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2.
MMWR Morb Mortal Wkly Rep ; 69(40): 1437-1442, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031362

RESUMO

During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Acesso aos Serviços de Saúde , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Adesão à Medicação/etnologia , Adolescente , Adulto , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
3.
PLoS One ; 15(9): e0238919, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925952

RESUMO

OBJECTIVES: Material well-being, beliefs, and emotional states are believed to influence one's health and longevity. In this paper, we explore racial differences in self-rated health, happiness, trust in others, feeling that society is fair, believing in God, frequency of sexual intercourse, educational attainment, and percent in poverty and their association with mortality. STUDY DESIGNS: Age-period-cohort (APC) study. METHODS: Using data from the 1978-2014 General Social Survey-National Death Index (GSS-NDI), we conducted APC analyses using generalized linear models to quantify the temporal trends of racial differences in our selected measures of well-being, beliefs, and emotional states. We then conducted APC survival analysis using mixed-effects Cox proportional hazard models to quantify the temporal trends of racial differences in survival after removing the effects of racial differences in our selected measures. RESULTS: For whites, the decline in happiness was steeper than for blacks despite an increase in high school graduation rates among whites relative to blacks over the entire period, 1978-2010. Self-rated health increased in whites relative to blacks from 1978 through 1989 but underwent a relative decline thereafter. After adjusting for age, sex, period effects, and birth cohort effects, whites, overall, had higher rates of self-rated health (odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.63, 2.16), happiness (OR = 2.05; 1.77, 2.36), and high school graduation (OR = 2.88; 2.34, 3.53) compared with blacks. Self-rated health, happiness, and high school graduation also mediated racial differences in survival over time. CONCLUSIONS: We showed that some racial differences in survival could be partly mitigated by eliminating racial differences in health, happiness, and educational attainment. Future research is needed to analyze longitudinal clusters and identify causal mechanisms by which social, behavioral, and economic interventions can reduce survival differences.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Adulto , Idoso , Comportamento , Estudos de Coortes , Emoções , Feminino , Humanos , Longevidade , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Análise de Sobrevida , Estados Unidos/etnologia
4.
AIDS Educ Prev ; 32(3): 229-242, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749875

RESUMO

Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Relações Comunidade-Instituição , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Hispano-Americanos/educação , Marketing Social , Estigma Social , Migrantes/educação , Baltimore , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Mídias Sociais , Migrantes/psicologia , Estados Unidos
5.
PLoS One ; 15(8): e0236706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760146

RESUMO

INTRODUCTION: Due to provider shortages, it is probable that non-Latinx health care providers (HCPs) will treat Latinx patients. Because of this discrepancy, both providers and patients are likely to experience barriers and cultural differences during medical encounters. This article discusses select cultural factors and behaviors such as language, communication styles, and health care practices of Latinx families through the lens of their non-Latinx HCPs. The purpose of this study was to examine how non-Latinx HCPs perceive and describe certain behaviors they observe during healthcare visits with Latinx patients and families, and to illustrate how those behaviors can alternatively be interpreted as representing Latinx cultural norms. METHODS: This qualitative study used a template coding approach to examine narrative interviews conducted with 18 non-Latinx HCPs to report how they described interactions with and the behaviors of their Latinx patients. Template codes were based on well-established Latinx cultural norms (e.g., familismo, respeto, personalismo, simpatía, confianza). RESULTS: Many HCP descriptions of Latinx patient behaviors were coded into the Latinx cultural values categories (familismo, personalismo, simpatía, respeto, and confianza) by the research team. Results suggest that HCPs were not aware of how several of their patients' behaviors may be culturally grounded, and that cultural differences between HCPs and their Latinx patients may exist. DISCUSSION: Understanding how Latinx-specific cultural norms may be exhibited by Latinx patients and their families during healthcare encounters has potential to improve providers' understanding of patient behavior, helping to promote culturally congruent care for Latinxs.


Assuntos
Assistência à Saúde/normas , Comportamentos Relacionados com a Saúde/etnologia , Pessoal de Saúde/psicologia , Hispano-Americanos/psicologia , Pesquisa Qualitativa , Adulto , Família , Feminino , Equidade em Saúde , Humanos , Renda , Masculino , Relações Profissional-Paciente
6.
AIDS Patient Care STDS ; 34(8): 344-355, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757979

RESUMO

Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/psicologia , Adesão à Medicação/etnologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Aculturação , Adulto , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Fatores Socioeconômicos , Estresse Psicológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
7.
J Anxiety Disord ; 75: 102291, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32827869

RESUMO

OBJECTIVE: COVID-19 is rearranging our society with fear and worry about the novel coronavirus impacting the mental health of Americans. The current study examines the intersection of COVID-19 fear, worries and perceived threat with social vulnerabilities and mental health consequences, namely anxiety and depressive symptomatology. METHODS: Using an online platform, a national sample (n = 10, 368) of U.S. adults was surveyed during the week of March 23, 2020. The sample was post-strata weighted to ensure adequate representation of the U.S. population based on population estimates for gender, race/ethnicity, income, age, and geography. RESULTS: Fear and worry are not distributed equally across the country; rather they are concentrated in places where the largest number of confirmed COVID-19 cases is found. Additionally, data highlight significant differences in the subjective perception of distress across groups with varying social vulnerabilities. Women, Hispanics, Asians, families with children under 18, and foreign-born respondents reported higher levels of subjective fear and worry compared to their counterparts. Finally, even after controlling for social vulnerability, subjective assessments of distress were positive, and significantly related to anxiety and depressive symptomatology; prior mental health research from China and Europe confirm what others have begun to document in the United States. CONCLUSIONS: This preliminary work provides practitioners with a glimpse of what lies ahead, which individuals and communities may be the most vulnerable, and what types of strategic interventions might help to address a wide range of mental health consequences for Americans in the months and years ahead.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/epidemiologia , Medo , Inquéritos Epidemiológicos , Saúde Mental/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Betacoronavirus , Criança , Depressão/epidemiologia , Grupos Étnicos/psicologia , Medo/psicologia , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Mulheres/psicologia , Adulto Jovem
8.
J Infect Dis ; 222(10): 1607-1611, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-32860499

RESUMO

We investigated individual behaviors taken by white, African American, and Latino United States (US) households in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and likelihood of using digital tools for symptom surveillance/reporting. We analyzed cross-sectional week 1 data (April 2020) of the coronavirus disease 2019 (COVID-19) Impact Survey in a large, nationally representative sample of US adults. In general, all groups engaged in the same prevention behaviors, but whites reported being more likely to use digital tools to report/act on symptoms and seek testing, compared with African Americans and Latinos. Individual behaviors may not explain COVID-19 case disparities, and digital tools for tracking should focus on uptake among race/ethnic minorities.


Assuntos
Afro-Americanos/psicologia , Atitude Frente a Saúde/etnologia , Betacoronavirus , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/epidemiologia , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Pneumonia Viral/etnologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Estudos Transversais , Características da Família , Feminino , Disparidades nos Níveis de Saúde , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Probabilidade , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto Jovem
9.
BMC Womens Health ; 20(1): 141, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631299

RESUMO

BACKGROUND: Male spouses and partners play an important role in determining a woman's willingness to participate in cervical cancer screening. However, the attitudes and behaviors by which they influence a woman's decision to undergo Pap testing remain poorly understood. METHODS: A series of semi-structured, qualitative interviews were conducted in Spanish with 19 recent Latino immigrants in Houston, Texas. The interview format was designed to establish each individual's pattern of engagement with the United States healthcare system, assess baseline knowledge of cervical cancer screening and evaluate attitudes and patterns of communication with their female partners regarding health care. Interview questions were constructed using principles of the Theory of Reasoned Action. All interviews were conducted in Spanish. After translation, responses were coded and scored with the goal of identifying themes and key observations. RESULTS: Most subjects reported few, if any, interactions with the healthcare system since their arrival in the United States. Although most participants reported being aware that women should be seen by their doctors regularly, fewer than half could clearly indicate the purpose of a Pap test or could state with certainty the last time their female partner had undergone screening. Multiple subjects expressed a general distrust of the health care system and concern for its costs. Approximately half of subjects reported that they accompanied their female partner to the health care provider's office and none of the participants reported that they were present in examination rooms at the time their partner underwent screening. Multiple participants endorsed that there may be some concerns within their community regarding women receiving frequent gynecologic care and distrust of the healthcare system. Almost all interviewed subjects stated that while they would allow their female partners to see male physicians, they also expressed the opinion that other men might be uncomfortable with this and that women would likely be more comfortable with female physicians. CONCLUSIONS: Strategies to enhance knowledge of HPV and cancer screening and improve trust in the health care system among male spouses or partners should be explored with the goal of promoting cervical cancer screening among immigrant Latinx populations.


Assuntos
Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Programas de Rastreamento/psicologia , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Teste de Papanicolaou , Pesquisa Qualitativa , Texas/epidemiologia , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/psicologia
10.
PLoS One ; 15(7): e0234821, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628674

RESUMO

This mixed-methods study examined awareness of and willingness to use pre-exposure prophylaxis (PrEP) among sexually active Black and Latinx adolescents (13-17 years) residing in five cities in the United States with some of the highest burden of HIV. Data are from adolescents who participated in a cross-sectional survey (n = 208) and one-on-one interviews and focus groups (n = 26) conducted from September 2017-August 2019. Approximately 50% of the sample were recruited through community efforts, and the other half through a panel. Logistic regression with covariates including sexual orientation, relationship status, socioeconomic status, and race/ethnicity were used to assess factors associated with PrEP awareness and willingness. For the qualitative data, thematic analysis was used to develop a codebook of a-priori and inductive codes while analytic memos were written to identify key themes. PrEP awareness was reported by 38% of the sample and was associated with Black race (AOR = 0.49; 95% CI = 0.27, 0.90) and prior HIV testing (AOR = 3.89, 95% CI = 1.25, 12.08). PrEP willingness (defined as "definitely would use PrEP") was reported by 22% of the sample and was associated with higher age, more education, having had condomless sex in the past 6 months (AOR = 0.23; 95% CI = 0.10, 0.56), perceived likelihood of acquiring HIV (AOR = 3.59; 95% CI = 1.06, 12.21), and PrEP awareness (AOR = 0.41; 95% CI = 0.19, 0.89). Qualitative data showed that misconceptions about PrEP persist and PrEP stigma, fear of being punished, provider attitudes and recommendations, and empowerment were related to adolescents' willingness to use PrEP. Study findings reveal important strategies for improving PrEP delivery and scale-up to Black and Latinx adolescents. These strategies include using sociodemographic and health behavior data to target adolescents who may be more or less willing to use PrEP, improving provider communication about PrEP, and creating culturally and developmentally appropriate PrEP education materials that address common misconceptions held by adolescents.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/tendências , Adolescente , Afro-Americanos/psicologia , Conscientização , Estudos Transversais/métodos , Feminino , Infecções por HIV/epidemiologia , Hispano-Americanos/psicologia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/métodos , Prevalência , Comportamento Sexual , Parceiros Sexuais , Inquéritos e Questionários , Estados Unidos
11.
JAMA Netw Open ; 3(6): e2012403, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-607323

RESUMO

Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Comportamentos de Risco à Saúde/fisiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Cultura , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Renda/tendências , Conhecimento , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
12.
BMC Public Health ; 20(1): 863, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503551

RESUMO

BACKGROUND: Nitrate contamination in groundwater disproportionately impacts agricultural Latino communities, creating a significant hazard for Latinos that rely on private wells. Private well users must conduct water testing and other well stewardship behaviors to ensure that their well water is safe to drink. This study sought to identify the key factors impacting private well water testing behavior in rural, agricultural Latino communities. METHODS: We conducted 4 focus groups with private well users, 2 in Spanish and 2 in English. We recruited 37 participants from the Lower Yakima Valley, Washington State, a rural, agricultural community with a large Latino population and elevated nitrate concentrations in groundwater. A semi-structured interview guide was developed to capture factors impacting testing as guided by the Risk, Attitudes, Norms, Ability, and Self-Regulation (RANAS) model. Inductive thematic analysis was conducted by two coders to identify common themes. RESULTS: Themes emerged around the factors impacting well stewardship, including well water testing, treatment, and maintenance, and were not specific to nitrate contamination. Private well users reported many of the same factors reported in other communities, with the exception of home repair experience and challenges around landlords and neighbors on shared wells, which have not been reported previously. In addition to landlords and neighbors, lack of actionable information, economic limitations, and lack of technical support emerged as factors that made well stewardship burdensome for individuals. The majority of participants reported using bottled water, including many who used point-of-use or point-of-entry water treatment systems. CONCLUSIONS: The burden of well stewardship in rural, agricultural Latino communities may suggest the need for interventions at the community, county, or state levels and not at the individual level alone. Additionally, the role of landlords, neighbors on shared wells, and home repair experience in well stewardship represent important areas of exploration for researchers and public health practitioners.


Assuntos
Fazendeiros/psicologia , Hispano-Americanos/psicologia , Setor Privado , Purificação da Água , Poços de Água , Adulto , Agricultura , Feminino , Grupos Focais , Água Subterrânea/análise , Humanos , Masculino , Nitratos/análise , Pesquisa Qualitativa , População Rural , Washington , Poluentes Químicos da Água/análise , Abastecimento de Água
13.
Clin Obes ; 10(5): e12386, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32515555

RESUMO

How the impact of the COVID-19 stay-at-home orders is influencing physical, mental and financial health among vulnerable populations, including those with obesity is unknown. The aim of the current study was to explore the health implications of COVID-19 among a sample of adults with obesity. A retrospective medical chart review identified patients with obesity from an obesity medicine clinic and a bariatric surgery (MBS) practice. Patients completed an online survey from April 15, 2020 to May 31, 2020 to assess COVID-19 status and health behaviours during stay-at-home orders. Logistic regression models examined the impact of these orders on anxiety and depression by ethnic group. A total of 123 patients (87% female, mean age 51.2 years [SD 13.0]), mean BMI 40.2 [SD 6.7], 49.2% non-Hispanic white (NHW), 28.7% non-Hispanic black, 16.4% Hispanic, 7% other ethnicity and 33.1% completed MBS were included. Two patients tested positive for severe acute respiratory syndrome coronavirus 2 and 14.6% reported symptoms. Then, 72.8% reported increased anxiety and 83.6% increased depression since stay-at-home orders were initiated. Also 69.6% reported more difficultly in achieving weight loss goals, less exercise time (47.9%) and intensity (55.8%), increased stockpiling of food (49.6%) and stress eating (61.2%). Hispanics were less likely to report anxiety vs NHWs (adjusted odds ratios 0.16; 95% CI, 0.05-0.49; P = .009). Results here showed the COVID-19 pandemic is having a significant impact on patients with obesity regardless of infection status. These results can inform clinicians and healthcare professionals about effective strategies to minimize COVID-19 negative outcomes for this vulnerable population now and in post-COVID-19 recovery efforts.


Assuntos
Ansiedade/psicologia , Infecções por Coronavirus/epidemiologia , Depressão/psicologia , Exercício Físico , Comportamento Alimentar/psicologia , Comportamentos Relacionados com a Saúde , Obesidade/terapia , Pneumonia Viral/epidemiologia , Perda de Peso , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Ansiedade/epidemiologia , Medicina Bariátrica , Cirurgia Bariátrica , Betacoronavirus , Depressão/epidemiologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Pandemias , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
15.
BMC Public Health ; 20(1): 840, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493245

RESUMO

BACKGROUND: Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program. METHODS: We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program. RESULTS: Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials. CONCLUSIONS: Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos.


Assuntos
Afro-Americanos/educação , Ensaios Clínicos como Assunto/psicologia , Assistência à Saúde Culturalmente Competente/métodos , Educação em Saúde/métodos , Hispano-Americanos/educação , Sujeitos da Pesquisa/educação , Adulto , Afro-Americanos/psicologia , Idoso , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , Pesquisa Qualitativa , Sujeitos da Pesquisa/psicologia
16.
JAMA Netw Open ; 3(6): e2012403, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32556260

RESUMO

Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Comportamentos de Risco à Saúde/fisiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Cultura , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Renda/tendências , Conhecimento , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
17.
BMC Public Health ; 20(1): 603, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357943

RESUMO

BACKGROUND: With the rapid advances in gene technologies in recent years, the potential benefits of precision medicine (PM) may spread unevenly to disadvantaged populations, such as Hispanics/Latinos. The objective of this study was to explore patient-level barriers and facilitators to dissemination and adoption of PM among Hispanics/Latinos, including knowledge and awareness. METHODS: Self-identified Hispanics/Latinos from diverse countries in Latin America (N = 41) participated in the study. Using a cross-sectional observational qualitative research design, six focus groups and a demographic questionnaire were collected in English and Spanish. Qualitative content analysis was utilized to code the transcripts and identify emerging themes. RESULTS: Hispanics/Latinos never heard of and had no knowledge about PM. Barriers to dissemination and adoption of PM included lack of health insurance, financial burden, participants' immigration status, distrust of government, limited English proficiency, low literacy levels, cultural norms, fear about genetic testing results, lack of transportation, newness of PM, and lack of information about PM. Facilitators included family support; information provided in Spanish; use of plain language and graphics; assistance programs for uninsured; trust in physicians, healthcare staff, well-known hospitals, academic institutions, and health care providers and community organization as sources of reliable information; personal motivation, and altruism or societal benefit. CONCLUSIONS: Culturally-and linguistically-tailored, low-literacy educational material about PM should be created in English and Spanish. Future research should examine provider-level and system-level barriers and facilitators to implementation and adoption of PM among Hispanic/Latino patients.


Assuntos
Barreiras de Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Medicina de Precisão/psicologia , Medicina de Precisão/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Grupos Focais , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
18.
BMC Health Serv Res ; 20(1): 375, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366309

RESUMO

BACKGROUND: Approaches that move beyond individuals and target couples may be an effective strategy for reducing sexual and reproductive health (SRH) disparities among adolescents and young adults (AYA). However, few researchers have attempted to recruit couples due to feasibility and methodological issues. This study aims to enhance implementation and methodological approaches to successfully engage heterosexual Black and Latino adolescent and young adult (AYA) couples in sexual reproductive health (SRH) research. METHODS: We developed a four-step approach to systematically engage AYA couples in a qualitative study examining factors that influence uptake of combination HIV prevention methods: 1) understanding barriers and facilitators to engaging AYA couples, (2) identifying AYAs living in geographic areas of HIV vulnerability, (3) recruiting and screening AYA couples, and (4) scheduling and completion of the interview session. RESULTS: Black and Latino youth aged 16 to 24 and their opposite sex romantic were recruited in the South Bronx, New York from September 2017-May 2018. Three hundred and seventy-two men and women completed screening procedures to determine eligibility for the index participant; 125 were eligible and enrolled into the study. Forty-nine nominated partners (NPs) participated in screening procedures and enrolled into the study. A total of 49 couples enrolled into the study; 23 couples completed study activities. CONCLUSIONS: Developing a systematic recruitment plan aided in successfully engaging Black and Latino heterosexual youth. Nevertheless, barriers to study enrollment remained including locating eligible IPs and screening of the NP. Targeting both young men and women was an effective recruitment strategy. Moreover, dyadic strategies that allow for simultaneous interaction with both couple members may be a beneficial strategy to couples' study enrollment and completion of study activities.


Assuntos
Afro-Americanos/psicologia , Pesquisa sobre Serviços de Saúde/métodos , Heterossexualidade/etnologia , Hispano-Americanos/psicologia , Saúde Reprodutiva , Saúde Sexual , Adolescente , Afro-Americanos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , New York , Adulto Jovem
19.
Int J Behav Med ; 27(4): 357-365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32394220

RESUMO

BACKGROUND: Latina breast cancer survivors (BCS) often report poorer health-related quality of life (HRQOL), higher symptom burden, and greater psychosocial needs compared to non-Latina BCS. However, Latinas are underrepresented in cancer survivorship research and more work is needed to examine the factors contributing to these psychosocial disparities. This study aimed to evaluate potentially modifiable patient characteristics associated with HRQOL, breast cancer concerns, and cancer-specific distress among Latina BCS. METHODS: Baseline data was evaluated in 95 Latina BCS who participated in a smartphone-based psychosocial intervention designed to improve HRQOL. Hierarchical linear regression analyses were conducted to evaluate the associations between modifiable factors that have been shown to favorably impact outcomes in cancer populations (i.e., cancer-relevant self-efficacy, breast cancer knowledge) with overall and domain-specific HRQOL, breast cancer symptom burden, and cancer-specific distress, after controlling for sociodemographic and cancer-related characteristics. RESULTS: Greater cancer-relevant self-efficacy was related to better overall HRQOL as well as better social, emotional, and functional well-being domains. Greater cancer-relevant self-efficacy was also related to less breast cancer symptom burden and less cancer-specific distress. Breast cancer knowledge was not associated with any of the study outcomes. CONCLUSIONS: Results demonstrate that cancer-relevant self-efficacy is a significant correlate of general and domain-specific HRQOL, breast cancer symptom burden, and cancer-specific distress among Latina BCS. Future interventions in this population should target cancer-relevant self-efficacy as a possible mechanism to improve HRQOL outcomes and survivorship experiences for Latina BCS.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Qualidade de Vida/psicologia , Autoeficácia , Adulto , Feminino , Hispano-Americanos/psicologia , Humanos , Pessoa de Meia-Idade , Projetos Piloto
20.
BMC Womens Health ; 20(1): 80, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326922

RESUMO

BACKGROUND: We explore the social network characteristics associated with depressive symptoms and social support among HIV-infected women of color (WOC). METHODS: Network data were collected from 87 HIV-infected WOC at an academic Infectious Disease clinic in the United States (US) south. With validated instruments, interviewers also asked about depressive symptoms, social support, and treatment-specific social support. Linear regression models resulted in beta coefficients and 95% confidence intervals for the relationships among network characteristics, depression, and support provision. RESULTS: Financial support provision was associated with lower reported depressive symptoms while emotional support provision was associated with increased reported social support. Talking less than daily to the first person named in her network, the primary alter, was associated with a nearly 3-point decrease in reported social support for respondents. Having people in their social network who knew their HIV status was also important. CONCLUSIONS: We found that both functional and structural social network characteristics contributed to perceptions of support by HIV-infected WOC.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Depressão/etnologia , Infecções por HIV/complicações , Hispano-Americanos/psicologia , Rede Social , Apoio Social , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Estudos Transversais , Depressão/etiologia , Depressão/psicologia , Feminino , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Saúde Mental , Pessoa de Meia-Idade , North Carolina/epidemiologia , Autorrelato
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