COVID-19 impacts and inequities among underserved communities with diabetes.

Background: People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes. Methods: From November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher's Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally. Results: Overall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p <.001). Participants reported pandemic-related healthcare changes (62 %) and higher costs of diabetes medications (41 %). Income loss was more frequent in Florida (76 %; p <.001). NHBs most frequently reported "severe" income loss (26.4 %; p =.0124). Loss of health insurance was more common among NHBs (13.3 %; p =.0416) and in Florida (9.7 %; p =.039). COVID-19 anxiety was highest among NHBs and Hispanics (IQR = [0.0, 3.0]; p =.0232) and in Florida (IQR = [0.0, 2.0]; p =.0435). Conclusions: Underserved communities with diabetes had high COVID-19 vaccine uptake but experienced significant COVID-19-related physical, psychosocial, and financial impacts. NHBs and those in Florida had worse outcomes than other racial/ethnic groups and those in California. Further research, interventions, and policy changes are needed to promote health equity for this population.

Limited English Proficiency and Screening for Cervical, Breast, and Colorectal Cancers among Asian American Adults.

BACKGROUND: Literature shows that limited English proficiency (LEP) influences individual healthcare-seeking behaviors. The Asian population is the fastest-growing racial/ethnic group in the US, and approximately 50% of foreign-born Asians are estimated to live with LEP. OBJECTIVE: To examine associations of LEP and patient-provider language concordance (PPLC) with evidence-based cancer screening utilization for cervical, breast, and colorectal cancers among Asian American adults. METHODS: We obtained LEP, PPLC, and up-to-date status on the three types of cancer screening from a nationally representative sample of Asian Americans aged ≥ 18 years in the 2010-2016 and 2018 Medical Expenditure Panel Surveys. We used multivariable logistic regression models with recommended survey weighting to examine associations of LEP and PPLC with the cancer screening uptake based on USPSTF guidelines. RESULTS: The study population comprised 8953 respondents, representing 8.17 million Asian American adults. Overall, 11.9% of respondents experienced LEP; of those with LEP, 20% were with PPLC. In multivariable models, compared to respondents without LEP, respondents with LEP and without PPLC were significantly less likely to report up-to-date status on breast (OR = 0.44; 95% CI: 0.26-0.76), cervical (OR = 0.44; 95% CI: 0.26-0.75), or colorectal cancer screening (OR = 0.46; 95% CI: 0.26-0.80). However, these differences were not detected in respondents with LEP and with PPLC. CONCLUSION: LEP is associated with lower up-to-date status on cancer screening among Asian Americans, while PPLC seems to moderate this association. These findings suggest the enhancement for language-appropriate and culturally competent healthcare for Asian Americans with LEP, which helps accommodate their communication needs and promotes cancer screening.

Psychological Outcomes of the COVID-19 Pandemic on People with Type 1 Diabetes Globally: A Scoping Review.

BACKGROUND: People with type 1 diabetes (T1D) face heightened risks for morbidity and mortality from the 2019 Coronavirus (COVID-19). They also have elevated risks for disparate psychological outcomes during the COVID-19 pandemic, given their predisposition to mental health disorders, including anxiety and depression, and skyrocketing rates of these conditions among the general population. METHODS: To investigate the psychological ramifications of the COVID-19 pandemic on people with T1D globally, we conducted a scoping review of recent literature across eight online databases. Articles were screened via a rigorous process, and data pertaining to psychological outcomes were coded into thematic areas for analysis. RESULTS: Forty articles presenting data from 27 countries and 14 categories of psychological outcomes affecting people with T1D were included in this review. Psychological outcomes, in order of most to least frequently identified, included: stress, anxiety, social factors, worry, distress, fear, sleep habits, quality of life, depression, attitudes regarding COVID-19, other psychological issues, mental health services utilization, burnout, and temperament. Recurring findings demonstrated significant increases in the prevalence of mental health conditions, changes in sleeping habits, reductions of social support, and extensive psychosocial concerns among people with T1D. Associations between patients' psychological issues and demographic characteristics, diabetes self-management behaviors, glycemic control, and overall wellbeing were evident. CONCLUSION: During the COVID-19 pandemic, people with T1D experienced pervasive psychological burdens. This review calls for further research examining the long-term impacts of the pandemic and strengthens awareness of the need for interventions to offset psychological challenges affecting people with T1D.

What does community resilience mean in the context of trauma-informed communities? A scoping review.

Several communities are implementing trauma-informed, community-level approaches focused on addressing/preventing adverse childhood experiences (ACEs), yet most community resilience definitions from published articles are based on acute traumas. This scoping review aims to determine how community resilience is defined and operationalized within the context of chronic/complex traumas. METHODS: We performed a rigorous, comprehensive literature search using multiple databases. RESULTS: The 38 included articles addressed multiple types of chronic traumas, including historical trauma, poverty, minority stress, mass incarceration, and ACEs. A variety of definitions of community resilience were cited, several of which stressed the ability to thrive despite risk factors and the safety and wellbeing of residents. Few articles operationalized community resilience within the context of ACEs, suggesting significant gaps in the literature. CONCLUSION: This review can serve as an important building block to develop expanded definitions of community resilience for chronic traumas and assist communities in promoting community-wide responses to ACEs.

Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews.

There exists a large body of literature examining the association between built environment factors and dietary intake, physical activity, and weight status; however, synthesis of this literature has been limited. To address this gap, we conducted a scoping review of reviews and identified 74 reviews and meta-analyses that investigated the association between built environment factors and dietary intake, physical activity, and/or weight status. Results across reviews were mixed, with heterogeneous effects demonstrated in terms of strength and statistical significance; however, preliminary support was identified for several built environment factors. For example, quality of dietary intake appeared to be associated with the availability of grocery stores, higher levels of physical activity appeared to be most consistently associated with greater walkability, and lower weight status was associated with greater diversity in land-use mix. Overall, reviews reported substantial concern regarding methodological limitations and poor quality of existing studies. Future research should focus on improving study quality (e.g., using longitudinal methods, including natural experiments, and newer mobile sensing technologies) and consensus should be drawn regarding how to define and measure both built environment factors and weight-related outcomes.

Associations between effort, importance, and self-monitoring during and after a 12-week behavioural weight management program.

OBJECTIVE: Self-monitoring of weight and caloric intake has been associated with improved weight loss and weight loss maintenance in behavioural weight loss programs; however, participants' adherence to self-monitoring tends to decrease over time. To identify potential barriers to self-monitoring adherence, the current study examined week-to-week associations between ratings of perceived effort, relative importance of weight loss goals, and adherence to self-monitoring of weight and caloric intake during and after a behavioural weight loss programme. METHOD: Participants were 74 adults with overweight and obesity enrolled in a 12-week, Internet-based weight loss programme followed by a 40-week "maintenance" period during which no additional intervention was provided. Participants self-reported adherence to self-monitoring and completed ratings of effort and importance on a study website weekly throughout the study period (1 year). RESULTS: Longitudinal multilevel models demonstrated that higher ratings of effort were associated with fewer days of self-monitoring of weight, ß = -0.100, p < .0001, and caloric intake, ß = -0.300, p < .0001. Conversely, higher ratings of importance were associated with more frequent self-monitoring of weight, ß = 0.360, p < .0001, and caloric intake, ß = 0.742, p < .0001. Moreover, the magnitude of these associations were stronger during the maintenance period than during initial intervention, ps < .01. CONCLUSIONS: Perceptions of effort and importance are both independently associated with adherence to self-monitoring weight and caloric intake, and this effect appears to be stronger after the end of initial intervention. Future research should investigate whether tailoring intervention content based on these constructs can improve adherence to self-monitoring.

Rural/urban disparities in access to the National Diabetes Prevention Program.

Residents of rural communities generally have limited access to preventive health services such as lifestyle programs for weight management. In 2009, the U.S. Congress authorized the Centers for Disease Control and Prevention (CDC) to partner with local community organizations to disseminate the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention for weight management. Given that the National DPP (NDPP) was designed to broaden nationwide access to weight-loss treatment for adults at high risk for developing diabetes, the present study examined the implementation of the NDPP in rural and urban counties across the USA. The names and locations of NDPP community partnership sites were collected from the CDC website and cross-referenced with the U.S. Census Bureau's classification of counties as rural versus urban. Results showed that overall 27.9% of the 3,142 counties in the USA contained one or more NDPP partnership sites. However, significantly fewer rural counties had access to a NDPP site compared with urban counties (14.6% vs. 48.4%, respectively, p < .001). This disparity was evident across all types of partnership sites (ps < .001). These findings indicate that implementation of the NDPP has expanded the overall availability of evidence-based weight-management programs across the USA. However, this increase has been disproportionately greater for urban counties versus rural counties, thereby widening the rural/urban disparity in access to preventive health services. Alternative dissemination strategies that address the special barriers to implementation faced by rural communities are needed to increase access to the NDPP.