What's in your social determinants of health teaching toolbox? Nursing pedagogical considerations.

Although the concept of Social Determinants of Health (SDOH) has been around for more than two decades, teaching methods and standards of curricula for nursing education related to SDOH are relatively new concepts. Here, we explore pedagogical frameworks, national standards, and recent progress in the study and implementation of SDOH curricula and the top teaching strategies implemented in various nursing and healthcare disciplines and across educational levels (undergraduate and graduate programs). Selected examples are used to illustrate lessons learned across disciplines in effective teaching strategies related to SDOH. Effective teaching strategies include experiential learning, longitudinal and community-based interactions, reflective opportunities, and structured assessment.

Self-regulatory coping among community dwelling older adults with multiple chronic conditions.

Objectives: Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC. Methods: A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study. Results: Three themes were developed from the analysis: (1) "I don't think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do": coping during a health event, and (3) "How do I know if what I did works?": appraisal of coping success. Discussion: Self-regulatory coping was influenced by individual beliefs and experiences (illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.

Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review.

BACKGROUND: Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown. OBJECTIVE: This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic. METHODS: Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020. RESULTS: Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients. CONCLUSIONS: Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.

Paid Leave for Fathers: Policy, Practice, and Reform.

Policy Points Government policies that secure paid leave for all parents, regardless of gender, can reduce structural inequalities, while promoting fathers' engagement in parenting. Such policies are likely to be most effective when they secure full, or almost full wage replacement, and when they provide incentives for fathers to take leave. Organizations must also participate in the culture shift, providing workplaces that encourage paternity leave rather than reinforcing the "male breadwinner" stigma.

Perceptions and patient care needs among hepatitis B patients during COVID-19.

BACKGROUND: The novel coronavirus of 2019 (COVID-19) has been and continues to be a rapidly developing public health crisis, that has also disrupted routine and maintenance health care for people living with chronic conditions. Some of these chronic conditions also put individuals at increased risk of COVID-19 complications, particularly if the condition is not under control. For these reasons, the exploratory study reported here examined the needs and preparedness of patients at a community health organization that specifically provides hepatitis B virus (HBV) care for high-risk groups that had previously tested positive for HBV. METHODS: Current study utilized exploratory analysis of qualitative COVID-19-related statements collected during calls to a total of 44 patients reached during April and May, 2020 in the Washington D.C. area. Researchers worked with a community based non-profit organization to reach current HBV + and HCV + patients to provide retention in care and assess patient needs in maintaining management of their condition adapted to include offering medication refills, telehealth, and other resources. We gathered emergent themes, using socio-ecological framework, regarding capacity and needs for managing their chronic condition in a vulnerable population during the initial, most interrupted, time period of a global public health crisis. RESULTS: From the notes of the calls, five thematic categories emerged: COVID-19 prevention awareness, assistance program access, medical resource access, access to knowledge and awareness about assistance programs, and needs and barriers. From these five themes, providers can develop strategies to better prepare their patients and provide care to patients with chronic conditions during major disruptions. CONCLUSIONS: Future recommendations include increasing hepatitis and COVID-19 vaccine efforts, collaborating with community partners, and screening and understanding social determinants of health that affect racial and ethnic minorities.

Communicating with Community: Health Disparities and Health Equity Considerations.

This article explores why communicating with communities is important to the health of individuals as well as public health, and best practices of how. We outline the use of relevant theoretic frameworks, understanding the role of technological contextual changes, trust despite misinformation, health and digital literacy skills, and working with the community for effective reciprocal communication. Strategies for developing community communication are also enumerated and applied to addressing health disparities.

A qualitative study of oral health knowledge among African Americans.

OBJECTIVES: The purpose of this qualitative oral health needs assessment was to probe and better understand the oral health knowledge, beliefs, and barriers of District residents, particularly in DC wards where oral health disparities are most prevalent. METHODS: Forty-eight (n = 48) participants were recruited for four focus groups. The focus group instrument consisted of a structured interview guide addressing the following topics: oral health history, perceived barriers to oral health, knowledge and perceptions about oral systemic health, and preferred message channels for receiving information on oral/dental health. Content analysis was performed using NVivo, a computerized, qualitative informatics tool. RESULTS: The majority of participants in this study practiced both brushing and flossing in their daily dental routine and did not believe that tooth loss is a normal part of ageing. There was lack of knowledge on the connection between oral and systemic health, specifically impact of smoking, alcohol use, and sweets and sexual activity. Focus groups identified two main barriers to healthcare access-communication and affordability. Participants who had a dentist were satisfied and felt that their needs were met. CONCLUSION: Our findings indicate a need for educational intervention and improved communication from oral health providers to increase awareness of the impact of systemic health and risky behaviors can have on oral health.

Exploring HPV Knowledge, Awareness, Beliefs, Attitudes, and Vaccine Acceptability of Latino Fathers Living in the United States: An Integrative Review.

To conduct an integrative review to identify and synthesize studies exploring human papillomavirus (HPV) knowledge, awareness, beliefs, attitudes, and acceptability of the HPV vaccine among Latino fathers living in the United States. The review methodology was informed by those developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed methods studies. Using the preferred reporting items for systematic reviews meta-analyses guidelines, five electronic databases (PubMed, Medline, PsycINFO, CINAHL, Science Direct) were searched for peer-reviewed, full-text studies published in English with samples that included Latino fathers and examined knowledge, awareness, beliefs, attitudes about the HPV and the HPV vaccines. Studies that did not provide information on the inclusion of fathers in the sample were excluded. Identified eligible studies were analyzed and synthesized using the matrix method. Eleven eligible studies were identified. Most (n = 10) included mothers and fathers. One study included only fathers, and this study determined that although fathers held positive attitudes toward the HPV vaccine, a notable number of participants were unsure of or had not formed an opinion about the HPV vaccine. Fathers felt that a recommendation from their child's physician would impact whether they vaccinated their child. Moreover, of the ten studies including both parents, only two specifically compared fathers' and mothers' knowledge and awareness about the HPV and vaccine acceptability. These two studies determined that fathers were less aware of the HPV and had lower HPV vaccine-related knowledge than mothers. Nevertheless, all of the 11 examined studies, found moderate to high acceptability of the HPV vaccine among Latino parents despite uncertainty about possible vaccine risks and costs. Only 11 studies were identified that included Latino fathers. Of these studies, only one was conducted exclusively with Latino fathers and two compared fathers and mothers. Additional research focusing on Latino fathers is needed given the central role of the family in the Latino culture and the shared role fathers and mothers have in decision-making related to their children's health.

Developing a Mass Media Campaign to Promote Mammography Awareness in African American Women in the Nation's Capital.

This study developed and examined the reach and impact of a culturally appropriate mass media campaign pilot, designed to increase awareness about the importance of mammography screening and the available community mammography services for low-income African American women ages 40 and above. We conducted formative research using focus groups to inform campaign development, resulting in five emergent themes-good breast health, holistic views of healthiness, cancer fatalism, fear of mammogram machines, and mammogram affordability. The campaign targeted specific low-income African American communities in the District of Columbia via print ads in Metro stations and on buses, print ads in the Washington Informer, and online ads on a local TV network website. Data were collected before, during, and after campaign implementation to assess reach and impact. Reach was measured by number of impressions (number of people exposed to the campaign), while impact was assessed via online ad click-through rates, website use and referrals, and mammography center calls. The campaign was successful in reaching the target audience, with a total combined reach from all media of 9,479,386 impressions. In addition, the mammography center received significant increases in new website visitors (1482 during the campaign, compared to 24 during the preceding period) as well as 97 calls to the dedicated phone line. Further research involving a more long-term investment in terms of funding and campaign run time, coupled with a more robust evaluation, is needed to assess if culturally appropriate mass media campaigns can generate increased mammography screening rates and decrease breast-cancer-related mortality.

A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study.

BACKGROUND: Data show that yoga is effective for improving health-related outcomes in breast cancer survivors. While breast cancer is the most commonly diagnosed cancer among African-American women (AAW), AAW are less likely to engage in yoga compared to other ethnic groups. The goals of the current study were to assess the feasibility of an 8-week restorative yoga program among African-American breast cancer survivors (AA BCS). Specifically, study aims were to (1) measure changes in study outcomes in a restorative yoga (RY) group compared to a wait list control group, (2) assess adherence to the RY program, and (3) assess program satisfaction among study participants. METHODS: Thirty-three AA BCS were randomly assigned to either the RY intervention (n = 18) or wait list control group (n = 15). RY classes met once per week for 8 weeks. Pre- and post-testing assessments were measured at 0 and 8 weeks (immediately post-intervention). RESULTS: Depression scores at follow-up were significantly lower in the yoga group (M = 4.78, SD = 3.56) compared to the control group (M = 6.91, SD = 5.86). No significant group differences were observed for sleep quality, fatigue, or perceived stress. Yoga program participants completing baseline assessments demonstrated 61% adherence to the yoga classes. Average rating of the yoga program was "very useful." Recommendations for future yoga programs were provided. CONCLUSIONS: This study suggests that yoga has a beneficial effect on depression in AA BCS. There is, however, a need to further explore the benefits of yoga among minority breast cancer survivors using a study with larger sample sizes.

A Post-Hurricane Katrina Examination of Substance Abuse Treatment Discharges With Co-Occurring Psychiatric and Substance Use Disorders.

OBJECTIVES: There is increasing literature supporting the adverse effects of disasters on substance use and psychiatric disorders. The co-occurrence of psychiatric disorders with substance use intensifies the challenge of treatment delivery. Thus the aim of this study was to examine the prevalence of substance use, treatment characteristics, and demographics of discharges from substance abuse treatment in New Orleans, post-Hurricane Katrina. Trends associated with discharges that have a co-occurring psychiatric and substance use disorder (COD) were also assessed. The secondary aim of this study was to examine the association of successful substance abuse treatment completion among those with a COD post-Hurricane Katrina. METHODS: Substance abuse treatment discharge data (N = 16,507) from New Orleans, Louisiana, for years 2006 through 2011 were obtained from the Treatment Episode Data Set-Discharge. Multiple logistic regression analysis was employed to examine the association of discharges with a COD and completion of substance abuse treatment. Demographic, psychiatric, and treatment characteristics of discharges in 2006 were compared to characteristics in 2011. Trends of characteristics were also assessed through the study period. RESULTS: Roughly a third (35.2%) of all discharges in New Orleans from 2006 to 2011 had a COD. After controlling for race, employment, treatment service setting at discharge, primary substance problem, and the discharge's principal source of referral, discharges with a COD were 29% less likely to complete treatment as compared to those with no COD (AOR = 0.71, 95% CI [0.56, 0.90], p = .004). Treatment completion among discharges with a COD has significantly declined from 36.8% in 2006 to 18.7% in 2011 (p < .0001). Notable significant trends in homelessness, criminality, and heroin use were identified among discharges with a COD. CONCLUSIONS: Substance abuse treatment undergoes various changes in the event of a natural disaster. These changes may increase challenges for successful treatment completion for vulnerable populations such as those with a COD. Results of this study demonstrate that discharges with a COD are less likely to complete treatment as compared to those with no COD disorder. Unmet treatment needs may also increase odds of criminalization and homelessness.

Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access.

OBJECTIVES: This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination. METHODS: Using cross-sectional data from 3573 girls aged 12-17 in the U.S. from the 2008-2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination. RESULTS: Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls. CONCLUSIONS: Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.

Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes.

BACKGROUND: This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS: We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS: African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS: Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.

The role of exergaming in improving physical activity: a review.

BACKGROUND: The high prevalence of obesity in America can be attributed to inadequate energy expenditure as a result of high levels of physical inactivity. This review presents an overview of the current literature on physical activity, specifically through active videogame systems (exergaming) and how these systems can help to increase physical activity levels. METHODS: The search strategy for this review was to identify previous studies that investigated energy expenditure levels using a single active video game or a combination of active videogames. RESULTS: Based on data from 27 studies, a strong correlation exists between exergaming and increased energy expenditure (up to 300% above resting levels). The majority of active videogames tested were found to achieve physical activity levels of moderate intensity, which meet American College of Sports Medicine guidelines for health and fitness. CONCLUSIONS: Exergaming is a new and exciting strategy to potentially improve physical activity levels and reduce obesity among Americans.

Is there an association between maternal pap test use and adolescent human papillomavirus vaccination?

PURPOSE: To identify the association between mother's recent receipt of a Pap test and daughter's uptake and completion of the three-shot human papillomavirus (HPV) vaccination series. METHODS: We used cross-sectional data from the 2008 to 2010 Behavioral Risk Factor Surveillance System from 9 U.S. states and Puerto Rico and logistic regression models to examine the association between mother's receipt of a Pap test in the past 3 years and daughter's uptake and completion of the three-shot HPV vaccination series among adolescent girls aged 9-17 years (N = 4,776). RESULTS: Approximately one-quarter of adolescent girls began the HPV vaccination series, and 13.6% completed the three-shot series. Uptake and completion were more likely among girls whose mothers had obtained a Pap test within the past 3 years-for HPV uptake, odds ratio: 1.342, 95% confidence interval: 1.073-1.692; for HPV completion, odds ratio: 1.904; 95% confidence interval: 1.372-2.721-but the relationship between mother's recent Pap test and vaccine uptake was explained by the mother's use of a personal doctor and obtaining a routine physical examination in the past year. CONCLUSIONS: HPV vaccination uptake and completion were more likely among adolescent girls whose mothers obtained a recent Pap test. Interventions designed to educate mothers on the importance of HPV vaccination and to facilitate relationships between physicians and mothers may prove successful at increasing HPV vaccination among adolescent girls.

Cholesterol, lipoproteins, and breast cancer risk in African American women.

BACKGROUND: Lipid levels, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides, have been reported to be associated with breast cancer risk. METHODS: We studied African American women (97 breast cancer cases and 102 controls) accrued through a population-based, case-control study in the Washington, DC metropolitan area during 1997 and 1998. Plasma lipid levels were measured using enzymatic methods. Logistic regressions (adjusted for age, age at menarche, parity, previous alcohol consumption, and education) were used to explore the associations between lipid levels and breast cancer. RESULTS: Through multivariable-adjusted regression, we observed a significant inverse association between breast cancer risk and increasing levels of total cholesterol (OR=.46, 95% Cl = .25-.85) and LDL (OR = .41, 95% CI = .21-.81), whereas lower levels of HDL were associated with a significant increase in risk (OR = 1.99, 95% CI = 1.06-3.74). CONCLUSIONS: Our data demonstrate significant reductions in breast cancer risk with high levels of total cholesterol and significant increase in risk when HDL levels are low. These data are in support of a protective effect of cholesterol which has been reported in other populations; further, these findings add to the literature in an understudied population, African American women.

Assessing the awareness of and willingness to participate in cancer clinical trials among immigrant Latinos.

Clinical trials are considered the gold standard of evidence about the efficacy of cancer prevention, early detection, and treatment interventions. A paucity of data exists on determinants of clinical trial participation in the growing US Latino population despite poor cancer outcomes in this group. This study seeks to describe correlates of awareness of and willingness to participate in clinical trials among largely Central, North, and South American Latinos using safety-net clinics. Between June 2007 and November 2008, we conducted an interviewer-administered, Spanish-language cross-sectional survey (n = 944). Logistic regression was used to assess effects of health information sources and psychosocial variables on awareness of and intention to participate in clinical trials. Analyses were completed in spring 2010. While only 48% knew what a clinical trial was, when explained, 65% indicated a willingness to participate. Providers were the most common source of health information. Use of Internet for health information, trust in health information, and higher education each independently increased the odds of clinical trial awareness, but obtaining information from providers did not. Contacting the Cancer Information Service and psychosocial factors were each independently associated with intent to join a clinical trial, while demographic factors were not. Information channels such as the Internet may be effective in conveying clinical trial information to Latinos. Providers being cited as the most common source of health information but not being associated with knowledge about or intent to participate in trials suggests a missed opportunity for communication to this population.

Information channels associated with awareness of human papillomavirus infections and vaccination among Latino immigrants from safety net clinics.

We report on information channels associated with awareness about human papillomavirus (HPV) among immigrant Central and South American Latinos. We conducted a survey of 1,334 Latino ≥ 21 years attending safety-net clinics in 2007-2008. Logistic regression analyses evaluated associations with HPV awareness. Forty-eight percent were aware of HPV infection and 40% were aware of the vaccine. Spanish television (38%) and providers (23%) were the primary HPV information sources. Infection awareness was associated with internet use (OR 1.47; 95% CI 1.10-1.96) and self-efficacy to find health information (OR 1.19; 95% CI 1.08-1.30). Vaccine awareness was associated with media use for health information (OR 1.27; 95% CI 1.09-1.49) and internet use (OR 1.59; 95% CI 1.18-2.13). Although Spanish television has reached this low HPV awareness group, there may be missed opportunities for education by providers. Television and the internet may also be effective channels for future interventions.

The impact of student diversity on interest, design, and promotion of Web-based tailored nutrition and physical activity programs for community colleges.

OBJECTIVE: To examine an organizational level perspective of the process of adopting Web-based tailored nutrition and physical activity programs for community college students. METHODS: In this qualitative study, 21 individual key informant interviews of community college student services and health center administrators were used to examine organizational-level perceptions of interest in, design characteristics of, and ways to promote health programs. A cross-classification matrix of a priori and emergent themes related to student diversity was created to describe cross-cutting patterns. RESULTS: Findings revealed 5 emergent themes for consideration in program development related to student diversity: (1) multiple roles played by students, (2) limited access to financial resources, (3) varied student demographics, (4) different levels of understanding, and (5) commuting to campus. CONCLUSIONS AND IMPLICATIONS: Nutrition and physical activity programs for community colleges need to specifically address the diverse nature of their students to increase the potential of adoption.

Physical activity reduces breast cancer risk in African American women.

OBJECTIVE: To examine the relationship between physical activity and breast cancer in African American women. DESIGN: A population-based case-control study was conducted with 199 women (97 cases and 102 controls) from the Washington, DC metro area. A physical activity questionnaire elicited responses on frequency of walking for exercise and vigorous physical activity (eg, running, aerobics) in the past year. Responses were used to calculate a metabolic equivalent (MET) score (MET-hours/week = hours/week vigorous activity x 7 + hours/week walking x 3). The MET score was categorized into low, medium, and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer. RESULTS: African American women who engaged in vigorous physical activity (> or = 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = .36; 95% confidence interval, CI = .17-.75). We also found a 64% reduced breast cancer risk in women with a high vs low tertile of total activity (OR = .36; 95% CI = .16-.79). For postmenopausal women, vigorous physical activity and total activity (high vs low tertile) also had an inverse relationship with breast cancer (P<.05). CONCLUSION: Data regarding the association of physical activity and breast cancer have been equivocal and lacking for African American women. This study found that modest levels of physical activity reduced breast cancer risk in this group. Targeted efforts are needed to encourage more African American women to engage in physical activity.