Factors influencing adoption of and adherence to indoor smoking bans among health disparity communities.

OBJECTIVES: We assessed current home smoking behaviors and secondhand smoke (SHS) levels among parents of children in low-income, racial/ethnic minority communities in Massachusetts. METHODS: We used a cross-sectional design to assess home smoking rules, smoking status, cigarettes smoked in the home, and barriers and benefits to attaining a smoke-free home among 138 caregivers (mean age=30.0 years; 92% women) of children aged 0 to 6 years, between April 2010 and September 2012. Indoor SHS was assessed using a nicotine dosimeter. RESULTS: Households with no ban reported a higher weekly mean number of cigarettes smoked in the home (114 cigarettes/week) than homes with partial (71 cigarettes/week) or complete (30 cigarettes/week) bans (P<.01). Smoking occurred outside more than inside homes with partial or complete bans. Air nicotine levels were positively associated with no household smoking ban, current smoking by the caregiver, and smoking indoors. CONCLUSIONS: Strategies to reduce home SHS should focus on a "complete" home smoking ban and smoking cessation. SHS mitigation strategies such as smoking outside were associated with lower SHS among participants unable to maintain a complete ban, and might enhance the likelihood of longer term success while immediately reducing home SHS.

Primary prevention for resettled refugees from Burma: where to begin?

Developing effective primary prevention initiatives may help recently arrived refugees retain some of their own healthy cultural habits and reduce the tendency to adopt detrimental ones. This research explores recent arrivals' knowledge regarding eating behaviors, physical activity and sleep habits. Working collaboratively with community members, a healthy living curriculum was adapted and pilot tested in focus groups. A community-engaged approach to revising and implementing a health promotion tool was effective in beginning dialogue about primary prevention among a group of recently arrived refugees from Burma. Seven themes were identified as particularly relevant: food choices, living environment, health information, financial stress, mobility/transportation, social interaction and recreation, and hopes and dreams. Refugees desire more specific information about nutrition and exercise, and they find community health workers an effective medium for delivering this information. The outcomes of this study may inform future targeted interventions for health promotion with refugees from Burma.

Perceptions of evidence-based programs among community-based organizations tackling health disparities: a qualitative study.

Dissemination of prevention-focused evidence-based programs (EBPs) from research to community settings may improve population health and reduce health disparities, but such flow has been limited. Academic-community partnerships using community-based participatory research (CBPR) principles may support increased dissemination of EBPs to community-based organizations (CBOs). This qualitative study examined the EBP-related perceptions and needs of CBOs targeting underserved populations. As part of PLANET MassCONECT, a CBPR study, we conducted six key informant interviews with community leaders and four focus groups with CBO staff members in Boston, Worcester and Lawrence, Massachusetts, in 2008. Working definitions of EBPs among CBO staff members varied greatly from typical definitions used by researchers or funders. Key barriers to using EBPs included: resource constraints, program adaptation challenges and conflicts with organizational culture. Important facilitators of EBP usage included: program supports for implementation and adaptation, collaborative technical assistance and perceived benefits of using established programs. This exploratory study highlights differences among key stakeholders regarding the role of evidence in program planning and delivery. An updated perspective should better incorporate CBO perspectives on evidence and place greater, and much needed, emphasis on the impact of context for EBP dissemination in community settings.

Group prenatal care: an analysis of cost.

INTRODUCTION: Group prenatal care may have benefits over traditional care; however, the economic performance of this model is largely unexplored. We sought to understand the finances of group prenatal care at a small, rural, critical access hospital. METHODS: Volume, cost, and revenue estimates were obtained and an economic model was created. Determination was made of total time spent providing prenatal care, financial breakeven point and number of hours of prenatal care per patient. RESULTS: Group size required to equal or exceed the time efficiency of traditional prenatal care varied based on the structure of the prenatal care models. Small group sizes decrease efficiency and increase costs. The baseline financial breakeven point of 305 deliveries per year decreases to 302 deliveries if all women receive group care. Shifting prenatal care from higher to lower cost providers decreases the breakeven point to 218 deliveries per year, if the acquired time is used to provide gynecologic services. With group sizes between eight and 12, the time efficiency of lower cost providers improves from an average of seven to four hours of prenatal care per patient. CONCLUSION: In organizations with low volume obstetrics, group prenatal care can lead to decreased efficiency and greater cost. In settings with sufficient volume, financial benefit is realized if prenatal care is shifted from higher to lower cost providers. Using a group model of prenatal care allows lower cost providers to see additional patients efficiently. Although group prenatal care may offer some benefits, cost analysis should be considered before initiation.

Subcutaneous Injection of Testosterone Is an Effective and Preferred Alternative to Intramuscular Injection: Demonstration in Female-to-Male Transgender Patients.

Context: Testosterone (T) is commonly administered intramuscularly to treat hypogonadal males and female-to-male (FTM) transgender patients. However, these injections can involve significant discomfort and may require arrangements for administration by others. Objective: We assessed whether T could be administered effectively and safely subcutaneously as an alternative to intramuscular (IM) injections. Design: Retrospective cohort study. Setting: Outpatient reproductive endocrinology clinic at an academic medical center. Patients: Sixty-three FTM transgender patients aged >18 years electing to receive subcutaneous (SC) T therapy for sex transition were included. Fifty-three patients were premenopausal. Intervention: Patients were administered T cypionate or enanthate weekly at an initial dose of 50 mg. Dose was adjusted if needed to achieve serum total T levels within the normal male range. Main Outcome Measurements: Serum concentrations of free and total T and total estradiol (E2), masculinization, and surveillance for reactions at injection sites. Results: Serum T levels within the normal male range were achieved in all 63 patients with doses of 50 to 150 mg (median, 75/80 mg). Therapy was effective across a wide range of body mass index (19.0 to 49.9 kg/m2). Minor and transient local reactions were reported in 9 out of 63 patients. Among 53 premenopausal patients, 51 achieved amenorrhea and 35 achieved serum E2 concentrations <50 pg/mL. Twenty-two patients were originally receiving IM and switched to SC therapy. All 22 had a mild (n = 2) or marked (n = 20) preference for SC injections; none preferred IM injections. Conclusions: Our observations indicate that SC T injections are an effective, safe, and well-accepted alternative to IM T injections.

An online social network to increase walking in dog owners: a randomized trial.

PURPOSE: Encouraging dog walking may increase physical activity in dog owners. This cluster-randomized controlled trial investigated whether a social networking Web site (Meetup™) could be used to deliver a multicomponent dog walking intervention to increase physical activity. METHODS: Sedentary dog owners (n = 102) participated. Eight neighborhoods were randomly assigned to the Meetup™ condition (Meetup™) or a condition where participants received monthly e-mails with content from the American Heart Association regarding increasing physical activity. The Meetup™ intervention was delivered over 6 months and consisted of newsletters, dog walks, community events, and an activity monitor. The primary outcome was steps; secondary outcomes included social support for walking, sense of community, perceived dog walking outcomes, barriers to dog walking, and feasibility of the intervention. RESULTS: Mixed-model analyses examined change from baseline to postintervention (6 months) and whether change in outcomes differed by condition. Daily steps increased over time (P = 0.04, d = 0.28), with no differences by condition. The time-condition interaction was significant for the perceived outcomes of dog walking (P = 0.04, d = 0.40), such that the Meetup™ condition reported an increase in the perceived positive outcomes of dog walking, whereas the American Heart Association condition did not. Social support, sense of community, and dog walking barriers did not significantly change. Meetup™ logins averaged 58.38 per week (SD, 11.62). Within 2 months of the intervention ending, organization of the Meetup™ groups transitioned from the study staff to Meetup™ members. CONCLUSIONS: Results suggest that a Meetup™ group is feasible for increasing physical activity in dog owners. Further research is needed to understand how to increase participation in the Meetup™ group and facilitate greater connection among dog owners.

Community capacity building and sustainability: outcomes of community-based participatory research.

BACKGROUND: For communities, the value of community-based participatory research (CBPR) is often manifested in the outcomes of increased capacity and sustainable adoption of evidence-based practices for social change. Educational opportunities that promote discourse between community and academic partners can help to advance CBPR and better define these outcomes. OBJECTIVES: This paper describes a community-academic conference to develop shared definitions of community capacity building and sustainability related to CBPR and to identify obstacles and facilitators to both. METHODS: "Taking It to the Curbside: Engaging Communities to Create Sustainable Change for Health" was planned by five Clinical Translational Science Institutes and four community organizations. After a keynote presentation, breakout groups of community and academic members met to define community capacity building and sustainability, and to identify facilitators and barriers to achieving both. Groups were facilitated by researcher-community partner teams and conversations were recorded and transcribed. Qualitative analysis for thematic content was conducted by a subset of the planning committee. RESULTS: Important findings included learning that (1) the concepts of capacity and sustainability were considered interconnected; (2) partnership was perceived as both a facilitator and an outcome of CBPR; (3) sustainability was linked to "transfer of knowledge" from one generation to another within a community; and (4) capacity and sustainability were enhanced when goals were shared and health outcomes were achieved. CONCLUSIONS: Community capacity building and sustainability are key outcomes of CBPR for communities. Co-learning opportunities that engage and mutually educate both community members and academics can be useful strategies for identifying meaningful strategies to achieve these outcomes.

Addressing cancer disparities via community network mobilization and intersectoral partnerships: a social network analysis.

Community mobilization and collaboration among diverse partners are vital components of the effort to reduce and eliminate cancer disparities in the United States. We studied the development and impact of intersectoral connections among the members of the Massachusetts Community Network for Cancer Education, Research, and Training (MassCONECT). As one of the Community Network Program sites funded by the National Cancer Institute, this infrastructure-building initiative utilized principles of Community-based Participatory Research (CBPR) to unite community coalitions, researchers, policymakers, and other important stakeholders to address cancer disparities in three Massachusetts communities: Boston, Lawrence, and Worcester. We conducted a cross-sectional, sociometric network analysis four years after the network was formed. A total of 38 of 55 members participated in the study (69% response rate). Over four years of collaboration, the number of intersectoral connections reported by members (intersectoral out-degree) increased, as did the extent to which such connections were reported reciprocally (intersectoral reciprocity). We assessed relationships between these markers of intersectoral collaboration and three intermediate outcomes in the effort to reduce and eliminate cancer disparities: delivery of community activities, policy engagement, and grants/publications. We found a positive and statistically significant relationship between intersectoral out-degree and community activities and policy engagement (the relationship was borderline significant for grants/publications). We found a positive and statistically significant relationship between intersectoral reciprocity and community activities and grants/publications (the relationship was borderline significant for policy engagement). The study suggests that intersectoral connections may be important drivers of diverse intermediate outcomes in the effort to reduce and eliminate cancer disparities. The findings support investment in infrastructure-building and intersectoral mobilization in addressing disparities and highlight the benefits of using CBPR approaches for such work.