Situating Food Insecurity in a Historic Albuquerque Community: The Whorled Relationship between Food Insecurity and Place

This article examines conceptualizations of the relationship between food insecurity and place. We use an ethnographically inspired and community-engaged approach to situate our analysis of fluid dynamics at work in a community with high levels of food insecurity. We propose that the relationship between place and people’s experience of food insecurity is recursive, dialectical, and “whorled.” This relationship reflects complex, interconnected, and multidimensional processes with consequences for the health of residents. Our research demonstrates the key nature of the health-place nexus by exploring how food insecurity articulates with place in unexpected ways that go beyond discussions of food, food environments, food access, food practices or food systems that have become common in the literature

An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement

Diabetes is an enormous public health problem with particular concern within Hispanic communities and among individuals with low wealth. However, attempts to expand the public health paradigm to include social determinants of health rarely include analysis of social and contextual factors considered outside the purview of health research. As a result, conceptualization of the dynamics of diabetes health disparities remains shallow. We argue that using a holistic anthropological lens has the potential to offer insights regarding the nature of the interface between broader social determinants, health outcomes and health disparity. In a primarily Hispanic, immigrant community in Albuquerque, New Mexico, we conducted a mixed methods study that integrates an anthropological lens with a community engaged research design. Our data from focus groups, interviews, a survey and blood sampling demonstrate the need to conceptualize social determinants more broadly, more affectively and more dynamically than often considered. These results highlight a need to include, in addition to individual - level factors that are traditionally the focus of public health and more innovative structural factors that are currently in vogue, an in - depth, qualitative exploration of local context, social environment, and culture, and their interactions and intersectionality, as key factors when considering how to achieve change. The discussion presented here offers a model for culturally situated and contextually relevant scientific research. This model achieves the objectives and goals of both public health and anthropology while providing valuable insights and mechanisms for addressing health disparity such as that which exists in relation to diabetes among Hispanic immigrants in New Mexico. Such an approach has implications for how research projects are designed and conceptualizing social determinants more broadly. The discussion presented provides insights with relevance for both disciplines

Situating Giving Back for Native Americans Pursuing Careers in STEM: “You Don’t Just Take, You Give Something Back”

This article explores how a desire to give back influences Native Americans pursuing education and careers in science, technology, engineering and mathematics (STEM). We present analysis of data from 51 interviews with Native students and STEM professionals. Despite the compelling evidence of the core significance of a community orientation among Native Americans, insufficient attention has been given to thinking about the unique challenges faced by STEM professionals in devising ways to give back and how this relates to the continuing problem of under-representation of Native Americans in STEM. Here we propose strategies for universities and industry to honor Native ways of being by recognizing and embracing giving back as a value, and supporting STEM students and STEM professionals to overcome challenges to be able to give back to their communities. These strategies for situating giving back will promote expanded participation for Native Americans in STEM. This work provides insight for thinking about other under-represented populations in STEM

Health Disparity and Structural Violence: How Fear Undermines Health Among Immigrants at Risk for Diabetes

Diabetes is a national health problem, and the burden of the disease and its consequences particularly affect Hispanics. While social determinants of health models have improved our conceptualization of how certain contexts and environments influence an individual\u27s ability to make healthy choices, a structural violence framework transcends traditional uni-dimensional analysis. Thus, a structural violence approach is capable of revealing dynamics of social practices that operate across multiple dimensions of people’s lives in ways that may not immediately appear related to health. Working with a Hispanic immigrant community in Albuquerque, New Mexico, we demonstrate how structural forces simultaneously directly inhibit access to appropriate healthcare services and create fear among immigrants, acting to further undermine health and nurture disparity. Although fear is not normally directly associated with diabetes health outcomes, in the community where we conducted this study participant narratives discussed fear and health as interconnected

From community data to research archive: Partnering to increase and sustain capacity within a native organization

Community engagement and participation in academic research is growing in popularity and acceptance. Communities are now routinely engaged and participate in academic research design, implementation and interpretation, but the capacity of communities to conduct their own research is not always a product of these engagement initiatives. This article describes a collaboration between an organisation that supports Native American participation in the fields of science, technology, engineering and mathematics (STEM) and university researchers to expand the organisation’s capacity to conduct research by creating a searchable database from their organisational records. We discuss how strategic design of a research collaboration can result in infrastructure development that contributes to community capacity

Training Patient Stakeholders Builds Community Capacity, Enhances Patient Engagement in Research

Our philosophical framework for research with low-income Latino patients with diabetes prioritizes hiring research staff who share the culture and language of the population of study. Inclusive research design requires an active role by patient stakeholders with training opportunities in a collaborative learning environment to allow patient stakeholder data collectors (PSDCs) to build on existing strengths and expertise. To develop this manuscript, our team reflected on our collective experiences in implementing research-specific trainings for PSDCs. Although our population of study is known to be difficult to recruit and retain, our PSDCs have successfully enrolled participants on schedule, and attrition is low. Although language, institutional requirements, and funding restrictions presented training challenges, we overcame these by using a flexible approach and by incorporating the data collectors’ expertise in refining our protocols. We propose that our success in recruiting and retaining participants is a reflection of our engaged research strategy and framework and demonstrates that engagement promotes better science. However, our experience also demonstrates research institutions need to make policy and infrastructural improvements to reduce barriers and make engaged approaches more feasible

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Well-being as a multidimensional concept : understanding connections among culture, community, and health

Socially determined? Frameworks for thinking about health equity and wellness / Emily Mendenhall & Lesley Jo Weaver -- Employing a cultural lens to health promotion interventions to enhance health equity / Nancy Schoenberg & Claire Snell-Rood -- Community well-being, community intervention, and community development : changing community ecology / Edison J. Trickett & Leigh Rauk -- Culture and practice in relational well-being / Jean Schensul -- The allure of community : the ethical journey of people living with HIV disease in Philadelphia / Jeff Maskovsky -- Free our people : a disability studies perspective on well-being / Andrew Marcum -- Finding the culture in acculturation : cultural consonance and health among Mexican immigrant women in Alabama / Courtney Andrews -- Health and well-being among Native American indigenous peoples / Valarie Blue Bird Jernigan & Rodney C. Haring -- Speak your mind and heart in the Indian way : wellness and agency among American Indian elders / Elise Trott Jaramillo, Cathleen E. Willging, Emily Haozous, Steven P. Verney, & Erik Lujan -- Starved for company : rural seniors, social isolation, food charity, and impact on community well-being / Alicia Edwards & Janet Page-Reeves -- Technological approaches to food-related health equity / Andrea G. Parker -- Food sovereignty and wellness in urban African American communities / Anthony Ryan Hatch & Deja Knight -- From cultural to structural competency : the evolving roles of healthcare providers and medical education training to address persistent disparities / Cirila Estela Vasquez Guzman & Andrew L. Sussman -- Evolving from a disease-focused to a health-focused healthcare system : from pathogenesis to salutogenesis / David Rakel -- The limits of resiliency : rethinking wellness in a family medicine residency program / Mary Alice Scott, John Andazola, & Russell L. Holman -- Milagro : an innovative program for pregnant women with substance use disorders / Nicole Yonke & Sarah Gopman -- Aligning research with action for health and well-being in the Columbia Gorge : the Community Health Advocacy and Research Alliance (CHARA) / Kristen Dillon, Paul Lindberg & Melinda Davis -- Shifting narratives for behavioral health justice : the #NMspeaksCrisis campaign / Jaelyn deMaría & Roberta Rael -- A place-based approach to assessing wellness : the New Mexico Community Data Collaborative / Thomas N. Scharmen & Gale G. Hannigan.https://digitalrepository.unm.edu/hsc_facbookdisplay/1001/thumbnail.jp