Racial and geographical disparities in oesophageal cancer incidence, mortality and county-level risk factors in the state of Mississippi between 2003 and 2019: a descriptive analysis.

Background: Oesophageal cancer is one of the most aggressive cancers. The aim was to describe the disparities in oesophageal cancer incidence and mortality, and county-level factors in the state of Mississippi from 2003 to 2019 by sex, race, and geolocation. Methods: This study used data from the Mississippi Cancer Registry, linked to county-level data from the Behavioral Risk Factor Surveillance System, the American Community Survey, and the Institutes for Health Metrics and Evaluation. We estimated age-standardised incidence (crude ASR) and mortality rates (crude AMR), mortality-incidence rate ratio and average annual percent change (AAPC) in rates by sex, race, and geolocation, using the Joinpoint Software V.5.0. We further calculated relative risks for oesophageal cancer using age-adjusted quasi-Poisson regression for each county-level factor including smoking, obesity, college degree completion, unemployment rate and median household income ranking within the state. Results: Between 2003 and 2019, a total of 2737 oesophageal cancer cases and 2259 oesophageal cancer deaths occurred in Mississippi. Black men had the greatest reduction in oesophageal cancer incidence and mortality despite high rates (crude ASR2019=10.5, crude AMR2019=7.3 per 100 000; AAPCincidence=-3.7%, p<0.001 and AAPCmortality=-4.9%, p<0.001). The reduction was largely driven by decreases in the non-Delta region (AAPCincidence=-4.2%, p<0.001), while incidence rate remained high among Black men in the Delta region (crude ASR2019=15.4 per 100 000, AAPCincidence=-1.8%, p=0.3). The rates among White men were relatively stable (crude ASR2019=8.5, crude AMR2019=7.6 per 100 000; AAPCincidence=0.18%, p=0.7, AAPCmortality=-0.4%, p=0.6). County-level smoking prevalence (in quartile, p=0.02) was significantly associated with oesophageal cancer incidence. Discussion: This study highlights the importance of targeted interventions to address the persistent high incidence rate of oesophageal cancer among Black men in the Delta region.

The Perceptions and Lived Experiences of African-American Pastors at the Onslaught of the COVID-19 Pandemic in Mississippi.

The purpose of this phenomenological study was to explore perceptions and lived experiences of African-American pastors addressing the onslaught of COVID-19 with their congregation. Thirty-seven pastors representing various denominations from across Mississippi participated in semi-structured, in-depth interviews. From the data, five themes emerged including (1) Pastors' relentlessness, (2) Pastors' adoption of new technology, (3) Maximized social capital, (4) Unintended consequences resulting from COVID-19, and (5) Unintended benefits resulting from COVID-19.

Hepatitis B Screening, Vaccination, and Linkage to Care: Lessons Learned from a Mississippi Vietnamese Community.

BACKGROUND: Asian-Americans and Pacific Islanders are disproportionately impacted by chronic hepatitis B infection (CHBI). The long-term effects of untreated CHBI include cirrhosis of the liver, hepatocellular carcinoma, and liver failure. Approximately two-thirds of those living with CHBI are unaware of their HBV status. OBJECTIVES: Plan, implement, and evaluate a culturally and linguistically appropriate screening, vaccination, and linkage-to-care initiative that used Vietnamese-speaking community health workers for care navigation among Vietnamese-Americans residing in the Mississippi coastal counties of Hancock, Harrison, and Jackson. METHODS: The initiative employed a community-based participatory framework to plan and implement the program. An active community advisory board was established and was representative of all the partners that worked together to make the initiative a success.Results and Lessons Learned: Before program implantation, results from focus groups indicated that the Vietnamese community had low knowledge about the risk of CHBI. Additionally, there were no Vietnamese-speaking health care providers, nor primary care providers treating CHBI in the prioritized counties. A total of 505 Vietnamese individuals were screened. One-half were immune by infection (n = 235 [46.5%]), 83 (16.4%) were immune by vaccination, 46 (9.1%) had CHBI, 130 (25.7%) were vaccine naïve, and 40 (7.9%) were undetermined, (n = 130), 101 (77.7%) received the complete three-injection vaccine series. Five new primary care providers now provide treatment for those with CHBI. Cultural competency and community/medical interpreter training were also provided to reduce language barriers during medical encounters. CONCLUSIONS: To ensure success, it is paramount that community input is not only solicited but that partnerships provide a space where the input informs all aspects of the program.

Engaging African American Pastors in COVID-19 Research During a Pandemic: Lessons Learned.

African American pastors are recognized as trusted information sources for their communities. The pastors willing to address health-related concerns such as preventing the spread of the coronavirus are invaluable for leading their congregation through relevant health programs. Underlining the importance of religion, spirituality, and faith-based leaders in addressing and furthering health promotion research, the article discusses lessons learned during the study implementation and the recommendations for engaging minority pastors in research during a global health pandemic.

Racial Disparities in Reproductive Healthcare among Parous and Nulliparous Women in Mississippi.

BACKGROUND: Long-standing racial disparities exist in reproductive healthcare and have been associated with negative health outcomes among minority women. This study aimed to analyze the racial disparities in reproductive healthcare among Mississippi women, particularly as it related to contraception access, usage, setting, provider type, and payer. METHODS: A two-stage stratified probability design was employed - 95 of the 1500 licensed childcare facilities across the state were randomly selected, and then two to three classrooms were randomly selected within each facility. The children were the means to obtaining a weighted sample of parous women of childbearing age (15-44). Once a parous woman completed the study, she could invite a nulliparous friend of similar age, race, and socioeconomic background to also participate in the study. RESULTS: Racial disparities were found in the reproductive healthcare of both the parous and nulliparous groups. Overall, black women were less likely to receive services from an obstetrics and gynecology. Parous and nulliparous black women were more likely to receive their reproductive healthcare at the health department and less likely to use the most effective methods of contraception. CONCLUSION: Low use of the most effective methods of contraception, despite high levels of general contraceptive use and high insurance coverage, hints at additional barriers to full access for black women in Mississippi. More equitable access to effective family planning counseling and contraception can have meaningful impact on the lives of black women in our state.

Test to Protect Family and Self-A Hepatitis B Screening and Care-Linkage Initiative in the Coastal Mississippi Vietnamese Community.

Although Asian Americans and Pacific Islanders represent less than 5% of the U.S. population, they represent approximately half of all people living with chronic hepatitis B virus (HBV). Harrison, Hancock, and Jackson counties are home to the largest portion of Vietnamese individuals in Mississippi, and have high prevalence rates of HBV. Most people living with HBV do not know they are infected. In 2015, Mississippi State Department of Health began a five-year initiative to implement system-level, evidence-based, community-informed strategies to address HBV in the Vietnamese population of Harrison, Hancock, and Jackson Counties of Mississippi's Gulf Coast region. Presented are results from focus groups conducted with the Vietnamese population that define health issues affecting the Vietnamese community, health care services availability, and knowledge, beliefs, and attitudes regarding HBV and screening. Findings from the focus groups were used to develop a culturally and linguistically tailored HBV screening and care-linkage initiative for the prioritized population.

Investing in Gulfport: Development of an Academic-Community Partnership to Address Health Disparities.

BACKGROUND: Invest Health, a collaboration between the Robert Wood Johnson Foundation and The Reinvestment Fund, selected 50 midsized cities to participate in a health initiative that encourages cross-sector alliances to think creatively about mechanisms that address barriers to reducing health disparities among low-income populations. Gulfport, Mississippi, was 1 of 50 teams chosen to participate. OBJECTIVE: To develop an academic-community partnership among the University of Southern Mississippi, Coastal Family Health Center (CFHC), Mercy Housing and Human Development (MHHD), the Mississippi State Department of Health Office of Health Disparity Elimination, and Gulfport residents to create the Healthy Gulfport Initiative, and, ultimately, the Gulf Coast Healthy Communities Collaborative (GCHCC). METHODS: A Gulfport City team was developed per Invest Health guidelines and included five individuals who represented the public sector, community development, and an academic or health-related anchor institution in the community. Several data sources were used to develop city-wide priority health outcomes. A priority neighborhood experiencing health disparities related to the priority health outcomes was identified. A community-engaged needs assessment was conducted in the priority neighborhood. Residents were engaged in prioritizing the health, education, and activity needs of their community via a participatory nominal group process and survey data collection. RESULTS: Residents in the priority neighborhood lack access to health care and healthy food options owing to transportation difficulties and proximity to resources. CONCLUSIONS: The GCHCC will be established to act as a "backbone organization," so that a common agenda can be created with an emphasis on potential for collective impact.

Increasing Research Capacity in Underserved Communities: Formative and Summative Evaluation of the Mississippi Community Research Fellows Training Program (Cohort 1).

BACKGROUND: The Mississippi Community Research Fellows Training Program (MSCRFTP) is a 15-week program conducted in Jackson, MS, USA consisting of training in the areas of evidence-based public health, research methods, research ethics, and cultural competency. The purpose of the program was to increase community knowledge and understanding of public health research, develop community-based projects that addressed health disparity in the participants' community, increase individual and community capacity, and to engage community members as equal partners in the research process. METHODS: A comprehensive evaluation of the MSCRFTP was conducted that included both quantitative and qualitative methods. All participants were asked to complete a baseline, midterm, and final assessment as part of their program requirements. Knowledge gained was assessed by comparing baseline assessment responses to final assessment responses related to 27 key content areas addressed in the training sessions. Assessments also collected participants' attitudes toward participating in research within their communities, their perceived influence over community decisions, and their perceptions of community members' involvement in research, satisfaction with the program, and the program's impact on the participants' daily practice and community work. RESULTS: Twenty-one participants, the majority of which were female and African-American, completed the MSCRFTP. Knowledge of concepts addressed in 15 weekly training sessions improved significantly on 85.2% of 27 key areas evaluated (p < 0.05). Two mini-grant community based participatory research projects proposed by participants were funded through competitive application. Most participants agreed that by working together, the people in their community could influence decisions that affected the community. All participants rated their satisfaction with the overall program as "very high" (76.2%, n = 16) or "high" (23.8%, n = 5). CONCLUSION: The evaluation of the MSCRFTP demonstrates that participants have the necessary knowledge to engage as research partners, and the pilot projects provided an opportunity for application of this objective to be realized. Overall, the MSCRFTP was an intervention that assisted community members in identifying their communities' strengths and weaknesses, interpret knowledge in a meaningful way, and create a self-reflective community of inquiry for change.

A survey tool for measuring evidence-based decision making capacity in public health agencies.

BACKGROUND: While increasing attention is placed on using evidence-based decision making (EBDM) to improve public health, there is little research assessing the current EBDM capacity of the public health workforce. Public health agencies serve a wide range of populations with varying levels of resources. Our survey tool allows an individual agency to collect data that reflects its unique workforce. METHODS: Health department leaders and academic researchers collaboratively developed and conducted cross-sectional surveys in Kansas and Mississippi (USA) to assess EBDM capacity. Surveys were delivered to state- and local-level practitioners and community partners working in chronic disease control and prevention. The core component of the surveys was adopted from a previously tested instrument and measured gaps (importance versus availability) in competencies for EBDM in chronic disease. Other survey questions addressed expectations and incentives for using EBDM, self-efficacy in three EBDM skills, and estimates of EBDM within the agency. RESULTS: In both states, participants identified communication with policymakers, use of economic evaluation, and translation of research to practice as top competency gaps. Self-efficacy in developing evidence-based chronic disease control programs was lower than in finding or using data. Public health practitioners estimated that approximately two-thirds of programs in their agency were evidence-based. Mississippi participants indicated that health department leaders' expectations for the use of EBDM was approximately twice that of co-workers' expectations and that the use of EBDM could be increased with training and leadership prioritization. CONCLUSIONS: The assessment of EBDM capacity in Kansas and Mississippi built upon previous nationwide findings to identify top gaps in core competencies for EBDM in chronic disease and to estimate a percentage of programs in U.S. health departments that are evidence-based. The survey can serve as a valuable tool for other health departments and non-governmental organizations to assess EBDM capacity within their own workforce and to assist in the identification of approaches that will enhance the uptake of EBDM processes in public health programming and policymaking. Localized survey findings can provide direction for focusing workforce training programs and can indicate the types of incentives and policies that could affect the culture of EBDM in the workplace.