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The purpose of the study was to investigate the acceptability, feasibility, potential efficacy, and putative mechanisms of a mindfulness-based intervention (MBI) to facilitate stress and smoking urge management that was tailored to low-income female smokers with children. Underserved maternal smokers have elevated levels of stress and depressive symptoms, and greater difficulty managing urges to smoke (key determinants of sustained smoking behavior) compared to the general population of smokers. An MBI that targets such determinants may be useful in facilitating smoking behavior change in this high-risk population. Purposive sampling targeted mindfulness naïve, low socioeconomic status, maternal smokers recruited from dental clinics and healthcare agencies serving low-income Philadelphia neighborhoods. The initial phase of this study used formative assessments to examine the acceptability and feasibility of mindfulness practices and guide the design of a tailored MBI. Next, the study used a randomized, two-group, repeated measures design to assess between-group effects on key factors associated with sustained smoking, comparing participants receiving MBI procedures and a control group receiving a parallel parenting skills intervention. The efficacy of MBI procedures was tested using a single 5-minute audio with MBI instructions vs a child safety recording (control) to examine group differences in negative affect and smoking urge following three massed smoking cue exposure trials at baseline. Subsequently, participants initiated four weeks of either MBI or parenting skills training delivered by daily text messages with prompts and links to group-specific audio. Participants’ smoking urge, perceived stress and daily cigarette consumption were assessed daily over the 4-week intervention via texted survey link and at end of treatment via telephone to examine efficacy in reducing stress and smoking urge and explore effects on daily cigarette smoking. The study also assessed attrition rate, adherence to daily text-based survey completion, and intervention satisfaction as indices of acceptability and feasibility. We hypothesized that the MBI would be feasible, acceptable, and, compared to the control group, demonstrate greater reductions in smoking urge and negative affect (single session assessments at baseline) as well as perceived stress and strength of smoking urge over time (4-week assessments). Between group comparisons on primary and exploratory outcomes were assessed with linear mixed models (LMM). The study also explored the facets of mindfulness and process measures. The participant sample (N = 40) was 88% African American, with an average age of 36 years old and 55% with a high school degree/GED or less. Mean baseline daily smoking consumption was around 10 cigarettes per day. Formative analyses suggested acceptability of mindfulness practice. The main theme that developed from the in-depth interviews was the need for tailored content such as shorter mediations, informal language, and text messages with pictures. Results of the single session MBI following cue exposure procedures showed no between group differences in urge or negative affect. Results of the 4-week MBI suggested that the intervention was feasible, with 4% attrition and an 87% response rate (~6 out of 7 days over 4 weeks). LMMs showed a significant time by condition effect for smoking urge, F (1, 545) = 5.38, PE = −0.038, SE = 0.016, p = 0.021, indicating that smoking urge declined significantly more over time in the MBI group compared to the control group, but no effect over time by condition for perceived stress. Thus, there was partial support for the primary hypotheses. Exploratory analyses showed a significant difference in mean cigs/day [F (1,35) = 6.993, p = 0.012] between groups (MBI mean = 5.51 cigs/day; Control mean = 8.12 cigs/day). Analysis of process measures showed the messages were well received and viewed as helpful, inspirational and motivational, providing further support of acceptability of MBI procedures. Together, results suggest acceptability and feasibility of MBI procedures in this under-studied, high risk population of smokers. Results suggest potential efficacy of 4-weeks of daily guided MBI practice at reducing smoking urges and cigarettes smoked per day among current maternal smokers, even though a single session of guided MBI among mindfulness naïve smokers may not have utility in suppressing cue-elicited smoking urge and negative affect. This study adds to the growing evidence supporting mindfulness practices to aid in smoking cessation. While the generalizability of this study is limited to a highly distressed population of maternal smokers not enrolled in smoking cessation treatment, future research could determine whether initiating this tailored MBI prior to a quit attempt could facilitate preparation of smoking cessation in a population of smokers known to have greater challenges quitting smoking. / Public Health

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Introduction: Homelessness is a complex and systemic problem within the United States, made more complicated by distributing federal funding to address this crucial issue. Regional Continuums of Care (CoC) is the primary method of designating organizational units by geography responsible for addressing homelessness within a given area. The primary duties of each CoC are to oversee the operation for the designated region, to maintain the Homeless Management Information System (HMIS), and plan for the CoC. The size and scope of CoCs can vary within some states, indicating larger or smaller groups of counties responsible for addressing homelessness in a given area. However, some states have entities known as Balance of the State (BoS) CoCs, which cover large geographic areas. The extent to which the smaller CoC model or the larger BoS model is associated with the overall effectiveness of addressing homelessness within a given state has not been examined and is the focus of this study. Methods: A cross-sectional study examining CoC structure and homelessness was used for this project. Per capita rates of homelessness were the primary outcome variable of interest. Per capita homeless was derived from general population numbers reported by the US Census Bureau in 2022 by PIT count per state as reported by HUD in the same year. States organizational structure as defined by the number of CoCs in a state was the independent variable of interest. To examine this potential relationship further, as well as the impact of other known factors that impact homelessness, an OLS regression was performed. Results: Overall, the number of CoCs ranged from 1 to 44. Overall the OLS regression model including three variables (CoC, state geographic location, and rurality) was statistically significant, F(6, 43)=4.406, p Conclusion: The initial examination of the relationship between homelessness per capita and the number of CoCs in a state suggests that other elements to account for effectiveness of CoC within a community setting need to be considered. Further explorations such as policy implications, weather patterns, and funding may need to be considered in seeing a reduction of homelessness per capita. A more comprehensive analysis of the relationship between states with exclusively CoCs and those BoS occupying large geographic areas indicates a need for standardization of data collection, distribution of federal funding, and culturally competent strategic planning for the reduction of homelessness.

LGBT+ patients, medical students, and healthcare providers have been shown to experience significant health disparities and poor health outcomes, to less frequently seek out healthcare, and to often face discrimination in healthcare settings. Researchers suggest the lack of high quality and in-depth training on LGBT+ health and communication skills may contribute to hostile clinic cultures and reinforce implicit and explicit biases towards LGBT+ patients. Despite the growing body of research and interest in curriculum reforms, there has not been an up to date, comprehensive review of LGBT+ health trainings and resources at U.S. medical schools since 2015. We conducted a systematic review of available information on the presence of LGBT+ trainings, support groups, and resources for medical students, residents, and faculty at all M.D.-granting institutions who are part of the Association of American Medical Colleges (AAMC). The systematic review was conducted between May and September 2020 through Google using pre-determined keyword search strategies. Collected information included type of programming, targeted audience, and length of training among others that was built into an easily accessible online database of LGBT+ health curriculums and resources. Similar to 2015, most U.S. medical schools (52%) do not have or do not provide easily accessible information about LGBT+ trainings for their students. Even fewer medical schools (39%) report that they require their students to take some form of LGBT+ health training, and almost no information is easily available on LGBT+ trainings for residents and medical school faculty. Our findings suggest that medical schools have made some progress in creating more inclusive curricula and training environments compared to 2015. However, there has not been a consensus in how medical students should be trained to be more aware of and to address biases, discrimination, and poor health outcomes affecting their LGBTQ+ patients and colleagues.

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Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children, 1) health literacy information in an experiential manner, and 2) practical skills to engage their families in healthy lifestyle choices, with the decisions for healthy lifestyle choices being based on the health knowledge provided in the intervention. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting skills, and mental wellness. The intervention was successful at improving diet/nutrition knowledge at least one month post-intervention and more immediate changes were found for participants' overall beliefs about diet/nutrition, children's vegetable consumption, and parents' fruits and vegetable consumption. Immediate improvements were also found for factual knowledge about physical activity, sleep, and the relationship between mental health and stress. Additionally, the intervention was successful at improving general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, and knowledge about common childhood sleep problems at least one month post-intervention. The intervention also reduced participants' bedtime interactions with children that are indicative of sleep problems at least one month post-intervention. Future research should conceptualize the intervention as a multiple health behavior intervention and reflect this in the evaluation.

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