A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family.

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

'We know what he likes, even if he doesn't know': how the children of South Asian immigrants characterize and influence the diets of their parents.

Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents' dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents' dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community.

Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review.

PURPOSE: There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer-related outcomes and oncologic care after a disaster event. METHODS: A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. RESULTS: Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. CONCLUSION: Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015.

Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18-35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3-4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

Associations Between COVID-19 Vaccine Hesitancy and Socio-Spatial Factors in NYC Transit Workers 50 Years and Older.

This analysis investigates how age, race/ethnicity, and geographic location contributed to vaccine hesitancy in a sample of 645 New York City (NYC) Transport Workers Union (TWU), Local 100 members surveyed in August 2020. Union members ages 50+ were 46% less likely to be vaccine hesitant than their younger counterparts (OR 0.64; 95% CI 0.42, 0.97). Non-Whites (OR 3.95; 95% 2.44, 6.39) and those who did not report their race (OR 3.10; 95% CI 1.87, 5.12) were significantly more likely to be vaccine hesitant than Whites. Those who were not concerned about contracting COVID-19 in the community had 1.83 greater odds (95% CI 1.12, 2.98) of being vaccine hesitant than those who were concerned. Older respondents tended to reside in Queens while vaccine hesitant and non-White respondents were clustered in Brooklyn. General trends observed in COVID-19 vaccine hesitancy persist in a population of high risk, non-healthcare essential workers.

Examining the effects of cumulative environmental stressors on Gulf Coast child and adolescent health.

This study examines how community-level cumulative environmental stress affects child and adolescent emotional distress and chronic health conditions both directly and indirectly through stressors at the household, family, and individual levels. Data comes from the Women and their Children's Health (WaTCH) Study, which sought to understand the health implications of exposure to the 2010 Deepwater Horizon oil spill (DHOS) among a cohort of 596 mothers with children ages 10 to 17 in southeastern Louisiana. Community-level environmental stress was measured using a newly developed geospatial index. Household-level stressors included previous hurricane impacts, impacts of DHOS, degree of financial difficulty, and degree of housing physical decay. Family stressors included maternal depression, self-rated physical health, and degree of parenting stress. Child stress was based on perceived stress; child mental health was based on serious emotional disturbance; and child physical health was based on diagnosis of chronic illness. Structural equation modeling used weighted least squares means and variance and theta parameterization. Results showed a significant negative direct path between community-level cumulative environmental stress and child/adolescent serious emotional disturbance and chronic illness. However, the indirect relationship through household, family, and individual-level stressors was significant and positive for both child/adolescent serious emotional disturbance and chronic illness. These findings point to the centrality of the household and family in determining child and adolescent physical and mental health outcomes in communities exposed to frequent disasters and ongoing environmental stressors.

Informal modes of social support among residents of the rural American West during the COVID-19 pandemic.

During the first year of the COVID-19 pandemic, federal spending to government safety net programs in the U.S. increased dramatically. Despite this unparalleled spending, government safety nets were widely critiqued for failing to fully meet many households' needs. Disaster research suggests that informal modes of social support often emerge during times of disruption, such as the first year of the pandemic. However, use of formal government programs and informal support are rarely examined relative to each other, resulting in an incomplete picture of how households navigate disaster impacts and financial shocks. This study compares estimates of informal social support to formal government program use in the rural U.S. West, drawing on data from a rapid-response survey fielded during the summer of 2020 and the 2021 Annual Social and Economic Supplement of the Current Population Survey (CPS-ASEC). We find that informal social support systems were, on aggregate, used almost as extensively as long-standing government programs. Our findings highlight the critical role of person-to-person assistance, such as sharing financial resources, among rural households during a disruptive disaster period. Routine and standardized data collection on these informal support behaviors could improve future disaster research and policy responses, especially among rural populations.

Mapping drivers of second-generation South Asian American eating behaviors using a novel integration of qualitative and social network analysis methods.

This study explores a novel, mixed qualitative method to deconstruct the diet of second-generation South Asian Americans (SAAs). Online interviews of 32 second-generation SAAs were conducted usingintegrated free-listing and mind-mapping. Ranked free-lists were aggregated to identify salient drivers, while connections made within mind-maps were analyzed using social network analysis (SNA) methods. Overall, 34 distinct drivers and 247 unique connections were identified. Taste, family, and health had the highest adjusted rankings, while health displayed the strongest network centrality. Interventions aimed at second-generation SAA dietary behaviors may benefit from family-based or multi-level interventions, which consider the complex, unique dietary norms identified.

Development of an Integrated Approach to Virtual Mind-Mapping: Methodology and Applied Experiences to Enhance Qualitative Health Research.

There is a growing need to better capture comprehensive, nuanced, and multi-faceted qualitative data while also better engaging with participants in data collection, especially in virtual environments. This study describes the development of a novel 3-step approach to virtual mind-mapping that involves (1) ranked free-listing, (2) respondent-driven mind-mapping, and (3) interviewing to enhance both data collection and analysis of complex health behaviors. The method was employed in 32 virtual interviews as part of a study on eating behaviors among second-generation South Asian Americans. Participants noted the mind-mapping experience to be (1) helpful for visual learners, (2) helpful in elucidating new ideas and to structure thoughts, as well as (3) novel and interesting. They also noted some suggestions that included improving interpretability of visual data and avoiding repetition of certain discussion points. Data collection revealed the adaptability of the method, and the power of mind-maps to guide targeted, comprehensive discussions with participants.

The effects of cumulative natural disaster exposure on adolescent psychological distress.

Natural disasters are becoming more frequent and destructive due to climate change and have been shown to be associated with a variety of adverse mental health outcomes in children and adolescents. This study utilizes data from three cohort studies of Hurricane Katrina survivors-including low-income mothers from New Orleans; displaced and highly impacted families from Louisiana and Mississippi; and Vietnamese immigrants in New Orleans-to examine the relationship between cumulative natural disaster exposure and adolescent psychological distress approximately 13 years after Katrina. Among 648 respondents with children ages 10-17, 112 (17.2%) reported that their child had exhibited one or more symptoms of psychological distress in the past month. Overall, respondents had experienced an average of 0.6 (SD 1.0) natural disasters following Hurricane Katrina. Each additional natural disaster experienced by the respondent was associated with 1.41 (95% CI 1.05, 1.88) greater odds of his or child experiencing psychological distress in the past month. This relationship was not significantly moderated by any measures of family resilience or vulnerability, nor by race/ethnicity or socioeconomic status, although family functioning, parental coping, and caregiver mental health were independently associated with adolescent psychological distress. The results of this analysis suggest that natural disasters have cumulative, detrimental impacts on adolescent mental health.

Impacts of the COVID-19 pandemic on rural America.

Despite considerable social scientific attention to the impacts of the COVID-19 pandemic on urbanized areas, very little research has examined its impact on rural populations. Yet rural communities-which make up tens of millions of people from diverse backgrounds in the United States-are among the nation's most vulnerable populations and may be less resilient to the effects of such a large-scale exogenous shock. We address this critical knowledge gap with data from a new survey designed to assess the impacts of the pandemic on health-related and economic dimensions of rural well-being in the North American West. Notably, we find that the effects of the COVID-19 pandemic on rural populations have been severe, with significant negative impacts on unemployment, overall life satisfaction, mental health, and economic outlook. Further, we find that these impacts have been generally consistent across age, ethnicity, education, and sex. We discuss how these findings constitute the beginning of a much larger interdisciplinary COVID-19 research effort that integrates rural areas and pushes beyond the predominant focus on cities and nation-states.

Identifying Barriers and Facilitators of Success for Female Radiology Researchers: An Analysis of In-Depth Interviews With Nationally Recognized Leaders of the Field.

OBJECTIVE: Women are highly underrepresented among leadership positions within radiology research, disproportionate to their underrepresentation in radiology overall. We sought to identify the causes and solutions of such disparity at the personal, organizational, and institutional levels among female radiology researchers who are leaders in the field. SUBJECTS AND METHODS: We used purposive sampling to identify nationally recognized female leaders in radiology research. We developed a semistructured interview guide and conducted in-depth one-on-one telephone interviews with participants (n = 16) that ranged from 36 to 65 min. All interviews were recorded and transcribed. Data were analyzed by two researchers trained in qualitative methods using Saldana's first- and second-cycle coding method. Themes were identified using a grounded theory approach to identify meaningful patterns that addressed the research question. RESULTS: Participants identified barriers to their professional development and success, including personal and professional obstacles often associated with work-life balance and the nonlinear nature of women's careers because of caregiving responsibilities. Participants also identified facilitators of success that operated at the individual, organizational, and institutional level, such as purposeful networking, having an advocate, and participating in leadership events. CONCLUSION: This study represents the first effort to qualitatively capture the facilitators of success for nationally recognized female radiology researchers. Findings suggest that synergistic efforts can be undertaken by early-career female radiologists and their colleagues, national radiology organizations, and academic institutions to systematically enable the inclusion and participation of women. The field of radiology should consider how to work dynamically at multiple levels to implement the identified potential changes.

Housing Transitions and Recovery of Older Adults Following Hurricane Sandy.

OBJECTIVES: This study explores the effects of social and environmental disruption on emergency housing transitions among older adults following Hurricane Sandy. It is based upon the Sandy Child and Family Health (S-CAFH) Study, an observational cohort of 1,000 randomly sampled New Jersey residents living in the nine counties most affected by Sandy. METHODS: This analysis examines the post-Sandy housing transitions and recovery of the young-old (55-64), mid-old (65-74), and old-old (75+) compared with younger adults (19-54). We consider length of displacement, number of places stayed after Sandy, the housing host (i.e., family only, friends only, or multi-host), and self-reported recovery. RESULTS: Among all age groups, the old-old (75+) reported the highest rates of housing damage and were more likely to stay in one place besides their home, as well as stay with family rather than by themselves after the storm. Despite this disruption, the old-old were most likely to have recovered from Hurricane Sandy. DISCUSSION: Findings suggest that the old-old were more resilient to Hurricane Sandy than younger age groups. Understanding the unique post-disaster housing needs of older adults can help identify critical points of intervention for their post-disaster recovery.

Support for vector control strategies in the United States during the Zika outbreak in 2016: The role of risk perception, knowledge, and confidence in government.

Limiting the spread and impact of Zika was a major global priority in 2016, which required a variety of vector control measures. The success of vector control campaigns is varied and often dependent on public or political will. This paper examines the change over time in the United States population's support for vector control and the factors that predicted support for three vector control strategies (i.e., indoor spraying, outdoor spraying, and use of larvacide tablets) during the 2016 Zika outbreak in the United States. Data is from a nationally representative random digit dial sample conducted at three time points in 2016. Bivariate and multivariate regression analyses were used, treating data as a pooled cross-sectional sample. Results show public support for vector control strategies depends on both perceived risk for disease and knowledge of disease characteristics, as well is confidence in government to prevent the threat. Support varied based on vector control method: indoor spraying, aerial spraying, and use of larvacide tables. Results can aide public health officials in implementing effective vector control campaigns depending on the vector control strategy of choice. Results have implications for ways to design effective prevention campaigns in future emerging infectious disease threats.

How the US Population Engaged with and Prioritized Sources of Information about the Emerging Zika Virus in 2016.

Emerging disease threats like Zika pose a risk to naïve populations. In comparison to chronic diseases, there is scientific uncertainty surrounding emerging diseases because of the lack of medical and public health information available as the threat emerges. Further complicating this are the multiple, diverse channels through which people get information. This article used bivariate and multivariate analysis to first describe the breadth of information sources individuals accessed about the Zika virus, and then describe individuals' primary sources of information for Zika using a nationally representative pooled cross-sectional data set collected at 3 time points in 2016 (N = 3,698). The analysis also highlights how 3 subgroups-high-education, high-income adults; Hispanic women of childbearing age; and retirees over the age of 65 with less than a high school education-varied in their use of information. Results suggest individuals accessed multiple sources, but TV and radio were the primary sources of Zika information for the public, followed by print news. Demographic variation in primary source of information means public health officials should consider alternative channels to reach target groups in an emerging event. Without an understanding of how information has reached people, and who individuals engaged with regarding that information, public health practitioners are missing a key piece of the puzzle to improving public health campaigns during a future event like Zika. This analysis aims to inform the public health community about the message channels the US population uses during an emerging disease event and the most prevalent channels for different demographic groups, who can be targeted with particular messaging.

Risk salience of a novel virus: US population risk perception, knowledge, and receptivity to public health interventions regarding the Zika virus prior to local transmission.

BACKGROUND: As the incidence of Zika infection accelerated in Central and South American countries from November 2015 through April 2016, U.S. public health officials developed vector control and risk communication strategies to address mosquito-borne and sexual modes of transmission. This study reports upon U.S. perceptions of the Zika virus prior to domestic transmission, and analyzes the association of socio-economic, political, knowledge and risk factors with population receptivity to selected behavioral, environmental, and clinical intervention strategies. METHODS: A representative sample of 1,233 U.S. residents was drawn from address-based telephone and mobile phone lists, including an oversample of 208 women of child-bearing age living in five U.S. southern states. Data were collected between April and June, 2016, and weighted to represent U.S. population distributions. RESULTS: Overall, 78% of the U.S. population was aware of Zika prior to domestic transmission. Those unaware of the novel virus were more likely to be younger, lower income, and of Hispanic ethnicity. Among those aware of Zika, over half would delay pregnancy for a year or more in response to public health warnings; approximately one third agreed with a possible vector-control strategy of targeted indoor spraying by the government; and nearly two-thirds agreed that the government should make pregnancy-termination services available to women who learn their fetus had a Zika-related birth defect. Receptivity to these public health interventions varied by age, risk perception, and knowledge of the virus. CONCLUSION: Risk salience and population receptivity to public health interventions targeting a novel virus can be conditioned on pre-existing characteristics in the event of an emerging infectious disease. Risk communicators should consider targeted strategies to encourage adoption of behavioral, environmental, and clinical interventions.

There's no place like home: Examining the emotional consequences of Hurricane Katrina on the displaced residents of New Orleans.

Using survey data from the Displaced New Orleans Residents Pilot Study (DNORPS), I examine the emotional consequences of Hurricane Katrina on the displaced residents of New Orleans. First, I employ an established framework within disaster research to investigate whether the stress level of displaced residents varies by race, income, and gender. As the residents in this dataset remained uprooted from their homes, I also examine three housing variables, including homeownership status, house type, and four levels of home damage. Contrary to previous research, home damage and homeownership status are significant predictors of displaced residents' emotional distress while the effect of race disappears. These findings suggest that future research on the mental health of disaster survivors, especially for displaced residents, expand the traditional analytical framework to consistently include housing variables, especially different categories of home damage, in addition to race, income, and gender.