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Introduction: Social determinants of health (SDoH) have been linked to poorer health outcomes and health disparities among patients (pts) with heart failure (HF). Attainment rates of selected SDoH indicators vary depending on the pt care environment. We sought to assess whether there are challenges in collecting SDoH indicators in an urban community clinic through a Plan-Do-Study-Act (PDSA) method of quality improvement (QI) using a physician-medical assistant team (PMAT). Methods: Using PDSA QI methodology, a trained PMAT tested use of an EHR-based survey to measure and record selected SDoH at each pt-visit over a span of four weeks. The survey includes questions about financial resource strain, housing stability, transportation needs, food insecurity and alcohol use. The target for improvement was input of SDoH indicators for 90% of consecutive patient visits. Successful completion of the survey required recording of responses for all SDoH measures. Results: Prior to the PDSA, SDoH indicators were collected in 51% of the pts seen between Jan 2019 and Dec 2020. Between April 26 and May 21, 2021, 114 pts were seen by the PMAT, with the SDoH indicators recorded in 88% of the pt-visits (n=101). Weekly rates ranged from 76.9%-100% (Week 1, 30/30 pts (100%); Week 2, 24/29 pts (82.7%); Week 3, 27/29 pts (93.1%); and Week 4, 20/26 pts (76.9%). Conclusion: The PMAT successfully increased measurement and recording of SDoH factors, although the target goal for improvement was not completely met 2 of the 4 weeks. Personnel substitutions and variable approaches to accessing the survey tool in the EHR resulted in smaller rates of improvement. Nonetheless the PDSA demonstrated the feasibility of increasing SDoH measurement. Expansion of the QI program will focus on clinic-wide staff training, standardization of SDoH assessment tool access in the EHR, and linking patients to resources with demonstrated social and economic needs identified by the SDoH survey tool.

Background: Hypertension (HTN) is the most potent cardiovascular disease worldwide and a major public health concern in the U.S. Although Social Determinants of Health (SDoH) are associated with HTN, it is unclear whether these indicators are routinely captured in the primary care setting. We sought to examine the prevalence of any HTN and its association with captured SDoH for new patients (pts) presenting to an urban community primary care clinic for 2019 and 2020. Methods and Results: We identified a cohort-based, cross-sectional sample of 2,577 new pts ≥ 18 years of age in a community clinic in Atlanta, GA, between Jan 2019 and Dec 2020. Electronic health records were reviewed to determine the rate of selected SDoH indicators (financial strain, transportation, medical transportation, and food insecurity) captured at any time and the presenting blood pressure for all new patients. Blood pressure was classified as follows: normal, systolic BP/diastolic BP (SBP/DBP) ≤120/80 mmHg, elevated SBP 120-129mmHg and DBP Conclusion: Routine assessments of SDoH for African American pts presenting for new pt visits are suboptimal in the primary care setting. However, financial strain and food insecurity are significantly associated with stage 1 and 2 HTN in this population. Standardization of intake processes is essential to increase the collection of SDoH indicators and may ultimately guide secondary prevention strategies for HTN interventions.

The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.

BackgroundHuman breastmilk contains pro- and anti-inflammatory compounds and hormones that can influence infant growth. However, little is known about the specific interrelationships between these compounds and whether their effects on infant growth may be influenced by pre-pregnancy weight status.ObjectiveThe purpose of this novel, prospective cohort study was to assess the interrelationships between pro-inflammatory cytokines (TNF-α, IL-6), hormones (insulin, leptin) and PUFAs (n-6, n-3) in blood and breastmilk in early postpartum between women with normal BMI (Group 1, n = 18; 18.5MethodsParticipants were robustly phenotyped along with their infants at 4-8 weeks postpartum. TNF-α, IL-6, insulin, leptin, and n-3 and n-6 PUFAs measured in blood and breastmilk and compared between pre-pregnancy BMI groups and with infant weight, length, head circumference and % fat mass.ResultsGroup 1 women had higher serum leptin (pConclusionsPro-inflammatory qualities of breastmilk were associated with infant growth measures regardless of maternal pre-pregnancy BMI. However, infants born to women with overweight or obesity demonstrated less responsive growth to breastmilk contents. More studies are needed to assess longitudinal effects of this impact.

BACKGROUND In 2010, the Louisiana Asthma Management and Prevention Program (LAMP) implemented the Asthma-Friendly Schools Initiative in high-risk Louisiana populations. The social ecological model (SEM) was used as a framework for an asthma program implemented in 70 state K-12 public schools over 2 years. METHODS Activities included a needs assessment, identification of students with asthma, individualized asthma action plans (AAP), staff trainings, environmental quality improvement, and school system policy changes to address the asthma burden. RESULTS There were 522 new or existing asthma cases recognized. Asthma knowledge/awareness was measurably improved among school personnel. School indoor air quality was improved across all locations. School-level polices were adopted that improved AAP collection, compliance to bus-idling restrictions, and asthma medication self-carry. CONCLUSIONS The SEM framework can be used for school-based programs to address successfully and improve asthma-related issues from the individual through policy levels.

Objective: Farmers’ markets are increas­ingly being promoted as a means to provide fresh produce to poor and underserved communities. However, farmers’ market (FM) use remains low among low-income patrons. The purpose of our study was to examine FM awareness and use, grocery shopping behaviors, and internet use among Supplemental Nutrition Assistance Program (SNAP) recipients.Design: A descriptive analysis of preliminary data was performed to evaluate quantita­tive baseline data among SNAP recipients between June and August 2016 in New Or­leans, Louisiana (N=51). Data were collected via a 42-item online survey that included demographics, internet use, FM awareness and use, health information seeking behaviors and fruit and vegetable purchasing behaviors.Results: Less than half of the survey respondents (n=24) had ever been to a FM. Local grocery stores and Wal-Mart were most used for purchasing fruits and vegetables (88% and 84%, respectively). The most common sources of healthy eat­ing information were Women, Infants and Children (WIC) and the internet, frequently accessed via smartphones. More than 80% of participants were not aware that local FMs accepted electronic benefit transfer payments as a form of payment.Conclusion: These results support the incorporation of promotional methodol­ogy that combines internet-based mobile technology and existing services (eg, WIC) as a viable strategy to improve farmers’ market use among low-income populations. As most participants were not aware that participating FMs accept electronic ben­efit transfer payments, this fact should be emphasized in promotional material.Ethn Dis. 2017;27(Suppl 1):295-302; doi:10.18865/ed.27.S1.295.

The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide. Significance for public health This brief report establishes the need for local farmers’ markets (FM) in New Orleans, Louisiana to distribute information to increase the awareness of the markets, especially among low-income individuals. A variety of the FMs in New Orleans offer discounts to increase access to fresh produce among underserved individuals. However, there is a lack of knowledge of these markets, the ability to utilize Supplemental Nutrition Assistance Program benefits to purchase food, and of the discounts offered. Furthermore, this assessment demonstrates that low-income individuals have adequate access to the internet and a variety of social media channels. Based on these results, our research establishes that cost-effective and efficient, web-based marketing could be used as means help increase FM participation among low-income individuals. Increasing awareness of FMs and discounts offered to low-income individuals is one step in creating better access to affordable produce, which could lead to increased fruit and vegetable consumption and better health outcomes among at-risk populations.

Background Adherence to self-management recommendations is critical for patients with chronic disease. Compared to nonsmokers, smokers with conditions such as diabetes, HIV, and heart disease are less likely to adhere to provider recommendations. Regarding lung disease, asthma and COPD can be caused and/or exacerbated by smoking, however little is known on the relationship between adherence and smoking status in these patients. The purpose of this study was to characterize the relationship between smoking status and adherence to multiple measures of self-care- including medication taking, medication filling, appointment keeping, yearly vaccinations, carrying medical supplies, and healthcare utilization- in patients with asthma and/or COPD. In addition to smoking status, we also included an examination of these measures by race/ethnicity, gender, and diagnosis. Methods This study employed a cross-sectional design on a convenience sample of n = 84 patients (40–64 years old) with a diagnosis of asthma and/or COPD. The study was conducted between November 2015 and February 2016 in the waiting rooms of the outpatient pulmonary clinics at the University Medical Center of New Orleans. Patients completed surveys while awaiting their clinic appointments. Smoking status, gender, race, and diagnosis were explored as predictors of adherence using descriptive statistics, chi square, and regression analyses. Results Compared to nonsmokers, smokers were less adherent to medication filling (p

Objective . Lack of health insurance is correlated with noncompliance in colorectal cancer screening. Louisiana ranks 48th among all states in residents with health insurance. This paper describes initial results of Louisiana’s first statewide colorectal cancer screening program. Methods . The program enhanced screening capacity of state hospitals by providing fecal immunochemical tests (FITs), colonoscopes, and funded patient navigators. The Social Ecological Model (SEM) was used as the framework for the program. Results . Patient navigators distributed 975 FITs to adults 50 to 64 years (21% men, 78% women).The overall return rate was 66%. There was no association among return rates, race, or gender. Participants who were previously screened (10.7%) were more likely to return their FIT. Discussion . The combination of patient navigation and providing patients with an easy-touse CRC screening option proved to be an effective method that potential colorectal cancer screening programs can deploy in similar populations of un- and under-insured adults.

Personal and public health information are often obtained from studies of large population groups. Risk factors for nutrients, toxins, genetic variation, and more recently, nutrient-gene interactions are statistical estimates of the percentage reduction in disease in the population if the risk were to be avoided or the gene variant were not present. Because individuals differ in genetic makeup, lifestyle, and dietary patterns than those individuals in the study population, these risk factors are valuable guidelines, but may not apply to individuals. Intervention studies are likewise limited by small sample sizes, short time frames to assess physiological changes, and variable experimental designs that often preclude comparative or consensus analyses. A fundamental challenge for nutrigenomics will be to develop a means to sort individuals into metabolic groups, and eventually, develop risk factors for individuals. To reach the goal of personalizing medicine and nutrition, new experimental strategies are needed for human study designs. A promising approach for more complete analyses of the interaction of genetic makeups and environment relies on community-based participatory research (CBPR) methodologies. CBPR's central focus is developing a partnership among researchers and individuals in a community that allows for more in depth lifestyle analyses but also translational research that simultaneously helps improve the health of individuals and communities. The USDA-ARS Delta Nutrition Intervention Research program exemplifies CBPR providing a foundation for expanded personalized nutrition and medicine research for communities and individuals.

The objective of this review is to explore how current research measures the effectiveness of inhaled corticosteroids (ICS) in smokers with asthma.PubMed, CINAHL and PsycINFO databases were searched for combinations of terms relating to asthma, tobacco use and ICS effectiveness.The search was limited to articles published between 2004 and 2015, in English language. Studies met inclusion criteria if reporting the use of guideline-based asthma control indicators to measure the therapeutic effects of ICS or ICS combination therapies. This review did not exclude articles based on study design. Data were extracted and summarized to describe how indicators were measured across studies in order to characterize and describe the effects of ICS in smokers.Thirteen studies were included in this review. Six of these 13 studies used only one indicator to measure asthma control in smokers and ICS was found to improve asthma in only one of six of these studies. Of studies evaluating combination therapy, three of four studies reported a therapeutic benefit to smokers. In these studies of combination therapy multiple indicators of control were measured to assess drug effects.To assess the therapeutic benefit of ICS drugs in smokers, multiple indicators should be measured to determine if current therapy is improving asthma control. Asthma therapy should then be adjusted based on the patient's current asthma status. The development of clinical treatment guidelines for asthmatic smokers may help clinicians make best-practice, evidence-based recommendations in order to optimize care for these patients.

IntroductionChildhood obesity is a growing worldwide epidemic. If currenttrends continue, 46% of children in North and South America areprojected to be overweight ( 85th percentile BMI for gender andage) by the year 2010 (Wang & Lobstein, 2006). Furthermore,overweight children and adolescents are more likely to becomeoverweight or obese adults (Baker, Olsen, & Sorensen, 2007;Bibbins-Domingo,Coxson,Pletcher,Lightwood,G Carruth et al., 1998;Cooke, 2007; Galloway, Lee, & Birch, 2003). This is particularlytroubling since current guidelines for dietary adequacy are morelikely to be met when a wide variety of foods are consumed on aregular basis (Carruth & Skinner, 2000).The Lower Mississippi Delta (LMD) is a region that has longbeen plagued by poverty and is possibly the poorest part of the US(USCommissiononCivilRights).InmanyLMDschooldistricts,80%or more of the students qualify for the federal free lunch program(US Commission on Civil Rights). Additionally, the diet quality ofadult LMD residents is significantly poorer than their nationalcounterparts according to Healthy Eating Index (HEI) scores(McCabe-Sellers et al., 2007). Based on the USDA MyPyramidguidelines, less than 16% and 25% of LMD adults met therecommended number of servings for fruits and vegetables

Although community-based participatory research (CBPR) principles stress the importance of "equitable partnerships" and an "empowering and power-sharing process that attends to social inequalities," descriptions of actual projects often focus on the challenges confronted in academic-community partnerships. These challenges occur in the context of economic and power inequities and the frequently limited diversity of researchers. Less often does this discourse attend to the link between the principles of CBPR and their empowering potential for community members who internalize and use these principles to hold outside partners accountable to these ideals.This article documents the participatory development and implementation of a community research workshop, the community and organizational contexts, the content of the workshop, and lessons learned. Workshop objectives included increasing community knowledge of the research process, positively impacting community members' perceptions and attitudes about research, and improving researchers' understanding of community knowledge, perceptions, and experiences with research.This project was conducted as a part of the larger United States Department of Agriculture, Agriculture Research Service (USDA ARS) Delta Nutrition Intervention Research Initiative (Delta NIRI). The workshop was developed by a joint academic-community team in partnership with a community-based workshop advisory committee (WAC) and implemented in three rural communities of the lower Mississippi Delta. Development included a dry run with the WAC, a pilot workshop, and a focus group to refine the final content and format.Applying participatory principles to the development of the community research workshop resulted in the creation of a mutually acceptable workshop and co-learning experience that empowered community members in their involvement in other community research projects.

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure children's willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test–retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbach's α ≥ 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5–14 years of age.