Opportunities and Challenges to Linkage to Housing in the Context of a Sexual and Reproductive Health Program for Youth Experiencing Homelessness.

Youth homelessness remains a major public health issue in the USA, and youth experiencing homelessness (YEH) are still one of the more understudied and underserved groups. Comprehensive sexual and reproductive health (SRH) programs for YEH are rare. Yet, such programs are potentially effective settings through which to link YEH with housing services. Wahine ("woman") Talk is one such comprehensive program for YEH, and is a multilevel intervention delivered out of a youth drop-in center in Honolulu, Hawai 'i. One of Wahine Talk's core components is addressing basic needs, including providing linkages to housing services. Little research exists on SRH programs' opportunities and challenges to providing linkage to housing for YEH. The current study is an exploratory study asking, "What are opportunities and challenges to linking young women experiencing homelessness to housing services through a comprehensive sexual and reproductive health program?" The study team collected in-depth qualitative data through seven focus groups and 25 individual interviews with Wahine Talk staff and youth participants aged 14-22 years. Multiple team members analyzed the data using template analysis. The analysis revealed that while comprehensive SRH programs may have some opportunities and challenges to linking YEH to housing services that are consistent with traditional housing assistance programs, there are also factors specific to SRH programs. In particular, opportunities would be SRH programs employing a housing staff person and bolstering staff-youth meetings and communication. A challenge specific to SRH programs would be prioritizing youth's reproductive justice (i.e., choice) in lieu of solely prioritizing pregnancy reductions and delays; thus, it is recommended to train staff to prioritize youth's reproductive justice. The findings highlight the importance of SRH programs having staff focused on housing, sufficient opportunities for youth and staff to communicate with each other, and staff trained to prioritize youth's reproductive justice.

The role of community health advisors' cancer history in implementation and efficacy of a cancer control intervention.

Community health advisors (CHAs) play a key role in promoting health in medically underserved communities, including in addressing cancer disparities. There is a need to expand the research on what characteristics make for an effective CHA. We examined the relationship between CHA personal and family history of cancer, and implementation and efficacy outcomes in a cancer control intervention trial. Twenty-eight trained CHAs implemented a series of three cancer educational group workshops for N = 375 workshop participants across 14 churches. Implementation was operationalized as participant attendance at the educational workshops, and efficacy as workshop participants' cancer knowledge scores at the 12-month follow-up, controlling for baseline scores. CHA personal history of cancer was not significantly associated with implementation, nor knowledge outcomes. However, CHAs with family history of cancer had significantly greater participant attendance at the workshops than CHAs without family history of cancer (P = 0.03) and a significant, positive association with male workshop participants' prostate cancer knowledge scores at 12 months (estimated beta coefficient = 0.49, P < 0.01) after adjusting for confounders. Findings suggest that CHAs with family history of cancer may be particularly suitable for cancer peer education, although further research is needed to confirm this and identify other factors conducive to CHA success.

Breast cancer knowledge & information seeking among African American women below screening age.

OBJECTIVES: African American women below screening age disproportionately face greater mortality from breast cancer relative to peers of other races and African American women of screening age. The current study examines breast cancer knowledge and health information seeking of African American women below screening age. METHODS: We collected survey data from 99 African American women below screening age on their breast cancer knowledge and health information seeking behaviors. As secondary analysis, we harmonized data from a previous study to compare breast cancer knowledge between African American women below and of (N = 209) screening age. RESULTS: The average woman below screening age correctly answered 2.84 (SD=1.08) of six breast cancer knowledge items, 2.67 (SD=1.01) of five mammogram items, 1.44 (SD=0.86) of three treatment items, and had lower knowledge (p < .001) in each area relative to screening age women. Women below screening age sought information primarily from medical providers and the internet. CONCLUSIONS: A strategy for eliminating early-onset breast cancer disparities impacting African American women is addressing the limited breast cancer knowledge in this age group. Practice Implications In addition to age-appropriate information for this group, guidance for medical providers would be beneficial, as providers are this group's most common source of health information.

Motives Driving Non-healthcare Community Organizations to Engage in Health Promotion Activities.

While health promotion is not the primary mission of many community organizations (e.g., libraries, religious organizations), it is well documented that many still engage in health promotion activities, even when their resources may be constrained. What is less understood are the driving forces that spur community organizations to divert finite resources to health promotion when it may not directly align with their primary mission. The current study explores the reasons why various community organizations might choose to engage in health promotion, particularly in the context of the COVID-19 pandemic. We conducted interviews with leaders of 22 mosques, public libraries, low-income housing communities, and university-affiliated fraternities/sororities in the state of Maryland and qualitatively analyzed the data using template analysis. Four themes detailing reasons these community organizations engage in health promotion were identified including Organizational perceptions of health, Identifying and addressing issues of accessibility, Organizational responsibility, and Member interest and initiative. Understanding the reasons community organizations outside of the healthcare setting engage in health promotion, especially during a global pandemic, can allow public health researchers and practitioners to develop increasingly relevant and, in turn, effective strategies for recruitment of community organizations and sustainment of partnerships with these organizations. This has implications for population-level health impacts by improving reach to those that may not engage with traditional healthcare providers.

Prior health promotion experience and intervention outcomes in a lay health advisor intervention.

Training lay community members to implement health promotion interventions is an effective method to educate medically underserved populations. Some trainings are designed for individuals who already have a health-related background; however, others are developed for those with no previous health promotion experience. It is unknown whether those with backgrounds in health promotion are more effective in this role than those without. This study assessed the relationship between health promotion experience among trained community health advisors (CHAs) and their self-efficacy to implement an evidence-based cancer control intervention, as well as cancer knowledge and screening behavior outcomes among intervention participants. Data were collected from 66 trained CHAs and 269 participants in CHA-led cancer awareness and early detection workshops. CHAs reported high self-efficacy to implement the intervention independent of their health promotion experience. CHA health promotion experience was neither indicative of differences in participant colorectal or breast cancer knowledge at 12 months, nor of changes in participant-reported cancer screening. However, participant prostate cancer knowledge at 12 months was greater when taught by CHAs with previous health promotion experience (P < 0.01). Prior health promotion experience of trained health advisors may not be pivotal across all contexts, but they may affect specific knowledge outcomes.

Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches.

The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.

Researchers have become interested in studying how health promotion activities fit within the organizational setting where they are delivered. Health activities that are integrated into the host setting's structures and routine operations are more likely to be fully executed, effective, and sustained. Unfortunately, we know little about how to achieve such integration. This is especially true when working outside of a healthcare system, in community organizations like churches. We report findings from a study that compared an approach to tailoring health promotion activities into their host settings, with a standard, non-tailored approach. The study was conducted in 14 African American churches randomly assigned to the tailored or standard group. The health promotion activity involved training lay people to conduct cancer educational workshops for church members. We measured the extent to which the churches integrated health promotion activities into their structures, processes, resources, and communication at the beginning and one year later. We found that while the churches had overall increases in these factors over time, those in the tailored group did not do so to a greater degree than those in the standard group. Even so, this approach to tailoring health promotion activities to the organizational setting merits future study.

Breast Cancer Educational Needs and Concerns of African American Women Below Screening Age.

African American women are disproportionately impacted by breast cancer, including triple-negative disease, at a young age. Yet most public health research in breast cancer focuses on women of screening age. This study identified the specific breast cancer educational needs of African American women below the recommended screening age. Data were collected through 30 key informant interviews with young African American women breast cancer survivors (diagnosed between 18 and 45), family members of African American women diagnosed between 18-45 years, and community organization leaders and healthcare providers who work with young African American women impacted by breast cancer. Data were coded and analyzed by multiple team members using template analysis. The analysis identified four overarching themes reflecting breast cancer educational needs of young African American women. Although most Breast Cancer Knowledge and Perceived Risk educational needs were consistent with those of older women, there were specific needs involving Cultural Reluctance in Health Disclosures and Breast Cancer Risk Reduction. With regard to Healthcare Provider Relationships, participants stated a need for younger women to be particularly proactive in advocating for their health, as providers may be dismissive about cancer concerns due to young age. Though breast cancer in younger women is statistically improbable, there are educational needs specific to young African American women involving self-advocacy and family history. Findings have implications for developing interventions guiding young women to advocate for themselves in medical encounters and in their families, as well as for teaching medical providers how to counsel the young women regarding breast cancer.