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Despite the availability of the human papillomavirus (HPV) vaccine, uptake has been sub-optimal among certain religious groups. Psychosocial factors (threat appraisal, coping appraisal, and attitudes) have been identified as independent determinants of HPV vaccination. However, their interdependent effects have not been tested. We examined the interdependency of these psychosocial factors in predicting HPV vaccination intention among Christian parents of unvaccinated adolescents (using a theory-driven conceptual model). A cross-sectional study of 342 participants showed that perceived self-efficacy (β = 0.2, 0.11-0.29, p =

Summary Background Lower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children. Objective To define normative reference ranges for non-invasive tests of bladder function in healthy, asymptomatic girls and adolescents. Study design A comprehensive search strategy was performed in seven electronic databases through October 2019. English-language studies reporting data on voiding frequency, voided and postvoid residual volumes (PVR) and uroflowmetry results in healthy, asymptomatic girls (mean age ≥ 5 years) were included. Two independent reviewers performed study review, data extraction, and quality assessment. Overall mean estimates and 95% confidence intervals for each bladder function parameter were calculated using random effects models, and 95% normative reference values were estimated. Results Ten studies met eligibility criteria for the meta-analysis (n = 2143 girls, age range: 3–18). Mean estimates of maximum voided volume and PVR were 233.4 ml (95% CI 204.3–262.6; n = 1 study) and 8.6 ml (95% CI 4.8–12.4; n = 2 studies) respectively. Pooled mean estimates for uroflowmetry parameters were: 21.5 ml/s (95% CI 20.5–2.5) for maximum flow rate (n = 6 studies), 12.5 ml/s (95% CI 11.2–13.8) for mean flow rate (n = 6 studies), 6.8 s (95% CI 4.4–9.3) for time to maximum flow (n = 3 studies), 15.7 s (95% CI 13.0–18.5) for flow time (n = 3 studies), and 198.7 ml (95% CI 154.2–234.2) for voided volume (n = 9 studies). No studies reported estimates of voiding frequency. Between-study heterogeneity was high (89.0–99.6%). Conclusions Although we were able to calculate pooled mean estimates for several parameters, the small number of included studies and the wide age ranges of participants preclude generalization of reference values to all healthy girls. Further research is needed to determine normative reference values within specific age groups.

Qualitative methods such as focus groups and interviews are common methodologies employed in participatory approaches to community health assessment to develop effective community health improvement plans. Oral histories are a rarely used form of qualitative inquiry that can enhance community health assessment in multiple ways. Oral histories center residents' lived experiences, which often reveal more complex social and health phenomena than conventional qualitative inquiry. This article examines an oral history research component of the Little Village Community Health Assessment, a collaborative research effort to promote health equity in an urban, Mexican ethnic enclave. We collected of 32 oral histories from residents to provide deeper, more grounded insight on community needs and assets. We initially used thematic data analysis. After analytic peer debriefings with the analysis team, we found the process inadvertently reductionist and instead opted for community listening events for participatory data analysis, knowledge translation, and dissemination of findings. Oral histories were most meaningful in their original audio form, adding to a holistic understanding of health by giving voice to complex problems while also naming and describing concepts that were culturally unique. Moreover, the oral histories collectively articulated a counternarrative that celebrated community cultural wealth and opposed the mainstream narrative of the community as deprived. We argue for the recognition and practice of oral histories as a more routine form of qualitative inquiry in community health assessment. In the pursuit of health equity and collaboratively working toward social justice, oral histories can push the boundaries of community health assessment research and practice.

In this pilot study we ascertained baseline knowledge of pelvic anatomy and function among female adolescents and tested the educational effectiveness of a pelvic health curriculum among female adolescent students with the hypothesis that teaching pelvic anatomy, muscle, and organ function, and pelvic hygiene increases pelvic health knowledge.Intervention-control group, community-based effectiveness study.Three Chicago area schools with racial minority and low-income student populations were selected as study sites.One hundred sixty-eight students with a mean age of 14.1 (±0.1) years. Most (69%) self-reported race as black or African American; 23.8% reported Hispanic ethnicity.Pelvic health teachers delivered 6 weekly, 1-hour classes (intervention group, n = 103; control group, n = 65). A comparison control group received standard curricula (physical education or science).Knowledge change was measured using the Adolescent Bladder and Pelvic Health Questionnaire. We used χBaseline pelvic anatomy and function knowledge was minimal. The level of anatomical knowledge was very low with few in either group correctly able to identify where urine exits the body or the number of openings in the vulva. After intervention, significant increases in knowledge included pelvic floor muscle awareness in the control and intervention group (20% vs 89%; P .001), pelvic floor muscle exercise benefit (31% vs 78%; P .001), and knowledge that urine loss was abnormal (25.4% vs 60%; P .001). More participants correctly identified organs within the pelvic structure, the vagina (21.5% vs 51.5%; P .001), pelvic floor (16.9% vs 57.3%; P .001), and the bladder (12.3% vs 42.7%; P .001).In this study we identified pelvic-related knowledge deficits among female adolescents and suggest that short-term pelvic health educational intervention results in significant knowledge acquisition.

Trusting, productive relationships between traditionally discordant stakeholders—community members and researchers—are critical for successful Community-Based Participatory Research. Practical guidance on processes allowing for partner trust-building and collaborative leadership development in Community-Based Participatory Research literature lacks specificity. In this paper, we introduce our praxis of Transformative Communication Spaces to facilitate purposeful, iterative discourse that occurs in, and fuels each research phase. We elaborate on the use of Transformative Communication Spaces through Pláticas de Salud, Oral History Listening Events, and Data Analysis Think Tanks within the framework of our Little Village Participatory Community Health Assessment. We believe the integrity and potential of Community-Based Participatory Research is contingent on the use of Transformative Communication Spaces strategies to foster trusting partnerships necessary for shared learning and co-leadership.

BACKGROUND AND OBJECTIVES: Chronically ill older adults must integrate self-care behaviors into their daily routine to promote health and reduce urgent health care utilization. Individuals of lower socioeconomic position (SEP) experience a disproportionate burden of stressors that challenge the formation of regular routines. We examined associations between the presence of a daily routine and older adults’ health status and urgent health care utilization, to determine whether higher levels of daily routine mediates associations between SEP and health outcomes. RESEARCH DESIGN AND METHODS: We used data from a cohort of older adult primary care patients in Chicago. Daily routine was measured using a brief, validated scale. A single factor score of SEP was created with measures of education, income, homeownership, and insurance status. Health status was assessed by Patient Reported Outcomes Measurement Information Service physical function, depression, and anxiety. Urgent health care utilization was patient reported. Multivariable models were used to assess the effect of routine and SEP on health status and urgent health care utilization. RESULTS: Individuals reporting low levels of daily routine reported worse physical function (β = −2.34; 95% CI −4.18, −0.50), more anxiety (β = 2.73; 95% CI 0.68, 4.78) and depressive symptoms (β = 2.83; 95% CI 0.94, 4.74) than those with greater daily routine. No differences in urgent health care utilization were observed by daily routine. Daily routine varied by SEP (p < .001); routine partially mediated the relationship between SEP and physical function and anxiety symptoms (ps < .05). DISCUSSION AND IMPLICATIONS: A daily routine may be an under recognized modifiable factor that could promote health outcomes among older adults.

In predominately immigrant neighborhoods, the nuances of immigrant life in the ethnic enclave have important, yet underappreciated impact on community health. The complexities of immigrant experiences are essential to unpacking and addressing the impact of acculturative processes on observed racial, ethnic, and class-based health disparities in the United States. These insights because they are largely unexplored are best captured qualitatively through academic-community research partnership. We established the participatory mixed method Little Village participatory community health assessment (CHA) to explore community health in an ethnic enclave. In this paper, we share findings from our qualitative component exploring: how do Residents in a Predominately Immigrant Neighborhood Perceive Community Health Needs and Assets in Little Village. Three major themes emerged: rich, health promoting community assets inherent in the ethnic enclave; cumulative chronic stress impacting the mental health of families and intra-familial strain; and, work and occupation as important but underappreciated community health determinants in an immigrant neighborhood. These nuanced findings enhanced our community health assessment and contributed to the development of two additional tailored CHA methods, a community member-administered Community Health Survey, and an oral history component that provided deeper insight on the community's health needs and assets, and a focus for action on work as a social determinant of health at the community level. Conducting trusted community-driven health assessments that are adaptive and flexible to capture authentic needs and assets are critical, given health consequences of the new anti-immigrant rhetoric and growing socio-political tensions and fear in immigrant neighborhoods in the United States.

To support patients in making decisions that align with their unique cultural beliefs, an understanding of factors underlying patient preferences is needed. We sought to identify psychosocial factors that influenced decision making among African-American and Hispanic patients referred for knee or hip arthroplasty. Thirty-six participants deciding on surgery were interviewed. Responses were audio-taped, transcribed, and read. Codes were assigned to the raw data and then clustered into categories that were analyzed to yield overarching themes. This process was repeated independently by two corroborators. Six categories described the mental calculations made in patients' decision-making processes: 1) self-assessment of fit for surgery based on age and comorbidity, 2) research and development of mental report cards of their surgeons, 3) reliving of social network experiences, 4) reliance on faith and spirituality for guidance, 5) acknowledgment of fear and anxiety, and 6) setting expectations for recovery. This study advanced the understanding of how decisions about joint replacement are constructed and identified cultural levers that can be targeted for intervention. Developing culturally tailored health information that addresses some of our findings and disseminating messages through social networks may reduce the underutilization of joint replacement among racial and ethnic minority populations.

Objective To determine the feasibility of an adapted pelvic fitness and educational program to control urinary incontinence (UI) and overactive bladder (OAB) symptoms in women older than 65 years. Design Feasibility study. Setting Residential independent-living facilities. Participants Forty-three study subjects, limited to women 65 years and older residing in or using an independent-living facility, who self-reported that they had symptoms of UI or OAB. Methods Study participants volunteered to participate in a 6-week pelvic fitness class. Classes were held at 3 different independent-living sites. Forty-three women in 4 different treatment groups with 9-15 women per group completed the adapted group pelvic fitness and education instruction, which was provided twice a week for 6 weeks. At one site, in addition to the treatment group, an education-only group met; in this group, 14 women received an alternate intervention consisting of only one educational session and a booklet presenting the didactic content without specific muscle isolation or training. Main Outcome Measurements In addition to demographics, standardized assessments using validated instruments were obtained before the first class and after the last class, including general health, self-reported bladder function, quality of life, and the timed up-and-go test. Results Most participants (97%) were white, with a mean age of 83 years (range, 67-95 years). Most participants in the treatment groups (83%) reported symptom improvement. Statistically significant improvements in OAB and bladder symptoms were found after 6 weeks in the treatment groups, based on visual analog scale scores ( P = .0058) for bothersomeness of bladder symptoms, the total score of the Urogenital Distress Inventory, Short Form ( P ≤ .0001), and the total score of the Incontinence Impact Questionnaire, Short Form ( P = .0036). Conclusions A group pelvic floor fitness program combined with pelvic health education is a promising approach to reduce urinary symptoms and improve the quality of life of older women living with OAB or UI symptoms.

Context Rigorous qualitative research can enhance local health departments' efforts to gain a deeper insight into residents' perceived community health inequities necessary for productive community health assessments (CHAs) and community health improvement plans (CHIPs). Objective The Chicago Department of Public Health and the Partnership for Healthy Chicago used the National Association of County & City Health Officials' Mobilizing for Action through Planning and Partnerships (MAPP) model to conduct its CHA/CHIP, Healthy Chicago 2.0 (HC 2.0). Public health graduate students conducted qualitative research for part of the Community Themes and Strengths Assessment (CTSA), one of the 4 MAPP assessments. Design Using a health equity lens, this qualitative component included focus groups and oral histories with residents in Chicago Community Areas with the highest social and economic hardship to better understand how residents perceive health inequities in their respective neighborhoods. Settings Community-based organizations in 6 Chicago neighborhoods with the highest quartile of social and economic hardship. Participants Forty-eight Chicago residents from 5 community areas participated in focus groups, and 6 residents of a Mexican ethnic enclave shared oral histories. Main outcome measure Residents' perceptions of community needs and assets. Results Needs identified include inaccessible resources and opportunities, economic instability, and safety. Assets include the efficacy and agency of resilient residents, as well as faith and spirituality. Systemic and institutional discrimination was identified at the roots of community health inequities. Conclusion Through qualitative inquiry, the more nuanced understanding of how residents perceive health inequities better positioned HC 2.0 to develop upstream strategies in line with advanced health equity practice. Engaging qualitative academic researchers in CTSA brings academic expertise to enrich the CHA while providing real-time learning experiences to prepare future public health practitioners to work on upstream structural determinants of health.

Research assessing attitudes toward consent processes for high-throughput genomic-wide technologies and widespread sharing of data is limited. In order to develop a better understanding of stakeholder views toward these issues, this cross-sectional study assessed public and biorepository participant attitudes toward research participation and sharing of genetic research data. Forty-nine individuals participated in 6 focus groups; 28 in 3 public focus groups and 21 in 3 NUgene biorepository participant focus groups. In the public focus groups, 75% of participants were women, 75% had some college education or more, 46% were African-American and 29% were Hispanic. In the NUgene focus groups, 67% of participants were women, 95% had some college education or more, and the majority (76%) of participants was Caucasian. Five major themes were identified in the focus group data: (a) a wide spectrum of understanding of genetic research; (b) pros and cons of participation in genetic research; (c) influence of credibility and trust of the research institution; (d) concerns about sharing genetic research data and need for transparency in the Policy for Sharing of Data in National Institutes of Health-Supported or Conducted Genome-Wide Association Studies; (e) a need for more information and education about genetic research. In order to increase public understanding and address potential concerns about genetic research, future efforts should be aimed at involving the public in genetic research policy development and in identifying or developing appropriate educational strategies to meet the public’s needs.

Background There is increasing evidence that neighborhood-level factors, in addition to individual-level factors, may contribute directly or indirectly to childhood asthma by affecting environmental and lifestyle factors. Exposure to neighborhood crime and violence has been associated with poor health outcomes, especially among underserved and minority populations, and its effect on respiratory health is an area of active research. Objective To examine the association of residential neighborhood crime with asthma and asthma-related outcomes among Mexican American children. Methods This cross-sectional study was conducted with parents of 2,023 Mexican American children. We derived measures of neighborhood (census tract) violent, property, and drug abuse crime and used multilevel generalized estimating equations to test associations of neighborhood crime counts with respiratory conditions. Results In multiple regression models, a 1-SD increase in neighborhood property crimes significantly increased the odds of lifetime asthma, lifetime wheezing, lifetime emergency department (ED) visits attributable to asthma or wheezing, and lifetime hospitalization attributable to asthma or wheezing by 25%, 18%, 44%, and 62%, respectively. A 1-SD elevation in neighborhood violent crime was positively and significantly associated with 21% and 57% higher odds of lifetime wheezing and ED visits, respectively. We also observed 13% and 44% significantly increased odds of lifetime wheezing and ED visits, respectively, for a 1-SD increase in drug abuse crime. These findings were not explained or modified by individual- and neighborhood-level covariates. Conclusion Higher neighborhood crime was associated with greater odds of asthma and asthma morbidity in Mexican American children.

OBJECTIVE : The objective of this study was to explore knowledge, barriers to seeking sociocultural perceptions of pelvic floor disorders (PFDs) among African American (AA) and Latina (LA) community-dwelling women. METHODS : Thirty-two women participated in 4 focus groups. The sample included AA and LA women aged 24 to 77 years. Focus groups were stratified by age and race/ethnicity. Discussion questions included knowledge of and related health needs and barriers to seeking care with respect to PFDs, urinary incontinence, and pelvic organ prolapse. Demographics and basic knowledge and experience with PFDs were also captured by survey. RESULTS : Several significant themes emerged from the data. AA and LA women had general misconceptions about PFDs and were unaware of PFDs causes, symptoms, and available treatments. Women were eager to receive more information, particularly prevention information that could be shared with their daughters. A major barrier to seeking care was the pattern of placing family demands before their own health needs. CONCLUSIONS : Findings suggest that there is a gap in information on PFDs among AA and LA women, yet a demand for information exists. Sociocultural perspectives discerned from focus group with AA and LA women can be used to tailor educational information and materials on PFDs. Findings may increase health provider awareness of the unique sociocultural barriers to seeking care for AA and LA women and improve patient education on PFDs.

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010–Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos.