Understanding Professional Medical Interpreters' Perspectives on Advancing Accurate and Culturally Informed Patient-Provider Communication for Filipinos in Hawai'i: Qualitative Analysis.

One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.

Mental Illness as a Predictor of Subjective Happiness Among University Employees Working in Hawai'i.

The World Health Organization adopted happiness as an indicator of societal progress in addressing conditions that directly affect psychological well-being and recommended communities address the determinants and obstacles to subjective well-being. Therefore, we conducted an online survey, informed by the Sustainable Happiness Model, among university employees that measured life circumstances (sociodemographics) and intentional leisure-time moderate-to-vigorous physical activity as potential predictors of subjective happiness (assessed using the Subjective Happiness Scale [SHS]). The multiethnic sample (N = 85) primarily included those who identified as White (44%), Asian (33%), and Native Hawaiian and other Pacific Islander (16%). The most prevalent age range was 41 to 50 years (31%), and 55% of the sample identified as female, 78% as faculty, and 22% as staff. Reporting a current mental health condition had significantly lower SHS scores compared to all other factors. Future research should explore interventions to support and improve university employee's mental health and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the GEM cluster-randomized trial.

Patients with gestational diabetes mellitus and from racial/ethnic minority groups face disproportionate risk for type 2 diabetes. Lifestyle interventions, if accessible and acceptable to diverse patients, could advance diabetes prevention and mitigate racial/ethnic disparities. Here we describe overall and race/ethnicity-specific reach, acceptability, and perceived success from an effective telehealth diabetes prevention lifestyle program for patients with gestational diabetes mellitus, implemented in the Gestational Diabetes Effects on Moms (GEM) cluster-randomized controlled trial. GEM tested a program of 13 telephone sessions and behavior change techniques (BCTs, e.g., goal setting) in a healthcare system. We evaluated participation (completing ≥1 session), acceptability of BCTs, and perceived success reaching program goals. Among 1,087 patients (75.2% from minority groups), 50.3% participated. Participation rates were 61.7% among Black, 56.4% among Hispanic, 55.6% among multiracial/other, 53.0% among White, and 43.7% among Asian/Pacific Islander patients. Evaluation survey respondents (n = 433/547; 79.2%) largely rated BCTs as very helpful (range 40.9%-58.4%) or moderately helpful (27.3%-34.9%). Respondents from minority groups largely rated goal setting for weight management as very or moderately helpful, with fewer minority respondents rating it as only a little/not at all helpful than White respondents (p = .02). Black and White respondents reported more limited success reaching a healthy weight than Asian/Pacific Islander, Hispanic, and multiracial/other women (p = .005). A telehealth diabetes prevention lifestyle program demonstrated reach and acceptability across racial/ethnic groups. While perceived success can be improved among Black and White participants, such programs could promote access to preventive care and help mitigate disparities in diabetes risk.

Health literacy in former Soviet Union immigrants in the US: A mixed methods study.

BACKGROUND: People with limited health literacy may have trouble finding, understanding, and using health-related information and services and navigating the healthcare system. PURPOSE: The purpose of this study was to assess the health literacy of immigrants from the former Soviet Union (FSU) using the Health Literacy Survey (HLS19-Q12 in Russian) and explore associated socio-demographic factors. METHOD: This mixed methods study recruited adult immigrants through social networks and social media and included data from online survey and follow-up interviews. Variance in health literacy was explained using multiple linear regression. Qualitative data were analyzed through modified Grounded Theory approach. FINDINGS: Survey respondents (n = 318) were primarily female college-educated FSU immigrants aged 20-74 from 14 of the 15 FSU countries and distributed across 33 US states. Forty percent scored at or below predefined cut-offs for inadequate or problematic health literacy levels. Social status, social support, and English proficiency were significant variables in explaining variance in health literacy scores while controlling for age, gender, and education. Interviews (n = 24) identified eight themes: English proficiency, social support, health insurance, experience with health care, complexity of the US healthcare system, relevant health information, health beliefs/practices, and trust. DISCUSSION: There is a need to distribute health-related information in the native language (e.g., Russian), potentially through social media and immigrants' social networks. Health providers should be aware of the prevalence of inadequate and problematic health literacy among FSU immigrants and consider associated social factors.

Neighborhood Obesogenic Environment and Risk of Prostate Cancer: The Multiethnic Cohort.

BACKGROUND: Obesity is associated with risk of aggressive prostate cancer. It is not known whether neighborhood obesogenic factors are independently associated with prostate cancer risk. METHODS: Neighborhood socioeconomic status (nSES) and four neighborhood obesogenic environment factors (urbanicity, mixed-land development, unhealthy food environment, and parks) were assessed for associations with prostate cancer risk among 41,563 African American, Japanese American, Latino, and White males in the Multiethnic Cohort (MEC) Study, California site. Multivariable Cox proportional hazards regression was used to estimate HRs and 95% confidence intervals (CI) for nonaggressive and aggressive prostate cancer, adjusting for individual-level sociodemographic, behavioral, and prostate cancer risk factors. Analyses were stratified by race, ethnicity, and, among Latino males, nativity. RESULTS: Males residing in low-SES, compared with high-SES, neighborhoods had lower risk of nonaggressive prostate cancer [lowest vs. highest quintile HR = 0.81; 95% confidence interval (CI) = 0.68-0.95, Ptrend 0.024], driven by a similar trend among foreign-born Latino males. Foreign-born Latino males in neighborhoods with low mixed-land development had increased risk of non-aggressive disease (lowest vs. highest quintile HR = 1.49; 95% CI = 1.07-2.09). For aggressive disease, the only association noted was between lower mixed-land development and lower risk among White males (Ptrend = 0.040). CONCLUSIONS: nSES and obesogenic environment factors were independently associated with prostate cancer risk; associations varied by race, ethnicity, nativity, and disease aggressiveness. IMPACT: Upstream structural and social determinants of health that contribute to neighborhood obesogenic characteristics likely impact prostate cancer risk differently across groups defined by race, ethnicity, and nativity and by disease aggressiveness.

Qualitative study on voyaging and health: perspectives and insights from the medical officers during the Worldwide Voyage.

OBJECTIVE: To examine the potential association of ocean voyaging with human health and well-being from the perspectives and experiences of the medical officers (MOs) who served during the Worldwide Voyage (WWV). DESIGN: Using a phenomenology framework, focus group and individual interviews were conducted and analysed by three diverse core researchers and then reviewed by three external researchers to enhance triangulation. Analysis used the Framework Method and Atlas-ti software (V.8.4.4) to facilitate coding, identify categories and develop an analytical matrix. The matrix was applied to all data using the constant comparative method to construct major themes and subthemes. Synthesised member checking was performed. SETTING: In 2014-2017, the WWV began in Hawai'i on a traditional voyaging canoe, known as Hokule'a, using a non-instrument navigational method, 'wayfinding', powered only by natural forces and guided by traditional ecological knowledge. Each segment of the voyage included ~12 individuals, including an MO physician. The entire WWV included 172 ports-of-call, 36 legs and 250+ crew members. PARTICIPANTS: We purposively sampled all MO physicians who participated in the WWV and enrolled 87% of eligible MOs (n=20 of 23). We conducted two focus groups (n=17=11+6, 85%) and three individual informant interviews (n=3, 15%). RESULTS: The four major themes: (1) Relationships; (2) Preventive Care to Enhance Health; (3) Holistic Health and Wellbeing beyond Voyaging and (4) Spiritual Transformative Experience, strongly suggest that ocean voyaging aboard a traditional voyaging canoe enhanced human health and well-being. The overall impact to perceived health and well-being extended beyond any increase in physical exercise. Essentially, traditional Polynesian ocean voyaging provided a cultural-based context for holistic health and well-being that influenced multiple levels and multiple dimensions. CONCLUSION: Polynesian ocean voyaging was perceived as positively associated with holistic health and overall well-being and it may offer a new approach to confront complex health disparities.

A Dietary Supplement Frequency Questionnaire Correctly Ranks Nutrient Intakes in US Older Adults When Compared to a Comprehensive Dietary Supplement Inventory.

BACKGROUND: Dietary supplements are commonly taken by adults in the United States and can contribute substantially to daily nutrient intakes. Short supplement-use questionnaires are often used in dietary surveys, but their accuracy has not been well studied. OBJECTIVES: The primary objective was to evaluate the accuracy of a short, self-administered supplement frequency questionnaire (SFQ) relative to a comprehensive 1-y inventory of supplement use. A secondary objective was to compare SFQ responses for participants in the intensive measurement study to those from a control group to investigate a possible research participation effect. METHODS: The Supplement Reporting study enrolled 1029 older adults in 2005-2006, with a mean age of 67.8 y, who participated in the Multiethnic Cohort and reported regular use of dietary supplements. Of these, 375 were interviewed quarterly to collect detailed information on types and amounts of dietary supplements used, while 654 served as the control group. All participants completed 2 SFQs, 1 y apart. RESULTS: Agreement between the 2 instruments in use at least weekly ranged from 88% to 97% for 15 of 16 supplement types, with a lower agreement of 74% for vitamin D. The correlations of nutrient intakes from supplements between the 2 instruments were high, ranging from 0.48 to 0.75, except for iron (r = 0.29). However, mean nutrient intakes as reported on the SFQ were higher than intakes from the inventory for most nutrients, sometimes twice as high. Nutrient intakes based on the SFQ were similar for the inventory and control groups, at both baseline and the end of the study. CONCLUSIONS: A self-administered short SFQ can be used in large surveys to identify participants who use 16 categories of dietary supplements at least once a week and can correctly rank participant intakes of nutrients. However, the SFQ does not accurately estimate absolute levels of nutrient intakes from supplements.

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants.

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants' health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants.

Among the world's 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants' health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants' health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants' health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants' health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.

Association of change in the neighborhood obesogenic environment with colorectal cancer risk: The Multiethnic Cohort Study.

BACKGROUND: Neighborhood environment has been associated with health behaviors. Despite the evidence of the influence of neighborhood social and physical factors on cancer risk, no research has evaluated whether changes in the neighborhood obesogenic environment, either by physical moves to different neighborhoods or experiencing neighborhood redevelopment or neglect, affect cancer risk. METHODS: The association of change in neighborhood environment attributes (socioeconomic status, population density, restaurant and retail food environments, numbers of recreational facilities and businesses, commute patterns, traffic density, and street connectivity) with colorectal cancer (CRC) risk was examined among 95,472 Los Angeles, CA, Multiethnic Cohort participants, including 2295 invasive CRC cases diagnosed between 1993 and 2010 using Cox proportional hazards regression, adjusting for age, race/ethnicity, other risk factors including BMI and physical activity, and baseline levels of neighborhood attributes. Stratified analyses were conducted by racial/ethnic group and moving status. RESULTS: 40% of participants moved (changed physical residence) during follow-up. Across all races/ethnicities, upward change in population density was statistically significantly associated with higher CRC risk among male and female non-movers (HR: 1.35 and 1.41, respectively). The same association was also observed separately among female African American and Japanese American non-movers, male Latino non-movers, female African American and male White movers. Downward change in population density was significantly related to higher CRC risk among female non-movers (HR: 1.33). Downward change in traffic density was associated with lower CRC risk among male non-movers but with higher CRC risk among female movers (HR: 0.66 and 1.43, respectively). Downward changes in street connectivity or the number of recreational facilities were associated with higher CRC risk (HR: 1.34 and 1.54, respectively). Upward change in the number of recreational facilities was associated with lower CRC risk among female non-movers (HR: 0.70). Changes in the other neighborhood attributes did not exhibit significant associations with CRC risk within more than one racial/ethnic group. CONCLUSION: Changes over time in neighborhood attributes have an effect on the risk of colorectal cancer, which is separate from the baseline levels of the same attributes and individual-level risk factors, and differs between sexes, movers and non-movers and across racial/ethnic groups.

A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans.

Asian Americans (AAs) are more likely to use complementary and alternative medicine (CAM) compared to other race/ethnicities, yet previous studies have conflicting results. The 2012 National Health Interview Survey data was analyzed to investigate AA's (n = 2214) CAM use for treatment. AAs were divided into four subgroups: Chinese, Asian Indian, Filipino, and Other Asian. Only 9% of AAs reported using CAM for treatment, with 6% indicating CAM use specifically for chronic conditions. This could be a form of medical pluralism, a mixture of Eastern and Western health approaches. The "Other Asian" subgroup reported highest use of CAM for treatment. Significant predictors included age (≥ 65 years) and high educational attainment (≥ college degree). Sociodemographic factors were also significant predictors within Asian subgroups. Further investigation of this and other forms of medical pluralism among AAs are needed to explore potential cofounders and risks like underreporting, CAM schedules/dosages, cultural influences, and CAM's impact on one's health.

HPV vaccination prevalence, parental barriers and motivators to vaccinating children in Hawai'i.

Objective: To determine the prevalence and barriers to human papillomavirus (HPV) vaccine uptake among 11-18 year olds in the Hawai'i's four major ethnic groups-Native Hawaiians, Filipinos, Japanese, and Caucasians. Study design: A telephone survey assessed parents' knowledge of HPV and the HPV vaccine, status of their child's HPV vaccine uptake, variables operationalizing the Health Belief Model, and barriers and motivators to uptake. Results: Across the groups, 799 parents completed the survey. About 35% of daughters and 19% of sons had received all three shots. Although ethnic differences in vaccine uptake were seen in bivariate analysis (with significantly lower uptake in Filipino youth), in multivariable logistic regression analysis, only Caucasian parents were significantly less likely to start their sons on the HPV vaccine series compared with Japanese parents (reference group). Having heard about the vaccine, believing in its effectiveness, and older age of the child were also associated with vaccine uptake. Motivators for HPV vaccination were physician's recommendation and wanting to protect one's child. The primary barrier to uptake was lack of knowledge about the vaccine. Conclusions: Findings reinforce the fact that a physician's recommendation and receipt of information about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity.

Engaging a Community Chaplaincy Resource for Interprofessional Health Care Provider Training in Facilitating Family Decision Making for Children at End-of-Life.

Coordinating the care of terminally ill children is difficult for both parents and the health care team. An underutilized resource is spiritual care, such as that provided by Pacific Health Ministry, a community-based nonprofit established to develop hospital ministry training programs in Hawai'i and provide chaplaincy services to local facilities. This paper describes a training exercise, called the Pediatric Interprofessional Program (PIPP), which is modeled after an adult program, the Hawai'i Interprofessional Training for End of Life Communication in the intensive care unit (HITEC-ICU). Both programs were developed to introduce teams of learners consisting of Pacific Health Ministry spiritual care residents, internal medicine or pediatric residents, undergraduate students in nursing, and graduate students in social work to techniques in delivering serious, life-altering information, and the dynamics of working as an interprofessional team through use of progressively unfolding clinical simulations. PIPP facilitators included chaplaincy instructors at Pacific Health Ministry, university faculty, and community practitioners in pediatrics, nursing, and social work. The simulations were conducted at the Translational Health Science Simulation Center (THSSC) of the University of Hawai'i at Manoa (UHM) School of Nursing and Dental Hygiene (SONDH), with simulated patients from the HealthCAST (Collaborative Acting Simulation Training) program, a collaborative agreement between SONDH and the UHM Department of Theatre and Dance. The training is ongoing, but has thus far demonstrated that interprofessional education programs are feasible across community, academic, and clinical lines, and benefit from the engagement of community resources.

Mediators of a 12-month change in physical activity in ethnically diverse sample of postpartum women.

PURPOSE: Understanding theoretically derived social and behavioral mediators of long-term increases in physical activity (PA) in a vulnerable population at risk for being underactive is needed to inform future research, clinical applications, and public health efforts. This is an analysis of potential mediators of an intervention that increased long-term (12-month) moderate-to-vigorous physical activity (MVPA) in postpartum (2-12months) women in a randomized trial, using a longitudinal analysis. METHODS: Healthy, underactive (i.e., not meeting national guidelines for MVPA) women (n = 311; mean age = 32 ± 5.6 years, 85% minorities) with infants (mean age: 5.7 ± 2.8 months) were randomly assigned to either a tailored eHealth condition consisting of personalized telephone counseling plus access to a website tailored to new mothers' MVPA issues or to a standard MVPA materials-only website. MVPA was assessed via surveys completed at baseline, then 6 and 12 months later. Theoretically derived mediators included social support for MVPA, self-efficacy to increase MVPA, barriers to increasing MVPA, and benefits of increasing MVPA. RESULTS: All mediators, except benefits, improved over the 12 months in the tailored eHealth condition. The tailored condition's effect on increasing MVPA from 6 months to 12 months was mediated by an increase in social support from baseline to six months. No other hypothesized mediators were significant. CONCLUSION: Our results demonstrated that learning strategies to increase social support for MVPA was instrumental in new mothers' increase in MVPA over a 12 month intervention. During this brief but impactful life-stage, where the focus can understandably be on her baby, being able to elicit support from friends and family may facilitate women's efforts to focus on their own needs with respect to MVPA. TRIAL REGISTRATION: ClinicalTrials.gov number.

Insights in Public Health: Ambulatory Blood Pressure Monitoring: Underuse in Clinical Practice in Hawai'i.

Hypertension is one of the leading causes of death and disability worldwide. Blood pressure reduction and control are associated with reduced risk of stroke and cardiovascular disease. To achieve optimal reduction and control, reliable and valid methods for blood pressure measurement are needed. Office based measurements can result in 'white coat' hypertension, which is when a patient's blood pressure in a clinical setting is higher than in other settings, or 'masked' hypertension, which occurs when a patient's blood pressure is normal in a clinical setting, but elevated outside the clinical setting. In 2015, the US Preventative Services Task Force recommended Ambulatory Blood Pressure Monitoring (ABPM) as the "best method" for measuring blood pressure, endorsing its use both for confirming the diagnosis of hypertension and for excluding 'white coat' hypertension. ABPM is a safe, painless and non-invasive test wherein patients wear a small digital blood pressure machine attached to a belt around their body and connected to a cuff around their upper arm that enables multiple automated blood pressure measurements at designated intervals (typically every 15 to 30 minutes) throughout the day and night for a specified period (eg, 24 hours). Patients can go about their typical daily activities wearing the device as much as possible, except when they are bathing, showering, or engaging in heavy exercise. Given the importance of blood pressure monitoring and control to population public health, this article provides details on the relevance and challenges of blood pressure measurement broadly then describes ABPM generally and specifically in the Hawai'i context.

Association between the neighborhood obesogenic environment and colorectal cancer risk in the Multiethnic Cohort.

BACKGROUND: Information on the role of the neighborhood environment and colorectal cancer risk is limited. We investigated the association between a comprehensive suite of possible obesogenic neighborhood attributes (socioeconomic status, population density, restaurant and retail food environments, numbers of recreational facilities and businesses, commute patterns, traffic density, and street connectivity) and colorectal cancer risk in the Multiethnic Cohort Study. METHODS: Among 81,197 eligible participants living in California (35,397 males and 45,800 females), 1973 incident cases (981 males and 992 females) of invasive colorectal cancer were identified between 1993 and 2010. Separately for males and females, multivariable Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for colorectal cancer risk overall and by racial/ethnic group (African American, Japanese American, Latino, white). RESULTS: In males, higher traffic density was associated with an increased risk of colorectal cancer (HR=1.29, 95% CI: 1.03-1.61, p=0.03, for quintile 5 vs. quintile 1; p-trend=0.06). While this association may be due to chance, this pattern was seen (albeit non-statistically significant) in all racial/ethnic groups except whites. There were no other significant associations between other neighborhood obesogenic attributes and colorectal cancer risk. CONCLUSION: Findings from our large racial/ethnically diverse cohort suggest neighborhood obesogenic characteristics are not strongly associated with the risk of colorectal cancer.

Contextual Impact of Neighborhood Obesogenic Factors on Postmenopausal Breast Cancer: The Multiethnic Cohort.

Background: While obesity is well-understood to increase breast cancer risk, the role of the neighborhood obesogenic environment, encompassing social and built environment attributes that influence body size, is poorly understood.Methods: Using principal components factor analysis, five composite factors [neighborhood socioeconomic status (nSES), urban, mixed-land development, unhealthy food environment, parks] on the basis of geospatial data were developed to characterize the obesogenic environment for 48,247 postmenopausal women in the Multiethnic Cohort, residing predominately in Los Angeles County. We used Cox proportional hazards regression to examine the association between neighborhood obesogenic factors and breast cancer risk (n = 2,341 cases after 17 years of follow-up), adjusting for body mass index (BMI), weight gain since age 21, education, established risk factors, other neighborhood factors, and clustering by block group.Results: Lower nSES was associated with lower breast cancer risk [quintile 1 vs. 5: HR, 0.79; 95% confidence interval (CI), 0.66-0.95], with a more pronounced association observed in Latinos (quintile 1 vs. 5: HR, 0.60; 95% CI, 0.43-0.85). More urban environments were associated with lower breast cancer risk in Japanese Americans (quintile 5 vs. 1: HR, 0.49; 95% CI, 0.26-0.90), and lower mixed-land development was associated with higher breast cancer risk in Latinos (quintile 1 vs. 5: HR, 1.46; 95% CI, 1.10-1.93).Conclusions: Obesogenic neighborhood environment factors, especially nSES, urbanicity, and mixed-land development, were differentially and independently associated with breast cancer risk in this multiethnic population.Impact: These findings highlight the need for additional studies of the driving contextual aspects of nSES that influence breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(4); 480-9. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Human Papillomavirus (HPV) Vaccination Motivators, Barriers, and Brochure Preferences Among Parents in Multicultural Hawai'i: a Qualitative Study.

The human papillomavirus (HPV) vaccine can prevent cervical and other cancers. Unfortunately, according to the National Immunization Survey-Teen 2014 data, completion of the HPV vaccine was only 38 % for 13- to 17-year-old girls and 31 % for 13- to17-year-old boys in the USA, and prevalence was similar in Hawai'i. Parents' acceptability of the HPV vaccine is critical for the vaccine uptake, and this can be increased by educational materials and interventions. However, HPV materials are not widely distributed in Hawai'i. The purpose of this qualitative study was to identify HPV vaccination barriers, motivators, and brochure preferences among parents of teens in multicultural Hawai'i. Twenty parents were interviewed in person or by telephone. Four major themes emerged: (1) the physician is critical in the decision to vaccinate, (2) parental perception of the child's sexual activity guides the timing of their willingness to vaccinate, (3) HPV health education materials should be provided and discussed by the physician, and (4) parents would prefer an educational brochure that features local faces and testimonials, includes an immunization chart, and addresses barriers to vaccination. These findings informed the development of HPV health education materials tailored to Asian Americans and Pacific Islanders in Hawai'i.

The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)-derived lifestyle intervention. RESEARCH DESIGN AND METHODS: This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 kg/m(2) or 2) losing 5% of pregravid weight if BMI ≥25.0 kg/m(2); and pregravid to postpartum weight change. RESULTS: On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference -0.64 kg [95% CI -1.13, -0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). CONCLUSIONS: A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.