http://www.rssboard.org/rss-specification 720 https://escholarship.org/uc/dahsm/rss Recent eScholarship items from Department of Humanities and Social Sciences Fri, 19 Jun 2026 13:30:16 +0000 https://escholarship.org/uc/item/9mf6b4k1 OBJECTIVE: To assess long-term safety of antiseizure medication (ASM) discontinuation after resolution of acute provoked neonatal seizures and prior to hospital discharge. METHODS: Prospective, observational, comparative effectiveness cohort study of neonates with acute provoked seizures born from July 2015 to March 2018, and followed until September 2024, at nine U.S. Neonatal Seizure Registry centers with Level IV neonatal intensive care units and Level IV pediatric epilepsy programs. Duration of ASM treatment was quantified as (1) discontinuation before discharge from the neonatal seizure admission or (2) maintenance at the time of hospital discharge. Outcomes were adjusted for propensity to receive ASM at discharge. Propensity for ASM maintenance was defined among enrolled participants by a logistic regression model including seizure etiology, gestational age, therapeutic hypothermia, worst electroencephalography (EEG) background, days of EEG seizures, and discharge neurological... https://escholarship.org/uc/item/9mf6b4k1 Thu, 26 Mar 2026 00:00:00 +0000 Glass, Hannah C https://orcid.org/0000-0002-3879-1966 Numis, Adam L https://orcid.org/0000-0002-1594-9812 Soul, Janet S Wusthoff, Courtney J Lemmon, Monica E Chu, Catherine J Massey, Shavonne L Thomas, Cameron Anwar, Tayyba Berl, Madison M Larson, Jennifer G Sturza, Julie Annis, Dana Rogers, Elizabeth E Franck, Linda S https://orcid.org/0000-0003-4291-9181 McCulloch, Charles E https://orcid.org/0000-0002-1279-6179 Shellhaas, Renée A https://escholarship.org/uc/item/8188d6mz Objective: Abnormal mammography results can contribute to anxiety for women, and primary care physicians (PCPs) are responsible for discussing these results with women. We sought to examine PCPs’ preparedness to discuss the breast biopsy process and biopsy results with women who have received an abnormal mammogram result and the physician, practice, panel, and communication factors associated with that preparedness. Methods: Cross-sectional analysis of internal medicine and family medicine PCPs in San Francisco, CA. We used multivariable logistic regression to examine the associations. Results: Of the 588 PCPs invited, 300 (51%) completed the survey. Seventy-three percent of respondents ( n = 219) felt equipped to explain a core biopsy, but only 40% of PCPs ( n = 120) felt that they had the expertise to answer questions from women about breast biopsy results. Family medicine training, private practice setting, greater percentage of panel of older patients, and viewing the... https://escholarship.org/uc/item/8188d6mz Thu, 29 Jan 2026 00:00:00 +0000 Murphy, Karly A Livaudais-Toman, Jennifer Kaplan, Celia P Kerlikowske, Karla Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Karliner, Leah S https://escholarship.org/uc/item/0f341662 This paper examines the rise of clinical decision support algorithms used to assess risk in pain management and the opioid industry’s influence on their development and implementation. To understand this influence, we conducted a qualitative study of documents related to the development of a tool that relied on artificial intelligence (AI) to suggest modifications in opioid prescribing, called NarxCare. The study began with keyword searches of the Opioid Industry Document Archive (OIDA), which contained over 3 million documents at the time of the study, to examine the pharmaceutical industry’s role in shaping the digital transformation of opioid prescribing. Our findings highlight industry-driven investments, educational campaigns, corporate policy activities, and the reliance on proprietary data that facilitated the widespread implementation of NarxCare. The increasing reliance on NarxCare raises concerns about its limited transparency, unknown reliability, and potential bias... https://escholarship.org/uc/item/0f341662 Tue, 19 Aug 2025 00:00:00 +0000 Kabella, Dan Apollonio, Dorie https://orcid.org/0000-0003-4694-0826 Young, Halle Knight, Kelly R https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/2gs527v0 Clinical Ethnographies of the Politics and Poetics of the US Healthcare Crisis https://escholarship.org/uc/item/2gs527v0 Tue, 29 Apr 2025 00:00:00 +0000 Buchbinder, Liza Holmes, Seth M https://orcid.org/0000-0002-2244-2868 Newmark, Rebecca Wong, Bonnie Bourgois, Philippe https://escholarship.org/uc/item/0z80c9cp <b>ABSTRACT</b>Recent academic and activist critiques raise important points about the ways in which coloniality, migration and racialization are often overlooked in global health research and practice. In particular, these critiques highlight how such structural forces perpetuate inequalities and exclusions, as well as processes of epistemic violence in global health. While agreeing with these critical interventions, this paper argues for a focus on care and the importance that concrete acts and systems of care in postcolonial, migratory and racialized contexts have on the suffering and vulnerability of individuals and communities. Drawing on case studies from multiple different geographic and social contexts, we argue that the perspective of racialization can highlight how multi-layered inequalities in global healthcare are shaped by the intertwined processes of coloniality and migration; thereby explaining the contextual, structural vulnerability of specific groups of people... https://escholarship.org/uc/item/0z80c9cp Tue, 29 Apr 2025 00:00:00 +0000 Dilger, Hansjörg Geeraert, Jérémy Goronga, Tinashe Mair, Lucia Mehran, Nassim Probst, Ursula Frankfurter, Raphael Greiwe, Vivien-Lee Jaeger, Margret Kluge, Ulrike Pape, Jillian Plummer, Jaleel Strohmeier, Hannah Vonk, Levi Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/0k71139h Recreational cannabis outlets may influence rates of interpersonal violence, but research has yielded inconsistent findings. Modification by alcohol outlet density may help explain inconsistencies. We estimated the impacts of recreational cannabis outlets on neighborhood-level assault injury rates in California and evaluated whether alcohol outlet density moderated these associations. We applied Bayesian spatiotemporal analyses to ZIP code-level statewide data on alcohol outlets, recreational cannabis outlets, and injuries and deaths due to firearm and nonfirearm assault, from 2017 to 2019, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities, overall and by age, sex, and race/ethnicity. If recreational cannabis outlets were never introduced, we estimated that nonfirearm assault injuries would have been 1.63 per 100 000 lower (95% CI, -3.08 to 0.01), but we observed... https://escholarship.org/uc/item/0k71139h Fri, 7 Mar 2025 00:00:00 +0000 Matthay, Ellicott C Charris, Rafael Ahern, Jennifer Apollonio, Dorie E https://orcid.org/0000-0003-4694-0826 Jent, Victoria Jacobs, Laurie M Jung, Shelley Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Gruenewald, Paul https://escholarship.org/uc/item/9fh8z5pw This article is a commentary on Preis et&nbsp;al.’s (2020) article “Improving Assessment, Treatment, and Understanding of Pregnant Women With Opioid Use Disorder: The Importance of Life Context.” Here I discuss the importance of structural racism in any evaluation of the life context of people of color in the United States. The recent “crack baby” epidemic provides an example of the impact of structural racism on the assessment and treatment of pregnant women of color. Structural analysis is often missing from medical education and training. I argue that physicians’ structural competence is necessary for reproductive justice. https://escholarship.org/uc/item/9fh8z5pw Fri, 28 Feb 2025 00:00:00 +0000 Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/8cf462ck Although qualitative interview studies provide in-depth understandings of the opinions and lived experiences of social groups, they are typically small in scale, bounded by a small number of physical or virtual spaces, and designed to capture relatively demarcated aspects of participants’ experiences. This paper describes the qualitative component of a large mixed method study of homelessness in California. The qualitative study consisted of seven substudies across eight counties, each exploring different dimensions of homelessness. We recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. Using a novel data management strategy, we analyzed each substudy as a stand-alone project, and explored the relationship between thematic content across the substudies. Our mereological study design presents an approach for developing... https://escholarship.org/uc/item/8cf462ck Fri, 28 Feb 2025 00:00:00 +0000 Duke, Michael Dhatt, Zena K Jacques, Tianna Garcia, Cheyenne https://orcid.org/0000-0002-6784-7260 Taylor, Grace Kushel, Margot https://orcid.org/0000-0002-1361-6889 Knight, Kelly https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/7270c2zj BACKGROUND: The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS: We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS:... https://escholarship.org/uc/item/7270c2zj Fri, 28 Feb 2025 00:00:00 +0000 Wenger, Lynn D Morris, Terry Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Megerian, Cariné E Davidson, Peter J Suen, Leslie W Majano, Veronica Lambdin, Barrot H Kral, Alex H https://escholarship.org/uc/item/6hd662ht Federal and State Regulatory Changes to Methadone Take-Home Doses: Impact of Sociostructural Factors https://escholarship.org/uc/item/6hd662ht Fri, 28 Feb 2025 00:00:00 +0000 Wyatt, Janan P Suen, Leslie W Coe, William H Adams, Zoe M Gandhi, Mona Batchelor, Hannah M Castellanos, Stacy Joshi, Neena Satterwhite, Shannon Pérez-Rodríguez, Rafael Rodríguez-Guerra, Esther Albizu-Garcia, Carmen E Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Jordan, Ayana https://escholarship.org/uc/item/3rx830v8 Importance: Harm reduction is associated with improved health outcomes among people who use substances. As overdose deaths persist, hospitals are recognizing the need for harm reduction services; however, little is known about the outcomes of hospital-based harm reduction for patients and staff. Objective: To evaluate patient and staff perspectives on the impact and challenges of a hospital-based harm reduction program offering safer use education and supplies at discharge. Design, Setting, and Participants: This qualitative study consisted of 40-minute semistructured interviews with hospitalized patients receiving harm reduction services and hospital staff at an urban, safety-net hospital in California from October 2022 to March 2023. Purposive sampling allowed inclusion of diverse patient racial and ethnic identities, substance use disorders (SUDs), and staff roles. Exposure: Receipt of harm reduction education and/or supplies (eg, syringes, pipes, naloxone, and test strips)... https://escholarship.org/uc/item/3rx830v8 Fri, 28 Feb 2025 00:00:00 +0000 Fraimow-Wong, Leah Martín, Marlene Thomas, Laura Giuliano, Ro Nguyen, Oanh Kieu Knight, Kelly https://orcid.org/0000-0002-5838-8592 Suen, Leslie W https://escholarship.org/uc/item/3hd7d7r7 People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities (e.g., drug prohibition, discriminatory housing policies), and prejudicial or illegal evictions are common. In Vancouver, Canada, evictions have proliferated in the Downtown Eastside, a historically low-income neighbourhood with high rates of drug use and housing instability, resulting in many PWUD being evicted into homelessness. This study characterizes housing trajectories of recently-evicted PWUD through the lens of the institutional circuit of homelessness, and explores how wider contexts of structural vulnerability shape experiences within this. Qualitative interviews were conducted with PWUD recently evicted in the Downtown Eastside (&lt;60 days). Peer research assistants recruited 58 PWUD through outreach activities. All PWUD participated in baseline interviews on the causes and contexts of evictions. Follow-up interviews were completed with 41 participants... https://escholarship.org/uc/item/3hd7d7r7 Fri, 28 Feb 2025 00:00:00 +0000 Fleming, Taylor Collins, Alexandra B Boyd, Jade Knight, Kelly R https://orcid.org/0000-0002-5838-8592 McNeil, Ryan https://escholarship.org/uc/item/18n9j82j BACKGROUND: Expanding access to opioid use disorder (OUD) treatment, including methadone, is imperative to address the US overdose crisis. In June 2021, the Drug Enforcement Administration announced new regulations allowing all opioid treatment programs (OTPs) to deploy mobile medication units, or methadone vans, to dispense OUD medication treatment outside of clinic walls, ending a 13-year moratorium. We conducted a qualitative study evaluating one opioid treatment program's experience, including benefits and challenges with implementing a methadone van, to inform future policy and clinical practice. METHODS: We recruited staff and patients receiving OUD medication treatment from an OTP in San Francisco, CA. The OTP had one operating van before March 2020 and began operating an additional van in response to COVID-19-related efforts to de-populate clinic settings. We interviewed 10 providers and 20 patients from August to November 2020. We transcribed, coded, and analyzed all... https://escholarship.org/uc/item/18n9j82j Fri, 28 Feb 2025 00:00:00 +0000 Suen, Leslie W Steiger, Scott Shapiro, Brad Castellanos, Stacy Joshi, Neena Lambdin, Barrot H Knight, Kelly R https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/17m6j2qm OBJECTIVES: Psychostimulant-related mortality is rising alongside increasing substance use-related hospitalizations, which are commonly complicated by patient-directed (or "against medical advice") discharges. Contingency management (CM) is an underused evidence-based treatment for substance use disorders with proven efficacy to support medication adherence. Our objective was to describe feasibility and preliminary effectiveness of a novel CM intervention incentivizing both drug use reduction and antibiotic adherence in the hospital setting. METHODS: We conducted a pilot intervention of twice weekly CM for stimulant and/or opioid use disorder and antibiotic adherence conducted on inpatient wards and/or an embedded skilled nursing facility in an urban public hospital. Based on point-of-care urine drug test results and objective antibiotic adherence review, participants earned increasing opportunities to receive incentives. We measured feasibility via number of visits attempted... https://escholarship.org/uc/item/17m6j2qm Fri, 28 Feb 2025 00:00:00 +0000 Appa, Ayesha Baral, Stefan Stein, Brianna Knight, Kelly https://orcid.org/0000-0002-5838-8592 Gandhi, Monica Coffin, Phillip Martin, Marlene https://orcid.org/0000-0001-8727-0289 https://escholarship.org/uc/item/0nb447mt Prenatal Opioid Use Disorder Treatment—the Importance of Shared Decision-Making https://escholarship.org/uc/item/0nb447mt Fri, 28 Feb 2025 00:00:00 +0000 Tiako, Max Jordan Nguemeni Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Schiff, Davida M https://escholarship.org/uc/item/0cr1145c BACKGROUND: People using opioids alone in private settings are at elevated risk of dying in the event of an overdose. In San Francisco, single room occupancy (SRO) tenants are 19 times more likely to die of overdose than non-SRO residents. The "SRO Project" pilot aimed to reduce fatal overdoses in SROs by recruiting and training tenants to distribute naloxone and provide overdose education in their buildings. We explore the implementation and program impacts of the SRO Project pilot in two permanent supportive housing SROs. METHODS: We conducted eight months of ethnographic fieldwork (May 2021 - Feb 2022), including 35 days observing SRO Project pilot activities, and semi-structured interviews with 11 housing staff and 8 tenant overdose prevention specialists ('specialists'). Data were analyzed using a grounded theory approach to characterize program impacts, implementation strengths, and implementation challenges from the perspective of specialists and housing staff. FINDINGS:... https://escholarship.org/uc/item/0cr1145c Fri, 28 Feb 2025 00:00:00 +0000 Olding, Michelle Joshi, Neena Castellanos, Stacy Valadao, Emily Hall, Lauren Guzman, Laura Knight, Kelly https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/7h30w2h1 Importance: The rise of high-potency opioids such as fentanyl makes buprenorphine initiation challenging due to the risks of precipitated withdrawal, prompting the exploration of strategies, such as low-dose initiation (LDI) of buprenorphine. However, no comparative studies on LDI outcomes exist. Objective: To evaluate outpatient outcomes associated with 2 LDI protocols of buprenorphine among individuals with opioid use disorder (OUD) using fentanyl. Design, Setting, and Participants: This cohort study analyzed data on adults with OUD who self-reported daily fentanyl use and underwent buprenorphine initiation using LDI. Data were extracted from the electronic health records of 2 substance use disorder treatment clinics using a specialty behavioral health pharmacy in San Francisco, California, from May 2021 to November 2022. Exposures: Type of LDI protocol selected by individuals: 4-day or 7-day protocol. Main Outcomes and Measures: The primary outcome was successful buprenorphine... https://escholarship.org/uc/item/7h30w2h1 Thu, 27 Feb 2025 00:00:00 +0000 Suen, Leslie W Chiang, Amy Y Jones, Benjamin LH https://orcid.org/0000-0002-4087-4832 Soran, Christine S Geier, Michelle Snyder, Hannah R Neuhaus, John Myers, Janet J Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Bazazi, Alexander R Coffin, Phillip O https://escholarship.org/uc/item/3fw1x5rr BACKGROUND: Cannabis use and alcohol use are associated with self-harm injuries, but little research has assessed links between recreational cannabis outlet openings on rates of self-harm within communities or the interactions of cannabis outlets with the density of alcohol outlets. We estimated the associations of recreational cannabis outlets, alcohol outlets, and their interaction on rates of fatal and nonfatal self-harm injuries in California, 2017-2019. METHODS: Using California statewide data on recreational cannabis outlets, alcohol outlets, and hospital discharges and deaths due to self-harm injuries, we conducted Bayesian spatiotemporal analyses of quarterly ZIP code-level data over 3 years, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities. RESULTS: If recreational cannabis outlets had never opened, we estimated that nonfatal self-harm injuries would have... https://escholarship.org/uc/item/3fw1x5rr Mon, 17 Feb 2025 00:00:00 +0000 Charris, Rafael Ahern, Jennifer Apollonio, Dorie E https://orcid.org/0000-0003-4694-0826 Jent, Victoria Jacobs, Laurie M Jung, Shelley Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Gruenewald, Paul Matthay, Ellicott C https://escholarship.org/uc/item/0462560k Despite the transformative contributions of Black feminist thought, medical anthropology often fails to recognize or center the works of Black feminist thinkers. We argue that Black feminist theory is critical for a study and praxis of new approaches to healing, health, medicine, illness, disability, and care. We can't continue to simply recognize that current systems are failing us; Black feminist theory moves us past recognition toward transformative liberation. This special issue emerges from works and conversations leading up to, during, and after the first Black Feminist Health Science Studies Collaboratory, held virtually in May 2021. Through the Collaboratory, we propose a new form of coming together around the sharing of knowledge and practice based in Black feminist thought and Black feminist healing arts. The collection of works that follow demonstrates and provides practical means toward a more liberatory practice of medical anthropology. https://escholarship.org/uc/item/0462560k Thu, 30 Jan 2025 00:00:00 +0000 Oni‐Orisan, Adeola Aboii, Sheyda M Edu, Ugo Felicia https://escholarship.org/uc/item/5k6631ng Scalable models for result disclosure are needed to ensure large-scale access to genomics services. Research evaluating alternatives to genetic counseling suggests effectiveness; however, it is unknown whether these findings are generalizable across populations. We assessed whether a letter is non-inferior to telephone genetic counseling to inform participants with no personal or family history of cancer of their normal results. Data were collected via self-report surveys before and after result disclosure (at 1 and 6 months) in a study sample enriched for individuals from underserved populations. Primary outcomes were subjective understanding of results (global and aggregated) and test-related feelings, ascertained via three subscales (uncertainty, negative emotions, and positive feelings) of the Feelings About genomiC Testing Results (FACToR) measure. Secondary outcomes related to satisfaction with communication. Non-inferiority tests compared outcomes among disclosure methods.... https://escholarship.org/uc/item/5k6631ng Sat, 18 Jan 2025 00:00:00 +0000 Gilmore, Marian J Leo, Michael C Amendola, Laura M Goddard, Katrina AB Hunter, Jessica Ezzell Joseph, Galen https://orcid.org/0000-0001-9179-7075 Kauffman, Tia L Rolf, Bradley Shuster, Elizabeth Zepp, Jamilyn M Wilfond, Benjamin S Biesecker, Barbara B https://escholarship.org/uc/item/3kt3d3zn OBJECTIVE: 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS: Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS: There were n =&nbsp;96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p&nbsp;=&nbsp;0.05).... https://escholarship.org/uc/item/3kt3d3zn Fri, 20 Dec 2024 00:00:00 +0000 Beck, Amy L Mora, Rosa Joseph, Galen https://orcid.org/0000-0001-9179-7075 Perrin, Eliana Cabana, Michael Schickedanz, Adam https://orcid.org/0000-0002-3182-1384 Fernandez, Alicia https://escholarship.org/uc/item/66j7c1hd BackgroundSocial norms can influence individual health behaviors. Shifts in social norms for smoking were critical for the effectiveness of tobacco control efforts such as excise taxes. Sugar-sweetened beverage (SSB) excise taxes have been implemented in municipalities across the United States to reduce SSB intake and improve health. We sought to identify trends in social norms and attitudes about healthfulness of sugar-sweetened beverage (SSB) consumption in the California Bay Area and examine whether social norms and attitudes changed following SSB taxes.MethodsData came from annual (2016–2019, 2021) cross-sectional surveys (n = 9128) in lower-income neighborhoods in Oakland, San Francisco, Berkeley, and Richmond. We assessed overall trends and compared pre-post tax changes in Oakland and San Francisco with comparison cities.ResultsWe observed a 28% reduction in social norms for SSB consumption (people’s perceptions of peers’ consumption) and variable reductions in attitudes... https://escholarship.org/uc/item/66j7c1hd Mon, 16 Dec 2024 00:00:00 +0000 Altman, Emily Schillinger, Dean Villas-Boas, Sofia https://orcid.org/0000-0001-8443-4364 Schmidt, Laura https://orcid.org/0000-0003-4346-7260 Falbe, Jennifer https://orcid.org/0000-0002-8405-4326 Madsen, Kristine A https://orcid.org/0000-0002-1880-5363 https://escholarship.org/uc/item/2m68s5nx BACKGROUND/OBJECTIVE: We sought to understand healthcare utilization and barriers to care among youth with chronic illness who interact frequently with the healthcare system. METHODS: This was a retrospective analysis of healthcare utilization for youth ≤25 years of age with chronic illness during one calendar year (1 January 2021-31 December 2021) in a single urban academic healthcare system. Inclusion criteria were (1) having at least one healthcare encounter in the calendar year of 2021 and (2) having at least six healthcare encounters over the preceding 3-year period or having a qualifying chronic illness. Demographic and clinical characteristics were collected along with self-reported and derived social determinants of health. Univariable and multivariable regression models were created to identify predictors of missed clinic visits, telehealth use, and activated patient portal accounts. RESULTS: The cohort (N = 14,245) was demographically, clinically, and socioeconomically... https://escholarship.org/uc/item/2m68s5nx Mon, 9 Dec 2024 00:00:00 +0000 Soulsby, William Daniel Franck, Linda S https://orcid.org/0000-0003-4291-9181 Perito, Emily https://orcid.org/0000-0002-2911-9684 Brakeman, Paul https://orcid.org/0000-0002-2268-7128 Cuneo, Addison Quill, Laura Boscardin, John von Scheven, Emily https://escholarship.org/uc/item/87c966sq PURPOSE: With increasing utilization of genetic testing, sharing genetic information can become part of general family health communication while providing biological relatives with important information about their own genetic risk. Importantly, little is known about motivations for and barriers to family communication of genetic information in historically underserved populations. METHODS: Using mixed methods, we explored patient experiences with family communication in a study population of English- and Spanish-speaking adults aged 18 to 49 years, enriched for participants from historically underserved backgrounds. Risk screening for hereditary cancer guided genetic testing for cancer risk genes and other medically actionable findings. RESULTS: Most participants overall (91%), including most with normal findings (89%), shared or planned to share their results with relatives. Common motivations for sharing results were to give relatives information about their genetic risk and... https://escholarship.org/uc/item/87c966sq Fri, 8 Nov 2024 00:00:00 +0000 Hunter, Jessica Ezzell Riddle, Leslie Joseph, Galen https://orcid.org/0000-0001-9179-7075 Amendola, Laura M Gilmore, Marian J Zepp, Jamilyn M Shuster, Elizabeth Bulkley, Joanna E Muessig, Kristin R Anderson, Katherine P Goddard, Katrina AB Wilfond, Benjamin S Leo, Michael C team, CHARM study Allen, Jake Angelo, Frank Arnold, Briana L Bellcross, Cecelia Bendelow, Tiffany Barbara, B Biesecker Breslin, Kristin D Booker, Kristina F Caruncho, Mikaella Davis, James V Deutsch, Sonia Devine, Beth Dorschner, Michael O Duenas, Devan Eubanks, Donna J Feigelson, Heather Spencer Freed, Amanda S Greaney, Clay Gruß, Inga Guerra, Claudia Guo, Boya Holup, Joan Ingphakorn, Chalinya L Jackson, Paige Jarvik, Gail P Jenkins, Charisma L Karliner, Leah S Kaufmann, Tia Keast, Erin Knerr, Sarah Koomas, Alyssa H Kraft, Stephanie A Lee, Mi H Lee, Robin Lee, Sandra Soo-Jin Lewis, Hannah S Liles, Elizabeth G Lindberg, Nangel M Lynch, Frances McMullen, Carmit K Medina, Elizabeth Mittendorf, Kathleen F Muessig, Kristin R Okuyama, Sonia Peterson, C Samuel Paolucci, Angela R Perez, Rosse Rodriguez Porter, Kathryn M Ransom, Chelese L Reyes, Ana Robinson, Sperry Rolf, Bradley A Rope, Alan F Schield, Emily Schneider, Jennifer L Shipman, Kelly J Shirts, Brian H Shuster, Elizabeth Syngal, Sapna Torgrimson-Ojerio, Britta N Ukaegbu, Chinedu Vandermeer, Meredith L Varga, Alexandra M Veenstra, David L Whitebirch, W Chris White, Larissa Lee https://escholarship.org/uc/item/858435w1 Landscapes of Care: Immigration and Health in Rural America by Thurka Sangaramoorthy (review) https://escholarship.org/uc/item/858435w1 Tue, 5 Nov 2024 00:00:00 +0000 Michaels, Theodore L Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/1q82v7v0 OBJECTIVE: Workplace sugar-sweetened beverage (SSB) sales bans can reduce SSB consumption. Because stress and anxiety can promote sugar consumption, we examined whether anxiety among hospital employees during the COVID-19 pandemic was associated with changes in SSB consumption and explored whether this relationship varied by exposure to a workplace SSB sales ban. DESIGN: In a prospective, controlled trial of workplace SSB sales bans, we examined self-reported anxiety (generalised anxiety disorder-7) and self-reported SSB consumption (fluid ounces/d) before (July 2019) and during (May 2020) the COVID-19 pandemic. SETTING: Hospital sites in two conditions (four with SSB sales bans and three without sales bans) in Northern California. PARTICIPANTS: We sampled 580 participants (hospital employees) from a larger trial of sales bans; all were regular consumers of SSB (minimum 3/week at main trial enrollment). This subsample was chosen based on having appropriately timed data for our... https://escholarship.org/uc/item/1q82v7v0 Fri, 20 Sep 2024 00:00:00 +0000 Jacobs, Laurie M Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Schillinger, Dean Schmidt, Jamey M Alegria, Katie E Parrett, Bethany Pickett, Amanda Epel, Elissa S https://escholarship.org/uc/item/2d70k69p OBJECTIVE: To examine the efficacy of a brief, online intervention designed to enhance genetic counseling students' patient-centered communication. METHODS: Genetic counseling students and recent graduates were randomized to two groups following a baseline standardized patient (SP) session: (1) immediate intervention exposure, which consisted of five modules that taught patient-centered communication skills followed by a second SP session, or (2) delayed intervention exposure following completion of the second session. Sessions were coded using the Roter Interaction Analysis System. Short-term efficacy was assessed by comparing communication during the second session between the delayed and immediate intervention exposure groups. Longer-term efficacy was assessed by comparing communication during a third session approximately five weeks later. RESULTS: During the second session, students in the immediate intervention exposure group (n&nbsp;=&nbsp;18) used more emotionally responsive... https://escholarship.org/uc/item/2d70k69p Mon, 16 Sep 2024 00:00:00 +0000 Lowe, Chenery Erby, Lori Biesecker, Barbara Beach, Mary Catherine Joseph, Galen https://orcid.org/0000-0001-9179-7075 Hundert, Rachel Roter, Debra L https://escholarship.org/uc/item/02b2c6qz Facial recognition technology (FRT) has been adopted as a precision medicine tool. The medical genetics field highlights both the clinical potential and privacy risks of this technology, putting the discipline at the forefront of a new digital privacy debate. Investigating how geneticists perceive the privacy concerns surrounding FRT can help shape the evolution and regulation of the field, and provide lessons for medicine and research more broadly. Five hundred and sixty-two genetics clinicians and researchers were approached to fill out a survey, 105 responded, and 80% of these completed. The survey consisted of 48 questions covering demographics, relationship to new technologies, views on privacy, views on FRT, and views on regulation. Genetics professionals generally placed a high value on privacy, although specific views differed, were context-specific, and covaried with demographic factors. Most respondents (88%) agreed that privacy is a basic human right, but only 37% placed... https://escholarship.org/uc/item/02b2c6qz Mon, 16 Sep 2024 00:00:00 +0000 Aboujaoude, Elias Light, Janice Brown, Julia EH Boscardin, W John Hallgrímsson, Benedikt Klein, Ophir D https://escholarship.org/uc/item/4p61m485 OBJECTIVES: Many older homeless adults maintain contact with family. We conducted a qualitative study examining the role of family caregiving for older homeless adults. METHOD: We conducted semi-structured qualitative interviews with a sample of 46 homeless participants who reported spending at least one night with a housed family member in the prior 6 months. RESULTS: A total of 13 of 46 older adult participants provided caregiving. Themes included (a) the death of the care recipient led to the participant's homelessness; (b) feeling a duty to act as caregivers; (c) providing care in exchange for housing; (d) caregivers' ability to stay was tenuous; (e) providing care conflicted with the caregiver's needs; and (f) resentment when family was ungrateful. DISCUSSION: In a sample of older homeless adults in contact with family, many provided caregiving for housed family. For some, caregiving precipitated homelessness; for others, caregiving provided temporary respite from homelessness,... https://escholarship.org/uc/item/4p61m485 Sun, 18 Aug 2024 00:00:00 +0000 Rosenwohl-Mack, Sarah https://orcid.org/0000-0002-2885-9605 Kushel, Margot https://orcid.org/0000-0002-1361-6889 Ramsey, Claire Handley, Margaret https://orcid.org/0000-0001-5034-2111 Knight, Kelly R https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/83c344nf Rurality has served as a key concept in popular and scientific understandings of the US overdose crisis, with White, rural, and low-income areas thought to be most heavily affected. However, we observe that overdose trends have risen nearly uniformly across the urban-rural designations employed in most research, implying that their importance has likely been overstated or incorrectly conceptualized. Nevertheless, urbanicity/rurality does serve as a key axis to understand inequalities in overdose mortality when assessed with more nuanced modalities-employing a more granular analysis of geography at the sub-county level, and intersecting rurality sociodemographic indices such as race/ethnicity. Using national overdose data from 1999-2021, we illustrate the intersectional importance of rurality for overdose surveillance. Finally, we offer recommendations for integrating these insights into drug overdose surveillance moving forward. https://escholarship.org/uc/item/83c344nf Fri, 16 Aug 2024 00:00:00 +0000 Textor, Lauren Friedman, Joseph Bourgois, Philippe Aronowitz, Shoshana Simon, Caty Jauffret-Roustide, Marie Namirembe, Sarah Brothers, Sarah McNeil, Ryan Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 Hansen, Helena https://escholarship.org/uc/item/67c080s9 The objective of this study was to identify interpretation challenges specific to exome sequencing and errors of potential clinical significance in the context of genetic counseling for adults at risk for a hereditary cancer syndrome. Thirty transcripts of interpreter-mediated telephone results disclosure genetic counseling appointments were coded for errors by bilingual researchers, and the coders applied an overall rating to denote the degree to which the errors interfered with communication overall. Genetic counselors reviewed a subset of errors flagged for potential clinical significance to identify those likely to have clinical impact. Qualitative interviews with 19 interpreters were analyzed to elucidate the challenges they face in interpreting for genetic counseling appointments. Our analysis identified common interpretation errors such as raising the register, omissions, and additions. Further, we found errors specific to genetic counseling concepts and content that appeared... https://escholarship.org/uc/item/67c080s9 Fri, 16 Aug 2024 00:00:00 +0000 Joseph, Galen https://orcid.org/0000-0001-9179-7075 Lindberg, Nangel M Guerra, Claudia Hernandez, Cindy Karliner, Leah S Gilmore, Marian J Zepp, Jamilyn Rolf, Bradley A Caruncho, Mikaella Riddle, Leslie Kauffman, Tia L Leo, Michael C Wilfond, Benjamin S https://escholarship.org/uc/item/98x7m6j8 Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach... https://escholarship.org/uc/item/98x7m6j8 Thu, 1 Aug 2024 00:00:00 +0000 Hargrave, Anita S Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Dhatt, Zena K Taylor, Grace Martinez, Dez Kushel, Margot https://orcid.org/0000-0002-1361-6889 https://escholarship.org/uc/item/67h0j28g Migration et exploitation des travailleur·se·s agricoles aujourd’hui. De l’importance de relier les enjeux de racialisation, migrations et santé https://escholarship.org/uc/item/67h0j28g Wed, 31 Jul 2024 00:00:00 +0000 Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/1583p2gk Providing cost-effective, comprehensive survivorship care remains a significant challenge. Breast cancer survivors (BCS) who have limited income and are from marginalized racial and ethnic groups experience a worse quality of life and report higher distress. Thus, innovative care models are required to address the needs of BCS&nbsp;in low resource settings. Group medical visits (GMV), utilized in chronic disease management, are an excellent model for education and building skills. This single-arm intervention study was conducted at a public hospital in California. GMVs consisted of five 2-h weekly sessions focused on survivorship care planning, side effects of treatment and prevention, emotional health, sexual health, physical activity, and diet. The patient navigators recruited three consecutive GMV groups of six English-speaking BCS (N = 17). A multidisciplinary team delivered GMVs, and a patient navigator facilitated all the sessions. We used attendance rates, pre- and post-surveys,... https://escholarship.org/uc/item/1583p2gk Tue, 16 Jul 2024 00:00:00 +0000 Trejo, Evelin Velazquez, Ana I Castillo, Elizabeth Couey, Paul Cicerelli, Barbara McBride, Robin Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Dixit, Niharika https://orcid.org/0000-0001-8677-8216 https://escholarship.org/uc/item/4m0450q5 BACKGROUND: Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures. METHODS: Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements). RESULTS: Localities that ultimately banned storefront... https://escholarship.org/uc/item/4m0450q5 Sat, 6 Jul 2024 00:00:00 +0000 Matthay, Ellicott C Mousli, Leyla M Sun, Chloe Lewis, Justin Jacobs, Laurie M Heard, Stuart Ho, Raymond Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Apollonio, Dorie E https://orcid.org/0000-0003-4694-0826 https://escholarship.org/uc/item/8kw1p9r9 INTRODUCTION: Population-based studies have reported high rates of smoking prevalence among Chinese and Vietnamese American men. Although nicotine replacement therapy (NRT) is effective, recommended, and accessible without prescription, these populations underuse NRT for smoking cessation. The aim of this study was to assess understanding and use of NRT and nonpharmacologic treatments among Chinese and Vietnamese American male smokers and their families. METHODS: In-depth qualitative interviews were conducted with 13 smoker-family pairs, followed by individual interviews with each participant. A total of 39 interviews were conducted in Vietnamese or Chinese, recorded, translated, and transcribed into English for analysis. RESULTS: Four themes were identified: use and understanding of NRT, nonpharmacologic strategies, familial and religious approaches, and willpower. Both smokers and their family members believed strongly in willpower and a sense of personal responsibility as the... https://escholarship.org/uc/item/8kw1p9r9 Mon, 17 Jun 2024 00:00:00 +0000 Tsang, Icarus K Tsoh, Janice Y https://orcid.org/0000-0003-0989-7187 Wong, Ching Le, Khanh Cheng, Joyce W Nguyen, Anthony N Nguyen, Tung T https://orcid.org/0000-0001-9897-6551 McPhee, Stephen J Burke, Nancy J https://orcid.org/0000-0002-2269-3341 https://escholarship.org/uc/item/4j85r3nd INTRODUCTION: Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. METHODS: Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. RESULTS: Use of the Health Behavior... https://escholarship.org/uc/item/4j85r3nd Mon, 17 Jun 2024 00:00:00 +0000 Maxwell, Annette E https://orcid.org/0000-0002-2334-8582 Bastani, Roshan https://orcid.org/0000-0001-6594-9231 Glenn, Beth A https://orcid.org/0000-0002-4937-8181 Taylor, Victoria M Nguyen, Tung T https://orcid.org/0000-0001-9897-6551 Stewart, Susan L Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Chen, Moon S https://escholarship.org/uc/item/3sw043bf BACKGROUND: Due to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consideration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women. METHODS: We report data from a qualitative interview study (n=30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs. RESULTS: Women in the study lived in... https://escholarship.org/uc/item/3sw043bf Sun, 16 Jun 2024 00:00:00 +0000 Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Lopez, Andrea M Comfort, Megan Shumway, Martha Cohen, Jennifer Riley, Elise D https://orcid.org/0000-0001-5867-1155 https://escholarship.org/uc/item/6r8448z3 BACKGROUND: Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes. METHODS: We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic development were used to collaboratively interpret fieldnotes and transcripts. RESULTS: Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child's day-to-day life. After sequencing, however, genetic information... https://escholarship.org/uc/item/6r8448z3 Mon, 27 May 2024 00:00:00 +0000 Ackerman, Sara L https://orcid.org/0000-0003-3567-7698 Brown, Julia EH Zamora, Astrid Outram, Simon https://escholarship.org/uc/item/93g96679 During the COVID-19 pandemic, there was slower growth in the number of new waivers authorizing clinicians to provide buprenorphine treatment for opioid use disorder. However, treatment capacity grew at a stable rate as a result of already authorized clinicians obtaining waivers for larger patient panels. Advanced practice nurses accounted for the largest portion of capacity growth during the pandemic. https://escholarship.org/uc/item/93g96679 Sat, 11 May 2024 00:00:00 +0000 Spetz, Joanne https://orcid.org/0000-0003-3112-5511 Hailer, Laurie Gay, Caryl https://orcid.org/0000-0002-6865-6335 Tierney, Matthew Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Phoenix, Bethany https://orcid.org/0000-0003-0399-4605 Chapman, Susan A https://escholarship.org/uc/item/0vj7b4rr The future of agricultural work in the United States (U.S.) must account for at least two important trends: 1) the persistence of the industry being riddled with high rates of injury and illness and 2) the growing proportion of hired farmworkers compared to family farmworkers working in these dangerous environments. These workers confront structural disadvantages that impede social justice and prosperity. Social structures like policies, economic systems, institutions, and social hierarchies create health disparities, often along the lines of social categories. The result is an already dangerous industry with vulnerable workers facing unjust risks, especially those that are undocumented. Agricultural health and safety professionals and other stakeholders should engage structural competency curricula in order to increase awareness of impact of structures and be better positioned to improve farmworker health and wellbeing. Similar work has been successful in the training healthcare... https://escholarship.org/uc/item/0vj7b4rr Wed, 1 May 2024 00:00:00 +0000 Bendixsen, Casper G Ramos, Athena K Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/8w9744zm BackgroundBuprenorphine is an effective treatment for opioid use disorder (OUD); however, buprenorphine initiation can be complicated by withdrawal symptoms including precipitated withdrawal. There has been increasing interest in using low dose initiation (LDI) strategies to reduce this withdrawal risk. As there are limited data on withdrawal symptoms during LDI, we characterize withdrawal symptoms in people with daily fentanyl use who underwent initiation using these strategies as outpatients.MethodsWe conducted a retrospective chart review of patients with OUD using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Two addiction medicine experts assessed extracted chart documentation for withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine. A third expert adjudicated disagreements. Data were analyzed using descriptive statistics.ResultsThere... https://escholarship.org/uc/item/8w9744zm Sat, 27 Apr 2024 00:00:00 +0000 Jones, Benjamin LH https://orcid.org/0000-0002-4087-4832 Geier, Michelle Neuhaus, John Coffin, Phillip O Snyder, Hannah R Soran, Christine S Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Suen, Leslie W https://escholarship.org/uc/item/0g5421g9 In September 2020 the US National Institutes of Health (NIH) allocated $12 million to support engagement with historically marginalized communities hardest hit by COVID-19. The award was designed to mobilize community-engagement in pandemic response, and to support partnerships as part of the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities. All aspects of the award were fast-tracked and NIH utilized a 'more flexible' funding mechanism (OTA) to facilitate swift distribution of funds. In this paper, we draw upon an analysis of findings from a 2021 survey conducted with 11 California CEAL sites representing urban and rural settings, private and public universities, and established and new community partners and qualitative analysis of 2020-2022 site-wide meeting minutes. We describe challenges posed at the federal (e.g., NIH funding), university, and community-university partnership levels as well as opportunities and creative workarounds. Challenges include... https://escholarship.org/uc/item/0g5421g9 Fri, 26 Apr 2024 00:00:00 +0000 Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Espinosa, Patricia Rodriguez Corchado, Claudia C Vázquez, Evelyn Rosas, Lisa G Wooe, Kent J LeSarre, Monique Gallegos-Castillo, Angela Cheney, Ann https://orcid.org/0000-0002-4032-6692 Lo, David D https://orcid.org/0000-0002-5962-9458 Hintz, Rachel Vassar, Stefanie D Brown, Arleen F https://orcid.org/0000-0001-9948-8955 https://escholarship.org/uc/item/1t4710t2 Introduction: Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. Methods: We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Results:... https://escholarship.org/uc/item/1t4710t2 Sun, 7 Apr 2024 00:00:00 +0000 Neff, Joshua https://orcid.org/0000-0002-0091-3630 Holmes, Seth M https://orcid.org/0000-0002-2244-2868 Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Strong, Shirley Thompson-Lastad, Ariana https://orcid.org/0000-0002-4880-1371 McGuinness, Cara Duncan, Laura Saxena, Nimish Harvey, Michael J Langford, Alice Carey-Simms, Katiana L Minahan, Sara N Satterwhite, Shannon Ruppel, Caitlin Lee, Sonia Walkover, Lillian De Avila, Jorge Lewis, Brett Matthews, Jenifer Nelson, Nicholas https://escholarship.org/uc/item/2t71x1hq Introduction: In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation. Methods: We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques... https://escholarship.org/uc/item/2t71x1hq Thu, 28 Mar 2024 00:00:00 +0000 Garrett, Sarah B Jones, Linda Montague, Alexandra Fa-Yusuf, Haleemat Harris-Taylor, Julie Powell, Breezy Chan, Erica Zamarripa, Stephen Hooper, Sarah Butcher, Brittany D Chambers https://escholarship.org/uc/item/9sz4d344 Antibias training is increasingly identified as a strategy to reduce maternal health disparities. Evidence to guide this work is limited. We conducted a community-guided scoping review to characterize new antibias research. Four of 508 projects met our criteria: US-based, publicly funded, initiated from January 1, 2018 to June 30, 2022, and featuring an intervention to reduce bias or racism in maternal health care providers. Training was embedded in multicomponent interventions in 3 projects, limiting its evaluation as a stand-alone intervention. Major public funders have sponsored few projects to advance antibias training research in maternal health. More support is needed to develop a rigorous and scalable evidence base. https://escholarship.org/uc/item/9sz4d344 Tue, 12 Mar 2024 00:00:00 +0000 Garrett, Sarah B Walia, Anjali Miller, Fiona Tahir, Peggy Jones, Linda Harris, Julie Powell, Breezy Chambers, Brittany https://orcid.org/0000-0002-7558-9580 Simon, Melissa A https://escholarship.org/uc/item/6x518157 BackgroundLoneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences.MethodsWe purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis.ResultsTwenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men... https://escholarship.org/uc/item/6x518157 Fri, 1 Mar 2024 00:00:00 +0000 Yuan, Yeqing Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Weeks, John King, Stephen Olsen, Pamela Kushel, Margot https://orcid.org/0000-0002-1361-6889 https://escholarship.org/uc/item/9q17z01d Examining the narratives of eighteen heterosexual drug-injecting men living with HIV, this study seeks to understand how HIV-positive men negotiate issues of masculinity, sexuality, and emotional intimacy. It focuses specifically on strategies HIV-positive men use to manage emotional vulnerability in sexual encounters. We identify a core theme of "splitting," in which men compartmentalize the domains of sexuality and emotional intimacy. We examine how this aspect of masculinity is at times exacerbated as a strategy to minimize emotional investment in sexual partners. By splitting the emotional and sexual domains, the men are able to perform sexually with casual sex partners while minimizing both the risk of infecting intimate partners and a fear of rejection from those they care about or desire most. However, the tensions created by splitting the emotional and sexual domains may disintegrate intimate interpersonal relationships that serve as a base of much-needed emotional support.... https://escholarship.org/uc/item/9q17z01d Mon, 26 Feb 2024 00:00:00 +0000 Missildine, Whitney Parsons, Jeffrey T Knight, Kelly https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/5qq5f8nt Structural Adaptations to Methadone Maintenance Treatment and Take-Home Dosing for Opioid Use Disorder in the Era of COVID-19 https://escholarship.org/uc/item/5qq5f8nt Mon, 26 Feb 2024 00:00:00 +0000 Suen, Leslie W Coe, William H Wyatt, Janan P Adams, Zoe M Gandhi, Mona Batchelor, Hannah M Castellanos, Stacy Joshi, Neena Satterwhite, Shannon Pérez-Rodríguez, Rafael Rodríguez-Guerra, Esther Albizu-Garcia, Carmen E Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Jordan, Ayana https://escholarship.org/uc/item/5pz847jr Abstract: Background: Amidst interrelated problems of increasing infections related to drug use and overdose deaths, contingency management (CM) is an underutilized substance use disorder treatment that leverages incentives for objective behavior change. CM implementation outside of drug treatment settings is limited, despite its regard as gold-standard treatment for stimulant use disorder and potential use to support infection treatment completion. Objective: to describe feasibility and preliminary effectiveness of a novel CM program incentivizing reduced drug use and antibiotic adherence in the acute care setting. Methods: We conducted a pilot of twice weekly CM in an urban public hospital and its attached skilled nursing facility with escalating opportunities to earn incentives from a fishbowl based on 1) antibiotic adherence and/or... https://escholarship.org/uc/item/5pz847jr Mon, 26 Feb 2024 00:00:00 +0000 Appa, Ayesha Ashley Stein, Brianna Baral, Stefan Knight, Kelly https://orcid.org/0000-0002-5838-8592 Gandhi, Monica Coffin, Phillip Martin, Marlene https://escholarship.org/uc/item/2xb1m25h The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID... https://escholarship.org/uc/item/2xb1m25h Mon, 26 Feb 2024 00:00:00 +0000 Aronowitz, Shoshana V Carroll, Jennifer J Hansen, Helena Jauffret-Roustide, Marie Parker, Caroline Mary Suhail-Sindhu, Selena Albizu-Garcia, Carmen Alegria, Margarita Arrendondo, Jaimie Baldacchino, Alexander Bluthenthal, Ricky https://orcid.org/0000-0003-3491-1702 Bourgois, Philippe Burraway, Joshua Chen, Jia-shin Ekhtiari, Hamed Elkholy, Hussien Farhoudian, Ali Friedman, Joseph Jordan, Ayana Kato, Lindsey Knight, Kelly https://orcid.org/0000-0002-5838-8592 Martinez, Carlos McNeil, Ryan Murray, Hayley Namirembe, Sarah Radfar, Ramin Roe, Laura Sarang, Anya Scherz, China Teck, Joe Tay Wee Textor, Lauren Oanh, Khuat Thi Hai https://escholarship.org/uc/item/1mm3q13s In an effort to deepen our understanding of how circumstances of forced separation and the interdiction of physical contact affect women's sexual behavior, we investigated the development and maintenance of heterosexual couples' intimacy when the male partner is incarcerated. As HIV-prevention scientists who work with women visiting men at a California state prison, we recognize that correctional control extends to these women's bodies, both when they are within the facility's walls visiting their mates and when they are at home striving to remain connected to absent men. This paper analyzes the impact of a peculiar public "place", a penitentiary, on couples' romantic and sexual interactions, drawing out the implications of imprisonment for relationship decision making, sexual health, and HIV risk. Using qualitative interviews with 20 women who visit their incarcerated partners and 13 correctional officers who interact with prison visitors, we examined how institutional constraints... https://escholarship.org/uc/item/1mm3q13s Mon, 26 Feb 2024 00:00:00 +0000 Comfort, Megan Grinstead, Olga McCartney, Kathleen Bourgois, Philippe Knight, Kelly https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/2699s6rt <i>Objectives.</i> To investigate the transfer of marketing knowledge and infrastructure for targeting racial/ethnic minorities from the tobacco to the food and beverage industry in the United States.<i>Methods.</i> We analyzed internal industry documents between April 2018 and April 2019 from the University of California San Francisco Truth Tobacco Industry Documents Library, triangulated with other sources.<i>Results.</i> In the 1980s, Philip Morris Companies purchased General Foods and Kraft Foods and created Kraft General Foods. Through centralized marketing initiatives, Philip Morris Companies directly transferred expertise, personnel, and resources from its tobacco to its food subsidiaries, creating a racial/ethnic minority-targeted food and beverage marketing program modeled on its successful cigarette program. When Philip Morris Companies sold Kraft General Foods in 2007, Kraft General Foods had a "fully integrated" minority marketing program that combined target marketing... https://escholarship.org/uc/item/2699s6rt Sun, 25 Feb 2024 00:00:00 +0000 Nguyen, Kim H Glantz, Stanton A Palmer, Casey N Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 https://escholarship.org/uc/item/77c9x5g2 In 2020, three crises coalesced to transform the clinical care landscape of addiction medicine in the United States (US). The opioid overdose crisis (crisis #1), which had been contributing to excess US mortality for over two decades, worsened during the COVID-19 pandemic (crisis #2). The racial reckoning (crisis #3) spurred by the murder of George Floyd at the hands of police impacted clinical care, especially in safety net clinical settings where the majority of people targeted by police violence, and other forms of structural violence, receive healthcare to mend both physical and psychological wounds. Collectively, the three crises changed how providers and patients viewed their experiences of clinical surveillance and altered their relationships to the violence of US healthcare. Drawing from two different research studies conducted during the years preceding and during the COVID-19 pandemic (2017–2022) with low income, safety net patients at risk for opioid overdose and their... https://escholarship.org/uc/item/77c9x5g2 Fri, 23 Feb 2024 00:00:00 +0000 Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/1xv738n7 BackgroundAgainst the backdrop of North America’s overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis.Harm reduction and overdose prevention in housingIn response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been... https://escholarship.org/uc/item/1xv738n7 Thu, 15 Feb 2024 00:00:00 +0000 Fleming, Taylor Boyd, Jade Chayama, Koharu Loulou Knight, Kelly R https://orcid.org/0000-0002-5838-8592 McNeil, Ryan https://escholarship.org/uc/item/5c439749 Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational aspects of the agricultural industry and broader socioeconomic and political conditions shaped farmworkers' COVID-19 workplace safety during the pandemic. Between July 2020 and April 2021, we conducted and analyzed fourteen in-depth, semi-structured phone interviews with Latinx farmworkers in California. Findings show that regulatory oversight reinforced COVID-19 workplace safety. In the absence of regulatory oversight, the organization of the agricultural industry produced COVID-19 workplace risks for farmworkers; it normalized unsafe working conditions and the worker-rather than employer-responsibility for workplace safety. Under these conditions, farmworkers enacted personal COVID-19 preventative... https://escholarship.org/uc/item/5c439749 Fri, 2 Feb 2024 00:00:00 +0000 Perez-Lua, Fabiola M Chan-Golston, Alec M Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Young, Maria-Elena De Trinidad https://escholarship.org/uc/item/33489809 With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how <i>promotoras</i> and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (<i>Am J Public Health</i>. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471). https://escholarship.org/uc/item/33489809 Thu, 1 Feb 2024 00:00:00 +0000 Rodriguez Espinosa, Patricia Vázquez, Evelyn AuYoung, Mona Zaldivar, Frank Cheney, Ann Marie Sorkin, Dara https://orcid.org/0000-0003-0742-9240 Zender, Robynn Corchado, Claudia G Burke, Nancy J https://orcid.org/0000-0002-2269-3341 https://escholarship.org/uc/item/24p0c0kj Large research teams and consortia present challenges for authorship. The number of disciplines involved in the research can further complicate approaches to manuscript development and leadership. The CHARM team, representing a multi-disciplinary, multi-institutional genomics implementation study, participated in facilitated discussions inspired by team science methodologies. The discussions were centered on team members' past experiences with authorship and perspectives on authorship in a large research team context. Team members identified challenges and opportunities that were used to create guidelines and administrative tools to support manuscript development. The guidelines were organized by the three values of equity, inclusion, and efficiency and included eight principles. A visual dashboard was created to allow all team members to see who was leading or involved in each paper. Additional tools to promote equity, inclusion, and efficiency included providing standardized... https://escholarship.org/uc/item/24p0c0kj Mon, 29 Jan 2024 00:00:00 +0000 Lewis, Hannah Biesecker, Barbara Lee, Sandra Soo-Jin Anderson, Katherine Joseph, Galen https://orcid.org/0000-0001-9179-7075 Jenkins, Charisma L Bulkley, Joanna E Leo, Michael C Goddard, Katrina AB Wilfond, Benjamin S https://escholarship.org/uc/item/8xs0b4j4 PURPOSE: California's failed attempts to enact a statewide sugary beverage tax presents an opportunity to advance understanding of advocacy coalition behavior. We investigate the participation of advocacy coalitions in California's statewide sugar-sweetened beverage (SSB) tax policy debate. DESIGN: Document analysis of legislative bills and newspaper articles collected in 2019. SETTING: California. METHOD: A total of 11 SSB tax-related bills were introduced in California's legislature between 2001-2018 according to the state's legislative website. Data sources include legislative bill documents (n = 94) and newspaper articles (n = 138). Guided by the Advocacy Coalition Framework (ACF), we identify advocacy coalitions involved in California's SSB tax debate and explore strategies and arguments used to advance each coalitions' position. RESULTS: Two coalitions (public health, food/beverage industry) were involved in California's statewide SSB tax policy debate. The public health... https://escholarship.org/uc/item/8xs0b4j4 Sat, 13 Jan 2024 00:00:00 +0000 Garibay, Kesia K Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Ramírez, A Susana Payán, Denise D https://escholarship.org/uc/item/4vz853t2 The purpose of this study was to provide formative data on the sexual behaviors of emerging adult Black men who attended a historically Black college/university. A convenience sample of 19 participants completed a demographic questionnaire and a semi-structured interview. This study utilized a phenomenological qualitative approach to explore the role of the developmental stage that emerging adulthood has on sexual health. Some of the major themes that emerged included maturation, sexual decision-making, respectability, a future orientation, and masculinity. Despite sexual initiation beginning prior to entering college, participants discussed how the college environment presented them with new information, experiences, and attitudes. This study provides useful information for the future investigation of emerging adult Black men who attend HBCUs. https://escholarship.org/uc/item/4vz853t2 Sun, 24 Dec 2023 00:00:00 +0000 Younge, Sinead N Boyer, Cherrie B Geter, Angelica Barker, Judith C https://orcid.org/0000-0002-7247-5844 Corneille, Maya https://escholarship.org/uc/item/9fh6d153 OBJECTIVE: To examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors. DESIGN: A controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban <i>n</i> 315; control <i>n</i> 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban. SETTING: Sutter Health, a large non-profit healthcare delivery system in Northern California. PARTICIPANTS: Full-time employees at Sutter Health screened for heavy SSB consumption. RESULTS: Participants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI -4·9, -0·5) fewer ounces... https://escholarship.org/uc/item/9fh6d153 Thu, 14 Dec 2023 00:00:00 +0000 Schmidt, Jamey M Epel, Elissa S Jacobs, Laurie M Mason, Ashley E Parrett, Bethany Pickett, Amanda M Mousli, Leyla M Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 https://escholarship.org/uc/item/8tz0v328 Relatively little is known about experiences of individuals with a pathogenic variant in a moderately penetrant breast cancer gene, particularly those without a personal history of cancer. The WISDOM trial is testing a model of risk-based breast cancer screening that integrates genomic (nine genes and polygenic risk) and other risk factors. In the context of an embedded Ethical, Legal, and Social Implications (ELSI) study of WISDOM, we conducted qualitative interviews at two timepoints post-result disclosure with 22 ATM and CHEK2 carriers. Results disclosure and interview recordings were transcribed and analyzed using a grounded theory analysis framework. We found that participants minimized the significance of their results in comparison to BRCA; were surprised but not alarmed by the results in the absence of family history; did not fundamentally change their perception of their breast cancer risk despite the new genomic information; exhibited variable responses to WISDOM's screening... https://escholarship.org/uc/item/8tz0v328 Thu, 14 Dec 2023 00:00:00 +0000 James, Jennifer Elyse Riddle, Leslie Caruncho, Mikaella Koenig, Barbara Ann Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/1130m6pn Polygenic risk scores (PRS) have the potential to improve the accuracy of clinical risk assessments, yet questions about their clinical validity and readiness for clinical implementation persist. Understanding how individuals integrate and act on the information provided by PRS is critical for their effective integration into routine clinical care, yet few studies have examined how individuals respond to the receipt of polygenic risk information. We conducted an embedded Ethical, Legal, and Social Implications (ELSI) study to examine if and how unaffected participants in a US population breast cancer screening trial understood and utilized PRS, as part of a multifactorial risk score combining traditional risk factors with a genetic risk assessment, to make screening and risk-reduction decisions. Semi-structured qualitative interviews were conducted with 24 trial participants who were designated at elevated risk for breast cancer due to their combined risk score. Interviews were... https://escholarship.org/uc/item/1130m6pn Fri, 27 Oct 2023 00:00:00 +0000 Riddle, Leslie Joseph, Galen https://orcid.org/0000-0001-9179-7075 Caruncho, Mikaella Koenig, Barbara Ann James, Jennifer Elyse https://escholarship.org/uc/item/44q242hw Adaptive pragmatic clinical trials offer an innovative approach that integrates clinical care and research. Yet, blurring the boundaries between research and clinical care raises questions about how clinicians and investigators balance their caregiving and research roles and what types of knowledge and risk assessment are most valued. This paper presents findings from an ethnographic ELSI (Ethical, Legal, Social Implications) study of an innovative clinical trial of risk-based breast cancer screening that utilizes genomics to stratify risk and recommend a breast cancer screening commensurate with the assessed risk. We argue that the trial demonstrates a fundamental tension between the promissory ideals of personalized medicine, and the reality of implementing risk stratified care on a population scale. We examine the development of a Screening Assignment Review Board in response to this tension which allows clinician-investigators to negotiate, but never fully resolve, the inherent... https://escholarship.org/uc/item/44q242hw Sat, 9 Sep 2023 00:00:00 +0000 James, Jennifer Elyse Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/3fd201rr Climate change is associated with adverse mental and emotional health outcomes. Social and economic factors are well-known drivers of mental health, yet comparatively few studies examine the social and economic pathways through which climate change affects mental health. There is additionally a lack of research on climate change and mental health in sub-Saharan Africa. This qualitative study aimed to identify potential social and economic pathways through which climate change impacts mental and emotional wellbeing, focusing on a vulnerable population of Kenyan smallholder farmers living with HIV. We conducted in-depth, semi-structured interviews with forty participants to explore their experience of climate change. We used a thematic analytical approach. We find that among our study population of Kenyan smallholder farmers living with HIV, climate change is significantly affecting mental and emotional wellbeing. Respondents universally report some level of climate impact on emotional... https://escholarship.org/uc/item/3fd201rr Sat, 9 Sep 2023 00:00:00 +0000 Beyeler, Naomi S Nicastro, Tammy M Jawuoro, Stanley Odhiambo, Gladys Whittle, Henry J Bukusi, Elizabeth A Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 Weiser, Sheri D https://escholarship.org/uc/item/8wn433df This commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID-19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID-19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID-19 alongside marginalized communities; support real-time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating... https://escholarship.org/uc/item/8wn433df Fri, 1 Sep 2023 00:00:00 +0000 Azevedo, Kathryn J Kalvesmaki, Andrea F Riendeau, Rachel P Sweet, Philip A Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/7663z768 The COVID-19 pandemic put clinical research in the media spotlight globally. This article proposes a first measure of familiarity with and attitude toward clinical research in France. Drawing from the "Health Literacy Survey 2019" (HLS19) conducted online between 27 May and 5 June 2020 on a sample of the French adult population (N = 1003), we show that a significant proportion of the French population claimed some familiarity with clinical trials (64.8%) and had positive attitudes (72%) toward them. One of the important findings of this study is that positive attitudes toward clinical research exist side by side with a strong distancing from the pharmaceutical industry. While respondents acknowledged that the pharmaceutical industry plays an important role in clinical research (68.3%), only one-quarter indicated that they trust the industry (25.7%). Positive attitudes toward clinical trials were associated with familiarity with clinical trials (Odds Ratio, OR 2.97 [1.90-4.63]),... https://escholarship.org/uc/item/7663z768 Fri, 1 Sep 2023 00:00:00 +0000 Schultz, Émilien Ward, Jeremy K Atlani-Duault, Laëtitia Holmes, Seth M https://orcid.org/0000-0002-2244-2868 Mancini, Julien https://escholarship.org/uc/item/6fc4g3j6 BackgroundPreventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality.MethodsWe explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and... https://escholarship.org/uc/item/6fc4g3j6 Fri, 1 Sep 2023 00:00:00 +0000 Gamlin, Jennie Holmes, Seth https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/5vh042x4 Ethnographic Research in Migration and Health https://escholarship.org/uc/item/5vh042x4 Thu, 31 Aug 2023 00:00:00 +0000 Holmes, Seth M https://orcid.org/0000-0002-2244-2868 Castaneda, Heide https://escholarship.org/uc/item/45p8d9ck Global Social Medicine for an Equitable and Just Future https://escholarship.org/uc/item/45p8d9ck Thu, 31 Aug 2023 00:00:00 +0000 Pinones-rivera, Carlos Martinez-hernaez, Angel Morse, Michelle E Nambiar, Kavya Ferrall, Joel Holmes, Seth M https://orcid.org/0000-0002-2244-2868 https://escholarship.org/uc/item/7m50q6rn BACKGROUND: Public health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches. METHODS: Using standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification... https://escholarship.org/uc/item/7m50q6rn Wed, 23 Aug 2023 00:00:00 +0000 Matthay, Ellicott C Mousli, Leyla Apollonio, Dorie E https://orcid.org/0000-0003-4694-0826 Schmidt, Laura A https://orcid.org/0000-0003-4346-7260 https://escholarship.org/uc/item/7z65202s BACKGROUND: Cambodian Americans have high rates of chronic hepatitis B virus (HBV) infection and liver cancer. There is very limited information about the utility of community health worker (CHW) approaches to cancer education for Asian American men. We have previously reported our positive findings from a trial of CHW education about HBV for Cambodian Americans who had never been tested for HBV. This report describes similarities and differences between the outcomes of our CHW HBV educational intervention among Cambodian American men and women. METHODS: The study group for this analysis included 87 individuals (39 men and 48 women) who were randomized to the experimental (HBV education) arm of our trial, participated in the CHW educational intervention, and provided follow-up data six months post-intervention. We examined HBV testing rates at follow-up, changes in HBV-related knowledge between baseline and follow-up, and barriers to HBV testing (that were reported to CHWs) by... https://escholarship.org/uc/item/7z65202s Fri, 18 Aug 2023 00:00:00 +0000 Taylor, Victoria Mary Burke, Nancy Jean https://orcid.org/0000-0002-2269-3341 Sos, Channdara Do, Huyen Hoai Liu, Qi Yasui, Yutaka https://escholarship.org/uc/item/30q168jh While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are underexamined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the likelihood of developing an OUD as an adult. However, the ACEs framework is criticized for failing to name the social and structural contexts that shape ACE vulnerabilities in families. Social scientific theory and ethnographic methods offer useful approaches to explore how interpersonally- and structurally-produced traumas inform the experiences of co-occurring CNCP, substance use, and mental health. We report findings from a qualitative and ethnographic longitudinal cohort study of patients with CNCP (n = 48) who received care in safety-net... https://escholarship.org/uc/item/30q168jh Wed, 16 Aug 2023 00:00:00 +0000 Castellanos, Stacy Cooke, Alexis Koenders, Sedona https://orcid.org/0000-0001-5150-1663 Joshi, Neena Miaskowski, Christine Kushel, Margot https://orcid.org/0000-0002-1361-6889 Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/0ck3h1s1 BACKGROUND: Clinicians' bias related to patients' race and substance use history play a role in pain management. However, patients' or clinicians' understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States. METHODS: We interviewed 46 clinicians and 94 patients, using semi-structured interview guides, from eight safety-net primary care clinics across the San Francisco Bay Area from 2013 to 2020. We used a modified grounded theory approach to code and analyze transcripts. RESULTS: Clinicians discussed using opioid prescribing guidelines with the goals of increased opioid safety and reduced bias in patient monitoring. While patients acknowledged the... https://escholarship.org/uc/item/0ck3h1s1 Wed, 16 Aug 2023 00:00:00 +0000 Cooke, Alexis Castellanos, Stacy Koenders, Sedona https://orcid.org/0000-0001-5150-1663 Joshi, Neena Enriquez, Celeste Olsen, Pamela Miaskowski, Christine Kushel, Margot https://orcid.org/0000-0002-1361-6889 Knight, Kelly R https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/5tw4k4xd <h4>Background</h4>Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.<h4>Methods</h4>Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.<h4>Results</h4>This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.<h4>Conclusion</h4>Increasing... https://escholarship.org/uc/item/5tw4k4xd Tue, 18 Jul 2023 00:00:00 +0000 Goliaei, Zahra https://orcid.org/0000-0001-7358-8448 Gonzalez, Mariaelena Diaz Rios, Karina https://orcid.org/0000-0003-3744-0264 Pokhrel, Mamata https://orcid.org/0009-0009-7250-2687 Burke, Nancy J https://escholarship.org/uc/item/2bm149pd BackgroundThe SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems.MethodsWe interviewed patients with chronic non-cancer pain and history of substance use (n = 22) and their primary care clinicians (n = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews.ResultsCOVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through... https://escholarship.org/uc/item/2bm149pd Fri, 14 Jul 2023 00:00:00 +0000 Cooke, Alexis Castellanos, Stacy Enriquez, Celeste Olsen, Pamela Miaskowski, Christine Kushel, Margot https://orcid.org/0000-0002-1361-6889 Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/41j3k36r Objective: To describe the early activities and lessons of the Share, Trust, Organize, Partner <i>COVID</i>-19 California Alliance (STOP COVID-19 CA), the California awardee of the NIH-funded multi-state Community Engagement Alliance (CEAL) against COVID-19. The Alliance was established to ensure equity in Coronavirus-19 disease (COVID-19) research, clinical practice, and public health for communities most impacted by the COVID-19 pandemic. Study setting: The STOP COVID-19 CA Alliance network of 11 universities and affiliated partner community-based organizations (CBOs) across California. Study design: Mixed methods evaluation consisting of an analysis of activity (August 2020 to December 2021) detailed in reports submitted by community-academic teams and a survey (August 2021) of academic investigators and affiliated community-based organization (CBO) partners. Data collection: We summarized activities from the 11 community-academic teams' progress reports and described results... https://escholarship.org/uc/item/41j3k36r Sat, 8 Jul 2023 00:00:00 +0000 Casillas, Alejandra Rosas, Lisa G Carson, Savanna L Orechwa, Allison North, Gemma AuYoung, Mona Kim, Gloria Guereca, Jesus A Ramers, Christian B Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Corchado, Claudia G Aguilar-Gaxiola, Sergio Cheney, Ann https://orcid.org/0000-0002-4032-6692 Rabin, Borsika A Stadnick, Nicole A https://orcid.org/0000-0001-6520-2920 Oswald, William Cabrera, Abby Sorkin, Dara H https://orcid.org/0000-0003-0742-9240 Zaldivar, Frank Wong, Wennie Yerraguntala, Anusha S Vassar, Stefanie D Wright, Aziza Lucas Washington, Donna L Norris, Keith C https://orcid.org/0000-0003-3071-0700 Brown, Arleen F https://orcid.org/0000-0001-9948-8955 https://escholarship.org/uc/item/73b3026c Amidst ongoing efforts to address racial injustice, U.S. medical institutions are grappling with the structural roots of anti-Black racism. The REPAIR (REParations and Anti-Institutional Racism) Project is a 3-year strategic initiative at the University of California, San Francisco aiming to address anti-Black racism and augment the presence and voices of people of color in science, medicine, and health care. The REPAIR Project was designed in response to an unmet need for critical dialogue, cross-disciplinary research, and curriculum development addressing structural racism. It offers a framework for thinking and acting to achieve repair in relation to racial injustice and is anchored by 3 concepts-reparations, abolition, and decolonization-which have been deployed as annual themes in academic years 2020-2021, 2021-2022, and 2022-2023, respectively. The theme of medical reparations builds on the longstanding call for slavery reparations and the paying of debts owed to Black Americans... https://escholarship.org/uc/item/73b3026c Fri, 7 Jul 2023 00:00:00 +0000 Committee, REPAIR Project Steering Medeiros, Aimee Johnson, Antoine Bouagnon, Aude Wong, Bonnie Martinez, Carlos Dzeng, Elizabeth https://orcid.org/0000-0001-5235-8053 Whitmarsh, Ian Plummer, Jaleel Zussman, Jay Lew, Joey Zamora, Kara Knight, Kelly https://orcid.org/0000-0002-5838-8592 Gaber, Nadia Adams, Vincanne https://escholarship.org/uc/item/3tq3c8f5 Genetic variants in <i>SLC22A5</i>, encoding the membrane carnitine transporter OCTN2, cause the rare metabolic disorder Carnitine Transporter Deficiency (CTD). CTD is potentially lethal but actionable if detected early, with confirmatory diagnosis involving sequencing of <i>SLC22A5</i>. Interpretation of missense variants of uncertain significance (VUSs) is a major challenge. In this study, we sought to characterize the largest set to date (<i>n</i> = 150) of OCTN2 variants identified in diverse ancestral populations, with the goals of furthering our understanding of the mechanisms leading to OCTN2 loss-of-function (LOF) and creating a protein-specific variant effect prediction model for OCTN2 function. Uptake assays with ¹⁴C-carnitine revealed that 105 variants (70%) significantly reduced transport of carnitine compared to wild-type OCTN2, and 37 variants (25%) severely reduced function to less than 20%. All ancestral populations harbored LOF variants; 62% of green... https://escholarship.org/uc/item/3tq3c8f5 Fri, 7 Jul 2023 00:00:00 +0000 Koleske, Megan L McInnes, Gregory Brown, Julia EH Thomas, Neil Hutchinson, Keino Chin, Marcus Y Koehl, Antoine Arkin, Michelle R Schlessinger, Avner Gallagher, Renata C Song, Yun S Altman, Russ B Giacomini, Kathleen M https://orcid.org/0000-0001-8041-5430 https://escholarship.org/uc/item/6td2q3n0 The COVID-19 pandemic revealed weaknesses in the public health infrastructure of the United States, including persistent barriers to engaging marginalized communities toward inclusion in clinical research, including trials. Inclusive participation in clinical trials is crucial for promoting vaccine confidence, public trust, and addressing disparate health outcomes. A long-standing body of literature describes the value of community-based participatory research in increasing marginalized community participation in research. Community-based participatory research emphasizes shared leadership with community members in all phases of the research process, including in the planning and implementation, interpretation, and dissemination. Shared leadership between academic and industry with marginalized communities can assist with inclusive participation in vaccine trials and increase public trust in the development of the vaccines and other therapies used during public emergencies. Nevertheless,... https://escholarship.org/uc/item/6td2q3n0 Wed, 5 Jul 2023 00:00:00 +0000 Adkins-Jackson, Paris B Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Espinosa, Patricia Rodriguez Ison, Juliana M Goold, Susan D Rosas, Lisa G Doubeni, Chyke A Brown, Arleen F https://orcid.org/0000-0001-9948-8955 Groups, The STOP COVID-19 California Alliance Trial Participation and Vaccine Hesitancy Working https://escholarship.org/uc/item/4x11d197 <h4>Background</h4>Homeless street sweeps are frequent operations in many cities in the USA in which government agencies move unhoused people living in public outdoor areas. Little research exists on the health impact of street sweeps operations.<h4>Objective</h4>This study was created at the request of community advocacy groups to investigate and document the health impacts of street sweeps from the perspective of healthcare providers.<h4>Design</h4>This is a qualitative study using data gathered from open-ended questions.<h4>Participants</h4>We recruited 39 healthcare providers who provided health and wellness services in San Francisco for people experiencing homelessness (PEH) between January 2018 and January 2020.<h4>Interventions</h4>We administered a qualitative, open-ended questionnaire to healthcare providers using Qualtrics surveying their perspectives on the health impact of street sweeps.<h4>Approach</h4>We conducted qualitative thematic analysis on questionnaire results.<h4>Key... https://escholarship.org/uc/item/4x11d197 Wed, 5 Jul 2023 00:00:00 +0000 Qi, Diane Abri, Kamran Mukherjee, M Rani Rosenwohl-Mack, Amy Khoeur, Lina Barnard, Lily Knight, Kelly Ray https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/56q3v0qv BACKGROUND: Opioid overdose mortality continues to increase in the United States despite significant investments to reverse the epidemic. The national response to-date has focused primarily on reducing opioid prescribing, yet reductions in prescribing have been associated with patients reporting uncontrolled pain, psychological distress, and transition to illicit substances. The aim of this study is to qualitatively explore chronic pain management experiences among PLWH with a history of illicit substance use after long-term opioid therapy reductions or discontinuations. METHODS: We analyzed 18 interviews, stopping upon reaching thematic saturation, with HIV-positive participants with a history of substance use who were enrolled in a longitudinal cohort study to assess the impact of prescribing changes among patients with chronic pain. Participants in this nested qualitative study had been reduced/discontinued from opioid pain relievers (OPRs) within the 12 months prior to interview.... https://escholarship.org/uc/item/56q3v0qv Tue, 4 Jul 2023 00:00:00 +0000 Behar, Emily Bagnulo, Rita Knight, Kelly https://orcid.org/0000-0002-5838-8592 Santos, Glenn-Milo Coffin, Phillip O https://escholarship.org/uc/item/92b924hd Abstract As the number of cancer survivors continues to increase and given the shortage of oncology clinicians in safety net health care settings, primary care providers (PCPs) in these settings will increasingly provide cancer survivorship care. In order to ensure equitable care for low-income and underserved breast and colon cancer survivors, it is essential to understand the safety-net PCPs’ perspective. We conducted semi-structured, in-depth qualitative interviews with 11 PCPs working in a safety-net health care system to identify their needs in caring for cancer survivors. Interviews were audio-recorded and professionally transcribed. Two coders independently coded the interviews and conducted regular meetings until we reached consensus on the results. Analysis was based in grounded theory and performed using the constant comparative method. Thematic analysis identified six themes as follows: (1) Cancer survivorship care can be integrated with the whole person and chronic... https://escholarship.org/uc/item/92b924hd Mon, 3 Jul 2023 00:00:00 +0000 Dixit, Niharika https://orcid.org/0000-0001-8677-8216 Rodriguez, Gladys Sarkar, Urmimala https://orcid.org/0000-0003-4213-4405 Burke, Nancy https://orcid.org/0000-0002-2269-3341 Trejo, Evelin Devore, Denise Joanna Couey, Paul Nápoles, Anna María https://escholarship.org/uc/item/1d10p600 BackgroundRisk assessment for hereditary cancer syndromes is recommended in primary care, but family history is rarely collected in enough detail to facilitate risk assessment and referral – a roadblock that disproportionately impacts individuals with healthcare access barriers. We sought to qualitatively assess a literacy-adapted, electronic patient-facing family history tool developed for use in diverse, underserved patient populations recruited in the Cancer Health Assessments Reaching Many (CHARM) Study.MethodsInterview participants were recruited from a subpopulation of CHARM participants who experienced barriers to tool use in terms of spending a longer time to complete the tool, having incomplete attempts, and/or providing inaccurate family history in comparison to a genetic counselor-collected standard. We conducted semi-structured interviews with participants about barriers and facilitators to tool use and overall tool acceptability; interviews were recorded and professionally... https://escholarship.org/uc/item/1d10p600 Sat, 1 Jul 2023 00:00:00 +0000 Mittendorf, Kathleen F Lewis, Hannah S Duenas, Devan M Eubanks, Donna J Gilmore, Marian J Goddard, Katrina AB Joseph, Galen https://orcid.org/0000-0001-9179-7075 Kauffman, Tia L Kraft, Stephanie A Lindberg, Nangel M Reyes, Ana A Shuster, Elizabeth Syngal, Sapna Ukaegbu, Chinedu Zepp, Jamilyn M Wilfond, Benjamin S Porter, Kathryn M https://escholarship.org/uc/item/4kk4r98h BackgroundRacial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis.MethodsThis qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family’s experiences preceding the patient’s diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data.ResultsThirty-two interviews were conducted with a diverse population of English and Spanish... https://escholarship.org/uc/item/4kk4r98h Fri, 30 Jun 2023 00:00:00 +0000 Ding, Lucky Szymczak, Julia E Evans, Erica Canepa, Emma Martin, Ashley E Contractor, Farah Aplenc, Richard Joseph, Galen https://orcid.org/0000-0001-9179-7075 Winestone, Lena E https://escholarship.org/uc/item/6pj7w08r INTRODUCTION: Flavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities. METHODS: We assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates. RESULTS: The weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income https://escholarship.org/uc/item/6pj7w08r Wed, 28 Jun 2023 00:00:00 +0000 Payán, Denise Diaz Burke, Nancy J https://orcid.org/0000-0002-2269-3341 Persinger, Jamie Martinez, Juliette Barker, Lisa Jones Song, Anna V https://orcid.org/0000-0002-1874-3326 https://escholarship.org/uc/item/5z06b91z PURPOSE: There is a critical need for genomic medicine research that reflects and benefits socioeconomically and ancestrally diverse populations. However, disparities in research populations persist, highlighting that traditional study designs and materials may be insufficient or inaccessible to all groups. New approaches can be gained through collaborations with patient/community stakeholders. Although some benefits of stakeholder engagement are recognized, routine incorporation into the design and implementation of genomics research has yet to be realized. METHODS: The National Institutes of Health-funded Clinical Sequencing Evidence-Generating Research (CSER) consortium required stakeholder engagement as a dedicated project component. Each CSER project planned and carried out stakeholder engagement activities with differing goals and expected outcomes. Examples were curated from each project to highlight engagement strategies and outcomes throughout the research lifecycle from... https://escholarship.org/uc/item/5z06b91z Wed, 28 Jun 2023 00:00:00 +0000 O’Daniel, Julianne M Ackerman, Sara https://orcid.org/0000-0003-3567-7698 Desrosiers, Lauren R Rego, Shannon Knight, Sara J Mollison, Lonna Byfield, Grace Anderson, Katherine P Danila, Maria I Horowitz, Carol R Joseph, Galen https://orcid.org/0000-0001-9179-7075 Lamoure, Grace Lindberg, Nangel M McMullen, Carmit K Mittendorf, Kathleen F Ramos, Michelle A Robinson, Mimsie Sillari, Catherine Madden, Ebony B Group, CSER Stakeholder and Engagement Work https://escholarship.org/uc/item/8qt1h9z6 Health care systems in the United States are experimenting with a form of surveillance and intervention known as "hot spotting," which targets high-cost patients-the so-called "super-utilizers" of emergency departments-with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures on health care for impoverished people. Through an ethnographic investigation of hot spotting's modes of distribution and its workings in the lives of patients and providers, we find that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. This has led to a convergence of caring and punitive strategies of governance. The boundaries between them are shifting as a financialized logic of governance has come to dominate both health and... https://escholarship.org/uc/item/8qt1h9z6 Mon, 26 Jun 2023 00:00:00 +0000 FLEMING, MARK D SHIM, JANET K YEN, IRENE DUBBIN, LESLIE THOMPSON‐LASTAD, ARIANA HANSSMANN, CHRISTOPH BURKE, NANCY J https://orcid.org/0000-0002-2269-3341 https://escholarship.org/uc/item/5359d1ps Population-based genomic screening is at the forefront of a new approach to disease prevention. Yet the lack of diversity in genome wide association studies and ongoing debates about the appropriate use of racial and ethnic categories in genomics raise key questions about the translation of genomic knowledge into clinical practice. This article reports on an ethnographic study of a large pragmatic clinical trial of breast cancer screening called WISDOM (Women Informed to Screen Depending On Measures of Risk). Our ethnography illuminates the challenges of using race or ethnicity as a risk factor in the implementation of precision breast cancer risk assessment. Our analysis provides critical insights into how categories of race, ethnicity and ancestry are being deployed in the production of genomic knowledge and medical practice, and key challenges in the development and implementation of novel Polygenic Risk Scores in the research and clinical applications of this emerging science.... https://escholarship.org/uc/item/5359d1ps Mon, 26 Jun 2023 00:00:00 +0000 James, Jennifer Elyse Riddle, Leslie Koenig, Barbara Ann Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/32t6k24n As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers' extension of medical stabilization into social,... https://escholarship.org/uc/item/32t6k24n Mon, 26 Jun 2023 00:00:00 +0000 Hanssmann, Christoph Shim, Janet K Yen, Irene H Fleming, Mark D Van Natta, Meredith Thompson‐Lastad, Ariana Rasidjan, Maryani Palupy Burke, Nancy J https://orcid.org/0000-0002-2269-3341 https://escholarship.org/uc/item/1cg2v7bf BACKGROUND: Social support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant. METHODS: Mothers of infants less than 33&nbsp;weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant's discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures. RESULTS: Of 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated... https://escholarship.org/uc/item/1cg2v7bf Sat, 24 Jun 2023 00:00:00 +0000 Haeusslein, Laurel Gano, Dawn https://orcid.org/0000-0003-4192-2362 Gay, Caryl L https://orcid.org/0000-0002-6865-6335 Kriz, Rebecca M Bisgaard, Robin Vega, Myrna Cormier, Diana M Joe, Priscilla Walker, Valencia Kim, Jae H Lin, Carol Sun, Yao Franck, Linda S https://orcid.org/0000-0003-4291-9181 https://escholarship.org/uc/item/0202x2p1 <b>Aim:</b> To increase Spanish speakers' representation in genomics research, accessible study materials on genetic topics must be made available in Spanish. <b>Materials &amp; methods:</b> The Clinical Sequencing Evidence-Generating Research&nbsp;consortium is evaluating genome sequencing for underserved populations. All sites needed Spanish translation of recruitment materials, surveys and return of results. <b>Results:</b> We describe our process for translating site-specific materials, as well as shared measures across sites, to inform future efforts to engage Spanish speakers in research. <b>Conclusion:</b> In translating and adapting study materials for roughly 1000 Spanish speakers across the USA, and harmonizing translated measures across diverse sites, we overcame numerous challenges. Translation should be performed by professionals. Studies must allocate sufficient time, effort and budget to translate and adapt participant materials. https://escholarship.org/uc/item/0202x2p1 Sat, 24 Jun 2023 00:00:00 +0000 Lindberg, Nangel M Gutierrez, Amanda M Mittendorf, Kathleen F Ramos, Michelle A Anguiano, Beatriz Angelo, Frank Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/60z2n952 Breast cancer (BC) is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed at later stages, receive poorer quality care and have a higher risk of mortality than non-Latina White (NLW) women. Among women with a genetic predisposition to hereditary BC, genetic counseling can be beneficial. Latinas participate in genetic counseling at lower rates than NLW women. The goal of this study was to develop comprehensive, culturally appropriate materials for community health educators (promotores)-led hereditary BC education program for Spanish-speaking Latinas. We developed the curriculum through feedback from 7 focus groups, with a total of 68 participants (35 promotores and 33 community members). We used a mixed-methods approach that relied on quantitative analysis of survey questions and qualitative content analysis of the focus groups transcripts. Pre and post promotores' training survey responses suggested improvement in the promotores'... https://escholarship.org/uc/item/60z2n952 Thu, 22 Jun 2023 00:00:00 +0000 Almeida, Rebeca Lopez-Macha, Alejandra Dugatkin, Tania Joseph, Galen https://orcid.org/0000-0001-9179-7075 Duron, Ysabel de Mendoza, Alejandra Hurtado Graves, Kristi D Fejerman, Laura https://orcid.org/0000-0003-3179-1151 https://escholarship.org/uc/item/3mv452fn Advances in the application of genomic technologies in clinical care have the potential to increase existing healthcare disparities. Studies have consistently shown that only a fraction of eligible patients with a family history of cancer receive recommended cancer genetic counseling and subsequent genetic testing. Care delivery models using pre-test and post-test counseling are not scalable, which contributes to barriers in accessing genetics services. These barriers are even more pronounced for patients in historically underserved populations. We have designed a multimodal intervention to improve subsequent cancer surveillance, by improving the identification of patients at risk for familial cancer syndromes, reducing barriers to genetic counseling/testing, and increasing patient understanding of complex genetic results. We are evaluating this intervention in two large, integrated healthcare systems that serve diverse patient populations (NCT03426878). The primary outcome is... https://escholarship.org/uc/item/3mv452fn Wed, 21 Jun 2023 00:00:00 +0000 Mittendorf, Kathleen F Kauffman, Tia L Amendola, Laura M Anderson, Katherine P Biesecker, Barbara B Dorschner, Michael O Duenas, Devan M Eubanks, Donna J Feigelson, Heather Spencer Gilmore, Marian J Hunter, Jessica Ezzell Joseph, Galen https://orcid.org/0000-0001-9179-7075 Kraft, Stephanie A Lee, Sandra Soo Jin Leo, Michael C Liles, Elizabeth G Lindberg, Nangel M Muessig, Kristin R Okuyama, Sonia Porter, Kathryn M Riddle, Leslie S Rolf, Bradley A Rope, Alan F Zepp, Jamilyn M Jarvik, Gail P Wilfond, Benjamin S Goddard, Katrina AB team, on behalf of the CHARM study https://escholarship.org/uc/item/1n25p92t BACKGROUND: The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. METHODS: We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. RESULTS: CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis... https://escholarship.org/uc/item/1n25p92t Wed, 21 Jun 2023 00:00:00 +0000 Cooke, Alexis C Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Miaskowski, Christine https://escholarship.org/uc/item/2840j69m Genomic sequencing results need to be effectively communicated across all populations and practice settings. Projects in the Clinical Sequencing Evidence-Generating Research (CSER) consortium enroll diverse racial/ethnic and medically underserved participants across various clinical contexts. This article explores a set of CSER results disclosure cases to expand the evidence base on experiences returning genomic results. Case details were collected using a structured set of questions. We identified common themes in the case set, and assessed challenges and strategies in achieving six relevant results disclosure objectives. CSER-affiliated patient/community stakeholder impressions of the findings were solicited via video conference calls. Seventeen cases across six CSER projects were included. Case themes sorted into four categories: (1) factors influencing participant understanding, (2) participant emotional response, (3) disease burden, and (4) logistical challenges. Challenges... https://escholarship.org/uc/item/2840j69m Tue, 20 Jun 2023 00:00:00 +0000 Suckiel, Sabrina A O’Daniel, Julianne M Donohue, Katherine E Gallagher, Katie M Gilmore, Marian J Hendon, Laura G Joseph, Galen https://orcid.org/0000-0001-9179-7075 Lianoglou, Billie R Mathews, Jennifer M Norton, Mary E https://orcid.org/0000-0002-5967-1701 Odgis, Jacqueline A Poss, Alexis F Rego, Shannon Scollon, Sarah Yip, Tiffany Amendola, Laura M https://escholarship.org/uc/item/5rn3t420 <i>Background:</i> Prior to the COVID-19 pandemic, the United States (US) was already facing an epidemic of opioid overdose deaths. Overdose deaths continued to surge during the pandemic. To limit COVID-19 spread and to avoid disruptions in access to medications for opioid use disorder (MOUD), including buprenorphine and methadone, US federal and state agencies granted unprecedented exemptions to existing MOUD guidelines for Opioid Treatment Programs (OTPs), including loosening criteria for unsupervised take-home doses. We conducted a qualitative study to evaluate the impact of these policy changes on MOUD treatment experiences for providers and patients at an OTP in California. <i>Methods:</i> We interviewed 10 providers (including two physicians, five social worker associates, and three nurse practitioners) and 20 patients receiving MOUD. We transcribed, coded, and analyzed all interviews to identify emergent themes. <i>Results:</i> Patient participants were middle-aged (median... https://escholarship.org/uc/item/5rn3t420 Mon, 19 Jun 2023 00:00:00 +0000 Suen, Leslie W Castellanos, Stacy Joshi, Neena Satterwhite, Shannon Knight, Kelly R https://orcid.org/0000-0002-5838-8592 https://escholarship.org/uc/item/5t71s81w OBJECTIVE: To describe the training and early implementation of the ARIA model of genetic counseling (Accessible, Relational, Inclusive, Actionable). METHODS: As part of the Cancer Health Assessments Reaching Many (CHARM) study, an interdisciplinary workgroup developed the ARIA curriculum and trained genetic counselors to return exome sequencing results using the ARIA model. CURRICULUM: The ARIA curriculum includes didactic elements, discussion, readings, role plays, and observations of usual care genetic counseling sessions. The ARIA model provides the skills and strategies needed for genetic counseling to be accessible to all patients, regardless of prior knowledge or literacy level; involves appropriate psychological and social counseling without overwhelming the patient with information; and leaves the patient with clear and actionable next steps. CONCLUSION: With sufficient training and practice, the ARIA model appears to be feasible, with promise for ensuring that genetic... https://escholarship.org/uc/item/5t71s81w Thu, 15 Jun 2023 00:00:00 +0000 Riddle, Leslie Amendola, Laura M Gilmore, Marian J Guerra, Claudia Biesecker, Barbara Kauffman, Tia L Anderson, Katherine Rope, Alan F Leo, Michael C Caruncho, Mikaella Jarvik, Gail P Wilfond, Benjamin Goddard, Katrina AB Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/3hf1f4st The descriptor 'usual care' refers to standard or routine care. Yet, no formal definition exists. The need to define what constitutes usual care arises in clinical research. Often one arm in a trial represents usual care in comparison with a novel intervention. Accordingly, usual care in genetic counseling research appears predominantly in randomized controlled trials. Recent standards for reporting genetic counseling research call for standardization, but do not address usual care. We (1) inventoried all seven studies in the Clinical Sequencing Evidence-Generating Consortium (CSER) about how genetic counseling was conceptualized, conducted, and whether a usual care arm was involved; (2) conducted a review of published randomized control trials in genetic counseling, comparing how researchers describe usual care groups; and (3) reviewed existing professionally endorsed definitions and practice descriptions of genetic counseling. We found wide variation in the content and delivery... https://escholarship.org/uc/item/3hf1f4st Thu, 15 Jun 2023 00:00:00 +0000 Biesecker, Barbara B Lillie, Sarah E Amendola, Laura M Donohue, Katherine E East, Kelly M Foreman, Ann Katherine M Gilmore, Marian J Greve, Veronica Liangolou, Billie O'Daniel, Julianne M Odgis, Jacqueline A Rego, Shannon Rolf, Bradley Scollon, Sarah Suckiel, Sabrina A Zepp, Jamilyn Joseph, Galen https://orcid.org/0000-0001-9179-7075 https://escholarship.org/uc/item/30k9j4v4 OBJECTIVE: The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). METHODS: The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. RESULTS: The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid... https://escholarship.org/uc/item/30k9j4v4 Thu, 15 Jun 2023 00:00:00 +0000 Servis, Mark https://orcid.org/0000-0003-1704-3229 Fishman, Scott M Wallace, Mark S Henry, Stephen G https://orcid.org/0000-0002-5643-0881 Ziedonis, Doug Ciccarone, Daniel https://orcid.org/0000-0002-2355-5477 Knight, Kelly R https://orcid.org/0000-0002-5838-8592 Shoptaw, Steven https://orcid.org/0000-0002-3583-0026 Dowling, Patrick Suchard, Jeffrey R Shah, Shalini Singh, Naileshni https://orcid.org/0000-0002-8838-5325 Cedarquist, Lynette C Alem, Navid Copenhaver, David J Westervelt, Marjorie Willis, Brigham C