Tobacco Use and Depression: A Hidden Epidemic among Smokers 18 Years and Older, Puerto Rico, 2018-2020.

OBJECTIVE: According to the literature, depression and tobacco use are closely linked. This study's main objectives were to provide the first population-based epidemiological profile of smokers with depression (SWD) who were 18 years and older and living in Puerto Rico (PR) from 2018 to 2020 and identify any statistically significant differences between SWD and smokers without depression (SWOD). METHODS: A descriptive cross-sectional study was carried out using PR Behavioral Risk Factor Surveillance System (PRBRFSS) data (2018-2020). Univariate analysis was performed to obtain an epidemiological profile of smokers who had depression. Likewise, using bivariate analysis, SWD and SWOD were compared to identify statistically significant differences in terms of chronic conditions, risk factors, and quit attempts. RESULTS: Depression prevalence among smokers 18 years and over in PR from 2018-2020 was 23.7%. Smokers with depression were more likely to be physically inactive (P < .001), overweight or obese (P < .001), have arthritis (P < .001), chronic obstructive pulmonary disease (P < .001), asthma (P < .001), high cholesterol (P < .001), hypertension (P < .001), coronary heart disease (P < .001), diabetes (P < .001), stroke (P < .001), and heart attack (P < .001) compared with SWOD. Likewise, SWD made more quitting attempts in the past year than did SWOD (P < .001). CONCLUSION: Our results indicate that SWD should be targeted in any health-based tobacco-control efforts to develop evidence-based strategies to reduce or eliminate tobacco use in this same population.

Resource Savings Associated With Use of an Automated Symptom Monitoring Tool for COVID-19 Public Health Response, Summer 2020-Summer 2021.

CONTEXT: Active symptom monitoring is a key component of the public health response to COVID-19, but these activities are resource-intensive. Digital tools can help reduce the burden of staff time required for active symptom monitoring by automating routine outreach activities. PROGRAM: Sara Alert is an open-source, Web-based automated symptom monitoring tool launched in April 2020 to support state, tribal, local, and territorial jurisdictions in their symptom monitoring efforts. IMPLEMENTATION: As of October 2021, a total of 23 public health jurisdictions in the United States had used Sara Alert to perform daily symptom monitoring for more than 6.1 million individuals. This analysis estimates staff time and cost saved in 3 jurisdictions that used Sara Alert as part of their COVID-19 response, across 2 use cases: monitoring of close contacts exposed to COVID-19 (Arkansas; Fairfax County, Virginia), and traveler monitoring (Puerto Rico). EVALUATION: A model-based approach was used to estimate the additional staff resources that would have been required to perform the active symptom monitoring automated by Sara Alert, if monitoring instead relied on traditional methods such as telephone outreach. Arkansas monitored 283 705 individuals over a 10-month study period, generating estimated savings of 61.9 to 100.6 full-time equivalent (FTE) staff, or $2 798 922 to $4 548 249. Fairfax County monitored 63 989 individuals over a 13-month study period, for an estimated savings of 24.8 to 41.4 FTEs, or $2 826 939 to $4 711 566. In Puerto Rico, where Sara Alert was used to monitor 2 631 306 travelers over the 11-month study period, estimated resource savings were 849 to 1698 FTEs, or $26 243 161 to $52 486 322. DISCUSSION: Automated symptom monitoring helped reduce the staff time required for active symptom monitoring activities. Jurisdictions reported that this efficiency supported a rapid and comprehensive COVID-19 response even when experiencing challenges with quickly scaling up their public health workforce.

Descriptive profile of people with diabetes who use the Puerto Rico Quitline.

OBJECTIVE: To provide a descriptive profile of the people with diabetes (PWD) who received the services of the Puerto Rico Quitline (PRQ) during 2008, compared to non-diabetic people (NDP) to establish a significant statistical difference. METHODS: Using a cross-sectional study methodology, the Quitline database was analyzed. Ninety-four percent of the 1,137 people who received the services of the PRQ during 2008 and completed all the interviews were included in the analysis. Frequency distributions and means calculation were performed to describe the PWD. Chi-square tests, odds ratio, t test and 95% confidence intervals were calculated to identify statistically significant differences between the PWD and NDP. RESULTS: Nearly 11 percent (10.9%) of the people who received the services of the PRQ during 2008 and completed all the interviews reported a diabetes diagnosis. Health conditions were reported by 95.7% of PWD vs. 62.3% of NDP (P < .01). People with diabetes were more likely to have hypertension (P < .01), circulatory problems (P < .01), and respiratory infections (P = .02) than NDP. They also reported a higher mean number of smoking years than the NDP (P < .01), but the PWD were less likely to use menthol cigarettes Sthan NDP (P =.01). A physician's recommendation is the only reason for trying to quit smoking with a statically significant difference between the PWD and the NDP (P = .02). The mean number of alcoholic beverages consumed per day for the PWD was 8 and for the NDP it was 5 (P < .01). CONCLUSION: This study provides important evidence that can help increase the chances of success in the smoking cessation process in the PWD who access the services of the Quitline program.