Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep.

OBJECTIVE: To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. METHODS: Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. RESULTS: Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. CONCLUSION: Improving sleep may lead to improvement in QoL in elderly adults with T2D.

Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol.

BACKGROUND: Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS: This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION: Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION: NCT04876053.

Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents.

OBJECTIVE: This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. DESIGN: Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. SETTING: The USA, including all 50 states and the District of Columbia. PARTICIPANTS: 383 NHPI adolescents aged 12-17 in the USA. RESULTS: A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. CONCLUSIONS: The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.

Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans.

BACKGROUND: Vaccines provide protection against numerous diseases that can cause serious illness and death. However, vaccine hesitancy threatens to undermine progress in reducing preventable diseases and illness. Vaccine hesitancy has been shown to vary by sociodemographic characteristics. However, studies examining associations between healthcare access and vaccine hesitancy are lacking. OBJECTIVE: Using a statewide random sample of Arkansas adults, we examined the relationship between general vaccine hesitancy and healthcare access. DESIGN: From July 12 to 30, 2021, participants were contacted by landlines and cellular phones using random digit dialing. PARTICIPANTS: A total of 1500 Arkansas adults were surveyed. Black/African American and Hispanic/Latinx adults were oversampled to ensure adequate representation. The survey had a cooperation rate of 20%. MAIN MEASURES: The dependent variable was an ordinal measure of general vaccine hesitancy. Age, gender, race, education, relationship status, and rural/urban residence were included in the model. Healthcare access was measured across four domains: (1) health insurance coverage; (2) having a primary care provider (PCP); (3) forgoing care due to cost; and (4) time since last routine checkup. The relationship between general vaccine hesitancy and healthcare access was modeled using ordinal logistic regression, controlling for sociodemographic characteristics. KEY RESULTS: Mean age was 48.5 years, 51.1% were women, 28% reported a race other than White, and 36.3% held a bachelor's degree or higher. Those with a PCP and those with health insurance had approximately two-thirds the odds of being more hesitant ([OR=0.63, CI=0.47, 0.84] and [OR=0.68; CI=0.49, 0.94]) than those without a PCP and those without health insurance. Participants reporting a routine checkup in the last 2 years were almost half as likely to be more hesitant than those reporting a checkup more than 2 years prior (OR=0.58; CI=0.43, 0.79). CONCLUSIONS: Results suggest improving access to health insurance, PCPs, and routine preventative care services may be critical to reducing vaccine hesitancy.

COVID-19 Death Exposure among Adults in the United States.

As of May 17, 2022, more than a million deaths due to COVID-19 have been recorded in the US. For each COVID-19 death, there are an estimated nine bereaved family members and an unknown number of bereaved friends. This study aimed to assess the correlates of self-reported COVID-19 death exposure (i.e., loss of a close friend or family member) among US adults using online survey data (n = 1,869) collected between September 17, 2021 and October 3, 2021. One in four US adults in this national sample reported the loss of a close friend or family member due to COVID-19. The odds of losing a close friend or family member due to COVID-19 death were greater for those age 60 or older, all minoritized racial/ethnic groups except for Asian American respondents, married/coupled respondents, those who had foregone care due to cost in the past year, and those who reported a COVID-19 infection.

Utilization of genetic testing: Analysis of 4,499 prior authorization requests for molecular genetic tests at four US regional health plans.

Continuous advances in genetic testing methodologies and an increased understanding of the genetic mechanisms of diseases have fueled genetic testing utilization across health care specialties. To our knowledge, national trends in the ordering of genetic testing have not been studied broadly across clinical indications, testing methodologies, and ordering provider specialties. We performed a retrospective analysis of 4,499 complete prior authorization requests for molecular genetic testing submitted to four regional health plans' commercial lines of business between May 1, 2019 and May 31, 2019. Ordering providers were characterized by their certification(s) and specialty of practice. Among 4,499 genetic testing requests, 92% were ordered by non-genetics providers. Obstetrician/gynecology (OBGYN) (63%), oncology (15%), and genetics (8%) providers ordered genetic testing most frequently. Reproductive, hereditary cancer, and tumor testing were the most frequently ordered genetic tests. Seventy-nine percent of all prior authorization requests were approved. When analyzing complex genetic testing requests, we found that testing ordered by genetics providers was more likely to be approved based on health plan policy than testing ordered by non-genetics providers. Our results suggest that health care providers across multiple medical specialties may benefit from involvement of genetics specialists in decision-making regarding molecular tests.

Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020.

Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .

A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol.

BACKGROUND: Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas. METHODS: The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers. DISCUSSION: Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.

Investigating the Association between English Proficiency and General Health among Marshallese Adults in the United States.

Prior studies have not examined the association between English proficiency and health among Marshallese adults. Cross-sectional data from 378 Marshallese adults enrolled in a Diabetes Prevention Program study in Arkansas and Oklahoma were used to document English proficiency, assess the relationship between sociodemographic health-related characteristics and English proficiency, and examine the association between English proficiency and general health. Approximately one-fifth of participants reported limited English proficiency (LEP). One-fifth of participants reported being in fair or poor health. General health, age group, education, household food insufficiency, inability to afford necessities, and comorbidities were significantly associated with LEP. Participants with LEP were 78% less likely to report better general health compared with those who reported speaking English very well. Limited English proficiency was high among this sample of Marshallese adults. Findings highlight the need for additional Marshallese clinical interpretation and translation services.

Effects of Race and Poverty on Sleep Duration: Analysis of Patterns in the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey and General National Health Interview Survey Data.

BACKGROUND: There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon race/ethnicity and socioeconomic status. Prior studies have suffered from inadequate measures of poverty and have not included Native Hawaiians and Pacific Islanders (NHPI). METHODS: Using the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS, the effect of race/ethnicity and poverty was examined for associations with sleep duration. RESULTS: Significant differences among race/ethnicity groups and sleep duration were found in adjusted associations. Compared with Whites, NHPIs and Blacks were twice as likely to experience very short sleep; NHPI, Hispanic, and Blacks were more likely to experience short sleep; Blacks were also more likely to experience long sleep. Asians were less likely to experience unhealthy sleep (very short, short, or long sleep). Persons living in poverty were significantly more likely to experience very short sleep compared with persons not living in poverty. CONCLUSION: This is the first population-based study that has examined the relationship between sleep duration and poverty with a large sample that included NHPI in relation to other races/ethnicities. The difference in sleep duration between NHPI and Asians provides a strong rationale for not aggregating Asian and NHPI data in population-based studies.

Factors Associated With Nurses' Acceptance of the Electronic Intensive Care Unit.

BACKGROUND: Telemedicine intensivist-led intensive care (electronic intensive care unit [eICU]) is recommended when on-site intensivist-led intensive care is not available. Although the effects of eICU on patient outcomes are comparable with bedside intensivist-led care, not all implementations of eICU are successful in improving patient outcomes. Therefore, the aims of this study were to (1) examine the associations of perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use and (2) determine which participant characteristics were associated with these four dependent variables. METHODS: This cross-sectional, correlational study asked bedside registered nurses to complete an anonymous online survey to explore their acceptance of eICU. RESULTS: Nurses' attitude toward eICU and intention-to-use eICU demonstrated the strongest association, r(120) = 0.83, p < .001. The most significant variable associated with perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use was support from nurses. In addition, support from physicians was significantly associated with perceived usefulness, perceived ease of use, and nurses' attitudes toward eICU. CONCLUSIONS: Support from both bedside physicians and registered nurses in the intensive care unit had the most association with acceptance of the eICU service. Gaining their support to use an eICU service is essential.