Condom use among women of reproductive age (18-49 years) in Puerto Rico during the 2016 Zika virus outbreak: secondary analysis of data from a cross-sectional, population-based, cell-phone survey.

OBJECTIVES: Zika virus (ZIKV) can be sexually transmitted, and ZIKV infection during pregnancy can cause birth defects. Contraception is a medical countermeasure to reduce unintended pregnancy and ZIKV-associated birth defects. We estimated the prevalence of condom use and associated factors among women at risk for unintended pregnancy in Puerto Rico during the 2016 ZIKV outbreak. DESIGN: Secondary analysis of a cross-sectional, population-based, cell-phone survey. SETTING AND PARTICIPANTS: Women, 18-49 years, living in Puerto Rico during July-November 2016. We limited our analytical sample (n=1840) to women at risk for unintended pregnancy, defined as those who were sexually active with a man in the last 3 months and did not report menopause, hysterectomy, current pregnancy or desiring pregnancy. OUTCOME MEASURES: We estimated the weighted prevalence of any condom use among women at risk for unintended pregnancy. We calculated crude and adjusted prevalence ratios (aPRs) to examine the association between condom use and ZIKV-related factors, stratified by use of more effective versus less effective or no contraception. RESULTS: Overall, 32.7% (95% CI: 30.2% to 35.1%) of women reported any condom use in the last 3 months. Among women using more effective contraception, condom use was higher for women who received ZIKV counselling (aPR: 1.61, 95% CI: 1.15 to 2.25) and those worried about having a child with a ZIKV-associated birth defect (aPR: 1.47, 95% CI: 1.03 to 2.10). Among women using less effective or no contraception, condom use was associated with being worried (aPR: 1.20, 95% CI: 1.01 to 1.43) compared with those not worried about ZIKV infection or with a previous known infection. CONCLUSIONS: During the 2016 ZIKV outbreak, one in three women at risk for unintended pregnancy reported any condom use. Counselling to promote consistent and correct condom use may address concerns regarding ZIKV among women of reproductive age, which may differ by use of effective contraception.

Zika Prevention Behaviors Among Women of Reproductive Age in Puerto Rico, 2016.

INTRODUCTION: Zika virus is primarily transmitted through mosquito bites. Because Zika virus infection during pregnancy can cause serious birth defects, reproductive-aged women need protection from Zika virus infection. This report describes Zika virus prevention behaviors among women aged 18-49 years and assesses whether pregnancy status and healthcare provider counseling increases Zika virus prevention behaviors. METHODS: A population-based cell phone survey of women aged 18-49 years living in Puerto Rico was conducted in July-November 2016. Data were analyzed in 2018-2019. Prevalence estimates and 95% CIs were calculated for Zika virus prevention behaviors. Adjusted prevalence ratios were estimated to examine the association of pregnancy status with healthcare provider counseling on Zika virus prevention behaviors, controlling for age, education, and health insurance status. RESULTS: Most women reported using screens on open doors/windows (87.7%) and eliminating standing water in/around their homes (92.3%). Other Zika virus prevention behaviors were less common (<33%). In adjusted analysis, pregnant women were more likely than women not at risk for unintended pregnancy to report using mosquito repellent every/most days (adjusted prevalence ratio=1.44, 95% CI=1.13, 1.85). Healthcare provider counseling was associated with receiving professional spraying/larvicide treatment (adjusted prevalence ratio=1.42, 95% CI=1.17, 1.74), sleeping under a bed net (adjusted prevalence ratio=2.37, 95% CI=1.33, 4.24), using mosquito repellent (adjusted prevalence ratio=1.57, 95% CI=1.40, 1.77), and wearing long sleeves/pants (adjusted prevalence ratio=1.32, 95% CI=1.12, 1.55). CONCLUSIONS: Receipt of healthcare provider counseling was more consistently associated with Zika virus prevention behaviors than pregnancy status. Healthcare provider counseling is an important strategy for increasing the uptake of Zika virus prevention behaviors among women aged 18-49 years.

Awareness of direct-to-consumer genetic tests and use of genetic tests among Puerto Rican adults, 2009.

INTRODUCTION: Genetic testing remains low among racial/ethnic minority populations in the United States. We aimed to determine the prevalence and correlates of awareness of direct-to-consumer (DTC) genetic tests and the prevalence of genetic test use in a population-based sample of adults in Puerto Rico. METHODS: We analyzed data from adults aged 18 years or older who completed information on genetic test awareness (n = 611; 96% of study population) from the Health Information National Trends Survey conducted in Puerto Rico in 2009. Odds ratios with 95% confidence intervals were estimated by using logistic regression models to identify factors associated with awareness of DTC genetic tests. RESULTS: The majority of respondents (56%) were aware of direct-to-consumer genetic tests, and approximately 4% had ever undergone any genetic test. Respondents who had never been married were less likely to be aware of DTC tests, as were current smokers. Respondents who ever sought cancer information were more likely to be aware of these tests. CONCLUSION: We provide the first published data on the awareness of DTC genetic tests and on use of genetic testing in Puerto Rico. Forty-four percent of our sample of Puerto Rican adults were unaware of direct-to-consumer genetic tests. Given the lack of clear benefits of DTC genetic tests to the general population, educational interventions should be developed to increase awareness and specific knowledge regarding the appropriate use of DTC genetic tests among people who are already aware of their existence.

Health and cancer information seeking practices and preferences in Puerto Rico: creating an evidence base for cancer communication efforts.

Effective communication around cancer control requires understanding of population information seeking practices and their cancer-relevant risk behaviors, attitudes, and knowledge. The Health Information National Trends Survey (HINTS) developed by the U.S. National Cancer Institute (NCI) provides surveillance of the nation's investment in cancer communication tracking the effects of the changing communication environment on cancer-related knowledge, attitudes, and behaviors. The University of Puerto Rico Comprehensive Cancer Center (UPRCCC), the Puerto Rico Behavioral Risk Factors Surveillance System (PRBRFSS), and the NCI implemented HINTS in Puerto Rico in 2009. In this article we describe the health and cancer information seeking behaviors, sources of information, trust in information sources, and experiences seeking information among the population of Puerto Rico. A total of 639 (603 complete and 36 partially complete) interviews were conducted. Nearly one-third of respondents had ever looked for information about health (32.9%) or about cancer (28.1%). The Internet was the most frequently reported source of information. College educated (odds ratio [OR] = 7.6) and females (OR = 2.8) were more likely to seek health information. Similarly, college educated (OR = 5.4) and females (OR = 2.0) were more likely to seek cancer information. Only 32.7% of respondents had ever accessed the Internet, and college educated were more likely to use it (OR = 12.2). Results provide insights into the health and cancer information seeking behaviors and experiences of the population in Puerto Rico and contribute to the evidence base for cancer control planning on the island.

Childhood asthma prevalence in northern Puerto Rico, the Rio Grande, and Loíza experience.

OBJECTIVE: Childhood asthma is highly prevalent in some areas of Puerto Rico. The objective of this study was to estimate the prevalence of asthma in two municipalities of Northern Puerto Rico. METHODS: Children 6 to 7 and 13 to 14 years of age participated in the school-based cross-sectional study. RESULTS: A total of 1,467 elementary school students and 1,334 junior-high school students were included in the survey. A high prevalence of asthma was observed; 46% in elementary schools and 24% in junior-high schools. In elementary schools, family history of asthma (FHA) was associated with ever wheezed (PR = 2.00, 95%CI 1.59, 2.52), wheeze during last year (PR = 2.02, 95%CI 1.54, 2.62), and asthma (PR = 2.33, 95%CI 1.86, 2.92). For junior-high schools FHA was associated with ever wheezed (PR = 2.01, 95%CI 1.56, 2.57), wheeze during previous year (PR = 2.00, 95%CI 1.47, 2.73), and asthma (PR = 2.72, 95%CI 2.06, 3.60). CONCLUSIONS: This study showed a high prevalence of asthma and related symptoms in Northern Puerto Rico. FHA was strongly associated with asthma and its symptoms. Further research is recommended to look at genetics, sensitivity levels, indoor and outdoor pollution, and gene-environment interactions.

Diseño de un sistema de vigilancia epidemiológica para los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Development of a system for epidemiologic surveillance for the XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event

Descripción de la morbilidad reportada en el sistema de vigilancia epidemiológica de los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Description of morbidity notified in the epidemiologic surveillance system of XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The objective of the epidemiological surveillance system for the XVII Central American and Caribbean Sports Games in 1993 in Puerto Rico was to estimate the morbidity related to infectious diseases and sports injuries during the competitions. In the village hospital a total of 794 medical consultations were reported; 57.7 per cent of the patients were athletes. Among athletes, the rate of consultation was 10.4 for every 100 participants. The consultations were more frequent in males (535, 67.4 per cent ). The analysis by country of origin revealed that the athletes from Guatemala (42, 9.2 per cent ) and Jamaica (35, 7.6 per cent ) used the services more frequently. The incidence of consultations by sport was higher in field hockey (47, 10.3 per cent ), followed by athletics (46, 10 per cent ), and softball (36, 7.9 per cent ). The most frequent diagnoses were injuries--302, 38.04 per cent ; of these 229 (75.8 per cent ) were athletes--,conditions of the respiratory system (180, 22.67 per cent ), problems of the skin and mucous membranes (85, 10.71 per cent ), and problems of the gastrointestinal tract (56, 7.05 per cent ). The severity of the majority of the conditions was mild and required primary care health professionals