The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis.

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

Effect of a Multicomponent Food Pantry Intervention in Client Subgroups.

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context.

Inconvenient sampling: Community-engaged and restorative justice approaches to genetic counseling student research.

Genetic counseling research requires a comprehensive approach since it frequently serves as the foundation for clinical care practice. Genetic counseling students play a pivotal role in advancing the profession, as they contribute a significant proportion of the research conducted within the genetic counseling community. However, a prevailing trend of convenience sampling of genetic counselors has limited the diversity of perspectives in student research projects. This article promotes a strategy for greater inclusivity and equity in research by emphasizing community-engaged and empowered research through the perspective of restorative justice. Reflecting on the shadow of the harmful ideologies of eugenics in our profession underscores the need to amplify patients' voices and diverse experiences. Community-engaged research-in collaboration with individuals, families, and communities directly impacted by genetic counseling-transcends traditional research paradigms, empowering patients and addressing systemic inequities. Incorporating community-engaged research into genetic counseling student projects aims to empower future professionals to better understand patient perspectives and needs while working toward addressing historical injustices. This article explores the potential benefits and pathways of incorporating community-engaged research and restorative justice principles into genetic counseling scholarly work, promoting empathy, cultural responsiveness, and ultimately, a more patient-centered approach to research and clinical care. By embracing this collective journey toward authentic partnership in the production of high-quality evidence in genetic counseling student research and more broadly, genetic counseling can become a more just and inclusive practice.

Integrating HPV self-collect into primary care to address cervical cancer screening disparities.

Human papillomavirus (HPV) self-collect shows promise to increase cervical cancer screening rates in underscreened populations, such as Somali patients, but little is known about how to integrate such an approach in primary care. In this study, primary care providers and staff who provide primary care services to Somali women were asked for their views on integrating HPV self-collect into routine care to address cervical cancer screening disparities. Thirty primary care providers and staff participated in semi-structured interviews exploring their views on HPV self-collect and their anticipated needs or barriers to implementing this approach into the clinic generally and with specific patient populations, such as Somali women. A thematic analysis using the constructivist version of grounded theory was undertaken. Providers and staff anticipate positive patient reaction to the option of HPV self-collect, and were interested in using this approach both for Somali patients and for all patients in general. HPV self-collect was viewed as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting primary HPV testing and HPV self-collect specifically, sharing concerns about effectiveness of self-collect and the lack of a physical exam. Providers felt clinic-wide staff education and patient education, along with strategies to address disparities, such as cultural and linguistic tailoring would be needed for successful implementation. Integrating HPV self-collect as an option in the cervical cancer screening process in a primary care clinical encounter offers considerable opportunity to address health disparities and may benefit all patients.

Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation.

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

A Cluster-Randomized Evaluation of the SuperShelf Intervention in Choice-Based Food Pantries.

BACKGROUND: Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease. PURPOSE: This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes. METHODS: Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life's Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition. RESULTS: In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p = .004); clients in control pantries had worsened Saturated Fat subcomponents scores (p = .019) and improved physical activity scores (p = .007). CONCLUSIONS: The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population.

Food pantries are an optimal setting to address health and diet quality among clients experiencing food insecurity. This study tests whether a food pantry intervention resulted in improved dietary and cardiovascular outcomes among clients. Sixteen Minnesota food pantries were randomized to either receive an intervention or a delayed intervention. The intervention offered food pantries technical assistance to improve healthy food supply and "nudge" clients toward healthy choices. Due to the COVID-19 pandemic, measures were completed 11 pantries (5 intervention, 6 control). Outcome measures included diet quality of food selected by clients, diet quality of food consumed by clients, and Life's Simple 7 measure of cardiovascular health. The intervention did not result in improved diet quality or cardiovascular health. Coordinated efforts across community settings are needed to address health risks facing this population.

Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness.

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6).  Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.

Applications of implementation science frameworks, models and theories in disparities-focused cancer screening interventions: a scoping review protocol.

BACKGROUND: Implementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps in understanding their applications in cancer health disparities contexts. This paper outlines a scoping review protocol designed to explore the utilisation of IS FMTs in cancer screening EBIs to inform intervention designs and adaptations. METHODS AND ANALYSIS: This scoping review protocol adheres to Arksey and O'Malley's five-step methodological framework for conducting scoping studies. Search strategies were conducted in five bibliographic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science and EMBASE. The search was run on 22 June 2023 with an English language filter and a date limit of 2001-current. Two reviewers will independently screen studies for inclusion and exclusion criteria. A third reviewer will be consulted, where appropriate at any of the review stages, to achieve consensus or resolve conflicts. Data will be collected, managed and analysed using Covidence. A narrative synthesis, based on Popay et al's methodology, will guide reporting and summarisation of results. The review will adhere to the PRISMA Extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION: This scoping review is a novel approach for examining a growing corpus of research literature on IS FMT applications used in cancer screening EBIs. As a secondary analysis, this scoping review does not require approval from an institutional review board. We anticipate the review will produce insightful information (eg, challenges, key areas for future directions) on the applications of IS TMFs in designing, deploying and testing EBIs for populations experiencing cancer screening disparities. We will disseminate the results through journals and conferences targeting IS and cancer prevention researchers and practitioners.

Genetic counseling processes and strategies for racially and ethnically diverse populations: A systematic review.

Genetic counseling outcomes are influenced by the processes and strategies used by counselors, yet little is known about how these strategies directly impact patients and populations. In particular, tailoring genetic counseling consultations to best meet the needs of cultural, racial, and ethnically diverse populations has been explored. This review aims to identify genetic counseling strategies tailored for a diversity of racial and ethnic populations with the goal to find ways to improve genetic counseling outcomes. Medline, Cochrane CENTRAL, Embase, PsychInfo, and CINAHL databases were searched for original research articles published in English that employed genetic counseling processes and strategies to improve genetic counseling outcomes, specifically for participants from ethnically or racially diverse populations. A review of 5300 titles and abstracts resulted in the identification of 36 articles that met the inclusion criteria. Three themes emerged: (1) community involvement in culturally tailoring genetic counseling, (2) creation and use of culturally tailored resources, and (3) modifications to the genetic counseling process. The effectiveness of genetic counseling strategies could not be evaluated due to lack of consistent outcome measures in the articles. The involvement of diverse ethnic and racial populations in developing inclusive genetic counseling tools and practices will help the profession provide better patient care in the future. More research connecting genetic counseling processes and outcomes will help to assess how well these modified approaches meet the needs of diverse populations.

Early results of a natural experiment evaluating the effects of a local minimum wage policy on the diet-related health of low-wage workers, 2018-2020.

OBJECTIVE: The current study presents results of a midpoint analysis of an ongoing natural experiment evaluating the diet-related effects of the Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/h. DESIGN: A difference-in-difference (DiD) analysis of measures collected among low-wage workers in two U.S. cities (one city with a wage increase policy and one comparison city). Measures included employment-related variables (hourly wage, hours worked and non-employment assessed by survey questions with wages verified by paystubs), BMI measured by study scales and stadiometers and diet-related mediators (food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation and daily servings of fruits and vegetables, whole-grain rich foods and foods high in added sugars measured by survey questions). SETTING: Minneapolis, Minnesota and Raleigh, North Carolina. PARTICIPANTS: A cohort of 580 low-wage workers (268 in Minneapolis and 312 in Raleigh) who completed three annual study visits between 2018 and 2020. RESULTS: In DiD models adjusted for time-varying and non-time-varying confounders, there were no statistically significant differences in variables of interest in Minneapolis compared with Raleigh. Trends across both cities were evident, showing a steady increase in hourly wage, stable BMI, an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes. CONCLUSION: There was no evidence of a beneficial or adverse effect of the Minimum Wage Ordinance on health-related variables during a period of economic and social change. The COVID-19 pandemic and other contextual factors likely contributed to the observed trends in both cities.

Asian American adolescent e-cigarette use and associated protective factors: Heterogeneity in a statewide sample.

OBJECTIVES: This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents. METHODS: Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group. RESULTS: Respondents included 9.0% Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity. CONCLUSIONS: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups.

Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study.

Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.

The lived experience of food pantry users in Minnesota: Qualitative findings from a statewide survey.

Objectives: In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients. Methods: Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed. Results: Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use. Conclusion: The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.

Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study.

BACKGROUND: Persistent infection with high-risk human papillomavirus (hrHPV) types is a well-documented cause of cervical cancer. Since the implementation of cervical cancer screening methods (e.g., Pap tests), cervical cancer rates have declined. However, Pap tests are still unacceptable to many women and require complex infrastructure and training. Self-sampling techniques for collecting HPV specimens (or "HPV self-sampling") have been proposed as a possible alternative to overcome these barriers. The objective of this study was to capture perspectives from health care personnel (providers, leaders, and clinic staff) across primary care systems on the potential implementation of an HPV self-sampling practice. METHODS: Between May and July 2021, a study invitation was emailed to various health care professional networks across the Midwest, including a snowball sampling of these networks. Eligible participants were invited to a 45-60-min Zoom-recorded interview session and asked to complete a pre-interview survey. The survey collected sociodemographics on age, occupation, level of educational attainment, race/ethnicity, gender, and awareness of HPV self-sampling. The semi-structured interview was guided by the Consolidated Framework for Implementation Research and asked participants about their views on HPV self-sampling and its potential implementation. All interviews were audio-recorded, transcribed, and analyzed using NVivo 12. RESULTS: Key informant interviews were conducted with thirty health care personnel-13 health care providers, 6 clinic staff, and 11 health care leaders-from various health care systems. Most participants had not heard of HPV self-sampling but reported a general enthusiasm for wanting to implement it as an alternative cervical cancer screening tool. Possible barriers to implementation were knowledge of clinical evidence and ease of integration into existing clinic workflows. Potential facilitators included the previous adoption of similar self-sampling tools (e.g., stool-based testing kits) and key decision-makers. CONCLUSION: Although support for HPV self-sampling is growing, its intervention's characteristics (e.g., advantages, adaptability) and the evidence of its clinical efficacy and feasibility need to be better disseminated across US primary care settings and its potential adopters. Future research is also needed to support the integration of HPV self-sampling within various delivery modalities (mail-based vs. clinic-based).

A qualitative analysis of SNAP and minimum wage policies as experienced by workers with lower incomes.

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to understand participant policy experiences in two contexts (Raleigh, North Carolina and Minneapolis, Minnesota). Participants experienced frequent, destabilizing changes to their United States Department of Agriculture Supplemental Nutrition Assistance Program benefits, which they identified as part of a broader safety net. Raleigh workers described an unsupportive policy environment; Minneapolis workers reaped few benefits from an ongoing wage increase. Many workers face complex financial tradeoffs; more sophisticated evaluations should consider broader policy contexts and long-range effects.

A randomized study of food pantry environment-level change following the SuperShelf intervention.

The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0-100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0-100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0-100). Descriptive analyses and t-tests examined pre-post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p < .001), as did FAST scores (p = .02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p = .56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients.

The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness.

BACKGROUND: In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants' experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016-2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory. RESULTS: Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process). CONCLUSION: There are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01932996 , registered 08/30/2013.

Implementing Chronic Care Model Treatments for Cigarette Dependence in Community Mental Health Clinics.

Objective: Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). Methods: Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. Results: Participants (n = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. Conclusions: CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs.

Belonging to Three Worlds: Somali Adolescent-Parent Relationships in the United States and Implications for Tobacco Prevention.

Immigrant family relationships help to buffer the adolescent adoption of health risk behaviors but can be strained by post-immigration structural and cultural barriers. This study qualitatively examines how Somali adolescent-parent relationship factors influence Somali adolescent tobacco use and identifies areas for further family support to prevent Somali adolescent tobacco use. We conducted fifteen key informant interviews with professionals serving the Somali community in clinical, educational, religious, or other community organization roles in one Minnesota metropolitan region. Data were collected and analyzed using approaches rooted in Grounded Theory. Key informants contrasted parenting experiences in Somalia with those in the United States and described how four key factors-structural and cultural barriers, multicultural identity formation, evolving parental expectations and responsibilities, and shifting family resources and support-have influenced Somali parent-child relationship quality and function following immigration. Informants shared the implications of these factors on parental ability to address adolescent tobacco use and discussed potential strategies to support parents that fell into two categories: assisting parents in adapting their parenting approaches to a new context and supporting knowledge and skill development in addressing tobacco use prevention specifically. Incorporating strategies that support Somali parents in their evolving parental roles and attend to structural and cultural barriers to tobacco prevention are essential to consider when developing family-centered tobacco prevention interventions in this population.

"Can we have a little humanity here?": Patient perspectives on the impact of a standardized care process for patients who use opioids for the management of chronic pain.

OBJECTIVE: Standardized processes have evolved in response to the opioid epidemic. The impact of standardized processes on patients has not been adequately described. METHODS: Five focus groups were held at four affiliated academic family medicine clinics. All participants experienced a transition to a standardized process for their ongoing opioid use for chronic, non-cancer pain. Data was analyzed and coded using a grounded theory approach with NVivo12 (QSR International). RESULTS: Thirty patients participated. Five main themes emerged: experience of pain; view of opioid medications; view of opioid prescribing process changes; "good patients" and trust; and experience with medical clinicians and clinics. CONCLUSIONS: Standardized processes created to improve the safety of opioid prescribing have burdened patients and resulted in a loss of trust and autonomy. Patients perceived greater risks for other patients prescribed opioids and processes are a result of their actions. PRACTICE IMPLICATIONS: Healthcare systems must acknowledge patients' burden, shift away from interventions that are limited in supporting data, reinforce patient agency and shift the conversation to unsafe medications rather than supervision of "bad actors".