Family-Centered Prevention to Reduce Discrimination-Related Depressive Symptoms Among Black Adolescents: Secondary Analysis of a Randomized Clinical Trial.

Importance: Racial discrimination undermines the mental health of Black adolescents. Preventive interventions that can attenuate the effects of exposure to racial discrimination are needed. Objective: To investigate whether participation in the Strong African American Families (SAAF) program moderates Black adolescents' depressive symptoms associated with experience of racial discrimination. Design, Setting, and Participants: This secondary analysis used data from a community-based randomized clinical trial of SAAF (SAAF vs no treatment control). Participants were followed up at 10, 22, and 34 months after the baseline assessment. Assessment staff were blind to participant condition. Participants in this trial lived in 7 rural counties in Georgia. SAAF was delivered at local community centers. Eligible families had a child aged 11 to 12 years who self-identified as African American or Black. The joint influence of random assignment to SAAF and exposure to racial discrimination was investigated. Data were analyzed from September 2022 to March 2023. Intervention: SAAF is a 7-session (14 hours) family skills training intervention that occurs over 7 weeks. Small groups of caregivers and their adolescents participate in a structured curriculum targeting effective parenting behavior, adolescent self-regulation, and Black pride. Main Outcomes and Measures: The main outcome was adolescent-reported depressive symptoms, assessed at 34 months via the 20-item Center for Epidemiologic Studies Depression Scale for Children. Results: Of 825 families screened randomly from public school lists, 472 adolescents (mean [SD] age, 11.6 years; 240 [50.8%] female) were enrolled and randomized to SAAF (252 participants) or a no treatment control (220 participants). Exposure to racial discrimination at age 13 years was associated with increased depressive symptoms at age 14 years (ß = 0.23; 95% CI, 0.13 to 0.34; P < .001). Interaction analyses indicated that the experimental condition significantly moderated the association of racial discrimination with depressive symptoms: (ß = -0.27; 95% CI, -0.47 to -0.08; P = .005). Probing the interaction with simple slopes at ±SD revealed that for the control group, racial discrimination was significantly associated with depressive symptoms (ß = 0.39; 95% CI, 0.23 to 0.54; P < .001), while for the SAAF group, there was no association between racial discrimination and depressive symptoms (ß = 0.12; P = .09). Conclusions and Relevance: This randomized clinical trial found that the SAAF intervention reduced the incidence of racism-associated mental health symptoms among Black adolescents. SAAF is recommended for dissemination to health care practitioners working with rural Black adolescents. Trial Registration: ClinicalTrials.gov Identifier: NCT03590132.

Prevalence and Cumulative Risk of Familial Idiopathic Dilated Cardiomyopathy.

Importance: Idiopathic dilated cardiomyopathy (DCM) aggregates in families, and early detection in at-risk family members can provide opportunity to initiate treatment prior to late-phase disease. Most studies have included only White patients, yet Black patients with DCM have higher risk of heart failure-related hospitalization and death. Objective: To estimate the prevalence of familial DCM among DCM probands and the age-specific cumulative risk of DCM in first-degree relatives across race and ethnicity groups. Design, Setting, and Participants: A family-based, cross-sectional study conducted by a multisite consortium of 25 US heart failure programs. Participants included patients with DCM (probands), defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes, and their first-degree relatives. Enrollment commenced June 7, 2016; proband and family member enrollment concluded March 15, 2020, and April 1, 2021, respectively. Exposures: The presence of DCM in a proband. Main Outcomes and Measures: Familial DCM defined by DCM in at least 1 first-degree relative; expanded familial DCM defined by the presence of DCM or either left ventricular enlargement or left ventricular systolic dysfunction without known cause in at least 1 first-degree relative. Results: The study enrolled 1220 probands (median age, 52.8 years [IQR, 42.4-61.8]; 43.8% female; 43.1% Black and 8.3% Hispanic) and screened 1693 first-degree relatives for DCM. A median of 28% (IQR, 0%-60%) of living first-degree relatives were screened per family. The crude prevalence of familial DCM among probands was 11.6% overall. The model-based estimate of the prevalence of familial DCM among probands at a typical US advanced heart failure program if all living first-degree relatives were screened was 29.7% (95% CI, 23.5% to 36.0%) overall. The estimated prevalence of familial DCM was higher in Black probands than in White probands (difference, 11.3% [95% CI, 1.9% to 20.8%]) but did not differ significantly between Hispanic probands and non-Hispanic probands (difference, -1.4% [95% CI, -15.9% to 13.1%]). The estimated prevalence of expanded familial DCM was 56.9% (95% CI, 50.8% to 63.0%) overall. Based on age-specific disease status at enrollment, estimated cumulative risks in first-degree relatives at a typical US advanced heart failure program reached 19% (95% CI, 13% to 24%) by age 80 years for DCM and 33% (95% CI, 27% to 40%) for expanded DCM inclusive of partial phenotypes. The DCM hazard was higher in first-degree relatives of non-Hispanic Black probands than non-Hispanic White probands (hazard ratio, 1.89 [95% CI, 1.26 to 2.83]). Conclusions and Relevance: In a US cross-sectional study, there was substantial estimated prevalence of familial DCM among probands and modeled cumulative risk of DCM among their first-degree relatives. Trial Registration: ClinicalTrials.gov Identifier: NCT03037632.

Racial/Ethnic Differences in Women's Life Event Exposure Across Midlife.

OBJECTIVE: Stressful life events are associated with poorer physical, cognitive, and mental health. Examining life events trends across midlife illustrates normative experiences of stress in a critical life period for intervention and disease prevention. Further, there is a critical need for research with racially/ethnically diverse samples to identify differences in life event exposure, as they may relate to later health disparities. METHOD: Annual life event reports were analyzed from 3,066 White, Black, Hispanic, Chinese, and Japanese women in the Study of Women's Health Across the Nation. Across ages 43-65, longitudinal trajectories were fit to annual number of life events and 9 subcategories of life events (i.e., work problems, economic problems, partner unemployment, illness/accident of loved one, caregiving, bereavement, relationship problems, family legal/police problems, and violent events that happened to the self or family). Racial/ethnic differences were examined, controlling for education. RESULTS: Number of annual life events declined with age and plateaued in later midlife. This pattern was largely consistent across types of life events, though family health and bereavement-related life events increased in later midlife. Compared to White women, Black women experienced more life events, while Chinese, Hispanic, and Japanese women experienced fewer life events. Racial/ethnic differences were amplified in specific subtypes of life events. DISCUSSION: Racial/ethnic differences in exposure to life events across midlife may contribute to racial/ethnic health disparities in later life.

Influencia del funcionamiento familiar y bienestar psicológico en padres de familia ecuatorianos / Influence of the family functioning and psychological well-being in Ecuadorian patresfamilias

RESUMEN Introducción: la presente investigación surge motivada por el estudio de las variables de funcionamiento familiar y bienestar psicológico en padres de familia. Objetivo: determinar la influencia del funcionamiento familiar en el bienestar psicológico de los padres de familia pertenecientes al Ministerio de Compasión Internacional, de las iglesias del Nazareno en Ecuador. Materiales y métodos: se hizo un estudio observacional, transversal y cuantitativo de 405 padres de familia de las ciudades de Riobamba, Guaranda, Puyo y Montalvo, en Ecuador, entre agosto y octubre de 2020. Se realizó una encuesta mediante Google Forms. Los datos del funcionamiento familiar y bienestar psicológico se procesaron en Microsoft Excel, y el cálculo del coeficiente de correlación de Spearman se realizó mediante el software SPSS 25. Resultados: se evidenció la prevalencia de una familia moderadamente funcional (50,9 %) y de bienestar psicológico bajo (61,5 %). La correlación entre las dos variables de estudio fue de rho = 0,215. Las familias fueron mayormente nucleares y predominó el estado civil casado. Conclusiones: se determinó que los resultados no fueron concluyentes, ya que no existió una correlación entre las variables de estudio: funcionamiento familiar y bienestar psicológico. Se infirió que existieron otras variables intervinientes que merecieron ser analizadas (AU).

ABSTRACT Introduction: the current research arises motivated by the study of the variables of family functioning and psychological well-being in patresfamilias. Objective: to determine the influence of family functioning on the psychological well-being of patresfamilias who belong to the Ministry of International Compassion of the churches of the Nazarene in Ecuador. Materials and method: an observational, cross-sectional and quantitative study was carried out, in 405 patresfamilias from the cities of Riobamba, Guaranda, Puyo and Montalvo, in Ecuador, in the period August-October 2020. An inquiry was applied through Google Forms. Data on family functioning and psychological well-being were processed in Microsoft Excel, and the SPSS 25 software was used for working Spearman correlation out. Results: the prevalence of a moderately functional family (50.9%) and low psychological well-being (61.5%) were evidenced. The correlation between the two study variables was rho=0.215. Families were mostly nuclear and married marital status predominated. Conclusions: it was determined that results were not conclusive, because there was not a correlation between the study variables: family functioning and psychological well-being. The authors inferred that there were other involved variables that need to be analyzed (AU).

In This Together: Navigating Ethical Challenges Posed by Family Clustering during the Covid-19 Pandemic.

Harrowing stories reported in the media describe Covid-19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision-making by reducing available surrogate decision-makers for incapacitated patients, increases the emotional burdens of surrogate decision-makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision-making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience.

The Need for Culturally Competent Care Within Gastroenterology Services: Evidence from Research with Adults of South Asian Origin Living with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: It is widely acknowledged that the incidence of inflammatory bowel disease [IBD] is rising within South Asian populations, yet research into the experiences of this group of patients is rare. In this study the lived experiences of UK South Asian adults with IBD, including support from gastroenterology services, was investigated. METHODS: A sample of 33 patients representing the diversity of the UK South Asian population were recruited through five gastroenterology clinics in England. In-depth semi-structured interviews were conducted, audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Although many experiences align with those of the general IBD population, participants believed that South Asian cultures and/or religions can lead to additional challenges. These are linked to: family and friends' understanding of IBD; self and family attributions regarding IBD; stigma surrounding ill health; the taboo of bowel symptoms; managing 'spicy food'; beliefs about food and ill health; roles within the family; living with extended family; the use of complementary and alternative therapies; and visits to family overseas. Religious faith helped many to cope with having IBD, but symptoms could hamper their ability to practise faith. Gastroenterology services were viewed positively, but unmet needs were identified, some of which were culturally specific. CONCLUSION: Gastroenterology services have an important role to play in helping patients to overcome the challenges they encounter in their everyday life, both by providing individual patients with culturally appropriate care and advice, and via interventions to increase awareness and understanding of IBD within wider South Asian communities.

Saberes populares en salud de las familias campesinas (Colombia) / Popular health knowledge of peasant families (Colombia) / Conhecimento popular em saúde de famílias de camponeses (Colômbia)

OBJETIVO: Comprender los saberes populares de las familias campesinas de Villamaría (Caldas, Colombia), a partir del rol de enfermería en la Atención Primaria de Salud. MÉTODO: Etnografía interpretativa con observación participante y entrevistas a profundidad. Participaron 7 familias de la zona rural dispersa. Se realizaron 29 visitas familiares (septiembre de 2017 a noviembre de 2018). El análisis se realizó con Atlas.ti mediante cuatro fases: recolección y registro de datos; agrupación, clasificación y codificación; identificación de patrones recurrentes, y hallazgos de investigación. RESULTADOS: Se identificó el tema cultural "Con nuestros saberes populares salimos adelante y nos cuidamos", justificado en tres patrones: "sobreviviendo con la familia, la espiritualidad y quienes nos apoyan", "riesgos y experiencias ante la salud y enfermedad" y "con las comidas y métodos para cuidar sobrevivimos a los riesgos". CONCLUSIONES: Los saberes populares de las familias campesinas están formados por varios elementos en búsqueda de bienestar. Para la enfermedad, se encuentra sincretismo entre la medicina occidental y los métodos naturales, en especial con el manejo de las plantas. Los resultados aportan al currículo y atención de los profesionales de la salud, especialmente a enfermería al contribuir como respuesta a la normativa actual en salud

OBJECTIVE: To understand the popular knowledge of the rural families of Villamaría (Caldas, Colombia), based on the role of nursing in Primary Health Care. METHODS: Interpretive ethnography with participant observation and in-depth interviews. Seven families from the dispersed rural area participated. 29 family visits were made (September 2017 to November 2018). The analysis was performed with Atlas.ti, through four phases: data collection and recording; grouping, classification and coding; identification of recurring patterns, and research findings. RESULTS: The cultural theme was identified "With our popular knowledge we go ahead and take care of ourselves", justified in three patterns: "Surviving with the family, spirituality and those who support us", "Risks and experiences in the face of health and illness" and "With the meals and caring methods we survive the risks". CONCLUSIONS: The popular knowledge of peasant families consists of several elements in search of well-being. For the disease, syncretism is found between Western medicine and natural methods, especially the use of plants. The results contribute to the curriculum and attention of health sciences professionals, particularly those of nursing by contributing in response to current health regulations

OBJETIVO: Compreender o conhecimento popular das famílias camponesas de Villamaría (Caldas-Colômbia), desde o papel da enfermagem na Atenção Primaria em Saúde. MÉTODOS: Etnografia interpretativa com observação participante e entrevistas a profundidade. Participaram 7 famílias da área rural dispersa. Foram realizadas 29 visitas familiares (setembro de 2017 até novembro de 2018). A análise foi feita com Atlas.ti, diante quatro momentos: recolecção e registro de dados; agrupação, classificação e codificação; identificação de padrões recorrentes, e achados de pesquisa. RESULTADOS: foi identificado o tema cultural "Com o nosso conhecimento popular vamos em frente e a gente se cuidou", justificado em três padrões: "sobrevivendo com a família, a espiritualidade e das pessoas que apoiam a gente", "Riscos e experiências diante a saúde e a doença" e "Com as comidas e métodos pra cuidar sobrevivemos a os riscos". CONCLUSÕES: O conhecimento popular das famílias camponesas está formado por vários elementos na procura de bem-estar. Pra doença, se encontra sincretismo entre a medicina ocidental e os métodos naturais, em especial no atendimento das plantas. Os resultados contribuem no currículo e atenção dos professionais das ciências da saúde, do jeito particular, os de enfermagem contribuindo como resposta a legislação atual de saúde

Athletes for life: Rationale and methodology of a community- and family-based randomized controlled trial to promote cardiovascular fitness among primarily Latino families.

BACKGROUND: Community-based programs have had modest success in combating obesity in Latino populations. Latino families' norms and beliefs about weight often hold larger body sizes to be normal, leading to lower engagement in weight-focused programs. Because improvements in cardiorespiratory fitness confer health benefits, regardless of weight, they offer an alternative to obesity-focused approaches. We describe the rationale and design of Athletes for Life (AFL), a community- and family-based intervention for Latino families. METHODS/DESIGN: This two-group randomized controlled trial will test the efficacy of AFL for improving cardiorespiratory fitness and diet in 6- to 11-year-old children (N = 160) and their parents, relative to a wait-list control group. Children will participate in 12 weeks of semiweekly sports skill programing and nutrition sessions. Concurrently, parents will participate in sports-focused activity and behavior change sessions that focus on nutrition, chronic disease prevention, and healthy eating. Cardiovascular fitness will be measured by the 1-mile run and 3-min step-test for both parents and children. Secondary outcomes include changes in objectively measured physical activity, dietary measures, body composition, and cardiometabolic risk (waist circumference, blood pressure, blood lipids, glucose, insulin, and C-reactive protein). DISCUSSION: AFL, implemented with a strong community partnership, will provide a test of the efficacy of culturally tailored intervention programming to promote positive health behaviors and improve health outcomes in Latino families. Intervention content, structure, and messaging will provide guidance for future methods to engage Latino families in health promotion programs that highlight their cultural norms, and beliefs. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03761589 (12/3/2018).

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families.

Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.

The Family Resilience Inventory: A Culturally Grounded Measure of Current and Family-of-Origin Protective Processes in Native American Families.

The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one's current family and in one's family of origin, enabling the assessment of family protective factors across these generations. The development of the FRI was the result of many years of ethnographic research with Southeastern Native American tribes; yet, we believe that this scale is applicable to families of various backgrounds. Items for the FRI were derived directly from thematic analysis of qualitative data with 436 participants, resulting in two 20-item scales. Due to missing data, eight cases were removed from the 127 participants across two tribes, resulting in an analytic sample size of 119. Conceptually, the FRI is comprised of two factors or scales measuring distinct dimensions of family resilience (i.e., resilience in one's current family and resilience in one's family of origin). The results of the confirmatory factor analysis supported the hypothesized two-factor structure (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Both the subscales and the total FRI scale (α = .92) demonstrated excellent reliability. The results also provided preliminary evidence of convergent and discriminant validity. This measure fills a gap in the absence of community-based, culturally grounded, and empirical measures of family resilience. The examination of family resilience, which may occur across generations, is an exciting new contribution of the FRI.

El propósito de este artículo es presentar el "Inventario de Resiliencia Familiar" (FRI, por sus siglas en inglés) y los resultados actuales sobre los primeros esfuerzos para validar esta medición. El FRI está diseñado para evaluar la resiliencia familiar en la familia actual de una persona y en la familia de origen de una persona, lo cual permite la evaluación de los factores protectores familiares entre estas generaciones. El desarrollo del FRI fue el resultado de muchos años de investigación etnográfica con tribus amerindias del sudeste; sin embargo, creemos que esta escala puede aplicarse a familias de diferentes orígenes. Los puntos que componen el FRI se obtuvieron directamente de análisis temáticos de datos cualitativos con 436 participantes, cuyo resultado fueron dos escalas de 20 puntos. Debidos a datos faltantes, se extrajeron ocho casos de los 127 participantes entre dos tribus, lo cual resultó en un tamaño de la muestra análitica de 119. Conceptualmente, el FRI está compuesto por dos factores o escalas que miden diferentes dimensiones de resiliencia familiar (p. ej.: la resiliencia en la familia actual de una persona y la resiliencia en la familia de origen de una persona). Los resultados del análisis factorial confirmatorio respaldaron la estructura de dos factores planteada como hipótesis (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Tanto las subescalas como la escala total del FRI (α = .92) demostraron una excelente fiabilidad. Los resultados también proporcionaron indicios preliminares de validez convergente y discriminante. Esta medición llena un vacío en ausencia de mediciones de resiliencia familiar comunitarias, basadas en la cultura y en la práctica. El análisis de la resiliencia familiar, que puede darse en distintas generaciones, es un nuevo y fascinante aporte del FRI.

Autoimmune diseases in first- and second-degree relatives of patients with inflammatory bowel diseases: a case-control survey in Israel.

BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic, relapsing, inflammatory diseases of the gastrointestinal tract with unknown etiology. IBD are complex, multi-factorial disorders, in which genetic factors play a major role, the so-called phenomenon of familial aggregation or clustering of IBD. A positive family history of IBD is often reported among CD and UC probands, with percentages depending on the geographic context in which the studies are carried out. Israel is a complex and pluralistic society comprising of two major ethno-national groups (Arabs and Jewish) and, as such, represents a unique living laboratory in which to test the role of genetic factors in the development of IBD as well as of associated autoimmune disorders (ADs). While some studies have found a lower prevalence of ADs among Arabs when compared to Jews, few studies directly compared the two ethnicities. METHODS: The present case-control study was designed to compare the rate of ADs in first- and second-degree relatives of IBD patients, stratified according to Jewish or Arabic ethnicity. RESULTS: We found that first-degree relatives of Jews patients had a higher risk of developing ADs (OR=1.89, P=0.0086). Classifying ADs into systemic and local (endocrinological, gastrointestinal, dermatological, and neurological) types, first-degree relatives of Jews patients had a higher OR of developing local ADs (OR=2.12, P=0.0056). CONCLUSIONS: Israeli Jewish IBD patients had more first-degree relatives with local ADs as compared to Arab patients.

A Family Belief Systems Theory for Transcultural Family Health Care Nursing.

To enable culturally congruent family health care nursing, the family belief systems theory proposed by Hohashi can be utilized. The family belief systems theory, developed through family ethnographic studies and questionnaire surveys conducted in the United States, Japan, China, Indonesia, and the Philippines, explains (a) structurization of a system, based on the family member's beliefs as cognition criteria, in which family member's emotions, decisions/acts, and physical responses (including health problems) occur; and (b) the process in which family beliefs are formed from family members' beliefs, by which intentional decisions/acts by the family (family decision making, family self-management, etc.) are performed. By identifying the mechanism of family belief systems, the nursing professional, through support for family/family members' beliefs, can completely change the intentional decisions/acts by the family.

Assessing research impact: Australian Research Council criteria and the case of Family Wellbeing research.

Researchers worldwide are increasingly reporting the societal impact of their research as part of national research productivity assessments. However, the challenges they encounter in developing their impact case studies against specified government assessment criteria and how pitfalls can be mitigated are not reported. This paper examines the key steps taken to develop an Aboriginal Family Wellbeing (FWB) empowerment research impact case study in the context of an Australian Research Council (ARC) pilot research impact assessment exercise and the challenges involved in applying the ARC criteria. The requirement that researchers demonstrate how their institutions support them to conduct impactful research has the potential to create supportive environments for researchers to be more responsive to the needs of users outside academia. However, the 15-year reference period for the associated research underpinning the reported impact and the focus on researcher's current institutional affiliation constitute potential constraints to demonstrating the true impact of research. For researchers working with Indigenous people, relationships that build over long periods of time, irrespective of university affiliation, are critical to conducting impactful research. A more open-ended time-frame, with no institutional restrictions for the 'associated research' provides the best opportunity to demonstrate the true benefits of research not only for Indigenous people but for Australian society more broadly.

¡Viva Maryvale!: A Multilevel, Multisector Model to Community-Based Diabetes Prevention.

INTRODUCTION: Latino communities are disproportionately affected by type 2 diabetes and experience disparities in access to diabetes prevention programs. The purpose of this study was to test the preliminary efficacy of a culturally grounded, diabetes prevention program for high-risk Latino families delivered through an integrated research-practice partnership. STUDY DESIGN: The integrated research-practice partnership was established in a predominantly Latino community and consisted of a Federally Qualified Health Center, a YMCA, an accredited diabetes education program, and an academic research center. Data were collected and analyzed from 2015 to 2018. SETTING/PARTICIPANTS: Latino families consisting of a parent with an obese child between age 8 and 12 years. INTERVENTION: The 12-week lifestyle intervention included nutrition education and behavioral skills training (60 minutes, once/week) and physical activity classes (60 minutes, three times/week) delivered at a YMCA. MAIN OUTCOME MEASURES: Outcomes included measures of adiposity (BMI, waist circumference, and body fat); HbA1c; and weight-specific quality of life. RESULTS: Over the course of the 2-year project period, 58 families (parents n=59, children n=68) were enrolled with 36% of parents and 29% of children meeting the criteria for prediabetes at baseline. Feasibility and acceptability were high, with 83% of enrolled families completing the program, 91% of the intervention sessions attended, and 100% of families stating they would recommend the program. The intervention led to significant decreases in percentage body fat among parents (46.4% [SD=10.8] to 43.5% [SD=10.5], p=0.001) as well as children (43.1% [SD=8.0] to 41.8% [SD=7.2], p=0.03). Additionally, HbA1c was significantly reduced in parents (5.6% [SD=0.4] to 5.5% [SD=0.3], p=0.03), and remained stable in children (5.5% [SD=0.3] vs 5.5% [SD=0.3], p>0.05). Significant improvements in quality of life were reported in parents (64.6 [SD=15.8] to 71.0 [SD=13.7], p=0.001) and children (69.7 [SD=15.8] to 72.6 [SD=13.7], p=0.05). CONCLUSIONS: These findings support the preliminary efficacy of an integrated research-practice partnership to meet the diabetes prevention needs of high-risk Latino families within a vulnerable community.

Prática alimentar e determinantes sociais na anemia em famílias atendidas pela Estratégia Saúde da Família no estado do Maranhão - estudo de base populacional / Food practice and social determinants of anemia in families attended by Family Health Strategy in the state of Maranhão - a population-based study

Introdução: A anemia é extremamente relevante no contexto da saúde pública. As prevalências em países em desenvolvimento, como o Brasil, são altas e, a despeito de todo o avanço no conhecimento, no diagnóstico e no tratamento, ainda são subestimadas pelo poder público no seu impacto. Objetivo: Avaliar a prática alimentar e determinantes sociais na anemia em mães atendidas pela Estratégia Saúde da Família no estado do Maranhão. Método: Estudo transversal de base populacional que fez parte do projeto \"Prevalência e Determinantes da Anemia em Mulheres e Crianças no Estado do Maranhão\". Foram utilizados dados do questionário socioeconômico e demográfico, do questionário de frequência alimentar (QFA), dados bioquímicos referentes à dosagem de hemoglobina das mulheres e escore de altura para idade das crianças. Para a análise das informações com base no QFA das mulheres (n=779), verificou-se a associação das variáveis com a presença ou ausência de anemia e seus determinantes sociais, a presença de marcadores de alimentação saudável (n=779) e o crescimento linear e anemia com os determinantes sociais (n=966). Resultados: As condições socioeconômicas das famílias não favoreceram o consumo regular de alimentos fonte de ferro e a proteção contra a anemia. A presença frequente de marcadores de alimentação saudável foi destacada pelo consumo de feijão (83,4%), peixe (53,7) e laranja (55,2%). A prevalência de baixa estatura para a idade foi de 9,7% para o estado e entre as variáveis estudadas apenas o Programa Bolsa Família atuou como uma proteção contra a anemia (p<0,003). Conclusão: A elevada demanda de ferro seria facilmente alcançada pela dieta desde que os alimentos considerados fonte fossem consumidos regularmente. Os resultados do estado do Maranhão e os determinantes sociais não mostraram associação direta, pois estão permeados pela pobreza. O Programa Bolsa Família contribuiu para amenizar a vulnerabilidade social da população beneficiária e a inserção na atenção básica, por meio da ESF, como forma de proteção

Introduction: Nutritional anemia is extremely relevant in the context of public health. Its prevalence in developing countries, such as Brazil, are high and, in spite of all advances in knowledge, diagnosis and treatment, its impact is still underestimated by the public power. Objective: To evaluate the feeding practice and social determinants of anemia in mothers assisted by Family Health Strategy (FHS) in the state of Maranhão. Methods: A population-based cross-sectional study that was part of the project \"Prevalence and Determinants of Anemia in Women and Children in the State of Maranhão\". Data from the socioeconomic and demographic questionnaire, the food frequency questionnaire (FFQ), biochemical data on the hemoglobin dosage of women and height-for-age children´s score were used. For the analysis of information based on women FFQ (n = 779), the association of the variables with the presence or absence of anemia and its social determinants was verified, the presence of healthy food markers (n = 779) and linear growth and anemia with social determinants (n = 966). Results: Socioeconomic conditions of families did not favor the regular consumption of iron source foods and the protection against anemia. The frequent presence of healthy food markers was highlighted by the consumption of beans (83.4%), fish (53.7) and orange (55.2%). The prevalence of short stature for age was 9.7% for the state and among the variables studied only Bolsa Família Program acted as a protection against anemia (p<0.003). Conclusion: High demand for iron would be easily achieved by the diet provided that the foods considered as source were consumed regularly. The results of the state of Maranhão and the social determinants showed no direct association, since they are permeated by poverty. Bolsa Família Program helped to alleviate the beneficiary population social vulnerability and the insertion in primary care, through the ESF, as a form of protection

An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families.

Objective: To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families. Design: Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders. Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK. Participants: African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7). Results: According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes. Conclusions: Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.

Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study.

BACKGROUND: Adolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children. METHODS: This cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15-19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future. RESULTS: Out of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness. CONCLUSIONS: Zambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.

BACKGROUND: Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE: Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS: Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS: The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION: Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02741037.

Low-birthweight infants born to short-stature mothers are at additional risk of stunting and poor growth velocity: Evidence from secondary data analyses.

Low-birthweight (LBW) infants are at an increased risk of stunting and poor linear growth. The risk might be additionally higher in these infants when born to short mothers. However, this hypothesis has been less explored. The objective of this secondary data analysis was to determine the risk of linear growth faltering and difference in linear growth velocity in LBW infants born to short mothers (<150 cm) compared to those born to mothers with height ≥150 cm during the first year of life. This analysis uses data from a community-based randomized controlled trial of 2,052 hospital-born term infants with birthweight ≤2,500g from urban low-middle socioeconomic neighbourhoods in Delhi, India. Data on maternal height and infant birth length were available from 1,858 (90.5%) of the infants. Infant anthropometry outcomes were measured at birth, 3, 6, 9, and 12 months of age. We found that infants born to short mothers had around twofold higher odds of stunting and lower attained length-for-age Z scores compared to infants of mothers with height ≥150 cm, at all ages of assessment. Linear growth velocity was significantly lower in infants of short mothers particularly in the first 6 months of life. We conclude that LBW infants born to short mothers are at a higher risk of stunting and have slower postnatal growth velocity resulting in lower attained length-for-age Z scores in infancy. Evidence-based strategies need to be tested to optimize growth velocity in LBW infants especially those born to short mothers.

The association of breastfeeding with insulin resistance at 17 years: Prospective observations from Hong Kong's "Children of 1997" birth cohort.

Breastfeeding has many benefits for mother and infant. Whether breastfeeding also protects against type 2 diabetes is unclear. To clarify the role of breastfeeding in type 2 diabetes, we assessed the association of breastfeeding with insulin resistance in late adolescence in a birth cohort from a non-Western setting where breastfeeding was not associated with higher socio-economic position. We used multivariable linear regression, with multiple imputation and inverse probability weighting, to examine the adjusted associations of contemporaneously reported feeding in the first 3 months of life (exclusively breastfed, mixed feeding, or always formula-fed) with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) at 17 years in a subset (n = 710, 8.6% of entire cohort) of the Hong Kong Chinese birth cohort "Children of 1997." We found a graded association of breastfeeding exclusivity in the first 3 months of life with lower fasting insulin and HOMA-IR (p-for-trend < .05), but not fasting glucose, at 17 years. Exclusively breastfed adolescents (7%) had nonsignificantly lowest fasting insulin and HOMA-IR, adjusted for sex, birth weight, parity, length of gestation, pregnancy characteristics, parents' education, and mother's place of birth. Exclusively breastfeeding for 3 months may be causally associated with lower insulin resistance in late adolescence. Further follow-up studies into adulthood are required to clarify the long-term protection of breastfeeding from type 2 diabetes.