"A Vulnerable Time To Be a Young Family in an Emergency": Qualitative Findings From an Exploration of an Emergency Perinatal and Infant Feeding Hotline in Louisiana.

BACKGROUND: Birthmark Doula Collective, a cooperative that provides doula and lactation services in the Greater New Orleans area, mounted an emergency response after two Category 4 storms: Hurricane Laura (2020) and Hurricane Ida (2021). The response included activating a no-cost emergency perinatal and infant feeding hotline. Both disasters coincided with a resurgence of COVID-19 infections in Louisiana. RESEARCH AIM: The aim of this study is to understand how an emergency perinatal and infant feeding hotline supported infant and young child feeding in emergencies during hurricanes in Louisiana. METHOD: This study used a cross-sectional, retrospective qualitative design in a population with low breastfeeding rates. We conducted a content analysis of 97 hotline call logs from Hurricanes Laura and Ida, focus groups with lactation support providers who staffed the hotline during either storm (n = 5), and interviews with mothers who called during Hurricane Ida (n = 2). Focus groups and interviews lasted 30 and 60 minutes, respectively. Transcripts were analyzed using thematic analysis techniques. RESULTS: Call logs revealed infant feeding needs (e.g., mastitis, low milk supply, relactation, and infant formula requests) and non-infant feeding needs (e.g., infant supplies, perinatal and infant care referrals, shelter information). Infant formula was the most requested supply during both hurricanes. Maternal participants discussed family vulnerabilities during Hurricane Ida. Staff described training and strategies to provide support while maintaining their own well-being. CONCLUSION: Providing a free emergency hotline service is one way to support pregnant and postpartum people and their families seeking infant feeding advice, supplies, and support in the immediate aftermath of a disaster.

Social Media Usage as a Form of Breastfeeding Support Among Black Mothers: A Scoping Review of the Literature.

INTRODUCTION: Social support has been identified in the literature as a key facilitator of breastfeeding success among Black mothers. Over the past decade, there has been a surge of social media groups that can now be used as a means of support for various health and social issues. Social media breastfeeding groups have been used as sources of additional support. A scoping review of the literature was conducted to explore social media usage as a form of social support among Black women in the postpartum period and how it may affect breastfeeding behaviors. METHODS: Using the 5-stage scoping review methodology, scholarly databases were searched for relevant articles. English-language articles on studies conducted both in and outside of the United States were included. Original studies that focused on social media as a form of breastfeeding support and included Black mothers as part of the study population were included. RESULTS: After screening 551 articles, 6 studies fulfilled the study criteria. Participants reported being provided with various forms of social support through social media within the included articles. Primary themes included (1) a sense of community and (2) self-efficacy and empowerment. Breastfeeding support through social media appears to positively influence breastfeeding intention and duration rates among Black mothers. DISCUSSION: Social media is an accessible avenue for breastfeeding information and support. Moreover, it provides a safe space for Black women to interact with others of shared cultural experiences. Therefore, incorporating social media into breastfeeding interventions can positively affect breastfeeding rates among Black women. More research is needed to assess the direct effect of social media breastfeeding support groups on the breastfeeding behaviors and experiences of Black women.

Grown woman: Understanding what influences health behaviors in black female students at a HBCU.

Objective: The purpose of this study was to understand what influences health behaviors in Black female students at a Historically Black College and University (HBCU).Participants and Methods: Twenty-five Black female students enrolled at a HBCU in the southern United States participated in five focus groups and one interview. Qualitative analysis was used to analyze data for similar themes and codes.Results: The three areas that appear to influence health behaviors are interpersonal, community, and society.Conclusions: These findings highlight the need for HBCUs to develop health programs for Black women on their campus that include elements of interpersonal support. Additionally, HBCUs need to work on how they create an environment that provides their female students with the resources they need to be able to live a healthy life.

Knowledge and attitudes towards low dose computed tomography lung cancer screening and smoking among African Americans-a mixed method study.

BACKGROUND: The purpose of this study is to investigate knowledge, attitudes, and smoking cessation needs for African Americans who receive low dose computed tomography (LDCT) in an effort to reduce the health burden of lung cancer. METHODS: A mixed method study was conducted among African Americans who received LDCT. Data were gathered using a self-administered questionnaire and structured in-depth interview. Descriptive statistics were used to provide summary information on knowledge, attitude and smoking behaviors. Thematic analysis was used to analyze interview data. The sample size for both the quantitative and qualitative approach was fifteen. RESULTS: The results showed that 73% of participants were male, the mean age was 61.8 (SD =4.6) years old, and 66.7% of participants had an income less than $20,000. Eighty percent had an education level of high school or below and 73.3% were overweight or obese. Smoking history was long (mean years =39 SD =14.9), but the number of cigarettes smoked per day was low (mean =9.2 SD =7.3), and 64% of the patients had a low nicotine dependence. Assessment of knowledge and attitudes towards LDCT revealed that participants had a moderate/lower knowledge score (mean =4.3 SD =2.6), and most had a positive attitude. All participants planned to quit smoking, with 73% planning to quit within the next 6 months. Similar findings were also observed in the qualitative analysis. CONCLUSIONS: African Americans who receive LDCT lung cancer screening in this study have a moderate/lower knowledge score and positive attitude towards LDCT. Most were not heavy smokers and had a lower nicotine dependence. Understanding the factors associated with smoking cessation among at-risk African American smokers will help reduce disparities in lung cancer burden, and is important to improve health for medically underserved minority populations.

Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program.

BACKGROUND: Previous interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges. METHODS: We approached students aged 18-26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data. RESULTS: During interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends' opinions, but would want to know about side effects that their vaccinated friends experienced. CONCLUSIONS: Successful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness.

"As a Community, We Need to be More Health Conscious": Pastors' Perceptions on the Health Status of the Black Church and African-American Communities.

BACKGROUND: Churches are recognized for their potential capacity to provide health services and interventions to address health disparities in African-Americans (blacks). Since pastors are central community leaders, their support and involvement can influence both implementation and outcomes for church-based health programs. The purpose of this qualitative study was to explore pastors' perceptions of congregant health status within the black church. METHODS: Semi-structured interviews were conducted with 11 pastors whose female congregants participated in a physical activity intervention. Thematic analysis techniques were used to analyze interview data. RESULTS: Three major themes emerged: (1) health risks in the African-American community, (2) health promotion in the black church, and (3) the importance of women in the black family and the church. Pastors noted numerous health disparities affecting their congregants and the African-American community at large, including obesity and infant mortality. They viewed health holistically and included faith in their perspectives. According to pastors, holistic health was promoted through health ministry programming in black churches. Women were described as the cornerstone of the black church, yet faced unique health concerns from their roles as family caretakers and congregants. DISCUSSION: Pastors shared their major concerns for congregant health status and the African-American community. Health interventions focusing on African-Americans in church settings should include pastor involvement and should incorporate holistic approaches to address health risks.

Training the Next Generation: Developing Health Education Skills in Undergraduate Public Health Students at a Historically Black College and University.

With the looming workforce crisis, undergraduate public health students could be an important link in filling this demand. As public health continues to face challenges in the future, it is important that the future workforce is not only diverse but also trained in a manner that exposes them to real-world experiences that give them an opportunity to apply coursework to solve problems. This article outlines how a health program planning course was taught at a Historically Black College and University using assignments that promote active learning. Students were assessed on their ability to plan and implement a health activity based on a developed metric. Student and instructor reflections were collected from final assessments of the health programs by both groups. All elements of the course are discussed from course design, structure, assignments, and outcomes along with student and instructor reflections and lessons learned. Results suggest that including assignments focused on active learning are beneficial to helping students learn course material. As public health continues to change, more work needs to focus on teaching pedagogies that better prepare students to address future public health issues.

Pastoral perceptions of the learning and developing individual exercise skills (L.A.D.I.E.S.) intervention: a qualitative study.

African-American women experience higher rates of obesity compared to other racial/ethnic groups. High levels of reported church attendance among African-Americans have led to the proliferation of faith-based health programs. Pastors can influence success for faith-based programs. The purpose of this study was to assess pastors' perceptions of the L.A.D.I.E.S. intervention, designed to increase physical activity levels in sedentary African-American women. For the L.A.D.I.E.S. intervention, 31 churches (n = 418 women) were randomized at the church level to a faith-based, non-faith-based or self-guided program. All 31 pastors were invited by telephone to participate in the current study. Using a qualitative design, semi-structured interviews were conducted with 11 pastors from participating churches. Thematic analysis and the ecological model were used to examine the findings. According to the pastors, women showed heightened awareness of the importance of health and physical activity, and increased levels of fellowship. L.A.D.I.E.S. also encouraged healthy church climates and new health ministries. Lessons learned included the need for an expanded participant base and curriculum. Pastors expressed appreciation for the culturally fitting approach of L.A.D.I.E.S. Findings have implications for faith-based and public agency partnerships.

Long-Term Breastfeeding in African American Mothers.

BACKGROUND: According to the Centers for Disease Control and Prevention, 39.1% of African American infants are breastfed at 6 months. However, few studies have explored the breastfeeding experiences of African American women who successfully breastfeed to 6 months or longer durations. Research aim: The goal of this qualitative study was to explore the long-term breastfeeding experiences of low-income African American women using the positive deviance approach. METHODS: African American women with breastfeeding experience were recruited through Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) breastfeeding peer counselors. Eligibility criteria included being age 18 or older, currently participating in WIC, and having breastfed one child for at least 6 months in the past 2 years. Semistructured, in-depth interviews were conducted with 11 participants. Interviews were audio-recorded and professionally transcribed. Transcripts were then analyzed for emerging themes using thematic analysis in NVivo software. RESULTS: Participants had on average three children each, with an average length of breastfeeding of 10.5 months per child. Four main themes developed: (a) deciding to breastfeed, (b) initiating breastfeeding, (c) breastfeeding long-term, and (d) expanding breastfeeding support. Participants offered culturally tailored suggestions to improve breastfeeding support for other African American women: prenatal discussions of breastfeeding with health care providers, African American lactation support personnel and breastfeeding support groups, and African American breastfeeding promotion in print and digital media. CONCLUSION: Women who participated in this study breastfed for longer durations than the national average for African Americans. Findings can inform practice and research efforts to improve breastfeeding rates in this population using lessons learned from successful women.

Implementation of a Postpartum HPV Vaccination Program in a Southeast Texas Hospital: A Qualitative Study Evaluating Health Care Provider Acceptance.

Introduction The objective of this qualitative study was to assess healthcare providers' acceptability of an ongoing postpartum human papillomavirus (HPV) vaccination program in Southeast Texas and its integration into everyday clinical care. Methods In 2012, the Department of Obstetrics & Gynecology at the University of Texas Medical Branch (UTMB) began offering HPV vaccination as part of standard postpartum care to increase vaccination rates among young women in Galveston County. Initial vaccine doses were offered on the postpartum unit while subsequent doses were coordinated with postpartum and well-baby visits. Thirty months after project initiation, semi-structured interviews of physicians (n = 12) and nurses (n = 6) involved in postpartum and pediatric care at UTMB were conducted. Interview transcripts were analyzed using thematic analysis in Nvivo10. Results Overall, providers demonstrated "pro-vaccine" attitudes and stated the program was an effective strategy for vaccinating hard-to-reach women. Cancer prevention was the main perceived benefit while follow-up compliance was the primary perceived patient barrier. The initial challenges with integrating postpartum HPV vaccination included miscommunication between providers regarding vaccine orders and coordination issues with well-baby visits for follow-up doses. One novel finding was providers' beliefs that women's personal HPV vaccine practices may positively impact their decisions about later vaccinating their children against HPV. Providers' suggestions to improve the program included: enhancing postpartum HPV vaccine education for patients, offering more continuing education for providers, and increasing community awareness of HPV vaccination. Discussion These findings can help providers of postpartum care understand how to integrate postpartum HPV vaccination into their current practices and how to overcome perceived vaccination barriers.

Association between mother-child sexual communication and HPV vaccine uptake.

OBJECTIVE: To examine the association between mother-child communication about sex, sexually transmitted diseases (STDs), and contraception/condoms and HPV vaccine uptake by gender. METHODS: Women (n = 1372) with ≥ 1 child aged 9-17 years receiving care in reproductive health clinics in Southeast Texas were asked to complete a self-administered questionnaire between September 2011 and October 2013. RESULTS: The majority of mothers with ≥ 1 eligible daughter (n = 886) reported having talked about 'sex' (77.7%), 'STDs' (76.6%) and 'contraception' (73.2%) with their daughters. The respective figures for mothers with ≥ 1 son (n = 836) were 68.8%, 69.0% and 65.3%. Mothers who discussed sex, STDs, or contraception with their daughters compared to those who did not were more likely to report that their daughter initiated (≥ 1 dose) HPV vaccination after adjusting for confounders (all p < .05). Similarly, mother-son discussions about STDs or condoms, but not sex, were associated with HPV vaccine initiation for their sons compared to those who did not discuss these topics. These associations were not significant with regard to HPV vaccine completion (3 doses) for neither daughters nor sons. CONCLUSION: Mother-child communication on STDs and contraception/condoms is associated with HPV vaccine initiation, but not completion, among both daughters and sons.

WIC peer counselors' perceptions of breastfeeding in African American women with lower incomes.

BACKGROUND: African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors' perceptions of breastfeeding in African American women. OBJECTIVE: As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs). METHODS: Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner's socioecological model was used to group categories into themes. RESULTS: Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs' low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a "sense of security," (2) cultural pressures to be a "strong black woman" can impede breastfeeding support, and (3) breastfeeding "generational gaps" have resulted from American "slavery" and when formula was "a sign of wealth." CONCLUSION: As PCs described, low-income African American women's breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.