Health Literacy: Cancer Prevention Strategies for Early Adults.

Health literacy, the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make health decisions, is an essential element for early adults (aged 18-44 years) to make informed decisions about cancer. Low health literacy is one of the social determinants of health associated with cancer-related disparities. Over the past several years, a nonprofit organization, a university, and a cancer center in a major urban environment have developed and implemented health literacy programs within healthcare systems and in the community. Health system personnel received extensive health literacy training to reduce medical jargon and improve their patient education using plain language easy-to-understand written materials and teach-back, and also designed plain language written materials including visuals to provide more culturally and linguistically appropriate health education and enhance web-based information. Several sustainable health system policy changes occurred over time. At the community level, organizational assessments and peer leader training on health literacy have occurred to reduce communication barriers between consumers and providers. Some of these programs have been cancer specific, including consumer education in such areas as cervical cancer, skin cancer, and breast cancer that are targeted to early adults across the cancer spectrum from prevention to treatment to survivorship. An example of consumer-driven health education that was tested for health literacy using a comic book-style photonovel on breast cancer with an intergenerational family approach for Chinese Americans is provided. Key lessons learned from the health literacy initiatives and overall conclusions of the health literacy initiatives are also summarized.

Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: a qualitative study of dietary preferences, knowledge and practices.

BACKGROUND: Urban centers in Sub-Saharan Africa, such as Kumasi, Ghana, are especially impacted by the dual burden of infectious and non-communicable disease (NCD), including a rise in type 2 diabetes mellitus (T2DM) prevalence. To develop effective intervention programs, the World Health Organization recommends more research to better understand the relationship between food consumption and the escalation of non-communicable disease such as T2DM. This study provides qualitative information about current food knowledge, attitudes and practices among T2DM patients and their caregivers in the region of Kumasi, Ghana. METHODS: In this qualitative study, three focus groups discussions of 30 persons total and 10 individual interviews were used to assess food preferences, knowledge, attitudes and practices of patients with T2DM as well as caregivers responsible for food preparation. Participants included both urban and rural dwellers. Hospital-based health talks were observed, a dietician was interviewed, and educational documents were collected. Themes were identified and coded using Nvivo10 software. RESULTS: Findings suggest that messages regarding sweetened foods, fats, use of seasonings and meal timing are followed. However, confusion exists regarding the impact of fruits, food portioning, plantains and processed foods on health outcomes for diabetic patients. Results also revealed a problem-solving approach to increasing vegetable consumption, and a concern about unhealthy food preferences among younger generations. CONCLUSIONS: Education about the impact of commonly available carbohydrates on blood sugar should be emphasized; messaging on portion sizes and certain foods should be more consistent; the economic benefits of local vegetable consumption should be promoted; and a research-informed, T2DM prevention campaign should be developed specifically for younger generations.

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

BACKGROUND: People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports. METHODS: The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the "10 Essential Public Health Services." RESULTS: Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system. CONCLUSION: The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the "grand challenges" of integrated community health services.

Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters.

To understand cardiovascular health in low socioeconomic populations, we analyzed the data from 426 low socioeconomic community-dwelling males and females and 287 homeless males in Philadelphia. Despite higher prevalence of smoking and hypertension, the proportion of homeless participants at increased risk for coronary heart disease was comparable with that of low socioeconomic community-dwelling participants. Among various characteristics, emotional stress was significantly associated with coronary heart disease risk in low socioeconomic community-dwelling participants only, suggestive of a differential psychosocial effect of stress. Our findings suggest that low socioeconomic populations are heterogeneous with respect to their risk factors and needs for interventions.