Design and Implementation of a Federal Program to Engage Community Partners to Reduce Disparities in Adult COVID-19 Immunization Uptake, United States, 2021-2022.

Vaccination disparities are part of a larger system of health inequities among racial and ethnic groups in the United States. To increase vaccine equity of racial and ethnic populations, the Centers for Disease Control and Prevention (CDC) designed the Partnering for Vaccine Equity program in January 2021, which funded and supported national, state, local, and community organizations in 50 states-which include Indian Health Service Tribal Areas; Washington, DC; and Puerto Rico-to implement culturally tailored activities to improve access to, availability of, and confidence in COVID-19 and influenza vaccines. To increase vaccine uptake at the local level, CDC partnered with national organizations such as the National Urban League and Asian & Pacific Islander American Health Forum to engage community-based organizations to take action. Lessons learned from the program include the importance of directly supporting and engaging with the community, providing tailored messages and access to vaccines to reach communities where they are, training messengers who are trusted by those in the community, and providing support to funded partners through trainings on program design and implementation that can be institutionalized and sustained beyond the COVID-19 pandemic. Building on these lessons will ensure CDC and other public health partners can continue to advance vaccine equity, increase vaccine uptake, improve health outcomes, and build trust with communities as part of a comprehensive adult immunization infrastructure.

An Innovative Community Health Nursing Virtual Reality Experience: A Mixed Methods Study.

Background: Virtual reality (VR) simulation in nursing education, especially about non-acute care including community health, is an emerging learning strategy; more research is needed about its effectiveness. Purpose: This study aimed to evaluate the effectiveness of an innovative community health nursing VR simulation on prelicensure students' knowledge about social determinants of health and cultural competence, with a goal of enhancing students' preparation for practice. Methods: In a convergent mixed methods study, 100 prelicensure nursing students in a community health nursing course at a Midwestern U.S., urban, public university completed a pretest, a VR simulation, a posttest, and an evaluation. Pre- and posttests containing content questions adapted from leading community health nursing text faculty resources were used to assess learning, and the Simulation Effectiveness Tool-Modified (SET-M) was used to assess perceived effectiveness of the intervention. Results: The majority of participants' posttest scores were higher than their pretest scores. Most participants strongly agreed that the VR simulation was effective, and reported on new knowledge/skills learned, material found most helpful, and benefit to their nursing practice. Conclusions: The community health nursing VR simulation was effective at increasing participants' knowledge and their confidence in their knowledge and abilities.

Parental Perceptions and Perceived Environmental Influences on Active Transport to School in U.S. Inner-City Neighborhoods: Through the Lens of Health Equity.

Physical inactivity remains high amongst Asian American (AA) children. The Safe Routes to School (SRTS) Program is a viable approach for increasing levels of physical activity by encouraging active transport to school (ATS). The objective of this study was to investigate the factors that affect ATS among Asian American children in inner-city schools. An adapted version of the national SRTS survey that measures socio-demographics, environmental factors, and parental perceptions toward school routes and transportation modes were administered in eight public schools in Hamtramck, Michigan. Multinominal logistic regression results indicated that the age of children, distance to school, perceived school encouragement, and parents' perceptions on safety were the predominant factors associated with Asian American children participating in ATS. The study is among the first to investigate underserved environmental and access factors that influence Asian American children's ATS patterns. Particularly, these findings showed that the safety perceptions of parents play a key role in affecting their decisions about ATS and should be considered in future interventions and programming designs to promote ATS.

Challenges and Successes in Health Communication Messaging With Asian Americans.

Asians are the fastest growing racial and ethnic group in the United States, and in Michigan, Asians represent 3.4% of the state's population. Asians have long been aggregated as a homogeneous group and stereotyped as a "model minority." Asians, however, are very diverse, and each subgroup has different values, histories, beliefs, and dialects. The diversity among populations and variations in chronic disease risks demonstrate the importance of disaggregating Asian American ethnicities with respect to health promotion, which must be culturally and linguistically tailored to make the biggest impact. This article describes our challenges and successes in health communication messaging with Asian Americans during the 4 years of our Racial and Ethnic Approaches to Community Health (REACH) Cooperative Agreement.

Utilizing Listening Sessions to Assess COVID-19 Vaccine Acceptance among Asian Americans in Michigan.

SARS-CoV-2 (COVID-19) hospitalizations and deaths have been in the forefront of healthcare and public health for the past two years. Despite widespread vaccinations campaigns, infection rates and serious illness and death remain high among immigrant and minority communities. There are many factors that increase the risk of hospitalization and death, including overall health of the individual as well as environmental and socioeconomic factors. Seven virtual listening sessions with 39 Asian American adults were conducted to assess acceptance of COVID-19 vaccines. Lack of access, confusion on eligibility, distrust of mass vaccination sites, and fear of long-term side effects were primary barriers to vaccine acceptance. Perspectives on the vaccines varied by ethnic groups, with Bangladeshi and Yemeni participants more likely to have negative views. Our findings show that while national statistics of the broad category "Asian" indicate higher COVID-19 vaccination rates than other minority groups, there are Asian ethnic groups that may not follow these trends. These groups are important to prioritize as they may be at increased risk for exposure and severe illness. However, these groups can be difficult to access for reasons such as language barriers and cultural norms. Information from these listening sessions was used to create resources and programs to clarify misconceptions and increase access to COVID-19 vaccines.

Using Community Engagement and Geographic Information Systems to Address COVID-19 Vaccination Disparities.

The COVID-19 pandemic has exacerbated existing health disparities and had a disproportionate impact on racial and ethnic minority groups in the United States. Limited COVID-19 data for Asian Americans have led to less attention for this population; nevertheless, available statistics have revealed lesser known impacts of COVID-19 on this population. Even with significant increases in vaccine supply and recent increases in COVID-19 vaccination rates, racial and ethnic disparities in vaccine uptake still persist. These disparities are amplified for individuals with limited English proficiency (LEP). The purpose of this paper is to apply community-engaged and geographic information system (GIS) strategies to increase equitable access to COVID-19 vaccination uptake by decreasing the structural barriers to COVID-19 vaccine uptake, with a particular focus on Asian Americans with LEP. Building upon existing community-academic partnerships between the academic unit and community-based organizations, the project team established community-led mobile and pop-up COVID-19 vaccination clinics to reach underserved individuals in their communities, worked with commercial pharmacies and reserved appointments for community-based organizations, used GIS to establish COVID-19 vaccination sites close to communities with the greatest need, and deployed trusted messengers to deliver linguistically and culturally relevant COVID-19 vaccine messages which built vaccine confidence among the community members. The implementation of mobile clinics expanded COVID-19 vaccine access and community-driven, multi-sector partnerships can increase the capacity to enhance efforts and facilitate access to COVID-19 vaccination for hard-to-reach populations.

Breast cancer early detection: A phased approach to implementation.

When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.

The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services Among Asian Americans in Michigan during Pre- and Post-Affordable Care Act Implementation.

Since the implementation of the Patient Protection and Affordable Care Act (ACA), significant increases in the percent of insured United States residents has steadily increased. Studies have shown that there is an increase in preventative services usage and a decrease in chronic disease burden with increased access to insurance. However, very little has been studied about how the implementation of ACA has impacted utilization of health services and health status among Asian Americans. In this study, we recruited 427 Asian Americans who attended health fairs and examined (1) changes in health care coverage and utilization of preventive health services before and after ACA, (2) health status on chronic disease risk factors, (3) comparing health services utilization by insurance status and types of insurance, and (4) identifying relationships between health care utilization and demographic factors. Study results indicate that even though the percentage of insured Asian Americans in Michigan increased significantly over study periods, health care utilization and chronic disease burden did not change significantly. The insured tended to utilize preventive health services more than the uninsured, but the types of insurance did not affect health care utilization. Gender and having a primary care physician were significant predictors in determining health care utilization. There is a need in this population for language-appropriate and culturally-sensitive education about the importance and availability of preventive services, which could improve adherence to preventive health services, thereby reducing health disparities.

Developing and evaluating an individually tailored intervention to increase mammography adherence among Chinese American women.

BACKGROUND: Breast cancer consistently is the most commonly diagnosed cancer and the second most common cause of cancer mortality among Asian Americans in the United States. The incidence of breast cancer in Asian American women has been increasing at a much higher rate than in white women. OBJECTIVES: A randomized control single-blind study was conducted comparing the efficacy of an individually tailored telephone counseling and National Cancer Institute brochure. METHODS: The sample consisted of 193 Chinese American women with no breast cancer history. The participants were randomly assigned to either an intervention or a control group. Self-reported data that included demographic variables, knowledge, beliefs, and screening behaviors were collected at baseline and 4 months. RESULTS: The intervention group had increased screening to 40% compared with 33% for the control group at 4 months; the difference was not statistically significant. When the subanalyses were performed, the intervention is effective in certain demographic groups (ie, elderly women aged ≥65 years and recent immigrants). The study intervention was well accepted by participants and perceived as feasible and culturally appropriate based on process evaluation. CONCLUSIONS: The study also demonstrates the feasibility of recruiting and retaining eligible women to participate, and the results show that both study intervention and printed materials increase awareness of the importance of breast cancer screening and screening behaviors for Chinese American women. IMPLICATIONS FOR PRACTICE: Oncology nurses and advanced practice nurses can play critical roles on this medically underserved population that experiences disparities in breast cancer mortality by providing culturally appropriate counseling to promote screening adherence.

A community-based intervention to promote breast cancer awareness and screening among Asian American women.

Cancer is the leading cause of death for Asian Americans, and breast cancer is the leading cancer diagnosed among Asian American women. Despite the alarming facts, Asian American women have low breast cancer screening rates. This study examined the effects of a culturally appropriate community-based breast intervention program on participants' knowledge about breast cancer and intention for screening among Southeast Asian and South Asian women in Michigan. Data were collected from 166 women. At baseline, participants had limited knowledge of breast cancer screening guidelines and misconceptions about the risk factors of breast cancer. After the educational intervention, participants reported significantly higher knowledge scores related to breast cancer and screening recommendations and intentions to obtain follow-up CBE and mammograms. This culturally appropriate intervention provides strategies to overcome personal instructional barriers to meet the needs of this group for early detection and cancer control.

Understanding breast cancer screening practices in Taiwan: a country with universal health care.

While the incidence of breast cancer (BC) has been relatively low in Asian countries, it has been rising rapidly in Taiwan. Within the last decade, it has replaced cervical cancer as the most diagnosed cancer site for women. Nevertheless, there is a paucity of studies reporting the attitudes and practices of breast cancer screening among Chinese women. The aim of this study is to assess Taiwanese women's knowledge of and attitudes toward BC screening and to identify potential factors that may influence screening behavior. The study population consisted of a sample of 434 Taiwanese women aged 40 and older. Despite access to universal health care for Taiwanese women and the fact that a majority of the women had heard of the breast cancer screening (mammogram, clinical breast exams, etc.), the actual utilization of these screening modalities was relatively low. In the current study, the majority of women had never had mammograms or ultrasound in the past 5 years. The number one most reported barriers were "no time, " "forgetfulness, " "too cumbersome, " and "laziness, " followed by the perception of no need to get screened. In addition, the results revealed several areas of misconceptions or incorrect information perceived by study participants. Based on the results from the regression analysis, significant predictors of obtaining repeated screening modalities included age, coverage for screening, barriers, self-efficacy, intention, family/friends diagnosed with breast cancer. The findings from the current study provide the potential to build evidence-based programs to effectively plan and implement policies in order to raise awareness in breast cancer and promote BC screening in order to optimize health outcomes for women affected by this disease.

Ethnicity and cardiovascular risk factors among Asian Americans residing in Michigan.

Asian Americans are at least 4% of the US population, but there are very few studies about the prevalence of cardiovascular risk factors among this group. Cardiovascular disease (CVD) is the leading cause of death among Asian Americans in the United States. Limited research that studied cardiovascular risks among Asian Americans were available, therefore, more information is urgently needed. Cross-sectional surveys and blood tests were conducted at community-based health fairs in southeastern Michigan. A total of 388 Asian participants provided data for this analysis. The results showed that four Asian groups differ in the level of specific risk factors; in particular, the most urgent hypertension and cholesterol problems were found among Chinese and Filipino participants, while the risk of diabetes may be highest among the Hmong participants. The results from the multivariate analysis showed that after controlling for demographic and medical care-related factors in the model, ethnicity is still a significant predictor that contributed to the differences in CVD risks. The results show that cardiovascular and diabetes risks are high in the Asian American populations studied. Attention needs to be paid to the extent and nature of ethnic-specific health problems because each culture's health-related habits and beliefs affect their entry into preventive care so that strategies can be designed and implemented to effectively reduce and ultimately eliminate health disparities.

Demographics and perceptions of barriers toward breast cancer screening among Asian-American women.

OBJECTIVE: The purpose of this study was to identify and compare the differences in perceived barriers for mammography screening among four ethnic groups of Asian-American women. METHODS: Self-administered questionnaires were completed by 315 women in these four groups. RESULTS: The results from the multivariate analyses indicated that even after taking into account insurance coverage and demographic variables, specific barriers still prevent Asian-American women from seeking mammography. DISCUSSION: Recognizing similarities and differences in the barriers among demographic variables such as ethnicity, age, and length of U.S. residency among Asian subgroups can assist health professionals to address their needs when promoting adherence to mammography guidelines.

Psychometric assessment of the Adolescent Physical Activity Perceived Benefits and Barriers Scales.

The purpose of this study was to psychometrically test the Adolescent Physical Activity Perceived Benefits and Barriers Scales developed for middle-school-age youth. A total of 206 racially diverse 6th, 7th, and 8th graders completed questionnaires at two time points (2 weeks apart). For the 10-item Perceived Benefits Scale and the 9-item Perceived Barriers Scale, test-retest reliability (r = .70; r = .71, respectively) and internal consistency (Cronbach's alpha was .80 and .79, respectively, at time 1) were supported. Principal components analysis with Varimax rotation was employed to assess construct validity. A 2-factor solution emerged for each scale as predicted. The relationship between both scale scores and self-reported physical activity provided additional evidence of validity. Both instruments were found to be reliable and valid for measuring the perceived benefits of and barriers to physical activity in middle school youth.

Cultural affiliation and mammography screening of Chinese women in an urban county of Michigan.

The aim of this study is to explore the relationship of culturally based attitudes on breast cancer screening behavior of Chinese women currently residing in the United States. This cross-sectional study used a survey instrument that was administered to a consecutive nonprobability sample of 202 Chinese women residing in an urban Michigan county. Mood's strength of cultural affiliation scale (SCAS) was modified for cultural appropriateness prior to being translated into Chinese, back-translated, and pretested prior to use for this study. Data were analyzed using descriptive, correlational, and multivariate analysis techniques. Statistical analyses revealed that cultural diversity within the Chinese sample was associated with differing health behaviors and that the SCAS had indirect effects, through access to health care, on women's mammography screening use (R2 = 28.3%). These study's findings reveal that cultural affiliation and beliefs are related to the breast cancer screening behavior of immigrant Chinese women.

Reliability and validity of the mammography screening beliefs questionnaire among Chinese American women.

Cancer is the leading cause of death for Asian American women, and the breast is a primary site of cancer in Chinese women. Although a number of studies have used constructs from the Health Belief Model (HBM) to examine their relation to mammogram screening, the validity and reliability of the instruments on HBM constructs among Chinese women have not been consistently examined. The purpose of this study was to describe the psychometric properties of a culturally sensitive questionnaire for measuring Chinese women's beliefs (susceptibility, seriousness, benefits, and barriers) related to breast cancer and mammogram screening. The items developed for the questionnaire were drawn from a comprehensive literature review and focus groups. The instrument was translated using back translation technique and evaluated by a panel of professional experts and lay experts. A total of 220 Chinese American women ages 40 to 85 years residing in a suburban Midwestern community were included in the sample. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. The Cronbach alpha for the subscales ranged from.77 to.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and testing correlations with mammography compliance.

Promoting physical activity among Taiwanese and American adolescents.

The purpose of this paper is to present a comparative analysis of the determinants of physical activity among adolescents in Taiwan and in the United States. Pender's Health Promotion Model (HPM) served as the theoretical framework for both studies (Pender, 1996). The major determinants of health behavior in the HPM are perceived benefits, perceived barriers, self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, and immediate competing demands. In Taiwan, 969 middle school students (55% males; 45% females) from Taipei provided data for the study. In the United States, the sample was collected from 286 late elementary and middle school students (48% males; 52% females). Results showed the gender differences in activity levels were apparent in the youths from both countries. In both Taiwanese and American youths, boys were more active than girls. Cross-cultural differences in the importance of barriers to physical activity emerged. Among Taiwanese adolescents, barriers did not emerge as a significant direct predictor of physical activity as they did among US adolescents. Perceived efficacy directly predicted physical activity among Taiwanese youths while it indirectly predicted physical activity and appeared to be mediated by beliefs regarding exercise benefits and barriers among American youths. In addition, the paths of effect for interpersonal influences were different when Taiwanese and US youths were compared. The findings from this paper have important and culturally-relevant information that can inform future physical activity intervention studies with diverse adolescents.

Determinants of physical activity among Taiwanese adolescents: an application of the health promotion model.

The purpose of this study was to examine the relationships among interpersonal influences (i.e., social support, norms, modeling), behavior-specific cognitions (i.e., self-efficacy, perceived benefits/barriers), competing demands, and physical activity among Taiwanese adolescents (N = 832). The results from structural equation modeling indicated that perceived self-efficacy was the most important predictor of physical activity. Interpersonal influences, when considered in total, had a weak and nonsignificant direct effect on physical activity but had indirect effects on physical activity thorough perceived benefits and perceived self-efficacy. When sources of interpersonal influences were considered separately, parental influences did not have direct effects on physical activity. In contrast, peers did have a significant direct effect on physical activity and also indirect influences on physical activity through perceived self-efficacy. All variables accounted for 30% of the variance in physical activity. Results of this study identify important influences useful to health professionals for promoting physical activity in this population.