Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort.

INTRODUCTION: Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) - the largest maternal tobacco cessation program in San Bernardino County, California - to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. METHODS: During 2012-2019, women who smoked during pregnancy were enrolled in CTTP's multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). RESULTS: We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. DISCUSSION: Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program.

Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study.

BACKGROUND: The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters. AIMS: To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices. METHOD: Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ±â€¯8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices. RESULTS: 66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (ß = 0.359, p = 0.004) as the strongest determinant, followed by attitude (ß = 0.195, p = 0.093), and perceived behavioral control (PBC) (ß = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (ß = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (ß = 0.636, p < 0.001) on future PPP implementations. DISCUSSION: This study demonstrates utility of the TPB in predicting implementation of PPPs. CONCLUSIONS: Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.

Maternal request caesareans and COVID-19: the virus does not diminish the importance of choice in childbirth.

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections (MRCS) as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people's health and autonomy in childbirth and argue that this remains crucial during the current emergency. We consider some potential arguments-based on pregnant people's health and resource allocation-that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital's ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances.

Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes.

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

Contributions of Public Health Social Work Students to Their Professions and Communities.

In the contemporary public health workforce environment, public health social workers (PHSW) bring integrated skills, from both fields, to meet the needs of vulnerable and underserved populations. They receive training in their Master of Public Health/Master of Social Work dual-degree programs, such as the one at New Mexico State University, which serves the U.S./Mexico border region. During their studies, dual-degree students are equipped to address health and human service issues at the micro, mezzo, and macro levels and complete field experience and practicum hours in their communities. Along with practical skills, these students learn culturally responsive/humble ways of being with communities of color and marginalized individuals. After graduation, these emerging career PHSWs enter the workforce in a variety of settings: nonprofit, educational, government, primary care, and more. In this article, the field of public health social work is described in its historic and present forms, followed by PHSWs' utility to the U.S./Mexico border region, in particular. Finally, we make the call to action for future career PHSWs to engage with this integrated, dynamic, innovative field, and its unique combination of community- and individual-based services and rewards.

Perceptions of organizational readiness for training and implementation of clinic-based community health workers.

PURPOSE: The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models. DESIGN/METHODOLOGY/APPROACH: A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software. FINDINGS: CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations. ORIGINALITY/VALUE: Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration.

Patient and Community Health Worker Perceptions of Community Health Worker Clinical Integration.

Traditional community health workers (CHWs) are expanding their role into clinical settings (cCHW) to support patients with care coordination and advocacy services. We investigated the potential to integrate cCHWs, via evaluation of patients' and CHWs' key demographics, needs, and abilities. This mixed-methods study, including adult patients and CHWs, was conducted in the Inland Valley of Southern California, between 2016 and 2017. Survey data, key informant interviews, and focus group discussions were evaluated to compare patient/CHW core demographics, and contrast patient-identified healthcare needs against CHW-identified cCHW service capabilities. Quantitative data were evaluated descriptively and bi-variably using two-sample independent t tests and Pearson's Chi square tests. Qualitative data were coded for emerging themes using a priori and standard grounded theory methods. Patients and CHWs were significantly similar in age, education, and income, but significantly differed in gender, race, United States generation, and marital status. For all healthcare-related services in which patients and CHWs exhibited significant differences, the odds CHWs perceived themselves capable of performing services were greater than patients' stated need of services. Patients and CHWs overlapped regarding their expectations of cCHWs. Although patients and CHWs differed somewhat, they shared many of the same expectations for cCHW integration. This information is critical to further contextualize cCHW training programs and emphasizes the need to education patients about this exciting new form of healthcare delivery. The active role of cCHWs in the clinical care team and the community may expand patient access to preventive healthcare, improve care quality, and minimize health inequities.

Survey of new Mexico school health professionals regarding preparedness to support sexual minority students.

BACKGROUND: For schools to be safe and supportive for students, school health professionals should be aware of the particular challenges lesbian, gay, bisexual, transgender, or questioning (LGBTQ) students face, especially the risk for discrimination, violent victimization, and depression in the school setting. We assessed school health professionals' preparedness to address needs of LGBTQ students. METHODS: We conducted a secondary analysis of data collected during a New Mexico school health conference. This analysis focused on the preparedness of 183 school nurses, counselors, and social workers to address needs of LGBTQ students. Data were analyzed by using chi-square tests, other non-parametric tests, and logistic regression. RESULTS: Social workers (84.6%) and counselors (81.5%) were more likely than school nurses (55.8%) to report moderate or high knowledge of LGBTQ youth health risks, including suicide and depression (p < .001). Approximately half of school counselors and social workers reported no or low knowledge of LGBTQ community-based organizations or knowledge of counselors experienced with LGBTQ concerns. CONCLUSION: School health professionals in New Mexico do not appear prepared to address needs of LGBTQ students. Schools should consider integrating specific content about LGBTQ health risks and health disparities in trainings regarding bullying, violence, cultural competency, and suicide prevention.

Immigration status, acculturation, and dating violence risk for Hispanic adolescent girls in New Mexico.

Little data exist on dating violence experienced by immigrant Hispanic adolescents. The present study examined the relationships between immigration status, language spoken at home, and dating violence experienced by Hispanic adolescent girls in New Mexico. Data from the 2007 New Mexico Youth Risk and Resiliency Surveys were analyzed. Adjusted logistic regression analyses were conducted among the full sample of Hispanic females (N = 3,412) and among strata based on immigration status. Immigrant Hispanic girls were as likely as non-immigrant Hispanic girls to have experienced dating violence in the prior year (P = 0.93). Among immigrant Hispanic girls, those who were Non-English-dominant were one-fourth as likely to have experienced dating violence as those immigrant girls who were English-dominant (aOR 0.27 [95% CI 0.08-0.87]). Among US-born Hispanic girls, those who were Non-English-dominant were less likely to have experienced dating violence; however, this value did not reach statistical significance (aOR 0.65 [95% CI 0.33-1.27]). Past sexual experience was a significant risk factor for dating violence for US-born Hispanic girls (aOR 4.99 [95% CI 3.18-7.83]) but not for immigrant Hispanic girls (aOR 1.66 [95% CI 0.63-4.43]). Immigrant status was not found to be protective against dating violence for New Mexico Hispanic girls. However, those immigrant girls who were less acculturated in terms of language used at home were found to have only a quarter of the risk of dating violence as those more acculturated. The use of heritage language by immigrant Hispanic girls may be a protective factor against dating violence. Further studies are indicated to confirm this finding.