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Abstract The purpose of the paper is to examine the effectiveness of a six-week, culturally sensitive, church-based health-promotion intervention in increasing nutrition label health literacy and health-promoting behaviors (i.e. healthy eating, healthy drinking, and physical activity) and improving weight and blood pressure among Black adults. Study participants are a sample of 321 Black adult churchgoers (N = 321) who were divided between an intervention group (N = 172) and a wait-list control group (N = 149). The health-promotion intervention program is informed by Health Self-Empowerment Theory. At post-test, the participants in the intervention group demonstrated significantly greater increases in nutrition label health literacy, overall level of engagement in health-smart behaviors, and levels of engagement in two specific health-smart behaviors (i.e. healthy eating and healthy drinking) compared with those in the wait-list control group. Implications of these findings for future similar health-promotion intervention programs and research are discussed. [ABSTRACT FROM AUTHOR]

Few empirical studies have evaluated how perceptions of the patient-provider relationship affect health care seeking among Haitian immigrants. In this cross-sectional study, we examined whether perceptions of practitioner support for patient autonomy facilitate or hinder health care seeking among Haitian women enrolled in a cervical self-sampling trial. Perceived autonomy support was measured using an adapted health care climate questionnaire. Associations between perceived autonomy support and health care seeking were modeled using logistic regression and classification and regression trees. Covariates included socioeconomic and structural access indicators. Dependent variables included receipt of any medical care in the past year and delayed health care seeking. Having a usual source of care was strongly associated with both dependent variables. Lower perceived autonomy support was associated with delayed health care seeking in regression models and classification and regression trees. Addressing the capacity of health workers to deliver autonomy-supportive care is essential for improving health services utilization in vulnerable populations. [ABSTRACT FROM AUTHOR]

Abstract Introduction. There is limited research about the poor and uninsured patients who visit free clinics. Methods. We conducted a retrospective chart review of uninsured adult patients in four free clinics seen between January and December 2015. Prevalence of chronic conditions and their association with socioeconomic factors were investigated. Results. In 2015, 3,196 adult patients with chronic conditions were managed in four free clinics. Many of these patients were women (60.8%) and Hispanic (44.7%); the group had a mean age of 47.9 years (SD=14.1) and a median income of $14,400. The top five prevalent conditions were hypertension (33.6%), hyperlipidemia (20.7%), diabetes (14%), major depression (11.7%), and arthritis (8.7%). In the multivariable analysis, clinic site, age, marital status, employment status, and household size were significantly associated with the Disease Burden Index. Discussion. Public health prevention programs should focus on uninsured patients of free clinics who are mainly low-income, sicker, and unemployed, and often women and Hispanics. [ABSTRACT FROM AUTHOR]

Prompt HIV diagnosis decreases the risk of HIV transmission and improves health outcomes. The study objective was to examine rates of delayed HIV diagnosis among non-Latino Black Caribbean immigrants in Florida. The sample included 39,008 Black HIV-positive individuals, aged 13 or older from the Caribbean and the mainland U.S. Delayed HIV diagnosis was defined as AIDS diagnosis within three months of HIV diagnosis. After adjusting for demographic factors, year of HIV diagnosis, transmission mode, neighborhood level socioeconomic status, and rural- urban residence, a disparity persisted for Caribbean-born Blacks in the Bahamas and Haiti compared with U.S.-born Blacks. Male Jamaican-Bahamian-Haitian-born Blacks were more likely to have delayed diagnosis (aOR 2.17, 95% confidence interval [CI] 1.53-3.03; aOR 1.88, 95% CI 1.01-3.44; aOR 1.58, 95%CI 1.58). Findings suggest the need for targeted, culturally relevant interventions to reduce delayed diagnosis incidence among specific Caribbean- born Blacks. [ABSTRACT FROM AUTHOR]

Objective. A recent policy statement from the American Academy of Pediatrics outlines the central role of pediatricians in screening for and addressing precipitants of toxic stress (e.g., adverse experiences). Despite these recommendations, it is unknown whether pediatricians are in fact screening for these precipitants. Methods. A sample of 210 pediatricians serving low-income children completed a survey regarding their responses to adverse childhood experiences (ACEs). Participants were asked to estimate the prevalence of ACEs in their practice, their current practices, and recommendations for screening. Results. For nearly all ACEs, pediatricians' estimates of the prevalence in their practice were lower than state-reported prevalence. For many ACEs, the number of pediatricians who support the need for recommended screening was far higher than the number who reported actually screening. Conclusions. Our findings suggest clinicians serving primarily low-income families recommend screening but may underestimate the prevalence of ACEs in their practice and may not be equipped to screen or address these matters consistently. [ABSTRACT FROM AUTHOR]

Background. Finding dentists who treat Medicaid-enrolled children is a struggle for many parents. The purpose of this study was to identify non-reimbursement factors that influence the decision by dentists about whether or not to participate in the Medicaid program in Florida. Methods. Data from a mailed survey was analyzed using a logistic regression model to test the association of Medicaid participation with the Perceived Barriers and Social Responsibility variables. Results. General and pediatric dentists (n=882) who identified themselves as either Medicaid (14%) or Non-Medicaid (86%) participants responded. Five items emerged as significant predictors of Medicaid participation, with a final concordance index of 0.905. Two previously unreported barriers to participation in Medicaid emerged: 1) dentists' perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred. Conclusions. This study provides new information about non-reimbursement barriers to Medicaid participation. [ABSTRACT FROM AUTHOR]

Background. Although emerging Treatment as Prevention models can be effective in reducing HIV incidence among high-risk populations, many HIV infected individuals remain undiagnosed or fail to engage in HIV care. Methods. This study examined the factors associated with HIV testing and care among a population of substance using female sex workers. Results. Recent HIV testing was associated with higher education level, having a regular health care provider or clinic, recent crack use, and higher sexual risk behaviors; HIV treatment utilization was associated with higher levels of social support, having a regular health care provider or clinic, housing stability and insurance coverage. Qualitative data revealed HIV-related stigma, denial, social isolation, and substance use as barriers to HIV testing and treatment; social support and accessibility of services were key enablers. Conclusions. Improving HIV testing and linkage to treatment among female sex workers will require structural initiatives to reduce stigma and increase service seeking support. [ABSTRACT FROM AUTHOR]

African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed f-tests. Overall, the intervention significantly improved respondents' prostate cancer knowledge (pc.0001), significantly improved decisional self-efficacy (p<.0001) and significantly reduced decisional conflict (p<.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to test the effects of a culturally sensitive, health empowerment-focused, community-based health promotion program tailored to adult patients with type 2 diabetes on these patients' body mass index (BMI), blood pressure, and self-reported blood glucose levels, treatment adherence, and stress levels. Study participants (N = 130) consisted mostly of African Americans (70%) and Hispanic/Latinos (22.3%) who were divided almost evenly between an intervention group and wait-list control group. The tested health promotion program is informed by Health Self-Empowerment Theory. At post-test, program participants in the intervention group as compared to those in the control group demonstrated significantly lower levels of BMI, diastolic blood pressure, and physical stress. Implications of these study findings for future similar programs and research are discussed. [ABSTRACT FROM AUTHOR]

Purpose. To understand the needs and challenges encountered by older homeless veterans. Methods. We conducted six focus groups of older veterans, two focus groups, and one semi-structured interview of VA staff liaisons, and two focus groups and one semi-structured interview of housing intervention providers. Results. Major themes for older veterans: 1) negative homelessness experience; 2) benefits of the structured transitional housing program; 3) importance of peer outreach; and 4) need for age-tailored job placement programs. Major themes for VA staff liaison/housing intervention providers: 1) belief that the transitional housing program has made a positive change; 2) need for individualized criteria to address the unique needs of veterans; 3) distinct differences between older and younger homeless veterans; 4) outreach services; 5) permanent housing issues; and 6) coordination of services. Discussion. Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change. [ABSTRACT FROM AUTHOR]