Qualitative Description of Exercise Perceptions and Experiences Among People With Human Immunodeficiency Virus in the High-Intensity Exercise to Attenuate Limitations and Train Habits Study.

BACKGROUND: The benefits of physical activity (PA), specifically exercise, among older adults in general are well known. Yet globally, there is concern regarding limited engagement in PA, increased obesity, and frailty among older people with human immunodeficiency virus related to low levels of PA. METHODS: We conducted in-depth interviews among 30 older, sedentary people with human immunodeficiency virus participating in the ongoing High-Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH study, NCT04550676) between February 2021 and August 2022. A semistructured interview guide, informed by two minds theory, which frames behavior change as an intention-behavior gap between 2 neurocognitive systems, was used to elicit data from participants. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations, and PA goals. Thirty interviews from 33 participants were recorded and transcribed verbatim, and deductive and inductive thematic analysis were used using Dedoose. RESULTS: Physical activity was defined as maintaining daily living activities and addressing health goals. Previous experiences with PA varied among participants and were influenced by chronic illnesses, including human immunodeficiency virus; motivation; work commitments; interest; and social support. Reported barriers to PA included antiretroviral adverse effects, comorbidities, aging, and the COVID-19 pandemic. Changes in health status, body changes, and relationships were identified as benefits of PA. Conversations with healthcare providers supporting exercise goals were perceived to be important but rarely received by the participants. CONCLUSION: Understanding how older people with human immunodeficiency virus perceive PA is crucial to developing tailored strategies and structuring service delivery within the healthcare setting to promote a physically active life.

IL-38 Ablation Reduces Local Inflammation and Disease Severity in Experimental Autoimmune Encephalomyelitis.

IL-38 is an IL-1 family receptor antagonist that restricts IL-17-driven inflammation by limiting cytokine production from macrophages and T cells. In the current study, we aimed to explore its role in experimental autoimmune encephalomyelitis in mice, which is, among others, driven by IL-17. Unexpectedly, IL-38-deficient mice showed strongly reduced clinical scores and histological markers of experimental autoimmune encephalomyelitis. This was accompanied by reduced inflammatory cell infiltrates, including macrophages and T cells, as well as reduced expression of inflammatory markers in the spinal cord. IL-38 was highly expressed by infiltrating macrophages in the spinal cord, and in vitro activated IL-38-deficient bone marrow-derived macrophages showed reduced expression of inflammatory markers, accompanied by altered cellular metabolism. These data suggest an alternative cell-intrinsic role of IL-38 to promote inflammation in the CNS.

Evaluation of a hepatitis B lay health worker intervention for Cambodian Americans.

Cambodian Americans have high rates of chronic hepatitis B virus (HBV) infection. However, only about one-half of Cambodian Americans have been serologically tested for HBV. We conducted a randomized controlled trial to evaluate the impact of a lay health worker (LHW) intervention on HBV testing and knowledge levels among Cambodian Americans. The study group included 250 individuals who participated in a community based survey in metropolitan Seattle and had not been tested for HBV. Experimental group participants received a LHW intervention addressing HBV and control group participants received a LHW intervention addressing physical activity. Trial participants completed a follow-up survey 6 months after randomization. Over four-fifths (82 %) of randomized individuals participated in a LHW home visit and the follow-up survey response rate was 80 %. Among participants with follow-up data, 22 % of the experimental group and 3 % of the control group reported HBV testing (p < 0.001). The experimental and control group testing difference remained significant in an intent-to-treat analysis. The experimental group was significantly more likely than the control group to know that Cambodians have higher rates of HBV infection than whites, HBV cannot be spread by eating food prepared by an infected person, HBV cannot be spread by sharing chopsticks, and HBV cannot be spread by shaking hands. Our findings indicate LHW interventions are acceptable to Cambodian Americans and can positively impact both HBV testing and knowledge levels.

HPV vaccination uptake among Cambodian mothers.

Women of Southeast Asian descent have higher cervical cancer incidence rates than any other group. Widespread use of HPV vaccination could prevent up to 70% of cervical cancers. There is little published information addressing HPV vaccination uptake among Asian Americans. We conducted a survey of Cambodian women with daughters who were age-eligible for HPV vaccination. Survey items addressed HPV vaccination barriers, facilitators, and uptake. Only 26% of the survey participants reported any of their age-eligible daughters had received vaccination, and only 40% reported a previous physician recommendation for vaccination. Higher levels of vaccine uptake were strongly associated with having received a doctor's recommendation for vaccination (p < 0.001) and having asked a doctor for vaccination (p = 0.002). HPV vaccine uptake was relatively low in our Cambodian study group. Educational initiatives should encourage health care providers who serve Cambodian families to recommend HPV vaccination and empower Cambodian mothers to ask their daughters' doctors for vaccination.

Chumnguh thleum: understanding liver illness and hepatitis B among Cambodian immigrants.

Cambodian immigrants are over 25 times more likely to have evidence of chronic hepatitis B infection than the general US population. Carriers of HBV are over 100 times more likely to develop liver cancer than non-carriers. Liver cancer incidence is the second leading cancer for Cambodian men and the sixth for Cambodian women. Despite this, this underserved population has received very little attention from health disparities researchers. Culturally and linguistically appropriate interventions are necessary to increase hepatitis B knowledge, serologic testing, and vaccination among Cambodian Americans. Eight group interviews were held with Cambodian American men (48) and women (49). Focus group discussion revealed unanticipated information about sociocultural influences on participants' understanding about hepatitis B transmission, disease course, and prevention and treatment informed by humoral theories underlying Khmer medicine, by biomedicine, and by migration experiences. Our findings reveal the value of qualitative exploration to providing cultural context to biomedical information--a formula for effective health promotion and practice.

HPV vaccine knowledge and beliefs among Cambodian American parents and community leaders.

BACKGROUND: The cervical cancer incidence rate among Cambodian American women is 15.0 per 100,000, compared to 7.7 per 100,000 among non-Latina white women. HPV infection has been identified as a universal risk factor for cervical cancer. The HPV vaccine was recently approved in the United States for females aged 9-26 years. There is little information about HPV vaccination knowledge and beliefs in Southeast Asian communities. METHODS: We conducted 13 key informant interviews with Cambodian community leaders, as well as four focus groups with Cambodian parents (37 participants). Two of the focus groups included fathers and two of the focus groups included mothers. Interview and focus group questions addressed HPV vaccine barriers and facilitators. RESULTS: Participants had limited knowledge about HPV infection and the HPV vaccine. Barriers to HPV vaccination included a lack of information about the vaccine, as well as concerns about vaccine safety, effectiveness, and financial costs. The most important facilitators were a health care provider recommendation for vaccination and believing in the importance of disease prevention. DISCUSSION: Future cervical cancer control educational programs for Cambodians should promote use of the HPV vaccine for age-eligible individuals. Health care providers who serve Cambodian communities should be encouraged to recommend HPV vaccination.

Heart disease prevention practices among immigrant Vietnamese women.

BACKGROUND: Cardiovascular disease is a leading cause of death in the United States as well as in many countries around the world, including Vietnam. METHODS: Using data from a household survey of Vietnamese American women aged 20-79 years in Seattle, Washington, collected in 2006 and 2007, we examined heart disease prevention practices. Multivariable analyses were conducted to examine the relationship between demographic factors and preventive behaviors. RESULTS: A total of 1523 immigrant women completed interviews. The average daily consumption of fruits and vegetables was 3.5 servings, and 31% of our sample reported being physically active (engaging in at least 30 minutes of physical activity 5 or more days per week). Few respondents reported being current smokers (1.5%). Over three quarters of women had received a recent blood pressure check and a recent cholesterol check. Age and length of time in the United States were strongly associated with several cardiovascular prevention behaviors. CONCLUSIONS: Our findings confirm the need for continued efforts to develop and implement targeted educational campaigns to reduce the risk of cardiovascular disease among Vietnamese American women.

Development of an ESL curriculum to educate Chinese immigrants about physical activity.

Regular physical activity reduces the risk of many chronic conditions. Multiple studies have shown that Asians in North America engage in less physical activity than the general population. One area for strategic development in the area of health education is the design and evaluation of English as a second language (ESL) curricula. The PRECEDE model and findings from focus groups were used to develop a physical activity ESL curriculum for Chinese immigrants. In general, focus group participants recognized that physical activity contributes to physical and mental wellbeing. However, the benefits of physical activity were most commonly described in terms of improved blood circulation, immune responses, digestion, and reflexes. The importance of peer pressure and the encouragement of friends in adhering to regular physical activity regimens were mentioned frequently. Reported barriers to regular physical activity included lack of time, weather conditions, and financial costs. The ESL curriculum aims to both promote physical activity and improve knowledge, and includes seven different ESL exercises. Our curriculum development methods could be replicated for other health education topics and in other limited English-speaking populations.

Secondhand smoke in the home and Pap testing among Vietnamese American women.

The purpose of this study was to report the prevalence of Vietnamese households with smokers and examine Papanicolau (Pap) testing among Vietnamese American women living in households with and without smokers. In 2002, we surveyed Vietnamese between 18 and 64 years of age from a population-based sample of randomly selected households in Seattle, Washington zip codes known to have a high density of Vietnamese residents. The response rate among eligible households was 82%, and our sample included 418 households. We used two measures of Pap testing: ever had a Pap test and had one in the last two years. Household smoking status was categorized as current smoker in the house vs. no current smoker in the house. Overall, 47% of Vietnamese American women lived with a current smoker in the household, 73% had ever received a Pap test, and 63% received one in the last two years. Pap testing behavior varied only slightly by household smoking status, and the findings were not statistically significant. With nearly half of Vietnamese women in our study currently living with smokers, future studies should examine the relationship between secondhand smoke at home and other health behaviors in Vietnamese American households.

Translation challenges of cross-cultural research and program development.

PURPOSE: Translation of cross-cultural surveys and programs pose unique challenges. This paper identifies potential pitfalls of current translation guidelines and presents solutions employed for one project. METHODS: We followed current guidelines for translation of survey instruments including forward and back translation, and also utilized qualitative methods to decenter survey questions. In addition, our project adapted translation by committee with a core translation team of bilingual/trilingual investigators and staff members with diverse skills and complementary degrees of proficiency in the languages and dialects of interest. PRINCIPAL FINDINGS: This approach resulted with a mechanism for emic equivalence, identifying and resolving dialectic and sociolinguistic concerns, selecting appropriate written Chinese styles, and providing appropriate linguistic training to interviewers. CONCLUSIONS: An understanding of the history of a people and its ramifications for the language are important components of the translation process. Allocation of appropriate time, resources, and skills are critical to the successful development of valid cross-cultural survey instruments and effective programs.

Development of cervical cancer control interventions for Chinese immigrants.

The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women's health practices.