Racial Discrimination and Multimorbidity Among Older Adults in Colombia: A National Data Analysis.

INTRODUCTION: Multimorbidity is a prevalent worldwide problem among older adults. Our objective was to assess the association between life-course racial discrimination and multimorbidity among older adults in Colombia. METHODS: We used data from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study in 2015 (N = 18,873), a national cross-sectional survey among adults aged 60 years or older. The outcome was multimorbidity, defined as having 2 or more chronic conditions. The main independent variables were 3 racial discrimination measures: 1) everyday racial discrimination (yes or no), 2) childhood racial discrimination score (scored from 0 [never] to 3 [many times]), and 3) situations of racial discrimination in the last 5 years (scored from 0 to 4 as a sum of the number of situations [group activities, public places, inside the family, health centers]). Other variables were sociodemographic characteristics, diseases, economic or health adversity during childhood, and functional status. We used weighted logistic regression analyses to adjust for differences between groups. RESULTS: Multivariate logistic regression models showed that multimorbidity was significantly associated with experiencing everyday racial discrimination (OR, 2.21; 95% CI, 1.62-3.02), childhood racial discrimination (OR, 1.27; 95% CI, 1.10-1.47), and the number of situations of racial discrimination (OR= 1.56; 95% CI, 1.22-2.00). Multimorbidity was also independently associated with multimorbidity during childhood. CONCLUSION: Racial discrimination experiences were associated with higher odds of multimorbidity among older adults in Colombia. Strategies to decrease life course experiences of racial discrimination may improve the health of older adults.

Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms.

Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.

Comparative study of HPV and Cervical Cancer Knowledge and Beliefs between Mexican Immigrant Women in the US and Peruvian Women.

Cervical cancer remains one of the major cancers affecting women from developing countries, especially those from socioeconomically disadvantage backgrounds. In the US, Hispanic immigrant women experience restricted access to health care and higher incidence rates of cervical cancer compared to the non-Hispanic white population. Knowledge of cervical cancer risk factors and symptoms is associated with greater interest in participating in regular cervical cancer screening. To explore knowledge and beliefs about cervical cancer, survey questionnaires were administered to Mexican immigrant women in southeast Georgia, US and to mestizo women - primarily Quechua language dominant speakers - in Cusco, Peru. As part of these survey studies, there was a list of 32 items asking participants to agree or disagree with whether certain symptoms or risk factors could cause cervical cancer and a pile sort of 15 of the most salient items. Cultural consensus analysis was used to calculate overall agreement with a cultural model of cervical cancer risk factor knowledge in each sample independently. For the Georgia sample, there was marginal consensus, but for the Peru sample, there was no consensus. Analysis of cultural competence values and residual agreement show significant differences across education in the Georgia study, with a positive correlation between education and cultural competence (r=0.50, p=0.001), but not in the Peru study. Likewise, the results of the pile sort data exhibited consensus for the Georgia sample for the cervical cancer risk factors, but not for the Peru sample. The lack of consensus among the Peru sample on either task suggests little widespread knowledge on risk factors of cervical cancer. Additional analyses related to factors associated with screening behaviors from the cultural cancer screening scale indicated more pronounced fatalistic beliefs and catastrophic disease expectations about cervical cancer among the Peruvian women compared to the Mexican immigrant women.

Social network characteristics and cervical cancer screening among Quechua women in Andean Peru.

BACKGROUND: Peru has high cervical cancer incidence and mortality rates compared to other Andean countries. Therefore, partnerships between governmental and international organizations have targeted rural areas of Peru to receive cervical cancer screening via outreach campaigns. Previous studies have found a relationship between a person's social networks and cancer screening behaviors. Screening outreach campaigns conducted by the nonprofit organization CerviCusco created an opportunity for a social network study to examine cervical cancer screening history and social network characteristics in a rural indigenous community that participated in these campaigns in 2012 and 2013. The aim of this study was to explore social network characteristics in this community related to receipt of cervical cancer screening following the campaigns. METHODS: An egocentric social network questionnaire was used to collect cross-sectional network data on community participants. Each survey participant (ego) was asked to name six other women they knew (alters) and identify the nature of their relationship or tie (family, friend, neighbor, other), residential closeness (within 5 km), length of time known, frequency of communication, topics of conversation, and whether they lent money to the person, provided childcare or helped with transportation. In addition, each participant was asked to report the nature of the relationship between all alters identified (e.g., friend, family, or neighbor). Bivariate and multivariate analyses were used to explore the relationship between Pap test receipt at the CerviCusco outreach screening campaigns and social network characteristics. RESULTS: Bivariate results found significant differences in percentage of alter composition for neighbors and family, and for mean number of years known, mean density, and mean degree centrality between women who had received a Pap test (n = 19) compared to those who had not (n = 50) (p's < 0.05). The final logistic regression model was statistically significant (χ2 (2) = 20.911, p < .001). The model included the variables for percentage of family alter composition and mean density, and it explained 37.8% (Nagelkerke R(2)) of the variance in Pap test receipt, correctly classifying 78.3% of cases. Those women with higher percentages of family alter composition and higher mean density in their ego networks were less likely to have received a Pap test at the CerviCusco campaigns. CONCLUSIONS: According to this exploratory study, female neighbors more than family members may have provided an important source of social support for healthcare related decisions related to receipt of a Pap test. Future studies should collect longitudinal social network data on participants to measure the network effects of screening interventions in rural indigenous communities in Latin American countries experiencing the highest burden of cervical cancer.

Cultural beliefs and understandings of cervical cancer among Mexican immigrant women in Southeast Georgia.

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants' characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.

Self-reported tooth loss and cognitive function: Data from the Hispanic established populations for epidemiologic studies of the elderly (Hispanic EPESE) / El auto-reporte de la pérdida de dientes y la función cognitiva: Datos de las poblaciones Hispanas establecidas para estudios epidemiológicos en ancianos (EPESE Hispano)

Abstract Objective: To explore the association between tooth loss and cognitive functioning among persons 65 years and older. Methods: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Wave 1: 1993-1994, n= 3,032; Wave 2: 1995-1996, n= 2,424; and Wave 3: 1998-1999, n= 1,967). The dependent variables were the scores from the total Mini-Mental State Examination (MMSE: score 0-30) and its global domains (memory: score 0-6; and no-memory: score 0-24). Independent variables included the number of teeth (0-12 vs. 13-32), socio-demographic characteristics, last dental office visit, medical conditions, depressive symptoms, and functional limitations which were tested for associations with the dependent variables. Results: In bivariate analyses, participants with fewer teeth (0-12) tended to have significantly lower mean scores for memory, no-memory, and total MMSE when compared to those with more teeth (13-32), both at baseline and at follow-up. In fully adjusted longitudinal-mixed models, participants with fewer teeth had a greater decline in total MMSE through five years of follow-up with a decrease of 0.12 fewer points each year (SE ± 0.05, p <0.01), when compared to those with more teeth. Conclusion: Having fewer teeth was associated with greater cognitive decline over time.

Resumen Objetivo: Explorar la asociación entre pérdida de dientes y función cognoscitiva en las personas de 65 años o más. Métodos: Datos del estudio EPESE (Poblaciones Establecidas para los Estudios Epidemiológicos de los Ancianos) Hispano (Encuesta 1: 1993-1994, n= 3,032; Encuesta 2: 1995-1996, n= 2,424; y Encuesta 3: 1998-1999, n= 1,967). Las variables independientes fueron el Examen MiniMental total (MMSE, 0-30 de puntaje) y sus dominios globales (memoria: 0-6 de puntaje; y no-memoria: 0-24 de puntaje). Variables independientes fueron el número de dientes presentes en la boca (0-12 vs. 13-32), características sociodemográficas, última visita al odontólogo, condiciones médicas, síntomas depresivos, y limitaciones funcionales a las cuales se les hicieron pruebas de asociación con las variables dependientes. Resultados: En análisis bivariados, los participantes con pocos dientes (0-12) tenían promedios de puntajes mas bajos en memoria, no-memoria y el MMSE total, comparado con los participantes con mas dientes (13-32) en la encuesta inicial y al seguimiento. En modelos mixtos longitudinales ajustados por todas las variables, los participantes con menos dientes tenían un declive mayor en el MMSE total a través de los cinco años de seguimiento, con una disminución de 0.12 puntos cada año (ES ± 0.05, p <0.01), comparado con quienes tenían mas dientes. Conclusión: La presencia de pocos dientes estuvo asociada con un mayor declive cognoscitivo a través del tiempo.

Self-reported tooth loss and cognitive function: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Hispanic EPESE).

OBJECTIVE: To explore the association between tooth loss and cognitive functioning among persons 65 years and older. METHODS: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Wave 1: 1993-1994, n= 3,032; Wave 2: 1995-1996, n= 2,424; and Wave 3: 1998-1999, n= 1,967). The dependent variables were the scores from the total Mini-Mental State Examination (MMSE: score 0-30) and its global domains (memory: score 0-6; and no-memory: score 0-24). Independent variables included the number of teeth (0-12 vs. 13-32), socio-demographic characteristics, last dental office visit, medical conditions, depressive symptoms, and functional limitations which were tested for associations with the dependent variables. RESULTS: In bivariate analyses, participants with fewer teeth (0-12) tended to have significantly lower mean scores for memory, no-memory, and total MMSE when compared to those with more teeth (13-32), both at baseline and at follow-up. In fully adjusted longitudinal-mixed models, participants with fewer teeth had a greater decline in total MMSE through five years of follow-up with a decrease of 0.12 fewer points each year (SE ± 0.05, p <0.01), when compared to those with more teeth. CONCLUSION: Having fewer teeth was associated with greater cognitive decline over time.

OBJETIVO: Explorar la asociación entre pérdida de dientes y función cognoscitiva en las personas de 65 años o más. MÉTODOS: Datos del estudio EPESE (Poblaciones Establecidas para los Estudios Epidemiológicos de los Ancianos) Hispano (Encuesta 1: 1993-1994, n= 3,032; Encuesta 2: 1995-1996, n= 2,424; y Encuesta 3: 1998-1999, n= 1,967). Las variables independientes fueron el Examen MiniMental total (MMSE, 0-30 de puntaje) y sus dominios globales (memoria: 0-6 de puntaje; y no-memoria: 0-24 de puntaje). Variables independientes fueron el número de dientes presentes en la boca (0-12 vs. 13-32), características sociodemográficas, última visita al odontólogo, condiciones médicas, síntomas depresivos, y limitaciones funcionales a las cuales se les hicieron pruebas de asociación con las variables dependientes. RESULTADOS: En análisis bivariados, los participantes con pocos dientes (0-12) tenían promedios de puntajes mas bajos en memoria, no-memoria y el MMSE total, comparado con los participantes con mas dientes (13-32) en la encuesta inicial y al seguimiento. En modelos mixtos longitudinales ajustados por todas las variables, los participantes con menos dientes tenían un declive mayor en el MMSE total a través de los cinco años de seguimiento, con una disminución de 0.12 puntos cada año (ES ± 0.05, p <0.01), comparado con quienes tenían mas dientes. CONCLUSIÓN: La presencia de pocos dientes estuvo asociada con un mayor declive cognoscitivo a través del tiempo.

Creating community-academic partnerships for cancer disparities research and health promotion.

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Maternal recognition and health care-seeking behavior for acute respiratory infection in children in a rural Ecuadorian county.

OBJECTIVES: To identify the factors which determine timely health care-seeking behaviors for childhood ARIs. METHODS: A semi-structured questionnaire was administered to a non-random purposive sample of 91 female caregivers (age 18-57 years), and was analyzed using SPSS. In addition, six focus group discussions with female caregivers and 25 in-depth interviews with members from the health care setting were conducted. RESULTS: The primary obstacles reported for timely health care-seeking among survey respondents were money for medicines (n=29, 32%), transportation fares (n=19, 21%), and restrictive hours of the health centers (n=13, 14%). The median household salary reported was $100 per month. There was an overall lack of recognition of the biomedical signs and symptoms of serious lower respiratory infections independent of socioeconomic status. CONCLUSIONS: Based on the study findings, the following recommendations are offered: (1) public health campaigns need to better address appropriate home health care management of childhood health and illness to improve maternal health-seeking behavior for ARIs; (2) provincial health authorities need to adhere to regular hours of operation, expand clinic hours and increase staff; (3) health posts should establish better policies for disbursement of antibiotics and ensure that patients follow prescribed regimens; and (4) through partnerships with economic development organizations and the private sector, there will be increased employment opportunities.