about expectant and new mothers' experiences with birthing during the pandemic. We sought to describe and understand pregnant and new mothers' lived experiences during the COVID-19 pandemic using authentic birth stories. STUDY DESIGN AND METHODS: Using a narrative analysis framework, we extracted relevant YouTube birth stories using predetermined search terms and inclusion criteria. Mothers' birth stories were narrated in their second or third trimester or those who had recently given birth during the pandemic. Birth stories were analyzed using an inductive and deductive approach to capture different and salient aspects of the birthing experience. RESULTS: N = 83 birth stories were analyzed. Within these birth stories, four broad themes and 13 subthemes were identified. Key themes included a sense of loss, hospital experiences, experiences with health care providers, and unique experiences during birth and postpartum. The birth stories revealed that the COVID-19 pandemic brought unexpected circumstances, both positive and negative, that had an impact on mothers' overall birthing experience. CLINICAL IMPLICATIONS: Results provided a detailed description of women's lived experience with giving birth during the COVID-19 pandemic. Maternity nurses should try to provide clear communication and compassionate patient-centered care to relieve women's anxieties about uncertain and unpredictable policy changes on COVID-19 as the pandemic continues to evolve.

Prevalence and factors associated with overweight and obesity in Kenya.

Overweight and obesity rates continue to rise globally and are associated with increased chronic disease morbidity and mortality. There is evidence of high overweight and obesity prevalence in Kenya, however; a gap exists in the knowledge of national prevalence and predictors of overweight and obesity. This cross-sectional study examined data from the 2015 World Health Organization (WHO) Kenya STEPwise Survey-the first nationally representative survey to objectively measure body mass index (BMI) among Kenyan men and women. Descriptive and logistic regression analysis of 4,340 adults aged 18-69 years examined the prevalence, sociodemographic, and behavioral risk factors associated with having overweight or obesity (overweight/obesity) defined by WHO The mean BMI was 23.51 with 31.13% having overweight/obese. The likelihood of having overweight/obesity was significantly higher among married individuals [odds ratio (OR) = 1.78, 95% confidence interval (CI) 1.19, 2.66], women (OR = 4.08, 95% CI 3.02, 5.51), urban dwellers (OR = 1.70, 95% CI 1.28, 2.25) and middle wealth or higher (OR = 2.45, 95% CI 1.91, 3.14). The likelihood of having overweight/obesity increased by age, compared to 18-29-year olds; (30-44 years (OR = 2.05 95% CI 1.50, 2.80), 45-59-year olds (OR = 2.67, 95% CI 1.97, 3.63), 60-69-year olds (OR = 3.00, 95% CI 1.99, 4.51). Adults with completed primary education or more had higher odd of having overweight/obesity (OR = 2.15, 95% CI 1.72, 2.70). compared to adults with less than primary education. Likelihood of having Overweight/obesity was highest among women, urban residents, and individuals with high education and wealth. Future studies should ascertain drivers of overweight/obesity to inform Targeted and tailored interventions and policies amongst high-risk groups.

Ageism in the Fitness and Health Industry: A Review of the Literature.

This review aims to understand how age-related stereotypes against older adults' physical capabilities influence their ability to engage in regular physical activity. The authors wanted to know how people construe ageism in the fitness and health arena, how ageism manifests in this field, and how ageism influences older adults' learning and practicing physical activity. Data was extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Twenty-two empirical studies met the selection criteria. The findings revealed that the attributes of ageism fell into either self-imposed or other-directed ageism categories and manifested as implicit or explicit ageism. The study also identified the following four themes: (a) perceptions of aging and exercise, (b) exercise motivation, (c) opportunities for older adults, and (d) ambiguous positionality as older exercisers. The research provides evidence for the existence of ageism against older exercisers. Further research considering the implication of ageism within the exercising industry is necessary.

Prevalence and predictors of receipt of weight loss advice among a nationally representative sample of overweight and obese Kenyans.

BACKGROUND: As Kenya continues to experience rapid development and urbanization, growing evidence shows an increasing prevalence of non-communicable diseases (NCDs) and overweight and obese citizens. OBJECTIVES: This study sought to explore the extent to which Kenyan overweight and obese participants reported receiving advice from physicians or health care providers to lose weight and to identify demographic characteristics associated with receipt of weight loss advice. METHODS: Descriptive statistics analyzed sociodemographic characteristics and weight loss advice from the 2015 Kenya WHO STEPwise survey (n = 1335). A bivariate logistic regression model estimated the association between socio-demographic characteristics and weight loss advice reported from a physician or health care provider. RESULTS: The prevalence of weight loss advice from health professionals among overweight and obese participants was 19%. Model results indicated that obese individuals [odds ratio (OR) = 2.11, 95% confidence interval (CI) (1.36, 3.26)], individuals with higher than a secondary education [OR = 2.26, 95% CI (1.39, 3.68)], urban dwellers [OR = 2.38, 95% CI (1.29, 4.39)], and women [OR = 3.13, 95% CI (1.60, 6.12)] were significantly more likely to receive weight loss advice from their physician or health care provider. CONCLUSION: This study found low levels of report of physician or health care provider advice for weight loss among overweight individuals. Advice was primarily reported by obese patients. Weight loss advice differed significantly based on educational attainment, geographical location, and gender thus calling for targeted interventions to increase equitable NCD prevention services from physicians.

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States.

The aim of this article is to promote the use of knowledge visualization frameworks in the creation and transfer of complex public health knowledge. The accessibility to healthy food items is an example of complex public health knowledge. The United States Department of Agriculture Food Access Research Atlas (FARA) dataset contains 147 variables for 72,864 census tracts and includes 16 food accessibility variables with binary values (0 or 1). Using four-digit and 16-digit binary patterns, we have developed data analytical procedures to group the 72,684 U.S. census tracts into eight and forty groups respectively. This value-added FARA dataset facilitated the design and production of interactive knowledge visualizations that have a collective purpose of knowledge transfer and specific functions including new insights on food accessibility and obesity rates in the United States. The knowledge visualizations of the binary patterns could serve as an integrated explanation and prediction system to help answer why and what-if questions on food accessibility, nutritional inequality and nutrition therapy for diabetic care at varying geographic units. In conclusion, the approach of knowledge visualizations could inform coordinated multi-level decision making for improving food accessibility and reducing chronic diseases in locations defined by patterns of food access measures.

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations.

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.

Social determinants of hypertension and type-2 diabetes in Kenya: A latent class analysis of a nationally representative sample.

INTRODUCTION: Cardiovascular disease is among the leading causes of death in Kenya and type II diabetes (T2D) is a growing chronic health concern in the country. However, a gap exists in examining how demographic and social characteristics coalesce to identify individuals at high risk for hypertension and/or T2D in Kenya. The current study examined demographic typologies associated with self-report diagnoses. METHODS: Nationally representative cross-sectional study using 43,898 individuals from the Kenya Demographic and Health Survey 2014. Main Outcome Measures were self-reported Hypertension and Type 2 Diabetes diagnosis. Descriptive analyses were conducted using STATA 14. Latent class analysis (LCA) was conducted using Mplus 7.4. RESULTS: Approximately 5% reported hypertension and 1% reported T2D. Latent class analysis suggested a 4-class solution. The class with the highest likelihood to report previous diagnosis of hypertension (10.4%), consisted of high proportion of married adult women. The second highest prevalence of previous diagnosis of hypertension (4.4%) consisted of a high proportion of married middle aged men with high probability of being smokers. The results suggest that Kenyan women over 30 years may be at increased risk of hypertension compared to men. Future studies should include additional socio-demographic and behavioral characteristics to better understand gender differences in correlates for hypertension to be used for targeted and tailored health promotion-interventions.

Delivering Tobacco Cessation Through Community Health Workers: Curriculum and Training Considerations.

Texas faces unique barriers in health status and risk behaviors such as smoking. To address tobacco use, community health workers (CHWs) are a resource for disseminating education among a population. To promote smoking cessation in Texas, there is a need for the development of a smoking cessation training program for CHWs. The National Community Health Worker Training Center used an approach with CHWs to develop a curriculum. From the curriculum development and with feedback from CHWs, 4 training courses were produced: online and in person, and in English and Spanish. The curriculum meets a need that disseminates smoking cessation strategies through peer-led, culturally relevant messages.

Until I get off parole then I can swim in it if I want to: Facilitators of and barriers to drug use among formerly incarcerated Black drug offenders.

Black Americans are overrepresented among those incarcerated for drug-related offenses. Drug use, postincarceration, is associated with high risk of recidivism and overdose deaths. We explored factors influencing drug use among former Black drug offenders. Qualitative interviews with 30 Black Americans released from prison within the past year explored drug behavior as well as institutional, environmental, and social factors that influence drug use. Findings show participants reentered drug-enticing environments and social networks. Being on parole, drug programs, and social support influenced abating drug use. Drug interventions postincarceration should consider the environment and social networks as leverage points for behavior change.

Embracing Causal Complexity in Health Disparities: Metabolic Syndemics and Structural Prevention in Rural Minority Communities.

Chronic discrimination and associated socioeconomic inequalities have shaped the health and well-being of Black Americans. As a consequence of the intersection of these factors with rural deprivation, rural Black Americans live and work in particularly pathogenic environments that generate disproportionate and interacting chronic comorbidities (syndemics) compared to their White and/or urban counterparts. Traditional prevention research has been unable to fully capture the underlying complexity of rural minority health and has generated mostly low-leverage interventions that have failed to reverse adverse metabolic outcomes among rural Black Americans. In contrast, novel research approaches-such as system dynamics modeling-that seek to understand holistic system structure and determine complex health outcomes over time provide a robust framework to develop a more accurate understanding of the key factors contributing to type 2 diabetes. This framework can then be used to establish more efficacious interventions to address disparities among minorities in rural areas. This paper advocates for a unified complex systems epistemology and methodology in advancing rural minority health disparities research. Toward this goal, we (1) provide an overview of rural Black American metabolic health research, (2) introduce a complex systems framework in rural minority health disparities research, and (3) demonstrate how community-based system dynamics modeling and simulation can help us plow new ground in rural minority health disparities research and action. We anticipate that this paper can serve as a catalyst for a long-overdue discourse on the relevance of complex systems approaches in minority health research, with practical benefits for numerous disproportionately burdened communities.