Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (helping end addiction long-term®) communities study.

BACKGROUND: Scaling up overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD) is needed to reduce opioid overdose deaths, but barriers are pervasive. This study examines whether the Communities That HEAL (CTH) intervention reduced perceived barriers to expanding OEND and MOUD in healthcare/behavioral health, criminal-legal, and other/non-traditional venues. METHODS: The HEALing (Helping End Addiction Long-Term®) Communities Study is a parallel, wait-list, cluster randomized trial testing the CTH intervention in 67 communities in the United States. Surveys administered to coalition members and key stakeholders measured the magnitude of perceived barriers to scaling up OEND and MOUD in November 2019-January 2020, May-June 2021, and May-June 2022. Multilevel linear mixed models compared Wave 1 (intervention) and Wave 2 (wait-list control) respondents. Interactions by rural/urban status and research site were tested. RESULTS: Wave 1 respondents reported significantly greater reductions in mean scores for three outcomes: perceived barriers to scaling up OEND in Healthcare/Behavioral Health Venues (-0.26, 95% confidence interval, CI: -0.48, -0.05, p = 0.015), OEND in Other/Non-traditional Venues (-0.53, 95% CI: - 0.84, -0.22, p = 0.001) and MOUD in Other/Non-traditional Venues (-0.34, 95% CI: -0.62, -0.05, p = 0.020). There were significant interactions by research site for perceived barriers to scaling up OEND and MOUD in Criminal-Legal Venues. There were no significant interactions by rural/urban status. DISCUSSION: The CTH Intervention reduced perceived barriers to scaling up OEND and MOUD in certain venues, with no difference in effectiveness between rural and urban communities. More research is needed to understand facilitators and barriers in different venues.

Strategies to promote language inclusion at 17 CTSA hubs.

The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution.

OBJECTIVES: To identify strategies and tactics communities use to translate research into environmental health action. METHODS: We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks. RESULTS: In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation. CONCLUSIONS: CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

Community advisory board members' perspectives on their contributions to a large multistate cluster RCT: a mixed methods study.

Background: Community advisory boards (CABs) are an established approach to ensuring research reflects community priorities. This paper examines two CABs that are part of the HEALing Communities Study which aims to reduce overdose mortality. This analysis aimed to understand CAB members' expectations, experiences, and perspectives on CAB structure, communication, facilitation, and effectiveness during the first year of an almost fully remote CAB implementation. Current literature exploring these perspectives is limited. Methods: We collected qualitative and survey data simultaneously from members (n = 53) of two sites' CABs in the first 9 months of CAB development. The survey assessed trust, communication, and relations; we also conducted 32 semi-structured interviews. We analyzed the survey results descriptively. The qualitative data were analyzed using a deductive codebook based on the RE-AIM PRISM framework. Themes were drawn from the combined qualitative data and triangulated with survey results to further enrich the findings. Results: CAB members expressed strong commitment to overall study goals and valued the representation of occupational sectors. The qualitative data described a dissonance between CAB members' commitment to the mission and unmet expectations for influencing the study within an advisory role. Survey results indicated lower satisfaction with the research teams' ability to create a mutually beneficial process, clear communication, and sharing of power. Conclusion: Building a CAB on a remote platform, within a study utilizing a community engagement strategy, still presents challenges to fully realizing the potential of a CAB. These findings can inform more effective operationalizing of community-engaged research through enhanced CAB engagement.

Advancing Environmental Justice in the Community Using Charrette: A Case Study in Boston Chinatown.

Background: Community research partners in Boston Chinatown implemented a planning charrette as a part of a community-based participatory study focused on near highway research and public health action to mitigate traffic-related air pollution (TRAP). Charrettes are intensive workshops for solution-oriented design and planning used to bring together diverse stakeholders to address complex environmental health concerns. Methods: The planning charrette included three phases: (1) community meetings and resident interviews, (2) a planning charrette to address community health concerns and air pollution within larger community wellness goals, and (3) development of a Master Planning document with policy, project, and practice recommendations to guide future community advocacy. Outcomes: Intergenerational residents, community leaders, planners, researchers, and volunteers (N = 90) joined a day-long planning charrette to inform the Chinatown Master Plan. Workshops were informed by resident interviews focused on finding solutions to three resident identified priorities: Healthy Housing, Healthy Mobility, and Healthy Public Realm. Air pollution mitigation strategies were embedded in discussions around each priority area. Discussion: The charrette provided an opportunity for community stakeholders to voice concerns about TRAP as part of a new framework focused on health and wellness. Concerns about pedestrian safety, housing access, and expansion of green and recreational spaces were highlighted by participants as important areas for further development. Conclusions: Boston Chinatown residents reaffirmed their investment in the community by highlighting concerns about TRAP within the context of other health-related concerns. Charrettes offer a vehicle to advance environmental justice in communities through collective problem-solving and decision making.

Project AquiLá: Community-engaged Planning to Explore the Relationship between Culture and Health.

BACKGROUND: Elements of charrette planning were employed to develop and examine the relationship between transnationalism, culture and health. OBJECTIVE: This paper describes the partnership, the first two stages of the planning charrette and lessons learned. METHODS: During charrette planning phase 1 we collected data through social network interviews (n = 58), cultural conversations (n = 88), and photovoice (n = 9). In the second phase we performed five charrette planning meetings. Data were synthesized by the planning team. LESSONS LEARNED: The issue centered focus facilitated trust among partners. The holistic, iterative process to planning and interpreting preliminary data provided a deeper understanding of the issues under investigation. Community partners at the table held us accountable to the communities we were studying and infused an undercurrent of social justice in our work. CONCLUSIONS: There are advantages in employing a community engaged transdisciplinary team-based approach to the study of transnationalism, culture and health.

The Black women first initiative: using implementation science to examine bundled interventions to improve care and treatment coordination for Black women with HIV.

BACKGROUND: Black cisgender and transgender women are disproportionately affected by the HIV epidemic compared to women of other racial and ethnic identities. Twelve demonstration sites across the United States are adapting, implementing and evaluating a comprehensive bundle of two or more evidence informed interventions to improve health and outcomes and quality of life for Black women with HIV. METHODS: Guided by Greenhalgh's Conceptual Model of Diffusion of Innovations in Health Service Organizations and Proctor's model for use of implementation strategies and evaluating implementation, service and client outcomes, this mixed methods study documents outcomes at the client, organization, and system level. Participant eligibility for the bundled interventions includes: individuals who are 18 years or older, identify as Black or African-American, identify as cisgender or transgender female and have a diagnosis of HIV. Qualitative data are collected systematically through a series of annual site visits and a standardized monthly call form to assess the barriers and facilitators to the implementation process and the key determinants impacting the intervention uptake and implementation strategies. Quantitative data collection for the implementation, service and client outcomes is conducted through a pre-post prospective study to examine the impact on Black women's health and well-being. Implementation outcomes include: the reach to Black women with HIV, adoption of interventions across the sites and their community; the fidelity to the components of the bundled interventions; the costs of the intervention; and the sustainability of the intervention in the organization and community. Primary service and client outcomes are improved linkage to and retention in HIV care and treatment, increased and sustained viral suppression, improved quality of life and resilience, and stigma reduction. DISCUSSION: The study protocol presented is specifically designed to advance the evidence for adopting culturally responsive and relevant care into clinic and public health settings to improve the health and well-being for Black women with HIV. In addition the study may advance the implementation science field by furthering what is known about the ways in which bundled interventions can address barriers to care and facilitate the uptake of organizational practices to improve health.

Policies enacted during COVID-19 came with unintended health benefits: why go back?

OBJECTIVES: To explore the impact of COVID-19 on the implementation of bundled interventions to improve the engagement and retention of Black women in HIV care. METHODS: Pre-implementation interviews conducted between January and April 202 L with 12 demonstration sites implementing bundled interventions for Black women with HIV. Directed content analysis was employed to examine the site interview transcripts. RESULTS: The pandemic intensified barriers to care and harmful social conditions. However, COVID-19 also forced pivots in health care and social service delivery and some of these changes benefited Black women living with HIV. CONCLUSIONS: The continuation of policies that support the material needs of Black women with HIV and ease access to care is critical. Racial capitalism impedes the enactment of these policies and thus threatens public health.

Adapting an In-Home Randomized Intervention Trial Protocol for COVID-19 Precautions.

BACKGROUND: The COVID-19 pandemic has significantly impacted the status of clinical trials in the United States, requiring researchers to reconsider their approach to research studies. In light of this, we discuss the changes we made to the protocol of the Home Air Filtration for Traffic-Related Air Pollution (HAFTRAP) study, a randomized crossover trial of air filtration in homes next to a major highway. The senior authors designed the trial prior to the pandemic and included in-person data collection in participants' homes. Because of the pandemic, we delayed the start of our trial in order to revise our study protocol to ensure the health and well-being of participants and staff during home visits. To our knowledge, there have been few reports of attempts to continue in-home research during the pandemic. METHODS: When pandemic-related protective measures were imposed in March 2020, we were close to launching our trial. Instead, we postponed recruitment, set a new goal of starting in September 2020, and spent the summer of 2020 revising our protocol by developing increased safety precautions. We reviewed alternative approaches to installing portable air filtration units in study participants' homes, in order to reduce or eliminate entry into homes. We also developed a COVID-19 safety plan that covered precautionary measures taken to protect both field team staff and study participants. RESULTS: Our primary approach was to minimize contact with participants when collecting the following measures in their homes: (1) placing portable air filtration units; (2) conducting indoor air quality monitoring; (3) obtaining blood samples and blood pressure measurements; and (4) administering screening, consent, and follow-up questionnaires that coincided with collection of biological measures. Adapting our public health trial resulted in delays, but also helped ensure ethical and safe research practices. Perceived risk of COVID-19 infection appeared to have been the primary factor for an individual in deciding whether or not to participate in our trial, particularly at the beginning of the pandemic, when less was known about COVID-19. CONCLUSIONS: We needed to be flexible, creative, and calm when collaborating with community members, the IRB, and the universities, while repeatedly adjusting to changing guidelines as we determined what worked and what did not for in-home data collection. We learned that high-quality air monitoring data could be collected with minimal in-person contact and without compromising the integrity of the trial. Furthermore, we were able to collect blood pressure and phlebotomy data with minimal risk to the participant.

A discussion among deans on advancing community engaged research.

The benefits of community-engaged research (CEnR) have been documented in the literature. However, the adoption of community engaged (CE) and participatory approaches among health researchers remains limited. The Boston University (BU) Clinical Translational Science Institute's community engagement program initiated a discussion among five BU Deans to explore their approaches to support the practice of CEnR among faculty in their schools. The discussion was recorded and the transcript analyzed to identify and explore themes that emerged. Most strategies discussed by the Deans were not focused on changing institutional systems to advance CEnR. Instead, the analyses showed that institutional CE efforts highlighted by the Deans were focused on "responsibility centered on one person" or "research mentors." Approaches to developing a culture of CEnR that centers responsibility for promoting it on a few people in a university may place significant burden on leadership and researchers and is not an effective way to promote culture change. Systems change is needed to support CEnR, improve accountability, and realize successful partnerships between academic institutions and communities. The dialogue among Deans focused on the topic of CEnR provided an effective method to catalyze discussion and over time may help to strengthen a culture of CEnR research.

Community engagement and financial arrangements: Navigating institutional change.

Despite their documented benefits, the widespread adoption of community-engaged and participatory approaches among health researchers remains limited. Institutional practices and policies influence the uptake of community engagement and participatory approaches. We examine the role of financial arrangements between university researchers and community partners, by exploring efforts to bridge the gap between research administration and researchers at two research-intensive institutions. The type of financial arrangement a researcher has with a community partner plays an important role in setting the stage for the structure of the partnership as it relates to shared decision-making and ownership of the research. Continued efforts to clarify and streamline subcontracting processes are needed as is infrastructure to support community partners and researchers as they navigate financial arrangements if progress is to be made.

El Sancocho, la Bandera y la Familia: La vida social de los alimentos y sus implicaciones para la salud y el bienestar de los inmigrantes dominicanos.

Para comprender mejor los factores que influyen en la salud y el bienestar de los inmigrantes dominicanos, exploramos las formas en que la inmigración influye en las prácticas culturales, el comportamiento de salud y la salud. Los inmigrantes dominicanos (n = 42) participaron en cinco discusiones grupales reflexivas y no estructuradas y (n = 5) participaron en un grupo de fotovoz intergeneracional. La pérdida del contexto familiar y social en el que tradicionalmente se llevan a cabo las prácticas dietéticas dominicanas fue un tema destacado. Para los participantes, comer se convirtió en una actividad apresurada y superficial que involucraba a menos personas y menos socialización. Las prácticas dietéticas en la República Dominicana se establecen en el contexto de las normas familiares y los procesos sociales, que brindan apoyo, así como oportunidades para la socialización y la transmisión de prácticas culturales a través de las generaciones. En los Estados Unidos, las fuerzas sociopolíticas más amplias se enfocan en el individualismo y no apoyan el desarrollo o mantenimiento de patrones culturales para los dominicanos. Las políticas que promueven el equilibrio entre el trabajo y la vida personal pueden tener implicaciones importantes para las prácticas dietéticas en las nuevas comunidades de inmigrantes.

Health literacy, health outcomes and community health worker utilization: a cohort study in HIV primary care.

BACKGROUND: People with HIV (PWH) have complex needs, and those with limited health literacy consistently have poorer HIV-related knowledge and health outcomes. One strategy to facilitate better outcomes for PWH is the inclusion of community health workers (CHWs) into care teams. This cohort study examines the effect of health literacy on clinical outcomes and utilization of CHW services among PWH enrolled in a CHW intervention. The secondary aim is to characterize most common purposes of CHW encounters. METHODS: PWH (n = 209) enrolled in a CHW intervention with completed 6-month follow-up evaluation visits were included. Health literacy level was measured at baseline with the BRIEF tool and categorized into inadequate, marginal, and adequate health literacy. Adjusted logistic regressions assessed the effect of health literacy on viral load suppression, HIV primary care visits at 6-month follow-up, CHW utilization and purpose of CHW encounter. Purpose of CHW encounters included logistical support, accompany to appointment, transportation coordination, concrete services, coaching, and emotional support. Linear regression assessed the association between purpose of CHW encounters and CHW utilization. RESULTS: Individuals with inadequate health literacy were more likely to receive coaching from CHWs (p = 0.029), and individuals with marginal health literacy were more likely to have an HIV primary care visit at 6 months (p = 0.044). Individuals receiving transportation coordination, concrete services, coaching, and emotional support had more total CHW encounters. CONCLUSIONS: Purpose of encounter was highly correlated with frequency of CHW encounters, while health literacy status was not. This suggests individuals receiving these services require more assistance from CHWs, regardless of health literacy level. Training CHWs to conduct comprehensive social needs assessment and screening for risk factors at the initial visit with clients can identify resources and guide CHW service delivery as part of the care team.

Integrating community engagement with implementation science to advance the measurement of translational science.

This special communication provides an approach for applying implementation science frameworks to a Clinical and Translational Science Institutes (CTSIs) community engagement (CE) program that measures the use of implementation strategies and outcomes that promote the uptake of CE in research. Using an iterative multi-disciplinary group process, we executed a four-phased approach to developing an evaluation plan: 1) creating an evaluation model adapted from Proctor's conceptual model of implementation research; 2) mapping implementation strategies to CTSI CE program interventions that support change in research practice; 3) identifying and operationalizing measures for each strategy; and 4) conducting an evaluation. Phase 2 employed 73 implementation strategies across 9 domains generated by the Expert Recommendations for Implementing Change project. The nine domains were used to classify each CE program implementation strategy. In Phase 3, the group used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to define measures for each individual strategy. Phase 4 demonstrates the application of this framework and measures Year 1 outcomes for the strategy providing interactive assistance, which we implemented using a centralized consultation model. This approach can support the CTSA program in operationalizing CE program measurement to demonstrate which activities and strategies may lead to benefits derived by the program, institution, and community.

Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study.

INTRODUCTION: Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions. METHODS: We conducted semi-structured interviews (N = 24) at a detox center (2018-2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes. RESULTS: Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions. CONCLUSIONS: Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for. individualized preferences and needs.

Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio.

INTRODUCTION: Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally. METHODS AND ANALYSIS: The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation. ETHICS AND DISSEMINATION: The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER: NCT04111939.

Virtual Reality Simulated Learning Environments: A Strategy to Teach Interprofessional Students About Social Determinants of Health.

PURPOSE: Physician assistants (PAs) and medical degree students (MDs) often lack training in addressing the social determinants of health (SDOH). Social work students (SWs), meanwhile, have extensive SDOH training; however, few medical professionals have opportunities to engage in interprofessional training with SWs. This study examined the feasibility, acceptability, and students' perceptions of an interprofessional virtual reality (VR) simulated learning environment (SLE) for teaching health professions students about the SDOH. METHOD: In January 2020, 15 students at Boston University School of Medicine attended web-based video conferences focused on SDOH, health equity, and team-based care. Subsequently, student dyads participated in a case-based learning activity using an immersive VR SLE to develop teamwork skills. Evaluation included a postsurvey and a focus group examining their experiences in the course to gauge feasibility and acceptability. Thematic analysis of open-ended survey responses from the postsurvey and focus group data was conducted. RESULTS: A total of 8 VR simulations were run. Findings indicated both MD and PA students learned patient engagement strategies from SW students, who enhanced their health care leadership capacity. Participants found the means of instruction acceptable, valued the hands-on VR interprofessional training, and expressed interest in learning more about the scope of one another's roles and the community resources available to patients. CONCLUSIONS: VR SLE is a feasible and acceptable means of instruction. It allowed students to connect across programmatic and geographic boundaries in a collaborative working environment mimicking the team approach to care they will use in their professional life. This experience illustrated for students the strengths a multidisciplinary team has to offer.

Toward Integration of Life Course Intervention and Youth Participatory Action Research.

We provide an overview of diverse forms of youth participation, with a focus on youth participatory action research (YPAR) and its synergies with life course intervention research to promote healthier development for young people and across the life span. We analyze why YPAR matters for research, practice, and policies related to the systems and settings in which young people develop. We also illustrate how young people perform YPAR work to improve the developmental responsiveness and equity of school and health systems, including descriptions of an innovative youth-led health center in Rwanda and a long-standing and evolving integration of YPAR into public high schools in the United States. We then briefly consider the adult capacities needed to do this work well, given that YPAR challenges typical youth-adult power relationships and broader assumptions about who can generate expert knowledge. We consider the alignment and potential challenges for integration of life course intervention research as well as YPAR and next steps for research and practice at this intersection.

Just Research: Advancing Antiracist and Antioppressive Social Work Research.

The Society for Social Work and Research (SSWR) created its Research Capacity and Development Committee in 2017 to build research capacity across the careers of social work scholars. The committee has initiated multiple conferences and webinar sessions that have increasingly focused on antiracist and antioppressive (ARAO) research, including "Mentorship for Antiracist and Inclusive Research" and "Strategies for Supporting Antiracist Pedagogy & Scholarship: Reimagining Institutional Systems & Structures." This commentary integrates themes from these sessions and other discussions among committee members about strategies to advance ARAO research. Although SSWR board members reviewed and approved this submission, it is not an official statement of SSWR or its board of directors.

El Sancocho, la Bandera y la Familia: The Social Life of Food and its Implications for Dominican Immigrant Health and Well-Being.

In order to better understand factors that influence the health and well-being of Dominican immigrants, we explored the ways in which immigration influences cultural practices, health behavior, and health. Dominican immigrants (n = 42) took part in five reflective and unstructured group discussions and (n = 5) participated in an intergenerational photovoice group. The loss of the familial and social context in which Dominican dietary practices traditionally take place was a salient theme. For participants, eating became a rushed, perfunctory activity involving fewer people and less socializing. Dietary practices in the Dominican Republic are set in the context of familial norms and social processes, which provide support as well as opportunities for socializing and the transmission of cultural practices across generations. In the United States, broader sociopolitical forces are guided by individualism and do not support the development or maintenance of these factors for Dominicans. Policies that promote work-life balance may have important implications for dietary practices in new immigrant communities.