How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency.

BACKGROUND: Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women's experiences negotiating for their first job out of residency to ascertain women's engagement with and approach to the negotiation process. METHODS: We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach. RESULTS: Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants' inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households. CONCLUSION: To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency.

Building Sustainable Community-Academic Partnerships while Implementing a Nutrition-Based Blackberry Garden Program at a Senior Center.

Due to limited access to and consumption of fruits and vegetables, older adults are at increased risk of worsening or developing chronic diseases. This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center. Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior center, Cooperative Extension Service, and a detention center. Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team suggested strategies to promote project longevity.

Community Forum Identifies Opportunities to Engage with Eastern Kentucky Community Leaders about Chronic Disease and Environmental Pollution.

The NIEHS-sponsored Appalachian Health & Well-Being Community Forum held in Eastern Kentucky brought various community members together to communicate and establish better coordination of efforts to improve health and address regional environmental issues. The two-hour forum discussion provided bi-directional feedback about the needs and interests of community members. Top concerns of community members included obesity and obesity-related diseases and environmental pollution. Healthful lifestyles were identified as part of the remedy to protect health from potential adverse health effects associated with environmental pollution. This study highlights opportunities to engage with Appalachian communities around topics related to health and environmental pollution.

Nutrition and Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors and Environmental Health Literacy.

Kentucky experiences some of the nation's worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the Commonwealth is home to 13 hazardous waste sites included in the United States Environmental Protection Agency Superfund National Priorities List (NPL). The NPL highlights priority sites for long-term remedial action to reduce environmental contaminants. To enhance the understanding of environmental health and protective actions, the University of Kentucky Superfund Research Center Community Engagement Core developed a 9-lesson extension curriculum "Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle" (Body Balance) and partnered with Kentucky's Family and Consumer Sciences (FCS) Cooperative Extension Service to pilot the curriculum in Kentucky communities. FCS agents in 4 Kentucky counties delivered the Body Balance pilot study (18-31 participants per lesson). Pre- and post-lesson questionnaires revealed increased knowledge and awareness of the effects of environmental pollution on health and the protective role of dietary strategies. Focus group participants (n = 18) self-reported positive behavior changes because of increases in knowledge and leadership from their FCS agent. The Body Balance curriculum appeared to be a promising mechanism for raising environmental health and diet knowledge, as well as for promoting positive behavior changes among white, middle/older-aged women in rural Kentucky communities.

Breastfeeding Practices among Native Hawaiians and Pacific Islanders.

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI.