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Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery. [ABSTRACT FROM AUTHOR]

Background: In the US, over 50% of suicide deaths are by firearm injury. Studies have found that limiting access to firearms, including storing them temporarily outside of the home or locking and unloading them securely at home, helps prevent suicide. Family members and other loved ones are in a unique position to encourage secure firearm storage. This paper describes the development of a workshop to empower loved ones of individuals at risk for suicide to discuss secure firearm storage in New York State. Methods: Using a multistakeholder engagement framework, we partnered with New York State county-level suicide prevention coalitions, local firearms experts, and other stakeholders to develop a 90-min workshop addressing secure firearm storage for suicide prevention. Pilot workshops were co-facilitated by a suicide prevention coalition member and a local firearms expert. Feedback gathered via surveys from workshop attendees and interviews with workshop co-facilitators were used to revise workshop content and inform dissemination. Following pilot workshops, a 1-day training event was held for potential future facilitators, and survey data were collected to assess trainee experiences and interest in facilitating future workshops. Data analysis included rapid qualitative analysis of interviews and statistical analysis of survey responses about acceptability of workshop. Results: Four pilot workshops included a total of 23 attendees. Pilot workshop attendees endorsed willingness and confidence to discuss secure firearm storage with a family member or loved one. The training event included 42 attendees, of which 26 indicated interest in facilitating a workshop within the next year. Co-facilitators agreed on several key themes, including the importance of having a "trusted messenger" deliver the firearms portion of the workshop, keeping the conversation focused on firearm safety for suicide prevention, and developing interventions that reflect firearm owning community's culture. Conclusions: Consistent with a public health approach to suicide prevention, this study leveraged a multistakeholder engagement framework to develop a community-based workshop empowering loved ones of individuals at risk for suicide to discuss secure firearm storage. The workshop will be disseminated across New York State. We noted positive and collaborative relationships across stakeholder groups, and willingness to facilitate the workshop among both suicide prevention and firearm stakeholders. [ABSTRACT FROM AUTHOR]

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The use of technology in intervention and instruction for adolescents with autism spectrum disorder (ASD) is increasing at a striking rate. The purpose of this paper is to examine the research literature underlying the use of technology in interventions and instruction for high school students with ASD. In this paper, authors propose a theoretical and conceptual framework for examining the use of technology by and for adolescents with ASD in school, home, and community settings. This framework is then used to describe the research literature on efficacy of intervention and instruction that utilizes technology. A review of the literature from 1990 to the end of 2013 identified 30 studies that documented efficacy of different forms of technology and their impact on academics, adaptive behavior, challenging behavior, communication, independence, social competence, and vocational skills. [ABSTRACT FROM AUTHOR]

In pandemic mitigation, strategies such as social distancing and mask-wearing are vital to prevent disease resurgence. Yet, monitoring adherence is challenging, as individuals might be reluctant to share behavioral data with public health authorities. To address this challenge and demonstrate a framework for conducting observational research with sensitive data in a privacy-conscious manner, we employ a privacy-centric epidemiological study design: the federated cohort. This approach leverages recent computational advances to allow for distributed participants to contribute to a prospective, observational research study while maintaining full control of their data. We apply this strategy here to explore pandemic intervention adherence patterns. Participants (n = 3808) were enrolled in our federated cohort via the "Google Health Studies" mobile application. Participants completed weekly surveys and contributed empirically measured mobility data from their Android devices between November 2020 to August 2021. Using federated analytics, differential privacy, and secure aggregation, we analyzed data in five 6-week periods, encompassing the pre- and post-vaccination phases. Our results showed that participants largely utilized non-pharmaceutical intervention strategies until they were fully vaccinated against COVID-19, except for individuals without plans to become vaccinated. Furthermore, this project offers a blueprint for conducting a federated cohort study and engaging in privacy-preserving research during a public health emergency. [ABSTRACT FROM AUTHOR]

There is a dearth of research examining what parents in MENA region know about children's brain development and the type of activities they engage their young children at home to promote their cognitive development. This article describes and compares the views and behaviors of parents with children 0–6 years old from Casablanca, Morocco, the US, and the UK on early parental engagement. Seventy-eight Moroccan parents were compared to 1066 US/UK parents. The study utilizes survey data and explores parents' understanding of and support for their children's early cognitive development. Results reveal that more than fifty percent of Moroccan parents do not see themselves as having an impact on brain development until after the first year of their child's life compared to 10% of US parents, in part because they believe that babies' capacity for learning in the earliest years is limited. Yet Moroccan parents reported higher frequencies of teaching their young children letters and numbers and reading a book to them than US parents. These differences in at-home teaching practices may reflect the higher percentage of US/UK children who participate in early learning programs outside their own homes; such programs are not culturally accepted in Morocco. The belief that there is little capacity for learning in children's earliest years among Moroccan parents may minimize parents' motivation to function as their child's first teacher in the absence of early education programs. Policy implications and interventions are discussed concerning ways to change parents' knowledge and beliefs to motivate early learning activities. Highlights: Moroccan parents view themselves as having limited impact on their children's cognitive development in the early years compared to US parents. Moroccan parents reported higher frequencies of teaching their young children numbers and reading compared to UK parents. Sending very young children to early education centers is less acceptable in Morocco than in the US/UK. Moroccan parents turn to their extended family more than US parents do for guidance on child-rearing. Interventions should be culturally relevant and target sources to whom parents turn for support; home visits are promising. [ABSTRACT FROM AUTHOR]

Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population. [ABSTRACT FROM AUTHOR]

Both theory and data suggest that religions shape the way individuals interpret and seek help for their illnesses. Yet, health disparities research has rarely examined the influence of a shared religion on the health of individuals from distinct minority communities. In this paper, we focus on Islam and American Muslims to outline the ways in which a shared religion may impact the health of a racially, ethnically, and socioeconomically diverse minority community. We use Kleinman's 'cultural construction of clinical reality' as a theoretical framework to interpret the extant literature on American Muslim health. We then propose a research agenda that would extend current disparities research to include measures of religiosity, particularly among populations that share a minority religious affiliation. The research we propose would provide a fuller understanding of the relationships between religion and health among Muslim Americans and other minority communities and would thereby undergird efforts to reduce unwarranted health disparities. [ABSTRACT FROM AUTHOR]

This paper discusses characteristics that are associated with enhanced maternal and child health (MCH) epidemiology functioning in state health agencies. The concept of the 'MCH Epidemiology Effort' is introduced as 'the epidemiologic work carried out by multiple units and agencies aimed at informing program planning and policy development on behalf of women, children and families.' This concept focuses attention on MCH epidemiology functioning at the organizational level rather than on individual MCH epidemiologists. The analysis used data from all 50 states and the District of Columbia. Each state participated in a telephone interview and submitted material that demonstrated the breadth, depth, and capacity of its MCH Epidemiology Effort. Several organizations, including the Council for State and Territorial Epidemiologists, the Health Resources and Services Administration/Maternal and Child Health Bureau, and the Centers for Disease Control and Prevention provided additional secondary data. The outcome for analysis was a three-category measure of MCH epidemiology functioning. The findings are consistent with, and add specificity to, those from prior assessments. In a multivariable model, agenda-setting by consensus, involvement of external stakeholders, the total of doctorally trained staff, and accessing CDC assignees or other staff were all significantly related to higher level MCH epidemiology functioning (ORs of 6.1, 6.6, 2.5, and 6.4, respectively; P < 0.05). Organizational visibility of the MCH Epidemiology Effort and a data environment marked by routine data-sharing and data integration were marginally related. We provide recommendations for action at the state and federal level for advancing evidence-based decision-making in maternal and child health. [ABSTRACT FROM AUTHOR]

Young mothers with child welfare involvement often participate in programs to prevent future child maltreatment. However, most programs are not designed for young mothers and overlook unique challenges related to development, psychosocial stressors, relationships, and stigma. This scoping review synthesized existing literature and mapped what is known about programs designed for young mothers with child welfare involvement in Canada and the United States. The scoping review protocol was designed using Arksey and O'Malley's methodological framework. An extensive search was conducted from university databases and grey literature. The inclusion criteria were (1) the program was designed for parents under 25 years old, (2) the program serves mothers with child welfare involvement, (3) the studies are published in English, and (4) the programs were delivered in Canada or the United States. The search results included 1925 articles and 14 were screened using the inclusion criteria. Article publication dates ranged from 1981 to 2017, with most studies being conducted in the United States. Three themes identified in this review were (1) service delivery approaches, (2) program outcomes, and (3) collaboration with child welfare services. The findings suggest that few programs designed for young mothers exist in Canada and the United States. A variety of program evaluation methods and program delivery approaches were found. Program characteristics that may benefit young mothers with child welfare involvement include incorporating peer support initiatives, the explicit intention to build a therapeutic alliance between the service provider and the mother, and prolonged service delivery. [ABSTRACT FROM AUTHOR]

Background: Childhood asthma is an important unmet need. To date, patient-reported outcome measures (PROMs) for children with asthma have used a combination of caregiver or proxy-reported and self-reported measures. No comprehensive measure is available to assess the severity and impact of daytime and nighttime asthma symptoms and rescue medication use for self-completion by children aged 6–11 years. This study aimed to develop a novel, interactive, electronic Pediatric Asthma Symptom Diary (ePASD) measuring self-reported key symptom severity and proximal impacts of asthma in young children with varying reading ability and disease severity, consistent with US Food and Drug Administration (FDA) PRO guidance and the International Society for Health Economics and Outcomes Research (ISPOR) good research practices. Methods: A targeted literature review and clinician interviews were undertaken to characterize symptoms and impacts experienced by children with mild-to-severe asthma. Concept elicitation interviews (CEIs) were conducted with 44 children and their caregivers (30 US; 14 UK). Following item and digital application development, the ePASD was assessed for relevance, understanding, and interpretability through cognitive debriefing interviews (CDIs) with 21 US children. Face validity/translatability assessments were also performed. Results: Key measurement concepts included cough, wheeze, difficulty breathing, chest tightness/discomfort, nighttime awakening, and daytime activity limitations. Concept saturation was reached during CEIs for primary asthma-related daytime and nighttime symptoms and core impacts. Most CDI participants found the ePASD items clear, understandable, and comprehensive. Standardized training is anticipated to facilitate reliable child self-report. Conclusion: The ePASD, a novel PROM for children aged 6–11 years with asthma, uses an innovative multimedia approach and has been developed in accordance with FDA PRO guidance and ISPOR good research practices, directly capturing the child's self-reported asthma symptoms, impacts on daily activities and nighttime awakening, and rescue medication use. [ABSTRACT FROM AUTHOR]

Background: Lower limb deformities include conditions such as leg length discrepancy, lower limb deficiency and associated angular and rotational deformities of the hips, knees, ankles and feet. Children with lower limb deformities often have physical limitations due to gait irregularities and pain. The differences in the appearance and function of their lower limbs can discourage participation in social, recreational and leisure activities, which may result in behavioural, emotional, psychological and social adjustment problems. The health-related quality of life (HRQL) of these children is often impacted due to the factors discussed above, as well as by the complex surgical procedures. Surgical treatment options for limb deformities in children vary from limb lengthening and reconstruction to amputation. The lack of evidence demonstrating superiority of either treatment options and their effect on HRQL limits the ability of healthcare providers to counsel families on the best evidence-based treatment option for them. This manuscript describes the international qualitative study which guided the development of a new patient-reported outcome measure (PROM). Individual semi-structured face-to-face interviews with children with lower limb deformities and their parents were conducted at five sites: Canada (2 sites), Ethiopia, India and the USA. Results: Seventy-nine interviews were conducted at five international sites. Five main themes emerged from the qualitative interviews and formed the basis of the conceptual framework. These themes were: 1) appearance, 2) physical health, 3) psychological health 4) school and 5) social health. Conclusions: Lower limb deformities have a substantial impact on the HRQL of children. The concepts of interest identified in our study were similar across children from all countries. The conceptual framework guided the development of outcome scales specific to these patients. The information about the impact of various treatment options on the HRQL of children with lower limb deformities, collected using this new PROM, could be used to inform parents and children about outcomes (physical, social, psychological) associated with specific treatment options. This information could supplement other objective outcome information (e.g., complication rates, how the leg will look, etc.) to help families to come to a more informed decision on a child's course of treatment. [ABSTRACT FROM AUTHOR]

Migration from countries where female genital cutting (FGC) is practiced means women's healthcare providers need to meet this population's unique healthcare needs. We explored providers' FGC-related experience, knowledge of the cultural practice, prior training, attitudes towards medicalization, including reinfibulation, and clinical practice. An online, 53-question survey to a multidisciplinary sample of women's health providers in the US were recruited by email via professional organizations, medical departments, and the authors' professional networks. From a total of 508 usable surveys, nearly half of respondents did not receive formal FGC training, but a majority had cared for FGC-affected women in their practice. A 'know-do' gap existed with managing infibulated patients; and surgical defibulation procedures were not routinely offered. Most respondents (79%, n = 402) reported a desire for additional education. Women's healthcare providers in the US, regardless of disciplinary backgrounds, are inadequately prepared to meet the needs of FGC-affected women. To address these, FGC content needs to be embedded in educational and training curricula, and ongoing clinical mentorship made available. [ABSTRACT FROM AUTHOR]

Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility—or improved socioeconomic standing relative to one's parents—may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity. [ABSTRACT FROM AUTHOR]

Purpose To provide recommendations for improving rates of infant mortality in a U.S. southeastern city using a collective impact approach. Description A convening organization and its academic partner devised a systematic process involving national experts and local stakeholders. Assessment A panel of infant mortality experts reached consensus on eight recommendations and three key overarching principles. Local stakeholder groups advanced four recommendations, of which three aligned closely with expert panel recommendations: (1) increasing access to, and use of 17-alpha hydroxyprogesterone caproate (17P); (2) reshaping housing policy using a health lens, and (3) supporting pre-conception health, intra-conception health and family planning. Conclusion The dynamic process of recommendation development occurred within a larger collective impact framework and can be used to shape a community-based approach to infant mortality. Other communities interested in improving rates of infant mortality or tackling other challenging public health issues could engage in a similar process. [ABSTRACT FROM AUTHOR]

In the past, epidemiologic research on acculturation and health has been criticized for its conceptual ambiguity and simplistic measurement approaches. This study applied a widely-used theoretical framework from cross-cultural psychology to identify acculturation strategies among South Asian immigrants in the US and to examine sociodemographic correlates of acculturation strategies. Data were from the Mediators of Atherosclerosis in South Asians Living in America study. We used latent class analysis to identify groups of individuals that were similar based on cultural attitudes and behaviors. We used latent class regression analysis to examine sociodemographic correlates of acculturation strategies. We found that South Asian immigrants employed three acculturation strategies, including separation (characterized by a relatively high degree of preference for South Asian culture over US culture), assimilation (characterized by a relatively high degree of preference for US culture over South Asian culture), and integration (characterized by a similar level of preference for South Asian and US cultures). Respondents with no religious affiliation, those with higher levels of income, those who lived a greater percentage of their lives in the US, and those who spoke English well or very well were less likely to use the separation strategy than the assimilation or integration strategies. Using epidemiologic cohort data, this study illustrated a conceptual and methodological approach that addresses limitations of previous research on acculturation and health. More work is needed to understand how the acculturation strategies identified in this study affect the health of South Asian immigrants in the US. [ABSTRACT FROM AUTHOR]

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported 'often' or 'always' needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants. [ABSTRACT FROM AUTHOR]

Lung cancer is a commonly occurring cancer among Korean American men. Korean Americans have lower rates of cancer screening participation than other Asian American sub-groups. However, little is known about factors that influence the cancer screening behavior of Korean immigrants. The purpose of this study was to explore facilitators of and barriers to lung cancer screening (i.e., low dose CT of the chest) among Korean immigrant men, using qualitative individual interviews and focus groups. A convenience sample of 24 Korean men who were immigrants, Washington State residents, able to speak Korean, aged 55-79, and eligible for lung cancer screening (based on current guidelines) were recruited from Korean churches and senior centers. Five focus groups (that included between two and five men) and nine individual interviews were conducted. Content analysis was used to analyze the qualitative data. Facilitators of lung cancer screening included perceptions about positive aspects of the health care system in South Korea, recommendations from others (physicians, family members, and community organizations), existing health problems and respiratory symptoms, interest in health, and the health consequences of aging. Barriers included costs of health care in the US, lack of time, lack of knowledge (about lung cancer and screening), attitudes about prevention, and lack of physician recommendation. This study adds new knowledge to a field where little information is available. It also lays the groundwork for developing culturally relevant lung cancer screening interventions for Korean Americans and the health care providers who serve them. [ABSTRACT FROM AUTHOR]

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel 'empowered' after 12 weeks compared to initially feeling 'out of control' with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness. [ABSTRACT FROM AUTHOR]

Religion plays a prominent role in Latino culture and could be influential during difficult life transitions, such as those experienced during the immigration process. This study examines relations between religious coping, acculturative stress, and alcohol use in a sample of 415 recent Latino immigrants. Higher levels of acculturative stress were associated more positive and negative religious coping. Positive religious coping was related to lower alcohol use. Negative religious coping moderated the relationship between acculturative stress and alcohol use. Participants who used more negative religious coping had higher rates of alcohol use when experiencing high levels acculturative stress. Implications for culturally tailored prevention/interventions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: In May 2012, the Association of Maternal and Child Health (MCH) Programs initiated a project to develop indicators for use at a state or community level to assess, monitor, and evaluate the application of life course principles to public health. Description: Using a developmental framework established by a national expert panel, teams of program leaders, epidemiologists, and academicians from seven states proposed indicators for initial consideration. More than 400 indicators were initially proposed, 102 were selected for full assessment and review, and 59 were selected for final recommendation as Maternal and Child Health (MCH) life course indicators. Assessment: Each indicator was assessed on five core features of a life course approach: equity, resource realignment, impact, intergenerational wellness, and life course evidence. Indicators were also assessed on three data criteria: quality, availability, and simplicity. Conclusion: These indicators represent a major step toward the translation of the life course perspective from theory to application. MCH programs implementing program and policy changes guided by the life course framework can use these initial measures to assess and influence their approaches. [ABSTRACT FROM AUTHOR]

Vietnamese Americans are at high risk for developing mental health disorders due to multiple risk factors such as trauma and acculturative stress. However, the utilization of mental health services has been low. The pilot project Tam An was implemented to raise mental health awareness by engaging community resources in the Vietnamese population. Informed by the Community Readiness Model and through local ethnic media sources, messages to destigmatize mental health and promote the willingness to initiate mental health treatment were presented. Using an exploratory perspective, findings from focus group data suggest that the project improved the community's stage of readiness. [ABSTRACT FROM AUTHOR]

Research on immigration and crime has only recently started to consider potential heterogeneity in longitudinal patterns of immigrant offending. Guided by segmented assimilation and life course criminology frameworks, this article advances prior research on the immigration-crime nexus in three ways: using a large sample of high-risk adjudicated youth containing first and second generation immigrants; examining longitudinal trajectories of official and self-reported offending; and merging segmented assimilation and life course theories to distinguish between offending patterns. Data come from the Pathways to Desistance study containing detailed offending and socio-demographic background information on 1,354 adolescents (13.6 % female; n = 1,061 native-born; n = 210 second generation immigrants; n = 83 first generation immigrants) as they transition to young adulthood (aged 14-17 at baseline). Over 84 months we observe whether patterns of offending, and the correlates that may distinguish them, operate differently across immigrant generations. Collectively, this study offers the first investigation of whether immigrants, conditioned on being adjudicated, are characterized by persistent offending. Results show that first generation immigrants are less likely to be involved in serious offending and to evidence persistence in offending, and appear to be on a path toward desistance much more quickly than their peers. Further, assimilation and neighborhood disadvantage operate in unique ways across generational status and relate to different offending styles. The findings show that the risk for persistent offending is greatest among those with high levels of assimilation who reside in disadvantaged contexts, particularly among the second generation youth in the sample. [ABSTRACT FROM AUTHOR]

Ethnic socialization and ethnic identity have been related to positive outcomes, but little research has examined these associations longitudinally. This three-wave study prospectively linked socialization messages at Time 1, ethnic identity and American identity at Time 2, and self-esteem and depressive symptoms at Time 3 in 147 (58 % female; 25 % first-generation) Asian-American adolescents. The results indicated positive links between cultural socialization messages and ethnic and American identity, though the latter association was significant only for females. Ethnic identity was positively related to self-esteem, and mediated the positive effect of cultural socialization on self-esteem. The promotion of mistrust was positively linked to self-esteem and negatively related to ethnic identity, though this latter association was significant for foreign-born youth only. Our findings highlight the importance of elucidating prospective links in identity development, and examining gender and generational differences within them. [ABSTRACT FROM AUTHOR]

This study assesses the health-related effects of trust-based prayer expectancies, which reflect the belief that God answers prayers at the right time and in the best way. The following relationships are evaluated in our conceptual model: (1) older Mexican Americans who attend worship services more often tend to develop a closer relationship with God; (2) people who feel close to God will be more likely to develop trust-based prayer expectancies; (3) people who endorse trust-based prayer expectancies will have greater feelings of self-esteem; and (4) higher self-esteem is associated with better self-rated health. The data support each of these relationships. [ABSTRACT FROM AUTHOR]

Although over 1.5 million African immigrants live in the US, few studies have examined the relationship of language acculturation to health outcomes among African immigrant adults. The primary objective of this research was to investigate the relationship between English proficiency and current self-rated health among African immigrant adults. Using a cross-sectional design, a secondary data analysis was performed on baseline data from the African immigrant adult subsample (n = 763) of the 2003 New Immigrant Survey, a longitudinal study of lawful permanent residents. Limited English proficiency (LEP), increased duration of US residence, older age at immigration, being male, less than 12 years of education, poor pre-migration health, and chronic disease were associated with good/fair/poor current self-rated health. Findings support consideration of pre-migration health and chronic disease in future acculturation and health studies, and provision of linguistically competent interventions for LEP African immigrants at risk for poor health outcomes. [ABSTRACT FROM AUTHOR]

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m, waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore pregnant and recently pregnant women's perceptions of influenza vaccine and antivirals during the 2009 H1N1 pandemic. We conducted 18 focus groups with pregnant and recently pregnant women in three US cities in September 2009. Participants were segmented into groups by insurance status (no or public insurance vs. private insurance), vaccine attitudes (higher vs. lower likelihood of acceptance of any vaccines, not only influenza vaccines), and parity (first child vs. other children in the home) based on information they provided on the screening questionnaire at the time of recruitment. We found that women are not well informed about influenza vaccinations and antiviral medicine and have significant concerns about taking them during pregnancy. An interest in their infant's well-being, however, can be strong motivation to adopt preventive recommendations, including vaccination. A woman's health care provider is a highly trusted source of information about the 2009 H1N1. Pregnant women have unique communication needs for influenza. Messages directing pregnant women to adopt public health recommendations, particularly for vaccination or prophylactic medication should include a detailed description of the benefits or lack of risk to the fetus and the safety of breastfeeding. Additionally, messages should recognize that pregnant women are taught to be selective about taking medication and provide a clear rationale for why the medicine or vaccine is necessary. [ABSTRACT FROM AUTHOR]

The 'Latina epidemiologic paradox' refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation. [ABSTRACT FROM AUTHOR]

There is limited information on the health status of South Asians. Our objective was to examine the delivery of clinical preventive services to South Asian adults. We used data from a 2001 mail survey to a nationwide sample of South Asians. We quantified the percentage of eligible adults who received screenings for colorectal cancer, cervical cancer, breast cancer, high blood pressure, lipid disorders, and vaccinations against influenza, pneumococcus, and tetanus. We also calculated the number of individuals who were up-to-date with all their recommended preventive healthcare. One-fourth of South Asians were up-to-date with their recommended preventive services, while more than half were not up-to-date with their services. Having a regular source of care was significantly associated with being up-to-date on recommended schedules. Despite their high level of education, the majority of South Asians in the US are not receiving the appropriate amount of preventive health services. [ABSTRACT FROM AUTHOR]

Despite the effectiveness of cancer screening procedures, its utilization among Latinas remains low. Guided, in part, by the Behavioral Model for Vulnerable Populations, this study examined the associations between predisposing, enabling, and need factors with self-reported breast, cervical, and colorectal cancer screening adherence. Participants were 319 Mexican-American women, from a range of socioeconomic backgrounds, living near the United States-Mexico border. Women were adherent with breast cancer (BC) screening (≥42 years) if they had received at least one mammogram within the last 2 years, with cervical cancer (CC) screening (≥40 years) if they had received at least one Pap exam in the last 3 years, and with colorectal cancer (CRC) screening (≥52 years) if they had undergone one or more of the following: Fecal Occult Blood Test within the last year, or sigmoidoscopy in the last 5 years, or colonoscopy within the last 10 years. BC and CC screenings were higher in the current sample compared to national and state figures: 82% with mammography and 86% adherent with Pap exam screening. However, only 43% were adherent with CRC screening recommendations. Characteristics associated with mammography adherence included CC adherence and usual source of care. BC adherence was associated to CC adherence. Characteristics associated with CRC adherence included BC adherence, being premenopausal, and insurance coverage. A key correlate of cancer screening adherence was adherence to other preventive services. Results underscore the need for continued efforts to ensure that Latinas of all SES levels obtain regular and timely cancer screenings. [ABSTRACT FROM AUTHOR]

Immigrants in the U.S. often experience better health than the native-born, and many explanations for this phenomenon center around the positive health behaviors that immigrants bring from their home cultures. Immigrants from the former Soviet Union may be an exception; because they come from societies where unhealthy lifestyles and high mortality are common, they are often expected to experience worse health than the native population. Using data from the Integrated Health Interview Series, I compare FSU immigrants with U.S.-born, non-Hispanic whites on several health measures. FSU immigrants are twice as likely as native whites to report fair or poor health, but they are less likely to smoke or drink, and are less likely to report a functional limitation. FSU immigrants' advantage in functional limitation is largely explained by their very high levels of education and marriage, indicating that selectivity is important to understanding the health of this population. [ABSTRACT FROM AUTHOR]

Literature and research examining father involvement has focused primarily on outcomes associated with the well-being and development of children. The contextual factors associated with fathers, and how these factors shape fathers' involvement with their young children, have received limited attention in this literature. Addressing this limitation, this study focuses on the relationship between fathers' residential status, age, race and ethnicity, educational attainment, financial status and father involvement. Results of the regression models indicate that fathers who reside with their children and fathers who are older are more involved with their children. Given these findings, policymakers, practitioners, and researchers have an opportunity to create and enhance policies and programs that may assist and support fathers in their development as parents and their involvement with their children. [ABSTRACT FROM AUTHOR]

Immigrants have a different social context from those who stay in their home country or those who were born to the country that immigrants now live. Cultural theory of risk perception suggests that social context influences one's interpretation of questionnaire items. We examined psychometric properties of job control and job demand scales with US- and foreign-born workers who preferred English, Spanish, or Chinese ( n = 3,114, mean age = 58.1). Across all groups, the job control scale had acceptable Cronbach's alpha (0.78-0.83) and equivalent factor loadings (ΔCFI < 0.01). Immigrants had low alpha (0.42-0.65) for the job demands scale regardless of language, education, or age of migration. Two job-demand items had different factor loadings across groups. Among immigrants, both scales had inconsistent associations with perceived job stress and self-rated health. For a better understanding of immigrants' job stress, the concept of job demands should be expanded and immigrants' expectations for job control explored. [ABSTRACT FROM AUTHOR]