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Human papillomavirus (HPV) is a common virus that currently infects nearly 80 million people in the United States (U.S.) and can lead to cancer. HPV vaccination provides safe, effective, and lasting protection against HPV infections. Nevertheless, vaccination rates remain suboptimal. The purpose of this study was to examine the relationship between sociodemographic characteristics, HPV and HPV vaccine awareness, and knowledge of HPV-associated cancers among U.S. adults. Using responses from 3504 U.S. adults (aged 18 years and older) from the Health Information National Trends Survey 5 Cycle 2 (January–May 2018), we performed descriptive analysis to assess the level of awareness of HPV and HPV vaccines and knowledge of HPV-associated cancer. Multivariable regression analysis (including race, gender, age, level of education, marital status, number of children younger than 18) was conducted with weighted analysis. About 62% of respondents had heard of HPV and HPV vaccine. Asians had a lower level of awareness than non-Hispanic Whites of HPV (36.4% vs. 66.1%) and HPV vaccine (48.7% vs. 67.1%). Multivariable analysis showed that race/ethnicity was associated with outcomes, with Asians being less likely to have heard about HPV (aOR = 0.17, 95% CI: 0.07–0.38) and non-Hispanic Blacks (aOR = 0.57, 95% CI: 0.35–0.91) and Hispanics (aOR = 0.54, 95% CI: 0.36–0.80) being less likely to have heard of the HPV vaccine than non-Hispanic Whites. In addition, gender, age, marital status, and education were associated with awareness of HPV and the HPV vaccine; in particular, individuals who were female, younger (18–45), married, and more highly educated were more likely to have heard of HPV and HPV vaccine. Results highlight disparities in HPV and HPV vaccine awareness among racial/ethnic minority populations. Future interventions and legislation should target racial/ethnic minority populations to foster improvements in HPV vaccine uptake and reduce disparities in HPV-associated cancers. [ABSTRACT FROM AUTHOR]

African Americans are at significantly greater risk for hypertension, as well as worse hypertension-related morbidity and mortality than other racial/ethnic groups. Prior research aiming to address these health disparities has focused on improving individual patient self-management, with few studies testing family-centered interventions. We aimed to explore the perspectives of African Americans with hypertension and their family members on hypertension, self-management, and reciprocal family-hypertension impacts to inform future intervention design. We conducted four dyadic focus groups (90–120 minutes) of African American adults with hypertension (i.e. patients) and their family members. We recruited patients (n = 23) and their family members (n = 23) from four African American-serving Christian churches over a period of three months (69.6% female, M age = 60.73 years). Patient–family member dyads were interviewed conjointly (groups ranged from 4 to 6 dyads, each) by facilitators using open-ended questions to elicit perspectives regarding contributors to hypertension, self-management strategies, family influence on self-management, and the impact of hypertension on the family. A grounded theory approach was used for analysis. Participants' responses highlighted themes of societal risk factors and barriers (e.g. racism-related stress worsens blood pressure), influences of African American culture (e.g. culturally-informed diet practices), the patient–physician relationship (e.g. proactive communication is beneficial), family-level influences on health (e.g. family monitoring patients' health behaviors), and patient-level risk factors and self-management strategies (e.g. prayer to cope with stress). Themes reflected a hierarchical, nested, ecological structure such that themes within unique levels of participants' social systems affected, and were affected by, stress, change, or behavior in the other levels. African American adults with hypertension and their family members described multilevel influences on hypertension and disease self-management, with a strong emphasis on the value of family support. Developing culturally appropriate, family-centered interventions to improve hypertension self-management will be an important next step. [ABSTRACT FROM AUTHOR]

Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide. Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework. Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events. Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US. [ABSTRACT FROM AUTHOR]

Objectives: We compare rates of ill health and socioeconomic inequalities in health by ethnic groups in Scotland by age. We focus on ethnic differences in socioeconomic inequalities in health. There is little evidence of how socioeconomic inequalities in health vary by ethnicity, especially in Scotland, where health inequalities are high compared to other European countries. Design: A cross-sectional study using the 2011 Scottish Census (population 5.3 million) was conducted. Directly standardized rates were calculated for two self-rated health outcomes (poor general health and limiting long-term illness) separately by ethnicity, age and small-area deprivation. Slope and relative indices of inequality were calculated to measure socioeconomic inequalities in health. Results: The results show that the White Scottish population tend to have worse health and higher socioeconomic inequalities in health than many other ethnic groups, while White Polish and Chinese people tend to have better health and low socioeconomic inequalities in health. These results are more salient for ages 30–44. The Pakistani population has high rates of poor health similar to the White Scottish for ages 15–44, but at ages 45 and above Pakistani people have the highest rates of poor self-rated health. Compared to other ethnicities, Pakistani people are also more likely to experience poor health in the least deprived areas, particularly at ages 45 and above. Conclusions: There are statistically significant and substantial differences in poor self-rated health and in socioeconomic inequalities in health between ethnicities. Rates of ill health vary between ethnic groups at any age. The better health of the younger minority population should not be taken as evidence of better health outcomes in later life. Since socioeconomic gradients in health vary by ethnicity, policy interventions for health improvement in Scotland that focus only on deprived areas may inadvertently exclude minority populations. [ABSTRACT FROM AUTHOR]

Objectives: To assess factors associated with HPV vaccine-related awareness and knowledge among caregivers of adolescents from five ethnic community groups in Utah. Design: For this community-based participatory research study, we surveyed N = 228 caregivers of teens aged 11–17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Utah about their HPV vaccine awareness and knowledge. Results: Participants exhibited high awareness of cervical cancer (71.05%), moderate awareness of HPV (53.95%), and low awareness of the HPV vaccine (46.49%). HPV vaccine-related knowledge was mostly worse, with fewer than half the participants reporting knowing that HPV can cause cervical cancer (46.93%), that most people are infected with HPV at some point in their lives (28.95%), that HPV is asymptomatic in females (36.40%) and males (37.28%), that the HPV vaccine is recommended for adolescent females (41.67%) and males (36.40%), and that the HPV vaccine requires more than one dose (27.19%). HPV vaccine-related awareness and knowledge were significantly associated with race/ethnicity, educational attainment, income, occupation, birthplace, parents' birthplace, English usage, health insurance coverage, type of health insurance, and child having a primary care provider (all p < 0.05). HPV vaccine-related knowledge (p < 0.05) and awareness (p < 0.05) of caregivers were associated with a child in the household receiving the HPV vaccine. Conclusion: Our findings indicate a need to develop educational interventions in collaboration with diverse communities in Utah. We underscore the importance of promoting knowledge about the existence of the HPV vaccine, as well as deeper HPV vaccine-related issues (e.g. HPV risks, treatment, and recommendations). [ABSTRACT FROM AUTHOR]

Objectives: Obesity and its associated health risks are on the rise throughout the US due, in part, to an overall decline in physical activity. Although public green spaces, and in particular trails, show promise as population-level interventions to promote physical activity among adults, these amenities may have disparate impacts across racial/ethnic and socioeconomic groups within a community. Design: This cross-sectional study employed an intercept survey of users of a newly opened $95 million rail-to-trail development in Chicago, IL, immediately after its opening and one year later to examine differences by race/ethnicity and educational attainment in trail use behaviors, motivations for trail use, safety concerns, and change in physical activity attributed to the trail. Results: Although the overall impact of the trail was positive, Latino users were more likely to report frequent use (4+ times/week), health motivations for using the trail, and increased physical activity attributed to the trail. However, Latino users were also more likely to indicate safety concerns and less likely to use areas of the trail in predominately white communities, even after controlling for community of residence. The least educated trail users frequented fewer trail areas and were less likely to indicate health motivations for trail use. Conclusions: Although urban trails represent an opportunity for cost-effective community-wide health promotion, they may not benefit all groups equally. Urban trails may have particularly promising benefits for Latino users, but safety concerns and the possibility of community racial segregation being replicated on trails should be addressed to maximize and sustain these benefits. Less educated residents in particular may not benefit from such projects as intended. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate potential county-level disparities among racial/ethnic and socioeconomic groups in confirmed COVID-19 cases and deaths in the United States in 100,000 population. Secondary data analysis using county-level data for 3,142 US counties was conducted in 2020. Hierarchical linear regression and concentration curve analyses were performed. The combined association of COVID-19 cases and deaths was examined separately by the county population's socioeconomic characteristics. Data from the American Community Survey (ACS) 5-year estimates (2014–2018), Area Health Resources File (AHRF) 2018–2019, Kaiser Health News 2020, and 2020 COVID-19 data from Johns Hopkins University were used in this study. After adjusting for covariates, U.S. counties with a higher proportion of the Black population and a higher proportion of adults with less than a high school diploma had disproportionately higher COVID-19 cases and deaths (β > 0, p<0.05 for all relations). A higher proportion of the Hispanic population was associated with higher confirmed cases (β = 0.68, 95% CI = 0.48–0.87). The majority observed disparities in COVID-19 deaths persisted even after controlling for all-cause deaths in 2019 and COVID-19 cases per 100,000 county population. This can potentially aggravate the existing health disparities among these population groups. Identification of disproportionately impacted population groups can pave the way towards narrowing the disparity gaps and guide policymakers and stakeholders in designing and implementing population group-specific interventions to mitigate the negative consequences of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: This study explored views of Moroccan migrant women on barriers and facilitators to the organized breast cancer screening program in Brussels (Belgium), and the potential of targeted printed invitations to increase this population's attendance to the program. Methods: We conducted one expert interview with the breast cancer screening program coordinator on current practices and challenges with regards to inviting Moroccan migrant women in Brussels for screening. Secondly, we held focus groups with Moroccan women aged 26–66. Sessions focused on perspectives on breast cancer screening and the existing generic program invitations. Directed content analysis of transcripts was based on the Health Belief Model. Alternative communication packages were developed based on barriers and suggestions from the focus groups. A second round of focus groups looked at the alternative communication packages and their potential to encourage Moroccan migrant women in Brussels to participate in the organized breast cancer screening program. Results: Alternative packages were appreciated by some, but a number of adjustments did not catch participants' attention. Printed communication delivered by post does not appear to be the preferred means of communication to encourage breast cancer screening for Moroccan migrant women in Brussels, nor does it seem appropriate to address the barriers to screening found in this study. Conclusions: The benefit of targeted postal invitation packages for Moroccan migrant women in Brussels seems limited for a variety of reasons. For future research, a large-scale study analyzing the topic in a cross-cultural perspective is warranted. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this review was to summarize the current status of knowledge regarding cognitive dysfunction and diabetes in minorities. Literature on the interaction of cognitive dysfunction and diabetes was analyzed to (a) examine the number and characteristics of studies in minority populations; (b) identify tests used to assess cognitive function in diabetes; (c) consider the impact of diabetes on cognitive function; and (d) assess the moderators of the association between diabetes and cognitive function. Design: A literature review and thematic analysis was conducted. Studies were mapped to describe their design, target population, instruments used, and the physiologic, psychosocial, and socioeconomic findings related to cognitive function and diabetes. Twelve studies met the inclusion criteria. Results: Hispanics were studied more than any other ethnic group. Rates and degree of cognitive dysfunction were more prevalent in minorities than non-Hispanic whites. Overall, 28 different tests were administered to evaluate cognitive function. There was some variation among findings regarding the relationship of cognitive function and diabetes. Risk for cognitive decline was associated with the diagnosis of diabetes alone, regardless of whether the diabetes was treated or untreated. Higher rates of discrimination were associated with greater cognitive decline Conclusion: Given the context of minority health, there is a potential for higher negative health impact due to the increased prevalence of diabetes and cognitive dysfunction and other related health disparities. Reduction of physiological risk factors for diabetes, consistency in assessment, as well as elimination of structural barriers such as access to care should be helpful in decreasing the incidence of both diabetes and cognitive decline. More research is needed to determine whether the observed differences are modifiable and to identify factors involved in the interaction of diabetes and cognitive decline—not only physiological factors, but factors related to socioeconomic status and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults. Design: We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios. Results: Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender. Conclusion: Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study’s model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii. [ABSTRACT FROM AUTHOR]

ObjectiveAlthough adolescent girls from ethnic minorities are at an increased risk of internalizing problems (e.g. depression), only a small fraction seeks formal help for these problems. To enhance help-seeking for internalizing problems among ethnic minority adolescent girls, insight into their help-seeking behaviour is required. This study explored the perceptions of adolescent girls from different ethnic backgrounds regarding their help-seeking behaviour for internalizing problems. DesignA qualitative study using focus group discussions (FGDs) was employed. Eight ethnic-specific FGDs were conducted with 50 adolescent girls of mostly Turkish (n=23), Moroccan (n=13), and Dutch (n=10) backgrounds recruited in Rotterdam, a multicultural city in the Netherlands. FGDs were conceptually framed within a help-seeking model, facilitated by a vignette and analysed using NVivo software. ResultsWhen describing the internalizing problems presented in the vignette, participants of non-Dutch FGDs tended to state the causes of the problems (e.g. lack of attention) whereas participants of Dutch FGDs mentioned the emotional state. Participants did not perceive the presented internalizing problems as severe. If participants were to face internalizing problems of their own, their decision to seek help would be hampered by negative attitudes towards professionals and school-based services. Particularly in non-Dutch FGDs the fear of parental and friend's reactions was identified as a barrier. Participants identified their mother and a good friend as primary sources of help. ConclusionIn this study, adolescent girls of Turkish, Moroccan and Dutch backgrounds had difficulty recognizing the severity of internalizing problems, and various barriers could hamper their decision to seek help. To enhance utilization of mental health services by youth, promoting a change in their attitudes towards mental health/school-based services is recommended. Guaranteeing confidentiality within school-based services, and training for professionals in communicating with adolescent girls, may also prove beneficial. In ethnic minorities, tackling the negative reactions of family/friends requires attention. [ABSTRACT FROM AUTHOR]

To discover the sociocultural patterns that influence decisions about organ and tissue donation among American Indian (AI) adults. This qualitative ethnographic study used a social–ecological framework. A snowball sampling technique was used to recruit 21 Oglala Lakota Sioux participants (age ≥ 19 years) living on the Pine Ridge Indian Reservation in South Dakota, USA. Face-to-face interviews were conducted using open-ended questions derived from the social–ecological perspective of Stokols (1992). Interviews were audiotaped and transcribed. Data were categorized into construct codes to identify concepts and to discover emerging themes. Personal and environmental themes regarding organ and tissue donation emerged. There were two personal themes: uncertain knowledge and the diabetes crisis. Participants knew very little about organ and tissue donation but there was a basic understanding of donor/recipient compatibility. The prevalence of diabetes in the community is contributing to a dire need for kidney donors. The diabetes crisis was acknowledged by every participant. There were three environmental themes: cultural transitions, healthcare system competence and outreach efforts. Traditional cultural beliefs such as entering the spirit world with an intact body were acknowledged. However, conversations reflected re-examination of traditional beliefs because of the need for kidney donors. The healthcare environmental context of organ and tissue donation emerged as a theme. Participants were not confident that the local health system was prepared to either address traditional beliefs about organ and tissue donation or implement a donation protocol. The final theme was the environmental context of outreach efforts. Participants desired relevant outreach targeted to the community and disseminated through local communication networks including the family, the media and tribal leaders. Sociocultural factors relevant to the personal and environmental context of the social ecological model influenced beliefs about organ and tissue donation among the Lakota people in this study. Outreach programs aimed at increasing donation need to respect traditional beliefs yet present the choice about organ and tissue donation within the cultural context. Telling the stories of community members affected by both diabetes and donation is important. Promoting family conversation is critical. Healthcare systems must approach potential donor families with an understanding of traditional beliefs and respect for the process of family communication about organ and tissue donation. [ABSTRACT FROM AUTHOR]

Purpose: To assess knowledge and opinions about the process of human organ donation and transplantation among American teenagers. Methods: A culturally sensitive 35-item self-administered survey assessing knowledge, opinions, and family discussion about organ donation and transplantation was conducted with 247 students in 13 separate classrooms encompassing three urban high schools in the same city. Results: More than 50% of the students did not know the correct answers to 13 of the 16 questions on factual knowledge. The sources of information about organ donation and transplantation among students were primarily television and school. African-Americans and Asian-Americans were significantly less likely to want to become organ donors when compared to non-African-Americans and non-Asian-Americans, respectively. Asian-Americans were significantly less likely to have discussed the matter with family members. Conclusions: Accurate, up-to-date, culturally sensitive youth-oriented health education that emphasizes family discussions about organ donation and transplantation is needed. [ABSTRACT FROM AUTHOR]

Keywords: Race, minority health, access to health care, socioeconomics, ethnicity. [ABSTRACT FROM AUTHOR]