Oncologists' perceived confidence and attitudes toward managing pre-existing chronic comorbidities during patients' active cancer treatment.

PURPOSE: To examine practicing oncologists' perceived confidence and attitudes toward management of pre-existing chronic conditions(PECC) during active cancer treatment(ACT). METHODS: In December 2018, oncologists in the National Cancer Institute's Community Oncology Research Program (NCORP) were invited to complete a was pilot-tested, IRB-approved online survey about their perceived confidence in managing PECC. Pearson chi-square test was used to identify oncologists' differences in perceived confidence to manage PECC and attitudes toward co-management of patients' PECC with non-oncologic care providers. Perceived confidence and attitudes were analyzed as a function of medical specialty while controlling demographic and medical practice variables. RESULTS: A total of 391 oncologists responded to the survey, 45.8% stated medical oncology as their primary specialty, 15.1% hematology oncology, 15.1% radiation oncology, 6.9% surgical oncology, and 17.1% other specialties such as gynecology oncology. Overall, 68.3% agreed (agree/strongly agree) that they were confident to manage PECC in the context of standard of care. However, only 46.6% and 19.7% remained confident when managing PECC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Most oncologists (58.3%) agreed that patients' overall care was well coordinated, and 63.7% agreed that patients had optimal cancer and non-cancer care when PECC was co-managed with a non-oncology care provider. CONCLUSION: Most oncologists felt confident to manage all PECC during patients' ACT, but their perceived confidence decreased for PECC previously managed by PCPs or by non-oncology subspecialists. Additionally, they had positive attitudes toward co-management of PECC with non-oncologic care providers. These results indicate opportunities for greater collaboration between oncologists and non-oncology care providers to ensure comprehensive and coordinated care for cancer patients with PECC.

Factors influencing cervical cancer screening among pregnant women in Nairobi, Kenya.

To characterize cervical cancer screening knowledge, beliefs, behaviors, and sociodemographic factors among women aged 25-45 years who access and utilize prenatal care services in Nairobi, Kenya. A descriptive cross-sectional design using a convenience sample of pregnant women receiving prenatal health services at a public and a private hospital in Nairobi, Kenya. Constructs from the Health Belief Model (HBM) guided the design, interpretation of the results, and recommendations. Data were analyzed using SPSS version 24. Bivariate analyses were conducted to examine associations between variables. There was a significant association (p=0.001) between knowledge and screening behaviors. There was no association (p=0.066) between cervical cancer beliefs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) and screening behaviors. Knowledge and beliefs influence cervical cancer screening behavior. Low cervical cancer screening uptake substantiates the need for tailoring culturally specific health behavior change communication to address misconceptions about cervical cancer screening in Kenya.

Factors influencing cervical cancer screening among pregnant women in Nairobi, Kenya

To characterize cervical cancer screening knowledge, beliefs, behaviors, and sociodemographic factors among women aged 25-45 years who access and utilize prenatal care services in Nairobi, Kenya. A descriptive cross-sectional design using a convenience sample of pregnant women receiving prenatal health services at a public and a private hospital in Nairobi, Kenya. Constructs from the Health Belief Model (HBM) guided the design, interpretation of the results, and recommendations. Data were analyzed using SPSS version 24. Bivariate analyses were conducted to examine associations between variables. There was a significant association (p=0.001) between knowledge and screening behaviors. There was no association (p=0.066) between cervical cancer beliefs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) and screening behaviors. Knowledge and beliefs influence cervical cancer screening behavior. Low cervical cancer screening uptake substantiates the need for tailoring culturally specific health behavior change communication to address misconceptions about cervical cancer screening in Kenya.

Barriers and enablers to nutrition and physical activity in Lima, Peru: an application of the Pen-3 cultural model among families living in pueblos jóvenes.

OBJECTIVES: Childhood obesity is increasing in Latin America as nutrition status and economies transition. Peru is one such country with an emerging childhood obesity epidemic. The Peruvian Ministry of Health established goals for achieving reductions in overweight and obesity prevalence among children 5 years and younger by 2021. However, specific intervention strategies for achieving these goals are lacking. Culturally appropriate interventions guided by evidence-based theories are needed to address the emerging problem of overweight and obesity among young children. This study utilized the Pen-3 model, a culture-based conceptual framework to explore barriers and facilitators to healthy diet and physical activity for parents of young children in pueblos jóvenes communities. DESIGN: A qualitative investigation was conducted as part of a larger cross-sectional survey study of parents of three and four-year-old children at five school sites in the peri-urban slum neighborhoods of southern Lima. Parents were asked to describe barriers and facilitators of healthy diet and physical activity for their preschoolers and families. Thematic analysis guided by PEN-3 model constructs assisted in identifying emergent themes. RESULTS: Two domains of the Pen-3 model guided the elucidation of barriers and facilitators of health behaviors deemed essential to healthy diet and physical activity. Parental perceptions about neighborhood safety, lack of community resources, such as parks and recreation spaces, and lack of information about appropriate serving sizes and healthy recipes were identified as barriers. Facilitators to healthy behaviors included mothers' views on their role as nurturers, and personal values for family-centered health behaviors. CONCLUSIONS: Parents identified specific barriers and facilitators of eating healthy and physical activity for their preschoolers and families living in resource poor areas of Peru. Health promotion professionals can utilize findings to inform the design of culturally appropriate family-based interventions in Peru's pueblos jóvenes.

Parental Attitudes and Beliefs About Preschooler Preventive Oral Health Behaviors: Implications for Health Promotion.

Dental caries affects 60-90% of school-aged children, with non-Hispanic Black children among those disproportionately affected. This study seeks to examine the attitudes, beliefs, and behaviors of Black parents about preventive measures against caries for their preschool children (3-5 years). Parents of Black preschool children in Miami-Dade County (n = 192) completed an oral health survey measuring oral health attitudes, beliefs, and behaviors. Descriptive statistics were used to analyze attitudes, beliefs and favorable oral health behaviors. Logistic regression was used to examine the relationship between parental oral health attitudes and beliefs and their children's oral health behaviors. Most of the parents reported positive attitudes with regards to sugar snacking (81%), brushing child's teeth (88%), attitude to prevention (85%), and perceived seriousness of decay (91%). Parental oral health attitudes were independently associated with children's preventive oral health behaviors (p < 0.05). Parental education should be included in interventions geared towards improving children's oral health.

"Sex Is a sin": Afro-Caribbean Parent and Teen Perspectives on Sex Conversations.

This study characterized (a) mothers' childhood and teenage experiences with sex conversations and (b) families' perceptions of current parent-child sex conversations within two underserved Afro-Caribbean communities in the U.S. Fourteen dyads comprised of Haitian and Jamaican mothers and teens (aged 14-18) living in Miami, Florida, completed semi-structured interviews sharing their experiences with sex conversations. Researchers analyzed data using thematic content analysis. Mothers' mean age was 41.85 years, (SD = 5.50) and teens' mean age was 16.35 years, (SD = 1.31). Most mothers reported forbidden or little childhood experiences with parent-child sex conversations. They affected their sexual attitudes, behaviors, and ability to discuss sex with their children. Although some mothers benefited from educational and skill development others shared fear-based messages with their children that some teens believed adversely affected the mother-child relationship quality. Culturally appropriate, skill-based approaches are necessary to improve families' communication self-efficacy for healthy sex conversations to occur in Afro-Caribbean families.

Applying geo-spatial analysis in community needs assessment: Implications for planning and prioritizing based on data.

BACKGROUND: Colonias are sub standardized and unincorporated areas located along the US-Mexico border, with severely lacking infrastructure. Residents have poor health and limited availability, accessibility and/or utilization of healthcare services in the region. METHODS: Using 2006-2007 community needs assessment (CNA) surveys collected by the Center for Housing and Urban Development of Texas A&M University, 410 randomly selected surveys from Hidalgo County, Texas were analyzed. Descriptive and spatial analyses were performed and Odds ratio (OR) was calculated. RESULTS: Out of 410 surveys, 333 were geo-coded to identify areas most in need of dental and vision care. Two hospitals existed within 5 miles radius of the mean centers for the two areas. Distance to health care facility was not statistically predictive of the need of dental care OR=0.96 (95% CI=0.855-1.078, p value=0.492) and vision care OR=1.083 (95% CI=0.968-1.212, p value=0.164). CONCLUSION: Integrating spatial analysis and CNA enhances planning to improve service accessibility and utilization in underserved areas.

Outcome of a food observational study among low-income preschool children participating in a family-style meal setting.

INTRODUCTION: In the United States, one out of every seven low-income children between the ages of 2 and 5 years is at risk for overweight and obesity. Formative research was conducted to determine if preschool children participating in family-style meals consumed the minimum food servings according to U.S. Department of Agriculture dietary guidelines. METHOD: Participants were 135 low-income children aged 3 to 4 years who attended an urban child care center. Participant's parents completed a Family Demographic Questionnaire to provide information on race/ethnicity, parent's level of education, and household income. Direct observation of children's food and beverage consumption during school breakfast and lunch was collected over 3 consecutive days. Dietary data were assessed using the Nutrition Data System for Research software. Height and weight measurements were obtained to determine risk for obesity. Descriptive statistics were reported by using the Statistical Package for the Social Sciences Version 16. RESULTS: Among 135 participants, 98% identified as Mexican American, 75% lived at or below poverty level, and 24% reported a family history of diabetes. Children consumed less than half of the calories provided between breakfast and lunch and did not consume the minimum recommended dietary food servings. Despite the poor dietary intake, physical measurement findings showed 25% obesity prevalence among study participants. CONCLUSIONS: Findings support the need for evidenced-based early childhood obesity prevention programs that provide behavior change opportunities for children, their families, teachers, and menu planners. Family-style meal settings are ideal opportunities for implementing nutrition education strategies to prevent early childhood obesity.

Can health equity coexist with housing inequalities? A contemporary issue in historical context.

The housing policies established by the Federal Home Loan Bank Board, Federal Housing Administration, and the Veterans Administration transformed the American housing market. However, these policies intentionally excluded communities of color from the postwar American housing boom by defining them as contaminants eroding national property values. Hence, racially restrictive federal housing policies established an inequitable generational trajectory for residents in communities across the United States. Public health practitioners are faced with the monumental challenge of addressing health disparities that were in part created by non-public health policies. The purpose of this article is to examine how federal housing policies historically contributed to creating the built environment and therefore establishing a foundation for health disparities. These pervasive, exclusionary policies and the generational stigma associated with this issue raise serious questions about the ethics of contemporary policies, practices, and research aimed at achieving health equity.

Managing ethical dilemmas in community-based participatory research with vulnerable populations.

This article describes two ethical dilemmas encountered by our research team during a project working with undocumented immigrants in Toronto, Canada. This article aims to be transparent about the problems the research team faced, the processes by which we sought to understand these problems, how solutions were found, and how the ethical dilemmas were resolved. Undocumented immigrants are a vulnerable community of individuals residing in a country without legal citizenship, immigration, or refugee status. There are more than half a million undocumented immigrants in Canada. Through an academic-community partnership, a study was conducted to understand the experiences of undocumented immigrants seeking health care in Toronto. The lessons outlined in this article may assist others in overcoming challenges and ethical dilemmas encountered while doing research with vulnerable communities.

A brotherhood perspective: how African American male relationships may improve trust and utilization of health care.

The objective of this research was to explore interview data to understand and characterize the nature of brotherhood in a sample of African American men at two historically Black colleges and universities. The authors used thematic analysis on semistructured interview data, collected by an ethnically diverse research team. Recruitment and interviews were conducted at two historically Black colleges and universities in Texas. Twenty African American men, 18 to 35 years old, were randomly selected from 62 recruited participants. Five categories framed brotherhood and health care utilization: (a) trust lessens individual barriers to action, (b) identity unites men through a process of authentication, (c) generations lead by example, (d) approaching life as a shared learning experience, and (e) social pressure and ridicule uphold collective action. Findings suggest that participants trust a group view, identify with the collective, and respond to social pressure to conform; therefore, brotherhood acts as a support mechanism, and its validation influences individual-level engagement and nonengagement.

Multicultural counseling competencies: an analysis of research on clients' perceptions: comment on Owen, Leach, Wampold, and Rodolfa (2011).

J. Owen, M. M. Leach, B. Wampold, and E. Rodolfa (see record 2010-24976-001) tested the hypotheses that (a) some therapists express more multicultural competencies (MCCs) more than other therapists and (b) clients' perceptions of their therapists' MCCs are a function of specific client or therapeutic factors. In the present analysis, the authors critiqued 3 major components of the study: conceptual and methodological underpinnings, interpretation of research findings, and implications for future research. Although the authors agree with the importance of this line of research, the authors also believe that some of the researchers' underlying assumptions are worthy of examination; alternate interpretations of the findings are possible, and several recommendations for future research are imperative.

The health disparities industry: is it an ethical conundrum?

Reducing health disparities is the purported mission of a huge network of professionals representing many specialties and organizations offering a variety of products and services. Given its elaborate infrastructure and specialized set of activities, we identity the network as the health disparities industry. In this article, we question the ethics of this industry. Specifically, we ask whether the public mission is trumped by questionable industry leadership, ethics, and quality assurances. Drawing on general principles of ethics and differentiating ethical concerns from ethical problems, we conclude that the collective behaviors within the industry may represent an ethical conundrum. The article concludes with a call for the cross-examination of the industry practices.