Michelle Teti

Disseminating images is a critical part of the photovoice process to move ideas to action. Viewers can help translate participants’ experiences to change. Yet, we know relatively little about the decisions made around photovoice dissemination or how photovoice images affect audiences. Relatedly, the audiences of photovoice remain understudied. To help close this gap, we describe a community-academic team’s process of moving photovoice results to change in the Reframing Life with HIV project, to chronicle the details of dissemination. This photovoice project was designed to give young, same gender loving men of color living with HIV (HIV + SGLMOC) in the urban Midwest a space to reframe the discussion around HIV medication adherence. Midway through the project, participants pivoted from planning to share their photo-stories with other HIV + SGLMOC via a photo exhibit – to creating a short video to decrease HIV stigma among emerging health professionals. We describe each step of the process and how the team made decisions about moving the project’s results to action and change. Steps included :1. Photovoice, 2. Post project interviews, 3. Video making, 4. Dissemination of stories via the video to teach others, 5. Project evaluation, and 6. Reflecting on lessons learned and next steps. The video that the participants made helped students understand HIV + SGLMOC, that they are human beings first, not illnesses or solely victims. Unfortunately, however, in post-video surveys, participants reported believing that people of certain races/ethnicities spread HIV, an unintended result of the project. Our findings suggest one way to approach photovoice dissemination, based in resilience and empowerment approaches, that is flexible, prioritizes participants’ project decisions, includes photovoice as one component of ongoing change, and underlines the importance of exploring and responding to viewer response to dissemination.

Background and Objective: Recent evidence suggests an increased demand for vasectomies following the Supreme Court’s Dobbs v. Jackson Women’s Health Organization overturning Roe v. Wade. Limited published information on vasectomies provided by publicly funded agencies exists. This study seeks to understand and document vasectomy services in Title X Family Planning health centers, including models of care, provider training, and financial strategies. Methods: We held qualitative interviews with 22 Title X organizations. Through an iterative, thematic analysis, our research team coded the data to produce findings illustrating the landscape of vasectomy service provision in Title X Family Planning health centers. Results: This qualitative research study indicated 3 central components of vasectomy care in publicly funded Title X clinics: models of care, finance models, and provider training. Individual approaches varied considerably depending on organization size, funding, provider types, and policy climate. Conclusions: This study confirms that a host of barriers exist to providing vasectomy services in publicly funded or “safety net” clinics, including: (1) Limited opportunities for provider training, (2) federal and state 30-day waiting periods for informed consent, and (3) low reimbursement rates. The study informs options for addressing these barriers in publicly funded settings.

Introduction: Evidence suggests a new demand for vasectomies following the Supreme Court's Dobbs v. Jackson Women's Health Organization [597 U.S. 215 (2022), (Dobbs)]. Vasectomies are safer and more cost-effective than tubal sterilization. Understanding how to support men's use of this procedure is important to improving sexual and reproductive health and wellbeing (SRHW). This study is an exploration of health care providers' perspectives on the gender, cultural and political influences on vasectomies at Title X-funded clinics across all regions of the US.Methods: Providers or health services staff (N = 21) at Title X-funded settings currently offering vasectomy services in their own clinics or via referral were recruited using list serve and email outreach. Participants took part in one-on-one or small group interviews about vasectomy procedures, patient experiences, and trends. A thematic analysis of interview transcripts through an iterative process of reviewing, note-taking, and discussing data assessed provider views on patient cultural, gender, and political vasectomy influences.Results: Qualitative interviews yielded four themes related to participant access to services, including income challenges, language barriers, medical distrust, and societal gender roles that stressed women's responsibility for contraception. Two additional themes focused on men's fear of losing reproductive health options and desire to “step up” to do their part to prevent unplanned pregnancies.Discussion: Interviewees stressed that vasectomy was for everyone but identified sub-groups of men who still faced logistical and social access challenges to the procedure. Providers also believed that men were concerned over reproductive justice in the US and wanted to do their part to help prevent unplanned pregnancies. They thought that the Dobbs decision may mark a turning point in reproductive care that could ultimately better public health initiatives and overall SRHW by including men in the conversation. Vasectomy education, marketing—along with policy changes that ease access, can support this goal.

COVID-19 continues to infect and affect college-aged youth. We lack information about how students experienced the pandemic day-to-day and what they need for recovery, from their own perspectives. This study employed peer ethnography to explore student's insights for current and future prevention and care. A team of eight students were trained as peer ethnographers to observe and record conversations with their peers in 15-minute increments during the COVID-19 pandemic. Transcripts of 200 conversations were collated and analysed via theme analysis to identify patterns. Student conversations revealed dichotomous perspectives about COVID-19. Some students prioritized safety, captured via three themes-caution, rethinking routines, and protecting others. Other students struggled to follow prevention guidelines and took risks, also captured by three themes-parties, denial, and misinformation. A third category of themes captured the results of this dichotomy-tense campus relationships and a health leadership vacuum. Our findings identify specific locations for intervention (e.g., off campus parties) and needed community collaborations (e.g., bars and universities) for COVID-19 and future pandemics. Our findings suggest that overarching approaches, like harm reduction or affirmation (versus shame), are helpful intervention frameworks. Findings also celebrate the value of peer-ethnography, to learn about pandemics and solutions from the ground up.

Canada and the USA are often compared for their markedly different approaches to health care despite cultural similarities and sharing the world’s longest international boundary. The period between the onset of the COVID-19 pandemic in January 2020 and the availability of a vaccine in December 2020 offers an ideal opportunity to compare subnational Canadian and American pandemic mortality. Preventing the spread of COVID-19 was through compliance with health orders and best practices; treatment was only available to those admitted to hospitals and whose lives were at risk. Using publicly available data from the Johns Hopkins University 2019 Novel Coronavirus Visual Dashboard, we seek to uncover if there were any similarities in Canadian provinces’ and American states’ monthly COVID-19 mortality per 100,000 people, building on a broader scientific push towards understanding the successes and failures of different health systems in the pandemic. The similar province and state cumulative COVID-19 mortality rate trajectories identified in our analyses do not amount to intuitive comparative jurisdictions which suggests the importance of identifying localized pandemic responses.

More than 11 million Americans provide unpaid care for people with dementia (PWD) and need emotional, financial, and physical support. This study explored how participants in Caregiver Speaks, a social networking and image-based storytelling intervention designed to help caregivers make meaning of caregiving, described their caregiving experiences and needs. Strategies of thematic analysis were used to identify patterns in 28 different caregivers’ images ( N = 59) and text interactions on social media. Caregivers identified as white (71.4%), as women (92.9%), and as an adult child or child-in-law of the PWD (85.7%). Through images and text, caregivers explained interrelated changes in their behaviors (e.g., managing dual roles), thoughts (e.g., realizing severity of illness), and feelings (e.g., trapped) throughout the caregiving process. Findings reiterate that caregiving changes significantly over time, that visual storytelling helps to concretely capture those changes, and that interventions are needed to respond to caregivers’ hardships across the caregiving time span.

Background: Promotion, uptake, and adherence of pre-exposure prophylaxis (PrEP) is paramount to ending the HIV epidemic among young Black men who have sex with men in the South. The purpose of this study was to explore strategies needed for and barriers to PrEP uptake needed to achieve HIV prevention goals identified in the U.S. Department of Health & Human Services initiative to reduce new HIV infections in the United States by 90 percent by 2030. Method: Young adults (n = 25) between the ages of 15–34 were recruited from community-based organizations in Memphis to participate in four focus group discussions. Discussion topics included motivations, barriers, and facilitators to PrEP use. Data were analyzed using thematic analysis. Results: All (100%) of participants self-identified as HIV-negative, Black (96%), men who have sex with men (96%), and currently prescribed PrEP/Truvada (60%). Themes identified for increasing uptake included 1) trusted peers, 2) relatable healthcare provider (e.g., Historically Black College and University (HBCU) trained, LGBTQ), and 3) use of social media. Mislabeling of PrEP as promiscuity promoting and limitations with PrEP marketing (e.g., solely LGBTQ) were recognized as barriers that perpetuated stigma. Conclusion: Findings suggest the importance of increasing awareness among health professions students matriculating at HBCUs of their perceived role as relatable healthcare providers by Black MSM; working closely with couples; and crafting of PrEP messaging that is non-stigmatizing. Findings will inform public health interventions for young Black MSM and facilitate HIV prevention efforts with other groups disproportionally affected by HIV in the South.

The COVID-19 pandemic not only had detrimental effects on physical health but also had adverse effects on college students’ mental health. This paper begins to fill a gap in knowledge related to the contextual factors that impacted college students’ mental health during COVID. Using in-depth interviews with a diverse sample of 33 college students at a Midwestern university, during Spring 2021, we highlight the pandemic’s role in shaping college students’ mental health and their outlook of the future. Thematic analysis revealed student reports of mental health decline during the pandemic attributed to campus closures and social distancing policies implemented by the institution to reduce the spread of COVID-19. Students shared that the pandemic created uncertainties about their future opportunities for education, career fulfillment, and employment. However, the interviews also suggested a general sense of adaptation to the pandemic’s impact which was students achieved via a combination of active and passive coping strategies. Expanding institution-based mental health services to include a variety of modalities and off-line toolkits for students can help students cope with mental health challenges, whether in ‘normal times’ or during national crises. Future research should focus on identifying strategies for promoting mental wellness among college students and exploring post-pandemic mental health wellbeing.

Purpose: In the US, the COVID-19 pandemic has exposed deeply rooted resistance to public health. This has important consequences for SARS-CoV-2 variant spread and for future uptake of influenza and other vaccines. We examine these phenomena in Missouri, where its low vaccination rates, high levels of uninsured residents, predominance of conservative values, and stark rural-urban divides are intricately connected to public health resistance. The Socio-Ecological model guides our approach. Methods: We use data from the Fall 2020 Midwestern University (MWU—a pseudonym) Study of Seropositivity and Risk for SARS-CoV-2 and COVID-19 which are harmonized with the American Community Survey, Missouri County-Level Study, and the USDA Rural-Urban Continuum Codes to estimate multi-level regression models on the relationship between undergraduate students’ “home” locales and their own COVID-19 and influenza vaccine hesitancy. Findings: The availability of primary care physicians, the prevalence of influenza vaccinations, and location type at the county level, as well as the percentage of residents without health insurance at the zip code level differentially predict COVID-19 and influenza vaccine hesitancy. Conclusions: There is a link between county-level health and geographic characteristics, and individuals’—who were influenced by those counties because that is where their parents live—hesitancy towards vaccines. Identifying feasible, precise, local solutions to reducing vaccine hesitancy could take place if community members and other stakeholders would be open to changes in local-level health policy or practice.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the diseases it causes remain a public health threat. Data describing health education campaigns for COVID-19 on university and college campuses are lacking, however. Purpose: This study explored college students’ experiences of a USA campus COVID-19 campaign encouraging masking, social distancing and handwashing. Methods: We conducted in-depth interviews with 33 demographically diverse students. Questions focused on students’ experiences during COVID-19, actions and beliefs, and reactions to the university’s COVID-19 prevention campaign. Thematic analysis was used to evaluate responses to the campaign and identify suggestions for future interventions. Results: Students identified three areas of concern – lack of enforcement for nonadherence, inequities and inconsistencies in messaging and failure to connect messages to students’ daily experiences – as problematic. Participants also said the campaign did not address their primary COVID-19 concerns, outlining four thematic content areas needing more attention – learning in quarantine, missing the ‘college experience’, difficult social relationships and chaos and uncertainty. Discussion: COVID-19 prevention campaigns on campus may be best served by a holistic ecological model engaging with needed forms of support on multiple levels. Conclusion: Health education and promotion campaigns that speak to individual, relational, community and policy aspects of disease such as COVID-19 are more promising than campaigns that promote single prevention actions.