Ethnicity & Disease最新文献

Objective: This study was conducted to assess the food environment (FE) within a historically Black university (HBU) and to examine the association between campus FE factors and metabolic health markers.

Design: Cross-sectional study and geographic information system (GIS) mapping.

Setting: Online survey among students of an HBU in Texas and GIS mapping of FE within 10 miles of the campus.

Participants: College students (n=390) 18-21 years of age, predominantly women (72.8%).

Result: Most of the participants obtained their fresh fruits and vegetables (FV) off campus from farmers' markets (2.8%), grocery shops within the county (7.3%), and grocery shops outside the county (43%). A majority (57.0%) of the participants carried out physical exercises less than 5 d/wk. Over 70% were unaware of the food pantry or meal share program, only 7.2% and 13.7%, respectively, used these campus resources. Food pantry awareness had significant associations with high blood pressure (P=.047) and high cholesterol (P=.048). Prediabetes was associated with quality of fresh FV (P=.017), the availability of a large selection of FV (P=.002), affordability of fresh FV (P=.008), and physical activity (P=.041). The campus FE variables explored significantly predicted prediabetes; participants who disagreed with the affordability of FV were more likely to have prediabetes (P=.044; odds ratio = 3.269; 95% confidence interval, [1.030, 10.375]).

Conclusions: Associations between campus FE factors and metabolic health indicators among this HBU population highlight the significance of interventions aimed at improving diet quality and increasing access to nutritious foods on campus.

Objective: Family-based health promotion and disease prevention strategies are recommended as best practice; however, there is limited knowledge regarding the family-level factors that influence modifiable behavior risk factors like physical activity (PA) among Latinx adolescents. This study addressed this knowledge gap by using qualitative methods to identify perceptions of family-level factors that influence PA among Hispanic youth.

Methods: We conducted semistructured, open-ended interviews with 20 Latinx adolescents (14-16 years) with obesity (body mass index ≥95th percentile) to identify their perceptions of how family influences PA. Content analysis was used to identify emergent themes, which were then compared across demographic factors, other identified themes, and participant-identified personal values.

Results: Fourteen adolescents (70%) perceived family factors that facilitated PA. They described family support received as doing PA together, modeling PA, and providing motivational or financial support. Ten adolescents (50%) viewed family as a barrier, more often citing active barriers such as family responsibilities. Across demographics, youth with divorced parents and parents who reported more working hours (≥40 hours per week) perceived their family as less supportive of PA. Additionally, perceptions of family support shaped self-identified health values (eg, being healthy and fit).

Conclusions: Family-based obesity prevention strategies should leverage factors that facilitate PA and should be designed to consider factors that serve as barriers to PA among this age group and population. Given that there is little guidance on the development and implementation of family-based obesity-prevention strategies, findings from this study will inform the development of future family-based prevention opportunities among high-risk youth and families.

Objectives: This study examined how Mexican and Central American immigrants' location of origin (in their home country) along the rural/urban continuum was associated with four selected dental outcomes among recent immigrants, prior to the 2020 COVID-19 pandemic.

Methods: Using baseline wave data from the 2017-2022 VidaSana study about the health and living environment of Mexican and Central American immigrants living in Indiana, this study used logistic regression models to examine the extent to which rural versus urban differences in location of origin and other sociodemographic variables predicted self-rated oral health, self-rated oral health knowledge, oral pain, and ever having fluoride applied in a dental office.

Results: The present analysis was based on 547 Mexican and Central American immigrant respondents (68% females; mean age, 34.4 years [SD, 11.2]; Central American: 42%; Mexican: 58%). A higher degree of rurality in the geographic location of origin was associated with less desirable oral health features.

Conclusions: The rural/urban divide is significantly associated with oral health impacts of Hispanic/Latinx groups. This may be partly due to the often-lower educational opportunities available and the socioeconomic status in rural areas, in comparison with more affluent urban locations; such disparity is likely to provide fewer opportunities to maintain a healthful status (eg, less access to actionable health maneuvers involving toothpaste, toothbrushes, and dental floss for good oral hygiene; or more limited access to dental offices). The degree of rurality in the location of origin appears to be one element in the complex health disparities landscape.

Social determinants of health (SDoH), health care use, and cardiovascular disease (CVD) risk perception are understudied among men who identify as Black and Hispanic. In this study we sought to describe these factors among a cohort of urban-residing Black men, participants in a community-engaged trial on hypertension prevention. We focused on presenting intermediary SDoH, including material circumstances, health behaviors, and psychosocial factors, which allow for a more robust understanding of health inequities but are underexplored. We analyzed baseline trial data (N=430) and compared subgroups (44% of participants self-identified as having Hispanic ethnicity and a Black racial identity). Average age was 38 years, with mean blood pressure of 129/83 mmHg. Hispanic Black (HB) men reported higher unemployment (21.4% versus 11.1%, P=.02) and more housing instability (28.7% versus 18.6%, P=.01) than did non-Hispanic Black (NHB) men. Overall, HB men reported worse household conditions compared with NHB men. Approximately half of both groups reported high stress, 45% (HB) and 51% (NHB), respectively. Both groups had low perception of personal CVD risk and underutilized health care. Hispanic Black men were less likely to have a primary care provider than were NHB men (17.6% versus 29.3%, P<.001). Non-Hispanic Black men reported lower physical activity than did HB men (median, 2655 vs 2547 metabolic equivalent minutes/week, P=.03). Recognizing heterogeneity among Black populations, including in social drivers of CVD disparities, will allow for more precision in designing CVD health promotion interventions. Findings also suggest that perception of personal CVD risk and health care utilization may be important targets for CVD prevention in Black men.

Objective: Given differences in disease presentation and potentially greater role of humoral immunity in Black patients with multiple sclerosis (MS) compared to White patients with MS, we analyzed the effectiveness of anti-CD20 therapies in the 2 groups of patients with relapsing MS. We included all anti-CD20 therapies and evaluated relapse rate, disability, and magnetic resonance imaging (MRI) outcomes.

Methods: This is an observational study of patients with MS with baseline and follow-up data, including race, annualized relapse rates (ARRs), Expanded Disability Status Scale (EDSS) score, new T2 lesions, and B-cell repletion. This is a chart review from Weill Cornell MS database.

Results: A total of 129 participants (42 Black patients with MS, 87 White patients with MS) aged 18-65 years with relapsing MS treated with anti-CD20 therapy, EDSS score ≤6.5, and ≥12 months follow-up were included in the study. There was no evidence of posttreatment ARR difference between groups (P=.696). Analysis of pretreatment data shows that at baseline, Black patients had, on average, 1.83 more relapses than White patients (95% CI, 1.14-2.92; P=.011). The percentage of patients with improved/stable/worsened EDSS score post treatment was similar in both groups.

Conclusions: Black patients with MS had higher baseline disability, relapse rates, and younger age at onset Both groups treated with anti-CD20 had similar reduced higher relapse rates and radiologic progression, with faster B-cell repletion post infusion in Black patients with MS.

Background: Individuals with severe mental illness (SMI)-schizophrenia, schizoaffective disorder, and bipolar disorder-are at higher risk for cardiovascular disease (CVD) than the general population. Black Americans are known to have a higher prevalence of cardiovascular risk factors. However, the association of SMI with CVD and its risk factors in this population has not been widely examined.

Methods: The analytic sample included 2305 participants from the African Ancestry-Genomic Psychiatric Cohort enrolled in Brooklyn, New York, between 2016 and 2020. SMI was identified by using the Diagnostic Interview for Psychoses and Affective Disorders. Associations between SMI and CVD and its risk factors, including high body mass index, diabetes, hypertension, and hypercholesterolemia, were evaluated by using logistic regression models adjusted for age, sex, alcohol, and tobacco use.

Results: After multivariable adjustment, compared to those without SMI, participants with SMI had significantly higher odds of CVD and CVD risk factors. After adjusting for all CVD risk factors mentioned above, SMI was independently associated with 57% higher odds of CVD (OR=1.57; 95% CI, 1.14-2.15). These associations were more pronounced among middle-aged adults (30-49 years), most notably for CVD (OR=5.13; 95% CI, 2.45-10.75), hypercholesterolemia (OR=2.88; 95% CI, 1.80-4.64), and diabetes (OR=3.08; 95% CI, 1.88-5.02).

Conclusions: In this sample, SMI was associated with higher CVD risk even after controlling for other CVD risk factors. There is an urgent need for earlier recognition and treatment of CVD and its risk factors in African American populations with SMI. Targeted clinical and lifestyle interventions in this population are warranted.

People living with HIV in sub-Saharan Africa bear a disproportionate burden of mental and behavioral health disorders compared with the general population. Several health care systems throughout the region have made efforts to integrate HIV and mental health care, but these systems have met challenges in long-term sustainability due to limited care continuity and insufficient attention to social determinants of health. In this commentary, we propose evidence-based recommendations for integrating HIV and mental health care that may overcome these barriers. These strategies include mental health screenings and referrals during routine HIV clinic visits, community-based mobile clinics and telemedicine to expand access to mental health services, concurrent mental health and HIV education within schools, and models for future health care innovation. These approaches have the potential to offer an entire continuum of care for people living with HIV and co-occurring mental health disorders, mitigating the dual burden of these conditions in sub-Saharan Africa.

Background: Diabetes mellitus (DM) is a global health concern that has affected various populations worldwide. Among the various methods to monitor the progress and management of DM, glycosylated hemoglobin (HbA_1c) serves as a key marker for understanding long-term glucose control. The Mayan populations of Yucatan represent a unique demographic in which the prevalence and management of DM can be distinctively analyzed.

Method: In this study, HbA_1c levels were monitored over 12 months in 1722 patients with DM from 17 medical units of the Mexican Institute of Social Security in the southern region of Yucatan. Based on initial HbA_1c levels, patients were assigned to either standard or intensive treatment. Treatment efficacy was analyzed based on sex, age, and location.

Results: HbA_1c levels significantly decreased in patients receiving intensive treatment, from means (±SD) of 9.7±1.9% to 8.9±2.0% after 12 months (P=.001), with notable reductions in remote areas such as Akil and Huntochac (P<.05). Although slight reductions were observed among women and middle-aged individuals, these reductions were not statistically significant (P=.2 and P=.4, respectively). Despite the initial improvement, standard treatment was more effective for maintaining long-term glycemic stability, with lower variability and better adherence. However, a 10% increase in HbA_1c was observed in this group by the end of the study.

Conclusion: Monitoring of DM in Mayan populations revealed significant HbA_1c reductions with intensive treatment, especially in remote areas. Consequently, strategies to improve primary care and promote self-care in DM patients in the Mayan population must be implemented.

Setting: In this commentary, 5 women of color who are engaged in different aspects of the research mission at the University of Vermont weigh in on the historical importance, current rationale, and persisting barriers to impactful health equity research.

Objective: Based on existing information, we delineate recommendations to grow capacity in this and similar majority White academic medical centers.

Conclusion: Our assertion is that an evolving, robust, and engaged infrastructure to support this research will benefit patients, faculty, and systems by providing evidence-based and culturally competent solutions that center and enhance the overall health of marginalized populations.