Father's Playbook: From Health Communication Research to Prenatal Health Intervention.

Research has demonstrated benefits of paternal involvement during the prenatal stage: increased prenatal visits, better adherence to postpartum best practices, and improved communication between partners. In the United States, where maternal morbidity remains higher than other advanced economies, the need for varied interventions aimed at improving the wellbeing of the entire family unit should remain a top priority. In an arena that is understandably dominated by interventions aimed at expectant mothers, scholars also advocate for including men in prenatal health care to reduce maternal morbidity and mortality. In practice, however, they are often excluded. Evidence suggests paternal prenatal health interventions can result in better outcomes for the entire family, and researchers developed Father's Playbook - a free bilingual evidence-based app for expectant fathers - in support of that goal. This article examines the creation of and lessons learned from this health communication intervention which represents a case study of implementation science in the field of health communication. This article documents how the project moved from early formative research to app development and now ongoing promotion of a state-funded health communication and public health intervention utilizing a variety of research approaches. Researchers believe this intervention can serve as a blueprint for other public health and health communication practitioners.

The Impact of Health Communication Research on Medical and Health Professional Education and Training.

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies of how health communication research informed the development and implementation of specific CSTs, and we reflect on how we can productively define "impact" in looking back as well as looking forward within this line of research.

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions.

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Interaction of curcumin with a winter flounder alpha-helical antifreeze protein.

The winter flounder, Pseudopleuronectes americanus, synthesizes a variety of alpha-helical antifreeze proteins (AFPs) that adhere to ice and inhibit its growth. The best studied of these is AFP6, which is a 37-residue protein abundant in the flounder blood plasma during winter. Curcumin from the turmeric plant (Curcuma longa) was found to interact with AFP6 in aqueous solutions, resulting in measurable changes in the curcumin, but not in the protein. Specifically, the secondary structure and unfolding of synthetic AFP6, shown by circular dichroism, appeared to be unaffected by curcumin. In contrast, the peak absorbance of curcumin shifted and increased in the presence of AFP6, and the maximum fluorescence emission was greater and blue shifted. These results also suggested the possibility of AFP6 detection by curcumin fluorescence. Synthetic AFP6 did not interact with Coomassie blue, silver or a commercial fluorescent stain following electrophoresis; however, the change in curcumin fluorescence upon binding to electrophoresed AFP6 resulted in a fluorescent signal, which was also detected upon interaction with purified natural AFP and flounder blood plasma containing the protein. Thus, aqueous curcumin can be used for the direct detection of AFP6 and curcumin binding could provide new avenues for the study of this protein.

A qualitative descriptive study of providers' perspectives on human papillomavirus vaccine administration among Latino/a adolescents in South Texas clinics: barriers and facilitators.

BACKGROUND: South Texas Latinas experience higher cervical cancer incidence and mortality compared to Latinas nationwide. Despite the availability of effective human papillomavirus vaccines, South Texas Latino/a adolescents sub-optimally complete the series. Research shows provider recommendation strongly predicts vaccine uptake, but minority adolescents are less likely to report that their provider recommended the vaccine and series completion. There is also scant information on the HPV vaccine administration process in clinic practices providing vaccination services to Latino adolescents with limited access to healthcare resources. The purpose of the study was to describe providers' experience with administering the HPV vaccine to Latino/a patients in their practices. METHODS: The study used qualitative description to describe the experience of 15 South Texas healthcare providers (doctors and nurses) with the process of HPV vaccine administration in their practices. We conducted open ended, audio-recorded interviews, which were subsequently transcribed verbatim and uploaded into Atlas.(ti) 7.0 for analysis. The interviews yielded detailed descriptions of barriers and facilitators that could potentially impact HPV vaccine uptake. RESULTS: Providers identified parental exposure to provider recommendation as enhancing HPV acceptance and existing policies and implementation of evidence-based practices as facilitators of HPV vaccine uptake. Barriers ranged from parental fears of adolescent sexual activity and potential vaccine side effects to lack of transportation and the cost of the vaccine. CONCLUSION: These findings reflect barriers and facilitators to administering the HPV vaccine previously identified and also highlight issues unique to the situation among Latinos in South Texas. Implications include the need to design and implement efforts to improve provider-parent communication and enhance parental and adolescent patients' understanding of and confidence in the HPV vaccine. Furthermore, policy changes are needed to rectify organizational/structural challenges to HPV vaccine administration.

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities.

The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.

Examining the Effectiveness of Genetic Counselors' Communication of Variant of Uncertain Significance Results of Breast Cancer Genes.

Receiving a variant of uncertain significance (VUS) result is quite common for individuals who undergo genetic testing. Because VUS results are often unexpected and necessarily complex, they are challenging for genetic counselors to deliver. The current research sought to examine how three specific message features (risk estimate formats, establishment of a future plan, and linguistic agency), and message receivers' intolerance of uncertainty, influenced the effectiveness of genetic counselors' communication of a VUS result. A series of MANCOVAs and multiple regressions suggested that these message features affected message receivers' perception of a genetic counselor's credibility and receivers' uncertainty appraisal and information-seeking intentions. Specifically, establishing a future plan and assigning agency to a VUS result enhanced perceived counselor credibility. When results were presented in a numeric format, assigning agency to counselors resulted in heightened danger appraisal and greater information-seeking intentions. Individuals' intolerance of uncertainty moderated the association between risk formats and uncertainty appraisal. These results have both theoretical and practical implications for communication of uncertainty in the context of genetic counseling.

Increasing Opportunities for Spiritual and Religious Supports to Improve HIV-Related Outcomes for Black Sexual Minority Men.

Given the importance of spirituality and religion in the lives of many Black gay, bisexual, and other Black sexual minority men (SMM) and the need for additional resources to improve HIV outcomes within this population, research on how spiritual and religious support can promote HIV prevention and treatment among Black SMM is greatly needed. We conducted nine focus groups with 52 spiritual and religious Black SMM in Baltimore, Maryland, to explore opportunities for HIV-related programming that incorporates spiritual and/or religious supports. Thematic analysis of the focus group transcripts was conducted using an iterative constant comparison coding process. Participants expressed a desire for more spiritual/religious support in non-church-based settings and identified the use of peer supports, inclusion of prayer and gospel music, and messaging related to the ideas that God is love, the Bible says to treat yourself preciously, and taking care of your health can strengthen your relationship with God as ways in which this could be incorporated into HIV-related programming. Participants living with HIV identified the message of "keeping the faith" as important for maintaining their HIV treatment plans. Participants also expressed a need for parental supports to improve HIV-related outcomes for Black SMM and potentially expand opportunities for spiritual and religious support to Black SMM within the church. Spirituality and religion can influence HIV outcomes for Black SMM, and the strategies identified by Black SMM in this study could aid in designing culturally congruent HIV prevention and treatment programs situated in the community.

Does Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity?

BACKGROUND: Intolerance of uncertainty-the tendency to overestimate the chance of and be unwilling to accept potential, but unlikely, negative outcomes in uncertain situations-is a cognitive construct that has been shown to affect symptoms and limitations for patients with traumatic and nontraumatic upper-extremity conditions. Cognitive flexibility and tolerance of uncertainty can be trained and practiced, with the potential to increase musculoskeletal health. However, to our knowledge, the degree to which intolerance of uncertainty might be associated with symptom intensity and the magnitude of limitations in adults with upper-extremity problems has not been characterized. QUESTIONS/PURPOSES: After accounting for personal and social factors, is intolerance of uncertainty independently associated with (1) the magnitude of physical limitations and (2) pain intensity? METHODS: In this cross-sectional, observational study, 139 new and returning patients presenting to one of four orthopaedic offices in a large urban area completed the Intolerance of Uncertainty Scale (a validated measure of the level of comfort with uncertain situations), the Patient-reported Outcomes Measurement Information System-Physical Function Upper Extremity computer adaptive test (to measure the magnitude of limitations), and an 11-point ordinal measure of pain intensity. The mean age of the 139 participants was 51 years ± 16 years and 55% (76 of 139) were men. Participants presented to the clinics with a wide variety of upper-extremity conditions, such as trigger finger, distal radius fractures, lateral epicondylitis, or non-specific shoulder pain. We also assessed sex, race, marital status, education level, income, public versus private insurance, area deprivation index, and the participant's self-perception of their healthcare experience through a multiple-choice question (answer choices: none, some, a little, and a lot of experience). The following patient characteristics were more common in our study participants: white, employed, part of a married or unmarried couple, and private insurance coverage. We created two multivariable linear regression models to assess factors independently associated with the magnitude of limitations and pain intensity. RESULTS: After controlling for potentially confounding variables including sex, insurance, area deprivation index, and type of visit, we found that fewer physical limitations were associated with a greater intolerance of uncertainty (regression coefficient [ß] -0.30; 95% confidence interval, -0.50 to -0.10; p = 0.003; semi-partial r = 0.07; adjusted r for the full model = 0.16), as was being a man (ß 3.2; 95% CI, 0.08-6.3; p = 0.045; semi-partial r = 0.03) and having private insurance coverage (ß 5.2; 95% CI, 2.1-8.2; p = 0.001; semi-partial r = 0.08). After controlling for one important potentially confounding variable, the level of education, greater pain intensity was associated with a greater intolerance of uncertainty (ß 0.08; 95% CI, 0.02-0.14; p = 0.009; semi-partial r = 0.05; adjusted r for the full model = 0.08). CONCLUSIONS: Intolerance of uncertainty-a byproduct of cognitive bias and error, which are elements of the normal functioning of the human mind-increases limitations and pain intensity across diagnoses, independent of demographic and social factors. Future studies can address the effect of strategies that incorporate mindset training (for example, cognitive behavioral therapy and its derivatives) on musculoskeletal symptoms and limitations. LEVEL OF EVIDENCE: Level II, prognostic study.

What Motivates Health Communication's Peer Reviewers to Review? A Survey of Our Scholarly Community.

The peer review process is a necessary, labor-intensive, and imperfect element of scientific research. Among the many issues identified by its critics, finding willing reviewers can be an arduous task for journal editors and is acknowledged as one of the primary factors holding up the publication process. In an attempt to better understand and serve Health Communication reviewers, we surveyed them and inquired about their motivations for reviewing a manuscript, including why they agree, decline, or disregard invitations to review submissions. According to responses from 380 reviewers, the most compelling reasons for agreeing to review reflected a dedication to performing scholarly service and loyalty to the journal. The primary reasons selected for declining to review included lack of time and insufficient expertise to evaluate the submission. The main reasons for failing to respond to requests to review were e-mail overload and indecision about whether to take on the review. Recognition for service was the most recommended suggestion offered to motivate reviewers to agree to take on more manuscripts. On the whole, reviewers feel a strong sense of duty to review manuscripts. However, time constraints, poor fit, and lack of recognition are roadblocks to agreeing.

Exploring the role of LGBT-affirming churches in health promotion for Black sexual minority men.

In the USA, Black sexual minority men (BSMM) remain disproportionately impacted upon by HIV and other sexual health issues. Individuals who attend church have lower rates of morbidity and mortality than those that do not; however, church attendance presents a paradox of being protective for some health outcomes and a risk for others among this population. Lesbian, gay, bisexual, and transgender (LGBT) affirming churches may offer support, but little is known about the role of LGBT-affirming churches in the lives of BSMM and how they may impact HIV and other health outcomes. This study explored the role of LGBT-affirming churches in the lives of BSMM. Nine focus groups (N = 52) were conducted in Baltimore City, Maryland between December 2017 and April 2018. Thematic analysis evaluated domains related to how men perceived, experienced, and engaged with LGBT-affirming churches. Three primary themes identified: (1) preferring traditional church environments over LGBT-affirming churches; (2) experiencing the LGBT-affirming church as a space of acceptance, emotional healing, and modelling loving same-sex relationships; and (3) perceiving LGBT-affirming churches as opportunities to engage community members to promote the well-being of BSMM. A secondary theme identified involvement in the house and ballroom community as an LGBT-affirming religious experience.

Parenting Practices, Autonomous Motivation, and Adolescent Diet Habits.

Guided by self-determination theory, the aim of this study was to examine whether adolescents' autonomous motivation for making healthy diet choices mediates the association between parenting practices regarding diet and adolescent food choices. We analyzed data from the NCI FLASHE study, a survey of demographically diverse parents and their adolescent children (N = 1,646 dyads). Path models supported self-determination theory's assertion that indirect, encouraging parenting practices fostered internal motivation; in contrast, regulation was both positively and negatively linked to motivation depending on the model. Models also yielded direct paths between parenting practices and healthy and unhealthy diet choices. Overall, regardless of what predicted motivation, adolescents' autonomous motivation was linked with their consumption of healthier foods and drinks. As such, cultivating a sense of internal motivation during these formative years may put young people on a path toward healthy patterns of self-regulation later in life.

Commensal microbiota influence systemic autoimmune responses.

Antinuclear antibodies are a hallmark feature of generalized autoimmune diseases, including systemic lupus erythematosus and systemic sclerosis. However, the processes underlying the loss of tolerance against nuclear self-constituents remain largely unresolved. Using mice deficient in lymphotoxin and Hox11, we report that approximately 25% of mice lacking secondary lymphoid organs spontaneously develop specific antinuclear antibodies. Interestingly, we find this phenotype is not caused by a defect in central tolerance. Rather, cell-specific deletion and in vivo lymphotoxin blockade link these systemic autoimmune responses to the formation of gut-associated lymphoid tissue in the neonatal period of life. We further demonstrate antinuclear antibody production is influenced by the presence of commensal gut flora, in particular increased colonization with segmented filamentous bacteria, and IL-17 receptor signaling. Together, these data indicate that neonatal colonization of gut microbiota influences generalized autoimmunity in adult life.

Health Literacy and Perceptions of Stigma.

Calls for progress in health literacy argue that efforts across society are promising for increasing capacities at a broader level. However, it is unknown how the general public perceives people who struggle with health information. While it may be ideal to establish interventions beyond the individual, stigma held by others could limit this work. This study explores whether one's personal health literacy skills are associated with stigma enacted toward others who struggle with health literacy. Adults (N = 5,151) responded to a survey consisting of health literacy assessments and a vignette in which a patient made a health-related mistake. Differences were observed regarding the number of participants who self-reported (n = 251) versus objectively scored as having low health literacy (n = 794). Participants who self-reported (MlowHL = 5.67, MhighHL = 5.99, p < .01) or had low objective health literacy (MlowHL = 5.75, MhighHL = 6.01, p < .001) exhibited less pity for the person in the vignette than health literate participants. Participants were more demanding of a young person featured in the vignette (33-year old), indicating greater personal responsibility (M72 = 5.12, M33 = 5.67), anger (M72 = 4.54, M33 = 5.57), and less pity (M72 = 6.18, M33 = 5.75) compared to an older person (72-year old). Results from the present study suggest contradictory perceptions among patients who are likely to feel stigma themselves.

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons.

BACKGROUND: In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. QUESTIONS/PURPOSES: (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? METHODS: We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. RESULTS: Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, -4; 95% CI, -7 to -1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; mean difference, -2; 95% CI, -4 to -1]; p < 0.001) and condition (2 ± 2 versus 3 ± 3; mean difference, -1; 95% CI, -3 to 0; p = 0.022). Nonwhite patients asked fewer questions than did white patients (5 ± 4 versus 9 ± 7; mean difference, -4; 95% CI, -7 to 0; p = 0.032). No other patient characteristics were associated with the number of questions asked. Surgeons only occasionally (29%; 24/84) asked patients if they had questions during the encounter, but when they did, most patients (79%; 19/24) asked questions. CONCLUSIONS: Limited health literacy is a barrier to effective patient engagement in hand surgery care. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly in practice settings where most decisions are preference-sensitive. Instead of assuming that patients understand what they are told, orthopaedic surgeons may take "universal precautions" by assuming that patients do not understand unless proved otherwise. LEVEL OF EVIDENCE: Level II, therapeutic study.

Applied Grant Writing Training for Future Health Communication Researchers: The Health Communication Scholars Program.

Health communication faculty face increasing expectations regarding their academic productivity, including the expectation to seek and secure external funding. Doctoral training in health communication that does not fully prepare students for the challenges of securing external funding is doing them a disservice that will make them less competitive for academic positions and less likely to succeed in the academic positions they assume. The purpose of this study is to share the evaluation of a program, the Health Communication Scholars Program (HCSP), designed to train future health communication researchers in the pursuit of external funding. The HCSP includes a grant-writing workshop, requires interdisciplinary graduate student teams to submit applications, and awards funding to top proposals. HCSP participants responding to an evaluation survey (N = 25) had overwhelmingly positive experiences; respondents felt the program provided great value, improved their writing skills, gave them skills to pursue funding in the future, and helped them secure tenure-track faculty positions. The results of this formal evaluation suggest the HCSP is an experience that builds crucial skills and prepares graduate students for the demands they will face as faculty. It is a relatively low-cost, replicable model that merits consideration and adoption at other institutions that hope to provide professional development for doctoral students interested in health communication.

Cyberframing Cancer: An Exploratory Investigation of Valenced Cybercoping on Cancer Blogs.

Although scholarship on coping with cancer implies many ways that coping is communicative, the discursive features of coping have been understudied. The purpose of the present investigation was to theorize the content of cancer blogs, a form of cybercoping, by examining valenced coping-relevant frames that bloggers use to describe their experiences with cancer. This research is both theoretically and methodologically innovative. Theoretically, we advance the concept of cyberframing by connecting the rather disconnected literatures on coping and framing and by studying this topic from a communication perspective. Methodologically, this is one of the few studies of coping with cancer that has used naturally occurring communication data to its advantage. A content analysis of cancer blog entries (N = 194) indicated that more than 90% of cancer blog posts were embedded in a valenced frame. The frames were either negative, positive, or balanced; balanced frames varied in the intensity of the valence. The most common frames were positive and balanced with low affect.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Lysophosphatidic acid receptor 5 inhibits B cell antigen receptor signaling and antibody response.

Lysophospholipids have emerged as biologically important chemoattractants capable of directing lymphocyte development, trafficking, and localization. Lysophosphatidic acid (LPA) is a major lysophospholipid found systemically, and its levels are elevated in certain pathological settings, such as cancer and infections. In this study, we demonstrate that BCR signal transduction by mature murine B cells is inhibited upon LPA engagement of the LPA5 (GPR92) receptor via a Gα12/13-Arhgef1 pathway. The inhibition of BCR signaling by LPA5 manifests by impaired intracellular calcium store release and most likely by interfering with inositol 1,4,5-triphosphate receptor activity. We further show that LPA5 also limits Ag-specific induction of CD69 and CD86 expression and that LPA5-deficient B cells display enhanced Ab responses. Thus, these data show that LPA5 negatively regulates BCR signaling, B cell activation, and immune response. Our findings extend the influence of lysophospholipids on immune function and suggest that alterations in LPA levels likely influence adaptive humoral immunity.

Sharing Health Information and Influencing Behavioral Intentions: The Role of Health Literacy, Information Overload, and the Internet in the Diffusion of Healthy Heart Information.

Low health literacy remains an extremely common and problematic issue, given that individuals with lower health literacy are more likely to experience health challenges and negative health outcomes. In this study, we use the first three stages of the innovation-decision process found in the theory of diffusion of innovations (Rogers, 2003). We incorporate health literacy into a model explaining how perceived health knowledge, information sharing, attitudes, and behavior are related. Results show that health information sharing explains 33% of the variance in behavioral intentions, indicating that the communicative practice of sharing information can positively impact health outcomes. Further, individuals with high health literacy tend to share less information about heart health than those with lower health literacy. Findings also reveal that perceived heart-health knowledge operates differently than health literacy to predict health outcomes.