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Purpose The purpose of this study was to identify patient and program delivery characteristics associated with engagement and weight loss in a Diabetes Prevention Program (DPP) implemented in an urban hospital system. Methods Patient and program delivery data were collected between July 2015 and December 2017. DPP eligibility was determined based on age, body mass index (BMI), and hemoglobin A1C data via the electronic health record. Engagement was measured at 3 levels: ≤3 sessions, 4 to 8 sessions, and ≥9 sessions. Weight was measured at each DPP session. Results Among the eligible patients (N = 31 524), referrals and engagement were lower in men than women, in Spanish speakers than English speakers, in younger (18-34 years) and middle-aged (35-54 years) than older adults, and in patients receiving Medicaid than other patients. Referral and engagement were higher in patients with higher BMIs and those prescribed ≥5 medications. Current smokers were less frequently engaged. Prior health care provider contact was associated with higher engagement. Overall, 28% of DPP participants achieved ≥5% weight loss; younger and middle-aged patients and those who gained weight in the prior 2 years were less likely to lose weight. Conclusion This assessment identified characteristics of patients with lower levels of referral and engagement. The DPP staff may need to increase outreach to address barriers to referral and during all points of engagement among men, younger patients, and Spanish speakers. Future research is needed to increase understanding with regard to why referrals and engagement are lower among these groups.

Objective: Housing status is a primary social determinant of health that is not typically not collected in clinical settings. Residential address data collected during clinical visits can identify patients at high-risk for cardio­metabolic disease (CMD) residing in public housing. Design: This study examined CMD and related risk factors among patients living in public housing and a comparison group not living in public housing. Setting: All patients (n=173,568) were receiving primary care in a large hospital system in the Bronx, New York between January 1, 2016 and December 31, 2017. Results: Patients in public housing were more likely to be women, to be Black or Hispanic, and to be on Medicaid compared with patients not living in public housing. Women in public housing were more likely than men to have had a higher prevalence of CMD and related risk factors. Conclusion: The burden of CMD among public housing residents shows sex disparities where women have a higher prevalence of CMD and related risk factors than men. Ethn Dis. 2019;29(3):463-468; doi:10.18865/ed.29.3.463

This study compared the prevalence of chronic pediatric health conditions for youth in public housing with youth not in public housing using clinical electronic health record (EHR) and housing data. Youth (ages 2-17 years) in a large urban health system were identified and categorized into two housing types—public housing (n = 10 770) and not in public housing (n = 84 883) by age (young childhood, middle childhood, young adolescence). The prevalence of some pediatric conditions was higher in public housing but varied by age. Disparities in health conditions among youth in public housing were more common in early adolescence: asthma (26.4 vs 18.6; P < .001); obesity (28.5 vs 24.6; P < .001); depression/anxiety (19.2 vs 17.3; P = .008); behavioral disorders (8.1 vs 5.3; P < .001). These results show that chronic pediatric conditions like asthma and obesity that lead to significant morbidity into adulthood are more common among youth living in public housing. However, this pattern is not consistent across all chronic conditions.

Purpose Limited research has examined maternal experiences of racial/ethnic discrimination in relation to child cardiometabolic health. In this study, we investigated whether maternal experiences of ethnic discrimination were associated with cardiometabolic risk in Hispanic/Latino youth several years later. Methods Our sample included 1146 youth (8–16 years) from the Study of Latino Youth (2012–2014), who were children of the Hispanic Community Health Study/Study of Latinos participants (2008–2011). We used regression models to examine the prospective associations between maternal report of ethnic discrimination in relation to her child's body mass index (BMI) z-score, metabolic syndrome score (MetS), and high sensitivity C-reactive protein (hsCRP) levels 2 years later. Results Maternal ethnic discrimination was associated with youth hsCRP, but not BMI or MetS (P-values >.05). Adjusting for age, nativity, and national background, maternal ethnic discrimination was associated with higher (log) hsCRP levels (β = 0.18, 95% CI = 0.04 to 0.32) in children. This association was robust to adjustment for maternal and household characteristics (β = 0.17, 95% CI = 0.04 to 0.31), as well as maternal depression and maternal BMI. Conclusions Maternal ethnic discrimination is associated with inflammation among Hispanic/Latino youth, and not BMI z-score or MetS. Studies are needed to address temporality and pathways.

Introduction: Sedentary behavior (SED) is associated with higher obesity and cardiometabolic risk in youth, independent of physical activity. Studies showing the association between screen time and SED among Hispanics/Latinos, have primarily focused on Mexican-origin Hispanics. Additional research is needed to examine other socio-environmental factors that can influence SED among diverse Hispanics/Latinos. This cross-sectional study examined the home-, neighborhood-, and school- environment to identify factors associated with total sedentary time among youth. Methods: Data from 1,104 youth ages 8-16 years and 728 caregivers (mean age 43.1 ± 8.2 years) from four U.S. cities, who participated in the Study of Latino Youth (2012-2014), were examined. Associations between socio-environmental factors (measured by self-report) and total sedentary time (measured by one-week Actical accelerometry) were examined in linear regression models that included MVPA minutes/day, demographic covariates, and accounted for the complex survey design and sampling weights. Results: Mean sedentary time was 10.1 ± 1.8 hours/day. Home environment factors, such as electronics in the bedroom and parent limit setting, were not associated with total sedentary time. Presence of barriers to physical activity in the neighborhood (e.g., muggings, gangs) was associated with 13.4 more minutes of sedentary time per day. Attending a school that never/rarely compared to sometimes offered after school physical activity opportunities was associated with more sedentary time (B=38.0 minutes/day; 95% Confidence Interval: 13.5-62.4). Conclusions: The study findings highlight the need for future research to investigate other sources of sedentary behavior in the home for interventionist to focus on specific SED-based strategies to decrease sedentary time among youth. Minimizing barriers by identifying safe places to be active in participant’s neighborhoods may also support youth to spend less time indoors where sedentary time is prevalent.

In this study of low-income Hispanic/Latino adults living in 291 individual apartments in the Bronx, New York, the apartment layout was significantly associated with the odds of depressive symptomology. Women living in apartments in which the most central rooms were the living, dining, or kitchen (i.e., rooms commonly used for communal activities) were less likely to have depressive symptomology (OR = 0.44, 95% CI = 0.22–0.86) than women in apartments where the central rooms were lobbies or corridors, adjusting for demographics, health conditions, and housing and neighborhood characteristics. No statistically significant association was observed in men. We present the logic underlying the use of layout variables in this study and discuss the implications it may have for understanding the role of the home environment on psychological distress among inhabitants. The results of this study show how space syntax analysis can be used to better understanding disparities in the risk of depression and offer an additional opportunity for public health stakeholders to identify those most at risk for depression.

Comparative effectiveness research trials in real-world settings may require participants to choose between preferred intervention options. A randomized clinical trial with parallel experimental and control arms is straightforward and regarded as a gold standard design, but by design it forces and anticipates the participants to comply with a randomly assigned intervention regardless of their preference. Therefore, the randomized clinical trial may impose impractical limitations when planning comparative effectiveness research trials. To accommodate participants’ preference if they are expressed, and to maintain randomization, we propose an alternative design that allows participants’ preference after randomization, which we call a “preference option randomized design (PORD)”. In contrast to other preference designs, which ask whether or not participants consent to the assigned intervention after randomization, the crucial feature of preference option randomized design is its unique informed consent process before randomization. Specifically, the preference option randomized design consent process informs participants that they can opt out and switch to the other intervention only if after randomization they actively express the desire to do so. Participants who do not independently express explicit alternate preference or assent to the randomly assigned intervention are considered to not have an alternate preference. In sum, preference option randomized design intends to maximize retention, minimize possibility of forced assignment for any participants, and to maintain randomization by allowing participants with no or equal preference to represent random assignments. This design scheme enables to define five effects that are interconnected with each other through common design parameters—comparative, preference, selection, intent-to-treat, and overall/as-treated—to collectively guide decision making between interventions. Statistical power functions for testing all these effects are derived, and simulations verified the validity of the power functions under normal and binomial distributions.

Excessive sedentary behavior is associated with negative health outcomes independent of physical activity. Objective estimates of time spent in sedentary behaviors are lacking among adults from diverse Hispanic/Latino backgrounds. The objective of this study was to describe accelerometer-assessed sedentary time in a large, representative sample of Hispanic/Latino adults living in the United States, and compare sedentary estimates by Hispanic/Latino background, sociodemographic characteristics and weight categories. This study utilized baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that included adults aged 18–74 years from four metropolitan areas (N = 16,415). Measured with the Actical accelerometer over 6 days, 76.9% (n = 12,631) of participants had > 10 h/day and > 3 days of data. Participants spent 11.9 h/day (SD 3.0), or 74% of their monitored time in sedentary behaviors. Adjusting for differences in wear time, adults of Mexican background were the least (11.6 h/day), whereas adults of Dominican background were the most (12.3 h/day), sedentary. Women were more sedentary than men, and older adults were more sedentary than younger adults. Household income was positively associated, whereas employment was negatively associated, with sedentary time. There were no differences in sedentary time by weight categories, marital status, or proxies of acculturation. To reduce sedentariness among these populations, future research should examine how the accumulation of various sedentary behaviors differs by background and region, and which sedentary behaviors are amenable to intervention., Graphical abstract, Highlights • We present accelerometer-assessed sedentary time in a representative sample of Hispanic/Latino adults living in the U.S. • We compare sedentary estimates by heritage and other socio-demographic variables such as education. • Adults of Mexican background were the least whereas adults of Dominican background were the most sedentary.