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1.
Prev Chronic Dis ; 18: E55, 2021 06 03.
Artículo en Inglés | MEDLINE | ID: mdl-34081577

RESUMEN

The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises.


Asunto(s)
COVID-19/etnología , Servicios de Salud Comunitaria/organización & administración , Disparidades en el Estado de Salud , Determinantes Sociales de la Salud , Adolescente , Afroamericanos/estadística & datos numéricos , Nativos Estadounidenses/estadística & datos numéricos , COVID-19/prevención & control , Niño , Enfermedad Crónica/etnología , Comorbilidad , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Pandemias , SARS-CoV-2 , Instituciones Académicas
3.
Pediatr Infect Dis J ; 40(7): e272-e274, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34097664

RESUMEN

The estimated severe acute respiratory syndrome coronavirus 2 seroprevalence in children was found to be 9.46% for the Washington Metropolitan area. Hispanic/Latinx individuals were found to have higher odds of seropositivity. While chronic medical conditions were not associated with having antibodies, previous fever and body aches were predictive symptoms.


Asunto(s)
Anticuerpos Antivirales/sangre , Prueba Serológica para COVID-19 , COVID-19/epidemiología , Adolescente , COVID-19/etnología , Niño , Preescolar , Enfermedad Crónica/epidemiología , District of Columbia/epidemiología , Femenino , Voluntarios Sanos , Hispanoamericanos , Humanos , Inmunoglobulina G/sangre , Lactante , Recién Nacido , Masculino , Maryland/epidemiología , Estudios Seroepidemiológicos , Virginia/epidemiología , West Virginia/epidemiología , Adulto Joven
4.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34092061

RESUMEN

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. METHODS: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. RESULTS: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

Asunto(s)
COVID-19/etnología , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Anciano , Americanos Asiáticos/estadística & datos numéricos , COVID-19/epidemiología , Prueba de COVID-19/estadística & datos numéricos , Estudios Transversales , Empleo/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Adulto Joven
5.
Artículo en Inglés | MEDLINE | ID: mdl-34062806

RESUMEN

Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration's (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020-5/31/2020 (spring); 6/1/2020-8/31/2020 (summer); and 9/1/2020-11/25/2020 (fall). We calculated COVID-19 infection and mortality predicted probabilities from logistic regression models that included time period-by-race/ethnicity interaction terms, and controlled for age, gender, and prior diagnosis of CDC risk factors. Racial/ethnic groups at higher risk for COVID-19 infection and mortality changed over time. American Indian/Alaskan Natives (AI/AN), Blacks, Hispanics, and Native Hawaiians/Other Pacific Islanders experienced higher COVID-19 infections compared to Whites during the summertime. There were mortality disparities for Blacks in springtime, and AI/ANs, Asians, and Hispanics in summertime. Policy makers should consider the dynamic nature of racial/ethnic disparities as the pandemic evolves, and potential effects of risk mitigation and other (e.g., economic) policies on these disparities. Researchers should consider how trends in disparities change over time in other samples.


Asunto(s)
COVID-19 , Grupos Étnicos , Hawaii , Disparidades en el Estado de Salud , Hispanoamericanos , Humanos , Grupos Minoritarios , SARS-CoV-2 , Estados Unidos/epidemiología
6.
JAMA Netw Open ; 4(5): e2111629, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-34042990

RESUMEN

Importance: The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective: To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group-based medical mistrust is a potential mediator of this association. Design, Setting, and Participants: This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures: Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results: Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], -0.06 [0.02]; P = .001; vaccine uptake: B [SE], -0.10 [0.02]; P < .001). Conclusions and Relevance: In this survey study of US adults, racial/ethnic group-based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.


Asunto(s)
Vacunas contra la COVID-19/uso terapéutico , COVID-19/etnología , Ensayos Clínicos como Asunto/psicología , Grupos de Población Continentales/psicología , Confianza , Negativa a la Vacunación/etnología , Adolescente , Adulto , Afroamericanos/psicología , Afroamericanos/estadística & datos numéricos , Anciano , Americanos Asiáticos/psicología , Americanos Asiáticos/estadística & datos numéricos , Actitud Frente a la Salud/etnología , COVID-19/prevención & control , Grupos de Población Continentales/estadística & datos numéricos , Estudios Transversales , Grupo de Ascendencia Continental Europea/psicología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/psicología , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Michigan , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Confianza/psicología , Negativa a la Vacunación/psicología , Negativa a la Vacunación/estadística & datos numéricos , Adulto Joven
7.
AIDS Patient Care STDS ; 35(5): 167-179, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33960844

RESUMEN

Latino sexual minority men (LSMM) are disproportionately affected by HIV in the United States. Concurrently, behavioral health disparities, including mental health and substance use concerns, worsen HIV disparities affecting LSMM. Yet, evidence-based HIV prevention and behavioral health services are insufficiently scaled up and out to this population, perpetuating health disparities, thwarting efforts to control the HIV epidemic, and highlighting the need for culturally relevant evidence-based implementation strategies that address these disparities. Participants included 28 LSMM with varying degrees of engagement in HIV prevention and behavioral health services, and 10 stakeholders with experience delivering HIV prevention and behavioral health services to LSMM in South Florida, an HIV epicenter in general and in particular for LSMM. Participants completed semistructured interviews (English/Spanish) regarding LSMM's barriers and facilitators to engaging in HIV prevention and behavioral health services. Interviews were audio recorded and analyzed using thematic analysis. The 16 themes that emerged from the qualitative analysis were consistent with the consolidated framework for implementation research, an implementation research framework that articulates barriers and facilitators to implementing clinical interventions. Findings suggested the need for implementation strategies that simplify and reduce costs of HIV prevention and behavioral health services, address syndemic challenges impacting service use among LSMM, reduce stigma about service utilization, leverage peer networks, increase provider and community knowledge about services, and build LSMM's readiness and motivation to engage in services. Such strategies may ultimately address HIV and behavioral health disparities among LSMM and facilitate achievement of ending the HIV epidemic goals in this disproportionally affected population.


Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Florida/epidemiología , Infecciones por VIH/prevención & control , Servicios de Salud , Hispanoamericanos , Humanos , Masculino , Estados Unidos/epidemiología
8.
BMC Public Health ; 21(1): 912, 2021 05 13.
Artículo en Inglés | MEDLINE | ID: mdl-33985468

RESUMEN

BACKGROUND: Food security status has been assessed as a representative score for households; however, different members in the same household may perceive and report food insecurity differently. A high prevalence of food insecurity has been reported among Latino households, therefore understanding differences in reporting food insecurity by Latino father-mother dyads may improve accuracy of assessment and plans to address food insecurity. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino father-mother dyads, and 2) identify factors associated with discordance in perceptions of food insecurity between dyads. METHODS: Baseline data were used from a community-based, youth obesity prevention program among Latino families (n = 106 father-mother dyads). Food security was assessed with a 2-item food insecurity screen. Logistic regression models were used to evaluate associations between reporting food security status and predictor variables for fathers, mothers, and dyad-discordant responses. RESULTS: Food insecurity was reported by 39% of fathers and 55% of mothers. Adjusted odds of reporting food insecurity were significantly higher for fathers perceiving their neighborhood was unsafe vs. safe (OR: 3.7, p < 0.05) and reporting lower vs. higher household income (OR: 3.2, p < 0.05). Adjusted odds of reporting food insecurity were significantly higher for mothers perceiving their neighborhood was unsafe vs. safe (OR: 4.1, p < 0.01) and reporting lower vs. higher home availability of fruit and vegetable (OR: 5.5, p < 0.01). Dyad discordance in reporting food security status occurred in 24% of the dyads. Adjusted odds of dyad discordant reports of food insecurity status were significantly higher for dyads reporting discordant responses regarding previous nutrition education (OR: 3.4, p < 0.05) and higher home fruit and vegetable accessibility (OR: 3.1, p < 0.05) compared to dyads reporting concordant responses. Among the 28 dyads who reported discordant nutrition education participation, 21 reported that fathers had never participated but mothers had participated more than once. CONCLUSIONS: Differential factors were associated with reporting food security among Latino father-mother dyads. Nutrition education for fathers that improves awareness of home food supplies and a better understanding of how food accessibility influences maternal perceptions may improve dyad discordance in reporting household food security.


Asunto(s)
Padre , Madres , Adolescente , Estudios Transversales , Femenino , Inseguridad Alimentaria , Abastecimiento de Alimentos , Hispanoamericanos , Humanos , Masculino
9.
BMC Public Health ; 21(1): 976, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-34034711

RESUMEN

BACKGROUND: Hispanic immigrants continue to experience higher rates of overweight and obesity compared to their non-Hispanic counterparts. Acculturation may contribute to unhealthy weight gain among immigrant populations by shifting dietary patterns from high fruit and vegetable consumption to unhealthier high fat diets. Healthy Fit, a culturally tailored community health worker (CHW) intervention, aims to reduce obesity related outcomes by providing physical activity and nutrition education and resources in a low-income Hispanic population. This study aims to evaluate outcomes of Healthy Fit participants and examine changes in body composition in relation to level of acculturation at baseline and follow-up. METHOD: In this longitudinal observational study, CHWs recruited 514 participants from community events and agencies serving low-income Hispanic populations in El Paso, Texas from 2015 to 2016. Following an in-person health screening, eligible participants received nutrition and physical activity education guided by fotonovelas, comic-like educational books. Telephone follow-ups made at 1, 3, and 6 months by CHWs encouraged follow-through on referrals. 288 participants completed the screening again during the 12-month follow-up. RESULTS: The sample was predominantly Hispanic (96%), female (82%), uninsured (79%), had a household income of less than $19,999 (70%), foreign-born (79%), preferred Spanish (86%) and few rated themselves as good or excellent for English proficiency (27%). Overall, Healthy Fit participants significantly improved (i.e., decreased) BFP by 0.71% (t = 2.47, p = 0.01) but not BMI (b = .01, t = - 0.14, p = .89). Contrary to expectations, acculturation was not associated with lower BMI (b = 0.09, p = 0.84) or BFP (b = 0.13, p = 0.85) at baseline. However, acculturation predicted changes in both BMI (b = 0.30, p = 0.03) and BFP (b = 1.33, p = 0 .01) from baseline to follow-up. Specifically, the low acculturation group improved in body composition measures over time and the high acculturation group did not improve in either measure. CONCLUSION: Findings suggest Healthy Fit was most effective among less acculturated individuals. The influence of acculturation on the efficacy of nutrition and exercise interventions suggests that Hispanics should not be treated as a homogenous subgroup.


Asunto(s)
Aculturación , Americanos Mexicanos , Composición Corporal , Femenino , Hispanoamericanos , Humanos , México , Texas/epidemiología
11.
Natl Vital Stat Rep ; 70(4): 1-115, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34029179

RESUMEN

Objectives-This report presents final 2018 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2018," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2018. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanic-origin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2018, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 73.8% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2018 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Diseases of the circulatory system; Respiratory distress of newborn; and Neonatal hemorrhage. Variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.


Asunto(s)
Causas de Muerte/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Distribución por Sexo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
12.
Natl Vital Stat Rep ; 70(5): 1-9, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34029182

RESUMEN

Objective-This report presents 2019 total fertility rates for the United States, by educational attainment and race and Hispanic origin of mother. Methods-Descriptive tabulations of the total fertility rate by educational attainment of mother for the United States are presented and described. The total fertility rate is the average number of children a group of women would expect to have at the end of their reproductive lifetimes. Data are based on the 2003 revision of the U.S. Standard Certificate of Live Birth. Results-In 2019, the U.S. total fertility rate (TFR) for all women aged 15-49 was 1,705 expected births per 1,000 women. TFRs decreased as level of education increased from women with a 12th grade education or less through an associate's and bachelor's degree, and then rose from bachelor's degree through a doctorate or professional degree. Among the race and Hispanic-origin groups, TFRs were highest for Hispanic women (1,939), followed by non-Hispanic black (1,774) and non-Hispanic white (1,610) women. Rates generally declined from the lowest educational level through a bachelor's degree for non-Hispanic white women, and through an associate's degree for Hispanic women, and then generally rose for both groups for women with advanced degrees. TFRs for non-Hispanic black women declined by educational level through a master's degree. Across the race and Hispanic-origin groups, the lowest TFR by educational level was for non-Hispanic black women with a master's degree (1,038), and the highest was for Hispanic women with a 12th grade education or less (3,025). TFRs for non-Hispanic black and Hispanic women with some college credit or less were generally higher than the rates for non-Hispanic white women, but TFRs for non-Hispanic black and Hispanic women with a master's degree or more were generally lower than the rates for non-Hispanic white women.


Asunto(s)
Tasa de Natalidad/etnología , Tasa de Natalidad/tendencias , Grupos de Población Continentales/estadística & datos numéricos , Escolaridad , Hispanoamericanos/estadística & datos numéricos , Madres/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estados Unidos/epidemiología , Adulto Joven
13.
BMJ Open ; 11(5): e044158, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33947732

RESUMEN

OBJECTIVES: By race/ethnicity and socioeconomic position (SEP), to estimate and examine changes over time in (1) mortality rate, (2) mortality disparities and (3) excess mortality risk attributed to diagnosed diabetes (DM). DESIGN: Population-based cohort study using National Health Interview Survey data linked to mortality status from the National Death Index from survey year up to 31 December 2015 with 5 years person-time. PARTICIPANTS: US adults aged ≥25 years with (31 586) and without (332 451) DM. PRIMARY OUTCOME: Age-adjusted all-cause mortality rate for US adults with DM in each subgroup of SEP (education attainment and income-to-poverty ratio (IPR)) and time (1997-2001, 2002-2006 and 2007-2011). RESULTS: Among adults with DM, mortality rates fell from 23.5/1000 person-years (p-y) in 1997-2001 to 18.1/1000 p-y in 2007-2011 with changes of -5.2/1000 p-y for non-Hispanic whites; -5.2/1000 p-y for non-Hispanic blacks; and -5.4/1000 p-y for Hispanics. Rates significantly declined within SEP groups, measured as education attainment (high school=-4.8/1000 p-y) and IPR group (poor=-7.9/1000 p-y; middle income=-4.7/1000 p-y; and high income=-6.2/1000 p-y; but not for near poor). For adults with DM, statistically significant all-cause mortality disparity showed greater mortality rates for the lowest than the highest SEP level (education attainment and IPR) in each time period. However, patterns in mortality trends and disparity varied by race/ethnicity. The excess mortality risk attributed to DM significantly decreased from 1997-2001 to 2007-2011, within SEP levels, and among Hispanics and non-Hispanic whites; but no statistically significant changes among non-Hispanic blacks. CONCLUSIONS: There were substantial improvements in all-cause mortality among US adults. However, we observed SEP disparities in mortality across race/ethnic groups or for adults with and without DM despite targeted efforts to improve access and quality of care among disproportionately affected populations.


Asunto(s)
Diabetes Mellitus , Grupos Étnicos , Adulto , Estudios de Cohortes , Hispanoamericanos , Humanos , Renta , Estados Unidos/epidemiología
14.
Nat Commun ; 12(1): 2721, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-34035248

RESUMEN

Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.


Asunto(s)
Exposición a Riesgos Ambientales/análisis , Disparidades en el Estado de Salud , Trastornos de Estrés por Calor/etnología , Calor , Salud Urbana/etnología , Afroamericanos/estadística & datos numéricos , Ciudades , Exposición a Riesgos Ambientales/efectos adversos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Geografía , Hispanoamericanos/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Maryland , Pobreza/estadística & datos numéricos , South Carolina , Estados Unidos
15.
Medicine (Baltimore) ; 100(20): e25976, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011086

RESUMEN

ABSTRACT: Disparities by race/ethnicity and socioeconomic status (SES) exist in rehospitalization rates and inpatient mortality rates. Few studies have examined how length of stay (LOS, a measure of hospital efficiency/quality) differs by race/ethnicity and SES.This study's objective was to determine whether differences in risk-adjusted LOS exist by race/ethnicity and SESUsing a retrospective cohort of 1,432,683 medical and surgical discharges, we compared risk-adjusted LOS, in days, by race/ ethnicity and SES (median household income by patient ZIP code in quartiles), using generalized linear models controlling for demographic and clinical factors, and differences between hospitals and between diagnoses.White patients were on average older than both Black and Hispanic patients, had more chronic conditions, and had a higher inpatient mortality risk. In adjusted analyses, Black patients had a significantly longer LOS than White patients (0.25-day difference when discharged to home and 0.23-day difference when discharged to non-home destinations, both P<.001); there was no difference between Hispanic and White patients. Wealthier patients had a shorter LOS than poorer patients (0.16-day difference when discharged to home and 0.06-day difference when discharged to nonhome destinations, both P<.001). These differences by race/ethnicity reversed for Medicaid patients.Disparities in LOS exist based on a patient's race/ethnicity and SES. Black and poorer patients, but not Hispanic patients, have longer LOS compared to White and wealthier patients. In aggregate, these differences may be related to trust and implicit bias and have implications for use of LOS as a quality metric. Future research should examine the drivers of these disparities.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Factores Socioeconómicos , Adulto , Afroamericanos/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , New York , Estudios Retrospectivos
16.
BMJ Open ; 11(5): e040955, 2021 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-34039570

RESUMEN

INTRODUCTION: Men who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition. METHODS AND ANALYSIS: Through extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention's potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial. ETHICS AND DISSEMINATION: This study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations. REGISTRATION DETAILS: Registered under the National Institutes of Health's ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017-0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Navegación de Pacientes , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Hispanoamericanos , Homosexualidad Masculina , Humanos , Masculino , Proyectos Piloto , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto Joven
17.
Health Aff (Millwood) ; 40(5): 802-811, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33939507

RESUMEN

The accessibility of pharmacies may be an overlooked contributor to persistent racial and ethnic disparities in the use of prescription medications and essential health care services within urban areas in the US. We examined the availability and geographic accessibility of pharmacies across neighborhoods based on their racial/ethnic composition in the thirty most populous US cities. In all cities examined, we found persistently fewer pharmacies located in Black and Hispanic/Latino neighborhoods than White or diverse neighborhoods throughout 2007-15. In 2015 there were disproportionately more pharmacy deserts in Black or Hispanic/Latino neighborhoods than in White or diverse neighborhoods, including those that are not federally designated Medically Underserved Areas. These disparities were most pronounced in Chicago, Illinois; Los Angeles, California; Baltimore, Maryland; Philadelphia, Pennsylvania; Milwaukee, Wisconsin; Dallas, Texas; Boston, Massachusetts; and Albuquerque, New Mexico. We also found that Black and Hispanic/Latino neighborhoods were more likely to experience pharmacy closures compared with other neighborhoods. Our findings suggest that efforts to increase access to medications and essential health care services, including in response to COVID-19, should consider policies that ensure equitable pharmacy accessibility across neighborhoods in US cities. Such efforts could include policies that encourage pharmacies to locate in pharmacy deserts, including increases to Medicaid and Medicare reimbursement rates for pharmacies most at risk for closure.


Asunto(s)
COVID-19 , Farmacias , Afroamericanos , Anciano , Baltimore , Boston , Chicago , Accesibilidad a los Servicios de Salud , Hispanoamericanos , Humanos , Illinois , Los Angeles , Massachusetts , Medicare , New Mexico , Philadelphia , SARS-CoV-2 , Texas , Estados Unidos , Wisconsin
18.
BMC Pregnancy Childbirth ; 21(1): 349, 2021 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-33934698

RESUMEN

BACKGROUND: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. METHODS: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. RESULTS: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices. CONCLUSION: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.


Asunto(s)
Toma de Decisiones , Personal de Salud/psicología , Servicios de Salud Materna , Madres/psicología , Adolescente , Actitud del Personal de Salud , California , Comunicación , Femenino , Grupos Focales , Hispanoamericanos/psicología , Humanos , Entrevistas como Asunto , México , Embarazo , Relaciones Profesional-Paciente , Investigación Cualitativa , Respeto
19.
PLoS One ; 16(5): e0251960, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34038459

RESUMEN

Social distancing prescribed by policy makers in response to COVID-19 raises important questions as to how effectively people of color can distance. Due to inequalities from residential segregation, Hispanic and Black populations have challenges in meeting health expectations. However, segregated neighborhoods also support the formation of social bonds that relate to healthy behaviors. We evaluate the question of non-White distancing using social mobility data from Google on three sites: workplaces, grocery stores, and recreational locations. Employing hierarchical linear modeling and geographically weighted regression, we find the relation of race/ethnicity to COVID-19 distancing is varied across the United States. The HLM models show that compared to Black populations, Hispanic populations overall more effectively distance from recreation sites and grocery stores: each point increase in percent Hispanic was related to residents being 0.092 percent less likely (p< 0.05) to visit recreational sites and 0.127 percent less likely (p< 0.01) to visit grocery stores since the onset of COVID-19. However, the GWR models show there are places where the percent Black is locally related to recreation distancing while percent Hispanic is not. Further, these models show the association of percent Black to recreation and grocery distancing can be locally as strong as 1.057 percent (p< 0.05) and 0.989 percent (p< 0.05), respectively. Next, the HLM models identified that Black/White residential isolation was related to less distancing, with each point of isolation residents were 11.476 percent more likely (p< 0.01) to go to recreational sites and 7.493 percent more likely (p< 0.05) to visit grocery stores compared to before COVID-19. These models did not find a measurable advantage/disadvantage for Black populations in these places compared to White populations. COVID-19 policy should not assume disadvantage in achieving social distancing accrue equally to different racial/ethnic minorities.


Asunto(s)
COVID-19/epidemiología , Grupos Étnicos/psicología , Distanciamiento Físico , Afroamericanos/psicología , Americanos Asiáticos/psicología , COVID-19/patología , COVID-19/virología , Grupo de Ascendencia Continental Europea/psicología , Hispanoamericanos/psicología , Humanos , Recreación , SARS-CoV-2/aislamiento & purificación , Supermercados , Estados Unidos/epidemiología , Lugar de Trabajo
20.
Prev Chronic Dis ; 18: E53, 2021 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-34043502

RESUMEN

INTRODUCTION: The disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress. We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response. METHODS: We used tracking sheets to identify 1,436 unique participants (aged 5-86) enrolled in Latino Health Access's Emotional Wellness program, of whom 346 enrolled in the pre-COVID-19 period (March 2019-February 2020) and 1,090 in the COVID-19 period (March-June 2020). Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson χ2 tests. Regression models were developed to compare factors associated with referrals in the pre-COVID-19 and COVID-19 periods. RESULTS: During the pandemic, service volume (P < .001) and participant volume (P < .001) increased significantly compared with the prepandemic period. Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic. Nonreferred services, such as peer support, increased during the pandemic period. Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income. CONCLUSION: An effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities. This study presents a model of how to integrate both factors by leveraging promotor-led programs.


Asunto(s)
Ansiedad , COVID-19 , Servicios Comunitarios de Salud Mental/organización & administración , Depresión , Hispanoamericanos , Estrés Psicológico , Adulto , Ansiedad/etiología , Ansiedad/prevención & control , COVID-19/epidemiología , COVID-19/psicología , Depresión/etiología , Depresión/prevención & control , Ajuste Emocional , Femenino , Hispanoamericanos/psicología , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Salud Mental/etnología , Sistemas de Apoyo Psicosocial , SARS-CoV-2 , Servicio Social/métodos , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Estados Unidos/epidemiología
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