Is there a link between wealth and cardiovascular disease risk factors among Hispanic/Latinos? Results from the HCHS/SOL sociocultural ancillary study.

OBJECTIVE: To examine the relationship between wealth and cardiovascular disease risk factors among Hispanic/Latinos of diverse backgrounds. DESIGN: This cross-sectional study used data from 4971 Hispanic/Latinos, 18-74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline exam and the HCHS/SOL Sociocultural Ancillary Study. Three objectively measured cardiovascular disease risk factors (hypertension, hypercholesterolemia, and obesity) were included. Wealth was measured using an adapted version of the Home Affluence Scale, which included questions regarding the ownership of a home, cars, computers, and recent vacations. RESULTS: After adjusting for traditional socioeconomic indicators (income, employment, education), and other covariates, we found that wealth was not associated with hypertension, hypercholesterolemia or obesity. Analyses by sex showed that middle-wealth women were less likely to have hypercholesterolemia or obesity. Analyses by Hispanic/Latino background groups showed that while wealthier Central Americans were less likely to have obesity, wealthier Puerto Ricans were more likely to have obesity. CONCLUSION: This is the first study to explore the relationship between wealth and health among Hispanic/Latinos of diverse backgrounds, finding only partial evidence of this association. Future studies should utilize more robust measures of wealth, and address mechanisms by which wealth may impact health status among Hispanic/Latinos of diverse backgrounds in longitudinal designs.

Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study.

BACKGROUND: A 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities. METHODS: Guided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data. RESULTS: Study participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health. CONCLUSIONS: This study's findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.

Representative Public Health Surveys Pose Several Challenges: Lessons Learned Across 9 Communities During the COVID-19 Pandemic.

Community surveillance surveys offer an opportunity to obtain important and timely public health information that may help local municipalities guide their response to public health threats. The objective of this paper is to present approaches, challenges, and solutions from SARS-CoV-2 surveillance surveys conducted in different settings by 2 research teams. For rapid assessment of a representative sample, a 2-stage cluster sampling design was developed by an interdisciplinary team of researchers at Oregon State University between April 2020 and June 2021 across 6 Oregon communities. In 2022, these methods were adapted for New York communities by a team of veterinary, medical, and public health practitioners. Partnerships were established with local medical facilities, health departments, COVID-19 testing sites, and health and public safety staff. Field staff were trained using online modules, field manuals describing survey methods and safety protocols, and in-person meetings with hands-on practice. Private and secure data integration systems and public awareness campaigns were implemented. Pilot surveys and field previews revealed challenges in survey processes that could be addressed before surveys proceeded. Strong leadership, robust trainings, and university-community partnerships proved critical to successful outcomes. Cultivating mutual trust and cooperation among stakeholders is essential to prepare for the next pandemic.

Evaluation of a Wastewater-Based Epidemiological Approach to Estimate the Prevalence of SARS-CoV-2 Infections and the Detection of Viral Variants in Disparate Oregon Communities at City and Neighborhood Scales.

BACKGROUND: Positive correlations have been reported between wastewater SARS-CoV-2 concentrations and a community's burden of infection, disease or both. However, previous studies mostly compared wastewater to clinical case counts or nonrepresentative convenience samples, limiting their quantitative potential. OBJECTIVES: This study examined whether wastewater SARS-CoV-2 concentrations could provide better estimations for SARS-CoV-2 community prevalence than reported cases of COVID-19. In addition, this study tested whether wastewater-based epidemiology methods could identify neighborhood-level COVID-19 hotspots and SARS-CoV-2 variants. METHODS: Community SARS-CoV-2 prevalence was estimated from eight randomized door-to-door nasal swab sampling events in six Oregon communities of disparate size, location, and demography over a 10-month period. Simultaneously, wastewater SARS-CoV-2 concentrations were quantified at each community's wastewater treatment plant and from 22 Newport, Oregon, neighborhoods. SARS-CoV-2 RNA was sequenced from all positive wastewater and nasal swab samples. Clinically reported case counts were obtained from the Oregon Health Authority. RESULTS: Estimated community SARS-CoV-2 prevalence ranged from 8 to 1,687/10,000 persons. Community wastewater SARS-CoV-2 concentrations ranged from 2.9 to 5.1 log10 gene copies per liter. Wastewater SARS-CoV-2 concentrations were more highly correlated (Pearson's r=0.96; R2=0.91) with community prevalence than were clinically reported cases of COVID-19 (Pearson's r=0.85; R2=0.73). Monte Carlo simulations indicated that wastewater SARS-CoV-2 concentrations were significantly better than clinically reported cases at estimating prevalence (p<0.05). In addition, wastewater analyses determined neighborhood-level COVID-19 hot spots and identified SARS-CoV-2 variants (B.1 and B.1.399) at the neighborhood and city scales. DISCUSSION: The greater reliability of wastewater SARS-CoV-2 concentrations over clinically reported case counts was likely due to systematic biases that affect reported case counts, including variations in access to testing and underreporting of asymptomatic cases. With these advantages, combined with scalability and low costs, wastewater-based epidemiology can be a key component in public health surveillance of COVID-19 and other communicable infections. https://doi.org/10.1289/EHP10289.

Commute times, food retail gaps, and body mass index in North Carolina counties.

INTRODUCTION: The prevalence of obesity is higher in rural than in urban areas of the United States, for reasons that are not well understood. We examined correlations between percentage of rural residents, commute times, food retail gap per capita, and body mass index (BMI) among North Carolina residents. METHODS: We used 2000 census data to determine each county's percentage of rural residents and 1990 and 2000 census data to obtain mean county-level commute times. We obtained county-level food retail gap per capita, defined as the difference between county-level food demand and county-level food sales in 2008, from the North Carolina Department of Commerce, and BMI data from the 2007 North Carolina Behavioral Risk Factor Surveillance System. To examine county-level associations between BMI and percentage of rural residents, commute times, and food retail gap per capita, we used Pearson correlation coefficients. To examine cross-sectional associations between individual-level BMI (n = 9,375) and county-level commute times and food retail gap per capita, we used multilevel regression models. RESULTS: The percentage of rural residents was positively correlated with commute times, food retail gaps, and county-level BMI. Individual-level BMI was positively associated with county-level commute times and food retail gaps. CONCLUSION: Longer commute times and greater retail gaps may contribute to the rural obesity disparity. Future research should examine these relationships longitudinally and should test community-level obesity prevention strategies.

A prospective cohort study of in utero and early childhood arsenic exposure and infectious disease in 4- to 5-year-old Bangladeshi children.

BACKGROUND: Previous research found that infants who were exposed to high levels of arsenic in utero had an increased risk of infectious disease in the first year of life. This prospective study examined the association between arsenic exposures during gestation, and respiratory, diarrheal, and febrile morbidity in children 4-5 years of age. METHODS: A cohort of pregnant women was recruited in 2008-2011 in Bangladesh. Their children (N = 989) were followed, and household drinking water samples were collected during pregnancy, toddlerhood (12-40 months of age), and childhood (4-5 years of age). We actively surveyed mothers every 2 weeks regarding their children's infectious diseases symptoms from 4 to 5 years of age. Poisson regression models were used to estimate the association between arsenic exposure and respiratory and febrile illness. RESULTS: Median drinking water arsenic was 4.6, 8.8, and 4.2 µg/L in pregnancy, toddlerhood, and childhood, respectively. We observed 0.01, 1.2, and 1.0 cases per 100 person-days of diarrhea, respiratory, and febrile illness, respectively. The incident rate ratios (IRRs) for each doubling of drinking water arsenic during pregnancy were 1.10 (95% confidence interval [CI] = 1.00, 1.22) and 0.93 (95% CI = 0.82, 1.05) for respiratory and febrile illness, respectively, after adjusting for covariates. The association between arsenic exposure measured during toddlerhood and childhood was attenuated and not significantly associated with either outcome. Diarrheal disease was too infrequent to assess. CONCLUSIONS: Drinking water arsenic exposure during pregnancy was associated with a higher risk of acute respiratory infections in children 4-5 years old in Bangladesh.

A new paradigm for quarantine and public health activities at land borders: opportunities and challenges.

The Institute of Medicine (IOM) report Quarantine Stations at Ports of Entry: Protecting the Public's Health focused almost exclusively on U.S. airports and seaports, which served 106 million entries in 2005. IOM concluded that the primary function of these quarantine stations (QSs) should shift from providing inspection to providing strategic national public health leadership. The large expanse of our national borders, large number of crossings, sparse federal resources, and decreased regulation regarding conveyances crossing these borders make land borders more permeable to a variety of threats. To address the health challenges related to land borders, the QSs serving such borders must assume unique roles and partnerships to achieve the strategic leadership and public health research roles envisioned by the IOM. In this article, we examine how the IOM recommendations apply to the QSs that serve the land borders through which more than 319 million travelers, immigrants, and refugees entered the U.S. in 2005.

Knowledge, attitudes and practices regarding influenza prevention and control measures among Hispanics in San Diego County--2006.

BACKGROUND: Influenza vaccination is the most effective method to avoid influenza virus infection and its potential serious complications; however, influenza vaccine is underutilized especially among minority groups. OBJECTIVES: We assessed the knowledge, attitudes, and practices (KAP) regarding influenza prevention and control measures among Hispanics in San Diego County. METHODS: We used a multistage cluster sampling scheme to administer an in-person, door-to-door KAP survey to 226 Hispanics aged > or = 18 years in three regions of San Diego County during July-August 2006. RESULTS: Hispanics in the three regions sampled for this survey varied widely by age, country of birth, years living in the United States, number of border crossings in previous month, and number of people in household. Awareness of the influenza vaccine was nearly 90% among survey respondents. The percentage of Hispanic males and females aged 50-64 years who received an influenza vaccination in the previous 12 months was 7.7% and 23.5%, respectively, and the percentage of Hispanic males and females aged > or = 65 years who received an influenza vaccination in the previous 12 months was 33.3% and 59.1%, respectively. CONCLUSIONS: This survey showed high awareness of the influenza vaccine among Hispanics in San Diego County but relatively low vaccination rates among respondents aged > or = 50 years, a group targeted for influenza vaccination. Differences in awareness and vaccination rates between Hispanic males and females across all age groups indicate that educational outreach efforts should specifically target Hispanic men.

Hydration and Cooling Practices Among Farmworkers in Oregon and Washington.

OBJECTIVES: Although recommendations for preventing occupational heat-related illness among farmworkers include hydration and cooling practices, the extent to which these recommendations are universally practiced is unknown. The objective of this analysis was to compare hydration and cooling practices between farmworkers in Oregon and Washington. METHODS: A survey was administered to a purposive sample of Oregon and Washington farmworkers. Data collected included demographics, work history and current work practices, hydration practices, access and use of cooling measures, and headwear and clothing worn. RESULTS: Oregon farmworkers were more likely than those in Washington to consume beverages containing sugar and/or caffeine. Workers in Oregon more frequently reported using various cooling measures compared with workers in Washington. Availability of cooling measures also varied between the two states. CONCLUSIONS: These results highlight the large variability between workers in two states regarding access to and use of methods to stay cool while working in the heat.

Sex differences and risk behaviors among indoor tanners.

OBJECTIVE: The objectives were to examine (1) sex differences in factors associated with indoor tanning, and (2) the relationship between cancer risk perception and skin cancer screening among indoor tanners. METHODS: Data are from the 2010 National Health Interview Survey. The sample was limited to U.S. adults (≥ 18 years) using an indoor tanning device in the last year (N = 1177). We conducted bivariate and multivariate weighted analyses. RESULTS: Among indoor tanners, less than 30% of men and women reported having ever had a skin exam. Male sex was significantly associated with rarely/never using sunscreen (51.4% of men vs. 36.4% of women) and with binge drinking of alcohol (47.6% of men vs. 37.4% of women). No sex differences in smoking were present. Indoor tanners who perceived themselves "about equally likely" to develop cancer (any type) as similar others were less likely to have received a skin cancer examination than those with high perceived risk. CONCLUSION: The relationship of cancer risk perception to skin cancer screening is complex. Rates of risk and protective behaviors observed among men and women who indoor tan suggest mixed-sex tanning prevention efforts should target multiple risk behaviors.

Utility of a Work Process Classification System for characterizing non-fatal injuries in the Alaskan commercial fishing industry.

BACKGROUND: The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers' lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. OBJECTIVES: This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. DESIGN: Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. RESULTS: We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. CONCLUSIONS: The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken.

Acculturation and smoking patterns among Hispanics: a review.

OBJECTIVE: To conduct a systematic review of published studies investigating the association of acculturation and smoking patterns among Hispanic men and women in the United States. METHODS: Online bibliographic databases were searched from 1985 to 2003 using three key search terms. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study population, study methods, exposure assessment, outcomes measured, acculturation measures used, and results. RESULTS: The literature search identified 78 articles from MEDLINE, PubMed, and PsychINFO databases; of these, 11 studies met the inclusion criteria. Seven regional studies based in the western United States and four nationwide studies were included in the review. Seven studies used formal acculturation scales, three used language spoken, and one used language spoken and country of birth to indicate acculturation status. Nine studies showed a positive association between acculturation and smoking among women, and one study involving men showed a negative association. CONCLUSIONS: The findings suggest that the association of acculturation and smoking is gender-specific. In this instance, increased smoking prevalence with increased acculturation is consistently observed among Hispanic women but not among men. As Hispanic women acculturate, their cigarette smoking may increase because their behavior becomes more strongly influenced by the norms and practices of the dominant group than among men. Immigrant- and gender-specific public health interventions need to be designed to combat the increase in smoking rates among Hispanics in the United States.

Acculturation and its association with health-risk behaviors in a rural Latina population.

PURPOSE: To evaluate the performance of proxy measures of acculturation and to examine the association between acculturation and selected health-risk behaviors. METHODS: Participants were 1062 Latina pregnant women who received prenatal care at clinics in San Joaquin County, California between 1999 and 2001. We used the receiver-operating characteristic (ROC) curve to characterize the sensitivity and specificity of proxy measures and regression analysis to examine health-risk behaviors. RESULTS: Using the ARSMA-II short version scale as a reference, age at immigration had the highest percentage of correctly classified individuals. Acculturation was significantly associated with a lifetime history of substance use, risky sexual behavior, low fruit consumption, and high fast-food meal consumption. CONCLUSIONS: Acculturation is an important predictor of health-risk behavior among women. Further research is needed to better understand the phenomenon and to avert associated adverse health consequences.

Arsenic exposure and prevalence of the varicella zoster virus in the United States: NHANES (2003-2004 and 2009-2010).

BACKGROUND: Arsenic is an immunotoxicant. Clinical reports observe the reactivation of varicella zoster virus (VZV) in people who have recovered from arsenic poisoning and in patients with acute promyelocytic leukemia that have been treated with arsenic trioxide. OBJECTIVE: We evaluated the association between arsenic and the seroprevalence of VZV IgG antibody in a representative sample of the U.S. METHODS: We analyzed data from 3,348 participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2009-2010 pooled survey cycles. Participants were eligible if they were 6-49 years of age with information on both VZV IgG and urinary arsenic concentrations. We used two measures of total urinary arsenic (TUA): TUA1 was defined as the sum of arsenite, arsenate, monomethylarsonic acid, and dimethylarsinic acid, and TUA2 was defined as total urinary arsenic minus arsenobetaine and arsenocholine. RESULTS: The overall weighted seronegative prevalence of VZV was 2.2% for the pooled NHANES sample. The geometric means of TUA1 and TUA2 were 6.57 µg/L and 5.64 µg/L, respectively. After adjusting for age, sex, race, income, creatinine, and survey cycle, odds ratios for a negative VZV IgG result in association with 1-unit increases in natural log-transformed (ln)-TUA1 and ln-TUA2 were 1.87 (95% CI: 1.03, 3.44) and 1.40 (95% CI: 1.0, 1.97), respectively. CONCLUSIONS: In this cross-sectional analysis, urinary arsenic was inversely associated with VZV IgG seroprevalence in the U.S. POPULATION: This finding is in accordance with clinical observations of zoster virus reactivation from high doses of arsenic. Additional studies are needed to confirm the association and evaluate causal mechanisms.

Coexistence of Avian Influenza Virus H10 and H9 Subtypes among Chickens in Live Poultry Markets during an Outbreak of Infection with a Novel H10N8 Virus in Humans in Nanchang, China.

Infection with the novel H10N8 virus in humans has raised concerns about its pandemic potential worldwide. We report the results of a cross-sectional study of avian influenza viruses (AIVs) in live poultry markets (LPMs) in Nanchang, China, after the first human case of H10N8 virus infection was reported in the city. A total of 201 specimens tested positive for AIVs among 618 samples collected from 24 LPMs in Nanchang from December 2013 to January 2014. We found that the LPMs were heavily contaminated by AIVs, with H9, H10, and H5 being the predominant subtypes and more than half of the LPMs providing samples that were positive for the H10 subtype. Moreover, the coexistence of different subtypes was common in LPMs. Of the 201 positive samples, 20.9% (42/201) had mixed infections with AIVs of different HA subtypes. Of the 42 mixed infections, 50% (21/42) showed the coexistence of the H9 and H10 subtypes, with or without H5, and were from chicken samples. This indicated that the H10N8 virus probably originated from segment reassortment of the H9 and H10 subtypes.

Heat-related illness among Oregon farmworkers.

Farmworkers are particularly vulnerable to climate-sensitive health outcomes such as heat-related illness (HRI) given their tasks involve heavy exertion in an outdoor setting. The objectives of the study were to: (1) describe symptoms of HRI experienced by farmworkers and (2) explore factors associated with heat knowledge, level of concern regarding HRI, and comfort level taking breaks at work. Bilingual research staff conducted personal interviews of 100 farmworkers during July and August 2013. Data collected included demographics, work history and current work practices, trainings received, HRI symptoms experienced, health status, and health behaviors. Nearly 30% of participants reported experiencing ≥ 2 HRI symptoms during the previous work. Few participants had high level of heat knowledge (21.0%) and 15.6% of participants reported being "very concerned" about the health effects of working in hot conditions. Participants who were paid by the piece were more likely to have a high heat knowledge score and be "very concerned" about HRI but less likely to be "very comfortable" taking a break compared to workers paid by the hour than those who had not received HRI training. Results suggest several areas in which employers and agencies conducting outreach and education to the workers about HRI can change their practices including providing cooling measures and HRI training about risk factors for HRI.

Brucellosis in dairy cattle and goats in northern Ecuador.

The purpose of this study was to conduct a convenience study for brucellosis prevalence in dairy-producing animals in northern Ecuador. In total, 2,561 cows and 301 goats were tested. Cattle sera were tested using the Rose Bengal card antigen test (RBCT), yielding an overall apparent prevalence of 5.5% (95% confidence interval [95% CI] = 4.7-6.5%) and true prevalence of 7.2% (95% CI = 6.0-8.5%). Prevalence varied by herd size and was highest in larger commercial herds. Polymerase chain reaction was used to test goat milk and lymph nodes, resulting in 9% and 8% positivity, respectively. The RBCTs from goat sera yielded an adjusted true prevalence of 17.8% (95% CI = 6.2-44.2%). Our findings are similar to other overall prevalence estimates for dairy herds but show higher prevalence in commercial herds compared with small groups (less than five animals). We also identify urban milking goats living in metropolitan Quito as a potential source of zoonosis.

Disparity in disaster preparedness between racial/ethnic groups.

Objective The objective of this study was to examine the association between race/ethnicity (including language subgroups among Hispanics) and disaster preparedness among Behavioral Risk Factor Surveillance System (BRFSS) survey respondents. Methods BRFSS data were obtained for eight states which implemented the optional general preparedness module from 2006 through 2010. Three dependent variables were analyzed including presence of four preparedness items (i.e., food, water, flashlight, and radio), emergency evacuation plan, and 3-d supply of medication. Primary independent variable included race/ethnicity accounting for language of survey. Data were analyzed in 2011 and accounted for BRFSS sampling design. Results Black (OR = 0.66, 95% CI = 0.56, 0.79), English-speaking Hispanic (OR = 0.48, 95% CI = 0.34, 0.69) and Spanish-speaking Hispanic respondents (OR = 0.20, 95% CI = 0.13, 0.29) were less likely than non-Hispanic white respondents to live in a household in which all members requiring medication had a 3-d supply. Results varied regarding presence of four preparedness items and an emergency evacuation plan. Conclusions Racial/ethnic minority groups were less likely to have medication supplies but only Spanish-speaking Hispanics were less likely to have an emergency evacuation plan than white respondents. Public health officials can use these findings to support targeting racial/ethnic minorities to increase the presence of preparedness items important to mitigate the effects of disasters, with particular emphasis on medication supplies and Spanish-speaking Hispanics.