Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment.

BACKGROUND: Adverse childhood experiences (ACE) have been previously linked to quality of life, health conditions, and life expectancy in adulthood. Less is known about the potential mechanisms which mediate these associations. This study examined how ACE influences adult health-related quality of life (HRQoL) in a low-income community in Florida. METHODS: A community-based participatory needs assessment was conducted from November 2013 to March 2014 with 201 residents of Tampa, Florida, USA. HRQoL was measured by an excessive number of unhealthy days experienced during the previous 30-day window. Mediation analyses for dichotomous outcomes were conducted with logistic regression. Bootstrapped confidence intervals were generated for both total and specific indirect effects. RESULTS: Most participants reported 'good to excellent health' (76%) and about a fourth reported 'fair to poor health' (24%). The mean of total unhealthy days was 9 days per month (SD ± 10.5). Controlling for demographic and neighborhood covariates, excessive unhealthy days was associated with ACE (AOR = 1.23; 95% CI: 1.06, 1.43), perceived stress (AOR = 1.07; 95% CI: 1.03, 1.10), and sleep disturbance (AOR = 8.86; 3.61, 21.77). Mediated effects were significant for stress (ß = 0.08) and sleep disturbances (ß = 0.11) as they related to the relationship between ACE and excessive unhealthy days. CONCLUSION: ACE is linked to adult HRQoL. Stress and sleep disturbances may represent later consequences of childhood adversity that modulate adult quality of life.

The Life Course Perspective on Older Adults' Health Trajectories: Risk and Protective Factors.

According to the life course perspective (LCP), optimal human development and healthy aging are key goals that must start preconceptionally and continue later in life. However, older adult health and family health across generations have received very little attention in maternal and child health (MCH). Community-based participatory research (CBPR) is an important strategy for putting the LCP into action by engaging those communities most affected by health disparities. We conducted six CBPR focus groups using the LCP as the theoretical framework to capture community members' perspectives of risk and protective factors for older adult health. Perceived protective factors for older adults included socialization, support systems, and practicing wellness. Perceived risk factors included caretaking responsibilities, isolation, medical issues, and lack of support. The identified risk and protective factors for older adult health must be considered when developing public health interventions that promote health equity in aging and MCH.

" [T]his is What We are Missing": The Value of Communicating Infant Feeding Information Across Three Generations of African American Women.

BACKGROUND: Breast/Chestfeeding remains a public health issue for African Americans, and increased rates would mitigate many health disparities, thus promoting health equity. RESEARCH AIMS: To explore the interplay of generational familial roles and meaning (or value) ascribed to communicating infant feeding information across three generations. METHOD: This prospective, cross-sectional qualitative study used an asset-driven approach and was guided by Black Feminist Thought and Symbolic Interactionism. African American women (N = 35; 15 family triads/dyads), residing in the southeastern United States were interviewed. Data were analyzed using thematic analysis. RESULTS: The older two generations described their role using assertive yet nurturing terms, while the younger generation carefully discussed the flexibility between their familial roles. Emergent themes described the meaning each generation attributed to communicating infant feeding information: "My Responsibility," "Comforting," "Bonding Experience," "She Cared," and "Gained Wisdom." CONCLUSIONS: Our findings have potential to contribute to achieving health equity in African American families. Future breast/chestfeeding promotion efforts may benefit from reframing the current approach to including protection language and not solely support language. Lactation professionals should further recognize and support strengths and resource-richness of intergenerational infant feeding communication within African American families using strength-based, empowerment-oriented, and ethnically sensitive approaches.

Effectiveness of a 24/7 Dad® Curriculum in Improving Father Involvement: Profiles of Engagement.

BACKGROUND OR OBJECTIVES: Father involvement is a key component in maintaining healthy families and communities. This study presents quantitative results of the first five years of a comprehensive fatherhood training program offered by REACHUP, Inc. in Florida, United States. METHODS: The program utilized the 24/7 Dad ® curriculum for the fatherhood training program. Key program outcome was differences in pre and post-test scores on self-awareness, fathering skills, parenting skills, relationship skills, and self-care. Demographic and pretest-posttest data collected between 2013 and 2017 were analyzed using chi-square test for categorical variables, McNemar's test for differences in proportions pre- and post-intervention, paired sample t-test to compare means in pretest and posttest scores and analysis of variance (ANOVA) to test the difference between means across years and demographic characteristics. RESULTS: Attendance in the program increased yearly, nearly doubling from 55 participants in 2013 to 97 in 2017. The mean pretest score was 8.90 (±4.04) and the mean posttest score was 16.42 (±4.54) out of 22 total points, representing a highly significant positive effect of the program on self-awareness, fathering skills, parenting skills, relationship skills and self-care which will enable men to establish long-lasting positive relationships with their children. There were significant differences by demographic characteristics. Younger participants tended to score lower on the pretest but made the most knowledge gains following the training as indicated by the difference in pre- and posttest scores (<0.001). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Increasing yearly attendance indicates the notion of male involvement is gaining momentum. An important lesson learned over the five-year period is that not all males who participated in the program were biological fathers of infants, young children or adolescents. Many participants were grandfathers, uncles and family friends, indicating that the benefits of a male involvement program can extend beyond the boundaries of biological fatherhood.

Evaluation of an Evidence-based and Community-responsive Fatherhood Training Program: Providers' Perspective.

BACKGROUND AND OBJECTIVES: Studies on male involvement and pregnancy outcomes have often not incorporated the providers' perspectives, which are potentially critical to understanding program context, evolution, perceived impact, and sustainability. We sought to evaluate the 24/7 Dad® program from the viewpoint of the program providers. METHODS: We conducted purposive sampling of 24/7 Dad program facilitators and administrators who were involved in recruitment, training, and follow up of program participants within a federal Healthy Start program (REACHUP) in Tampa, Florida, USA. Using a snowballing approach, we recruited six key informants who had administered the program for at least four years. We elicited and evaluated factors impacting the performance of the father involvement program using content analysis. RESULTS: Under program participation and perceived impact, most providers thought that the program had created a safe space previously unavailable for men in the community. The most useful recruitment strategy was building partnerships with other organizations. The key informants noted an important evolutionary trend in the father involvement program over time as well as the nature of linkages to partner organizations within the area. Threats to program sustainability included the continued reluctance and scepticism to invest funds to address male issues, sub-optimal retention of participants who were living transient lives as well as geographical/transportation barriers. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: The involvement of fathers during pregnancy has significant implications for healthy babies. Our study results provide a clarion call to augment capacity and infuse more resources to improve paternal involvement in order to attain the United Nations Sustainable Goal (2015-2030) of ensuring healthy lives and the promotion of well-being for all at all ages.

Protective Factors Using the Life Course Perspective in Maternal and Child Health.

The life course perspective (LCP), a valuable theoretical framework for investigating racial disparities in birth outcomes, examines the cumulative exposure of risk and protective factors throughout the life span. Although risk and protective exposures are equally vital to health, most studies have focused solely on the risk factor exposures faced by vulnerable populations. In clear contrast to the traditional public health approach, which emphasizes a deficit model, strengths-based approaches focus on protective factors and fostering resilience. These approaches view communities as valuable assets that have the capacity to fully engage themselves and their residents to achieve optimal health. Participatory action research methods are well suited to apply a strengths-based approach to understand health disparities. Our study aimed to explore maternal and child health protective factors from community residents' perspective. A group of researchers, including active members in the community with a long history of grassroots development work, conducted ten community-based participatory focus groups with community residents in Tampa, FL, using the LCP framework. A total of 78 residents participated in ten focus groups. Perceived protective factors during pregnancy included self-esteem, spirituality, pregnancy support, good nutrition, prenatal care, and community resources. Protective factors for non-pregnant women were self-esteem, spirituality, social support, health literacy, community support and community resources, and societal factors. For children and adolescents, relevant protective factors were self-esteem, positive role models, nutrition and physical activity, and community support. The identified factors are community assets or strengths that mitigate or eliminate maternal and child health risks in families and communities residing in low-income neighborhoods, which must be considered in developing effective maternal and child health interventions.

Exploring the Life Course Perspective in Maternal and Child Health through Community-Based Participatory Focus Groups: Social Risks Assessment.

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Linking movement, diving, and habitat to foraging success in a large marine predator.

Establishing where and when predators forage is essential to understanding trophic interactions, yet foraging behavior remains poorly understood in large marine carnivores. We investigated the factors leading to foraging success in gray seals (Halichoerus grypus) in the Northwest Atlantic in the first study to use simultaneous deployments of satellite transmitters, time depth recorders, and stomach-temperature loggers on a free-ranging marine mammal. Thirty-two seals were each fitted with the three types of instrumentation; however, complete records from all three instruments were obtained from only 13 individuals, underscoring the difficulty of such a multi-instrument approach. Our goal was to determine the characteristics of diving, habitat, and movement that predict feeding. We linked diving behavior to foraging success at two temporal scales: trips (days) and bouts (hours) to test models of optimal diving, which indicate that feeding can be predicted by time spent at the bottom of a dive. Using an information-theoretic approach, a Generalized Linear Mixed Model with trip duration and accumulated bottom time per day best explained the number of feeding events per trip, whereas the best predictor of the number of feeding events per bout was accumulated bottom time. We then tested whether characteristics of movement were predictive of feeding. Significant predictors of the number of feeding events per trip were angular variance (i.e., path tortuosity) and distance traveled per day. Finally, we integrated measures of diving, movement, and habitat at four temporal scales to determine overall predictors of feeding. At the 3-h scale, mean bottom time and distance traveled were the most important predictors of feeding frequency, whereas at the 6-h and 24-h time scales, distance traveled alone was most important. Bathymetry was the most significant predictor of feeding at the 12-h interval, with feeding more likely to occur at deeper depths. Our findings indicate that several factors predict feeding in gray seals, but predictor variables differ across temporal scales such that environmental variation becomes important at some scales and not others. Overall, our results illustrate the value of simultaneously recording and integrating multiple types of information to better understand the circumstances leading to foraging success.

Usability of Low-Cost Android Data Collection System for Community-Based Participatory Research.

BACKGROUND: Android tablet computers can be valuable tools for data collection, but their usability has not been evaluated in community-based participatory research (CBPR). OBJECTIVES: This article examines the usability of a low-cost bilingual touchscreen computerized survey system using Android tablets, piloted with a sample of 201 community residents in Tampa, Florida, from November 2013 to March 2014. METHODS: Needs assessment questions were designed with the droidSURVEY software, and deployed using Android tablet computers. In addition, participants were asked questions about system usability. RESULTS: The mean system usability was 77.57 ± 17.66 (range, 0-100). The mean completion time for taking the 63 survey questions in the needs assessment was 23.11 ± 9.62 minutes. The survey completion rate was optimal (100%), with only 6.34% missingness per variable. We found no sociodemographic differences in usability scores. CONCLUSIONS: Our findings indicate that Android tablets could serve as useful tools in CBPR studies.

Community-academic partnerships to reduce black-white disparities in infant mortality in Florida.

PROBLEM: In Florida, data reveal a widening black-white disparity in infant mortality to the disadvantage of black families. Eight Florida counties have a significantly pronounced black-white infant mortality gap: Broward, Duval, Gadsden, Hillsborough, Miami-Dade, Orange, Palm Beach, and Putnam. PURPOSE: The black Infant Health Community Collaborative (BIHCC) was established to address the rising racial/ethnic disparities in infant mortality. The program used a community-based participatory research (CBPR) approach to enable communities to develop sustainable initiatives to improve community health and reduce infant mortality. KEY POINTS: Grounded in CBPR principles, a community-academic-state partnership was created to address the upsurge in black-white disparity in infant mortality. Community teams from each participating county underwent a 2-year period of capacity building. The culmination of this process was community-driven action plans to alleviate infant health disparities. CONCLUSION: The BIHCC provides a replicable model for the development of community-academic-state partnerships to enhance capacity for improving infant health outcomes.

High risk community--men's perceptions of black infant mortality: a qualitative inquiry.

Infant mortality has been identified as a key public health concern in the United States. Although infant mortality rates (IMRs) in the United States have declined during the past 10 years, the rates among Blacks are more than two times higher as compared with other racial and ethnic groups. This study used focus groups to explore Black men's awareness and perceptions of the rising IMR in their community. Twenty-five men participated in an initial and follow-up focus group, which revealed that men had limited awareness of infant mortality, reduced sense of personal responsibility for pregnancy outcomes, and perceptions that stress, the age of the mother, and the health care system were responsible for poor birth outcomes. The role of the community and possible interventions to involve and educate men were also explored.

Stomach temperature telemetry reveals temporal patterns of foraging success in a free-ranging marine mammal.

1. We studied feeding frequency in free-ranging grey seals using stomach temperature telemetry to test if previously reported sex differences in the diving, movement and diet were reflected in the temporal pattern of foraging success. 2. Data were retrieved from 21 of 32 grey seals from 1999 to 2001, totalling 343 days and 555 feeding events, with individual record length varying from 2 to 40 days (mean: 16.33 +/- 2.67 days/seal). 3. Seals fed on 57.8 +/- 6.46% of days sampled and had an average of 1.7 +/- 0.26 meals per day, but individual variability was apparent in the temporal distribution of feeding as evidenced by high coefficients of variation (coefficient of variation = 69.0%). 4. Bout analysis of non-feeding intervals of six grey seals suggests that feeding intervals of individuals were varied and probably reflect differences in prey availability. Grey seals tended to have many single feeding events with long periods separating each event, as would be expected for a large carnivore with a batch-reactor digestive system. 5. We found significant sex differences in the temporal distribution of feeding. The number of feeding events per day was greater in males (2.2 +/- 0.4 vs. 1.0 +/- 0.2), as was time associated with feeding per day (56.6 +/- 5.8 min vs. 43.9 +/- 9.4 min). 6. The number of feeding events varied with time of day with the least number occurring during dawn. Feeding event size differed significantly by time of day, with greater meal sizes during the dawn and the smallest meals during the night. 7. The length of time between meals increased with the size of the previous meal, and was significantly less in males (541.4 +/- 63.5 min) than in females (1092.6 +/- 169.9 min). 8. These results provide new insight into the basis of sex differences in diving and diet in this large size-dimorphic marine predator.