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Safe and effective vaccines have been developed that protect against high-risk strains of HPV, but uptake is relatively low. We previously identified factors such as sexual attitudes and HPV knowledge that impact the intent of Christian parents to vaccinate their children against HPV. We hypothesized that culturally specific interventions in the form of short videos would be effective at improving HPV vaccine intentions and attitudes. We made three short educational videos, one with a Christian focus, one informational about HPV, and one control. Videos were distributed electronically with accompanying surveys, and responses were measured before and after watching a randomly selected video. The religious-focused and educational interventions significantly (p < 0.0001, p = 0.0015) improved intentions towards HPV vaccination. The religiously-focused video also significantly diminished the belief that the HPV vaccine is unnecessary because of a family's values (p = 0.014). Parents significantly credited both interventions with improving their intent to vaccinate their children against HPV (p < 0.001 for both). These results suggest that culturally focused educational interventions are effective at influencing vaccine intentions and attitudes, even when those are based on religious or cultural feelings. Highly specific interventions are likely to be necessary for optimal improvement in vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questionnaire was mailed in 2014 to adults aged 50-75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1200 surveys mailed, 393 were returned (rural n = 200, urban n = 193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening. [ABSTRACT FROM AUTHOR]

Free clinics provide free or reduced fee health services to the un- or under-insured. Patient engagement is important to understand patients' needs and to improve healthcare systems. There are few studies that examined patient engagement and satisfaction among the underserved and how patients perceive the quality of healthcare services in a free clinic setting. This study examined free clinic patients' satisfaction in order to better understand how free clinic patients perceive quality of healthcare services. English or Spanish speaking patients (N = 351), aged 18 years or older completed a self-administered survey using standardized measures of patient satisfaction and health status. Additional questions of patient satisfaction and experience with healthcare which fit a free clinic setting were developed. While the satisfaction with interpreter services was overall high, there were potential issues of a family member as an interpreter and unmet needs for interpreter services. Participants reported different levels of patient satisfaction by three language categories: native English speakers, non-native English speakers, and Spanish speakers. Health status is an important indicator to determine patient satisfaction. To improve patient satisfaction and engagement among free clinic patients, factors such as: quality of a family interpreter, unmet needs for interpreter services, social support, and health education programs may need to be considered. The differences in these three language groups indicate that not all free clinic patients may be combined together into a general category of free clinic patients. It may be necessary to provide customized treatment for each of these groups. [ABSTRACT FROM AUTHOR]

Nonpharmacological treatment of chronic pain in older people can be effective but attitudes and adherence to use of this treatment may differ by ethnicity. This study supports that a modified 14-item instrument based on the modified Health Belief Model-the arthritis-related health belief instrument (AHBI)-can be used across ethnically diverse older adults (i.e., European Americans, Hispanics, African Americans, and Afro-Caribbeans). Confirmatory factor analysis tested the factor structure of the AHBI to eliminate items inappropriate for this population. Structural equation modeling tested expected relationships among four latent variables-severity, susceptibility, barriers, and benefits-across the four ethnic groups. Findings suggest that the modified 14-item AHBI (eliminating two items from the original AHBI) adequately described the four latent factors pertaining to use of nonpharmacological pain therapy in this sample. All items registered substantial loadings (.41-.95) on the hypothesized factors, operating similarly across the four ethnic groups. The modified 14-item AHBI may be useful in (a) assessing how individual perceptions influence access to nonpharmacological pain therapy among ethnically diverse community-dwelling older adults, with the goal to develop and implement effective pain treatment for this population; and (b) measuring the likelihood of using nonpharmacological pain therapy by older adults. The modified 14-item AHBI can help health care providers to provide accurate pain assessment and examine domains that could affect use of nonpharmacological pain therapy by ethnically diverse older adults and guide practice with them by identifying barriers to use of such therapies and providing education to encourage their use. [ABSTRACT FROM AUTHOR]

This exploratory study assesses the dental care needs and access of low-income, mostly immigrant cancer patients enrolled in New York City's Integrated Cancer Care Action Network (ICCAN). A nested cohort of patients from ICCAN responded to a dental needs assessment that surveyed current dental health as well as access to, and use of, dental services. 373 patients participated. Self-report of having a dentist to visit, current dental problems, income, and insurance most significantly predicted a dentist visit in the past year. Discussing treatment-related oral side effects with the oncologist greatly increased the likelihood of seeing a dentist, but few patients reported having had this conversation. There is a lack of oral care information flowing from oncologists to low income patients. We found a high number of reported dental problems: concerning because of potential treatment interference and risk for infection. Finally, ability to pay largely determined dental care access in our study participants. [ABSTRACT FROM AUTHOR]

Although growing research focuses on breast cancer screenings, little is known about breast cancer prevention with risk reduction awareness for ethnic differences among college-age women. This study examined breast cancer prevention knowledge, beliefs, and information sources between non-Hispanic and Hispanic college women. Using a cross-sectional study, women at a university in the Southwest completed a 51-item survey about breast cancer risk factors, beliefs, and media and interpersonal information sources. The study was guided by McGuire's Input Output Persuasion Model. Of the 546 participants, non-Hispanic college women (n = 277) and Hispanic college women (n = 269) reported similar basic knowledge levels of modifiable breast cancer risk factors for alcohol consumption (52 %), obesity (72 %), childbearing after age 35 (63 %), and menopausal hormone therapy (68 %) using bivariate analyses. Most common information sources were Internet (75 %), magazines (69 %), provider (76 %) and friends (61 %). Least common sources were radio (44 %), newspapers (34 %), and mothers (36 %). Non-Hispanic college women with breast cancer family history were more likely to receive information from providers, friends, and mothers. Hispanic college women with a breast cancer family history were more likely to receive information from their mothers. Breast cancer prevention education for college women is needed to include risk reduction for modifiable health behavior changes as a new focus. Health professionals may target college women with more information sources including the Internet or apps. [ABSTRACT FROM AUTHOR]

Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes [LDL-cholesterol (LDL-c) < 100 mg/dl, AlC < 9.0 %, and blood pressure (BP) < 140/80 mmHg], and body mass index (BMI) < 30 kg/m. Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP < 140/80 [Adjusted odds ratio (AOR) = 0.45; 95 % CI 0.22, 0.92], and BMI < 30 (AOR = 0.43; 95 % CI 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP. [ABSTRACT FROM AUTHOR]

Use of outdoor recreation areas (ORAs) is correlated with physical activity (PA) in community-dwelling adults. Additionally, the wide spread availability of ORAs, including their placement in disadvantaged neighborhoods, make them an especially promising venue through which to promote PA. The purpose of this study was to examine the combination of individual-level factors associated with ORA use in a socioeconomically diverse Southeastern US county. A 2011 random digit-dial survey included 829 adults aged 18+ years with complete data; questions assessed PA level and use/perceived safety of ORAs. Signal detection analysis, a non-parametric recursive partitioning technique, identified cutpoints for defining subgroups of respondents based on ORA use. Seven subgroups were defined ranging from 77.2 % ORA use (younger, met PA recommendations) to 31.8 % ORA use (older, perceived ORAs to be less safe). Signal detection did not identify gender or race as important for defining subgroups. Results suggest that gendered and ethnically-focused ORA promotion campaigns might be unnecessary. Instead, efforts could focus on increasing awareness of ORA facilities among older, less active adults. [ABSTRACT FROM AUTHOR]

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61 % reported being diagnosed with three or more physical conditions and 73 % with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition ( p > .001; CI 1.334-2.566). Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population. [ABSTRACT FROM AUTHOR]

Free clinics provide free primary care to the under or uninsured and have been playing an important role in serving the socio-economically disadvantaged. Free clinic patients represent a group of people who experience significant barriers to receiving diabetes prevention and intervention. This study examined diabetes attitudes among free clinic patients and volunteers. English or Spanish speaking patients and volunteers (N = 384), aged 18 years or older completed a self-administered survey. Diabetic patients and volunteers shared similar levels of diabetes attitudes compared to non-diabetic patients. Among patients, ethnicity, education level, diabetes education, and family history affected diabetes attitudes. Among volunteers, diabetes education was an important factor associated with positive diabetes attitudes. Whether the volunteer is a healthcare professional or student was related only to one aspect of diabetes attitudes, seriousness of type 2 diabetes. The results, indicating free clinic diabetic patients and volunteers shared similar levels of diabetes attitudes, were positive for maintaining and developing diabetes education programs at a free clinic. Unfortunately, the average length of volunteering at this free clinic was short and student volunteers likely leave the clinic upon graduation. Future research should examine issues of volunteer retention in free clinics. Diabetes education for patients may need to be diversified according to ethnicity, family history of diabetes, and educational level. Finally, non-healthcare professional volunteers could potentially be involved in diabetes education at a free clinic. [ABSTRACT FROM AUTHOR]

To assess the burden and spectrum of refractive and non-refractive ophthalmic disorders in south-eastern Nigerians with oculocutaneous albinism. In a population-based survey in Enugu state, between August, 2011 and January, 2012, albinos were identified using the database of the Enugu state's Albino Foundation, and mass media-based mobilisation. The participants were enrolled at the Eye Clinics of the University of Nigeria Teaching Hospital and Enugu State University of Science and Technology Teaching Hospital using a defined protocol. Relevant socio-demographic and clinical data were obtained from each participant. Descriptive and comparative statistics were performed. Statistical significance was indicated by p < 0.05. The participants (n = 153; males, 70) were aged 23.5 + 10.4 SD years (range 6-60 years). Both refractive and non-refractive disorders were present in all participants. Non-refractive disorders comprised nystagmus, foveal hypoplasia, hypopigmented fundi and prominent choroidal vessels in 100.0 % participants; and strabismus in 16.3 % participants. Refractive disorders comprised astigmatism −73.2 % eyes, myopia −23.9 % and hypermetropia 2.9 %. Spherical refractive errors ranged from −14.00 DS to +8.00 DS while astigmatic errors ranged from −6.00 DC to +6 DC. Mixed refractive and non-refractive disorder i.e. presenting visual impairment was present in 100.0 % participants. Overall, refractive error was associated with non-possession of tertiary education (OR 0.61; 95 % CI 0.38-0.96; p = 0.0374). There is high prevalence of refractive, non-refractive and mixed ophthalmic disorders among albinos in south-eastern Nigeria. This underscores the need for tailored provision of resources to address their eye care needs, and creation of needs awareness amongst them. [ABSTRACT FROM AUTHOR]

Despite the fact infectious diseases can spread readily in grade schools, few studies have explored prevention in this setting. Additionally, we lack valid tools for students to self-report knowledge, attitudes, and behaviors. As part of an ongoing study of a curriculum intervention to promote healthy behaviors, we developed and evaluated age-appropriate surveys to determine students' understanding of influenza prevention. Surveys were adapted from adolescent and adult influenza surveys and administered to students in grades 2-5 (ages 7-11) at two Rochester public schools. We assessed student understanding by analyzing percent repeatability of 20 survey questions and compared percent 'don't know' (DK) responses across grades, gender, and race. Questions thought to be ambiguous after early survey administration were investigated in student focus groups, modified as appropriate, and reassessed. The response rate across all surveys was >87 %. Survey questions were well understood; 16 of 20 questions demonstrated strong pre/post repeatability (>70 %). Only 1 question showed an increase in DK response for higher grades ( p < .0001). Statistical analysis and qualitative feedback led to modification of 3 survey questions and improved measures of understanding in the final survey administration. Grade-school students' knowledge, attitudes and behavior toward influenza prevention can be assessed using surveys. Quantitative and qualitative analysis may be used to assess participant understanding and refine survey development for pediatric survey instruments. These methods may be used to assess the repeatability and validity of surveys to assess the impact of health education interventions in young children. [ABSTRACT FROM AUTHOR]

Indigent elderly residing in low-income urban communities face many adversities. This study investigated the health status and health needs of the elderly collecting an old-age pension at pay points in impoverished urban communities in the City of Cape Town. The pay-out points were selected to constitute a fair representation of points serving impoverished areas of the city. Data was gathered by means of a structured interview with a formal questionnaire since a large proportion of the participating elderly could not read well. Systematic sampling with random starting points of persons in the pay-out queue was used and 703 pensioners were selected to participate from eight pension points in four urban poor communities. All agreed to do so. The health status of the participants was not good: 82.8 % were on chronic medication, 32 % had diarrhoea in the previous 2 weeks, 24 % had TB in the past and 36 % reported a previous heart attack. Their health needs were equally not great: 48 % reported that their spectacles need changing while 56 % have trouble hearing well and 65 % needed dentures, while 66 % needed a walking aid. Only 4.7 % did not have problems with activities of daily living while many faced added burdens such as custodial child care. [ABSTRACT FROM AUTHOR]

Our aim was to assess the prevalence and demographic correlates of overweight and obesity among children in Albania, a transitional country in Southeastern Europe. A nationwide survey was conducted in Albania in 2013 including a representative sample of 5,810 schoolchildren aged 7.0-9.9 years (51.5 % boys aged 8.5 ± 0.6 years and 49.5 % girls aged 8.4 ± 0.6 years; overall response: 97 %). All children were measured height and weight, based on which the body mass index (BMI) was calculated. The criteria of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to describe the distribution of BMI among children. Overall, mean value of BMI was 16.4 ± 2.4 (16.7 ± 2.5 in boys vs. 16.2 ± 2.4 in girls, P < 0.001). As per WHO criteria, 9.8 % of the boys were obese versus 5.5 % of the girls ( P < 0.001). The prevalence of both overweight and obesity were remarkably higher among urban children compared with their rural counterparts (17.9 vs. 10.5 and 11.9 vs. 4.0 %, respectively, P < 0.001). As per IOTF criteria, 3.8 % of the boys were obese compared with 2.8 % of the girls ( P < 0.001). The prevalence of overweight and obesity were similarly higher among urban children than in rural children (15.6 vs. 7.3 and 5.5 vs. 1.4 %, respectively, P < 0.001). Our findings indicate that Albania is in the middle of nutritional transition with a high prevalence of overweight and obesity among children aged 7.0-9.9 years. This is particularly evident in urban areas of the country. Conversely, our data do not indicate a double burden of malnutrition among children in Albania. [ABSTRACT FROM AUTHOR]

While the human papillomavirus (HPV) vaccine has potential to protect against the majority of HPV-associated cancers, vaccination rates in the United States remain low. Racial/ethnic and economic disparities exist for HPV vaccination completion rates. We conducted a mixed-methods study using the theory of planned behavior framework to explore attitudes and beliefs about HPV vaccination among urban, economically disadvantaged adolescents. Fifty adolescents aged 14-18 years were recruited from community-based organizations to complete a written survey and participate in a focus group. The mean age was 15.5 ± 1.3 years; 98 % were African American or mixed race; 64 % were female; 52 % reported previous sexual intercourse; 40 % reported receipt of ≥1 HPV vaccine dose. The knowledge deficit about the HPV vaccine was profound and seemed slightly greater among males. Mothers, fathers and grandmothers were mentioned as important referents for HPV vaccination, but peers and romantic partners were not. Common barriers to vaccination were lack of awareness, anticipated side effects (i.e., pain), and concerns about vaccine safety. Characteristics associated with ≥1 vaccine dose were: having heard of the HPV vaccine versus not (65 vs. 20 %, p = 0.002) and agreeing with the statement 'Most people I know would think HPV vaccine is good for your health' versus not (67 vs. 27 %, p = 0.007). Our work indicates a profound lack of awareness about HPV vaccination as well as the important influence of parents among urban, economically-disadvantaged youth. Awareness of these attitudes and beliefs can assist providers and health officials by informing specific interventions to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

Tobacco smoking is the preventable health issue worldwide. The harmful consequences of tobacco smoking and exposure to second-hand tobacco smoke are well documented. The aim of this study is to compares the prevalence of smoking among students, faculty and staff and examines their interest to quit. Study also determines the difference on perceptions of smoking and non-smoking students, faculty and staff with regard to implementation of a smoke-free policy. A cross-sectional survey was administered to one of the largest universities in Riyadh, Saudi Arabia during the academic year of 2013. A Likert scale was used on questionnaires towards attitude to smoking and smoking free policy. The Chi squared test was used to determine the difference of support on completely smoke free campus for smokers and non-smokers. Smoking rates were highest among staff members (36.8 %) followed by students (11.2 %) and faculty (6.4 %). About half of the smokers (53.7 %) within the university attempted to quit smoking. Students (OR 3.10, 95 % CI 1.00-9.60) and faculty (OR 4.06, 95 % CI 1.16-14.18) were more likely to make quit smoking than staff members. Majority of the respondents (89.6 %) were supportive of a smoking-free policy and indicated that should be strictly enforced especially into public places. Results also showed that smokers were more likely to support a smoke-free policy if there are no fines or penalties. These baseline findings will provide information among administrators in formulating and carrying out a total smoke free policy. Although the majority of people within the King Saud University demonstrate a high support for a smoke-free policy, administrators should consider difference between smokers and non-smokers attitudes when implementing such a policy. [ABSTRACT FROM AUTHOR]

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance ( P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings ( P < .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening. [ABSTRACT FROM AUTHOR]

Free clinics across the country provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. This study examined perceived health status among diabetic and non-diabetic free clinic patients and family members of the patients. Diabetes self-efficacy among diabetic free clinic patients was also investigated with the goal of developing appropriate diabetes health education programs to promote diabetes self-management. English or Spanish speaking patients and family members (N = 365) aged 18 years or older completed a self-administered survey. Physical and mental health and diabetes self-efficacy were measured using standardized instruments. Diabetic free clinic patients reported poorer physical and mental health and higher levels of dysfunction compared to non-diabetic free clinic patients and family members. Having a family history of diabetes and using emergency room or urgent care services were significant factors that affected health and dysfunction among diabetic and non-diabetes free clinic patients and family members. Diabetic free clinic patients need to receive services not only for diabetes, but also for overall health and dysfunction issues. Diabetes educational programs for free clinic patients should include a component to increase diabetes empowerment as well as the knowledge of treatment and management of diabetes. Non-diabetic patients and family members who have a family history of diabetes should also participate in diabetes education. Family members of free clinic patients need help to support a diabetic family member or with diabetes prevention. [ABSTRACT FROM AUTHOR]

This study was designed to determine the prevalence of active smoking and environmental tobacco smoke (ETS) exposure among medical students in Riyadh, Saudi Arabia, and to examine their attitudes and beliefs towards tobacco control programs. The investigation was a cross-sectional study conducted during the first semester of 2013 at King Saud University School of Medicine located in Riyadh, Saudi Arabia. Invited to participate in this study were 1,789 medical students. A descriptive data analysis was performed. A total of 805 medical students completed the questionnaire. The prevalence of experimentation with cigarette smoking was 11.3 %. The estimated prevalence of current smoking among the study participants was 4.7 %. The majority of the students held positive attitudes toward tobacco control and approximately 93.1 % of the students felt that health care professionals should be required to receive training for cessation counseling while only 36.8 % of the students reported having received any training in this area. Over the study's duration 57.7 % of participants reported that ETS exposure was much higher in public places, while 13.9 % reported exposure at home. This investigation revealed that ETS exposure among medical students in Riyadh is at an alarmingly high rate. The data suggests a need for a more robust smoke-free policy and a commitment to greater enforcement in public places. The results of the study also demonstrate a positive attitude among participants for tobacco control. It also indicates a need for cessation counseling and training which could be incorporated into medical school curriculum. [ABSTRACT FROM AUTHOR]

Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985-2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95 % CI 1.13-1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13-1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI. [ABSTRACT FROM AUTHOR]

Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. The purpose of this study is to examine health-related quality of life (HRQoL) among free clinic patients and its association with somatic symptoms, depression, and perceived neighborhood environment. Free clinic patients (n = 186) aged 18 years or older completed a self-administered survey. HRQoL, depression, somatic symptoms, and perceived neighborhood environment were measured using standardized instruments. Overall, the participants reported low level of HRQoL compared to the general healthy population. US born participants (n = 97) reported poorer psychological QoL and social relations, more somatic symptoms, and were more likely to be depressed than non-US born participants (n = 89). Higher numbers of somatic symptoms were associated with poorer environmental QoL. Depression was associated with all aspects of QoL; a higher level of depression was related to poorer QoL in all aspects. Our findings show that free clinic patients, especially US born patients, have poor HRQoL. Depression and perceived neighborhood satisfaction are key factors to determine HRQoL among free clinic patients. Mental health services and collaboration with other community organizations may help in improving HRQoL among free clinic patients. Finally, health promotion programs at the community level, not just at the clinic level, would be valuable to improve health of free clinic patients as perceived neighborhood environment is associated with their HRQoL. [ABSTRACT FROM AUTHOR]

Despite the growing body of health information available online, patients with limited health literacy may lack either internet access or skills necessary to utilize this information. Nonetheless, patients at all health literacy levels may prefer other primary sources to obtain health information. We conducted a cross-sectional study to measure health literacy of patients attending two clinics in Dallas, TX and determine associations between health literacy, health information access and internet usage before and after controlling for confounders. Patients from both clinics (county N = 265; private N = 233) completed a brief survey which included sociodemographics, internet patterns, confidence in filling out medical forms and a self-administered Newest Vital Sign to measure health literacy. In the county clinic, most patients (61.5 %) were Hispanic, had low income (<$19,000/year), limited education (<11th grade) and a high likelihood or possibility of limited health literacy (68.5 %). In the private clinic, participants were mostly black (40.4 %) or white (38.6 %), had higher incomes (≥$46,000), higher education (technical college or college) and adequate health literacy (75.1 %). The primary source of obtaining health information in both clinics was their health care professional (50.6 % county; 40.1 % private). In multivariate analyses to determine differences by health literacy level, there were no statistically significant differences between patients with limited and adequate health literacy and their primary information source. Regardless of health literacy, patients rely on their health care providers to obtain health information. These results showcase the importance of providers' effective communication with patients to make shared decisions about their health regardless of other factors. [ABSTRACT FROM AUTHOR]

The federal government promotes 'patient-centered medical homes' to plan care with respect to patients' cultures and values and support patients' self-care efforts. To promote self-care, the medical home would be best utilized by activated, engaged patients. The objective of this study was to measure and compare patient activation scores in English-, Spanish-, and Haitian Creole-speaking patients seen at an inner-city hospital ambulatory care practice. Patient activation was measured using the patient activation measure (PAM). Mean PAM scores and activation levels differed according to survey language ( p < 0.001). US-born participants had higher mean PAM scores than persons born outside of the US. Participants living in the US longer had higher mean PAM scores than participants newer to the US. Levels of activation and mean PAM scores increased with greater comfort reading, speaking, and thinking in English. The mean PAM (SD) score of 61.5 (16.5) for Haitian Creole-speaking Caribbean Blacks was significantly lower than the mean PAM score of 68.8 (15.6) for English-speaking Caribbean Blacks ( p value = 0.006). Although mean PAM scores did not significantly differ between Haitian Creole and Spanish speakers, PAM stages differed according to language of survey completion ( p < 0.001), with a greater percentage of Haitian Creole speakers being categorized as stage 1 (least activated) as well as stage 4 (most activated). Spanish and Haitian Creole speakers have lower mean PAM scores than English speakers. Mean PAM scores did not differ between Hispanics and non-Hispanics or according to race, illustrating the need to examine the role of language and culture on patient activation. [ABSTRACT FROM AUTHOR]

There are differences in cancer-risk perception among racial/ethnic groups that may affect health risk behaviors. Using a community partnered-participatory research approach, we conducted a survey on cancer screening, risk behaviors, and related knowledge/attitudes within 11 churches in South Los Angeles with predominantly African-American parishioners. This analysis examines correlates of perceived risk of developing cancer among 755 African American adults. Almost 15 % of participants indicated higher perceived risk for cancer compared to the average man/woman of the same age, 38 % indicated same risk, whereas 48 % perceived lower risk. Sixty-nine individuals (9 %) reported a cancer history and 63 % reported at least one blood relative with cancer. Controlling for demographic characteristics and healthcare access, participants who reported higher risk of cancer had higher level of cancer-related knowledge; were current and ex-smokers; had poorer health status; had a blood relative with cancer; had a cancer history; and had discussed their risk of cancer with their doctor. The bivariate association between high perceived cancer risk and lack of exercise and obesity disappeared after adjusting for demographic characteristics and perceived health status. Our data suggest that a substantial proportion of African Americans in South Los Angeles may underestimate their cancer risk. Additionally, lack of exercise and obesity are not recognized as independent cancer risk factors as much as smoking and personal and family history of cancer. Next steps will be to inform participating churches about our findings and explore their interest in taking steps to reduce health risk behaviors among their parishioners. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess cervical cancer knowledge and prevention practices among college women and to determine predictors of human papillomavirus (HPV) vaccination in this group. A quantitative approach using two varying groups of women was undertaken. College women and women visiting a local community health center were surveyed on items assessing cervical cancer knowledge and prevention practices. Altogether, 410 women were sampled, 217 college women and 193 from the local community health center. HPV vaccine initiation was higher among the college group (36 %) compared to (5 %) among the community health center group. Seventy three (73 %) percent of women in the community group had a Papanicolaou test in the preceding 3 years compared to (61.8 %) in the college group. College women reported higher cervical cancer knowledge than community women. This study highlights that cervical cancer knowledge and preventive practices are variable among women and that significant differences exist among college and community women. This calls for more strategic and accessible services incorporating group specific messages and interventions. [ABSTRACT FROM AUTHOR]

Cervical cancer is a leading cause of death in US women, with Hispanic women at higher risk of mortality than non-Hispanic white women. While the human papillomavirus (HPV) vaccine represents substantial progress towards cervical cancer prevention, little is currently known about Hispanic student's beliefs regarding the HPV vaccine. To assess the knowledge, attitudes, behaviors, and beliefs of college students in the US-Mexico border region following the release of the HPV vaccine for both males and females. This survey was conducted using a convenience sample were participants were recruited from pre-nursing and nursing courses. The self-administered questionnaire ascertained HPV vaccination status, and knowledge and beliefs regarding the HPV vaccine. 202 male and female students responded. 28.9 % of respondents reported having received the HPV vaccine. Of the non-vaccinated students under age 27, 27.3 % Hispanic students reported an intention to receive the vaccine. Misinformation about HPV was common and was associated with intention to get vaccinated among non-Hispanic white students. We found a relatively small proportion of unvaccinated Hispanic and non-Hispanic nursing students intend to be vaccinated for HPV. Findings indicate an intervention to increase vaccination rates among college-aged students may not be as straightforward as increasing knowledge of HPV. Nurses are in a unique position to educate and recommend HPV to underserved patients. Thus, educating nursing students regarding HPV and the associated cancers is paramount if we are to encourage ethnic minorities to receive the HPV vaccine. [ABSTRACT FROM AUTHOR]

The present study is a Cross-Sectional Study and was conducted in Post-graduate department of Community Medicine, Govt. Medical College, Srinagar between Feb. 2012 and Jan. 2013. The sample size of 1,041 was estimated. The study was conducted to estimate the effect of relationship of salt iodine level and prevalence of goiter among women of reproductive age group in two districts of Kashmir valley, district Srinagar and district Ganderbal, which were selected randomly. A frame of the blocks and villages in the two districts and their population was formed. From each district 10 % of the blocks were selected using simple random sampling. From each block, 5 % of the villages were selected using simple random sampling. A door to door survey was conducted in the selected villages and all the women in the reproductive age group (15-49 years) identified and examined clinically for goiter after taking informed consent. Salt samples (one teaspoonful) from every household were taken and assessed for iodine content on spot and the iodine content of salt was assessed qualitatively by spot testing kits. The results of the present study have indicated that iodine deficiency continues to be a health problem. Almost the whole population consumes powdered salt but the storage and cooking practices diminish the iodine content of salt and results in decreased intake. Thus the need of the hour is to make people aware about proper storage and cooking practices. Women in the reproductive age group especially need to be made aware about the importance of consumption of adequately iodized salt because of the wide range of ill effects of iodine deficiency on the developing fetus and the growing child. In addition monitoring of iodine content of salt at distributor level should be done. [ABSTRACT FROM AUTHOR]

This study characterized the prevalence of overweight and obesity and assessed their cardiometabolic comorbidities in the population aged 21-79 years living in the San Juan metropolitan area of Puerto Rico. We analyzed data from a household survey conducted in Puerto Rico between 2005 and 2007 that used a representative sample of 840 non-institutionalized adults living in the San Juan metropolitan area. Body mass index categories were classified as normal weight, overweight and obese. Poisson regression model with robust variance was used to estimate the prevalence ratio to assess the association of each cardiometabolic comorbidity (hypertension, dyslipidemia, diabetes, prediabetes, systemic inflammation, prothrombotic state, and coronary heart disease) with overweight and obesity. Age-standardized prevalence of overweight and obesity was 35.9 and 41.5 %, respectively, figures higher than the combined prevalence for the U.S. adult population (68.8 %) but similar to all mainland Hispanics (78.8 %). Men were more likely to be overweight than women (40.4 vs. 33.4 %), whereas more women than men were obese (43.7 vs. 37.6 %). Prevalence of all cardiometabolic comorbidities was significantly ( p < 0.05) higher among overweight and obese adults than those of normal weight after adjusting for age, sex, years of education, smoking status, alcohol consumption and physical activity. A considerable proportion of adults in this population are overweight or obese. In view of the wide-ranging effects that overweight and obesity have on health, preventive actions to avert the rise of excess body weight as well as the design of lifestyle interventions are largely needed in this population. [ABSTRACT FROM AUTHOR]

Canadians in their early twenties represent the highest prevalence of reported tobacco use among all age groups. With the majority of Canadian young adults accessing post-secondary education, post-secondary institutions can facilitate targeting of health promotion efforts to curb tobacco use among young adults. Effective targeting requires clear comprehensive campus tobacco policies. However, the development and implementation of comprehensive campus tobacco policies has been lacking among Canadian post-secondary institutions. As the first step towards the development of a comprehensive campus tobacco policy at the University of Guelph, an on-line survey of students, faculty and staff was conducted in November 2012. The objectives of this survey were two-fold: (1) Determine the current level of exposure to second-hand smoke on campus, the type and frequency of tobacco use, opinions on seven different tobacco policy options, and the level of awareness of current tobacco policies and programs and; (2) Determine if any associations between opinions on tobacco policy options and exposure to second-hand smoke and tobacco use existed. The results of this survey demonstrate that tobacco use is associated with opinions on tobacco policy options and that the level of awareness of tobacco policies and programs is relatively low and is not associated with tobacco use. This study represents one of the first studies to examine the association between tobacco use and support of policy options and awareness of tobacco policies and programs. As other post-secondary institutions develop comprehensive tobacco policies, these findings will serve as a comparison for other similar institutions. [ABSTRACT FROM AUTHOR]

The current study aimed to (1) offer a large-scale enumeration of college students' lifetime sexual behaviors and sexual behaviors at last event, and (2) apply a gender discrepancy lens to college students' sexual behaviors in order to examine potential gender differences in heterosexual college students' experiences. Nine-hundred and seventy college students between the ages of 18 and 27 from two large universities in the United States participated in the current study. Participants filled out a paper-pencil questionnaire during the last 30 min of class. Measures of lifetime sexual behaviors and engagement in behaviors at last sexual event were replicated from the National Survey of Sexual Health Behavior. Most college students engaged in some form of sexual behavior (manual, oral, vaginal-penile, anal). Men more frequently reported engaging in receptive sexual behaviors (e.g., receiving oral sex) where as women were more likely to engage in performative sexual behaviors (e.g., performing oral sex). At most recent sexual event, men were more likely than women to report being the sexual initiator. Findings highlight gender differences in sexual behavior and provide a foundation for social norms interventions. Holistic sexual health promotion for young adults includes acknowledging and discouraging sites of disparity in equity and pleasure. Therefore, college-level sexual health educators should pay attention to the potential pleasure gap between men and women in heterosexual encounters, and to see pleasure as an important part of sexual health that should be included in social norms campaigns. [ABSTRACT FROM AUTHOR]

To measure parent knowledge levels and opinions related to the human papillomavirus (HPV) and the two vaccines used to prevent it. To measure parent behavior in terms of whether or not to have their children vaccinated. Between June 19, 2012, and August 24, 2012, questionnaires were distributed to parents while waiting for their child to see their pediatrician at a local group practice. The survey was reviewed for face validity by College of Pharmacy social science and clinical faculty members, and an earlier version of it had been used successfully in a published study of biomedical students' knowledge of and attitudes toward the HPV vaccine. 129 usable surveys were obtained. 48.1 % of subjects said they learned about the HPV vaccines from the media, while 47.3 % identified health care practitioner(s) as a source of knowledge. The mean score on a 20-item knowledge test regarding the infection and vaccines was 36 % (range 0-80 %). Opinions on the subject varied widely. For example, 22.4 % of subjects agreed that schools should require that students be vaccinated before enrolling, while 3.2 % agreed that vaccination causes patients to become sexually active. Subjects reported vaccination status for 253 children (mean age 13) as follows: 33 % vaccinated; 28 % not vaccinated but will be; 11 % will never be vaccinated; and 28 % not decided. These results are somewhat encouraging, because many parents are hearing about the vaccines from their providers. Although not an equally valid source, the media are also raising awareness. Based on the knowledge and opinion results of this study, there is a need for pharmacists and other providers to educate their patients about the vaccines and the virus and to converse with them regarding the moral and psychological implications of vaccination. Still, it is encouraging that these subjects had or plan to have over half (61 %) of their children vaccinated. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is the most common sexually transmitted disease in the US and the primary cause of cervical cancer. Vietnamese American women have the highest incidence rates of cervical cancer but one of the lowest HPV vaccination rates. Parental knowledge is an important predictor of HPV vaccination; however, little is known about HPV knowledge in the Vietnamese American community. We aimed to describe the HPV knowledge of Vietnamese mothers in Houston, Texas and their intention to vaccinate their daughters. We conducted face-to-face interviews with Vietnamese mothers who had daughters aged 9-26 years. We collected data on demographics, acculturation, HPV knowledge, and vaccination intention. Knowledge scores (0-5) were calculated using 5 knowledge questions. We used logistic regression to identify predictors of HPV knowledge. Participants had low levels of acculturation by report of reading (31 %) and writing (23 %) English well. Less than 50 % of participants (n = 47) had heard of HPV, and among these, the mean HPV knowledge score was 4. Although only 1 in 3 had discussed HPV with their medical provider, nearly 86 % of participants who had not heard of HPV would vaccinate their daughter if their doctor had recommended it. Good written English skills and belief that the HPV vaccine was not expensive were predictors of HPV awareness. HPV awareness is low among less acculturated Vietnamese mothers in Houston. Future educational efforts about the role of HPV vaccine in preventing cervical cancer should be made in their language when targeting parents of a high risk Vietnamese population. [ABSTRACT FROM AUTHOR]

Despite evidence that food insecurity negatively impacts child health, health care providers play little role in addressing the issue. To inform potential primary care interventions, we sought to assess a range of challenges faced by food insecure (FI) families coming to an urban, pediatric primary care setting. A cross-sectional study was performed at a hospital-based, urban, academic pediatric primary care clinic that serves as a medical home for approximately 15,000 patients with 35,000 annual visits. Subjects included a convenience sample of caregivers of children presenting for either well child or ill care over a 4 months period in 2012. A self-administered survey assessed household food security status, shopping habits, transportation access, budgeting priorities, and perceptions about nutrition access in one's community. Bivariate analyses between food security status and these characteristics were performed using Chi square statistics or Fisher's exact test. The survey was completed by 199 caregivers. Approximately 33 % of families were FI; 93 % received food-related governmental assistance. FI families were more likely to obtain food from a corner/convenience store, utilize food banks, require transportation other than a household car, and prioritize paying bills before purchasing food. FI families perceived less access to healthy, affordable foods within their community. Thus, FI families may face unique barriers to accessing food. Knowledge of these barriers could allow clinicians to tailor in-clinic screening and create family-centered interventions. [ABSTRACT FROM AUTHOR]

Asian Americans experience diabetes at a higher rate than non-Hispanic whites. Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results, yet there have been no culturally-tailored programs for diabetes prevention in the Korean community. We explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve health behaviors and promote diabetes prevention among Korean Americans using a randomized controlled trial. Between 2011 and 2012, a total of 48 Korean Americans at risk for diabetes living in New York City (NYC) participated in the intervention. Participants were allocated to treatment or control groups. A community-based participatory research approach guided development of the intervention, which consisted of 6 workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to health care. Changes over 6 months were examined for clinical measurements (weight, BMI, waist circumference, blood pressure, glucose, and cholesterol); health behaviors (physical activity, nutrition, food behaviors, diabetes knowledge, self-efficacy, and mental health); and health access (insurance and self-reported health). In this small pilot study, changes were seen in weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. Qualitative findings provide additional contextual information that inform ways in which CHWs may influence health outcomes. These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC, and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable populations. [ABSTRACT FROM AUTHOR]

To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences ( p < 0.05) in a number of variables: threefold increased recording of lipids and body mass index ( p = 0.001); moderate increased recording of comorbidities and aspirin prescription ( p < 0.012); eightfold increased recording of dyslipidemia management plan, twofold increased recording for CVD management plan and fivefold increased recording for CVD absolute risk ( p = 0.000). Missing records of electrocardiography and urine/creatinine analyses decreased statistically significantly ( p < 0.05). Statistically significant decrease was observed in prescription of thiazides and angiotensin receptor blockers/angiotensin converting enzyme inhibitors ( p < 0.005), while prescription of statins and statins with diet for dyslipidemia management showed increased recording ( p < 0.05). Similarly, we observed increased records for counseling of rehabilitation physical activity ( p = 0.006). In this survey most differences in pre- and post-evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores. [ABSTRACT FROM AUTHOR]

Ischemic heart disease (IHD) remains one of the most important disorders associated with disability and mortality worldwide, and is one of the major causes of cardiovascular diseases in Mongolia. The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia. We conducted a nationwide cross-sectional survey between March and September, 2009. General participants were recruited from urban to rural regions in a multistage random cluster sampling method. The diagnosis of IHD was based on the Rose questionnaire (World Health Organization) and electrocardiographic findings. A total of 369 (16.2 %) subjects with IHD were diagnosed among 2,280 participants. The prevalence of subjects with IHD was significantly increased by age: from 9.9 % in individuals age 40-44 years compared to 17.7 % in those over 60 years. Smoking habits (former and current) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men, while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women. IHD was found to be prevalent, especially among people aged over 40 years, in Mongolia. Statistical factors related to IHD were found to be significantly different based on sex. The current data may provide relevant information to prevent IHD in the Mongolian population. [ABSTRACT FROM AUTHOR]

In recent years, the government has paid more attention to the development of community health service (CHS) in urban areas in China. Therefore, determining if it plays important roles and establishing methods to evaluate the effects of CHS are critical emphases in research. This study measured the effects of CHS through the choices of patients and their evaluation of CHS, and aimed to contribute to the development of primary health services. Face-to-face interviews were performed using the questionnaire with a random sample of 865 patients in CHS institutions from five provinces in China. Pearson's Chi square tests and binary logistic regression were used to analyze influencing factors that are associated with the patients' choices and evaluations. A total of 62.2 % of the patients would choose CHS for their first treatment. Patient choice was mainly affected by the following: (1) social demographic factors of the patients, namely, age, educational level, medical insurance, and survey areas; (2) evaluation of CHS by the patients: convenience, reasonable charges, and attitude of the doctors. In addition, the patients showed more satisfaction with convenience, waiting time, and communication with doctors, and less satisfaction with the medical charges, drug costs, and medical equipment of CHS. Through the results, we suggest that the government should provide more regard to the convenience, reasonable charges, and the attitude of the doctors as important factors to attract the patients to CHS. The government should also exert efforts to reduce the medical charges (especially the drug costs) for CHS. [ABSTRACT FROM AUTHOR]

Hypertension remains disproportionately high among Filipinos compared to other racial and ethnic minority populations, and little research on cardiovascular disease risk factors has been conducted among Filipino immigrants in the Northeastern part of the United States. To determine hypertension prevalence and risk factors among Filipino Americans in the New York City area, blood pressure and other clinical measurements were taken from a sample of Filipino Americans during 119 community health screenings conducted between 2006 and 2010. Additional socio-demographic and health-related characteristics were also collected via a cross-sectional survey. A total of 1,028 Filipino immigrants completed the survey and had clinical readings collected. Bivariate analyses and logistic regression were performed in order to predict and assess risk factors for hypertension among our sample. Fifty-three percent of individuals were hypertensive, and half of hypertensive individuals were uninsured. Logistic regression indicated that older age, male gender, living in the United States for over 5 years, a BMI greater than 23.0 kg/m, an elevated glucose reading, a family history of hypertension, and fair or poor self-reported health status were predictors of hypertension. There is a great need to develop more effective community-based interventions in the Filipino community to address cardiovascular health disparities. [ABSTRACT FROM AUTHOR]

Cervical cancer is one of the most important disease burdens experienced by Vietnamese-American women. Human papillomavirus (HPV) is the etiological agent in almost all cases of cervical cancer. We surveyed Vietnamese-American women to determine receipt of HPV vaccine and assessed if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake. Of the 113 Vietnamese-American women who participated in the study, 58 % (n = 68) was born in Vietnam. The mean years of residency in the United States was 12.75 years. Only 16 (14 %) reported receiving HPV vaccine and 11 (9 %) reported receiving all three shots. Thirteen women responded that they are not at all likely to receive HPV vaccine. Of the whole sample, 47 % (n = 53) reported proficiency in spoken and written English. English proficiency was significantly associated with receipt of HPV vaccine (OR = 4.4; confidence interval (95 % CI) = 1.2; 16.50; p = 0.03). Of the knowledge items, 70 % (n = 79) responded correctly that HPV increases the risk for cervical cancer. However, as many as 60 % responded incorrectly, that HPV infection can be cured with medication. The item, 'People infected with HPV can be cured with medication,' was the most important variable associated with receipt of HPV vaccine. Specifically, those with correct response were 3.8 times more likely to report receiving the HPV vaccine (OR = 3.8; 95 % CI = 1.1; 13.5; p = 0.04). Important public health needs are the development and evaluation of educational programs on HPV and cervical cancer that are designed for Vietnamese-American women. [ABSTRACT FROM AUTHOR]

Pharmacists have shown to increase clinical and humanistic outcomes in medically underserved populations through non-dispensing services. Limited information is available regarding the pharmacy workforce's involvement and ability to serve in this role. The objectives were to measure the proportion of pharmacists working with underserved populations and to assess barriers they encountered when trying to assist. 363 licensed Ohio pharmacists responded to an electronic survey between December 2011 and March 2012 (response rate 19.7 %). The survey assessed personal and environmental barriers that prevent pharmacist involvement with underserved populations using 5-point Likert scales. Multiple logistic regressions identified barriers that influenced pharmacists' involvement in providing non-dispensing services to underserved populations. 43 % of respondents were assisting underserved populations mostly in their place of work (83 %). Environmental barriers were indicated to effect pharmacists most. Uninvolved pharmacists most agreed with environmental barriers of 'Hesitant to volunteer before knowing commitment', 'Never approached to assist', and 'Not enough time during shifts'. Logistic regression 1 incorporated all pharmacists and indicated barriers of 'Not interested in this area of work' (OR = 0.589) and 'Unsure where to volunteer' (OR = 0.660) as significant. Logistic regression 2 was limited to pharmacists with access to patients at place of work and indicated 'Not interested in this area of work' (OR = 0.443), 'Employer never approached to assist' (OR = 0.557), 'No time during work shifts' (OR = 0.537), and 'Work location low underserved accessibility' (OR = 0.487) as significant predictors. More pharmacists might become engaged as volunteers. Increasing communication between community and pharmacists may reduce reported volunteering barriers. [ABSTRACT FROM AUTHOR]

This study aims to describe the prevalence of preventive dental care among New York City (NYC) children, including disparities by race/ethnicity or poverty and to identify health care utilization factors associated with these outcomes. Data were obtained from the 2009 NYC Child Community Health Survey. Descriptive statistics were calculated for preventive dental visits in the past 12 months among children aged 2-12 years ( n = 2,435) and receipt of sealants among children aged 6-12 years ( n = 1,416). Multivariable logistic regression was used to compute adjusted prevalence ratios (aPRs). One in four (23.3 %) NYC children aged 2-12 years, including 57.3 % of 2-3-year olds, had no preventive dental visit in the past 12 months. Lack of preventive visits was more prevalent among Asian/Pacific Islander children compared with non-Hispanic white children (aPR 1.42 [95 % CI 1.07-1.89]), and among children living in poorer households compared with wealthier households (aPR 1.47 [95 % CI 1.13-1.92]). Two-thirds (64.5 %) of children aged 6-12 years never had sealants. Compared with non-Hispanic white children, Asian/Pacific Islander (aPR 1.26 [95 % CI 1.01-1.56]), non-Hispanic black (aPR 1.24 [95 % CI 1.06-1.46]), and Hispanic (aPR 1.21 [95 % CI 1.04-1.41]) children were more likely not to have sealants, as were children without a personal health care provider compared with children with a provider (aPR 1.33 [95 % CI 1.14-1.56]). Disparities in preventive dental care exist by race/ethnicity, poverty, and health care utilization. Personal health care providers may improve children's oral health by linking them to preventive dental care and promoting sealant application. [ABSTRACT FROM AUTHOR]

This study was done to access the knowledge and perceptions of Patent Medicine Dealers (PMDs) in Owerri Metropolis of Nigeria about Artemisinin Based Combination Therapy as first line treatment for malaria using structured pre-tested questionnaires administered to 80 randomly selected and consenting respondents. About 67.5 and 32.5 % of males and females respectively participated in the study. Most of them (56.3 %) had secondary school education with about 50 % having 5-10 years experience in the business. The level of knowledge was shown to be high (82.5 %), with 81.3 % having proper understanding of the term 'artemisinin-based combination therapies (ACTs)' and 80 % knowing the correct dosage for ACTs. But despite the level of awareness, only 32.5 % knew the correct timing for administration of the drugs. The result of this study showed no significant relationship between the level of knowledge and either educational attainment (χ = 4.889, df = 4, p value = 0.558) or the years of experience (χ = 29.095, df = 4, p value = 0.000) although knowledge improved a bit as experience increased. 93.8 % in the study reported that ACTs are more effective than other anti-malarial drugs. The quantity of ACT available on counters are low and there is no significant relationship (χ = 18.833, df = 6, p value = 0.004) between the availability of ACT and the quantity of ACT available in stock at the time of this study. This study shows that awareness on ACTs has improved among PMDs, even though other anti-malarial drugs are still in use and are marketed by them. It becomes necessary that efforts towards awareness be scaled up with emphasis on recommended time of administration and correct prescriptions to enhance and sustain intermittent presumptive treatment as an effective method of malaria control since this group of people still provide the major access to drugs in Nigeria and other tropical endemic areas. [ABSTRACT FROM AUTHOR]

To explore compliance of Arab-Americans to colorectal cancer (CRC) screening and identify the barriers for non-compliance. An observational community based study. Arab-American Friday prayer attendees' ≥50 years in three mosques in Dearborn, MI volunteered. Demographics, health insurance status, screening history, availability of a primary care physician (PCP) and the ability to communicate in Arabic were inquired. The responses were compared using a student t test between respondents who have had CRC screening with colonoscopy and those who have not had any screening tests. A p value of 0.05 or lower was considered statistically significant. Total number surveyed was 130. Average age is 64 years. Males were 76 % (99) and females 24 % (31). More than 50 % were Lebanese and 28 % were from Yemen. Majority had health insurance (89 %), and 86 % had a primary care physician of which 79 % of them spoke Arabic. Half of the participants had colonoscopy mostly for screening purposes. Fifty-eight (45 %) participants did not have CRC screening. Majority of the females (72.4 %) had colonoscopy compared to 46.8 % of the males ( p value = 0.016). The mean length of stay in the U.S was 39.16 years in the colonoscopy group compared to 30.77 years in the non-screening group ( p value = 0.006). Participants without a PCP did not have CRC screening (77.8 %) ( p value = 0.005). Participants with a non-Arabic speaking PCP had more colonoscopy rates (77.3 %) compared to those with an Arabic speaking PCP (50 %) ( p value = 0.027). More Lebanese had colonoscopy (71.9 %) compared to 25.7 % of the surveyed Yemenis ( p value = 0.00). Discomfort, unawareness about CRC screening, and nonrecommendation by PCP were reported barriers. Arab-Americans have lower screening colonoscopy rates. Unfamiliarity of the importance of screening is a principal issue. Having a non-arabic speaking PCP is beneficial. Better education to this population about the benefits and ease of screening could increase adherence to screening for this population. [ABSTRACT FROM AUTHOR]

To compare the characteristics (demographic, access to care, health-related behavioral, self and family medical history, psychosocial) of women aged 40 years and above who utilize a mobile mammography unit with those women aged 40 years and above who obtain mammography screening at a stationary facility. A cross-sectional study design was used with participant cohorts comprised of women age 40 years and above throughout West Virginia (WV) who utilized mobile mammography unit to get mammogram and those who had mammography screening at the stationary facility and completed the Mammography Screening and Preventive Care Survey. A total of 1,161 women who utilized the mobile mammography unit and 1,104 women who utilized stationary facility were included in the analysis. In logistic regression after adjusting for all the variables, women who utilized mobile mammography unit were more likely to be in age group 40-49, with lower income, with no health insurance coverage, not visit doctor or obstetrician/gynecologist (OB/GYN) in the past year, not adherent to clinical breast exam and mammography screening guidelines, with lower perceived five-year risk of developing breast cancer and with high knowledge about mammography screening. Women who utilize mobile unit are not adherent to mammography screening guidelines thereby suggesting that the mobile mammography unit is indeed reaching a rural vulnerable population who may not routinely access preventive health services. Financial and insurance constraints, as well as access to medical care, restricted WV women from receiving mammography screening from the stationary screening facilities. [ABSTRACT FROM AUTHOR]

Latinos tend to be under-represented in cancer research and in bio-repositories. We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 foreign-born Latinos from Central and South America attending safety-net clinics in order to describe factors associated with knowledge about and intention to provide bio-specimens for research purposes. We used logistic regression and multiple imputation methods to evaluate associations between socio-cultural measures, medical trust, demographics, as well as knowledge about and intentions to provide bio-specimens. Almost half (47 %) of respondents knew what bio-specimens were, and 67 % said that they would provide a specimen after being given information about what this involved; this increased to 72 % among those with prior knowledge. Controlling for covariates, Latinos with a high school education and above were more likely to know what a bio-specimen was and to say they would provide bio-specimens than were those with lower levels of education [adjusted OR (aOR) 2.85, 95 % CI 1.37-5.96; and 3.49, 95 % CI 1.41-8.63, p ≤ 0.01, respectively]. Those with greater social integration were more likely to know about bio-specimens than those with less integration (aOR 2.54, 95 % CI 1.45-4.46, p = 0.001). Higher endorsement of family values was independently associated with intent to give bio-specimens (aOR 1.11, 95 % CI 1.02-1.20, p = 0.017 per five-point increase in 'familism' score). Medical mistrust was not related to intentions to provide specimens. Our results suggest that interventions to increase willingness to provide bio-specimens could leverage trusted clinics or social networks and should consider individuals' education and socio-cultural perspectives. [ABSTRACT FROM AUTHOR]

Although breast cancer prevention targets mostly women ages 40 and older, little is known about breast cancer prevention for young women and mother's advice. The purpose of this study was to examine breast cancer prevention knowledge, attitudes, and behaviors among college women and mother-daughter communication. Hispanic and non-Hispanic students at a southwestern university completed a breast cancer prevention survey with items for mother's advice, breast self-awareness and risk reduction knowledge, self-efficacy, susceptibility, family history, provider breast self-exam (BSE) recommendation, peer norms, BSE practice, and demographics. An openended item was also used to elicit types of mother's advice. Logistic regression was used to assess predictors for receiving mother's advice for breast cancer prevention and BSE practice. Self-reported data using a survey were obtained from 546 college women with a mean age of 23.3 (SD = 7.75). Nearly 36 % received mothers' advice and 55 % conducted BSE. Predictors for receiving mother's advice were age, self-efficacy, and family history of breast cancer. Predictors for BSE practice were mother's advice, age, self-efficacy, and provider BSE recommendation. Family history of breast cancer and knowledge were not significant predictors for BSE practice. Findings support the need for clinicians, community health educators, and mothers to provide breast cancer prevention education targeting college women. [ABSTRACT FROM AUTHOR]

Community-based interventions (CBI) have been targeted as a potential means of tackling cardiovascular disease in women. However, there have been mixed results in terms of their impact on health, with at least some of this being attributed to high attrition rates. This study explores factors that may be contributing to the low retention of women in cardiovascular CBIs. In 2009, Sister to Sister, a national organization that sponsors community health fairs, provided free cardiovascular health screenings for a total of 9,443 women nationwide. All participants were invited to enroll in a 1 year, survey-based observational study to assess the effectiveness of these community health screenings. Of these 9,443 women, 5.9 % actively participated in the follow-up study. Participants were more likely to have health insurance (75.5 vs. 65.3 %, p < 0.001), have an annual income above 75,000 dollars (26.7 vs. 19.7 %, p < 0.001), and identify themselves as white (50.0 vs. 31.5 %, p < 0.001). They were also more likely to have hypertension (32.1 vs. 27.4 %, p = 0.018) and metabolic syndrome (35.7 vs. 20.4 %, p < 0.001). Our results suggest that white, affluent women with health insurance and cardiovascular risk factors are more likely to engage in CBIs that require longitudinal assessment. This study gives insight into the demographics, socioeconomic status, and cardiovascular comorbidities of women who participate in cardiovascular CBIs. The results may prove to be useful in understanding the biopsychosocial barriers to participation in CBIs in order to develop more effective interventions in the future. [ABSTRACT FROM AUTHOR]

Although the effectiveness of tetanus toxoid (TT) immunization during pregnancy in preventing maternal and neonatal tetanus is well established, in many developing countries, TT immunization programs are underutilized. The objective of this study was to examine factors associated with sufficient TT immunization among postpartum women in Kenya. Population based secondary data analysis was conducted using de-identified data from the 2008-2009 Kenyan Demographic and Health Survey (KDHS) for 1,370 female participants who had a live birth during or within 12 months of the cross-sectional survey. Chi-square test and independent sample t test were conducted to assess bivariate associations and a multivariable logistic regression analysis was conducted to examine associations before and after adjustment for demographic, socioeconomic, cultural, and access to care factors. The main factors contributing to having been sufficiently immunized against tetanus were lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Implications for health care providers and other professionals involved in development of strategies and interventions aimed at improving immunization rates are discussed. [ABSTRACT FROM AUTHOR]

Non communicable diseases (NCDs) are now the major cause of death and disability worldwide. It increasingly affects people from developing as well as developed countries. Over the coming decades the burden from NCDs is projected to rise particularly fast in the developing world. There is a lack of optimal data collection about the burden of risk factors related to NCDs especially in the developing countries. To assess the burden of healthcare utilization and out-of-pocket costs associated with NCDs in an Indian setting. A cross sectional study was performed to enroll a convenient sample of 166 participants aged 18 years and above from a tertiary hospital in Punjab, a Northern state of India. The data was gathered during the period of Feb 2010-April 2010. A mixed methods approach was used to assess the burden of diabetes, hypertension, high cholesterol, and their associated risk factors. Further we evaluated the burden of healthcare utilization and out-of-pocket costs associated with these conditions using self-reported assessments. Results showed the average age of the participants was 50 years, 63 % (n = 104) were females, 32 % (n = 53) had education less than high school and 20 % (n = 33) had no formal education. About 96 % of the study participants were living with a partner. Majority of the study participants were non-smokers and 17 % (n = 27) of them reported to have history of alcohol consumption. The majority of the participants had access to cell phones (94 %; n = 156) and about 40 % (n = 66) had computers at home. About 33 % (n = 55) of the study participants had some form of previous knowledge of computers. Majority of the study participants went to the private hospital (47.5 %) for seeking healthcare. About 32 % (n = 53) also sought healthcare from some kind of healthcare professional including a primary care doctor or a nurse or even a pharmacist in a village setting. Doctor visits related to diabetes were higher as compared to the individuals either with hypertension or high cholesterol. However; the out-of-pocket costs of the visit to the healthcare professional were much higher for hypertension than for diabetes or high cholesterol. A strengthened surveillance system, effective inter-sectoral action, and improved access to basic healthcare are pivotal to prevent NCDs. A multifaceted NCDs surveillance system could help us measure the burden of risk factors, its associated health care utilization and out of pocket costs, and further facilitate interventions that can guide evidence based decision making. [ABSTRACT FROM AUTHOR]

Mobile mammography services are typically offered as a means to increase access and adherence to mammography screenings. As mobile mammography becomes a viable strategy to increase screening, a 3 year study of such a state-wide program in WV found surprisingly high rates of obesity within the study population. Thus, the objectives were to: (1) describe the demographic characteristics and comorbidities of women who utilized the WV program, and (2) determine the association between body mass index (BMI) and personal health and screening history, preventive care and wellness behaviors, nutrition and exercise behaviors, and demographics. Data collected from 1,099 women, age 40 and above, were analyzed using descriptive statistics, bivariate analyses, and a multivariate regression model. The majority (60.4 %) were married, had an income <$25,000 (59.2 %), and had health insurance (53.5 %). Major comorbidities were hypertension (49 %) and high cholesterol (43.9 %). Based on BMI scores, 884 participants were either overweight (26.6 %), mildly obese (27.7 %), moderately obese (15.1 %), or severely obese (11.1 %). Bivariate analyses indicated that increasing BMI was significantly associated with factors such as having hypertension or diabetes, limited daily activities, perceived health, and not smoking or drinking. The regression model was significant ( p < 0.001; R2 = 0.425) indicating that women who engaged in preventive care behaviors were less likely to be obese than those who did not. The WV mobile mammography program appeared to attract women who were disproportionately obese and had multiple comorbidities, thus providing a great opportunity for targeted interventions related to improving preventive care and screening behaviors. [ABSTRACT FROM AUTHOR]