Trends in heroin use and injection drug use among high school students in five urban school districts in the US (2005-2017).

Background. We describe the prevalence of and changes in heroin use and injection drug use (IDU) among high school students in five large, urban school districts in the US (2005-2017); nearly three-fourths of the students were Black and/or Hispanic/Latino.Methods. Data are from the Centers for Disease Control and Prevention's "Youth Risk Behavior Survey" program, which includes biennial surveys in urban school districts. We pooled data across districts and survey years, and then generated weighted prevalence estimates (and 95% CIs) for any lifetime heroin use and IDU. Joinpoint regression modeling was used to estimate changes in prevalence over the study period.Results. Biennial prevalence estimates (2005-2017) for heroin use and IDU were above 1.8% for all seven timepoints. In 2017, prevalence of heroin use and IDU were 2.9% and 2.5%, respectively. Both heroin use and IDU were higher among boys than girls. There were statistically significant increases in heroin use and IDU among girls from 2005-2009, whereas changes over time were stable among boys.Conclusions. High school students in large, urban school districts may have higher rates of heroin use and IDU than US high school students in general, and there is little evidence of increases since 2009. This study suggests that adolescence may be a critical period for initiation of heroin use among adolescents in large urban school districts, the majority of whom are Black and/or Latino.Supplemental data for this article is available online at https://doi.org/10.1080/15332640.2021.1992327 .

Urban-rural disparity in cancer mortality and changing trend in Tianjin, China, during 1999 and 2016.

OBJECTIVE: Compare the urban-rural disparity in cancer mortality and changing trend during the past 18 years in Tianjin, China. METHODS: Cancer death data were obtained from Tianjin All Cause of Death Registration System (CDRS), which covers the whole population of Tianjin. We calculated and compared the constituent ratio of cancer deaths, age-standardized mortality rate(ASR)and changing trends between urban and rural areas. RESULTS: From 1999 to 2016, a total of 245,744 cancer deaths were reported, accounting 21.7% of all deaths in Tianjin. The ASR of total cancer mortality was higher in urban areas than in rural areas. A total of 33,739 persons were avoided dying of cancers in rural area compared to the urban death level from 1999 to 2016, which was 40.1% compare to the current level of rural areas. But the gap between urban and rural areas became narrowed gradually. The urban-rural ratios (urban/rural) of total cancer mortality changed from 1.76 (125.7/71.5)[95%CI,1.67,1.84] in 1999 to 1.11 (99.6/90.0)[95%CI,1.06,1.15] in 2016. The ASR of lung, liver and esophagus cancer became higher in rural areas than in urban areas in 2016. CONCLUSION: Cancer transition was obviously occurred in Tianjin and showed different speeds and big gap between urban and rural areas. Much more attention was needed to pay in rural areas which still have increasing trends in most cancers mortality recently.

Changes in the associations of race and rurality with SARS-CoV-2 infection, mortality, and case fatality in the United States from February 2020 to March 2021: A population-based cohort study.

BACKGROUND: We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study. METHODS AND FINDINGS: In a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value <0.001), mortality (AOR 3.85 [95% CI 3.30 to 4.50], p-value < 0.001), and case fatality (AOR 2.56, 95% CI 2.23 to 2.93, p-value < 0.001) in February to March 2020, but these associations were attenuated and not statistically significant by November 2020 for infection (AOR 1.03 [95% CI 1.00 to 1.07] p-value = 0.05) and mortality (AOR 1.08 [95% CI 0.96 to 1.20], p-value = 0.21) and were reversed for case fatality (AOR 0.86, 95% CI 0.78 to 0.95, p-value = 0.005). American Indian/Alaska Native (AI/AN versus White) race was associated with higher risk of SARS-CoV-2 infection in April and May 2020; this association declined over time and reversed by March 2021 (AOR 0.66 [95% CI 0.51 to 0.85] p-value = 0.004). Hispanic (versus non-Hispanic) ethnicity was associated with higher risk of SARS-CoV-2 infection and mortality during almost every time period, with no evidence of attenuation over time. Urban (versus rural) residence was associated with higher risk of infection (AOR 2.02, [95% CI 1.83 to 2.22], p-value < 0.001), mortality (AOR 2.48 [95% CI 2.08 to 2.96], p-value < 0.001), and case fatality (AOR 2.24, 95% CI 1.93 to 2.60, p-value < 0.001) in February to April 2020, but these associations attenuated over time and reversed by September 2020 (AOR 0.85, 95% CI 0.81 to 0.89, p-value < 0.001 for infection, AOR 0.72, 95% CI 0.62 to 0.83, p-value < 0.001 for mortality and AOR 0.81, 95% CI 0.71 to 0.93, p-value = 0.006 for case fatality). Throughout the observation period, high comorbidity burden, younger age, and obesity were consistently associated with infection, while high comorbidity burden, older age, and male sex were consistently associated with mortality. Limitations of the study include that changes over time in the associations of some risk factors may be affected by changes in the likelihood of testing for SARS-CoV-2 according to those risk factors; also, study results apply directly to VA enrollees who are predominantly male and have comprehensive healthcare and need to be confirmed in other populations. CONCLUSIONS: In this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021.

Factors Associated with Unsuccessful Outcomes of Tuberculosis Treatment in 125 Municipalities in Colombia 2014 to 2016.

Our aim was to identify the risk factors associated with unsuccessful outcomes of tuberculosis (TB) treatment in patients diagnosed between 2014 and 2016 in the 125 municipalities of Antioquia, Colombia. We studied a retrospective cohort of patients with TB diagnosed between 2014 and 2016, from national routine surveillance systems, in 125 municipalities of Antioquia. Factors associated with unsuccessful tuberculosis treatment outcomes (treatment failed, lost to follow up, or death) were identified utilizing a Poisson regression with robust variance. Over 3 years, of the 6,739 drug-susceptible tuberculosis patients, 73.4% had successful treatment and 26.6% unsuccessful outcomes (17% lost to follow up, 8.9% deaths, and 0.7% treatment failures). Patients with subsidized health insurance (Relative risk [RR]: 2.4; 95% CI: 2.1-2.8) and without health insurance (RR: 2.5; 95% CI: 2.1-3.0) had a higher risk for unsuccessful tuberculosis treatment compared to those with contributive health insurance. Other risk factors included age over 15 years, male sex, homelessness, people living with HIV, previous treatment, and primary diagnosis during hospitalization. Protective factors were living in a rural area and extrapulmonary disease. It is important to generate strategies that improves tuberculosis diagnosis in primary healthcare institutions. In addition, it is imperative to initiate new research about the barriers and obstacles related to patients, healthcare workers and services, and the health system, including the analysis of urban violence, to understand why the goal of TB treatment success has not been reached.

Urban seismic monitoring in Brasília, Brazil.

Urban seismology has gained scientific interest with the development of seismic ambient noise monitoring techniques and also for being a useful tool to connect society with the Earth sciences. The interpretation of the sources of seismic records generated by sporting events, traffic, or huge agglomerations arouses the population's curiosity and opens up a range of possibilities for new applications of seismology, especially in the area of urban monitoring. In this contribution, we present the analysis of seismic records from a station in the city of Brasilia during unusual episodes of silencing and noisy periods. Usually, cultural noise is observed in high-fequency bands. We showed in our analysis that cultural noise can also be observed in the low-frequency band, when high-frequency signal is attenuated. As examples of noisy periods, we have that of the Soccer World Cup in Brazil in 2014, where changes in noise are related to celebrations of goals and the party held by FIFA in the city, and the political manifestations in the period of the Impeachment trial in 2016, which reached the concentration of about 300,000 protesters. The two most characteristic periods of seismic silence have been the quarantine due to the COVID-19 pandemic in 2020, and the trucker strike that occurred across the country in 2018, both drastically reducing the movement of people in the city.

Access to Mechanical Thrombectomy for Ischemic Stroke in the United States.

Background and Purpose: Mechanical thrombectomy helps prevent disability in patients with acute ischemic stroke involving occlusion of a large cerebral vessel. Thrombectomy requires procedural expertise and not all hospitals have the staff to perform this intervention. Few population-wide data exist regarding access to mechanical thrombectomy. Methods: We examined access to thrombectomy for ischemic stroke using discharge data from calendar years 2016 to 2018 from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Facilities were classified as hubs if they performed mechanical thrombectomy, gateways if they transferred patients who ultimately underwent mechanical thrombectomy, and gaps otherwise. We used standard descriptive statistics and unadjusted logistic regression models in our primary analyses. Results: Among 205 681 patients with ischemic stroke, 100 139 (48.7% [95% CI, 48.5%­48.9%]) initially received care at a thrombectomy hub, 72 534 (35.3% [95% CI, 35.1%­35.5%]) at a thrombectomy gateway, and 33 008 (16.0% [95% CI, 15.9%­16.2%]) at a thrombectomy gap. Patients who initially received care at thrombectomy gateways were substantially less likely to ultimately undergo thrombectomy than patients who initially received care at thrombectomy hubs (odds ratio, 0.27 [95% CI, 0.25­0.28]). Rural patients had particularly limited access: 27.7% (95% CI, 26.9%­28.6%) of such patients initially received care at hubs versus 69.5% (95% CI, 69.1%­69.9%) of urban patients. For 93.8% (95% CI, 93.6%­94.0%) of patients with stroke at gateways, their initial facility was capable of delivering intravenous thrombolysis, compared with 76.3% (95% CI, 75.8%­76.7%) of patients at gaps. Our findings were unchanged in models adjusted for demographics and comorbidities and persisted across multiple sensitivity analyses, including analyses adjusting for estimated stroke severity. Conclusions: We found that a substantial proportion of patients with ischemic stroke across the United States lacked access to thrombectomy even after accounting for interhospital transfers. US systems of stroke care require further development to optimize thrombectomy access.

The persistence of ancient settlements and urban sustainability.

We propose a dedicated research effort on the determinants of settlement persistence in the ancient world, with the potential to significantly advance the scientific understanding of urban sustainability today. Settlements (cities, towns, villages) are locations with two key attributes: They frame human interactions and activities in space, and they are where people dwell or live. Sustainability, in this case, focuses on the capacity of structures and functions of a settlement system (geography, demography, institutions) to provide for continuity of safe habitation. The 7,000-y-old experience of urbanism, as revealed by archaeology and history, includes many instances of settlements and settlement systems enduring, adapting to, or generating environmental, institutional, and technological changes. The field of urban sustainability lacks a firm scientific foundation for understanding the long durée, relying instead on narratives of collapse informed by limited case studies. We argue for the development of a new interdisciplinary research effort to establish scientific understanding of settlement and settlement system persistence. Such an effort would build upon the many fields that study human settlements to develop new theories and databases from the extensive documentation of ancient and premodern urban systems. A scientific foundation will generate novel insights to advance the field of urban sustainability.

The impact of occupational structures on ethnic and gendered employment gaps: An event history analysis using social security register data.

Ethnic and gendered employment gaps are mainly explained by individual characteristics, while less attention is paid to occupational structures. Drawing on administrative data, this article analyses the impact of occupational characteristics on top of individual attributes in the urban labour market of Vienna. Both set of variables can explain observed employment gaps to a large extent, but persistent gaps remain, in particular among females. The article's main finding is that the occupational structure appears to have gendered effects. While men tend to benefit from ethnic segregation, women face difficulties when looking for jobs with high shares of immigrant workers. Looking for jobs in occupations that recruit from relatively few educational backgrounds (credentials) is beneficial for both sexes at the outset unemployment, but among females this competitive advantage diminishes over time. The article concludes by discussing potential strategies to avoid the traps of occupational segregation.

Urban attractors: Discovering patterns in regions of attraction in cities.

Understanding the dynamics by which urban areas attract visitors is important in today's cities that are continuously increasing in population towards higher densities. Identifying services that relate to highly attractive districts is useful to make policies regarding the placement of such places. Thus, we present a framework for classifying districts in cities by their attractiveness to daily commuters and relating Points of Interests (POIs) types to districts' attraction patterns. We used Origin-Destination matrices (ODs) mined from cell phone data that capture the flow of trips between each pair of places in Riyadh, Saudi Arabia. We define the attraction profile for a place based on three main statistical features: The number of visitors a place received, the distribution of distance traveled by visitors on the road network, and the spatial spread of locations from where trips started. We used a hierarchical clustering algorithm to classify all places in the city by their features of attraction. We discovered three main types of Urban Attractors in Riyadh during the morning period: Global, which are significant places in the city, Downtown, which contains the central business district, and Residential attractors. In addition, we uncovered what makes districts possess certain attraction patterns. We used a statistical significance testing approach to quantify the relationship between Points of Interests (POIs) types (services) and the patterns of Urban Attractors detected.

Topological indexes and community structure for urban mobility networks: Variations in a business day.

Topological analysis and community detection in mobility complex networks have an essential role in many contexts, from economics to the environmental agenda. However, in many cases, the dynamic component of mobility data is not considered directly. In this paper, we study how topological indexes and community structure changes in a business day. For the analyzes, we use a mobility database with a high temporal resolution. Our case study is the city of São José dos Campos (Brazil)-the city is divided into 55 traffic zones. More than 20 thousand people were asked about their travels the day before the survey (Origin-Destination Survey). We generated a set of graphs, where each vertex represents a traffic zone, and the edges are weighted by the number of trips between them, restricted to a time window. We calculated topological properties, such as degree, clustering coefficient and diameter, and the network's community structure. The results show spatially concise community structures related to geographical factors such as highways and the persistence of some communities for different timestamps. These analyses may support the definition and adjustment of public policies to improve urban mobility. For instance, the community structure of the network might be useful for defining inter-zone public transportation.

Negative responses to urban residential noise as a social rebound effect of increasing population density: Legislative challenges and auditory territoriality.

Populations in cities are projected to increase globally, densifying urban residential environments with both positive and negative effects. Positive social effects are offset by negative health effects however; urban residential noise has been identified in a large number of studies as a significant contributor to social unrest as well as a risk to physiological and psychological health caused by stress, making this topic highly relevant to the discussion on sustainability urban growth. Focusing on the psychological rebound effect of urban residential noise, this paper attempts to explain how and why auditory aspects of the spatial environment negatively influences urban residents. To provide context and to indicate areas in need of improvement, the legislative challenges to be faced are considered, with Sweden as a prime example of a first world country grappling with the effects of increased urban density. Existing building legislation regarding residential noise is considered in relation to studies investigating the effects of residential noise on psychological and physiological health, outlining areas in need of future development. Then, health responses to residential noise are placed in a broader evolutionary context by considering how these effects might be the result of triggered evolutionary mechanisms for keeping population size optimal. Further, the spatial dimension of hearing is discussed with reference to theories of territoriality in environmental psychology and the concept of auditory territoriality is described.

The double burden of malnutrition in India: Trends and inequalities (2006-2016).

Rapid urban expansion has important health implications. This study examines trends and inequalities in undernutrition and overnutrition by gender, residence (rural, urban slum, urban non-slum), and wealth among children and adults in India. We used National Family Health Survey data from 2006 and 2016 (n = 311,182 children 0-5y and 972,192 adults 15-54y in total). We calculated differences, slope index of inequality (SII) and concentration index to examine changes over time and inequalities in outcomes by gender, residence, and wealth quintile. Between 2006 and 2016, child stunting prevalence dropped from 48% to 38%, with no gender differences in trends, whereas child overweight/obesity remained at ~7-8%. In both years, stunting prevalence was higher in rural and urban slum households compared to urban non-slum households. Within-residence, wealth inequalities were large for stunting (SII: -33 to -19 percentage points, pp) and declined over time only in urban non-slum households. Among adults, underweight prevalence decreased by ~13 pp but overweight/obesity doubled (10% to 21%) between 2006 and 2016. Rises in overweight/obesity among women were greater in rural and urban slum than urban non-slum households. Within-residence, wealth inequalities were large for both underweight (SII -35 to -12pp) and overweight/obesity (+16 to +29pp) for adults, with the former being more concentrated among poorer households and the latter among wealthier households. In conclusion, India experienced a rapid decline in child and adult undernutrition between 2006 and 2016 across genders and areas of residence. Of great concern, however, is the doubling of adult overweight/obesity in all areas during this period and the rise in wealth inequalities in both rural and urban slum households. With the second largest urban population globally, India needs to aggressively tackle the multiple burdens of malnutrition, especially among rural and urban slum households and develop actions to maintain trends in undernutrition reduction without exacerbating the rapidly rising problems of overweight/obesity.

Esophageal cancer: trends in incidence and mortality in China from 2005 to 2015.

BACKGROUND: The long-term trend analysis of esophageal cancer is rarely reported in China. Our purpose is to analyze the incidence and mortality trends of esophageal cancer in China from 2005 to 2015. METHOD: Based on the data in the annual report of the China Cancer Registry, a comprehensive analysis of esophageal cancer cases and deaths from 2005 to 2015 was carried out. The incidence and mortality of esophageal cancer are stratified by gender and region (urban or rural). Long-term trend analysis was conducted using Joinpoint regression model. RESULT: In China, the age-standardized incidence rates by the world population declined from 13.84/105 in 2005 to 11.64/105 in 2015. Annual percent changes were 3.4% (95% CI: 0.6%, 6.3%) in the period 2005-2011, -7.4% (95% CI: -10.1%, -4.7%) in the period 2011-2015, respectively. The age-standardized mortality rates declined from 10.86/105 in 2005 to 8.57/105 in 2015. And the average annual percent change was -4.1% (95% CI: -6.7%, -1.5%). The incidence and mortality of esophageal cancer in men are higher than those in women, and the incidence and mortality of esophageal cancer in rural areas are much higher than those in urban areas. CONCLUSION: In China, the incidence of esophageal cancer first increased and then decreased during 2005-2015, while the mortality rate has been declining.

Generalized Vertical Components of built-up areas from global Digital Elevation Models by multi-scale linear regression modelling.

The estimation of the vertical components of built-up areas from free Digital Elevation Model (DEM) global data filtered by multi-scale convolutional, morphological and textural transforms are generalized at the spatial resolution of 250 meters using linear least-squares regression techniques. Six test cases were selected: Hong Kong, London, New York, San Francisco, Sao Paulo, and Toronto. Five global DEM and two DEM composites are evaluated in terms of 60 combinations of linear, morphological and textural filtering and different generalization techniques. Four generalized vertical components estimates of built-up areas are introduced: the Average Gross Building Height (AGBH), the Average Net Building Height (ANBH), the Standard Deviation of Gross Building Height (SGBH), and the Standard Deviation of Net Building Height (SNBH). The study shows that the best estimation of the net GVC of built-up areas given by the ANBH and SNBH, always contains a greater error than their corresponding gross GVC estimation given by the AGBH and SGBH, both in terms of mean and standard deviation. Among the sources evaluated in this study, the best DEM source for estimating the GVC of built-up areas with univariate linear regression techniques is a composite of the 1-arcsec Shuttle Radar Topography Mission (SRTM30) and the Advanced Land Observing Satellite (ALOS) World 3D-30 m (AW3D30) using the union operator (CMP_SRTM30-AW3D30_U). A multivariate linear model was developed using 16 satellite features extracted from the CMP_SRTM30-AW3D30_U enriched by other land cover sources, to estimate the gross GVC. A RMSE of 2.40 m and 3.25 m was obtained for the AGBH and the SGBH, respectively. A similar multivariate linear model was developed to estimate the net GVC. A RMSE of 6.63 m and 4.38 m was obtained for the ANBH and the SNBH, respectively. The main limiting factors on the use of the available global DEMs for estimating the GVC of built-up areas are two. First, the horizontal resolution of these sources (circa 30 and 90 meters) corresponds to a sampling size that is larger than the expected average horizontal size of built-up structures as detected from nadir-angle Earth Observation (EO) data, producing more reliable estimates for gross vertical components than for net vertical component of built-up areas. Second, post-production processing targeting Digital Terrain Model specifications may purposely filter out the information on the vertical component of built-up areas that are contained in the global DEMs. Under the limitations of the study presented here, these results show a potential for using global DEM sources in order to derive statistically generalized parameters describing the vertical characteristics of built-up areas, at the scale of 250x250 meters. However, estimates need to be evaluated in terms of the specific requirements of target applications such as spatial population modelling, urban morphology, climate studies and so on.

A population estimation study reveals a staggeringly high number of cattle on the streets of urban Raipur in India.

Cattle are cosmopolitan in distribution. They are economically and ecologically significant. The cattle menace on the urban streets of developing and underdeveloped countries is challenging. The number of road accidents is increasing rapidly over time, in the urban areas of most of the developing countries, like India. In the present study, we estimated the population of cattle wandering on the streets/roads/highways of Raipur city of India using the direct headcount method and advanced Photographic Capture-Recapture Method (PCRCM). We compared these two methods of population estimation to check their suitability and adequacy. We superimposed 163 grids (1.0 x 1.0 km each) on the map of Raipur city using Quantum Geographic Information System (QGIS) software. We randomly selected 20 grids for the estimation of the street cattle population. We used both line transect and block count sampling techniques under the direct headcount method. The estimates of visibly roaming cattle on the Raipur city streets were 11808.45 and 11198.30 using the former and the latter sampling techniques, respectively. Further, advanced PCRCM indicated an estimated 35149.61 and 34623.20 cattle using the line transect and block counting sampling techniques, respectively. We observed a female-biased sex ratio in both mature and immature cattle. The frequency of mature cattle was significantly higher than that of naive cattle, followed by the calf. Further, we noticed the frequency of cattle in a grid in the following order: cow > bull > heifer > immature male > female calf > male calf. We concluded that the estimated population of street cattle in Raipur city is about 35 thousand. The results of both the techniques, i.e., direct headcount method and PCRCM, are consistent for population estimation. The direct headcount method yields the number of cattle visibly roaming on the street at a particular time. In contrast, advanced PCRCM gives the total population of street cattle in the city. Active surveillance of the urban cattle population might be of critical importance for municipal and city planners. A better understanding of the urban cattle population might help mitigate the cattle menace on the street, eventually preventing cattle-human conflict and minimizing road accidents. The techniques adopted in this study will also help estimate the population of free-ranging dogs and other wildlife animals in any target location.

What influences home delivery among women who live in urban areas? Analysis of 2014 Ghana Demographic and Health Survey data.

BACKGROUND: In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. MATERIALS AND METHODS: Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. RESULTS: We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17-0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06-3.86], women who professed other religions [AOR = 3.45; CI = 1.53-7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64-31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17-0.53], compared to those with no formal education. CONCLUSION: The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.

Health literacy, preventive COVID 19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan.

BACKGROUND AND AIMS: Potential role of health literacy in determining adherence to COVID-19 preventive behavior, pharmacological, and lifestyle management among diagnosed patients of chronic diseases during nationwide lockdown is inadequately investigated. METHODS: A cross-sectional study was conducted from May-August 2020 among diagnosed patients of chronic diseases residing in a COVID-19 hotspot of urban Jodhpur, Rajasthan, and availing health services from primary care facility. Telephonic interviews of participants were conducted to determine their health literacy using HLS-EU-Q47 questionnaire, adherence to COVID-19 preventive behaviour as per World Health Organization recommendations, and compliance to prescribed pharmacological and physical activity recommendations for chronic disease. RESULTS: All the 605 diagnosed patients of chronic diseases availing services from primary care facility were contacted for the study, yielding response rate of 68% with 412 agreeing to participate. Insufficient health literacy was observed for 65.8% participants. Only about half of participants had scored above median for COVID-19 awareness (55.1%) and preventive behavior (45.1%). Health literacy was observed to be significant predictor of COVID-19 awareness [aOR: 3.53 (95% CI: 1.81-6.88)]; COVID-19 preventive behavior [aOR: 2.06, 95%CI; 1.14-3.69] and compliance to pharmacological management [aOR: 3.05; 95% CI: 1.47-6.35] but not for physical activity. CONCLUSION: COVID-19 awareness, preventive behavior, and compliance to pharmacological management is associated with health literacy among patients of chronic disease availing services from primary health facility. Focusing on health literacy could thus be an essential strategic intervention yielding long term benefits.