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As the United States' population grows via migration and immigration, with this rise in diverse identities, there has been increasing concern regarding disparities for undocumented immigrants living in the U.S. with limited access to the health system. Given the various constraints involving communication and social structures that undocumented immigrants face, a culture-centered approach is drawn on to investigating how this group goes about navigating a dominant health system given their restricted access. I explore co-constructed themes that emerged through conversations with undocumented immigrants, (people without papers as I call them in this work) living in the United States to gain an understanding as to the structural and cultural limitations faced by this group. By doing qualitative semi-structured interviews with local participants living in the South Florida region, I describe the various features of a complex U.S. health system that undocumented immigrants (people without papers) deemed as important obstacles that limit their willingness to interact with official medical spaces. This work draws on narratives and accounts to shed light on the intersection of disparities this group has to overcome in order to consider entering a medical space to receive the treatment they might need. The findings of this article highlighted the structural violence that certain subaltern groups, such as people without papers experience due to their limited access to foundational systems in their environment. [ABSTRACT FROM AUTHOR]

Background: Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. Aims: Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. Methods: A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. Results: Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. Conclusions: Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people. [ABSTRACT FROM AUTHOR]

Introduction: Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida.Study Design: This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018.Setting/participants: Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex.Intervention: Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages.Main Outcome Measures: Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status.Results: Significant time effects only were found for daily fruit and vegetable intake (p<0.001), fat intake (p<0.001), and the Fat Screener (p<0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time (p<0.001) and the interaction between time and treatment (p<0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 (p=0.03).Conclusions: Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants.Trial Registration: This study is registered at www.clinicaltrials.govNCT03339050. [ABSTRACT FROM AUTHOR]

Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies. [ABSTRACT FROM AUTHOR]

Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. Factors contributing to treatment decisions among Latinos diagnosed with cancer must be studied. This paper aims to identify treatment decisions among Latinos with cancer and examine factors influencing these decisions. A qualitative exploratory study using semi-structured interviews of 60 Latino/as diagnosed with cancer was conducted. Close-ended responses were analyzed using percentages and frequency distributions, while open-ended responses were analyzed using open coding and thematic categorization. Surgery was the most commonly chosen treatment among participants because it was perceived as providing the highest chance of prolonging life. Only 57% of participants were provided with treatment options. Latinos/as typically prefer modest, paternalistic patient-physician relationships. Therefore, providing culturally appropriate information is valuable. This study underscores the need for health providers to present all available treatment options to enhance cancer treatment outcomes [ABSTRACT FROM AUTHOR]

Home visitation programs offer a unique opportunity to implement a novel digital early childhood obesity prevention program. Evaluate usability of a digital infant feeding nutrition education module with key stakeholders (N=21) of a home visiting program in Florida. Home visitors (n=11) and enrolled mothers (n=10) of a home visiting program in Florida participated in a one-time, 45-minute qualitative interview via Zoom with a trained researcher using a semi-structured script based on constructs from the Technology Acceptance Model (TAM) and Social Cognitive Theory (SCT). Participants also completed a modified version of the mHealth App Usability Questionnaire (MAUQ). Interviews were audio-recorded, deidentified, transcribed verbatim and coded by two trained researchers using an inductive thematic analysis approach based on TAM and SCT constructs to develop themes. MAUQ subscales were analyzed using descriptive statistics. Most participants noted that they liked the digital format, and specifically mentioned the visual or interactive components, convenience and accessibility of the information, and general preference for digital information over paper handouts. Home visitors were interested in content related to food allergies and readiness for solid foods, whereas mothers were interested in all of the infant feeding topics. Nonetheless, the majority (90%) reported that they would be very likely to use information in the learning modules as part of home visits. Usability of the module was high across all three MAUQ subscales (mean ratings out of 7±SD: ease of use = 6.88±0.2, interface and satisfaction = 6.90±0.4, usefulness = 6.78±0.1). Limited access to technology by parents, compatibility of the module with various phone types, and necessity of keeping information updated were mentioned by home visitors as limitations that may impact usability. The results revealed that a digital nutrition education module to prevent early childhood obesity was deemed usable by both staff and parents of a home visiting program. Future research is needed to determine impact on parental feeding behaviors and child health outcomes. University of Florida Mowery Innovative Research Fund [ABSTRACT FROM AUTHOR]

Nearly one-third of children in the United States (U.S.) are overweight or obese and at a higher risk for numerous comorbidities. School nurses are ideally positioned to contribute to strategic childhood obesity prevention (COP) efforts, but there are substantial variations with their involvement in COP practices. The research question posed was: "Are personal, professional, and/or job-related characteristics associated with school nurse engagement in child-level or school-level childhood obesity prevention practices?" In this descriptive cross-sectional study, Florida school nurses (N = 171) were recruited via email and two professional conferences to complete an anonymous online or paper survey. Items included questions about various characteristics and how often they performed certain COP practices. Engagement in COP practices was measured on a Likert-type scale with response options of 1 = never; 2 = rarely; 3 = sometimes; 4 = often. Data analyses included correlations, t tests, and ANOVA to determine associations between personal, professional, and job-related characteristics with child-level and school-level school nurse COP practices. Significant associations (p < 0.05) were found between school nurse COP practices and professional characteristics that indicated additional education (i.e., highest nursing degree, COP education, professional organization membership, and national certified school nurse certification). The number of students provided care, age, years in current position, and experience as a nurse and school nurse positively correlated to child-level COP practices, while socioeconomic levels of school(s) were inversely correlated to these practices. Findings support the need for funding and providing additional COP educational opportunities to increase school nurse involvement in preventing childhood obesity. [ABSTRACT FROM AUTHOR]

Aims: In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.Method: Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.Results: Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.Conclusions: Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships. [ABSTRACT FROM AUTHOR]

Introduction: Technology has transformed our lifestyles in dramatic and significant ways, including new and less expensive options for recruiting study participants. This study examines cost and participant differences between two recruitment sources, Craigslist (CL), and print newspapers (PNs). This paper also reviewed and compared studies involving clinical trials published since 2010 that recruited participants using CL alone or in combination with other methods.Method: Secondary data analyses from a parent study involving a randomized controlled trial of a mail-based intervention to promote self-change with problem drinkers.Results: Significant differences were found between CL and PN participants on most demographic and pretreatment drinking variables. While all participants had AUDIT scores suggestive of an alcohol problem and reported drinking at high-risk levels, CL participants had less severe drinking problem histories, were considerably younger, and had a higher socioeconomic status than PN participants. The total advertising costs for the 65 CL ads ($275) were significantly less than the 69 PN ads ($33, 311). The recruiting cost per eligible participant was vastly less expensive using CL ($1.46) compared to print newspaper ads ($116.88).Conclusions: Using CL is a viable recruitment method for soliciting participants, particularly those that are younger, for alcohol intervention studies. It is also less expensive than newspaper ads. When CL participants were recruited, they reported being slightly more confident to change their drinking than PN participants. Limitations of using CL are discussed, including that some initial ad responders gave inconsistent answers to similar questions and a few tried to enter the study more than once. [ABSTRACT FROM AUTHOR]

Equivalency of test versions is often assumed by counselors and evaluators. This study examined two versions, paper–pencil and computer based, of the Driver Risk Inventory, a DUI/DWI (driving under the influence/driving while intoxicated) risk assessment. An overview of computer-based testing and standards for equivalency is also provided. Results of the study confirmed reliability, validity, and equivalency of the versions. [ABSTRACT FROM AUTHOR]