"I think we can do without [tobacco]": support for policies to end the tobacco epidemic among California adolescents.

INTRODUCTION: The tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors. METHODS: Teens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12-17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies. RESULTS: Most survey participants agreed or strongly agreed with tobacco product sales restrictions (72%-75%, depending on the policy), bans on use in public spaces (76%-82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at 'tobacco' (vs 'vapes' or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured 'should end' (vs 'not allowed'). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults' freedoms and unintended consequences. CONCLUSIONS: Most participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.

Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel.

BACKGROUND: Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS: Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS: With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS: Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.

Beliefs and practices regarding solid food introduction among Latino parents in Northern California.

Latino children are more likely to be obese than non-Hispanic white children, and feeding patterns that begin in infancy may contribute to this disparity. The objective of this study was to elucidate beliefs and practices related to the introduction of solids and solid food feeding in the first year of life among low-income Latino parents residing in Northern California. We conducted 26 semi-structured interviews that explored the timing of introduction of solids, selection of foods to serve to infants, feeding strategies, sources of information on solid food feeding and concerns about infant weight. We found that most parents relied on traditional practices in selecting first foods for infants and had a strong preference for homemade food, which was often chicken soup with vegetables. Parents generally described responsive feeding practices; however a minority used pressuring practices to encourage infants to eat more. Very few parents practiced repeated gentle introduction of unfamiliar food to increase acceptance. High calorie low nutrient foods were typically introduced at around 12 months of age and parents struggled to limit such foods once children were old enough to ask for them. Parents were concerned about the possibility of infants becoming overweight and considered health care providers to be an important source of information on infant weight status. The results of this study can be used to inform the development of interventions to prevent obesity in Latino children with similar demographics to our study population.

Rural Latino caregivers' beliefs and behaviors around their children's salt consumption.

BACKGROUND: Prevalence of high blood pressure has been increasing in U.S. children, with implications for long term health consequences. Sodium consumption, a modifiable risk factor for high blood pressure, is above recommended limits and increasing. Very little is known about Latino caregiver beliefs and behaviors around their children's salt consumption. METHODS: In California's Central Valley, qualitative interviews in Spanish investigated low-income caregivers' views and understandings of their children's dietary salt consumption. Thirty individual interviews and 5 focus groups were conducted (N=61). Interview transcripts were translated and transcribed, coded and thematically analyzed. RESULTS: Seven primary topic areas around children's salt intake and its impact on health were identified: children's favorite foods, children's dietary salt sources, superiority of home-cooked foods, salty and sweet foods, managing salt for health, developing children's tastes, and adding salt added at the table. Parents recognize common sources of sodium such as "junk food" and processed food and made efforts to limit their children's consumption of these foods, but may overlook other significant sodium sources, particularly bread, cheese, prepared soups and sports drinks. Caregivers recognize excess salt as unhealthy for children, but don't believe health problems (like high blood pressure) can occur in young children. Nevertheless, they made efforts to limit how much salt their children consumed through a variety of strategies; school meals were a source of high sodium that they felt were outside of their control. CONCLUSION: Latino caregivers are concerned about their children's salt intake and attempt to limit consumption, but some common sources of sodium are under-recognized.

Using community participation to assess acceptability of "Contra Caries", a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study.

BACKGROUND: Latino children experience more prevalent and severe tooth decay than non-Hispanic white and non-Hispanic black children. Few theory-based, evaluated and culturally appropriate interventions target parents of this vulnerable population. To fill this gap, the Contra Caries Oral Health Education Program, a theory-based, promotora-led education program for low-income, Spanish-speaking parents of children aged 1-5 years, was developed. This article describes qualitative findings of the acceptability of curriculum content and activities, presents the process of refinement of the curriculum through engaging the target population and promotoras, and presents results from the evaluation assessing the acceptability of the curriculum once implemented. METHODS: Focus groups were conducted with low-income Spanish-speaking parents of children 1-5 years living in a city in an agricultural area of California. Interviews were digitally recorded, translated and transcribed, checked for accuracy and the resulting data was thematically coded and analyzed using a social constructionist approach. The Contra Caries Oral Health Education Program was then implemented with a separate but similar sample, and after completing the program, participants were administered surveys asking about acceptability and favorite activities of the education program. Data were entered into a database, checked for accuracy, open-ended questions were categorized, and responses to close-ended questions counted. RESULTS: Twelve focus groups were conducted (N = 51), 105 parents attended the Contra Caries Oral Health Education Program, and 83 parents filled out surveys. Complete attendance and retention was high (89% and 90%, respectively). This study found that their children's oral health is a high priority. Parents were not only interested in, but actually attended classes focused on increasing their knowledge and skills with respect to early childhood oral health. The Contra Caries content and format was perceived as acceptable by parents. Strong opinions about curriculum content were expressed for including information on how caries starts and progresses, weaning from the bottle, oral health care for children and adults, motivational strategies for children's tooth brushing, dental visits and cavity restorations. CONCLUSIONS: The Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1-5 years. Participating in the curriculum development and revision process likely played an important role in the parents' high acceptability of the program.

Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children.

The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.

Flavored Tobacco and Nicotine Use Among California Adolescents: Preferences by Use Experience and Survey Format Effects.

PURPOSE: This study assessed flavored tobacco use among adolescent e-cigarette, cigarette, cigar, hookah, and smokeless tobacco users; specific e-cigarette flavor preferences; risk profiles of youth that use various flavors; and the impact of survey question wording on prevalence. METHODS: Cross-sectional data from 4,956 California adolescent participants (aged 12-17 years) in the Teens, Nicotine, and Tobacco 2021-2022 online panel survey estimated the survey-weighted prevalence of flavored tobacco use. An embedded randomized experiment assessed survey wording effects (i.e., any vs. "usual" flavor use). Qualitative data from four contemporaneous cycles of Teens, Nicotine, and Tobacco focus groups with California adolescents (N = 63) added themes relevant to the quantitative findings. RESULTS: 88.1% of current any tobacco users reported flavored tobacco use in the past 30 days. Flavor use was lowest for cigarettes (66.7%) and highest for hookah (92.8%). Fruit was the most popular e-cigarette flavor (51.6% any use; 28.8% usual use). E-cigarette users also commonly reported use of candy and cooling flavors. Sweet flavors were used most often among adolescents otherwise at low risk of tobacco use. Survey item format did not meaningfully affect overall prevalence of flavored product use but did impact reports of specific e-cigarette flavors. Focus group participants described sweet and fruity flavors as a motivating factor in their own e-cigarette use and as designed to appeal to children. DISCUSSION: Despite local policies, flavored tobacco use remains common among California adolescents. Survey items asking about any flavor use rather than usual use provide more information without affecting the overall prevalence of flavored tobacco use.

Implementation of a novel program to support colorectal cancer screening in a community health center consortium before and after the onset of COVID-19: a qualitative study of stakeholders' perspectives.

BACKGROUND: In 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program's Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic. METHODS: Semi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis. RESULTS: Twenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities. CONCLUSIONS: Implementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.

Spanish-speaking Mexican-American parents' experiences while navigating the dental care system for their children.

OBJECTIVES: The purpose of this study is to describe Mexican-American parents' experiences navigating the dental care system for their children. METHODS: Thirty in-depth qualitative interviews were conducted with Spanish-speaking caregivers of young children in an urban county of Northern California, asking about their experiences navigating dental care for their children. Interviews were digitally recorded, translated, transcribed, coded, and analyzed using standard qualitative procedures. RESULTS: Caregivers reported challenges that highlight how various aspects of navigating the health care system are elemental to oral health literacy. These included making appointments, finding a provider they trust, using their dental insurance, and communicating with the dental care provider. CONCLUSIONS: When addressing oral health literacy, it is important to consider the navigational components to improve children's oral health literacy.

Maternal beliefs and motivations for first dental visit by low-income Mexican American children in California.

PURPOSE: The purpose of this study was to examine Mexican American immigrant caregivers' beliefs and motivations surrounding the first dental visit for their young children (median age=5-years-old). METHODS: Qualitative interviews were conducted among a convenience sample of 48 low-income, Mexican American mothers about their young children's oral health. Transcripts were independently read, coded, and thematically analyzed. RESULTS: Half (51%) of first dental visits were for parent-initiated reasons, including: for pain or visible dental problems; for parent's proactive desire to get a checkup; or to avoid future dental problems. The other half was initiated by external prompts, especially pediatrician recommendations and school requirements. Once a child went to the dentist for his/her first visit, 94% continued with regular checkups. The mean age for a first dental visit was 3-years-old. Three parents reported cases in which dentists discouraged visits for symptomatic children before they were 3-years-old. CONCLUSIONS: The low-income, urban Mexican American parents interviewed take their children to their first dental visit when they are approximately 3-years-old, much later than the recommended 1-year-old first visit for this at-risk population. Physicians are well positioned to play an important role in prompting first dental visits.

Adolescents' Substance Use and Physical Activity Before and During the COVID-19 Pandemic.

Importance: Stay-at-home policies related to the COVID-19 pandemic could disrupt adolescents' substance use and physical activity. Objective: To compare adolescents' substance use and physical activity behaviors before and after stay-at-home restrictions. Design, Setting, and Participants: Ongoing prospective cohort study of tobacco use behaviors among ninth- and tenth-grade students enrolled at 8 public high schools in Northern California from March 2019 to February 2020 and followed up from September 2019 to September 2020. Race/ethnicity was self-classified from investigator-provided categories and collected owing to racial/ethnic differences in tobacco and substance use. Exposures: In California, a COVID-19 statewide stay-at-home order was imposed March 19, 2020. In this study, 521 six-month follow-up responses were completed before the order and 485 were completed after the order. Main Outcomes and Measures: The prevalence of substance use (ie, past 30-day use of e-cigarettes, other tobacco, cannabis, and alcohol) and physical activity (active ≥5 days/week) was compared at baseline and follow-up. A difference-in-difference approach was used to assess whether changes from baseline to 6-month follow-up varied if follow-up occurred after the stay-at-home order, adjusting for baseline behaviors and characteristics. All models were weighted for losses to follow-up using the inverse probability method. Weights were derived from a logistic regression model for having a follow-up response (dependent variable), as predicted by baseline characteristics and behaviors. Results: Of 1423 adolescents enrolled at baseline, 1006 completed 6-month follow-up (623 [62%] were female, and 492 [49%] were non-Hispanic White). e-Cigarette use declined from baseline to 6-month follow-up completed before the stay-at-home order (17.3% [89 of 515] to 11.3% [58 of 515]; McNemar χ2 = 13.54; exact P < .001) and 6-month follow-up completed after the stay-at-home order (19.9% [96 of 482] to 10.8% [52 of 482]; McNemar χ2 = 26.16; exact P < .001), but the extent of decline did not differ statistically between groups responding before vs after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P = .58). In contrast, being physically active was unchanged from baseline if follow-up was before the order (53.7% [279 of 520] to 52.9% [275 of 520]; McNemar χ2 = 0.09; exact P = .82) but declined sharply from baseline if follow-up was after the order (54.0% [261 of 483] to 38.1% [184 of 483]; McNemar χ2 = 30.72; exact P < .001), indicating a pronounced difference in change from baseline after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.49; 95% CI, 0.35-0.69; P < .001). Overall in the cohort, reported use of other tobacco, cannabis, and alcohol did not differ meaningfully before and after the order. Conclusions and Relevance: In this cohort, a reduction in e-cigarette use occurred independently of COVID-19 stay-at-home restrictions, but persistent cannabis and alcohol use suggest continued need for youth substance use prevention and cessation support. Declining physical activity during the pandemic is a health concern.

Rural Latino farmworker fathers' understanding of children's oral health.

PURPOSE: This study's purpose was to examine rural Latino fathers' understanding of their children's oral health. METHODS: A convenience sample (n=20) of fathers from a small agricultural community in California was recruited door-to-door and interviewed in their homes. Individual qualitative interviews in Spanish were conducted. Interviews were audiotaped, translated, and transcribed. Codes were developed, and the text was analyzed for recurrent themes. RESULTS: Fathers came from Mexico (n=15) and El Salvador (n=5). Fathers had very little understanding of the etiology and clinical signs of dental caries. Overall, 18 of 19 fathers reported that their wife was primarily responsible for taking care of the children's hygiene. Fathers agreed that children's teeth should be taken care of from a young age, considered to be after 2 years. The fathers described very minimal hygiene assistance given to children by either parent and often considered a verbal reminder to be sufficient assistance. Fathers generally thought a child did not need supervision after approximately age 4 (range=1-11 years). CONCLUSIONS: While rural Latino fathers might not actively participate in their children's oral hygiene, they do place value on it. Men are supportive of dental treatments, albeit later than recommended. Educational messages aimed at these families will disseminate to the fathers, indirectly.

A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India.

BACKGROUND: Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. METHODS: The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0-2 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. RESULTS: A complex set of barriers and facilitators influence mothers'/caregivers' infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers'/caregivers' key barriers and facilitators to recommended infant-toddler feeding practices. CONCLUSIONS: Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines.

Barriers and Facilitators to Promoting Oral Health Literacy and Patient Communication among Dental Providers in California.

Studies demonstrate that dental providers value effective provider-patient communication but use few recommended communication techniques. This study explored perspectives of California dental providers and oral health literacy experts in the United States on use of communication techniques. We conducted a qualitative key informant interview study with 50 participants between November 2019 and March 2020, including 44 dental providers (dentists, hygienists, and assistants) in public or private practice in California and 6 oral health literacy (OHL) experts. We undertook thematic analysis of interview transcripts and descriptive statistics about interviewees from pre-surveys. Dental providers reported frequently speaking slowly, and using simple language and models/radiographs to communicate with patients, while infrequently using interpretation/translation, illustrations, teach-back, or motivational interviewing. Providers reported using only 6 of the 18 American Medical Association's (AMA) recommended communication techniques and only 3 of the 7 AMA's basic communication techniques. A majority of providers indicated using one of five oral health assessment and educational strategies. Key barriers to effective communication included limited time, financial incentives promoting treatment over prevention, lack of OHL training, limited plain-language patient education materials, and patients with low OHL knowledge. Dental organizations should prioritize supporting dental providers in effective patient communication practices. Standardizing OHL continuing education, creating an evidence-based OHL toolkit for dental teams, ensuring accessible interpretation/translation services, and incentivizing dental providers to deliver education could improve oral health literacy and outcomes.

Mexican American mothers' initiation and understanding of home oral hygiene for young children.

PURPOSE: To investigate caregiver beliefs and behaviors as key issues in the initiation of home oral hygiene routines. Oral hygiene helps reduce the prevalence of early childhood caries, which is disproportionately high among Mexican-American children. METHODS: Interviews were conducted with a convenience sample of 48 Mexican-American mothers of young children in a low income, urban neighborhood. Interviews were digitally recorded, translated, transcribed, coded and analyzed using standard qualitative procedures. RESULTS: The average age of tooth brushing initiation was 1.8 +/- 0.8 years; only a small proportion of parents (13%) initiated oral hygiene in accord with American Dental Association (ADA) recommendations. Mothers initiated 2 forms of oral hygiene: infant oral hygiene and regular tooth brushing. For the 48% of children who participated in infant oral hygiene, mothers were prompted by pediatrician and social service (WIC) professionals. For regular tooth brushing initiation, a set of maternal beliefs exist about when this oral hygiene practice becomes necessary for children. Beliefs are mainly based on a child's dental maturity, interest, capacity and age/size. CONCLUSIONS: Most (87%) of the urban Mexican-American mothers in the study do not initiate oral hygiene practices in compliance with ADA recommendations. These findings have implications for educational messages.

Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study.

PURPOSE: This study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors. METHODS: Thirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes. RESULTS: Twenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks. CONCLUSIONS: Most parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Maintaining Traditions: A Qualitative Study of Early Childhood Caries Risk and Protective Factors in an Indigenous Community.

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child's caries burden. A convenience sample of 18 "outlier" families was identified: low-caries children with ≤2 carious teeth vs. high-caries children with ≥10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child's diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health.

An ethnographic study of salt use and humoral concepts in a Latino farm worker community in California's Central Valley.

BACKGROUND: This article reports on the use of domestic or table salt for its perceived health effects and healing properties in a Latino farmworker community. It explores how contemporary salt usage beliefs can be seen to have roots in long-standing humoral theories of medicine and health. METHODS: This qualitative investigation comprised 30 in-depth individual interviews and five focus groups conducted in Spanish with Mexican and Central American immigrants in one small city in California's Central Valley (N = 61 total participants). Interviews and focus groups were audiotaped, translated into English and transcribed. Several researchers independently and iteratively read transcripts, developed and applied codes, and engaged in thematic analysis. RESULTS: Strongly emergent themes identified the importance of balance in health, and beliefs about the effects on salt on health. Valued for its culinary role, for bringing out the flavors in food, and used by people of all ages, salt use is part of a robust set of cultural practices. Salt was regularly mixed with foods in different combinations and ingested to restore balance, prevent disequilibrium or reduce vulnerability to diverse illnesses, promote rehydration, and address symptoms of exposure to extremes of temperature or physical or emotional stress. Statements made and practices engaged in by participants were highly suggestive of health and healing beliefs common to humoral belief systems based primarily on a hot-cold dichotomy in classifications of foods and healing behaviors. We evaluate these statements and practices in the context of the existing literature on historical and contemporary humoral beliefs in Latin American communities, in Mexico and Central America, and in the United States. CONCLUSION: Humoral theory is a useful framework for understanding contemporary rural Latino migrant farmworkers' perceptions of the importance of salt for their health.

Childhood Socioeconomic Position and Pubertal Onset in a Cohort of Multiethnic Girls: Implications for Breast Cancer.

Background: Higher socioeconomic position (SEP) has been associated with increased risk of breast cancer. Its relationship with earlier age of pubertal onset, a risk factor for breast cancer, is less clear.Methods: We studied the relationship of SEP to pubertal onset in a multiethnic cohort of 1,237 girls ages 6 to 8 years at baseline. Girls in three U.S. cities were followed for 5 to 8 years with annual clinical examinations from 2004 to 2012. SEP measures were examined for associations with pubertal onset, assessed by breast budding (thelarche) and pubic hair development (adrenarche). Analyses were conducted with accelerated failure time models using a Weibull distribution, with left, right, and interval censoring.Results: Higher body mass index percentage at entry to the study and black or Hispanic race/ethnicity were the strongest predictors of age at pubertal onset. An SEP index comprising household family income, mother's education, and home ownership was an independent predictor of thelarche in adjusted models for all girls together and for white and Latina, separately, but not black girls, and the relationship varied by study site. The SEP index was not related to adrenarche in adjusted models. Overall, girls from the lowest quintile of SEP entered puberty on average 6% earlier than girls from the highest quintile (time ratio = 0.94; 95% confidence interval 0.91-0.97) in adjusted models.Conclusions: Our results suggest that early-life SEP may influence the timing of pubertal development.Impact: Factors related to lower SEP in childhood can adversely affect early development in ways that may increase the risk of breast cancer. Cancer Epidemiol Biomarkers Prev; 26(12); 1714-21. ©2017 AACR.

Acceptability of Salt Fluoridation in a Rural Latino Community in the United States: An Ethnographic Study.

Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California's rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers' experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having 'extra' benefits. Once informed about fluoride's safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging.