The relationship between obstructive sleep apnea and haemoglobin A1c and the moderating role of glycaemic status in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

This study investigated the relationship between obstructive sleep apnea and haemoglobin A1c (HbA1c) among Hispanics/Latinos in the United States and assessed whether this relationship was moderated by glycaemic status. This was a cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos cohort. The sample consisted of 13,394 participants with valid measures of obstructive sleep apnea, HbA1c, and study covariates. Obstructive sleep apnea was assessed with the apnea-hypopnea index and categorised as obstructive sleep apnea if the apnea-hypopnea index was ≥5 events/h. HbA1c measures were obtained through fasting blood samples. Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG) and use of antihyperglycaemic medications were used to define glycaemic status (i.e., normoglycaemia [FPG < 5.6 mmol/L (< 100 mg/dL) and 2h-PG < 7.8 mmol/L (140 mg/dL)], prediabetes [FPG 5.6-6.9 mmol/L (100-125 mg/dL), and/or 2h-PG 7.8-11.0 mmol/L (140-199 mg/dL)], diabetes without treatment [FPG > 7.0 mmol/L (≥ 126 mg/dL) and/or 2h-PG ≥ 11.1 mmol/L (≥ 200 mg/dL)], and diabetes with treatment. Multivariable linear regression was used to calculate adjusted least square means. Overall, 25.9% of the sample had obstructive sleep apnea and 49.2% had normal glycaemic levels, 36.1% had prediabetes, 6.5% diabetes without receiving treatment, and 8.3% diabetes and undergoing treatment for it. Participants with obstructive sleep apnea had significantly higher adjusted mean HbA1c (adjusted mean [standard error] 5.85 [0.03)]) than those without (5.70 [0.02)]; p < 0.001). Models stratified by diabetes status showed that the association between obstructive sleep apnea (versus not) and higher HbA1c was only for participants with normal glycaemic status (adjusted mean [standard error] 5.27 [0.01] versus 5.30 [0.01]; p = 0.013) and prediabetes (5.59 [0.01] versus 5.66 [0.01]; p < 0.001). In conclusion, obstructive sleep apnea was associated with higher HbA1c in a diverse sample of Hispanic/Latino adults in the United States. This association was present only for participants with normal glycaemic status or with prediabetes. Studies are needed to further understand the clinical implications of the association between obstructive sleep apnea and HbA1c according to glycaemic status.

Shift-and-persist strategies as a potential protective factor against symptoms of psychological distress among young adults in Puerto Rico.

OBJECTIVE: Residents of Puerto Rico are disproportionately exposed to social and environmental stressors (e.g., Hurricane María and the 2020 sequence of tremors) known to be associated with psychological distress. Shift-and-persist (SP), or the ability to adapt the self to stressors while preserving focus on the future, has been linked with lower psychological distress, but no study has evaluated this in Puerto Rico. This study examined the association between SP and psychological distress (including that from natural disasters) in a sample of young adults in Puerto Rico. METHODS: Data from the Puerto Rico-OUTLOOK study (18-29 y) were used. Participants (n = 1497) completed assessments between September 2020 and September 2022. SP was measured with the Chen scale and categorized into quartiles (SPQ1-SPQ4). Psychological distress included symptoms of depression (CESD-10), anxiety (STAI-10), post-traumatic stress disorder (Civilian Abbreviated Scale PTSD checklist), and ataque de nervios (an idiom of distress used by Latinx groups). Outcomes were dichotomized according to clinical cutoffs when available, otherwise used sample-based cutoffs. Two additional items assessed the perceived mental health impact of Hurricane María and the 2020 sequence of tremors (categorized as no/little impact vs. some/a lot). Adjusted prevalence ratios (PR) and their 95% confidence intervals (CI) were estimated. RESULTS: The most commonly reported psychological distress outcome was PTSD (77%). In adjusted models, compared to SP Q1, persons in SP Q2-Q4 were less likely to have elevated symptoms of depression (PR Q2 = 0.79, 95% CI = 0.72-0.85; PR Q3 = 0.65, 95% CI = 0.58-0.73; and PR Q4 = 0.41, 95% CI = 0.35-0.48), PTSD (PR Q2 = 0.92, 95% CI = 0.87-0.98; PR Q3 = 0.86, 95% CI = 0.80-0.93; and PR Q4 = 0.76, 95% CI = 0.70-0.83), anxiety (PR Q2 = 0.39, 95% CI = 0.31-0.48; PR Q3 = 0.27, 95% CI = 0.20-0.37; and PR Q4 = 0.11, 95% CI = 0.07-0.17) and experiences of ataque de nervios (PR Q2 = 0.85, 95% CI = 0.76-0.94; PR Q3 = 0.79, 95% CI = 0.70-0.90; and PR Q4 = 0.68, 95% CI = 0.60-0.78). Compared to persons in SP Q1, persons in SP Q3-Q4 were less likely to report adverse mental health impacts from Hurricane María (PR Q3 = 0.66, 95% CI = 0.55-0.79; and PR Q4 = 0.53, 95% CI = 0.44-0.65) and the 2020 sequence of tremors (PR Q3 = 0.77, 95% CI = 0.61-0.98; and PR Q4 = 0.74, 95% CI = 0.59-0.94). CONCLUSION: SP was associated with lower psychological distress. Studies are needed to confirm our findings and evaluate potential mechanisms of action.

Association between poor sleep quality and emotional eating in US Latinx adults and the mediating role of negative emotions.

INTRODUCTION: Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. OBJECTIVE: To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions. METHODS: This cross-sectional analysis used data from the Latino Health and Well-being Study. Sleep quality was measured with the Pittsburgh Sleep Quality Index. EE was measured with the EE subscale of the Three Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Negative emotions were measured via a composite score that included depression, anxiety, and perceived stress. Poisson regression models with robust variance errors estimated prevalence ratios (PR) and 95% confidence intervals (CI). Mediation was evaluated with the Karlsson-Holm-Breen method. RESULTS: More individuals with poor (vs. good) sleep quality experienced high EE (39.1% vs. 17.9%). Individuals with poor (vs. good) sleep quality were more likely to experience high EE vs. no EE (total effect = 1.74; 95% CI = 1.34, 2.26). Controlling for negative emotions, the effect of poor sleep on high EE was reduced to 1.23 (95% CI = 0.92, 1.65), leaving an indirect effect of 1.41 (95% CI = 1.25, 1.60); 62.6% of the effect was explained by negative emotions. CONCLUSION: Poor sleep quality was associated with high EE in US Latinx adults and negative emotions partially mediated this relationship. Longitudinal studies are needed. Interventions and clinical programs should concomitantly address sleep quality and negative emotions to help prevent dysfunctional eating behaviors.

Association Between Optimism and Negative Emotional Eating in Caribbean Latinx Adults in the Northeast US.

BACKGROUND: Negative emotional eating (EE) is associated with unfavorable behavioral and health outcomes. Understanding its association with positive factors, such as optimism, may shed light into novel interventions. We examined the association between optimism and negative EE in US Caribbean Latinx adults, a population disproportionately exposed to adversity. METHOD: This cross-sectional analysis used data from the Latino Health and Well-being Study (21-84 years; n = 579). Optimism was measured with the Life Orientation Test-Revised version. EE was measured with the Three-Factor Eating Questionnaire R18-V2. Adjusted Poisson models with robust error variance estimated prevalence ratios (PR). RESULTS: The proportion of individuals reporting high EE was greater in the low (39.0%) and moderate (36.8%) optimism groups than that in the high optimism group (24.8%; p = 0.011). Individuals with high optimism (vs. low) were less likely to report high EE over no EE (PR = 0.68; 95% CI = 0.53-0.88). CONCLUSION: High optimism was negatively associated with high EE. Future studies are needed to confirm our findings and test interventions promoting optimism for preventing negative EE in US Caribbean Latinx adults.

Deep-Structure Attitudes and Reasons Toward Healthy Eating and Self-Rated Diet and Health in Ethnically Diverse U.S.-Hispanics/Latinos.

Little is known about deep-structure (i.e., embedded) cultural attitudes toward healthy eating among Hispanics/Latinos in the United States. This study aimed to identify ethnic-specific dietary attitudes of Latino adults and evaluate their associations with self-rated diet and health. Participants (n = 200) were community-based Latinos (25-65 y/o) living in the Boston, Massachusetts metro area who completed a survey assessing agreement with 20 statements on attitudes toward healthy eating (eight positive and 12 negative) and 15 statements on reasons for healthy eating across seven constructs. Multinomial logistic regression models tested the association of sum scores of positive or negative attitudes and reasons for healthy eating with self-rated diet or self-rated health for participants of Caribbean versus Non-Caribbean backgrounds. Most participants of both backgrounds agreed that healthy eating would keep them healthy and make them look good, and that families should eat together. Differences by background were noted in statements regarding eating at special occasions, cost of healthy foods, self-efficacy (i.e., cravings), and cultural beliefs. Negative attitudes were associated with lower odds of better self-rated health for Caribbean, but not for non-Caribbean, participants. Positive attitudes were associated with 1.85 (95% CI [1.10, 3.12]) odds of better self-rated diet for Caribbean participants and 3.13 (95% CI [1.26, 7.81]) for non-Caribbean participants. Non-Caribbean participants were more likely to self-rate very good/excellent diet with higher reasons for healthy eating. Latinos have shared and ethnic-specific deep-structure attitudes toward healthy eating related to their perceived diet quality and health. Programs promoting healthy eating for Latino adults should be deeply tailored by ethnicity.

Examination of the Allostatic Load Construct and Its Longitudinal Association With Health Outcomes in the Boston Puerto Rican Health Study.

OBJECTIVE: Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability. METHODS: Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing the presence of 21 dysregulated multisystem physiological parameters using the following: a) z scores, b) population-based quartile cutoffs, c) clinical-based cutoffs, d) 10 preselected clinical-based cutoffs (AL-reduced), and e) 12 clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment. RESULTS: AL-quartile was associated with greater odds of T2D (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.07-1.35) and CVD (OR = 1.14; 95% CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95% CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95% CI = 1.07-1.21), IADL (OR = 1.11; 95% CI = 1.04-1.19), and ADL (OR = 1.15; 95% CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95% CI = 1.14-1.61), CVD (OR = 1.21; 95% CI = 1.11-1.32), IADL (OR = 1.15; 95% CI = 1.04-1.26), and ADL (OR = 1.24; 95% CI = 1.08-1.41). No associations were found with AL z-score. CONCLUSIONS: AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

Association between adverse experiences during Hurricane María and mental and emotional distress among adults in Puerto Rico.

OBJECTIVES: To evaluate the association between adverse experiences during Hurricane María and mental and emotional distress in Puerto Rico. METHODS: This cross-sectional study used baseline data from adult (30-75 years) participants of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Enrolled individuals prior to COVID-19 who completed a 33-item questionnaire on Hurricane María-related experiences (sub-categorized as personal, service, or property losses), depression symptomatology, post-traumatic stress disorder (PTSD), and anxiety were included for analysis (n = 456). RESULTS: Most participants experienced fear for their family's safety, damage to their home and personal items, communication outages, and water shortages. Each additional stressor was significantly associated with higher odds of depression symptoms, PTSD, and anxiety. Personal losses were significantly associated with higher likelihood of all outcomes, while services losses were associated with depression symptoms and anxiety; property loss was not significantly associated with any outcome. CONCLUSIONS: Adverse experiences during a major natural disaster are associated with mental and emotional distress. Strategies to minimize hardships during natural disasters, especially personal and service losses, are essential to preserve mental health. Post-disaster psychological support to individuals is crucial.

Changes in Glycemic Load Are Positively Associated with Small Changes in Primary Stress Markers of Allostatic Load in Puerto Rican Women.

BACKGROUND: Puerto Ricans experience a high prevalence of type 2 diabetes. Dietary glycemic load (GL) and allostatic load (AL) have been linked with diabetes. AL, the wear and tear on the body from chronic stress, starts with secretion of primary stress markers from activation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS), and immune system. GL can act as a physiological stressor, contributing to the primary AL response. OBJECTIVE: We examined the relation between GL and a composite score of primary stress markers of AL in Puerto Rican adults. METHODS: Data were from the Boston Puerto Rican Health Study, a cohort study of Puerto Ricans, aged 45-75 y, including 262 men and 697 women with complete data at baseline and 2-y follow-up. GL was calculated from dietary intake obtained with an FFQ. Sex-specific composite primary AL scores included markers of the HPA axis (cortisol and dehydroepiandrosterone sulfate), SNS (epinephrine and norepinephrine), and immune system (C-reactive protein). Linear regression models were stratified by sex and adjusted for covariates. RESULTS: Mean ± SD baseline GL score was 155 ± 28 for men and 135 ± 34 for women. Mean primary stress AL score was 1.25 ± 1.14 for men and 1.25 ± 1.06 for women. GL was not associated with AL score in men. In women, increasing GL from baseline to 2 y was significantly associated with increasing AL, after adjusting for sociodemographics, physical activity, smoking, BMI, menopause, and baseline AL score (ß = 0.03; P = 0.049). Results became marginally significant after further adjustment for chronic diseases (P = 0.06) and intake of fats (P values: saturated fats = 0.08; trans fats = 0.06; unsaturated fats = 0.07), but the magnitude of the association remained unchanged. CONCLUSIONS: Increasing GL over 2 y was positively associated with increasing composite score of primary markers of AL in Puerto Rican women. More studies are needed to confirm our findings.

Association between food insecurity and emotional eating in Latinos and the mediating role of perceived stress.

OBJECTIVE: To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. DESIGN: Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen's Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression. SETTING: A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community. PARTICIPANTS: Latinx individuals (n 580), aged 21-84 years. RESULTS: Overall, 34·4 % were food insecure and 33·8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1·96; 1·28, 3·02) but not Low EE (1·27; 0·82, 1·99). Food insecurity was associated (ß; 95 % CI) with higher perceived stress (5·69; 4·20, 7·19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1·09; 1·06, 1·12) but not Low EE (1·00; CI 0·97, 1·02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1·31; 0·83, 2·07) and explained 69·9 % of the association between food insecurity and High EE. CONCLUSIONS: The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed.

Association Between Obstetric Provider's Advice and Gestational Weight Gain.

Objective This study examined associations between pregnant women's report of obstetric provider GWG advice, self-reported adherence to such advice, and GWG. Methods Healthy pregnant women (N = 91) who started obstetric care prior to 17 weeks of gestation completed assessments between 30 and 34 weeks of gestation. These included survey (questions on receipt of and adherence to provider GWG advice, and demographics) and anthropometric measures. GWG data were abstracted from electronic health records. Analyses included Chi square and Mann-Whitney tests, and binary and multivariate logistic regressions. Results The cohort's median age was 28 years, 68% of women were White, 78% had a college education, 50.5% were overweight or obese before the pregnancy, and 62.6% had GWGs above the Institute of Medicine-recommended ranges. Sixty-seven percent of women reported having received GWG advice from their obstetric providers and, of those, 54.1% reported that they followed their provider's advice. Controlling for race, education and pre-pregnancy BMI, receipt of GWG advice was marginally associated with increased odds of excessive weight gain (OR 2.52, CI 0.89-7.16). However, women that reported following the advice had lower odds of excessive GWG (OR 0.18, CI 0.03-0.91) and, on average, gained 11.3 pounds less than those who reported following the advice somewhat or not at all. Conclusions Frequency of GWG advice from obstetric providers is less than optimal. When given and followed, provider advice may reduce the risk of excessive GWG. Research to understand factors that facilitate providers GWG advice giving and women's adherence to providers' advice, and to develop interventions to optimize both, is needed.

Micronutrient Intake among Children in Puerto Rico: Dietary and Multivitamin-Multimineral Supplement Sources.

BACKGROUND: Micronutrients are critical for healthy growth and development of children. Micronutrient intake from dietary sources is inadequate among some children and may be improved by use of multivitamin and multimineral (MVMM) supplements. OBJECTIVE: To assess micronutrient intake from dietary and MVMM supplement sources among 12-year-old children in Puerto Rico. METHODS: A representative sample of 732 children enrolled in an oral health study in Puerto Rico, who completed dietary and MVMM assessments through one 24-h recall, were included in this analysis. Micronutrient intake sources were described and compared to the Dietary Reference Intakes (DRIs) using the Estimated Average Requirement when available (used Adequate Intake for vitamin K and pantothenic acid). Micronutrient profiles of MVMM users and non-users were compared using t-tests. RESULTS: Mean intakes of vitamins A, D, E, and K, pantothenic acid, calcium, and magnesium from food and beverage sources were below the DRIs. From food and beverage sources, MVMM users had higher intakes of riboflavin and folate compared to non-users (p < 0.05). When MVMM supplements were taken into account, users had higher intakes of all nutrients except vitamin K. With the help of MVMM, users increased intake of vitamins E, A, D, and pantothenic acid to IOM-recommended levels but calcium, magnesium, and vitamin K remained below guidelines. CONCLUSION: Micronutrient intake from diet was below the IOM-recommended levels in the total sample. MVMM use improved intake of selected micronutrients and facilitated meeting recommendations for some nutrients. Public health measures to improve micronutrient intake among children in Puerto Rico are needed.

Association of the Intestinal Microbiota and Obesity.

Obesity is a condition mainly caused by an alteration in energy intake, shifting towards positive energy balance, which can be influenced by genetic and environmental factors. The human gut is heavily populated with microbial organisms. Recent evidence suggests that obesity is influenced by specific bacterial phyla present in the human gut that have increased energy harvesting capabilities. The main objective of this review is to identify the microbial taxa that are related to obesity and weight loss. In this review, we also discuss the differences between the phylum ratio of the gut microbiota population of obese individuals and that of individuals who have healthy weight. It has been shown that obese individuals have a higher ratio of Firmicutes to Bacteroidetes than healthy weight individuals. The few studies to date have shown that weight-loss treatment may change microbial population of the gut, as there is a decrease in the ratio of Firmicutes to Bacteroidetes. Treating imbalances of the gut microbiota may offer new possibilities for treating obesity.

Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study - Health Assessment.

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study - Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

Self-reported engagement in healthy eating behaviors is associated with favorable dietary intake among adults in Puerto Rico.

A diet high in quality is essential for prevention of chronic diseases. Specific healthy eating behaviors may modulate dietary intake. However, these behaviors have been seldomly studied, particularly in Puerto Rico (PR), a population with documented poor dietary quality and high burden of chronic diseases. This study aimed to document self-reported engagement in eating behaviors and examine their associations with intake of nutrients and diet quality. We hypothesized that greater engagement in healthy eating behavior would be associated with greater diet quality. This cross-sectional analysis used data from the PRADLAD study (adults aged 30-75 years residing in the San Juan, PR, area [n = 234]). Frequency (never, sometimes, often, always) of habitual eating behaviors was measured. Dietary intake was assessed with a food frequency questionnaire. Diet quality was measured with the Alternate Healthy Eating Index-2010. Statistical analyses included adjusted linear models. The most common behavior was "controlling intake of salt" (51.7%). Engaging "always" (vs. less frequently) in making healthier meals, reading nutrition facts labels, searching media for healthy eating information, counting calories, buying organic foods, eating a vegetarian diet, and controlling intake of salt, fat, carbohydrates/sugar, and portions were associated with higher Alternate Healthy Eating Index-2010 scores (P < .05). Controlling intakes of fats, carbohydrates/sugars, and portions "always" was associated with lower intakes of trans fats, added sugars, and total food (g), respectively (P < .05). Engagement in eating a vegetarian diet "always" was associated with higher intake of plant-based protein (P < .05). In conclusion, adults following several habitual eating behaviors had greater diet quality and a lower amount of unfavorable nutrients. Encouraging adherence to these behaviors may contribute to healthier dietary intake.

Challenges Accessing Food, Water, Healthcare Services, and Medications During the COVID-19 Pandemic Among Adults in Puerto Rico and Their Association with Self-Rated Health: Assessments of PR-CEAL.

BACKGROUND: The COVID-19 pandemic created challenges in accessing food, water, medications, and healthcare services some of which are linked with lower self-rated health (SRH). These challenges have already been documented in the US, but it remains unknown how the pandemic affected access to food, water, medications and healthcare services, and how these challenges relate to SRH in this group, a population experiencing profound health disparities and limited resources prior to the pandemic. OBJECTIVE: To assess associations between challenges accessing food, water, healthcare, and medications during the COVID-19 pandemic and SRH among adults in Puerto Rico. METHODS: Cross-sectional analysis of Puerto Rico-CEAL. Adults (>18 years; n=582) completed an online survey (December 30, 2021-February 8, 2022). Presence of each challenge during the past 30 days was measured and analyzed individually and combined (0, 1, >2). SRH (rated from poor-excellent) was measured before and at pandemic. Change in SRH was calculated. Adjusted Poisson models with robust variance errors estimated prevalence ratios (PR). RESULTS: Experiencing food, water, medication, and healthcare challenges (vs. not) were associated with pandemic fair-poor SRH (PR=1.44, 95%CI=1.06-1.97; PR=1.59, 95%CI=1.15-2.18; PR=1.38, 95%CI=1.05-1.81; and PR=1.56,9 5%CI=1.15-2.12, respectively). Experiencing 2+ challenges (vs. none) was associated with pandemic fair-poor SRH (PR=1.77, 95%CI=1.22-2.55). Additionally, experiencing food, medication, and healthcare challenges (vs. not) was associated with decreased SRH (PR=1.35, 95%CI=1.08-1.69; PR=1.24, 95%CI=1.01-1.51; and PR=1.25, 95%CI=1.01-1.54, respectively), as well as experiencing 2+ challenges (vs. none; PR =1.49, 95%CI=1.15-1.92). CONCLUSION: Challenges accessing food, water, medications, and healthcare services during the pandemic were associated with fair-poor SRH and decreased SRH in Puerto Rico. Public health policy should ensure access to basic needs.

Age-Related Differences in Anxiety and Depression Diagnosis among Adults in Puerto Rico during the COVID-19 Pandemic.

Residents of Puerto Rico bear a significant burden of mental health disorders, which the COVID-19 pandemic may have exacerbated. However, age-specific data on these disorders during the pandemic in Puerto Rico are scarce. This study evaluated age-related differences in the self-reported diagnosis of depression and anxiety among adults ≥18 years residing in Puerto Rico during the pandemic. An anonymous online survey was administered from December 2020 to February 2021 via Google Forms to measure self-reported sociodemographic and behavioral characteristics and physician-diagnosed mental health disorders. Multivariable logistic regression models were conducted for each self-reported mental health diagnosis after adjusting for sex, education, income, marital status, chronic diseases, and smoking. Out of 1945 adults, 50% were aged 40 years and over. Nearly 24% of responders self-reported an anxiety diagnosis, whereas 15.9% reported depression. Compared to individuals 50 years and over, those 18-29 y, 30-39 y, and 40-49 y had significantly higher odds of an anxiety diagnosis (OR = 1.84, 95% CI = 1.34-2.55; OR = 1.50, 95% CI = 1.09-2.07; and OR = 1.37, 95% CI = 1.01-1.87, respectively). However, no association between age and depression diagnosis was found. Despite anxiety and depression being frequent disorders during the pandemic in this sample, younger adults bear a higher burden of anxiety. Further research is needed to allocate appropriate mental health resources during emergencies according to population subgroups.

Food Insecurity Is Associated With Dysfunctional Eating Behaviors Among Adults in Puerto Rico.

OBJECTIVE: To examine the association between food insecurity and dysfunctional eating behaviors among adults in Puerto Rico. METHODS: Data from 865 participants were obtained from baseline interviews from the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. The association between food insecurity and emotional eating (EE) and uncontrolled eating (UE) (categorized as no/moderate/high) was examined using multinomial logistic models. Potential mediation by perceived stress was explored. RESULTS: The prevalence of food insecurity was 20.3%. Compared with adults with food security, adults with food insecurity had higher odds of both moderate EE (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.18-3.09) and high EE (OR, 2.85; 95% CI, 1.75-4.64), and both moderate UE (OR, 1.78; 95% CI, 0.91-3.50) and high UE (OR, 3.28; 95% CI, 1.70-6.33). Perceived stress slightly attenuated these associations. CONCLUSIONS AND IMPLICATIONS: Food insecurity was associated with a higher likelihood of engaging in dysfunctional eating behaviors. Interventions alleviating food insecurity or stress might help adults sustain healthy eating behaviors.

The Healthy Kids & Families study: Outcomes of a 24-month childhood obesity prevention intervention.

Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent/guardian (Kindergarten to 6th grade at baseline) dyads (n = 247) recruited through schools located in socioeconomically disadvantaged neighborhoods in Worcester, MA, USA. Using a quasi-experimental design, the study tested the impact of Healthy Kids & Families, a theory-based, low-intensity, parent-focused, CHW-delivered intervention to improve children's weight, healthy eating and physical activity. The attention-control comparison condition was a positive parenting intervention. The primary outcome was change in child body mass index (BMI) z-score at 24 months. Secondary outcomes included number of positive child and parent changes in selected diet and physical activity behaviors targeted by the intervention and change in parent BMI. Outcomes were assessed following the intent-to-treat principle and using multivariable generalized linear mixed models. Compared to the attention-control comparison condition, the Healthy Kids & Families intervention led to a greater reduction in children's BMI z-score (ß = -0.17, 95 %CI: -1.92 to -0.36; p = 0.057) and a greater number of positive behavior changes among children (ß = 0.57, 95 %CI: 0.08-1.06; p = 0.02) at 24 months. There was no significant change in parent outcomes. The Healthy Kids & Families intervention shows promise for obesity prevention among children in socioeconomically disadvantaged communities.

COVID-19 Vaccine Booster Hesitancy among Hispanic Adults: A Cross-Sectional Study from the Puerto Rico Community Engagement Alliance against COVID-19 Disparities (PR-CEAL).

Hispanic/Latino communities have suffered a disproportionate burden of the COVID-19 pandemic. Although Puerto Rico has one of the highest COVID-19 primary series vaccination rates nationwide, this estimate contrasts with the reported booster doses' low uptake. This study aimed to assess health belief correlates of COVID-19 vaccine booster uptake. Using a convenience sampling approach, the Puerto Rico-Community Engagement Alliance (PR-CEAL) conducted a cross-sectional study where 787 participants were recruited using online and in-person strategies between December 2021 and February 2022. Participants were adults 18 years or older, Spanish-speaking, and residents of Puerto Rico. The Health Belief Model was used to evaluate attitudes and beliefs. A total of 784 participants were used in this analysis. Adjusted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of booster refusal. Overall, 22% of participants refused the vaccine booster or had not gotten it yet. Adjusted models showed that (i) participants who disagreed that getting the booster dose either made them feel less worried about COVID-19 or (ii) felt that the vaccine decreased their chances of getting COVID-19 presented higher booster-refusal prevalence ratios (PR = 4.20, 95% CI: 3.00, 5.90; PR = 3.70, 95% CI: 2.64, 5.18). Moreover, participants that (iii) reported having concerns for booster side effects [PR = 2.47; 95% CI = 1.73, 3.51], (iv) booster efficacy [PR = 2.50; 95% CI = 1.75, 3.58], and (v) booster safety [PR = 2.80; 95% CI = 1.96, 3.99] were significantly more likely to refuse the booster. In conclusion, booster vaccination refusal was associated with lower perceived vaccine benefits and greater barriers among adults in Puerto Rico. These results informed the development of PR-CEAL's targeted community outreach strategies and public health campaigns to increase booster vaccine uptake.

Corrigendum to "The Healthy Kids & Families study: Outcomes of a 24-month childhood obesity prevention intervention" [Prev. Med. Rep. 31 (2023) 102086].

[This corrects the article DOI: 10.1016/j.pmedr.2022.102086.].