"We feel like it was better back home:" Stress, Coping, and Health in a U.S. Dwelling African Immigrant Community.

BACKGROUND: This study examines stress and stress management from the perspective of African immigrants in southwestern Pennsylvania. Our research questions explore how participants define stress, the most common causes of stress, manifestations of stress, and common strategies for stress management. METHODS: We conducted a descriptive, cross-sectional, qualitative study with 34 African immigrants. Data were collected via three focus groups. Qualitative data were audio-recorded, transcribed verbatim, and analyzed to identify common themes. RESULTS: Five major types of stressors included: remittances, financial and job-related challenges, children, disconnected families, and unrealized expectations. Participants reported both physical and mental manifestations of stress and used both group-based and individual-focused coping strategies. DISCUSSION: African immigrants suffer from sources of stress that are uniquely attributed to their cultural background, immigration modalities, acculturation processes, and unrealized expectations. Health care providers must be aware of these sources of stress and potential management strategies.

Implementing a Replicable Model for K-12 Health Literacy to Promote Positive Youth Development.

This article describes a replicable model of health literacy that promotes positive youth development. Now in its fifth year of implementation and run by Advance African Development, Inc., it is an integrated year-long, in-class, student-centered, technology-driven, and service-learning youth empowerment program. Forty-minute sessions are offered once a week to create health literate K-12 public school students able to use the Internet to obtain and understand health information, and to practice informed decision-making about their health. Data collected were qualitative and included student service learning projects to solve community health issues. Community engagement exposed students to problem-solving, collaborative and transformational leadership, and advocacy skills. Prior to the program, less than half of the students had heard of MedlinePlus, and those who had heard of it rarely could describe its purpose. Approximately 500 students and 10 teachers participated, and over 40 sessions were provided from August 2015 to June 2016.

Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices.

OBJECTIVE: Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently. METHODS: Twenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance year. The intervention included the 4 Pillars Immunization Toolkit-a practice improvement toolkit, early delivery of donated vaccine for disadvantaged children, staff education, and feedback on progress. During the maintenance year, practices were not assisted or contacted, except to complete follow-up surveys. Student's t tests assessed vaccine uptake of children aged 6 months to 18 years, and multilevel regression modeling in repeated measures determined variables related to the likelihood of vaccination. RESULTS: Influenza vaccine uptake increased 12.4 percentage points (PP; P < .01) during active intervention and uptake was sustained (+0.4 PP; P > .05) during maintenance, for an average change of 12.7 PP over all sites, increasing from 42.2% at baseline to 54.9% (P < .001) during maintenance. In regression modeling that controlled for age, race, and insurance, likelihood of vaccination was greater during intervention than baseline (odds ratio 1.47; 95% confidence interval 1.44-1.50; P < .001) and greater during maintenance than baseline (odds ratio 1.50; 95% confidence interval 1.47-1.54; P < .001). CONCLUSIONS: In primary care practices, a multistrategy intervention that included the 4 Pillars Immunization Toolkit, early delivery of vaccine, and feedback was associated with significant improvements in childhood influenza vaccination rates that were maintained 1 year after active intervention.

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care.

PURPOSE: To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial. METHODS: Twenty primary care practices treating children (range for n=536-8183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months-18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010-2011 and 2011-2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes. RESULTS: Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P<0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms - 8/10 Intervention (all P<0.001) and 7/10 Control sites (P-values=0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23-1.34), having commercial insurance (OR=1.30; 95%CI=1.25-1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16-1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01-1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates. CONCLUSIONS: Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates. Clinical trial registry name/number: From Innovation to Solutions: Childhood Influenza/NCT01664793.

Barriers to and facilitators of child influenza vaccine - perspectives from parents, teens, marketing and healthcare professionals.

BACKGROUND: The CDC recommends annual influenza vaccination for all children age 6 months and older, yet vaccination rates remain modest. Effective strategies to improve influenza vaccination for children are needed. METHODS: Eight focus groups with 91 parents, teens, pediatric healthcare staff and providers, and immunization and marketing experts were conducted, audiotaped, transcribed verbatim, and coded based on grounded theory. RESULTS: Three themes emerged: barriers, facilitators, and strategies. Barriers included fear, misinformation, and mistrust, with exacerbation of these barriers attributed to media messages. Many considered influenza vaccination unnecessary and inconvenient, but would accept vaccination if recipients or other family members were considered high risk, if recommended by their doctor or another trusted person, or if offered or mandated by the school. Access to better information regarding influenza disease burden and vaccine safety and efficacy were notable facilitators, as were prevention of the inconvenience of missing work or important events, and if the child requests to receive the vaccine. Marketing strategies included incentives, jingles, videos, wearable items, strategically-located information sheets or posters, and promotion by informed counselors. Practice-based strategies included staff buy-in, standing orders protocols, vaccination clinics, and educational videos. Teen-specific strategies included message delivery through schools, texting, internet, and social networking sites. CONCLUSION: To improve influenza vaccination rates for children using practice-based interventions, participants suggested campaigns that provide better information regarding the vaccine, the disease and its implications, and convenient access to vaccination. Strategies targeting adolescents should use web-based social marketing technologies and campaigns based in schools.