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• 1. [Article] Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families

  Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) ...

  Citation × Citation Citation Abstract Copy Title: Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families Author: Zuckerman, Katharine E., Lindly, Olivia J., Reyes, Nuri M., Chavez, Alison E., Macias, Kristy, Smith, Kathryn N., Reynolds, Ann Year: 2017 Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) or limited English proficiency (L-LEP). Methods: We conducted a mixed-mode survey of families of children with confirmed ASD seen at specialty clinics in 3 United States cities. Bivariate and multivariate analyses compared barriers to ASD diagnosis, current service use, and unmet therapy need among NLW, L-EP, and L-LEP families. Results: Overall, barriers to ASD diagnosis were prevalent: families (n = 352) experienced a mean of 8 of 15 barriers to ASD diagnosis. The most prevalent barriers overall were "stress of diagnostic process," "parent knowledge about ASD," and "understanding medical system." Compared with NLW families, L-LEP families were more likely to experience barriers related to knowledge about ASD and trust in providers. Children in L-LEP families also had fewer current therapy hours and more unmet therapy needs than children in NLW families. L-EP families' barriers and treatment services use profile was more similar to NLW than to L-LEP families. Conclusions: English proficiency was an important marker for barriers to ASD diagnosis and treatment in Latinos. Increasing ASD-related knowledge and provider trust may decrease disparities in the diagnosis and treatment of ASD among US Latinos. Title: Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families Author: Zuckerman, Katharine E., Lindly, Olivia J., Reyes, Nuri M., Chavez, Alison E., Macias, Kristy, Smith, Kathryn N., Reynolds, Ann Year: 2017 Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) or limited English proficiency (L-LEP). Methods: We conducted a mixed-mode survey of families of children with confirmed ASD seen at specialty clinics in 3 United States cities. Bivariate and multivariate analyses compared barriers to ASD diagnosis, current service use, and unmet therapy need among NLW, L-EP, and L-LEP families. Results: Overall, barriers to ASD diagnosis were prevalent: families (n = 352) experienced a mean of 8 of 15 barriers to ASD diagnosis. The most prevalent barriers overall were "stress of diagnostic process," "parent knowledge about ASD," and "understanding medical system." Compared with NLW families, L-LEP families were more likely to experience barriers related to knowledge about ASD and trust in providers. Children in L-LEP families also had fewer current therapy hours and more unmet therapy needs than children in NLW families. L-EP families' barriers and treatment services use profile was more similar to NLW than to L-LEP families. Conclusions: English proficiency was an important marker for barriers to ASD diagnosis and treatment in Latinos. Increasing ASD-related knowledge and provider trust may decrease disparities in the diagnosis and treatment of ASD among US Latinos. Close

• 2. [Article] North Douglas County Community Needs Health Assessment (Phase 1)

  Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ...

  Citation × Citation Citation Abstract Copy Title: North Douglas County Community Needs Health Assessment (Phase 1) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2016 Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ages birth-to-8 and their families. The purpose of this process was to explore, understand, and integrate linkages between early learning and young child and family health; identify health-related resources currently available and accessible to NDC families; and prioritize health areas of interest to be explored during the CHNA. The North Douglas County CHNA builds on community partnerships already established in the region through initiatives that aim to coordinate and align early learning and K-12 systems. The work of Yoncalla Early Works (“YEW”, initiated in 2012 with funding from The Ford Family Foundation and Children’s Institute) and North Douglas P3 (“NDP3”, initiated in 2014 with funding from the Oregon Community Foundation) demonstrate community commitment to supporting young children and families. The work of community members through these initiatives laid the foundation for the region’s readiness to engage in a Community Health Needs Assessment (CHNA) planning process Ultimately, this first planning phase of the CHNA resulted in recommendations to conduct Phase 2 of the CHNA in North Douglas County, and is expected to get underway in summer/fall 2016 in collaboration with community members. The Community Health Needs Assessment will seek to answer the following questions: 1. What does health look like for children ages birth-to-8 and their families in North Douglas County? 2. What health services are available and accessible to children and families in North Douglas County? 3. What health services do families in North Douglas County need and want? 4. What needs to happen for health services to be available and accessible for North Douglas County children ages birth-to-8 and their families? Title: North Douglas County Community Needs Health Assessment (Phase 1) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2016 Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ages birth-to-8 and their families. The purpose of this process was to explore, understand, and integrate linkages between early learning and young child and family health; identify health-related resources currently available and accessible to NDC families; and prioritize health areas of interest to be explored during the CHNA. The North Douglas County CHNA builds on community partnerships already established in the region through initiatives that aim to coordinate and align early learning and K-12 systems. The work of Yoncalla Early Works (“YEW”, initiated in 2012 with funding from The Ford Family Foundation and Children’s Institute) and North Douglas P3 (“NDP3”, initiated in 2014 with funding from the Oregon Community Foundation) demonstrate community commitment to supporting young children and families. The work of community members through these initiatives laid the foundation for the region’s readiness to engage in a Community Health Needs Assessment (CHNA) planning process Ultimately, this first planning phase of the CHNA resulted in recommendations to conduct Phase 2 of the CHNA in North Douglas County, and is expected to get underway in summer/fall 2016 in collaboration with community members. The Community Health Needs Assessment will seek to answer the following questions: 1. What does health look like for children ages birth-to-8 and their families in North Douglas County? 2. What health services are available and accessible to children and families in North Douglas County? 3. What health services do families in North Douglas County need and want? 4. What needs to happen for health services to be available and accessible for North Douglas County children ages birth-to-8 and their families? Close

• 3. [Article] Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis

  Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. ...

  Citation × Citation Citation Abstract Copy Title: Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis Author: Zuckerman, Katharine E., Sinche, Brianna, Cobian, Martiza, Cervantes, Marlene, Mejia, Angie, Becker, Thomas, Nicolaidis, Christina Year: 2014 Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis. Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an ASD diagnosis. Focus groups and interviews were audio-recorded, transcribed and independently coded. Coded data were analyzed using thematic analysis. Results—Many Latino families in the study had not heard of ASD or had little information about it. Families sometimes assumed ASD red flags were normal or could be attributed to family dysfunction. Families also had concerns about provider communication and access to language services. Having a child with a developmental delay was associated with embarrassment, rejection, and family burden, making it difficult for parents to raise developmental concerns with providers. Conclusion—Pediatric providers should not assume that Latino parents have heard of ASD or know its symptoms. Providers should be aware that parents may be reluctant to mention concerns due to cultural factors. The health care system needs to improve resources for Latino parents with limited English proficiency. Policies should encourage the use of developmental screening in primary care Title: Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis Author: Zuckerman, Katharine E., Sinche, Brianna, Cobian, Martiza, Cervantes, Marlene, Mejia, Angie, Becker, Thomas, Nicolaidis, Christina Year: 2014 Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis. Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an ASD diagnosis. Focus groups and interviews were audio-recorded, transcribed and independently coded. Coded data were analyzed using thematic analysis. Results—Many Latino families in the study had not heard of ASD or had little information about it. Families sometimes assumed ASD red flags were normal or could be attributed to family dysfunction. Families also had concerns about provider communication and access to language services. Having a child with a developmental delay was associated with embarrassment, rejection, and family burden, making it difficult for parents to raise developmental concerns with providers. Conclusion—Pediatric providers should not assume that Latino parents have heard of ASD or know its symptoms. Providers should be aware that parents may be reluctant to mention concerns due to cultural factors. The health care system needs to improve resources for Latino parents with limited English proficiency. Policies should encourage the use of developmental screening in primary care Close

• 4. [Article] Evaluating Knowledge of Developmental Disabilities Among WIC Participants

  Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in ...

  Citation × Citation Citation Abstract Copy Title: Evaluating Knowledge of Developmental Disabilities Among WIC Participants Author: Regalado Murillo, Carolina, Zuckerman, Katharine, Dr., Chavez, Alison, Reeder, Julie A, Dr. Year: 2017 Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in parent information about DDs could contribute to diagnostic delays, but little is known about differences in parent DD familiarity. Objectives: To assess DD knowledge and information in a sample of low-income families. Methods: We conducted a self-administered survey on 539 parents attending their child’s appointment at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in six Oregon counties. Survey items assessed familiarity with early signs of DDs, self-reported knowledge about DDs, and having a friend or family member with ASD. Bivariable and multivariable analyses assessed differences in outcomes for following ethnicity/language groups: non-Latino white [white], Latino-English proficient [Latino-EP], Latino-limited English proficient [Latino-LEP], and non-Latino other race English proficient [other race]. Results: Overall, participants correctly identified 64.7% of early signs of DDs. White participants correctly identified the most signs after adjustment for socio-demographic differences. Latino-LEP and other race participants more likely to have never heard of several prevalent DDs, and were also less likely to have a friend or family member with a DD compared to white families. Conclusions: Low-income parents, particularly Latino-LEP and other race parents, have relatively little familiarity or personal experience with DDs, and are less aware of DD early signs. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in low-income and racial/ethnic minority communities. Title: Evaluating Knowledge of Developmental Disabilities Among WIC Participants Author: Regalado Murillo, Carolina, Zuckerman, Katharine, Dr., Chavez, Alison, Reeder, Julie A, Dr. Year: 2017 Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in parent information about DDs could contribute to diagnostic delays, but little is known about differences in parent DD familiarity. Objectives: To assess DD knowledge and information in a sample of low-income families. Methods: We conducted a self-administered survey on 539 parents attending their child’s appointment at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in six Oregon counties. Survey items assessed familiarity with early signs of DDs, self-reported knowledge about DDs, and having a friend or family member with ASD. Bivariable and multivariable analyses assessed differences in outcomes for following ethnicity/language groups: non-Latino white [white], Latino-English proficient [Latino-EP], Latino-limited English proficient [Latino-LEP], and non-Latino other race English proficient [other race]. Results: Overall, participants correctly identified 64.7% of early signs of DDs. White participants correctly identified the most signs after adjustment for socio-demographic differences. Latino-LEP and other race participants more likely to have never heard of several prevalent DDs, and were also less likely to have a friend or family member with a DD compared to white families. Conclusions: Low-income parents, particularly Latino-LEP and other race parents, have relatively little familiarity or personal experience with DDs, and are less aware of DD early signs. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in low-income and racial/ethnic minority communities. Close

• 5. [Article] North Douglas County Community Needs Health Assessment (Phase 2)

  Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, ...

  Citation × Citation Citation Abstract Copy Title: North Douglas County Community Needs Health Assessment (Phase 2) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2017 Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, Elkton, and Yoncalla, Oregon in the development and administration of a regional health services survey. The purpose of the survey was to learn from families with children ages 0-8 in the NDC region in order to: • Identify service needs across a range of health service types, e.g., dental care, immunizations, prenatal care, well-child care, primary care, and mental health; • Identify barriers to access; • Prioritize the programs and resources families most need to be able to support their and their children’s health; • Learn about preferred ways families would like to access these services; and • Recommend strategies to address the prioritized issues, needs, and barriers that emerge from the survey findings. Title: North Douglas County Community Needs Health Assessment (Phase 2) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2017 Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, Elkton, and Yoncalla, Oregon in the development and administration of a regional health services survey. The purpose of the survey was to learn from families with children ages 0-8 in the NDC region in order to: • Identify service needs across a range of health service types, e.g., dental care, immunizations, prenatal care, well-child care, primary care, and mental health; • Identify barriers to access; • Prioritize the programs and resources families most need to be able to support their and their children’s health; • Learn about preferred ways families would like to access these services; and • Recommend strategies to address the prioritized issues, needs, and barriers that emerge from the survey findings. Close

• 6. [Article] Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries

  Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central ...

  Citation × Citation Citation Abstract Copy Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Close

• 7. [Article] The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes

  The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving ...

  Citation × Citation Citation Abstract Copy Title: The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes Author: Green, Beth L., Ayoub, Catherine, Bartlett, Jessica Dym, Ende, Adam Von, Furrer, Carrie Jeanne, Chazen-Cohen, Rachel, Vallotton, Claire, Klevens, Joanne Year: 2014 The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse. Title: The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes Author: Green, Beth L., Ayoub, Catherine, Bartlett, Jessica Dym, Ende, Adam Von, Furrer, Carrie Jeanne, Chazen-Cohen, Rachel, Vallotton, Claire, Klevens, Joanne Year: 2014 The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse. Close

• 8. [Article] Interpretations of Interpretations: Combining Community-Based Participatory Research and Interpretive Inquiry to Improve Health

  Background: Latina immigrants from Mexico suffer significantly increased morbidity and mortality from cervical cancer when compared with non-Hispanic White women, largely owing to lack of screening and ...

  Citation × Citation Citation Abstract Copy Title: Interpretations of Interpretations: Combining Community-Based Participatory Research and Interpretive Inquiry to Improve Health Author: Gregg, Jessica, Centurion, Lourdes, Maldonado, Julio, Aguillon, Raquel, Celaya-Alston, Rosemary Carmela, Farquhar, Stephanie Year: 2010 Background: Latina immigrants from Mexico suffer significantly increased morbidity and mortality from cervical cancer when compared with non-Hispanic White women, largely owing to lack of screening and appropriate treatment. Objectives: To demonstrate that by combining the tools of community-based participatory research (CBPR) with the tools of interpretive inquiry, it is possible to address explicit community concerns surrounding a particular problem such as cervical cancer while also examining what other, perhaps less immediately visible, matters consume the time and attention of community members. Methods: We first briefly discuss and compare CBPR as an approach to research and interpretive inquiry as a qualitative research method. We then provide a case study from our own research using a CBPR approach to examine beliefs and attitudes about cervical cancer prevention among Oregon Latinos. Methods in that study included extensive discussions with our community advisory board (CAB) and promotores (community health workers) regarding barriers to cervical cancer screening for Latinas and community health concerns in general, and in-depth interviews with more than 50 Latino immigrants. Conclusion: Combining the tools of CBPR with the tools of interpretive qualitative inquiry may allow researchers to address explicit community concerns while also examining what other, less immediately visible, issues consume the time and attention of community members. In our specific case, combining the insights of our community partners with the results of our interpretive analysis helped us shift the focus from cervical cancer alone to a focus on gender relations and family health as we design future interventions. Title: Interpretations of Interpretations: Combining Community-Based Participatory Research and Interpretive Inquiry to Improve Health Author: Gregg, Jessica, Centurion, Lourdes, Maldonado, Julio, Aguillon, Raquel, Celaya-Alston, Rosemary Carmela, Farquhar, Stephanie Year: 2010 Background: Latina immigrants from Mexico suffer significantly increased morbidity and mortality from cervical cancer when compared with non-Hispanic White women, largely owing to lack of screening and appropriate treatment. Objectives: To demonstrate that by combining the tools of community-based participatory research (CBPR) with the tools of interpretive inquiry, it is possible to address explicit community concerns surrounding a particular problem such as cervical cancer while also examining what other, perhaps less immediately visible, matters consume the time and attention of community members. Methods: We first briefly discuss and compare CBPR as an approach to research and interpretive inquiry as a qualitative research method. We then provide a case study from our own research using a CBPR approach to examine beliefs and attitudes about cervical cancer prevention among Oregon Latinos. Methods in that study included extensive discussions with our community advisory board (CAB) and promotores (community health workers) regarding barriers to cervical cancer screening for Latinas and community health concerns in general, and in-depth interviews with more than 50 Latino immigrants. Conclusion: Combining the tools of CBPR with the tools of interpretive qualitative inquiry may allow researchers to address explicit community concerns while also examining what other, less immediately visible, issues consume the time and attention of community members. In our specific case, combining the insights of our community partners with the results of our interpretive analysis helped us shift the focus from cervical cancer alone to a focus on gender relations and family health as we design future interventions. Close

• 9. [Article] Occupational Health and Safety Status of Indigenous and Latino Farmworkers in Oregon

  Exposure to pesticides poses great risk to agricultural workers and their families. Of the approximately 174,000 agricultural workers in Oregon, studies estimate that up to 40% of the workers in Oregon ...

  Citation × Citation Citation Abstract Copy Title: Occupational Health and Safety Status of Indigenous and Latino Farmworkers in Oregon Author: Farquhar, Stephanie, Goff, Nancy M., Shadbeh, Nargess, Samples, Julie, Ventura, Santiago, Sanchez, Valentin, Rao, Pamela, Davis, Shelley Year: 2009 Exposure to pesticides poses great risk to agricultural workers and their families. Of the approximately 174,000 agricultural workers in Oregon, studies estimate that up to 40% of the workers in Oregon are indigenous and may be particularly vulnerable to the health risks of working in pesticide treated areas. Surveys conducted with Oregon farmworkers suggest that Latino and indigenous farmworkers differ demographically and may have diverse occupational and health needs. All Latino workers reported Spanish as their native language, while indigenous workers spoke several different native languages. Latino workers were employed mostly in orchards (28%) and nurseries (24%), while indigenous workers were mostly pickers (40%). Indigenous farmworkers reported less frequent suitable occupational safety training, and potentially less knowledge of the health consequences of pesticides. Addressing the barriers to obtaining pesticide health and safety information is of primary importance, given the changing demographics of farmworkers in Oregon. This article concludes with a discussion of these findings and the programmatic activities that have been implemented in Oregon to improve farmworkers' understanding of hazards and rights associated with agricultural work. Title: Occupational Health and Safety Status of Indigenous and Latino Farmworkers in Oregon Author: Farquhar, Stephanie, Goff, Nancy M., Shadbeh, Nargess, Samples, Julie, Ventura, Santiago, Sanchez, Valentin, Rao, Pamela, Davis, Shelley Year: 2009 Exposure to pesticides poses great risk to agricultural workers and their families. Of the approximately 174,000 agricultural workers in Oregon, studies estimate that up to 40% of the workers in Oregon are indigenous and may be particularly vulnerable to the health risks of working in pesticide treated areas. Surveys conducted with Oregon farmworkers suggest that Latino and indigenous farmworkers differ demographically and may have diverse occupational and health needs. All Latino workers reported Spanish as their native language, while indigenous workers spoke several different native languages. Latino workers were employed mostly in orchards (28%) and nurseries (24%), while indigenous workers were mostly pickers (40%). Indigenous farmworkers reported less frequent suitable occupational safety training, and potentially less knowledge of the health consequences of pesticides. Addressing the barriers to obtaining pesticide health and safety information is of primary importance, given the changing demographics of farmworkers in Oregon. This article concludes with a discussion of these findings and the programmatic activities that have been implemented in Oregon to improve farmworkers' understanding of hazards and rights associated with agricultural work. Close

• 10. [Article] Coffee Intake and Risk of Incident Diabetes in Puerto Rican Men: Results from the Puerto Rico Heart Health Program

  Objective: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). Methods: Of ...

  Citation × Citation Citation Abstract Copy Title: Coffee Intake and Risk of Incident Diabetes in Puerto Rican Men: Results from the Puerto Rico Heart Health Program Author: Fuhrman, Barbara J., Smit, Ellen, Crespo, Carlos J., Garcia-Palmieri, Mario R. Year: 2008 Objective: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). Methods: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar). Results: Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1?2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0·64; 95 % CI 0·43, 0·94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0·02); intake of ≥4 servings/d was associated with an odds ratio of 0·75 (95 % CI 0·58, 0·97).. Conclusions: Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk. Title: Coffee Intake and Risk of Incident Diabetes in Puerto Rican Men: Results from the Puerto Rico Heart Health Program Author: Fuhrman, Barbara J., Smit, Ellen, Crespo, Carlos J., Garcia-Palmieri, Mario R. Year: 2008 Objective: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). Methods: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar). Results: Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1?2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0·64; 95 % CI 0·43, 0·94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0·02); intake of ≥4 servings/d was associated with an odds ratio of 0·75 (95 % CI 0·58, 0·97).. Conclusions: Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk. Close