Rickie Brawer

Obesity and Cancer

Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. Physicians have a key role in integrating multifactorial approaches to prevention and management into clinical care and advocating for systemic prevention efforts. This article provides an introduction to the epidemiology and magnitude of childhood and adult obesity; the relationship between obesity and cancer and other chronic diseases; potential mechanisms postulated to explain these relationships; a review of recommended obesity treatment and assessment guidelines for adults, adolescents, and children; multilevel prevention strategies; and an approach to obesity management in adults using the Chronic Care Model.

Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters.

To understand cardiovascular health in low socioeconomic populations, we analyzed the data from 426 low socioeconomic community-dwelling males and females and 287 homeless males in Philadelphia. Despite higher prevalence of smoking and hypertension, the proportion of homeless participants at increased risk for coronary heart disease was comparable with that of low socioeconomic community-dwelling participants. Among various characteristics, emotional stress was significantly associated with coronary heart disease risk in low socioeconomic community-dwelling participants only, suggestive of a differential psychosocial effect of stress. Our findings suggest that low socioeconomic populations are heterogeneous with respect to their risk factors and needs for interventions.

Cultural factors in preventive care: African-Americans.

In summary, the implications for healthcare practitioners in caring for African American patients in a culturally sensitive manner include: Gaining trust, and understanding the historical distrust of the health care system Understanding and employing the kinship web in decisions regarding screening and treatment Involving the church in developing and delivering prevention and care messages Asking patients about the meaning of words or phrases Asking patients about the use of alternative medicines and herbs Tailoring messages about prevention to depictions of real life situations Paying attention to body language and other nonverbal communication.

Stage of change and other predictors of participant retention in a behavioral weight management program in primary care.

High attrition often limits the efficacy of weight management programs, particularly those that serve primary care patients. We investigated stage of change and other predictors of retention in a behavioral intervention program that enrolled adult obese patients at three primary care sites. The program included practice improvements and provider training, as well as individual lifestyle counseling and educational group classes for participants. We analyzed predictors of whether participants returned for counseling visits and whether they attended group classes. The 461 participants were mainly women (84%) and minorities (87%), and most of them were in the preparation stage for dietary and physical activity changes. A total of 134 (29%) participants returned for at least one follow-up visit with their counselor and 85 (18%) attended at least one class. Baseline stage of change was not significantly associated with either return visits or class attendance (p = .875 and .182, respectively). Men and participants with children in the household were less likely to return for subsequent counseling sessions (p = .012 and .027, respectively). Age and employment were associated with class attendance (p = .099 and .034, respectively). Focus groups with participants confirmed that reasons for dropout included physical limitations or health issues, family issues, stress, and lack of social support. We conclude that prescreening of patients for readiness to participate and attention to personal barriers related to family and work might improve program retention. More frequent contacts between visits and stronger provider engagement might also strengthen the intervention.

Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: a qualitative study of dietary preferences, knowledge and practices

BackgroundUrban centers in Sub-Saharan Africa, such as Kumasi, Ghana, are especially impacted by the dual burden of infectious and non-communicable disease (NCD), including a rise in type 2 diabetes mellitus (T2DM) prevalence. To develop effective intervention programs, the World Health Organization recommends more research to better understand the relationship between food consumption and the escalation of non-communicable disease such as T2DM. This study provides qualitative information about current food knowledge, attitudes and practices among T2DM patients and their caregivers in the region of Kumasi, Ghana.MethodsIn this qualitative study, three focus groups discussions of 30 persons total and 10 individual interviews were used to assess food preferences, knowledge, attitudes and practices of patients with T2DM as well as caregivers responsible for food preparation. Participants included both urban and rural dwellers. Hospital-based health talks were observed, a dietician was interviewed, and educational documents were collected. Themes were identified and coded using Nvivo10 software.ResultsFindings suggest that messages regarding sweetened foods, fats, use of seasonings and meal timing are followed. However, confusion exists regarding the impact of fruits, food portioning, plantains and processed foods on health outcomes for diabetic patients. Results also revealed a problem-solving approach to increasing vegetable consumption, and a concern about unhealthy food preferences among younger generations.ConclusionsEducation about the impact of commonly available carbohydrates on blood sugar should be emphasized; messaging on portion sizes and certain foods should be more consistent; the economic benefits of local vegetable consumption should be promoted; and a research-informed, T2DM prevention campaign should be developed specifically for younger generations.

Community-Based Partnerships for Improving Chronic Disease Management

With the growing burden of chronic disease, the medical and public health communities are re-examining their roles and opportunities for more effective prevention and clinical interventions. The potential to significantly improve chronic disease prevention and have an impact on morbidity and mortality from chronic conditions is enhanced by adopting strategies that incorporate a social ecology perspective, realigning the patient-physician relationship, integrating population health perspectives into the Chronic Care Model, and effectively engaging communities using established principles of community engagement.

The value template process: a participatory evaluation method for community health partnerships.

This article presents the results of a pilot implementation of an evaluation process designed to help community health collaboratives obtain relevant information for planning and evaluation. The Value Template Process assists collaboratives to identify performance and impact indicators that are meaningful and measurable with accessible data. The process also encourages communication and engagement in assessment among collaborative members. The pilot study demonstrated that the processs underlying assumptions of social capital were valid and that the process was feasible and useful to the community health collaborative.

Addressing Chronic Disease Within Supportive Housing Programs

Background: Tenants of supportive housing have a high burden of chronic health conditions. Objectives: To examine the feasibility of developing a tenant-involved health promotion initiative within a “housing first” agency using a community-based participatory research (CBPR) framework. Methods: Qualitative analyses of nine research capacity-building group meetings and fifteen individual pre- and post-interviews with those who completed a chronic disease self-management program, resulting in the development of several themes. Results: Tenants of supportive housing successfully partnered with health care providers to implement a chronic disease self-management program, noting that “health care becomes ‘relevant’ with housing.” Conclusions: Supportive housing organizations are well-situated to implement health promotion initiatives. Such publicly subsidized housing that is accompanied by comprehensive supports must also include self-management training to help people overcome both internal and external barriers to addressing chronic health needs.

Trial of a behavioral intervention to increase dilated fundus examinations in African–Americans aged over 65 years with diabetes

This article describes a randomized clinical trial to test the impact of a home-based behavioral activation program to improve rates of dilated fundus examinations in older African–Americans with diabetes. This trial is enrolling subjects who have not met the recommendations for annual eye examinations. The intervention being testing is novel, culturally relevant and has the potential to reduce a significant health disparity regarding vision impairment. Subjects are randomized to behavioral activation or a placebo condition to control for the effects of attention. Both the active and control interventions are delivered in subjects’ homes by a community healthcare worker. The primary outcome is whether a subject had a dilated fundus examination by an ophthalmologist by 6 months.

Envisioning Home: The Philadelphia Refugee Mental Health Photovoice Project as a Story of Effective Relationship Building

As refugee populations are displaced from their countries of origin, they experience population-specific physical, psychological, and social challenges that have a profound impact on mental health. This chapter describes a community engagement program that used photovoice methodology to engage and empower refugee families around the issue of mental health during resettlement. Through the eyes of the program’s key collaborators, you will learn how photographs and accompanying narratives were used to develop thriving partnerships and arts-based mental health programming focused on themes of resilience, cultural inheritance, community-building, and environmental transformation. The research was conducted by members of the Philadelphia Refugee Mental Health Collaborative, a group of organizations working to promote refugee community engagement and build an effective, wellness-based model for refugee mental health in the city of Philadelphia.