Developing Capacity, Skills, and Tobacco Control Networks to address Tobacco-related Disparities: Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP)

Priority populations disproportionately experience tobacco-related disparities, despite population level declines in tobacco use. The Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP) recruits and trains African immigrants/African Americans, Asian Americans/Pacific Islanders, American Indians, Chicano/Latinos, and LGBTQ community members to develop leaders to address tobacco harms in their communities. This paper describes and evaluates the LAAMPP Institute, and discusses lessons learned through the Institute and future directions for community-based tobacco-control efforts. The mixed-methods evaluation included qualitative key informant interviews with LAAMPP Fellows and community and project contacts, a Skills Assessment Tool, project case studies, and a social network analysis of the Fellows’ tobacco-control social networks at baseline and follow-up. At follow-up, Fellows’ tobacco control networks were larger, more extensive and diverse, and included more actors perceived to be influential in tobacco control. Fellows’ skills increased in core competencies (tobacco control, advocacy, facilitation, collaboration, cultural/community competence) and Fellows used tobacco, advocacy and cultural/community competencies more frequently. Four of five cohorts successfully passed policies. The results of LAAMPP suggest that a cross-cultural leadership institute contributes to the successful development of capacity and leadership skills among priority populations and may be a useful model for others working toward health equity

Breast and Cervical Cancer Screening Practices for Low-Income Asian American Women in Ethnic-Specific Clinics

Introduction: Early detection and screening are the most effective means to reduce cancer mortality in all populations. Asian American (AA) women have among the lowest rates in aggregate for use of early detection, and screening practices of all ethnic populations. The only nationally disaggregated populationbased data on these ethnic groups at the time of the study was the 1993-1994 National Health Interview Survey (NHIS) of English speaking AA, but 70% of the AA population is non-English speaking. Our study presents heretofore unavailable data for cancer screening for monolingual AA women for a comparable time period in California between 1992 and 1994, prior to initiation of the state and Federal programs targeting this group of women. Methods: Retrospective chart reviews of randomly selected medical records were conducted for the breast and cervical cancer screening practices of low-income, non-English speaking Chinese, Korean, and Thai women attending ethnic specific community-based health clinics. All women seen in the clinics between 1992-1994 who were within the appropriate screening age categories were eligible. Results: Asian American women utilizing ethnic specific clinics had equal to or better screening rates for mammography and Pap tests than mainstream services for English-speaking AA women in a national survey. These screening rates, however, were still well below nationally recommended screening rates for breast and cervical cancer according to Healthy People 2000 or 2010 goals. Conclusion: These data support the effectiveness of Community Based Clinics (CBOs) to reach these hard to reach women and address the call for the elimination of health disparities. In addition, we compare our findings with national data to highlight within group variations

Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience

Purpose: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. Methods: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. Results: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eightweeks (range, 4-14weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of twoyears. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to threeweeks (0.2, 0.1-1.9) or ≥ 3weeks (0.3, 0.1-2.4). More than sixweeks of total antibiotic treatment equalled ≤ six weeks (0.8, 0.1-5.2). Conclusions: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observatio

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Slowing the epidemic of tobacco use among Asian Americans and Pacific Islanders.

Data on tobacco use among the Asian American/Pacific Islander (AAPI) population remain limited, although existing studies indicate that tobacco use prevalence among males from specific AAPI groups is significantly higher than in the general US male population. This high prevalence of tobacco use and the disparities in use result from social norms, targeted marketing by the tobacco industry, lack of culturally and linguistically tailored prevention and control programs, and limited impact of mainstream tobacco control programs for AAPIs. We review the available literature on tobacco use among AAPI men and women, highlight a national agenda that promotes tobacco prevention and control for AAPI communities, and acknowledge recent trends including the increase of tobacco use among AAPI women and girls

Environmental influences on tobacco use among Asian American and Pacific Islander youth.

There is growing interest in understanding individual and environmental influences on youth risk behaviors, including tobacco use. The purpose of this article is to describe the processes and findings from a study that sought to increase the capacity of Asian American and Pacific Islander (AAPI) community-based organizations to understand and address the environmental influences on tobacco use among AAPI youth. Using a multimethod approach to data collection that included GIS (geographic information system) mapping, Photovoice, and individual youth surveys, a team of community and university researchers conducted a 3-year study to assess and address the environmental influences of tobacco use among youth. Community-based participatory research principles guided the study and facilitated unique capacity building and analyses throughout the study period. Results in Long Beach from all three methods highlighted the associations between youth smoking and environmental factors: GIS mapping identified at least 77 separate locations of pro-tobacco influences, photographs captured many of these locations and provided youth leaders with opportunities to identify how other influences contributed to smoking risk, and surveys of youth indicated that perceived community safety and proximity to pro-tobacco influences were associated with smoking in the past 30 days. Subsequent community-based organization activities undertaken by study partners are also discussed, and lessons learned summarized

Environmental influences on tobacco use among Asian American and Pacific Islander youth.

There is growing interest in understanding individual and environmental influences on youth risk behaviors, including tobacco use. The purpose of this article is to describe the processes and findings from a study that sought to increase the capacity of Asian American and Pacific Islander (AAPI) community-based organizations to understand and address the environmental influences on tobacco use among AAPI youth. Using a multimethod approach to data collection that included GIS (geographic information system) mapping, Photovoice, and individual youth surveys, a team of community and university researchers conducted a 3-year study to assess and address the environmental influences of tobacco use among youth. Community-based participatory research principles guided the study and facilitated unique capacity building and analyses throughout the study period. Results in Long Beach from all three methods highlighted the associations between youth smoking and environmental factors: GIS mapping identified at least 77 separate locations of pro-tobacco influences, photographs captured many of these locations and provided youth leaders with opportunities to identify how other influences contributed to smoking risk, and surveys of youth indicated that perceived community safety and proximity to pro-tobacco influences were associated with smoking in the past 30 days. Subsequent community-based organization activities undertaken by study partners are also discussed, and lessons learned summarized

Using Photovoice to assess and promote environmental approaches to tobacco control in AAPI communities.

Asian American and Pacific Islander (AAPI) communities face enormous health disparities, with tobacco use contributing to high rates of cancer and heart disease. There is growing interest nationwide on the influence of environmental factors on tobacco use. AAPI communities have been found to have higher exposures to tobacco company marketing compared to the general population. The authors describe the use of Photovoice (a qualitative needs assessment technique) to empower AAPI youth to identify and understand environmental characteristics associated with tobacco use in four AAPI communities in California and Washington. Of the six major environmental themes identified from the photos, three themes were found across all four communities. Debrief sessions with youth and community leaders underscore the relevance of Photovoice for identifying community needs and motivating community organization for change. Despite some logistical challenges, Photovoice exemplifies the power and potential of this community-based methodology to capture how the environment influences youth on tobacco use