Those who bear the greatest environmental burdens often have the least access to information, and explanations for engaging communities to develop solutions are lacking. We describe, and use a case study to depict, a participatory process of urban academic and community members to co-produce educational and communication tools. Over five years, we interfaced with 763 individuals at eleven events and three times that (n=2,273) through attendees' networks at 109 small group events using snowball methods. The resulting communication tools, paired resources, and mobile dissemination were responsive to residents' circumstances and enhanced their ability to access health protecting information and resources.

African Americans suffer disproportionately from colorectal cancer (CRC), due in part to disparities in CRC screening. Better understanding culturally relevant psychosocial factors that impact CRC screening is therefore critical. This study examined how African Americans' perceived cultural competency of their physician is associated with receptivity to take-home stool-based CRC screening. CRC screening deficient African Americans (N = 457) completed a patient-focused measure of perceived cultural competency and watched a brief video about CRC risks, prevention, and screening. Receptivity to stool-based CRC screening was measured using Theory of Planned Behavior (TPB) constructs . Participants were also given an opportunity to receive a no-cost at-home Fecal Immunochemical Test (FIT) kit, and we measured acceptance of this offer as a behavioral outcome (yes-no). Results showed that perceived cultural competency was associated with higher receptive attitudes, more favorable norms, greater perceived behavioral control towards stool-based screening, and also greater intentions to engage in FIT Kit screening (p < 0.001). We also found significant indirect effects of perceived cultural competency on FIT kit uptake through intention-mediated pathways. This study provides crucial evidence that participants' perceived cultural competency may play an important role in preventive health behavior among racial minorities, including CRC screening uptake among African Americans.

Firefighters are susceptible to auditory dysfunction due to long-term exposure to noise from sirens, air horns, equipment, and tools used in forcible entry, ventilation, and extrication. In addition, they are exposed to ototoxic chemicals, particularly, during overhaul operations. Studies indicate that 40% of firefighters have hearing loss in the noise-sensitive frequencies of 4 and 6 kHz. Noise-induced hearing loss (NIHL) is often accompanied by tinnitus, which is characterized by ringing noise in the ears. The presence of phantom sounds can adversely affect the performance of firefighters. However, there has been limited research conducted on the prevalence of tinnitus in firefighters. We enrolled firefighters from Michigan, with at least 5 years of continuous service. The hearing handicap inventory for adults (HHIA) was used to determine the difficulty in hearing perceived by the firefighters and the tinnitus functional index (TFI) was used to determine the severity of tinnitus. Self-perceived hearing handicap was reported by 36% of the participants, while tinnitus was reported by 48% of the participants. The TFI survey indicated that 31% perceived tinnitus as a problem. More importantly, self-perceived hearing handicap was significantly associated with the incidence of tinnitus in firefighters, suggesting a potential link between occupational exposure to ototraumatic agents and tinnitus in firefighters.

This study demonstrates the potential of racial identity to moderate how gain and loss-framed messaging, as well as culturally-targeted messaging, can affect receptivity to preventive health screening. African–Americans (N = 132) who were noncompliant with recommended colorectal cancer (CRC) screening completed a measure of racial identity centrality—encompassing the extent to which racial identity is a core component of self-concept—and then participated in an online education module about CRC screening, during which either gain or loss-framed messaging was introduced. Half of African–Americans were also exposed to a culturally-targeted self-help message about preventing CRC. Theory of Planned Behavior measures of attitudes, normative beliefs, perceived behavioral control, and intentions to obtain a CRC screen served as outcomes. Results confirmed that effects of messaging on receptivity to CRC screening depended on racial identity. Among low racial identity African Americans, gain-framed messaging most effectively increased normative beliefs about obtaining CRC screening, whereas among high racial identity African Americans loss-framed messaging was most compelling. However, these effects most strongly emerged when culturally-targeted self-help messaging was included. We discuss implications for health disparities theory and research, including a potential to simultaneously deploy culturally-targeted and tailored messaging based on racial identity.

Police officers are regularly exposed to traumatic critical incidents. The substantial mental, behavioral, and social costs of police trauma indicate a substantial need for prevention. We have refined and enhanced a previously tested Swedish program to the harsh conditions of U.S. inner cities. The program was designed to strengthen resilience during stressful encounters and teach methods of coping after exposure, thereby preventing the emergence of maladaptive symptoms and behaviors with adverse effects on professionalism. In an uncontrolled demonstration project, junior officers were trained by senior officers to engage in imaginal rehearsal of specific dangerous situations while incorporating optimal police tactics and healthy emotional reactions. A class of 32 officers in the police academy engaged in the program, and they and the trainers reported high satisfaction with it. After their first year of field work, 22 officers were reassessed. Compared to pre-training, these officers showed significant increases in the use of positive reframing and humor and significant reductions in anxiety and alcohol use over the year. Trauma symptoms did not increase. These results offer preliminary evidence for the feasibility and effectiveness of this trauma prevention program for new police officers.

The health impact of exposures to toxic environmental substances has been under-represented in gerontology research. Older adults in Detroit may be especially susceptible to poor health outcomes by virtue of being older, minority, and urban dwelling. The cumulative effect of a lifetime of unquantified exposures to such things as pollution and toxic chemicals from factories exacerbates health concerns and disease in late life. African American older adults have disproportionate health outcomes that may be compounded by chemical (e.g., air pollution, heavy metals) and nonchemical (e.g., psychosocial) stressors especially prevalent in the urban industrialized environments where they reside. In response to such matters, the Center for Urban Responses to Environmental Stressors (CURES), located in the heart of Detroit, aims to understand and address the adverse health effects of complex urban exposures through research, outreach, and advocacy. Interdisciplinary teams of scientists and community partners cooperate to understand the consequences of lead poisoning, air pollution, and psychosocial stressors.

OBJECTIVE:This preliminary study examined the effect of gain versus loss-framed messaging as well as culturally targeted personal prevention messaging on African Americans' receptivity to colorectal cancer (CRC) screening. This research also examined mechanistic functions of perceived racism in response to message framing.DESIGN AND METHODS:Community samples of African Americans (N = 132) and White Americans (N = 50) who were non-compliant with recommended CRC screening completed an online education module about CRC, and were either exposed to a gain-framed or loss-framed message about CRC screening. Half of African Americans were exposed to an additional and culturally targeted self-control message about personal prevention of CRC. Theory of planned behavior measures of attitudes, normative beliefs, perceived behavioural control, and intentions to obtain a CRC screen served as primary outcomes. The effect of messaging on perceived racism was also measured as an outcome.RESULTS:Consistent with prior research, White Americans were more receptive to CRC screening when exposed to a loss-framed message. However, African Americans were more receptive when exposed to a gain-framed message. The contrary effect of loss-framed messaging on receptivity to screening among African Americans was mediated by an increase in perceived racism. However, including an additional and culturally targeted prevention message mitigated the adverse effect of a loss-framed message.CONCLUSION:This study identifies an important potential cultural difference in the effect of message framing on illness screening among African Americans, while also suggesting a culturally relevant linking mechanism. This study also suggests the potential for simultaneously presented and culturally targeted messaging to alter the effects of gain and loss-framed messaging on African Americans.STATEMENT OF CONTRIBUTION:What is already known on this subject? African Americans are at an increased risk of both developing and dying from colorectal cancer (CRC). These disparities can be attributed in large part to deficits in the use of CRC screening among African Americans. Guided by prospect theory, available literature suggests that selectively pairing gain and loss-framed messaging with illness prevention and detection can better promote adaptive health behaviour. Specifically, loss-framed messages that emphasize the potential costs of failing to act may promote better use of illness detection behaviours, such as CRC screening. Emerging literature highlights the potential for cultural differences in the effects of gain and loss messaging on health behaviour, especially among collectivist or interdependent cultures. What does this study add? This study is the first to identify a potential and important cultural difference in the effect of message framing on cancer screening among African Americans, whereby gain-framed messaging better compelled receptivity to CRC screening. This study is also the first to show that the use of loss-framed messaging may reduce receptivity to CRC screening among African Americans by increasing perceived racism. This study demonstrates that simultaneously including a culturally targeted personal prevention message may attenuate the negative effects of loss-framed messaging on CRC screening among African Americans.

OBJECTIVES:To assess "at-home" preparedness and barriers to preparedness in a cohort of public health employees.METHOD:Conducted a cross-sectional survey involving 100 employees attending emergency preparedness training that emphasized incident command training and included a segment on "at-home" preparedness.RESULTS:Fifteen percent of participants were rated as "better prepared," and only 8% of participants would be considered "most prepared." There was no relationship between the concern for bioterrorism and other disasters and preparedness. The principal barrier involved challenges in getting the task done versus lack of desire or knowledge.CONCLUSIONS:There is great potential for distraction of public health workers during an emergent event if they are not prepared at home and have concern for family members. At-home preparedness training efforts that emphasize what should be done and why are likely to have limited impact on changing behavior. Strategies that ensure that small steps are taken are likely to be more successful.

Washington State's workers' compensation claims filed in 1984 and followed through 1988 contained 11,356 claims for occupational disease and 178,927 claims for occupational injury. There was a higher rate of rejection (18% v 4%) and resource utilization (14% v 5%) for occupational disease when compared to occupational injury. The factors most predictive of rejection included the specific disease category and the provider frequency of filing. Development of diagnostic guidelines would aid health providers in identifying and properly characterizing occupational diseases.