Foundational features of indigenous pregnancy care: Lessons learned from indigenous pregnancy care providers.

PROBLEM: Indigenous populations experience higher odds of poor maternal and infant health outcomes than non-Hispanic White mothers yet have lower odds of receiving adequate prenatal care. BACKGROUND: Many Indigenous communities rely on modern Western medical institutions to provide pregnancy related health care. These systems were not developed with or for Indigenous communities and often fail to meet the needs of Indigenous pregnant patients. Offering culturally congruent models of care may increase prenatal care utilization. QUESTION, HYPOTHESIS OR AIM: This paper used qualitative inquiry to identify Indigenous approaches to caring for pregnancy. METHODS: Our team conducted 16 semi-structured individual interviews and one group interview with a total of 19 respondents. To arrive at thematic categories, the research team engaged in a modified pile sorting technique. The final set of categories, along with sub-themes, descriptions and example quotes, were sent to interviewees for approval. FINDINGS: Ten Foundational Features of Indigenous Pregnancy Care were identified. These covered themes related to Indigenous cultural practices, relationships, Indigenous sovereignty, local Indigenous community, full spectrum care, wholistic care, birthing person's wisdom, power and autonomy, flexibility, historical trauma, and cultural awareness. DISCUSSION: Modern midwifery care delivered by Indigenous practitioners may partially bridge the cultural gap; however, intentional effort is needed to integrate Indigenous ways into medical doctor practice models and facilities. CONCLUSION: This paper identifies ten foundational features of Indigenous pregnancy care and demonstrates the importance of recognizing the effects of trauma and providing opportunities for healing, upholding sovereignty, and centering relationships when caring for Indigenous pregnancies.

Racial Disparities in Patterns and Modes of Current and Daily Marijuana Use among Adults Living with Children.

OBJECTIVE: This study sought to examine racial disparities in marijuana use among U.S. adults living with children. METHODS: Data are drawn from the 2022 Behavioral Risk Factor Surveillance System to examine the prevalence of current (past month) and frequent (≥20 days in the last 30 days) marijuana use along with the mode of marijuana use by 7 racial and ethnic groups (non-Hispanic [NH] White, NH-Black, Hispanic, NH American Indian or Alaskan Native [AI/AN], NH-Asian, NH Native Hawaiian or other Pacific Islander only [NH/PI], and other/multiple races, n=22,659). RESULTS: Compared to NH White adults with children, NH Black adults had a higher prevalence of current marijuana use (23.1% vs. 16.9%, p=0.003) and NH AI/AN adults had two times higher prevalence of frequent use (17.3% vs. 8.4%, p=0.0003). Adults living in recreational marijuana legal states (vs. no) were also more likely to report marijuana use, and there were significant age × race/ethnicity and education × race/ethnicity interactions (p<0.05) on marijuana use. Regarding the mode of use, racial minority users except Asians also reported a higher prevalence of smoking marijuana than their White counterparts. CONCLUSIONS AND RELEVANCE: Substantial racial disparities in marijuana use patterns among adults who live with children highlight a potential risk for adolescents' health. Addressing these differences is essential for promoting equitable health outcomes in diverse communities.

Barriers and opportunities for promoting health professions careers among African American students in the Midwest.

The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.

Communicating Native American Cancer Efforts and Resources in the Great Plains.

American Indians' cancer disparities vary by region, signifying the importance of understanding community-specific levels of readiness to address cancer. Twenty-four key respondents from an urban American Indian community in the Great Plains, community leaders (n = 8), educators (n = 8), and students (n = 8), were interviewed following the Community Readiness Model. Using framework analysis, we qualitatively examined data related to efforts and resources in interview transcripts. One overarching emergent theme and three subthemes were identified. We found that communication of efforts and resources is critical to increasing community readiness to address cancer and is most successful when the community (1) prioritizes cancer as an issue in the community, (2) cultivates trusting relationships among stakeholders, and (3) practices cultural responsiveness in efforts. These findings emphasize the need for better communication of cancer efforts and resources and can inform strategic efforts to promote cancer prevention, treatment, and research among American Indians/Alaska Natives in the Great Plains.

COVID-19 pandemic and changes in children's physical activity in a rural US community: a mixed methods study.

OBJECTIVES: To examine differences in rural community children's moderate-to-vigorous physical activity (MVPA) and participation in out-of-school activities from fall 2019 to fall 2020 and explore enacted PA opportunity modifications post initial COVID-19 disruption. DESIGN: Mixed methods study using the validated Youth Activity Profile (YAP), administrator reports and stakeholder surveys and semistructured interviews. SETTING: Children and community stakeholders from one rural US Great Plains community in the state of Nebraska were recruited. PARTICIPANTS: Third through fifth graders in fall 2019 (n=144) and fall 2020 (n=174) reported MVPA and participation in out-of-school activities using the YAP. School administrators reported weekly physical education (PE) and recess minutes. Community stakeholders reported pandemic-related changes in community social structures in semistructured interviews (n=4) and surveys (n=19). RESULTS: Average daily MVPA minutes increased from 2019 to 2020 (75.0 vs 81.3, SE=1.6, p<0.05). Minutes of MVPA increased during: school hours (MD=2.7, SE=0.5, p<0.5); out-of-school time on weekdays (MD=3.9, SE=1.3, p<0.5); and on weekends (MD=5.5, SE=2.4, p<0.5). On average, fewer children participated in youth sport (42.5% vs 47.2%), youth clubs (10.3% vs 16.0%) and other out-of-school activities (24.1% vs 38.2%) in 2020, compared with 2019. Weekly PE/recess minutes increased from 208.3 to 241.7 from 2019 to 2020. Stakeholder surveys revealed community-driven modifications to PA opportunities, and interviews suggested children played outside more frequently, especially when school was closed and out-of-school activities were shut down. CONCLUSIONS: Increased minutes of PE and recess, and decreased out-of-school activity participation may have increased children's overall free play and MVPA during the pandemic. Free play was an important contributor to children's PA during the pandemic and should be prioritised by educators, coaches and other leaders of child PA opportunities. TRIAL REGISTRATION NUMBER: NCT03380143.

Arts-Based Research Methods to Explore Cancer in Indigenous Communities.

Background: Indigenous peoples experience an inequitable burden of cancer compared with other populations. The arts can serve as a culturally relevant cancer intervention and research method. Methods: A scoping review was conducted to determine how arts-based research methods have been used to address cancer in Indigenous peoples. Literature searches identified 129 publications; 32 were selected for review. The following data were extracted: communities employing arts-based cancer research, cancer control continuum stages, cancer types, art forms, and methodologies. Results: Most studies were conducted in the United States. Art as research and sound art forms were the most utilized arts-based methods. Cancer types and control continuum stages were not often specified. Conclusions: Culturally responsive, arts-based methods can enhance research and education across the cancer-control continuum with Indigenous populations.

Lead Toxicity and Environmental Health Justice Stories in Black and White Woodcut Portraits.

Background: Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members. Methods: The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters. Results: Shared stories of lead exposure and poisoning conveyed in the portraiture and printmaking processes revealed structural racism as an emergent theme. Conclusions: Arts-based research methods, such as portraiture, can be scaled and applied to support national and international community engagement efforts to advocate for environmental justice and public health.

What Lawrence's Story Tells Health Researchers About Arts-Based Interactions.

In arts-based-research, knowledge and meaning emerge from people's experiences of being in dynamic, ambiguous, intentional, and ethical relationships with each other and the arts. This case study draws on Launer's "7 C's" (context, conversations, curiosity, complexity, challenge, caution, and care) to understand the aesthetics (shape and form) and ethics of relationships between an artist-researcher and patient-sitter in portraiture-based medical research. This case supports the 7 C's being embodied in the art-making process, as the approach can usefully frame ethical challenges and rewards of portraiture-based health research for artist-researcher and patient-participant.

Stress Correlates Related to Depressive Symptoms Among Young Black Men in Southern California.

Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.

Collective Re-Storying of Mentee and Mentor Experiences in a Cancer Research Education Program for American Indian and Alaska Native Students.

The Youth Enjoy Science program at the University of Nebraska Medical Center has engaged American Indian/Alaska Native youth in mentored cancer research internships from 2017 to 2022. The primary purpose of this study was to examine mentor and mentee lived experiences of participation in Youth Enjoy Science research education internships and to provide insights that can inform mentorship practices in research education programs for American Indians/Alaska Natives. We conducted semi-structured interviews with current and former Youth Enjoy Science mentees (n=8) and mentors (n=8). Following a narrative inquiry research approach, we analyzed interview transcripts and collectively re-storied interview data. Participants described program characters, settings, problems, actions to address the problems identified, and resolutions that led to various recommendations for ways to raise contextual awareness between mentees and mentors.

Rural community systems: Youth physical activity promotion through community collaboration.

A common way to address rural population health issues is through community stakeholders working together. Youth physical activity (PA) happens in adult-led in-school and out-of-school group opportunities that vary across communities and generally occur in isolated settings. This study explores similarities and differences in rural community system structure and collaborative process variables that help to conceptualize the collaborative impact influencing population youth PA outcomes. Stakeholders (Community 1, n = 23; Community 2, n = 26) and youth (Community 1, n = 205; Community 2, n = 213) were recruited in 2018-2019 as part of Wellscapes, a hybrid implementation-effectiveness community randomized trial. A stakeholder survey (n = 49) measured community system structures and collaboration processes. Youth completed the Youth Activity Profile to measure PA levels. More Community 1 respondents than Community 2 resided within city limits (73.9% vs. 34.6%). Collective efficacy was significantly greater in Community 1 (M = 4.0, SD = 0.5) than in 2 (M = 3.2, SD = 0.4), p < 0.05. Perceptions of trust scored significantly greater in Community 1 (M = 4.1, SD = 0.3) than in 2 (M = 3.3, SD = 0.5), p < 0.05. Though both communities met rural definitions and had stakeholder investment, Community 1 had a greater proportion of PA-implementing stakeholders and more residing within city limits which may have influenced that community's higher scores in collective efficacy and trust. Community 2 had more stakeholders in administrator roles and yielded greater youth PA levels. Unique and common variables of rural communities should be considered in understanding system factors that impact youth PA.

Tailoring Our Approach in Response to the SARS-CoV-2 Pandemic and Transcending Science Outreach Modalities for Native American Students in a Cancer Research Education Program.

In response to the SARS-CoV-2 pandemic, a cancer research education program at the University of Nebraska Medical Center designed for Native American middle school, high school and undergraduate students adapted activities to be delivered online. There are considerable challenges to adapting in-person science programming to online delivery that can impact overall effectiveness. These challenges are further exacerbated when the cognate student population also faces significant disparities in health, wealth, and educational outcomes. We encountered both disadvantages and advantages in transitioning programming to online virtual formats. Challenges faced in delivering our programming during the pandemic included varied online accessibility, peripheral stressors, and disconnection to places and people. Despite these challenges, we found several benefits in remote delivery, some of which have alleviated barriers to program participation for Native American students. Some successes achieved by transitioning to fully remote programming included increased program reach, sustainability, and cultural relevancy. In this overview of the implementation of four online programs at the middle school, high school, and undergraduate levels, we highlight the challenges and successes experienced. Through this program description, we aim to provide insight into potential strategies to improve program delivery designed for Native American students during the SARS-CoV-2 pandemic and beyond.

Urban American Indian Community Health Beliefs Associated with Addressing Cancer in the Northern Plains Region.

American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha's urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community's perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region.

Sociodemographic Differences and Factors Affecting Patient Portal Utilization.

BACKGROUND: The primary function of the patient portal is to give patients greater access to their personal health information. Granting patients electronic access allows them to make well-informed health care decisions. OBJECTIVE: This study aimed to identify sociodemographic differences in patient portal use and examine factors affecting patient portal utilization following the final stage of the Meaningful Use program which aimed to promote the use of certified electronic health record (EHR) technology. RESEARCH DESIGN: Survey data from Health Information National Trends Survey (HINTS) 5, cycles 1, 2, and 3 were analyzed. The sample included 8291 completed surveys. Multivariable logistic regression on a selected response for each surveyed question was used to assess the racial and ethnic difference after controlling for age, sex, income, and education. SUBJECTS: Subjects included English and Spanish speaking adults in the USA. MEASURES: Measures included assessment of patient portal use, patient portal access, understanding health information, usefulness of health records, and privacy and security. RESULTS: After adjusting for age, sex, income, and education, there was a significant association between race/ethnicity and patient portal non-users responding, "no need to use online medical record" as the reason for not using the patient portal (P = 0.005). Among the portal users, there were significant associations between race/ethnicity and health care provider maintaining an EHR (P = 0.006), being offered access to their portal (P < 0.001), understanding health information in the portal (P = 0.004), finding the portal useful for health monitoring (P < 0.001), reporting concern about unauthorized access (P = 0.017), and keeping information from health care providers (P = 0.012). CONCLUSIONS: Race/ethnicity affects perceptions on the need for the patient portal, being offered access to a portal, and the reasons to access information online. Understanding the factors affecting patient portal use can inform future strategies aimed at increasing adoption.

Anthony and the Role of Silence in Portraiture in Clinical Settings.

This article describes one collaborative arts-based research project. Portrait artist Mark Gilbert and coinvestigators consider lessons for art and healing from one patient, Anthony, whose experience of head and neck cancer diagnosis, surgery, and recovery suggests how silence is ethically, artistically, and clinically significant.

Health Care Professionals' Journeys of Caring Through Portraiture.

Metropolitan Community College, a comprehensive multicampus academic institution in Omaha, Nebraska, installed portraits by the third author (MG) in the Health Careers Building and integrated them into an associate degree nursing curriculum. One goal was to expose nursing students to patients' stories in ways that encourage them to look beyond pain rating scales and protocols to the many dimensions of patients as human beings. Using portraiture in this way could be applied to any health professions curriculum, as the intersections of humanities and health care prompted students and clinicians to look beyond science and into the emotional journeys of caring.

Neurofibromatosis and a Portrait of 1 in 3000.

Neurofibromatosis, a genetic disorder that occurs in 1 in 3000 births, can cause tumors to grow anywhere on or in the body. The first author (RM), an artist-researcher and mother of a son living with neurofibromatosis, has painted and exhibited more than 200 portraits of people living with neurofibromatosis to raise awareness of and resources for this little-known disorder. Among many stories shared through RM's works is the story of Ashok, a Nepali man who has undergone 3 surgeries to remove facially disfiguring tumors that developed as a result of neurofibromatosis. This article analyzes portraits of Ashok and interviews that the senior author (RI) conducted with Ashok and RM during each phase of his surgical process to present a case study of their lived experience at the intersection of art and medicine that illustrates the power of portraiture as medicine.

Portraits of Suzanne, an Osage Woman's Story of Loving the Sun and Living With Skin Cancer.

Suzanne, an elder of The Osage Nation, has been diagnosed with basal cell carcinoma, squamous cell carcinoma, and melanoma skin cancer. Her daughter, Bobbie, a cancer researcher working for the Youth Enjoy Science Research Education Program, conducted a case study to share Suzanne's story through written narrative and a series of images that present Suzanne's reflections on cancer prevention and treatment from a holistic perspective. Seven interview transcripts, as well as photographs, drawings, and paintings of Suzanne, were created and analyzed to explore Suzanne's lived experience of cancer. In her story of living with cancer, Suzanne shares an elder's love and wisdom that can inform cancer education and prevention efforts to help address Native American cancer disparities.