Functional capacity and depressive symptoms were analyzed as outcomes respectively. Of the 2370 men, 1434 (60.5%) lived with women who had experience as a health promotion volunteer in the past. Modified Poisson regression analysis adjusting for covariates showed that living with women who had this experience was inversely associated with depressive symptoms , but not with low functional capacity. These results suggest that living with women who had the experience as health promotion volunteer might affect depressive symptoms of elderly men.In Japan, there are traditionally many health promotion volunteer activities. However, the effects these activities have on the volunteers’ families are not clear. This study examined whether the well-being of Japanese elderly men was affected by cohabiting with women who have had experience as a health promotion volunteer. The study area was Suzaka City, where more than 7500 women have been elected and served as health promotion volunteers for over 60 years. A cross-sectional survey targeting all residents aged 65 years or over was conducted in 2014 using a self-administered questionnaire and 10,758 (77.7%) residents participated. Of those, married men who lived with married women were analyzed ( There are a variety of health promotion volunteer organizations (a type of community organization) and activities in Japan, which operate under the support of a municipal public health nurse. Further, health promotion volunteering has played an important role in public health in Japan. For example, the Nagano prefecture, which is located in central Japan and had the highest average life expectancy for both men and women in 2010 . These vSeveral studies have suggested that experience as a health promotion volunteer is associated with the volunteer’s own health behaviors, health literacy, and health conditions ,5,6,7. FThe purpose of the current study is to examine whether the well-being of elderly men is affected by cohabiting with women who have had experience as a health promotion volunteer. The study was conducted using cross-sectional survey data in a Japanese suburban city, where more than 7500 women have been elected and served as health promotion volunteers for over 60 years.The study area was Suzaka City, Nagano prefecture, Japan, which is located adjacent to the prefectural capital  of its population of 52,176 were aged 65 years or older). Suzaka City’s health promotion volunteer organization (“Hoken-hodouin” organization) has the oldest history in Nagano prefecture and was originally established in 1945 in the former Takaho village, based on the idea of using women residents and the village’s public health nurses collaboratively to improve hygiene and prevent infectious disease . The eleA self-administered cross-sectional questionnaire survey on health and daily life, including questions about women’s experience as health promotion volunteers, was conducted in Suzaka City. The target population were those aged 65 or older as of 1 February 2014. However, those who were facility residents, hospital inpatients, or who met degree 4 or more (out of 5) in their long-term care insurance service were excluded from the survey. Long-term care insurance services comprise the national health service in Japan, for which every Japanese person aged 65 and older is eligible . Degree n = 763), who had no other women respondent in the same household (n = 1009), who were living with two or more respondents, (n = 98), who were living with unmarried woman or married woman who were older or younger than the men by more than 10 years (n = 155), and had missing values for covariates (n = 405). After these exclusions, we were left with 2370 whose data were analyzed in the study  were men. In this study, we intended to analyze men from married couples. However, in this dataset, we could not identify the respondents’ marital relationship who was married with whom, even if we could identify the respondents’ marital status and household information. Therefore, we analyzed the data from married men who lived with married women who were close in age (plus or minus 10 years from the man’s age), suggesting that they were the man’s spouse. Of the participating men, we excluded those who were not married , the responses of women from the same household were dichotomized into “not experienced” or “experienced”. “Experienced” meant that the cohabiting women would have served as a health promotion volunteer for two years. In addition, within “experienced”, the following three subcategories were also set: years since experience , leadership role , and satisfaction with the experience .We set two outcomes which represented well-being in elderly people: functional capacity and depressive symptoms. Functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which measures higher-level competence, such as instrumental self-maintenance, intellectual activity, and social role in elderly people using 13 items . The cutIn addition to age, socioeconomic status, health condition, and health-related behavior of the study population were considered as covariates that might be related to the well-being of elderly people. Educational attainment and equivalent household income  were selected to represent socioeconomic status; history of major diseases was selected to represent health condition; and exercise habits, consciousness of healthy eating habits, current drinking, and current smoking were selected to represent health-related behaviors. Equivalent household income was obtained from the Suzaka City database of administrative information, and the other covariates were from the questionnaire. History of major diseases was defined as having any one of the following diseases known to be causes of death or disability in older adults; stroke, myocardial infarction/angina, diabetes, Parkinson’s disease, femoral neck fracture, and cancer. Age was a continuous variable, and the other covariates were divided into two or four categories each: educational attainment (“≥10 years” and “<10 years”); equivalent household income ; history of major diseases (“no” and “yes”); exercise habits (“one hour or more per week” and “less than one hour per week”); consciousness of healthy eating habits (“conscious” and “not conscious”); current drinking (“no” and “yes”); and current smoking (“no” and “yes”).p < 0.05. All analyses were performed with STATA, version 14.0 .Prevalence ratios (PRs) of low functional capacity and depressive symptoms were estimated respectively using a modified Poisson regression analysis to analyze whether the cohabiting women’s experience as a health promotion volunteer was associated with the well-being of the study population. The modified Poisson regression analysis rectify variance overestimation that occur when Poisson regression is applied to binary data and estimate effect measure directly by using a robust error variance . The refn = 2370) was 74.8 years . n = 1434) lived with women who had experience as a health promotion volunteer. These respondents were older, more educated, and had a higher equivalent household income than those who did not live with women who had experience.The mean age of the study population . However, the characteristics of the study population  showed tIn addition, depressive symptoms in elderly men might be affected by cohabiting women’s depressive symptoms itself. Previous studies have indicated that there is concordance in health status including depressive symptoms within married couples ,16. It mWe also examined the differences in the results depending on how long ago the women served as a health promotion volunteer, experience in a leadership role, and satisfaction with their experience. In terms of how long since the experience, the lowest adjusted PR for depressive symptoms was found in the category of “0–19 years”. This suggests that shorter the period since the served term as a health promotion volunteer, the more the experience might remain and be strongly associated with well-being of men from the same household. Further, in terms of experience in a leadership role, the lowest adjusted PR for depressive symptoms was found in in the “yes” group. It has previously been found that the numbers of days in which women took part in activities during their term were higher in the health promotion volunteers in a leadership position compared with those who were not . This meOne of the advantages of this study was a relatively high response rate of the survey (77.7%), which can be considered to reflect the actual condition of the elderly people in Suzaka City well. In addition, our study considered not only medical history and health-related behaviors, but also socioeconomic status, including objective data on household income as covariates. There were, however, a number of limitations. First, there was a possibility of reverse causation. The results of this study might not indicate that the well-being of men was affected by the cohabiting women’s experience as a health promotion volunteer, but instead it may indicate that women in a household in which the well-being of cohabiting men may be elected as a health promotion volunteer more easily. However, health promotion volunteers in Suzaka City are elected mainly through a rotation system and serve 2-year terms . TherefoIn conclusion, cohabiting women’s experience as a health promotion volunteer was inversely associated with depressive symptoms in elderly men from the same household, but not with functional capacity. In addition, the association were stronger when the women had volunteered 0–19 years ago, had experience in a leadership role, and had a higher satisfaction with the experience. These results give a suggestion to other regions  that, in public health initiatives, elderly men may have better well-being by educating health promotion volunteers effectively.


Latent class analyses were used to establish activity profiles and determine class membership; ANCOVA was used to investigate differences in mental wellbeing  and perceived overall health between groups. Data came from a cross-sectional, population-level child self-report survey  implemented with 4th grade children in public schools. We found four distinct ECA profiles: participation in “All Activities”, “No activities”, “Sports” , and “Individual activities” . Wellbeing and health scores were highest for children in the “All Activities” and the “Sports” clusters, and lowest for those in “No Activities” and the cluster reflecting individual activities . Results are discussed in the context of previous research, and with respect to practical relevance.This study examined profiles of participation in extracurricular activities (ECAs) in 4 There has been much interest in understanding the ways in which children and youth spend their time after school, and how these experiences are associated with developmental outcomes . This inth grade students in British Columbia (BC), Canada. Our goal was to identify profiles of extracurricular participation, and to investigate whether membership in an extracurricular profile group was associated with differences in children’s wellbeing  and their perceived overall health. Our research builds on previous studies that have identified links between participation in ECAs and a range of positive developmental outcomes. For example, in research with children and adolescents in the United States, extracurricular engagement was positively related to academic performance  compared to children who reported only English as their first language . The pattern was reversed for the clusters “Sports” and “No Activities”, with a language other than English being under-represented  compared to English only as first language . We compared the probabilities of ECA latent class membership by first language learned (English only versus other) and gender . In the clusters “Individual activities” and “All Activities”, children reporting a language other than English as their first language learned at home were over-represented  compared to boys . Girls were under-represented in “All Activities” and “No Activities”  compared to boys . Regarding the probabilities of ECAs latent class membership across genders , girls were over-represented in the clusters “Individual activities” and “Individual & Team Sports” [PThe goal of this study was to identify profiles of extracurricular engagement in a population of grade 4 children in BC, Canada, and to investigate whether membership in a specific profile group was linked to differences in children’s positive wellbeing and health, taking into account gender and home language background. Based on self-reports from more than 27,000 children, we identified four distinct profiles that reflected (1) no involvement, (2) involvement in all activities, (3) involvement in individual programs , and involvement in individual and team sports during extracurricular hours. Most children fell into the clusters of non-participants (39%) and sports (40%). The smallest cluster consisted of the children who participated in all activities (9%), followed by those who participated in activities within the education lessons, arts/music, and individual sports domains (11%). These profiles were overall in alignment with previous research that has identified clusters of youth that were highly involved, uninvolved, and predominately involved in sports ,43,44, sA major finding in the present study was that across the profile groups, wellbeing  and health were highest in children who were involved in all ECAs and those who were involved in sports, compared to children who were uninvolved and those who predominately participated in educational programs, arts and music, and individual sports. There were no significant differences regarding the wellbeing and health outcomes when comparing children who participated in all activities to those who predominately participated in sports . This finding is interesting because it suggests that participation in sports in particular was a key ingredient in the identified clusters in the present study that was associated with better wellbeing and health.Previous research has underscored the benefits of sports for wellbeing and positive development. For example, a systematic review of extracurricular participation in sports during childhood and adolescence found that sports engagement potentially improves internalizing problems and enhances positive mental wellbeing . The benHowever, our finding highlighting higher levels of health and wellbeing for children in the sports group also contrasts two previous person-centered studies on extracurricular engagement ,44. Specth grade girls [A second important finding in the present study was that children who were a part of the “no activities” cluster did not differ significantly regarding wellbeing and health outcomes from those who predominately participated in educational programs, arts/music, and individual sports. This finding can be interpreted in several ways. First, it is likely that the activities in this cluster  have a strong individual focus, rather than a social focus. Previous research has highlighted that some of benefits of ECA participation are specifically tied to the social interactions that children are gaining with peers through the activities . Further, educational lessons in this study were described as “tutoring, math, and language school”; arts and music lessons included the examples of “drawing, painting, and playing a musical instrument”. Whereas a systematic review has suggested positive effects of extracurricular academic tutoring for middle school students’ academic achievement ,60, resede girls . One intN > 2,000) tend to yield smaller but more accurate effects sizes in research than studies using small sample sizes [The findings in the present study had small effect sizes. Nevertheless, their importance should not be disregarded. The present study was based on a very large population-level sample. Methodological research has shown that population-level and large-scale samples  was not available. Future research needs to include more finely nuanced questions about program type and characteristics. Similarly, additional demographic data  and information about parental expectations and whether children self-selected activities were not available and could therefore not be taken into account. Additional information is necessary to distinguish the different sub-groups of children who are non-participants . The present research was focused on children in grade 4 in public schools in BC. Future research needs to explore profiles that may emerge in other age groups, whether profiles tend to be stable over time.S1 Table(PDF)Click here for additional data file.


Seventeen years after the initial publicationx of the human genome, we still haven’t found all of our genes. The answer turns out to be more complex than anyone had imagined when the Human Genome Project began. It’s hard to overestimate the importance of the human gene list. Thousands of studies rely upon it, including efforts to discover the genetic causes of cancer, complex disorders such as schizophrenia and dementia, Mendelian disorders, and many more. Upon receiving the DNA sequencing results for a sick patient, the first question usually asked is, “what genes are affected?” The very question itself assumes that we know where the genes are—and yet, despite tremendous progress over the past two decades, our knowledge of the human gene catalog is still far from complete.The primary goals of the Human Genome Project (HGP), which lasted from 1990 until 2003, were to determine both the DNA sequence and “the location of the estimated 100,000 human genes” [In order to answer the question of how many genes we have, we must first agree on what we mean by the word “gene”. The definition has evolved ever since Mendel, but the focus as the HGP got under way was primarily on protein-coding genes; i.e., regions of the genome that are transcribed into RNA and then translated to create proteins. However, many genes are noncoding: the HGP’s original paper, in 2001, acknowledged that “thousands of human genes produce noncoding RNAs as their ultimate product,” although the paper itself reported just 706 noncoding RNA genes [Gene: any interval along the chromosomal DNA that is transcribed into a functional RNA molecule or that is transcribed into RNA and then translated into a functional protein.gene would likely take many pages to describe.This definition includes both noncoding RNA genes and protein-coding genes, and it also groups all the alternative splice variants at a single locus together, counting them as variants on the same gene. It is meant to exclude pseudogenes, which are non-functional remnants of true genes. Admittedly, though, this definition raises the question of what is meant by functional, and a truly comprehensive definition of the term Using this definition, though, do we have agreement on the number of protein-coding genes? The short answer is no. The human genome began with the assumption that our genome contains 100,000 protein-coding genes, and estimates published in the 1990s revised this number slightly downward, usually reporting values between 50,000 and 100,000. The two initial human genome papers reported 31,000  and 26,5more RNA genes than protein-coding genes  at NIH, and Ensembl/Gencode, which is maintained by the European Molecular Biology Laboratory (EMBL). Even after all this time—despite much progress—the two catalogs today have hundreds of disagreements between their lists of protein-coding genes, thousands of inconsistencies between their lncRNAs, and multiple categories of genes  where they diverge even further, sometimes not even agreeing on the type of gene  appear to be highly tissue-specific, and until we survey all human cell types more thoroughly—which may take many more years—we cannot be sure that we have discovered all human genes and transcripts. For most other animal and plant species, we know even less about their gene catalogs, although our knowledge is rapidly improving. Our inability to find a simple answer to the fundamental question of the HGP does not mean we have failed, however. On the contrary, our knowledge of human genes is vastly richer than it was at the outset of the HGP, and technological advances of the past decade provide me with optimism that we will eventually pin down this number.


Rheindorf and Wodak argue that such cultural politics use a wide spectrum of discursive strategies both inside and outside established party politics and that the accompanying production of an ideal extreme-right subject is informed by nativist ideology. The cross-sectional analysis demonstrates that the cultural politics of the Austrian extreme right ranges from appropriated national symbols to coded National Socialist iconography. These politics pervasively construct a gendered and racialized national body, policed by a ‘strict father’ and nurtured by a ‘self-sacrificing mother’,  Homo Austriacus/Homo Externus; (2) the narration and construction of a shared political past; (3) a shared culture; (4) a shared political present and future; and (5) the discursive construction of a ‘national body’.The research reported in this paper was conducted as part of a large-scale, longitudinal study of the construction of national identity/ies in Austria. The study, carried out within the framework of the Discourse Historical Approach (DHA), compiled a multifaceted and triangulated data set throughout 2015 and compared its results to similar constructions in 2005 and 1995.Homo Austriacus and the national body—that characterizes the discourse of the far and extreme right in Austria, becoming the focal point of discursive practices and argumentative patterns, and serving related constructions of ‘us’ versus ‘them’. Such constructions emphasize national uniqueness and (inner) homogeneity and downplay heterogeneity and difference within the population. Simultaneously, they also focus on differences to members of other nations, often resorting to stereotyping and singularization. Here, we focus on the extreme-right elements within the far right, which includes both mainstream populist and extreme actors. Indeed, the Freiheitliche Partei Österreichs  must be distinguished from other populist far-right parties, not only in some of its ideological positions but in terms of its history and ties to National Socialism.We argue that it is the integration of the first and fifth categories—the Homo Nationalis in more detail, in particular the gender and body politics.Volk—imagined as ideal male and female bodies, their roles and relationships—is articulated most clearly.The ‘national body’ is constructed in terms of a nation’s territory, its ‘natural’ landscape as well as its built environment , its institutions  and its national ‘heroes’ .Volkskörper.Extreme-right discourses have reinforced this link, once part and parcel of fascist  discourses in the imaginary of the Staatsvertrag (state treaty) of 1955. Between 1945 and 1955, the Allies supported the development of a bipolar political scene by encouraging (1) the cooperation of socialist-democratic movements on the left and the formation of what would later evolve into the Sozialdemokratische Partei Österreichs ; and (2) the merging of various right-wing, conservative and pro-clerical movements into the Österreichische Volkspartei . Simultaneously, the forerunner of the FPÖ, the Verband der Unabhängigen  was formed by incorporating political movements comprised of ‘old Nazis, German nationalists and a fair number of liberals’,The history of the FPÖ dates back to the years after the Second World War, and the political situation created and supported by the four post-war Allied Powers until the In the 1949 parliamentary elections, the VdU won 12 per cent of the vote and soon called for ‘the abolition of all laws governing de-Nazification procedures’.Following an internal crisis of the VdU, the FPÖ was established in 1955–6 ‘as a German nationalist party of the far right, in which former, seriously incriminated National Socialists took the leading functions’.When Friedrich Peter (another former SS member) took over the FPÖ in 1958, the party’s agenda did not change significantly. However, throughout the 1960s, the drive to moderate the FPÖ could be observed when both liberal and national views were given a voice. In 1970 the newly elected Chancellor Bruno Kreisky (SPÖ) formed a minority government with the support of the FPÖ and appointed ‘four former NSDAP members to ministerial posts’.Throughout the late 1980s and early 1990s, the nationwide anti-foreigner petitions championed by Haider’s FPÖ, most prominently the 1992 ‘Austria First’ petition, significantly increased its electoral support.Although sanctions against the Austrian government were eventually introduced by the fourteen other EU member states, it was not this external pressure but the controversial performance of the ÖVP-FPÖ government that pushed the FPÖ into gradual decline. At the next parliamentary elections, the FPÖ  and the Bündnis Zukunft Österreich , a splinter group headed by Haider, managed a combined 15.1 per cent of the vote. Following extensive negotiations, neither party became part of the new government, formed in early 2007 and headed by the SPÖ. And, thus, after eight years in government, the FPÖ returned to its opposition role until December 2017, when it became the junior partner in a governing conservative coalition between the ÖVP and FPÖ. After Haider’s death in 2008, the BZÖ dwindled into electoral insignificance. The fact that the FPÖ uses a vast array of populist strategies has sometimes obscured the fact that it continues to follow a xenophobic, anti-EU and anti-immigration agenda. The misogynist, anti-intellectual, anti-modern and anti-urban or anti-cosmopolitan aspects of its agenda have gone even more unnoticed. Indeed, today’s FPÖ has a ‘softer’ face in public, while mainstream parties have appropriated many policies formerly suggested by the FPÖ. In this way, the dominant agenda of the FPÖ has become normalized not only as part of the political mainstream,normalization  of extreme-right ideology in Austria. Specifically, we provide a cross-sectional analysis of the fields of politics  and popular culture (music). This allows us to trace continuities not only historically but across fields, showing how extreme-right positions are recontextualized from closed-door meetings  is well known as one of the authors of the FPÖ’s programmatic agenda; moreover, his explicitly racist, nativist, antisemitic and homophobic offstage utterances have frequently been leaked to the press and caused scandals.While addressing closed-door meetings, Gudenus has often expressed ideological positions in unambiguous terms. These have included racial policies supporting the purity of Europe: ‘Europe is the cradle of the white race. We demand a Europe-wide, coordinated policy for the family and reproduction, including a commitment to the fact that Europe is white.’Für ein freies Österreich (For a Free Austria), written by Michael Howanietz, a local FPÖ politician.Handbuch freiheitlicher Politik (Handbook of FPÖ Politics), drafted by the party leadership to serve as an internal guide for party functionaries regarding key policy areas.Gudenus’s utterances bear a strong similarity to the party-affiliated publication Für ein freies Österreich is introduced by approving forewords written by the FPÖ’s chairman, Heinz-Christian Strache, and vice-chairman, Norbert Hofer. The text defines itself as a call for ‘an autonomous, independent country’, independent, that is, of transnational organizations, international law, international economy and the exchange of goods, all of which are seen as ways that Austria is controlled by others.Heimat supposedly still exists in the country and rural areas, manifest in higher birth rates, manual labour as in centuries past, hardy craftsmen and ‘timeless’ values.Heimat is thus to protect one’s true self.The book relates this initial statement to arguments concerning the national body as ‘state territory’ and its ‘borders’, as ‘landscape and nature’, and as ‘the core family’ and ‘procreation’. Indeed, the call for ‘liberation’ from dependency is presented as a duty to ‘our children’, particularly that of men to their families: ‘We owe it to those who come after us, our children.’Deutschland schafft sich ab (Germany Is Doing Away with Itself).kulturfremde) “neo-Austrians” and years with a low birth-rate. Every unborn potential mother and father of the future accelerates the process of self-annihilation.’Handbuch. Here, the argument is presented in the form of statistics: ‘in 2009, 76,344 births and 50,000 abortions killed some 125,000 children [meaning that] 4 out of 10 children are killed in the womb. This would make the uterus the place with the highest mortality rate in our country.’In the extreme-right world view articulated in the book, which casts the modern and in particular the urban and intellectual as weak as opposed to the archaic, migrants are a threat precisely because they have stronger identities: their ‘assault’ or slow invasion to ‘demographically displace’ the Austrian people makes the latter ‘a species on the brink of extinction’.die Familienzerstörer, destroyers of families.The child needs the safety of the family. Its pillars are father and mother as positive male and female example. Both have been made deeply insecure in their self-understanding by the deliberate demolition of their nature-given roles. Their disorientation leads to temporary relationships, because the image corresponding to their inner longing for the respective counterpart is not found. Man, who has been cast from his throne at the head of the family, still longs for a female partner who, in spite of the girls-own-the-world magazines, is still able to think in homemaking categories, whose maternal drive exceeds the imposed ambitions for personal fulfilment. Woman, redefined by feminist deconstructionist ambitions as a birth-certificate mother required to pursue personal fulfilment, still longs for a real man who gives her all the emotional and economic security that a young mother needs to devote herself almost free from worry to her offspring.The book shamelessly uses hyperbole and straw-man fallacies to drive home this point: ‘Because we are still permitted, without official permission, to have children and raise them as best we can, independent of ideological approaches that want to tear children away from their parents immediately after birth.’The gravest threat to the nation, however, is identified in decaying national pride: honour and loyalty to the community of the nation are seen as the foundation for loyalty and faithfulness in heterosexual relationships.Volk. ‘Fake news’  of Germany). Two such provocations relate to Austria’s national anthem: first, the public refusal to sing the amended national anthem , thus breaking the relevant law; and, second, the use of an alternative anthem, titled ‘Immer wieder Österreich’, for the party’s campaigns. The lyrics of this song incorporate a well-known chant by football fans at matches played by the Austrian national team—‘Immer wieder, immer wieder, immer wieder Österreich’ —but also appeal to the ‘honesty, righteousness and loyalty’ of all true Austrians, calling on them to ‘pledge’ their loyalty to ‘their country’. The song features in a campaign video that semiotically reinterprets the lyrics of the actual Austrian anthem and alludes to the aesthetics of Nazi-era films (such as Leni Riefenstahl’s work), that focus on mountains, streams and other aspects of the national body, white men and women, industry in the form of hammers, and agriculture in the form of fields . The Catholic Church has protested against the party’s accompanying claims to represent (and defend) the Christian heritage of Austria in the face of an alleged Islamic invasion. Indeed, the Austrian far and extreme right’s Othering has come to focus strongly on religion, that is, Islam. In this opposition, the Self is largely culturalized (Christian-Judean culture) and may even be secularized (European Enlightenment) or Europeanized , whereas the Other is cast as an ethnic Other, mediaeval/pre-modern/barbaric or religious zealot/fanatic or terrorist threat.Further notable provocations pertaining to the national body involve the use of religious imagery and symbols as well as the redefinition of religious concepts  in public, there are still prominent exceptions, such as the so-called ‘Facebook incident’ of 2012.Despite the focus on ‘Islamization’—and despite the fallacious claim that the FPÖ is ‘the new Jew’ or being persecuted ; Heimatliebe (love for the homeland); Sicherheit (security); Flagge zeigen . Indeed, the Austrian flag and its colours were dominant in his campaign (some posters show as many as five Austrian flags in different shapes and sizes), but it also made use of religion and religious imagery.In the 2016 presidential election, the FPÖ candidate Norbert Hofer’s campaign offered a toned-down version of such ideology. The campaign was organized around central notions connected to the national body and its protection: Despite notable moderation, the FPÖ’s gender politics remain patriarchal. In several television debates leading up to the election, Hofer maintained that any marriage of gay or lesbian couples as well as related adoption rights would destroy ‘natural family structures’: ‘The life partnership of man and woman becomes a family only through the child. Those who raise a child on their own create a family with the children.’ He also voiced his rejection of gender mainstreaming: ‘The aim of “gender mainstreaming” is nothing short of creating the ‘new human being’ that Marxists-Leninists already aspired to.’ Similar to many fundamentalist Tea Party Republicans in the United States, Hofer also rejected ‘pro-choice’ policies for women, that is, women’s right to decide on abortion.Volk and the Volkskörper across German and British nationalist writing since the eighteenth century.In this context, Hofer also described ‘the womb as the place with the highest mortality rate in our country’.Schlager variants, often draws on such images, sometimes naively and sometimes with a pinch of irony. Figurations of banal nationalism are nothing new in pop songs such as ‘I Am from Austria’ by Reinhard Fendrich  or ‘Skifoan’ by Wolfgang Ambros (ironic in its exaggerations). There is also a history, extending well beyond Austrian borders, of extreme-right discourse in songs,The Austrian brand of banal nationalism—in the form not only of state symbols, such as the anthem or flag, but mythopoeia that enshrines mountain tops, farmers and rural villages as the heartland of the Austrian people—is well established in collective identity. Popular culture, including popular music in its pop, folk or A recent development, however, is the particular brand of pop music performed since 2008 by Andreas Gabalier, which he himself has labelled ‘Volks-Rock’n’Roll’. In his music, lyrics, stage performances and interviews, Gabalier not only blurs the boundaries of musical genres, he also realizes the culturalization of extreme-right ideologies on a grand scale. He is currently the most popular performing artist from Austria, playing concerts for audiences of 70,000; he has sold more than two million records and attracts young audiences from rural and urban areas alike.Heimat, to a disconcertingly chauvinistic view of gender roles and the family, as well as ambiguous language and visuals that may well be read as coded allusions to National Socialism. The latter has caused some mild scandal in Austrian media, most prominently with respect to the controversial cover of his album Volks-Rock’n’Roller, which depicts Gabalier in an oddly contorted posture intimating the outlines of a swastika  that he describes as an ‘Eisernes Kreuz’ (Iron Cross), defying storms and fire on a mountain top.The political in his performances ranges from forms of banal nationalism and a deeply conservative view of tika see .67 AmongGabalier’s popular music is not, however, always as carefully hedged and coded with regard to its extreme-right politics. The 2015 song ‘Königin der Alpen’ (Queen of the Alps) describes Gabalier as a ‘Germanic prince’,vis-à-vis an equally traditional femininity. In songs like ‘Meine Heimat’ (My Homeland) he presents these as values passed on to him by his grandfather, connecting him to the land and his ancestors ‘forever’. One of the most important attributes of the thereby constructed homeland is a place ‘where our girls love us because they know what kind of men we are’.More overtly, Gabalier’s music has followed the traditional formula of romantic love, family and homeland. His songs frequently name specific regions, mountains, valleys or rivers, describing their beauty. In this scenery, Gabalier positions himself not only as an advocate but also a representative of traditional masculinity vis-à-vis the purported sexual confusion of other, lesser men:Now I would almost have forgotten, there is that kind of woman tooWho builds on anything but femininityIt flatters us, but it doesn’t turn us onWhy does girl today have to be like a man?Completely grim, almost in pain from emancipationSo that you lose all joy in making outBut not all of us are into menWe much prefer to nibble at a real girl.The song’s phrasing in the final two lines not only reveals anxiety vis-à-vis an (imagined) homosexual majority and defines who is to be regarded as a true girl, denying emancipated women that gender identity, but it also incorporates the victim–perpetrator reversal that Gabalier publicly expressed in interviews and at the ceremony for the Amadeus Music Award, Austria’s largest music award. The true heterosexual man, he implies, is in the minority today and must defend his natural right not only to desire girls but to demand that girls be desirable for him.Public controversy around Gabalier’s work—primarily in interviews and television debates—has led him to take an even clearer stance in more recent songs. In ‘Mei Großvater hat gesagt’ (My Grandfather Said), Gabalier praises traditional, girlish femininity in familiar terms but ends with a remark on progressive, emancipated women. He links the lack of femininity of emancipated women to ‘being like a man’, and takes the fact that this does not sexually arouse him as proof of his own heterosexuality national body, facilitates a clear view of the extreme right’s imaginary of a Volkskörper in its contemporary forms. This imaginary reveals National Socialist ideology to be in evidence not only superficially , but as a politics of heteronormative, procreational gender roles predicated on the ideal of national integrity as racial purity. The ideal Homo nationalis is thus constructed as white, binary , heterosexual,  Christian and rooted (by blood) in the soil of the national body. This ideal is opposed to a negative imaginary that constructs Austrians as compromised on all levels, colonized by ‘parasites’ as well as ruled by (foreign) elites, incapable of action or emancipation. The ideal subject of the extreme right, our analyses show, is constructed across a number of social fields and contexts, evidencing continuities from offstage politics to popular culture.Our conceptual focus on identity politics as articulated in body and gender politics, theorized through the notion of the With these results in mind, we must acknowledge that the FPÖ, as the only established party in Austria that has consistently provided a home for extreme-right positions, is far from homogeneous. The ideological positions articulated by its leading figures range from extreme-right and pan-German nationalism to toned-down positions, particularly in their public iterations. Indeed, the ability to alternate between ‘strong’ and ‘soft’ performances according to context and audience is a defining characteristic of the contemporary far right in Austria. Both allusions and encoded references to extreme-right and Nazi ideologies are thus part of the strategy of calculated ambivalence that ensures deniability. Closely related to these strategic performances are processes of normalization, removing taboos through recontextualization and semiotic reinterpretations as aspects of extreme-right imaginaries move from offstage to onstage and from party politics to popular culture.1984; likewise, it is invoked to mobilize voters and stifle voices of criticism as ‘unpatriotic’ in the face of imminent extinction. Its culturalization has made it more pervasive, more naturalized and seemingly less political than ever before.In this dynamic, we would argue, the counterpart to the ideal extreme-right subject must not be overlooked. It is the discursive construction of a multilayered and ever-present threat to the nation and the ideal subject identified with that nation; in as much as this threat is extreme, the defence is justified to be extreme as well. This is an imaginary of perpetual crisis, reminiscent of Orwell’s perpetual and omnipresent (yet invisible) war in


African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk. Cardiovascular disease (CVD) remains the leading cause of death for adults in the United States (US) with an estimated 85.6 million Americans experiencing some form of CVD ,2. The tThe reasons for these disparities in disease risk and mortality are multi-factorial. Differential health care access and quality, environmental or neighborhood influences, persistent racial discrimination, health behaviors such as diet, smoking, socioeconomic status, and genetic variation have been hypothesized as contributors to African American CVD risk ,10. Yet,Previous CVD risk studies conducted among African Americans have included those living in the US as a whole, or individuals living in states within the American South. These results are limited, as they may inadvertently omit unique characteristics of other regional populations and cultural differences within populations ,12. LifeIn Arizona, African Americans comprise 4.9% of the total population, yet they have the highest CVD-related burden in the state ,5. In 20One of the first steps to reduce disease burden is to identify sources of health disparities and assess health resources of population groups and communities. However, few studies have evaluated the reasons behind the CVD-related health disparities faced by African Americans in Arizona ,10. QualThe purpose of this mixed methods study was to examine the perceptions and knowledge of African American adults regarding heart-healthy behaviors and etiological factors associated with heart disease and other chronic diseases through focus groups (FGs) and self-administered questionnaires. The research objectives were to determine participant knowledge, attitudes, and perceptions of: (1) leading health concerns and causes of death within the African American community; (2) CVD and CVD risk factor etiology; (3) healthcare access concerns among African Americans in Arizona; and (4) the presence of and need for community-based programming for CVD prevention. Study findings were provided to the Arizona Department of Public Health to address health disparities in CVD with African Americans in Arizona. Other research findings on specific food intakes and physical activity among FG participants have been presented elsewhere ,21.Participants were eligible for the study if they self-identified as African American or Black, were between the ages of 25–60 years, and resided in Arizona at the time of recruitment. Potential participants were contacted through email listservs, civic organizations, snowball sampling, and agencies that served the African American community. Flyers were distributed in community locations and in surrounding areas where the FGs were to be held. An online survey service (Survey Monkey) was used to send email invitations and to pre-screen potential participants for eligibility. More than 406 persons contacted the researchers via email for participation. Another 35–40 persons were recruited verbally through snowball sampling or in person at study sites. Screening information was sorted by gender, age group, preferred locations, and days and times to compile groups of 5–10 participants for each FG and a list of alternates. The day before the session, participants were sent a reminder email and contacted by telephone to confirm their attendance, location, and time. If a potential participant cancelled, an attempt was made to find a replacement from the list of alternates.Fourteen FGs were conducted with African Americans in Mesa, Phoenix, Tucson, and Casa Grande, Arizona between January and February 2009. Discussions were held at community centers, and public library meeting rooms. Sessions lasted 1–1.5 h. Only the research team and consented participants were allowed in the room. To enhance participant comfort and to keep conversations relevant to their life stage, FGs were divided, in most cases, by gender and age . For two scheduled FGs with men, only one man attended at each site. Data from these two individual interviews were retained for subsequent analysis. All participants provided written, informed consent. A $25 gift card to a major retailer was provided as an incentive at the end of the FG session. This study was approved by the Arizona State University Institutional Review Board (NTS0017).FGs were led by female African American graduate student moderators who were trained in qualitative methods by the lead author (CD). Moderators had no prior relationships with participants but were familiar with African American informal social networks in Arizona. A standardized moderator’s guide was developed based on a review of the published literature and the researchers’ previous work in African American communities. The moderator’s guide was pilot tested with five African American women aged 22–29 for clarity of questions and reviewed for cultural appropriateness. The research staff continually monitored the moderator guide for content and flow.Digital audio recordings were transcribed verbatim and verified for accuracy prior to coding and analysis in N-Vivo software . Consistent with principles of Grounded Theory, an inductive and iterative approach was used during the coding and analysis process . This anParticipants completed a series of questionnaires upon arrival at the FG venue. Demographic information included age, education, marital status, household income, and self-reported height and weight. Questions from an American Heart Association national survey on women’s health risks , degree of concern about health conditions, access to healthcare services, and familiarity with heart disease programs targeted towards African Americans were adapted in wording for use with women and men ,23.p = 0.019). A greater percentage of the younger cohort were single (49% vs. 35%), and a larger portion of the older group were divorced, separated, or widowed . Although 11% preferred to not report income, 56% of the respondents earned less than $50,000 per year (n.s.).Demographic information for FG participants (n = 103) is displayed in p = 0.047). Although 62% of all participants reported they never smoked cigarettes, current smoking rates were higher among men compared to women . A higher percentage of older (63%) vs. younger (31%) participants reported at least one previous discussion about heart disease with a physician (p = 0.002). More women than men had received a recent blood test for cholesterol (p = 0.018). Most respondents indicated they had health insurance (78%) and that finances had not restricted their ability to seek medical care in the past 12 months (79%).p < 0.001), HIV/AIDS (p = 0.010), lung cancer (p = 0.047), smoking (p = 0.001), and drug/alcohol addiction (p = 0.008) differed by gender. A higher percentage of the younger cohort (23%) than the older cohort  reported they worried a lot about HIV/AIDS. Breast cancer concern differed by age cohort (p = 0.049) among women. No other significant differences were seen by gender or age  about 10 diseases or risk factors ,23. Nearr or age .Results from the focus group discussions The diseases or conditions that emerged as leading causes of death among African-Americans were similar to the priority health concerns and conditions described by FG participants: heart disease, hypertension, cancer, diabetes, HIV or AIDS, and stroke. Participants voiced concern that the greater risk of acquiring these diseases was related to health behaviors. Across FGs, it was emphasized that increased disease risk was due to stress and lifestyle factors. Elevated disease risk was attributed to issues related to healthcare access, health education, and availability of healthy foods in their communities. Few participants perceived African American genetics or family history as a reason for the higher disease rates, with the exception of sickle cell anemia. Several participants mentioned HIV and AIDS as a problem that was not openly discussed in the African American community.I think it’s heart disease, prostate cancer, diabetes, and one that I say is silent because we don’t talk about it as much, is HIV and AIDS.”“Participants indicated that access to quality healthcare was a concern. When asked about what influenced the quality of their healthcare, the majority expressed that having high quality health insurance, such as an employer-based group health plan, resulted in good healthcare regardless of skin color. Having more comprehensive health insurance was perceived as advantageous for accessing satisfactory or high-quality health care. For example, it was believed that having comprehensive health insurance affords individuals who are dissatisfied with the care they are receiving from their doctor the opportunity to find another healthcare provider to satisfy any healthcare needs. Without adequate health insurance coverage, which included being uninsured or having insurance through a state provided health insurance plan , the perceived likelihood of receiving quality healthcare was marginal at best. Being underinsured or uninsured was viewed as reducing access to quality healthcare providers and to treatment in general, as illustrated in the quote below. These issues relate to limited income and the general financial restrictions of almost 50% of the FG cohort.I don’t think it has nothing to do with you being Black. I think it has something to do with that insurance card, because they don’t care if you’re purple… They don’t ask you, ‘What color are you?’ They say, ‘Who do you have insurance through?’ And once you say, ‘Nobody,’ you’re in that room a little longer waiting for results.”“FG participants expressed that health insurance played a role in doctor–patient relationships as it influenced the amount of time the doctor spent with the patient and when the patient was able to seek and obtain care. Participants indicated having access to healthcare allowed one to establish a regular, consistent relationship with a physician. In contrast, those who were uninsured or underinsured often had tremendous wait times and were not able to be seen for a condition until it had worsened, negatively affecting the patient-physician relationship. Several younger male participants indicated that they were less likely to seek out routine healthcare and would not go to the doctor unless they were sick.Although most participants felt access to adequate health insurance was the larger issue, there were some indications that connecting with a doctor they felt comfortable with remained a struggle. This difficulty in finding a doctor was multi-faceted. Several participants stated they tried to find healthcare providers who were persons of color because they believed these healthcare providers would relate to them better. Others expressed that the healthcare received from non-minority doctors was based on stereotypes. For example, one participant discussed how a doctor was insistent that she had high blood pressure because “all African Americans had high blood pressure.” However, other contributors specified that all doctors stereotyped patients to a certain degree. Examples of other stereotypes by doctors were those based on an individual’s weight, age, or income level. Discussants stated finding a minority healthcare provider in Arizona was challenging because the African American population within the state is so small. However, others felt that this was slowly improving as more African Americans were moving to Arizona. Additional selected quotes about healthcare access and insurance are shown in Participants gave a wide variety of responses about the meaning of heart disease. The majority did not provide a medical or mechanistic definition for heart disease , although participants in 5 of the 14 FGs identified heart disease as a buildup of plaque or a blocked artery. In four FGs, participants openly expressed their lack of knowledge regarding these definitions. Moderator observations suggest that people in several of the other groups were unaware of the definition of these diseases or risk factors and chose to remain silent. One participant communicated a common theme of a biological system unable to tolerate more stress.It’s a buildup of plaque and-and cholesterol. And your heart can only function so much, so there’s more stress on it. And, uh, when your heart is—when the stress is there, uh, you’re just not able to function like you normally would be because of all that stress on your heart.”“Most participants associated “what it means to have heart disease” with lifestyle choices or having other heart related conditions or chronic illnesses . There were frequent references to the role of diet, exercise, not being proactive about one’s health, and lack of education in CVD development.Few discussants could explain the different types of stroke , or what causes a stroke. The FG participants were, however, able to identify stroke symptoms. Commonly mentioned symptoms of a stroke included, “paralysis,” “slurred speech,” “numbness,” and “impaired movement on the left side of the body.” In contrast, other FG participants incorrectly identified chest pain and shortness of breath as symptoms of a stroke. The older FG participants were more aware of stroke symptoms due to personal experiences, such as observing a stroke in a friend or family member. Participants were asked to define hypertension, symptoms of hypertension, and diagnostic cutoff points. Only a few participants were able to define hypertension from a medical perspective. In general, there was a lack of understanding among participants about high blood pressure or hypertension suggesting a need for expanded education on this topic.Participants were asked to identify heart disease risk factors and diseases they perceived as related to heart disease development. Participants identified salient modifiable causes of CVD and associated it with several lifestyle choices including poor nutrition, physical inactivity, stress, smoking, and overweight or obesity. Often the lifestyle choices were mentioned in tandem, such as poor diet and physical inactivity. FG discussants frequently mentioned that people had multiple risk factors which contributed to heart disease development. Non-modifiable risk factors that emerged included genetics or heredity and socioeconomic status.Perhaps the most prominent risk factor across FGs was the role of diet and proper nutrition in the development and/or prevention of heart disease. Diet was mentioned as a CVD risk factor over 100 times across 14 groups. Participants suggested that “not eating right” and “bad dietary habits” were responsible for the development of heart disease, while a high-fat diet was identified as a key contributor. Specifically, participants told us that eating fruits and vegetables, whole grains, foods that are high in dietary fiber, low-fat foods including lean sources of protein, organic foods, and lower sodium foods reduce heart disease risk. There were consistent perceptions about which foods were unhealthy. These included items that were processed, high fat, or fried, red meat or pork, and fast foods. Comprehensive coverage of diet, nutrition and foods is beyond the scope of the current paper and has been discussed in part elsewhere ,21.A lot of whole grains are very good. It’s probably easier to say what’s not good than what is good but just to try to focus on positive things that are good are going to be fresh vegetables and fruits, less processed food, less fatty foods. Try to avoid anything with white flour, and white vegetables like the corn or the white onions. Just—just think of more colorful things are usually better, if they’re prepared properly.”“Many participants indicated that they consumed a high fat diet due to traditional African American foods, highly available fast food, and a lack of affordable healthy choices. The traditional or ‘Soul Food’ preparation techniques with added fat or lard  were perceived to reduce diet quality. FG participants suggested baking, instead of frying, foods as one way to ensure food is healthier. Another recommendation for consumption of healthy foods was substituting traditional recipes with replacements items, such as swapping turkey for ham hocks and olive oil for bacon when cooking green beans. However, some FG participants expressed their concerns about the cultural acceptability of modified recipes, and flavor loss of the original dish if these changes were made, as shown below.…when you cook Soul Food, meals are cooked like for, you know, hours basically—they’re lifeless. So that’s the problem. And then on top of that, people add the butter, the pork, the grease, and all of those things on top of it…”“Other foods recognized as potentially bad for one’s heart included fast foods and processed foods such as those made with high fructose corn syrup, white flour, and sugar. Participants postulated that fast foods and highly processed foods were eaten in the community due to low cost, convenience, and widespread availability. There was also a general perception that healthier foods were more expensive, which was thought to contribute to the inadequate dietary choices made by African Americans. Younger participants were more likely to mention cost as a reason for their dietary choices than the older cohort. Some participants stated that they knew which foods they should be eating, but chose out of convenience, preference, or for economic reasons to eat foods that were not necessarily healthy. These sentiments were more commonly expressed among the younger FG participants. Having a lower socio-economic status was perceived as a CVD risk factor as it was thought to limit healthy food choices and act as a barrier to accessing medical care. And diet’s going to be the big one. Eating poorly is very inexpensive. And that’s going to run prominently in the African-African American community all over the place. They have less funds, so they eat the cheapest stuff they can find, which—it’s not good for you.”“Stress was the second most commonly mentioned risk factor for heart disease. Stress was reported to stem from one’s job, living in poverty, experiencing prejudice, having too many commitments, or a combination of factors. Respondents were aware that being African American brought more stress and that difficult economic times aggravated these conditions.There’s the stress of being Black in America that nobody’s writing about, or being a minority in America that, nobody’s writing about—of being a certain minority in America. And, you know, I’m not one to-to blame anybody or play the race card, but in my life experience, it’s just a part of reality.”“I think, uh, stress. A lot of times we feel like we have a lot of stress going on in our lives and everything. So, when there is… no outlet people tend to hold things in. And that leads to heart disease. To stress. To high blood pressure. Things of that nature.”“Physical inactivity was the third most commonly mentioned CVD risk factor. Participants were typically brief in their description of the role of exercise as a risk factor for heart disease, stating that it was a lack of exercise that caused heart disease. There were few references to how exercise reduces CVD risk or improves overall health. As with diet and stress, culture or the social environment and income level emerged as influential factors for making exercise a habitual practice. Concerns about balancing multiple family and work roles due to low income were also mentioned as complicating one’s ability to succeed at achieving adequate physical activity. Respondents across groups suggested that one’s neighborhood location and social environment influence physical activity and that role models and social support facilitate these behaviors.Try to get some physical exercise every day, or most days—at least five or six days a week. It’s sometimes hard because of other commitments, you know, for family and your work and all that at the end of the day to take care of yourself or to get up early to take care of yourself, but some kind of physical exercise.”“I think a lot of it is cultural… you’re either in one of … in one of two camps when you’re African American. You’re either working hard, trying to get ahead. You don’t have time to go out jogging for the fun of it. Or you’re not working at all, in which case you don’t care … You’re not motivated to get up and exercise.”“FG participants described several health behavior changes to prevent CVD, including physical activity, eating a “good” diet, obtaining regular check-ups and screenings, and stress management. The FG participants often indicated multiple behaviors that needed to be changed and that a lifestyle approach involving changes in multiple health-related domains should be taken to prevent heart disease. Another aspect of prevention pertained to “mindset”. Participants in six FGs called attention to the importance of having a positive attitude toward life and health as a component of preventing heart disease. They also suggested that wanting to change or being motivated to change was necessary for halting CVD-risk enhancing health behaviors. Although less frequently mentioned than the behavioral strategies, participants expressed the need for education about risk factors for heart disease, dietary practices to prevent heart disease, and to a much lesser extent, about which exercises are beneficial for heart disease.I would say attitude, because a lot of times your attitude about something will tell you—will sway you basically if you’re gonna do something about it or not. Are you positive about it or negative about it?”“Participants were asked to describe heart disease prevention programs that were currently available to them, the types of programs they would like to see made available, the types of information they would like to receive, ways to make the information culturally relevant, and what they perceived as the best way to disseminate information on heart disease in an attempt to better understand these factors.FG participants were evenly divided as to whether there were any CVD-related programs available to them. Participants in eight FGs did not know of any programs, and several indicated that they had never seen any programs offered, typically expressing this lack of programs with the simple word, “nothing.” A couple of participants expanded their answer, however, and indicated that part of the problem is that while they are African American, they live in areas that are not predominantly African American.In contrast, participants in six FGs indicated that there were activities in their community or employer-based health information or programs to prevent heart disease. Participants in four FGs stated that they receive information about health from their church and that churches were doing a lot to improve the health of African Americans. One participant discussed how the Black Nurses Association was partnering with churches to offer programs to African Americans. Other less frequently mentioned community-based resources for heart disease prevention included schools, health fairs, senior centers, and the internet.In response to the type of programs needed to promote heart disease prevention, a majority of discussants expressed a need for more prevention outreach and awareness and were interested in learning more about CVD themselves. Others indicated that they wanted to learn more about heart disease-related data statistics and to hear from people who have the disease to better understand its consequences. Another suggestion was for education material that not only explained the problem but “offered solutions.”There was a strong consensus that people would not actively seek out resources to receive information on health and heart disease. There was a sense that programs needed to “reach the people where they are.” Suggested approaches for improving community outreach included offering more church-based health programs, community-based health fairs, and additional health information obtained through flyers, pamphlets, and the internet. Strategies included using different forms of the media to deliver messages, such as ethnically oriented magazines, newspapers, television, the radio and celebrities. Several FGs suggested the internet as a medium to deliver health information and viewed it as easily accessible to most people. Other participants felt that medical professionals, perceived as a “respected” and “trustworthy’ source of information, would be the most appropriate source for health knowledge. Yet, some participants commented that medical professionals are not accessible to everyone. Some of the older women said that it was “too late” to start educating individuals in their age group and that resources should be targeted toward the youth to address potential adverse health behaviors early on so that such changes can make a more substantial benefit. Participants expressed the need for CVD-focused programs to target youth and that these programs can be implemented in schools to influence behaviors from a younger age.Participants had mixed responses about messages tailored to their race and were split as to whether it was necessary to adapt messages to African Americans. Some felt strongly that health messages did not need to be race-specific. Other participants stated that the messages did not need to be personalized for African Americans, but that there was a need to deliver the information to the African American community. They felt that health information was not necessarily available to everyone who needed it, which was an issue in and of itself.All Americans need information on health care, heart disease, lung, strokes. It’s not a race issue. It’s a people issue.”“…everybody is being affected, you know, and especially diabetes and high blood pressure. All races are being affected.”“To make messages more tailored, participants indicated making the information relevant to African Americans and including information that would “catch the eye.” Respondents indicated that not only did current health messages contain images of Caucasian individuals, but they focused on statistics pertaining to whites. It was suggested that the materials had to include both African American images and pertinent statistics. If health messages only contained statistics about other races or images of people from other races, African Americans might believe the illness does not apply to them. In terms of making the materials culturally relevant, it was strongly perceived that it takes more than just including pictures of African Americans to make the materials relevant. Participants indicated that they have different cultural beliefs and engage in different behaviors than other population groups and that these need to be addressed. Some participants felt that a way to connect the message to the community was to deliver it through faith-based organizations. Additionally, some of the participants stressed that the materials needed to be linguistically accurate and not demeaning.Many African American FG participants had a general awareness of CVD including knowledge about the signs and symptoms of heart attack, stroke, hypertension, and high cholesterol. CVD and related diseases were not the only priority health concerns to emerge from the FGs and surveys, however. Cancer, diabetes, and HIV or AIDS were also viewed as leading causes of death and health worries. These disease rankings were similar to our previous survey results from young adult African Americans in metro Phoenix, and other national surveys with African American women ,23,24,25Despite the participants’ expressed concern about CVD, knowledge of heart disease and related diseases was mixed. Most people could not define heart disease but did correctly associate it with related conditions such as heart attack, stroke, hypertension, high cholesterol, and with unhealthy behaviors such as poor diet, stress, and physical inactivity. While participants were knowledgeable regarding risk factors for heart attacks, stroke, hypertension, and high cholesterol, they expressed a lack of understanding of the pathophysiology and mechanisms behind these conditions. Many did not know the cut-off points for diagnosing hypertension or high cholesterol. They were also limited in their ability to describe the signs and symptoms of heart disease, indicating that for some conditions, they only knew they had these conditions because their doctors told them.This lack of full understanding can also be confirmed from findings from an earlier national survey inquiring about perceptions and knowledge of heart disease from women, with an over sampling of African Americans. Mosca et al. report only 47% of African American women (n = 130) feel “moderately informed” on heart disease, with 17% “very well informed” and 12% “not at all informed” . A natioFG findings indicate a need to provide more education and awareness about what it means when an individual has CVD. This education should include information on CVD signs and symptoms, a basic understanding of CVD risk factors and pathophysiology, and effective prevention strategies. This information needs to be presented in a way that is understandable to the general public, while showing individuals what they can do to prevent and reduce their risk of heart disease using a culturally relevant approach ,26. EffeDiet, stress, and physical inactivity were identified as salient risk factors for heart disease in the group discussions. Yet, there was a notable disjunction between the FG discussions and the responses on the self-administered questionnaires with many of the participants not practicing healthy lifestyles. This disconnection between knowledge and action underscores the need to enhance opportunities for behavior change. Similar findings were observed with young adult African Americans from the same Arizona communities in a previous study . This diQualitative inquiry can be the best approach for identifying the unique barriers to and motivators for sustainable change ,31. As sIt is notable that overweight and obesity were rarely mentioned in FG discussions as a factor in CVD or health risk. Other research has suggested that African Americans may be more comfortable with their bodies regardless of medical or mainstream social norms regarding body size . ConsideStress produced by one’s job, poverty, having too many commitments, experiencing prejudice, or a combination of factors was recognized as associated with the development of CVD. Many participants indicated that African Americans led particularly stressful lives. These discussions frequently centered on economic limitations, rather than racial discrimination. It is important to note the complex interactions between socioeconomic status, race, gender, and age in CVD risk ,32,35. HNon-modifiable risk factors for heart disease, such as socio-economic status and heredity, were also discussed. Those with a lower socioeconomic status were perceived as having more life stressors and reduced access to health insurance and healthcare, healthy food choices, and places to be physically active. Participants identified lower socio-economic status as a potential precursor to not only heart disease but to engaging in fewer healthy behaviors. This provides implications in terms of possible interventions. While socio-economic status is not always modifiable, interventions can focus on ways to improve dietary quality, how to locate healthy, affordable foods, and how to engage in low-cost physical activities. Interventions can also focus on enhancing healthcare access among low income individuals through screenings and improving connectivity to healthcare. Pace et al., found that rural African Americans in Alabama felt that lack of income directed one’s focus on daily activities rather than preventative health practices .Genetics or heredity was considered a significant risk factor in CVD, but it was also suggested that genetics could be overcome by engaging in healthy behaviors. It was expressed that behaviors are passed on within families and that this may drive the apparent association between genetics/heredity and heart disease.Strengths of the current study include the large sample size for qualitative analysis, breadth of perspectives from both men and women, young adult through middle age, and variety of geographic locations in Arizona. There are several limitations to be noted. Perceptions and experiences of the participants may be different from those who did not engage in the research study. The nature of FG methodology is such that quotes are not linked to the quantitative survey responses of individuals. Our qualitative and quantitative results may not represent all African American’s views in Arizona or nationally.Consistent with national data on cardiovascular disease and other chronic illnesses, FG participants recognized African Americans were at higher risk for numerous chronic illnesses including heart disease, stroke, cancer, diabetes and HIV/AIDS. Participants clearly recognized the need to intervene on lifestyle factors related to the development of these chronic conditions. Responses regarding the etiology and consequences of cardiovascular diseases, as well as the lifestyle behaviors associated with increased cardiovascular risk, suggest the need for increasing the availability of educational programming. Medical professionals were perceived as the most appropriate source of health information despite discussion on issues with adequate healthcare.Suggested avenues for heart disease prevention programs in the African American Community included outreach and awareness programs, health fairs, and programs offered through schools and churches. Relevant topics include information regarding strategies for heart disease prevention, the signs and symptoms of heart disease, and feasible approaches for making behavior changes. It should also be noted that an important viewpoint also emerged: heart disease is a problem that touches all humans regardless of race or ethnicity and making the information available is most important.While participants were mixed in their opinions about whether the materials and programs needed to be specifically tailored to African Americans, key strategies were identified for tailoring the intervention materials, including disseminating the information through ethnically relevant images, statistics, media, health behaviors, health concerns, and language. It was suggested to engage trusted members of the African American community in the delivery of health messages, especially when suggesting health behavior changes and recipe alterations.The findings from this study can be used to help create targeted interventions, particularly with low income African Americans. One important avenue to address CVD risk is through culturally appropriate nutrition and shared experiences . Program