Immigrant and Refugee Explanatory Models of Chronic Disease: Provider "Learning Up" for Culturally Responsive Care.

Immigrant and refugee populations in North Carolina bring with them traditionally based explanatory models (EMs) of disease that influence health care interactions. Providers who encounter these models are often challenged with how best to leverage them for prevention outreach and care. Participation in "learning up" opportunities increases provider awareness and capacity for cultural responsiveness when dealing with immigrant and refugee clients.

Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

PURPOSE: The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. METHODS: This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. RESULTS: Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. CONCLUSIONS: In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Using Community-Based Participatory Research to Characterize Health and Lifestyle Behaviors of Montagnards, a Refugee-Origin Asian-American Subgroup.

Montagnards, an indigenous multitribal refugee-origin population concentrated in North Carolina, remain an invisible, medically underserved, and socioeconomically underrepresented Asian American sub-group. Yet this group is resilient, with language diversity, rich cultural traditions and family caregiving in multigenerational households. Using community-based participatory research methods, we developed and administered a two-part survey to 144 Montagnard adults, documenting socioeconomic characteristics, health indicators and lifestyle behaviors. Forty-one percent of participants had no formal education, 76% had little/no English proficiency and 28% described having a very hard time paying their bills. Seventy-seven percent were overweight per BMI category, 79% had elevated blood pressure and 100% scored high for significant depressive symptoms. Participants reported high levels of physical inactivity and daily dietary intake of MSG. However, Montagnards reported limited tobacco and alcohol use, a diet of fresh vegetables and rice, and regular church attendance. These represent protective lifestyle behaviors and targets for culturally responsive health interventions.

"The Wheel of My Work": Community Health Worker Perspectives and Experiences with Facilitating Refugee Access to Primary Care Services.

Purpose: Community health workers (CHWs) are trusted community leaders and public health workers dedicated to promoting the health and well-being of community members. CHWs, who share similar language and culture, work with refugee communities that are often missed in traditional U.S. health systems. CHWs help refugees gain access to health care through culturally appropriate strategies. However, the scope of their study as cultural brokers with regard to refugee health access is largely unknown in the peer-reviewed literature. This qualitative research study used a constructivist grounded approach to examine the extent to which CHWs helped refugee clients gain access to the health care system. Methods: Data were collected through interviews with a purposeful sample of 10 CHW participants affiliated with a primary care access program in Greensboro, North Carolina. Results: The diagram derived from this study provided a schema that allowed for an improved understanding of CHW perspectives and experiences when connecting refugee clients to the health care system. Conclusions: Further research incorporating CHW voices is recommended because CHWs are instrumental in improving the health and well-being of refugees.

Challenges for Non-COVID Patients with Chronic Kidney Disease in Bangladesh: An Observation during Coronavirus Disease Pandemic.

The coronavirus disease pandemic has created a crisis for patients with chronic kidney disease, as far as getting treatment facilities are concerned. The crisis is more intense in developing countries where the health system is more vulnerable due to poor infrastructures and insufficient health professionals. Bangladesh, being a developing nation, is also facing similar challenges to provide sufficient services to patients with chronic kidney disease. In this short report, we have discussed the challenges and barriers non-COVID chronic kidney disease patients are facing in terms of healthcare access along with getting proper medical interventions and suggested probable strategies to minimize the suffering.

Pattern of antibiotic use for acute respiratory infections among out-patients in South Asian Region: Protocol for a systematic review.

BACKGROUND: South Asian region has been experiencing the increasing burden of antimicrobial resistance (AMR) primarily due to over and irrational prescribing of antibiotics. Acute respiratory infections (ARIs) are the leading cause of out-patients' visits in the region. Despite commonly known viral aetiology, ARI is the single largest reason for antibiotic prescriptions contributing the exponential growth of AMR in the region. Collated data on antibiotic consumption for ARI at outpatients and resistance pattern of respiratory pathogen are lacking in the region. METHODS: MEDLINE, Cochrane, CINAHL Plus (EBSCO), and Web of Science will be searched for eligible papers. Titles and abstracts, and full texts of the relevant studies will be screened by 2 independent reviewers against the inclusion criteria. Data extraction and quality of the studies will be assessed by 2 reviewers independently using the JBI Critical Appraisal Tools. A third reviewer will resolve any disagreement at any point between 2 reviewers. RESULTS: The review will assess proportions of ARI patients receiving antibiotic therapy and types of antibiotics prescribed among outpatients of all ages in South Asia. This review will also assess the pattern of antimicrobial resistance among respiratory pathogens causing ARI in the region. CONCLUSIONS: This systematic review will evaluate published literature, summarize the existing data on the antibiotic prescribing patterns for outpatients with ARI in South Asia. The holistic finding of the proportion of patients receiving antibiotic therapy for ARI, proportion of different types of antibiotic received, and resistance against respiratory pathogen might guide future research. This underscores a need for formulating regional and national policy for AMR mitigation strategy, and revising clinical practice guidelines for the clinician to ensure rational use of antibiotics for ARI. PROSPERO: registration no: CRD42018116658.

Fostering Inclusion through an Interinstitutional, Community-Engaged, Course-Based Undergraduate Research Experience.

Creation of an inclusive environment requires a culture of equity, justice, value and respect for diverse backgrounds, and opportunities for students to engage with communities while addressing issues in science and society. These tasks are particularly challenging for institutions lacking a diverse population. Here, we demonstrate evidence of a successful model for creating an inclusive environment in an interinstitutional course between a large, public, historically black institution and a small, private, primarily white institution. Because many individuals from underrepresented minority groups tend to value communal goals of working together and helping their communities, we incorporated two high-impact practices of community-engaged learning and course-based undergraduate research experiences (CUREs) focused on health disparities research in neighboring communities. Although the research projects varied each semester, they were linked by their impact on and engagement with the community. Students practiced cultural competency skills in both small group projects within the class and engagement activities in the community. We measured the efficacy of CURE components (novel authentic research, scientific process skills, iteration, collaboration, and broader impact) through a combination of direct and indirect assessments, quantitative and qualitative analysis. More than simply scientific skills, students from both institutions developed lasting interest in working with diverse populations as well as respecting and valuing different backgrounds. This inclusive environment, combined with increased interest in research, suggests that this course could potentially serve as a model for interinstitutional collaborations in creating inclusive environments that support the future success of diverse students, eventually changing the STEM research culture.

When Community Calls, We Collaborate! Community-Based Participatory Research With the Multilanguage Montagnard Refugee Community.

BACKGROUND: Montagnard refugees, an indigenous multilingual tribal people from Vietnam, experience lifestyle changes and post-resettlement challenges in the United States that contribute to chronic health conditions. Foundational research and health data are lacking. OBJECTIVES: We describe the Montagnard Hypertension Study, a community-based participatory research (CBPR) project documenting chronic disease risk. METHODS: We developed a Montagnard dictionary of hypertension-specific terminology and conducted two focus group discussions (FGD), 131 biological assessments (blood pressure, height, weight, waist circumference, scalp hair and saliva sample collection), and 127 behavioral surveys. We implemented two health fairs that offered services to the community. LESSONS LEARNED: This is the first study to examine chronic disease using a CBPR framework for Montagnard health. We highlight lessons learned specific to constituents and their capacities, historical and current conflicts, and the iterative processes in CBPR design. CONCLUSIONS: CBPR is a practically achievable approach to studying chronic disease risk within indigenous, tribal communities, with implications for future research with Asian American subgroups and other minority populations.

Beneficioso y Una Prioridad: Latina Women's Perceptions about HIV Testing.

OBJECTIVES: Studies indicate a higher rate of HIV infection among Latinos in the United States, and a pattern of later testing associated with poorer disease management, greater risk of spreading infection, and higher death rates. Thus, it is imperative to generate culturally holistic strategies to improve HIV testing among Latina women. METHODS: We surveyed 182 Latina women in the southeastern US. We cross-tabulated demographic, social, and experiential factors of women who have taken a previous HIV test with women who have not yet been tested. We examined key comparisons between these women in terms of socio-demographic characteristics, sources of information about HIV testing, and responses to questions that identify factors enabling women to take an HIV test. RESULTS: Our results indicate that Latina women perceive HIV testing as worthwhile, beneficial, and a priority for them. They demonstrate the importance of family networks, trusted and bilingual service providers, and known test locations associated with higher percentages of women taking the HIV test. CONCLUSIONS: The results provide input to community health advocates to identify women who need additional support to take an HIV test.

Community Health Advocate-Identified Enablers of HIV Testing for Latina Immigrant Women.

This study aims to identify enablers or facilitators of HIV testing among Latina immigrant women through qualitative interviews with five community health advocates (CHAs). CHAs act as cultural bridges between Latinos and service providers. We employed a single case-study design using the PEN-3 model as a conceptual framework for situating HIV testing behaviors within cultural and structural contexts of Latina immigrant women's lives. A cross-case analysis of themes revealed that intrinsic enablers of HIV testing included individual trust, confidentiality, intergenerational family participation, and peers. The extrinsic enablers were local community outreach, bicultural/bilingual testing staff, service location and mass media outlets. These results have implications for the cultural competency of health and social service providers, instituting and revising HIV testing outreach interventions, and the earlier identification of women who may have been infected. They offer important insights for promoting other health behaviors among the Latino communities.

Does Neighborhood Risk Explain Racial Disparities in Low Birth Weight among Infants Born to Adolescent Mothers?

STUDY OBJECTIVE: To test associations and interactions between racial identification, neighborhood risk, and low birth weight disparities between infants born to African-American and white adolescent mothers. DESIGN: Retrospective cross-sectional study. Birth cases were geocoded and linked to census tract information from the 2010 US Census and the 2007-2011 American Community Survey. A "neighborhood risk" index was created using principal component analysis, and mothers were grouped into 3 neighborhood risk levels (low, medium, high). Multilevel models with cross-level interactions were used to identify variation in racial differences in low birth weight outcomes across neighborhood risk levels when controlling for maternal demographic characteristics and pregnancy behaviors (smoking, prenatal care use). SETTING: North Carolina, United States. PARTICIPANTS: Singleton infants (n = 7923 cases) born to non-Hispanic African American and white adolescent mothers from the North Carolina State Center of Health Statistics for 2011. MAIN OUTCOME MEASURES: Low birth weight. RESULTS: African American mothers were significantly more likely to have infants of low birth weight than white mothers in this sample (odds ratio = 1.89; 95% confidence interval, 1.53-2.34). Mothers that resided in areas of high neighborhood risk were significantly more likely to have infants of low birth weight than mothers residing in areas of low neighborhood risk (odds ratio = 1.55; 95% confidence interval, 1.25-1.93). Even when controlling for confounding factors, racial disparities in low birth weight odds did not significantly vary according to neighborhood risk level. CONCLUSION: Racial disparities can remain in low birth weight odds among infants born to adolescent mothers when controlling for maternal characteristics, pregnancy behaviors, and neighborhood risk.

HIV/AIDS among African Immigrants in the U.S.: The Need for Disaggregating HIV Surveillance Data by Country of Birth.

The goals of the United States' National HIV/AIDS Strategy are reducing HIV infections, increasing linkage to care, and reducing health disparities. To accomplish these, it is imperative to have accurate data about HIV prevalence, especially in high-burden populations, including immigrants, ethnic/racial minorities and other minority populations. However, recent increases in HIV prevalence among Black migrants from sub-Saharan Africa has drawn attention to the need to examine the epidemiological diversity of the Black population, and accurately account for HIV prevalence within it. In most HIV surveillance data, a single category, Black/African American, is used to combine data for U.S.-born and foreign-born Blacks, including migrants from sub-Saharan Africa. Such categorizations result in under-estimation of HIV prevalence in the African immigrant population, making it difficult to allocate resources appropriately for HIV prevention and treatment. This paper highlights and provides recommendations regarding the importance of disaggregating HIV surveillance data on Blacks by country of birth.

TRUCE for advocacy and peer education in tobacco prevention.

In response to aggressive marketing of tobacco to college students, Florida's legislature allocated multi-settlement agreement dollars to fund tobacco prevention programming at state institutions of higher learning. The Student Tobacco Reform Initiative: Knowledge for Eternity (STRIKE) was one such program. Its purpose was to increase awareness and support college student advocacy for prevention. In this program note, we introduce Targeting, Resource Identification, and Unification for College Peer Education (TRUCE), the strategy used to facilitate implementation of STRIKE tobacco prevention programming by student advocates at a metropolitan university campus.

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers.

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17-19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.

Reaching Latinas with Our Bodies, Ourselves and the Guía de Capacitación para Promotoras de Salud: health education for social change.

As the cultural and linguistic diversity of the United States continues to grow and population shifts transform the communities where we live and work, health care providers continue to face challenges to deliver health services in demographically redefined terrains. This report describes the development of a Spanish-language training guide for community health workers (Guía de Capacitación para Promotoras de Salud) based on the book Nuestros Cuerpos, Nuestras Vidas (NCNV), the Spanish-language translation and cultural adaptation of the classic women's health book Our Bodies, Ourselves. The guide aims to 1) provide a tool for addressing the health education needs of immigrant Latinas and 2) facilitate the use of the book NCNV as a health education tool in Latino communities. Thirty telephone interviews with individuals working in agencies and organizations serving Latinos and 2 focus groups with Latinas were conducted to select the topics included in the training guide, all of which were drawn directly from NCNV. The guide contains 11 modules organized into 6 workshops. The modules address 11 topics related to women's health, ranging from sexuality and pregnancy to domestic violence and mental health. An ecological framework is used to deliver the health information. The materials acknowledge the roles of history, environment, culture, economic conditions, migration history, and politics as key determinants of health and illness. The workshops are designed to train community health workers on the women's health topics contained in the guide and to equip them for the delivery of health education among immigrant Latinas.

Cultural adaptation resources for nutrition and health in new immigrants in Central North Carolina.

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community's ability to provide essential human services to population groups not yet language proficient and acculturated to "American community standards."

Uncompensated care and emergency department utilization: a local study having national implications.

This article provides a comprehensive picture of the manner in which uncompensated care patients utilize the emergency departments (EDs) of two Central Florida hospitals. Specifically, this study assesses the impact of treating uncompensated and primary care patients in ED settings on scarce hospital and community resources. Recommendations are being offered to manage a troubling situation that is occurring with alarming frequency in today's health care system throughout the United States. Special emphasis is placed on recommendations addressing alternative triage and financing models that are considered to be both socially responsible and economically viable. The results of this study suggest strongly that health care organizations must find an alternative to the current trend in ED utilization, in order to meet the primary care needs of patients and not compromise the care provided to those with emergent conditions. The recommendations emanating from this study outline a mechanism that can improve the timeliness of emergency care to those in need, while at the same time, making available primary care resources to those seeking services through an emergency department.