Communication about sex and HPV among Puerto Rican mothers and daughters.

OBJECTIVE: Although opportunities to vaccinate against human papillomavirus (HPV) are available, vaccination rates in Puerto Rico remain low. Communication between parents and adolescents about sexual topics may influence decisions about HPV vaccination uptake, particularly among young women; yet, few studies have addressed this issue. This qualitative study explored Puerto Rican mothers' and daughters' communication on sex-related topics, and HPV, including the HPV vaccine. DESIGN: Thirty participants, including 9 mothers and 21 daughters, participated in seven focus groups. Participants were divided into groups of mothers and daughters, and further stratified by vaccination status. Transcripts were analyzed using a modified grounded theory approach to identify emergent themes. RESULTS: Focus group data revealed four main themes: (1) limited parent-daughter communication about sex-related topics; (2) daughters' discomfort discussing sex-related topics with their parents; (3) parental focus on abstinence; and, (4) limited parent-daughter communication about HPV and the HPV vaccine. CONCLUSION: Although daughters in this study struggled with feelings of embarrassment, invasion of privacy, encouragement of abstinence, and the fear of parents' reaction to them being sexually active prior to marriage, they also recognized the need to increase the parent-daughter communication about sex-related topics including HPV and the HPV vaccine. Educational efforts should target both daughters and parents to increase communication skills and self-efficacy and to enable them to discuss sexual health in open and nonjudgmental conversations.

Association between Health Care Utilization with Asthma Control Levels among a Sample of Adult Patients in Puerto Rico.

OBJECTIVE: Asthma is an important and serious public health problem in Puerto Rico; however, very few studies measuring the association between health care utilization and asthma control levels in adult asthma patients in Puerto Rico have been done. METHODS: This study is secondary analysis of an observational and cross-sectional database generated by the Latin American Asthma Insights and Management (LA AIM) survey. Our sub-sample consisted of adults 18 years or older living with asthma, representing a total of 343 individuals. This study determined the numbers of ambulatory physician visits, emergency visits to a physician or an emergency room, and hospitalizations that took place the 12 months prior to the survey. Patients were characterized as having well-controlled, partly controlled, or uncontrolled asthma. Descriptive and inferential statistics were performed to detect differences in the mean and number of events for physician visits, emergency visits, and hospitalizations by asthma control groups. RESULTS: After adjusting for age, sex, and chronic health conditions (other than asthma), adult asthma patients with controlled asthma had 92.0% fewer physician visits, 82.5% fewer emergency visits, and 92.2% fewer hospitalizations than did those with uncontrolled asthma. CONCLUSION: Interventions geared toward controlling asthma symptoms and clinical manifestations in adults asthma patients-which interventions might include strategies for controlling environmental risk factors, increasing patient and family education with regard to asthma management, and boosting the use of appropriate and effective medications-may have significant potential in terms of reducing the direct and indirect costs of asthma, costs that have a critical impact on the whole health care system.

Incidence of oral cavity and pharyngeal cancers by anatomical sites in population-based registries in Puerto Rico and the United States of America.

OBJECTIVE: Puerto Rico's (PR) epidemiological data on each oral cavity and pharynx cancer (OCPC) site is yet largely unexplored. Our aim was to compare OCPC incidence in PR, by anatomical site, with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanic (USH) individuals in the USA. METHODS: Data from the Surveillance Epidemiology and End Results program and the PR Central Cancer Registry were collected and analyzed. Age-standardized rates, percent changes, and standardized rate ratios were estimated with 95% confidence intervals. RESULTS: Although declining incidence rates were observed for most anatomical sites in most racial/ethnic groups and in both sexes, the incidence of oropharynx cancers slightly increased for cancers in the oropharynx among PR women, both in the base of tongue and soft palate/other oropharynx (p>0.05). The incidence of soft palate/other oropharynx cancers in PR men was about 2.8 times higher than in USH men (p<0.05) and about 1.4 times higher than in NHW men but 21% lower than in NHB men (p>0.05). Significant interactions terms formed with racial/ethnic group and age were shown in various sites. The largest differences between sexes were consistently noted in PR. CONCLUSION: Further research in PR should assess the effect of the HPV infection, as well as of other risk factors, in OCPC incidence by anatomical site in younger populations. These data could explain more precisely the reasons for the differences observed in this study, particularly among sexes in PR.

Oral Inflammation and Human Papilloma Virus Association among Hispanics.

Background: Identifying factors related to persistent human papillomavirus (HPV) infection is essential to reduce the incidence of HPV-related cancers. Objective: To evaluate whether gingival/periodontal inflammation is associated with oral HPV infection. Methods: This cross-sectional study (n = 740) uses data from the follow-up visit of the San Juan Overweight Adults Longitudinal Study, which recruited overweight/obese adults aged 40-65 from Puerto Rico. Participants completed a dental examination and two interviews (face-to-face/ACASI) and provided oral rinse samples for HPV detection. Oral inflammation was assessed using two definitions: (1) the number of sites with bleeding on probing (BOP), and (2) the number of teeth with probing pocket depths (PPD) ≥ 4 mm and BOP. Multivariate logistic regression was used to assess the association between oral inflammation and oral HPV. Results: Nearly three-quarters (72%) of participants were female, and 68% had 50 years or older. Participants with HPV had a higher mean number of sites with BOP (15.5 vs. 10.1) and teeth with PPD ≥ 4 mm and BOP (8.5 vs. 3.2) than participants without HPV (p < 0.05). After adjusting for sex, age, income, and the number of oral sex partners, the odds of having an oral HPV infection increased by 3% (95% confidence interval (CI): 1.00-1.06) for any additional sites with BOP and 5% (95% CI: 1.02-1.09) for any other teeth with PPD ≥ 4 mm and BOP. Conclusions: We found that oral inflammation was associated with oral HPV infection among adults in Puerto Rico. Future studies need to further investigate the underlying mechanisms.

Comparison of oral human papilloma virus detection methods among Hispanic adults.

OBJECTIVES: Oral human papilloma virus (HPV) infection is associated with nearly three-quarters of all oropharyngeal cancers in the United States. Research also suggests its association with periodontal disease. There are limited studies evaluating differences in HPV detection methods; however, oral rinse is considered the most sensitive detection method. We compared HPV detection by self-collected oral rinse versus self-collected cytobrush and assessed whether the strength of association between periodontitis and HPV is modified by the collection method. MATERIALS AND METHODS: Data from a cross-sectional study of Hispanic adults in Puerto Rico (n = 346) who provided oral rinse and cytobrush samples for oral HPV detection and were clinically evaluated for periodontitis. The agreement between the oral mouthwash and cytobrush methods was assessed using the Kappa (κ) statistic. Logistic regression models were used to determine if the association between HPV infection and other risk factors varied by oral sample collection method. RESULTS: HPV prevalence was slightly higher using cytobrush than oral rinse (5.8% vs. 4.3%). The sensitivity of cytobrush to detect oral HPV was 64.7%, and the specificity was 97.4%. We observed a κ of 0.61 (95% confidence interval [CI]: 0.45-0.78), indicative of fair to good agreement between the two collection methods. The association between oral HPV infection and periodontitis severity was stronger when using the oral rinse collection method (odds ratio [OR] = 3.23, 95% CI: 1.06-9.84); the association was not statistically significant for cytobrush (OR = 1.96, 95% CI: 0.68-5.65). CONCLUSIONS: These findings support the significance of choosing the most suitable collection method in oral HPV-related studies. Selecting the most appropriate collection method is an essential criterion in oral HPV-related studies.

Reduced exposure to secondhand smoke at casinos in Puerto Rico after the implementation of a workplace smoking ban in 2007: a pre-post design.

OBJECTIVE: Tobacco use and the involuntary exposition to secondhand smoke (SHS) is one of the leading causes of cancer. The objective of this study was to assess the effect of the smoke free workplace ban implemented in March of 2007 in Puerto Rico on the exposure of casino workers to secondhand smoke measured in terms of fine particulate matter and cotinine level. METHODS: This study used a pre-post comparison design to measure exposure to secondhand smoke before (February, 2007) and after (December, 2007 to February, 2008) the workplace smoking ban was implemented. The samples included level of cotinine in saliva from 20 randomly sampled casino union workers and indoor concentrations of fine particulate matter (2.5 microm diameter, PM2.5) in 10 casinos located in the San Juan metropolitan area. Paired t-tests were used to test any statistically significant change in particulate matter and cotinine levels before and after the ban went into effect. RESULTS: The average PM2.5 level in San Juan metropolitan area casinos decreased by 88.5% (95% CI: 63.9%, 96.3%) and the average cotinine level for the sample of nonsmoking casino workers decreased by 52.1% (95% CI: 40.6%, 61.4%). Both reductions were statistically significant (p < 0.01). CONCLUSION: The implementation of the smoke free workplace ban in 2007 resulted in a significant reduction of the exposure to secondhand smoke to casino workers in the San Juan metropolitan area of Puerto Rico.

Sex Differences in Risk Factors for Oral and Pharyngeal Cancer among Puerto Rican Adults.

BACKGROUND: Oral and pharyngeal cancer (OPC) is a frequent type of cancer in Puerto Rico, with the risk being higher in men relative to women. We assessed differences in OPC risk factors implicated in these sex disparities. METHODS: We analyzed data of 740 adult participants (40-65 years) from the San Juan Overweight Adults Longitudinal Study (SOALS). A comprehensive questionnaire was administered to collect information on sociodemographic characteristics, cigarette smoking, binge drinking, oral high-risk HPV infection, fruit and vegetable consumption, sexual behavior, and oral hygiene practices. A full-mouth periodontal examination was also performed. Sixteen OPC known and potential risk factors were evaluated. Crude and adjusted prevalence ratio (PR) estimates for individual OPC risk factors, by sex, were calculated using log-binomial regression. RESULTS: Compared to women, men had significantly increased prevalence of several OPC risk factors including current smoking (PR: 1.91, 95% Confidence interval [CI]: 1.35-2.70), binge drinking (PR: 1.92, 95% CI: 1.31-2.84), and severe periodontitis (PR: 2.05, 95% CI: 1.47-2.85). CONCLUSIONS: Men were significantly more likely than women to have risk factors for OPC. Cancer prevention and control efforts should focus on sex-specific interventions that help reduce this disparity.

Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico.

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.

Characteristics of smokers accessing the Puerto Rico Quitline.

BACKGROUND: In 2004, the Puerto Rico Department of Health implemented the Puerto Rico Quitline (PRQ), a proactive, telephone-based smoking cessation counseling program. This study examines the demographic and smoking-related characteristics of the individuals served by the PRQ. METHODS: Analyses included PRQ participants registered from December 2004-December 2005. PRQ call rates and rate ratios (RR) were calculated overall, among smokers, and stratified by relevant covariates. Associations between sex and relevant characteristics of PRQ participants were compared using regression models. RESULTS: Call rates per 100,000 smokers in PR were lower among men than women (RR = 0.50, 95% CI = 0.44-0.56), and higher among all age groups > or = 25 years of age as compared to those aged 15-24 years (RRs = 4.34-8.14) and among smokers living in the San Juan metropolitan area relative to smokers residing outside the metropolitan area (RR = 1.45, 95% CI = 1.29-1.63). Mass media was the most common way in which participants learned about the PRQ (> 70%), with only 2-3% of callers reporting a physician's referral as the source of their information about the PRQ. With respect to reasons for quitting, men were less likely than women to report concern about a child's health (OR = 0.62, 95% CI = 0.46-0.84) and cigarette odor (OR = 0.64, 95% CI = 0.41-0.99). Meanwhile, men were more likely (OR = 1.39, 95% CI = 1.01-1.91) to report the influence of other smokers as a barrier during quitting. CONCLUSIONS: PRQ promotion and outreach efforts should target populations underserved by the PRQ including male, young adult, and non-metropolitan area smokers. Initiatives that link the PRQ with primary care providers in promoting smoking cessation should be encouraged.

Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial.

Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, "Motivation And Problem Solving Plus" (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.

Disproportionate Tobacco Use in the Puerto Rico Lesbian, Gay, Bisexual, and Transgender Community of 18 Years and Over-A Descriptive Profile.

PURPOSE: Tobacco use is currently one of the most critical public health issues affecting sexual and gender minority individuals. The primary objective of this research was to provide the first population-based epidemiological profile of tobacco use in the LGBT community in Puerto Rico. The secondary objective was to identify differences between LGBT smokers (LGBT-S) versus LGBT nonsmokers (LGBT-NS). METHODS: We conducted a secondary data analysis of the 2011 Puerto Rico Behavioral Risk Surveillance System database through a cross-sectional study methodology. A univariate analysis was performed to obtain an epidemiological profile of the LGBT-S. Through a bivariate analysis, we compared LGBT-S with LGBT-NS to identify differences. RESULTS: A higher prevalence of tobacco use was found in the Puerto Rico LGBT community (20.8%) compared with the Puerto Rico general population (14.8%). The groups with higher prevalence were females (23.2%), bisexuals (23.9%), people aged 25-34 years (52.0%), people with some years in university or technical school (23.9%), people who reported being out of work for more than 1 year (45.5%), and people who reported an annual income of $50,000 or more (12.5%). LGBT-S were more likely to report a history of cancer, arthritis, kidney disease, overweight or obesity, depressive disorder, and anxiety disorder than LGBT-NS. CONCLUSION: Health surveys should incorporate sexual and gender identity questions in order to learn more about the health status of the LGBT community, especially given the disproportionate use of tobacco. The data may be useful to implement health promotion strategies related to tobacco control in this community.

Promoting tobacco cessation and smoke-free workplaces through community outreach partnerships in Puerto Rico.

BACKGROUND: Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. OBJECTIVES: The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. METHODS: Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. RESULTS: Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. CONCLUSIONS: This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.