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.

Racism, Psycho-Social Stress, and Health-related Quality of Life.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress.

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.

The CI Index (CII): A New Instrument to Evaluate and Foster Collaborative Partnership in Public Health.

BACKGROUND OR OBJECTIVES: Collective Impact (CI) is the sum of collaborative actions through coalition building to examine and address issues that threaten public health. We sought to develop an instrument to measure CI across diverse health-related organizations. METHODS: The study was performed in 5 phases initiated with a comprehensive literature review through the generation of candidate items using a deductive instrument development approach. A matrix was then created to map assembled items onto related CI domains. An one-hundred and nine (n=109) item questionnaire covering multiple items per domain was administered to 200 health-related organizations selected randomly throughout the United States. Survey data were evaluated using Principal Component Analysis and Kaiser criterion or eigenvalue-greater-than-one rule was the factor retention method utilized. RESULTS: Based on Kaiser's eigenvalue criteria and communality estimates, the number of items across the five domains of CI was reduced from 109 to 20, with 4 items populating each subdomain. All communality estimates in the final instrument had values > 0.6, which was sufficiently adequate as per Kaiser's criterion. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: This pilot study demonstrates CI represents a multi-factorial concept with domains that are multi-dimensional capturing diverse aspects of a construct. We developed the first measure of CI for public health practice. The index bears potential utility for assessing and monitoring areas of strengths and weaknesses within collaborative partnerships across the spectrum of population health.

Social Support and Health-Related Quality of Life Among Low-Income Women: Findings from Community-Based Participatory Research.

OBJECTIVES: This study examined the association between social support and health-related quality of life (HRQoL) among low-income women in the southeastern region of the United States. METHODS: Analysis was performed on data from a community needs assessment survey that was designed to explore social determinants of health and QoL indicators using a community-based participatory research approach. The study sample comprised 132 women aged 18 years old and older. Bivariate analysis and logistic regressions with bootstrapping were performed. RESULTS: Social support was predictive of physical and mental HRQoL in a contrasting fashion, suggesting a complex relation. Other social determinants of global HRQoL independent of social support status include marital and employment status, maternal age, and income. Our results also demonstrate complex interaction patterns across race, social support, and HRQoL. CONCLUSIONS: The linkage between social support and HRQoL may not be a simple relation, as previously assumed. Rather, it is characterized by multifaceted interactions through which social determinants of health modulate the impact of social support on HRQoL. These are new findings.

Community-based fortified dietary intervention improved health outcomes among low-income African-American women.

Poor dietary exposure disproportionately affects African-Americans and contributes to the persistence of disparities in health outcomes. In this study, we hypothesized that fortified dietary intervention (FDI) will improve measured dietary and related health outcomes and will be acceptable among low-income African-American women living in Tampa, FL. These objectives were tested using a prospective experimental study using pretest and posttest design with a control group, using a community-based participatory research approach. The intervention (FDI) was designed by the community through structural modification of a preexisting, diet-based program by the addition of a physical and mental health component. Paired sample t tests were used to examine preintervention and postintervention changes in study outcomes. A total of 49 women participated in the study, 26 in the FDI group and 23 controls. Two weeks postintervention, there were significant improvements in waist circumference and health-related quality of life related to physical health (P< .0001), physical fitness subscores (P= .002), and nutritional subscores (P= .001) in the FDI group. Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted. In the control group, a decrease in waist circumference was observed. Implementation of the FDI through a community-based participatory research approach is feasible and effective among low-income African-American women in general and overweight/obese women in particular. Social reengineering of a nutritional intervention coupled with community-based approach will enhance health outcomes of low-income women.

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 Priority Index: Utility, Applicability and Validation for Priority Setting in Community-Based Participatory Research.

BACKGROUND: Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR), the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting. DESIGN AND METHODS: Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI) that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation. RESULTS: For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00), lack of affection (CPI=0.87; 95%CI: 0.69, 1.00), and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00). For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00), low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00), and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00). For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00), low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94), and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94). CONCLUSIONS: This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR. Significance for public healthCommunity-based participatory research (CBPR) has been credited to be a promising approach for the reduction of health disparities and as an effective way to create sustainable community outcomes. Priority setting is an essential decision-making step in community-based participatory research. Issue prioritization must be driven not just by the importance of the issue, but also what realistically can be changed with available funds. However, there is little guidance on how to approach priority setting with objective and subjective measures while implementing CBPR. This study depicts the invention of a Community Priority Index (CPI), which can be used to prioritize community health issues by combining subjective and objective markers into a single measure. The CPI shown in this study represents a viable systematic approach to improve the objectivity and reliability of community-based decision-making.

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.

Effectiveness of a federal Healthy Start Program on HIV/AIDS risk reduction among women in Hillsborough County, Florida.

OBJECTIVES: To examine the impact of the Central Hillsborough Healthy Start Project (CHHS) on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) diagnosis rates in women in Hillsborough County, Florida. METHODS: Project records were linked to hospital discharge data and vital statistics (Florida, 1998-2007; N = 1,696,221). The χ(2) test was used to compare rates for HIV/AIDS and pregnancy-related complications for mothers within the CHHS service area with mothers in Hillsborough County and the rest of Florida. RESULTS: During a 10-year period, HIV/AIDS diagnosis rates among women in the CHHS service area declined by 56.3% (P = 0.01). The observed decline was most evident among black women. HIV/AIDS diagnosis rates in the rest of Hillsborough County and Florida remained unchanged (P = 0.48). CONCLUSIONS: Lessons learned from the CHHS Project can be used to develop effective and comprehensive models for addressing the HIV epidemic.

Impact of a federal healthy start program on feto-infant morbidity associated with absent fathers: a quasi-experimental study.

The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small-for-gestational age. Previous research has shown that the Central Hillsborough Healthy Start project (CHHS)-a federally funded initiative in Tampa, Florida-has improved birth outcomes. This study explores the effectiveness of the CHHS project in ameliorating the adverse effects of fathers' absence during pregnancy. This retrospective cohort study used CHHS records linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on residence in the CHHS service area. Propensity score matching was used to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95 % confidence intervals (CI) for matched observations. Women residing in the CHHS service area were more likely to be high school graduates, black, younger (<35 years), and to have adequate prenatal care compared to controls (p < 0.01). These differences disappeared after propensity score matching. Mothers with absent fathers in the CHHS service area had a reduced likelihood of LBW (OR 0.76, 95 % CI 0.65-0.89), PTB (OR 0.72, 95 % CI 0.62-0.84), very low birth weight (OR 0.50, 95 % CI 0.35-0.72) and very preterm birth (OR 0.48, 95 % CI 0.34-0.69) compared to their counterparts in the rest of the state. This study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse fetal birth outcomes in families with absent fathers.

The impact of birth spacing on subsequent feto-infant outcomes among community enrollees of a federal healthy start project.

Numerous studies have shown an association between shorter birth intervals, and several adverse fetal outcomes, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). However, there is little evidence on the effectiveness of interconception care on fetal outcomes associated with sub-optimal interpregnancy interval (IPI). The purpose of this study is to examine the influence of the Federal Healthy Start's interconception care services on IPI and fetal growth outcomes. This is a retrospective cohort study used records from the Central Hillsborough Healthy Start program in Tampa, Florida linked to Florida vital statistics data covering the period 2002-2009. Only first and second pregnancies were considered, and interpregnancy interval (IPI), the exposure of interest, was categorized in months as 0-5, 6-17, 18-23, and ≥24. The following feto-infant morbidities were considered as primary outcomes: LBW, PTB, and SGA. A composite variable coding the presence of any of the aforementioned adverse fetal events was also created. Multivariate logistic regression modeling was applied Overall, mothers with the shortest IPI (0-5 months: AOR = 1.39, 95% CI 1.23-1.56) and longest IPI (≥60 months: AOR = 1.13, 95% CI 1.03-1.23) were at a greater risk for adverse fetal growth outcomes, compared to the referent category (18-23 months). Our findings support the need for inter conception care that addresses IPI and delayed childbearing among women.

Effectiveness of a federal healthy start program in reducing the impact of particulate air pollutants on feto-infant morbidity outcomes.

We sought to assess (1) the relationship between air particulate pollutants and feto-infant morbidity outcomes and (2) the impact of a Federal Healthy Start program on this relationship. This is a retrospective cohort study using de-identified hospital discharge information linked to vital records, and air pollution data from 2000 through 2007 for the zip codes served by the Central Hillsborough Federal Healthy Start Project in Tampa, Florida. Mathematical modeling was employed to compute minimal Euclidean distances to capture exposure to ambient air particulate matter. The outcomes of interest were low birth weight (LBW), very low birth weight (VLBW), small for gestational age, preterm (PTB), and very preterm birth. We used odds ratios to approximate relative risks. A total of 12,356 live births were analyzed. Overall, women exposed to air particulate pollutants were at elevated risk for LBW (AOR = 1.24; 95% CI = 1.07-1.43), VLBW (AOR = 1.58; 95% CI = 1.09-2.29) and PTB (AOR = 1.18; 95% CI = 1.03-1.34). Analysis by race/ethnicity revealed that the adverse effects of air particulate pollutants were most profound among black infants. Infants of women who received services provided by the Central Hillsborough Federal Healthy Start Project experienced improved feto-infant morbidity outcomes despite exposure to air particulate pollutants. Environmental air pollutants represent important risk factors for adverse birth outcomes, particularly among black women. Multi-level interventional approaches implemented by the Central Hillsborough Federal Healthy Start were found to be associated with reduced likelihood for feto-infant morbidities triggered by exposure to ambient air particulate pollutants.

Risk factors for major antenatal depression among low-income African American women.

OBJECTIVES: Data on risk factors for major antenatal depression among African American women are scant. In this study, we seek to determine the prevalence and risk factors for major antenatal depression among low-income African American women receiving prenatal services through the Central Hillsborough Healthy Start (CHHS). METHODS: Women were screened using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of > or =13 as positive for risk of major antenatal depression. In total, 546 African American women were included in the analysis. We used logistic regression to identify risk factors for major antenatal depression. RESULTS: The prevalence of depressive symptomatology consistent with major antenatal depression was 25%. Maternal age was identified as the main risk factor for major antenatal depression. The association between maternal age and risk for major antenatal depression was biphasic, with a linear trend component lasting until age 30, at which point the slope changed markedly tracing a more pronounced likelihood for major depression with advancing age. Women aged > or =30 were about 5 times as likely to suffer from symptoms of major antenatal depression as teen mothers (OR = 4.62, 95% CI 2.23-9.95). CONCLUSIONS: The risk for major antenatal depression increases about 5-fold among low-income African American women from age 30 as compared to teen mothers. The results are consistent with the weathering effect resulting from years of cumulative stress burden due to socioeconomic marginalization and discrimination. Older African American mothers may benefit from routine antenatal depression screening for early diagnosis and intervention.