Piloting Safety and Stabilization: A Multi-component Trauma Intervention to Improve HIV Viral Suppression, Retention in Care, and Post-traumatic Stress Disorder in a Southern United States HIV Service Organization.

In this observational study, we assessed the extent to which a community-created pilot intervention, providing trauma-informed care for persons with HIV (PWH), affected HIV care retention and viral suppression among PWH attending an HIV Services Organization in the Southern US. PWH with trauma exposure and/or trauma symptoms (N = 166) were offered a screening and referral to treatment (SBIRT) session. Per self-selection, 30 opted-out, 29 received SBIRT-Only, 25 received SBIRT-only but reported receiving other behavioral health care elsewhere, and 82 participated in the Safety and Stabilization (S&S) Intervention. Estimates from multivariable logistic regression analyses indicated S&S Intervention participants had increased retention in HIV care (adjusted odds ratio [aOR] 5.46, 95% CI 1.70-17.50) and viral suppression (aOR 17.74, 95% CI 1.83-172), compared to opt-out participants. Some evidence suggested that PTSD symptoms decreased for intervention participants. A randomized controlled trial is needed to confirm findings.

Educational Attainment and Educational Contexts as Social Determinants of Health.

Research demonstrates that nearly all health outcomes are patterned by level of education. Specifically, adults with lower educational attainment report more chronic conditions, more functional limitations, and worse overall health. In addition to affecting educational attainment, schools provide an important context in which students spend a substantial portion of their time. Because access to salutogenic school environments, as well as opportunities for educational attainment and advancement are themselves unequal, education is considered a social determinant of health. In this article, we explore the relationships between educational attainment and health. We also emphasize the importance of educational contexts as determinants of health that precede educational attainment and contribute to related health outcomes. Finally, we discuss implications for primary care practitioners and their efforts to address disparities in health and education.

Network Analysis for Formative Evaluation of Collaborative, Team Science Research Partnerships.

Cancer health disparities persist across the cancer care continuum despite decades of effort to eliminate them. Among the strategies currently used to address these disparities are multi-institution research initiatives that engage multiple stakeholders and change efforts. Endemic to the theory of change of such programs is the idea that collaboration-across institutions, research disciplines, and academic ranks-is necessary to improve outcomes. Despite this emphasis on collaboration, however, it is not often a focus of evaluation for these programs and others like them. In this paper we describe a method for evaluating collaboration within the Meharry-Vanderbilt-Tennessee State University Cancer Partnership using network analysis. Specifically, we used network analysis of co-authorship on academic publications to visualize the growth and patterns of scientific collaboration across partnership institutions, research disciplines, and academic ranks over time. We presented the results of the network analysis to internal and external advisory groups, creating the opportunity to discuss partnership collaboration, celebrate successes, and identify opportunities for improvement. We propose that basic network analysis of existing data along with network visualizations can foster conversation and feedback and are simple and effective ways to evaluate collaboration initiatives.

Longitudinal Education and Career Outcomes of a Cancer Research Training Program for Underrepresented Students: The Meharry-Vanderbilt-Tennessee State University Cancer Partnership.

This study examined longitudinal education and career outcomes of the Meharry-Vanderbilt-Tennessee State University Cancer Partnership, the longest-running National Cancer Institute (NCI) Comprehensive Partnerships in Advancing Cancer Health Equity (CPACHE) program site in the United States. Degree completion rates were calculated and progression along the entire postsecondary "pipeline" was quantified for 204 participants recruited between 2011 and 2020. For participants who had entered the workforce, career outcomes were also analyzed. Relative to comparison data, participants completed degrees and progressed through the higher education "pipeline" to earn advanced degrees at remarkably high rates; the majority entered careers in which they support or conduct cancer research. The latter is important, because most participants identify with demographic categories currently underrepresented in the cancer research workforce. This article makes two contributions to knowledge on research training programs for underrepresented students: 1) it quantifies participants' progression along the entire postsecondary education pipeline as well as into the workforce, and 2) it identifies points where participants are most prone to exit the pipeline rather than progress. We identify two types of exits-permanent and temporary-and offer empirically supported operational definitions for both. Evaluators may find the quantitative model and/or definitions useful for analyzing similar programs.

The Meharry-Vanderbilt-Tennessee State University Cancer Partnership (MVTCP): History and Highlights of 20 Years of Accomplishments.

Cancer health disparities among populations are the result of a combination of socioeconomic, environmental, behavioral, and biological factors, which affect cancer incidence, prevalence, mortality, survivorship, financial burden, and screening rates. The long-standing Meharry Medical College (MMC), Vanderbilt-Ingram Cancer Center (VICC), Tennessee State University (TSU) Cancer Partnership has built an exceptional cancer research and training environment to support the efforts of diverse investigators in addressing disparities. Over the past 20 years, collaborative partnership efforts across multiple disciplines have supported research into the determinants of cancer health disparities at a National Cancer Institute-designated comprehensive cancer center (VICC) along with enhancing research infrastructure and training at MMC and TSU, two institutions that serve predominantly underserved populations and underrepresented students. Moreover, the geographical placement of this partnership in Tennessee, a region with some of the highest cancer incidence and mortality in the United States, has provided an especially important opportunity to positively affect outcomes for cancer patients.

Addiction, recovery, and work: Surviving the daily grind.

BACKGROUND: Employment is a predictor of sobriety for women in recovery from addiction, however, finding and maintaining employment is often a challenge. A number of interventions and a large body of research exist related to improving employment outcomes of women in recovery, but most fail to account for employment as an on-going, uneven process. OBJECTIVE: This study applied a longitudinal, qualitative design to explore employment experiences of women in recovery, as well as how those experiences interact with participants' sobriety, health, and well-being. METHODS: Nineteen women from two residential recovery programs were interviewed four times over the course of nine months. Data were analyzed using longitudinal coding. RESULTS: Women encounter on-going struggle to find and keep employment, and multiple forces exacerbate this struggle. At the same time, positive work experiences described by some participants illustrate opportunities for the creation of new workplace structures that address employment needs of women in recovery while supporting sobriety and overall well-being. CONCLUSION: Understanding employment as an on-going process that interacts with addiction and sobriety in complex and multiple ways could contribute to improved employment and health outcomes for women in recovery.

Individual and household influences on food security and dietary diversity in seven Dominican batey communities.

BACKGROUND: To identify individual and household characteristics associated with food security and dietary diversity in seven Haitian-Dominican bateyes. METHODS: A cross-sectional sample of 667 households were surveyed. Novel household food security scores were calculated from components of the Household Food Insecurity Assessment Scale, while the Food and Agricultural Organization's Household Dietary Diversity Score was utilized to calculate individual dietary diversity scores. Multivariable analyses were performed using ordinal logistic regression models to estimate the association between these scores and the covariate variables. Secondary dietary diversity analyses were performed after removing non-nutritious food groups. RESULTS: Food security was significantly associated with being above the poverty line (OR 3.14, 95% CI 1.92 to 5.14), living in a rural batey (OR 1.44, 95% CI 1.02 to 2.03), receiving gifts and/or donations (OR 1.76, 95% CI 1.03 to 3.00) and having a salaried job (i.e., not being paid hourly; OR 1.67, 95% CI 1.05 to 2.64). Dietary diversity was significantly associated with living in a semi-urban batey (OR 1.70, 95% CI 1.26 to 2.30), living with a partner (OR 1.47, 95% CI 1.08 to 2.00), growing at least some of one's own food (OR 1.62, 95% CI 1.17 to 2.23), and receiving gifts and/or donations (OR 1.72, 95% CI 1.08 to 2.73). CONCLUSIONS: Food insecurity and low dietary diversity are highly prevalent in Haitian-Dominican bateyes. The inclusion of sweets and non-milk beverages in dietary diversity calculations appear to skew scores towards higher levels of diversity, despite limited nutritional gains.

Navigating Community Development Conflicts: Contested Visions of Poverty & Poverty Alleviation.

This article explores an ethical dilemma that arose from the author's involvement in a project intended to identify and address the needs of seven batey communities in the Dominican Republic. In the summer of 2014, the author conducted a large-scale needs assessment to inform strategic planning for a foundation that was invested in community development work in those communities. Through a collaborative process, the author worked with the foundation, representatives of the migrant communities, and other researchers to develop survey and focus group tools that were administered to 1,360 and 54 people, respectively. Data collection, analysis, and dissemination proceeded as planned. The conflict and resulting ethical dilemma emerged at the point of data interpretation and strategic planning, processes that revealed that the different parties held conflicting theories of poverty. The ideological conflicts related to why poverty exists, who is responsible for it, and what should be done about it made proceeding with the project ethically tenuous for the author. The author describes the values and theories of ethics on which she relied to navigate this challenge, as well as reflections on her continued participation in the community development process.

Community health needs assessment and action planning in seven Dominican bateyes.

Haitians and persons of Haitian descent living in the Dominican Republic are often relegated to living in deeply impoverished communities called bateyes. Despite obvious needs and some NGO presence in the bateyes, little assessment has been done to identify specific needs as understood and experienced by community members themselves. This article describes a community health needs assessment and action planning process developed and implemented by university researchers, NGO staff, and community members to identify needed areas for community-based health intervention in seven Dominican bateyes. Surveys and focus groups were used to collect data about the needs and assets of the bateyes and their residents around the following broad topics: demographics, health, education, financial/economy, legal issues, and transportation/infrastructure. These data were then used to guide an action-planning process that identified clean water, access to food and nutritional diversity, and economic development as primary and immediate needs in the communities. The process, its outcomes, and lessons learned are discussed.

A Co-Learning Model for Community-Engaged Program Evaluation.

OBJECTIVES: The development, implementation, and assessment of a masters-level program evaluation course designed to train future and current leaders of community-based organizations (CBOs) is described. BACKGROUND: In addition to sending students "out" into the community, staff from local community organizations were invited "in" to the classroom to take the course alongside students. Community partners selected a specific evaluation need within their organization that teams could address. The "final" for the course involved creating a comprehensive evaluation plan for each organization to implement. METHODS: Student course evaluations and semistructured interviews with community partners were conducted and analyzed to assess how course goals were met.Results/Lessons Learned: The course goals were met, the partnering experience was highly valued, and insightful improvements were suggested. CONCLUSIONS: This program evaluation course provides an innovative, effective, flexible, and replicable partnership practice model that builds student skills and community capacity in evaluation research.

Examining perceptions about mental health care and help-seeking among rural African American families of adolescents.

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers' to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents' mental health problems, and building community resources to enable all youth to participate in community life.