Awareness of Sickle Cell among People of Reproductive Age: Dominicans and African Americans in Northern Manhattan

Sickle cell disease is a chronic condition that is characterized by severe anemia, painful crises, and organ dysfunction. In the USA, sickle cell is a health burden typically associated with African Americans. Dominicans constitute the largest Latino group in New York City (NYC) and have the second overall highest prevalence of sickle trait—one in 20 births, compared to one in 12 African American births. We aimed to document the prevalence of sickle within the largely Dominican and African American community of Northern Manhattan (Washington Heights, Inwood, Harlem), assess and compare knowledge about sickle disease and carrier status in young adults of reproductive age between African Americans and Dominicans, and elicit preferred sources of health information. NY State Newborn Screening data in Northern Manhattan were analyzed by zip code. A brief oral survey was administered to 208 parents of young children—150 Dominicans and 58 African Americans. Significant differences were seen in knowledge about sickle—27% of Dominican parents surveyed correctly defined sickle cell disease as an inherited blood disorder, compared to 76% of African Americans (p < 0.001). Only 7% of African Americans did not know their own trait status, compared to 43% of Dominicans (p < 0.001). Parents were better informed if they or family members were affected by sickle conditions. Participants from both groups prefer receiving information from doctors and online. A separate group of 168 predominantly Dominican youth, ages 14–24, demonstrated knowledge levels similar to that of Dominican parents. These results suggest that many of reproductive age in a NYC community affected by sickle conditions frequently lack basic relevant information, with larger information gaps among Dominicans. Expanded efforts are warranted to inform young adults of diverse affected communities.     

International studies of prenatal exposure to polycyclic aromatic hydrocarbons and fetal growth

OBJECTIVES: Polycyclic aromatic hydrocarbons (PAHs) are ubiquitously distributed human mutagens and carcinogens. However, lack of adequate air monitoring data has limited understanding of the effects of airborne PAHs on fetal growth. To address this gap in knowledge, we examined the association between prenatal exposure to airborne PAHs and birth weight, birth length, and birth head circumference, respectively, in Krakow, Poland, and New York City (NYC). METHODS: The parallel prospective cohort studies enrolled nonsmoking, healthy, and nonoccupationally exposed women and their newborns. Personal air monitoring of pregnant women was conducted over 48 hr. To control for maternal environmental tobacco smoke (ETS) exposure, we excluded those with umbilical cord plasma cotinine concentrations > 25 ng/mL. Mean cord plasma cotinine concentrations in both ethnic groups were 相似文献   

The cultural and social context of oral and pharyngeal cancer risk and control among Hispanics in New York

New York City (NYC) has one of the highest incidence and mortality rates of oral and pharyngeal cancer (OPC) for Hispanics of any major U.S. city. This qualitative assessment explores OPC awareness, attitudes, and screening practices among at-risk Hispanics, health care providers, and community leaders in a Hispanic neighborhood of NYC. Four focus groups (N=39) were conducted with at-risk Hispanics. Structured interviews were conducted with ten health care providers (four physicians, four dentists, two dental hygienists) and three key community leaders. Results showed major gaps in OPC awareness across all key stakeholders. Focus group participants expressed difficulty in accessing appropriate health care. Health care providers were not familiar with OPC prevention and early detection practices. Community leaders lacked the knowledge and resources necessary for advocating prevention and early detection for their constituencies. All participants reported cultural, social, and structural barriers to prevention. There is a need for developing a comprehensive, culturally competent health communication program that targets all key stakeholders in the at-risk Hispanic community of NYC.     

A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community

Asian Americans experience diabetes at a higher rate than non-Hispanic whites. Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results, yet there have been no culturally-tailored programs for diabetes prevention in the Korean community. We explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve health behaviors and promote diabetes prevention among Korean Americans using a randomized controlled trial. Between 2011 and 2012, a total of 48 Korean Americans at risk for diabetes living in New York City (NYC) participated in the intervention. Participants were allocated to treatment or control groups. A community-based participatory research approach guided development of the intervention, which consisted of 6 workshops held by CHWs on diabetes prevention, nutrition, physical activity, diabetes complications, stress and family support, and access to health care. Changes over 6 months were examined for clinical measurements (weight, BMI, waist circumference, blood pressure, glucose, and cholesterol); health behaviors (physical activity, nutrition, food behaviors, diabetes knowledge, self-efficacy, and mental health); and health access (insurance and self-reported health). In this small pilot study, changes were seen in weight, waist circumference, diastolic blood pressure, physical activity nutrition, diabetes knowledge, and mental health. Qualitative findings provide additional contextual information that inform ways in which CHWs may influence health outcomes. These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC, and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable populations.     

Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin

OBJECTIVES: We estimated prevalence and control of type 2 diabetes in Puerto Rican, Dominican, and non-Hispanic White (NHW) elders and associated them with sociodemographic and health behavior variables and with body mass index (BMI) and waist circumference. METHODS: We used a cross-sectional analysis with a sample of Hispanic elders in Massachusetts and a comparison group of NHWs (1991-1997). The analysis included 379 Puerto Ricans, 113 Dominicans, and 164 NHWs, aged 60 to 96 years, with complete questionnaires and blood samples. RESULTS: Type 2 diabetes was significantly more prevalent among Puerto Ricans (38%) and Dominicans (35%) than among NHWs (23%). Differences remained after covariates were adjusted for. Hispanics with diabetes were approximately 3 times more likely to use insulin than NHWs. Puerto Ricans were 2 times, and Dominicans 3 times, more likely to have glycosylated hemoglobin concentrations of 7% or above than NHWs. BMI and waist circumference were individually associated with diabetes. When included in the model together, waist circumference, but not BMI, remained independently associated with diabetes. CONCLUSIONS: Ethnicity was more strongly associated with diabetes status and control than were socioeconomic or measured health behavior variables, suggesting that genetic or other culturally related factors may explain these differences.     

Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes

Focus groups were conducted to explore health-related beliefs and experiences of African American, Hispanic/Latino, American Indian, and Hmong people with diabetes and engage community members in improving diabetes care and education for these populations. Eighty participants attended 12 focus groups, 3 per population. Major themes were loss of health attributed to modern American lifestyles, lack of confidence in the medical system, and the importance of spirituality. Participants recommended improvements in the areas of health care, diabetes education, social support, and community action. Their recommendations emphasize the importance of respectful, knowledgeable health care providers; culturally responsive diabetes education for people with diabetes and their families; and broad-based community action. These recommendations align with current public health priorities and medical knowledge. It is proposed that healthy traditions from diverse populations can be leveraged to improve the health of all people with diabetes.     

2007年山东省部分基层全科医生慢性病防治知识调查

[目的]了解基层全科医生慢性病防治知识知晓情况,为开展基层全科医生慢性病教育培训提供依据。[方法]2007年4月,在山东省6个市对接受培训的基层全科医生于培训后进行问卷调查。[结果]调查基层全科医生1047名,其中大学本科及以上学历者占25.02%;知道高血压的定义和分类的占88.44%,知道肥胖诊断标准的占61.41%,知道世界糖尿病宣传日时间的占58.16%,知道高血压宣传日时间的占56.92%;对重点人群进行过健康教育宣传的占38.30%,对重点人群进行过高血压、糖尿病筛查的占44.13%。[结论]山东省基层全科医生高血压、糖尿病相关防治知识水平不高。     

Knowledge, Attitudes, and Perceptions about Breast Cancer and Breast Cancer Screening Among Hispanic Women Residing in South Central Pennsylvania

The purpose of this investigation was to assess the knowledge, attitudes, and perceptions about breast cancer, and screening behaviors among Hispanic women in Pennsylvania. Eight focus groups were conducted with Hispanic women to obtain answers to the questions of interest. Results, based on content analysis, showed that cultural factors, such as family and fatalism, influence breast cancer knowledge and screening among this group. In addition, these women had some misconceptions regarding breast cancer and breast cancer detection screening. Most participants reported that they would like to receive breast cancer education in Spanish from health care providers or health educators. These results can help health professionals, including health educators, in the development of suitable breast cancer education and screening promotion programs for Hispanic women. This study was funded by the Research Council of The Penn State Capital College.     

Change in Diabetes Prevalence and Control among New York City Adults: NYC Health and Nutrition Examination Surveys 2004–2014

National examination surveys provide trend information on diabetes prevalence, diagnoses, and control. Few localities have access to such information. Using a similar design as the National Health and Nutrition Examination Survey (NHANES), two NYC Health and Nutrition Examination Surveys (NYC HANES) were conducted over a decade, recruiting adults ≥?20 years using household probability samples (n =?1808 in 2004; n =?1246 in 2013–2014) and physical exam survey methods benchmarked against NHANES. Participants had diagnosed diabetes if told by a health provider they had diabetes, and undiagnosed diabetes if they had no diagnosis but a fasting plasma glucose ≥?126 mg/dl or A1C?≥?6.5%. We found that between 2004 and 2014, total diabetes prevalence (diagnosed and undiagnosed) in NYC increased from 13.4 to 16.0% (P =?0.089). In 2013–2014, racial/ethnic disparities in diabetes burden had widened; diabetes was highest among Asians (24.6%), and prevalence was significantly lower among non-Hispanic white adults (7.7%) compared to that among other racial/ethnic groups (P <?0.001). Among adults with diabetes, the proportion of cases diagnosed increased from 68.3 to 77.3% (P =?0.234), and diagnosed cases with very poor control (A1C >?9%), decreased from 26.9 to 18.0% (P =?0.269), though both were non-significant. While local racial/ethnic disparities in diabetes prevalence persist, findings suggest modest improvements in diabetes diagnosis and management.     

Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men

Black men who have sex with men (MSM) are disproportionately affected by HIV and AIDS in New York City (NYC). Black churches in NYC have a history of engaging in community mobilisation; however, research suggests that churches play a role in promoting stigma against Black MSM, which impedes prevention efforts. The goal of this study was to explore church ideologies surrounding sexuality and health, and the relationship of these ideologies to church mobilisation in response to HIV/AIDS among Black MSM. We conducted interviews and focus groups with pastors and parishioners at Black churches in NYC. Three prominent themes were identified: (1) 'Love the sinner, hate the sin'--distinguishing behaviour and identity; (2) 'Don't ask, don't tell'--keeping same-sex behaviour private; and (3) 'Your body is a temple'--connecting physical and spiritual health. We discuss the implications of these ideologies for church mobilisation and HIV prevention efforts. In doing so, we pay close attention to how ideologies may both impede and facilitate church dialogue around sexuality and heightened responses to the HIV crisis affecting Black MSM.     

Thunder and Lightning and Rain: a Latino/Hispanic diabetes media awareness campaign

The prevalence rates of diabetes in communities of color are higher than in Caucasian populations. Social marketing can be an effective approach to educating communities and encouraging visits to health care providers. This article describes Thunder and Lightning and Rain, a diabetes media awareness campaign implemented in a 5-county area in central Washington State with a large Latino/Hispanic population. The Washington State Department of Health's Diabetes Prevention and Control Program, along with national and community partners and focus groups, used a social marketing model to reach those with uncontrolled diabetes. A telephone survey-based evaluation, conducted in Spanish, provided data on demographics, media access, calls to a toll-free information line, provider visits, and recall of the campaign's central message: "Control your diabetes. For Life."     

Qualitative evaluation of a diabetes advisory system, DiasNet

We carried out a qualitative evaluation of the implementation of a computerized diabetes advisory system, DiasNet. Three patients with insulin-dependent diabetes used the system. The methodological frame of reference was the case study. Qualitative interviews were conducted with patients. In addition, 10 qualitative interviews were conducted with health-care professionals and one focus group interview was held. The study lasted for six months. The results showed that patients experienced greater confidence and a more personal rapport with the staff. DiasNet brought about changes in the tasks and duties performed by all professional groups in the diabetes team. From the perspective of the diabetes team, email facilitated a dialogue between the patient and the diabetes team which was independent of time and place.     

Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City

Background

Mercury is a toxic metal that has been used for centuries as a constituent of medicines and other items.

Objective

We assessed exposure to inorganic mercury in the adult population of New York City (NYC).

Methods

We measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 μg/L were followed up with a telephone or in-person interview that asked about potential sources of exposure, including ritualistic/cultural practices, skin care products, mercury spills, herbal medicine products, and fish.

Results

Geometric mean urine mercury concentration in NYC was higher for Caribbean-born blacks [1.39 μg/L; 95% confidence interval (CI), 1.14–1.70] and Dominicans (1.04 μg/L; 95% CI, 0.82–1.33) than for non-Hispanic whites (0.67 μg/L; 95% CI, 0.60–0.75) or other racial/ethnic groups. It was also higher among those who reported at least 20 fish meals in the past 30 days (1.02 μg/L; 95% CI, 0.83–1.25) than among those who reported no fish meals (0.50 μg/L; 95% CI, 0.41–0.61). We observed the highest 95th percentile of exposure (21.18 μg/L; 95% CI, 7.25–51.29) among Dominican women. Mercury-containing skin-lightening creams were a source of exposure among those most highly exposed, and we subsequently identified 12 imported products containing illegal levels of mercury in NYC stores.

Conclusion

Population-based biomonitoring identified a previously unrecognized source of exposure to inorganic mercury among NYC residents. In response, the NYC Health Department embargoed products and notified store owners and the public that skin-lightening creams and other skin care products that contain mercury are dangerous and illegal. Although exposure to inorganic mercury is not a widespread problem in NYC, users of these products may be at risk of health effects from exposure.     

Obesity and awareness of obesity as risk factors for breast cancer in six ethnic groups

OBJECTIVE: To document BMI and knowledge regarding obesity as a risk factor for breast cancer among subpopulations of African-, Caribbean-, and European-American women and to consider the variables predicting obesity in these diverse groups. RESEARCH METHODS AND PROCEDURES: A stratified cluster-sampling plan was used to recruit 1364 older women from Brooklyn, NY, during 2000-2002. Two groups were born in the United States (African Americans and European Americans), whereas others were from the English-speaking Caribbean, Haiti, the Dominican Republic, and Eastern Europe. Participants provided demographics, height and weight measures, and estimates of the risk obesity posed for breast cancer. RESULTS: Women from all groups were significantly overweight (BMI > 25 kg/m(2)), although European Americans were lowest, followed by Dominicans and Haitians; African-American and English-speaking Caribbean women fell into the obese range, even when background variables were controlled. Knowledge of obesity as a breast cancer risk factor was also poor across groups, but Dominicans and Haitians had the lowest scores on knowledge. Importantly, knowledge was not associated with BMI in the overall sample, even when controlling for demographics and ethnicity, although logistic regressions comparing normal weight women with overweight and obese groupings suggested some knowledge of breast cancer risk in the overweight, but not the obese, group. DISCUSSION: The findings remind health professionals of the need to consider more specific ethnic groupings than has hitherto been the case, as well as consider how ethnic and cultural variables may influence perceptions of obesity and its relation to cancer risk.     

Dietary and plasma lipid,lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes

BACKGROUND: There are limited data about dietary intakes and plasma lipids of elderly US Hispanics. OBJECTIVE: The disparity in prevalence of type 2 diabetes among population groups underscored our need to assess dietary and plasma risk factors for cardiovascular disease. DESIGN: Plasma lipids and apolipoproteins and dietary intakes of macronutrients were measured in elderly subjects (60-98 y): 490 Hispanics of Caribbean origin (Puerto Ricans and Dominicans) and 163 non-Hispanic whites. Plasma values were related to ethnicity and to macronutrient intake. Differences in plasma lipids due to diabetes were assessed among the Hispanics. RESULTS: Intakes of carbohydrate and polyunsaturated fatty acids were higher and intakes of cholesterol and saturated and monounsaturated fatty acids were lower in Hispanics than in non-Hispanic whites. Concentrations of total cholesterol, HDL cholesterol, and apolipoprotein A-I were significantly lower among Hispanic women than among non-Hispanic white women; a similar trend was seen in men. Dyslipidemia (high triacylglycerols and low HDL cholesterol) was more prevalent among Hispanics with than without diabetes. CONCLUSIONS: Ethnic differences in serum lipids exist and appear to be associated with differences in dietary intakes. However, both Hispanics and non-Hispanic whites had lipid profiles indicating a high risk of cardiovascular disease. Hispanics with diabetes were at higher risk of dyslipidemia than were those without diabetes. Our data suggest that lifestyle changes, including diet modification and exercise, could be of significant benefit to both ethnic groups.     

Developing Culturally Relevant Educational Materials About Emergency Contraception

New York City has growing numbers of Mexican and Caribbean born residents, who have been identified as underserved communities for reproductive health care. We conducted exploratory focus groups to develop and test messages about emergency contraception that would be culturally relevant to these communities. Findings reveal lack of knowledge about what emergency contraception is and how it works, concerns about safety, and health care barriers. Multiple messages were tested in Spanish and English, and participants expressed positive attitudes about using emergency contraception once they knew that is was different from an abortion pill.     

Use of environmental scan to assess density,content, and variation of predatory food and beverage marketing in New York City

To explore the presence of predatory food and beverage marketing in different neighborhoods in New York City (NYC), this study describes the methodology of an outdoor environmental scan of the physical environment. The study was conducted in four NYC neighborhoods over a three-week period, in which pairs of trained researchers canvassed designated neighborhoods to document the presence of food and beverage marketing using photographs taken on digital smart phone devices. Commercial areas in the vicinity of NYC Public Schools and NYC Housing Authority campuses located in four neighborhoods with the highest and lowest nutrition related health indicators were studied: South Bronx, Pelham Throggs Neck, Upper West Side, Chelsea/Greenwich Village. Advertisements were coded against 50+ indicators to quantify pertinent variables including the frequency and content of food and beverages advertised and all forms of predatory marketing observed. Comparisons of prevalence and content of food and beverage advertisements and predatory marketing were made across neighborhoods with the highest and lowest health indicators, using chi-squared analysis, and a significance level of p < 0.05. This article demonstrates a disproportionate presence of predatory marketing in low income NYC neighborhoods with negative health outcomes compared to wealthier neighborhoods. Further, this paper demonstrates the benefits and limitations of using an environmental scan methodology to assess predatory food and beverage marketing in a large urban area such as NYC.     

Diet,Physical Activity,and Cardiovascular Disease Risk Factors Among Older Chinese Americans Living in New York City

Cardiovascular disease (CVD) is the leading cause of death in the US and affects Chinese Americans disproportionately compared to other ethnic groups in the American population. However, few studies have examined CVD risk factors, including diet and physical activity, in Chinese Americans. This investigation used a cross-sectional design to evaluate the dietary intake, dietary supplement use, and physical activity of 125 older Chinese Americans aged 50–98 years, and to determine how these behaviors may be related to obesity and other CVD risk factors. Sociodemographic information, CVD risk factors, dietary intake, and physical activity were obtained from all participants recruited from health fairs conducted in New York City (NYC). The findings revealed that older Chinese American adults living in NYC had a high prevalence of overweight and obesity, borderline hypertension, pre-diabetes, and diabetes. Many participants did not meet their daily requirements calcium, potassium, folate, vitamin B6, and vitamin B12, several minerals and vitamins important for cardiovascular health. Although most participants consumed an adequate numbers of servings of foods from the main food groups, most did not meet the recommended number of servings of dairy foods and only one in four adults took a multivitamin supplement daily. After adjusting for potential confounders, daily consumption of oil/sweets and dairy foods was positively associated with waist circumference. Also, daily consumption of oils/sweets, meats, and grains was positively associated with systolic blood pressure. The majority of the participants reported at least 30 min of moderate intensity physical activity per day. Dietary intake or supplement use did not show protective effects but performing vigorous physical activity may reduce risk of CVD in this population.