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Examining the association between possessing a regular source of healthcare and adherence with cancer screenings among Haitian households in Little Haiti, Miami-Dade County, Florida.

ABSTRACT: Immigrant minorities regularly experience higher incidence and mortality rates of cancer. Frequently, a variety of social determinants create obstacles for those individuals to get the screenings they need. This is especially true for Haitian immigrants, a particularly vulnerable immigrant population in South Florida, who have been identified as having low cancer screening rates. While Haitian immigrants have some of the lowest cancer screening rates in the country, there is little existing literature that addresses barriers to cancer screenings among the population of Little Haiti in Miami-Dade County, Florida. The objective of this study was to evaluate the association between having a regular source of healthcare and adherence to recommended cancer screenings in the Little Haiti population of Miami.This secondary analysis utilized data collected from a random-sample, population-based household survey conducted from November 2011 to December 2012 among a geographic area approximating Little Haiti in Miami-Dade County, Florida. A total of 421 households identified as Haitian. The main exposure of interest was whether households possessed a regular source of care. Three separate outcomes were considered: adherence with colorectal cancer screening, mammogram adherence, and Pap smear adherence. Analysis was limited to households who met the age criteria for each outcome of interest. Bivariate associations were examined using the chi square test and Fisher exact test. Binary logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).After adjusting for the head of household's education and household insurance status, households without a regular source of care were significantly less likely to adhere with colorectal cancer screening (OR = 0.33; 95% CI: 0.14-0.80) or mammograms (OR = 0.28; 95% CI: 0.11-0.75). Households with insurance coverage gaps were significantly less likely to adhere with mammograms (OR = 0.40; 95% CI: 0.17-0.97) or Pap smears (OR = 0.28; 95% CI: 0.13-0.58).Our study explored adherence with multiple cancer screenings. We found a strong association between possessing a regular source of care and adherence with colorectal cancer screening and mammogram adherence. Targeted approaches to improving access to regular care may improve adherence to cancer screening adherence among this unique immigrant population.

SUBMITTER: Pang H

PROVIDER: S-EPMC5556222 | biostudies-other | 2017 Aug

REPOSITORIES: biostudies-other

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Project description:Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014-2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)-the ratio of the prevalence among BAAs to that among nHWs-as an index of BAA-nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains-health behaviors, clinical care, social and economic and physical environment-as contributors to BAA-nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = -0.21, p < 0.001) and social and economic (β = -0.11, p < 0.01) domains were significantly inversely associated with the observed BAA-nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA-nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.

Project description:Urbanization is increasing globally, and construction sites are an integral part of the urbanization process. It is unknown to what extent construction sites create favorable breeding conditions for mosquitoes. The main objectives of the present study were to identify what species of mosquitoes are present at construction sites and the respective physical features associated with their production. Eleven construction sites were cross-sectionally surveyed for the presence of mosquitoes in Miami-Dade County, Florida including in areas previously affected by the Zika virus outbreak in 2016. A total of 3.351 mosquitoes were collected; 2.680 adults and 671 immatures. Aedes aegypti and Culex quinquefasciatus comprised 95% of all collected mosquitoes and were the only species found in their immature forms breeding inside construction sites. Results for the Shannon and Simpson indices, considering both immature and adult specimens, yielded the highest values for Cx. quinquefasciatus and Ae. aegypti. The individual rarefaction curves indicated that sampling sufficiency was highly asymptotic for Cx. quinquefasciatus and Ae. aegypti, and the plots of cumulative species abundance (ln S), Shannon index (H) and log evenness (ln E) (SHE) revealed the lack of heterogeneity of species composition, diversity and evenness for the mosquitoes found breeding in construction sites. The most productive construction site breeding features were elevator shafts, Jersey plastic barriers, flooded floors and stair shafts. The findings of this study indicate that vector mosquitoes breed in high numbers at construction sites and display reduced biodiversity comprising almost exclusively Ae. aegypti and Cx. quinquefasciatus. Such findings suggest that early phase construction sites have suitable conditions for the proliferation of vector mosquitoes. More studies are needed to identify modifiable worker- and organizational-level factors to improve mosquito control practices and guide future mosquito control strategies in urban environments.

Project description:BackgroundRecent commentary on the health consequences of natural disasters has suggested a dearth of research on understanding the antecedents prior to the disaster that are associated with health consequences after the disaster. Utilizing data from a two-wave panel survey of Port-au-Prince, Haiti, conducted just prior to and six weeks after the January 2010 earthquake, we test factors prior to the quake hypothesized to be associated with food insecurity after the quake.MethodsUsing random Global Positioning System (GPS) sampling, we re-interviewed 93.1% (N = 1732) of the original 1,800 households interviewed in 2009. Respondents were queried with regard to mortalities, injuries, food security, housing, and other factors after the quake.FindingsChild food insecurity was found to be common on all three indices of food security (17.2%-22.6%). Additionally, only 36.5% of school-aged children were attending school prior to the quake. Findings suggest that prior schooling was associated with a substantial reduction on food insecurity indices (OR 0.62-0.75). Findings further suggest that several household characteristics were associated with food insecurity for children. Prior chronic/acute illnesses, poor living conditions, remittances from abroad, primary respondent mental health, and histories of criminal and other human rights violations committed against family members prior to the quake were associated with food insecurity after the earthquake. Earned household income after the quake was only associated with one of the measures of food insecurity.InterpretationFood insecurity for children was common after the quake. Those households vulnerable on multiple dimensions prior to the quake were also vulnerable to food insecurity after the quake. Remittances from abroad were leading protective factors for food security. Because Haiti is well known for the potentiality of both hurricanes and earthquakes, reconstruction and redevelopment should focus on ameliorating potential vulnerabilities to poor outcomes in these natural disasters.

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Examining the association between possessing a regular source of healthcare and adherence with cancer screenings among Haitian households in Little Haiti, Miami-Dade County, Florida.

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