Family & Community Health最新文献

Disparities in sexual health outcomes between racial and ethnic groups throughout the state of Washington suggest the presence of systemic inequities impeding young people's experience with and access to sexual health care and education. Emerging innovations in sexual health look to center young people, particularly those who have been historically excluded, in the design and implementation of programs that aim to serve them. The Washington Youth Sexual Health Innovation and Impact Network (WYSHIIN) and 11 grant-funded partners engaged communities of youth across the state of Washington, including Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQIA+) and Black, Indigenous, and People of Color (BIPOC) youth, with the goal of equitably engaging participants and stakeholders to broaden services in schools and community settings. Evaluation staff from the Washington State Department of Health conducted virtual interviews with community partners for preliminary program evaluation purposes and identified 6 strategies for engaging youth. WYSHIIN partners highlighted strategies for centering youth voice and needs at all levels of program development and implementation, embracing holistic and culturally relevant approaches, and 2SLGBTQIA+ inclusion. These themes, reflective of wisdom across multiple Washington communities, offer strategies to address systemic issues that negatively impact youth access to and experience with sexual health care.

With rising childhood obesity rates, ensuring children adopt healthy habits early is imperative. Given the unique context for Alaska Native families living in rural remote communities, who are concurrently experiencing changes in traditional practices, we investigated what impacts parents' decisions as they relate to daily living before revising a preschool curriculum focused on healthy habits. The objective of this study was to explore factors influencing parents' decisions about their children's foods, beverages, and activities. In focus group discussions with AN parents of young children across 12 communities, we asked about meals, traditional foods, beverages, physical activity, and screen time. All sessions were recorded, transcribed, and analyzed using open and selective coding to allow the most important themes to emerge. As parents discussed how they make decisions, several trends emerged related to adults' and children's food and beverage preferences; the impact of adult modeling on children; and how convenience, seasonality, access, and a reluctance to engage in conflict all impact decision-making. Parents and other community members shared important perspectives on exposing children to traditional subsistence foods and activities and passing important traditional knowledge to them at an early age. These perspectives will form the basis for preschool curricula in these communities.

Hispanic/Latinx communities remain an underserved population in terms of health and physical activity opportunities. The rise of sport specialization can jeopardize these opportunities. Understanding the appeal and welcomeness that minoritized populations feel toward sport and sport specialization culture can play an important role in health promotion and breaking down barriers that widen the gap on physical activity levels in Hispanic/Latinx communities. To date, these studies have not qualitatively investigated Hispanic/Latinx youth sport dyads (parent and child) and how sport specialization perceptions have affected their sport participation experiences. We used a qualitative interpretative phenomenological analysis to explore experiences of Hispanic/Latinx high school athletes. We engaged in semistructured interviews with 12 parent-child dyads. The following 3 interrelated themes emerged: (a) expectations of youth sport participation, (b) meeting expectations of youth sport participation, (c) and (mis)alignment of cultures. Dyads describe a negative youth sport experience when both cultures do not align because of the rise in sport specialization and pay-to-play culture. Findings indicate that dyads understand what is necessary to participate in organized sport and do this by methods that are rooted in their Hispanic/Latinx culture.

Greenspace positively impacts mental health. Previous research has focused on the greenspace-mental health relationship in urban areas. Yet, little work has looked at rural areas despite rural communities reporting similar rates of poor mental health outcomes and higher rates of suicide mortality compared with urban areas. This ecological research study examined the following research questions: (1) Do public and/or private greenspaces affect the spatial distribution of mental health outcomes in North Carolina? (2) Does this relationship change with rurality? Emergency department data for 6 mental health conditions and suicide mortality data from 2009 to 2018 were included in this analysis. Spatial error and ordinary least squares regressions were used to examine the influence of public and private greenspace quantity on mental health in rural and urban communities. Results suggest greenspace benefits mental health in rural and urban communities. The strength of this relationship varies with urbanity and between public and private greenspaces, suggesting a more complex causal relationship. Given the high case counts and often lower density of mental health care facilities in rural areas, focusing attention on low-cost mental health interventions, such as greenspace, is important when considering rural mental health care.

Racially minoritized groups have disproportionately borne the impacts of the COVID-19 pandemic in America. We draw on Public Health Critical Race Praxis to investigate racial differences in college students' attitudes about mitigation efforts to limit the spread of COVID-19 and concerns about one's own and others' actions in these efforts. We used survey data from a random sample of Midwestern undergraduates (n = 620) who participated in a fall 2020 COVID-19 study; chi-square tests and logistic regression modeling were employed. Students of color were more likely than white students to report mitigation strategies as not sufficiently restrictive and that communities ought to prioritize limiting the spread of COVID-19. Students of color were also more likely to be concerned that the actions of others were spreading COVID-19. Universities need to continuously ask how their policies and practices acknowledge the broader racial context and seek the perspectives of diverse students.

The United Nation's Agenda 2030 recognizes unpaid domestic caregiving in the home as the largest barrier to gender equality. However, little research has been conducted to understanding the social process through which fathers engage in caregiving. The purpose of this constructivist grounded theory study was to explore the social process of caregiving in fathers. Recruited from multiple community settings, 35 fathers participated in intensive interviews with the investigator. The initial interview guide was developed through Swanson's Theory of Caring and modified as themes emerged. Data analysis occurred using an iterative categorization matrix for organization and clarity. This study proposed the action-based Caregiving in Fathers Theory. The 3 main themes of the theory center on the following: (1) reconciling the past through "Reinventing the Kitchen Table"; (2) managing the present through "Creating a Home"; and (3) preparing for the future through "Discovering Empowerment." For fathers, gender equality in society begins with accepting fathers as proficient, competent, and primary caregivers. This theory reveals the motivations of fathers in participating in unpaid domestic caregiving in the home.

For many African American adults, the church has the potential to be a place to receive education about advance care planning (ACP). The current study was conducted to (1) identify the frequency of ACP conversations and caregiving and (2) evaluate interest in church-placed end-of-life (EOL) care education. Data were collected from parishioners in 2 African American churches in an urban city in the mid-Atlantic region of the United States. Individuals older than 50 years reported a higher frequency of caregiving ( P < .001) and were more likely to have talked to someone about EOL care ( P < .001) than individuals younger than 50 years. Nearly all respondents considered EOL conversations "important" or "very important" (99.1%) and wanted more information about EOL conversations available via the church (95.8%). Our findings suggest EOL conversations are happening within families and with health care providers, but they are not documented in ways (eg, in writing) that research has focused on previously. Future EOL education will focus more on the importance of documenting and sharing EOL care wishes with family and health care professionals.

This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.

Background: Mortality due to coronavirus disease-2019 (COVID-19) among Black and Hispanic populations is disproportionately high compared to white populations. This study aimed to explore the association between COVID-19 mortality and social determinants of health (SDOH) among Black and Hispanic populations in Virginia.

Method: County-level publicly available COVID-19 mortality data from Virginia, covariates, and SDOH indicators were used. An independent t-test and hierarchical multiple regression analysis were performed to assess the association between SDOH and COVID-19 death rates, with a focus on racial/ethnic disparities.

Results: Counties in the lowest quartile had a mean death rate of 44.72 (SD = 13.8), while those in the highest quartile had a mean death rate of 239.02 (SD = 123.9) per 100, 000 people ( P < .001). Counties with the highest death rates had significantly lower mean socioeconomic status. The regression analysis revealed that 32% of the variance in the COVID-19 mortality rate was associated with SDOH after controlling for the covariates ( P < .01). Identifying as Hispanic ethnicity accounted for 8.5% of the variance, while median household income, being uninsured, and education accounted for 32.7%, 12.9%, and 7.1%, respectively.

Conclusions: The findings provide evidence that disparities in SDOH experienced by Hispanic populations play a significant role in increased COVID-19 mortality, thus highlighting the social needs of low-income, low-education, and Hispanic populations to advance equity in health outcomes.