Caring for Stroke Survivors: Ethnic Differences in Informal Caregiver Needs Among Mexican American and Non-Hispanic White Communities.

BACKGROUND: After stroke, Mexican American (MA) individuals have worse 90-day neurological, functional, cognitive, and quality of life outcomes and a higher prevalence of poststroke depression compared with non-Hispanic White (NHW) individuals. MA individuals receive more help through informal, unpaid caregiving than NHW individuals. We examined ethnic differences in needs identified by MA and NHW stroke caregivers. METHODS: Caregivers were identified from the population-based BASIC study (Brain Attack Surveillance in Corpus Christi) in Nueces County, Texas from October 2019 to November 2021. Responses to the Caregiver Needs and Concerns Checklist were collected at 90-day poststroke to assess caregiver needs. Using the cross-sectional sample, prevalence scores and bivariate analyses were used to examine ethnic differences between Caregiver Needs and Concerns Checklist items. Linear regression was used to examine adjusted associations of ethnicity with the total average needs for each domain. Models were adjusted for patient and caregiver age and sex, caregiver education level, and employment status, patient insurance status, prestroke function, cognitive status, language, and functional outcome at 90 days, intensity and duration of caregiving, presence of other caregivers (paid/unpaid), and cohabitation of patient and caregiver. RESULTS: A total of 287 were approached, and 186 stroke caregivers were included with a median age of 54.2 years and 80.1% being women caregivers: 74.3% MA and 25.7% NHW individuals. MA caregivers had significantly lower education (

Promoting Health Equity Through Preventing or Mitigating the Effects of Gentrification: A Theoretical and Methodological Guide.

Public health researchers are increasingly questioning the consequences of gentrification for population health and health equity, as witnessed in the rapid increase in public health publications on the health (equity) effects of gentrification. Despite methodological challenges, and mixed results from existing quantitative research, qualitative evidence to date points to the role of gentrification processes in exacerbating health inequities. Here we discuss past methodological and theoretical challenges in integrating the study of gentrification with public health research. We suggest taking an interdisciplinary approach, considering the conceptualization of gentrification in measurement techniques and conceiving this process as a direct exposure or as a part of broader neighborhood changes. Finally, we discuss existingpolicy approaches to mitigating and preventing gentrification and how these could be evaluated for effectiveness and as public health promotion and specifically as interventions to promote health equity.

Without Affordable, Accessible, and Adequate Housing, Health Has No Foundation.

Policy Points Today's housing disparities are rooted in the increasing commodification of housing that has taken precedence over the need for shelter, a basic human right. With rising housing costs across the country, more residents are finding their monthly income going to rent, mortgage payments, property taxes, and utilities, leaving little for food and medication. Housing is a determinant of health, and with increasing housing disparities, action must be taken to ensure no individual is displaced, communities remain intact, and cities continue to thrive.

Historic Redlining Practices and Contemporary Determinants of Health in the Detroit Metropolitan Area.

Objectives. To examine how redlining, a historical racially discriminatory housing policy implemented by the Home Owners' Loan Corporation (HOLC), is associated with current neighborhood determinants of health in the Detroit Metropolitan Area. Methods. We analyzed associations between census tract‒level HOLC color grades (red = "hazardous"; yellow = "declining"; blue = "desirable"; and green = "best") and a developed neighborhood determinants of health index (DOHI) consisting of 8 indicators of economic, social, governance, and physical environment characteristics using spatial regression analysis and controlling for change in the census tract's percentage of White residents. Results. A total of 484 Detroit Metropolitan Area census tracts had HOLC grades. The mean redlining score across all census tracts was 3.02 (min = 1.0; max = 4.0). The mean contemporary DOHI was 19.11 (min = 8.0; max = 36.0). Regression models show significantly higher DOHI scores in yellowlined (b = 2.71; 95% confidence interval [CI] = 1.52, 3.91), bluelined (b = 5.33; 95% CI = 3.65, 7.01), and greenlined (b = 9.25; 95% CI = 6.86, 11.64) neighborhoods compared with redlined neighborhoods. Conclusions. Historical redlined neighborhoods experience contemporary determinants of health conditions that are less conducive to health compared with those in nonredlined neighborhoods. These differences also reflect the accumulation of resources essential for health in greenlined neighborhoods. Public Health Implications. Neighborhood development initiatives should consider the impacts of historical redlining on contemporary neighborhood conditions. (Am J Public Health. 2023;113(S1): S49-S57. https://doi.org/10.2105/AJPH.2022.307162).

Bricks and mortar of well-being: exploring the housing-health connection.

Housing is a determinant of health. Increasing housing costs and worsening housing conditions have impacted populations worldwide. This Editorial aims to examine the dynamic connection between housing and health and the role of public health in addressing this relationship for a Collection launched at BMC Public Health on Housing as a determinant of health and well-being.

A community-based study of reporting demographic and clinical information concordance between informants and cognitively impaired participants.

BACKGROUND: Understanding concordance between informants' and cognitively impaired participants' information reporting is crucial for Alzheimer's and Alzheimer's-related dementia studies. METHODS: The Brain Attack Surveillance in Corpus Christi-Cognitive is a community-based cohort study. Households in Nueces County, Texas, USA, were randomly identified. 330 dyads of participants and their named informants answered questions. Models were generated to examine which predictors, including age, gender, ethnicity, cognitive function, and relationship to informant, influenced answer discordance. RESULTS: For demographic items, female participants and participants with spouses/partners as informants had significantly less discordance, with incidence rate rations (IRRs) of 0.65 (CI = 0.44, 0.96) and 0.41 (CI = 0.23, 0.75), respectively. For health items, better cognitive function of the participant was associated with less discordance, with an IRR of 0.85 (CI = 0.76, 0.94). CONCLUSIONS: Demographic information concordance is most associated with gender and informant-participant relationship. Level of cognitive function is most associated with concordance for health information. CLINICALTRIALS: gov identifier NCT03403257.

The effects of housing insecurity on children's health: a scoping review.

There is a well-established connection between housing conditions and children's health. However, little is known on how housing insecurity indicators including, multiple moves, being behind on rent/mortgage, doubling up and crowding, affect child health. The purpose of this paper is to identify how pathways of association between housing insecurity and health may become established during childhood, using evidence from the literature. Using the Joanna Briggs Institute framework for scoping reviews, a search was conducted using key terms associated with housing insecurity and health among children. Twenty-seven articles were included in the review. Forty-six outcomes related to child health were identified throughout the articles. Physical health was the most commonly examined outcome in these articles. Multiple moves was the most common housing insecurity indicator associated with health. This review identified multiple studies showing negative associations between housing insecurity and poorer health-related indicators among children. Results from this review provide important information on the implication of certain housing insecurity indicators for children's health. Although housing is increasingly recognized as a social determinant of health, it may be particularly important to go beyond physical housing conditions to consider and measure housing insecurity in future work, as a key social determinant shaping health in pediatric populations.

In this scoping review, we examine the evidence for pathways linking housing insecurity including, multiple moves, being behind on rent/mortgage, doubling up and crowding, and multiple health outcomes (i.e. physical and mental health, behavior, cognitive development) in early and middle-aged children. It is important to acknowledge housing insecurity as a barrier to achieving optimal health in children.

Differential Impact of Stroke on Cognitive Impairment in Mexican Americans and Non-Hispanic White Americans.

BACKGROUND: The association between stroke and dementia is well established. Less is known about this association in underrepresented ethnic groups. In a large ethnically diverse cohort, we examined whether history of stroke was associated with cognitive impairment, and whether this relationship differed by ethnicity (Mexican American [MA] versus non-Hispanic White). METHODS: This was a population-based cohort study conducted in Nueces County, TX, a biethnic community with a large and primarily nonimmigrant MA population. Residents aged ≥65 were recruited door-to-door or by telephone between May 2018 and December 2021. The primary exposure was history of stroke, obtained by self-report. Demographic, medical, and educational histories were also obtained. The primary outcome was the Montreal Cognitive Assessment (MoCA), a scale that evaluates multiple domains of cognitive performance. Scores were divided into 3 ordinal categories, roughly corresponding to normal cognition (MoCA 26-30), mild cognitive impairment (MoCA 20-25), or probable dementia (MoCA 0-19). RESULTS: One thousand eight hundred one participants completed MoCA screening (55% female; 50% MA, 44% Non-Hispanic White, 6% other), of whom 12.4% reported history of stroke. Stroke prevalence was similar across ethnicities (X2 2.1; P=0.34). In a multivariable cumulative logit regression model for the ordinal cognition outcome, a stroke by ethnicity interaction was observed (P=0.01). Models stratified by ethnicity revealed that stroke was associated with cognitive impairment across ethnicities, but had greater impact on cognition in non-Hispanic Whites (cumulative odds ratio=3.81 [95% CI, 2.37-6.12]) than in MAs (cumulative odds ratio=1.58 [95% CI, 1.04-2.41]). Increased age and lower educational attainment were also associated with cognitive impairment, regardless of ethnicity. CONCLUSIONS: History of stroke was associated with increased odds of cognitive impairment after controlling for other factors in both MA and Non-Hispanic White participants. The magnitude of the impact of stroke on cognition was less in MA than in Non-Hispanic White participants.

Differential Relationships Between the Montreal Cognitive Assessment and Informant-Rated Cognitive Decline Among Mexican Americans and Non-Hispanic Whites.

OBJECTIVES: We compared the concurrent validity of the Montreal Cognitive Assessment (MoCA) with other cognitive screening instruments among Mexican Americans (MA) and non-Hispanic whites (NHW). METHODS: In a community-based study in Nueces county, Texas (5/2/18-2/26/20), participants 65+ with MoCA ≤25 completed the Harmonized Cognitive Assessment Protocol. Regressions examined associations between MoCA and: 1) Mini Mental State Examination (MMSE); 2) abbreviated Community Screening Interview for Dementia (CSI-D); 3) Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). RESULTS: MA (n = 229) and NHW (n = 81) differed by education but not age or sex. MoCA and cognitive performance associations (MMSE, CSI-D-Respondent) did not differ between MA and NHW (p's > .16). MoCA and informant rating associations (IQCODE, CSI-D-Informant) were stronger in NHW than MA (NHW R2 = 0.39 and 0.38, respectively; MA R2 = 0.30 and 0.28, respectively). DISCUSSION: Our findings suggest non-equivalence across cognitive screening instruments among MAs and NHWs.

Dementia care needs for individuals and caregivers among Mexican Americans and non-Hispanic Whites.

Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified.Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority.Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers.By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs.

Methods and early recruitment of the Brain Attack Surveillance in Corpus Christi-Post-acute Care (BASIC-PAC) Project.

OBJECTIVES: Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke outcomes. We report here the methods, background literature, and initial recruitment of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers, and community. MATERIALS AND METHODS: Rigorous active and passive stroke surveillance captures all strokes in Nueces County, Texas. Stroke patients are followed for 90 days to determine their care transitions and factors influencing their rehabilitation setting. Informal caregivers of the stroke patients are identified and interviewed at 90 days to determine aspects of their caregiving and caregiver outcomes. Available community resources are compared with stated needs among stroke patient and caregivers to determine unmet needs. RESULTS: Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413 were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by 355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating potential caregivers met the eligibility criteria. CONCLUSIONS: BASIC-PAC has strong initial recruitment and is poised to provide valuable data on multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse stroke outcomes in MAs. Based on the study findings, interventions can be developed that will improve stroke health equity.

Urban renewal, gentrification and health equity: a realist perspective.

Background: Up to now, research has focused on the effects of urban renewal programs and their impacts on health. While some of this research points to potential negative health effects due to gentrification, evidence that addresses the complexity associated with this relation is much needed. This paper seeks to better understand when, why and how health inequities arise from urban renewal interventions resulting in gentrification. Methods: A realist review, a qualitative systematic review method, aimed to better explain the relation between context, mechanism and outcomes, was used. A literature search was done to identify theoretical models of how urban renewal programs can result in gentrification, which in turn could have negative impacts on health. A systematic approach was then used to identify peer-reviewed studies that provided evidence to support or refute the initial assumptions. Results: Urban renewal programs that resulted in gentrification tended to have negative health effects primarily in residents that were low-income. Urban renewal policies that were inclusive of populations that are vulnerable, from the beginning were less likely to result in gentrification and more likely to positively impact health through physical and social improvements. Conclusions: Research has shown urban renewal policies have significant impacts on populations that are vulnerable and those that result in gentrification can result in negative health consequences for this population. A better understanding of this is needed to impact future policies and advocate for a community-participatory model that includes such populations in the early planning stages.

Place-Based Measures of Inequity and Vision Difficulty and Blindness.

Importance: Known social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty. Objective: To investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty). Design, Setting, and Participants: This cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023. Main Outcomes and Measures: The main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression. Results: In total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P < .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P < .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P < .001). Conclusions and Relevance: In this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.

A Community-Based Study of Dementia in Mexican American and Non-Hispanic White Individuals.

BACKGROUND: Little information is available on the prevalence of cognitive impairment in Mexican American persons. OBJECTIVE: To determine the prevalence of mild cognitive impairment (MCI) and dementia in those 65 years and older among Mexican American and non-Hispanic white individuals in a community. METHODS: This was a population-based cohort study in Nueces County, Texas, USA. Participants were recruited using a random housing sample. The Harmonized Cognitive Assessment (HCAP) participant and informant protocol was performed after Montreal Cognitive Assessment (MoCA) screening. An algorithm was used to sort participants into diagnostic categories: no cognitive impairment, MCI, or dementia. Logistic regression determined the association of ethnicity with MCI and dementia controlling for age, gender, and education. RESULTS: 1,901 participants completed the MoCA and 547 the HCAP. Mexican Americans were younger and had less educational attainment than non-Hispanic whites. Overall, dementia prevalence was 11.6% (95% CI 9.2-14.0) and MCI prevalence was 21.2% (95% CI 17.5-24.8). After adjusting for age, gender, and education level, there was no significant ethnic difference in the odds of dementia or MCI. Those with ≤11 compared with ≥16 years of education had much higher dementia [OR = 4.9 (95% CI 2.2-11.1)] and MCI risk [OR = 3.5 (95% CI 1.6-7.5)]. CONCLUSIONS: Dementia and MCI prevalence were high in both Mexican American and non-Hispanic white populations. Mexican American persons had double the odds of mild cognitive impairment and this was attenuated when age and educational attainment were considered. Educational attainment was a potent predictor of cognitive impairment.

Exploring Pathways to Caregiver Health: The Roles of Caregiver Burden, Familism, and Ethnicity.

OBJECTIVES: This study examines the associations of ethnicity, caregiver burden, familism, and physical and mental health among Mexican Americans (MAs) and non-Hispanic Whites (NHWs). METHODS: We recruited adults 65+ years with possible cognitive impairment (using the Montreal Cognitive Assessment score<26), and their caregivers living in Nueces County, Texas. We used weighted path analysis to test effects of ethnicity, familism, and caregiver burden on caregiver's mental and physical health. RESULTS: 516 caregivers and care-receivers participated. MA caregivers were younger, more likely female, and less educated compared to NHWs. Increased caregiver burden was associated with worse mental (B = -0.53; p < .001) and physical health (B = -0.15; p = .002). Familism was associated with lower burden (B = -0.14; p = .001). MA caregivers had stronger familism scores (B = 0.49; p < .001). DISCUSSION: Increased burden is associated with worse caregiver mental and physical health. MA caregivers had stronger familism resulting in better health. Findings can contribute to early identification, intervention, and coordination of services to help reduce caregiver burden.

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan.

Aim: Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Methods: Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Results: Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001). Conclusion: Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for their inequitable impact on local governments' financial solvency and service quality, but also for their negative consequences for population health and racial health equity. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

A Community-Based Study of Cognitive Impairment Caregiving Outcomes Pre- and During the COVID-19 Pandemic.

The impact of the COVID-19 pandemic on informal caregiving was examined in a Mexican American (MA) and Non-Hispanic White (NHW) population-based cohort. 395 participants age > 65 years were recruited via door-to-door and phone recruitment as part of the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C) project. Both recipients and caregivers answered questions regarding the recipient's health and the COVID-19 pandemic. 15% of caregivers saw their caregiving recipient less than before the pandemic and 18% saw their recipient more than before. 55% of caregivers reported a slight to severe impact of the pandemic on their caregiving, and 45% reported no impact. For most caregivers, their caregiving role did not change markedly during the pandemic. MA and NHW caregivers had similar survey responses.

Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals.

BACKGROUND: Individuals with Alzheimer's disease and Alzheimer's disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort. METHODS: This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann-Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia. RESULTS: There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire. CONCLUSIONS: The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.