Communities In Minnesota Research Articles

The impact of trait number and correlation on functional diversity metrics in real-world ecosystems.

The use of trait-based approaches to understand ecological communities has increased in the past two decades because of their promise to preserve more information about community structure than taxonomic methods and their potential to connect community responses to subsequent effects of ecosystem functioning. Though trait-based approaches are a powerful tool for describing ecological communities, many important properties of commonly-used trait metrics remain unexamined. Previous work with simulated communities and trait distributions shows sensitivity of functional diversity measures to the number and correlation of traits used to calculate them, but these relationships have yet to be studied in actual plant communities with a realistic distribution of trait values, ecologically meaningful covariation of traits, and a realistic number of traits available for analysis. To address this gap, we used data from six grassland plant communities in Minnesota and New Mexico, USA to test how the number of traits and the correlation between traits used in the calculation of eight functional diversity indices impact the magnitude of functional diversity metrics in real plant communities. We found that most metrics were sensitive to the number of traits used to calculate them, but functional dispersion (FDis), kernel density estimation dispersion (KDE dispersion), and Rao's quadratic entropy (Rao's Q) maintained consistent rankings of communities across the range of trait numbers. Despite sensitivity of metrics to trait correlation, there was no consistent pattern between communities as to how metrics were affected by the correlation of traits used to calculate them. We recommend that future use of evenness metrics include sensitivity analyses to ensure results are robust to the number of traits used to calculate them. In addition, we recommend use of FDis, KDE dispersion, and Rao's Q when ecologically applicable due to their ability to produce consistent rankings among communities across a range of the numbers of traits used to calculate them.

"We Feel Alone and Not Listened To": Parents' Perspectives on Pediatric Serious Illness Care in Somali, Hmong, and Latin American Communities.

The experience of ethnically diverse parents of children with serious illness in the US health care system has not been well studied. Listening to families from these communities about their experiences could identify modifiable barriers to quality pediatric serious illness care and facilitate the development of potential improvements. Our aim was to explore parents' perspectives of their children's health care for serious illness from Somali, Hmong, and Latin-American communities in Minnesota. We conducted a qualitative study with focus groups and individual interviews using immersion-crystallization data analysis with a community-based participatory research approach. Twenty-six parents of children with serious illness participated (8 Somali, 10 Hmong, and 8 Latin-American). Parents desired 2-way trusting and respectful relationships with medical staff. Three themes supported this trust, based on parents' experiences with challenging and supportive health care: (1) Informed understanding allows parents to understand and be prepared for their child's medical care; (2) Compassionate interactions with staff allow parents to feel their children are cared for; (3) Respected parental advocacy allows parents to feel their wisdom is heard. Effective communication is 1 key to improving understanding, expressing compassion, and partnering with parents, including quality medical interpretation for low-English proficient parents. Parents of children with serious illness from Somali, Hmong, and Latin-American communities shared a desire for improved relationships with staff and improved health care processes. Processes that enhance communication, support, and connection, including individual and system-level interventions driven by community voices, hold the potential for reducing health disparities in pediatric serious illness.

Posttraumatic Epilepsy and Dementia Risk

Although both head injury and epilepsy are associated with long-term dementia risk, posttraumatic epilepsy (PTE) has only been evaluated in association with short-term cognitive outcomes. To investigate associations of PTE with dementia risk. The Atherosclerosis Risk in Communities (ARIC) study initially enrolled participants from 1987 to 1989 and this prospective cohort study uses data through December 31, 2019, with a median follow-up of 25 years. Data were analyzed between March 14, 2023, and January 2, 2024. The study took place in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC study participants initially enrolled, 2061 were ineligible and 1173 were excluded for missing data, resulting in 12 558 included participants. Head injury was defined by self-report and International Classification of Diseases (ICD) diagnostic codes. Seizure/epilepsy was defined using ICD codes. PTE was defined as a diagnosis of seizure/epilepsy occurring more than 7 days after head injury. Head injury, seizure/epilepsy, and PTE were analyzed as time-varying exposures. Dementia was defined using cognitive assessments, informant interviews, and ICD and death certificate codes. Adjusted Cox and Fine and Gray proportional hazards models were used to estimate dementia risk. Participants had a mean (SD) age of 54.3 (5.8) years at baseline, 57.7% were female, 28.2% were of self-reported Black race, 14.4% were ultimately categorized as having head injury, 5.1% as having seizure/epilepsy, and 1.2% as having PTE. Over a median follow-up of 25 (25th to 75th percentile, 17-30) years, 19.9% developed dementia. In fully adjusted models, compared with no head injury and no seizure/epilepsy, PTE was associated with 4.56 (95% CI, 4.49-5.95) times the risk of dementia, while seizure/epilepsy was associated with 2.61 (95% CI, 2.21-3.07) times the risk and head injury with 1.63 (95% CI, 1.47-1.80) times the risk. The risk of dementia associated with PTE was significantly higher than the risk associated with head injury alone and with nontraumatic seizure/epilepsy alone. Results were slightly attenuated in models accounting for the competing risks of mortality and stroke, but patterns of association remained similar. In secondary analyses, the increased dementia risk associated with PTE occurring after first vs second head injury and after mild vs moderate/severe injury was similar. In this community-based cohort, there was an increased risk of dementia associated with PTE that was significantly higher than the risk associated with head injury or seizure/epilepsy alone. These findings provide evidence that PTE is associated with long-term outcomes and supports both the prevention of head injuries via public health measures and further research into the underlying mechanisms and the risk factors for the development of PTE, so that efforts can also be focused on the prevention of PTE after a head injury.

Healthy immigrant community study protocol: A randomized controlled trial of a social network intervention for cardiovascular risk reduction among Hispanic and Somali adults

BackgroundImmigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations. MethodsWe developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's “Life's Simple 7”: BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality. ResultsA total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5–12). The mean BMI of the sample (32.2) was in the “obese” range. ConclusionProcesses and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.

LIVING FOREVERWELL IN RURAL AMERICA: RESULTS FROM A QUALITATIVE EVALUATION OF A YMCA HEALTHY AGING PROGRAM

Abstract Older adults benefit from community programs that promote physical and mental health, reduce social isolation, and offer connections to community resources. However, older adults living in rural communities have access to fewer health and social services and experience barriers to participation such as access to transportation. Recognizing these challenges, the YMCA of the USA (Y-USA) expanded ForeverWell, a healthy aging model, to 17 YMCAs (“Ys”) serving adults aged 55+ living in rural areas. Developed by the YMCA of the North in Minnesota, ForeverWell is a flexible set of Y activities focused on five dimensions of healthy aging: mind, body, community, spirit, and nature. The goals of ForeverWell are to improve health and well-being, decrease social isolation, and increase community connections among older adults. NORC at the University of Chicago conducted a qualitative evaluation of ForeverWell’s expansion in 17 communities in Minnesota, North Dakota, and South Dakota. NORC conducted virtual interviews with 25 Y staff members and 24 program participants to identify facilitators, challenges, and outcomes. NORC transcribed interviews and conducted qualitative content analysis to identify themes. This session describes findings from the interviews. A key facilitator of success was the flexibility of the model. Challenges included staff and financial resources, outreach in rural areas, and transportation access. Ys developed and enhanced older adult programming and created new partnerships. Program participants reported improvements in physical and mental health and strong social connections. ForeverWell is a flexible, holistic healthy aging program that shows promise for older adults living in rural communities.

Head Injury and Long-term Mortality Risk in Community-Dwelling Adults

Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited. To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity. This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants. Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure. All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022. More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline. In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.

Place of last drink enforcement: Effects on alcohol-related traffic crashes.

Binge drinking can result in various types of harms including traffic crashes. Bars and restaurants that serve alcohol to patrons who are obviously intoxicated (i.e., overservice) contribute to these crashes. One strategy to address overservice is place of last drink (POLD) where law enforcement officers responding to alcohol-related incidents inquire about where the individuals last drank alcohol. This information may then be used to identify bars and restaurants that frequently overserve alcohol. There is limited evaluation of the effectiveness of POLD in reducing overservice, traffic crashes, and other harms. We evaluated the effects of a POLD initiative, developed by some law enforcement agencies in Minnesota (USA), on alcohol-related traffic crashes from 2010 to 2019. Among 89 intervention (POLD) vs. comparison communities, we fit regression models with participation in POLD as the predictor. As secondary analyses, we fit models with POLD implementation level as the predictor (implementation levels were assessed via a survey of law enforcement agencies). We controlled for relevant community and agency characteristics. In the model with participation in POLD as a predictor, there was little difference in the rate of total alcohol-related crashes (rate ratio [RR]=1.07, 95% CI: 0.85-1.34). In the model with level of implementation as a predictor, the rate of total alcohol-related crashes was comparable between communities with high implementation and those with no implementation (RR=0.89; 95% CI: 0.71-1.10). Similar results were seen for alcohol-related crashes with nonfatal injury and property damage outcomes. This study found little evidence that the POLD initiative, as currently implemented, was associated with reductions in traffic crashes across communities in Minnesota. Further research could explore whether specific characteristics of POLD are particularly important and whether POLD could be combined with other strategies to reduce traffic crashes and other alcohol-related harms.

Between Suffering and Liberation: Complexities of Blackness Among East African Immigrants in Minnesota in the George Floyd Moment

In this paper, we explore moments of racial awakening among East African communities in Minnesota. We examine how the events around the George Floyd protests have opened up racial conversations (and gave permission) for many East African Americans in Minnesota, to voice their own pain of being racialized. We call these private and public stories of racial resistance. We highlight stories that take place in private spaces of the community, where experiences of racial violence are silenced, avoided, or outright denied because they cause shame, which mirrors other types of supremacist ideologies within East African societies. We find that these narratives add complexity to notions of Blackness and Black suffering. By looking closer, they are motivated by a desire to struggle against white supremacy. We draw on three of our own stories from two distinct contexts: community conversations and George Floyd protest site in Minneapolis, Minnesota. We do this to examine the different discourses surrounding notions of Blackness and Black sufferings. Through lived experiences of racialization, we interrogate the issue of Black voice, and particularly Black immigrant voice as a site of complex and competing interest that seeks to reconcile different ideologies around Blackness. We put phenomenology of race in conversation with Coloniality and anti-colonial literature to tease out tensions surrounding Blackness and Black suffering in US context. We end with suggestions on alliance building that recognizes and builds on the collective humanity of Black diasporic people.

Participatory Microbiome Research With Hmong and Karen Communities: Lessons Learned

In this brief report, we share lessons learned from the Immigrant Microbiome Project (IMP), a microbiome research study conducted in partnership with the Hmong and Karen communities in Minnesota. Members of the IMP academic-community research team and community advisory board reflected on the community-based participatory research (CBPR) approach used for the IMP project, which informed these lessons learned. The IMP illustrates how microbiome researchers can utilize CBPR, which can improve the validity of research projects, create respectful partnerships, build trust between community members and researchers, and ensure that research results are returned to the community as actions that can improve health.

Diverse community leaders\u2019 perspectives about quality primary healthcare and healthcare measurement: qualitative community-based participatory research

BackgroundHealthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores.MethodsA Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified.ResultsListening sessions produced three major themes, with recommended actions for primary care clinics.#1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity.#2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion.#3: Funding Based on Current Quality Measures Perpetuates Health Inequities.ConclusionCommunity leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare.

Quantifying opioid use disorder Cascade of Care outcomes in an American Indian tribal nation in Minnesota

American Indian communities in Minnesota have been disproportionately impacted by the opioid use disorder (OUD) epidemic, which tribal communities have taken numerous steps to address. The Cascade of Care is a public health framework for measuring population-level OUD risk, treatment engagement, treatment retention, and recovery outcomes, which can help communities monitor the impact of responses to the OUD epidemic and identify where treatment- and recovery-related barriers and facilitators may exist. However, no studies have quantified the Cascade of Care stages within tribal communities and the extent to which these stages can be quantified using existing data sources is unknown. We utilized data from the Minnesota Drug and Alcohol Abuse Normative Evaluation System (DAANES) to quantify OUD Cascade of Care stages for an American Indian tribal nation in Minnesota and for the entire state. DAANES data indicated 269 individuals in the tribal community received treatment for opioid-related problems in 2018. Among them, an estimated 65–99 % initiated medications for OUD and an estimated 13–41 % were retained in treatment for at least 180 days. Existing state-level data can provide information about Cascade of Care stages for American Indian communities, particularly with regard to treatment admission, initiation of medications for OUD, and treatment retention. Additional data sources are needed to measure population-level OUD risk, recovery, and cultural and contextual factors that may impact treatment and recovery.

Strategies to Enhance Culturally Responsive Research: Community Research Recommendation Tool.

Under-representation of minorities in research hinders the ability to address persistent societal inequities. To understand how to increase the cultural responsiveness of research, a community-academic partnership conducted listening sessions and community forums with African Americans in North Carolina, Native Hawaiians in Hawai'i, and Hmong and Latino/a/x communities in Minnesota. Participants shared their concerns and desires for research, as well as generated strategies aimed at communities, researchers, and partnerships to enhance culturally responsive research practices. These findings resulted in a Community Research Recommendation Tool (CRRT) that can be used to guide community members, researchers, and partnerships as they build equitable research partnerships that honor cultural practices, account for sociopolitical contexts, and aim to redress societal inequities.

Bicycle and pedestrian manual count programs: Assessing the feasibility and value for measuring local active transportation work

IntroductionPromoting walking and bicycling has been a major focus in the US in recent years. Bicyclist and pedestrian manual counting programs are used to measure how many people are walking and bicycling in specific locations and their characteristics. The purpose of this study was to understand how communities use this data and assess the potential to use manual count data for assessment and evaluation. MethodsSix communities in Minnesota were selected to participate in this study. One semi-structured interview per community was conducted with local public health staff who participated in manual counts in 2012, 2014, and 2016. Interviews were transcribed and analyzed using a thematic analysis approach. ResultsCommunities described their motivation to conduct counts, management of existing programs, and how they interpreted and used the count data. Among the many uses of the data discussed were documenting use of facilities, allocating resources, assessing efficiency of investments or need for safety interventions, informing or conducting research, and community engagement. Communities also described how the setting and circumstances that exist in the community affect both data interpretation and implications of the data as well as barriers, facilitators, and technical assistance needs for collecting and using count data effectively. ConclusionsCommunities may need technical assistance to know how to use data collected through bicyclist and pedestrian manual counting. However, with appropriate instruction and assistance, counts are a feasible assessment tool for local active transportation (bicycling and walking) promotion efforts. However, contextual information about the setting and circumstances that exist in local communities is necessary to properly interpret and use count data and therefore is also necessary when using counts for assessment or evaluation. This method supports equity as manual counts do not require expensive equipment, and are relatively easy to implement.

Addressing Cardiovascular Health Disparities in Minnesota: Establishment of a Community Steering Committee by FAITH! (Fostering African-American Improvement in Total Health).

Despite its rank as the fourth healthiest state in the United States, Minnesota has clear cardiovascular disease disparities between African-Americans and whites. Culturally-tailored interventions implemented using community-based participatory research (CBPR) principles have been vital to improving health and wellness among African-Americans. This paper delineates the establishment, impact, and lessons learned from the formation of a community steering committee (CSC) to guide the Fostering African-American Improvement in Total Health (FAITH!) Program, a CBPR cardiovascular health promotion initiative among African-Americans in Minnesota. The theory-informed CSC implementation process included three phases: (1) Membership Formation and Recruitment, (2) Engagement, and (3) Covenant Development and Empowerment. The CSC is comprised of ten diverse community members guided by mutually agreed upon bylaws in their commitment to FAITH!. Overall, members considered the CSC implementation process effective and productive. A CBPR conceptual model provided an outline of proximal and distal goals for the CSC and FAITH!. The CSC implementation process yielded four lessons learned: (1) Have clarity of purpose and vision, (2) cultivate group cohesion, (3) employ consistent review of CBPR tenets, and (4) expect the unexpected. A robust CSC was established and was instrumental to the success and impact of FAITH! within African-American communities in Minnesota.

Abstract P113: Predictors and Correlates of Secondhand Smoke in Work Environments Among Rural and Urban American Indians

Objective: In 2010 nearly 60% of American Indian (AI) adults in Minnesota reported they currently used cigarettes, a prevalence 3.5 times greater than the general population in that region. Here, we aim to describe the prevalence of secondhand smoke exposure and its correlates among Upper Midwest AIs in their homes and at work. Methods: Between 2010 and 2012 the American Indian Community Tobacco Project (AICTP) administered the Adult Tobacco Survey in collaboration with seven reservations and three urban communities in Minnesota. Eligible participants (n=2926) answered questions regarding exposure to secondhand smoke. Results: A third [33% (347 of 1059), 95% CI (30-36%)] of AIs reported being exposed to smoke in their workplace (compared to the 9% of the general Minnesota population). Half of males [50% (155 of 365), 95% CI (42-58%)] were exposed to secondhand smoke in the workplace, whereas only 27% [188 of 686, 95% CI (26-33%)] of females were exposed to secondhand smoke in the work environment. Of those who work on the reservation, 42% [237 of 570, 95% CI (36-48%)] of AI’s were exposed to secondhand smoke at their workplace. Within AI’s who have never smoked 25% [34 of 134, 95% CI (21-41%)] were still exposed to secondhand smoke within the workplace. Among AI’s who reported smoking policies in the workplace 30% [205 of 671, 95% CI (26-38%)] were exposed to secondhand smoke within the workplace, and 27% [158 of 578, 95% CI (20-30%)] of AI’s who stated their workplace was always enforced were still exposed to secondhand smoke in the workplace. A third [37% (120 of 321), 95% CI (35-54%)] of those who reported not having a workplace policy were exposed to secondhand smoke, demonstrating the need for policy development regarding smoking in the workplace. Conclusions: In conclusion, although strong policy protects most Minnesotans from secondhand smoke in workplaces, these policies do not seem to be benefitting AIs in the state. Discovery of who is at greatest risk for secondhand smoke exposure can inform future interventions and inform future policy optimization and protection.

Colonic Transit and Bile Acid Synthesis or Excretion in PatientsWith Irritable Bowel Syndrome-Diarrhea Without BileAcid Malabsorption.

Bile acids (BAs) are passively absorbed to a different extent along the mammalian colon, so that levels are lower in the feces than in proximal colon. Our aim was to explore associations among total, primary, and secretory BA in stool and colonic transit in patients with irritable bowel syndrome-diarrhea (IBS-D) without overt BA malabsorption (BAM). In a cross-sectional observational study of 116 patients with IBS-D recruited from local communities in Minnesota, we measured total and individual main fecal BA excretion, fecal fat and fecal weight over 48 hours, fasting serum levels of C4 (surrogate for BA synthesis), and overall colonic transit by scintigraphy (geometric center at 24 hours and 48 hours). Patients without overt BAM were assigned to groups based on total fecal BA level below 2337 μmol/48 hours (n= 86) or serum levels of C4 below 47.1 ng/mL (n= 91). We used Spearman correlations to test study hypotheses with correction for 14 correlations tested (P < .0036). Data from 30 healthy volunteers were used as control subjects. Patients with IBS-D who had increased or normal total BA excretion in stool or BA synthesis had higher stool proportions of primary BAs (especially chenodeoxycholate), compared with healthy control subjects. In patients with IBS-D without overt BAM (normal 48-hour total fecal BA or serum C4), there were significant positive correlations between total fecal BA, fecal primary and secretory BA, fecal weight, and increased geometric center at 24 and 48 hours (P<.0036). Normal and slightly increased levels of total fecal BA have greatest effects on colonic transit at 48 hours. In the absence of overt BAM, the total, primary, and secretory BAs in stool contribute to the acceleration of colonic transit and fecal weight in the diarrhea of patients with IBS-D.

One Size Does Not Fit All: Effective Community-Engaged Outreach Practices with Immigrant Communities

Generic outreach approaches are commonly used to target as many individuals as possible in a cultural community to achieve a greater response rate. However, this one-size-fits-all tactic is rarely effective. Community-engaged outreach practices have been successful with immigrant communities in Minnesota's Twin Cities. When practitioners, clinicians, and scholars engage in these practices, they not only build trusting relationships with cultural communities over time but also achieve mutual benefit, reciprocity, and the leveraging of institutional resources.

Culture, acculturation and smoking use in Hmong, Khmer, Laotians, and Vietnamese communities in Minnesota.

BackgroundSoutheast Asian communities in the United States have suffered from high rates of tobacco use and high rates of chronic diseases associated with firsthand and secondhand smoking. Research is needed on how best to reduce and prevent tobacco use and exposure to secondhand smoke in these communities. The objective of this study was to examine how tobacco use patterns in Minnesota’s Southeast Asian communities have been shaped by culture, immigration, and adjustment to life in America in order to inform future tobacco control strategies.MethodsThe study consisted of semi-structured interviews with 60 formal and informal leaders from Minnesota’s Hmong, Khmer (Cambodian), Lao, and Vietnamese communities and incorporated principles of community-based participatory research.ResultsAmong Khmer, Lao and Vietnamese, tobacco in the homeland was a valued part of material culture and was used to signify social status, convey respect, and support social rituals among adult men (the only group for whom smoking was acceptable). Among the Hmong, regular consumption of tobacco was unacceptable and rarely seen until the civil war in Laos when a number of Hmong soldiers became smokers. In Minnesota, social norms have begun to shift, with smoking becoming less acceptable. Although older male smokers felt social pressure to quit, smoking functioned to reduce the stress of social isolation, economic hardship, prior trauma, and the loss of power and status. Youth and younger women no longer felt as constrained by culturally-rooted social prohibitions to smoke.ConclusionsLeaders from Minnesota’s Southeast Asian communities perceived key changes in tobacco-related attitudes, beliefs, and behaviors which were embedded in the context of shifting power, status, and gender roles within their communities. This has practical implications for developing policy and interventions. Older Southeast Asians are likely to benefit from culturally-tailored programs (e.g., that value politeness and the importance of acting in ways that benefit the family, community, and clan) and programs that work with existing social structures, as well as initiatives that address smokers’ psychological distress and social isolation. Leaders remained uncertain about how to address smoking uptake among youth, pointing to a need for additional research.

Protective Effects of Parental Monitoring of Children’s Media Use

Children spend more time with electronic media than they do in any other activity, aside from sleep. Many of the negative effects that stem from media exposure may be reduced by parental monitoring of children's media use; however, there lacks a clear understanding of the mechanisms and extent of these protective effects. To determine the prospective effects of parental monitoring of children's media on physical, social, and academic outcomes. Prospective cohort design. Data were collected by in-home and in-school surveys in 2 communities in Iowa and Minnesota, where 1323 third- (n = 430), fourth- (n = 446), and fifth- (n = 423) grade students participated. A primary caregiver and teachers also provided data about the student. Participants in the current study were recruited to participate in a social ecological model-based obesity prevention program. Body mass index, average weekly sleep, school performance, prosocial behavior, and aggressive behavior. RESULTS Structural equation modeling revealed that parental monitoring of children's media influences children's sleep, school performance, and prosocial and aggressive behaviors and that these effects are mediated through total screen time and exposure to media violence. Parental monitoring of media has protective effects on a wide variety of academic, social, and physical child outcomes. Pediatricians and physicians are uniquely positioned to provide scientifically based recommendations to families; encouraging parents to monitor children's media carefully can have a wide range of health benefits for children.

Can leadership development act as a rural poverty alleviation strategy?

Though it is a pervasive problem, relatively little research focuses on rural poverty and leadership initiatives designed to alleviate rural poverty. Using a comparative case study approach, this article assesses community-level change in rural communities in Montana and Minnesota that participated in Horizons, a leadership development program that seeks to encourage community action to reduce poverty. We focus on the effects of various strategies for Horizons implementation in Montana and Minnesota as a possible explanation for different community-level outcomes experienced in these states. We argue that different methods of Horizons implementation influenced the skills and knowledge that coaches brought to their communities and also helped to determine how receptive communities were toward working with coaches. Research results also indicate that relatively minor investments in leadership development can yield dramatic changes in a community's capacity to identify and address problems.