NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all of their faculty’s publications into one, easy to navigate database. The findings of the CHER researchers can be accessed quickly and conveniently in their publication directory.
2019 |
Camplain, Ricky; Baldwin, Julie A; Warren, Meghan; Camplain, Carolyn Physical Activity in People Who Are Incarcerated: A Social Justice Issue Journal Article Journal of Physical Activity and Health, 16 (5), pp. 306-307, 2019. @article{Camplain2019, title = {Physical Activity in People Who Are Incarcerated: A Social Justice Issue}, author = {Ricky Camplain and Julie A Baldwin and Meghan Warren and Carolyn Camplain}, url = {https://journals.humankinetics.com/doi/full/10.1123/jpah.2019-0055}, year = {2019}, date = {2019-05-05}, journal = {Journal of Physical Activity and Health}, volume = {16}, number = {5}, pages = {306-307}, abstract = {Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention. |
Camplain, Ricky; Warren, Meghan; Baldwin, Julie; Camplain, Carolyn; Fofanov, Viacheslav Y; Trotter, Robert T Epidemiology of incarceration Characterizing jail incarceration for public health research Journal Article Epidemiology, 2019. @article{Camplain2019b, title = {Epidemiology of incarceration Characterizing jail incarceration for public health research}, author = {Ricky Camplain and Meghan Warren and Julie Baldwin and Carolyn Camplain and Viacheslav Y Fofanov and Robert T Trotter}, url = {https://journals.lww.com/epidem/Abstract/publishahead/Epidemiology_of_incarceration__Characterizing_jail.98558.aspx}, year = {2019}, date = {2019-04-08}, journal = {Epidemiology}, abstract = {Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. |
Williamson, Heather J; Fisher, Kim W; Madhavni, Devanshi; Talarico, Lori Inclusion, 7 (1), pp. 24-40, 2019. @article{Williamson2019, title = {#ADA25 Campaign: Using Social Media to Promote Participation, Social Inclusion, and Civic Engagement of People With Intellectual and Developmental Disabilities}, author = {Heather J Williamson and Kim W Fisher and Devanshi Madhavni and Lori Talarico}, url = {http://cher.nau.edu/wp-content/uploads/2019/03/Williamson.2019_Twitter.pdf}, year = {2019}, date = {2019-03-01}, journal = {Inclusion}, volume = {7}, number = {1}, pages = {24-40}, abstract = {Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks. |
Hulen, Elizabeth; Hardy, Lisa J; Teufel-Shone, Nicolette; Sanderson, Priscilla R; Schwartz, Anna L; Begay, Cruz R Community Based Participatory Research (CBPR): A Dynamic Process of Health care, Provider Perceptions and American Indian Patients' Resilience Journal Article Journal of Health Care for the Poor and Underserved, 30 (1), pp. 221-237, 2019. @article{Hulen2019, title = {Community Based Participatory Research (CBPR): A Dynamic Process of Health care, Provider Perceptions and American Indian Patients' Resilience}, author = {Elizabeth Hulen and Lisa J Hardy and Nicolette Teufel-Shone and Priscilla R Sanderson and Anna L Schwartz and Cruz R Begay}, url = {https://muse.jhu.edu/article/717742}, year = {2019}, date = {2019-02-01}, journal = {Journal of Health Care for the Poor and Underserved}, volume = {30}, number = {1}, pages = {221-237}, abstract = {American Indians are disproportionately affected by factors that lead to health disparities, however many Native people demonstrate resilience when faced with health risks. Study objectives were to use a resilience framework to identify wellness strategies among American Indian people and to assess health care provider perceptions of American Indian wellness. Participants included 39 American Indian adults who self-reported resilient change and 22 health care providers who served American Indian patients. Thematic categories across American Indian and health care provider data were identified: 1) relationships inform resilience; 2) prejudice stymies resilience; and 3) place shapes resilience. Results indicated the salience of relationships in demonstrating resilience. Identified challenges and supporters of resilience are discussed.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indians are disproportionately affected by factors that lead to health disparities, however many Native people demonstrate resilience when faced with health risks. Study objectives were to use a resilience framework to identify wellness strategies among American Indian people and to assess health care provider perceptions of American Indian wellness. Participants included 39 American Indian adults who self-reported resilient change and 22 health care providers who served American Indian patients. Thematic categories across American Indian and health care provider data were identified: 1) relationships inform resilience; 2) prejudice stymies resilience; and 3) place shapes resilience. Results indicated the salience of relationships in demonstrating resilience. Identified challenges and supporters of resilience are discussed. |
Cordova-Marks, Felina M; Harris, Robin; Teufel-Shone, Nicolette I; Norton, Beatrice; Mastergeorge, Ann M; Gerald, Lynn Characteristics of American Indian Female Caregivers on a Southwest American Indian Reservation Journal Article Journal of Community Health, 44 (1), pp. 52-60, 2019. @article{Cordova-Marks2019, title = {Characteristics of American Indian Female Caregivers on a Southwest American Indian Reservation}, author = {Felina M Cordova-Marks and Robin Harris and Nicolette I Teufel-Shone and Beatrice Norton and Ann M Mastergeorge and Lynn Gerald}, url = {https://link.springer.com/article/10.1007/s10900-018-0552-7}, year = {2019}, date = {2019-02-01}, journal = {Journal of Community Health}, volume = {44}, number = {1}, pages = {52-60}, abstract = {American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress. |
Wilson, Jamie; Sabo, Samantha; Chief, Carmenlita; Clark, Hershel; Yazzie, Alfred; Nahee, Jacqueline; Leischow, Scott; Henderson, Patricia Nez DINÉ (NAVAJO) HEALER PERSPECTIVES ON COMMERCIAL TOBACCO USE IN CEREMONIAL SETTINGS: AN ORAL STORY PROJECT TO PROMOTE SMOKE-FREE LIFE Journal Article American Indian and Alaska Native Mental Health Research, 26 (1), pp. 63-78, 2019. @article{Wilson2019, title = {DINÉ (NAVAJO) HEALER PERSPECTIVES ON COMMERCIAL TOBACCO USE IN CEREMONIAL SETTINGS: AN ORAL STORY PROJECT TO PROMOTE SMOKE-FREE LIFE}, author = {Jamie Wilson and Samantha Sabo and Carmenlita Chief and Hershel Clark and Alfred Yazzie and Jacqueline Nahee and Scott Leischow and Patricia Nez Henderson}, url = {http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/CAIANH/journal/Documents/Volume-26/26_1_2019_63_wilson.pdf}, year = {2019}, date = {2019-01-01}, journal = {American Indian and Alaska Native Mental Health Research}, volume = {26}, number = {1}, pages = {63-78}, abstract = {Many American Indian (AI) healers are faced with a dilemma of how to maintain the ceremonial uses of traditional tobacco meant to encourage the restoration and balance of mind, body, and spirit, while discouraging commercial tobacco use and protecting against secondhand smoke exposure in ceremonial settings. To explore this dilemma and offer culturally informed solutions, researchers conducted qualitative interviews with Navajo healers who describe the history and role of commercial tobacco within ceremonial contexts. Healers understand the importance of their role on their community’s health and expressed deep concern about the use of commercial tobacco in the ceremonial setting. Healers play an important role in curbing the use of commercial tobacco and limiting the exposure to secondhand smoke in ceremonial settings and beyond. Study implications include the importance of understanding traditional and cultural knowledge and its potential as a pathway to solve contemporary public health issues facing AI communities.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many American Indian (AI) healers are faced with a dilemma of how to maintain the ceremonial uses of traditional tobacco meant to encourage the restoration and balance of mind, body, and spirit, while discouraging commercial tobacco use and protecting against secondhand smoke exposure in ceremonial settings. To explore this dilemma and offer culturally informed solutions, researchers conducted qualitative interviews with Navajo healers who describe the history and role of commercial tobacco within ceremonial contexts. Healers understand the importance of their role on their community’s health and expressed deep concern about the use of commercial tobacco in the ceremonial setting. Healers play an important role in curbing the use of commercial tobacco and limiting the exposure to secondhand smoke in ceremonial settings and beyond. Study implications include the importance of understanding traditional and cultural knowledge and its potential as a pathway to solve contemporary public health issues facing AI communities. |
Valdez, Elizabeth Salerno; Sabo, Samantha; Butler, Matthew; Camplain, Ricky; Simpson, Rosi; Castro, Yara Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border Journal Article Journal of Rural Mental Health, 43 (1), pp. 38-44, 2019. @article{Valdez2019, title = {Perinatal Depression Symptom Prevalence on the U.S.–Mexico Border}, author = {Elizabeth Salerno Valdez and Samantha Sabo and Matthew Butler and Ricky Camplain and Rosi Simpson and Yara Castro}, editor = {PhD James L. Werth}, url = {https://psycnet.apa.org/record/2019-06780-004?doi=1}, year = {2019}, date = {2019-01-01}, journal = {Journal of Rural Mental Health}, volume = {43}, number = {1}, pages = {38-44}, abstract = {At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved)}, keywords = {}, pubstate = {published}, tppubtype = {article} } At the U.S.–Mexico border, immigration policies have been documented to exacerbate health inequities among immigrant communities. We examined the prevalence of perinatal depressive symptomatology among Mexican-origin mothers living on the U.S.–Mexico border. Data for 1,629 pre- and postnatal women were drawn from a Community Health Worker Home Visiting Program from 2008 to 2016. Participants were screened for perinatal depressive symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Prevalence and associated 95% confidence intervals for prenatal and postnatal depression scores were estimated among women with prenatal depression scores only, postnatal depression scores only, and among women with both prenatal and postnatal scores by year and by participant characteristics. Participants were predominantly Mexican, Spanish-speaking, unmarried, with less than high school education, and with an annual income of less than $15,000. Prenatal and postnatal EPDS scores indicating low risk for depression (i.e., 0–5) ranged from 59.4% to 64.8% and 62.2% to 71.9%, respectively. Moderate risk prenatal and postnatal EPDS scores (i.e., 6–12) ranged from 28.6% to 32.1% and 22.8% to 25.6%, respectively. High-risk prenatal and postnatal EPDS scores (i.e., ≥13) ranged from 6.6% to 8.5% and 5.3% to 12.3%, respectively. In the context of a proliferation of anti-immigrant policies that jeopardize social determinants of maternal well-being, we observed a sustained upward trend in mean EPDS scores. U.S.–Mexico border women may be at particular risk for discrimination, stress, and victimization because of U.S. immigration and border security policies. This brief report generates a baseline prevalence of perinatal depressive symptomatology among women of Mexican origin and offers public health research explanations for maternal mental well-being at the U.S.–Mexico border. (PsycINFO Database Record (c) 2019 APA, all rights reserved) |
Teufel-Shone, Nicolette I; Schwartz, Anna L; Hardy, Lisa J; Heer, Hendrik De D; Williamson, Heather J; Dunn, Dorothy J; Polingyumptewa, Kellen; Chief, Carmenlita Supporting New Community-Based Participatory Research Partnerships Journal Article International Journal of Environmental Research and Public Health, 16 (1), pp. 44, 2019. @article{Teufel-Shone2019, title = {Supporting New Community-Based Participatory Research Partnerships}, author = {Nicolette I Teufel-Shone and Anna L Schwartz and Lisa J Hardy and Hendrik De D Heer and Heather J Williamson and Dorothy J Dunn and Kellen Polingyumptewa and Carmenlita Chief}, url = {https://www.mdpi.com/1660-4601/16/1/44/htm}, year = {2019}, date = {2019-01-01}, journal = {International Journal of Environmental Research and Public Health}, volume = {16}, number = {1}, pages = {44}, abstract = {Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline. |
2018 |
Lam, Felix; Pro, George; Agrawal, Shreya; Shastri, Vishal Dev; Wentworth, Leslie; Stanley, Melinda; Beri, Nitin; Tupe, Abhishek; Mishra, Ashutosh; Subramaniam, Hamsa; Schroder, Kate; Prescott, Marta Rose; Trikha, Naresh Journal of Global Health, 9 (1), 2018. @article{Lam2018, title = {Effect of enhanced detailing and mass media on community use of oral rehydration salts and zinc during a scale-up program in Gujarat and Uttar Pradesh}, author = {Felix Lam and George Pro and Shreya Agrawal and Vishal Dev Shastri and Leslie Wentworth and Melinda Stanley and Nitin Beri and Abhishek Tupe and Ashutosh Mishra and Hamsa Subramaniam and Kate Schroder and Marta Rose Prescott and Naresh Trikha}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287208/}, year = {2018}, date = {2018-12-10}, journal = {Journal of Global Health}, volume = {9}, number = {1}, abstract = {Background The Clinton Health Access Initiative implemented a program from 2012-2016 to increase use of oral rehydration salts (ORS) and zinc to treat diarrhea in children under five in three states in India: Gujarat, Madhya Pradesh, and Uttar Pradesh. The program interventions included detailing and development of a rural supply chain to reach private rural health care providers, training of Accredited Social Health Activists (ASHAs), technical support to the state governments, and a mass media campaign targeted at caregivers. In Gujarat and Uttar Pradesh, some of the program activities, such as detailing and ASHA trainings, were targeted to high-burden focal districts, thus providing an opportunity to study their effect compared to statewide activities that covered all districts, such as the mass media campaign. Our study aimed to estimate the effect of activities on ORS and zinc use. Methods Household surveys were conducted at two points during the program and in both focal and non-focal districts. We used a difference-in-difference quasi-experimental approach to estimate the effect of the enhanced activities in focal districts and mass media campaign on the odds of a child being treated with ORS and zinc. Findings Focal district interventions were associated with a significant increase in the odds of a diarrhea episode receiving ORS in Gujarat and Uttar Pradesh. Living in focal districts increased the odds of receiving ORS in Gujarat and Uttar Pradesh by factors of 3.42 (95% CI = 1.39-8.33) and 2.29 (95% CI = 1.19-4.39), respectively. Focal district interventions were also associated with 15.02 (95% CI = 2.97-75.19) greater odds of receiving both ORS and zinc in Gujarat. In Uttar Pradesh, where the mass media campaign was focused, exposure to the campaign further modified the odds of receiving ORS and combined ORS and zinc by 1.38 (95% CI = 1.04-1.84) and 1.57 (95% CI = 1.01-2.46), respectively. Conclusion Comprehensive public and private provider interventions combined with mass media are effective strategies for increasing ORS and zinc use.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background The Clinton Health Access Initiative implemented a program from 2012-2016 to increase use of oral rehydration salts (ORS) and zinc to treat diarrhea in children under five in three states in India: Gujarat, Madhya Pradesh, and Uttar Pradesh. The program interventions included detailing and development of a rural supply chain to reach private rural health care providers, training of Accredited Social Health Activists (ASHAs), technical support to the state governments, and a mass media campaign targeted at caregivers. In Gujarat and Uttar Pradesh, some of the program activities, such as detailing and ASHA trainings, were targeted to high-burden focal districts, thus providing an opportunity to study their effect compared to statewide activities that covered all districts, such as the mass media campaign. Our study aimed to estimate the effect of activities on ORS and zinc use. Methods Household surveys were conducted at two points during the program and in both focal and non-focal districts. We used a difference-in-difference quasi-experimental approach to estimate the effect of the enhanced activities in focal districts and mass media campaign on the odds of a child being treated with ORS and zinc. Findings Focal district interventions were associated with a significant increase in the odds of a diarrhea episode receiving ORS in Gujarat and Uttar Pradesh. Living in focal districts increased the odds of receiving ORS in Gujarat and Uttar Pradesh by factors of 3.42 (95% CI = 1.39-8.33) and 2.29 (95% CI = 1.19-4.39), respectively. Focal district interventions were also associated with 15.02 (95% CI = 2.97-75.19) greater odds of receiving both ORS and zinc in Gujarat. In Uttar Pradesh, where the mass media campaign was focused, exposure to the campaign further modified the odds of receiving ORS and combined ORS and zinc by 1.38 (95% CI = 1.04-1.84) and 1.57 (95% CI = 1.01-2.46), respectively. Conclusion Comprehensive public and private provider interventions combined with mass media are effective strategies for increasing ORS and zinc use. |
Green, Shana M; Turner, DeAnne; Baldwin, Julie A; Walsh-Buhi, Eric R; Vamos, Cheryl A; Dagne, Getachew; Marhefka, Stephanie L AIDS and Behavior, 2018. @article{Green2018, title = {Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline}, author = {Shana M Green and DeAnne Turner and Julie A Baldwin and Eric R Walsh-Buhi and Cheryl A Vamos and Getachew Dagne and Stephanie L Marhefka}, url = {https://link.springer.com/article/10.1007/s10461-018-2349-1#citeas}, year = {2018}, date = {2018-12-01}, journal = {AIDS and Behavior}, abstract = {The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants’ IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants’ IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners. |
II, Robert Trotter T; Lininger, Monica R; Camplain, Ricky; Fofanov, Viacheslav Y; Camplain, Carolyn; Baldwin, Julie A International Journal of Environmental Research and Public Health, 15 (11), 2018. @article{II2018b, title = {A Survey of Health Disparities, Social Determinants of Health, and Converging Morbidities in a County Jail: A Cultural-Ecological Assessment of Health Conditions in Jail Populations}, author = {Robert Trotter T II and Monica R Lininger and Ricky Camplain and Viacheslav Y Fofanov and Carolyn Camplain and Julie A Baldwin}, url = {https://www.mdpi.com/1660-4601/15/11/2500}, year = {2018}, date = {2018-11-08}, journal = {International Journal of Environmental Research and Public Health}, volume = {15}, number = {11}, abstract = {The environmental health status of jail populations in the United States constitutes a significant public health threat for prisoners and the general population. The ecology of jails creates a dynamic condition in relation to general population health due to the concentrated potential exposure to infectious diseases, difficult access to treatment for chronic health conditions, interruption in continuity of care for serious behavioral health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. This paper reports on elements of a cross-sectional survey embedded in a parent project, “Health Disparities in Jail Populations.” The overall project includes a comprehensive secondary data analysis of the health status of county jail populations, along with primary data collection that includes a cross-sectional health and health care services survey of incarcerated individuals, coupled with collection of biological samples to investigate infectious disease characteristics of a county jail population. This paper reports on the primary results of the survey data collection that indicate that this is a population with complex and interacting co-morbidities, as well as significant health disparities compared to the general population.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The environmental health status of jail populations in the United States constitutes a significant public health threat for prisoners and the general population. The ecology of jails creates a dynamic condition in relation to general population health due to the concentrated potential exposure to infectious diseases, difficult access to treatment for chronic health conditions, interruption in continuity of care for serious behavioral health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. This paper reports on elements of a cross-sectional survey embedded in a parent project, “Health Disparities in Jail Populations.” The overall project includes a comprehensive secondary data analysis of the health status of county jail populations, along with primary data collection that includes a cross-sectional health and health care services survey of incarcerated individuals, coupled with collection of biological samples to investigate infectious disease characteristics of a county jail population. This paper reports on the primary results of the survey data collection that indicate that this is a population with complex and interacting co-morbidities, as well as significant health disparities compared to the general population. |
Walters, Karina L; Johnson-Jennings, Michelle; Stroud, Sandra; Rasmus, Stacy; Charles, Billy; John, Simeon; Allen, James; Kaholokula, Joseph Keawe‘aimoku; Look, Mele A; de Silva, Māpuana; Lowe, John; Baldwin, Julie A; Lawrence, Gary; Brooks, Jada; Noonan, Curtis W; Belcourt, Annie; Quintana, Eugenia; Semmens, Erin O; Boulafentis, Johna Prevention Science, pp. 1-11, 2018. @article{Walters2018, title = {Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities}, author = {Karina L Walters and Michelle Johnson-Jennings and Sandra Stroud and Stacy Rasmus and Billy Charles and Simeon John and James Allen and Joseph Keawe‘aimoku Kaholokula and Mele A Look and Māpuana de Silva and John Lowe and Julie A Baldwin and Gary Lawrence and Jada Brooks and Curtis W Noonan and Annie Belcourt and Eugenia Quintana and Erin O Semmens and Johna Boulafentis}, url = {https://link.springer.com/article/10.1007%2Fs11121-018-0952-z}, year = {2018}, date = {2018-11-06}, journal = {Prevention Science}, pages = {1-11}, abstract = {Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions. |
II, Robert Trotter T; Camplain, Ricky; Eaves, Emery R; Fofanov, Viacheslav Y; Dmitrieva, Natalia O; Hepp, Crystal M; Warren, Meghan; Barrios, Brianna A; Pagel, Nicole; Mayer, Alyssa; Baldwin, Julie A Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study Journal Article JMIR Res Protoc, 7 (10), 2018. @article{II2018b, title = {Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study}, author = {Robert Trotter T II and Ricky Camplain and Emery R Eaves and Viacheslav Y Fofanov and Natalia O Dmitrieva and Crystal M Hepp and Meghan Warren and Brianna A Barrios and Nicole Pagel and Alyssa Mayer and Julie A Baldwin}, editor = {Gunther Eysenbach and Nicola Kuter}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231773/}, year = {2018}, date = {2018-10-24}, journal = {JMIR Res Protoc}, volume = {7}, number = {10}, abstract = {Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337 |
Boucher, Nathan A; Bull, Janet H; Cross, Sarah H; Kirby, Christine; Davis, Kelly J; Jr., Donald Taylor H Patient, caregiver and taxpayer knowledge of palliative care and views on a model of community-based palliative care Journal Article Journal of Pain and Symptom Management, 2018. @article{Boucher2018, title = {Patient, caregiver and taxpayer knowledge of palliative care and views on a model of community-based palliative care}, author = {Nathan A Boucher and Janet H Bull and Sarah H Cross and Christine Kirby and Kelly J Davis and Donald Taylor H Jr.}, url = {https://www.sciencedirect.com/science/article/pii/S0885392418304378}, year = {2018}, date = {2018-08-25}, journal = {Journal of Pain and Symptom Management}, abstract = {Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC. |
Williamson, Heather J; Perkins, Elizabeth A; Massey, Oliver T; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Levins, Bruce L Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports Journal Article Journal of Policy and Practice in Intellectual Disabilities, 15 (3), pp. 214-225, 2018. @article{Williamson2018, title = {Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports}, author = {Heather J Williamson and Elizabeth A Perkins and Oliver T Massey and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Bruce L Levins}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jppi.12258}, year = {2018}, date = {2018-08-24}, journal = {Journal of Policy and Practice in Intellectual Disabilities}, volume = {15}, number = {3}, pages = {214-225}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS. |
Cordova-Marks, Felina M; Harris, Robin; Teufel-Shone, Nicolette; Norton, Beatrice; Mastergeorge, Ann M; Gerald, Lynn Characteristics of American Indian female caregivers on a Southwest American Indian reservation Journal Article Journal of Community Health, 2018. @article{Cordova-Marks2018, title = {Characteristics of American Indian female caregivers on a Southwest American Indian reservation}, author = {Felina M Cordova-Marks and Robin Harris and Nicolette Teufel-Shone and Beatrice Norton and Ann M Mastergeorge and Lynn Gerald}, url = {https://link.springer.com/article/10.1007%2Fs10900-018-0552-7}, year = {2018}, date = {2018-07-28}, journal = {Journal of Community Health}, abstract = {American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress. |
Tyson, Dinorah Martinez; Teran, Enrique; Dao, Lillie Uyen-Loan; Chee, Vanessa; Hernandez, Isabel; Flores, Mercedes; Ortiz, Miguel Reina; Izurieta, Ricardo; Baldwin, Julie A Cancer is in Style: Lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador Journal Article Ethnicity and Health, 2018. @article{Tyson2018, title = {Cancer is in Style: Lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador}, author = {Dinorah Martinez Tyson and Enrique Teran and Lillie Uyen-Loan Dao and Vanessa Chee and Isabel Hernandez and Mercedes Flores and Miguel Reina Ortiz and Ricardo Izurieta and Julie A Baldwin}, url = {https://www.tandfonline.com/doi/abs/10.1080/13557858.2018.1493437?journalCode=ceth20}, doi = {10.1080/13557858.2018.1493437}, year = {2018}, date = {2018-07-04}, journal = {Ethnicity and Health}, abstract = {Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America. Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques. Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets. Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America. Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques. Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets. Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America. |
Siwon, Jang; Liller, Karen; Baldwin, Julie A; Zhu, Yiliang; VandeWeerde, Carla The relationship between high school coaches' injury beliefs and practices Journal Article Health Behavior and Policy Review, 5 (4), pp. 39-49, 2018. @article{Siwon2018, title = {The relationship between high school coaches' injury beliefs and practices}, author = {Jang Siwon and Karen Liller and Julie A Baldwin and Yiliang Zhu and Carla VandeWeerde}, url = {https://www.ingentaconnect.com/contentone/psp/hbpr/2018/00000005/00000004/art00005}, doi = {10.14485/HBPR.5.4.5}, year = {2018}, date = {2018-07-01}, journal = {Health Behavior and Policy Review}, volume = {5}, number = {4}, pages = {39-49}, abstract = {Objective In this paper, we describe high school coaches’ beliefs and knowledge pertaining to sports injury and their readiness for the practice of high school injury prevention. Methods A mixed-methods approach was used to assess 111 Florida high school coaches’ beliefs and knowledge related to sports injury, readiness for injury prevention practice, and the relationship between coaches’ beliefs, knowledge and readiness. Results Whereas only 22% of respondents exhibited high injury susceptibility beliefs, levels of self-efficacy were strongly related to particular injury prevention behaviors. Coaches who employed medical staff were 4 times more likely to implement prevention programs and have emergency plans. Conclusion This research supports coaches having access to evidence-based injury prevention programs and policies should be developed on the need for coaches to execute prevention programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective In this paper, we describe high school coaches’ beliefs and knowledge pertaining to sports injury and their readiness for the practice of high school injury prevention. Methods A mixed-methods approach was used to assess 111 Florida high school coaches’ beliefs and knowledge related to sports injury, readiness for injury prevention practice, and the relationship between coaches’ beliefs, knowledge and readiness. Results Whereas only 22% of respondents exhibited high injury susceptibility beliefs, levels of self-efficacy were strongly related to particular injury prevention behaviors. Coaches who employed medical staff were 4 times more likely to implement prevention programs and have emergency plans. Conclusion This research supports coaches having access to evidence-based injury prevention programs and policies should be developed on the need for coaches to execute prevention programs. |
Dickerson, Daniel; Baldwin, Julie A; Belcourt, Annie; Belone, Lorenda; Gittelsohn, Joel; Kaholokula, Joseph Keawe'aimoku; Lowe, John; Patten, Christi A; Wallerstein, Nina Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions Journal Article Prevention Science, 2018. @article{Dickerson2018, title = {Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions}, author = {Daniel Dickerson and Julie A Baldwin and Annie Belcourt and Lorenda Belone and Joel Gittelsohn and Joseph Keawe'aimoku Kaholokula and John Lowe and Christi A Patten and Nina Wallerstein}, url = {https://link.springer.com/article/10.1007%2Fs11121-018-0926-1}, doi = {10.1007/s11121-018-0926-1}, year = {2018}, date = {2018-06-29}, journal = {Prevention Science}, abstract = {American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health. |
Camplain, Ricky; Kucharska-Newton, Anna; Keyserling, Thomas C; Layton, Bradley J; Loehr, Laura; Heiss, Gerardo Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals Journal Article The American Journal of Cardiology, 121 (1), pp. 1328-1335, 2018. @article{Camplain2018, title = {Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals}, author = {Ricky Camplain and Anna Kucharska-Newton and Thomas C Keyserling and Bradley J Layton and Laura Loehr and Gerardo Heiss}, url = {https://www.sciencedirect.com/science/article/pii/S0002914918302509?via%3Dihub}, doi = {10.1016/j.amjcard.2018.02.014}, year = {2018}, date = {2018-06-01}, journal = {The American Journal of Cardiology}, volume = {121}, number = {1}, pages = {1328-1335}, abstract = {Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends. |
King, Caroline; Atwood, Sidney; Brown, Chris; Nelson, Adrianne Katrina; Lozada, Mia; Wei, Jennie; Merino, Maricruz; Curley, Cameron; Muskett, Olivia; Sabo, Samantha; Gampa, Vikas; Orav, John; Shin, Sonya Primary Care Diabetes, 12 (3), pp. 212-217, 2018. @article{King2018, title = {Primary care and survival among American Indian patients with diabetes in the Southwest United States: Evaluation of a cohort study at Gallup Indian Medical Center, 2009-2016}, author = {Caroline King and Sidney Atwood and Chris Brown and Adrianne Katrina Nelson and Mia Lozada and Jennie Wei and Maricruz Merino and Cameron Curley and Olivia Muskett and Samantha Sabo and Vikas Gampa and John Orav and Sonya Shin}, url = {https://www.primary-care-diabetes.com/article/S1751-9918(17)30184-5/fulltext}, year = {2018}, date = {2018-06-01}, journal = {Primary Care Diabetes}, volume = {12}, number = {3}, pages = {212-217}, abstract = {Objectives To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Methods Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. Results Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider. Conclusions Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Methods Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. Results Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider. Conclusions Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission. |
Vassy, Jason L; Davis, Kelly J; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation Journal Article Journal of General Internal Medicine, 33 (6), pp. 877-885, 2018. @article{Vassy2018, title = {How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation}, author = {Jason L Vassy and Kelly J Davis and Christine Kirby and Ian J Richardson and Robert C Green and Amy L McGuire and Peter A Ubel}, url = {https://link.springer.com/article/10.1007/s11606-017-4295-4}, year = {2018}, date = {2018-06-01}, journal = {Journal of General Internal Medicine}, volume = {33}, number = {6}, pages = {877-885}, abstract = {Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results. |
Teufel-Shone, Nicolette; Jiang, Luohua; Rockwell, Jennifer; Chang, Jennifer; Beals, Janette; Bullock, Ann; Manson, Spero M Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes Journal Article Public Health Nutrition, pp. 1-9, 2018. @article{Teufel-Shone2018, title = {Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes}, author = {Nicolette Teufel-Shone and Luohua Jiang and Jennifer Rockwell and Jennifer Chang and Janette Beals and Ann Bullock and Spero M Manson}, url = {https://www.cambridge.org/core/journals/public-health-nutrition/article/food-choices-and-distress-in-reservationbased-american-indians-and-alaska-natives-with-type-2-diabetes/6D6B00EE8887E3B23255592E333FADBE}, year = {2018}, date = {2018-03-12}, journal = {Public Health Nutrition}, pages = {1-9}, abstract = {Objective: To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes. Design: Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes. Setting: Rural AI reservations and AN villages. Subjects: AI/AN (n 2484) with type 2 diabetes. Results: Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β = 0·078}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes. Design: Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes. Setting: Rural AI reservations and AN villages. Subjects: AI/AN (n 2484) with type 2 diabetes. Results: Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β = 0·078 |
Sabo, Samantha; Champion, Catalina Denman; Bell, Melanie L; Vucovich, Elsa Cornejo; Ingram, Maia; Valencia, Celina; del Vasquez, Maria Carmen Castro; Gonzalez-Fagoaga, Eduardo; de Zapien, Jill Geurnsey; Rosales, Cecilia B Meta Salud Diabetes study protocol: A cluster-randomized trial to reduce cardiovascular risk among a diabetic population of Mexico Journal Article BMJ Open, 8 (3), 2018. @article{Sabo2018, title = {Meta Salud Diabetes study protocol: A cluster-randomized trial to reduce cardiovascular risk among a diabetic population of Mexico}, author = {Samantha Sabo and Catalina Denman Champion and Melanie L Bell and Elsa Cornejo Vucovich and Maia Ingram and Celina Valencia and Maria Carmen Castro del Vasquez and Eduardo Gonzalez-Fagoaga and Jill Geurnsey de Zapien and Cecilia B Rosales}, url = {10.1136/bmjopen-2017-020762}, year = {2018}, date = {2018-03-12}, journal = {BMJ Open}, volume = {8}, number = {3}, abstract = {Introduction Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system. Methods and analysis The Meta Salud Diabetes (MSD) research project is a parallel two-arm cluster-randomised clinical behavioural trial based in 22 (n=22) health centres in Sonora, Mexico. MSD aims to evaluate the effectiveness of the MSD intervention for the secondary prevention of CVD risk factors among a diabetic population (n=320) compared with the study control of usual care. The MSD intervention consists of 2-hour class sessions delivered over a 13-week period providing educational information to encourage sustainable behavioural change to prevent disease complications including the adoption of physical activity. MSD is delivered within the context of Mexico’s national primary care health centre system by health professionals, including nurses, physicians and community health workers via existing social support groups for individuals diagnosed with chronic disease. Mixed models are used to estimate the effect of MSD by comparing cardiovascular risk, as measured by the Framingham Risk Score, between the trial arms. Secondary outcomes include hypertension, behavioural risk factors and psychosocial factors. Ethics and dissemination This work is supported by the National Institutes of Health, National Heart Lung and Blood Institute (1R01HL125996-01) and approved by the University of Arizona Research Institutional Review Board (Protocol 1508040144) and the Research Bioethics Committee at the University of Sonora. The first Internal Review Board approval date was 31 August 2015 with five subsequent approved amendments. This article refers to protocol V.0.2, dated 30 January 2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences and will be shared through meetings with health systems officials.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system. Methods and analysis The Meta Salud Diabetes (MSD) research project is a parallel two-arm cluster-randomised clinical behavioural trial based in 22 (n=22) health centres in Sonora, Mexico. MSD aims to evaluate the effectiveness of the MSD intervention for the secondary prevention of CVD risk factors among a diabetic population (n=320) compared with the study control of usual care. The MSD intervention consists of 2-hour class sessions delivered over a 13-week period providing educational information to encourage sustainable behavioural change to prevent disease complications including the adoption of physical activity. MSD is delivered within the context of Mexico’s national primary care health centre system by health professionals, including nurses, physicians and community health workers via existing social support groups for individuals diagnosed with chronic disease. Mixed models are used to estimate the effect of MSD by comparing cardiovascular risk, as measured by the Framingham Risk Score, between the trial arms. Secondary outcomes include hypertension, behavioural risk factors and psychosocial factors. Ethics and dissemination This work is supported by the National Institutes of Health, National Heart Lung and Blood Institute (1R01HL125996-01) and approved by the University of Arizona Research Institutional Review Board (Protocol 1508040144) and the Research Bioethics Committee at the University of Sonora. The first Internal Review Board approval date was 31 August 2015 with five subsequent approved amendments. This article refers to protocol V.0.2, dated 30 January 2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences and will be shared through meetings with health systems officials. |
Wohl, David A; Panter, A T; Kirby, Christine; Magnus, Brokke E; Hudgens, Michael G; Allmon, Andrew G; Mollan, Katie R Estimating HIV medication adherence and persistence: Two instruments for clinical and research use Journal Article AIDS and Behavior, 22 (3), pp. 948-960, 2018. @article{Wohl2018, title = {Estimating HIV medication adherence and persistence: Two instruments for clinical and research use}, author = {David A Wohl and A T Panter and Christine Kirby and Brokke E Magnus and Michael G Hudgens and Andrew G Allmon and Katie R Mollan}, url = {https://link.springer.com/article/10.1007/s10461-017-1772-z}, doi = {10.1007/s10461-017-1772-z}, year = {2018}, date = {2018-03-01}, journal = {AIDS and Behavior}, volume = {22}, number = {3}, pages = {948-960}, abstract = {Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence. |
2017 |
Sabo, Samantha; Allen, Caitlin G; Sutkowi, Katherine; Wennerstrom, Ashley Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce Journal Article American Journal of Public Health, 107 (12), pp. 1964-1969, 2017. @article{Sabo2017, title = {Community health workers in the United States: Challenges in identifying, surveying, and supporting the workforce}, author = {Samantha Sabo and Caitlin G Allen and Katherine Sutkowi and Ashley Wennerstrom}, url = {https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304096}, year = {2017}, date = {2017-11-08}, journal = {American Journal of Public Health}, volume = {107}, number = {12}, pages = {1964-1969}, abstract = {Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHWs) are members of a growing profession in the United States. Studying this dynamic labor force is challenging, in part because its members have more than 100 different job titles. The demand for timely, accurate information about CHWs is increasing as the profession gains recognition for its ability to improve health outcomes and reduce costs. Although numerous surveys of CHWs have been conducted, the field lacks well-delineated methods for gaining access to this hard-to-identify workforce. We outline methods for surveying CHWs and promising approaches to engage the workforce and other stakeholders in conducting local, state, and national studies. We also highlight successful strategies to overcome challenges in CHW surveys and future directions for surveying the field. |
Henson, Michele; Sabo, Samantha; Trujillo, Aurora; Teufel-Shone, Nicolette Identifying protective factors to promote health in American Indian and Alaska Native adolescents: A literature review Journal Article Journal of Primary Prevention, 38 (1-2), pp. 5-26, 2017. @article{Henson2017, title = {Identifying protective factors to promote health in American Indian and Alaska Native adolescents: A literature review}, author = {Michele Henson and Samantha Sabo and Aurora Trujillo and Nicolette Teufel-Shone}, url = {https://link.springer.com/article/10.1007/s10935-016-0455-2}, year = {2017}, date = {2017-11-08}, journal = {Journal of Primary Prevention}, volume = {38}, number = {1-2}, pages = {5-26}, abstract = {Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent’s environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent’s environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excluded publications were those that did not focus on AIAN adolescents (n = 3341), did not identify protective factors (n = 56), were not original research studies (n = 8), or were not written in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents. |
Camplain, Ricky; Kucharska-Newton, Anna; Loehr, Laura; Keyserling, Thomas C; Layton, Bradley J; Wruck, Lisa; Folsom, Aaron R; Bertoni, Alain G; Heiss, Gerardo Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study Journal Article Journal of Cardiac Failure, 23 (11), pp. 802-808, 2017. @article{Camplain2017b, title = {Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study}, author = {Ricky Camplain and Anna Kucharska-Newton and Laura Loehr and Thomas C Keyserling and Bradley J Layton and Lisa Wruck and Aaron R Folsom and Alain G Bertoni and Gerardo Heiss}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28893677}, year = {2017}, date = {2017-11-01}, journal = {Journal of Cardiac Failure}, volume = {23}, number = {11}, pages = {802-808}, abstract = {Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition. |
Mayer, Alyssa B; McDermott, Robert J; Bryant, Carol A; Baldwin, Julie A; Kromrey, Jeffrey Sustainability of community-based health promotion coalitions: Putting theory into practice Journal Article Health Behavior and Policy Review, 4 (6), pp. 511-520, 2017. @article{Mayer2017, title = {Sustainability of community-based health promotion coalitions: Putting theory into practice}, author = {Alyssa B Mayer and Robert J McDermott and Carol A Bryant and Julie A Baldwin and Jeffrey Kromrey}, url = {http://ingentaconnect.com/contentone/psp/hbpr/2017/00000004/00000006/art00001;jsessionid=22whnsckp4hwq.x-ic-live-03}, year = {2017}, date = {2017-11-01}, journal = {Health Behavior and Policy Review}, volume = {4}, number = {6}, pages = {511-520}, abstract = {Objective: Despite their rich potential, community coalitions enjoy mixed success in effecting long-term population health improvement. A need exists for strategies that augment and sustain their functional success. We undertook a study to enhance definition of the elements of coalition success and sustainability that, in turn, may foster better achievement in community-based participatory research (CBPR) and concomitant health-related outcomes. Methods: We conducted in-depth, semi-structured interviews (N = 42) with academic researchers and their community coalition partners about the effectiveness of their collaborative endeavors. A grounded theory analysis of interview data informed the identification of domains and thematic elements influencing coalition effectiveness. Results: Seven domains emerged: (1) Characteristics related to coalition structure and processes; (2) Partner characteristics, eg, diversity, patience, flexibility, expertise; (3) Community characteristics, eg, capacity, ownership; (4) Partnership dynamics and synergy; (5) Tangible benefits; (6) Available resources, and; (7) Project characteristics. In all, 70 elements representing these domains influenced coalition effectiveness over time. Conclusions: These results extend our knowledge of factors contributing to coalition effectiveness and the sustainability of academic-community partnerships. Attention to these domains during key operational stages of CBPR initiatives is likely to have broad stakeholder benefits.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: Despite their rich potential, community coalitions enjoy mixed success in effecting long-term population health improvement. A need exists for strategies that augment and sustain their functional success. We undertook a study to enhance definition of the elements of coalition success and sustainability that, in turn, may foster better achievement in community-based participatory research (CBPR) and concomitant health-related outcomes. Methods: We conducted in-depth, semi-structured interviews (N = 42) with academic researchers and their community coalition partners about the effectiveness of their collaborative endeavors. A grounded theory analysis of interview data informed the identification of domains and thematic elements influencing coalition effectiveness. Results: Seven domains emerged: (1) Characteristics related to coalition structure and processes; (2) Partner characteristics, eg, diversity, patience, flexibility, expertise; (3) Community characteristics, eg, capacity, ownership; (4) Partnership dynamics and synergy; (5) Tangible benefits; (6) Available resources, and; (7) Project characteristics. In all, 70 elements representing these domains influenced coalition effectiveness over time. Conclusions: These results extend our knowledge of factors contributing to coalition effectiveness and the sustainability of academic-community partnerships. Attention to these domains during key operational stages of CBPR initiatives is likely to have broad stakeholder benefits. |
Camplain, Ricky; Kucharska-Newton, Anna; Loehr, Laura; Keyserling, Thomas C; Layton, Bradley J; Wruck, Lisa; Folsom, Aaron R; Bertoni, Alain G; Heiss, Gerardo Accuracy of self-reported heart failure. The atherosclerosis risk in communities (ARIC) study Journal Article Journal of Cardiac Failure, 23 (11), pp. 802-808, 2017. @article{Camplain2017c, title = {Accuracy of self-reported heart failure. The atherosclerosis risk in communities (ARIC) study}, author = {Ricky Camplain and Anna Kucharska-Newton and Laura Loehr and Thomas C Keyserling and Bradley J Layton and Lisa Wruck and Aaron R Folsom and Alain G Bertoni and Gerardo Heiss}, url = {https://www.sciencedirect.com/science/article/pii/S1071916417311673?via%3Dihub}, year = {2017}, date = {2017-11-01}, journal = {Journal of Cardiac Failure}, volume = {23}, number = {11}, pages = {802-808}, abstract = {Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. Methods and Results ARIC cohort members (60–83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias–adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%–38%) and specificity was high (96%–97%). Agreement was poor (kappa 0.32–0.39) and increased when adjusted for prevalence and bias (PABAK 0.73–0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. Conclusions For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition. |
Pohl, David A; Kuwahara, Rita K; Javadi, Kamran; Kirby, Christine; Rosen, David L; Napravnik, Sonia; Farel, Claire Financial barriers and lapses in treatment and care of HIV-infected adults in a southern state in the United States Journal Article AIDS Patient Care and STDs, 31 (11), pp. 463-469, 2017. @article{Pohl2017, title = {Financial barriers and lapses in treatment and care of HIV-infected adults in a southern state in the United States}, author = {David A Pohl and Rita K Kuwahara and Kamran Javadi and Christine Kirby and David L Rosen and Sonia Napravnik and Claire Farel}, url = {https://www.liebertpub.com/doi/abs/10.1089/apc.2017.0125}, year = {2017}, date = {2017-11-01}, journal = {AIDS Patient Care and STDs}, volume = {31}, number = {11}, pages = {463-469}, abstract = {Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of … |
Reinschmidt, Kerstin M; Ingram, Maia; Morales, Stephanie; Sabo, Samantha; Blackburn, John; Murrieta, Lucy; David, Cassalyn; Carvajal, Scott C Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015 Journal Article Journal of Ambulatory Care Management, 40 (4), pp. 305-315, 2017. @article{Reinschmidt2017, title = {Documenting community health worker roles in primary care: Contributions to evidence-based integration into health care teams, 2015}, author = {Kerstin M Reinschmidt and Maia Ingram and Stephanie Morales and Samantha Sabo and John Blackburn and Lucy Murrieta and Cassalyn David and Scott C Carvajal}, url = {https://journals.lww.com/ambulatorycaremanagement/Fulltext/2017/10000/Documenting_Community_Health_Worker_Roles_in.11.aspx}, year = {2017}, date = {2017-10-01}, journal = {Journal of Ambulatory Care Management}, volume = {40}, number = {4}, pages = {305-315}, abstract = {The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements. |
Arora, Nonie S; Davis, Kelly J; Kirby, Christine; McGuire, Amy L; Green, Robert C; Blumenthal-Barby, J S; Ubel, Peter A Communication challenges for non geneticist physicians relaying clinical genomic results Journal Article Personalized Medicine, 14 (5), pp. 423-431, 2017. @article{Arora2017, title = {Communication challenges for non geneticist physicians relaying clinical genomic results}, author = {Nonie S Arora and Kelly J Davis and Christine Kirby and Amy L McGuire and Robert C Green and J S Blumenthal-Barby and Peter A Ubel}, url = {https://www.futuremedicine.com/doi/abs/10.2217/pme-2017-0008}, year = {2017}, date = {2017-09-15}, journal = {Personalized Medicine}, volume = {14}, number = {5}, pages = {423-431}, abstract = {Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Aim: Identify the behavioral challenges to the use of genome sequencing (GS) in a clinical setting. Materials & methods: We observed how general internists and nongenetic specialists delivered GS results to patients enrolled in the MedSeq Project. Using transcripts of such disclosure interactions, we made qualitative observations of communication behaviors that could limit the usefulness of GS results until reaching the point of thematic saturation. Results: Findings included confusion regarding genomic terminology, difficulty with the volume or complexity of information and difficulties communicating complex risk information to patients. We observed a broad dismissal of clinical value of GS by some physicians and sometimes ineffective communication regarding health behavior change. Conclusion: Overcoming these behavioral challenges is necessary to make full use of clinical GS results. |
Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; de Zapien, Jill Guernsey; Carvajal, Scott C Community health worker impact on chronic disease outcomes within primary care examined using electronic health records Journal Article American Journal of Public health, 107 (10), pp. 1668-1674, 2017. @article{Ingram2017, title = {Community health worker impact on chronic disease outcomes within primary care examined using electronic health records}, author = {Maia Ingram and Kevin Doubleday and Melanie L Bell and Abby Lohr and Lucy Murrieta and Maria Velasco and John Blackburn and Samantha Sabo and Jill Guernsey de Zapien and Scott C Carvajal}, url = {https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.303934 https://www.ncbi.nlm.nih.gov/pubmed/?term=28817321}, year = {2017}, date = {2017-09-13}, journal = {American Journal of Public health}, volume = {107}, number = {10}, pages = {1668-1674}, abstract = {Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives. To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). Methods. We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Results. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = −0.24, −0.06), body mass index decreased 0.29 kilograms per meter squared (CI = –0.39, −0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = −13.5, −10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = –0.7, −0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = −0.14, −0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = −39.0, −6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = −6.6, −0.6) in health center 1 was the only improvement tied to CHW contact. Conclusions. Although patients’ chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs’ evolution may elucidate CHW contributions moving forward. |
MacFarlan, Shane J; Remiker, Mark Cultural multi-level selection and biological market theory explain the coupled dynamics of labor exchange cooperation and social support Journal Article Sustainability Science, 13 (1), pp. 59-70, 2017. @article{MacFarlan2017, title = {Cultural multi-level selection and biological market theory explain the coupled dynamics of labor exchange cooperation and social support}, author = {Shane J MacFarlan and Mark Remiker}, url = {https://link.springer.com/article/10.1007/s11625-017-0481-x}, year = {2017}, date = {2017-09-13}, journal = {Sustainability Science}, volume = {13}, number = {1}, pages = {59-70}, abstract = {Smallholders rely on labor exchange and social support networks; however, little is known about the cooperative dynamics of these interlinked systems. Whereas cultural multi-level selection (CLMS) predicts group membership and changes in the dominant level of selection modulates cooperation, biological market theory (BMT) posits market size fluctuations affect cooperation. We assess these predictions by examining two dimensions of labor exchange, competitive helping and labor reciprocity, and their downstream impacts on social support in a Dominican community between 2007 and 2010. First, we analyze within-community labor organization. Next, we analyze how international regulatory change and the 2008–2009 World Trade Collapse affected local labor organization and its impacts on competitive helping and labor reciprocity. Finally, we show how labor dynamics affected social support. Analyses reveal that (1) village labor initially involved two levels (labor contracting and labor exchange) and the presence of a structured group who maintained higher rates of reciprocal labor relative to non-group members; (2) changes in the international commodities market reduced labor contracting, the size of the labor exchange market, and the dominant level of selection, resulting in less competitive helping, lower rates of reciprocity for group members, and more cliquish social support; and (3) as the global market for bay oil ameliorated, labor organization shifted back to a pre-recession structure, resulting in a larger labor market with more competitive helping and higher rates of reciprocity amongst group members. We highlight the utility of an integrated CMLS and BMT framework for analyzing cooperative dynamics and socio-economic systems sustainability.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Smallholders rely on labor exchange and social support networks; however, little is known about the cooperative dynamics of these interlinked systems. Whereas cultural multi-level selection (CLMS) predicts group membership and changes in the dominant level of selection modulates cooperation, biological market theory (BMT) posits market size fluctuations affect cooperation. We assess these predictions by examining two dimensions of labor exchange, competitive helping and labor reciprocity, and their downstream impacts on social support in a Dominican community between 2007 and 2010. First, we analyze within-community labor organization. Next, we analyze how international regulatory change and the 2008–2009 World Trade Collapse affected local labor organization and its impacts on competitive helping and labor reciprocity. Finally, we show how labor dynamics affected social support. Analyses reveal that (1) village labor initially involved two levels (labor contracting and labor exchange) and the presence of a structured group who maintained higher rates of reciprocal labor relative to non-group members; (2) changes in the international commodities market reduced labor contracting, the size of the labor exchange market, and the dominant level of selection, resulting in less competitive helping, lower rates of reciprocity for group members, and more cliquish social support; and (3) as the global market for bay oil ameliorated, labor organization shifted back to a pre-recession structure, resulting in a larger labor market with more competitive helping and higher rates of reciprocity amongst group members. We highlight the utility of an integrated CMLS and BMT framework for analyzing cooperative dynamics and socio-economic systems sustainability. |
Hunter, Wynn G; Zafar, Yousuf S; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Ubel, Peter A Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters Journal Article Journal of Oncology Practice, 12 (11), pp. e944-e956, 2017. @article{Hunter2017, title = {Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters}, author = {Wynn G Hunter and Yousuf S Zafar and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Peter A Ubel}, url = {http://ascopubs.org/doi/abs/10.1200/JOP.2017.022855}, year = {2017}, date = {2017-08-23}, journal = {Journal of Oncology Practice}, volume = {12}, number = {11}, pages = {e944-e956}, abstract = {Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients … |
Baldwin, Julie A; Williamson, Heather J; Eaves, Emery R; Levin, Bruce L; Burton, Donna L; Massey, Oliver T Broadening measures of success: Results of a behavioral health translational research training program Journal Article Implementation Science, 12 (92), 2017. @article{Baldwin2017b, title = {Broadening measures of success: Results of a behavioral health translational research training program}, author = {Julie A Baldwin and Heather J Williamson and Emery R Eaves and Bruce L Levin and Donna L Burton and Oliver T Massey}, url = {https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0621-9}, year = {2017}, date = {2017-07-24}, journal = {Implementation Science}, volume = {12}, number = {92}, abstract = {Background While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap. |
Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review Journal Article OTJR: Occupation, Participation and Health, 37 (4), pp. 227-236, 2017. @article{Williamson2017b, title = {Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review}, author = {Heather J Williamson and Graciela M Contreras and Erica S Rodriguez and Jennifer M Smith and Elizabeth A Perkins}, url = {http://journals.sagepub.com/doi/abs/10.1177/1539449217714148}, year = {2017}, date = {2017-07-13}, journal = {OTJR: Occupation, Participation and Health}, volume = {37}, number = {4}, pages = {227-236}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment. |
Baldwin, Julie A; Williamson, Heather J; Eaves, Emery R; Levin, Bruce L; Burton, Donna L; Massey, Oliver T Broadening measures of success: results of a behavioral health translational research training program Journal Article Implementation Science, 12 (92), 2017. @article{Baldwin2017b, title = {Broadening measures of success: results of a behavioral health translational research training program}, author = {Julie A Baldwin and Heather J Williamson and Emery R Eaves and Bruce L Levin and Donna L Burton and Oliver T Massey}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525239/}, year = {2017}, date = {2017-07-04}, journal = {Implementation Science}, volume = {12}, number = {92}, abstract = {Background: While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods: Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results: Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions: This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects. Methods: Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes. Results: Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations. Conclusions: This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap |
Sabo, Samantha; Flores, Melissa; Wennerström, Ashley; Bell, Melanie L; Verdugo, Lorena; Carvajal, Scott; Ingram, Maia Community health workers promote civic engagement and organizational capacity to impact policy Journal Article Journal of Community Health, 42 (6), pp. 1197-1203, 2017. @article{Sabo2017b, title = {Community health workers promote civic engagement and organizational capacity to impact policy}, author = {Samantha Sabo and Melissa Flores and Ashley Wennerström and Melanie L Bell and Lorena Verdugo and Scott Carvajal and Maia Ingram}, url = {https://link.springer.com/article/10.1007/s10900-017-0370-3}, year = {2017}, date = {2017-06-06}, journal = {Journal of Community Health}, volume = {42}, number = {6}, pages = {1197-1203}, abstract = {Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change. |
Brown, Gregory D; Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Byelmac, Dmytro; Ubel, Peter A Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions Journal Article Psychiatric Services, 68 (6), pp. 610-617, 2017. @article{Brown2017, title = {Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions}, author = {Gregory D Brown and Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Dmytro Byelmac and Peter A Ubel}, url = {https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201600275}, year = {2017}, date = {2017-05-19}, journal = {Psychiatric Services}, volume = {68}, number = {6}, pages = {610-617}, abstract = {Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute … |
Salinas-Miranda, Abraham; King, Lindsey M; Salihu, Hamisu M; Berry, Estrellita; Austin, Deborah; Nash, Susan; Scarborough, Kenneth; Best, Evangeline; Cox, Lillian; King, Georgette; Hepburn, Carrie; Burpee, Conchita; Richardson, Eugene; Ducket, Marlo; Briscoe, Richard; Baldwin, Julie A Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risk assessment Journal Article Journal of Health Disparities Research and Practice, 10 (1), pp. 143-166, 2017. @article{Salinas-Miranda2017, title = {Exploring the life course perspective in maternal and child health through community-based participatory focus groups: Social risk assessment}, author = {Abraham Salinas-Miranda and Lindsey M King and Hamisu M Salihu and Estrellita Berry and Deborah Austin and Susan Nash and Kenneth Scarborough and Evangeline Best and Lillian Cox and Georgette King and Carrie Hepburn and Conchita Burpee and Eugene Richardson and Marlo Ducket and Richard Briscoe and Julie A Baldwin}, url = {https://digitalscholarship.unlv.edu/jhdrp/vol10/iss1/9/}, year = {2017}, date = {2017-04-20}, journal = {Journal of Health Disparities Research and Practice}, volume = {10}, number = {1}, pages = {143-166}, abstract = {Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents’ health risks were childhood obesity, lack of physical activity, and low self-esteem. Women’s health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents’ health risks were childhood obesity, lack of physical activity, and low self-esteem. Women’s health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies. |
Williamson, Heather J; Perkins, Elizabeth A; Levin, Bruce L; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Massey, Oliver T Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas Journal Article Intellectual and Developmental Disabilities, 55 (2), pp. 84-96, 2017. @article{Williamson2017b, title = {Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas}, author = {Heather J Williamson and Elizabeth A Perkins and Bruce L Levin and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Oliver T Massey}, url = {http://www.aaiddjournals.org/doi/10.1352/1934-9556-55.2.84}, year = {2017}, date = {2017-04-01}, journal = {Intellectual and Developmental Disabilities}, volume = {55}, number = {2}, pages = {84-96}, abstract = {Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs. |
Williamson, Heather J; Perkins, Elizabeth A; Levin, Bruce L; Baldwin, Julie A; Lulinksi, Amie; Armstrong, Mary I; Massey, Oliver T Implementation of medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas Journal Article Intellectual and Developmental Disabilities, 55 (2), pp. 84-96, 2017. @article{Williamson2017c, title = {Implementation of medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas}, author = {Heather J Williamson and Elizabeth A Perkins and Bruce L Levin and Julie A Baldwin and Amie Lulinksi and Mary I Armstrong and Oliver T Massey}, url = {http://www.aaiddjournals.org/doi/abs/10.1352/1934-9556-55.2.84?code=aamr-site}, doi = {10.1352/1934-9556-55.2.84}, year = {2017}, date = {2017-04-01}, journal = {Intellectual and Developmental Disabilities}, volume = {55}, number = {2}, pages = {84-96}, abstract = {Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs. |
Martinez-Hume, Anna C; Baker, Allison M; Bell, Hannah S; Montemayor, Isabel; Elwell, Kristan; Hunt, Linda M "They Treat you a Different Way:" Public Insurance, Stigma, and the Challenge to Quality Health Care Journal Article Culture, Medicine, and Psychiatry, 41 (1), pp. 161-180, 2017. @article{Martinez-Hume2017, title = {"They Treat you a Different Way:" Public Insurance, Stigma, and the Challenge to Quality Health Care}, author = {Anna C Martinez-Hume and Allison M Baker and Hannah S Bell and Isabel Montemayor and Kristan Elwell and Linda M Hunt}, url = {https://www.ncbi.nlm.nih.gov/pubmed/28025774}, year = {2017}, date = {2017-03-01}, journal = {Culture, Medicine, and Psychiatry}, volume = {41}, number = {1}, pages = {161-180}, abstract = {Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy. |
Panzera, Anthony D; Bryant, Carol A; Hawkins, Fran; Goff, Rhonda; Napier, Ashley; Schneider, Tali; Kirby, Russell S; Coulter, Martha L; Sappenfield, William M; Baldwin, Julie A; O'Rourke, Kathleen Mapping a WIC Mother's Journey: A preliminary analysis Journal Article Social Marketing Quarterly, 23 (2), pp. 1-17, 2017. @article{Panzera2017, title = {Mapping a WIC Mother's Journey: A preliminary analysis}, author = {Anthony D Panzera and Carol A Bryant and Fran Hawkins and Rhonda Goff and Ashley Napier and Tali Schneider and Russell S Kirby and Martha L Coulter and William M Sappenfield and Julie A Baldwin and Kathleen O'Rourke}, url = {http://journals.sagepub.com/doi/full/10.1177/1524500417692526}, year = {2017}, date = {2017-02-21}, journal = {Social Marketing Quarterly}, volume = {23}, number = {2}, pages = {1-17}, abstract = {While the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides numerous benefits to many enrolled families across the United States, including access to nutritious foods, some recent drops in maternal participation in Kentucky resulted from failures to retrieve those benefits. We explored perceived benefits of and encountered barriers to food benefit retrieval. Journey mapping included direct observations of client appointments, clinic lobby areas, and a shopping experience and was augmented with focus groups conducted in two urban and two rural areas. Major touchpoints before WIC appointments, during those appointments at clinics, and after appointments when redeeming food benefits were identified. Across touchpoints, mothers identified childcare, transportation issues, long waits, confusion regarding eligibility, problems scheduling appointments, and stigma as barriers to their ability to retrieve food instruments. Despite these barriers mothers value the benefits of WIC, especially access to healthy foods, infant formula, and nutrition education. This work demonstrates a method by which WIC mothers’ experiences shed light on client service shortfalls and possible opportunities to improve client services.}, keywords = {}, pubstate = {published}, tppubtype = {article} } While the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides numerous benefits to many enrolled families across the United States, including access to nutritious foods, some recent drops in maternal participation in Kentucky resulted from failures to retrieve those benefits. We explored perceived benefits of and encountered barriers to food benefit retrieval. Journey mapping included direct observations of client appointments, clinic lobby areas, and a shopping experience and was augmented with focus groups conducted in two urban and two rural areas. Major touchpoints before WIC appointments, during those appointments at clinics, and after appointments when redeeming food benefits were identified. Across touchpoints, mothers identified childcare, transportation issues, long waits, confusion regarding eligibility, problems scheduling appointments, and stigma as barriers to their ability to retrieve food instruments. Despite these barriers mothers value the benefits of WIC, especially access to healthy foods, infant formula, and nutrition education. This work demonstrates a method by which WIC mothers’ experiences shed light on client service shortfalls and possible opportunities to improve client services. |
Camplain, Ricky; Kucharska-Newton, Anna; Cuthbertson, Carmen C; Wright, Jacqueline D; Alonso, Alvaro; Heiss, Gerardo Pharmacoepidemiology and Drug Safety, 26 (4), pp. 421-428, 2017. @article{Camplain2017c, title = {Misclassification of incident hospitalized and outpatient heart failure in administrative claims data: the Atherosclerosis Risk in Communities (ARIC) study.}, author = {Ricky Camplain and Anna Kucharska-Newton and Carmen C Cuthbertson and Jacqueline D Wright and Alvaro Alonso and Gerardo Heiss}, url = {http://onlinelibrary.wiley.com/doi/10.1002/pds.4162/abstract;jsessionid=84471AF98391D8C41703CB2E376B34F1.f04t01}, year = {2017}, date = {2017-01-25}, journal = {Pharmacoepidemiology and Drug Safety}, volume = {26}, number = {4}, pages = {421-428}, abstract = {PURPOSE: The aim of this study was to quantify the influence of the length of the look-back period on misclassification of heart failure (HF) incidence in Medicare claims available for participants of a population-based cohort. METHODS: Atherosclerosis Risk in Communities participants with ≥3 years of continuous fee-for-service Medicare enrollment from 2000 to 2012 was assigned an index date 36 months after enrollment separating the time-in-observation period into the look-back and the incidence periods. Incident HF events were identified using ICD-9-CM code algorithms as the first observed hospitalization claim or the second of two HF outpatient claims occurring within 12 months. Using 36 months as a referent, the look-back period was reduced by 6-month increments. For each look-back period, we calculated the incidence rate, percent of prevalent HF events misclassified as incident, and loss in sample size. RESULTS: We identified 9568 Atherosclerosis Risk in Communities participants at risk for HF. For hospitalized and outpatient HF, the number of events misclassified as incident increased, and the total number of incident events decreased with increased length of the look-back period. The incident rate (per 1000 person years) decreased with increased length of the look-back period from 6 to 36 months and had a greater impact on outpatient HF; for example, from 11.2 to 10.6 for ICD-9-CM 428.xx hospitalization in the primary position and 10.5 to 7.9 for outpatient HF. CONCLUSION: Our estimates can be used to optimize trade-offs between the degree of misclassification and number of events in the estimation of incident HF from administrative claims data, as pertinent to different study questions. Copyright © 2017 John Wiley & Sons, Ltd.}, keywords = {}, pubstate = {published}, tppubtype = {article} } PURPOSE: The aim of this study was to quantify the influence of the length of the look-back period on misclassification of heart failure (HF) incidence in Medicare claims available for participants of a population-based cohort. METHODS: Atherosclerosis Risk in Communities participants with ≥3 years of continuous fee-for-service Medicare enrollment from 2000 to 2012 was assigned an index date 36 months after enrollment separating the time-in-observation period into the look-back and the incidence periods. Incident HF events were identified using ICD-9-CM code algorithms as the first observed hospitalization claim or the second of two HF outpatient claims occurring within 12 months. Using 36 months as a referent, the look-back period was reduced by 6-month increments. For each look-back period, we calculated the incidence rate, percent of prevalent HF events misclassified as incident, and loss in sample size. RESULTS: We identified 9568 Atherosclerosis Risk in Communities participants at risk for HF. For hospitalized and outpatient HF, the number of events misclassified as incident increased, and the total number of incident events decreased with increased length of the look-back period. The incident rate (per 1000 person years) decreased with increased length of the look-back period from 6 to 36 months and had a greater impact on outpatient HF; for example, from 11.2 to 10.6 for ICD-9-CM 428.xx hospitalization in the primary position and 10.5 to 7.9 for outpatient HF. CONCLUSION: Our estimates can be used to optimize trade-offs between the degree of misclassification and number of events in the estimation of incident HF from administrative claims data, as pertinent to different study questions. Copyright © 2017 John Wiley & Sons, Ltd. |
Davis, Jenna L; McGinnis, Kara E; Walsh, Margaret L; Williams, Coni; Sneed, Kevin B; Baldwin, Julie A; Green, Lee B An Innovative Approach for Community Engagement: Using an Audience Response System Journal Article Journal of Health Disparities Research and Practice, 5 (2), pp. 1, 2017. @article{Davis2017, title = {An Innovative Approach for Community Engagement: Using an Audience Response System}, author = {Jenna L Davis and Kara E McGinnis and Margaret L Walsh and Coni Williams and Kevin B Sneed and Julie A Baldwin and Lee B Green}, url = {https://www.ncbi.nlm.nih.gov/pubmed/23302776}, year = {2017}, date = {2017-01-01}, journal = {Journal of Health Disparities Research and Practice}, volume = {5}, number = {2}, pages = {1}, abstract = {Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups. ARS was implemented at a community town hall event sponsored by a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, the Center for Equal Health. Participants appreciated being able to see how everyone else answered and felt included in the research process. ARS is beneficial because the community can answer truthfully and provides instant research results. Additionally, researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. Audience Response Systems proved to be an effective tool for successfully accomplishing community-based participatory research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups. ARS was implemented at a community town hall event sponsored by a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, the Center for Equal Health. Participants appreciated being able to see how everyone else answered and felt included in the research process. ARS is beneficial because the community can answer truthfully and provides instant research results. Additionally, researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. Audience Response Systems proved to be an effective tool for successfully accomplishing community-based participatory research. |
2016 |
Williamson, Heather J; Perkins, Elizabeth A; Acosta, Annie; Fitzgerald, Maureen; Agrawal, Jui; Massey, Oliver T Journal of Policy and Practice in Intellectual Disabilities, 13 (4), pp. 287-296, 2016. @article{Williamson2016, title = {Family Caregivers of Individuals with Intellectual and Developmental Disabilities: Experiences with Medicaid Managed Care Long-Term Services and Supports in the United States}, author = {Heather J Williamson and Elizabeth A Perkins and Annie Acosta and Maureen Fitzgerald and Jui Agrawal and Oliver T Massey}, url = {http://onlinelibrary.wiley.com/doi/10.1111/jppi.12198/abstract}, year = {2016}, date = {2016-12-01}, journal = {Journal of Policy and Practice in Intellectual Disabilities}, volume = {13}, number = {4}, pages = {287-296}, abstract = {A majority of individuals with intellectual and developmental disabilities need the support of a family caregiver. In the USA, more states are transitioning to a managed care model to provide long-term services and supports (LTSS) and family caregivers are vital partners in the successful management of LTSS. This study's purpose is to illustrate the lived experience of receiving LTSS in a managed care model from the family caregiver perspective. In-depth semi-structured interviews were completed with 16 caregivers in four states with Medicaid managed LTSS (MLTSS). The themes include the importance of the family caregiver as supported and active partners in the provision of MLTSS, the family caregiver experiences with care coordination and access to services in MLTSS, and the family caregivers’ overall impression of MLTSS. Results indicate caregiver advocacy is critical to coordinating needed MLTSS and family support services help caregiver's maintain their vital role in the MLTSS system. Access to services and care coordination in MTLSS varies depending on state of residence. Some caregivers experienced less flexibility in the provision of services and supports and limited access to services making it more complicated for them to feel supported in their caregiving role. Care coordination in MLTSS was largely seen as paperwork processing function. Family caregivers can provide a wealth of knowledge from lived experiences on best practices for MLTSS. Given the move to more home and community-based services, the role of the family caregiver as an active partners in MLTSS will remain the reality for many individuals with IDD. Family caregivers are a key component in MLTSS and more needs to be done to encourage their involvement in the design and oversight of MLTSS. More research is needed to explore best practices for effective stakeholder engagement in the provision of MLTSS.}, keywords = {}, pubstate = {published}, tppubtype = {article} } A majority of individuals with intellectual and developmental disabilities need the support of a family caregiver. In the USA, more states are transitioning to a managed care model to provide long-term services and supports (LTSS) and family caregivers are vital partners in the successful management of LTSS. This study's purpose is to illustrate the lived experience of receiving LTSS in a managed care model from the family caregiver perspective. In-depth semi-structured interviews were completed with 16 caregivers in four states with Medicaid managed LTSS (MLTSS). The themes include the importance of the family caregiver as supported and active partners in the provision of MLTSS, the family caregiver experiences with care coordination and access to services in MLTSS, and the family caregivers’ overall impression of MLTSS. Results indicate caregiver advocacy is critical to coordinating needed MLTSS and family support services help caregiver's maintain their vital role in the MLTSS system. Access to services and care coordination in MTLSS varies depending on state of residence. Some caregivers experienced less flexibility in the provision of services and supports and limited access to services making it more complicated for them to feel supported in their caregiving role. Care coordination in MLTSS was largely seen as paperwork processing function. Family caregivers can provide a wealth of knowledge from lived experiences on best practices for MLTSS. Given the move to more home and community-based services, the role of the family caregiver as an active partners in MLTSS will remain the reality for many individuals with IDD. Family caregivers are a key component in MLTSS and more needs to be done to encourage their involvement in the design and oversight of MLTSS. More research is needed to explore best practices for effective stakeholder engagement in the provision of MLTSS. |
Fleischhacker, Sheila; Roberts, Erica; Camplain, Ricky; Evenson, Kelly R; Gittelsohn, Joel Journal of Racial and Ethnic Health Disparities, 3 (4), pp. 608-624, 2016. @article{Fleischhacker2016, title = {Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives}, author = {Sheila Fleischhacker and Erica Roberts and Ricky Camplain and Kelly R Evenson and Joel Gittelsohn}, url = {https://link.springer.com/article/10.1007%2Fs40615-015-0180-1}, year = {2016}, date = {2016-12-01}, journal = {Journal of Racial and Ethnic Health Disparities}, volume = {3}, number = {4}, pages = {608-624}, abstract = {Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth. |