Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic.

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.

Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation.

INTRODUCTION: This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation. METHODS: Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work. RESULTS: Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities. DISCUSSION: Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.

Community Engagement Practices at Research Centers in U.S. Minority Institutions: Priority Populations and Innovative Approaches to Advancing Health Disparities Research.

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.

Reanimating the Body: Comics Creation as an Embodiment of Life with Cancer.

Cancer is regarded as a disease that redefines an individual's life and relationships. The medicalization and reclamation of the individual's sense of body, self, and social life have been long examined by psychiatry and anthropology alike. We argue that creating comics is a form of artistic narrative that affirms and proclaims the existence of a past and future possibilities for individuals diagnosed with cancer. Despite the interconnections among lived experience and meaning making, little attention has been paid to the potential therapeutic effects of comics creation. Individuals diagnosed with cancer were recruited for ten weekly comics making workshops. Data include qualitative interviews and workshop observations. Six women who were diagnosed with cancer consented to participate. Meaning making themes included (1) slowing down to process their experiences, (2) expressing frustration with medical encounters, and (3) reflecting on traumatic relationships. The process of redefining their cancer experience connects the sufferer's individual and social context. We find that the physical act of 'making' comics works to create meaning and an embodied expression of meaning. Creating comics, for our participants, offered multiple entry points and perspectives for redefining their stories that provided new insights and paths to explore their medical traumas and reanimating their bodies.

Unintentional Injury, Supervision, and Discourses on Childproofing Devices.

Unintentional injury prevention research focuses on parental supervision as critical to reducing toddler injury. We examine how the promotion of childproofing-as a mode of supervision-sells mothers "peace of mind" while also increasing "intensive mothering" and the "privatization of risk." Drawing on the childproofing literature and meaning centered interviews with mothers of toddlers and childproofing business owners, we argue that the connection made by these groups between childproofing and "good parenting" ultimately obscures how this form of harm reduction economically and socially individualizes responsibility for child care.

From Particularities to Context: Refining Our Thinking on Illness Narratives.

This paper examines how illness narratives are used in medical education and their implications for clinicians' thinking and care of patients. Ideally, collecting and reading illness narratives can enhance clinicians' sensitivity and contextual thinking. And yet these narratives have become part of institutionalizing cultural competency requirements in ways that tend to favor standardization. Stereotyping and reductionistic thinking can result from these pedagogic approaches and obscure structural inequities. We end by asking how we might best teach and read illness narratives to fulfill the ethical obligations of listening and asking more informative clinical interview questions that can better meet the needs of patients and the community.

Cancer and the Comics: Graphic Narratives and Biolegitimate Lives.

Cancer graphic narratives, I argue, are part of a medical imaginary that includes representations of difference and biomedical technology that engage Fassin's (2009) concept of biolegitimacy. Framed in three parts, the argument first draws on discourses about cancer graphic narratives from graphic medicine scholars and authors to demonstrate a construction of universal suffering. Second, I examine tropes of hope and difference as a biotechnical embrace. Finally, I consider biosociality within the context of this imaginary and the construction of a meaningful life. Autobiographical graphic narrative as a creative genre that seeks to give voice to individual illness experiences in the context of biomedicine raises anthropological questions about the interplay between the ordinary and biolegitmate. Cancer graphic narratives deconstruct the big events to demonstrate the ordinary ways that a life constructed as different becomes valued through access to medical technologies.

Watching as an ordinary affect: Care and mothers' preemption of injury in child supervision.

As unintentional injuries continue to be the leading cause of hospitalization and death for toddlers between the ages of 1 and 4, the Centers for Disease Control has argued that child supervision is a key factor in reducing these injuries and fatalities. This article focuses on the affective relationships in the concept of supervision and practice of watching as an injury prevention method. Three parts frame our argument. First, we describe how watching is an ordinary affect. Second, as part of the ethos of caring, watching is embedded in a temporal frame of anticipation and gives rise to an affectsphere of watching and to a parents' subjectivity as 'good' or 'bad' supervisors. Third, these affective relationships generate seemingly contradictory outcomes wherein children are expected to gain independence and experience injury. The affective qualities of watching provide a critique of the individualizing forces of supervision and an analysis of subjectivities generated by gender and class.

Dietary intakes, obesity and health behaviors in Native Hawaiians residing in Southern California.

OBJECTIVES: Accessing dietary intakes, body mass index (BMI) and health behaviors in Native Hawaiians residing in Southern California. DESIGN: Cross-sectional, community based participatory research. PARTICIPANTS: Native Hawaiian (N = 55); Mean age 59 (± 15). MAIN OUTCOME MEASURES: Diet, body mass index (BMI), and diet/exercise health behaviors. Collected diet via 24-hr dietary recalls, health behaviors through questionnaires and BMI via measurement/self-report. ANALYSIS: Frequencies/means and multiple linear regression were used to assess diet, BMI, and health behaviors. RESULTS: Nearly 90% of the participants were either overweight or obese. Less than 20% met the vegetable, fruit, fiber, and whole grain recommendations. Most were a little or somewhat sure (relative to almost always sure) about their ability "to stick with an exercise program when attending a cultural gathering", and "when visiting Hawai'i". CONCLUSIONS AND IMPLICATIONS: These results suggest that developing a culturally-based education program to reduce obesity and improve diet is critical for Native Hawaiians residing in Southern California.

Diet, psychosocial factors related to diet and exercise, and cardiometabolic conditions in Southern Californian Native Hawaiians.

OBJECTIVE: Native Hawaiians are at higher risk for cardiometabolic disease, including diabetes and cardiovascular disease compared with other ethnic groups. Diet, body mass index (BMI) and psychosocial, as well as cultural issues may influence risk for cardiometabolic disease. Our team conducted a community-based participatory research study and examined diet, height/weight, psychosocial factors, and community health concerns in Native Hawaiians living in Southern California. DESIGN AND METHODS: Cross-section of 55 participants, <18-years-old. Dietary data were collected via three 24-hr dietary recalls, anthropometrics were measured, and psychosocial factors and cardiometabolic conditions were self-reported. Talk story related to diet and health was completed in a sub-sample. Means and frequencies were calculated on dietary intakes, cardiometabolic disease and BMI. Independent t-test and chi square analyses, as appropriate, were performed to assess differences in dietary intakes, obesity and psychosocial factors between those with and without a pre-existing cardiometabolic condition. RESULTS: Of those with pre-existing health conditions (n=28), 72% reported being diagnosed with a cardiometabolic condition. For those with pre-existing cardiometabolic conditions, the daily vegetable consumption was 2.57 servings (+/-1.66) and the mean fruit consumption was 1.43 servings (+/-0.1.99). The mean fiber intake was 16.24 grams (+/-6.92), the mean percentage energy from fat was 34.82% (+/-6.40) and the mean % energy from carbohydrate was 47.15 (+/-6.77). The psychosocial data showed significantly (p<0.05) lower social support, social interaction, self-monitoring and cognitive-behavioral strategies related to exercise for those with cardiometabolic disease compared with those without disease. All the talk story discussion groups expressed concern over diabetes and weight management, both as an individual and community issue. CONCLUSIONS: The dietary data indicate that Native Hawaiians residing in Southern California should aim to increase their vegetable, fiber, and reduce % energy from fat and saturated fat. Additionally, the psychosocial data suggests that implementing physical activity programs based on socio-cultural values such as ohana, community gatherings, as well as individual self-monitoring and cognitive-behavioral strategies may improve cardiometabolic outcomes. In efforts to reduce cardiometabolic disease disparity, these data suggest that Native Hawaiians in Southern California are aware and concerned about cardiometabolic disease in the community, and that implementation of an effective energetic (diet plus physical activity) intervention that is socially, and culturally specific for Native Hawaiians in Southern California is critical.

Native Hawaiian Voices: Enhancing the Role of Cultural Values in Community Based Participatory Research.

Following the goals of Community Based Participatory Research (CBPR), this paper describes how Native Hawaiian values emerged as a methodology for the conduct of a study with Native Hawaiians residing in Southern California. The equitable placing of community values side by side with scientific values show that community concepts can parallel and extend CBPR premises and are more than a variable to be added in the analysis. The community partners, whose voices guide this paper, introduced the values associated with the concepts of "aloha," "malama," "maihilahila," "na'auao," and "ano ano hua." These concepts were employed and maintained throughout the study that assessed diet, obesity, and psychosocial factors related to food and nutrition as a cancer prevention method. We describe and examine these values in light of persistent challenges in CBPR; ensuring that the topic is a community driven issue, fair representation and data dissemination. We argue that Native Hawaiian values are touchstones that intersect in important ways with the goals of CBPR - equality, respecting each other's strengths and the elimination of health disparities for future generations.

Tongan perceptions of cancer.

BACKGROUND: There is little published information about cancer-related knowledge, attitudes, and preventive behaviors of Tongans in the United States. The purpose of this study was to evaluate answers to the following questions: What is cancer? What causes cancer? And what can you do to prevent cancer? METHODS: We completed face-to-face, semi-structured interviews with 48 self-reported Tongans (16 men and 32 women) over the age of 18 years, selected through non-probability purposive sampling with help from Tongan community-based organizations. The questions regarded demographic characteristics, and cancer-related knowledge, attitudes and preventive behaviors. The research settings were San Mateo, California and Salt Lake City, Utah. We analyzed the data using qualitative content analysis of individual interviews to identify themes. RESULTS: All but one of the 48 participants had migrated to the U.S. from Tonga. The average income was approximately $3100 per month and average household size was six. Fewer than half of participants had health insurance. The theme that cancer was equivalent to death was pervasive through all the responses. Weaknesses in the body and exposure to toxins in the environment were dominant themes in the causation of cancer. Leading a healthy life and prayer were among the preventive measures cited by the respondents. CONCLUSION: The association of cancer with death is a strong indication that cancer information is not reaching this community. Interventions must take this into account and include Tongan cancer survivors in order to enhance the effectiveness of early screening efforts.

Legacy of the Pacific Islander cancer control network.

The groundwork for the Pacific Islander cancer control network (PICCN) began in the early 1990s with a study of the cancer control needs of American Samoans. The necessity for similar studies among other Pacific Islander populations led to the development of PICCN. The project's principal objectives were to increase cancer awareness and to enhance cancer control research among American Samoans, Tongans, and Chamorros. PICCN was organized around a steering committee and 6 community advisory boards, 2 from each of the targeted populations. Membership included community leaders, cancer control experts, and various academic and technical organizations involved with cancer control. Through this infrastructure, the investigators developed new culturally sensitive cancer education materials and distributed them in a culturally appropriate manner. They also initiated a cancer control research training program, educated Pacific Islander students in this field, and conducted pilot research projects. PICCN conducted nearly 200 cancer awareness activities in its 6 study sites and developed cancer educational materials on prostate, colorectal, lung, breast, and cervical cancer and tobacco control in the Samoan, Tongan, and Chamorro languages. PICCN trained 9 students who conducted 7 pilot research projects designed to answer important questions regarding the cancer control needs of Pacific Islanders and to inform interventions targeting those needs. The legacy of PICCN lies in its advancement of improving cancer control among Pacific Islanders and setting the stage for interventions that will help to eliminate cancer-related health disparities. Cancer 2006. (c) 2006 American Cancer Society.

Testing the exportability of a tool for detecting operational problems in VA teaching clinics.

BACKGROUND: Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE: This study tests the exportability of a unique CCA tool to identify site-specific operational problems at 5 different VA teaching clinics. DESIGN: We used the CCA tool at 5 teaching clinics to identify group preference differences between the above groups. We averaged the CCA results for all 5 sites. We compared each site with the averages in order to isolate each site's most anomalous responses. Major operational problems were independently identified by workgroups at each site. Cultural consensus analysis performance was then evaluated by comparison with workgroup results. PARTICIPANTS: Twenty patients, 10 residents, 10 faculty, members, and 10 administrators at each site completed the CCA. Workgroups included at minimum: a patient, resident, faculty member, nurse, and receptionist or clinic administrator. APPROACH: Cultural consensus analysis was performed at each site. Problems were identified by multidisciplinary workgroups, prioritized by anonymous multivoting, and confirmed by limited field observations and interviews. Cultural consensus analysis results were compared with workgroup results. RESULTS: The CCA detected systematic, group-specific preference differences at each site. These were moderately to strongly associated with the problems independently identified by the workgroups. The CCA proved to be a useful tool for exploring the problems in depth and for detecting previously unrecognized problems. CONCLUSIONS: This CCA worked in multiple VA sites. It may be adapted to work in other settings or to better detect other clinic problems.

The call to life: revitalizing a healthy Hawaiian identity.

The meaning of health is typically defined as the absence of disease. This definition, while highlighting our ability to measure the physiological attributes of health through morbidity and mortality statistics in turn obscures alternative meanings of health. In this paper, I ask three questions about the meaning of health. First, is health simply the body without disease? Second, are there alternative meanings of health that are not solely informed by Enlightenment views of science and biomedicine? Third, in what ways does health give meaning to and inform social orders and our place within them? Drawing on interviews with Native Hawaiians conducted on the islands of Maui and Hawaii, this paper examines what it means to be a "healthy Hawaiian", and in doing so, problematizes meanings of health. For those I interviewed, definitions of health were embedded in understandings of what it means to be a Native Hawaiian and presented an opportunity to talk about the cultural and material dispossession of Native Hawaiians. These definitions also remind the present generation of the vitality of their ancestors. In remembering the life, health and subsequent dispossession of Hawaiian ancestors, contemporary Hawaiians are provided with an alternative definition of what it means to be a "healthy Hawaiian", thus raising serious questions about "health" as defined by biomedicine and how best to achieve it. This case illustrates how a focus on concepts of health elucidates the relationship between health and inequality as well as Native Hawaiian's agency in charting a positive direction for health that has meaning in the everyday life of Hawaiians.

Exploring beliefs about cancer among American Samoans: focus group findings.

OBJECTIVE: To evaluate answers to the following questions among American Samoans: What is cancer? What causes cancer? And what can you do to prevent cancer? DESIGN: Focus groups (four with women and four with men). SETTINGS: Pago Pago and the Manu'a islands, American Samoa; Honolulu, Hawaii; Los Angeles, California. PARTICIPANTS: 80 self-reported Samoan men and women over the age of 18 years, selected through non-probability purposive sampling with help from Samoan community-based organizations. MEASUREMENT: Qualitative content analysis of focus findings to identify themes. RESULTS: The concepts that cancer was not a Samoan illness, that failure to follow fa'aSamoa (the traditional Samoan way of life) could lead to cancer, and that a return to fa'aSamoa could prevent cancer were the prevalent themes in the focus groups. CONCLUSION: The value that Samoans place on fa'aSamoa, a traditional healthy lifestyle, provides insights into the design of future intervention programs aimed at improving cancer control in this population.

Influence of beliefs about cervical cancer etiology on Pap smear use among Latina immigrants.

OBJECTIVE: To assess Latina immigrants' beliefs about the role of sexual activities in cervical cancer etiology and the impact of the beliefs on Papanicolaou (Pap) smear use. Previous research has found that Latinas, particularly immigrants, believe that cervical cancer is related to 'unwise' sexual activities; however, their beliefs about the nature of the relationship are unclear. DESIGN: We conducted semi-structured face-to-face interviews with a non-probability purposive sample of 20 Mexican immigrant women who resided in Orange County, California regarding their beliefs about risk factors for cervical cancer and Pap smear use. We used qualitative content analysis to identify major themes. Three investigators independently reviewed transcripts of the audio-taped interviews to identify themes and came to a consensus about them. RESULTS: The women had a mean age of 39 years and had resided in the USA for an average of 16.3 years. We identified several themes. The majority of respondents had limited knowledge about cervical cancer and no knowledge about human papillomavirus (HPV); believed that infections caused by physical trauma, certain sexual activities, and poor hygiene caused cervical cancer; believed that they only needed a Pap smear if they developed symptoms of a pelvic infection; and felt that women who engaged in 'unwise' sexual behaviors, in particular, should receive regular Pap smear exams. CONCLUSION: The results suggest that culturally related beliefs about the etiology of cervical cancer play a role in the decision to obtain Pap smears for Latina immigrants. The findings may help to explain why researchers have found Latino ethnicity to be an independent predictor of Pap smear use. They also suggest that programs designed to improve cervical cancer screening, particularly among Latina immigrants, should stress the nature of HPV transmission, its role in the etiology of cervical cancer, and the importance of Pap smear screening in the absence of symptoms.

Impact of U.S. citizenship status on cancer screening among immigrant women.

OBJECTIVES: We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California. DESIGN: Cross-sectional study using data from the 2001 California Health Interview Survey. PATIENTS/PARTICIPANTS: Noninstitutionalized, civilian women, aged 18 years and older living in California. MEASUREMENTS AND MAIN RESULTS: We analyzed data from the 2001 California Health Interview Survey and used logistic regression models to adjust for sociodemographic factors and for access and utilization of health services. After adjusting we found that U.S. citizen immigrants were significantly more likely to report receiving a Pap smear ever (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), a recent Pap smear (aPR, 1.07; 95% CI, 1.03 to 1.11), a mammogram ever (aPR, 1.17; 95% CI, 1.12 to 1.21), and a recent mammogram (aPR, 1.38; 95% CI, 1.26 to 1.49) as compared to immigrants who are not U.S. citizens. Also associated with receiving cancer screening were income, having a usual source of care, and having health insurance. Hispanic women were more likely to receive Pap smears as compared to whites and Asians. CONCLUSIONS: Not being a U.S. citizen is a barrier to receiving cervical and breast cancer screening. Additional research is needed to explore causal factors for differences in cancer screening rates between citizens and noncitizens.

Cultural consensus analysis as a tool for clinic improvements.

Some problems in clinic function recur because of unexpected value differences between patients, faculty, and residents. Cultural consensus analysis (CCA) is a method used by anthropologists to identify groups with shared values. After conducting an ethnographic study and using focus groups, we developed and validated a CCA tool for use in clinics. Using this instrument, we identified distinct groups with 6 important value differences between those groups. An analysis of these value differences suggested specific and pragmatic interventions to improve clinic functioning. The instrument has also performed well in preliminary tests at another clinic.

Addressing the cancer control needs of Pacific Islanders: experience of the Pacific Islander Cancer Control Network.

PURPOSE: This paper describes the accomplishments of the Pacific Islander Cancer Control Network (PICCN). PICCN's objectives fall under two broad categories: increasing cancer awareness and enhancing cancer control research among Samoans, Tongans, and Chamorros. METHODS: PICCN established an infrastructure for addressing the goals that include the University of California, Irvine; the UCI Chao Family Comprehensive Cancer Center; and community-based organizations (CBOs) in areas where large numbers of Pacific Islanders live. Activities that increase cancer awareness include assessing existing cancer education materials, developing new culturally-sensitive materials, and distributing the materials in a culturally-sensitive manner. Activities that enhance cancer control research include training Pacific Islander investigators and providing them with mentors to help with the development of research projects. RESULTS: During the four project years, PICCN has conducted more than 180 cancer awareness activities in its six study sites: Carson, CA; San Mateo, CA; San Diego, CA; Salt Lake City, UT; American Samoa; and Guam. PICCN members have also participated in conferences and lead discussions about the importance of clinical trials for Pacific Islanders. In addition, the Network has trained nine Pacific Islander investigators (three individuals from each ethnic group) in its cancer control academy. Finally, PICCN investigators are conducting pilot research projects that will answer important questions regarding the cancer control needs of these Pacific Islanders and set the stage for interventions aimed at addressing the needs. CONCLUSION: PICCN is advancing the national goal of eliminating cancer-related health disparities through its cancer awareness and research activities for Pacific Islanders.