Neighbourhood walking tours for physicians-in-training.

Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents' perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients' health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was 'access to primary care' (67%) compared with post-tour: 'income' (44%) and 'transportation' (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p<0.001). Walking tours helped physician-residents recognise the importance of SDoH and the value of community resources, and may have broadened frameworks for counselling patients on healthy lifestyles.

Predictors of breast and cervical cancer screening among Chamorro women in Southern California.

This study examined the role of sociodemographic characteristics, health insurance, cancer knowledge, perceived health risk, and having a recent physicians' visit on breast and cervical cancer screening utilization among a randomly selected group of Chamorro women (n = 250) residing in San Diego, California. Data were collected by a telephone survey and analyzed using multiple logistic regression models. After adjusting for covariates, having a recent full exam was the strongest predictor of having had a Pap exam in the past 2 years for women 21 years and older and a clinical breast exam in the past 2 years for women 40 years and over.

Breast cancer screening among Chamorro women in California.

BACKGROUND: This study evaluated breast cancer-related knowledge, attitudes and behaviors among Chamorros in San Diego, California and compared mammogram use between those affiliated with the military and others. METHODS: A survey was administered to 110 self-reported Chamorro women. Inclusion criteria included being self-reported Chamorro woman >40 years with no history of breast cancer. Approximately equal proportions of participants with (52%) and without (48%) military affiliation were recruited to test the assumption that use of mammography differed between the two groups. Descriptive statistics and bivarate analyses were conducted. RESULTS: Of the 110 respondents, 42% had at least some college education, 41% had household incomes of at least $50,000, and 87% reported having health insurance. Approximately 93% reporting ever having a mammogram and 75% reported having it within the past 2 years. The difference between mammography use among women with and without military affiliation was not significant (85% versus 72%; p=0.11). However, women with military insurance (95%) were more likely than others (74%) to have had a mammogram within that time frame (p=.05). Other factors associated with higher mammography use included reporting better access to medical care (p=.03), receiving a recommendation for mammography from a health care provider (p=.002), and knowledge that cancer can be cured if detected early (p=.01) and that women should get a mammogram yearly (p=.01). CONCLUSION: Chamorro women in San Diego have relatively high rates of mammography use. This finding may be due, in part, to the relatively high rates of health insurance coverage (particularly military insurance) among these women.

Cardiovascular risk factors among Chamorros.

BACKGROUND: Little is known regarding the cardiovascular disease risk factors among Chamorros residing in the United States. METHODS: The Chamorro Directory International and the CDC's Behavioral Risk Factor Surveillance System Questionnaire (BRFSS) were used to assess the health related practices and needs of a random sample of 228 Chamorros. RESULTS: Inactivity, hypertension, elevated cholesterol and diabetes mellitus were more prevalent in this Chamorro sample compared to the US average. Participants who were 50-and-older or unemployed were more likely to report hypertension, diabetes and inactivity, but they were also more likely to consume more fruits and vegetables than their younger and employed counterparts. Women were more likely to report hypertension and diabetes, whereas men were more likely to have elevated BMI and to have never had their blood cholesterol checked. CONCLUSION: The study provides data that will help healthcare providers, public health workers and community leaders identify where to focus their health improvement efforts for Chamorros and create culturally competent programs to promote health in this community.

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.

Diabetes management in San Diego's Chamorro community.

PURPOSE: The purpose of this study was to assess the diabetes risk status, incidence, and morbidity within San Diego's Chamorro community as a foundation to help community leaders and health care providers create culturally customized health promotion interventions. METHODS: The Behavioral Risk Factor Surveillance Survey was used to query a randomly selected, convenience sample of San Diego Chamorros (N = 228) drawn from the Chamorro Directory International. Based on individual survey responses, participants were mailed personalized health-promoting information. Subsequently, they received information that addressed the most commonly observed overall threats to the Chamorro community's health. RESULTS: A higher than average prevalence of diabetes and gestational diabetes was reported by study participants along with a high prevalence of the risk factors associated with the premature onset of diabetes and its consequences. CONCLUSION: Collaborative partnerships between health professionals and community leaders can help identify opportunities and strategies for improving the health of the nation's population subgroups. San Diego's Chamorro community leaders now have a clearer understanding of the prevalence of diabetes risk factors within their community and can begin working with public health educators to create culturally aligned diabetes prevention and management programs. Given the willingness of Chamorro leaders to get involved in the development of a diabetes awareness campaign and the community's closely knit social network, it should be possible to promote (1) community participation in the intervention program, (2) an increase in the community's adherence to recommended behavioral changes, and (3) identification of additional program modifications that will further enhance the program's cultural relevance.

Cancer risk factor assessment among Chamorro men in San Diego.

BACKGROUND: Little is known about the health of Chamorros residing in the United States. METHOD: The CDC's Behavioral Risk Factor Surveillance System was used to assess cancer-related behavioral risk factors in San Diego's Chamorro men, and the Chamorro Directory International was used to recruit them. RESULTS: Of the 100 Chamorro men, 19% smoked, 38.4% reported eating 5 or more fruits and vegetables daily, 48.8% reported being current on their prostate cancer screening, and 74.4% reported being current on their colorectal cancer screening. CONCLUSIONS: This sample of Chamorro men reported higher rates of health-promoting practices than nationwide averages.

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.

Cancer risk factor assessment among Chamorro women.

BACKGROUND: Little is known about the health of Chamorros residing in the United States. METHODS: The Chamorro Directory International and CDC's Behavioral Risk Factor Surveillance System were used to assess behavioral risk factors and health needs of San Diego's Chamorro women. RESULTS: Of 128 Chamorro women, 42.2% reported having a total frequency of five or more fruits and vegetables daily, 54.5% reported being current on their colorectal cancer screening, and 9.4% smoke. CONCLUSIONS: While this sample of Chamorro women reported higher rates of healthpromoting practices than nationwide averages, significant health improvement opportunities remain.