The Past Is so Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data.

BACKGROUND: African Americans (AAs) are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities. OBJECTIVE: The present study aims to explore vaccine attitudes and intentions among program participants, understand the role of an African American faith-based wellness program in COVID-19 awareness and vaccine uptake, and solicit potential solutions for this deep-rooted public health problem. METHODS: Data were collected through 21 in-depth interviews among individuals involved within a community-based wellness program. Sixteen phone and five in-person interviews were conducted with church leaders, lifestyle coaches, and program participants. All interviews were audio-recorded, transcribed verbatim, and inductively and thematically analyzed by three researchers. FINDINGS: Live Well by Faith (LWBF) acted as a trusted information source for COVID-19 resources for the AA community. Services provided by Live Well by Faith included enrolling community members for vaccines, negotiating vaccine provision to and facilitating the establishment of vaccine clinics at AA churches, and connecting community members to healthcare providers. Despite the role Live Well by Faith played, VH was a significant concern due, in part, to historical mistrust of government and pharmaceutical companies conducting unethical healthcare research among Black populations. Other factors included uncertainty about vaccination (vaccines' safety, efficacy, and necessity), social media misinformation, and political affiliation. Participants expressed the need for government to commit resources towards addressing historical factors and building trust with minority populations. CONCLUSION: Resource targeting programs such as Live Well by Faith that engage faith and community leaders in co-designed shared and culturally grounded interventions can help restore and strengthen trust in vaccines and governments and reduce vaccine hesitancy.

Physical Activity and Mental Health Declined during the Time of the COVID-19 Pandemic: A Narrative Literature Review.

(1) Introduction: Mental health (MH) and physical activity (PA) share a bi-directional relationship, but most studies report MH as the outcome. With diminishing pandemic-related MH, this review examines the impact of diminished MH on PA. (2) Methods: This narrative literature review included 19 empirical studies published since the COVID-19 pandemic. Electronic databases such as MEDLINE, PsycINFO, and CINAHL were searched for English language articles in peer-reviewed journals using equivalent index terms: "anxiety", "depression", "stress", "mental health", "exercise", "activity", "COVID-19", "coronavirus", and "2019 pandemic". The search reviewed 187 articles with double-rater reliability using Covidence. A total of 19 articles met the inclusion criteria. (3) Results: MH themes that impacted PA were depression and/or anxiety (n = 17), one of which identified inadequate coping and excessive pandemic stress (n = 2). In addition, women are more likely to suffer diminished MH and reduced PA throughout the pandemic. (4) Conclusion: Current research suggests that individuals with pre-pandemic MH episodes are correlated with more effective coping skills and fewer adverse effects from COVID-19 than expected. As we emerge from this pandemic, equipping all individuals, especially women, with positive coping strategies may accelerate a seamless return to PA.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors.

PURPOSE: Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors. METHODS: Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes. RESULTS: Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being. CONCLUSIONS: Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

Narrative Analysis of Childbearing Experiences During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has disrupted health care delivery and services around the world causing rapid changes to maternity care protocols and pregnant women to give birth with tight restrictions and significant uncertainties. There is a gap in evidence about expectant and new mothers' experiences with birthing during the pandemic. We sought to describe and understand pregnant and new mothers' lived experiences during the COVID-19 pandemic using authentic birth stories. STUDY DESIGN AND METHODS: Using a narrative analysis framework, we extracted relevant YouTube birth stories using predetermined search terms and inclusion criteria. Mothers' birth stories were narrated in their second or third trimester or those who had recently given birth during the pandemic. Birth stories were analyzed using an inductive and deductive approach to capture different and salient aspects of the birthing experience. RESULTS: N = 83 birth stories were analyzed. Within these birth stories, four broad themes and 13 subthemes were identified. Key themes included a sense of loss, hospital experiences, experiences with health care providers, and unique experiences during birth and postpartum. The birth stories revealed that the COVID-19 pandemic brought unexpected circumstances, both positive and negative, that had an impact on mothers' overall birthing experience. CLINICAL IMPLICATIONS: Results provided a detailed description of women's lived experience with giving birth during the COVID-19 pandemic. Maternity nurses should try to provide clear communication and compassionate patient-centered care to relieve women's anxieties about uncertain and unpredictable policy changes on COVID-19 as the pandemic continues to evolve.

Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States.

The aim of this article is to promote the use of knowledge visualization frameworks in the creation and transfer of complex public health knowledge. The accessibility to healthy food items is an example of complex public health knowledge. The United States Department of Agriculture Food Access Research Atlas (FARA) dataset contains 147 variables for 72,864 census tracts and includes 16 food accessibility variables with binary values (0 or 1). Using four-digit and 16-digit binary patterns, we have developed data analytical procedures to group the 72,684 U.S. census tracts into eight and forty groups respectively. This value-added FARA dataset facilitated the design and production of interactive knowledge visualizations that have a collective purpose of knowledge transfer and specific functions including new insights on food accessibility and obesity rates in the United States. The knowledge visualizations of the binary patterns could serve as an integrated explanation and prediction system to help answer why and what-if questions on food accessibility, nutritional inequality and nutrition therapy for diabetic care at varying geographic units. In conclusion, the approach of knowledge visualizations could inform coordinated multi-level decision making for improving food accessibility and reducing chronic diseases in locations defined by patterns of food access measures.

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations.

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) (p < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.

Social determinants of hypertension and type-2 diabetes in Kenya: A latent class analysis of a nationally representative sample.

INTRODUCTION: Cardiovascular disease is among the leading causes of death in Kenya and type II diabetes (T2D) is a growing chronic health concern in the country. However, a gap exists in examining how demographic and social characteristics coalesce to identify individuals at high risk for hypertension and/or T2D in Kenya. The current study examined demographic typologies associated with self-report diagnoses. METHODS: Nationally representative cross-sectional study using 43,898 individuals from the Kenya Demographic and Health Survey 2014. Main Outcome Measures were self-reported Hypertension and Type 2 Diabetes diagnosis. Descriptive analyses were conducted using STATA 14. Latent class analysis (LCA) was conducted using Mplus 7.4. RESULTS: Approximately 5% reported hypertension and 1% reported T2D. Latent class analysis suggested a 4-class solution. The class with the highest likelihood to report previous diagnosis of hypertension (10.4%), consisted of high proportion of married adult women. The second highest prevalence of previous diagnosis of hypertension (4.4%) consisted of a high proportion of married middle aged men with high probability of being smokers. The results suggest that Kenyan women over 30 years may be at increased risk of hypertension compared to men. Future studies should include additional socio-demographic and behavioral characteristics to better understand gender differences in correlates for hypertension to be used for targeted and tailored health promotion-interventions.

Measuring Type 2 diabetes mellitus knowledge and perceptions of risk in middle-class African Americans.

There is a paucity in the literature examining the African American middle-class. Most studies of African Americans and Type 2 Diabetes Mellitus (T2DM) have concentrated on lower-SES individuals, or make no distinction between African Americans of varying socio-economic positions. Middle-class African Americans are vulnerable in ways often overlooked by researchers. This study quantitatively examines specific T2DM knowledge and perceptions of risk in middle-class African Americans (N = 121). The majority of respondents, 70.2%, were unable to correctly identify all the warning signs of T2DM development. Only 3.3% of respondents correctly identified all risk factors provided as 'possible causes' of T2DM development. The difference between those participants who considered themselves to be at risk for T2DM development and their level of risk, according to the American Diabetes Associations' risk assessment, was not statistically significant (P = 0.397). However, there were statistically significant differences between participants' perceptions of their weight and clinical definitions of overweight, a major risk factor in T2DM development, based on BMI (P = 0.000). Middle-class African Americans are not inherently protected or exempt from developing T2DM. This study demonstrates gaps in knowledge and overall incongruent levels of perceived susceptibility, suggesting a need for additional research and health education in this segment of the population.

Pastoral perceptions of the learning and developing individual exercise skills (L.A.D.I.E.S.) intervention: a qualitative study.

African-American women experience higher rates of obesity compared to other racial/ethnic groups. High levels of reported church attendance among African-Americans have led to the proliferation of faith-based health programs. Pastors can influence success for faith-based programs. The purpose of this study was to assess pastors' perceptions of the L.A.D.I.E.S. intervention, designed to increase physical activity levels in sedentary African-American women. For the L.A.D.I.E.S. intervention, 31 churches (n = 418 women) were randomized at the church level to a faith-based, non-faith-based or self-guided program. All 31 pastors were invited by telephone to participate in the current study. Using a qualitative design, semi-structured interviews were conducted with 11 pastors from participating churches. Thematic analysis and the ecological model were used to examine the findings. According to the pastors, women showed heightened awareness of the importance of health and physical activity, and increased levels of fellowship. L.A.D.I.E.S. also encouraged healthy church climates and new health ministries. Lessons learned included the need for an expanded participant base and curriculum. Pastors expressed appreciation for the culturally fitting approach of L.A.D.I.E.S. Findings have implications for faith-based and public agency partnerships.

A Qualitative Inquiry of Lower Extremity Disease Knowledge Among African Americans Living With Type 2 Diabetes.

The purpose of this study was to investigate how personal illness representations of type 2 diabetes affected the level of foot care knowledge and self-care strategies among African Americans adults. Thirteen African Americans (ages 32-72 years) participated in individual semistructured qualitative interviews regarding self-care practices and lower extremity disease knowledge related to type 2 diabetes. Using phenomenological methodology, all interviews were transcribed and analyzed by the research team for themes. Three major themes emerged from the interviews: basic foot care knowledge, lower extremity disease knowledge, and patient-provider communication. The study yielded that the majority of the participants lacked understanding of basic diabetic foot care as well as how lower extremity complications can evolve from uncontrolled type 2 diabetes. Diabetes self-management education is an essential component that could aid in the improvement of poor health outcomes of African Americans. Diabetes self-management education programs should consider implementing more detailed foot care educational tools, especially those individuals who are affected with complications due to the disease and that can lead to lower extremity amputations. This study provided insight on the importance of this knowledge as it relates to making common sense assumptions about the disease and self-management strategies.

Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise.

African-American (AA) men have higher arterial stiffness and augmentation index (AIx) than Caucasian-American (CA) men. Women have greater age-associated increases in arterial stiffness and AIx than men. This study examined racial and sex differences in arterial stiffness and central hemodynamics at rest and after an acute bout of maximal exercise in young healthy individuals. One hundred young, healthy individuals (28 AA men, 24 AA women, 25 CA men, and 23 CA women) underwent measurements of aortic blood pressure (BP) and arterial stiffness at rest and 15 and 30 min after an acute bout of graded maximal aerobic exercise. Aortic BP and AIx were derived from radial artery applanation tonometry. Aortic stiffness (carotid-femoral) was measured via pulse wave velocity. Aortic stiffness was increased in AA subjects but not in CA subjects (P < 0.05) after an acute bout of maximal cycling exercise, after controlling for body mass index. Aortic BP decreased after exercise in CA subjects but not in AA subjects (P < 0.05). Women exhibited greater reductions in AIx after maximal aerobic exercise compared with men (P < 0.05). In conclusion, race and sex impact vascular and central hemodynamic responses to exercise. Young AA and CA subjects exhibited differential responses in central stiffness and central BP after acute maximal exercise. Premenopausal women had greater augmented pressure at rest and after maximal aerobic exercise than men. Future research is needed to examine the potential mechanisms.

Perceived social support and preventive health behavioral outcomes among older women.

Although research has documented that social support is a positive pathway to healthpromoting behavioral practices, very few longitudinal studies have assessed the relationship between social support and health-promoting behaviors among older, diverse women. Three waves of data from the Americans' Changing Lives (ACL) survey assessed whether or not changes in perceived social support influenced behavioral outcomes among 671 African American women and non-Hispanic white women aged 60 years and older. Positive social support from friends was the most successful in predicting physical activity across the life span while positive spousal support, positive support from children, and health behavior-specific support were insignificant determinants of physical activity. The results suggest that social support from friends may be an important predictive factor in engaging older women in physical activity during the aging process.

The role of spirituality in the self-management of chronic illness among older African and Whites.

This study used data from in-depth interviews collected from 88 African American and White men and women aged 65 years and older who reside in Allegheny County, Pennsylvania. The purpose of this study was to understand the role of spirituality in the self-management of chronic illness among this population. Thematic content analysis addressed two specific questions: (1) how do older adults use spirituality to help manage their chronic illness, and (2) are there any racial differences in the use of spirituality. Several core themes emerged from the linkage of spirituality and self-management: God: the healer, God: the enabler through doctors, faith in God, prayer as a mediator, spirituality as a coping mechanism, combining conventional medicine and spiritual practices, and empowering respondents to practice healthy eating habits. These results display racial differences in the use of spirituality in the self-management of chronic illness. African American elders were more likely than White elders to endorse a belief in divine intervention. White elders were more likely than African America elders to merge their spirituality in various self-management practices. Despite these differences, spirituality can play an integral part in a person's health and well-being of chronically ill elders.