Recruiting Latino young adults into a vaping cessation study via social media: Feasibility and cost analysis.

INTRODUCTION: This study aims to assess the feasibility and cost of recruiting young Latino adults (aged 18-25 years) to participate in a vaping cessation study via social media and to describe the baseline characteristics of participants enrolled via social media. METHODS: Paid advertisements were launched using the Meta Ads platform, which serves ads to users on Facebook and Instagram. Key measures of audience targeting included ages 18-25 years, all genders, and the following interests: 'electronic cigarettes', 'vape', 'Latin pop', and 'Latin music'. The advertisements invited young Latino adults to join a text messaging vaping cessation study. By clicking on the advertisements, interested individuals were directed to a website to fill in a contact form. The study team contacted individuals who filled in the form, assessed them for study eligibility, and, if eligible, enrolled them in the study. RESULTS: A total of 164 individuals completed the contact form, and 26 were successfully enrolled in the study. The enrollment efficiency ratio was 15.9% (26/164). The cost per enrollment was US$94.14. The participants' mean age was 22.7 years (SD=1.6). Half of the participants (50%) were male, 38.5% were female, and 11.5% were gender non-conforming/non-binary. Two-thirds of the participants (69.2%) were born in the US, 23.1% in Puerto Rico, and 7.7% in Mexico. Eight participants (30.7%) selected Spanish as their language of preference. In terms of the type of vaping device, 16 participants (61.5%) indicated using disposables, 6 (23.1%) cartridges/pods, and 4 (15.4%) tanks/refillable. Sixteen participants (61.5%) reported using marijuana in e-cigarettes. Six participants (23.1%) had high e-cigarette dependence. Twenty participants (76.9%) had attempted to quit e-cigarettes in the past year. CONCLUSIONS: It is feasible to recruit young Latino adults for a vaping cessation study via social media. Social media offers a relatively low-cost approach to recruiting a diverse sample of Latino young adults who vape.

Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis.

OBJECTIVES: The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation. METHODS: In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted. RESULTS: The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (-R$2 585 178.29 to -R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%). CONCLUSION: The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.

Revisiting the lung cancer screening eligibility criteria to promote equity for Black individuals.

BACKGROUND: Early detection using low-dose computed tomography reduces lung-cancer-specific mortality by 20% among high-risk individuals. Blacks are less likely than Whites to meet lung cancer screening (LCS) criteria under both the former and the updated United States Preventive Services Task Force (USPSTF) guidelines. The purpose of this study was to assess racial disparities in LCS eligibility and to propose tailored eligibility criteria for Blacks to enable equitable screening rate between Whites and Blacks. METHODS: Data for this study were obtained from the Behavioral Risk Factor Surveillance System (2017-2021). 101,552 subjects were included in the final analysis. By employing a systematic approach, we sought cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. We evaluated the minimum age and smoking pack-years for Blacks while we retained the 2021 USPSTF criteria for Whites. The final decision was based on the minimum Wald's Chi-square statistics. RESULTS: The model we employed identified cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. Retaining the 2021 USPSTF criteria for Whites, the model discovered a new pair of points for Blacks by reducing the minimum age to 43 years and decreasing the cumulative number of cigarettes smoked to 15 pack-years. Based on these cut-off points, we created tailored criteria for Blacks. Under the tailored criteria, Blacks (OR: 1.00; 95 %CI: 0.88-1.14) had the same odds of eligibility for LCS as Whites. The odds of eligibility for LCS by sex under the tailored criteria did not differ significantly for Black men (OR: 1.02; 95 %CI: 0.85-1.24) and Black women (OR: 0.95; 95 %CI: 0.81-1.12) compared to their respective White counterparts. CONCLUSIONS: These tailored criteria for Blacks eliminate the disparities between Blacks and Whites in LCS eligibility. Future studies should test the sensitivity and specificity of these tailored criteria.

Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of a Mobile Health Smoking Cessation Randomized Clinical Trial.

BACKGROUND: Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. OBJECTIVE: The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. METHODS: Latino smokers were enrolled into Decídetexto from 4 states-New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. RESULTS: Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). CONCLUSIONS: Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services-groups who might benefit a great deal from the intervention. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-DOI: 10.1016/j.cct.2020.106188.

Knowledge, attitudes and behaviors of Latinas in cleaning occupations in northern New Jersey: a cross-sectional mixed methods study.

BACKGROUND: In the United States, 88.3% of all 1,163,000 maids and housekeeping cleaners are female, and approximately half of them Latinas. Latinas are understudied and underrepresented in health research, particularly involving chemical exposure in cleaning practices, lack of job training, and inadequate access to personal protective equipment. The purpose of this study is twofold: 1) to examine the knowledge (via training experiences), attitudes and behaviors of a heterogeneous group of Latinas who clean occupationally and 2) to assess their cleaning practices at work and at home. METHODS: This mixed-method study consisted of two phases: 1) three focus groups to explore knowledge (via training experiences), attitudes, and behaviors regarding cleaning practices (N = 15) and 2) a 43-question cross-sectional survey. Focus group audio recordings were analyzed using descriptive and in vivo coding and then coded inductively to explore thematic analysis. Statistical analysis of the survey evaluated means, frequency and percentage for each of the responses. RESULTS: Participants (n = 9) were women (mean age = 48.78 and SD = 6.72) from South America (n = 5), Mexico (n = 1), El Salvador (n = 1) and Dominican Republic (n = 2). The mean length of time living in the US was 18.78 years and over half (55.6%) worked in the cleaning industry for 10 or more years. Findings from the three focus groups (n = 15) included that training in cleaning often occurred informally at a very young age at home. Participants reported cleaning in groups where tasks are rotated and/or shared. Most were the primary person cleaning at home, suggesting increased exposure. Gloves and masks were the most frequently used PPE, but use was not consistent. For participants who purchase their own products, driving factors included price, smell and efficacy. Some participants used products supplied or preferred by the employer. CONCLUSIONS: Latinas in cleaning occupations face a range of social and health barriers including lack of safety and health training, inadequate PPE and low literacy. To address these issues, the development of an intervention is warranted to provide training and resources for this critical population of essential workers.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities.

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Feasibility and Acceptability of a Culturally- and Linguistically-Adapted Smoking Cessation Text Messaging Intervention for Latino Smokers.

Objective: Assess the feasibility and acceptability of a culturally- and linguistically-adapted smoking cessation text messaging intervention for Latino smokers. Methods: Using a community-based strategy, 50 Latino smokers were recruited to participate in a smoking cessation pilot study. Participants received a 12-week text messaging intervention and were offered Nicotine Replacement Therapy (NRT) at no cost. We assessed biochemically verified abstinence at 12 weeks, text messaging interactivity with the program, NRT utilization, self-efficacy, therapeutic alliance, and satisfaction. Results: Participants were 44.8 years old on average (SD 9.80), and they were primarily male (66%) and had no health insurance (78%). Most of the participants were born in Mexico (82%) and were light smokers (1-10 CPD) (68%). All participants requested the first order of NRT, and 66% requested a refill. Participants sent an average of 39.7 text messages during the 12-week intervention (SD 82.70). At 12 weeks, 30% of participants were biochemically verified abstinent (88% follow-up rate) and working alliance mean value was 79.2 (SD 9.04). Self-efficacy mean score increased from 33.98 (SD 10.36) at baseline to 40.05 (SD 17.65) at follow-up (p = 0.04). The majority of participants (90.9%, 40/44) reported being very or extremely satisfied with the program. Conclusion: A culturally- and linguistically-adapted smoking cessation text messaging intervention for Latinos offers a promising strategy to increase the use of NRT, generated high satisfaction and frequent interactivity, significantly increased self-efficacy, produced high therapeutic alliance, and resulted in noteworthy cessation rates at the end of treatment. Additional testing as a formal randomized clinical trial is warranted.

Cancer Prevention in Indigenous Communities from Guatemala: A Needs Assessment Study.

BACKGROUND: Guatemala lacks cancer prevention strategies and has low screening rates. OBJECTIVE: To assess the history of chronic conditions, risk factors, and cancer screening uptake among three Indigenous populations of Southwestern Guatemala. METHODS: We conducted a health needs assessment. RESULTS: The assessment was completed by 247 adults. Median age was 40 years old (IR: 28-59). Most participants were female (94.3%), of Mayan descent (95.8%), and did not have a primary health care provider (84.2%). Most have never been screened for colorectal (men=100.0%; women=98.8%), prostate (75.0%), breast (90.9%), or cervical (76.9%) cancer, and all have severe tooth decay. However, most participants reported healthy behaviors including being physically active (women=59.7%; men=92.9%), being nonsmokers (women=99.6%; men=78.6%), and not consuming alcohol (women=82.3%; men=46.7%). CONCLUSIONS: Although most participants reported healthy behaviors, there is a remarkable lack of access to cancer screening. An increase in cancer incidence is expected unless cancer prevention efforts are undertaken.

Exploring Latinidad, Migration Processes, and Immigrant Experiences: Experiences Influencing Latino Health.

INTRODUCTION: Over the last few decades, Latino migration to the U.S. has re-shaped the ethnic composition of the country, and influenced the meaning of "ethnic" and "racial" identity. The purpose of this qualitative study was to explore the definition and meaning of being Latino and how this may guide the development of interventions to promote their health. METHODS: Twenty-six Latino immigrants living in Kansas completed a socio-demographic survey and semi-structured interviews to assess and explore personal immigration experiences and perspectives on the meaning of being Latino in the U.S. RESULTS: Participant reports were grouped into eight themes on Latino identity that were organized by geographic origin, family roots/ties, and acculturation. Immigration experiences were described as both positive and negative with most participants experiencing discrimination and loneliness, but also reports of improved quality of life. Further, most participants reported a strong sense of Latinidad; that Latino immigrant communities in the U.S. are interdependent and supportive of each other. CONCLUSIONS: The experience of being a member of a minority group might contribute to the development of a cohesive sense of Latino identity as participants acculturate to the U.S. while preserving a sense of attachment to their culture of origin. Future interventions should be sensitive to migration experiences as they might influence changes in health behaviors.

Assuring Health Access and Culturally Competent Health Services Through the Latino Health for All Coalition.

Although the importance of health care access is widely acknowledged, less is known about how partnerships can help assure access to quality health services for those experiencing health inequities. This report describes implementation of collaborative efforts through the Health Access Committee of the Latino Health for All Coalition (Wyandotte County/Kansas City, Kansas) to address its three goal areas (1) improving cultural competence through organizational change, (2) improving access to quality health services through access to diabetes prevention services, and (3) improving access and linkage to care via enrollment in health insurance. Using community-based participatory approaches, we documented and reflected on the pattern of activities facilitated by the coalition and its partners for each goal area over a 1-year period. This case report outlines strategies, activities, and lessons learned by coalition partners. This article offers practical guidance about how to structure and implement a coalition that provides technical support for increasing health care access and cultural competency.

Empowering Promotores de Salud as partners in cancer education and research in rural southwest Kansas.

PURPOSE/OBJECTIVES: To describe community-based participatory processes used to develop promotore training on cancer research, and to assess the feasibility of training promotores from rural communities to disseminate cancer research information. DESIGN: Prospective, cohort design. SETTING: Rural communities in the state of Kansas. SAMPLE: 34 Spanish-speaking promotores attended an information session; 27 enrolled and 22 completed training. METHODS: With input from a community advisory board, the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research. Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer, cancer treatment and cancer research studies, and intent to participate in cancer research. MAIN RESEARCH VARIABLES: Cancer knowledge, awareness of cancer clinical trials, interest in participating in cancer clinical research studies. FINDINGS: Compared to pretraining, after training, promotores were more likely to correctly define cancer, identify biopsies, describe cancer stages, and report ever having heard of cancer research studies. CONCLUSIONS: Completion rates of the training and willingness to participate in cancer research were high, supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation. IMPLICATIONS FOR NURSING: Nursing professionals and researchers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere. Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials.

Engaging diverse underserved communities to bridge the mammography divide.

BACKGROUND: Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. METHODS/DESIGN: In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas-Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded with our Healthy Living Kansas-Breast Health program and guide their peers through the program. Women in the MI2 condition will receive assistance with operationalizing their screening intentions and identifying and addressing their stated screening barriers with the goal of guiding them toward accessing screening services near their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model. DISCUSSION: This highly innovative project will be guided and initiated by AI/AN and Latina community members and will test the practical application of emerging behavioral theory among minority persons living in rural communities.

Medidas prospectivas de sintomas depressivos entre idosos residentes na comunidade / Medidas prospectivas de síntomas depresivos entre ancianos residentes en la comunidad / Prospective measures of depressive symptoms in community-dwelling elderly individuals

OBJETIVO: Identificar fatores sociodemográficos associados a padrões de incidência, remissão e estabilidade de sintomas depressivos entre idosos residentes na comunidade. MÉTODOS: Estudo prospectivo em que foram entrevistados 310 idosos residentes na comunidade, em Juiz de Fora, MG, entre 2002 e 2004. O seguimento (T2) foi realizado 15,7 meses após a primeira entrevista (T1). Os sintomas de depressão foram avaliados pela escala do Center for Epidemiological Studies - Depression. Os idosos foram classificados segundo a evolução dos sintomas de depressão e comparados quanto às variáveis sociodemográficas com o teste de qui-quadrado e Exato de Fisher. RESULTADOS: Não houve diferenças na prevalência de sintomas depressivos entre T1 e T2 (33,8 por cento). Foram identificados quatro grupos segundo a evolução dos sintomas da primeira para a segunda medida: livres de depressão (50,9 por cento); recorrência (19,7 por cento); incidência (15,2 por cento); remissão (14,2 por cento). Ter pontuado para depressão em T1, ser do sexo feminino e possuir baixa escolaridade representaram riscos para a manifestação de sintomas depressivos em T2. CONCLUSÕES: Piores trajetórias de evolução em sintomatologia depressiva (incidência e recorrência) associaram-se ao gênero feminino.

OBJETIVO: Identificar factores sociodemográficos asociados a patrones de incidencia, remisión y estabilidad de síntomas depresivos entre ancianos residentes en la comunidad. MÉTODOS: Estudio prospectivo en que fueron entrevistados 310 ancianos residentes en la comunidad, en Juiz de Fora, Sureste de Brasil, entre 2002 y 2004. El seguimiento (T2), fue realizado 15,7 meses posteriores a la entrevista (T1). Los síntomas de depresión fueron evaluados por la escala Center for Epidemiological Studies - Depression. Los ancianos fueron clasificados según la evolución de los síntomas de depresión y comparados con relación a las variables sociodemográficas con las pruebas de chi-cuadrado y Exacto de Fisher. RESULTADOS: No hubo diferencias en la prevalencia de síntomas depresivos entre T1 y T2 (33,8%). Fueron identificados cuatro grupos según la evolución de los síntomas de la primera para la segunda medida: libres de depresión (50,9%); recurrencia (19,7%); incidencia (15,2%); remisión (14,2%). Haber mostrado depresión en T1, ser del sexo femenino y poseer baja escolaridad representaron riesgos para la manifestación de síntomas depresivos en T2.

Prospective measures of depressive symptoms in community-dwelling elderly individuals.

OBJECTIVE: To identify sociodemographic factors associated with patterns of incidence, remission and stability of depressive symptoms in community-dwelling elderly individuals. METHODS: prospective study was conducted, where 310 community-dwelling elderly individuals of the city of Juiz de Fora, Southeastern Brazil, were interviewed between 2002 and 2004. Follow-up (T2) was performed 15.7 months after the first interview (T1). Depressive symptoms were evaluated with the Center for Epidemiological Studies Depression Scale. Elderly individuals were classified according to the progression of depressive symptoms and compared in terms of sociodemographic variables with Pearson's chi-square test and Fisher's exact test. RESULTS: There were no differences in the prevalence of depressive symptoms between T1 and T2 (33.8%). A total of four groups were identified, according to the progression of symptoms from the first to the second measure: without depressive symptoms (50.9%); recurrence (19.7%); incidence (15.2%); and remission (14.2%). Scoring for depression in T1, being female and having a low level of education represented risks of manifesting depressive symptoms in T2. CONCLUSIONS: The worst progressions of depressive symptoms (incidence and recurrence) were associated with the female gender.