Suchergebnisse

Objectives: The goal of this study was to establish relationships with Latino churches in South Los Angeles and to collect data from parishioners regarding their access to care, cancer risk factors, and cancer-related knowledge, attitudes and screening.Methods: In 2014, we approached five La­tino churches. All allowed us to describe the study and to consent potential respondents at a designated time during the church service.Results: 398 Latino respondents (75% female) completed the survey in English (15%) or Spanish (85%). Most respondents were born in Mexico (63%). Only 56% had health insurance and 51% had a regular doctor. Based on self-reported height and weight, 33% were overweight and 51% were obese. However, only 42% of obese respondents had been told by their doctor that they were obese. Although it is well-established that obesity is a major cancer risk factor, respondents lacked knowledge about the important role of nutrition and exercise in cancer prevention. Among women, adherence to national screening guidelines was 88% for cervical cancer, 72% for breast cancer and 58% for colorectal cancer. However, they were quite willing to undergo cancer screening if recommended by a physician and reported few barriers to colorectal cancer screening.Conclusions: Our data suggest a need to focus on both primary and secondary cancer prevention by promoting healthy lifestyles to curb the obesity epidemic and by promoting colorectal cancer screening. These data will inform future interventions to promote wellness in South Los Ange­les in collaboration with the Latino faith community. Ethn Dis. 2019;29(2):239-246; doi:10.18865/ed.29.2.239

Background: Patient and community engagement in under-resourced communi­ties is a key issue for precision medicine research. We report proceedings from a community-academic partnered confer­ence in Los Angeles to promote community understanding of precision medicine and generate engagement recommendations.Methods: Planning group review of plan­ning, presentations, and audience discus­sions from facilitator notes and participant survey data from a one-day conference.Findings: Community-academic planning broadened community participation and presentations. More than 80% of survey par­ticipants indicated they would participate in the national precision medicine initia­tive, and most were willing to share diverse sources of data. Discussions identified trust concerns related to historical research abus­es, data privacy, potential effects of findings on health care, personal safety, research procedures, the time-frame for benefit, and confusion about different initiatives. Con­cerns were balanced by belief in science to improve health. Recommendations in­cluded a community partnered participatory approach with support for local community and academic teams to engage stakeholders with written/online resources and partnered workgroups addressing key concerns.Conclusion: Conference participants expressed high willingness to participate in precision medicine studies, but discus­sions highlighted trust and transparency issues and suggested community partnered research with local capacity building.Ethn Dis. 2018:28(Suppl 2):503-510; doi:10.18865/ed.28.S2.503.

Objective: With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health compara­tive-effectiveness research.Methods: Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical as­sistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contribu­tions of the CPIC Council and the study's design committee are highlighted.Results: CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimit­ing the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to deter­mine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policy­makers, and has fueled ongoing research collaborations.Conclusions: Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging comple­mentary areas of knowledge and expertise among members of the investigative team.Ethn Dis. 2018;28(Suppl 2):357-364; doi:10.18865/ed.28.S2.357.

Significance: Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Re­sources for Services (RS) for program techni­cal assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical condi­tions (MCC) are unknown.Objective: To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.Design: Secondary analyses of a cluster-randomized trial.Setting: 93 health care and community-based programs in two neighborhoods.Participants: Of 4,440 clients screened, 1,322 depressed (Patient Health Question­naire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys.Intervention: CEP or RS for implementing depression quality improvement programs.Outcomes and Analyses: Primary: depres­sion (PHQ9 ≥10), poor MHRQL (Short Form Health Survey, SF-12<40); Second­ary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate interven­tion effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by- MCC interactions (exploratory).Results: Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increas­ing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC.Conclusions: CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.Ethn Dis. 2018;28(Suppl 2):325-338; doi:10.18865/ed.28.S2.325.

<p><strong>Objective</strong>: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multicomponent<br />study to understand and document health risk and resources in a<br />low-income and minority community.</p><p><strong>Design</strong>: A community-partnered participatory research project.<br />Setting: A low-income, biethnic African American and Latino neighborhood in South Los Angeles.</p><p><strong>Participants</strong>: Adult community residents aged &gt;18 years.</p><p><strong>Main Outcome Measures</strong>: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping.</p><p><strong>Results</strong>: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination,<br />and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged &gt;50 years and participated in functional status<br />measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants<br />resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants.</p><p><strong>Conclusions</strong>: The HCNI communityacademic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use<br />culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to<br />understand strategies for developing and implementing interventions to mitigate these disparities. <em>Ethn Dis</em>. 2016;26(1):123-132; doi:10.18865/ed.26.1.123</p>