The association between lung cancer stigma and race: A descriptive correlational study.

BACKGROUND: Stigma is a formidable burden for survivors of lung cancer that can reduce the quality of life (QOL), resulting in physical, social and psychological challenges. This study investigates associations between stigma and depression, QOL and demographic and health-related characteristics, including race. DESIGN: An adapted conceptual model derived from the Cataldo Lung Cancer Stigma Scale guided this descriptive correlation study assessing stigma in African American and Caucasian survivors of lung cancer. Self-reported, written surveys measuring depression, QOL, lung cancer stigma and demographics were administered. Statistical analysis was conducted to assess associations between stigma and depression, stigma and QOL and stigma and race, while adjusting for demographic characteristics. RESULTS: Participants (N = 56) included 30 Caucasian and 26 African American survivors of lung cancer recruited from a cancer registry of an American College of Surgeons-accredited programme, a survivors' support club and an ambulatory oncology practice in the southeastern United States. Statistical analysis yielded (1) a significant moderate positive association between depression and lung cancer stigma; (2) a significant moderate negative association between QOL and lung cancer stigma; and (3) significant relationships between race and lung cancer stigma, specifically higher degree of stigma among African Americans compared to Caucasians. CONCLUSION: Stigma affects many aspects of survivors' lives. Healthcare professionals need to consider how health-related stigma may further complicate the physical burdens, psychological distresses and social challenges that accompany the disease, especially among African American survivors. Additional enquiry and interventions are needed to assist with mitigating the negative effects of stigma on survivors and their family members and friends. PATIENT OR PUBLIC CONTRIBUTION: Fifty-six survivors of lung cancer participated in this descriptivecorrelation study. They completed written surveys measuring depression, QOL, and lung cancer stigma, plus an investigator-developed demographic information form.

Study protocol: randomised controlled hybrid type 2 trial evaluating the scale-up of two arts interventions for postnatal depression and Parkinson's disease.

INTRODUCTION: Research on the benefits of 'arts' interventions to improve individuals' physical, social and psychological well-being is growing, but evidence on implementation and scale-up into health and social care systems is lacking. This protocol reports the SHAPER-Implement programme (Scale-up of Health-Arts Programmes Effectiveness-Implementation Research), aimed at studying the impact, implementation and scale-up of: Melodies for Mums (M4M), a singing intervention for postnatal depression; and Dance for Parkinson's (PD-Ballet) a dance intervention for Parkinson's disease. We examine how they could be embedded in clinical pathways to ensure their longer-term sustainability. METHODS AND ANALYSIS: A randomised two-arm effectiveness-implementation hybrid type 2 trial design will be used across M4M/PD-Ballet. We will assess the implementation in both study arms (intervention vs control), and the cost-effectiveness of implementation. The design and measures, informed by literature and previous research by the study team, were refined through stakeholder engagement. Participants (400 in M4M; 160 in PD-Ballet) will be recruited to the intervention or control group (2:1 ratio). Further implementation data will be collected from stakeholders involved in referring to, delivering or supporting M4M/PD-Ballet (N=25-30 for each intervention).A mixed-methods approach (surveys and semi-structured interviews) will be employed. 'Acceptability' (measured by the 'Acceptability Intervention Measure') is the primary implementation endpoint for M4M/PD-Ballet. Relationships between clinical and implementation outcomes, implementation strategies (eg, training) and outcomes will be explored using generalised linear mixed models. Qualitative data will assess factors affecting the acceptability, feasibility and appropriateness of M4M/PD-Ballet, implementation strategies and longer-term sustainability. Costs associated with implementation and future scale-up will be estimated. ETHICS AND DISSEMINATION: SHAPER-PND (the M4M trial) and SHAPER-PD (the PD trial) are approved by the West London and GTAC (20/PR/0813) and the HRA and Health and Care Research Wales (REC Reference: 20/WA/0261) Research Ethics Committees. Study findings will be disseminated through scientific peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBERS: Both trials are registered with NIH US National Library of Medicine, ClinicalTrials.gov. The trial registration numbers, URLs of registry records, and dates of registration are: (1) PD-Ballet: URL: NCT04719468 (https://eur03.safelinks.protection. OUTLOOK: com/?url=https%3A%2F%2Fwww.clinicaltrials.gov%2Fct2%2Fshow%2FNCT04719468%3Fterm%3DNCT04719468%26draw%3D2%26rank%3D1&data=04%7C01%7Crachel.davis%40kcl.ac.uk%7C11a7c5142782437919f808d903111449%7C8370cf1416f34c16b83c724071654356%7C0%7C0%7C6375441942616) (date of registration: 22 Jan 2021). (2) Melodies for Mums: NCT04834622 (https://clinicaltrials.gov/ct2/show/NCT04834622?term=shaper-pnd&draw=2&rank=1) (date of registration: 8 Apr 2021).

Exploring practitioner and policymaker perspectives on public health approaches to address Adverse Childhood Experiences (ACEs) in South Carolina.

OBJECTIVE: We examined the perspectives of child and family-serving professionals (CFSP) and state policymakers on protective factors to develop policy and program recommendations including current and needed approaches for addressing ACEs. METHODS: In 2018, we conducted semi-structured, in-depth interviews with 23 CFSP and 24 state policymakers in South Carolina. Data were analyzed applying the Multiple Streams Theory using thematic analyses. RESULTS: CFSPs and policymakers had varying opinions on state government involvement and primary prevention for ACEs. Three protective factors emerged from their perspectives: 1) loving, trusting, and nurturing relationships; 2) safe home environments; and 3) opportunities to thrive. For each of these protective factors, participants suggested policy options that support existing community efforts, attempt to alleviate poverty, and improve child and family serving systems. CONCLUSION: This study suggests that CFSPs and policymakers recognize the importance of protective factors in a child's life to buffer the effect of ACEs. More awareness is needed about the feasibility and significance of primary prevention of ACEs. The study's findings can be used to strengthen advocacy priorities for a wide range of public health outcomes associated with ACEs and help further bridge the gap between research and policy.

Addressing Health and Well-Being Through State Policy: Understanding Barriers and Opportunities for Policy-Making to Prevent Adverse Childhood Experiences (ACEs) in South Carolina.

PURPOSE: As adverse childhood experiences (ACEs) become increasingly recognized as a root cause of unhealthy behaviors, researchers, practitioners, and legislators seek to understand policy strategies to prevent and mitigate its effects. Given the high prevalence of ACEs, policies that address ACEs can meaningfully prevent disease in adulthood and improve population health. We sought to understand barriers and opportunities for policies to prevent and mitigate ACEs by exploring state legislator perspectives. SETTING AND PARTICIPANTS: Twenty-four current state legislators in South Carolina. DESIGN: In 2018, we conducted semistructured interviews with 24 state legislators. Participants were recruited using maximum variation sampling. The researchers individually analyzed each interview transcript using focused coding qualitative techniques. A high inter-rater agreement was demonstrated (κ = .76 to .87), and discrepancies were resolved through discussion. METHOD: The data collection and analysis were guided by Multiple Streams Theory, which identifies 3 key components (attention to the problem, decisions about policy options, and the impact of political landscape) that can lead windows of opportunity for passing policies. RESULTS: Legislators identified several factors that can influence the passage of legislation on ACEs: awareness of ACEs; gaps in understanding about what can be done about ACEs; the use of data and stories that contextualize the problem of ACEs; capitalizing on the bipartisanship of children's issues; and linking to current ACEs-related issues on the policy agenda, such as school safety and violence prevention and the opioid epidemic. CONCLUSION: Public health researchers and practitioners should focus on the factors identified to advocate for policies that prevent ACEs and/or address their health consequences.

Impact of the Terms "Regular" or "Pasable" as Spanish Translation for "Fair" of the Self-Rated Health Question Among US Latinos: A Randomized Experiment.

Objectives. To examine measurement comparability of a Spanish version of self-rated health (SRH) with pasable as an alternative to regular for the response category "fair" in the English version.Methods. We translated "fair" into 2 Spanish versions: regular and pasable. We implemented a split-half experiment in 3 surveys independently conducted from October 2015 to January 2016, from April to November 2016, and from August to November 2017. Within each survey, we randomly assigned Spanish-interviewed Latino respondents to 1 of the 2 SRH versions. The total sample included 3261 Latino and 738 non-Latino White adults in the United States.Results. Spanish-interviewed Latinos reported substantively more favorable health on SRH with pasable than with regular. When pasable instead of regular was used for SRH, we observed a larger difference between respondents reporting positive versus negative SRH on objective health measures, including the frequency of doctor's visits. Furthermore, when we accounted for correlates of health, Latino-White disparities were attenuated with pasable.Conclusions. We recommend using pasable instead of regular for SRH Spanish translations to improve measurement equivalence in cross-lingual and cross-cultural research.

Development of a Bidimensional Simpatía Scale for Use With Mexican American, Puerto Rican, and Cuban American Adults.

BACKGROUND: Through its influence on social interactions, simpatía may have a wide-ranging influence on Latinx health. Simpatía-which does not have a direct English translation-refers to being perceived as likeable, pleasant, and easygoing. Research to investigate the influence simpatía on Latinx health is limited, likely due to a lack of options for measuring simpatía among diverse Latinx populations. OBJECTIVES: The goal of this research was to develop a bilingual, survey-based simpatía scale for use among ethnically diverse Latinx adults in health-related settings. METHODS: Data were obtained through a telephone survey data of 1,296 Mexican American, Puerto Rican, and Cuban American adults living in the United States. Interviews were conducted in English and Spanish. Exploratory factor analysis, item response theory analysis, confirmatory factor analysis, and computation of estimates of internal consistency reliability were conducted to inform the development of the final simpatía scale. RESULTS: Results indicate that the final, nine-item, simpatía scale has high internal consistency (α = .83) and measurement invariance among Mexican American, Puerto Rican, and Cuban American adults. Two dimensions were identified, as indicated by a perceptions subscale and a behavior subscale. Cuban Americans were found to have the highest simpatía scores, followed by Puerto Ricans and Mexican Americans. DISCUSSION: Culture is often identified as a powerful potential influence on health-related behaviors, but measures are often not available to assess specific cultural traits. By developing a new tool for measuring simpatía, this research advances opportunities for understanding and promoting Latinx health.

An Experimental Test of the Two-Dimensional Theory of Cultural Sensitivity in Health Communication.

Based on a theoretical framework describing culturally sensitive (CS) health communication, this experiment tested the relative contributions of surface structure and deep structure in the recall of oral health information from pamphlets varied in written message and images. Using a 2 × 2 factorial design, Spanish-speaking Mexican heritage mothers of children under six (n = 160) were randomly assigned to read one of four 12-page pamphlets containing the same oral health information in Spanish: (1) standard written message/standard images; (2) standard written message/CS images; (3) CS written message/standard images; and (4) CS written message/CS images. Participants completed a 22-item oral health knowledge questionnaire before and after reading the pamphlet. Controlling for the effects of pretest scores, acculturation, and educational level on information recall, findings showed significant positive main effects for CS images (F(1, 152) = 5.03, p = .026, partial ŋ2 = .032) and CS written message (F(1, 152) = 5.21, p = .024, partial ŋ2 = .033). There was no interaction. These results support the two dimensions of CS and their independent effects. They should be applicable to a variety of health communication channels. Further research is needed to investigate the causal mechanism behind the observed effects.

An Exploration of How Mexican American WIC Mothers Obtain Information About Behaviors Associated With Childhood Obesity Risk.

OBJECTIVE: To explore how a sample of Mexican American mothers with preschool-aged children recruited from a Midwestern Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic obtained information about 4 behaviors associated with childhood obesity risk: eating, physical activity, screen time, and sleep. DESIGN: One-on-one structured interviews in which participants were asked how they communicated with family, learned to take care of their first infant, and obtained information about the 4 targeted behaviors for their preschool-aged child. SETTING: An urban WIC clinic in the Midwest. PARTICIPANTS: Forty Mexican-descent mothers enrolled in WIC with children aged 3-4 years. PHENOMENON OF INTEREST: Exposure to information about the 4 targeted behaviors among Mexican-descent mothers participating in WIC. ANALYSIS: Quantitative and qualitative data were used to characterize and compare across participants. RESULTS: Participants primarily obtained information from their child's maternal grandmother during their first child's infancy and from health professionals for their preschool-aged child. Participants typically obtained information through interpersonal communication, television, and magazines. Participants were most interested in healthy eating information and least interested in screen time information. Some participants did not seek information. CONCLUSIONS AND IMPLICATIONS: Participants engaged in different patterns of information seeking across their child's development and the 4 behaviors, which suggests that future research should be behaviorally specific. Findings from this study suggest several hypotheses to test in future research.

A Tale of Two Stories: An Exploration of Identification, Message Recall, and Narrative Preferences Among Low-Income, Mexican American Women.

Additional research is needed to guide the design of narratives for use in practice-oriented, naturalistic settings to maximize health behavior change, particularly among populations affected by health disparities. This mixed-methods study explored the influence of cultural tailoring and emotional arousal on identification and message recall in narratives promoting childhood obesity prevention among 40 Mexican American mothers. Participants were also asked about narrative exposure, narrative preferences, and beliefs about the purpose of a story. Participants were randomly assigned to listen to two stories: (a) a story tailored on noncultural or cultural variables, and (b) a story designed to enhance or minimize emotional arousal. Participants reported high engagement and identification with all stories. Participants generally envisioned protagonists as Latina, despite limited cues, and identified with protagonists in four ways: sharing personal characteristics; having similar thoughts and feelings; engaging in similar actions; and experiencing similar situations. Mothers were most interested in narratives that helped them to improve their lives. Findings from this study yield several hypotheses for consideration in future study, including ways in which story setting and message enactment may moderate message recall.

Eat, play, view, sleep: Exploring Mexican American mothers' perceptions of decision making for four behaviors associated with childhood obesity risk.

OBJECTIVE: This mixed methods study sought to understand who makes decisions about whether preschool-aged Mexican American children engage in eating, outdoor play, sleep, and screen time behaviors. METHODS: Forty Mexican American mothers of children ages 3-4 participated in two interviews, during which both closed- and open-ended questions elicited perceptions of who made decisions for the four behaviors, as well as who was present, mealtime rules, and food choice values. Interviews were transcribed, coded for emergent themes, and compared across participants. RESULTS: Participants generally perceived themselves to be primary decision makers for all four behaviors; however, food decisions often seemed to be made collaboratively with the child. Fathers were most likely to participate in evening television decisions. Other family members were rarely mentioned. Selecting foods that children liked was a strong food choice value, while cost was rarely mentioned. Participants appeared to have low perceived control over their child's behaviors relative to their perceived roles in decision making. CONCLUSIONS: Mothers may be the primary audience for obesity prevention messages for preschool-aged, Mexican American children; however, health promotion programs may need to increase mothers' awareness of their control over children's behaviors. Understanding how children's behaviors are regulated is an important aspect of obesity prevention for low-income, Mexican American children.

Predictors of Patients' Intentions to Participate in Incident Reporting and Medication Safety.

BACKGROUND: To date, there is a paucity of theory-driven research on the likely determinants of patient involvement in safety-relevant behaviors. In particular, very little work has focused on predictors of patient behaviors that do not involve direct interactions with health-care staff. OBJECTIVE: To examine predictors of patients' intentions to engage in 2 safety behaviors: (1) reporting an error to a national reporting system and (2) bringing medicines into hospital. DESIGN: Cross-sectional survey study. PARTICIPANTS: Eighty medical and surgical hospital inpatients aged 18 to 80 years (mean, 48 years) from one inner city London teaching hospital. METHOD: Survey that measured the utility of constructs of the health belief model and theory of planned behavior in predicting patients' intentions to report an error to a national reporting system or to bring their medications into hospital. Data were analyzed using multiple regression analysis. RESULTS: Control beliefs were the strongest predictors of patients' intentions. Normative beliefs were also a strong predictor of intentions to report an error to a national reporting system. The regression model accounted for smaller percentage of the variance in patients' intentions to bring medications into hospital than to report an error to a national reporting system (37% and 48%, respectively). CONCLUSIONS: Interventions aimed at encouraging the participation of patients in promoting their own safety should consider the extent to which patients feel in control and capable of performing the behavior in question; this will help support patients to work with health-care professionals in ensuring safe care.

Hospital patients' reports of medical errors and undesirable events in their health care.

OBJECTIVE: To investigate hospital patients' reports of undesirable events in their health care. DESIGN: Cross-sectional mixed methods design. PARTICIPANTS: A total of 80 medical and surgical patients (mean age 58, 56 male). INTERVENTION: Patients were interviewed post-discharge using a survey to assess patient reports of errors or problems in their care. Patients' medical records and notes were also reviewed. MAIN OUTCOME MEASURES: Frequency of health care process problems, medical complications and interpersonal problems, and patient willingness to report an undesirable event in their care. RESULTS: In total, 258 undesirable events were reported (rate of 3.2 per person), including 136 interpersonal problems, 90 medical complications and 32 health care process problems. Patients identified a number of events that were reported in the medical records (30 out of 36). In addition, patients reported events that were not recorded in the medical records. Patients were more willing (P < 0.05) to report undesirable events to a researcher (as in the present case) than to a local or national reporting system. CONCLUSION: Patients appear able to report undesirable events that occur in their health care management over and above those that are recorded in their medical records. However, patients appear more willing to report these incidents for the purpose of a study rather than to an established incident reporting system. Interventions aimed at educating and encouraging patients about incident reporting systems need to be developed in order to enhance this important contribution patients could make to improving patient safety.

A new audience segmentation tool for African Americans: the black identity classification scale.

Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n = 306). The final scale then was administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS also was explored by comparing participants' responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.

Ethnic Identity predicts loss-to-follow-up in a health promotion trial.

BACKGROUND: Higher rates of attrition in health research have been reported for African Americans (AAs). However, little is known about which AAs are more prone to drop out and why. One potential predictor that has not been explored is Ethnic Identity (EI). This study examined the association between EI and loss-to-follow-up among AAs enrolled in a health promotion intervention to increase fruit and vegetable intake. METHODS: Five hundred and sixty AA adults from two integrated health care delivery systems in Atlanta and Detroit were enrolled into a randomized intervention trial. At baseline, all participants were classified into six EI core groups: Afrocentric, Black American, Bicultural, Multicultural, Assimilated, and High Cultural Mistrust. We examined loss-to-follow-up rates by these EI type. RESULTS: Overall, 92 participants (16%) were lost to follow up. Loss-to-follow-up rates were higher among those classified as Afrocentric (24%) than those without an Afrocentric identity (13%). After adjustment for covariates, Afrocentric participants were 1.9 times (CI: 1.1-3.6) more likely to be lost to follow up than participants without this identity type. CONCLUSIONS: Assessing EI of AAs in research studies may help identify groups at risk for dropout and/or non-response.

Challenges in researching racially sensitive topics in HMOs.

When research designed to close the disparities gap is conducted in real-world health care settings, unique sensitivities may arise, particularly when race is the focus of interventions. Researchers encountered this issue in the course of a randomized trial investigating the influence of ethnic identity (EI) among African American (AA) study participants. The study was conducted by the research programs at three health maintenance organizations (HMOs) and the University of Michigan Center for Health Communications Research, as described in this issue of the journal (Resnicow et al., 2009). This commentary describes the research partnership's concerns for the racially sensitive nature of the study and the precautions undertaken to mitigate them. The research study's experiences may be informative and insightful for health plans and research centers invested in health disparities research.

Tailoring a fruit and vegetable intervention on novel motivational constructs: results of a randomized study.

BACKGROUND: Tailored health communications to date have been based on a rather narrow set of theoretical constructs. PURPOSE: This study was designed to test whether tailoring a print-based fruit and vegetable (F & V) intervention on relatively novel constructs from self-determination theory (SDT) and motivational interviewing (MI) increases intervention impact, perceived relevance, and program satisfaction. The study also aimed to explore possible user characteristics that may moderate intervention response. METHODS: African American adults were recruited from two integrated health care delivery systems, one based in the Detroit Metro area and the other in the Atlanta Metro area, and then randomized to receive three tailored newsletters over 3 months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was tailored on SDT and MI principles and strategies. The primary focus of the newsletters and the primary outcome for the study was fruit and vegetable intake assessed with two brief self-report measures. Preference for autonomy support was assessed at baseline with a single item: "In general, when it comes to my health I would rather an expert just tell me what I should do". Most between-group differences were examined using change scores. RESULTS: A total of 512 (31%) eligible participants, of 1,650 invited, were enrolled, of which 423 provided complete 3-month follow-up data. Considering the entire sample, there were no significant between-group differences in daily F & V intake at 3 month follow-up. Both groups showed similar increases of around one serving per day of F & V on the short form and half a serving per day on the long form. There were, however, significant interactions of intervention group with preference for autonomy-supportive communication as well as with age. Specifically, individuals in the experimental intervention who, at baseline, preferred an autonomy-supportive style of communication increased their F & V intake by 1.07 servings compared to 0.43 servings among controls. Among younger controls, there was a larger change in F & V intake, 0.59 servings, than their experimental group counterparts, 0.29 servings. Conversely, older experimental group participants showed a larger change in F & V, 1.09 servings, than older controls, 0.48. CONCLUSION: Our study confirms the importance of assessing individual differences as potential moderators of tailored health interventions. For those who prefer an autonomy-supportive style of communication, tailoring on values and other motivational constructs can enhance message impact and perceived relevance.