Economic and Psychosocial Impact of COVID-19 in the Hispanic Community Health Study/Study of Latinos.

Objectives: To examine the prevalence and correlates of economic hardship and psychosocial distress experienced during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in a large cohort of Hispanic/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing multicenter study of Hispanic/Latino adults, collected information about COVID-19 illness and psychosocial and economic distress that occurred during the pandemic (N=11,283). We estimated the prevalence of these experiences during the initial phase of the pandemic (May 2020 to May 2021) and examined the prepandemic factors associated with pandemic-related economic hardship and emotional distress using multivariable log linear models with binomial distributions to estimate prevalence ratios. Results: Almost half of the households reported job losses and a third reported economic hardship during the first year of the pandemic. Pandemic-related household job losses and economic hardship were more pronounced among noncitizens who are likely to be undocumented. Pandemic-related economic hardship and psychosocial distress varied by age group and sex. Contrary to the economic hardship findings, noncitizens were less likely to report pandemic-related psychosocial distress. Prepandemic social resources were inversely related to psychosocial distress. Conclusions: The study findings underscore the economic vulnerability that the pandemic has brought to ethnic minoritized and immigrant populations in the United States, in particular noncitizens. The study also highlights the need to incorporate documentation status as a social determinant of health. Characterizing the initial economic and mental health impact of the pandemic is important for understanding the pandemic consequences on future health. Clinical Trial Registration Number: NCT02060344.

The Association of Predicted Resting Energy Expenditure with Risk of Breast Cancer among Postmenopausal Women in the Women's Health Initiative Cohort.

Obesity and obesity-related metabolic disorders, such as diabetes and chronic inflammation, have been positively associated both with postmenopausal breast cancer and with resting energy expenditure (REE). However, there is limited epidemiologic evidence on the associations between REE and risk of postmenopausal breast cancer. We used multivariable Cox proportional hazards models to examine the association between predicted REE (calculated using the Ikeda, Livingston, and Mifflin equations) and risk of postmenopausal breast cancer overall and by subtypes, and by level of body fat) among 137,283 postmenopausal women in the Women's Health Initiative (WHI). All predicted REEs were positively associated with risk of invasive breast cancer [HRq5 vs. q1 = 1.69; 95% confidence interval (CI), 1.57-1.81; HR = 1.69; 95% CI, 1.57-1.82; and HR = 1.68; 95% CI, 1.56-1.80 for Ikeda, Livingston, and Mifflin, respectively]. These positive associations were observed irrespective of the hormone receptor subtype, grade, and stage of the tumors, but were most pronounced for estrogen receptor-positive/progesterone receptor-positive tumors. After additional adjustment for body mass index (BMI), the associations were mostly attenuated and remained statistically significant for most of the outcomes. We also observed an interaction between the predicted REEs and BMI, with the associations being somewhat stronger among normal weight and overweight women than among obese women (Pinteractions < 0.05). Our findings indicate that relatively high REE is associated with increased risk of invasive breast cancer among postmenopausal women (particularly for the obesity-related tumor subtypes), irrespective of the equation used. Further studies using more objective measures of REE are, however, needed to confirm our findings. PREVENTION RELEVANCE: This study showed that higher resting energy expenditure (REE) was associated with higher postmenopausal breast cancer risk. REE provides energy to support cancer-associated disorders such as obesity and inflammation. Thus, studies on its association with breast cancer can help to improve our understanding of the pathophysiology of breast cancer.

High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: We assessed high cholesterol (HC) awareness, treatment, and control rates among US Hispanic/Latino adults and describe factors associated with HC awareness and management. METHODS AND RESULTS: Baseline data (collected 2008-2011) from a multisite probability sample of Hispanic/Latino adults in the Hispanic Community Health Study/Study of Latinos (18 to 74 years old; N=16 207) were analyzed. HC was defined as low-density lipoprotein-cholesterol ≥130 mg/dL and/or total cholesterol ≥240 mg/dL or use of cholesterol-lowering medication. Among Hispanic/Latino adults with HC, almost half (49.3%) were not aware of their condition and only 29.5% were receiving treatment. Men had a higher HC prevalence than women (44.0% versus 40.5%) but a lower rate of treatment (28.1% versus 30.6%). Younger adults were significantly less likely to be HC aware compared to those who were older. Those with hypertension, diabetes, and high socioeconomic position were more likely to be HC aware. US-born Hispanic/Latino were more likely to be HC unaware than foreign-born Hispanics/Latinos, but longer US residency was significantly associated with being HC aware, treated, and controlled. Cholesterol control was achieved among 64.3% of those who were HC treated. However, younger adults, women, those with lower income, those uninsured, and more recent immigrants were less likely to be HC controlled. Individuals of Puerto Rican or Dominican background were most likely to be HC aware and treated, whereas those of Mexican or Central American background were least likely to be HC treated. Individuals of Cuban and South American background had the lowest rates of HC control, whereas Puerto Ricans had the highest. CONCLUSIONS: Understanding gaps in HC awareness, treatment, and control among US Hispanic/Latino adults can help inform physicians and policymakers to improve disease management and patient education programs.

Psychological and social characteristics associated with religiosity in Women's Health Initiative participants.

Measures of religiosity are linked to health outcomes, possibly indicating mediating effects of associated psychological and social factors. We examined cross-sectional data from 92,539 postmenopausal participants of the Women's Health Initiative Observational Study who responded to questions on religious service attendance, psychological characteristics, and social support domains. We present odds ratios from multiple logistic regressions controlling for covariates. Women attending services weekly during the past month, compared with those not attending at all in the past month, were less likely to be depressed [OR = 0.78; CI = 0.74-0.83] or characterized by cynical hostility [OR = 0.94; CI = 0.90-0.98], and more likely to be optimistic [OR = 1.22; CI = 1.17-1.26]. They were also more likely to report overall positive social support [OR = 1.28; CI = 1.24-1.33], as well as social support of four subtypes (emotional/informational support, affection support, tangible support, and positive social interaction), and were less likely to report social strain [OR = 0.91; CI = 0.88-0.94]. However, those attending more or less than weekly were not less likely to be characterized by cynical hostility, nor were they less likely to report social strain, compared to those not attending during the past month.

Design and implementation of the Hispanic Community Health Study/Study of Latinos.

PURPOSE: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive multicenter community based cohort study of Hispanics/Latinos in the United States. METHODS: The Study rationale, objectives, design, and implementation are described in this report. RESULTS: The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino, 18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago, Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000 persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban, and Central and South American. The study includes research in the prevalence of and risk factors for heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders. CONCLUSIONS: The HCHS/SOL will (1) characterize the health status and disease burden in the largest minority population in the United States; (2) describe the positive and negative consequences of immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population with diverse environmental exposures, genetic backgrounds, and early life experiences.

The effect of race/ethnicity, sex, and social circumstances on coronary revascularization preferences: a vignette comparison.

Disparities in cardiac care cannot be explained by clinical factors alone. We previously found that physicians' perceived nonclinical factors such as patient preferences influenced decisions for coronary revascularization. For this study, we mailed a questionnaire to a random sample of family medicine physicians, internists, cardiologists, and cardiothoracic surgeons to examine whether the patient's sex, race/ethnicity, and social circumstances impacted treatment preferences for different physician subgroups. All physicians were randomized to receive 1 of 4 questionnaires that contained a vignette describing certain hypothetical situations (desire for an active lifestyle, heavy career or family demands) for a 50-year patient who was a candidate for coronary revascularization who was 1) female, 2) male, 3) black male, or 4) white male. The response rate was 70% (544 of 777). The patient's race/ethnicity and sex did not significantly affect the physicians' treatment preferences. However, significant differences were found according to the social circumstance. More male physicians (78%) than female physicians (66%) recommended revascularization for patients with heavy family demands (P < 0.05). In logistic regression analyses, if the patient desired an active lifestyle, black and Hispanic physicians and fee-for-service physicians preferred revascularization less often than white and salaried physicians, respectively (odds ratio [OR] = 0.45 [0.21-0.94] for black/Hispanic; OR = 0.40 [0.18-0.86] for fee-for-service). Based on these results, certain social circumstances might influence treatment preferences among physician subgroups more than sex- or race-based patient factors. Research examining for causes of disparities in cardiac care should consider the effects of sociocultural issues on management decisions.