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Introduction: Somali American adolescent tobacco use has increased over the past decade amid a high prevalence of tobacco use among Somali American adults. While established adolescent tobacco use determinants may apply for Somali youth, a deeper understanding of these influences is imperative to the development of effective prevention strategies for this population. This study aimed to identify risk and protective factors influencing Somali American adolescent tobacco use decision making and potential family and community roles in tobacco prevention. Method: We conducted 15 semistructured, in-depth interviews with 12 Somali and 3 non-Somali professionals serving Minnesotan metropolitan Somali communities in clinical, educational, religious, and other community organizations. Grounded Theory informed our data collection and analysis. Results: Key informants cited three major influences on Somali adolescent tobacco use--evolving norms and increasing exposure to tobacco products in the United States, low risks perception, especially for waterpipes, and conflicting interpretations of faith. Informants highlighted the important roles of families in Somali youth tobacco prevention while acknowledging areas where families would benefit from greater support. Proposed sources of support included faith communities and nonparental, ethnically similar adult mentors. Informants acknowledged challenges to addressing youth tobacco prevention in clinics and underscored the importance of youth involvement in developing prevention strategies. Conclusions: Our results indicate Somali adolescent tobacco prevention efforts should address the evolving tobacco use exposures and norms, low risk perceptions, and clarify faith messaging. Effective strategies may include strengthening family-based tobacco prevention approaches that also engage faith and other community leaders along with youth themselves.

Genetic counseling outcomes are influenced by the processes and strategies used by counselors, yet little is known about how these strategies directly impact patients and populations. In particular, tailoring genetic counseling consultations to best meet the needs of cultural, racial, and ethnically diverse populations has been explored. This review aims to identify genetic counseling strategies tailored for a diversity of racial and ethnic populations with the goal to find ways to improve genetic counseling outcomes. Medline, Cochrane CENTRAL, Embase, PsychInfo, and CINAHL databases were searched for original research articles published in English that employed genetic counseling processes and strategies to improve genetic counseling outcomes, specifically for participants from ethnically or racially diverse populations. A review of 5300 titles and abstracts resulted in the identification of 36 articles that met the inclusion criteria. Three themes emerged: (1) community involvement in culturally tailoring genetic counseling, (2) creation and use of culturally tailored resources, and (3) modifications to the genetic counseling process. The effectiveness of genetic counseling strategies could not be evaluated due to lack of consistent outcome measures in the articles. The involvement of diverse ethnic and racial populations in developing inclusive genetic counseling tools and practices will help the profession provide better patient care in the future. More research connecting genetic counseling processes and outcomes will help to assess how well these modified approaches meet the needs of diverse populations. [ABSTRACT FROM AUTHOR]

Context: Somali patients in the U.S. experience persistently low cervical cancer screening rates due to a complex mix of barriers. Primary care clinic-based HPV self-sampling could effectively increase cervical cancer screening rates in Somali women by positioning providers to address some key screening barriers, enabling clinics to opportunistically fit in HPV self-sampling in the clinical encounter, and providing an alternative modality for patients. Research to date has focused primarily on mailing HPV self-sampling kits to patients, and less is known about offering HPV self- sampling during the patient encounter in the primary care clinic setting. Objective: Primary care providers and staff were asked for their views on implementing HPV self-sampling in clinic. Findings will be used to inform an effectiveness-implementation study testing the impact of offering HPV self-sampling as an option for cervical cancer screening for Somali patients. Study Design: Primary care providers and staff participated in semi- structured interviews, exploring their views on HPV self-sampling and their anticipated needs or barriers to implementing this approach in the clinic setting and clinical encounter. The Consolidated Framework for Implementation Science (CFIR) was used to inform the interview guide. Analysis: Interviews were recorded and transcribed. A thematic analysis using the constructivist version of grounded theory was undertaken. Population Studied: 30 primary care providers and staff in two clinics in Minneapolis, Minnesota who serve large Somali patient populations. Results: Providers and staff anticipate positive patient reactions to the option of HPV self-sampling, although some voiced concern about patients perceiving HPV self-sampling as a less effective option, and worry about the lack of a physical exam. HPV self-sampling was mostly viewed favorably as a modality to help increase screening and was seen as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting the accuracy of HPV self-sampling for cervical cancer screenings and felt clinic wide staff and patient education would be needed. Conclusions: HPV self-sampling in clinic was viewed favorably, particularly to reach under-screened populations, and was seen as being easy to implement in current workflows. Clinic-wide education on the current evidence on HPV self-sampling will be essential to support implementation., Presenters Rebekah Pratt, PhD, Rachel Winer, PhD, MPH, Adam Szpiro, John Lin, Timothy J. Ramer, MD, Christina Bliss Barsness, MPH, RD, Rahel Ghebre, Jay Desai, [...]

Context: Asian Americans are a diverse racial group, yet little research has described how adolescent tobacco use varies among Asian ethnic groups and how protective factors for tobacco use among general adolescent populations apply to these groups. Objective: To describe tobacco use patterns and protective factors in a statewide sample of Asian American adolescents by ethnicity. Setting/Dataset: 2019 Minnesota Student Survey. Population Studied: 8th, 9th, and 11th grade Asian Americans in Minnesota (n=10,482). Outcome measures: Dichotomized past 30-day use of cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, dual/poly (>2), and any tobacco. Study Design & Analysis: Descriptive statistics examined tobacco use differences by ethnicity. Multivariable logistic regression modelled associations between 6 protective factors (internal developmental assets, positive student-teacher relationships, peer and parent anti-smoking norms, college aspirations, family caring) and e-cigarette use, adjusting for sex, grade, metro residence, and economic hardship. An interaction model (protective factor x ethnicity) assessed differences by ethnicity. Results: Among respondents, 9.0% identified as Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multiple Asian ethnicities, and 21.6% multiracial. E-cigarettes were the predominant form of tobacco use across groups. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indian groups reported the lowest levels (4.7% and 5.0%). All 6 protective factors were significantly associated with lower odds of e-cigarette use across groups with significant interactions for internal developmental assets and peer anti-smoking norms. Higher developmental asset scores were associated with lower e-cigarette use in Asian Indian, Chinese, Hmong, Vietnamese, and multi-racial respondents. Peer antismoking norms were associated with lower e-cigarette use in Asian Indian, Chinese, Hmong, Vietnamese, and other respondents. Conclusions: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota. Protective factors from the general population appear to function similarly for these youth. Heterogeneity in e-cigarette use by ethnicity underscores the importance of disaggregating tobacco use by ethnicity to inform tailored tobacco prevention and control strategies., Presenters April Wilhelm, MD, MPH, Patrick Hammett, Steven Fu, Rebekah Pratt, PhD, Marla Eisenberg, Michele Allen, MD, MS, [...]

We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina. Inadequate economic opportunities and assistance programs, and high costs of living, compounded into cycles of playing catch up on expenses. Assistance programs aimed at alleviating hardships related to poverty were described as piecemeal. We found that social and economic systems failed to support parents earning low wages. Our findings suggest that ordinances that assure a livable minimum wage paired with expansions of safety net programs could better meet the needs these parents. [ABSTRACT FROM AUTHOR]

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context. [ABSTRACT FROM AUTHOR]

Background Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease. Purpose This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes. Methods Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life's Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition. Results In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p =.004); clients in control pantries had worsened Saturated Fat subcomponents scores (p =.019) and improved physical activity scores (p =.007). Conclusions The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota. Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy. Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation. Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers. [ABSTRACT FROM AUTHOR]

Objective: The current study presents results of a midpoint analysis of an ongoing natural experiment evaluating the diet-related effects of the Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/h. Design: A difference-in-difference (DiD) analysis of measures collected among low-wage workers in two U.S. cities (one city with a wage increase policy and one comparison city). Measures included employment-related variables (hourly wage, hours worked and non-employment assessed by survey questions with wages verified by paystubs), BMI measured by study scales and stadiometers and diet-related mediators (food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation and daily servings of fruits and vegetables, whole-grain rich foods and foods high in added sugars measured by survey questions). Setting: Minneapolis, Minnesota and Raleigh, North Carolina. Participants: A cohort of 580 low-wage workers (268 in Minneapolis and 312 in Raleigh) who completed three annual study visits between 2018 and 2020. Results: In DiD models adjusted for time-varying and non-time-varying confounders, there were no statistically significant differences in variables of interest in Minneapolis compared with Raleigh. Trends across both cities were evident, showing a steady increase in hourly wage, stable BMI, an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes. Conclusion: There was no evidence of a beneficial or adverse effect of the Minimum Wage Ordinance on health-related variables during a period of economic and social change. The COVID-19 pandemic and other contextual factors likely contributed to the observed trends in both cities. [ABSTRACT FROM AUTHOR]

In 1999 we began research, funded by the "Thomas Clinton Trust", to explore the opinions of visually impaired people on visual impairment research. We found people wanted greater inclusion of visually impaired people in such research and participatory, empowering and emancipatory research was a priority for them. We also found, through reviewing the academic literature, that there was a dearth of such work in the field. In this article we revisit the topic to review research that has or has not been conducted since our first study to see if there has been a change in the use of emancipatory methods in the field. We have contextualized our review in a discussion on the field of disability studies and the international social policy context of disability issues. We found a growth of interest and activity in participatory, emancipatory and empowering research in the field of disability research more generally. There was also some indication that the social model of disability has had an impact on national and international social policy. However, our review found that there continues to be a dearth of emancipatory research in relation to visual impairment. The one study we did locate highlighted how participatory methods are not, in our view, necessarily consistent with the epistemological underpinnings of emancipatory methods. We believe the call from within disability studies for the greater use of emancipatory research methods has not been sufficiently realized in the field of visual impairment and more needs to be done to ground politically informed epistemological understandings in visual impairment research if more progress is to be made.

In 2017, a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients. Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed. Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use. The supportive environment provided by food pantries positions them to address the needs of clients, including those with complex health needs. [ABSTRACT FROM AUTHOR]

THE INNOVATION Despite Somali patients in Minnesota testing at a positivity rate of 23% for coronavirus disease 2019 (COVID-19), there is underutilization of testing and virtual health care technologies, creating [...]

Objective: Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). Methods: Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. Results: Participants (n = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. Conclusions: CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs. [ABSTRACT FROM AUTHOR]

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to understand participant policy experiences in two contexts (Raleigh, North Carolina and Minneapolis, Minnesota). Participants experienced frequent, destabilizing changes to their United States Department of Agriculture Supplemental Nutrition Assistance Program benefits, which they identified as part of a broader safety net. Raleigh workers described an unsupportive policy environment; Minneapolis workers reaped few benefits from an ongoing wage increase. Many workers face complex financial tradeoffs; more sophisticated evaluations should consider broader policy contexts and long-range effects. [ABSTRACT FROM AUTHOR]

The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0–100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0–100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0–100). Descriptive analyses and t -tests examined pre–post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p <.001), as did FAST scores (p =.02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p =.56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients. [ABSTRACT FROM AUTHOR]

Abstract Emerging models of subjective experience, awareness and coping in early-stage dementia may usefully be enhanced by incorporating a temporal perspective. As an initial step in this direction, we undertook [...]

Introduction Here we describe the development of a user-led model of intervention for people with dementia called the 'Talking About Memory Coffee Group'. In this innovative practice development we explored [...]

Introduction: Somali American adolescent tobacco use has increased over the past decade amid a high prevalence of tobacco use among Somali American adults. While established adolescent tobacco use determinants may apply for Somali youth, a deeper understanding of these influences is imperative to the development of effective prevention strategies for this population. This study aimed to identify risk and protective factors influencing Somali American adolescent tobacco use decision making and potential family and community roles in tobacco prevention. Method: We conducted 15 semistructured, in-depth interviews with 12 Somali and 3 non-Somali professionals serving Minnesotan metropolitan Somali communities in clinical, educational, religious, and other community organizations. Grounded Theory informed our data collection and analysis. Results: Key informants cited three major influences on Somali adolescent tobacco use: evolving norms and increasing exposure to tobacco products in the United States, low risks perception, especially for waterpipes, and conflicting interpretations of faith. Informants highlighted the important roles of families in Somali youth tobacco prevention while acknowledging areas where families would benefit from greater support. Proposed sources of support included faith communities and nonparental, ethnically similar adult mentors. Informants acknowledged challenges to addressing youth tobacco prevention in clinics and underscored the importance of youth involvement in developing prevention strategies. Conclusions: Our results indicate Somali adolescent tobacco prevention efforts should address the evolving tobacco use exposures and norms, low risk perceptions, and clarify faith messaging. Effective strategies may include strengthening family-based tobacco prevention approaches that also engage faith and other community leaders along with youth themselves. [ABSTRACT FROM AUTHOR]