Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration.

BACKGROUND: Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS: Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS: Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS: Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

Inclusionary Trials: A Review of Lessons Not Learned.

The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless, epidemiologic and clinical research do not yet have a strong culture of community partnership in the scientific process, which takes time to build and therefore may be difficult to develop and rapidly scale to respond to the pandemic. We outline practices that contribute to a lack of inclusive participation and suggest steps that trialists and other researchers can take to increase marginalized communities' participation in research. Practices include planning for community engagement during the planning and recruitment phases, having regular dialogues with communities about their priorities, supporting them throughout a study, and navigating complex structural determinants of health. Additionally, we discuss how research institutions can support inclusive practices by reexamining their policies to increase participation in clinical trials and instilling institutional trustworthiness.

Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods.

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.

Social Support Protects Against Symptoms of Anxiety and Depression: Key Variations in Latinx and Non-Latinx White College Students.

Social support protects against perceived stress and its harmful effects on psychological well-being. College students in general are at high risk for mental health disorders, and Latinx college students face unique stressors placing them at greater risk of psychological distress. Social support may be a key construct in improving outcomes for college students; however, few studies have empirically tested whether the protective effect of social support is equivalent across racial/ethnic groups. Using a series of regression models, we investigated whether social support moderates the relationship between perceived stress and endorsement of depression and anxiety symptoms in Latinx (n = 265) and non-Latinx White college students (n = 216) and whether this moderating effect varied by group membership. Participants completed a series of questionnaires measuring social support, perceived stress, and depression and anxiety symptoms. The moderating effects of social support varied by group membership and outcomes (i.e., depression and anxiety). Social support moderated the relationship between perceived stress and depression symptoms for both Latinx and non-Latinx White students. However, social support only buffered the effect of perceived stress on anxiety symptom endorsement for Latinx college students. These findings suggest that social support does not function uniformly across racial/ethnic groups or the endorsement of depression and anxiety symptoms. Social support may be particularly important for Latinx students by providing a buffer between perceived stress and symptoms of anxiety.

El apoyo social protege contra el estrés y sus efectos en el bienestar psicológico. El riesgo de desarrollar trastornos psicológicos es elevado en estudiantes universitarios. Estudiantes universitarios Latinxs enfrentan situaciones relacionadas con identificatión de minoría que pueden contribuir a una elevación en el riesgo de desarrollar problemas psicológicos. Como tal, el apoyo social es un área clave para la preventión y mejoría del bienestar psicológico. Sin embargo, pocas investigaciones han comparado los efectos protectores del apoyo social a través de raza y etnia. Usamos una serie de modelos de regresión para investigar si el apoyo social modera la relación entre la percepción de estrés y el reporte de síntomas de depresión y ansiedad en estudiantes universitarios Latinxs y anglosajones. Además, investigamos si este efecto de moderación varia en dependencia de la membresía etnia. Participantes completaron una serie de cuestionarios midiendo variables de interés, incluyendo apoyo social, percepcicón de estrés, síntomas de depresión y ansiedad. El apoyo social modera la relación entre la percepcición de estrés y síntomas de depresión en los dos grupos étnicos, Latinxs y anglosajones. Sin embargo, para los síntomas de ansiedad, el efecto protector del apoyo social fue distinto para los estudiantes Latinxs. Estos resultados sugieren que la función del apoyo social no es uniforme a través de grupos étnicos o en términos de protectión contra diferentes problemas psicológicos. El apoyo social es particularmente importante para los estudiantes Latinxs en términos de proveer protectión contra síntomas de ansiedad en la presencia de la perceptión del estrés.

Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.

Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not been rigorously evaluated against standard telehealth advising programs. The objective of the On The Move randomized controlled trial is to test the effectiveness of a linguistically and culturally targeted SMS PA intervention (SMS PA Advisor) versus two comparison conditions: a) a standard, staff-delivered phone PA intervention (Telephone PA Advisor) and b) an attention-control arm consisting of a culturally targeted SMS intervention to promote a healthy diet (SMS Nutrition Advisor). The study sample (N = 350) consists of generally healthy, insufficiently active Latino adults ages 35 years and older living in five northern California counties. Study assessments occur at baseline, 6, and 12 months, with a subset of participants completing 18-month assessments. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of PA, assessed via validated self-report measures and supported by accelerometry, and physical function and well-being variables. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial Registration: clinicaltrial.gov Identifier = NCT02385591.

Employing Participatory Citizen Science Methods to Promote Age-Friendly Environments Worldwide.

The trajectory of aging is profoundly impacted by the physical and social environmental contexts in which we live. While "top-down" policy activities can have potentially wide impacts on such contexts, they often take time, resources, and political will, and therefore can be less accessible to underserved communities. This article describes a "bottom-up", resident-engaged method to advance local environmental and policy change, called Our Voice, that can complement policy-level strategies for improving the health, function, and well-being of older adults. Using the World Health Organization's age-friendly cities global strategy, we describe the Our Voice citizen science program of research that has specifically targeted older adults as environmental change agents to improve their own health and well-being as well as that of their communities. Results from 14 Our Voice studies that have occurred across five continents demonstrate that older adults can learn to use mobile technology to systematically capture and collectively analyze their own data. They can then successfully build consensus around high-priority issues that can be realistically changed and work effectively with local stakeholders to enact meaningful environmental and policy changes that can help to promote healthy aging. The article ends with recommended next steps for growing the resident-engaged citizen science field to advance the health and welfare of all older adults.

Culturally sensitive assessments as a strength-based approach to wellness in Native communities: A community-based participatory research project.

American Indians and Alaska Natives (AI/ANs) have a unique, traumatic, and alienating history of education in the U.S., which may be directly related to overall health and well-being. Community engagement is critical in well-being research with Native communities, especially when investigating culturally sensitive topics, such as early education experiences. This study investigates the value of a community-based participatory research approach in gaining valuable culturally sensitive information from Native people in a respectful manner. Assessment participation and feedback are analyzed and presented as indicators of Native participant engagement success in a potentially sensitive research project exploring early education experiences.