Deaf Weight Wise: A novel randomized clinical trial with Deaf sign language users.

OBJECTIVE: The goal of this study was to address the absence of evidence-based weight-control programs developed for use with Deaf people. METHODS: Community-based participatory research informed the design of the Deaf Weight Wise (DWW) trial and intervention. DWW focuses primarily on healthy lifestyle and weight through change in diet and exercise. The study enrolled 104 Deaf adults aged 40 to 70 years with BMI of 25 to 45 from community settings in Rochester, New York, and randomized participants to immediate intervention (n = 48) or 1-year delayed intervention (n = 56). The delayed intervention serves as a no-intervention comparison until the trial midpoint. The study collected data five times (every 6 months) from baseline to 24 months. All DWW intervention leaders and participants are Deaf people who use American Sign Language (ASL). RESULTS: At 6 months, the difference in mean weight change for the immediate-intervention arm versus the delayed-intervention arm (no intervention yet) was -3.4 kg (multiplicity-adjusted p = 0.0424; 95% CI: -6.1 to -0.8 kg). Most (61.6%) in the immediate arm lost ≥5% of baseline weight versus 18.1% in the no-intervention-yet arm (p < 0.001). Participant engagement indicators include mean attendance of 11/16 sessions (69%), and 92% completed 24-month data collection. CONCLUSION: DWW, a community-engaged, culturally appropriate, and language-accessible behavioral weight loss intervention, was successful with Deaf ASL users.

Cross-Sectional Analysis of Medical Conditions in the U.S. Deaf Transgender Community.

Purpose: This first U.S.-based, descriptive study of transgender Deaf adults looks to contribute to the gap in research regarding those who lie at the intersection of Deaf and transgender identities. The study objective is to identify characteristics that associate with medical conditions, including depression and anxiety disorders, among Deaf transgender adults. Methods: We gathered self-reported data from 74 Deaf transgender adults who used American Sign Language. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates of having a medical condition among nonbinary individuals compared with gender binary individuals. Results: The sample lifetime prevalence for medical conditions in the Deaf transgender sample were as follows: 48.6% for depression/anxiety disorders, 28.8% for hypertension, 20.3% for lung conditions, 16.2% for arthritis/rheumatism, 12.3% for diabetes, 7.0% for cirrhosis/liver/kidney problems, 5.5% for heart conditions, and 2.7% for cancer. In cross-tabulation analysis across binary and nonbinary subsamples, the lifetime prevalence was significantly different only for depression and anxiety disorder with higher percentage in the nonbinary subsample. After adjusting for covariates in a regression model, identification as nonbinary increased a Deaf person's risk for being diagnosed with depression or anxiety disorder by 80% (95% confidence interval, 1.11-2.90) relative to Deaf people who self-identified as a binary gender. Conclusion: Study findings suggest that the Deaf transgender community is at risk for developing mental and physical health conditions.

Culture-centeredness in community-based participatory research: contributions to health education intervention research.

Health education research emphasizes the importance of cultural understanding and fit to achieve meaningful psycho-social research outcomes, community responsiveness and external validity to enhance health equity. However, many interventions address cultural fit through cultural competence and sensitivity approaches that are often superficial. The purpose of this study was to better situate culture within health education by operationalizing and testing new measures of the deeply grounded culture-centered approach (CCA) within the context of community-based participatory research (CBPR). A nation-wide mixed method sample of 200 CBPR partnerships included a survey questionnaire and in-depth case studies. The questionnaire enabled the development of a CCA scale using concepts of community voice/agency, reflexivity and structural transformation. Higher-order confirmatory factor analysis demonstrated factorial validity of the scale. Correlations supported convergent validity with positive associations between the CCA and partnership processes and capacity and health outcomes. Qualitative data from two CBPR case studies provided complementary socio-cultural historic background and cultural knowledge, grounding health education interventions and research design in specific contexts and communities. The CCA scale and case study analysis demonstrate key tools that community-academic research partnerships can use to assess deeper levels of culture centeredness for health education research.

Considering parental hearing status as a social determinant of deaf population health: Insights from experiences of the "dinner table syndrome".

The influence of early language and communication experiences on lifelong health outcomes is receiving increased public health attention. Most deaf children have non-signing hearing parents, and are at risk for not experiencing fully accessible language environments, a possible factor underlying known deaf population health disparities. Childhood indirect family communication-such as spontaneous conversations and listening in the routine family environment (e.g. family meals, recreation, car rides)-is an important source of health-related contextual learning opportunities. The goal of this study was to assess the influence of parental hearing status on deaf people's recalled access to childhood indirect family communication. We analyzed data from the Rochester Deaf Health Survey-2013 (n = 211 deaf adults) for associations between sociodemographic factors including parental hearing status, and recalled access to childhood indirect family communication. Parental hearing status predicted deaf adults' recalled access to childhood indirect family communication (χ2 = 31.939, p < .001). The likelihood of deaf adults reporting "sometimes to never" for recalled comprehension of childhood family indirect communication increased by 17.6 times for those with hearing parents. No other sociodemographic or deaf-specific factors in this study predicted deaf adults' access to childhood indirect family communication. This study finds that deaf people who have hearing parents were more likely to report limited access to contextual learning opportunities during childhood. Parental hearing status and early childhood language experiences, therefore, require further investigation as possible social determinants of health to develop interventions that improve lifelong health and social outcomes of the underserved deaf population.

Collaboration With Deaf Communities to Conduct Accessible Health Surveillance.

INTRODUCTION: Populations of deaf sign language users experience health disparities unmeasured by current public health surveillance. Population-specific health data are necessary to collaboratively identify health priorities and evaluate interventions. Standardized, reproducible, and language-concordant data collection in sign language is impossible via written or telephone surveys. METHODS: Deaf and hearing researchers, community members, and other stakeholders developed a broad computer-based health survey based on the telephone-administered Behavioral Risk Factor Surveillance System. They translated survey items from English to sign language, evaluated the translations, and filmed the survey items for inclusion in their custom software. They initiated the second Rochester Deaf Health Survey in 2013 (n=211). Analyses (conducted in 2015) compared Rochester Deaf Health Survey 2013 findings with those of the Behavioral Risk Factor Surveillance System with the general adult population in the same community (2012, n=1,816). RESULTS: The Rochester Deaf Health Survey 2013 participants' mean age was 44.7 (range, 18-87) years. Most were deaf since birth or early childhood (87.1%) and highly educated (53.6% with ≥4 years of college). The median household income was <$35,000. The prevalence of current smokers was low (8.1%). Nearly all (93.8%) reported having health insurance, yet barriers to appropriate health care were evident, with high emergency department use (16.2% with two or more past-year visits) and 22.7% forgoing needed health care in the past year because of cost. CONCLUSIONS: Community-engaged research with deaf populations identifies strengths and priorities, providing essential information otherwise missing from existing public health surveillance, and forming a foundation for collaborative dissemination to facilitate broader inclusion of deaf communities.