UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study

Background: Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. Aims: (1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study. Methods: Three-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions. Results: There were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five ‘top-priority’ interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation. Limitations: No Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups. Future work: To include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities

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This thesis was presented by Thomas C. Baumgartner Jr. It was defended o

Lower HIV prevalence among Asian/Pacific islander men who have sex with men: A critical review for possible reasons

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors - unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services - do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions. © 2010 Springer Science+Business Media, LLC

OVARIAN CANCER WORKSHOP PROGRAM AT THE UNIVERSITY OF PITTSBURGH: SURVIVORS AND CLINICIANS WORKING TOGETHER TO EDUCATE FUTURE PRACTITIONERS OVARIAN CANCER WORKSHOP PROGRAM AT THE UNIVERSITY OF PITTSBURGH: SURVIVORS AND CLINICIANS WORKING TOGETHER TO EDUCAT

Abstract: Existing programs within ovarian cancer nonprofit organizations where survivors of the disease teach health practitioner students exist, but their evidence base needs to be strengthened in order to better understand their effect and generalizability within current health practitioner education. Amid concerns that health practitioner education does not involve patients in empowering roles or encourage empathy for patients among the soon-to-be medical professionals, giving patients/survivors leadership roles and a forum to have their voices heard is likely to be beneficial to all parties involved. The National Ovarian Cancer Coalition (NOCC) Pittsburgh Chapter has an existing speaker's bureau program that utilizes both clinician and survivor teaching to reach future health practitioners, with a one-hour presentation given on a volunteer basis. The objective of this thesis is to propose an enhanced implementation plan, as well as offer an evaluation plan that will be sustainable for the NOCC Pittsburgh Chapter. Current non-student participants will be polled to build a larger network, with an internal communications strategy laid out to continue to grow and strengthen the program. Students will complete empathy questionnaires before presentations, and again with a two-month follow up survey. Survivor participants will complete empowerment surveys via email. Data will be analyzed and presented to network members regularly via email, with a final in-person presentation at the end of the one-year program. The public health impact of an innovative, evidence-based health education program can be measured in greater survivor involvement and practitioner empathy, with an endpoint of better health outcomes among future patients

Examining psychosocial correlates of loneliness and perceived isolation among marginalized youth

Adolescents and emerging adults from marginalized groups (e.g., racial/ethnic, sexual, and gender minorities; rural-living) have disproportionately higher risk of mental health problems (e.g., depression, anxiety, suicidal thoughts and behaviors) and substance use than their peers from non-marginalized groups. Loneliness and perceived isolation are well-known predictors of mental health problems, and their prevalence among youth and emerging adults has significantly increased in the last decade. However, there is limited research to identify modifiable psychosocial, familial, interpersonal (in person and on social media), and structural factors that could reduce loneliness and perceived isolation in this population. We will partner with community-based organizations that serve marginalized youth and emerging adults with lived experience, to contextualize the experiences of feeling lonely and isolated. Then, we will leverage mixed methods (longitudinal survey study, focus groups/individual interviews) and social media data to uncover psychosocial, familial, interpersonal, and structural correlates of loneliness and perceived isolation, which can be used as targets for behavioral interventions for reducing loneliness, isolation, and associated mental health problems. We will use our findings to apply for extramural funding at the National Institutes of Health, which has calls directly related to loneliness and isolation (funding opportunities PAR-21-131, PAR-21-350, and PAR-21-134)

Racial/Ethnic Differences in Women's Experiences of Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy

ObjectiveTo explore racial/ethnic differences in reproductive coercion (RC), intimate partner violence (IPV), and unintended pregnancy (UIP).Materials and methodsWe analyzed cross-sectional, baseline data from an intervention that was conducted between August 2008 and March 2009 in five family planning clinics in the San Francisco, California area, to examine the association of race/ethnicity with RC, IPV, and UIP among female patients aged 16-29 (n = 1234).ResultsRC was significantly associated with race/ethnicity, p < 0.001, [prevalence estimates: Black (37.1%), multiracial (29.2%), White (18.0%), Hispanic/Latina (24.0%), and Asian/Pacific Islander/other (API/other) (18.4%)]. Race/ethnicity was not associated with IPV. UIP was more prevalent among Black (50.3%) and multiracial (47.2%) women, with an overall range of 37.1%-50.3% among all racial/ethnic groups (p < 0.001). In adjusted analyses, factors associated with UIP were RC [adjusted odds ratio (AOR) = 1.59, 95% confidence interval (95% CI) = 1.26-2.01] and Black (AOR = 1.63, 95% CI = 1.02-2.60) and API/other (AOR = 1.41, 95% CI = 1.15-1.73) race/ethnicity, which remained significant in the presence of RC. Race-stratified models revealed that RC increased odds of UIP for White (AOR = 2.06, 95% CI = 1.45-2.93) and Black women (AOR = 1.72, 95% CI = 1.14-2.60).ConclusionsBlack and multiracial women seeking care in family planning clinics have a disproportionately high prevalence of RC and UIP. RC may partially explain differences in UIP prevalence, with the effect of race/ethnicity slightly attenuated in RC-adjusted models. However, the impact of RC on risk for UIP was similar for White and Black women. Findings from this study support the need to understand and prevent RC, particularly among women of color. Results are foundational in understanding disparities in RC and UIP that may have implications for refinement of clinical care