Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

Awareness of Hospice Care Among Rural Residents: Findings from Social Determinants of Health Framework

Although the demand for hospice care increases as our society ages, the awareness of hospice care among adults in the southern rural region of the US has not been documented. This study aims to assess the rate of hospice care awareness among rural residents living in the Black Belt Region and examine social determinants of health (SDH) associated with the awareness. A cross-sectional survey was conducted among a convenient sample living in rural Alabama (N=182, age=18-91). Participants’ awareness of hospice care, demographic characteristics (i.e., age, gender), and SDH (i.e., financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and awareness of hospice care among participants while controlling for demographic characteristics. The majority of participants had heard of hospice care (82.4%), and older participants (over 50 years old) were more likely to report having heard of hospice care (OR=7.35, p&lt;0.05). Participants reporting worries about stable housing (OR=0.05, p&lt;0.05) and higher social isolation were less likely to have heard of hospice care (OR=0.53, p&lt;0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR=2.60, p&lt;0.01). Our study is the first study assessing the status of hospice care awareness among residents living in the Black Belt Region. This study highlighted that factors including age and certain SDH (i.e., housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice care awareness.

Intention to Communicate End-of-Life Wishes among Rural African Americans: Is Awareness of Hospice Care Important?

The intention to communicate end-of-life wishes and its related factors among adults in the southern rural region of the US has not been studied. This study aims to: (1) assess the intention to communicate end-of-life wishes among rural residents living in the Black Belt Region; (2) controlling for demographics and social determinants of health (SDH), examine the relationship between awareness of hospice care and the intention to communicate end-of-life wishes. A convenient sample living in rural Alabama was collected to complete a cross-sectional survey (N=182, age=18-91). Univariate analyses were conducted to assess participants’ intention to communicate end-of-life wishes, demographic characteristics, and SDH. Binary logistic regressions were used to examine the relationship between awareness of hospice care and the intention to communicate end-of-life wishes while controlling for demographics and SDH. The majority of participants were willing to communicate end-of-life wishes to their family (77.5%) or doctors (72.5%). Participants who were aware of hospice care were more likely to be willing to communicate end-of-life wishes to both their families (OR=10.08, p&lt;0.01) and doctors (OR=7.20, p&lt;0.05). Moreover, participants who were older were less likely to communicate end-of-life wishes to their doctors while participants with higher social isolation scores had lower intention to communicate end-of-life wishes to their families (OR=0.53, p&lt;0.05). This is the first study assessing the intention of communicating end-of-life wishes among residents living in the Black Belt Region. This study demonstrated that awareness of hospice care is positively associated with the intention to communicate end-of-life wishes to both families and doctors.

“We’re Not Meat Shamers. We’re Plant Pushers.”: How Owners of Local Vegan Soul Food Restaurants Promote Healthy Eating in the African American Community

Obesity remains a prevalent public health epidemic, and African American (AA) adults are disproportionately affected by obesity more than any other ethnic group, particularly in the Southern region of the United States. Addressing poor dietary habits is important for improving obesity rates among AAs, but there has been limited research that has focused on specifically developing culturally tailored interventions. With a recent number of soul food restaurants serving exclusively vegan meals opening up across the country to appeal to AAs and others interested in eating healthier soul foods, there is a unique opportunity to explore how these restaurants might impact AA dietary habits. The purpose of this study was to assess how owners of vegan soul food restaurants located in states within the Black Belt region view their roles as promoters of health in their community and to identify strategies that they use to make plant-based diets (PBDs) more culturally appealing in the AA community. In-depth interviews were conducted with owners ( N = 12) of vegan soul food restaurants from seven states. Five themes emerged from the interviews related to (a) the restaurants providing access to vegan meals, (b) restaurant owners educating their customers about vegan diets and healthy eating, (c) using fresh ingredients to make vegan soul foods taste good, (d) addressing limited cooking skills among AAs, and (e) discussing nonhealth reasons to become vegan. The findings indicate there may be future opportunities for health educators to partner with these restaurant owners to improve healthy eating among AAs.

Community-based Organizations and Issues in Community Development in an Era Constant Change

The failure of top-down categorical approaches for generating solutions to many local problems has led to the adoption of alternate approaches. Many scholars believe that a confluence of local and global forces have generated complex problems, which call for new approaches to problem solving. Previously, the top-down approach relied entirely on the knowledgeable elite. Communities were seen as passive study subjects and information flow was one way only- from knowledgeable elites to the less knowledgeable community agents or community-based organization acting on behalf of communities. The objectives of this study are to provide a review of governance as a means of organizing community action to address community problems in the Black Belt Region (BBR) of the Southeastern United States, and an assessment of community problems in the BBR from the perspectives of community-based organizations (CBOs). Data was collected from CBOs via a telephone survey in eleven Southeastern states and via listening sessions conducted with CBOs in 9 Southeastern states. The study provides valuable insight regarding the challenges faced by these organizations and strategies they employ in adapting to serve their communities.

STEM Education in Rural Areas

Science, technology, engineering, and mathematics (STEM) education is challenged to produce enough graduates to maintain nationwide STEM workforce needs. This chapter discloses the importance of STEM education for developing a more scientifically literate citizenry prepared to face the challenges of an increasingly technological society and meet U.S. workforce demands. An examination of the state of STEM education reveals its current inability to produce enough qualified graduates to meet current and future needs. The researchers propose looking towards rural areas to supply the STEM pipeline running from college to STEM career. In order to capitalize on the rural school population, programs are needed to address the barriers between the rural student and college. This chapter outlines and expounds these barriers as well as introduces Project Engage as one such program determined to prepare rural students from the Alabama Black Belt region, particularly rural minority students, for STEM futures.