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Objective: To discuss the engagement of patients and stakeholders (ie, faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.

Familial dysautonomia (FD) is a rare sensory and autonomic neuropathy that results from a mutation in the ELP1 gene. Virtually all patients report gastrointestinal (GI) dysfunction and we have recently shown that FD patients have a dysbiotic gut microbiome and altered metabolome. These findings were recapitulated in an FD mouse model and moreover, the FD mice had reduced intestinal motility, as did patients. To understand the cellular basis for impaired GI function in FD, the enteric nervous system (ENS; both female and male mice) from FD mouse models was analyzed during embryonic development and adulthood. We show here that not only is Elp1 required for the normal formation of the ENS, but it is also required in adulthood for the regulation of both neuronal and non-neuronal cells and for target innervation in both the mucosa and in intestinal smooth muscle. In particular, CGRP innervation was significantly reduced as was the number of dopaminergic neurons. Examination of an FD patient's gastric biopsy also revealed reduced and disoriented axons in the mucosa. Finally, using an FD mouse model in which Elp1 was deleted exclusively from neurons, we found significant changes to the colon epithelium including reduced E-cadherin expression, perturbed mucus layer organization, and infiltration of bacteria into the mucosa. The fact that deletion of Elp1 exclusively in neurons is sufficient to alter the intestinal epithelium and perturb the intestinal epithelial barrier highlights a critical role for neurons in regulating GI epithelium homeostasis., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions., (© 2023. The Author(s).)

With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. ( Am J Public Health . 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).

This qualitative study examines the social determinants of health among noncitizen deported United States veterans. We utilized Photovoice, a participatory action research method used to inform structural level change, with 12 veterans. Audio-recorded semi-structured interviews explored photos and discussed deportation's effects on veteran health. We performed rapid template and matrix analysis of interview transcripts. Interviews were conducted in Tijuana, Mexico from December 2018 to January 2019. Study findings show that veterans prioritize returning to the United States to improve their quality of life. Analysis of photos and narrative text indicated that deportation caused social, economic, and political insecurities. Veterans struggled to maintain access to necessities post-deportation. Disrupted social networks compounded their situation, resulting in chronic stress and poor health outcomes. The findings from this study offer insight into the ways deportation acts as a social determinant of health. The findings suggest modifying veteran reintegration programs, as well as reforming criminal justice and immigration laws, such as creating more Veteran Treatment Courts and allowing immigration judges to consider military history during deportation proceedings involving noncitizen veterans., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Tao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This research investigated Latinx and Indigenous Mexican caregivers' perspectives of the Salton Sea's environment (e.g., dust concentrations and other toxins) on child health conditions. The Salton Sea is a highly saline drying lakebed located in the Inland Southern California desert borderland region and is surrounded by agricultural fields. Children of Latinx and Indigenous Mexican immigrant families are especially vulnerable to the Salton Sea's environmental impact on chronic health conditions due to their proximity to the Salton Sea and structural vulnerability. From September 2020 to February 2021, we conducted semi-structured interviews and focus groups with a total of 36 Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress living along the Salton Sea. A community investigator trained in qualitative research conducted interviews in Spanish or Purépecha, an indigenous language spoken by immigrants from Michoacán, Mexico. Template and matrix analysis was used to identify themes and patterns across interviews and focus groups. Participants characterized the Salton Sea's environment as toxic, marked by exposure to sulfuric smells, dust storms, chemicals, and fires, all of which contribute to children's chronic health conditions (e.g., respiratory illnesses such as asthma, bronchitis, and pneumonia, co-presenting with allergies and nosebleeds). The findings have important environmental public health significance for structurally vulnerable child populations in the United States and globally.

Central metabolism has a profound impact on the clinical phenotypes and penetrance of neurological diseases such as Alzheimer's (AD) and Parkinson's (PD) diseases, Amyotrophic Lateral Sclerosis (ALS) and Autism Spectrum Disorder (ASD). In contrast to the multifactorial origin of these neurological diseases, neurodevelopmental impairment and neurodegeneration in Familial Dysautonomia (FD) results from a single point mutation in the ELP1 gene. FD patients represent a well-defined population who can help us better understand the cellular networks underlying neurodegeneration, and how disease traits are affected by metabolic dysfunction, which in turn may contribute to dysregulation of the gut-brain axis of FD. Here, 1 H NMR spectroscopy was employed to characterize the serum and fecal metabolomes of FD patients, and to assess similarities and differences in the polar metabolite profiles between FD patients and healthy relative controls. Findings from this work revealed noteworthy metabolic alterations reflected in energy (ATP) production, mitochondrial function, amino acid and nucleotide catabolism, neurosignaling molecules, and gut-microbial metabolism. These results provide further evidence for a close interconnection between metabolism, neurodegeneration, and gut microbiome dysbiosis in FD, and create an opportunity to explore whether metabolic interventions targeting the gut-brain-metabolism axis of FD could be used to redress or slow down the progressive neurodegeneration observed in FD patients.

Background: The Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs., Methods: Diverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants' motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation., Results: A total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings., Conclusion: This study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation., (© 2023. The Author(s).)

Familial dysautonomia (FD) is a rare genetic neurologic disorder caused by impaired neuronal development and progressive degeneration of both the peripheral and central nervous systems. FD is monogenic, with >99.4% of patients sharing an identical point mutation in the elongator acetyltransferase complex subunit 1 (ELP1) gene, providing a relatively simple genetic background in which to identify modifiable factors that influence pathology. Gastrointestinal symptoms and metabolic deficits are common among FD patients, which supports the hypothesis that the gut microbiome and metabolome are altered and dysfunctional compared to healthy individuals. Here we show significant differences in gut microbiome composition (16 S rRNA gene sequencing of stool samples) and NMR-based stool and serum metabolomes between a cohort of FD patients (~14% of patients worldwide) and their cohabitating, healthy relatives. We show that key observations in human subjects are recapitulated in a neuron-specific Elp1-deficient mouse model, and that cohousing mutant and littermate control mice ameliorates gut microbiome dysbiosis, improves deficits in gut transit, and reduces disease severity. Our results provide evidence that neurologic deficits in FD alter the structure and function of the gut microbiome, which shifts overall host metabolism to perpetuate further neurodegeneration., (© 2023. The Author(s).)

Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.

Purpose: Managers and leaders have a critical role to play in sexual and gender-based harassment prevention within organizations. Although the Veterans Health Administration has committed to eliminating harassment through national directives and training programs, it is unclear how aware local-level managers and leaders are about public harassment at their facilities and how they perceive sexual and gender-based harassment. We examined middle managers' and leaders' views about whether harassment is perceived as a problem locally, and what policies and procedures (if any) are in place to address public harassment., Methods: We conducted 69 semistructured telephone interviews with middle managers and facility leaders before implementation of an evidence-based quality improvement project designed to improve delivery of comprehensive women's health care. Transcripts were coded using the constant comparative method and analyzed for overarching themes., Results: Perceptions of the prevalence of sexual and gender-based public harassment varied among middle managers and leaders. A little more than one-half of respondents were unaware of facility-level policies and procedures to address public harassment between patients. To decrease patient-to-patient harassment, both groups generally supported the creation of separate clinical spaces for women. However, middle managers also stated that education was needed to change patient harassing behavior, which they tied to male military culture., Conclusions: Aligning divergent perspectives of what constitutes sexual and gender-based harassment and how to address it is a necessary step towards tackling harassment at the local level. Managers and leaders should continue to assess environments of care and share findings widely among employees and leadership to improve awareness and inform a unified response., (Published by Elsevier Inc.)

Using statewide hospital discharge data from 2005 to 2014, this study aimed to describe and identify predictors of firearm assault among young Black men ages 18 to 44 in Arkansas. Descriptive analyses of data were performed for patient demographics (age, marital status, residential location, etc.), injury, and health care information (hospital charges, length of stay, mortality, time, day and season of injury, etc.). Logistic regression analysis was performed to identify significant predicting factors for firearm assault among this population. Most of the sample survived firearm assault injury, were ages 18-35, were not married, resided in Central Arkansas, and were admitted to a Central Arkansas hospital during night hours on weekends. The majority had a short hospital stay, and total charges exceeded $34 million during the study observation years. Most patients had no diagnosis of a mental disorder, and a little less than half had drug use disorders. Being ages 18-25, living in the Central region of Arkansas, and being married were all significant predictors of firearm assault for this population. Death was also significantly associated with firearm assault. Our findings lay the groundwork for understanding firearm assault injury among young Black men in Arkansas. Research should be expanded to examine other important data sources for firearm assault and to further explore the context of predicting factors, in order to provide a more comprehensive understanding of firearm assault and to better inform future prevention efforts.

Background: A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths., Methods: This study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination., Results: Using theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency., Conclusions: This immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population., (© 2022. The Author(s).)

Introduction: We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions., Methods: We conducted a scoping review following the Arksey and O'Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded., Results: Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions ( n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions ( n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake ( n = 5), parental feeding practices ( n = 3), and screen time ( n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.

Introduction: Latino farmworkers lack access to basic needs, including health care services. These farmworkers face barriers common to rural areas (eg, limited health services and public transportation), as well as language barriers, an unfamiliar medical system, no health insurance, and income-based financial challenges exacerbated by a lack of workers' rights., Methods: This study involved focus group discussions to elicit community health priorities and barriers to health care service use among Latinos in rural farm working communities, as well as participants' ideal model for health care services delivery. Free mobile clinics were subsequently implemented at locations and times the community identified as ideal, and pre- and postinterviews of patients' experiences utilizing clinic services, and perceptions of access barriers, were conducted., Results: Results from focus group discussions (n = 82) and one-on-one interviews (n = 15) to evaluate mobile clinic health care services use confirmed documented barriers to health care for this population, shed light on structural and cultural barriers to service access, and suggested innovative models for service delivery to Spanish-speaking Latino farmworkers in rural communities. These models should (1) provide care within farm working communities, (2) offer services at times outside of business hours, and (3) encourage provider immersion in patient communities to better understand their health care needs., Discussion: Traditional models of care that expect patients to access health care services at brick and mortar structures are impractical for Latino farmworkers in rural communities. Innovative models bringing health care services to community spaces can reduce access barriers and emergency department utilization and improve health outcomes for this structurally vulnerable population., (© 2020 National Rural Health Association.)

Despite growing recognition of the high rates of sexual violence experienced by men serving in the U.S. military, male victimization, specifically sexual assault in military (SAIM), is an understudied topic. We qualitatively describe servicemen's awareness and perceptions of male SAIM, and their understanding of common barriers to servicemen reporting sexual assault. Participants included Midwestern Active Component and Reserve and National Guard servicemen, actively serving or Veteran, who had returned from Iraq or Afghanistan deployments during Operation Enduring/Iraqi Freedom eras. Eleven focus groups were held with 34 servicemen (20 Reserve/National Guard and 14 Active Component). Qualitative analyses used inductive and deductive techniques. Servicemen reported a lack of awareness of male SAIM, a tendency to blame or marginalize male victims, and substantial barriers to reporting sexual assault. Reserve/National Guard participants emphasized barriers such as a perception of greater stigma due to their unique status as citizen-soldiers, an ethos of unit conformity and leadership modeling, and a lack of confidence in leadership and the SAIM reporting process. In contrast, Active Component servicemen emphasized the deployment location and sex of victim and perpetrator as key reporting barriers. Findings make an important contribution to the scant literature on risk and protective factors for male SAIM and servicemen's perceptions of sexual violence and assault reporting barriers by their service type and location. This work has implications for routine screening for sexual violence experiences of male service members and Veterans. Providers' knowledge of gender stereotypes regarding sexual assault, assault risks and experiences of deployed servicemen, and potential barriers to SAIM disclosure is vital for patient-centered care delivery. Additional research to address factors that influence post-SAIM care engagement of males is indicated.

Background: The prevalence of obesity among children remains high. Given obesity's significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them., Methods: In partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program., Discussion: We outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.

Background: Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations., Methods: This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid., Results: In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices., Conclusions: Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure., (Copyright © 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Background: Institutions of higher education are increasingly attending to the health of their campus community. This article reports on a Healthy Campus Initiative (HCI) to build a culture of health., Objectives: Evaluate the applicability of the four action areas of the Robert Wood Johnson Foundation Culture of Health Framework to campus health and discuss challenges and lessons learned., Methods: Observational, qualitative, and quantitative data were collected to describe partnership development, key stakeholder engagement, and stakeholder perceptions of healthy campus activity between 2016 and fall 2018., Results: This initiative aligned with 3 of the four action areas of the Culture of Health Framework by making campus health as a shared value, fostering campus and local community collaborations, and creating a healthier and more equitable campus community., Conclusions: For institutions of higher education, the Culture of Health Framework is ideal to engage stakeholders to take action to create and build cultures of health.

In this study, we examined the sociocultural factors underlying infant feeding practices. We conducted four focus groups with 19 Latina mothers of children 0 to 2 years of age enrolled in Early Head Start programs in the United States over a 1-year period. We found these mothers considered both science- and family-based feeding recommendations. However, advice from family was often inconsistent with science- and nutrition-based recommended feeding practices. In the interest of showing respect and preserving harmonious relationships, some mothers accepted family advice instead of recommended practices while others employed strategies to follow recommended practices without offending. Nutrition educators need to consider the intersection of macro, organizational, and community factors with micro-level processes in shaping the implementation of recommended feeding practices within family systems. Nutrition interventions for Latino families should capitalize on Latina mothers' strategies for navigating multiple information sources while preserving cultural values and family relationships., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Thousands of Mexicans and Central Americans settle in communities along the borderlands between Mexico and the United States. Many live and work in rural communities characterized by poverty and limited access to basic resources. Drawing on qualitative research, this article reports on inequalities and health among foreign-born Latinos in rural borderland communities. From 2015 to 2016, the study team conducted research in Inland Southern California's Eastern Coachella Valley with Mexican farmworkers, farmworker advocates, community leaders, healthcare service providers, and local political leaders. The analysis of field notes and interviews demonstrates how situational and temporal factors position this foreign-born population as vulnerable to inequalities across multiple social systems resulting in low social status, lack of employment and housing stability, and limited access to healthcare services. Over time, the experience of both situational life events and persistent and daily chronic strain infringes on self-concept, including mastery or control over life and self-worth, and contributes to stress and subsequent poor mental health outcomes (e.g., depression). The research calls for local community action, healthcare policy change, and further in-depth research on structural inequalities in health among foreign-born Latinos., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Scholars have traced the processes through which moral subjectivities are constituted in culturally meaningful ways through eating disorders and recovery practices, demonstrating how subjective meanings of eating disorders and recovery from them are imbued with moral undertones and become meaningful ways of existing within specific historical and cultural contexts. Drawing on ethnographic insights and interviews with young women with disordered eating histories in southern Italy, we show how suffering from eating disorders and recovery from them enables women to retool their identities and craft moral selves. We draw attention to the value of medical anthropology in the care and comprehension of well-being of girls and women suffering from disordered eating., (© 2018 by the American Anthropological Association.)

Background: Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services., Methods: Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans' barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior., Results: Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services., Conclusions: These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans' mental health-seeking behaviors.

In this article, we examine methamphetamine (meth) use initiation as influenced by Latinas' social positions within institutions (e.g., family and economy). We conducted ethnographic fieldwork in five women's residential substance use treatment facilities in Los Angeles County with women who considered meth to be their primary drug of choice. Using an urban ethnographic framing, we demonstrate the effects of low-income young Latinas' spatial- and social-context rendered vulnerability to abuse and neglect, and the resulting emotional distress, on meth use initiation. When considering pathways to substance use intervention for vulnerable Latina girls and women, clinicians, researchers, and policy makers need to understand substance use pathways as dynamic processes to cope with psychosocial stress while living in communities with easy access to illicit substances such as methamphetamine.

This theoretical treatise uses the scientific literature concerning help seeking for mental illness among those with a background in the U.S. military to posit a more complex definition of military culture. The help-seeking literature is used to illustrate how hegemonic masculinity, when situated in the military field, informs the decision to seek formal treatment for mental illness among those men with a background in the U.S. military. These analyses advocate for a nuanced, multidimensional, and situated definition of U.S. military culture that emphasizes the way in which institutional structures and social relations of power intersect with individual values, beliefs, and motivations to inform and structure health-related practices.

Objective: Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches., Methods: Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data., Results: Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness., Conclusions: Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population.

Background: African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States., Objectives: We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state., Methods: Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas., Results: Numerous important themes emerged from participants' narratives, including chronic involvement with the criminal justice system (being a "career criminal"), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.

Background: Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery., Objectives: This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns., Methods: The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery., Results: The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety., Conclusions: Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Objective: Millions of disadvantaged youth and returning veterans are enrolled in community colleges. Our objective was to determine the prevalence of mental disorders and help-seeking behaviors among community college students., Methods: Veterans (n=211) and non-veterans (n=554) were recruited from 11 community colleges and administered screeners for depression (PHQ-9), generalized anxiety (GAD-7), posttraumatic stress disorder (PC-PTSD), non-lethal self-injury, suicide ideation and suicide intent. The survey also asked about the perceived need for, barriers to and utilization of services. Regression analysis was used to compare prevalence between non-veterans and veterans adjusting for non-modifiable factors (age, gender and race/ethnicity)., Results: A large proportion of student veterans and non-veterans screened positive and unadjusted bivariate comparisons indicated that student veterans had a significantly higher prevalence of positive depression screens (33.1% versus 19.5%, P<.01), positive PTSD screens (25.7% versus 12.6%, P<.01) and suicide ideation (19.2% versus 10.6%, P=.01). Adjusting for age, gender and race/ethnicity, veterans were significantly more likely than non-veterans to screen positive for depression (OR=2.10, P=.01) and suicide ideation (OR=2.31, P=.03). Student veterans had significantly higher odds of perceiving a need for treatment than non-veterans (OR=1.93, P=.02) but were more likely to perceive stigma (beta=0.28, P=.02). Despite greater need among veterans, there were no significant differences between veterans and non-veterans in use of psychotropic medications, although veterans were more likely to receive psychotherapy (OR=2.35, P=.046)., Conclusions: Findings highlight the substantial gap between the prevalence of probable mental health disorders and treatment seeking among community college students. Interventions are needed to link community college students to services, especially for student veterans., (Copyright © 2016. Published by Elsevier Inc.)

Background: The Department of Veterans' Affairs (VA)/Student Partnership for Rural Veterans (VSP) built partnerships between institutional (health services researchers, VA chaplains) and community groups to develop veteran-to-veteran services on college campuses., Objectives: Describe challenges and lessons learned in year 1 of the VSP project at six campuses in rural Arkansas., Methods: Researchers leveraged established community advisory boards (CABs) to develop veteran-to-veteran services. Ethnographic and qualitative methods were used to assess partnership building and evaluate peer-led services., Results: Local established CABs and buy-in from student services and veteran organizations was instrumental to building partnerships and developing services. Challenges included developing rapport with campus leaders and creating sustainable role/expectations for student veteran leaders., Conclusions: Peer-led services are an ideal way to connect student veterans and link them to resources and health care services. Partnerships can facilitate grassroots efforts to develop local services that meet the needs of diverse student veteran populations.

Objective: To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization., Study Design: Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress)., Principal Findings: In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital-based treatment (OR = 1.29) were positively associated with perceived need among all users., Conclusions: Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking., (© 2014 National Rural Health Association.)

Objective: The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas., Methods: Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group., Results: Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful., Conclusions: These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.

Background: The Theory of Planned Behavior (TPB) can provide insights into perceived need for cocaine treatment among African American cocaine users., Methods: A cross-sectional community sample of 400 (50% rural) not-in-treatment African-American cocaine users was identified through respondent-driven sampling in one urban and two rural counties in Arkansas. Measures included self-reports of attitudes and beliefs about cocaine treatment, perceived need and perceived effectiveness of treatment, and positive and negative cocaine expectancies. Normative beliefs were measured by perceived stigma and consequences of stigma regarding drug use and drug treatment. Perceived control was measured by readiness for treatment, prior drug treatment, and perceived ability to cut down on cocaine use without treatment., Findings: Multiple regression analysis found that older age (standardized regression coefficient β=0.15, P<0.001), rural residence (β=-0.09, P=0.025), effectiveness of treatment (β=0.39, P<0.001), negative cocaine expectancies (β=0.138, P=0.003), experiences of rejection (β=0.18, P<0.001), need for secrecy (β=0.12, P=0.002), and readiness for treatment (β=0.15, P<0.001) were independently associated with perceived need for cocaine treatment., Conclusions: TPB is a relevant model for understanding perceived need for treatment among African-American cocaine users. Research has shown perceived need to be a major correlate of treatment participation. Study results should be applicable for designing interventions to encourage treatment participation., (Copyright © 2014. Published by Elsevier Ltd.)

In this study we examined how social processes, specifically the acquisition of postsecondary education and capital, shaped perceptions of sexual risk and impacted sexual practices and sexual health among young adults. Using qualitative research methods we collected and analyzed data among students attending a 4-year university in the northeastern region of the United States over a 1-year period. By analyzing participants' narratives, we found that the reproduction of shared norms and values encouraged educated young adults to focus on educational and professional success, pressing many of them to be concerned about preventing pregnancy rather than preventing disease transmission, and increasing their risk for sexually transmitted infections, including HIV/AIDS. Sexual-health educators need to address how social processes shape sexual practices, encourage educated young adults to challenge unequal gender expectations, and consider how sexually transmitted infections might also interfere with life plans., (© The Author(s) 2014.)

The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between "the pew" and "the couch."

Background: The Mental Health-Clergy Partnership Program established partnerships between institutional (Department of Veterans' Affairs [VA] chaplains, mental health providers) and community (local clergy, parishioners) groups to develop programs to assist rural veterans with mental health needs., Objectives: Describe the development, challenges, and lessons learned from the Mental Health-Clergy Partnership Program in three Arkansas towns between 2009 and 2012., Methods: Researchers identified three rural Arkansas sites, established local advisory boards, and obtained quantitative ratings of the extent to which partnerships were participatory., Results: Partnerships seemed to become more participatory over time. Each site developed distinctive programs with variation in fidelity to original program goals. Challenges included developing trust and maintaining racial diversity in local program leadership., Conclusions: Academics can partner with local faith communities to create unique programs that benefit the mental health of returning veterans. Research is needed to determine the effectiveness of community based programs, especially relative to typical "top-down" outreach approaches.

This article examines lifetime sexual assault (LSA) and mental health history as risk factors associated with body mass index (BMI) in a population of women veterans. This cross-sectional study of a retrospective cohort of 948 Veterans Affairs (VA)-enrolled midwestern enlisted rank women veterans included computer-assisted telephone interviews. Findings show that 33.4% of the participants had a BMI of 30.0 or more meeting the criteria for obesity and 62.5% reported lifetime attempted or completed sexual assault. Greater BMI was positively associated with older age, less education, LSA, depression, and borderline personality disorder (BPD) and negatively associated with current substance use disorder in multivariate models. Mediation analysis found that the relationship between sexual assault and BMI was completely mediated by BPD and depression. Interventions should combine physical and mental health care in gender-specific services for overweight women veterans with trauma histories and mental health conditions.

This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God's will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.

This study is one of the first to examine the narrative links connecting social change, contested gender norms, body image, and eating disordered practices among southern Italian women. The research is based on 16 months of fieldwork, and I compare and contrast the stories of 23 educated women in southern Italy to highlight the contentious realities of entering adolescence in conservative social contexts where gender relations and value systems are undergoing rapid transformations. I examine how these young women dealt with conflicting cultural expectations of womanhood and whether it affected their emotional, psychological, and physical well-being. Their stories shed light on how parental control, community surveillance, and conflicts in developing gender identities and maturing womanly bodies contributed to their emotional distress. Distressed young women used rebellion and manipulation and control of food and the body to negotiate unjust social relations, specifically gender relations, that delegitimized their selves and, in some cases, their bodies.

In this article, I present the findings from an ethnographic study of 18 women college students living in the northeastern United States. I examine how ethnically diverse women dealt with the messages of the dominant White society's obsession with thinness, and whether it affected their perceptions of an ideal body image. From the analysis of the interviews, I identified and extracted several themes related to ethnicity, aesthetic body ideals, body dissatisfaction, and disturbed eating. Grounded in the women's narratives, I found that ethnically diverse women coming of age in American society experience anxieties and emotional stress as they related to others in their daily lives. Their stories shed light on how the body is a vehicle for social mobility and is used by women from marginalized identities to strategically negotiate social inequalities embedded in daily social relationships and interactions that more privileged women do not encounter.

Orthopedic surgical procedures requiring a long period of time in the operating room and in recuperation can often result in pressure ulcers of the heels. These are among the ulcers most difficult to heal; therefore, prevention is important. Instituting pre- and postoperative patient education, elevating the heels off the mattress, and using heel protectors resulted in 30 patients with total hip replacement having no pressure ulcers of the heels.