Cultural adaptation resources for nutrition and health in new immigrants in Central North Carolina.

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community’s ability to provide essential human services to population groups not yet language proficient and acculturated to “American community standards.

Emerging Trends in Family Caregiving Using the Life Course Perspective: Preparing Health Educators for an Aging Society

Background: As life expectancy and morbidity related to chronic disease increase, the baby boomers will be called upon to provide care to aging members of their family or to be care recipients themselves. Purpose: Through the theoretical lens of the life course perspective, this review of the literature provides insight into what characteristics of baby boomers separate them from previous caregiving cohorts and how these characteristics will affect family caregiving. Methods: A systematic process to identify literature was completed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Findings suggest multiple emerging trends related to caregiving, including (1) increasing use of digital technology for information gathering and support, (2) more diversity among caregivers and care recipients, (3) strained finances and loss of entitlements, (4) more complex care and care management, (5) demand for public policies related to caregiving, and (6) balancing work, family, chronic disease, and caregiving. Discussion: Examining the literature related to family caregiving and baby boomers through a life course perspective offers a unique and more complete understanding of emerging trends related to chronic disease management. Translation to Health Education Practice: These emerging trends offer health educators implications for strategies and best practices intended to support those involved in family caregiving

American-Indian diabetes mortality in the Great Plains Region 2002–2010

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed.Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates.Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25.Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR

Marital violence and women’s reproductive health care in Uttar Pradesh, India

Objective: Although the impact of marital violence on women’s reproductive health is recognized globally, there is little research on how women’s experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. Method: This study analyzes data on 9,639 currently married women from India’s 2006–2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married women’s reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. Results: Currently married women’s experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171–1.588] for physical violence; OR, 1.649 [95% CI, 1.323–2.054] for sexual violence; OR, 1.273 [95% CI, 1.117–1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533–0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458–0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. Conclusion: This study suggests that experiencing marital violence may have a negative impact on multiple aspects of women’s reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality

¿Qué te parece?: Pre-testing an HIV Testing Enablers Diagnostic Tool among Hispanic/ Latino Immigrant Women

This article describes the procedures used to determine the conceptual adequacy and cultural appropriateness of a newly developed HIV Testing Enablers Assessment (H-TEA) instrument to be used with underserved Hispanic/Latino immigrant women. The aim was to create an appropriate format for women with similar language proficiencies and ethnic backgrounds. We discuss the feedback we received from the women in terms of cultural nuances we must pay attention to when creating items and organizing them into an assessment instrument. Women reported on the understandability, com-fort level, likelihood of truthfulness, and cultural relevancy of questions and response options for the instrument. These are key factors in developing an instrument that is relevant, reliable, and culturally appropriate for our target population

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers

Few studies have examined disparities in adverse birth outcomes and compared contributingsocioeconomic factors specifically between African-American and White teen mothers. Thisstudy examined intersections between neighborhood socioeconomic status (as defined by censustractmedian household income), maternal age, and racial disparities in preterm birth (PTB)outcomes between African-American and White teen mothers in North Carolina. Using a linkeddataset with state birth record data and socioeconomic information from the 2010 US Census,disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariateand multilevel analyses. African-American teens had significantly greater odds of PTB outcomesthan White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantlyvaried by neighborhood income; PTB rates were 2.1 times higher for African-American teens inhigher income neighborhoods compared to White teens in similar neighborhoods. Disparities inPTB did not vary significantly between teens younger than age 17 and teens ages 17–19,although the magnitude of racial disparities was larger between younger African-American andWhite teens. These results justify further investigations using intersectional frameworks to testthe effects of racial status, neighborhood socioeconomic factors, and maternal age on birthoutcome disparities among infants born to teen mothers

Violence against women, symptom reporting, and treatment for reproductive tract infection in Kerala State, South India

In this article we examine factors associated with women's self-reports of reproductive ill health symptoms and factors associated with seeking and receiving treatment for the symptoms. We focus on indicators of women's societal position, especially empowerment (indicated by experience of and attitudes toward violence against women), autonomy, and education. We used data from the National Family Health Survey-2 from Kerala state in Southern India. Based on our results we suggest that violence against women, whether actually experienced or internalized as acceptance of its justification, is associated with increased ill health symptoms, and the acceptance of violence is associated with decreased chance of treatment. Women's higher formal education appeared to reduce treatment seeking for reproductive ill health, perhaps due to the stigma associated with sexually transmitted disease (STD) in this cultural setting. Women's work participation had no significant impact, nor did indicators of women's economic and personal autonomy

Enhancing gerontology interest among MPH students: Is adding aging to international service learning effective?

With the proportions and numbers of older adults increasing rapidly in the United States and worldwide, there is acute need for professionals with “gero-competency” and “gero-interest” in the spectrum of health and human service fields. We examine whether adding on gerontology content to an existing international health-focused service learning course would suffice to spark interest in gerontology and gero-focused careers among Master’s in Public Health students in Community Health Education. Currently, comparatively few graduate programs in public health education in the United States offer aging concentrations. We thus explore this alternative strategy. We used case study methodology to guide our assessment, which included content and thematic analyses of “artifacts of learning” and transcripts of in-depth interviews with five graduate students. Despite little prior exposure to gerontology and limited preparation with gerontology content, the students were able to competently analyze community aging issues. They recommended that aging-related courses with experiential opportunities be offered in health education curricula. Of the five students, three were not interested in a gero-focused career, one was open to the idea, and the other had found her niche in an aging-related position and enjoyed working in that environment. As the population ages, there is great need to spark students’ interest in aging-related careers. Adding on gerontology content to an existing health education course appeared less effective in sparking gero-interest, despite proven pedagogical approaches such as service learning. Encouraging students to take aging-focused courses with experiential learning components and offering more gerontology concentrations in Master’s in Public Health–level community health education programs may be more effective

Small and invisible, yet strong and impactful: North Carolina's Montagnard community responds to COVID-19

As COVID-19's impact disproportionately affects minority communities, North Carolina's Montagnard refugee and immigrant community has been no exception. Montagnards, a multi-tribal group, were resettled to the United States from the Vietnam highlands after suffering retribution for supporting American troops during the Vietnam war. The Montagnard Dega Association (MDA) and its youth branch, the Montagnard American Organization (MAO), estimated 50 COVID-19 positive cases by September 10, 2020 (Montagnard Dega Association, email communication, September 10, 2020). But community cases could well be higher (more than 100+) at the writing of this correspondence, since not all affected Montagnards have contacted MDA/MAO regarding infection

“Our Elders, Our Legacy”: Needs assessment of older adults in the Montagnard refugee community, Greensboro NC [White paper]

The Montagnard community, who represent multi-tribal, multilingual indigenous people from the Central Highlands of Vietnam, faces significant challenges in the Greensboro, North Carolina area, where they have been resettled for decades. Despite their prolonged presence, older Montagnards are poorly acculturated, with limited English proficiency, low income, and a lack of formal education. This demographic with unique needs is largely overlooked by federal, state, and local service providers.Our comprehensive needs assessment, conducted from January 2020 to December 2021, revealed a triple disadvantage for older Montagnards due to their intersectional factors of age, low income, and immigrant/ethnic minority status. The challenges include difficulties in accessing income, housing, health services, and social connections. Despite residing in a resource-rich city, the distribution of services is uneven, and collaboration among agencies is lacking.In conclusion, the Montagnard community in Greensboro, particularly its older population, requires targeted and culturally sensitive support to address their unique challenges. Implementing these recommendations will contribute to a more inclusive and supportive environment for this vulnerable group