Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use.

PURPOSE: We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS: Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS: AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION: Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study.

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Relationship between Acculturative Stress and Pain Catastrophizing in Korean Americans.

Acculturative stress is speculated to be a sociocultural factor contributing to pain since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship between acculturative stress and pain catastrophizing remains poorly understood. Therefore, we examined the relationship between acculturative stress and pain catastrophizing in Korean Americans. We collected survey data from Korean American in Texas (N = 374). Acculturative stress was measured with the Acculturative Stress Scale, and pain catastrophizing was measured with the Pain Catastrophizing Scale. Participants' mean age was 46.89 years, and 63% were women. Bivariate and multivariate statistical analyses indicated that higher acculturative stress may contribute to higher pain catastrophizing (regression coefficient = 1.02, P = 0.04). These findings advance our understanding of sociocultural factors associated with pain in Korean Americans; additional research with a larger sample is warranted for cross-validation.

The Relationship Between ß-Endorphin and Experimental Pain Sensitivity in Older Adults With Knee Osteoarthritis.

Osteoarthritis (OA) is the most common cause of pain in people aged >45 years, and the knee is the most commonly affected joint. There is a growing interest in understanding the biological factors that influence pain among older adults, but few studies have examined the relationship between ß-endorphin and experimental pain sensitivity in older adults with knee OA pain. The purpose of this study was to investigate the relationship between resting plasma levels of ß-endorphin and experimental pain sensitivity. This study was a secondary analysis of data for 40 adults with knee OA pain in whom quantitative sensory testing was used to measure experimental sensitivity to heat- and mechanically induced pain. The mean age of the sample was 60 years (SD = 9 years), and approximately half were female (53%). Regression analyses indicated that ß-endorphin level was negatively related to pressure pain threshold (ß = -17.18, p = .02) and positively related to punctate mechanical pain (ß = 17.13, p = .04), after controlling for age, gender, and OA severity. We did not find a significant relationship between ß-endorphin and heat pain tolerance. The results suggest that higher circulating levels of ß-endorphin at rest are associated with increased sensitivity to mechanical pain in older adults with knee OA. These findings add to the literature regarding biological factors associated with pain sensitivity in older adults with chronic pain. Additional studies are needed to identify mediators of the relationship between ß-endorphin and pain sensitivity in OA and other musculoskeletal pain conditions.

Smoking Behaviors in Arab Americans: Acculturation and Health Beliefs.

INTRODUCTION: Arab Americans are a growing population in the United States. In the 2011 American Community Survey, the U.S. Census Bureau reported there were close to 1.8 million Arab Americans living within the United States, a 47% increase in population size from 2000. According to the Arab American Institute, currently, that estimate has grown to approximately 3.7 million. They have high rates of smoking and low rates of smoking cessation. In this study, the researchers investigated factors influencing desire to quit smoking among Arab Americans, and their association with acculturation and health beliefs. METHODOLOGY: Cross-sectional descriptive study investigating smoking behaviors and factors influencing the desire to quit smoking among adult Arab American. Data were collected to measure tobacco use, nicotine dependence, desire to quit smoking, acculturation, and health beliefs. RESULTS: The sample ( N = 96) was 55% female, mean age of 44 years (±14.79). The desire to quit smoking was positively associated with perceived severity (p < .05) and susceptibility to cancer (p < .05), perceived benefits of quitting smoking ( p < .01); and negatively associated with smoking barriers (addiction barriers p < .05, external barriers p = .27, internal barriers p < .05), and nicotine dependence (p < .05). Being female, having a lower level of nicotine dependence, and a higher perception of cancer severity predicted higher desire to quit smoking ( p < .01). DISCUSSION: Smoking cessation intervention studies need to target appropriate health beliefs, especially the high risk of cancer caused by smoking among Arab Americans.

Association of CTRP13 With Liver Enzymes and Cognitive Symptoms in Nonalcoholic Fatty Liver Disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease in which patients present with metabolic dysregulation and obesity as well as fat accumulation in the liver. Those with NAFLD frequently have symptoms of fatigue, sleep disturbance, depression, and cognitive dysfunction. C1q/TNF-related protein 13 (CTRP13) regulates glucose metabolism and obesity in mice, yet the role of CTRP13 in human NAFLD has not been elucidated. AIMS: Our aims were to examine whether the plasma levels of CTRP13 are (a) increased in patients with NAFLD; (b) associated with metabolic dysregulation, obesity, liver enzymes, and dyslipidemia; and (c) associated with putative symptoms of NAFLD. METHODS: An observational study was conducted with 23 adults with confirmed NAFLD. Plasma levels of CTRP13, insulin resistance, insulin sensitivity, HbA1C, lipid profile, and liver enzymes were collected. Anthropometric analysis (body mass index, waist-hip circumference ratio) and bioelectrical impedance analysis of body composition were used to assess obesity. Symptom questionnaires were used to assess putative symptoms of NAFLD. Plasma levels of CTRP13 were measured in 21 age- and sex-matched control samples from a biobank. Paired t test was used for comparison of the CTRP13 between NAFLD and controls. Pearson's correlation coefficients were used to examine associations among variables. RESULTS: Plasma levels of CTRP13 were significantly higher in patients with NAFLD than in normal controls (p < .001), were associated with higher levels of aspartate aminotransferase, alanine aminotransferase (both p < .05), triglycerides (p < .001), and poorer cognitive function, particularly visuospatial memory (p < .001). CONCLUSIONS: CTRP13 may be a surrogate biomarker of NAFLD symptoms and associated with hepatocellular damage, dyslipidemia, and cognitive dysfunction.

Trustworthiness, Readability, and Suitability of Web-Based Information for Stroke Prevention and Self-Management for Korean Americans: Critical Evaluation.

BACKGROUND: Websites are common sources of health information to stroke survivors and caregivers for continual management of stroke and its long-term sequelae. The presence of risk factors and mortality rates related to stroke are high in Korean Americans. A vast majority of this group are active Web users and rely on the Web-based information due to lack of insurance and, thus, limited access to long-term stroke care. Thus, it is critical to evaluate existing stroke websites for their trustworthiness, readability, and suitability. OBJECTIVE: The objective of our study was to provide a systematic evaluation of stroke-related websites regarding (1) trustworthiness, (2) readability, and (3) suitability for stroke prevention and self-management for Korean Americans. METHODS: We selected a total of 156 websites using search terms "stroke," "CVA," "중풍 (jungpung)," and "뇌졸증 (noejoljung)" on Google and Yahoo. After eliminating duplicates and irrelevant websites (n=116), we evaluated a total of 42 websites (15 in English and 27 in Korean) using the National Library of Medicine's health website's evaluation tool for trustworthiness; Simple Measure of Gobbledygook for readability; and Suitability Assessment of Materials for suitability. All three instruments used the 3-point Likert scale: superior (=2), adequate (=1), or not suitable (=0). RESULTS: Of the 42 websites evaluated, we rated 62% (26/42) websites as "adequate" or above for trustworthiness. The information on 48% (20/42) websites had not been updated for more than a year, which indicates poor currency; 33% (14/42) websites failed to provide the publisher and contact information, which yields poor authority; 50% (21/42) websites did not cite sources of health information, which indicates lack of accuracy. Only 2 websites met the recommended readability (5th grade or lower reading level). The suitability was also suboptimal; only 1 website was rated as "superior"; 60% (25/42) websites were "adequate," and 38% (16/42) were "not suitable." Most websites were limited in graphical directions, interactive motivations for desired healthy behaviors, and multiple language translations. CONCLUSIONS: The existing stroke-related websites in either English or Korean are trustworthy and suitable, yet precise citation of evidence-based information will improve trustworthiness. The contents requiring high reading level may set a barrier to the utilization of Web-based health information for Korean Americans with a lower level of education. In addition, supplementing graphical examples, interaction features, and culturally relevant information in multiple languages are the areas for improvement in suitability. The improved features can reduce the reading burden of stroke patients or caregivers and build their confidence when applying the information for stroke management in daily living. These strategies are especially crucial to Korean Americans, who inevitably seek Web-based information to fill the gap between their demand and access to health care for a long-term self-management after a stroke.

Cardiovascular Disease in Korean Americans: A Systematic Review.

BACKGROUND: Despite Korean Americans being one of the fastest growing immigrant groups in the United States, little is known about their cardiovascular health or cardiovascular disease risk factors. PURPOSE: The purpose of this report is to describe the prevalence of cardiovascular disease risks and their contributing factors in Korean Americans and recommend future directions for the development of cardiovascular disease prevention or management research to meet the unique needs of this ethnic group. METHODS: We conducted a systematic review using databases of PubMed, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews and identified 27 studies that reported the prevalence of cardiovascular disease or its risk factors in Korean Americans, published in English between 2000 and 2016. RESULTS: We found high rates of unhealthy behaviors (eg, consumption of a high-sodium diet, physical inactivity, smoking) and risk factors (eg, hypertension, diabetes) for cardiovascular disease. Moreover, they were less likely to receive counseling about their diseases from healthcare providers and modify their lifestyle (eg, reduce their diet sodium intake, control their weight) to manage their diseases than were other ethnic populations. Individual-, interpersonal-, community-, and societal-level influences contributed to the high prevalence of cardiovascular risk factors. CONCLUSIONS: Data on subgroups of Asian Americans indicate that Korean Americans have significant lifestyle-related cardiovascular disease risks, which could be a critical agenda for researchers and clinicians to better understand cardiovascular health disparities in the United States.

Unidimensional and Bidimensional Approaches to Measuring Acculturation.

BACKGROUND AND PURPOSE: Researchers easily overlook the complexity of acculturation measurement in research. This study is to elaborate the shortcomings of unidimensional approaches to conceptualizing acculturation and highlight the importance of using bidimensional approaches in health research. METHODS: We conducted a secondary data analysis on acculturation measures and eating habits obtained from 261 Korean American adults in a Midwestern city. RESULTS: Bidimensional approaches better conceptualized acculturation and explained more of the variance in eating habits than did unidimensional approaches. CONCLUSION: Bidimensional acculturation measures combined with appropriate analytical methods, such as a cluster analysis, are recommended in health research because they provide a more comprehensive understanding of acculturation and its association with health behaviors than do other methods.

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey.

OBJECTIVE: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. METHODS: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. RESULTS: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). CONCLUSIONS: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Decreased Interleukin-4 Release from the Neurons of the Locus Coeruleus in Response to Immobilization Stress.

It has been demonstrated that immobilization (IMO) stress affects neuroimmune systems followed by alterations of physiology and behavior. Interleukin-4 (IL-4), an anti-inflammatory cytokine, is known to regulate inflammation caused by immune challenge but the effect of IMO on modulation of IL-4 expression in the brain has not been assessed yet. Here, it was demonstrated that IL-4 was produced by noradrenergic neurons in the locus coeruleus (LC) of the brain and release of IL-4 was reduced in response to IMO. It was observed that IMO groups were more anxious than nontreated groups. Acute IMO (2 h/day, once) stimulated secretion of plasma corticosterone and tyrosine hydroxylase (TH) in the LC whereas these increments were diminished in exposure to chronic stress (2 h/day, 21 consecutive days). Glucocorticoid receptor (GR), TH, and IL-4-expressing cells were localized in identical neurons of the LC, indicating that hypothalamic-pituitary-adrenal- (HPA-) axis and sympathetic-adrenal-medullary- (SAM-) axis might be involved in IL-4 secretion in the stress response. Accordingly, it was concluded that stress-induced decline of IL-4 concentration from LC neurons may be related to anxiety-like behavior and an inverse relationship exists between IL-4 secretion and HPA/SAM-axes activation.

Salivary Biomarkers of Chronic Psychosocial Stress and CVD Risks: A Systematic Review.

BACKGROUND: The use of salivary biomarkers in stress research is increasing, and the precision and accuracy with which researchers are able to measure these biomarkers have dramatically improved. Chronic psychosocial stress is often linked to the pathogenesis of cardiovascular disease (CVD). Salivary biomarkers represent a noninvasive biological method of characterizing the stress phenomenon that may help to more fully describe the mechanism by which stress contributes to the pathogenesis and outcomes of CVD. OBJECTIVES: We conducted a systematic review of 40 research articles to identify the salivary biomarkers researchers have most commonly used to help describe the biological impact of chronic psychosocial stress and explore its associations with CVD risk. We address strengths and weaknesses of specimen collection and measurement. METHODS: We used PubMed, CINAHL, EBSCOhost, Web of Science, BIOSIS Previews, Biological Sciences (ProQuest), and Dissertations/Theses (ProQuest) to retrieve 387 initial articles. Once we applied our inclusion/exclusion criteria to specifically target adult human studies dealing with chronic stress rather than acute/laboratory-induced stress, 40 studies remained, which we synthesized using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS: Cortisol was the biomarker used most frequently. Sources of psychosocial stress included job strain, low socioeconomic status, and environmental factors. Overall, psychosocial stress was associated with CVD risks such as vascular pathology (hypertension, blood pressure fluctuation, and carotid artery plaque) as well as metabolic factors such as abnormal blood glucose, dyslipidemia, and elevated cardiac enzymes. CONCLUSION: Diverse salivary biomarkers have been useful in stress research, particularly when linked to CVD risks.

Factors Associated With the Hospital Arrival Time in Patients With Ischemic Stroke in Korea.

BACKGROUND: Stroke is a leading cause of death and disability among the Korean population. Ischemic stroke patients tend to delay arrival at the hospital and often miss the "golden" 3-hour window, which is optimal for tissue plasminogen activator treatment. OBJECTIVE: The purposes of this study were to compare demographic, clinical/behavioral, and sociocultural characteristics of ischemic stroke patients who reside in urban and rural areas of Korea and to identify factors contributing to the time taken from symptom onset to hospital arrival. METHODS: A cross-sectional, descriptive study was conducted using a structured survey in a convenience sample of 229 ischemic stroke patients in Korea. RESULTS: Individuals who resided in rural areas were more likely to be female, older, less educated; had lower incomes; contacted adult children at the onset of stroke; and took a longer time to be transported to a hospital than did those who resided in urban areas (P < .05). Patients who visited an emergency room, transferred via an ambulance, contacted emergency medical services, perceived symptoms as serious, had a family history of stroke, or experienced hemiparesis as the primary stroke symptom arrived at the hospital relatively sooner, whereas patients who experienced unclear symptoms took relatively more time to arrive at the hospital following symptom onset (P < .05). CONCLUSIONS: Nationwide efforts are needed to promote public awareness of stroke and to develop strategies to reduce prehospital delay time for ischemic stroke patients, particularly those who reside in rural areas in Korea.

IL-4 Inhibits IL-1ß-Induced Depressive-Like Behavior and Central Neurotransmitter Alterations.

It has been known that activation of the central innate immune system or exposure to stress can disrupt balance of anti-/proinflammatory cytokines. The aim of the present study was to investigate the role of pro- and anti-inflammatory cytokines in the modulation of depressive-like behaviors, the hormonal and neurotransmitter systems in rats. We investigated whether centrally administered IL-1ß is associated with activation of CNS inflammatory pathways and behavioral changes and whether treatment with IL-4 could modulate IL-1ß-induced depressive-like behaviors and central neurotransmitter systems. Infusion of IL-4 significantly decreased IL-1ß-induced anhedonic responses and increased social exploration and total activity. Treatment with IL-4 markedly blocked IL-1ß-induced increase in PGE2 and CORT levels. Also, IL-4 reduced IL-1ß-induced 5-HT levels by inhibiting tryptophan hydroxylase (TPH) mRNA and activating serotonin transporter (SERT) in the hippocampus, and levels of NE were increased by activating tyrosine hydroxylase (TH) mRNA expression. These results demonstrate that IL-4 may locally contribute to the regulation of noradrenergic and serotonergic neurotransmission and may inhibit IL-1ß-induced behavioral and immunological changes. The present results suggest that IL-4 modulates IL-1ß-induced depressive behavior by inhibiting IL-1ß-induced central glial activation and neurotransmitter alterations. IL-4 reduced central and systemic mediatory inflammatory activation, as well as reversing the IL-1ß-induced alterations in neurotransmitter levels. The present findings contribute a biochemical pathway regulated by IL-4 that may have therapeutic utility for treatment of IL-1ß-induced depressive behavior and neuroinflammation which warrants further study.

Integrative Review of Co-Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice.

PURPOSE: Chronic liver disease affects over 30 million people worldwide, and despite advances in medical management that have increased survival, a majority of these individuals report multiple symptoms that severely impair function and quality of life. The purpose of this integrative review was to examine and summarize the current literature focused on self-reported symptoms in individuals with chronic liver disease in order to inform the development and delivery of symptom management strategies in clinical practice. DESIGN AND METHODS: Combinations of search terms related to the symptom experience were used to search three electronic databases. Inclusion criteria were empirical studies that measured self-reported symptoms in populations with chronic liver disease published in English between 2003 and 2014. The literature search initially yielded 112 results; 26 quantitative studies met the inclusion criteria. FINDINGS AND CONCLUSIONS: The symptom of fatigue was commonly reported across chronic liver disease populations and was often found to co-occur with other distressing symptoms, including depression, sleep disturbance, pain, cognitive impairment, and dizziness associated with autonomic dysfunction. Due to the high prevalence and persistence of these "core" symptoms, the use of core symptom measures integrated longitudinally across populations would inform the development and delivery of symptom management interventions as well as enhance the ability of nurses to incorporate population-level symptom management programs. CLINICAL RELEVANCE: Nurses play an important role in symptom assessment and may use the findings from the integrative review to incorporate core symptom measures across chronic liver disease populations and advance the development and delivery of symptom management interventions.

Decreased low back pain intensity and differential gene expression following Calmare®: results from a double-blinded randomized sham-controlled study.

In this double-blinded, randomized controlled trial we evaluated the effects of Calmare®, a non-invasive neurocutaneous electrical pain intervention, on lower back pain intensity as measured by the "worst" pain score and on pain interference using the Brief Pain Inventory-Short Form, on measures of pain sensitivity assessed by quantitative sensory testing, and on mRNA expression of pain sensitivity genes. Thirty participants were randomized to receive up to 10 sessions of Calmare® treatment (n = 15) or a sham treatment (n = 15) using the same device at a non-therapeutic threshold. At 3 weeks after conclusion of treatment, compared with the sham group, the Calmare® group reported a significant decrease in the "worst" pain and interference scores. There were also significant differences in pain sensitivity and differential mRNA expression of 17 pain genes, suggesting that Calmare® can be effective in reducing pain intensity and interference in individuals with persistent low back pain by altering the mechanisms of enhanced pain sensitivity. Further study of long-term pain outcomes, particularly functional status, analgesic use and health care utilization, is warranted.

Psychological strains, salivary biomarkers, and risks for coronary heart disease among hurricane survivors.

OBJECTIVE: To examine the associations of psychological strains, salivary biomarkers, and coronary heart disease (CHD) risks in hurricane survivors 2 years after Hurricane Ike in the United States. BACKGROUND: Hurricane survivors often suffer from long-lasting posttraumatic stress disorder (PTSD) and other forms of psychological strain related to surviving a natural disaster and dealing with its aftermath. Psychological strains may be associated with biomarkers, which, in turn, may be associated with a higher incidence of CHD risks. METHODS: Structured interviews were conducted with 19 hurricane survivors to assess psychological strains (PTSD, perceived stress, depression, and anxiety) and measure CHD risks. Saliva samples were collected by the passive drool method and analyzed for inflammatory cytokine (interleukin [IL]-1ß, IL-6, and IL-10) and chemokine (monocyte chemotactic protein [MCP]-1) biomarkers. RESULTS: The salivary level of MCP-1 was significantly associated with PTSD symptoms, depression (both p < .01), and anxiety (p < .05). There were significant associations between anxiety and hypertension (p < .01), perceived stress and blood glucose level (p < .05), and perceived stress and obesity (p < .05). CONCLUSION: Our findings that long-lasting psychological strains are associated with major CHD risks and salivary MCP-1 levels suggest that the mechanism by which such strains play a role in the development of CHD involves recruitment of monocyte cells in response to chronic endothelial inflammation. Further studies are needed to advance our understanding of the underlying mechanisms by which the PTSD and other psychological strains contribute to the development of CHD.

Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research.

Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.

We stop for no storm: coping with an environmental disaster and public health research.

Coping with natural disasters is part of the public nurses' role, and the public health nursing (PHN) researcher is doubly challenged with continuing to conduct community-based research in the midst of the disaster. The PHN may provide service along with attempting to continue the research. The challenges faced by public/community health nurse researchers as a result of hurricane Ike are discussed to provide lessons for other public/community health researchers who may be affected by natural disasters in the future. It is important to consider challenges for recruitment and retention of research subjects after a disaster, impact of natural disasters on ongoing research, and opportunities for research to be found in coping with natural disasters. A community-based study that was in progress at the time of hurricane Ike will be used as an example for coping with a natural disaster. We will present "lessons learned" in the hope of helping researchers consider what can go wrong with research studies in the midst of natural disasters and how to proactively plan for keeping research reliable and valid when natural disasters occur. We will also discuss the opportunities for collaborations between researchers and the community following any disaster.