COVID-19 vaccine uptake among non-US-born populations in the United States, 2020-2022.

BACKGROUND: In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable. Understanding baseline COVID-19 vaccine coverage among these populations and determining if disparities exist is essential for quality improvement initiatives and public health interventions. METHODS: Baseline COVID-19 vaccination rates for both primary series and booster doses were calculated at four health systems located in Minnesota, Colorado, and Pennsylvania participating in the Minnesota Department of Health's Center of Excellence in Newcomer Health. Patients aged ≥5 years as of 1/1/22, seen for ≥1 primary care visit during 7/1/2019-6/30/22 were included. Descriptive statistics were calculated for three measures of COVID-19 vaccine coverage during 12/14/2020-6/30/2022: 1) initiation of primary series; 2) completion of primary series; 3) completion of first booster. We calculated vaccine coverage rates for the entire population and stratified by subgroup including country of origin, refugee status, and primary language preference. RESULTS: We included 1,624,573 patients eligible for COVID-19 primary series vaccine and 907,749 eligible for COVID-19 booster vaccination. The percent of eligible patients who completed a COVID-19 primary series (63.4 %) and booster dose (66.2 %) were similar. Completion of the primary series was higher for non-US-born persons (72.7 %) compared with US born persons (65.4 %), similar among refugees (63.5 %) and non-refugees (63.4 %), and lower in patients with language preference other than English (62.7 %) compared with English preferring patients (63.6 %). Booster completion was lower for non-US-born persons (61.8 %), refugees (46.7 %), and patients with language preference other than English (55.3 %) compared with US-born (70 %), non-refugees (66.3 %), and English preferring patients (67.3 %) respectively. CONCLUSIONS: This evaluation identified disparities in COVID-19 vaccination rates among non-US-born persons and persons with a language preference other than English living in the US. Targeted outreach efforts may be beneficial in reaching these populations.

Using Adolescent SBIRT With Simulation to Teach Nursing Students Substance Use Assessment.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol for early identification and treatment for substance use. Adolescents are a high-risk group for substance use. METHOD: SBIRT simulation was conducted among nursing students (n = 79). Surveys were administered before (pretest), immediately after (posttest 1), and 3 weeks (posttest 2) after simulation. Outcome scores including attitude, role security, therapeutic commitment, knowledge, confidence, competence, readiness, and response to scenarios and cases were compared between traditional undergraduate nursing students who received educational reinforcement before the posttest 2 survey and postbaccalaureate students. RESULTS: Mean scores for attitude, role security, knowledge, confidence, competence, readiness, and scenarios or cases improved significantly after the simulation (p < .005). Traditional undergraduate and postbaccalaureate students had similar posttest 1 and posttest 2 scores. CONCLUSION: After SBIRT simulation, outcomes improved and were maintained after educational reinforcement, which could increase the success of interventions for substance use among adolescents. [J Nurs Educ. 2024;63(4):247-251.].

Work-life balance and professional quality of life among nurse faculty during the COVID-19 pandemic.

BACKGROUND: The rapid transition to online teaching during the COVID-19 pandemic created additional stress and workload issues for nurse faculty. Burnout has been reported in nurse faculty who cite workplace factors that influence satisfaction and work-life balance as major contributing factors. PURPOSE: The purpose of this study was to examine life balance and professional quality of life among nurse faculty (N = 216) in 2021 during the first year of the COVID-19 pandemic and to describe the challenges of delivering virtual learning experiences. METHODS: A cross-sectional design was utilized to survey nurse faculty using the Life Balance Inventory and the Professional Quality of Life Scale. Descriptive statistics and correlations were calculated. RESULTS: Nurse faculty reported an unbalanced life balance (median = 1.76), average compassion satisfaction (median = 40.00), average burnout (median = 24.00), and low secondary traumatic stress (median = 21.00). Narrative themes included (1) COVID-19 pandemic has made balance nearly impossible, (2) Intentional disconnection from work activities, (3) Challenging/changing priorities, (4) Promoting a healthy work environment, and (5) Moral distress and exhaustion. DISCUSSION: Understanding the factors that influence nurse faculty delivery of virtual learning experiences during the COVID-19 pandemic may provide opportunities to improve nurse faculty work-life balance and professional quality of life.

Increasing COVID-19 Vaccination Coverage for Newcomer Communities: The Importance of Disaggregation by Language.

The COVID-19 pandemic has disproportionately affected refugee, immigrant, and migrant populations. Vaccines are essential for decreasing transmission and severity of COVID-19 infection. Understanding differences in vaccination coverage based on preferred language is crucial for focusing efforts to decrease COVID-19-related disparities. Four sites in the Minnesota Center of Excellence in Newcomer Health collaboratively evaluated completion of primary COVID-19 vaccination series on or before December 31, 2021, for patients who were 12 years or older on June 30, 2021, by preferred language. The non-English/non-Spanish speaking population included 46,714 patients who spoke 174 languages; COVID-19 vaccination coverage by language ranged from 26.2% to 88.0%. Stratifying vaccination coverage by specific language is a critical first step toward dismantling disparities and shaping interventions that best meet the needs of communities served.

Hepatitis C Screening and Antibody Prevalence Among Newly Arrived Refugees to the United States, 2010-2017.

Six refugee screening sites collaborated to estimate the prevalence of hepatitis C virus (HCV) antibodies among newly arrived refugees in the United States from 2010 to 2017, identify demographic characteristics associated with HCV antibody positivity, and estimate missed HCV antibody-positive adults among unscreened refugees. We utilized a cross-sectional study to examine HCV prevalence among refugees (N = 144,752). A predictive logistic regression model was constructed to determine the effectiveness of current screening practices at identifying cases. The prevalence of HCV antibodies among the 64,703 refugees screened was 1.6%. Refugees from Burundi (5.4%), Moldova (3.8%), Democratic Republic of Congo (3.2%), Burma (2.8%), and Ukraine (2.0%) had the highest positivity among refugee arrivals. An estimated 498 (0.7%) cases of HCV antibody positivity were missed among 67,787 unscreened adults. The domestic medical examination represents an opportunity to screen all adult refugees for HCV to ensure timely diagnosis and treatment.

COVID-19 Infection and Contact Tracing Among Refugees in the United States, 2020-2021.

Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.

A Review of the Maternal and Child Health APHA Policy Statements, 1970-2019.

INTRODUCTION: The American Public Health Association (APHA) policy statements are written by members and approved by the APHA Governing Council. Policy statements inform APHA's position on key public health issues. Maternal and child health (MCH) is a broad discipline focused on health issues concerning women, children, youth, and families. APHA's MCH policies from the last 50 years were reviewed in celebration of the 100th anniversary of the MCH Section of APHA. METHODS: A cross-sectional design was utilized to identify MCH-related statements within the larger APHA policy statement database from 1970 to 2019 (N = 1,110). The policy statements were coded as primary MCH (main focus was MCH) or secondary MCH (mentioned MCH subpopulations as vulnerable population). The primary MCH themes were also identified. RESULTS: 545 (49%) of the APHA policy statements were related to MCH, including 226 (20%) coded as primary MCH and 319 (29%) secondary MCH. The primary MCH policy statements had a main focus on the following subpopulations: women (44%), children (33%), adolescents/young adults (15%), infants (12%), families (5%), and men (2%). Major themes included reproductive health/family planning, school health, children's health, pregnancy/childbirth, and breastfeeding/nutrition. CONCLUSIONS: MCH policy statements remained an important part of APHA's policy and advocacy focus over time as indicated through the continuous high number and proportion of MCH policy statements. The historical overview of MCH policy provides insight into critical policy issues confronting the MCH field over the decades and provides guidance for future policy initiatives including a need for increased emphasis on diverse MCH populations. SIGNIFICANCE: This analysis provides a 50 year overview of MCH themes as viewed by the policy statements published by APHA, the largest public health professional organization in the United States. These policy statements represent the cutting edge of MCH policy efforts and were written to influence national, state, and local public health policy. APHA policy statements should continue to address these important MCH topics in the future with an increased emphasis on diverse MCH populations. APHA policy making is a valuable national professional activity for the MCH field with the goal of improving the health for MCH communities.

A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee.

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)-the largest medical society dedicated to refugee health in North America-have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.

Acceptance of COVID-19 Vaccine Among Refugees in the United States.

OBJECTIVE: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.

Health of Asylees Compared to Refugees in the United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis.

BACKGROUND: Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice. METHODS: We conducted a retrospective cross-sectional analysis of domestic medical examination data from 9 US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C virus (HBV, HCV), and select sexually transmitted infections and parasites by refugee or asylee visa status. RESULTS: The leading nationalities for all asylees were China (24%) and Iraq (10%), while the leading nationalities for refugees were Burma (24%) and Iraq (19 %). Approximately 15% of asylees were diagnosed with LTBI, and 52% of asylee adults were susceptible to HBV infection. Prevalence of LTBI (prevalence ratio [PR] = 0.8), hepatitis B (0.7), hepatitis C (0.5), and Strongyloides (0.5) infections were significantly lower among asylees than refugees. Prevalence of other reported conditions did not differ by visa status. CONCLUSIONS: Compared to refugees, asylees included in our dataset were less likely to be infected with some infectious diseases but had similar prevalence of other reported conditions. The Centers for Disease Control and Prevention's Guidance for the US Domestic Medical Examination for Newly Arrived Refugees can also assist clinicians in the care of asylees during the routine domestic medical examination.

Preventive Care and Management of Chronic Diseases in Immigrant Adults.

Immigrants may have variable access to chronic disease screening and treatment in their countries of origin and host country, often limited by their immigration status. Immigrants face barriers to chronic disease management and preventive care, including health insurance access, linguistic challenges, lack of culturally sensitive care, limited records, and acculturation. Health care providers should prioritize chronic disease screening and follow up regularly to encourage preventive care and self-management of chronic disease.

Hepatitis B Evaluation and Linkage to Care for Newly Arrived Refugees: A Multisite Quality Improvement Initiative.

A quality improvement collaborative evaluated Hepatitis B virus (HBV) care for resettled refugees and identified strategies to enhance care. 682 of the 12,934 refugees from five refugee health clinics in Colorado, Minnesota, and Pennsylvania had chronic HBV. Timely care was defined relative to a HBsAg + result: staging (HBV DNA, hepatitis Be antigen, hepatitis Be antibody, alanine transaminase testing) within 14 days, comorbid infection screening (hepatitis C virus and HIV) within 14 days, and linkage to care (HBV specialist referral within 30 days and visit within 6 months). Completed labs included: HBV DNA (93%), hepatitis Be antigen (94%), hepatitis Be antibody (92%), alanine transaminase (92%), hepatitis C screening (86%), HIV screening (97%). 20% had HBV specialist referrals within 30 days; 36% were seen within 6 months. Standardized reflex HBV testing and specialist referral should be prioritized at the initial screening due to the association with timely care.

Organizational Readiness to Change: Quality Improvement in Family Medicine Residency.

INTRODUCTION: Primary care is evolving to meet greater demands for the inclusion of collaborative health care quality improvement (QI) processes at the practice level. Yet, data on organizational preparedness for change are limited. We assessed the feasibility of incorporating an organizational-level readiness-to-change tool that identifies factors relevant to QI implementation at the practice level impacting new family medicine physicians. METHODS: We assessed organizational readiness to change at the practice level among residents participating in a team-based QI training curriculum from April 2016 to April 2019. Seventy-six current and former residents annually completed the modified Organizational Readiness to Change Assessment (ORCA) survey. We evaluated QI and leadership readiness among five subscales: empowerment, management, QI, QI leadership (skills), and QI leadership (ability). We calculated mean survey scores and compared across all 3 years. Resident interviews captured unique perspectives and experiences with team-based activities. Qualitative analysis identified emergent themes. RESULTS: Residents completed 73 modified ORCA surveys (96% response rate). Compared to years 2016-2019, 2018 results were highest in mean negative responses for the QI subscale (24.62, SD 6.70). Four volunteers completed postsurvey interviews. Qualitative analysis identified issues concerning communication, team collaboration, practice site functioning, and survey relevance. CONCLUSIONS: Our study determined that miscommunication and practice site disruptions undermine organizational-level readiness to change, as measured by the ORCA tool which was part of a multimethod assessment included within a team-based QI training curriculum. Training programs undergoing curricula transformations may feasibly incorporate ORCA as a tool to identify impediments to collaborative practice and inform resource allocation important for enhancing physician training in QI leadership.

Evaluation of a Program to Improve Linkage to and Retention in Care Among Refugees with Hepatitis B Virus Infection - Three U.S. Cities, 2006-2018.

An estimated 257 million persons worldwide have chronic hepatitis B virus (HBV) infection (1). CDC recommends HBV testing for persons from countries with intermediate to high HBV prevalence (≥2%), including newly arriving refugees (2). Complications of chronic HBV infection include liver cirrhosis and hepatocellular carcinoma, which develop in 15%-25% of untreated adults infected in infancy or childhood (3). HBV-infected patients require regular monitoring for both infection and sequelae. Several studies have evaluated initial linkage to HBV care for both refugee and nonrefugee immigrant populations (4-9), but none contained standardized definitions for either linkage to or long-term retention in care for chronic HBV-infected refugees. To assess chronic HBV care, three urban sites that perform refugee domestic medical examinations and provide primary care collaborated in a quality improvement evaluation. Sites performed chart reviews and prospective outreach to refugees with positive test results for presumed HBV infection during domestic medical examinations. Linkage to care (29%-53%), retention in care (11%-21%), and outreach efforts (22%-71% could not be located) demonstrated poor access to initial and ongoing HBV care. Retrospective outreach was low-yield. Interventions that focus on prospective outreach and addressing issues related to access to care might improve linkage to and retention in care.

Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis.

BACKGROUND: Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS: This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION: In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.

Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014-2016: A cross-sectional analysis.

BACKGROUND: Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program's potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination's impact on screening coverage resulting from this examination. METHODS AND FINDINGS: We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from January 2014 to December 2016 from persons receiving a domestic medical examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic medical examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes. CONCLUSIONS: In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic medical examination and lower screening coverage for mental health. This analysis provided evidence that the domestic medical examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research.

Designing and Evaluating a Prediabetes Shared Decision Aid.

BACKGROUND: Prediabetes is increasing in prevalence and is associated with risk of developing diabetes, heart disease, stroke, and retinopathy. Clinicians have limited tools to facilitate prediabetes discussions within primary care visits. PURPOSE: 1) Develop a Patient and Stakeholder Advisory Committee (PASAC) to design, evaluate, and revise a prediabetes shared decision aid, and 2) evaluate the feasibility and experience of implementing the tool within primary care practice. METHODS: A prediabetes decision aid (double-sided infographic with decision questions) was created by a PASAC that included patients, primary care clinicians, diabetes educators, endocrinologists, and pharmacists. Five clinicians within 3 primary care practices tested the prediabetes tool with 50 adult patients with prediabetes. Patients completed 2 surveys immediately after the office visit and 6 weeks later. Clinicians and PASAC members completed a postintervention survey. RESULTS: The prediabetes shared decision aid was created through a deliberative process over 3 PASAC meetings. Ninety-six percent of patients felt the tool prepared them to decide on a diabetes prevention plan, and 100% of clinicians would use the tool again and felt the tool did not extend visit length. DISCUSSION: It was feasible to cocreate a prediabetes shared decision aid within a PASAC and implement the tool within a primary care setting. Patients and clinicians reported a prediabetes discussion, which may mitigate rates of progression to diabetes and associated complications. Future research should evaluate which of the intervention components most effectively promotes discussion of prediabetes within a primary care setting.

Women's Health Screening and Mapped Community Resources for Refugees Resettled in Philadelphia, Pennsylvania.

BACKGROUND: About 22,000 refugee women are resettled in the U.S. annually. Women's health screenings for breast and cervical cancer and reproductive health should be examined within the context of the built environment where refugees are resettled. PURPOSE: 1) Analyze the proportion of resettled refugees who had women's health screenings and 2) map the available refugee, health, and social services organizations compared with the ZIP codes where refugees were resettled. METHODS: Two clinical sites in Philadelphia conducted a retrospective chart review (N = 914). Community organizations were mapped. RESULTS: Within age guidelines, 460 (59%) women had a cervical cancer screening, 95 (63%) had a breast cancer screening, 296 (51%) were currently using contraception, and 118 (13%) became pregnant. Most community organizations were not located within ZIP codes where refugees resettled. DISCUSSION: There is a need for increased resources-which could increase women's screening rates-within a broader area of Philadelphia.

Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings.

Objective: People with serious mental illness (SMI) experience significant disparities in morbidity and mortality from preventable and treatable medical conditions. Women with SMI have low mammography screening rates. SMI, poverty, and poor access to care can have a significant effect on a woman's opportunity to learn about and discuss breast cancer screening with health care providers. This study examines the feasibility pilot outcomes of mammography decision support and patient navigation intervention (DSNI) for women with SMI living in supportive housing settings. The primary research question was: Does the DSNI increase knowledge, promote favorable attitudes, and decrease decisional conflict relating to screening mammography? Methods: We developed the intervention with the community using participatory methods. Women (n = 21) with SMI who had not undergone screening mammography in the past year participated in an educational module and decision counseling session and received patient navigation over a 6-month period. We conducted surveys and interviews at baseline and follow-ups to assess mammography decisional conflict. Results: Among study participants, 67% received a mammogram. The mammogram DSNI was feasible and acceptable to women with SMI living in supportive housing settings. From baseline to 1-month follow-up, decisional conflict decreased significantly (P = .01). The patient navigation process resulted in 270 attempted contacts (M = 12.86, SD = 10.61) by study staff (phone calls and emails with patient and/or case manager) and 165 navigation conversations (M = 7.86, SD = 4.84). A barrier to navigation was phone communication, with in-person navigation being more successful. Participants reported they found the intervention helpful and made suggestions for further improvement. Conclusions: The process and outcomes evaluation support the feasibility and acceptability of the mammography DSNI. This project provides initial evidence that an intervention developed with participatory methods can improve cancer screening outcomes in supportive housing programs for people with SMI.