Objective: More than 3.5 million female breast cancer (BrCa) survivors live in the United States, and the number continues to grow. Health status and quality of life among survivors are variable, and African American (AA) survivors suffer disproportionately from BrCa morbidity and mortality. Emerging evidence suggests that peer support is an effective strategy to promote positive survivorship outcomes for AA BrCa survivors. This study aimed to explore the role of peer support in the BrCa experiences of AA survivors.Methods: Working collaboratively with The Breakfast Club, Inc. (BCI), a communitybased BrCa peer support organization, we conducted a quasiexperiment to compare the BrCa experiences of AA survivors. We conducted in-depth interviews with two survivor groups (N = 12 per group), categorized according to receiving peer support during their BrCa experiences. Results:Survivors who received peer support reported greater access to and utilization of alternative support sources, more capacity to process BrCa-related stress, and improved quality of life and adjustment to life as BrCa survivors compared with those who did not receive peer support. Conclusions: Peer relationships provide consistent, quality social support.Consistent peer support helps survivors cope with the continued stress of BrCa, with implications for psychosocial health and quality of life. Findings expand our current understanding of peer support and may enable public health and clinical practitioners to better recognize and intervene with those for whom additional support services are needed. KEYWORDSAfrican Americans, breast neoplasms, cancer, cancer survivors, health status disparities, health care disparities, minority health, oncology, peer support, social support 1 | BACKGROUND More than 3.5 million female breast cancer (BrCa) survivors live in the United States, a number projected to exceed 4.5 million by 2026, 1,2 highlighting the need for comprehensive survivorship care following BrCa diagnosis. BrCa survivors face multiple challenges with † Mayo Clinic, Rochester, MN

Increasing public health interventions aimed at educating people with diabetes about self-management could improve outcomes.

In the early 1990s, St. Louis County had multiple foodservice worker-related hepatitis A outbreaks uncontrolled by standard outbreak interventions. Restaurant interest groups and the general public applied political pressure to local public health officials for more stringent interventions, including a mandatory vaccination policy. Local health departments can enact mandatory vaccination policies, but this has rarely been done. The study objectives were to describe the approach used to pass a mandatory vaccination policy at the local jurisdiction level and illustrate the outcome from this ordinance 15 years later. A case study design was used. In-depth, semi-structured interviews using guided questions were conducted in spring, 2015, with six key informants who had direct knowledge of the mandatory vaccination policy process. Meeting minutes and/or reports were also analyzed. A Poisson distribution analysis was used to calculate the rate of outbreaks before and after mandatory vaccination policy implementation. The policy appears to have reduced the number of hepatitis A outbreaks, lowering the morbidity and economic burden in St. Louis County. The lessons learned by local public health officials in passing a mandatory hepatitis A vaccination policy are important and relevant in today's environment. The experience and lessons learned may assist other local health departments when faced with the potential need for mandatory policies for any vaccine preventable disease.

tion between self-management behaviors and DSME. Results: Adjusted logistic regression revealed that all three self-management behaviors were significantly associated with diabetes education. Respondents who reported not engaging in physical activity were significantly less likely to engage in diabetes education compared to those that engaged in physical activity (aOR = 0.73; 95% CI: 0.66 -0.81). Respondents who reported never checking their feet for sores compared to those that reported checking their feed one or more times per day were significantly less likely to engage in diabetes education (aOR = 0.40; 95% CI: 0.34 -0.47). Respondents who reported checking blood sugar once a week, month or year (aOR = 0.78; 95% CI: 0.69 -0.87), and respondents who reported never checking their blood sugar (aOR = 0.44; 95% CI: 0.36 -0.54) were significantly less likely to engage in diabetes education compared to those that reported checking their blood sugar one or more times per day. ConClusions: Self-management behaviors are strongly associated with diabetes education. Increasing public health interventions aimed at educating diabetics would provide a means for improving outcomes and decreasing costs.