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Browsing by Author "Foster, Pamela"

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    African American Clergy Recommendations to Enhance the Federal Plan to End the HIV Epidemic: A Qualitative Study
    (Springer, 2022) Arnold, Trisha; Haynes, Tiffany; Foster, Pamela; Parker, Sharon; Monger, Mauda; Malyuta, Yelena; Cain, Othor; Coats, Cassie Sutten; Murphy, Matthew; Thomas, Gladys; Sockwell, Latunja; Klasko-Foster, Lynne; Galipeau, Drew; Dobbs, Thomas E.; Smith, Michelle; Mena, Leandro; Nunn, Amy; Brown University; Lifespan Health Rhode Island; Rhode Island Hospital; University of Arkansas Medical Sciences; University of Alabama Tuscaloosa; University of North Carolina; North Carolina A&T State University; University of Mississippi; University of Mississippi Medical Center; University of Pennsylvania; Miriam Hospital
    African Americans in the southern United States continue to be disproportionately affected by HIV. Although faith-based organizations (FBOs) play important roles in the social fabric of African American communities, few HIV screening, care, and PrEP promotion efforts harness the power of FBOs. We conducted 11 focus groups among 57 prominent African American clergy from Arkansas, Mississippi, and Alabama. We explored clergy knowledge about the Ending the HIV Epidemic: A Plan for America (EHE); normative recommendations for how clergy can contribute to EHE; and how clergy can enhance the HIV care continua and PrEP. We explored how clergy have responded to the COVID-19 crisis, and lessons learned from pandemic experiences that are relevant for HIV programs. Clergy reported a moral obligation to participate in the response to the HIV epidemic and were willing to support efforts to expand HIV screening, treatment, PrEP and HIV care. Few clergy were familiar with EHE, U = U and TasP. Many suggested developing culturally tailored messages and were willing to lend their voices to social marketing efforts to destigmatize HIV and promote uptake of biomedical interventions. Nearly all clergy believed technical assistance with biomedical HIV prevention and care interventions would enhance their ability to create partnerships with local community health centers. Partnering with FBOs presents important and unique opportunities to reduce HIV disparities. Clergy want to participate in the EHE movement and need federal resources and technical assistance to support their efforts to bridge community activities with biomedical prevention and care programs related to HIV. The COVID-19 pandemic presents opportunities to build important infrastructure related to these goals.
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    COVID-19 Pandemic Implications on College Undergraduates' College Experience
    (University of Alabama Libraries, 2024) McIntyre, Alissa Carolina; Allen, Rebecca S.
    Since early 2020, high school students have been greatly affected by the COVID-19 pandemic, resulting in various life changes and challenges pertaining to graduating and moving onto post-secondary educational opportunities. Previous research suggests that after the pandemic, college-aged adults reported increased anxiety and stress due to social distancing and isolation. However, there is little literature that examines the relation between COVID-19 pandemic stress and college experiences. The purpose of this study was to better understand the impact and implications of COVID-related exposure, such as isolation, social distancing, masking, vaccination controversies, and adverse health outcomes, on college students' anxieties early in their college experience. This study aimed to understand the effects of COVID-related adversities on health and psychosocial factors relating to anxiety among undergraduate college students. To measure this, participants completed an online Qualtrics survey lasting 20-30 minutes that consisted of items regarding generalized and social anxiety, self-efficacy, first-year college experiences, and everyday experiences concerning COVID-19. It is hypothesized that college students will report greater overall anxiety due to experiencing COVID-related exposures and to adjusting to living an independent life in college. Study design included a multiple linear equation model to examine the association of COVID-19 pandemic experiences and everyday college experiences on generalized anxiety, social anxiety levels, and sense of general self-efficacy. Results showed a significant effect of COVID-19 experiences and high self-reported social anxiety, more so than generalized anxiety. Understanding the impact the COVID-19 pandemic had on college students' experience is important for future research examining cohort effects on experienced anxiety throughout the adult lifespan, along with experienced anxiety during a global outbreak.
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    Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality
    (Springer, 2019) Nunn, Amy; Jeffries, William L.; Foster, Pamela; McCoy, Katryna; Sutten-Coats, Cassandra; Willie, Tiara C.; Ransome, Yusuf; Lanzi, Robin Gaines; Jackson, Edward; Berkley-Patton, Jannette; Keefer, Michael; Coleman, Jason D.; Brown University; Centers for Disease Control & Prevention - USA; University of Alabama Tuscaloosa; University of Washington; University of Washington Bothell; Yale University; University of Alabama Birmingham; University of Missouri Kansas City; University of Rochester
    Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.
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    Understanding the Drivers of Vaccine Hesitancy During COVID-19 in Mississippi, United States
    (University of Alabama Libraries, 2025) Naher, Shabnam; Hites, Lisle
    This dissertation examines vaccine hesitancy in Mississippi, a state with low vaccination rates and healthcare disparities. Using a quantitative approach with secondary data, guided by the Health Belief Model and Social Ecological Model, this study explores vaccine acceptance through three interconnected papers. The first two analyze data from the “Mississippi State Department of Health Vaccine Confidence Survey”, while the third uses the “Mississippi Medical Professional Vaccine Confidence Survey”. In the first study, I explored how physician-participant demographic concordance affects vaccine intentions. Race-concordant physician trust consistently associated with lower vaccine intentions, potentially reflecting deep-rooted historical (mis)trust. Gender- and age-concordant trust initially showed negative associations but shifted after adjusting for demographic and socioeconomic factors. Subgroup analyses revealed that race-concordant trust increased intentions among both White and Black participants, while gender-concordance was linked to lower intentions for both men and women. Age-concordance negatively influenced older adults’ intentions. Education, income, and widowhood increased vaccine confidence; however, private/no insurance and Republican affiliation lowered it. Physician diversity is likely to improve trust; however, Mississippi’s provider shortage necessitates practical strategies to increase representation where feasible.In the second study, I examined demographic predictors of two domains of vaccine concerns: health risk and trust, and efficacy and timing. Older age and higher education correlated with reduced health risk and trust concerns, while Black participants reported more skepticism. Education also corresponded with slightly greater concerns about efficacy and timing, particularly among women. Higher income decreased overall concerns, whereas Republican affiliation was linked to lower perceived safety and effectiveness. In my third paper, I examined how demographic and decision-making factors influence HCWs' vaccine advocacy. Conspiracy-related concerns reduced vaccine promotion, while risk and safety concerns were not predictive. Political affiliation was non-significant, though Independents trended toward greater encouragement than Republicans. Gender had no significant effect. Interaction analysis revealed no moderating effects of gender or political affiliation, reinforcing that attitudinal rather than demographic factors drive hesitancy. Given the small sample and exclusion of pediatric providers, results should be interpreted cautiously. Findings highlight the need for HCW training, peer influence, and (mis)information correction to strengthen vaccine promotion in MS.
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    A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial
    (Oxford University Press, 2011) Estrada, Carlos A.; Safford, Monika M.; Salanitro, Amanda H.; Houston, Thomas K.; Curry, William; Williams, Jessica H.; Ovalle, Fernando; Kim, Yongin; Foster, Pamela; Allison, Jeroan J.; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; University of Alabama Birmingham; VA Tennessee Valley Healthcare System; Geriatric Research Education & Clinical Center; Vanderbilt University; University of Alabama Tuscaloosa; University of Massachusetts Worcester
    To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control. Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physicians practice. Eleven US Southeastern states, 200608. Two hundred and five rural primary care physicians. Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools. oAcceptable control' [hemoglobin A1c 9, blood pressure (BP) 140/90 mmHg, low-density lipoprotein cholesterol (LDL) 130 mg/dl] and ooptimal control' (A1c 7, BP 130/80 mmHg, LDL 100 mg/dl). Of 364 physicians attempting to register, 205 were randomized to the intervention (n 102) or control arms (n 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c 9 was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95 confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95 CI: 0.80, 1.69)]; BP 140/90 mmHg and LDL 130 mg/dl were also similar at both measurement points (P 0.66, P 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.481.8) for a median total of 37 min (IQR: 1666). A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US.