Black women's perspectives on bladder health: Social-ecological and life course contexts.

AIMS: This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective. METHODS: We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American. RESULTS: Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems. CONCLUSIONS: Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.

A community-engaged approach to the design of a population-based prospective cohort study to promote bladder health.

INTRODUCTION: Community engagement is increasingly recognized as a critical component of research, but few studies provide details on how to successfully incorporate community perspectives in urological research. This manuscript describes the community engagement strategy used by the Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS) to design RISE FOR HEALTH (RISE), a multicenter, population-based, prospective cohort study to promote bladder health. METHODS AND RESULTS: The PLUS Community Engagement Subcommittee, guided by a set of antiracist community engagement principles and practices, organized, implemented, and communicated findings for all RISE community engagement activities. Community engagement was conducted through a diverse network of community partners at PLUS clinical research centers called Rapid Assessment Partners (RAPs). Via online surveys (4), virtual discussion groups (14), and one-on-one interviews (12), RAPs provided input on RISE processes and materials, including in-person visit procedures, specimen collection instructions, survey data collection instruments, recruitment materials, the study website, and the study name. This process resulted in significant changes to these aspects of the study design with reciprocal benefits for the community partners. DISCUSSION: Meaningful community engagement improved the design and implementation of RISE. PLUS will continue to engage community partners to interpret the RISE study results, disseminate RISE findings, and inform other PLUS studies toward the development of interventions to promote bladder health. Future urological studies would also benefit from community participation in determining priority research questions to address.

Thriving, Managing, and Struggling: A Mixed Methods Study of Adolescent African Refugees' Psychosocial Adjustment.

OBJECTIVES: The purpose of this mixed method study was to characterize the patterns of psychosocial adjustment among adolescent African refugees in U.S. resettlement. METHODS: A purposive sample of 73 recently resettled refugee adolescents from Burundi and Liberia were followed for two years and qualitative and quantitative data was analyzed using a mixed methods exploratory design. RESULTS: Protective resources identified were the family and community capacities that can promote youth psychosocial adjustment through: 1) Finances for necessities; 2) English proficiency; 3) Social support networks; 4) Engaged parenting; 5) Family cohesion; 6) Cultural adherence and guidance; 7) Educational support; and, 8) Faith and religious involvement. The researchers first inductively identified 19 thriving, 29 managing, and 25 struggling youths based on review of cases. Univariate analyses then indicated significant associations with country of origin, parental education, and parental employment. Multiple regressions indicated that better psychosocial adjustment was associated with Liberians and living with both parents. Logistic regressions showed that thriving was associated with Liberians and higher parental education, managing with more parental education, and struggling with Burundians and living parents. Qualitative analysis identified how these factors were proxy indicators for protective resources in families and communities. CONCLUSION: These three trajectories of psychosocial adjustment and six domains of protective resources could assist in developing targeted prevention programs and policies for refugee youth. Further rigorous longitudinal mixed-methods study of adolescent refugees in U.S. resettlement are needed.

Lessons learned from Chicago's emergency response to mass evacuations caused by Hurricane Katrina.

OBJECTIVES: We analyzed the response of the Chicago Department of Public Health with respect to its effectiveness in providing health care to Hurricane Katrina evacuees arriving in the city. METHODS: Between September 12 and October 21, 2005, we conducted a real-time qualitative assessment of a medical unit in Chicago's Hurricane Victim Welcome and Relief Center. A semistructured guide was used to interview 33 emergency responders in an effort to identify key operational successes and failures. RESULTS: The medical unit functioned at a relatively high level, primarily as a result of the flexibility, creativity, and dedication of its staff and the presence of strong leadership. Chronic health care services and prescription refills were the most commonly mentioned services provided, and collaboration with a national pharmacy proved instrumental in reconstructing medication histories. The lack of a comprehensive and well-communicated emergency response plan resulted in several preventable inefficiencies. CONCLUSIONS: Our findings highlight the need for improved planning for care of evacuee populations after a major emergency event and the importance of ensuring continuity of care for the most vulnerable. We provide an emergency response preparedness checklist for local public health departments.