Participation in COVID-19 clinical trials, willingness to participate, and trust in sources of information among persons with and without cancer in Puerto Rico

Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.

HPV and COVID-19 vaccines attitudes and preferred sources of information among adults living in Puerto Rico

Prior to the COVID-19 pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. Yet, widespread misleading information about the COVID19 vaccine might negatively impact HPV vaccine attitudes. This study aims to assess and compare HPV and COVID-19 vaccines attitudes toward school-entry policies among adults living in PR. A convenience sample of 222 adults (>=21 years old) living in PR were recruited through social media and completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID-19 vaccines knowledge (ranging from 0=none to 3=high knowledge), attitudes toward vaccination policies for school-entry, and perceptions of trusted and untrusted sources of information. Descriptive statistics were computed to identify the demographics characteristics of the participants. We also estimated the prevalence ratio (PRadjusted) using a logistic regression model to assess the magnitude of association between COVID-19 vaccination for the school-entry policy and HPV vaccination for school-entry policy agreement, adjusting for different confounders. The mean age of the study sample was 36.73 +/- 11.18 years. The majority of the sample were female (87%, n=194), with at least some college of education (92%;n=205) and employed (61%;n=165). One-fifth of the participants reported having children between ages 11 and 16 (n=46). Participants' perceived knowledge about the HPV vaccine was moderate (mean=1.72;SD=1.12), while for COVID-19 vaccine was moderately high (mean=2.47;SD=.68). The most trusted form of information for HPV and COVID-19 vaccines were health care providers (42% and 17%, respectively), the Centers for Disease Control and Prevention (35% and 55%, respectively), and the Department of Health (15% and 19%, respectively). The least trusted source of information included social media (40% and 39%, respectively), friends and family (23% n=47, and 17% n=33, respectively), and the Department of Health (15% n=30, and 18% n=36, respectively). More than half of the participants agreed that HPV (76% n=156) and COVID vaccines (69% n=136) should be required for school-entry. Agreement with COVID-19 vaccination for the school-entry policy was significantly associated with HPV vaccination for school-entry policy agreement (PRadjusted:1.96;95% CI:1.48-2.61) after controlling for age, sex, education, and having children between age 11 and 16. Findings suggest that adults living in PR have an overall positive attitude about mandatory HPV and COVID-19 vaccination school-entry policies, and these attitudes are interrelated. Yet, it is concerning that the Department of Health is identified as one of the least trusted sources of information, as it has a prominent role in implementing HPV and COVID-19 vaccine policies in PR. Further research should elucidate why the Department of Health is considered an untrusted source of information among adults living in PR and evaluate the implications of the COVID-19 pandemic on HPV vaccine attitudes and adherence rates.

Online Cognitive-Behavioral Intervention on Adherence and Quality of Life in Elderly Adults with Diabetes: Two cases study

During the COVID-19 pandemic, elderly adults with type 2 diabetes mellitus (T2DM) have experienced difficulties to adhere to their therapy (TA), a situation which not only has had an impact on their glycemic control, but on their quality of life (QoL) as well. Telepsychology has proved to be an effective alternative to treat health-related complications in patients with this disease, however, results of same are unknown among the Latin American population. The aim of this study was determining the effect of Online Cognitive-Behavioral Therapy on TA, overall QoL and specific QoL in two elderly adults with T2DM. The case of a 62-year-old woman and a 60-year-old man who was offered an intervention consisting of nine sessions offered through a video conference platform is presented. The procedure included: psychoeducation, self-control training techniques, behavior reinforcement, feedback and problem solving. The Objective Clinical Change (OCC) evidences an increase in TA behaviors, such as use of medications, following a healthy diet (OCC≥ 0.20) and monitoring capillary blood glucose in the medium term (four months). Likewise, improve specific QoL for T2DM patients (OCC≤ -0.20). It is concluded that telepsychology is a low-cost, safe, feasible and effective type of therapy to increase and maintain TA behaviors, as well as to improve the QoL of patients suffering T2DM. Even though, more research is needed to increase the effectiveness of this therapy modality © 2022 AAC

Impact of COVID-19 public policies on utilization on cervical cancer screening in Puerto Rico during March 15, 2020 to July 31, 2020

Introduction: Among jurisdictions of the United States, Puerto Rico (PR) has the highest incidence of cervical cancer, and cervical cancer screening (CCS) is below 80%. Public health emergencies have an impact on people's access to health care services. We examined the impact of the public policy implemented by the government of Puerto Rico during the first 5 months of the COVID-19 pandemic in the utilization of CCS for participants of the Government's Public Health Plan. Methodology: This was a retrospective cohort study. A total of 40 government executive orders (issued between March 15 to July 31, 2020) were analyzed according to the level of restrictions they imposed on the population. Three periods with the greatest restrictions were identified: two of them in the government's initial response phase (March 15-30th & March 31st -April 12th ) and one in the re-opening phase (July 17-July 31st ). We examined the utilization of all modalities of CCS (pap test only and pap + HPV contesting). Rate ratios (RRs) were estimated to compare to CCS rates during periods of 2020 and compared to 2018-2019. Results: In comparison to 2019, CCS decreased during the most restricted period (March 31st-April 12th) of the response phase (RR= 0.19, 95% CI=0.15-0.24 for women 21-29 years;RR= 0.04 95% CI= 0.03-0.05 for women 30-65 years). During the re-opening phase, screening services started to rebound. However, an increase in COVID-19 cases led to another restriction (July 17-July31st), which led to a second phase of decrease in utilization of CCS (RR=0.17 95% CI=0.13-0.21 for women 21-29 years (RR= 0.09, 95% CI=0.08-0.10 for women 30-65 years). Conclusion: Our results evidence how the public policy implemented as a result of the COVID-19 pandemic in Puerto Rico had a direct impact on the utilization of CCS services in this Hispanic population. Future studies should examine screening patterns and social barriers of service utilization after July 2020 in Puerto Rico.

Influence of health beliefs on COVID-19 vaccination among patients with cancer and other comorbidities in Puerto Rico

Background: Ethnic minority populations are more likely to suffer from chronic comorbidities, making them more susceptible to the poor health outcomes associated with COVID-19 infection. Ensuring COVID-19 vaccination among vulnerable populations, such as cancer patients, is of utmost importance. Thus, we aimed to investigate health behaviors and perceptions related to COVID-19 vaccination among adults with cancer and other chronic comorbidities in Puerto Rico (PR). Methods: This secondary analysis used data from 1,911 participants who completed an online survey from December 2020 to February 2021. The Health Belief Model (HBM) was used to measure perceptions surrounding COVID-19 vaccination among individuals diagnosed with cancer, adults with other chronic comorbidities, and healthy adults. Multivariate logistic regression analyses assessed the associations of disease status (healthy, cancer diagnosis, other chronic conditions/comorbidities [excluding cancer]) with individual HBM constructs and vaccine intent, while adjusting for age, sex, education, income, employment status, influenza vaccine, health literacy, and religiosity. Results: Among study participants, 76% were female, 34% greater than or equal to 50 years old, 5% had a cancer diagnosis, and 70% had other chronic conditions/comorbidities. Participants with a cancer diagnosis had significantly higher odds of getting vaccinated when the vaccine was made available to them compared to healthy individuals (OR: 2.08 95%CI: 1.00-4.30). Compared to healthy participants, those diagnosed with cancer and those with other chronic conditions other than cancer had higher odds of perceiving their chance of getting COVID-19 as high (OR: 1.63 95%CI: 1.01-1.62;OR: 1.39 95%CI: 1.11-1.73), believed getting COVID-19 was a possibility for them (OR: 1.94 95%CI: 1.16-3.25;OR: 1.56 95%CI: 1.24-1.97), perceived they would get very sick if infected with COVID-19 (OR: 4.18 95%CI: 2.30-7.58;OR: 1.83 95%CI: 1.47-2.28), and were afraid of COVID-19 (OR 2.51: 95%CI: 1.18-5.35;OR 1.67: 95%CI: 1.25-2.22). Individuals with other chronic comorbidities also had increased odds of perceiving that COVID-19 side effects would interfere with their usual activities (OR: 1.32 95%CI: 1.06-1.64), worrying about their likelihood of getting COVID-19 (OR: 1.63 95%CI: 1.09- 2.44), and taking the vaccine regardless of the information provided (OR: 1.42 95%CI: 1.14-1.77). COVID-19 vaccine safety was the main reason for vaccine hesitancy among all participants. Discussion: Understanding vaccine hesitancy and willingness is essential in creating effective vaccine promotion programs and informing health policy. Our findings elucidate the effect of disease status on health-related decision making and isolate what steps can be taken to increase vaccine uptake among vulnerable ethnic minority populations. Acknowledgements: This work was supported by Award Grant R25CA240120 and RCMI grant U54-MD007600.