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1.
Braz. j. oral sci ; 20: e214270, jan.-dez. 2021. tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1254738

RESUMO

There are various instruments to measure attitudes toward persons with disabilities (PwD). The Multidimensional Attitudes Scale (MAS) toward PwD is a three-dimension scale with good psychometric properties; the Spanish version has been validated with a four-factor structure. Aim: To examine the factor structure of a cross-cultural adapted version of the Spanish MAS towards deaf persons in a sample of Chilean dental students. Methods: This cross-sectional study involved five Chilean public health experts that reviewed the scale for obtaining a preliminary version of a 30-item modified MAS towards deaf persons; a pilot with 15 dental students was performed, and a final sample composed of 311 students was included. For the exploratory factor analysis (EFA), maximum likelihood estimation (ML) for determining the number of factors and parallel analysis (PA) was used, with Oblimin for the rotation method. Cronbach's alpha was used to assess reliability. The root mean square error of approximation (RMSEA), comparative fit index (CFI), incremental fit index (IFI), goodness of fit index (GFI), Tucker-Lewis fit index (TLI-NNF) and root mean square of residuals (RMSR) were used to assess model fit. Results: All items had a normal distribution with the exception of items 7 and 10. The four-factor structure without item 10 in this EFA presented an adequate Cronbach's alpha (>0.83), suggesting acceptable reliability. RMSEA, TLI-NNFI, RMSR, GFI and CFI indices suggested a good fit of the model and were consistent with the literature. Conclusion: The Spanish modified version of the MAS towards deaf persons has a four-factor structure, which in consistent with a previous version of the MAS


Assuntos
Humanos , Masculino , Feminino , Estudantes de Odontologia , Atitude , Hispano-Americanos , Chile , Surdez , Estudos de Validação como Assunto
2.
Cien Saude Colet ; 26(7): 2575-2586, 2021 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231671

RESUMO

Health Promotion (HP) has recently been strengthened within public policies and still shows strong consonance with international determinations regarding childhood and adolescence in Latin America (LA). Debating HP becomes all the more urgent considering the increasing prevalence of psychological distress in this age group and the historical political construction of Latin American countries. This research aimed to identify and analyze, through an integrative review of the literature, the academic productions on strategies for mental HP of adolescents in LA and, thus, to visualize the actions and arouse reflections dialoguing with the Southern critics, represented by the Bogotá declaration. Six studies were selected after applying the inclusion and exclusion criteria. We identified that the main space where actions are developed is the school. The potential measures identified were professional training, group action, and strengthening primary and territorial care. We discussed that the historically structured socioeconomic reality of LA reflects an organization of HP actions. Furthermore, the visualization of strategies that enhance at low cost the improved mental health of adolescents can contribute to the current reflection.


Assuntos
Promoção da Saúde , Saúde Mental , Adolescente , Criança , Hispano-Americanos , Humanos , América Latina/epidemiologia
3.
JAMA Netw Open ; 4(7): e2117074, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34264327

RESUMO

Importance: Black and Latinx communities have been disproportionately affected by the COVID-19 pandemic, yet little work has sought to understand their perspectives. Objective: To explore the experiences of Black and Latinx communities during the pandemic to better understand their perspectives on COVID-19 mitigation behaviors (eg, mask wearing), testing, and vaccines. Design, Setting, and Participants: In this community-engaged qualitative study conducted with 18 community-based organizations and 4 health care organizations between November 19, 2020, and February 5, 2021, in New Jersey counties severely affected by the pandemic, group and individual interviews were used to purposively sample 111 Black and Latinx individuals. A total of 13 group interviews were organized by race/ethnicity and language: 4 English-speaking groups with Black participants (n = 34), 3 Spanish-speaking groups with Latinx participants (n = 24), and 4 English-speaking groups with Black and Latinx participants (n = 36). To understand the views of health care workers from these communities, 2 additional groups (n = 9) were convened and supplemented with individual interviews. Main Outcomes and Measures: Description of Black and Latinx participants' experiences during the COVID-19 pandemic and their perspectives on mitigation behaviors, testing, and vaccines. Results: The study included 111 participants (87 women [78.4%]; median age, 43 years [range, 18-93 years]). Participants described the devastating effects of the pandemic on themselves, loved ones, and their community. Their experiences were marked by fear, illness, loss, and separation. These experiences motivated intense information seeking, mitigation behaviors, and testing. Nevertheless, vaccine skepticism was high across all groups. Participants did not trust the vaccine development process and wanted clearer information. Black participants expressed that they did not want to be subjects of experiments. Conclusions and Relevance: The remaining unknowns about new vaccines need to be acknowledged and described for Black and Latinx communities to make informed decisions. Ultimately, scientists and public officials need to work transparently to address unanswered questions and work collaboratively with trusted community leaders and health professionals to foster partnered approaches, rather than focusing on marketing campaigns, to eliminate vaccine skepticism.


Assuntos
Afro-Americanos , Atitude/etnologia , Vacinas contra COVID-19 , COVID-19 , Hispano-Americanos , Pandemias , Confiança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/etnologia , COVID-19/prevenção & controle , COVID-19/psicologia , Teste para COVID-19 , Feminino , Humanos , Comportamento de Busca de Informação , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , New Jersey , Pesquisa , SARS-CoV-2 , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-34204687

RESUMO

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Vaping , Adulto , Feminino , Hispano-Americanos , Humanos , Masculino , Percepção , Porto Rico/epidemiologia , Inquéritos e Questionários
5.
Artigo em Inglês | MEDLINE | ID: mdl-34199732

RESUMO

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004-2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III-IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53-2.12), and cervical (aOR: 1.45,95% CI: 1.26-1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48-0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60-0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58-0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.


Assuntos
Neoplasias , Cuidados Paliativos , Grupos Étnicos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Estados Unidos/epidemiologia
7.
WMJ ; 120(2): 152-155, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34255958

RESUMO

BACKGROUND: The objective of this study was to determine the associations between heart disease, obesity, and demographic factors and increased COVID-19 mortality. METHODS: We extracted deidentified patient-level data from the Froedtert Health System and Children's Hospital of Wisconsin and used descriptive statistics and multivariable logistic regression to characterize relationships between heart disease, obesity, age group, sex, race and ethnicity and mortality following COVID-19 diagnosis. RESULTS: We found heart disease (adjusted odds ratio [AOR] 2.85; 95% CI, 2.11-8.83) and other demographic factors are significant predictors of increased mortality in COVID-19 patients. However, obesity was not a significant predictor of mortality (AOR 1.04; 95% CI, 0.53- 3.10). DISCUSSION: These unique results indicate some comorbid conditions and patient demographics contribute more strongly to mortality in COVID-19 patients.


Assuntos
COVID-19/etnologia , COVID-19/mortalidade , Cardiopatias/complicações , Hispano-Americanos/estatística & dados numéricos , Obesidade/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Cardiopatias/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Pandemias , SARS-CoV-2 , Fatores Sexuais , Wisconsin/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34207968

RESUMO

Sexual health communication warrants greater attention as it may help to reduce the rates of HIV incidence among youth. A growing body of literature suggests that conversations about sexual health among Black and Latino youth may serve as a potential strategy for HIV prevention. The current study investigates whether sexual health communication-in particular, conversations about sexual health and HIV-influences Black and Latino youth's personal agency regarding their role in achieving an HIV-free generation. For this secondary data analysis, we used the National Survey of Teens and Young Adults on attitudes towards HIV/AIDS (n = 701). Participants included youth between the ages 15 and 24, and the average was 20 years. We used a multiple regression analysis to examine whether sexual health communication contributed to youth knowledge and awareness of (1) the national plan for EHE, and (2) their role in ending the epidemic". (1) knowledge and awareness of the national plan for EHE, and (2) role in ending the epidemic. The final multiple regression model was statistically significant [R2 = 0.16 F (12, 701) = 001, p < 0.001] for both outcomes. Study results found that sexual health communication was positively related to Black and Latino youth's awareness of efforts to end the HIV epidemic (EHE) and their belief that they could play a role in achieving EHE. In addition, HIV stigma influenced personal agency and whether youth were aware of efforts to achieve EHE. Our results demonstrated that openly communicating about sexual health and HIV may contribute to a sense of personal agency among Black and Latino youth. In addition, understanding whether sexual health communication contributes to a sense of personal agency among youth may inform HIV prevention efforts to achieve the goals set forth by the national EHE plan for the U.S.


Assuntos
Epidemias , Infecções por HIV , Comunicação em Saúde , Saúde Sexual , Adolescente , Adulto , Afro-Americanos , Infecções por HIV/epidemiologia , Hispano-Americanos , Humanos , Adulto Jovem
9.
JAMA Netw Open ; 4(7): e2117049, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34279648

RESUMO

Importance: Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. Objective: To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. Design, Setting, and Participants: In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Main Outcomes and Measures: Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. Results: A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). Conclusions and Relevance: In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.


Assuntos
COVID-19/prevenção & controle , Emigração e Imigração/tendências , Hispano-Americanos/estatística & dados numéricos , Adulto , Arizona/epidemiologia , COVID-19/epidemiologia , Teste para COVID-19/métodos , Teste para COVID-19/estatística & dados numéricos , Chicago/epidemiologia , Estudos Transversais , Emigração e Imigração/estatística & dados numéricos , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários
10.
Int J Clin Pract ; 75(8): e14454, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34289647
11.
Artigo em Inglês | MEDLINE | ID: mdl-34199895

RESUMO

While men and women make up a similar number of COVID-19 cases, and are equally likely to know someone who has become ill due to the virus, the gendered and systemic implications of immigration during public health emergencies among minority groups in the United States are empirically underexplored. Using the SOMOS COVID-19 Crisis National Latino Survey, we conduct a series of intersectional analyses to understand the extent to which personal experiences with COVID-19, gendered structural factors, and spillover effects of US immigration policies impact the mental health of US Latina/os during a public health emergency. The results show that among Latinas, knowing an undocumented immigrant and someone ill with COVID-19 increases the probability of reporting worse mental outcomes by 52 percent. Furthermore, being a woman increases the probability of reporting the highest level of mental health problems by 30 percent among Hispanic people who know someone with COVID-19 and an undocumented immigrant. These findings indicate that the effects of the COVID-19 outbreak among US Latinas and Latinos are entrenched in gendered and systemic inequalities.


Assuntos
COVID-19 , Emigração e Imigração , Surtos de Doenças , Feminino , Hispano-Americanos , Humanos , Masculino , Saúde Mental , SARS-CoV-2 , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia
12.
BMC Public Health ; 21(1): 1330, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229621

RESUMO

BACKGROUND: Disparate racial/ethnic burdens of the Coronavirus Disease 2019 (COVID-19) pandemic may be attributable to higher susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or to factors such as differences in hospitalization and care provision. METHODS: In our cross-sectional analysis of lab-confirmed COVID-19 cases from a tertiary, eight-hospital healthcare system across greater Houston, multivariable logistic regression models were fitted to evaluate hospitalization and mortality odds for non-Hispanic Blacks (NHBs) vs. non-Hispanic Whites (NHWs) and Hispanics vs. non-Hispanics. RESULTS: Between March 3rd and July 18th, 2020, 70,496 individuals were tested for SARS-CoV-2; 12,084 (17.1%) tested positive, of whom 3536 (29.3%) were hospitalized. Among positive cases, NHBs and Hispanics were significantly younger than NHWs and Hispanics, respectively (mean age NHBs vs. NHWs: 46.0 vs. 51.7 years; p < 0.001 and Hispanic vs. non-Hispanic: 44.0 vs. 48.7 years; p < 0.001). Despite younger age, NHBs (vs. NHWs) had a higher prevalence of diabetes (25.2% vs. 17.6%; p < 0.001), hypertension (47.7% vs. 43.1%; p < 0.001), and chronic kidney disease (5.0% vs. 3.3%; p = 0.001). Both minority groups resided in lower median income (median income [USD]; NHBs vs. NHWs: 63,489 vs. 75,793; p < 0.001, Hispanic vs. non-Hispanic: 59,104 vs. 68,318; p < 0.001) and higher population density areas (median population density [per square mile]; NHBs vs. NHWs: 3257 vs. 2742; p < 0.001, Hispanic vs. non-Hispanic: 3381 vs. 2884; p < 0.001). In fully adjusted models, NHBs (vs. NHWs) and Hispanics (vs. non-Hispanic) had higher likelihoods of hospitalization, aOR (95% CI): 1.42 (1.24-1.63) and 1.61 (1.46-1.78), respectively. No differences were observed in intensive care unit (ICU) utilization or treatment parameters. Models adjusted for demographics, vital signs, laboratory parameters, hospital complications, and ICU admission vital signs demonstrated non-significantly lower likelihoods of in-hospital mortality among NHBs and Hispanic patients, aOR (95% CI): 0.65 (0.40-1.03) and 0.89 (0.59-1.31), respectively. CONCLUSIONS: Our data did not demonstrate racial and ethnic differences in care provision and hospital outcomes. Higher susceptibility of racial and ethnic minorities to SARS-CoV-2 and subsequent hospitalization may be driven primarily by social determinants.


Assuntos
Afro-Americanos , COVID-19 , Estudos Transversais , Grupos Étnicos , Hispano-Americanos , Hospitalização , Humanos , SARS-CoV-2
13.
PLoS One ; 16(7): e0254127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242275

RESUMO

Pundits and academics across disciplines note that the human toll brought forth by the novel coronavirus (COVID-19) pandemic in the United States (U.S.) is fundamentally unequal for communities of color. Standing literature on public health posits that one of the chief predictors of racial disparity in health outcomes is a lack of institutional trust among minority communities. Furthermore, in our own county-level analysis from the U.S., we find that counties with higher percentages of Black and Hispanic residents have had vastly higher cumulative deaths from COVID-19. In light of this standing literature and our own analysis, it is critical to better understand how to mitigate or prevent these unequal outcomes for any future pandemic or public health emergency. Therefore, we assess the claim that raising institutional trust, primarily scientific trust, is key to mitigating these racial inequities. Leveraging a new, pre-pandemic measure of scientific trust, we find that trust in science, unlike trust in politicians or the media, significantly raises support for COVID-19 social distancing policies across racial lines. Our findings suggest that increasing scientific trust is essential to garnering support for public health policies that lessen the severity of the current, and potentially a future, pandemic.


Assuntos
Afro-Americanos/psicologia , COVID-19 , Disparidades nos Níveis de Saúde , Hispano-Americanos/psicologia , Pandemias , Distanciamento Físico , SARS-CoV-2 , Confiança , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia
14.
BMJ Open ; 11(6): e048006, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155078

RESUMO

OBJECTIVE: To evaluate COVID-19 infection and mortality disparities in ethnic and racial subgroups in a state-wise manner across the USA. METHODS: Publicly available data from The COVID Tracking Project at The Atlantic were accessed between 9 September 2020 and 14 September 2020. For each state and the District of Columbia, % infection, % death, and % population proportion for subgroups of race (African American/black (AA/black), Asian, American Indian or Alaska Native (AI/AN), and white) and ethnicity (Hispanic/Latino, non-Hispanic) were recorded. Crude and normalised disparity estimates were generated for COVID-19 infection (CDI and NDI) and mortality (CDM and NDM), computed as absolute and relative difference between % infection or % mortality and % population proportion per state. Choropleth map display was created as thematic representation proportionate to CDI, NDI, CDM and NDM. RESULTS: The Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median 158%, IQR 100%-200%). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median 50%, IQR 25%-100%). The AA population had the most disproportionate mortality, with a median of 46% higher mortality than the % population proportion (median 46%, IQR 18%-66%). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian populations, with 100% excess infections than the % population proportion seen in nine states for AI/AN and seven states for Asian populations. There was no disproportionate impact in the white population in any state. CONCLUSIONS: There are racial/ethnic disparities in COVID-19 infection/mortality, with distinct state-wise patterns across the USA based on racial/ethnic composition. There were missing and inconsistently reported racial/ethnic data in many states. This underscores the need for standardised reporting, attention to specific regional patterns, adequate resource allocation and addressing the underlying social determinants of health adversely affecting chronically marginalised groups.


Assuntos
COVID-19 , Grupos Étnicos , Grupos de Populações Continentais , Disparidades nos Níveis de Saúde , Hispano-Americanos , Humanos , SARS-CoV-2 , Estados Unidos/epidemiologia
15.
BMC Public Health ; 21(1): 1250, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187414

RESUMO

BACKGROUND: Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics. METHODS: Six-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle. RESULTS: Counties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02-1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01-1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02-1.03) or Native American (IRR = 1.02, 95% CI: 1.01-1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01-1.05) and deaths (IRR = 1.04, 95% CI: 1.01-1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01-1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94-0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04-1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01-1.07) were associated with more deaths. CONCLUSIONS: These results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events.


Assuntos
Grupos Étnicos , Pobreza , Disparidades nos Níveis de Saúde , Hispano-Americanos , Humanos , Fatores de Risco , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia
16.
Prev Chronic Dis ; 18: E55, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081577

RESUMO

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


Assuntos
COVID-19/etnologia , Serviços de Saúde Comunitária/organização & administração , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde , Adolescente , Afro-Americanos/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , COVID-19/prevenção & controle , Criança , Doença Crônica/etnologia , Comorbidade , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pandemias , SARS-CoV-2 , Instituições Acadêmicas
17.
Menopause ; 28(7): 772-786, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34165446

RESUMO

OBJECTIVES: The purpose of this study was to examine the specific characteristics that were directly linked to menopausal symptoms of midlife women from four major racial/ethnic groups in the United States using a decision tree analysis. METHODS: This was a secondary analysis of the data from 1,027 midlife women from 2 larger Internet-based studies. The parent studies used the Midlife Women's Symptom Index with multiple questions on background characteristics and health and menopausal status. The data were analyzed using ANOVA and decision tree analyses. RESULTS: Across all the racial/ethnic groups, menopausal stage and country of birth were significantly related to the total number and total severity scores of menopausal symptoms (P < 0.001). In each racial/ethnic group, different combined characteristics of the participants were closely linked to the total number and total severity scores of menopausal symptoms (P < 0.05). For instance, in African Americans, the total severity scores of menopausal symptoms increased among those who were postmenopausal (P < 0.001), US born (P < 0.001), and with low family income (P = 0.030). CONCLUSIONS: Specific risk groups by the combined characteristics need to be considered in future practice with midlife women.


Assuntos
Americanos Asiáticos , Grupo com Ancestrais do Continente Europeu , Árvores de Decisões , Feminino , Hispano-Americanos , Humanos , Menopausa , Estados Unidos/epidemiologia , Saúde da Mulher
19.
Environ Sci Technol ; 55(12): 8128-8138, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34078083

RESUMO

Hairdressers may be differentially exposed to phthalates through hair salon services provided and products used, yet no U.S. studies have investigated these exposures in this population. We characterized concentrations and exposure determinants to nine phthalate metabolites in postshift urine samples among 23 hairdressers from three Black and three Dominican salons, as well as a comparison group of 17 female office workers from the Maryland/Washington D.C. metropolitan area. Overall, hairdressers had higher metabolite concentrations than office workers. The geometric mean (GM) for monoethyl phthalate (MEP) was 10 times higher in hairdressers (161.4 ng/mL) than office workers (15.3 ng/mL). Hairdressers providing select services and using certain products had higher GM MEP concentrations than those who did not: permanent waves/texturizing (200.2 vs 115.4 ng/mL), chemical straightening/relaxing (181.6 vs 92.1 ng/mL), bleaching (182.3 vs 71.6 ng/mL), permanent hair color (171.9 vs 83.2 ng/mL), and Brazilian blowout/keratin treatments (181.4 vs 134.6 ng/mL). Interestingly, hairdressers providing natural services had lower GM MEP concentrations than those who did not: twists (129.1 vs 215.8 ng/mL), sister locs/locs (86.0 vs 241.9 ng/mL), and afros (94.7 vs 203.9 ng/mL). Larger studies are warranted to confirm our findings and identify disparities in occupational phthalate exposures.


Assuntos
Exposição Ocupacional , Ácidos Ftálicos , Afro-Americanos , Brasil , Exposição Ambiental , Feminino , Hispano-Americanos , Humanos , Maryland , Projetos Piloto , Washington
20.
West J Emerg Med ; 22(3): 660-666, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-34125043

RESUMO

INTRODUCTION: Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care. In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients - a majority of whom were UDLI and LLRC - participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization. METHODS: We conducted a multi-site study, surveying patients in three California safety-net EDs serving large immigrant populations from June 2017-December 2018. Of 1684 patients approached, 1337 (79.4%) agreed to participate; when given the option to provide open-ended comments, 260 participants provided perspectives about their experiences during the years immediately following the 2016 United States presidential election. We analyzed these qualitative data using constructivist grounded theory. RESULTS: We analyzed comments from 260 individuals. Among ED patients who provided qualitative data, 59% were women and their median age was 45 years (Interquartile range 33-57 years). Undocumented Latino immigrants comprised 49%, 31% were LLRC, and 20% were non-Latino legal residents. As their primary language, 68% spoke Spanish. We identified six themes: fear as a barrier to care (especially for UDLI); the negative impact of fear on health and wellness (physical and mental health, delays in care); factors influencing fear (eg, media coverage); and future solutions, including the need for increased communication about rights. CONCLUSION: Anti-immigrant rhetoric during the 2016 US presidential campaign contributed to fear and safety concerns among UDLI and LLRC accessing healthcare. This is one of the few studies that captured firsthand experiences of UDLI in the ED. Our findings revealed fear-based barriers to accessing emergency care, protective and contributing factors to fear, and the negative impact of fear. There is a need for increased culturally informed patient communication about rights and resources, strategic media campaigns, and improved access to healthcare for undocumented individuals.


Assuntos
Racismo , Imigrantes Indocumentados/psicologia , Adulto , California , Serviço Hospitalar de Emergência/organização & administração , Emigração e Imigração/legislação & jurisprudência , Medo/psicologia , Feminino , Acesso aos Serviços de Saúde , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Política , Pesquisa Qualitativa , Provedores de Redes de Segurança , Imigrantes Indocumentados/estatística & dados numéricos
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