Feasibility and Outcomes of Meta Salud Diabetes Behavioral Health Intervention: A Pilot Study of a Community Health Worker-Administered Educational Intervention to Prevent Cardiovascular Disease and Its Complications among Hispanic Patients with Type-2 Diabetes.

BACKGROUND: Hispanics in the United States experience a greater burden of type-2 diabetes (T2D), with a prevalence rate (17%) more than twice that of non-Hispanic whites (8%). Cardiovascular disease (CVD) is the leading cause of death among people with T2D. A culturally appropriate behavioral health intervention that addresses healthy lifestyle promotion is an impactful approach for health systems with scarce medical resources and a high prevalence of chronic conditions, including obesity and high blood pressure, which increase the likelihood of CVD mortality among type-2 diabetics. PURPOSE: To assess the feasibility and outcomes of a behavioral intervention to decrease CVD and complications in a Hispanic diabetic population. METHODS: Meta Salud Diabetes (MSD), a behavioral intervention effective in a Mexican population, consists of a 13-week intervention addressing CVD and T2D knowledge and risk reduction. It was implemented in a sample of Hispanic diabetic patients from two federally qualified health centers (FQHCs). Clinical and behavioral variables were measured at baseline, postintervention, and 1-year follow-up. RESULTS: The feasibility of MSD was rated as successful by all FQHC staff and well-received by both staff and study participants, with positive remarks about the culturally relevant components of the intervention. The sample size was n = 30 (baseline), n = 23 (postintervention), and n = 19 (1-year follow-up). Of note, quantitative results showed trending decreases in Hba1c (7.06; 6.80; 6.30), blood pressure (132/83; 126/80; 123/78), and total cholesterol (160; 159; 154). CONCLUSION: MSD is a feasible intervention and can address the need to improve health outcomes among Hispanic patients with T2D.

Determining Regional Differences in Barriers to Accessing Health Care Among Farmworkers Using the National Agricultural Workers Survey.

Farmworkers are an essential workforce in the U.S. We assessed the regions in the National Agricultural Workers Survey on the difficulty of accessing health care among farmworkers in the U.S. The study included 9577 farmworkers. Farmworkers in all regions were more likely to report having difficulty accessing health care because it was too expensive. The overall odds ratio for difficulty accessing health care was lower in the MW after adjusting. Farmworkers employed in the SE had greater difficulty accessing health care because of language barriers. Farmworkers employed in CA had difficulty accessing health care in the U.S. because it was too expensive or far away. Results follow previous studies on barriers to access health care among the farmworker population. Understanding regional disparities in the presence of barriers to accessing health care among farmworkers is an essential step to improving equitable health care access in the U.S.

Health knowledge and livelihood experiences with COVID-19 amongst Arizona residents.

The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health concern that is rapidly evolving and has impacted individuals and communities differently. We analyzed deidentified survey datasets to evaluate the perceptions, experiences, and impacts of COVID-19 among Arizona residents. The survey included 1,472 eligible Spanish-speaking participants in Southern (Pima, Santa Cruz, Cochise, Yuma County) and Central Arizona (Maricopa County). Eighteen questions which included participants' health and socio-economic status, source of information on COVID-19, preventive measures, the impact of COVID-19 on household income, and vaccination status were administered to the survey respondents. The analyzed data showed an unequal proportion of the reported source of COVID-19 information between Southern and Central Arizona participants. More male respondents (n = 833, 57%) participated in the study than did the female respondents (n = 638, 43%). Of the 1,472 total participants in both regions, 1,011 (68.7%) participants represented Southern Arizona while 461 (31.3%) participants represented Central Arizona. Of the 461 participants in Central Arizona, the majority reported television (56%) and social media (20%) as their primary source of information. Whereas, of the 1,011 participants in Southern Arizona, the majority reported social media (37%) and television (32%) as their major source of information on COVID-19. Overall, 82% of the participants were vaccinated, with a statistically significant difference between the proportion of vaccinated individuals in the Southern and Central Arizona (chi-square p-value of 0.00139). More individuals in Southern Arizona participated in the survey than in Central Arizona across both genders, with 58% of women reporting loss of jobs due to COVID-19. This study demonstrated that the COVID-19 pandemic profoundly had a more socio-economic impact on women than men, particularly Hispanic women in this subset.

Health conditions among farmworkers in the Southwest: An analysis of the National Agricultural Workers Survey.

Agricultural jobs pose many challenges to the health and wellbeing of a disadvantaged population. In the Southwest region, the socioeconomic factors of living along the U.S.-Mexico border, migration patterns, lack of access to health care, low utilization of health care services, lack of health insurance, and highly demanding occupation may uniquely affect health outcomes for farmworkers. This paper presents descriptive information for professionals to improve access to care by tackling barriers afforded by the agricultural industry. The National Agricultural Worker Survey (NAWS) is an employment-based, random-sample survey of U.S. agricultural workers in six regions: East, Southeast, Midwest, Southwest, Northwest, and California. We examined farmworkers' self-reported health conditions, including asthma, diabetes, high blood pressure, other chronic conditions, or any condition by region from 2013 to 2016. We used logistic regression to determine differences in lifetime prevalence of health conditions between farmworkers in the Southwest region (n = 727) and farmworkers in other regions (n = 8,850) using weighted data. After adjusting for age, gender, income, insurance status, and English-speaking ability, the odds of high blood pressure and other condition were similar in all regions. The prevalence of diabetes was almost double in the Southwest (114.2 per 1,000 farmworkers). The odds of diabetes were 1.31 (95% CI 0.99, 1.74) times greater in the Southwest region than in the other regions. Asthma was the only condition that was lower in the Southwest (22 per 1,000 farmworkers) compared to the other regions. The odds of asthma were 0.61 (95% CI 0.36, 1.03) times lower in the Southwest region than in other regions. The results follow previous studies on the prevalence of asthma among the farmworker population and elevated probability of chronic diseases including diabetes among the Latino population in the U.S.