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The University of South Florida, College of Public Health, is dedicated to providing career planning and professional development services for students in varying formats. However, changing public health training needs and an emerging need for focused attention on professional development necessitated the development of an evaluative program to better understand our students’ needs in these areas. Specifically, anecdotal student feedback about feeling unprepared professionally and survey feedback from students, preceptor feedback regarding the need for students to be better trained in core professional concepts, and low rates of attendance in standard professional development events resulted in a quality improvement study to identify students’ perceived career planning and professional development needs. Findings were used to redesign current services and provided the basis for developing more targeted trainings to ensure that public health graduates are better prepared to meet employer expectations and to excel in the workforce. This article provides an overview of this transformative process, including the results of the qualitative survey on student, faculty, alumni, and community preceptor perspectives, and resulting prototypes developed for the professional development pilot along with preliminary insights.

Latinos in the United States represent a disproportionate burden of illness and disease and face barriers to accessing health care and related resources. Culturally tailored, evidence‐based interventions hold promise in addressing many of these challenges. Yet, ensuring patient voice is vital in the successful development and implementation of such interventions. Thus, this paper examines the application of analytic hierarchy process (AHP) to inform the augmentation and implementation of an evidence‐based chronic disease self‐management programme for underserved Latinos living with both minor depression and chronic illness. The process of AHP allows for direct input from the individuals that would utilize such a programme, including afflicted individuals, their family members and the health educators/promotores that would be responsible for implementation. Specifically, 45 participants, including 15 individuals with chronic disease, 15 family members/caregivers and 15 promotores, partook in the Stakeholder Values Questionnaire, which elicited preferences and values regarding major goals, processes and content for the intervention. AHP was employed to analyse pairwise comparison ratings and to determine differences and similarities across stakeholder groups. This analytical technique allowed for the adaptation of the EBI to stakeholders' specific priorities and preferences and facilitated complex decision‐making. Findings not only shed light on similarities and differences between stakeholder groups, but also the magnitude of these priorities and preferences and allowed the intervention to be driven by the participants, themselves. Applying AHP was a unique opportunity to optimize the decision‐making process to inform cultural adaptation of an EBI while considering multiple viewpoints systematically.

The COVID-19 pandemic is highlighting deep-rooted health inequities. While the virus itself does not discriminate, gaps in access to services and disparities in health outcomes are prevalent. Concerns over worsening mental health outcomes and increases in family violence exist. Thus, service organizations have faced an unprecedented call to rethink services, with many transitioning to virtual programming to ensure the needs of their clients can be met. This brief highlights lessons learned as one organization pivoted to meet critical client needs during the COVID-19 pandemic. Evidence suggests atypically high engagement and retention in family education and family violence reduction programming under Safer at Home orders when compared with pre-COVID engagement. Findings suggest key tenants for program success are tied to strong programming, staff engagement, and participation retention and satisfaction. Program adaptations create opportunities for increasing service equity, improving engagement and satisfaction, and improving family and mental health outcomes by maintaining connections, while providing a model for delivering services to reduce child maltreatment during times of social isolation and increased hardship.

Public health and global health practitioners need to develop global health diplomacy (GHD) skills to efficiently work within complex global health scenarios, such as the current coronavirus disease (COVID-19) pandemic. Problem-based learning was used as a framework to create a scenario-based activity designed to develop GHD-related skills. The application and effectiveness of this scenario-based activity to develop GHD-related skills were assessed. A mixed-methods approach involving a self-administered survey and one focus group discussion was used. The survey collected baseline participant characteristics as well as understanding and improvements in GHD-related skills using a 5-point Likert scale. The focus group was audio-recorded and thematically analyzed using both inductive and deductive codes. Data integration was achieved by connecting and weaving. Method and investigator triangulation techniques were used. Participants self-reported significantly better postscenario-based activity responses when asked about their understanding of diplomacy, negotiation, communication, and how to address public health emergencies (P < 0.01, Wilcoxon signed rank test). Most participants either agreed or strongly agreed that their GHD-related skills improved with participation in the scenario-based activity (diplomacy = 55.6%; negotiation = 66.5%; communication = 72.2%; addressing public health emergencies = 72.1%). Overall, qualitative data were consistent with results obtained using quantitative methods. The scenario-based activity was effective for improving the self-reported understanding of GHD-related skills. The scenario-based activity was also effective for developing the selected GHD-related skills (as self-reported). This scenario-based activity is likely to reduce cognitive load and avoid participant overload, thereby facilitating learning. Further research is required to elucidate its long-term impact on skills development.

Background The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.

While fertility is a widely studied public health issue, infertility among college students is rarely examined. Research on fertility among college students focuses primarily on pregnancy prevention. Often constructed as hyper-fertile, cohorts of women in graduate studies are struggling with fertility issues and left to suffer in silence.

Hispanic Americans are the fastest growing minority group in the United States. They face a distinct set of health challenges, resulting in persistent health disparities. Chronic disease self-management programs hold promise in addressing individual-level, behavioral risks factors, such as dietary habits and physical activity patterns. In light of the unique barriers Hispanic men face, including low participation in evidence-based health intervention research, this article argues for a gendered perspective when approaching Hispanic men’s physical and mental health needs. Through the analysis of data collected from male-only focus groups ( N = 3, n = 15) with Hispanic Americans in west central Florida, this study identified that masculine identity is influenced by chronic disease and comorbid depression status. Diagnosis with a chronic disease and/or depression is accompanied by lifestyle adaptations, activity restrictions, and changes in income and health care demands that can undermine traditional notions of Hispanic masculinity. Consequently, masculine identity is associated with self-management strategies in complex ways. Public health interventions aimed at addressing comorbid chronic disease and depression among Hispanic men must take into consideration the role of gender identity and relevant conceptualizations of masculinity in order to better serve this underserved and understudied population.

To understand the positives and negatives of online dating according to the lived experience of older women, telephone interviews were conducted with 45 women ages 50+ who date online. Interviews were audio recorded, transcribed verbatim, and thematically team coded. The opportunity to expand one's social network for both friendships and romantic partners, the ability to control dating risks and pace of relationship formation, and knowing more about one's partner were significant reported benefits of online dating. Dating online also includes unique risks, such as pervasive lying, attempted financial exploitation in the form of scammers, and unwanted electronic sexual aggression.

Public health professionals have been challenged to radically reform public health training to meet evolving demands of twenty-first century public health. Such a transformation requires a systems thinking approach with an interdisciplinary focus on problem solving, leadership, management and teamwork, technology and information, budgeting and finance, and communication. This article presents processes for implementing and evaluating a revised public health curriculum and outlines lessons learned from this initiative. To date, more than 200 students have participated in the initial pilot testing of this program. A rigorous process and outcome evaluation plan was developed and employed. Results from the evaluation were used to enhance the resulting curriculum. Specifically, all instructional materials were evaluated by both the students who received the materials and the faculty who presented the materials. As each successive pilot is delivered, both enrollment and faculty involvement has increased. Through this process, the value of committed faculty, the importance of engaging learners in the evaluation of an education program, and the need to implement curriculum that has been carefully evaluated and evidence-informed in nature has emerged. We credit our successful transformation of the Masters in Public Health core to the challenge provided by the Framing the Future task force, the commitment of our College of Public Health leadership, the engagement of our faculty, and the time we allowed for the process to unfold. Ultimately, we believe this transformed curriculum will result in better trained public health professionals, interdisciplinary practitioners who can see public health challenges in new and different ways.

In the twenty-first century, the dynamics of health and health care are changing, necessitating a commitment to revising traditional public health curricula to better meet present day challenges. This article describes how the College of Public Health at the University of South Florida utilized the Intervention Mapping framework to translate revised core competencies into an integrated, theory-driven core curriculum to meet the training needs of the twenty-first century public health scholar and practitioner. This process resulted in the development of four sequenced courses: History and Systems of Public Health and Population Assessment I delivered in the first semester and Population Assessment II and Translation to Practice delivered in the second semester. While the transformation process, moving from traditional public health core content to an integrated and innovative curriculum, is a challenging and daunting task, Intervention Mapping provides the ideal framework for guiding this process. Intervention mapping walks the curriculum developers from the broad goals and objectives to the finite details of a lesson plan. Throughout this process, critical lessons were learned, including the importance of being open to new ideologies and frameworks and the critical need to involve key-stakeholders in every step of the decision-making process to ensure the sustainability of the resulting integrated and theory-based curriculum. Ultimately, as a stronger curriculum emerged, the developers and instructors themselves were changed, fostering a stronger public health workforce from within.

Twenty-first century health challenges have significantly altered the expanding role and functions of public health professionals. Guided by a call from the Association of Schools and Programs of Public Health’s (ASPPH) and the Framing the Future: The Second 100 Years of Education for Public Health report to adopt new and innovative approaches to prepare public health leaders, the University of South Florida College of Public Health aimed to self-assess the current Masters of Public Health (MPH) core curriculum with regard to preparing students to meet twenty-first century public health challenges. This paper describes how Intervention Mapping was employed as a framework to increase readiness and mobilize the COPH community for curricular change. Intervention Mapping provides an ideal framework, allowing organizations to access capacity, specify goals, and guide the change process from curriculum development to implementation and evaluation of competency-driven programs. The steps outlined in this paper resulted in a final set of revised MPH core competencies that are interdisciplinary in nature and fulfill the emergent needs to address changing trends in both public health education and challenges in population health approaches. Ultimately, the competencies developed through this process were agreed upon by the entire College of Public Health faculty, signaling one college’s readiness for change, while providing the impetus to revolutionize the delivery of public health education at the University of South Florida.

OBJECTIVES: Research indicates increasing trends among older adults toward heavy and abusive drinking, often associated with depressive symptoms. Possible exceptions are residents of planned retirement communities, whose drinking may be associated with social activities. To better understand these relationships, this study examined the relationship of depressive symptoms and drinking in a large retirement community. METHODS: The Villages, a retirement community in central Florida with a focus on healthy, active living, has almost 90 000 residents. In 2012, a population-based needs assessment was conducted in partnership with University of South Florida Health. In the present study, 11 102 surveys were completed and returned. A structural equation model was utilized to analyze the relationship between depressive symptoms and alcohol use as measured by the three-item Alcohol Use Disorders Identification Test (AUDIT-C). RESULTS: Hazardous drinking was reported in 15.4% of respondents, somewhat higher than the general population of older adults (around 10%). Variables of depressive symptoms, physical activity, total health problems, and poor general health loaded significantly into the factor of depression indicators, which was shown to have a significant, negative correlation with risk of hazardous drinking (λ = 0.16, p CONCLUSIONS: Results suggest at-risk drinking among respondents was not associated with depression, in contrast to studies of older adults living alone where alcohol abuse was often associated with depression. Implications for successful aging are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Language: en

In contrast to younger populations, little attention has been paid to the increase in seniors using Internet-based venues to find relationships and the potential risk for adverse outcomes this poses. This study examined data collected via an online survey from 45 ethnically diverse women aged 50+ "seeking relationships" on MySpace. The majority of women reported a relationship with someone they met online (85%). They also reported experiencing adverse events including financial exploitation (40%), threats (55%), and physical harm (38%) by someone they met online at levels greater than traditional relationship seeking in the general population. Directions for future research are explored.

Informal caregiving can be fundamental to disease management. Yet, the psychosocial, physical, and financial burden experienced by caregivers can be significant. In the US, Latinos experience increasing rates of chronic conditions, the highest uninsured rates in the country, and a growing dependence on informal caregivers. This article explores the impact of caregiving on caregivers of individuals with comorbid chronic disease and depression. Findings highlight the impact of caregiving on financial insecurity, balancing competing demands, increased emotional distress, and community supports. Findings support the inclusion of caregivers in disease management programs to enhance psychosocial outcomes for both caregivers and their patients.

The co-occurrence of depression and chronic diseases is often under-recognized, under-treated, and under-studied. Among Latinos, complex structural and cultural barriers exist which complicate the translation of chronic disease self-management programs (CDSMP) for this population. To better understand those barriers and deliver a CDSMP designed to best meet local needs, a community-based, mixed methods study was designed. Formative research was conducted through focus groups with Latinos with chronic illness and minor depression (ICD) and family members to obtain insight into perceived needs and interviews with stakeholders to assess barriers and facilitators to the adoption of CDSMPs. Analytic Hierarchy Process was employed to determine core elements of a CDSMP for ICDs, family members, and the promotores who deliver these programs. Findings guided the transcreation of a CDSMP. This study offers a promising model for enhancing the effects of evidence-based interventions and emphasizes the importance of meeting differing needs within the local population.

The purpose of this paper is to share lessons learned from a collaborative, community-informed mixed-methods approach to adapting an evidence-based intervention to meet the needs of Latinos with chronic disease and minor depression and their family members. Mixed-methods informed by community-based participatory research (CBPR) were employed to triangulate multiple stakeholders' perceptions of facilitators and barriers of implementing the adapted intervention in community settings. Community partners provided an insider perspective to overcome methodological challenges. The study's community informed mixed-methods: research approach offered advantages to a single research methodology by expanding or confirming research findings and engaging multiple stakeholders in data collection. This approach also allowed community partners to collaborate with academic partners in key research decisions.

In this paper, we use game theory to understand decisions to cooperate or to compete in the delivery of public health services. Health care is a quasi-public good that is often associated with altruistic behavior, yet it operates in an increasingly competitive environment. With mounting health care regulation and changes in privatization, altruistic arguments give way to more competitive rationales for market decisions. Profit and not-for-profit institutions must address widespread health care needs while balancing the needs of more lucrative markets against the needs of lesser ones. Recognizing the roles of cooperation and competition as motivators in the delivery of health care to the public is imperative. We explore two game theory models (Nash's Equilibrium and the Prisoner's Dilemma) and their related concepts of simultaneous interdependence and rationality to examine decision-making. Four hypothetical public health case studies are presented. We conclude that understanding game theory and t...

Only 41% of eligible Ethiopian women completed (PMTCT) therapy in 2012, with MTCT rate of 20%.This study elicited the perspectives of HIV positive mothers on the situation and the unique beliefs, attitudes, cultural norms and individuals who have influence over them during their pregnancy.The mixed-methods parent study included community level surveys, focus groups and in-depth individual interviews of HIV positive women with a child at least one year of age in Addis Ababa, Ethiopia: only focus group and interview data are presented here. All tools were completed in Amharic with English translation.23 women completed in-depth interviews; 27 participated within 4 focus groups. The greatest barriers to PMTCT completion were: feelings of hopelessness and carelessness, lack of understanding of the efficacy of ARV, and negative religious influences. The advice to improve PMTCT adherence most frequently offered included increasing PLWHIV peer support and improving and extending current HIV educational efforts. Participants recommended that PLWHIV mothers be utilized in all PMTCT planning and interventions in the future.Maintaining the motivation to adhere to the entire PMTCT cascade requires that a PLWHIV mother understands the validity of the steps she is taking and receives support for the many challenges she faces. Engaging PLWHIV peers as active members of the health care workforce and expanding their use as educators and counselors is important. Health officials can consider these findings to develop innovative and effective PMTCT interventions.

Compared with non-Latino Whites, Latino immigrants have a lower prevalence of depression. However, they are also less likely to seek professional mental health services. Our objective was to compare and contrast perceptions of depression and access to mental health care among four of the largest Latino immigrant subgroups in Florida (Puerto Rican, Cuban, Mexican, and Colombian). We conducted a total of 120 interviews (30 men and women from each subgroup). Thematic analysis of qualitative data revealed that participants across the four groups were aware of the signs and symptoms of depression and had similar perceptions of depression. However, notable differences by subgroup emerged with regard to perceptions of access to mental health care. We suggest that the variation stems from differences in life experiences and the immigration context. Understanding the variances and nuances of Latino immigrants’ cultural construction of depression and immigration experience will enable practitioners to better serve this community.

Introduction Although hookah smoking is becoming a source of tobacco use among college students in the United States, little is known of the students’ knowledge, attitudes, and practices regarding hookah use. This cross-sectional study was aimed at determining the prevalence of hookah use and describing social and behavioral factors associated with hookah smoking among university students in a large urban university in Florida. Methods A convenience sample of 478 undergraduate and graduate students was recruited. Lifetime use and current use was evaluated. Logistic regression modeling was used to assess the independent association between study covariates and hookah use. Results Prevalence among students of having ever used hookah during their lifetime was 54.4%. Hookah use within the past 30 days was 16.3%. Hookah use was significantly associated with cigarette smoking (odds ratio [OR], 4.52; 95% confidence interval [CI], 2.13–9.60) and hookah ownership (OR, 10.67; 95% CI, 4.83–23.66) but not with alcohol use (OR, 1.73; 95% CI, 0.74–4.04). Findings also suggest hookah is perceived as a safer alternative to cigarette smoking. Almost 30% of those who never smoked hookah reported they would consider smoking hookah in the future. Conclusion Hookah smoking is popular among college students. Misperceptions associated with hookah use indicate a starting point for developing health behavior change interventions. Future studies should investigate social and behavioral determinants of hookah use and determine the incidence of hookah use among college and high school students. Tobacco control activities should include prevention of hookah tobacco use in university settings.

Background: Elder mistreatment is a serious issue affecting between 300,000 and 800,000 older adults. Elder mistreatment has serious consequences for older adults and can include immunological dysfunction, increased mortality and emotional difficulties such as depression, feelings of inadequacy and self-contempt. Sub-groups such as persons with Alzheimer’s disease have heightened risk for elder mistreatment, but it is not clear whether this heightened risk represents life-long patterns of abuse between persons or whether they represent a change in conflict style over time as a result of changes associated with dementia. Methods: Data analyzed in this study were collected as part of the Aggression and Violence in Community Based Alzheimer’s Study [AV-CAD] and represents patient caregiver/dyads who received care at one of five state funded medical clinics or who belonged to one of three local chapters of the Alzheimer’s Association. Data were collected via in-person interview and mailed survey, and changes in conflict resolution style (reasoning, verbal aggression and violence) pre and post dementia were measured using the Conflict Tactic Scale (CTS) and analyzed using McNemar’s Test. Results: Reasoning was used as a conflict resolution style in 91.4% of caregivers and 89.3% of elders prior to the onset of dementia and in 66.3% of caregivers and 45.3% of elders in the past year (post dementia diagnosis). Reasoning in the post dementia period was significantly related to use of reasoning in the pre dementia period for caregivers (X2=7.47, p=.0032) and approached significance for elders (X2=6.00; p=.057). Use of verbal aggression (VA) and violence (V) as a conflict resolution style post dementia was higher for both caregivers (VA: 59.3%; V: 16.8%) and elders (VA: 68.7%; V: 24%), but was not significantly related to behaviors in the pre-dementia period for caregivers (V: X2=1.55, p=.536; VA: X2=0.67, p=.528) or elders (V: X2=0.54, p=.628; VA: X2=0.43, p=.621) Conclusions: This study lends support to the idea that elder abuse in a large number of persons with Alzheimer’s disease may be in part a result of the etiology of the disease and is susceptible over time. Implications for policy, practice and future research are discussed.

Modeled upon the ecclesiastic community group concept of Latin America to unite and strengthen the bond between the Church and neighborhoods, a community-based organization created Vecinos Unidos por la Salud (Neighbors United for Health) to bring health messages into urban Latino neighborhoods. The model is based on five tenants, and incorporates Latino subjective norms to strengthen the bonds of group members with similar interest, lifestyles, language and acculturation.

Introduction. Understanding sexual behavior is important when evaluating the health needs of older adults. Little research has addressed the effect of specific health conditions on sexual inactivity in this growing population. Aim. The study aims to assess the association of mental and physical health conditions with sexual inactivity among adults 55 and older living in The Villages, Florida. Methods. Exposure data for 22 self-reported health conditions were assessed in relation to sexual inactivity in 22,654 participants ages 55 and older, including 1,879 participants over age 80 in a community-based cross-sectional study. Logistic regression analyses were conducted separately for men and women to evaluate the likelihood of being sexually active for each health condition. Covariates included age, race, education, income, self-reported overall health, and marital status. Main Outcome Measures. The odds ratio and 95% confidence intervals for sexual activity status were calculated separately for men and women. Results. Fifty-five percent of men and 45% of women reported being sexually active. Significant positive correlates of sexual activity included walking at least 1-2 times per week, participating in at least two registered clubs, engaging in physical and social activities, no tobacco use, fewer medications, increased alcohol consumption, and reporting a good quality of life, psychological well-being, or social support. Sexual inactivity was significantly related to cancer, bladder/bowl problems, major surgery, poor vision, mental health conditions, and cardiovascular disease and its risk factors including diabetes, hypertension, and high cholesterol. Additional associations with sexual inactivity included hearing loss and dementia for men, and dermatologic conditions, problems with the joints, bone or back, gastroin- testinal problems, alcohol misuse, chronic wound care, and gum disease in women. Conclusions. Mental and physical health conditions have very similar associations with sexual inactivity in men and women. Increased sexual activity was associated with positive physical, social, and emotional health indicators. Bach LE, Mortimer JA, VandeWeerd C, and Corvin J. The association of physical and mental health with sexual activity in older adults in a retirement community. J Sex Med **;**:**-**.

Physical mistreatment has been estimated to affect 2 million older persons each year and dramatically affects health outcomes. While researchers have attempted to examine risk factors for specific forms of abuse, many have been able to focus on only victim or perpetrator characteristics, or a limited number of psychosocial variables at any one time. Additionally, data on risk factors for subgroups such as persons with Alzheimer’s disease who may have heightened and/or unique risk profiles has also been limited. This paper examines risk for physical violence in caregiver/patient dyads who participated in the Aggression and Violence in Community-Based Alzheimer’s Families Grant. Data were collected via in-person interview and mailed survey and included demographics as well as measures of violence, physical and emotional health, and health behaviors. Logistic regression analysis indicated that caregivers providing care to elders with high levels of functional impairment or dementia symptoms, or who had alcohol problems, were more likely to use violence as a conflict resolution strategy, as were caregivers who were providing care to elders who used violence against them. By contrast, caregivers with high self-esteem were less likely to use violence as a conflict resolution strategy. Significant interaction effects were also noted.

Background: There are notable health disparities among Latinos in the US associated with chronic diseases (e.g., diabetes) and depression. Further, chronic diseases and minor depression tend to co-occur among Latino populations. This paper reports findings from a community-based participatory research study using dyadic focus groups with Latinos who have chronic disease and minor depression and their family members. The goal of this study was to better understand barriers and facilitators to chronic disease self-management among underserved Latinos living with both chronic illness and minor depression and their families using a socio-ecological approach. Methods: In total, five focus groups were conducted with individuals with chronic disease (n=25) and four with nominated family members (n=17). All focus groups were digitally recorded and transcribed by a professional transcription agency in Spanish. Transcripts were imported into Atlas.ti V 6.2 software program and analyzed in Spanish by a team of bilingual researchers using content analysis. Qualitative results are presented thematically by level of analysis or behavioral influence (i.e., individual, family, and community levels) and barriers and facilitators are discussed within each level. Results: Results revealed individual, family, and community level barriers (e.g., transportation, expressed emotion, and lack of health care providers) and facilitators to managing chronic disease and minor depression (e.g., acceptance, family support, and Spanish speaking support groups). Conclusion: Findings have important implications for the understanding of chronic disease management for Latinos and emphasize the need to use evidence based approaches that address barriers and facilitators across the social-ecological continuum.

Recovery narratives describe the culturally shared understandings about the ideal or desirable way to recover from an illness experience. This paper examines ethnic differences in recovery narratives among women participating in breast cancer support groups in Central Florida, USA. It compares groups serving African-American, Latina, and European American women, with the objective of better understanding the appeal of ethnic-specific illness support groups for culturally diverse populations.A mixed-method study design combined qualitative and quantitative measures, including in-depth interviews, participant observation at support group meetings, collection of printed documents, and a structured survey.Core elements of the recovery narrative drew from the dominant societal cancer discourse of optimism and personal transformation through adversity; however, important ethnic differences were evident in the meaning assigned to these themes. Groups gave distinctive salience to themes of faith and spirituality, empowerment through the migration experience, and becoming a better person through the journey of recovery.The findings suggest that ethnic cancer support groups draw upon dominant societal discourses about cancer, but they espouse distinctive recovery narratives that are consonant with the groups' cultural models of illness. Similarity between ethnic members' individual recovery narratives and that of the group may contribute to the appeal of ethnic illness support groups for culturally diverse populations.