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1.
J Migr Health ; 4: 100049, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34405194

RESUMO

Background: Though refugees often survive in refugee camps for many years, little is known about the impact of their interactions within the healthcare system during that time and how it may affect current concerns with the healthcare system after resettlement. Guiding our analysis was the Community Health Development model, which emphasizes the importance of understanding the impact of historical experiences on a community's health to identify specific current health needs, and plan solutions alongside the community to address and improve health concerns. Objective: To better understand the healthcare system related experiences of Bhutanese refugees before and after resettlement, and describe potential solutions based on their perspectives to improve their health status. Methods: This study used an explorative qualitative research design. Four focus group discussions were conducted with 40 female participants to examine their experiences within the healthcare system in Nepal (e.g. before resettlement) and the US (after resettlement). Focus group data were audio-recorded, translated, coded, and reported based on qualitative thematic analysis. Results: Findings revealed that Bhutanese refugees were mistreated in the Nepalese healthcare system, often neglected from healthcare access and services because of their refugee status. Upon arrival to the United States after resettlement, study participants also reported experiencing challenges within the US health care system including cultural and linguistic barriers when interacting with medical interpreters during visits with their providers, as well as having inadequate time during the visit to fully express their concerns. Respondents' recommendations to improve their overall health centered on their experiences with the US health care system including initiatives developing leadership skills for building community capacity towards advocating for the refuges, while increasing access to external resources. Conclusion: The result of this study outlines an account of Bhutanese refugees' experiences and recommendations for improving their community's health based on such past experiences and their current needs. These findings provide a starting point for future research with underserved refugee migrant groups and indicate a need for health programs to be historically and culturally sensitive in order to be more effective. Further, the understanding of refugees' collective history should inform the development of collaborative interventions with community members in order to be effective.

3.
Prev Med ; 139: 106214, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32693175

RESUMO

Diverse neighborhood-level environmental and social impacts on health are well documented. While studies typically examine these impacts individually, examining potential health impacts from multiple sources as a whole can provide a broader context of overall neighborhood-level health impacts compared to examining each component independently. This study examined the association between cumulative neighborhood-level potential health impacts on health and expected life expectancy within neighborhoods (census tracts) across Texas using the Neighborhood Potential Health Impact Score tool. Among urban census tract neighborhoods, a difference of nearly 5 years was estimated between neighborhoods with the least health promoting cumulative health impacts compared to neighborhoods with the most health promoting cumulative health impacts. Differences were observed between rural and urban census tract neighborhoods, with rural areas having less variability in expected life expectancy associated with neighborhood-level cumulative potential health impacts compared to urban areas.


Assuntos
Expectativa de Vida , Características de Residência , Nível de Saúde , Humanos , População Rural , Texas
4.
Psychol Health Med ; 25(4): 402-409, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31532238

RESUMO

Breast and cervical cancer screening are associated with dramatically reduced cancer mortality. Mental illnesses have been demonstrated to influence preventative behaviours. This study aims to explore whether anxiety or depressive symptoms is associated with breast and cervical cancer screening. We analyzed data (n = 3104) from the 2013 Brazos Valley Community Health Assessment. The GAD-7 Scale was used to assess the anxiety level, and PHQ-2 was used to assess the depressive symptoms. Stata 15.0 statistical software was used to perform descriptive and logistic regression analysis. Overall, 80.61% of women in each sample met breast cancer or cervical cancer screening guidelines, respectfully. Anxiety was associated with missing breast and cervical cancer screening, but the association was only significant for cervical cancer (OR = 1.430, CI = 1.009, 2.026), not for breast cancer (OR = 1.406, CI = .952, 2.078). Depressive symptom was significantly associated with missing breast (OR = 1.502, CI = 1.051, 2.149) and cervical (OR = 1.689, CI = 1.208, 2.362) cancer screening after controlling for demographics. Women with depressive symptoms and anxiety had higher odds of missing breast and cervical cancer screening. Health promotion programs should consider targeting individuals with anxiety and depression to improve cancer-screening rates..


Assuntos
Ansiedade/epidemiologia , Neoplasias da Mama/diagnóstico , Depressão/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Texas/epidemiologia
5.
JMIR Mhealth Uhealth ; 6(5): e117, 2018 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-29728343

RESUMO

BACKGROUND: Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation. OBJECTIVE: The aim of this study was to use the technology acceptance model to explore the influence of the factors-perceived ease of use, perceived usefulness, attitude, and free of cost-on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available. METHODS: A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes. RESULTS: Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models. CONCLUSIONS: Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes.

8.
J Public Health Manag Pract ; 23 Suppl 4 Suppl, Community Health Status Assessment: S14-S21, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28542059

RESUMO

Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the assessment findings and/or the plan; planning for sustainability; and celebrating success. Within several of these components, we discuss characteristics that are critical to improving community health. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health.


Assuntos
Planejamento em Saúde Comunitária/métodos , Determinação de Necessidades de Cuidados de Saúde , Saúde Pública/métodos , Melhoria de Qualidade , Hospitais Filantrópicos/tendências , Humanos
10.
J Public Health Manag Pract ; 23(2): 112-121, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26554464

RESUMO

CONTEXT: Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA. OBJECTIVE: To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities. DESIGN: Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement. RESULTS: Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs. CONCLUSIONS: On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.


Assuntos
Planejamento em Saúde Comunitária/métodos , Participação da Comunidade/métodos , Comportamento Cooperativo , Planejamento em Saúde Comunitária/legislação & jurisprudência , Estudos Transversais , Prioridades em Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Patient Protection and Affordable Care Act/organização & administração , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Pesquisa Qualitativa , Encaminhamento e Consulta/estatística & dados numéricos , Texas
11.
Rehabil Psychol ; 61(3): 240-250, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26891247

RESUMO

OBJECTIVE: The authors examined depression and health-related quality of life among individuals with self-reported sensory impairments living in a health professional shortage area. RESEARCH METHOD: Health surveys of residents were conducted in 2006 and 2010. Responses were analyzed by groups of residents reporting vision loss, hearing loss, dual hearing and vision loss, and no sensory loss. In 2006, the total sample size was n = 2,591, and in 2010, it was n = 3,955. MAIN OUTCOME MEASURES: The CESD-5 scale (Shrout & Yager, 1989) was included in 2006, and the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) was included in 2010. Rates of depression on the CESD-5 were determined by the recommended cut-off scores and on the PHQ-9 by the recommended algorithm. The Centers for Disease Control (CDC) Healthy Days instrument (Moriarty, Zack, & Kobau, 2003) was used in both surveys to assess health-related quality of life. RESULTS: In both surveys, individuals who reported sensory loss had higher rates of depression and lower health-related quality of life than individuals with no reported sensory loss. CONCLUSIONS: Individuals reporting sensory loss had high rates of depression and a compromised quality of life compared to respondents without these impairments. These data imply strategic community-based health care services, including mental health initiatives, may be indicated for individuals with sensory loss living in underserved regions. Implications for rehabilitation psychology research, service, and policy are discussed as innovations in these areas are needed to better understand and address the disparities that may compromise the overall well-being of residents of underserved communities. (PsycINFO Database Record


Assuntos
Transtorno Depressivo/reabilitação , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Perda Auditiva/psicologia , Perda Auditiva/reabilitação , Área Carente de Assistência Médica , Qualidade de Vida/psicologia , Transtornos da Visão/psicologia , Transtornos da Visão/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
12.
Popul Health Manag ; 19(3): 178-86, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26440370

RESUMO

Derived from various health care policies and initiatives, the concept of population health has been newly adopted by health care and medicine. In particular, it has been suggested that the Patient Protection and Affordable Care Act provision that requires nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address health priorities has the potential to improve population health. A mixed methods study design was used to examine the potential for population health improvements to occur through the Internal Revenue Service (IRS)-mandated nonprofit hospital CHNA and planning processes. Methods involved a 2-phased approach composed of (1) content analysis of 95 CHNA/implementation strategies reports and (2) interviews with key informants, consultants, and community stakeholders involved in CHNA and planning processes. Although this is a great opportunity for the nonprofit hospital assessment and planning processes to influence population health outcomes, the findings from the first 3-year assessment and planning cycle (2011-2013) suggest this is unlikely. As nonprofit hospitals begin the second 3-year assessment and planning cycle, this article offers recommendations to increase the potential for nonprofit hospitals to improve population health. These recommendations include clarifying the purpose of IRS CHNA regulations, engaging community stakeholders in collaborative assessment and planning, understanding disease etiology and identifying and addressing broader determinants of health, adopting a public health assessment and planning model, and emphasizing population health improvement. (Population Health Management 2016;19:178-186).


Assuntos
Nível de Saúde , Determinação de Necessidades de Cuidados de Saúde , Saúde Pública , Planejamento em Saúde Comunitária , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Estados Unidos
13.
Am J Public Health ; 105(3): e103-13, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25602862

RESUMO

OBJECTIVES: We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports. METHODS: Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality. RESULTS: There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports. CONCLUSIONS: At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.


Assuntos
Planejamento em Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/legislação & jurisprudência , Hospitais Filantrópicos/legislação & jurisprudência , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/normas , Análise de Variância , Planejamento em Saúde Comunitária/métodos , Planejamento em Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Relações Comunidade-Instituição/legislação & jurisprudência , Comportamento Cooperativo , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/organização & administração , Prioridades em Saúde/legislação & jurisprudência , Prioridades em Saúde/organização & administração , Hospitais Filantrópicos/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Texas , Estados Unidos
14.
Public Underst Sci ; 24(1): 23-37, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25193967

RESUMO

In Ghana, as in many other developing countries, most science reporting is done by general reporters. However, few studies have investigated science reporting in such a situation. To understand better the dynamics of science reporting in such context, we surveyed 151 general reporters in Ghana. Respondents' demographic characteristics resembled those found in studies elsewhere. Respondents perceived health professionals and scientists as very important sources of information for reporting science. There was an inverse correlation between journalism experience and the number of science feature stories reported in the past 12 months (p=.017). Most respondents indicated that science journalism training would motivate them to report science more. Likewise, most reported that easier access to research findings would do so. We identify characteristics of reporters, media, scientific, and training institutions that are important influences of Ghanaian reporters' coverage of science. We provide recommendations for advancing science reporting in Ghana.


Assuntos
Disseminação de Informação , Jornalismo/normas , Ciência , Gana , Humanos , Meios de Comunicação de Massa/normas , Motivação
15.
Artigo em Inglês | MEDLINE | ID: mdl-24859101

RESUMO

BACKGROUND: Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues. OBJECTIVES: This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues. METHODS: Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009. RESULTS: Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased. CONCLUSION: This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership's efforts to address access to care can strengthen a community's capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.


Assuntos
Fortalecimento Institucional/métodos , Redes Comunitárias/organização & administração , Humanos , Disseminação de Informação/métodos , Relações Interinstitucionais , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Texas
16.
J Clin Psychol ; 69(3): 252-63, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23307284

RESUMO

OBJECTIVES: Examined the severity of depressive symptoms and the rates of probable depression assessed by different instruments that were included in two separate surveys of residents in a predominately rural region of the United States. METHOD: Surveys of the Brazos Valley region in south central Texas were conducted and responses to the short form of the Center for Epidemiological Studies-Depression scale (in the 2006 survey) and the Patient Health Questionnaire-9 (in the 2010 survey) were analyzed. RESULTS: Regardless of instrument used, results indicate that women and African Americans are at greater risk for depression in this underserved region, but no unique effects were found for rural residency. IMPLICATIONS: Implications for research, assessment, program planning, and policy are discussed.


Assuntos
Depressão/diagnóstico , População Rural , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Depressão/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Texas/epidemiologia , Texas/etnologia , Adulto Jovem
17.
J Prim Prev ; 32(1): 29-41, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21249452

RESUMO

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.


Assuntos
Serviços de Saúde Bucal/provisão & distribuição , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Saúde Bucal , Adolescente , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Texas , Adulto Jovem
19.
J Prim Prev ; 31(1-2): 9-19, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20135230

RESUMO

The purpose of this article is to propose a set of ideas for reinventing America's health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/organização & administração , Reforma dos Serviços de Saúde , Acesso aos Serviços de Saúde , Colorado , Planejamento em Saúde Comunitária/métodos , Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Atenção à Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Estudos de Casos Organizacionais , Mudança Social , Texas , Estados Unidos
20.
Ethn Dis ; 19(3): 280-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19769010

RESUMO

An assessment of the risk or diagnosis of diabetes in a random sample of 386 adult border residents found 46% obese, 12% at risk for diabetes, and 18% diagnosed with diabetes. While obesity was associated with greater diabetes risk, > 50% of obese adults reported not being told of their diabetes risk. Independent of other characteristics, boomers were at increased risk (OR 3.88) for diabetes. Comorbidities increased the risk for actual diabetes diagnosis (OR 4.79). Skipping medications increased risk of developing diabetes (OR 2.98). Disadvantaged obese boomers are at particular risk, warranting culturally appropriate interventions before onset of chronic illnesses.


Assuntos
Diabetes Mellitus/etnologia , Nível de Saúde , Obesidade/etnologia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Fatores Etários , Comorbidade , Demografia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação , Obesidade/epidemiologia , Medição de Risco , Fatores de Risco , Fumar/epidemiologia , Fumar/etnologia , Fatores Socioeconômicos , Texas/epidemiologia
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