Preferences and Demand for Mosquito Control among Dengue-Endemic Communities in Peñuelas, Puerto Rico: An Application of the Best-Worst Choice Model.

Aedes aegypti is the primary vector of dengue virus and threatens 3.9 billion people living in many tropical and subtropical countries. Prevention and reduction of dengue and other Aedes-borne viruses, including Zika and chikungunya, requires control of mosquito populations. Community mobilization and input are essential components of vector control efforts. Many vector control campaigns do not engage communities prior to implementation, leading to program failure. Those that do often conduct basic knowledge, attitude, and practice surveys that are not designed to explicitly elicit preferences. Here, we applied a novel stated preference elicitation tool, best-worst choice, to understand preferences, willingness to participate, and willingness to pay for mosquito control in dengue-endemic communities of Peñuelas, Puerto Rico. Findings revealed that the community preferred mosquito control programs that are 1) applied at the neighborhood level, 2) implemented by the local government, and 3) focused specifically on reducing disease transmission (e.g., dengue) instead of mosquito nuisance. Programs targeting the reduction of disease transmission and higher educational level of participants increased willingness to participate. Participants were willing to pay an average of $72 annually to have a program targeting the reduction of diseases such as dengue. This study serves as a model to engage communities in the design of mosquito control programs and improve stakeholders' decision-making.

Adherence to a Traditional Mexican Diet Is Associated with Lower Hepatic Steatosis in US-Born Hispanics of Mexican Descent with Overweight or Obesity.

Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic adults of Mexican descent (n = 102 men, 178 women) with overweight or obesity enrolled in a cross-sectional observational study were analyzed. The tMexS was calculated from 24 h dietary recalls. Hepatic steatosis and fibrosis measurements were assessed using transient elastography (Fibroscan®). Linear regression models testing the association between tMexS and hepatic steatosis and fibrosis were run individually and through the stratification of significant modifiers. Mean tMexS were 5.9 ± 2.1, hepatic steatosis scores were 288.9 ± 48.9 dB/m, and fibrosis scores were 5.6 ± 2.2 kPa. Among the US-born group, with every point increase in the tMexS, there was a statistically significant 5.7 lower hepatic steatosis point (95% CI: -10.9, -0.6, p-value = 0.07). Higher adherence to a traditional Mexican diet was associated with lower hepatic steatosis in US-born Hispanics of Mexican descent. Findings from the current work may serve to inform future culturally relevant interventions for NAFLD prevention and management in individuals of Mexican descent.

Cardiopulmonary Resuscitation Training in Select Rhode Island High Schools: A Descriptive Study.

Fewer than 15% of people who have out-of-hospital cardiac arrests survive, but chances of survival can be tripled with effective bystander cardiopulmonary resuscitation (CPR). The majority of states, including Rhode Island, require high school CPR training, yet the impact of this is not well studied. A 33-question REDCap survey regarding cardiac arrest preparedness, CPR education, and barriers to CPR training was emailed to high school staff in Rhode Island. There were 62 responses; 26% reported their school taught CPR and 94% felt it was important for students to have CPR certification. Barriers included time (85%), budget (82%), and materials (79%). Over 80% felt students would not be able to perform high-quality CPR or properly use a defibrillator. Despite laws requiring CPR training and the belief by school staff of the importance of CPR training, the majority of students are not receiving CPR training. Staff report students do not have the ability to perform effective CPR or use a defibrillator.

Deconstructing PTSD: Trauma and emotion among Mexican immigrant women.

The symptomatology for Post-Traumatic Stress Disorder (PTSD) narrowly focuses on particular diagnostic frames and a single triggering event. Such narrow definitions of trauma and recovery have been heavily critiqued by anthropologists and cultural psychiatrists for overlooking cultural complexity as well as the effects of multiple and overlapping events that may cause someone to become "traumatized" and thereby affect recovery. This article investigates how subjective reporting of traumatic experience in life history narratives relates to depressive and PTSD symptomatology, cultural idioms, and repeated traumatic experiences among low-income Mexican immigrant women in Chicago. We interviewed 121 Mexican immigrant women and collected life history narratives and psychiatric scales for depression and PTSD. Most women spoke of the detrimental effects of repeated traumatic experiences, reported depressive (49%) and PTSD (38%) symptoms, and described these experiences through cultural idioms. These data complicate the PTSD diagnosis as a discrete entity that occurs in relation to a single acute event. Most importantly, these findings reveal the importance of cumulative trauma and cultural idioms for the recognition of suffering and the limitation of diagnostic categories for identifying the needs of those who experience multiple social and psychological stressors.

The Donora Smog Revisited: 70 Years After the Event That Inspired the Clean Air Act.

At a storefront museum approximately 25 miles southeast of Pittsburgh, Pennsylvania, a sign reads, "Clean Air Started Here." This is not hyperbole. At the end of October 1948, the communities of Donora and Webster in Pennsylvania were visited by a smog that changed the face of environmental protection in the United States. Conservative estimates showed that 20 individuals died, while an additional 5900-43% of the population of Donora-were affected by the smog. This event led to the first large-scale epidemiological investigation of an environmental health disaster in the United States. Questions remain about the long-term effects of the smog, because higher rates of cardiovascular disease and cancer than were expected were observed in the region in the decade following the smog. Recent work has suggested that environmental contaminants from a bygone era in Donora might have an impact even today. In addition, reports regarding air pollution have indicated that levels of pollutants similar to those estimated to have occurred in Donora are currently present in some rapidly industrializing regions of China and India. Seventy years after the smog, this event still resonates.

Self-care and Subjectivity among Mexican Diabetes Patients in the United States.

Type 2 diabetes is considered a public health crisis, particularly among people of Mexican descent in the United States. Clinical approaches to diabetes management increasingly emphasize self-care, which places responsibility for illness on individuals and mandates self-regulation. Using narrative and free-list data from a two-phase study of low-income first- and second-generation Mexican immigrants living with diabetes, we present evidence that self-care among our participants involves emotion regulation as well as maintenance of and care for family. These findings suggest, in turn, that the ideology of selfhood on which these practices are based does not correspond with the ideology of selfhood cultivated in the U.S. clinical sphere. Divergence between these ideologies may lead to self-conflict for patients and the experience of moral blame. We argue that our participants use their explanations of diabetes causality and control as a form of self-making, which both resists such blame and asserts an alternative form of selfhood that may align more closely with the values held by our Mexican-American participants.

Depression among diabetic women in urban centers in Mexico and the United States of America: a comparative study / Depresión en mujeres diabéticas de los centros urbanos de México y los Estados Unidos: un estudio comparativo

OBJECTIVE: To compare the prevalence and patterns of depressive symptoms among women with type 2 diabetes in Puebla, Mexico, and Chicago, United States. METHODS: Two cross-sectional studies were conducted independently, in Puebla (September 2010-March 2011) and in Chicago (January-July 2010). Depression symptomatology was evaluated in a random sample of 241 women self-reporting type 2 diabetes in Puebla and a convenience sample of 121 women of Mexican descent seeking care for type 2 diabetes in Chicago. Depressive symptomatology was measured by the Center for Epidemiologic Studies Depression Scale administered in either English or Spanish. Women were similarly socioeconomically disadvantaged with low education levels in both locations. RESULTS: The Chicago sample of women reported higher levels of depression than the Puebla sample (38% versus 17%, P < 0.0001). Among those with comorbid depression and diabetes in both sites, minimal variations in symptoms were observed. Depressive symptoms, specifically the subjective element (feeling sad) and symptoms associated with diabetes (fatigue and sleep problems) were heightened in both groups. More frequent reporting of "feeling fearful" was statistically significant in Puebla. CONCLUSIONS: Despite a higher prevalence of depression among Mexican immigrant women with diabetes in the United States compared to Mexico, there was little variation in their depressive symptoms, regardless of residence. However, women in Mexico did report a higher incidence of fear. Screening for depression in patients with diabetes should take into account symptoms of fatigue and sleep and the bi-directional relationship of depression and diabetes.

OBJETIVO: Comparar la prevalencia y las características de los síntomas depresivos en mujeres aquejadas de diabetes tipo 2 en Puebla (México) y Chicago (Estados Unidos). MÉTODOS: Se llevaron a cabo independientemente dos estudios transversales, en Puebla (de septiembre del 2010 a marzo del 2011) y en Chicago (de enero a julio del 2010). Se evaluó la sintomatología depresiva en una muestra aleatoria de 241 mujeres con diagnóstico de diabetes de tipo 2 en Puebla, y en una muestra de conveniencia de 121 mujeres de ascendencia mexicana que acudieron en busca de atención de su diabetes de tipo 2 en Chicago. La sintomatología depresiva se midió mediante la Escala de Depresión del Centro de Estudios Epidemiológicos, administrada ya fuera en inglés o en español. En ambas ubicaciones, las mujeres pertenecían a niveles socioeconómicos desfavorecidos de forma similar y sus niveles de educación eran bajos. RESULTADOS: Se notificaron niveles más altos de depresión en la muestra de mujeres de Chicago que en la muestra de Puebla (38 frente a 17%, P < 0,0001). En ambos sitios, se observaron variaciones mínimas en los síntomas de las mujeres que padecían depresión y diabetes de manera concomitante. Los síntomas depresivos, específicamente el elemento subjetivo (sentirse triste) y los síntomas asociados con la diabetes (cansancio y problemas de sueño), aparecían intensificados en ambos grupos. La mayor frecuencia de la notificación de "sentirse temerosa"encontrada en Puebla fue estadísticamente significativa. CONCLUSIONES: A pesar de una mayor prevalencia de depresión en las mujeres mexicanas con diabetes inmigrantes en los Estados Unidos, en comparación con las que vivían en México, hubo poca variación en los síntomas depresivos, independientemente de la residencia. Sin embargo, las mujeres residentes en México notificaron una mayor incidencia de temor. El tamizaje de la depresión en pacientes con diabetes debe tener en cuenta los síntomas de cansancio y de trastornos del sueño, y la relación bidireccional entre la depresión y la diabetes.

Undocumented immigration status and diabetes care among Mexican immigrants in two immigration "sanctuary" areas.

The objective of this study is to investigate the relationship between immigration status and the patient experience of health care, diabetes self-management, and clinical outcomes among Mexican immigrants with diabetes receiving health care in two immigration sanctuary cities. We used data from the Immigration, Culture and Health Care study, a cross-sectional survey and medical record study of low-income patients with diabetes recruited from public hospitals and community clinics in the San Francisco Bay Area and Chicago. Undocumented Mexican, documented Mexican immigrants, and US-born Mexican-Americans' health care experiences, diabetes self-management, and clinical outcomes were compared using multivariate linear and logistic regressions. We found no significant differences in reports of physician communication, or in measures of diabetes management between undocumented and documented immigrants. All three groups had similar clinical outcomes in glycemic, systolic blood pressure, and lipid control. These results indicate that, at least in some settings, undocumented Mexican immigrants with diabetes can achieve similar clinical outcomes and report similar health care experiences as documented immigrants and US-born Mexican-Americans.

Depression among diabetic women in urban centers in Mexico and the United States of America: a comparative study.

OBJECTIVE: To compare the prevalence and patterns of depressive symptoms among women with type 2 diabetes in Puebla, Mexico, and Chicago, United States. METHODS: Two cross-sectional studies were conducted independently, in Puebla (September 2010-March 2011) and in Chicago (January-July 2010). Depression symptomatology was evaluated in a random sample of 241 women self-reporting type 2 diabetes in Puebla and a convenience sample of 121 women of Mexican descent seeking care for type 2 diabetes in Chicago. Depressive symptomatology was measured by the Center for Epidemiologic Studies Depression Scale administered in either English or Spanish. Women were similarly socioeconomically disadvantaged with low education levels in both locations. RESULTS: The Chicago sample of women reported higher levels of depression than the Puebla sample (38% versus 17%, P < 0.0001). Among those with comorbid depression and diabetes in both sites, minimal variations in symptoms were observed. Depressive symptoms, specifically the subjective element (feeling sad) and symptoms associated with diabetes (fatigue and sleep problems) were heightened in both groups. More frequent reporting of "feeling fearful" was statistically significant in Puebla. CONCLUSIONS: Despite a higher prevalence of depression among Mexican immigrant women with diabetes in the United States compared to Mexico, there was little variation in their depressive symptoms, regardless of residence. However, women in Mexico did report a higher incidence of fear. Screening for depression in patients with diabetes should take into account symptoms of fatigue and sleep and the bi-directional relationship of depression and diabetes.

Association between parity and obesity in Mexican and Mexican-American women: findings from the Ella binational breast cancer study.

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m(2), waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m(2)) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.

Interpersonal abuse and depression among mexican immigrant women with type 2 diabetes.

Evidence for a bi-directional relationship of depression and type 2 diabetes suggests that social distress plays a role in depression among people with diabetes. In this study, we examine the relationship between subjective distress and depression in 121 first- and second-generation Mexican immigrant women seeking diabetes care at a safety-net hospital in Chicago. We used a mixed-methods approach including narrative interview, survey, and finger-stick blood HbA1c data. Using grounded theory analysis, we identified seven life stressors from narrative interviews: interpersonal abuse, stress related to health, family, neighborhood violence, immigration status, and work, and feeling socially detached. Women reported unusually high rates of interpersonal abuse (65%) and disaggregated physical abuse (54%) and sexual abuse (23%). We evaluated depression using CES-D cut-off points of 16 and 24 and assessed rates to be 49 and 34%, respectively. We found that interpersonal abuse was a significant predictor of depression (CESD ≥ 24) in bivariate (OR 3.97; 95% CI 1.58-10.0) and multivariate (OR 5.51; 95% CI 1.85, 16.4) logistic regression analyses. These findings suggest that interpersonal abuse functions as an important contributor to depression among low-income Mexican immigrant women and should be recognized and addressed in diabetes care.

The meaning of numbers in health: exploring health numeracy in a Mexican-American population.

BACKGROUND: Health numeracy can be defined as the ability to use numeric information in the context of health. The interpretation and application of numbers in health may vary across cultural groups. OBJECTIVE: To explore the construct of health numeracy among persons who identify as Mexican American. DESIGN: Qualitative focus group study. Groups were stratified by preferred language and level of education. Audio-recordings were transcribed and Spanish groups (n = 3) translated to English. An analysis was conducted using principles of grounded theory. PARTICIPANTS: A purposeful sample of participants from clinical and community sites in the Milwaukee and Chicago metropolitan areas. MAIN MEASURES: A theoretical framework of health numeracy was developed based upon categories and major themes that emerged from the analysis. KEY RESULTS: Six focus groups were conducted with 50 participants. Initial agreement in coding was 59-67% with 100% reached after reconciliation by the coding team. Three major themes emerged: 1) numeracy skills are applied to a broad range of communication and decision making tasks in health, 2) affective and cognitive responses to numeric information influence use of numbers in the health setting, and 3) there exists a strong desire to understand the meaning behind numbers used in health. The findings informed a theoretical framework of health numeracy. CONCLUSIONS: Numbers are important across a range of skills and applications in health in a sample of an urban Mexican-American population. This study expands previous work that strives to understand the application of numeric skills to medical decision making and health behaviors.