Kathryn Pitkin Derose

• RAND Corporation

Latinos have high rates of type 2 diabetes mellitus (T2DM) yet are characterized as having health-promoting social networks. The impacts of COVID-19 on personal networks were complex, especially in urban areas with high proportion of immigrants such as the Bronx in NYC. Our objective was to test the extent to which network characteristics increase...

Partnerships between public health and faith-based organizations draw on the strengths of both sectors to achieve a shared interest in promoting health and reducing disparities. However, information about implementation of faith and public health partnerships-particularly those involving diverse racial-ethnic groups-is limited. This paper reports o...

HIV-related stigmas contribute to disparities, and contact with HIV-positive individuals has been suggested to reduce stigma. Faith-based organizations have been recognized as important to stigma reduction efforts among African American populations; however, relatively few church-based studies have measured HIV-related stigma. This study uses basel...

Latino communities within the U.S. are disproportionately affected by persistent, high levels of untreated mental illness. Limited mental health literacy, stigma, and cultural factors are major contributors to Latino mental health treatment disparities. Although Latino individuals may be reluctant to seek out mental health professionals, they often...

Remittances confirm an immigrant's continued social membership in their country of origin and they have been associated with improved nutritional outcomes among those who receive them. Yet, the relationship between remittances and nutrition outcomes of remitters is not well understood. We use data from 81 Mexican immigrants living in the Bronx, New...

We conducted a cross-sectional secondary analysis of data from the 2012 National Congregation Study, a nationally representative survey of religious congregations in the United States ( N = 1,331). Multivariate logistic regression was used to identify congregational characteristics associated with providing substance use support programing. Nearly...

Background Regular physical activity (PA) contributes to positive health outcomes, but a minority of US adults meet minimum guidelines for moderate-to-vigorous PA (MVPA) and muscle-strengthening, and Latinos are less likely than whites to meet these guidelines. Public parks can be leveraged for community PA but tend to be underutilized, while churc...

Churches can be important settings for promoting physical activity (PA) among Latinx populations. Little is known about what factors across the church context-social, organizational, and physical (outdoor spaces)-are associated with Latinx PA to inform faith-based PA interventions. This study investigated associations of church contextual factors w...

Objective The purpose of the study is to present a comprehensive systematic review of the effects of park-based interventions on health outcomes among youth, defined as children and adolescents. Data Source Web of Science, MEDLINE, and Scopus databases searched through November 2020. Study Inclusion and Exclusion Criteria Interventions conducted...

Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, an...

Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and park-based physical activity include place-based interventions (e.g., park renovations) and person-based interventions (e.g., park-based walking or exercise classes). Using adapted...

Objective The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management. Design We conducted semi-structured interviews with PLHIV. We gener...

Latinos face healthcare access barriers and are highly religious. Church-based health interventions could help address these disparities. We conducted a systematic review of church-based health interventions among Latinos using multiple search terms and databases. The 21 articles reviewed represented 19 interventions. Only six were tested through f...

Background: Public parks serve as spaces within neighborhoods for encouraging a variety of physical and mental health-related behaviors. Over the past decade, there have been a number of interventions conducted in public parks, often aimed at improving an aspect of mental or physical health. A common type of park-based interventions is aimed at in...

Religious congregations can potentially reach disproportionately affected populations with HIV programming, however, factors that influence congregational involvement in HIV are not well-studied. Utilizing comparative case methods and in-depth qualitative data from a diverse sample of 14 urban congregations, we examine a range of attitudinal, organ...

Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and...

Context: Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants...

Women use parks less for physical activity than men, and explanations include gendered concerns regarding personal safety and access to walking paths. This study conducted mediation analyses to examine the effects of gender and presence of park walking path on park use, participation in park programs, and park-based physical activity through the hy...

Faith-based drug treatment programs are common, and many are implemented through congregations; however, little is documented about how congregations conceptualize and implement these programs. We use case study analysis to explore congregational approaches to drug treatment; qualitative findings emerged in three areas: (1) religion’s role in congr...

Church-based programs can act on multiple levels to improve dietary and physical activity behaviors among African Americans and Latinos. However, the effectiveness of these interventions may be limited due to challenges in reaching all congregants or influencing behavior outside of the church setting. To increase intervention impact, we sent mobile...

An HIV diagnosis may be associated with severe emotional and psychological distress, which can contribute to delays in care or poor self-management. Few studies have explored the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in low-resource settings. We conducted in-depth interviews with 30 women living with HIV in...

Food insecurity has been a persistent problem in the U.S., and yet over the past three decades, federally funded food programs have become more restrictive. Scholars and policymakers have inquired whether the nonprofit sector is increasing its food provision activities to address this unmet need. This study analyzes data from the U.S. Census and a...

Religious congregations play an important role in HIV prevention and care. However, most research on congregation-based HIV activities has focused on prevention. Using data from a nationally representative survey of U.S. congregations, this study found that 18.6% of congregations were engaged in some type of HIV activity; 8.7% engaged in prevention...

Purpose To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes. Design Cluster randomized controlled trial (pilot). Setting Two midsized (∼200 adults) African Am...

Background:: Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). Objective:: To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. Methods:: Thr...

Neighborhood parks are important venues for the urban population to do moderate-to-vigorous physical activity in leisure time. Parks can be particularly important for low-income neighborhoods, whose residents suffer from high rates of chronic diseases and may have less access to fee-based fitness exercise facilities. This study assessed the contrib...

Routine physical activity is important for everyone and most urban areas have an infrastructure of neighborhood parks that are intended to serve as a setting for recreation and leisure. However, parks are not used proportionally by all age groups, genders and socio-economic groups. This paper explores factors associated with park use by different a...

Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participator...

African Americans experience significant disparities in treatment access, retention, and quality of care for alcohol and drug use (AOD) problems. Religious congregations, often the first point of contact for help with AOD problems, can play an integral role in improving access to treatment. However, little is known about the role of African America...

Introduction: Crime and safety are often cited as potential hurdles to park use and park-based physical activity. Using comprehensive data sources including both objective and subjective measurements at the park level and the individual level, this study aimed to assess the association between crime rates and use of local parks in low-income urban...

Introduction: Physical inactivity is more prevalent among women than men and is related to poor health outcomes. Neighborhood parks constitute an important resource for physical activity (PA), however, previous studies of park users have found fewer women being physically active. Methods: We conducted a hierarchical mixed-effect regression analy...

Embedding health messages into sermons is a potentially valuable strategy to address HIV and other health disparities in churches that predominantly serve racial and ethnic minorities. This study explores implementation of an HIV sermon as part of a multi-component intervention in three churches (Latino Catholic, Latino Pentecostal, and African Ame...

Objective: This study assessed the prevalence of and factors associated with congregation-based programming in support of people with mental illness. Methods: To estimate the proportion of congregations that provide mental health programming, this study reports analyses of survey responses from the 2012 National Congregations Study, a nationally...

Purpose: Faith-based organizations may be effective in addressing HIV-related disparities, but few interventions have been implemented across diverse churches. The Facilitating Awareness to Increase Testing for HIV (FAITH) intervention harnessed peer leadership to decrease HIV stigma and promote HIV testing in African American and Latino congregati...

Background Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity. Methods We examined factors contributing to food insecurity among women l...

Project on food and nutritional security of women in the Dominican Republic: Interview guide (English translation). (PDF)

Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic,...

Although physical activity can help mitigate or prevent multiple chronic diseases, most people in the U.S., especially high-poverty minority groups, engage in insufficient levels of physical activity. To test ways to promote more physical activity in high-poverty area public parks we conducted a randomized controlled intervention trial. After compl...

This study summarizes more than a decade of research on how well neighborhood parks in Los Angeles support physical activity. Between 2003 and 2015, researchers at the RAND Corporation studied 83 parks in the city of Los Angeles, conducting thousands of observations and fielding nearly 28,000 surveys of park users and local residents. About half of...

Background The increasing proportion of women in the medical profession is a worldwide phenomenon often called the “feminization of medicine.” However, it is understudied in low and middle-income countries, particularly in Latin America. Methods Using a qualitative, descriptive design, we explored the influence of gender and other factors on physic...

Community-based human immunodeficiency virus (HIV) testing at religious congregations has been proposed as a potentially effective way to increase screening among disproportionately affected populations, such as those self-identifying as African American and Latino. Although congregations may provide reach into these communities, the extent to whic...

Congregation-based health program evaluations often rely on surveys, but little documentation is available regarding specific methods and challenges. Here we describe methods used to achieve acceptable response rates (73–79%) in a survey of HIV-related attitudes and behaviors in two African American and three Latino churches in high HIV-prevalence...

HIV-related stigma and mistrust contribute to HIV disparities. Addressing stigma with faith partners may be effective, but few church-based stigma reduction interventions have been tested. We implemented a pilot intervention with 3 Latino and 2 African American churches (4 in matched pairs) in high HIV prevalence areas of Los Angeles County to redu...

Physical activity is beneficial for health, but there are limited opportunities in urban areas to safely access public streets for traffic-free cycling, skating or walking. Ciclovías are open streets programs that close major roads to motor vehicles so they can be exclusively used by bicyclists and pedestrians. We estimated participation in one Los...

Religious congregations may be well equipped to address veterans' reintegration needs, but little is known about the prevalence and nature of such support. We conducted a mixed methods study using nationally representative congregational survey data and in-depth interviews with congregational leaders. Overall, 28 % of congregations nationally repor...

Concerns about safety and perceived threats have been considered responsible for lower use of parks in high-poverty neighborhoods. To quantify the role of perceived threats on park use, we systematically observed 48 parks and surveyed park users and household residents in low-income neighborhoods in the City of Los Angeles. Across all parks, the ma...

Faith-based organizations (FBOs) are an important community-based resource for veterans as they readjust to civilian life. Through interviews with both national-level and smaller, local FBOs, the authors sought to understand better the current and potential roles for FBOs in veteran reintegration. Interviewees suggested that veterans may look to FB...

Background: Food insecurity and poor nutrition are key barriers to anti-retroviral therapy (ART) adherence. Culturally-appropriate and sustainable interventions that provide nutrition counseling for people on ART and of diverse nutritional statuses are needed, particularly given rising rates of overweight and obesity among people living with HIV (...

Racial-ethnic disparities in physical activity present important challenges to population health. Public parks provide access to free or low-cost physical activity opportunities, but it is unclear to what extent parks are utilized by various race-ethnic groups in diverse urban settings. Here, we examine racial ethnic differences in park use and phy...

Objectives: To inform church-based stigma interventions by exploring dimensions of HIV stigma among African American and Latino religious congregants and determining how these are related to drug addiction and homosexuality stigmas and knowing someone HIV-positive. Method: In-person, self-administered surveys of congregants 18+ years old across 2 A...

This study aims to examine the reliability of a 12-button counter to simultaneously assess physical activity by age and gender subgroups in park settings. A total of 1,160 pairs of observations were conducted in 481 target areas of 19 neighborhood parks in the great Los Angeles area between June 2013 and March 2014. Inter-rater reliability was asse...

Faculty, students, and alumni in a university-based kinesiology program developed an innovative model for health promotion practice by partnering with the local park administration in San Fernando, California to offer these exercise classes for free in a low-income, predominantly Latino neighborhood park. The classes were taught by students as prac...

There is a large literature on promotores' involvement in health promotion and a smaller literature on their roles in data collection, most often among predominantly Latino populations. But the extent to which promotores can be successful as the primary data collectors across racially/ethnically and socioeconomically diverse neighborhoods is less w...

Substance use patterns among Latinos likely reflect changes in attitudes resulting from acculturation, but little is known about Latinos' attitudes regarding drug addiction. We surveyed a church-based sample of Latinos and African Americans (N = 1,235) about attitudes toward drug addiction and socio-demographics. Linear regression models compared L...

Faith-based organizations can be key settings in which to reach African Americans and Latinos for HIV prevention, but little is known regarding factors that predict congregants' HIV testing behaviors. We examined the extent to which sociodemographic factors, HIV-related cues to action (e.g., knowing someone who is HIV-positive), and the social clim...

Optimal strategies to improve food security and nutrition for people living with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern. However, no studies among PLHIV have investigated the impact of food support on nutritional outcomes in these settings. We therefore assessed the...

Background: Overweight is an important risk factor for cardiovascular disease and is of increasing concern among people with HIV on antiretroviral therapy. Objective: To estimate overweight prevalence among Panamanian HIV-infected adults. Methods: A cross-sectional study was conducted from November 2013 to March 2014 in 2 HIV care centers in La Cho...

Objective: To quantify the contribution of neighborhood parks to population-level, moderate-to-vigorous physical activity (MVPA). Method: We studied park use in 83 neighborhood parks in Los Angeles between 2003 and 2014 using systematic observation and surveys of park users and local residents. We observed park use at least 3-4 times per day ove...

Purpose Identify and compare predictors of the existence of congregational human immunodeficiency virus (HIV) and other health programs. Design Cross-sectional study. Setting United States. Subjects A nationally representative sample of 1506 U.S. congregations surveyed in the National Congregations Study (2006–2007). Measures Key informants at...

Food insecurity and malnutrition negatively affect adherence to antiretroviral therapy (ART) and are associated with poor HIV clinical outcomes. We examined the effect of providing household food assistance and nutrition education on ART adherence. A 12-month prospective clinical trial compared the effect of a monthly household food basket (FB) plu...

Prior literature on social capital and health has predominantly focused on health outcomes and individual access to healthcare services. It is not known to what degree, if any, community social capital influences the performance or behaviors of public hospitals, a key source of healthcare for disadvantaged communities in the United States. In this...

To describe implementation of a randomized controlled trial of community-based participatory research (CBPR) approaches to increase park use and physical activity across 33 diverse neighborhoods in Los Angeles. Fifty parks were randomly assigned based on park size, facilities and programs, and neighborhood socio-demographic characteristics to: park...

Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities.

HIV-related stigma negatively affects prevention and care, and community-based interventions are needed. Here we describe the development of a multi-ethnic, faith-based intervention to reduce HIV stigma that included: educational workshops on HIV, testing, and stigma; peer leader workshops using role plays and drawing on principles of motivational...

Purpose To assess the use of new pocket parks in low-income neighborhoods. Design The design of the study was a quasi-experimental post-test only comparison. Setting Los Angeles, California, was the setting for the study. Subjects Subjects were park users and residents living within .5 mile of three pocket parks and 15 neighborhood parks. Inter...

Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found...

Poor nutrition and food insecurity negatively affect antiretroviral adherence and HIV outcomes, but few relevant interventions have been documented in Latin America and the Caribbean (LAC). RAND and the World Food Program formed a partnership to develop and evaluate pilot projects that address the nutritional needs and food insecurity among PLHIV i...

Background. HIV is a critical health concern, but many infected persons are unaware of their status because they have not been tested. Despite documented disparities, many African Americans and Latinos remain untested, due in part to poor access to medical services. One way to increase screening is to expand testing services to community settings,...

Physical inactivity is an important health risk factor that could be addressed at the community level. The goal of the study was to determine whether using a community-based participatory approach with park directors and park advisory boards (PABs) could increase physical activity in local parks. Whether involving PABs would be more effective than...

This paper examines facilitators and barriers to HIV activities within religious congregations, the relative internal or external sources of these influences, and suggestive differences across congregational types. Results are based on in-depth interviews with clergy and lay leaders (n = 57) from 14 congregations in Los Angeles County, California,...

Purpose Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Design Multiple case studies. Setting Los Angeles County, California. Participants Purposive sample of 14 congregations representing diverse races/ethnicities (African-American, Latino, and white) and fa...

Introduction: Health and development organizations increasingly promote livelihood interventions to improve health and economic outcomes for people living with HIV (PLHIV) receiving treatment with antiretroviral therapy (ART). In-depth understanding about how PLHIV make labor decisions in the context of treatment for HIV - and treatment decisions...

Community health centers (CHCs) play a critical role in the primary care safety net. Partnerships between CHCs and faith-based organizations are promoted as a way to increase outreach to underserved populations and support health-promoting behaviors and effective disease management. Through six focus groups (totaling 58 participants), we explored l...

Most religious congregations in the USA are involved with some type of social service activity, including health activities. However, relatively few formally engage with people with HIV, and many have reported barriers to introducing HIV prevention activities. We conducted a qualitative case study of HIV involvement among 14 urban congregations in...

Background: Faith-based organizations are uniquely positioned to address the HIV epidemic. They represent trusted social networks that can disseminate health information, and many have a history of engaging in social issues. However, few congregations have developed HIV programs. We examined the extent to which congregational factors and community...

Issues: Religious congregations in African American and Latino communities are uniquely positioned to address HIV. However, few have done so, in part because of HIV-related stigma and discomfort with harm reduction strategies. Description: Through a partnership between a research organization, religious leaders, and a local health department, we...

A rich literature indicates that individuals of lower socio-economic status engage in less leisure time physical activity than individuals of higher socio-economic status. However, the source of the difference is believed to be, in part, due to differential access to resources that support physical activity. However, it has not been shown as to whe...

Over the past 15 years, striking new settlement patterns have emerged that have brought about unprecedented geographic dispersion in the population of approximately 45 million Hispanics in the United States. In this study, the authors compare the health care experiences of working age U.S.-born Mexican Americans and Mexican immigrants living in new...

Parks provide numerous opportunities for physical activity (PA). Previous studies have evaluated parks' physical features, but few have assessed how park staff influence PA. We conducted semistructured interviews with 49 park directors, focusing on perceptions of their role, park programs, marketing and outreach, external collaborations, and PA pro...

This study explores how religious congregations interact with other community organizations to address health and, in particular, HIV-related needs within their membership and/or local communities. Case study data from a diverse sample of 14 urban congregations (6 Black, 4 Latino, 2 White, and 2 mixed race-ethnicity) indicate that they engaged in t...

To develop a culturally appropriate, multi‐component nutrition intervention for people living with HIV in Honduras, and test its effect on ART adherence. 401 adults receiving ART who showed household food insecrity and/or undernutrition were recruited from four HIV clinics received nutritional assessment and dietary counseling, and were followed at...

HIV-related stigmas have been seen as a barrier to greater religious congregation involvement in HIV prevention and care in the United States and elsewhere. We explored congregational and community norms and attitudes regarding HIV, sexuality, and drug use through a qualitative case study of 14 diverse religious congregations in Los Angeles County,...

Research has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking. The authors used multivariable logistic regression to examine the effects of...

Attempts to explain disparities in access to health care faced by racial and ethnic minorities and other underserved populations often focus on individual-level factors such as demographics, personal health beliefs, and health insurance status. This article proposes an examination of these disparities-and an effort to redress them-through the lens...

Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural...

Limited literacy contributes to suboptimal care and outcomes for patients. The Institute of Medicine noted that future work in health literacy should consider multiple literacy skills. However, lacking empirical evidence of the relationship between different literacy skills, reading skills are often used as proxies of literacy in research and pract...

Coronary heart disease (CHD) is a leading cause of morbidity and mortality. Reducing the disease burden requires an understanding of factors associated with the prevention and management of CHD. Literacy skills may be one such factor. To examine the independent and interactive effects of four literacy skills: reading, numeracy, oral language (speak...

Poor nutrition and food insecurity are emerging as important barriers to antiretroviral therapy access and adherence in low-resource settings, yet little is known about these barriers in Latin America and Caribbean. This qualitative study used community expert interviews to explore the links between food insecurity, undernutrition, and HIV/AIDS tre...

Faith-based organizations (FBOs) have historically played an important role in delivering health and social services in developing countries; however, little research has been done on their role in HIV prevention and care, particularly in Latin America. This article summarizes a study that describes FBO involvement in HIV/AIDS in three Central Amer...

Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations. Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in...

Religious organizations may be uniquely positioned to address HIV by offering prevention, treatment, or support services to affected populations, but models of effective congregation-based HIV programs in the literature are scarce. This systematic review distils lessons on successfully implementing congregation HIV efforts. Peer-reviewed articles o...

Prison inmates are disproportionately sicker than the general population and upon release from prison often face serious gaps in potential access to care (accessibility and capacity of safety-net providers), particularly among certain racial ethnic groups and for specific types of service (primary care, mental health care, or alcohol/drug treatment...

Comparative case studies were used to explore religious congregations' HIV involvement, including types and extent of activities, interaction with external organizations or individuals, and how activities were initiated and have changed over time. The cases included 14 congregations in Los Angeles County representing diverse faith traditions and ra...