Barriers to disaster preparedness among medical special needs populations

A medical special needs (MSN) assessment was conducted among 3088 respondents in a hurricane prone area. The sample was female (51.7%), Hispanic (92.9%), aged \u3e45 years (51%), not insured for health (59.2%), and with an MSN (33.2%). Barriers to preparedness were characterized for all households, including those with inhabitants reporting MSN ranging from level 0 (mild) to level 4 (most severe). Multivariable logistic regression tested associations between hurricane preparedness and barriers to evacuation by level of MSN. A significant interaction effect between number of evacuation barriers and MSN was found. Among households that reported individuals with level 0 MSN, the odds of being unprepared increased 18% for each additional evacuation barrier [OR = 1.18, 95% CI (1.08, 1.30)]. Among households that reported individuals with level 1 MSN, the odds of being unprepared increased 29% for each additional evacuation barrier [OR = 1.29, 95% CI (1.11, 1.51)]. Among households that reported individuals with level 3 MSN, the odds of being unprepared increased 68% for each additional evacuation barrier [OR = 1.68, 95% CI (1.21, 1.32)]. MSN alone did not explain the probability of unpreparedness, but rather MSN in the presence of barriers helped explain unpreparedness

Factors associated with meeting physical activity guidelines during the COVID-19 pandemic

Introduction: The COVID-19 pandemic impacted individual physical activity levels. Less is known regarding how factors such as sociodemographic and built environment were associated with physical activity engagement during the pandemic. Understanding these factors is critical to informing future infectious disease mitigation policies that promote, rather than hinder physical activity. The purpose of this study was to assess predictors of physical activity levels during the beginning of the pandemic (April-June 2020), including Stay-at-Home length and orders, neighborhood safety, and sociodemographic characteristics. Methods: Data included 517 participants who responded to an anonymous online survey. Physical activity was assessed with a modified Godin Leisure-time exercise questionnaire. We used logistic regression models to estimate unadjusted and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) for the associations between independent variables (e.g., demographic variables, neighborhood safety, COVID Stay-at-Home order and length of time) and physical activity levels that did not meet (i.e., \u3c 600 metabolic equivalents of task [MET]-minutes/week) or met guidelines (i.e., ≥ 600 MET-minutes/week). We used R-Studio open-source edition to clean and code data and SAS V9.4 for analyses. Results: Most participants were 18-45 years old (58%), female (79%), Hispanic (58%), and college/post-graduates (76%). Most (70%) reported meeting physical activity guidelines. In multivariate-adjusted analyses stratified by income, in the highest income bracket (≥ $70,000) pet ownership was associated with higher odds of meeting physical activity guidelines (aOR = 2.37, 95$40,000). Within this lowest income bracket, we also found that a lower level of education was associated with reduced odds of meeting physical activity guidelines. Discussion: We found that perceived neighborhood safety, education and pet ownership were associated with meeting physical activity guidelines during the early months of the COVID-19 pandemic, but associations differed by income. These findings can inform targeted approaches to promoting physical activity during subsequent waves of COVID-19 or future pandemics

Adherence to U.S. Physical Activity and Dietary Guidelines Among A Mexican American Cohort

Purpose: The purpose of this study is to examine adherence to risk factors for chronic diseases among Mexican Americans residing along Texas / Mexico border. Method: Data was derived from the Cameron County Hispanic Cohort (CCHC), a prospective cohort study of over 2600 Mexican American adults aged 18 years and older living in a large and poor city along the Texas / Mexico border. Descriptive statistics and regression analysis were used to analyze the data. Results:The sample (67.06% female) has a mean age of 48.06 ± 15.60 years, 48.81% employed, 45.66% has less than high school education, 77.57% completed the survey in Spanish, and 31.65% has some type of public or private insurance. More than 85% of the sample were either overweight (25≤BMI Conclusions: Preventive behaviors including regular moderate to vigorous physical activity and a diet rich with fruit and vegetables are uncommon among Mexican Americans. Younger age and lower BMI were associated with meeting preventive behavior guidelines along Texas / Mexico border Mexican Americans

Metabolic Health Has Greater Impact on Diabetes than Simple Overweight/Obesity in Mexican Americans

To compare the risk for diabetes in each of 4 categories of metabolic health and BMI. Methods. Participants were drawn from the Cameron County Hispanic Cohort, a randomly selected Mexican American cohort in Texas on the US-Mexico border. Subjects were divided into 4 phenotypes according to metabolic health and BMI: metabolically healthy normal weight, metabolically healthy overweight/obese, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obese. Metabolic health was defined as having less than 2 metabolic abnormalities. Overweight/obese status was assessed by BMI higher than 25 kg/m2. Diabetes was defined by the 2010 ADA definition or by being on a diabetic medication. Results. The odds ratio for diabetes risk was 2.25 in the metabolically healthy overweight/obese phenotype (95% CI 1.34, 3.79), 3.78 (1.57, 9.09) in the metabolically unhealthy normal weight phenotype, and 5.39 (3.16, 9.20) in metabolically unhealthy overweight/obese phenotype after adjusting for confounding factors compared with the metabolically healthy normal weight phenotype. Conclusions. Metabolic health had a greater effect on the increased risk for diabetes than overweight/obesity. Greater focus on metabolic health might be a more effective target for prevention and control of diabetes than emphasis on weight loss alone

Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border

Background: Non-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border. Methods: Two weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008–2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05. Results: Both samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use. Conclusion: The lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered

Health coaching to encourage obese adults to enroll in commercially-available weight management programs: The path to health study

Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥4 calls as compared to those who completedstudy, we found that phone health coaching was successful in increasing obese adults\u27 enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes

Anxiety, depression and smoking status among adults of Mexican heritage on the Texas-Mexico Border

The goal of the current analysis is to examine relationships between smoking status and anxiety and depression among adults of Mexican heritage to inform the development of culturally relevant smoking cessations efforts. Mexican heritage residents (N=1,791) of the city of Brownsville, TX, aged 18 years or older, enrolled in the Cameron County Hispanic Cohort, were selected through two stage cluster sampling of randomly selected census tracts from the first and third quartile of SES using Census 2000. Among current smokers, anxiety and depression scores were highest among women who had not completed high school (p\u3c0.05). Former smoking women, but not men, with at least a high school education and former smoking women born in the United States reported higher levels of anxiety and depression than never smoking women. Negative affective states may represent a greater barrier to smoking cessation among women than men

Gender Difference in Obesity and Preventive Health Behaviors in A US-Mexico Border Hispanic Cohort

Purpose: Overweight and obesity is a prevalent chronic disorder in Mexican Americans, however, obesity-related behaviors and the role of gender remain unclear. This study examined gender difference in obesity-related health behaviors among Mexican Americans. Methods: A sample (n=1439) was drawn from the Cameron County Hispanic Cohort, a prospective cohort sample of Mexican American adults aged 18 years and older living in a large and poor city along the Texas / Mexico border. The participants’ baseline demographic, behavioral, and clinical measures were used for this analysis. Descriptive statistics and chi-square tests were conducted to analyze the data. Results: The sample had a mean age of 48.06 ± 15.60 years, 67.06% female, 48.81% employed, 45.66% had less than high school education, 77.57% chose to complete survey in Spanish, and 31.65% had some type of public or private insurance. Females (57.82% vs. 47.08% males) were more likely to have a lower than high school education (p\u3c.0001), while males were more likely to be employed (66.31% vs. 40.41%). About 88% males and 84% females were either overweight (25≤BMI\u3c30) or obese (BMI≥30). Males (39.47% vs. 31.18%) were more likely overweight, while females (53.28% vs. 48.68% in males) were more likely obese. We also found poor health behaviors contributing to the high obesity prevalence. Females (18.98% vs. 11.11%) were more likely to adhere to U.S. fruit and vegetables guidelines of more than 5 portions, p=.0005, while males (36.42% vs. 27.94%) were more likely to adhere to U.S. physical activity guidelines of 150 minutes moderate to vigorous weekly, p=0.0013. Conclusions: There were significant gender differences in obesity-related behaviors in the Texas / Mexico Hispanic cohort. Interventions for this population need to take gender difference into consideration when designing appropriate behavior change strategies

Interventions to Increase Follow-Up of Abnormal Cervical Cancer Screening Results: A Systematic Literature Review and Meta-Analysis

INTRODUCTION: Ensuring timely follow-up of abnormal screening results is essential for eliminating cervical cancer. OBJECTIVE: The purpose of the study was to review single and multicomponent interventions designed to improve follow-up of women with abnormal cervical cancer screening results. We report on effectiveness across studies, and describe what aspects of these interventions might be more impactful. METHODS: Publications were searched between January 2000 and December 2022. The search included observational, quasi-experimental (pre-post studies) and randomized controlled studies describing at least one intervention to increase follow-up of women with abnormal cervical cancer screening results. Outcomes of studies included completion of any follow-up (i.e., attending a follow-up appointment), timely diagnosis (i.e., colposcopy results within 90 days of screening) and time to diagnostic resolution (i.e., days between screening and final diagnosis). We assessed risk of bias for observational and quasi-experimental studies using the Newcastle-Ottawa Scale (NOS) tool and the Cochrane collaboration tool for randomized studies. We conducted a meta-analysis using studies where data were provided to estimate a summary average effect of the interventions on follow-up of patients and to identify characteristics of studies associated with an increased effectiveness of interventions. We extracted the comparison and intervention proportions of women with follow-up before and after the intervention (control and intervention) and plotted the odds ratios (ORs) of completing follow-up along with the 95% confidence intervals (CIs) using forest plots for the interventions vs. controls when data were available. FINDINGS: From 7,457 identified studies, 28 met the inclusion criteria. Eleven (39%) of the included studies had used a randomized design. Most studies (63%) assessed completion of any follow-up visit as the primary outcome, whereas others measured time to definite diagnosis (15%) or diagnostic resolution (22%). Navigation was used as a type of intervention in 63% of the included studies. Most interventions utilized behavioral approaches to improve outcomes. The overall estimate of the OR for completion of follow-up for all interventions was 1.81 (1.36-2.42). The highest impact was for programs using more than one approach (multicomponent interventions) to improve outcomes with OR = 3.01 (2.03-4.46), compared with studies with single intervention approaches with OR = 1.56 (1.14-2.14). No statistical risks were noted from publication bias or small-study effects in the studies reviewed. CONCLUSION: Our findings revealed large heterogeneity in how follow-up of abnormal cervical cancer screening results was defined. Our results suggest that multicomponent interventions were more effective than single component interventions and should be used to improve follow-up after abnormal cervical cancer screening results. Navigation appears to be an important tool for improving follow-up. We also provide recommendations for future studies and implications for policy in terms of better defining outcomes for these interventions