Attitudes and experiences regarding preventive strategies for the deaf population in Western New York.

People for whom English is a second language, such as the deaf population, often have unequal access to health information and low health literacy. In the context of a wider study on risk of tick-borne illness in deaf communities, we explored barriers, opportunities, and nuances to accessible health information and communication among deaf people. Semi-structured qualitative individual and group interviews were conducted with 40 deaf people in upstate New York, to explore factors associated with health literacy and health information accessibility. Interviews were conducted in American Sign Language (ASL) by a deaf researcher fluent in ASL. Data analysis included the translation of ASL signs into English words, systematic coding, and generation of themes. A total of 21 interview events (mean time per interview = 41 minutes) were conducted. Two main themes and multiple sub-themes emerged from the data: 1) Layers of obstacles faced by deaf people confirms (or reinforces) exclusion; and 2) preventive information is unavailable or inaccessible to deaf people. Sub- themes identified in the results were perceptions of the deaf community and deaf culture, complex layers of obstacles faced by deaf individuals, the digital divide, the culture of communication, awareness of tick and tick-borne disease (TBD) diseases, importance of using certified deaf interpreters (CDI), health information dissemination strategies and collaborations with the education system, and physical/virtual community engagement. The data suggested several challenges to health literacy in the deaf population, including healthcare and education inequalities and negative perceptions of deaf people by both deaf and hearing people. Improving health literacy in the deaf population requires more interpreters who themselves are deaf ("certified deaf interpreters"), provision of health information in ASL, and a greater engagement with the deaf population by education and healthcare systems.

Dental Health Utilization in Palau: Feasibility of an Oral Cancer Screening Program.

Background: Cancer is the second leading cause of death in the Western Pacific region. The prevalent tradition of chewing betel nut in Palau, an island nation in this region, is a risk factor in the development of oral cancer. Oral cancer is the fifth most common cancer in Palau, and the prognosis can be improved with early detection facilitated by visual inspection of the oral cavity by dentists. The purpose of this study is to assess the feasibility of oral cancer screening using existing dental health infrastructure in Palau. Methods: A mixed methods approach was used to explore topics related to the use of dental care resources in Palau. Primary outcome measures were collected using an electronic survey with closed- and open-ended questions addressing dental health utilization as well as barriers and facilitators to accessing dental care. Secondary measures assessed knowledge, attitudes, and beliefs about betel nut use and oral cancer. Open-ended survey questions were analyzed and coded to develop themes based in grounded theory. Results: Two hundred twenty-three surveys were completed. The mean age was 42.7 years, 80% identified as female, and most (94.3%) report having seen a dentist in Palau. Dental care is seen as important (mean score 82.3/100), and 57.9% reported it was easy to access a dentist. Themes regarding facilitators include multilevel resources and transportation. Themes regarding barriers include cost and availability of dentists/appointments. Approximately half of the respondents were current users of betel nut. Conclusion: Our results suggest facilitators are in place to promote seeking and obtaining dental care; however, existing infrastructure may not support an oral cancer screening program. These data provide important areas to address that can improve access and support the implementation of oral cancer screening through existing dental care in the future.

Sharing the Details: Implementing and Evaluating the Integration of New York State AIDS Institute Health Equity Competencies for Health Care Providers into Clinical Training Activities.

Background: The New York State (NYS) Department of Health (DOH) AIDS Institute (AI) Clinical Education Initiative (CEI) trains the NYS health care workforce to improve health outcomes related to HIV, sexual health, hepatitis C, and for people who use drugs. Methods: In 2019, CEI began consistently integrating health equity into CEI activities through a working group that mapped NYS DOH AI health equity competencies for providers onto planned clinical education. We conducted a convergent mixed methods study on qualitative and quantitative participant feedback form (PFF) data to evaluate these competencies between April 1, 2021, and September 30, 2022, and conducted an annual survey of NYS clinician needs in 2021 and 2022. Results: The CEI Health Equity Working Group analyzed 25 measures within 4 health equity competencies that were grouped into 4 interventions: resources, internal tools, activity creation, and evaluation. Eighty-nine percent of PFF respondents (n=20,166) strongly agreed/agreed that CEI activities included multiple viewpoints; qualitative comments described informative and helpful activities. When asked how they address patient-identified social determinants of health (SDOH) needs, 84% and 71% of annual survey respondents reported they made the highest number of referrals for health insurance coverage assistance in 2021 and 2022, respectively. Discussion: CEI continues to address participant feedback and seamless incorporation of health equity components into their work. Health Equity Implications: Health equity in clinical practice and trainings is crucial in acknowledging and addressing SDOH that continue to impact NYS clinicians and their patients.

Ending the Epidemic: Building Health Care Capacity Through HIV and HCV Preceptorship Programs.

Since 2015, Mount Sinai HIV/HCV Center of Excellence has implemented two-day HIV and HCV preceptorships for New York State health care. Participants assessed their knowledge of and confidence to perform 13 HIV or 10 HCV prevention- and treatment-related skills, measured on a 4-point Likert scale from "not at all" to "very" knowledgeable/confident at baseline, exit survey, and a recent evaluation. Wilcoxon signed rank sum tests determined mean differences at all three time points. Between baseline to exit assessment and baseline to evaluation assessment, HIV and HCV preceptorship attendees reported significant increases in knowledge for five HIV and three HCV components and confidence for two HIV and three HCV tasks (p < .05), respectively. The preceptorship significantly and positively impacted short-term and long-term knowledge and confidence around HCV and HIV clinical skills. The implementation of HIV and HCV preceptorship programs may increase HIV and HCV treatment and prevention service efficacy within key population areas.

Associations of childhood hearing loss and adverse childhood experiences in deaf adults.

Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.

An evaluation of statistical differential analysis methods in single-cell RNA-seq data.

Background: Single-cell RNA Sequencing is gaining popularity in recent years. Compared to bulk RNA-Seq, single-cell RNA Sequencing allows the gene expression being measured within individual cells instead of mean gene expression levels across all cells in the sample. Thus, cell-to-cell variation of gene expressions could be examined. Gene differential expression analysis remains the major purpose in most single-cell RNA sequencing experiments and many methods have been developed in recent years to conduct gene differential expression analysis for single-cell RNA sequencing data. Results: Through simulation studies and real data examples, we evaluated the performance of five open-source popular methods used for gene differential expression analysis in single-cell RNA sequencing data. The five methods included DEsingle (Zero-inflated negative binomial model), Linnorm (Empirical Bayes method on transformed count data using the limma package), monocle (An approximate Chi-Square likelihood ratio test), MAST (A generalized linear hurdle model), and DESeq2 (A generalized linear model with empirical Bayes approach and also commonly used for bulk RNA sequencing differential express analyses). We assessed the false discovery rate (FDR) control, sensitivity, specificity, accuracy, and area under the receiver operating characteristics (AUROC) curve for all five methods under different sample sizes, distribution assumptions, and proportions of zeros in the data. Conclusions: We found the MAST method performed the best among the five methods compared with the largest AUROC values across all tested sample sizes and different proportion of truly differential expressed genes, when the data followed negative binomial distributions. When the sample size increased to 100 in each group, the MAST method showed the best performance with the highest AUROC regardless of the data distributions. If the excess zeros were first filtered out before the gene differential analyses, the DESingle, Linnorm, and DESeq2 performed relatively better than the MAST and the monocle methods with higher AUROC values.

Artificial intelligence-powered smartphone application, AICaries, improves at-home dental caries screening in children: Moderated and unmoderated usability test.

Early Childhood Caries (ECC) is the most common childhood disease worldwide and a health disparity among underserved children. ECC is preventable and reversible if detected early. However, many children from low-income families encounter barriers to dental care. An at-home caries detection technology could potentially improve access to dental care regardless of patients' economic status and address the overwhelming prevalence of ECC. Our team has developed a smartphone application (app), AICaries, that uses artificial intelligence (AI)-powered technology to detect caries using children's teeth photos. We used mixed methods to assess the acceptance, usability, and feasibility of the AICaries app among underserved parent-child dyads. We conducted moderated usability testing (Step 1) with ten parent-child dyads using "Think-aloud" methods to assess the flow and functionality of the app and analyze the data to refine the app and procedures. Next, we conducted unmoderated field testing (Step 2) with 32 parent-child dyads to test the app within their natural environment (home) over two weeks. We administered the System Usability Scale (SUS) and conducted semi-structured individual interviews with parents and conducted thematic analyses. AICaries app received a 78.4 SUS score from the participants, indicating an excellent acceptance. Notably, the majority (78.5%) of parent-taken photos of children's teeth were satisfactory in quality for detection of caries using the AI app. Parents suggested using community health workers to provide training to parents needing assistance in taking high quality photos of their young child's teeth. Perceived benefits from using the AICaries app include convenient at-home caries screening, informative on caries risk and education, and engaging family members. Data from this study support future clinical trial that evaluates the real-world impact of using this innovative smartphone app on early detection and prevention of ECC among low-income children.

An evaluation of RNA-seq differential analysis methods.

RNA-seq is a high-throughput sequencing technology widely used for gene transcript discovery and quantification under different biological or biomedical conditions. A fundamental research question in most RNA-seq experiments is the identification of differentially expressed genes among experimental conditions or sample groups. Numerous statistical methods for RNA-seq differential analysis have been proposed since the emergence of the RNA-seq assay. To evaluate popular differential analysis methods used in the open source R and Bioconductor packages, we conducted multiple simulation studies to compare the performance of eight RNA-seq differential analysis methods used in RNA-seq data analysis (edgeR, DESeq, DESeq2, baySeq, EBSeq, NOISeq, SAMSeq, Voom). The comparisons were across different scenarios with either equal or unequal library sizes, different distribution assumptions and sample sizes. We measured performance using false discovery rate (FDR) control, power, and stability. No significant differences were observed for FDR control, power, or stability across methods, whether with equal or unequal library sizes. For RNA-seq count data with negative binomial distribution, when sample size is 3 in each group, EBSeq performed better than the other methods as indicated by FDR control, power, and stability. When sample sizes increase to 6 or 12 in each group, DESeq2 performed slightly better than other methods. All methods have improved performance when sample size increases to 12 in each group except DESeq. For RNA-seq count data with log-normal distribution, both DESeq and DESeq2 methods performed better than other methods in terms of FDR control, power, and stability across all sample sizes. Real RNA-seq experimental data were also used to compare the total number of discoveries and stability of discoveries for each method. For RNA-seq data analysis, the EBSeq method is recommended for studies with sample size as small as 3 in each group, and the DESeq2 method is recommended for sample size of 6 or higher in each group when the data follow the negative binomial distribution. Both DESeq and DESeq2 methods are recommended when the data follow the log-normal distribution.

Piling it on: Perceived stress and lack of access to resources among US-based LGBTQ+ community members during the COVID-19 pandemic.

OBJECTIVES: While the LGBTQ+ community has been disproportionally impacted by COVID-19 medical complications, little research has considered non-medical impact. METHODS: We conducted a secondary analyses of USA-based respondents from a global cross-sectional online mixed-methods survey collecting sexual orientation, gender identity, and the perceived stress scale (PSS). Bivariate and multivariate ordinal regression statistics were performed. RESULTS: Fourteen percent (n = 193,14.2%) identified as LGBTQ+. Variables significantly associated with LGBTQ+ included: COVID testing/treatment affordability, canceled activities, stocking food/medications, quitting job, lost income, and inability to procure groceries/cleaning supplies/medications. Adjusting for Hispanic ethnicity and income, BIPOC LGBTQ+ individuals had twice the odds (OR:2.02;95%CI:1.16-3.53) of moderate compared to low PSS scores, and high compared to moderate PSS scores, compared to white non-LGBTQ+ individuals. Adjusting for Hispanic ethnicity, income, age, and education, deaf LGBTQ+ individuals had twice the odds (OR:2.00;95%CI:1.12-3.61) of moderate compared to low PSS scores, and high compared to moderate PSS scores, compared to hearing non-LGBTQ+ individuals. CONCLUSION: The LBGTQ+ community has increased stress due to COVID-19. Public health interventions must mitigate stress in BIPOC and deaf LGBTQ+ communities, addressing their intersectional experiences.

The Implementation of a State-wide Rapid Initiation of Antiretroviral Therapy as a Best Practice in Primary Care Practices Using an Academic Detailing Approach: Lessons Learned from New York State, United States.

Background: New York State Department of Health AIDS Institute policy recommends that primary care clinicians should initiate same-day-antiretroviral treatment (ART) of a new HIV diagnosis or at the next clinical visit as the standard of care. However, non-HIV-specialized primary care clinicians might not be sufficiently trained to initiate a specialized ART with a newly HIV diagnosed patient. We assessed clinicians' knowledge and attitudes toward the rapid initiation of ART and provided academic sessions as a training method to guide clinicians through the implementation of a new standard of care. Methods: A Research Electronic Data Capture (REDCap), Health Insurance Portability and Accountability Act (HIPAA)-compliant, online survey was sent to primary care clinicians to assess their knowledge and attitudes towards Rapid Initiation of ART (RIA). We provided personalized academic detailing sessions, addressing questions and concerns gathered from both the initial survey and the individual pre-assessment questionnaire completed prior to the sessions. Results: The survey was initially distributed in February 2019, followed by 4 weekly reminders. Approximately 585 providers completed the survey. Subsequently, 552 health care providers from 25 out of 62 counties in NY State were detailed between March 2019 and March 2021. Lessons learned from the sessions included the identification of pragmatic strategies that could be used in the design of effective detailing sessions, followed by enhanced clinical knowledge, which improved patient care. Conclusion and Global Health Implications: Inconsistencies in the current testing practices result in missed HIV diagnoses and an increased risk of HIV transmission. Academic detailing-training techniques can be used to respond to clinician-identified key issues/attitudes that may result in a new intervention, suggesting a promising approach in addressing the implementation barriers of of rapid-treatment initiation as the standard of care. The academic detailing approach can be easily adapted and can be beneficial in global public health, HIV/ AIDS control, and other conditions that require a medical practice change.

Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras.

INTRODUCTION: Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras. METHODS: Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings. RESULTS: Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes. CONCLUSIONS: SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations. IMPLICATIONS: The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.

Social media study of public opinions on potential COVID-19 vaccines: informing dissent, disparities, and dissemination.

Background The current development of vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unprecedented. Little is known, however, about the nuanced public opinions on the vaccines on social media. Methods We adopted a human-guided machine learning framework using more than six million tweets from almost two million unique Twitter users to capture public opinions on the vaccines for SARS-CoV-2, classifying them into three groups: pro-vaccine, vaccine-hesitant, and anti-vaccine. After feature inference and opinion mining, 10,945 unique Twitter users were included in the study population. Multinomial logistic regression and counterfactual analysis were conducted. Results Socioeconomically disadvantaged groups were more likely to hold polarized opinions on coronavirus disease 2019 (COVID-19) vaccines, either pro-vaccine ( B = 0.40 , SE = 0.08 , P < 0.001 , OR = 1.49 ; 95 % CI = 1.26 -- 1.75 ) or anti-vaccine ( B = 0.52 , SE = 0.06 , P < 0.001 , OR = 1.69 ; 95 % CI = 1.49 -- 1.91 ). People who have the worst personal pandemic experience were more likely to hold the anti-vaccine opinion ( B = - 0.18 , SE = 0.04 , P < 0.001 , OR = 0.84 ; 95 % CI = 0.77 -- 0.90 ). The United States public is most concerned about the safety, effectiveness, and political issues regarding vaccines for COVID-19, and improving personal pandemic experience increases the vaccine acceptance level. Conclusion Opinion on COVID-19 vaccine uptake varies across people of different characteristics.

Science, healthcare system, and government effectiveness perception and COVID-19 vaccination acceptance and hesitancy in a global sample: an analytical cross-sectional analysis.

BACKGROUND: Determinants of COVID-19 vaccine acceptance are complex; how perceptions of the effectiveness of science, healthcare and government impact personal COVID-19 vaccine acceptance is unclear, despite all three domains providing critical roles in development, funding and provision, and distribution of COVID-19 vaccine. OBJECTIVE: To estimate impact of perception of science, healthcare systems, and government along with sociodemographic, psychosocial, and cultural characteristics on vaccine acceptance. DESIGN: We conducted a global nested analytical cross-sectional study of how the perceptions of healthcare, government and science systems have impacted COVID-19 on vaccine acceptance. SETTING: Global Facebook, Instagram and Amazon Mechanical Turk (mTurk) users from 173 countries. PARTICIPANTS: 7411 people aged 18 years or over, and able to read English, Spanish, Italian, or French. MEASUREMENTS: We used Χ2 analysis and logistic regression-derived adjusted Odds Ratios (aORs) and 95% CIs to evaluate the relationship between effectiveness perceptions and vaccine acceptance controlling for other factors. We used natural language processing and thematic analysis to analyse the role of vaccine-related narratives in open-ended explanations of effectiveness. RESULTS: After controlling for confounding, attitude toward science was a strong predictor of vaccine acceptance, more so than other attitudes, demographic, psychosocial or COVID-19-related variables (aOR: 2.1; 95% CI: 1.8 to 2.5). The rationale for science effectiveness was dominated by vaccine narratives, which were uncommon in other domains. LIMITATIONS: This study did not include participants from countries where Facebook and Amazon mTurk are not available, and vaccine acceptance reflected intention rather than actual behaviour. CONCLUSIONS: As our findings show, vaccine-related issues dominate public perception of science's impact around COVID-19, and this perception of science relates strongly to the decision to obtain vaccination once available.

Heat-killed Mycolicibacterium aurum Aogashima: An environmental nonpathogenic actinobacteria under development as a safe novel food ingredient.

Over the last few decades, a wealth of evidence has formed the basis for "the Old Friends hypothesis" suggesting that, in contrast to the past, increasingly people are living in environments with limited and less diverse microbial exposure, with potential consequences for their health. Hence, including safe live or heat-killed microbes in the diet may be beneficial in promoting and maintaining human health. In order to assess the safety of microbes beyond the current use of standardized cultures and probiotic supplements, new approaches are being developed. Here, we present evidence for the safety of heat-killed Mycolicibacterium aurum Aogashima as a novel food, utilizing the decision tree approach developed by Pariza and colleagues (2015). We provide evidence that the genome of M. aurum Aogashima is free of (1) genetic elements associated with pathogenicity or toxigenicity, (2) transferable antibiotic resistance gene DNA, and (3) genes coding for antibiotics used in human or veterinary medicine. Moreover, a 90-day oral toxicity study in rats showed that (4) the no observed adverse effect level (NOAEL) was the highest concentration tested, namely 2000 µg/kg BW/day. We conclude that oral consumption of heat-killed M. aurum Aogashima is safe and warrants further evaluation as a novel food ingredient.

Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study.

BACKGROUND: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. OBJECTIVE: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence-powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. METHODS: Our previous work has led to the prototype of AICaries, which offers artificial intelligence-powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. RESULTS: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. CONCLUSIONS: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/32921.

Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study.

BACKGROUND: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island's environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. OBJECTIVE: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. METHODS: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. RESULTS: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). CONCLUSIONS: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes).

Social Stressors, Arboviral Infection, and Immune Dysregulation in the Coastal Lowland Region of Ecuador: A Mixed Methods Approach in Ecological Perspective.

Aedes aegypti, the mosquito that transmits arboviral diseases such as dengue (DENV), chikungunya (CHIKV), and Zika viruses (ZIKV), is present in tropical and subtropical regions of the world. Individuals at risk of mosquito-borne disease (MBD) in the urban tropics face daily challenges linked to their socio-environment conditions, such as poor infrastructure, poverty, crowding, and limited access to adequate healthcare. These daily demands induce chronic stress events and dysregulated immune responses. We sought to investigate the role of socio-ecologic risk factors in distress symptoms and their impact on biological responses to MBD in Machala, Ecuador. Between 2017 and 2019, individuals (≥ 18 years) with suspected arbovirus illness (DENV, ZIKV, and CHIKV) from sentinel clinics were enrolled (index cases, N = 28). Cluster investigations of the index case households and people from four houses within a 200-m radius of index home (associate cases, N = 144) were conducted (total N = 172). Hair samples were collected to measure hair cortisol concentration (HCC) as a stress biomarker. Blood samples were collected to measure serum cytokines concentrations of IL-10, IL-8, TNF-α, and TGF-ß. Univariate analyses were used to determine the association of socio-health metrics related to perceived stress scores (PSS), HCC, and immune responses. We found that housing conditions influence PSS and HCC levels in individuals at risk of MBD. Inflammatory cytokine distribution was associated with the restorative phase of immune responses in individuals with low-moderate HCC. These data suggest that cortisol may dampen pro-inflammatory responses and influence activation of the restorative phase of immune responses to arboviral infections.

Participation in genetic research among Latinx populations by Latin America birth-residency concordance: a global study.

Latinx populations are underrepresented in DNA-based research, and risk not benefiting from research if underrepresentation continues. Latinx populations are heterogenous; reflect complex social, migration, and colonial histories; and form strong global diasporas. We conducted a global study using a survey tool (Amazon's Mechanical Turk portal) to ascertain willingness to participate in genetic research by Latin America birth-residency concordance. Participants in the global study identified as Latinx (n=250) were classified as the following: (1) born/live outside of Latin America and the Caribbean (LAC), (2) born within/live outside LAC, and (3) born/live within LAC. Latinx were similarly likely to indicated they would participate DNA-based research as their non-Latinx counterparts (52.8% vs. 56.2%, respectively). Latinx born and living in LAC were significantly more willing to participate in DNA-based research than Latinx born and living outside of LAC (OR: 2.5; 95% CI: 1.3, 4.9, p<.01). Latinx indicating they would participate in genetic research were more likely to trust researchers (<.05), believe genetic research could lead to better understanding of disease (<.05), and that genetic research could lead to new treatments (p<.05) when compared with Latinx not interested in participating in genetic research. In summary, significant variation exists in genetic research interest among Latinx based on where they were born and live, suggesting that this context itself independently influences decisions about participation. Cultivating and investing in a research ecosystem that addresses, values, and respects Latinx priorities, circumstances, and researchers would likely increase research participation and, even more importantly, potentially impact the inequitable health disparities disproportionately represented in Latinx communities.

Relationship between perceived social support and postpartum care attendance in three Latin American countries: a cross-sectional analytic study.

BACKGROUND: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras. METHODS: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit. RESULTS: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity). CONCLUSIONS: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.