Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults in the Boricua Youth Study - Health Assessment.

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study - Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

Adaptation of a community health outreach model during the COVID-19 pandemic: the case of the Mexican consulates in the United States of America.

The Ventanillas de Salud (VDS - "Health Windows") are a culturally sensitive outreach program within the 49 Mexican Consulates in the United States that provides information and health care navigation support to underserved and uninsured Mexican immigrants. During the COVID-19 pandemic the VDS rapidly transitioned to remote operations adding new services. Based on the EquIR implementation framework, this qualitative study investigates how adaptations to improve emergency preparedness were performed. We conducted motivational interviews with three actors - six VDS coordinators, eight partner organizations, and ten VDS users- in two VDS, Los Angeles and New York, to document specific needs of the target population and identify implementation processes to adapt and continue operating. The VDS adapted their model by adding new services for emerging needs, by switching service provision modalities, and by expanding the network of partner organizations. According to the VDS staff, these adaptations increased their topics, depth, reach, and diversified their users. Users had mostly positive opinions about the VDS adaptation, although they highlighted some heterogeneity across service provision. The VDS is a public health intervention able to serve a marginalized population and its implementation offers valuable lessons to complement health systems and to improve preparedness and resiliency for future crises.

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border.

Background: Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods: We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results: About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion: These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.

Mental Health Needs of an Emerging Latino Community.

Over the last decade, Baltimore has become a non-traditional sanctuary city, receiving an unprecedented influx of Latino immigrants, mostly from Central America's Northern Triangle, who are often fleeing violence in their home countries. This study explored the nature and frequency of healthcare utilization for mental health problems among uninsured/uninsurable Latinos who received outpatient care between 2012 and 2015 through an academic hospital-affiliated program that covers primary and specialty services to uninsured patients without regard to documentation status. Encounters for mental health disorders were the most common category, accounting for 14.88% of all visits. Mood (78%) and anxiety disorders (16%) were the most prevalent mental health diagnoses. The most frequent reason to seek care was symptom, signs, and ill-defined conditions (37.47%), and within this subgroup, pain was the leading cause of seeking care (88%), which may indicate high rates of somatization of mental health distress. This study presents a unique opportunity to explore the burden and nature of mental health needs among a population for which healthcare information is rarely attainable and highlights the need for culturally competent screening mechanisms and interventions to address the stressors faced by emergent communities.

Heterogeneity in Current Cigarette Smoking among Hispanic/Latino Heritage Groups in New York City, 2003-2016.

Objectives: We assessed differences in trends, prevalence, and sociodemographic correlates of current smoking among several predominant Hispanic/Latino heritage groups (Puerto Ricans, Dominicans, Central and South Americans, and other Hispanic/Latinos) in New York City (NYC). We additionally compared current smoking prevalence between heritage groups and non-Hispanic/Latino Whites. Design and Methods: Data from the Community Health Survey, a representative, dual-frame landline/cellphone survey, were analyzed to assess age-adjusted prevalence of current smoking, separately among heritage groups from 2003-2016. Logistic regression was used to estimate odds ratios and 95% CIs for current smoking by Hispanic/Latino heritage group relative to non-Hispanic/Latino Whites in combined 2012-2016 data. Logistic regression was also used to examine correlates of smoking among each heritage group, separately. Results: Between 2003-2016, current smoking prevalence decreased among all Hispanic/Latinos heritage groups except Puerto Ricans, who had the highest smoking prevalence among all groups examined. Sex-stratified trend analyses showed decreases among all groups except Puerto Rican and other Hispanic/Latino males. In multivariable-adjusted models, relative to non-Hispanic/Latino Whites, there was no association with current smoking among Puerto Ricans, but odds of smoking were lower among all other heritage groups. Female sex was inversely associated with current smoking among all heritage groups, and acculturation was positively associated with smoking among all groups except Central/South Americans. Lower educational attainment was strongly associated with smoking among Puerto Ricans. Conclusions: Lack of progress in reducing smoking among Puerto Ricans in NYC is concerning. Opportunities for cultural, sex-specific, and other targeted outreach to this community should be explored.

Exposures at day labor corners: using existing georeferenced data to describe features of urban environments.

PURPOSE: Latino day laborers are male immigrants from mainly Mexico and Central America who congregate at corners, that is, informal hiring sites, to solicit short-term employment. Studies describing the occupational environment of Latino day laborers traditionally measure jobsite exposures, not corner exposures. We sought to elucidate exposures at corners by describing their demographic, socioeconomic, occupational, business, built, and physical environmental characteristics and by comparing corner characteristics with other locations in a large urban county in Texas. METHODS: We used multiple publicly available data sets from the U.S. Census, local tax authority, Google's Nearby Places Application Programming Interface, and Environmental Protection Agency at fine spatial scale to measure 34 characteristics of corners with matched comparison locations. RESULTS: Corners were located close to highways, high-traffic intersections, hardware and moving stores, and gas stations. Corners were in neighborhoods with large foreign-born and Latino populations, high rates of limited English proficiency, and high construction-sector employment. CONCLUSIONS: Publicly available data sources describe demographic, socioeconomic, occupational, business, built, and physical environment characteristics of urban environments at fine spatial scale. Using these data, we identified unique corner-based exposures experienced by day laborers. Future research is needed to understand how corner environments may influence health for this uniquely vulnerable population.

Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border.

BACKGROUND: Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. METHODS: The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. DISCUSSION: The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. TRIAL REGISTRATION: This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018.

Use of Health Services by Maltreated Children in Two Different Sociocultural Contexts: Where Can Doors for Interventions Be Opened?

Among maltreated children, elevated use of non-routine (for illness or injury) services may coexist with underutilization of preventive services. Besides physical health problems, lack of contact with primary care may preclude the identification and delivery of appropriate interventions. We examined health service utilization in the longitudinal Boricua Youth Study of Puerto Rican children residing in the South Bronx (SBx), New York City ( n = 901), and San Juan metropolitan area, Puerto Rico ( n = 1,163). Parents and children ( Mage = 9 years) reported on child physical abuse, sexual abuse, and neglect. Parents reported if their child had been to illness, injury, and well-child visits in the past year. In the SBx site, caretakers were more likely to report the children seeing a doctor for a well-child visit (90%) compared with children in Puerto Rico (71%). Children in Puerto Rico were more likely to visit a doctor for an injury in the past year compared with children in the SBx (39% vs. 24%). Twenty-one percent of children in the SBx reported maltreatment versus 16% in Puerto Rico. Adjusting for sociodemographic factors, compared with non-maltreated children, those who experienced two or more types of maltreatment were more likely to have an illness visit in Puerto Rico (prevalence ratio [PR] = 1.5, 95% confidence interval [CI] = [1.1, 2.2]) and the SBx (PR = 1.8, 95% CI = [1.1, 3.0]), or an injury visit (PR = 4.1, 95% CI = [1.9, 8.9]) in Puerto Rico only. Children in the SBx who reported only one type of maltreatment were less likely to use services for injuries than non-maltreated children (PR = 0.42, 95% CI = [0.2, 0.9]). No relation between maltreatment and well-child visits was noted. Children who experience maltreatment may frequently come in contact with health care providers, presenting opportunities for intervention and the prevention of further maltreatment.

Inequality and health among foreign-born latinos in rural borderland communities.

Thousands of Mexicans and Central Americans settle in communities along the borderlands between Mexico and the United States. Many live and work in rural communities characterized by poverty and limited access to basic resources. Drawing on qualitative research, this article reports on inequalities and health among foreign-born Latinos in rural borderland communities. From 2015 to 2016, the study team conducted research in Inland Southern California's Eastern Coachella Valley with Mexican farmworkers, farmworker advocates, community leaders, healthcare service providers, and local political leaders. The analysis of field notes and interviews demonstrates how situational and temporal factors position this foreign-born population as vulnerable to inequalities across multiple social systems resulting in low social status, lack of employment and housing stability, and limited access to healthcare services. Over time, the experience of both situational life events and persistent and daily chronic strain infringes on self-concept, including mastery or control over life and self-worth, and contributes to stress and subsequent poor mental health outcomes (e.g., depression). The research calls for local community action, healthcare policy change, and further in-depth research on structural inequalities in health among foreign-born Latinos.

Cross-border Ties as Sources of Risk and Resilience: Do Cross-border Ties Moderate the Relationship between Migration-related Stress and Psychological Distress for Latino Migrants in the United States?

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation.

Seasoning ingredient variety, but not quality, is associated with greater intake of beans and rice among urban Costa Rican adults.

Exposure to a variety of flavors may promote food enjoyment, but few studies have examined the relationship between food seasoning and food intake. We hypothesized that using a higher variety (number) of 11 seasonings to prepare 2 staple foods (beans, white rice) would be associated with intake of those foods in a population-based case-control study of Costa Rican adults in urban vs rural areas (n=1025), where cooking and dietary practices differ. Participants were surveyed about the variety of seasoning ingredients added when preparing beans or rice. Ingredients were also categorized by their dietary quality (healthfulness), and scores for seasoning variety and quality were created. Multivariable linear regression was used to determine the association between variety and quality scores (continuously and in tertiles (T)) and intake of each staple food. Seasoning variety was positively associated with daily servings of beans (ß=.02, P=.01; 1.31 and 1.23 servings/day in T2 and T3 versus 1.02 servings/day in T1, P<.05) and rice (ß=.04, P=.005) in the urban areas only. No differences in ingredient quality across increasing intakes of beans or rice were noted, and the joint associations between variety and quality were not significant. In conclusion, a greater variety, but not quality, of seasoning ingredients was positively associated with intakes of beans and rice in urban Costa Rican adults. Our results suggest that increasing the variety of seasonings added to beans may be a culturally-appropriate strategy to improve intake of this healthy staple food among urban Costa Rican adults.

Social and Environmental Determinants of Child Physical Activity in a Rural Mexican-Origin Community.

California's rural agricultural communities face an increased burden of obesity and metabolic disease. The present objective is to define the social and environmental influences to child obesity and physical activity within Mexican-origin communities in California's Central Valley. A range of data (anthropometric, socioeconomic, demographic, cultural and environmental) were collected on more than 650 children enrolled in Niños Sanos, Familia Sana. Physical activity data were gathered from a subsample of children 4-7 years of age (n = 148) via accelerometer. Cross sectional analyses explored the relationship between BMI and physical activity and the influence of numerous social and environmental variables. In this sample 45 % of children were determined to be overweight or obese. Boys had a higher daily average moderate-to-vigorous physical activity than girls (p = 0.008). Chi square analyses showed weight status was associated with activity level in girls (p = 0.03) but not boys. Multivariate regression revealed several social and environmental indicators influenced BMI and physical activity (p = 0.004). In this population of school-age children of Mexican-origin, girls may benefit more from targeted efforts to increase MVPA. Family and community support systems may also boost child participation in physical activities.

Language use affects food behaviours and food values among Mexican-origin adults in the USA.

OBJECTIVE: Previous studies have established that acculturation is associated with dietary intake among Mexican immigrants and their offspring, but few studies have investigated whether food purchasing, food preparation or food-related values act as mechanisms of dietary acculturation. We examine the relationship between language use and a wide range of food behaviours and food-related values among Mexican-American adults. DESIGN: Nationally representative probability sample of the US population. SETTING: 2005-2010 National Health and Nutrition Examination Survey. SUBJECTS: Mexican-American adults (n 2792) at least 20 years of age. RESULTS: Mexican Americans who speak only or mostly English consume more energy from fast-food and sit-down restaurants and report increased consumption of non-homemade meals, fast-food and pizza meals, frozen meals and ready-to-eat meals relative to Spanish speakers. English speakers prepare one fewer homemade dinner per week and spend less time on meal preparation. English speakers are more likely than Spanish speakers to cite convenience as an important reason why they prefer fast food over cooking at home. There is no relationship between language use and the perceived importance of the nutritional quality, price or taste of fast food. CONCLUSIONS: Our results provide evidence that the well-documented relationship between acculturation and diet among Mexican Americans may be just one indicator of a broader pattern characterized by decreased home meal preparation and increased reliance on convenience foods.