Decision Making About Method of Delivery on the U.S.–Mexico Border

We explored how low-risk, nulliparous pregnant women and their doctors in two contiguous U.S.–Mexico border communities communicate about methods of delivery and how they perceive that the delivery method decision is made. We recruited 18 women through obstetricians in El Paso, Texas (n = 10), and prenatal care providers in Ciudad Juárez, Mexico (n = 8). We observed prenatal care visits, interviewed women prenatally and postpartum, and interviewed the El Paso obstetricians. Qualitative analysis demonstrated that birthing decisions are complex and involve multiple influences, including women's level of knowledge about birth, doctor–patient communication, and women's participation in decision making.     

Deportation Along the U.S.–Mexico Border: Its Relation to Drug Use Patterns and Accessing Care

Since migration has been linked to new drug trends and risky behaviors, and deported individuals face unique economic and social stressors, we investigated behaviors of injection drug users (IDUs) from Tijuana, Mexico in relation to deportation history. In 2005, IDUs ≥18 years old who injected within the prior month were recruited by respondent-driven sampling, administered a questionnaire, and underwent antibody testing for HIV, HCV, and syphilis. Logistic regression compared IDUs who reported coming to Tijuana due to deportation from the U.S. versus others in the study. Of 219 participants, 16% were deportees. Prevalence of HIV, HCV and syphilis was 3, 95 and 13%, respectively. Deportees had lived in Tijuana for a shorter time (median: 2 vs. 16 years), were more likely to inject multiple times/day (OR: 5.52; 95%CI: 1.62–18.8), but less likely to have smoked/inhaled methamphetamine (OR: 0.17; 95%CI: 0.17–0.86). Deportation history was inversely associated with receiving drug treatment (OR: 0.41; 95%CI: 0.19–0.89), recent medical care (OR: 0.37; 95%CI: 0.13–1.00), or HIV testing (OR: 0.44; 95%CI: 0.19–1.02). Deportees had different drug use patterns and less interaction with public health services than other study participants. Our study is an indication that migration history might relate to current risk behaviors and access to health care. More in-depth studies to determine factors driving such behaviors are needed.     

The Household Food Insecurity and Health Outcomes of U.S.–Mexico Border Migrant and Seasonal Farmworkers

Emerging evidence suggests chronic household food insecurity has an adverse effect on health. This study examined the prevalence, predictors and health outcomes associated with food insecurity in 100 migrant and seasonal farmworker (MSFW) households living on the U.S.–Mexico border. Data were collected using the U.S. Food Security Scale, California Agricultural Worker’s Health Survey, and objective anthropometric, clinical and biochemical indicators. Food insecurity affected 82% of households; 49% also had hunger. Household food insecurity was predicted by the presence of minor children in the home and low maternal education. Food insecure households were more likely to have at least one member affected by symptoms of depression (deprimido), nervios (an ethnospecific condition), learning disorders, and symptoms suggestive of gastrointestinal infection. Although not directly associated with food insecurity, adult obesity, central body adiposity, elevated blood pressure, and blood lipid and glucose disturbances were common. These findings highlight the significant food security and health challenges faced by border area MSFW families.     

Exploratory Study of the Occupational Health and Health-Seeking of Migrant and Seasonal Farmworkers on the U.S.–Mexico Border

The U.S. migrant and seasonal farmworker (MSFW) workforce is aging. Aging causes functional changes that can affect work performance and increase injury/accident risk. It also has been linked with deferred health-seeking. The exploratory study was conducted to investigate occupational injuries and health-seeking in Hispanic MSFW on the U.S.-Mexico border. Data were collected using an abbreviated Spanish-version of the California Agricultural Worker Health Survey. Nearly 60% of the 141 participants were middle-aged or older. Musculoskeletal injuries and those consistent with agrochemical and environmental exposures were common. Farmworkers aged >40 years were 2.5-5 times more likely than younger MSFW to report persistent single and multiple injuries involving the knees, shoulder, feet, and hands. Except for neck and back injuries, few received any medical treatment. Although many self-treated with traditional home remedies, few used CAM practitioners. The study findings highlight the multiple workplace health and health-seeking challenges faced by aging immigrant MSFW.     

Cost-effectiveness of Community Health Workers in controlling diabetes epidemic on the U.S.–Mexico border

Objectives

This study attempted to evaluate clinical outcomes and long-term cost-effectiveness of an intervention involving Community Health Workers (CHW's, a.k.a. promotoras de salud in Spanish) in assisting Mexican-American diabetes type-2 patients with controlling their condition. The intervention has been carried out in Hidalgo County, TX which is situated on the U.S.–Mexico border.

Study design

The design of the study is experimental. The sample (n = 30) was recruited from Mexican–American diabetes patients aged 30 or above. The intervention group received monthly visits from CHW's, while the control group did not.

Methods

Incremental lifetime health outcomes and related expenditures were calculated using the CDC Diabetes Cost-Effectiveness Model (DCEM) which is a probabilistic computer simulation model of disease progression and cost-effectiveness for type 2 diabetes patients. The DCEM allows projection of lifetime healthcare costs and Quality-Adjusted Life-Years (QALYs).

Results

The intervention group showed a significant improvement in glycemic control and cholesterol management after two years of intervention. The intervention is expected to reduce long-term complications, resulting in an increase in residual life-years and quality-adjusted life-years. The incremental cost-effectiveness ratio has been estimated to be $13,810, which is below the level of comparable studies.

Conclusions

Intervention has a substantial impact on the medical costs of type 2 diabetes treatment. The estimates presented in this model may be used to analyse the cost-effectiveness of interventions involving CHW's for type 2 diabetes.     

Parabens and measures of adiposity among adults and children from the U.S. general population: NHANES 2007–2014

Background

Emerging experimental studies suggest that parabens could affect metabolism by altering the microbiome or signaling pathways involved in adipocyte differentiation. While human exposure to parabens is widespread, epidemiologic studies assessing the role of these chemicals on adiposity measures are scarce.

Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S.

ObjectivesThe purpose of this cross-sectional study was to examine associations between physical activity, screen-time, sleep duration, and their combinations based on 24-h movement guidelines with anxiety and depression among a nationally representative cohort aged 6–17 years in the US.MethodsThe 2016 National Survey of Children's Health (NSCH) data from a representative sample of children (n = 15,010) aged 6–11 years and adolescents (n = 20,708) aged 12–17 years were analyzed using logistic regression. This analysis examined parent-reported demographics, lifestyle-related behavioral variables, adverse childhood experiences, and history of anxiety and depression.ResultsPhysical activity participation was associated with anxiety and depression. Children with 0 days/week of physical activity were about twice more likely to have anxiety (Odds ratio (OR) = 2.19), and adolescents were over twice as likely to have anxiety (OR = 2.25) and depression (OR = 2.18), than peers with daily physical activity ≥ 60 min. There was no significant difference in the ORs of anxiety or depression between the children with daily physical activity and those with physical activity ≥60 min on 1–3 days/week or 4–6 days/week. Extracurricular activity participation and sleep duration were also significantly associated with anxiety and depression along with demographic variables such as race and weight status.ConclusionSome physical activity or organized extracurricular activity participation are associated with decreased odds of experiencing anxiety among children and adolescents, and depression among adolescents. Meeting all three 24-h movement guidelines was associated with lower ORs for anxiety for children and adolescents and depression among adolescents.     

Crossing Borders in Health Communication Research: Toward an Ecological Understanding of Context,Complexity, and Consequences in Community-Based Health Education in the U.S.–Mexico Borderlands

In the past 15 years, researchers in health information dissemination have made significant strides in addressing context, complexity, and consequences (Sharf's “3 Cs”) in theory, research, and praxis. The goal of integrating the 3 Cs in this field, however, remains a challenge. In this article, the authors present 6 principles of a postmodern ecological approach to health information dissemination that attempts such integration. The authors outline proposed principles and use a multiyear, interdisciplinary, and interinstitutional collaboration along the U.S.–Mexico border to illustrate this postmodern ecological approach. The goal of this article is to provide a framework for understanding other projects and communities in which efforts are undertaken to cross physical, social, cultural, economic, and political borders.     

Fatalities of Pedestrians,Bicycle Riders,and Motorists Due to Distracted Driving Motor Vehicle Crashes in the U.S., 2005–2010

Objective

Distracted driving is an increasingly deadly threat to road safety. This study documents trends in and characteristics of pedestrian, bicycle rider, and other victim deaths caused by distracted drivers on U.S. public roads.

Methods

We obtained data from the Fatality Analysis Reporting System database from 2005 to 2010 on every crash that resulted in at least one fatality within 30 days occurring on public roads in the U.S. Following the definition used by the National Highway Traffic Safety Administration, we identified distracted driving based on whether police investigators determined that a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities.

Results

The rate of fatalities per 10 billion vehicle miles traveled increased from 116.1 in 2005 to 168.6 in 2010 for pedestrians and from 18.7 in 2005 to 24.6 in 2010 for bicyclists. Pedestrian victims of distracted driving crashes were disproportionately male, 25–64 years of age, and non-Hispanic white. They were also more likely to die at nighttime, be struck by a distracted driver outside of a marked crosswalk, and be in a metro location. Bicycling victims of distracted crashes were disproportionately male, non-Hispanic white, and struck by a distracted driver outside of a crosswalk. Compared with pedestrians, bicyclists were less likely to be hit in early morning.

Conclusions

Distracted drivers are the cause of an increasing share of fatalities found among pedestrians and bicycle riders. Policies are needed to protect pedestrians and bicycle riders as they cross intersections or travel on roadways.Mounting evidence links the use of electronic devices with increased traffic deaths and injuries.^1–4 Even though traffic deaths are declining, deaths from distracted driving are rising, with one study attributing much of this increase to texting volume, which surpassed 100 billion monthly text messages in 2008.⁵ However, there are many potential causes of distraction other than electronic devices that threaten roadway safety. Most of this research has examined aggregate fatalities and injuries from distracted driving crashes, but little is known about the characteristics of victims killed in these crashes despite extensive research on predictors of pedestrian injuries.^6–11 Policy makers and advocacy organizations need greater understanding of the characteristics of victims who are most at risk from distracted drivers.In this study, we report the number of pedestrians, bicyclists, and motorist victims who died from distracted driving-related motor vehicle crashes from 2005 to 2010, and describe the victims'' characteristics. We identified a distracted driving-related crash according to whether a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities.     

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000–2012)

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual’s willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women’s and men’s magazines (2000–2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ² = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ² = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.     

Education differentials by race and ethnicity in the diagnosis and management of hypercholesterolemia: a national sample of U.S. adults (NHANES 1999–2002)

Objectives:  To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3 race/ethnic groups. Methods:  We analyzed data for a nationally representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white, black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey from 1999–2002. Results:  Participants with < high school education were 2.5 times less likely than participants with ≥ high school education to have been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3–0.5, and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends associated with education after adjusting for age, gender, race and comorbidities. Conclusions:  Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease. Submitted: 31 March 2007; revised: 27 March 2008, 09 September 2008; accepted: 29 September 2008     

Urinary Concentrations of 2,4-Dichlorophenol and 2,5-Dichlorophenol in the U.S. Population (National Health and Nutrition Examination Survey, 2003–2010): Trends and Predictors

Background: 2,4-Dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), and their precursors are widely used in industry and in consumer products. Urinary concentrations of these dichlorophenols (DCPs) have been measured as part of four National Health and Nutrition Examination Survey (NHANES) cycles in order to assess the exposure to these compounds or their precursors among the general U.S. population.Objectives: We identified predictors and evaluated trends in DCP concentrations according to race/ethnicity, age, sex, family income, and housing type.Methods: We used analysis of covariance to examine associations of various demographic parameters and survey cycle with urinary concentrations of DCPs during NHANES 2003–2010. We also conducted weighted logistic regressions to estimate associations of DCP concentrations above the 95th percentile with housing type, race/ethnicity, and income.Results: We detected DCPs in at least 81% of participants. Geometric mean (GM) urinary concentrations were higher for 2,5-DCP (6.1–12.9 μg/L) than 2,4-DCP (0.8–1.0 μg/L) throughout 2003–2010. Adjusted GM concentrations of the DCPs among children (6–11 years of age) and adults > 60 years of age were higher than among adolescents and other adults. Adjusted GM concentrations among non-Hispanic whites were lower than among non-Hispanic blacks and Mexican Americans, although differences according to race/ethnicity were less pronounced among participants in high-income households. Among non-Hispanic blacks and Mexican Americans, adjusted GM concentrations were lowest among high-income participants relative to other income groups, with a monotonic decrease with increasing income among Mexican Americans. Type of housing and race/ethnicity were significant predictors of DCP urinary concentrations above the 95th percentile. Furthermore, urinary DCP concentrations have showed a downward trend since 2003.Conclusions: Exposure to DCPs and their precursors was prevalent in the general U.S. population in 2003–2010. We identified age and race/ethnicity, family income, and housing type as predictors of exposure to these compounds.Citation: Ye X, Wong LY, Zhou X, Calafat AM. 2014. Urinary concentrations of 2,4-dichlorophenol and 2,5-dichlorophenol in the U.S. population (National Health and Nutrition Examination Survey, 2003–2010): trends and predictors. Environ Health Perspect 122:351–355; http://dx.doi.org/10.1289/ehp.1306816     

Mycobacterium Tuberculosis Infection,Immigration Status,and Diagnostic Discordance: A Comparison of Tuberculin Skin Test and QuantiFERON?-TB Gold In-Tube Test Among Immigrants to the U.S.

Objective

We used a recent source of nationally representative population data on tuberculosis (TB) infection to characterize concordance between the tuberculin skin test (TST) and the QuantiFERON^®-TB Gold In-Tube (QFT-GIT) blood test for immigrants in the United States.

Methods

We used TB screening data from the 2011–2012 National Health and Nutrition Examination Survey to examine concordance between the TST and QFT-GIT—an interferon-gamma release assay (IGRA) blood test—for 7,097 U.S. natives, naturalized citizens, and noncitizens.

Results

Consistent with prior findings, one in five immigrants in the survey was identified with latent TB infection (LTBI), a rate 14 times higher than for U.S. natives. We also found higher rates of discordant TST/IGRA results among immigrants than among U.S. natives. Unadjusted discordance between TST and IGRA was 3% among U.S. natives (weighted N=5,684,274 of 191,179,213) but ranged up to 19% for noncitizens (weighted N=3,722,960 of 19,377,147). Adjusting for age, sex, and race/ethnicity, noncitizens had more than nine times the odds of having a positive TST result but negative QFT-GIT result compared with U.S. natives.

Conclusions

Our findings suggest that whether and how either of these tests should be deployed is highly context sensitive. Significant discordance in test results when used among immigrants raises the possibility of missed opportunities for harm reduction in this already at-risk population. However, we found little distinction between the tests in terms of diagnostic outcome when used in a U.S. native population, suggesting little benefit to the adoption and use of the QFT-GIT test in place of TST on the basis of test performance alone for this population.Although systematic public health efforts during the last 60 years have produced dramatic reductions in domestic tuberculosis (TB) incidence, prevalence, and fatalities, TB remains a major public health threat to global populations, with serious health and economic consequences, especially TB that is resistant to treatment.^1–6 One focus of public health efforts to control TB in the United States has been to screen immigrants for active TB by collecting a medical history, conducting a physical examination, and performing a chest radiography for all visa applicants aged ≥15 years.^7–9 Still, many immigrants, especially from high-burden regions, enter the United States in apparent health but carrying latent TB infection (LTBI) from some prior TB exposure. As a result, nearly two-thirds of new TB cases in the United States occur among the foreign-born.¹ LTBI may not be promptly identified and treated for immigrants in part because of well-documented barriers to health-care access for this population and also because of the complexity of diagnosing LTBI and effectively evaluating the risks and benefits of its treatment.¹⁰The current mainstay of TB risk evaluation—the tuberculin skin test (TST)—has many limitations, including a requirement for two health worker visits up to 72 hours apart, inability to distinguish LTBI from active TB, subjective interpretation of test results, and the test being subject to confounding by other infections or bacille Calmette-Guérin (BCG) immunization.^7,8,11–13 A new generation of diagnostic tests, Interferon Gamma-Release Assays (IGRAs), shows promise as an effective screening method for LTBI in part because these tests may have fewer limitations than TSTs; they have reduced confounding by immune response and less subjectivity in interpreting results, and are based on more specific markers.^11,12 The IGRA requires only one health-care visit during which a blood sample is drawn. Laboratory results for the IGRA can be available within 24 hours.¹³However, much remains unknown about the efficacy of IGRAs relative to TSTs, and without a gold standard diagnostic, the Centers for Disease Control and Prevention (CDC) recommends screening for TB using either the TST or IGRA, but not both.¹³ TSTs cost less than IGRAs, which may be an important consideration for public health departments.^14–18 Other disadvantages of IGRAs are that blood samples must be collected, transported to a laboratory, and processed shortly after collection.¹³ More importantly, growing evidence suggests that IGRA and TST results may be widely discordant when used among immigrants or other special groups relative to a U.S. native or more generalized U.S. population. One study of 279 immigrants to Italy found only a 70.9% concordance between these tests.¹⁹ A separate study of 132 U.S. visa applicants from Vietnam with culture-confirmed TB found a lack of concordance for 16 tested applicants.²⁰ A study of 604 newly arrived refugees in Decatur, Georgia, documented that one in four had discordant test results between TST and QuantiFERON^®-TB Gold In-Tube (QFT-GIT, QIAGEN, Hilden, Germany).²¹ This lack of concordance—in combination with CDC recommendations against using both tests for TB screening—may result in substantial numbers of immigrants receiving inaccurate test results when being initially screened for TB.To our knowledge, no nationally representative study of concordance between the TST and IGRA for immigrants in the United States has been conducted. We used a well-established source of nationally representative population data on TB infection to characterize concordance between the TST and the IGRA for immigrants in the United States.     

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men,Transgender Women,and Transgender Men Who Have Sex with Men: April–May 2020

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n?=?3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β?=?0.90, 95% CI 0.40–1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR?=?1.21), being Black (AOR?=?1.79) or Latinx (AOR?=?1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR?=?1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.