Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination.

Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders' and members' perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their "community" as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.

Autophagy receptor NDP52 alters DNA conformation to modulate RNA polymerase II transcription.

NDP52 is an autophagy receptor involved in the recognition and degradation of invading pathogens and damaged organelles. Although NDP52 was first identified in the nucleus and is expressed throughout the cell, to date, there is no clear nuclear functions for NDP52. Here, we use a multidisciplinary approach to characterise the biochemical properties and nuclear roles of NDP52. We find that NDP52 clusters with RNA Polymerase II (RNAPII) at transcription initiation sites and that its overexpression promotes the formation of additional transcriptional clusters. We also show that depletion of NDP52 impacts overall gene expression levels in two model mammalian cells, and that transcription inhibition affects the spatial organisation and molecular dynamics of NDP52 in the nucleus. This directly links NDP52 to a role in RNAPII-dependent transcription. Furthermore, we also show that NDP52 binds specifically and with high affinity to double-stranded DNA (dsDNA) and that this interaction leads to changes in DNA structure in vitro. This, together with our proteomics data indicating enrichment for interactions with nucleosome remodelling proteins and DNA structure regulators, suggests a possible function for NDP52 in chromatin regulation. Overall, here we uncover nuclear roles for NDP52 in gene expression and DNA structure regulation.

The journey of 'Living with Pain': A feasibility study of the development and running of a collective narrative group.

INTRODUCTION: Chronic Pain is increasingly affecting young people, their quality of life and wellbeing including education, social life and mental health. Current Western approaches to psychological support for Chronic Pain often focus on 'pain management' and learning skills and strategies from professionals, making use of Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and psychoeducation approaches in individual and group interventions. As a Paediatric Psychology service, we have trialled groups running over multiple weeks informed by these approaches and experienced low attendance rates. METHOD: This paper describes a feasibility study of an alternative group intervention; the 'Living with Pain group', which combines the 'Journey of Life' (Denborough, 2014) with collective narrative and liberation psychology approaches. RESULTS: Thirty three young people and eight parents / carers attended the intervention. Attendance rates, quantitative and qualitative feedback from one face-to-face group for young people and parents and two online groups for young people showed increased access and acceptability of the group. CONCLUSION: The findings from this study have shown that a 1-day collective narrative group intervention is feasible, suitable and acceptable and has increased access to our group intervention. Future directions include co-creation with young people and families, community engagement to increase accessibility of our groups and developing partnerships to respond to young people's hopes to raise awareness.

A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south.

HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.

The Impact of Religious Participation and Religious Upbringing on the Sexual Behavior of Emerging Adults in the Southern United States.

Emerging adults face a disproportionate burden of unintended pregnancies and sexually transmitted diseases, especially in the southern United States. This study investigates how multiple dimensions of current religiosity as well as religious upbringing influence the sexual behaviors, including contraceptive usage, of individuals 18-25 years old (n=211) in the South. Based on regression analyses, results suggest that emerging adults with higher levels of current religiosity are more likely to remain abstinent, but less likely to use pregnancy prevention methods, such as birth controls pills and long-acting reversible contraceptives. Having a religious upbringing is also associated with lower contraceptive usage. Through the assessment of multiple dimensions of religiosity and various sexual behaviors, this study presents a nuanced picture of the complex associations between religion and sexual health, specifically among emerging adults in the southern United States.

Re-membering HIV in the Black Church: women's religious and social identity in relation to perceived risk and men on the down low.

This analysis of 84 interviews with female Black Church leaders and members from Atlanta, GA, examined how women in Black churches construct definitions of, and identities in relation to, HIV narratives about men on the down low. We analyse these narratives as collective memories, through the theoretical lens of memory and trauma studies, by identifying how women understand themselves as the victims of men on the down low transmitting HIV; describe this as a painful experience; make public claims about this experience; and draw on theological understandings to make these claims. The narratives articulate how Black communal modes of meaning making have been disrupted by the HIV epidemic and assign responsibility for HIV transmission to men on the down low, who are perceived to be engaged in risky sexual behaviour. We discuss these results in relation to HIV education and prevention and suggest health educators can engage Black church leaders by understanding these narratives as forms of countermemory.

Dating app use among rural men who have sex with men and its relationship to HIV prevention and risk behaviors: a mixed-methods analysis.

INTRODUCTION: Men who have sex with men (MSM) in rural areas have limited access to HIV prevention and education resources. Given the growing usage of mobile dating apps among the wider MSM population, this research sought to explore their use among MSM in rural areas and their potential for delivering HIV prevention information. METHODS: Participants were recruited from different areas of the rural Southern USA. This mixed-methods study consisted of an online survey (n=85) and follow-up qualitative phone interviews with 20 survey respondents. The survey assessed dating app use, sexual behaviors, and pre-exposure prophylaxis (PrEP) awareness, usage, and attitudes among MSM in the rural, Southern USA. Interviews explored perceptions of dating apps and their potential value as a source of health and HIV prevention information. RESULTS: Among survey respondents, 74% had used a dating app, with Grindr being the most frequently used app. Of individuals who were in a relationship, 41% had met their current partner online. Using a dating app was associated with having a greater number of sexual partners. Three-quarters of participants had heard of PrEP, but only 7% had ever received a prescription for it and less than one-third reported that it would be easy to get PrEP if they wanted it. Dating app users were more likely than non-app users to have more positive attitudes toward taking PrEP and interest in taking PrEP. In qualitative interviews, respondents expressed support for integrating HIV prevention information into dating apps. CONCLUSION: Dating app usage is high among rural MSM. Individuals who use these apps have more sexual partners and also are more interested in PrEP for HIV prevention, suggesting that this is an ideal group to target for PrEP education and interventions. This could be especially beneficial for MSM in rural areas, as most have difficulty accessing PrEP and PrEP education.

The Availability of HIV and Sexually Transmitted Infection Testing and Treatment Services at Crisis Pregnancy Centers in the United States.

BACKGROUND: Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to prevent abortion and promote sexual abstinence before marriage only often using misinformation and deceptive tactics. We sought to describe the availability of HIV and sexually transmitted infection (STI) testing, treatment, and referral services at CPCs in the United States. METHODS: We used CPC Map, an online geocoded directory, to identify US CPCs. From December 2018 to August 2019, we assessed HIV/STI services advertised on CPC Web sites and used a standard script to call CPCs about the availability of services. Referrals were not requested but recorded. RESULTS: Of 2400 CPCs (96.3%) with accessible Web sites, 507 (21.1%) advertised STI testing, 291 (12.1%) STI treatment, and 114 (4.8%) HIV testing. Of 2467 (99.0%) CPCs reached by telephone, 552 (22.4%) offered STI testing, 377 (15.3%) STI treatment, and 208 (8.4%) HIV testing. At centers where services were unavailable, 795 (41.5%) proactively referred for STI testing, 170 (8.1%) for STI treatment, and 170 (7.5%) for HIV-related services. Nearly one-quarter (22.8%) of centers that offered STI testing did not offer treatment or provide a referral. CONCLUSIONS: A minority but substantial number of CPCs advertised and offered HIV/STI services. People at risk for pregnancy who seek CPC services likely have outstanding need for HIV/STI services.

Keeping young people connected during COVID-19: the role of online groups.

The COVID-19 pandemic has had a profound impact on young people, disrupting education, routines, hobbies and peer interactions and there is concern for longer term effects on physical and mental health outcomes. Young people living with chronic health conditions face additional challenges including reduced or no face-to-face contact with medical teams, shielding and the increased stressors of being in 'at-risk' groups and social isolation. In a climate of social isolation and disconnectedness, online groups could provide a method of delivering healthcare and support that strengthens social connectedness and reduces isolation. Despite the technology being available, uptake and evidence for online groups is limited. This article shares learnings from a paediatric and adolescent psychology service delivering online groups for young people with chronic health conditions and their healthcare teams. Ideas for how to transfer group process to online platforms are considered, with examples and tips. With sufficient staffing, preparation, thought, creativity and innovation, it is possible for face-to-face groups to successfully be offered online. Caution should be exercised trying to run online groups without these provisions in place, as the safety, comfort and experience of young people could be jeopardised. Further research is needed to better understand group processes online and to consider what is lost and what is gained when comparing online to face-to-face groups.

Business as usual? Psychological support at a distance.

The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.

A Web-Based Geolocated Directory of Crisis Pregnancy Centers (CPCs) in the United States: Description of CPC Map Methods and Design Features and Analysis of Baseline Data.

BACKGROUND: Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to dissuade people considering abortion. The centers frequently advertise in misleading ways and provide inaccurate health information. CPCs in the United States are becoming more medicalized and gaining government funding and support. We created a CPC Map, a Web-based geolocated database of all CPCs currently operating in the United States, to help individuals seeking health services know which centers are CPCs and to facilitate academic research. OBJECTIVE: This study aimed to describe the methods used to develop and maintain the CPC Map and baseline findings regarding the number and distribution of CPCs in the United States. We also examined associations between direct state funding and the number of CPCs and relationships between the number of CPCs and state legislation proposed in 2018-2019 to ban all or most abortions. METHODS: In 2018, we used standard protocols to identify and verify the locations of and services offered by CPCs operating in the United States. The CPC Map was designed to be a publicly accessible, user-friendly searchable database that can be easily updated. We examined the number of CPCs and, using existing data, the ratios of women of reproductive age to CPCs and CPCs to abortion facilities nationally and by region, subregion, and state. We used unadjusted and adjusted negative binomial regression models to examine associations between direct state funding and the number of CPCs. We used unadjusted and adjusted logistic regression models to examine associations between the number of CPCs by state and legislation introduced in 2018-2019 to ban all or most abortions. Adjusted models controlled for the numbers of women of reproductive age and abortion facilities per state. RESULTS: We identified 2527 operating CPCs. Of these, 66.17% (1672/2527) offered limited medical services. Nationally, the ratio of women of reproductive age to CPCs was 29,304:1. The number of CPCs per abortion facility was 3.2. The South and Midwest had the greatest numbers of CPCs. The number of CPCs per state ranged from three (Rhode Island) to 203 (Texas). Direct funding was associated with a greater number of CPCs in unadjusted (coefficient: 0.87, 95% CI 0.51-1.22) and adjusted (coefficient: 0.45, 95% CI 0.33-0.57) analyses. The number of CPCs was associated with the state legislation introduced in 2018-2019 to ban all or most abortions in unadjusted (odds ratio [OR] 1.04, 95% CI 1.01-1.06) and adjusted analyses (OR 1.11, 95% CI 1.04-1.19). CONCLUSIONS: CPCs are located in every state and particularly prevalent in the South and Midwest. Distribution of CPCs in the United States is associated with state funding and extreme proposals to restrict abortion. Researchers should track CPCs over time and examine factors that influence their operations and impact on public health and policy.

A Multilevel Intervention With African American Churches to Enhance Adoption of Point-of-Care HIV and Diabetes Testing, 2014-2018.

We describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.

Effect of Hypoglycemia on Inflammatory Responses and the Response to Low-Dose Endotoxemia in Humans.

CONTEXT: Hypoglycemia is emerging as a risk for cardiovascular events in diabetes. We hypothesized that hypoglycemia activates the innate immune system, which is known to increase cardiovascular risk. OBJECTIVE: To determine whether hypoglycemia modifies subsequent innate immune system responses. DESIGN AND SETTING: Single-blinded, prospective study of three independent parallel groups. PARTICIPANTS AND INTERVENTIONS: Twenty-four healthy participants underwent either a hyperinsulinemic-hypoglycemic (2.5 mmol/L), euglycemic (6.0 mmol/L), or sham-saline clamp (n = 8 for each group). After 48 hours, all participants received low-dose (0.3 ng/kg) intravenous endotoxin. MAIN OUTCOME MEASURES: We studied in-vivo monocyte mobilization and monocyte-platelet interactions. RESULTS: Hypoglycemia increased total leukocytes (9.98 ± 1.14 × 109/L vs euglycemia 4.38 ± 0.53 × 109/L, P < 0.001; vs sham-saline 4.76 ± 0.36 × 109/L, P < 0.001) (mean ± SEM), mobilized proinflammatory intermediate monocytes (42.20 ± 7.52/µL vs euglycemia 20.66 ± 3.43/µL, P < 0.01; vs sham-saline 26.20 ± 3.86/µL, P < 0.05), and nonclassic monocytes (36.16 ± 4.66/µL vs euglycemia 12.72 ± 2.42/µL, P < 0.001; vs sham-saline 19.05 ± 3.81/µL, P < 0.001). Following hypoglycemia vs euglycemia, platelet aggregation to agonist (area under the curve) increased (73.87 ± 7.30 vs 52.50 ± 4.04, P < 0.05) and formation of monocyte-platelet aggregates increased (96.05 ± 14.51/µL vs 49.32 ± 6.41/µL, P < 0.05). Within monocyte subsets, hypoglycemia increased aggregation of intermediate monocytes (10.51 ± 1.42/µL vs euglycemia 4.19 ± 1.08/µL, P < 0.05; vs sham-saline 3.81± 1.42/µL, P < 0.05) and nonclassic monocytes (9.53 ± 1.08/µL vs euglycemia 2.86 ± 0.72/µL, P < 0.01; vs sham-saline 3.08 ± 1.01/µL, P < 0.05), with platelets compared with controls. Hypoglycemia led to greater leukocyte mobilization in response to subsequent low-dose endotoxin challenge (10.96 ± 0.97 vs euglycemia 8.21 ± 0.85 × 109/L, P < 0.05). CONCLUSIONS: Hypoglycemia mobilizes monocytes, increases platelet reactivity, promotes interaction between platelets and proinflammatory monocytes, and potentiates the subsequent immune response to endotoxin. These changes may contribute to increased cardiovascular risk observed in people with diabetes.

The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention.

As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.

A formative evaluation of social media campaign to reduce adolescent dating violence.

BACKGROUND: The Emory Jane Fonda Center implemented the Start Strong Atlanta social marketing campaign, "Keep It Strong ATL", in 2007 to promote the development of healthy adolescent relationships and to foster the prevention of adolescent dating abuse among 11-14 year olds. OBJECTIVE: A formative evaluation was conducted to understand whether messages directed at the target audience were relevant to the program's relationship promotion and violence prevention goals, and whether the "Web 2.0" social media channels of communication (Facebook, Twitter, YouTube, Flickr, Tumblr, and Pinterest) were reaching the intended audience. METHODS: Mixed methodologies included qualitative interviews and a key informant focus group, a cross-sectional survey, and web analytics. Qualitative data were analyzed using constant comparative methodology informed by grounded theory. Descriptive statistics were generated from survey data, and web analytics provided user information and traffic patterns. RESULTS: Results indicated that the Keep It Strong ATL social marketing campaign was a valuable community resource that had potential for broader scope and greater reach. The evaluation team learned the importance of reaching adolescents through Web 2.0 platforms, and the need for message dissemination via peers. Survey results indicated that Facebook (ranked 6.5 out of 8) was the highest rated social media outlet overall, and exhibited greatest appeal and most frequent visits, yet analytics revealed that only 3.5% of "likes" were from the target audience. These results indicate that the social media campaign is reaching predominantly women (76.5% of viewership) who are outside of the target age range of 11-14 years. CONCLUSIONS: While the social media campaign was successfully launched, the findings indicate the need for a more focused selection of communication channels, timing of media updates to maximize visibility, balancing message tone and delivery, and incorporating differentiated messaging for the target audiences. Collaboration with parents and community partners is also emphasized in order to expand the campaign's reach and create more channels to disseminate relationship promotion and dating violence prevention messaging to the intended audience.