Racial/Ethnic and social class differences in preventive care practices among persons with diabetes

BACKGROUND: Diabetes is the sixth leading cause of death in the United States. Persons with diabetes are at increased risk for serious complications including CVD, stroke, retinopathy, amputation, and nephropathy. Minorities have the highest incidence and prevalence of diabetes and related complications compared to other racial groups. Preventive care practices such as smoking cessation, eye examinations, feet examinations, and yearly checkups can prevent or delay the incidence and progression of diabetes related complications. The purpose of this study was to examine racial/ethnic differences in diabetes preventive care practices by several socio-demographic characteristics including social class. METHODS: Data from the Behavioral Risk Factor Surveillance Survey for 1998–2001 were used for analyses. The study population consisted of persons who indicated having diabetes on the BRFSS, 35 yrs and older, and Non-Hispanic Black, non-Hispanic White, or Hispanic persons. Logistic regression was used in analyses. RESULTS: Contrary to our hypotheses, Blacks and Hispanics engaged in preventive care more frequently than Whites. Whites were less likely to have seen a doctor in the previous year, less likely to have had a foot exam, more likely to smoke, and less likely to have attempted smoking cessation. Persons of lower social class were at greatest risk for not receiving preventive care regardless of race/ethnicity. Persons with no health care coverage were twice as likely to have not visited the doctor in the previous year and twice as likely to have not had an eye exam, 1.5 times more likely to have not had a foot exam or attempted smoking cessation. CONCLUSION: This study showed that persons of lower social class and persons with no health insurance are at greatest risk for not receiving preventive services

A Socio-Ecological Approach to Addressing Digital Redlining in the United States: A Call to Action for Health Equity

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity

A Socio-Ecological Approach to Addressing Digital Redlining in the United States:A Call to Action for Health Equity

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity

Acculturation and dietary intake pattern among Jamaican immigrants in the US

Information on dietary intakes of Jamaican immigrants in the United States is sparse. Understanding factors that influence diet is important since diet is associated with chronic diseases. This study examined the association between acculturation, socio-cultural factors, and dietary pattern among Jamaican immigrants in Florida. Jamaican persons 25–64years who resided in two South Florida counties were recruited for participation. A health questionnaire that assessed acculturation, dietary pattern, and risk factors for cardiovascular disease was administered to participants. Generalized Estimating Equations were used to determine associations. Acculturation score was not significantly associated with dietary intake pattern (β=−0.02 p=0.07). Age at migration was positively associated with traditional dietary pattern (β=0.02 p<0.01). Persons with 12 or fewer years of education (β=−0.55 p<0.001), divorced (β=−0.26 p=0.001), or engaged in less physical activity (β=−0.07 p=0.01) were more likely to adhere to a traditional diet. Although acculturation was not a statistically significant predictor of dietary intake, findings show the role of demographic and lifestyle characteristics in understanding factors associated with dietary patterns among Jamaicans. Findings point to the need to measure traditional dietary intakes among Jamaicans and other immigrant groups. Accurate assessment of disease risk among immigrant groups will lead to more accurate diet-disease risk assessment and development of effective intervention programs. Keywords: Dietary patterns, Acculturation, Cardiovascular risk, Jamaica

Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study

Introduction: Studies conducted in the US and other high-income countries show that the local food environment influences dietary intakes that are protective for cardiovascular health. However, few studies have examined this relationship in the Caribbean. This study aimed to determine whether perceptions of the local food environment were associated with fruit and vegetable (FV) intake in the Eastern Caribbean, where daily FV intake remains below recommended levels. Methods: Cross-sectional analysis of Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) baseline data (2013–2016) from Barbados, Puerto Rico, Trinidad and Tobago, and US Virgin Islands was conducted in 2020. The National Cancer Institute Dietary Screener Questionnaire was adapted to measure daily servings of FV. Existing scales were used to assess participant perceptions of the food environment (availability, affordability, and quality). Chi-square tests and Poisson regression were used for analyses. Results: Participants reported eating one mean daily serving of FV. Mean daily intake was higher among those who perceived FV as usually/always affordable, available, and high quality. Multivariate results showed statistically significant associations between FV and affordability. Persons who perceived FV as affordable had 0.10 more daily servings of FV compared to those who reported FV as not always affordable (p = 0.02). Food insecurity modified the association between affordability and FV intake. Conclusions: This study highlights the importance of affordability in consumption of FV in the Eastern Caribbean, and how this relationship may be modified by food insecurity

Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean

OBJECTIVE: Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. DESIGN: SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. SETTING: Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. PARTICIPANTS: Participants ( 1701) enrolled in the ECS. RESULTS: Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). CONCLUSIONS: Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean