High-Frequency, High-Throughput Quantification of SARS-CoV-2 RNA in Wastewater Settled Solids at Eight Publicly Owned Treatment Works in Northern California Shows Strong Association with COVID-19 Incidence.

A number of recent retrospective studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in wastewater are associated with coronavirus disease 2019 (COVID-19) cases in the corresponding sewersheds. Implementing high-resolution, prospective efforts across multiple plants depends on sensitive measurements that are representative of COVID-19 cases, scalable for high-throughput analysis, and comparable across laboratories. We conducted a prospective study across eight publicly owned treatment works (POTWs). A focus on SARS-CoV-2 RNA in solids enabled us to scale up our measurements with a commercial lab partner. Samples were collected daily, and results were posted to a website within 24 h. SARS-CoV-2 RNA in daily samples correlated with the incidence of COVID-19 cases in the sewersheds; a 1 log10 increase in SARS-CoV-2 RNA in settled solids corresponds to a 0.58 log10 (4×) increase in sewershed incidence rate. SARS-CoV-2 RNA signals measured with the commercial laboratory partner were comparable across plants and comparable to measurements conducted in a university laboratory when normalized by pepper mild mottle virus (PMMoV) RNA. Results suggest that SARS-CoV-2 RNA should be detectable in settled solids for COVID-19 incidence rates of >1/100,000 (range, 0.8 to 2.3 cases per 100,000). These sensitive, representative, scalable, and comparable methods will be valuable for future efforts to scale up wastewater-based epidemiology. IMPORTANCE Access to reliable, rapid monitoring data is critical to guide response to an infectious disease outbreak. For pathogens that are shed in feces or urine, monitoring wastewater can provide a cost-effective snapshot of transmission in an entire community via a single sample. In order for a method to be useful for ongoing COVID-19 monitoring, it should be sensitive for detection of low concentrations of SARS-CoV-2, representative of incidence rates in the community, scalable to generate data quickly, and comparable across laboratories. This paper presents a method utilizing wastewater solids to meet these goals, producing measurements of SARS-CoV-2 RNA strongly associated with COVID-19 cases in the sewershed of a publicly owned treatment work. Results, provided within 24 h, can be used to detect incidence rates as low as approximately 1/100,000 cases and can be normalized for comparison across locations generating data using different methods.

Improving Rigor in a Door-to-Door Health Survey: A Participatory Approach in a Low-Income Latino Neighborhood.

BACKGROUND: Engaging community partners in research has the potential to make findings higher quality, more actionable, and more meaningful. Less rigorous approaches, often used by community-engaged partnerships, may diminish data quality. OBJECTIVE: This study highlights the key guiding principles of a community-based participatory research (CBPR) approach, particularly in regards to improving rigor, for a door-to-door health survey conducted by promotoras in a low-income, Latino neighborhood in San Jose, California. METHODS: We describe the partnership formed to conduct the study and the participatory process used throughout the study in questionnaire and sample design, training, and survey administration that adheres to key CBPR principles. LESSONS LEARNED: Our participatory approach required building the capacity of partners, having all partners weigh in on issues that arose in the field, enlisting outside expertise, being responsive to partner concerns while adhering to validated survey methods, simplifying sample design, incorporating expectations for data quality into training, and dedicating sufficient staffing to survey administration. CONCLUSION: The procedures, materials, and tools used by the community-engaged partnership in this study can be replicated by other community partnerships seeking to improve the quality of data used for decision making, program planning, and resource allocation.

A Tool for Providing Data on Small Areas: Development of Neighborhood Profiles for Santa Clara County, California, 2014.

Data on small geographic areas that can be easily accessed and updated have become essential for targeting public health programs and services. Disaggregating data at the sub-county or sub-city level has the potential to reveal disparities not otherwise evident for large geographies. As important as such data are, the methods to produce data on small geographic areas are challenging and resource-intensive, and little description and analysis of such tools exists. We describe a tool--neighborhood profiles--that provides a way for public health agencies and their partners to define neighborhood boundaries, select indicators, and disseminate data in a user-friendly format. We also share lessons learned, including the importance of involving planning departments in boundary definition to ensure relevance to the community, selecting a framework that links indicators to broader conceptual categories that can highlight disparities, and forming a team with the diverse skills necessary for planning and developing the profiles.

An automated telephone nutrition support system for Spanish-speaking patients with diabetes.

In the United States, Spanish-speaking patients with diabetes often receive inadequate dietary counseling. Providing language and culture-concordant dietary counseling on an ongoing basis is critical to diabetes self-care. To determine if automated telephone nutrition support (ATNS) counseling could help patients improve glycemic control by duplicating a successful pilot in Mexico in a Spanish-speaking population in Oakland, California. A prospective randomized open-label trial with blinded endpoint assessment (PROBE) was performed. The participants were seventy-five adult patients with diabetes receiving care at a federally qualified health center in Oakland, California. ATNS, a computerized system that dialed patients on their phones, prompted them in Spanish to enter (via keypad) portions consumed in the prior 24 hours of various cultural-specific dietary items, and then provided dietary feedback based on proportion of high versus low glycemic index foods consumed. The control group received the same ATNS phone calls 14 weeks after enrollment. The primary outcome was hemoglobin A1c % (A1c) 12 weeks following enrollment. Participants had no significant improvement in A1c (-0.3% in the control arm, -0.1% in the intervention arm, P = .41 for any difference) or any secondary parameters. In our study, an ATNS system did not improve diabetes control in a Spanish-speaking population in Oakland.

Demographic factors associated with perceptions about water safety and tap water consumption among adults in Santa Clara County, California, 2011.

The objective of this study was to examine differences in tap water consumption and perceptions of bottle versus tap water safety for Hispanics and non-Hispanic whites, as well as associations with other demographic characteristics. Data are from the Santa Clara County, California, Dietary Practices Survey (2011; N = 306). We used logistic regression to examine associations between demographic characteristics and 1) perceptions that bottled water is safer than tap and 2) primarily consuming tap water. Hispanics were less likely than non-Hispanic whites to primarily drink tap water (OR = 0.33; 95% CI, 0.11-0.99), although there was no significant difference in perceptions that bottled water is safer between these groups (OR = 0.50; 95% CI, 0.11-2.27). Hispanics may be an important population for interventions promoting tap water consumption.

Determinants of exposure to secondhand smoke among Vietnamese adults: California Vietnamese Adult Tobacco Use Survey, 2007-2008.

Because smoking rates are high among Vietnamese men, we used data from the 2007-2008 California Vietnamese Adult Tobacco Use Survey to estimate secondhand smoke exposure and associated risk factors among Vietnamese nonsmokers. Thirty percent of nonsmokers were exposed to secondhand smoke (SHS) at home, 8% at work, 52% in bars, and 67% on a college campus. At home, odds of SHS exposure were greater for women than for men and for adults aged less than 40 years than for older adults. Odds of SHS exposure were higher for former smokers at work (among employed men) and among men when in bars. Future interventions should consider sex, age, and smoking history in efforts to prevent SHS exposure among Vietnamese adults.

Neighborhood deprivation and change in BMI among adults with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).

OBJECTIVE: To compare associations between neighborhood deprivation and measures of BMI change among adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures of BMI change over 3 years: 1) a continuous measure and 2) a categorical measure of clinically substantive BMI loss or gain (≥7% of baseline BMI) versus stable BMI. The sample included 13,609 adults. RESULTS: On average, there was little change in BMI (-0.12, SD 3.07); 17.0 and 16.1% had clinically substantive BMI loss or gain, respectively, at follow-up. There was a positive association between neighborhood deprivation and BMI change for adults in the most versus least-deprived quartile of neighborhood deprivation (ß = 0.22, P = 0.02) in adjusted models. In addition, relative to the least-deprived quartile (Q1), adults in more-deprived quartiles of neighborhood deprivation were more likely to experience either substantive BMI loss (Q2 relative risk ratio 1.19, 95% CI 1.00-1.41; Q3 1.20, 1.02-1.42; Q4 1.30, 1.08-1.55) or gain (Q2 1.25, 1.04-1.49; Q3 1.24, 1.04-1.49; Q4 1.45, 1.20-1.75). CONCLUSIONS: Greater neighborhood deprivation was positively associated with BMI change among adults with diabetes as well as with clinically substantive BMI loss or gain. Findings stress the importance of allowing for simultaneous associations with both gain and loss in future longitudinal studies of neighborhood deprivation and weight change, which may be particularly true for studies of patients with diabetes for whom both weight loss and gain have health implications.

The influence of indigenous status and community indigenous composition on obesity and diabetes among Mexican adults.

In many high-income countries, indigenous populations bear a higher burden of obesity and diabetes than non-indigenous populations. Less is known about these patterns in lower- and middle-income countries. We assessed the hypothesis that obesity and diabetes were less prevalent among indigenous than non-indigenous adults in Mexico, home to the largest indigenous population in Latin America. We investigated socioeconomic explanations for differences. In a related line of inquiry, we examine whether adults in communities with higher versus lower percentages of indigenous residents were buffered against these conditions. We assessed whether differences were partially explained by lower development in higher-indigenous communities. Obesity was based on measured height and weight, and diabetes on a diagnosis from a healthcare professional. The analysis for obesity included 19 577 adults aged 20 and older from the Mexican Family Life Survey (2002), a nationally representative survey of Mexican households and communities; for diabetes, we restricted analysis to adults with health insurance. We used multilevel logistic regression to estimate the odds of obesity and diabetes by indigenous status and community percent indigenous. Results suggest that indigenous adults had significantly lower odds of obesity and diabetes than non-indigenous adults. This advantage was not explained by the lower socioeconomic status of indigenous individuals. A higher percentage of indigenous individuals in communities provided protection against obesity, although not for diabetes. Differences for obesity were not accounted for by community development. Findings suggest that an opportunity may exist to prevent disparities in obesity and diabetes from developing by indigenous characteristics in Mexico. Identifying the sources of protective effects of individual and community indigenous characteristics relative to these health conditions should be a priority, given global implications for prevention.

Education associations with smoking and leisure-time physical inactivity among Hispanic and Asian young adults.

OBJECTIVES: We assessed whether associations between education and 2 health behaviors--smoking and leisure-time physical inactivity (LTPI)--depended on nativity and age at immigration among Hispanic and Asian young adults. METHODS: Data came from the 2000-2008 National Health Interview Survey. The sample included 13 345 Hispanics and 2528 Asians aged 18 to 30 years. Variables for smoking and LTPI were based on self-reported data. We used logistic regression to examine education differentials in these behaviors by nativity and age at immigration. RESULTS: The association of education with both smoking and LTPI was weaker for foreign-born Hispanics than for US-born Hispanics but did not vary by nativity for Asians. Education associations for smoking and LTPI among foreign-born Hispanics who had immigrated at an early age more closely resembled those of US-born Hispanics than did education associations among foreign-born Hispanics who had immigrated at an older age. A similar pattern for smoking was evident among Asians. CONCLUSIONS: Health-promotion efforts aimed at reducing disparities in key health behaviors among Hispanic and Asian young adults should take into account country of residence in childhood and adolescence as well as nativity.

F2-isoprostanes and adiposity in older adults.

We examined whether a systemic marker of oxidative stress, F(2)-isoprostanes (F(2)-IPs), was associated with total and regional adiposity, adipocytokines, and change in adiposity. Using data from 726 participants enrolled in the Health, Aging, and Body Composition (Health ABC) study, F(2)-IPs and adipocytokines were measured from baseline plasma samples. Total adiposity was measured by whole-body dual-energy X-ray absorptiometry and regional adiposity by abdominal and thigh computed tomography scans at baseline and 5-year follow-up. ANOVA models were estimated to examine associations between F(2)-IP tertiles and baseline adiposity and changes in body composition. Median F(2)-IPs was 54.3 pg/ml; women had significantly higher levels than men (61.5 vs. 48.9 pg/ml, P < 0.001). F(2)-IPs were associated with higher levels of adiponectin, leptin, and tumor necrosis factor-α (TNF-α). Positive associations were found between F(2)-IPs and all measures of total and regional adiposity among women. In linear regression models, adipocytokines mediated associations among women. Over 5 years of follow-up, women in the highest vs. lowest F(2)-IP tertile exhibited significant loss of weight (lowest tertile: -1.1 kg, highest tertile: -2.7 kg, P < 0.05). In conclusion, F(2)-IPs were associated with measures of total and regional adiposity in women alone and these associations were partially explained by adipocytokines. F(2)-IPs predicted loss of total adiposity over time among women.

Blood pressure control, hypertension, awareness, and treatment in adults with diabetes in the United States-Mexico border region.

OBJECTIVE: To determine prevalence of blood pressure control, hypertension, hypertension awareness, and antihypertensive treatment among adults (> 18 years old) with diabetes living in the border region between the United States of America and Mexico, and to explore variation in those variables between all adults on the Mexican side of the border ("Mexicans") and three groups on the U.S. side of the border ("all U.S. adults," "U.S.-born Hispanics," and "Mexican immigrants"). METHODS: Using data from Phase I (February 2001-October 2002) of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, age-adjusted prevalence of hypertension-related variables was calculated for the sample (n = 682) and differences between the border groups were examined through logistic regression. RESULTS: Less than one-third of the sample had controlled blood pressure (< 130/80 mm Hg), almost half had hypertension (≥140/90 mm Hg), and hypertension awareness and treatment were inadequate. After adjusting for demographics, body mass index, and access to health care, there were no differences in blood pressure control, hypertension, hypertension awareness, or treatment between Mexicans and both U.S. adults and Mexican immigrants. However, compared to Mexicans and Mexican immigrants, U.S.-born Hispanics, particularly younger individuals, had the lowest rates of blood pressure control (17.3%) and the highest rates of coexisting hypertension (54.8%). Compared to Mexicans, U.S.-born Hispanics had lower odds of controlled blood pressure (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.09-0.95) and greater odds of hypertension (OR 3.75, 95% CI 1.51-9.29) and hypertension awareness (OR 6.19, 95% CI 1.46-26.15). CONCLUSION: Co-occurrence of diabetes and hypertension is a major public health problem among U.S.-Mexico border residents. The low rate of blood pressure control among various border groups, especially younger U.S.-born Hispanics, suggests that initiatives should aggressively target blood pressure control.

Disparities in undiagnosed diabetes among United States-Mexico border populations.

OBJECTIVE: To compare the prevalence of undiagnosed diabetes among populations with diabetes living on the United States (U.S.)-Mexico border, examine explanations for differences between groups, and investigate differences in metabolic outcomes by diagnosis status. METHODS: Data come from the U.S.-Mexico Border Diabetes Prevention and Control Project survey (2001-2002), which used a stratified, multistage design. The sample included 603 adults (18 years or older) with diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose (FPG) value of ≥ 126 mg/dL and no report of diagnosis. Logistic regression was used to compare the odds of being undiagnosed among border populations with diabetes. Metabolic outcomes included FPG, glycosylated hemoglobin, and mean arterial blood pressure. RESULTS: One in four adults with diabetes (25.9%) living on the U.S.-Mexico border was undiagnosed. Mexicans (43.8%) and Mexican immigrants (39.0%) with diabetes were significantly more likely to be undiagnosed than were U.S.-born Hispanics (15.0%; P < 0.05 for either comparison) or non-Hispanic whites (6.6%; P < 0.001 for either comparison). Mexicans were more likely to be undiagnosed than were all U.S. adults (14.7%; P < 0.001) with diabetes. Significant differences in the likelihood of being undiagnosed remained between all groups with diabetes after adjustment for sociodemographic and healthcare-related covariates, with the exception of that between Mexicans and U.S.-born Hispanics. Worse metabolic control and potentially greater benefits of diagnosis for control were observed for Mexicans in particular compared with U.S. groups with undiagnosed diabetes. CONCLUSIONS: Efforts to improve diabetes diagnosis should concentrate on Mexican and Mexican immigrant populations on the U.S.-Mexico border.

Smoking behavior among Hispanic adults with diabetes on the United States-Mexico border: a public health opportunity.

OBJECTIVE: To examine the prevalence of smoking behaviors among adults with diabetes on the United States-Mexico border, to compare these behaviors in U.S. Hispanics and Mexicans with diabetes, and to identify explanations for group differences. METHODS: Data came from the U.S.-Mexico Border Diabetes Prevention and Control Project survey (2001-2002), a stratified, multistage sample representative of the border population. The analytic sample included adults from all racial and ethnic backgrounds with diabetes (n = 665), including 333 Mexicans and 268 U.S. Hispanics. Smoking behaviors were based on self-reports. Age- and gender-specific prevalence of smoking behavior was estimated and logistic regression was used for mediation analysis of group differences. RESULTS: One in five adults with diabetes (20.1%) in the region was a current smoker. Prevalence was higher among Mexicans (26.2%) than U.S. Hispanics (10.1%, P = 0.003); differences were not explained by sociodemographic or healthcare-related characteristics (odds ratio [OR] 3.86, 95% confidence interval [CI] 1.50-9.91, P = 0.004). Younger Mexicans with diabetes (< 55 years) were four times more likely to smoke than younger U.S. Hispanics (32.1% versus 8.1%, P < 0.001) and Mexican men with diabetes were more than twice as likely to smoke as U.S. Hispanic men (38.9% versus 15.8%, P = 0.003). Among adults with diabetes with a smoking history, 52.5% were former smokers; U.S. Hispanics were more likely to be former smokers than Mexicans with diabetes (62.6% versus 27.5%, P = 0.001). A marginally significant difference remained after adjusting for potential mediators (OR 0.42, 95% CI 0.17-1.08, P = 0.074). CONCLUSIONS: Smoking interventions should focus on Mexicans with diabetes in the border region, especially younger adults and men. Identifying sources of differences in smoking behaviors among border groups with diabetes may further inform intervention.

Blood pressure control, hypertension, awareness, and treatment in adults with diabetes in the United States-Mexico border region / Control de la presión arterial, hipertensión, concientización y tratamiento en adultos con diabetes de la zona fronteriza entre México y los Estados Unidos

OBJETIVE: To determine prevalence of blood pressure control, hypertension, hypertension awareness, and antihypertensive treatment among adults (> 18 years old) with diabetes living in the border region between the United States of America and Mexico, and to explore variation in those variables between all adults on the Mexican side of the border ("Mexicans") and three groups on the U.S. side of the border ("all U.S. adults," "U.S.-born Hispanics," and "Mexican immigrants"). METHODS: Using data from Phase I (February 2001-October 2002) of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, age-adjusted prevalence of hypertension-related variables was calculated for the sample (n = 682) and differences between the border groups were examined through logistic regression. RESULTS: Less than one-third of the sample had controlled blood pressure (< 130/80 mm Hg), almost half had hypertension (>140/90 mm Hg), and hypertension awareness and treatment were inadequate. After adjusting for demographics, body mass index, and access to health care, there were no differences in blood pressure control, hypertension, hypertension awareness, or treatment between Mexicans and both U.S. adults and Mexican immigrants. However, compared to Mexicans and Mexican immigrants, U.S.-born Hispanics, particularly younger individuals, had the lowest rates of blood pressure control (17.3 percent) and the highest rates of coexisting hypertension (54.8 percent). Compared to Mexicans, U.S.-born Hispanics had lower odds of controlled blood pressure (odds ratio [OR] 0.30, 95 percent confidence interval [CI] 0.09-0.95) and greater odds of hypertension (OR 3.75, 95 percent CI 1.51-9.29) and hypertension awareness (OR 6.19, 95 percent CI 1.46-26.15). CONCLUSION: Co-occurrence of diabetes and hypertension is a major public health problem among U.S.-Mexico border residents. The low rate of blood pressure control among various border groups, especially younger U.S.-born Hispanics, suggests that initiatives should aggressively target blood pressure control.

OBJETIVO: Determinar la prevalencia del control de la presión arterial, la hipertensión, la concientización en materia de hipertensión y el tratamiento antihipertensivo entre los adultos (> 18 años) con diabetes residentes en la zona fronteriza entre México y los Estados Unidos, y analizar las diferencias de esas variables en todos los adultos del lado mexicano de la frontera ("mexicanos") y tres grupos del lado estadounidense ("todos los adultos estadounidenses", "los hispanos nacidos en los Estados Unidos" y "los inmigrantes mexicanos"). MÉTODOS: A partir de los datos de la primera fase (febrero del 2001 a octubre del 2002) del Proyecto de Prevención y Control de la Diabetes en la Frontera México- Estados Unidos, un estudio sobre la prevalencia de la diabetes tipo 2 y sus factores de riesgo, se calculó en la muestra (n = 682) la prevalencia ajustada por edad de las variables relacionadas con la hipertensión, y se analizaron las diferencias entre los grupos fronterizos mediante regresión logística. RESULTADOS: Menos de un tercio de la muestra tenía una presión arterial controlada (< 130/80 mm de Hg), casi la mitad presentaba hipertensión (> 140/90 mm de Hg), y la concientización y el tratamiento de la hipertensión eran inadecuados. Tras el ajuste en cuanto a los factores demográficos, el índice de masa corporal y el acceso a la atención de salud, no se observaron diferencias en cuanto al control de la tensión arterial (normotensión), la hipertensión, la concientización en materia de hipertensión o el tratamiento entre los mexicanos y los adultos estadounidenses o los inmigrantes mexicanos. Sin embargo, en comparación con los mexicanos y los inmigrantes mexicanos, los hispanos nacidos en los Estados Unidos, en particular los más jóvenes, presentaban las menores tasas de presión arterial normal (17,3 por ciento) y las mayores tasas de hipertensión coexistente (54,8 por ciento). En comparación con los mexicanos, la probabilidad de tener una tensión arterial normal era menor entre los hispanos nacidos en los Estados Unidos (razón de posibilidades [OR] 0,30, intervalo de confianza [IC] 95 por ciento 0,09-0,95), y eran mayores las probabilidades de hipertensión (OR 3,75, IC 95 por ciento 1,51-9,29) y concientización en materia de hipertensión (OR 6,19, IC 95 por ciento 1,46-26,15). CONCLUSIONES: La coexistencia de diabetes e hipertensión constituye un importante problema de salud pública en los residentes de la zona fronteriza entre México y los Estados Unidos. La baja tasa de normotensión entre los diversos grupos fronterizos, especialmente en los jóvenes hispanos nacidos en los Estados Unidos, indica que se deben llevar a cabo iniciativas dirigidas enérgicamente hacia el control de la presión arterial.

Disparities in undiagnosed diabetes among United States-Mexico border populations / Disparidades en la prevalencia de diabetes no diagnosticada en las poblaciones residentes en la frontera México-Estados Unidos

OBJECTIVE: To compare the prevalence of undiagnosed diabetes among populations with diabetes living on the United States (U.S.)-Mexico border, examine explanations for differences between groups, and investigate differences in metabolic outcomes by diagnosis status. METHODS: Data come from the U.S.-Mexico Border Diabetes Prevention and Control Project survey (2001-2002), which used a stratified, multistage design. The sample included 603 adults (18 years or older) with diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose (FPG) value of > 126 mg/dL and no report of diagnosis. Logistic regression was used to compare the odds of being undiagnosed among border populations with diabetes. Metabolic outcomes included FPG, glycosylated hemoglobin, and mean arterial blood pressure. RESULTS: One in four adults with diabetes (25.9 percent) living on the U.S.-Mexico border was undiagnosed. Mexicans (43.8 percent) and Mexican immigrants (39.0 percent) with diabetes were significantly more likely to be undiagnosed than were U.S.-born Hispanics (15.0 percent; P < 0.05 for either comparison) or non-Hispanic whites (6.6 percent; P < 0.001 for either comparison). Mexicans were more likely to be undiagnosed than were all U.S. adults (14.7 percent; P < 0.001) with diabetes. Significant differences in the likelihood of being undiagnosed remained between all groups with diabetes after adjustment for sociodemographic and healthcare-related covariates, with the exception of that between Mexicans and U.S.-born Hispanics. Worse metabolic control and potentially greater benefits of diagnosis for control were observed for Mexicans in particular compared with U.S. groups with undiagnosed diabetes. CONCLUSIONS: Efforts to improve diabetes diagnosis should concentrate on Mexican and Mexican immigrant populations on the U.S.-Mexico border.

OBJETIVO: Comparar la prevalencia de diabetes no diagnosticada en la población con diabetes residente en la zona fronteriza entre México y los Estados Unidos; intentar explicar las diferencias entre grupos, e investigar las diferencias de los resultados metabólicos según la situación diagnóstica. MÉTODOS: Los datos proceden de la encuesta del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (2001-2002), que utilizó un diseño estratificado polietápico. La muestra incluyó a 603 adultos (> 18 años) con diabetes. Se definió como diabetes no diagnosticada una glucemia plasmática en ayunas > 126 mg/dl sin diagnóstico previo. Se utilizó un modelo de regresión logística para comparar la probabilidad de que la diabetes no fuera diagnosticada en las poblaciones fronterizas. Los resultados metabólicos incluyeron la glucemia plasmática en ayunas, la hemoglobina glicosilada (HbA1c) y la presión arterial media. RESULTADOS: Uno de cada cuatro (25,9 por ciento) adultos diabéticos residentes en la zona fronteriza entre México y los Estados Unidos no había sido diagnosticado. La probabilidad de que los mexicanos (43,8 por ciento) y los inmigrantes mexicanos (39,0 por ciento) con diabetes no hubieran sido diagnosticados fue significativamente mayor en comparación con los hispanos nacidos en los Estados Unidos (15,0 por ciento; P < 0,05 para cualquiera de las comparaciones) o los blancos no hispanos (6,6 por ciento; P < 0,001 para cualquiera de las comparaciones). Los mexicanos con diabetes tenían una probabilidad mayor de no estar diagnosticados que los adultos estadounidenses con diabetes en su conjunto (14,7 por ciento; P < 0,001). Tras el ajuste para las covariables sociodemográficas y relacionadas con la atención de salud, se mantuvieron diferencias significativas entre todos los grupos con diabetes en cuanto a la probabilidad de que su diabetes no fuera diagnosticada, excepto cuando se compararon los mexicanos con los hispanos nacidos en los Estados Unidos. En los mexicanos se observó un peor control metabólico y mayores beneficios potenciales en cuanto al control como consecuencia del diagnóstico, en particular en comparación con los grupos estadounidenses con diabetes no diagnosticada. CONCLUSIONES: En la zona fronteriza entre los Estados Unidos y México, las actividades orientadas a mejorar el diagnóstico de la diabetes deben centrarse en las poblaciones mexicanas y de inmigrantes mexicanos.

Smoking behavior among Hispanic adults with diabetes on the United States-Mexico border: a public health opportunity / Hábito tabáquico en adultos hispanos con diabetes residentes en la frontera México-Estados Unidos: una oportunidad de salud pública

OBJECTIVE: To examine the prevalence of smoking behaviors among adults with diabetes on the United States-Mexico border, to compare these behaviors in U.S. Hispanics and Mexicans with diabetes, and to identify explanations for group differences. METHODS: Data came from the U.S.-Mexico Border Diabetes Prevention and Control Project survey (2001-2002), a stratified, multistage sample representative of the border population. The analytic sample included adults from all racial and ethnic backgrounds with diabetes (n = 665), including 333 Mexicans and 268 U.S. Hispanics. Smoking behaviors were based on self-reports. Age- and gender-specific prevalence of smoking behavior was estimated and logistic regression was used for mediation analysis of group differences. RESULTS: One in five adults with diabetes (20.1 percent) in the region was a current smoker. Prevalence was higher among Mexicans (26.2 percent) than U.S. Hispanics (10.1 percent, P = 0.003); differences were not explained by sociodemographic or healthcare-related characteristics (odds ratio [OR] 3.86, 95 percent confidence interval [CI] 1.50-9.91, P = 0.004). Younger Mexicans with diabetes (< 55 years) were four times more likely to smoke than younger U.S. Hispanics (32.1 percent versus 8.1 percent, P < 0.001) and Mexican men with diabetes were more than twice as likely to smoke as U.S. Hispanic men (38.9 percent versus 15.8 percent, P = 0.003). Among adults with diabetes with a smoking history, 52.5 percent were former smokers; U.S. Hispanics were more likely to be former smokers than Mexicans with diabetes (62.6 percent versus 27.5 percent, P = 0.001). A marginally significant difference remained after adjusting for potential mediators (OR 0.42, 95 percent CI 0.17-1.08, P = 0.074). CONCLUSIONES: Smoking interventions should focus on Mexicans with diabetes in the border region, especially younger adults and men. Identifying sources of differences in smoking behaviors among border groups with diabetes may further inform intervention.

OBJETIVO: Analizar la prevalencia de tabaquismo en adultos con diabetes residentes en la zona fronteriza entre los Estados Unidos y México, comparar este hábito entre los hispanos estadounidenses y los mexicanos con diabetes, y tratar de explicar las diferencias observadas entre ambos grupos. MÉTODOS: Los datos procedieron de la encuesta del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (2001-2002), llevada a cabo en una muestra estratificada polietápica, representativa de la población fronteriza. La muestra analítica incluyó a adultos con diabetes de todos los orígenes raciales y étnicos (n = 665), incluidos 333 mexicanos y 268 hispanos estadounidenses. La información en cuanto al hábito de fumar fue facilitada por los entrevistados. Se calculó la prevalencia específica de tabaquismo según sexo y edad, y se llevó a cabo el análisis de mediación de las diferencias entre grupos mediante regresión logística. RESULTADOS: En el momento de la encuesta, uno de cada cinco (20,1 por ciento) adultos con diabetes de la región era fumador. La prevalencia fue mayor entre los mexicanos (26,2 por ciento) que entre los hispanos estadounidenses (10,1 por ciento, P = 0,003); estas diferencias no se pudieron explicar por las características sociodemográficas o las relacionadas con la atención de salud (razón de posibilidades [OR] 3,86, intervalo de confianza [IC] de 95 por ciento 1,50-9,91, P = 0,004). La probabilidad de que los mexicanos más jóvenes con diabetes (menores de 55 años) fueran fumadores fue cuatro veces mayor que la de los estadounidenses hispanos más jóvenes (32,1 por ciento frente a 8,1 por ciento, P < 0,001). La probabilidad de que los varones mexicanos con diabetes fumaran fue más del doble que la de los varones hispanos estadounidenses (38,9 por ciento frente a 15,8 por ciento, P = 0,003). Entre los adultos con diabetes que tenían antecedentes de tabaquismo, 52,5 por ciento eran ex fumadores; la probabilidad de que los hispanos estadounidenses con diabetes fueran ex fumadores resultó mayor que la de los mexicanos con diabetes (62,6 por ciento frente a 27,5 por ciento, P = 0,001). Tras el ajuste por mediadores potenciales se mantuvo una diferencia marginalmente significativa (OR 0,42, IC 95 por ciento 0,17-1,08, P = 0,074). CONCLUSIONES: Las intervenciones en materia de tabaquismo en la zona fronteriza deben centrarse en los mexicanos con diabetes, especialmente en los varones jóvenes y adultos. La determinación de las causas que ocasionan las diferencias en el hábito de fumar entre los grupos fronterizos de personas con diabetes puede aportar nuevos datos útiles para futuras intervenciones.

Risk of smoking initiation among Mexican immigrants before and after immigration to the United States.

Research has suggested that Latinos are less likely to initiate smoking than non-Latino whites. This advantage may be due in part to social and structural factors that deter smoking initiation among Latino immigrants, such as entry into the restrictive regulatory environment surrounding smoking in the U.S. and decreased exposure to family smoking influences, given that immigrants often leave parents and siblings behind in countries of origin. Although available data do not support a direct test of this hypothesis this study conducts an indirect test by comparing risk of initiation among Mexican immigrants before and after immigration to the U.S. If such factors influence initiation among Mexican immigrants, their risk should decline after immigration, relative to risk before immigration, since they are subject to these forces only after moving to the U.S. Using data from the National Health Interview Survey, discrete-time hazards analysis is used to estimate risk of initiation of regular smoking from ages 10 to 30, based on retrospective reports of age of smoking initiation. Retrospective data on age at immigration are used to create a time-varying variable indicating country of residence (U.S. or Mexico) during each person year of risk. Through this approach, risk in the person years before immigration is determined only among those who will eventually immigrate, which discounts health selection as an explanation for changes in risk after immigration. Consistent with the social and structural perspective, results indicate that the odds of smoking initiation decline among Mexican immigrants after immigration, relative to risk before immigration. This decline is unlikely due to alternative factors often cited to explain patterns of health behaviors among Mexican immigrants, such as health-protective cultural characteristics, since such characteristics are presumably in place before immigration. Findings suggest that Mexican immigrants may be particularly receptive to smoking prevention efforts after immigration.