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The purpose of this study was to gain an understanding of the ambiguities and uncertainties experienced by a diverse group of African-American caregivers. The study applied Schlossberg's transition theory (TT) and Mishel’s revised uncertainty theory to narratives of self-identified African-American caregivers who provided care at least 5 h a week. The men (6) and women (8) were mostly unmarried, mostly caring for a parent or grandparent. The caregivers’ average age was 52 (SD = 19; ages ranged from 24 to 82 years); and the care recipients’ average age was 84 (SD = 9). Six care recipients had dementia and the remainder had multiple disease diagnoses. Narratives were obtained by in-depth interviews or focus group discussions. These were audio-recorded, transcribed verbatim professionally and analyzed independently by trained coders. Schlossberg’s TT contextualized whereas Mishel’s RUIT illuminated the characteristics of the transition, its associated uncertainty, and their relationship to the development of caregiver stress. Situational factors such as difficulties with illness symptoms of the care recipient, conflict between previous experience and current expectations and the adjustments to the new caregiving role, burdened younger caregivers more than older caregivers. Self-factors related to lack of knowledge about the illness and feelings of lack of control. Social support was predominantly provided by family members, and its absence resulted in conflict among siblings and caregiver stress. The most common coping strategies include religiosity, expectations of reciprocity, and coming to terms with the uncertainty. Understanding the feelings, perceptions and needs of caregivers in transition is tantamount to providing nursing care.

This study sought to understand why college students are food insecure and what the impact is on their academics. A generic qualitative study design was utilized that consisted of written surveys and semi-structured interviews. Participants (n = 19) self-identified as food insecure based upon their answers to the 6-item Short Form Food Security Survey Module. Two researchers independently coded the data for themes and patterns. Risk factors for food insecurity included finances, time, and lack of resources/skills to provide for healthy eating. Time and money put commuter students at risk for food insecurity. While students within this convenience sample reported negative impacts on their academic achievement from food insecurity, their coping mechanisms prioritized cost and convenience over food quality, possibly exacerbating their situation.College food insecurity is a complex issue and raw measurements may not paint a complete picture. Conflicting priorities in addition to income and time pressures mean that interventions should be tailored from current approaches. Colleges may need to find unique ways to ensure food security for at risk students within financial aid packages and/or university programs to ensure student success.

There is a lack of qualitative and strengths-based knowledge about the lived experience of transgender women of color in the US. To address this research gap, a Photovoice project was undertaken with five transgender women living in a small urban area. Thematic analysis of the participants' discussion of their photographs identified three major themes: Hope, courage, and resilience. Analysis suggests a framework for understanding these women's lived experiences and the psychosocial tools that they use to negotiate their daily lives and persevere in the face of interpersonal and structural oppression. © 2019 Nova Southeastern University. All rights reserved.

Approximately 34% of residents from New Haven’s six lowest-income neighborhoods are food insecure, significantly higher than the rest of Connecticut and country (both approximately 12%). To understand the availability, accessibility, and utility of emergency food programs, we conducted 34 semi-structured qualitative interviews with 20 food insecure residents and 14 emergency food providers. Many depend on food programs as a long-term strategy of supplementing groceries rather than a temporary solution in emergency situations; providers are struggling to meet this demand. Transportation and time are barriers to accessing food from programs. Policies and food programs should focus on disseminating accurate information, streamlining policies and practices, and supporting and expanding food programs to meet population need.

Incidence and prevalence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and other sexually transmitted infections (STIs) continue to increase among young heterosexual men and women in the United States. Although research studies examine the reasons why these young people are not engaging in safe sex behavior, many have not explored factors beyond individual behaviors. Much of the current research focuses on young women, for the most part leaving men out of the equation. In this study, a Photovoice methodology was used to examine social norms, media messaging and perceptions of responsibility surrounding safe sex practices, specifically condom use, among male heterosexual undergraduate students. Results showed that college-aged men are still prioritizing pregnancy prevention over disease prevention, which leads to assumptions that their female partners are on birth control and they do not need to use condoms. Participants pointed to media messages and condom placement that supports women’s responsibility for safer sex and condom negotiation. Future health promotion research and practice should focus on including men in the design and implementation process to address social norms and increase their sense of responsibility.

Background: Few studies have explored changing patterns of alcohol consumption among young females and differences based on race/ethnicity. Objective: This study examined differences in alcohol consumption between black and white undergraduate females and compared trends in three different measures of alcohol consumption over a 10-year period from 2004 to 2014. Methods: The CORE Alcohol and Drug Survey was used to collect data from female undergraduates attending a public university in the northeastern USA. Classes were randomly selected into the sample; class acceptance was 68% and student participation was 96%. The chi-square test examined differences between groups and the Cochrane Armitage Test for Trend assessed changes over time. Results: In 2014, for every measure of alcohol consumption examined, a significantly larger percentage of white females engaged in the behavior compared to black females. Trend analysis from 2004 to 2014 demonstrated a narrowing of this gap. Controlling for age, any alcohol use in past 30 days and binge drinking in the past 2 weeks increased significantly for black females 21 years or older. Any alcohol use in the past 30 days decreased significantly for white females under 21 years. Conclusion: These findings introduce many questions which should be explored through additional research.

Adolescent violence is a significant public health problem. The goal of this evaluation was to determine whether communication skills, relationships with adults, and relationships with peers were enhanced through participating in an after-school program aimed at reducing violence-related behaviors among urban middle school youth. Elements that helped to foster success among our population were providing a program that enabled consistent choice in recreational activities in a safe place, and also providing busing home to increase safety. A non-experimental study was conducted with 115 students who participated in the program. Bivariate, ANOVA analysis, and Kruskal–Wallis tests were carried out. Results indicated that participating in the program significantly impacted student relationships with adults and their peers as well as positively impacted their communication skills. The program was designed with purposeful activities that would address pro-social behaviors, enhance youth interest, and increase attendance. The program specifically used recreation to help foster relationships with their peers and the adults in the program, with the intention of reducing conflict, and therefore violence among the students.

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N=1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low-resource urban community settings.

Perceptions of neighborhood safety shape the well-being of individuals and communities, affecting neighborhood walkability, associated physical activity behaviors, and health conditions. However, less is known about the factors that determine perceptions of safety. One factor that may affect perceptions of neighborhood safety is the length of time someone has lived in their neighborhood. We use a representative, adult sample of urban low-income residents from the 2015 New Haven Health Survey (n = 1189) to investigate the associations between length of residence (new residents of < 1 year in neighborhood versus longer-term residents of 1 or more years in neighborhood) and perceptions of neighborhood safety (whether feeling unsafe to walk at night). We then examine the potential moderating effect of exposure to neighborhood violence on these associations. We find that the association between length of residence and perceived safety differs by exposure to neighborhood violence. Among those unexposed to neighborhood violence, longer-term neighborhood residents were more likely to feel unsafe compared to new residents (OR = 2.03, 95% CI 1.19, 3.45). Additionally, the effect of exposure to violence on feelings of safety was larger for new residents (OR = 9.10, 95% CI 2.72, 30.44) compared to longer-term residents (OR = 1.88, 95% CI 1.28, 2.77). Our findings suggest that length of residence may have implications for feelings of safety, and that experiences of violence may uniquely contribute to feelings of unsafety among new residents. These findings hold implications for interventions and policy efforts aimed at neighborhood safety improvements through community development, housing, or city urban planning initiatives, particularly for new neighborhood residents or those who experience neighborhood violence.

PURPOSE: Our objective is to evaluate the "reach" component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program., DESIGN: A cross-sectional study design was used., SETTING: The setting was a large health system in the Midwest., PARTICIPANTS: Prediabetic health plan enrollees and spouses (N = 2158)., MEASURES: An online health survey, annual voluntary biometric screenings delivered by a trained health-care professional using standardized protocols via point-of-care testing, and records from the DPP office were the sources of data for this study., ANALYSIS: Health behaviors and biometric screening results were simultaneously compared using multivariable logistic regression., RESULTS: The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (SD = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP, if they were female (adjusted odds ratio [AOR]: 2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; 95% CI: 1.43-3.47; P < .001), older in age (AOR: 1.08; 95% CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; 95% CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; 95% CI: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; 95% CI: 0.99-4.57; P = .05), after controlling for other covariates., CONCLUSION: Current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. These findings inform future engagement strategies, and we recommend that public health practitioners evaluate reach to ensure that health promotion programs are of high value.

Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out. Results Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%). However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation and race. Discussion CenteringPregnancy can have positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care.

Purpose. To compare the effects of nut-based snack bars (NBSB) vs. prepackaged 200-kcal portions of typical conventional snack foods, when consumed over a 12-week period by a group of overweight adults. Design. Randomized, single-blind parallel design with two treatment groups. Setting. Clinical trial. Subjects. Thirty-four overweight participants were enrolled. Intervention. Commercially available NBSB or conventional snack foods as part of an ad libitum diet for 12 weeks. Measures. Primary outcome measures: body mass index, body weight, body composition, waist circumference. Secondary outcome measures: blood pressure, lipid profile, nutrients intake, hunger/satiety, quality of life. Analysis. Generalized linear models with time as repeated measure were used to analyze these data. Results. Daily consumption of NBSB for 12 weeks, as compared to daily consumption of conventional snacks, significantly reduced percentage body fat (-1.7% +/- 10.8% vs. 6.2% 6 9.3%; p = .04) and visceral fat (-1.3 +/- 5.9 vs. 2.7 +/- 4.0; p = .03). There were no between-group differences (p ¿ .05) for blood pressure, lipid panel, satiety, or quality of life measures. Conclusion. Our data suggest that daily consumption of NBSB for 12 weeks reduced body fat and had no adverse effects on weight, blood pressure, lipid profile, satiety, or quality of life in this small sample of overweight adults.

PURPOSE OF REVIEW: Evidence has clearly demonstrated the importance of lifestyle factors (e.g., diet, physical activity, smoking) in the development of cardiovascular disease (CVD). Interventions targeting these behaviors may improve outcomes for CVD patients. The aim of this review is to summarize the effects of lifestyle interventions in individuals with established CVD., RECENT FINDINGS: Most recent trials focused on diet, physical activity, stress reduction, or a combination of these. Findings were mixed, but most interventions improved at least some markers of cardiovascular risk. Few studies measured long-term clinical outcomes, but some suggested a possible benefit of stress reduction and multifaceted interventions on cardiovascular events. The benefits of lifestyle change for CVD patients have been established by decades of evidence. However, further research is needed to determine the optimal intensity, duration, and mode of delivery for interventions. Additional studies with long-term follow-up and measurement of clinical outcomes are also needed.

We have described self-reported exposure to gun violence in an urban community of color to inform the movement toward a public health approach to gun violence prevention. The Community Alliance for Research and Engagement at Yale School of Public Health conducted community health needs assessments to document chronic disease prevalence and risk, including exposure to gun violence. We conducted surveys with residents in six low-income neighborhoods in New Haven, Connecticut, using a neighborhood-stratified, population-based sample (n=1189; weighted sample to represent the neighborhoods, n = 29 675). Exposure to violence is pervasive in these neighborhoods: 73% heard gunshots; many had family members or close friends hurt (29%)or killed (18%)by violent acts. Although all respondents live in low-income neighborhoods, exposure to violence differs by race/ ethnicity and social class. Residents of color experienced significantly more violence than did White residents, with a particularly disparate increase among young Black men aged 18 to 34 years. While not ignoring societal costs of horrific mass shootings, we must be clear that a public health approach to gun violence prevention means focusingonthedualepidemicofmass shootings and urban violence.

Purpose. To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students. Design. Quasi-experimental with three arms. Setting. Elementary schools, students' homes, and a supermarket. Subjects. A total of 1487 third-grade students. Intervention. The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families. Measures. Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD). Analysis. Multivariable generalized linear model and logistic regression to assess change in outcome measures. Results. Both the SI and EI groups gained less weight than the control (p ¡ .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p - .10) in the EI group. Use of ADHD medication remained unchanged (p = .34). Conclusion. The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

Previous literature indicates that pre-diagnostic diabetes and blood glucose levels are inversely related to glioma risk. To replicate these findings and determine whether they could be attributed to excess glucose consumption by the preclinical tumour, we used data from the Apolipoprotein MOrtality RISk (AMORIS) (n = 528,580) and the Metabolic syndrome and Cancer project (Me-Can) cohorts (n = 269,365). We identified individuals who were followed for a maximum of 15 years after their first blood glucose test until glioma diagnosis, death, emigration or the end of follow-up. Hazard ratios (HRs), 95% confidence intervals (CIs) and their interactions with time were estimated using Cox time-dependent regression. As expected, pre-diagnostic blood glucose levels were inversely related to glioma risk (AMORIS, P trend = 0.002; Me-Can, P trend = 0.04) and pre-diagnostic diabetes (AMORIS, HR = 0.30, 95% CI 0.17 to 0.53). During the year before diagnosis, blood glucose was inversely associated with glioma in the AMORIS (HR = 0.78, 95% CI 0.66 to 0.93) but not the Me-Can cohort (HR = 0.99, 95% CI 0.63 to 1.56). This AMORIS result is consistent with our hypothesis that excess glucose consumption by the preclinical tumour accounts for the inverse association between blood glucose and glioma. We discuss additional hypothetical mechanisms that may explain our paradoxical findings.

Three community engagement projects on the South Island of New Zealand are enacting education and communication initiatives to improve the uptake of best management practices on farms regarding nutrient management for improving water quality. Understanding the enablers and barriers to effective community-based catchment management is fundamental to planning, implementing and evaluating these initiatives. This article investigates some key predictors of success or determinants of effective community engagement. Six factors were identified: access to science, training, and information; confidence in regulatory policies; leadership; farm planning and monitoring; trust in the public; and concern for water quality. © 2017 Taylor & Francis Group, LLC.