Adaptation of an evidence-based cardiovascular health intervention for rural African Americans in the Southeast

Background: African Americans (AA) living in the southeast United States have the highest prevalence of cardiovascular diseases (CVD) and rural minorities bear a significant burden of co-occurring CVD risk factors. Few evidence-based interventions (EBI) address social and physical environmental barriers in rural minority communities. We used intervention mapping together with community-based participatory research (CBPR) principles to adapt objectives of a multi-component CVD lifestyle EBI to fit the needs of a rural AA community. We sought to describe the process of using CPBR to adapt an EBI using intervention mapping to an AA rural setting and to identify and document the adaptations mapped onto the EBI and how they enhance the intervention to meet community needs. Methods: Focus groups, dyadic interviews, and organizational web-based surveys were used to assess content interest, retention strategies, and incorporation of auxiliary components to the EBI. Using CBPR principles, community and academic stakeholders met weekly to collaboratively integrate formative research findings into the intervention mapping process. We used a framework developed by Wilstey Stirman et al. to document changes. Results: Key changes were made to the content, context, and training and evaluation components of the existing EBI. A matrix including behavioral objectives from the original EBI and new objectives was developed. Categories of objectives included physical activity, nutrition, alcohol, and tobacco divided into three levels, namely, individual, interpersonal, and environmental. Conclusions: Intervention mapping integrated with principles of CBPR is an efficient and flexible process for adapting a comprehensive and culturally appropriate lifestyle EBI for a rural AA community context

Implementation of PHQ-9 Depression Screening for HIV-Infected Patients in a Real-World Setting

The prevalence of depression is 20%-30% for people living with HIV, and while it is associated with poorer adherence to antiretrovirals, it is often unrecognized by medical providers. Although it has been challenging for some health care settings to develop consistent depression screening mechanisms, it is feasible to create screening protocols using the 9-item Patient Health Questionnaire (PHQ-9). Establishing a depression screening and response protocol is an iterative process that involves preparing staff, determining screening frequency, and developing procedures for response and appropriate medical record documentation. While there are multiple issues and potential challenges during implementation, it is possible to incorporate systematic depression screening into HIV primary care in a manner that achieves staff buy-in, minimizes patient burden, streamlines communication, and efficiently uses the resources available in the medical setting

Heart Matters: a study protocol for a community based randomized trial aimed at reducing cardiovascular risk in a rural, African American community

Abstract Background African Americans living in the rural south have the highest prevalence of cardiovascular disease (CVD) risk in the United States. Given this geographic and racial disparity, intervention implementation needs to be evaluated for effectiveness and feasibility with African Americans in the rural south. Methods The trial developed out of a community-based participatory research partnership, Project GRACE, and community partners who are collaborators throughout the study. Heart Matters is a randomized stepped wedge trial that will assess the effectiveness of a 12-month behavioral change intervention adapted from PREMIER, an evidence-based treatment targeting multiple CVD risk factors. 140 participants will be recruited through 8 community- or faith-based organizations to participate in the intervention. Through matched pair randomization, organizations will be randomized to begin immediately after baseline data collection (Arm 1) or delayed 6 months (Arm 2). Data collection will occur at baseline, 6, 12, and 18 months. The primary outcome is change in body weight. In addition to assessing effectiveness, the study will also evaluate process and feasibility outcomes through quantitative and qualitative data collection. Discussion This study will contribute to CVD prevention research and likely have a positive impact on the rural, African American community where the trial occurs. Our study is unique in its use of community partnerships to develop, implement, and evaluate the intervention. We expect that this approach will enhance the feasibility of the trial, as well as future dissemination and sustainability of the intervention. Trial registration Clinical Trials, NCT02707432 . Registered 13 March 2016

Providers' Attitudes Towards Treating Depression and Self-Reported Depression Treatment Practices in HIV Outpatient Care

Depression is highly prevalent among HIV-infected patients, yet little is known about the quality of HIV providers' depression treatment practices. We assessed depression treatment practices of 72 HIV providers at three academic medical centers in 2010–2011 with semi-structured interviews. Responses were compared to national depression treatment guidelines. Most providers were confident that their role included treating depression. Providers were more confident prescribing a first antidepressant than switching treatments. Only 31% reported routinely assessing all patients for depression, 13% reported following up with patients within 2 weeks of starting an antidepressant, and 36% reported systematically assessing treatment response and tolerability in adjusting treatment. Over half of providers reported not being comfortable using the full FDA-approved dosing range for antidepressants. Systematic screening for depression and best-practices depression management were uncommon. Opportunities to increase HIV clinicians' comfort and confidence in treating depression, including receiving treatment support from clinic staff, are discussed

Metropolitan Areas, Housing Instability, and Child Health: Examining the Influence of Residential Mobility and Race on Child and Adolescent Behavior

Neighborhoods have a profound impact on healthy child development and well-being, particularly among Black and Latinx children and adolescents. Neighborhoods provide unique social and physical environments that impact child health by determining access to resources that are (or not) available to them. In the United States (US), neighborhoods have been structurally designed to restrict non-white racialized populations from upward mobility particularly through racist housing policies. The US has a long history of discriminatory housing policies and practices that have subsequently forced Black and Latinx families into precarious housing situations. Housing instability is prevalent among non-white racialized populations and has consequences for the health and well-being of children and adolescents. Using a Public Health Critical Race praxis framework, this dissertation examines how structural racism, defined and exhibited through historical and contemporary discriminatory housing policy, in the US affects neighborhood opportunities, housing instability, measured through residential mobility, and their association with health in children and adolescents who live in metropolitan areas. In study 1, I used the Delphi method to develop a framework exploring how structural racism influences neighborhood opportunities and the immediate factors that exist between these opportunities and healthy child development and well-being, particularly among Black children. Findings from the conceptual framework in study 1 emphasize the effects of structural racism and housing as an upstream determinant of health that influences child health and health inequities. To further examine some of the pathways between housing instability and child health, I used the Future of Families and Child Wellbeing dataset to investigate the associations between housing instability, gender, and internalizing and externalizing behaviors in children and adolescents, in study 2. Here I found that for every move a child experienced by ages 9 and 15 the standard deviation of their internalizing behavior scores increased, meaning children exhibited worse internal and external behaviors during this developmental period. Gender did not modify the association between residential mobility and internalizing and externalizing behaviors in children and adolescents. From here, to further explore the role of structural racism manifested through housing instability, using the same dataset as study 2, in study 3 I examined if race modifies the association between housing instability and internalizing externalizing behaviors in children and adolescents. Findings showed that race modified the association between residential mobility and child and adolescent behavior. Black and Hispanic/Latinx children exhibited fewer internalizing behaviors compared to white children. Finally, findings show that race did not modify the association between residential mobility and externalizing behaviors in children or adolescents. The research in this dissertation has important implications for future work in structural racism, housing instability, and child health inequities and well-being. Additionally, it emphasizes the importance of using the Public Health Critical Race praxis when exploring health inequities in racialized populations, particularly when it comes to the relationship between housing and child and adolescent health.PhDHealth Behavior & Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/177895/1/kbess_1.pd

Interrupting the Pathway From Discrimination to Black Adolescents’ Psychosocial Outcomes: The Contribution of Parental Racial Worries and Racial Socialization Competency

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170982/1/cdev13607.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170982/2/cdev13607_am.pd

Providers' Attitudes Towards Treating Depression and Self-Reported Depression Treatment Practices in HIV Outpatient Care

Depression is highly prevalent among HIV-infected patients, yet little is known about the quality of HIV providers' depression treatment practices. We assessed depression treatment practices of 72 HIV providers at three academic medical centers in 2010–2011 with semi-structured interviews. Responses were compared to national depression treatment guidelines. Most providers were confident that their role included treating depression. Providers were more confident prescribing a first antidepressant than switching treatments. Only 31% reported routinely assessing all patients for depression, 13% reported following up with patients within 2 weeks of starting an antidepressant, and 36% reported systematically assessing treatment response and tolerability in adjusting treatment. Over half of providers reported not being comfortable using the full FDA-approved dosing range for antidepressants. Systematic screening for depression and best-practices depression management were uncommon. Opportunities to increase HIV clinicians' comfort and confidence in treating depression, including receiving treatment support from clinic staff, are discussed