"I can be the Judge of What's Serious": A Qualitative Pilot Study of Parents' Responses to Messaging About Side Effects of the HPV Vaccine.

OBJECTIVE: Parents' concerns about vaccine safety and side effects likely contribute to low rates of human papillomavirus (HPV) vaccination among adolescents. To facilitate parent-provider discussions about the HPV vaccine, we developed and tested the content of a clinical decision support application for implementation in pediatric clinical settings. This study sought to elicit perspectives of parents and providers on the best way to communicate information on vaccine side effects. METHODS: To understand the acceptability of the application's content, we conducted focus groups with parents (n = 11) and providers (n = 9) at three primary care clinics. Focus groups transcriptions were analyzed using iterations of deductive and inductive coding, with independent coding by two trained reviewers to improve inter-rater reliability. RESULTS: Surprisingly, when parents reviewed screen shots of HPV vaccine safety and side effect messages, parents took exception to the expression "no evidence of serious side effects". Parents wanted side effects listed explicitly so they could decide for themselves which side effects were "serious". Parents also felt that the HPV vaccine did have serious side effects, and the wording undermined their trust in the vaccine messaging overall. Providers accepted the phrasing of side effects and did not express concerns that parents would object to the messaging. CONCLUSIONS: Further research is needed to confirm parents' concerns with the phrasing "no serious side effects" for the HPV vaccine and to assess the impact on HPV vaccination deferral or delay.

Pockets of progress amidst persistent racial disparities in low birthweight rates.

Racial disparities persist in adverse perinatal outcomes such as preterm birth, low birthweight (LBW), and infant mortality across the U.S. Although pervasive, these disparities are not universal. Some communities have experienced significant improvements in black (or African American) birth outcomes, both in absolute rates and in rate ratios relative to whites. This study assessed county-level progress on trends in black and white LBW rates as an indicator of progress toward more equal birth outcomes for black infants. County-level LBW data were obtained from the 2003 to 2013 U.S. Natality files. Black LBW rates, black-white rate ratios and percent differences over time were calculated. Trend lines were first assessed for significant differences in slope (i.e., converging, diverging, or parallel trend lines). For counties with parallel trend lines, intercepts were tested for statistically significant differences (sustained equality vs. persistent disparities). To assess progress, black LBW rates were compared to white LBW rates, and the trend lines were tested for significant decline. Each county's progress toward black-white equality was ultimately categorized into five possible trend patterns (n = 408): (1) converging LBW rates with reductions in the black LBW rate (decreasing disparities, n = 4, 1%); (2) converging LBW rates due to worsening white LBW rates (n = 5, 1%); (3) diverging LBW rates (increasing disparities, n = 9, 2%); (4) parallel LBW rates (persistent disparities, n = 373, 91%); and (5) overlapping trend lines (sustained equality, n = 18, 4%). Only four counties demonstrated improvement toward equality with decreasing black LBW rates. There is significant county-level variation in progress toward racial equality in adverse birth outcomes such as low birthweight. Still, some communities are demonstrating that more equitable outcomes are possible. Further research is needed in these positive exemplar communities to identify what works in accelerating progress toward more equal birth outcomes.

State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013.

OBJECTIVES: To assess state-level progress on eliminating racial disparities in infant mortality. METHODS: Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. RESULTS: We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. CONCLUSIONS: States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success.

African American Dementia Caregiver Problem Inventory: Descriptive analysis and initial psychometric evaluation.

OBJECTIVES: The primary objectives of the present study were: (a) to develop the African American Dementia Caregiver Problem Inventory (DCPI-A) that assesses the types and frequency of problems reported by African American dementia caregivers seeking cognitive-behavioral intervention, (b) to evaluate the intercoder reliability of the DCPI-A, and (c) to measure the perceived severity of common problems reported by this caregiver population. METHOD: The development of the DCPI-A was divided into 3 major steps: (a) creating an initial sample pool of caregiver problems derived from 2 parent randomized clinical trials, (b) formulating a preliminary version of the DCPI-A, and (c) finalizing the development of the DCPI-A that includes 20 problem categories with explicit coding rules, definitions, and illustrative examples. RESULTS: The most commonly reported caregiver problems fell into 5 major categories: (a) communication problems with care recipients, family members, and/or significant others, (b) problems with socialization, recreation, and personal enhancement time; (c) problems with physical health and health maintenance, (d) problems in managing care recipients' activities of daily living; and (e) problems with care recipients' difficult behaviors. Intercoder reliability was moderately high for both percent agreement and Cronbach's kappa. A similar positive pattern of results was obtained for the analysis of coder drift. CONCLUSIONS: The descriptive analysis of the types and frequency of problems of African American dementia caregivers coupled with the outcomes of the psychometric evaluation bode well for the adoption of the DCPI-A in clinical settings. (PsycINFO Database Record

Interventions for improving nutrition and physical activity behaviors in adult African American populations: a systematic review, January 2000 through December 2011.

INTRODUCTION: The incidence of preventable chronic diseases is disproportionally high among African Americans and could be reduced through diet and physical activity interventions. Our objective was to systematically review the literature on clinical outcomes of diet and physical activity interventions conducted among adult African American populations in the United States. METHODS: We used the Preferred Reporting Items for Systematic Review and Meta Analysis construct in our review. We searched Medline (PubMed and Ovid), Cochrane, and DARE databases and restricted our search to articles published in English from January 2000 through December 2011. We included studies of educational interventions with clinically relevant outcomes and excluded studies that dealt with nonadult populations or populations with pre-existing catabolic or other complicated disorders, that did not focus on African Americans, that provided no quantitative baseline or follow-up data, or that included no diet or physical activity education or intervention. We report retention and attendance rates, study setting, program sustainability, behavior theory, and education components. RESULTS: Nineteen studies were eligible for closer analysis. These studies described interventions for improving diet or physical activity as indicators of health promotion and disease prevention and that reported significant improvement in clinical outcomes. CONCLUSION: Our review suggests that nutrition and physical activity educational interventions can be successful in improving clinically relevant outcomes among African Americans in the United States. Further research is needed to study the cost and sustainability of lifestyle interventions. Further studies should also include serum biochemical parameters to substantiate more specifically the effect of interventions on preventing chronic disease and reducing its incidence and prevalence.