Chronic Hepatitis B (CHB), a serious disease requiring lifelong management, disproportionately affects Asian Americans, including Korean Americans. Many Korean Americans experience linguistic and sociocultural barriers, potentially worsening health challenges. While social ties and social support are well-recognized determinants of health, their role within unique populations merits exploration. Using longitudinal survey data, we identified patterns of social ties and social support among Korean Americans living with CHB, and how these related to self-assessed physical and mental health over time. Patients in Los Angeles and Philadelphia (n = 309) completed surveys at two timepoints between 2021 and 2024. We measured social ties with the Lubben Social Network Scale (LSNS-6), social support with the eight-item Medical Outcomes Study Social Support Survey (mMOS-SS), and self-assessed health using SF-12 Physical and Mental Component Summary Scores (PCS, MCS). Greater baseline social ties were higher among married, college-educated, and bicultural- or Western-identifying participants. Social support scores were higher among married, English-fluent, and currently working participants. Greater social ties were associated with better baseline physical health (β = 0.134, p = 0.009), and greater social support with better mental well-being (β = 0.206, p < 0.001). Controlling on baseline health, social ties predicted better follow-up PCS (β = 0.108, p = 0.012), and social support predicted better follow-up MCS (β = 0.136, p = 0.007), suggesting that social ties and social support independently and differentially influence physical and mental health over time. Strengthening both structural connections through social ties and perceived social support may delay health decline among immigrant populations managing chronic conditions.

Historical redlining, a housing policy applied across numerous cities in the United States in the 1930s, resulted in disinvestment in predominantly non-White, immigrant, or impoverished neighborhoods and has been associated with various adverse health outcomes. However, little is known about the effects of gentrification and residential mobility on health in historically redlined neighborhoods. Using linear regression, we evaluated the association between redlining, gentrification, and life expectancy at birth before and after adjustment for socio-spatial residential mobility in the Philadelphia metropolitan area. Tract-level data on life expectancy were obtained from the Centers for Disease Control and Prevention. Census data were used to define tract gentrification status in 2000–2010 (earlier-gentrification) and 2011–2018 (recent-gentrification). Tract socio-spatial mobility characteristics were defined using DataAxle’s household-level data. Life expectancy at birth was generally higher in historically privileged than disadvantaged tracts. After stratification by gentrification status, however, life expectancy in historically disadvantaged (redlined) areas was higher in earlier-gentrified than non-gentrified tracts. This difference was largely explained by socio-spatial mobility, namely a greater influx of moderate- and higher-income households to gentrified and lower-income households to non-gentrified tracts. In redlined tracts, for example, life expectancy in the unadjusted model was 4.7 years lower in non-gentrified than earlier-gentrified tracts (confidence interval: − 6.4, − 2.9); this difference decreased to 1.7 years (− 3.2, − 0.1) after adjustment for socio-spatial mobility. These findings have substantial implications for future public health research, highlighting the importance of including gentrification and/or socio-spatial mobility data when evaluating the association between historical policies, like redlining, and health outcomes in a given geographic area.

Background:Hepatitis B virus (HBV) infection disproportionately affects Asian Americans, who often experience additional social and structural challenges that may influence quality of life. This study examined how social determinants of health (SDOH) are associated with physical and mental health related quality of life among Korean Americans living with chronic hepatitis B (CHB). Methods:A total of 365 CHB patients completed the enrollment survey. SF-12 was used to measure quality of life, calculating physical and mental components summary scores (PCS-12 and MCS-12). SDOH were measured across five domains, including education access, economic stability, social/community context, neighborhood, and health care access. Descriptive statistics and multivariable linear regression were used. Results:Participants had a mean age of 60.1 years, and 44% were female. In multiple linear regression analyses, employment and financial stability were significantly associated with higher PCS-12 and MCS-12 scores. Social support and perceived neighborhood social cohesion were associated with better mental health, while marital status was associated with better physical health. In addition, females had lower levels of physical health than males. Older adults reported worse physical but better mental health. Conclusions:Economic stability, social support, and neighborhood cohesion are the key determinants of quality of life among Korean Americans with CHB. These findings emphasize the need for interventions that address both structural and psychosocial factors to improve quality of life in this underserved population. Further research is warranted to explore the nuanced dynamics of different SDOH domains interact over time and to identify intervention targets in this underserved population.

Background Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world and disproportionately affects Asian Americans, who are further impacted by the lower quality of life imposed by the infection. Limited English proficiency (LEP) and acculturative stress play an important role in the study of patients with CHB, but the interrelationships of LEP, acculturative stress, and health outcomes are not well studied in this population. This study aims to explore how acculturative stress mediates the relationship between LEP and health outcomes among Korean American patients with CHB. Methods A total of 365 CHB patients completed the enrollment survey. SF-12v2 was used to measure physical and mental component summary scores (PCS-12, MCS-12). The Riverside Acculturative Stress Inventory (n=15, alpha=0.89) measured acculturative stress. Linear regression analyses were conducted. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. Results LEP was associated with higher acculturative stress (β=3.62, p<.01). LEP had a direct effect on physical health and no direct effect on mental health. Acculturative stress partially mediated the relationship between LEP and health outcomes (e.g., PCS-12, MCS-12). Discussion This study indicates that acculturative stress plays an important role in mediating the relationship between LEP and both physical and mental health outcomes. Future studies will develop interventions to achieve better health outcomes by reducing acculturative stress in this population.

BACKGROUND:Adherence to renal dietary guidelines, which includes monitoring dietary intake of sodium, potassium, phosphorus and fluids, and consuming sufficient protein and fiber, may prevent hospitalizations and mortality in kidney failure. Forty percent of individuals with ESKD are estimated to have obesity (BMI ≥ 30 kg/m2) and may be advised to lose weight for kidney transplantation eligibility. Although social support influences chronic disease management, mechanisms linking social support and renal diet adherence in ESKD and obesity remain unclear. METHODS:We conducted an interpretive phenomenological analysis of in-depth interviews with 40 English-speaking adults with ESKD and obesity, recruited using purposive sampling for geographic and demographic diversity. We coded transcripts with interdisciplinary team members, used analytical memos and matrices to compare cases. We grouped participants by self-reported levels of perceived social support and dietary adherence. RESULTS:Twenty-three participants were female; 35% identified as Black/African American and 13% as Hispanic/Latino. Narratives highlighted the socially isolating nature of being an ESKD patient. Fatigue, limited mobility, and long treatment times were seen as barriers to cooking and grocery shopping. Twenty-three (58%) reported high levels of perceived social support, with instrumental support from household members being the most common. Nineteen participants (48%) described high levels of perceived renal diet adherence, characterized by reading nutrition labels, cooking, meal planning, and using kidney-friendly substitutions. Three main findings emerged: 1) household members are the primary sources of social support that facilitate dietary behaviors, 2) gender and social roles, especially caregiving and accommodating household food preferences, influence whether existing social networks are leveraged to support dietary adherence, 3) the availability of social support is dynamic and its loss prompts convenience behaviors that jeopardize dietary adherence. CONCLUSIONS:Social support plays a central role in diet-related behaviors of individuals with ESKD and obesity. Interventions that engage household members have the potential to promote dietary adherence.

Father involvement is an important factor in childhood vaccination. Despite Tajikistan's significant efforts to improve vaccination coverage, vaccine hesitancy persists, with parents exhibiting signs of mistrust towards vaccinations due to misinformation. This study aims to examine how fathers describe their role in their child's vaccination plans and to explore their beliefs and attitudes regarding childhood vaccinations through thematic analysis of data from seven focus groups. Focus group discussions aimed to understand influences on immunization and potential communication channels, messages, and behavior change goals for future campaigns. Our analysis categorized fathers based on their attitudes towards vaccines (supportive or hesitant) and on their level of engagement in vaccine decisions (active or passive). Fathers in the focus groups reported seeing themselves as protectors, particularly given their cultural role as primary decision-makers for their children's health. Our findings indicate that, although many fathers are supportive of childhood vaccines, vaccine hesitancy due to misinformation remains a concern. Current gender norms, as well as employment logistics, also pose barriers for fathers to become more involved in their children's vaccination process. Fathers expressed a desire for more opportunities to learn about health issues in their communities. These insights offer opportunities for public health campaigns to educate and engage fathers as partners in advocating for childhood vaccinations. Future interventions should focus on promoting father involvement, both in terms of attitude and agency, while remaining sensitive to cultural gender norms.

Medication nonadherence among patients with chronic hepatitis B (CHB) can lead to severe liver disease progression, including liver cirrhosis and hepatocellular carcinoma (HCC). Yet the factors that influence adherence in high-risk groups, like Korean Americans, remain unclear. Thus, this study explored the psychosocial and clinical factors affecting medication adherence in CHB patients. A cohort of 365 Korean American patients with CHB from two clinics in Philadelphia and Los Angeles was studied. The 8-item Morisky Medication Adherence Scale (MMAS-8) gauged their adherence to antiviral medication. Using descriptive and multivariable logistic regression analyses, we identified factors associated with MMAS-8 scores. Of the participants, 78% were undergoing antiviral therapy, with over two-thirds (69%) reporting medium to high adherence levels. The multivariable logistic regression analysis revealed that age, knowledge of sequalae of CHB, perceived HBV stigma and possession of pharmacy plan were associated with medication adherence. Older participants had higher medication adherence than younger. High knowledge of sequalae of CHB and low perceived HBV stigma were associated with higher medication adherence. Having pharmacy plans was also associated with higher medication adherence to antiviral therapy. These findings highlight the critical role of person-related factors (e.g., knowledge and stigma) and healthcare factors in medication adherence. Future research should focus on developing targeted educational interventions focusing on personal factors to improve medication adherence among Korean American patients with CHB.

Background:Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media. Objective:This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions. Methods:In May 2020, Twitter was used to recruit parents of children aged 9-14 years, who were active users of the platform and were interested in serving on a CAB focused on child health and online programs. The recruitment campaign included Twitter (rebranded as X in 2023) advertising tools (eg, "interests" and "audience look-a-likes"). A total of 17 parents completed a screening survey and 6 completed a follow-up phone interview. Following phone interviews, 6 parents were invited to join the CAB, where they committed to a 1-year involvement. The CAB participated in eleven 1-hour online meetings in the first year, contributing to monthly feedback through participatory workbooks. Long-term engagement was sustained through icebreakers and casual online interactions, as well as providing real-time updates to demonstrate CAB feedback integration. An anonymous midterm evaluation was conducted at the end of the project's first year to assess processes and identify future growth opportunities. Results:A total of 6 parents (5 females and 1 male) with children aged 9-14 years from diverse racial and ethnic backgrounds (African American, South Asian American, and White) across 6 states in the United States, representing urban, suburban, and rural areas, agreed to serve as CAB members. All 6 CAB members committed to 1 year of service beginning in July 2020 with 4 extending their participation into a second year (August 2021-August 2022). The CAB provided expert insights and feedback to co-develop the intervention, including character development, narrative content creation, study recruitment, survey development, and intervention delivery. The midterm evaluation showed 100% (6/6) satisfaction among CAB members, who valued the connections with other parents and their contribution to research. While all members felt confident discussing HPV, 83% (5/6) suggested diversifying the group and increasing informal bonding to enhance engagement and inclusivity, especially for differing vaccination views. Conclusions:This study demonstrates that online CABs are a highly effective model for co-creating and informing online health communication interventions. The engagement of parents from diverse backgrounds and the structured use of online tools (eg, interactive workbooks) creates a constructive and thoughtful environment for incorporating parent contributions to research. This study highlights guiding principles to forming, engaging, and maintaining an online CAB to enhance health research and practice.

The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) revised eligibility for the Supplemental Nutrition Assistance Program (SNAP), permanently banning individuals with past felony drug-related convictions, but allowing states to opt out or modify bans. By 2024, 28 states and Washington, DC, fully opted out and 21 states modified PRWORA; only South Carolina maintains a full ban. However, because federal restrictions remain, state legislatures episodically consider reintroduction of restrictions or bans. Household food insecurity exacerbated by SNAP restrictions increases risk of both recidivism and adverse family health. To strengthen advocacy arguments for full SNAP access, we examined state-level public discourse regarding PRWORA policies, including stakeholders and arguments highlighted. We analyzed local media coverage of PRWORA/SNAP legislative and related activity, identifying 84 stories between 1997 and 2022. State-specific case studies compared coverage in states considering lifting (West Virginia), relaxing (Missouri), or tightening (Pennsylvania) PRWORA provisions. Although most coverage was positive towards lifting bans, stories lacked content on nutrition or health policy. Without repeal of the 1996 federal statute, state-specific PRWORA provisions continue to threaten SNAP access. Nutrition advocacy should monitor and influence public discourse about this social justice issue, to shape policies protecting vulnerable populations from food insecurity.

Narrative persuasion has been widely used in health communication campaigns and persuasive message design. However, several meta-analyses showed that the relative effectiveness of narratives in promoting behavior change was not consistently observed in the existing literature. With the goal of exploring boundary conditions of narrative effects, this study investigates the interaction effects of narrative persuasion and stages of change on promoting behavior change in the context of encouraging parents to vaccinate their children against human papillomavirus (HPV). Findings from an online experiment (N = 593) showed that non-narrative messages were more effective in bolstering behavioral intention than narrative messages among people who were not ready to engage in behavior change (i.e. in the precontemplation stage). In addition, among people who were thinking about changing their behavior (i.e. in the contemplation stage) or motivated to take action (i.e. in the preparation stage), both narratives and non-narratives were effective in increasing behavioral intention. This study contributes important theoretical insights to the role of narratives in health communication. Public health professionals may consider tailoring message design strategies to audience characteristics to enhance message effectiveness.

Youth HPV vaccination rates have yet to reach the national goal of 80 percent. One understudied population with respect to the HPV vaccine is youth with special healthcare needs. This study seeks to understand differences in HPV vaccine health information preferences and ratings of narrative content of parents with children with special healthcare needs to inform future communication efforts to improve HPV vaccine rates. A national sample of U.S. parents and caregivers (N = 512) were recruited through Qualtrics panels. Parents completed a survey about their oldest child aged 9–14. Parents who answered yes to “Does this child need or use more medical, mental health, or education services than most children who are the same age?” were classified as having an index child with special healthcare needs. The survey also measured social media use and information seeking, narrative engagement, and perceptions of usefulness and understanding of vaccine messages. Fifteen percent (N = 77) of parents indicated that their index child had special healthcare needs. These parents were more likely to have a male index child, report social media as a first source of health information, and report greater understanding of HPV vaccine information presented in the stimulus materials. There were no differences for most demographics, social media use, HPV vaccine information source, and perceived usefulness of the HPV vaccine information. Overall, parents in this sample with and without an index child with special healthcare needs are similar in terms of how useful they found the materials. Parents with children who have special healthcare needs may have a greater preference for accessing information on social media, and may be better able to understand narrative health messages. One understudied population with respect to the HPV vaccine is youth with special healthcare needs. Parents in this sample with and without an index child with special healthcare needs had similar perceptions about the usefulness of the HPV vaccine information, but differed in their understanding of messages. We must do more to further refine the needs of different populations, and continue to evolve and adapt our communication strategies to meet audience needs, especially as social media platforms evolve, and new technology and forms of communication continue to emerge.

Chronic hepatitis B (CHB) is a condition that disproportionately affects Asian Americans in the United States. Knowledge of transmission is crucial for CHB patients to practice prevention methods to limit the spread of the hepatitis B virus (HBV), but also live their lives free from unwarranted fears or restrictions. Among Asian CHB patients, several misperceptions about HBV transmission have been identified. This analysis aims to assess the current state of HBV knowledge among a cohort of Korean-American CHB patients. This mixed-methods study includes 363 respondents who completed a survey in either Korean (N = 298) or English (N = 65) at two clinical care settings in Philadelphia (N = 161) and Los Angeles (N = 202); 30 participants also completed in-depth interviews. Knowledge was measured on a 10-point scale, asking patients yes or no transmission questions (n = 10, alpha = 0.87). The average knowledge score was 6.3. In multivariate analyses, older age was associated with lower knowledge (β=-0.25, p < 0.001). More years of formal education (β = 0.09, p = 0.076) and utilizing more sources for health information (β = 0.12, p = 0.023) were both independently associated with higher knowledge scores. Qualitative findings show that misperceptions about transmission through shared food still exist and that provider communication is an important part of knowledge acquisition. These results suggest that despite receiving specialized, culturally concordant medical care for their disease, some Korean-American CHB patients have an inadequate understanding of transmission and that opportunities exist to improve education in this population. Identifying additional factors that influence knowledge acquisition and retention is key to developing culturally effective education interventions for this population.

It is well described in current literature that Hepatitis B virus (HBV) affects Asian Americans more than any other racial group in the United States and that there is a stigma attached to this condition. The effects of stigma can be lasting, penetrating physiologically and psychologically, yet few studies have focused on the consequences of this phenomenon. The purpose of this study was to examine the mediating role of stigma in the effect of racial discrimination and knowledge (of HBV sequelae) on health status of Korean Americans with chronic hepatitis B (CHB). Three hundred sixty-five CHB patients were recruited and enrolled from two clinics in Philadelphia and Los Angeles. Depressive symptoms were measured using the Patient Health Question-9 (PHQ-9), physical health via self-rated health survey and stigma via hepatitis B quality of life (HBQOL)-stigma survey. Perceived racial discrimination and knowledge of CHB sequelae were independent variables. The cohort had an average age of 60.1 years (range 19-84, SD 10.7), 56% were male and 94% were born in South Korea. Mediational analysis found that stigma was a significant mediator between both racial discrimination (indirect effect = .037, Bootstrap 95% CI = [.010-.064]) and sequelae knowledge (indirect effect = .097, Bootstrap 95% CI = [.018-.176]) and depressive symptoms. Stigma also had a direct effect on depressive symptoms (beta = .136, p < .01) and self-rated health (beta = .018, p < .05). In addition, age, gender, education and employment were related to health outcomes. The findings of this study indicate that HBV-related stigma is an important mediator of mental health outcomes in this population. Future studies should identify other psychosocial factors to develop effective intervention programs to reduce stigma and improve quality of life among CHB patients.

Background: In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine. Methods: In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9-14 years. Respondents completed a 20 -minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change. Results: Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention. Conclusions: Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents.