This study examines associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma (DCIS) of the breast. From the Missouri Cancer Registry, we identified 9,195 women with DCIS diagnosed between 1996 and 2011. A composite index using U.S. Census data and American Community Survey data was developed to assess census tract-level socioeconomic deprivation, and rural-urban commuting area codes were used to define rural census tracts. ORs and 95% confidence intervals (CIs) of the treatment were estimated using logistic regression. Hazard ratios (HRs) of DCIS outcomes were estimated using Cox proportional hazards regression. Women in the most socioeconomically deprived census tracts were more likely than those in the least deprived to have mastectomy (OR = 1.44; 95% CI, 1.25-1.66; < 0.0001), no surgery (OR = 1.54; 95% CI, 1.02-2.30; = 0.04), no radiotherapy post-breast conserving surgery (OR = 1.90; 95% CI, 1.56-2.31; <0.0001), delayed radiotherapy (OR = 1.26; 95% CI, 1.01-1.57; = 0.02), and ipsilateral breast tumors (HR = 1.59; 95% CI, 1.07-2.38; = 0.03). There was no significant difference in risk of contralateral breast tumors. Compared with urban women, rural women had significantly higher odds of underutilization of radiotherapy (OR = 1.29; 95% CI, 1.08-1.53). Rural locations were not associated with risk of ipsilateral or contralateral breast tumors. Neighborhood socioeconomic deprivation was associated with higher risks of suboptimal treatment and ipsilateral breast tumors. While DCIS treatment significantly varied by rural/urban locations, we did not observe any statistically significant rural-urban differences in risks of second breast tumors. Neighborhood attributes may affect treatment and outcomes of patients with DCIS.

Physical activity among youth is shaped by the natural and built environment within which they live; however, few studies have focused on assessing playground safety and proximity in detail as part of the built environment for youth physical activity. We analyzed data on 100 publicly accessible playgrounds from Play Across St. Louis, a community-partnered study of the built environment for youth physical activity. Outcomes included overall playground safety, maintenance, and construction scores; distance to nearest playground; and distance to nearest top playground. Independent variables included neighborhood % youth, % black residents, % owner-occupied units, and % vacant units. Playgrounds in the city have varying degrees of safety and proximity. Mean overall playground safety score was 67.0 % (CI = 63.5, 70.4). Neighborhood % youth and % black residents were inversely associated with overall playground safety (p = 0.03 and p < 0.01) and maintenance (p < 0.01 and p < 0.0001). Mean distance to nearest playground was 638.1 and 1488.3 m to nearest top playground. Clusters of low safety scores were found in the northern and central areas while all high safety score clusters were found in the southern part of St. Louis. Public playground safety and proximity vary across St. Louis neighborhoods, especially by neighborhood demographics. Disparities in playground safety and proximity reveal an opportunity to develop community-wide interventions focused on playgrounds for youth activity. Further work is needed to examine the association between playground safety, proximity, and use and youth physical activity and weight.

Purpose: Community-based training in public health research can build capacity for community-based participatory research (CBPR) and foster health partnerships between academics and stakeholders. We describe a community-academic partnership developed from a 15-week program, the Community Research Fellows Training (CRFT), designed to increase research literacy and facilitate equitable relationships in community/researcher collaborations and partnerships. The article provides a description of a community and faculty collaboration to conduct a participatory pilot research project that followed program completion.Methods: Four CRFT program alumni formed a community research team and selected a faculty mentor. After a request for proposal release, the team developed a pilot research proposal that addressed a concern for mental health among women experiencing economic stress. After completion of the pilot research, the community researchers elected to participate in two dissemination efforts, including a manuscript reflecting on their research experience. Team successes, challenges, and recommendations for future training are discussed.Results: Each member of the CRFT pilot research team reflects on how training prepared community members to conduct CBPR research through development and implementation of a pilot research project. Community researchers gained experience in grant proposal development, choosing appropriate health interventions, conducting in-person surveys and telephone interviews, and disseminating study findings.Conclusions: Providing training in public health research before community/researcher collaboration can increase community capacity to engage in research as equitable partners in research question development, study design, and data interpretation and dissemination. The project success suggests that this and similar programs maximize the potential of community-academic health partnerships to address health disparities.

The Community Research Fellows Training program is designed to enhance capacity for community-based participatory research; program participants completed a 15-week, Master of Public Health curriculum. We conducted qualitative, semistructured interviews with 81 participants from two cohorts to evaluate the learning environment and how the program improved participants' knowledge of public health research. Key areas that provided a conducive learning environment included the once-a-week schedule, faculty and participant diversity, and community-focused homework assignments. Participants discussed how the program enhanced their understanding of the research process and raised awareness of public health-related issues for application in their personal lives, professional occupations, and in their communities. These findings highlight key programmatic elements of a successful public health training program for community residents.

Active engagement in HIV clinical care, including uptake and adherence to antiretroviral therapy (ART), is necessary to optimize treatment benefit and can reduce the spread of HIV infection. Among a predominately minority sample of 303 HIV-infected men who have sex with men (MSM) who were either newly diagnosed with HIV or showed evidence of inconsistent engagement in HIV care, we explored rates of exposure to crime, sexual and physical trauma, and associations with factors potentially related to poor engagement in care. Two thirds of participants experienced a crime-related event, and nearly one third reported exposure to physical and/or sexual trauma. All three types of exposure were related to HIV stigma and to concerns about initiating ART. Associations between exposure and social support and HIV disclosure needs were also observed. Findings have implications for the role of trauma exposure and efforts to optimize treatment engagement for HIV-infected MSM.

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Engaging community members as collaborators in the research process is often the missing link to improving the quality and outcomes of health promotion activities, disease prevention initiatives, and research studies (Minkler, 2004; Minkler & Wallerstein, 2008). CBPR has been shown to be an effective strategy for improving community health and addressing health disparities, especially in marginalized populations (Israel et al., 2010; Viswanathan, 2004). One of the challenges to CBPR is to enhance the research capacity of communities through existing institutions such as community-based organizations (CBO's) that work with academic researchers. The processes and methods used by CBPR researchers vary by the research question, how the communities will benefit from the intended research or intervention, the public health issue being addressed, and the level of community competence. These factors may determine how a community can and will be engaged and the processes needed to build its capacity. Academic partners bring a variety of research methods to CBPR partnerships, and 715652P HPXXX10.

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