A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US-Mexico border region.

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)-Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient-provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient-provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US-Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

A binational study of patient-initiated changes to antiretroviral therapy regimen among HIV-positive Latinos living in the Mexico-U.S. border region.

Research is lacking on factors associated with antiretroviral therapy (ART) sub-optimal adherence among U.S. Latinos, who are disproportionately affected by HIV and face substantial health care barriers. We examined self-reported, patient-initiated changes to ART (i.e., made small/major changes from the antiretroviral drugs prescribed) among HIV-positive Latinos. Trained interviewers administered surveys to 230 participants currently on ART in San Diego, U.S. and Tijuana, Mexico. We identified factors independently associated with ART changes. Participants were Spanish-language dominant (86%), mean age of 41 years, male (77%), and born in Mexico (93%). Patient-initiated changes to ART were reported in 43% of participants. Being female, having ≥1 sexual partner (past 3 months), ≤6 years since HIV diagnosis and poor health were associated with increased odds of ART changes. Findings raise concern about sub-optimal adherence among this binational population. Longitudinal studies are needed to further explore adherence barriers and avenues for intervention.

Choosing sides: HIV health care practices among shared populations of HIV-positive Latinos living near the US-Mexico border.

BACKGROUND: We compared HIV-positive patients receiving care in the border cities of San Diego, United States, with Tijuana, Mexico. METHODS: Participants were HIV-positive Latinos (n = 233) receiving antiretroviral therapy (ART) from San Diego-Tijuana clinics (2009-2010). Logistic regression identified correlates of receiving HIV care in San Diego versus Tijuana. RESULTS: Those with their most recent HIV visit in San Diego (59%) were more likely to be older, have at least a high school education, and were less likely to have been deported than those with last visits in Tijuana. Despite reporting better patient-provider relationships and less HIV-related stigma than those with visits in Tijuana, San Diego patients were twice as likely to make unsupervised changes in their ART regimen. CONCLUSIONS: We observed poorer relative adherence among HIV-positive Latinos receiving care in San Diego, despite reports of good clinical relationships. Further study is needed to ascertain underlying reasons to avoid ART-related resistance.

The Development of a Collaborative Binational Strategy to Support the San Diego-Tijuana Transborder Community During the COVID-19 Pandemic.

The COVID-19 pandemic illustrates the need for and importance of cross-border public health collaboration. San Diego, California and Tijuana, Baja California are an interconnected region with one of the busiest international borders in the world and hundreds of thousands bi-directional crossings each day. As the sister cities witnessed the rising case numbers early in the pandemic, it became essential and urgent to implement a formal structure to facilitate cross-border COVID-19 communication, coordination, and collaboration. The present article describes how the development of a Collaborative Binational Strategy led to coordinated outreach and initiatives that addressed access and equity in the transborder region. Through examples, the article illustrates how regional leaders in San Diego and Tijuana harnessed existing transborder partnerships to collaboratively build infrastructure and communication pathways to exchange data, guidance, troubleshoot shared challenges, build capacity, and establish cross-border testing and vaccine opportunities. The challenges, lessons learned, and best practices may inform other multi-level, interdisciplinary, and cross-border jurisdictions on how to support a transborder community during a pandemic or other health emergency.

The Partner Relay Communication Network: Sharing Information During Emergencies with Limited English Proficient Populations.

Sharing information with people with limited English proficiency is a universal challenge. The County of San Diego has a diverse population and, as a result, language and access barriers present serious risks when communicating disaster and public health emergency information. In support of the "Live Well San Diego" vision of a county that is healthy, safe, and thriving, the County of San Diego Office of Emergency Services and Health and Human Services Agency, Public Health Services, worked to design a community-based program to address this critical issue. Program development included a literature review of existing strategies as well as gathering community input. Documented promising practices included: (1) community engagement during planning, design, and implementation of communication plans to create buy-in and a sense of ownership; (2) dissemination of translated messages; and (3) communication through culturally appropriate and trusted channels, including individuals, community groups, and organizations. Using a systematic approach, the program engaged leaders and community representatives of the top 6 languages spoken in San Diego (following English)-Spanish, Tagalog, Chinese, Arabic, Korean, and Vietnamese-and 2 recently arrived refugee groups, Karen and Somali. Community input was gathered through focus groups, feedback sessions, training sessions, and drills. The community's recommendations mirrored the existing promising practices, and a program strategy was adopted.

The Border Health Consortium of the Californias-Forming a Binational (California-Baja California) Entity to Address the Health of a Border Region: A Case Study.

The California-Baja California border region is one of the most frequently traversed areas in the world with a shared population, environment, and health concerns. The Border Health Consortium of the Californias (the "Consortium") was formed in 2013 to bring together leadership working in the areas of public health, health care, academia, government, and the non-profit sector, with the goal of aligning efforts to improve health outcomes in the region. The Consortium utilizes a Collective Impact framework which supports a shared vision for a healthy border region, mutually reinforcing activities among member organizations and work groups, and a binational executive committee that ensures continuous communication and progress toward meeting its goals. The Consortium is comprised of four binational work groups which address human immunodeficiency virus, tuberculosis, obesity, and mental health, all mutual priorities in the border region. The Consortium holds two general binational meetings each year alternating between California and Baja California. The work groups meet regularly to share information, resources and provide binational training opportunities. Since inception, the Consortium has been successful in strengthening binational communication, coordination, and collaboration by providing an opportunity for individuals to meet one another, learn about each other systems, and foster meaningful relationships. With binational leadership support and commitment, the Consortium could certainly be replicated in other border jurisdictions both nationally and internationally. The present article describes the background, methodology, accomplishments, challenges, and lessons learned in forming the Consortium.

The California Border Health Collaborative: A Strategy for Leading the Border to Better Health.

There are hundreds of people and organizations working on border health issues in the California-Baja California border region trying to protect and improve health. These efforts are being conducted without a collaborative structure that integrates jurisdictions and organizations. Thus, there is a need to coordinate these organizations to work together and benefit from their collective effort and each other's best practices. The outcome of such an effort could effectively improve the health in the border region. The newly developed "California Border Health Collaborative" unites organizations and provides the leadership and collaborative culture to positively improve the health of the border region; it is referred to as the "Collaborative." This article describes the developmental process of this Collaborative, including partner engagement, governance, strategic planning, key elements for success, the roles of multi-level jurisdictions, and policy implications. This paper focuses on describing the preparation and processes that created the U.S./California side of this binational collaborative effort and is a strong reflection of the theory of border collaboration as described by Denman and De Sonora (1) in "Working beyond Borders: A Handbook for Transborder Projects in Health."

One Bioregion/One Health: An Integrative Narrative for Transboundary Planning along the US-Mexico Border.

Global megatrends-including climate change, food and water insecurity, economic crisis, large-scale disasters and widespread increases in preventable diseases-are motivating a bioregionalisation of planning in city-regions around the world. Bioregionalisation is an emergent process. It is visible where societies have begun grappling with complex socio-ecological problems by establishing place-based (territorial) approaches to securing health and well-being. This article examines a bioregional effort to merge place-based health planning and ecological restoration along the US-Mexico border. The theoretical construct underpinning this effort is called One Bioregion/One Health (OBROH). OBROH frames health as a transborder phenomenon that involves human-animal-environment interactions. The OBROH approach aims to improve transborder knowledge networking, ecosystem resilience, community participation in science-society relations, leadership development and cross-disciplinary training. It is a theoretically informed narrative to guide action. OBROH is part of a paradigm shift evident worldwide; it is redefining human-ecological relationships in the quest for healthy place making. The article concludes on a forward-looking note about the promise of environmental epidemiology, telecoupling, ecological restoration, the engaged university and bioregional justice as concepts pertinent to reinventing place-based planning.

Sedentary behaviors of adults in relation to neighborhood walkability and income.

OBJECTIVE: Sedentary (sitting) time is a newly identified risk factor for obesity and chronic diseases, which is behaviorally and physiologically distinct from lack of physical activity. To inform public health approaches to influencing sedentary behaviors, an understanding of correlates is required. METHODS: Participants were 2,199 adults aged 20-66 years living in King County/Seattle, WA, and Baltimore, MD, regions, recruited from neighborhoods high or low on a "walkability index" (derived from objective built environment indicators) and having high or low median incomes. Cross-sectional associations of walkability and income with total sedentary time (measured by accelerometers and by self-report) and with self-reported time in seven specific sitting-related behaviors were examined. RESULTS: Neighborhood walkability and income were unrelated to measures of total sitting time. Lower neighborhood walkability was significantly associated with more driving time (difference of 18.2 min/day, p < .001) and more self-reported TV viewing (difference of 14.5 min/day, p < .001). Residents of higher income neighborhoods reported more computer/Internet and reading time, and they had more objectively measured sedentary time. CONCLUSIONS: Neighborhood walkability was not related to total sedentary time but was related to two specific sedentary behaviors associated with risk for obesity-driving time and TV viewing time. Future research could examine how these prevalent and often prolonged sedentary behaviors mediate relationships between neighborhood walkability and overweight/obesity. Initiatives to reduce chronic disease risk among residents of both higher-and lower-income low-walkable neighborhoods should include a focus on reducing TV viewing time and other sedentary behaviors and enacting policies that can lead to the development or redevelopment of more-walkable neighborhoods. (PsycINFO Database Record (c) 2012 APA, all rights reserved).