97 results on '"Felix HC"'
Search Results
2. Evaluation of a workshop to improve community involvement in community-based participatory research efforts.
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Stewart MK, Colley D, Felix HC, Huff A, Shelby B, Strickland E, McCabe-Sellers B, Redmond P, Evans M, Baker B, Stephens G, and Bogle ML
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- 2009
3. Issues in assessing satisfaction: findings of the Arkansas Medicaid Family Planning Demonstration Waiver Evaluation.
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Felix HC, White M, McCullough A, Morgan J, and Stewart K
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Arkansas was one of the first states to expand family planning services under its state Medicaid plan through a Section 1115 Demonstration Waiver. In addition to an assessment of other outcome measures, evaluators used exit interviews, which had been designed to reduce courtesy bias, to assess client satisfaction with family planning services available under the waiver in public health units. Client satisfaction with family planning services can serve as a simple measure of one dimension of perceived quality of care. Findings indicate overall client satisfaction with family planning services. However, noted methodological issues may limit the generalizability of these findings. Potential corrective measures are suggested for improving client satisfaction with family planning services and for increasing the utility of survey instrument utilized in this effort. [ABSTRACT FROM AUTHOR]
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- 2004
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4. Additional research on the cost of caring for obese nursing home residents is critical to maintaining adequate resources in the long-term care industry.
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Powell LS, Felix HC, Bradway C, Miller E, Heivly A, and Fleshner I
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- 2010
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5. Making hospital grounds smoke-free: a case study of Arkansas Act 134 of 2005.
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Felix HC, Wheeler JG, Pulley L, Stewart MK, Bursac Z, Mays GP, and Mackey DS
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The impact of tobacco use and environmental tobacco smoke (ETS) has been well documented. Many policies have been implemented to curb tobacco use and to reduce exposure to ETS. The purpose of this article is to describe the development and passage of Arkansas Act 134 of 2005, the first state law to prohibit the use of tobacco products on the grounds of all nonfederal community (nonpsychiatric) hospital facilities in the state. Efforts to bring this and other tobacco control policies to the attention of policy makers will be discussed in the context of several agenda-setting strategies. The strategy used by stakeholders in Arkansas to bring out Act 134 as well as the other agenda-setting strategies described in the article provide insight into the ways other states and communities seeking to adopt smoking bans and related public health policies can bring such policies to the attention of policy makers. [ABSTRACT FROM AUTHOR]
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- 2009
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6. Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey.
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Narcisse MR, Andersen JA, Felix HC, Hayes CJ, Eswaran H, and McElfish PA
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- Humans, Female, Male, United States, Middle Aged, Adult, Young Adult, Aged, Adolescent, SARS-CoV-2, Patient Acceptance of Health Care statistics & numerical data, Health Services Accessibility statistics & numerical data, Health Surveys, Socioeconomic Factors, Pandemics, Telemedicine statistics & numerical data, COVID-19 epidemiology
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Introduction: During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population., Methods: The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen's model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations., Results: 32.5% of adults ( n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19., Conclusion: There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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7. Patient satisfaction with Saudi community pharmacy services (Wasfaty System).
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Alzahrani AM, Felix HC, Alzhrani AA, Alharbi KK, Arbaein TJ, Shahzad MW, and Monshi SS
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Introduction: The healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system., Methods: This cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted., Results: The sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03-1.37) and waiting time (OR: 1.23; 95% CI: 1.03-1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85-0.99). Saudi patients had lower odds of being satisfied with multiple services., Conclusions: The overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient-pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes., (© 2024 The Authors.)
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- 2024
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8. Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia.
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Alzahrani AM, Alzhrani AA, Felix HC, Alharbi KK, Shahzad MW, Arbaein TJ, and Monshi SS
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Introduction: Saudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems., Materials and Methods: This cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist's explanation of the prescription, and waiting time to get medications) were the main outcomes., Results: The study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47-0.51), pharmacists' explanation of prescription (OR = 0.55, 95 % CI = 0.53-0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75-0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types., Conclusions: The significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V. on behalf of King Saud University.)
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- 2024
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9. Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep.
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Narcisse MR, McElfish PA, Schootman M, Selig JP, Kirkland T, McFarlane SI, Felix HC, Seixas A, and Jean-Louis G
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- Adult, Humans, Aged, United States, Medicare, Ethnicity, Sleep, Quality of Life psychology, Diabetes Mellitus, Type 2
- Abstract
Objective: To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+., Methods: Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity., Results: Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality., Conclusion: Improving sleep may lead to improvement in QoL in elderly adults with T2D., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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10. Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol.
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Short E, Selig JP, Felix HC, Painter J, McElfish PA, Rowland B, Ammerman AS, Bounds K, Henske J, Hudson JS, Li J, Young SG, and Long CR
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- Adult, Female, Humans, Male, Body Mass Index, Comparative Effectiveness Research, Cost-Benefit Analysis, Food Supply, Patient Education as Topic methods, Patient Education as Topic organization & administration, Self-Management methods, Randomized Controlled Trials as Topic, Diabetes Mellitus, Type 2 therapy, Diet, Healthy methods, Glycated Hemoglobin analysis, Rural Population
- Abstract
Background: Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes., Methods: This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone., Conclusion: Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food., Clinical Trial Registration: NCT04876053., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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11. Non-use and inadequate use of cervical cancer screening among a representative sample of women in the United States.
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Narcisse MR, McElfish PA, Hallgren E, Pierre-Joseph N, and Felix HC
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- Humans, Female, Adult, United States, Middle Aged, Aged, Young Adult, Patient Acceptance of Health Care statistics & numerical data, Mass Screening statistics & numerical data, Uterine Cervical Neoplasms diagnosis, Early Detection of Cancer statistics & numerical data
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Introduction: Women's adherence to the United States (U.S.) Preventive Services Task Force guidelines for cervical cancer screening was determined by examining predisposing, enabling, and needs factors from Andersen's Behavioral Model of Health Services Use conceptual framework., Methods: The outcome was operationalized as cervical cancer screening use, non-use, and inadequate-use. Multinomial logistic regression was conducted on data from the 2019 National Health Interview Survey of 7,331 eligible women aged 21-65., Results: Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Non-Users than those aged 21-29. Hispanic, Asian, and American Indian/Alaska Native (AIAN) women were more likely to be Non-Users than White women. More educated women were less likely to be Non-Users. Foreign-born women <10 years in the U.S. were more likely to be Non-Users than U.S.-born women. Women with financial hardship were less likely to be Non-Users. Poorer women and uninsured women were more likely to be Non-Users. Women with children in their household were less likely to be Non-Users than those without children. Women who had a well-visit in the past year were less likely to be Non-Users. Women with a history of human papillomavirus (HPV) vaccination were less likely to be Non-Users. Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Inadequate-Users. AIAN women were more likely to be Inadequate-Users. Women of other races were less likely to be Inadequate-Users. Employed women were less likely to be Inadequate-Users. Uninsured women were more likely to be Inadequate-Users. Women who had a well-visit within a year were less likely to be Inadequate-Users. Women with past HPV vaccination were more likely to be Inadequate-Users. Smokers were less likely to be Inadequate-Users., Discussion: Predisposing, enabling, and needs factors are differently associated with non-use and inadequate use of cervical cancer screening. Understanding factors associated with the use, non-use, and inadequate use of cervical cancer screening is crucial to avoid or curb unnecessary tests, increased costs to both society and individuals, and the ill-allocation of limited resources., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Narcisse, McElfish, Hallgren, Pierre-Joseph and Felix.)
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- 2024
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12. Association Between Physical Activity and Physical Function in a Marshallese Population with Type 2 Diabetes.
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Walter CS, Narcisse MR, Felix HC, Rowland B, Selig JP, and McElfish PA
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- Adult, Humans, Exercise, Health Behavior, Patient Education as Topic, Diabetes Mellitus, Type 2 rehabilitation, Native Hawaiian or Other Pacific Islander, Self-Management education
- Abstract
Physical activity can delay functional decline in people with type 2 diabetes (T2D), but these associations have not been studied within a sample of Native Hawaiian or Pacific Islander adults with T2D. Using data from a randomized control trial in which 218 Marshallese adults with T2D participated in a 10-week diabetes self-management education intervention, this study tested our hypothesis that physical activity would predict physical function when controlling for time and other variables. Levels of physical activity were positively associated with levels of physical function, even after controlling for time and other covariates. These findings provide a more robust understanding of the relationship between physical activity and physical function in a sample of minority adults with T2D. Future studies should further explore levels of physical activity needed to maintain and improve physical function so that culturally appropriate physical activity interventions can be developed., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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13. Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands.
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Andersen JA, Rowland B, Gloster E, Felix HC, Riklon S, Jenkins D, Bing WI, Mendoza Kabua P, Hudson JS, Edem D, Niedenthal J, and McElfish PA
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- Adult, Humans, Self Care, Health Education, Micronesia epidemiology, Surveys and Questionnaires, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 therapy
- Abstract
Aims: The aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI)., Methods: The study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge., Results: Results indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge., Conclusions: The results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system., Competing Interests: Declaration of Competing Interest The authors declared no competing interests., (Copyright © 2023 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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14. Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity.
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Andersen JA, Bradway CW, and Weech-Maldonado R
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Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring., Competing Interests: Conflict of interest The authors declare no conflicts of interest.
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- 2023
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15. Characteristics of Nursing Homes with High Rates of Urinary Tract Infections among Their Residents with Obesity.
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Andersen JA, Weech-Maldonado R, and Bradway CW
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Nursing home residents with obesity are at high risk for contracting urinary tract infections. In this research study, we found nursing homes in multi-facility chain organizations, for-profit status, nursing home size, obesity rate of resident population, and market competition were significantly associated with rates of urinary tract infections among residents with obesity.
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- 2023
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16. Characteristics of nursing homes with high percentages of falls and falls with injuries among residents with obesity.
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, and Bradway CK
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- Humans, United States, Risk Factors, Nursing Homes, Obesity complications, Obesity epidemiology
- Abstract
Background: Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group., Aim: We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity., Method: We used resident assessment data and logistic regression analysis., Results: We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day., Conclusion: Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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17. Health Profiles of Marshallese With and Without a Type 2 Diabetes Diagnosis in the Republic of the Marshall Islands.
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Andersen JA, Felix HC, Malhis JR, Gloster E, and McElfish PA
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Background: The Republic of the Marshall Islands (RMI) faces a high prevalence of type 2 diabetes (T2DM)., Objectives: The aim of the study is to document the health of Marshallese with and without a T2DM diagnosis to inform future interventions., Design: Data are from screenings collected in preparation for a diabetes education intervention. Data, including HbA1c, random glucose, cholesterol, weight, and self-rated health, were collected., Methods: Kruskal-Wallis and Fisher's exact tests were used to identify differences in participants with and without T2DM diagnosis., Results: There were significant differences in both HbA1c level ( P ⩽ .0001) and glucose level ( P ⩽ .0001) between the diagnosed T2DM and non-diagnosed T2DM groups, as well as diastolic blood pressure ( P = .0179), systolic blood pressure ( P = .0003), and pulse pressure ( P = .0023). There were no differences in weight, body mass index (BMI), high density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol, or self-rated health. Marshallese without a T2DM diagnosis have signs of insulin resistance, including elevated glucose and triglyceride levels., Conclusion: The results indicate a need for a socioecological approach to T2DM interventions, and interventions in the RMI should consider inclusion of blood pressure and cholesterol management. There is a need for interventions to prevent prediabetes and its progression to T2DM., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
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- 2023
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18. Factors associated with breast cancer screening services use among women in the United States: An application of the Andersen's Behavioral Model of Health Services Use.
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Narcisse MR, Shah SK, Hallgren E, Felix HC, Schootman M, and McElfish PA
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- Humans, United States, Female, Early Detection of Cancer, Health Services, Insurance, Health, Preventive Health Services, Health Services Accessibility, Breast Neoplasms diagnosis, Breast Neoplasms prevention & control
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This study applied Andersen's Behavioral Model of Health Services Use to examine predisposing, enabling, and need factors associated with adherence to the United States Preventive Services Task Force (USPSTF) guidelines for breast cancer screening (BCS). Multivariable logistic regression was used to determine factors of BCS services utilization among 5484 women aged 50-74 from the 2019 National Health Interview Survey. Predisposing factors significantly associated with use of BCS services were: being a Black (odds-ratios [OR]:1.49; 95% confidence interval [CI]:1.14-1.95) or a Hispanic woman (OR:2.25; CI:1.62-3.12); being married/partnered (OR:1.32, CI:1.12-1.55); having more than a bachelor's degree (OR: 1.62; CI:1.14-2.30); and living in rural areas (OR:0.72; CI:0.59-0.92). Enabling factors were: poverty level [≤138% federal poverty level (FPL) (OR:0.74; CI:0.56-0.97), >138-250% FPL (OR:0.77; CI:0.61-0.97), and > 250-400% FPL (OR:0.77; CI:0.63-0.94)]; being uninsured (OR:0.29; CI:0.21-0.40); having a usual source of care at a physician office (OR:7.27; CI:4.99-10.57) or other healthcare facilities (OR:4.12; CI:2.68-6.33); and previous breast examination by a healthcare professional (OR:2.10; CI:1.68-2.64). Need factors were: having fair/poor health (OR:0.76; CI:0.59-0.97) and being underweight (OR:0.46; CI:0.30-0.71). Disparities in BCS services utilization by Black and Hispanic women have been reduced. Disparities still exist for uninsured and financially restrained women living in rural areas. Addressing disparities in BCS uptake and improving adherence to USPSTF guidelines may require revamping policies that address disparities in enabling resources, such as health insurance, income, and health care access., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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19. Determinants of periodic health examination uptake among adults in Al-Jouf Region, Saudi Arabia.
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Alzahrani AM, Felix HC, and Al-Etesh NS
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Background: Periodic Health Examinations (PHEs) typically occur annually and provide an important opportunity for providers to screen their patients for undiagnosed health conditions and monitor existing conditions, such as diabetes and hypertension. Unfortunately, PHEs are reported to be low in Saudi Arabia. This study's aim was to assess the regular uptake of PHEs by adults residing in Al-Jouf region, Saudi Arabia., Materials and Methods: A cross-sectional survey was conducted among adults (aged ≥ 20 years) residing in five communities in the Al-Jouf Region on sociodemographic characteristics, self-reported chronic conditions, knowledge of PHEs, and their regular uptake. Chi-square tests and multivariate logistic regression analysis were performed to determine the factors associated with regular uptake of PHEs., Results: A total of 624 participants completed the survey questionnaire. Of the participants, 27.7% reported a regular uptake of PHEs. The odds of regular uptake of PHEs were higher among older respondents (odds ratio [OR] =1.98; P = 0.002), those who reported that they had diabetes (OR = 3.25; P < 0.001), hypertension (OR = 4.11; P = 0.001), hyperlipidemia (OR = 2.66; P = 0.003), and those with a higher PHEs knowledge score (OR = 1.35; P < 0.001). However, the odds regular uptake of PHEs among respondents residing in the three governorates and Skaka city were significantly lower (OR = 0.27; P = 0.001 and OR = 0.30; P = 0.002, respectively) than their counterparts., Conclusion: Low rates of PHEs uptake were observed among the survey participants in the Al-Jouf Region of Saudi Arabia. The characteristics of individuals associated with low uptake of PHEs were identified. Tailored interventions, such as the use of community health workers and clinic communications, could target these individuals to increase the uptake of PHEs., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family and Community Medicine.)
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- 2023
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20. Low uptake of seasonal influenza vaccination in Al-Jouf region of Saudi Arabia.
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Alzahrani AM, Felix HC, and Al-Etesh NS
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Introduction: Seasonal influenza is a contagious viral respiratory condition typically occurring in the fall to early spring months of the year globally. The risk of infection from seasonal influenza can be greatly reduced with vaccination. Unfortunately, research has indicated that the seasonal influenza vaccination rate in Saudi Arabia is low. This study assessed the uptake of seasonal influenza vaccination among adults residing in Al-Jouf region, Saudi Arabia., Materials and Methods: A cross-sectional survey targeting adults (20-80 years) residing in Al-Jouf region, Saudi Arabia, was conducted to gather information about their sociodemographic characteristics, chronic conditions, knowledge about periodic health examinations (PHE), regular use of PHE, and uptake of seasonal influenza vaccination. Comparative statistics and a multivariate logistic regression analysis were conducted to determine characteristics associated with the uptake of seasonal influenza vaccination., Results: A total of 624 respondents completed the survey and participated in this study. Among the participants, 27.4% indicated they visited their primary healthcare centers or hospitals every year to get a seasonal influenza vaccination. The regression analysis showed that the odds of getting a seasonal influenza vaccination were higher among employed respondents (Odds Ratio [OR] = 1.73; P = 0.039), respondents who were employees of the healthcare sector (OR = 2.31; P = 0.001), and those with a higher PHE Knowledge Score (OR = 1.22; P = 0.008), compared to their counterparts., Conclusions: Seasonal influenza is a serious condition warranting appropriate prevention measures, including vaccination. However, this study confirmed low rates of seasonal influenza vaccination in Al-Jouf Region of Saudi Arabia. Interventions to boost vaccination uptake, in particular among unemployed individuals, those not working in the healthcare sector, and those with lower PHE knowledge Scores, are therefore recommended., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)
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- 2023
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21. An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol.
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Short E, Gannon MA, Bounds K, Faitak B, Martin P, Moore S, Shannon D, Selig JP, English ES, Felix HC, Haggard-Duff L, Mejia-Otero J, McElfish PA, and Long CR
- Abstract
Background: Diabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D., Methods: This is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress., Results: Recruitment began in August 2021 and enrollment is anticipated to be complete in March 2023., Conclusion: Findings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting., Competing Interests: None., (© 2023 Published by Elsevier Inc.)
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- 2023
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22. A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults.
- Author
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McElfish PA, Felix HC, Bursac Z, Rowland B, Yeary KHK, Long CR, Selig JP, Kaholokula JK, and Riklon S
- Subjects
- Adult, Humans, Obesity prevention & control, Risk Factors, Weight Loss physiology, Overweight prevention & control, Overweight complications, Diabetes Mellitus, Type 2 prevention & control, Diabetes Mellitus, Type 2 complications
- Abstract
This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m
2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c , blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months ( P = .3599) or at 12 months ( P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months ( P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.- Published
- 2023
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23. Associations among Self-Reported Mental Health, Physical Activity, and Diet during the COVID-19 Pandemic.
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Andersen JA, Rowland B, Gloster E, Willis DE, Hernandez N, Felix HC, Long CR, and McElfish PA
- Subjects
- Adult, Humans, Mental Health, Cross-Sectional Studies, Self Report, Diet, Vegetables, Exercise, Pandemics, COVID-19 epidemiology
- Abstract
Background: Understanding the relationship between physical activity, diet, and mental health during the COVID-19 pandemic may help inform resources encouraging healthy lifestyle choices during the time of an increased threat to health and wellbeing. Aim: Our objective was to examine how self-rated mental health was associated with engagement in physical activity and consumption of fruits and vegetables during the COVID-19 pandemic. Methods: The study utilized cross-sectional survey data from adults (≥18 years of age) living, working, and/or receiving healthcare in Arkansas (n = 754). Multivariable regression models were used to examine the associations between self-rated mental health and the number of days respondents engaged in 30 min of physical activity and the number of days respondents consumed five or more servings of fruits and vegetables. Results: Respondents who reported somewhat poor/poor mental health reported engaging in at least 30 min of physical activity fewer days per week (β = -.77, p = .018) compared with those reporting excellent mental health, after controlling for sociodemographic factors and self-rated health. The significant association observed in the first two models between mental health and number of days consuming five or more servings of fruits and vegetables became non-significant after inclusion of self-rated health. Conclusion: The relationship between mental health and physical activity and diet reaffirms a need for healthcare providers to promote the importance of maintaining both a healthy physical activity level and a nutrient-rich diet in the face of challenging circumstances, such as a global pandemic.
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- 2022
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24. Characteristics Associated with Knowledge about Periodic Health Examinations among Adults in Al-Jouf Region, KSA.
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Alzahrani AM, Felix HC, and Al-Etesh NS
- Abstract
Objectives: A lack of knowledge is one of the key barriers that hinders the use of Periodic Health Examinations (PHEs). This study aimed to investigate the knowledge of PHE among adults residing in Al-Jouf region, KSA, and determine characteristics associated with such knowledge., Methods: A cross-sectional survey targeting adults (≥18 years) residing in Al-Jouf region, KSA, was conducted to gather information relating to their sociodemographic characteristics, needs for healthcare, and knowledge about and practices toward PHE. Comparative statistics and multivariate linear regression analysis were conducted to determine the key characteristics associated with knowledge about PHE., Results: A total of 624 respondents completed the survey and participated in this study. Among the participants, the mean PHE knowledge score was 5.26 (SD = 0.05) with a range of 0-7. Regression analysis showed that the PHE knowledge score was significantly higher among females, respondents with a college degree, and those worked in the healthcare field when compared to their counterparts., Conclusion: Analysis revealed a relatively high overall knowledge score for PHE among surveyed adults in KSA although knowledge score varied in males, those with lower educational levels and those who did not work in the healthcare field; these cohorts were significantly less knowledgeable about PHE than their peers even after controlling for other characteristics that may affect knowledge levels. Research to address knowledge of other health topics and health behaviors, including the utilization of health services, may provide guidance to those in KSA to improve the knowledge and use of PHE overall and within specific groups., (© 2022 [The Author/The Authors].)
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- 2022
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25. Effectiveness-implementation trial comparing a family model of diabetes self-management education and support with a standard model.
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Mayberry LS, Felix HC, Hudson J, Curran GM, Long CR, Selig JP, Carleton A, Baig A, Warshaw H, Peyrot M, and McElfish PA
- Subjects
- Adolescent, Adult, Glycated Hemoglobin, Health Behavior, Humans, Self Care methods, Diabetes Mellitus, Type 2 therapy, Self-Management education
- Abstract
Background: Diabetes self-management education and support (DSMES) is an effective approach for improving diabetes self-care behaviors to achieve improved glycemic management and other health outcomes. Engaging family members may improve outcomes, both for the person with diabetes (PWD) and for the family members. However, family models of DSMES have been inconsistently defined and delivered. We operationalize Family-DSMES to be generalizable and replicable, detail our protocol for a comparative effectiveness trial comparing Standard-DSMES with Family-DSMES on outcomes for PWDs and family members, and detail our mixed-methods implementation evaluation plan., Methods: We will examine Family-DSMES relative to Standard-DSMES using a Hybrid Type 1 effectiveness-implementation design. Participants are ≥18 years old with type 2 diabetes mellitus and hemoglobin A1c ≥7.0%, recruited from rural and urban primary care clinics that are part of an academic medical center. Each participant invites a family member. Dyads are randomly assigned to Family- or Standard-DSMES, delivered in a small-group format via telehealth. Data are collected at baseline, immediately post-intervention, and 6-, 12-, and 18-months post-intervention. Outcomes include PWDs' hemoglobin A1c (primary), other biometric, behavioral, and psychosocial outcomes (secondary), and family members' diabetes-related distress, involvement in the PWD's diabetes management, self-efficacy for providing support, and biometric outcomes (exploratory). Our mixed-methods implementation evaluation will include process data collected during the trial and stakeholder interviews guided by the Consolidated Framework for Implementation Research., Conclusion: Results will fill knowledge gaps about which type of DSMES may be most effective and guide Family-DSMES implementation efforts., Registration: The trial is pre-registered at clinicaltrials.gov (#NCT04334109)., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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26. Physical activity and fruit and vegetable consumption during the COVID-19 pandemic for people with type 2 diabetes mellitus.
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Andersen JA, Willis DE, Hallgren E, McElfish PA, and Felix HC
- Subjects
- Diet, Exercise, Female, Fruit, Humans, Male, Pandemics, Vegetables, COVID-19 epidemiology, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 therapy
- Abstract
Aims: To understand the associations between sociodemographic factors, self-rated health, and COVID-19-related changes in physical activity and diet and the reported number of days per week participants engaged in physical activity and consumed fruits and vegetables for people with type 2 diabetes mellitus (T2DM)., Methods: Respondents from Arkansas primary care clinics completed a survey between October 2020 and January 2021. Multivariable regression determined associations between sociodemographic factors, self-rated health, and COVID-19-related changes in physical activity and diet and the reported number of days per week participants engaged in physical activity and consumed fruits and vegetables., Results: Respondents exercised for at least 30 min on a mean of 2.09 days and consumed five or more fruit and vegetable servings on a mean of 3.57 days. Males engaged in one additional day of physical activity compared to women. Respondents with a college degree or higher ate 5 or more fruit and vegetable servings on fewer days per week than those with a high school education or less., Conclusions: Results reaffirm a need for diabetes education programs and health care providers to provide information on the importance of maintaining physical activity and a healthy diet as part of a self-care plan for T2DM, especially during public health emergencies like the COVID-19 pandemic., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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27. Associations between physical activity and functional limitations in Native Hawaiian and Pacific Islander middle-aged and older adults in the United States.
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Walter CS, Narcisse MR, Vincenzo JL, Felix HC, and McElfish PA
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- Aged, Cross-Sectional Studies, Exercise, Hawaii, Humans, Middle Aged, United States, Mobility Limitation, Native Hawaiian or Other Pacific Islander
- Abstract
Objectives: Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States., Design: Cross-sectional data from the 2014 NHPI-National Health Interview Survey ( N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module : needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL., Results: Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines., Conclusions: PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL.
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- 2022
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28. Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations.
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McElfish PA, Riklon S, Purvis RS, Long CR, Felix HC, Hudson JS, Alik D, Henske J, Edem D, O'Connor G, Boyers J, Rowland B, and Selig JP
- Abstract
Background: Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches)., Methods: Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy., Conclusion: The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Inc.)
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- 2022
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29. Nursing home directors of nursing experiences regarding safety among residents with obesity.
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Sefcik JS, Felix HC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, Brown CC, and Bradway CK
- Subjects
- Humans, Obesity, Skilled Nursing Facilities, Nursing Assistants, Nursing Homes
- Abstract
The prevalence of nursing home (NH) residents with obesity is rising. Perspectives of NH Directors of Nursing (DONs) who oversee care trajectories for residents with obesity is lacking. This study aimed to describe the experiences of NH DONs regarding care and safety for NH residents with obesity. An adapted version of Donabedian's structure-process-outcome model guided this qualitative descriptive study. Semi-structured interviews were conducted with 15 DONs. Data were analyzed using directed content analysis, and findings are presented under the model's constructs. We learned that admission decisions for NH referrals of patients with obesity are complex due to reimbursement issues, available space and resources, and resident characteristics. DONs described the need to coach and mentor Certified Nursing Assistants to provide safe quality care and that more staff education is needed. We identified novel findings regarding the challenges of short-term residents' experience transitioning out of care due to limited resources., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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30. Factors Associated with Arkansans' First Use of Telehealth during the COVID-19 Pandemic.
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Andersen JA, Felix HC, Su D, Selig JP, Ratcliff S, and McElfish PA
- Abstract
Objective: To examine the factors associated with the first use of telehealth during the COVID-19 pandemic using Andersen's Model of Healthcare Utilization. Andersen's Model of Healthcare Utilization allowed the categorization of the independent variables into the following: (1) predisposing factors, including sociodemographic variables and health beliefs; (2) enabling factors, including socioeconomic status and access to care; and (3) need for care, including preexisting or newly diagnosed conditions and reasons to seek out care or to utilize a new mode of care., Methods: Potential respondents ( n = 4,077) were identified for recruitment from a volunteer registry in Arkansas. Recruitment emails provided a study description, the opportunity to verify meeting the study's inclusion criteria and to consent for participation, and a link to follow to complete the survey online. The online survey responses were collected between July and August of 2020 ( n = 1,137)., Results: Telehealth utilization included two categories: (1) utilizers reported the first use of telehealth services during the pandemic, and (2) nonutilizers reported they had never used telehealth. Lower odds of reporting telehealth utilization during the pandemic were associated with race (Black; OR = 0.57, CI [0.33, 0.96]) and education (high School or less; OR = 0.45, CI [0.25, 0.83]). Higher odds of reporting telehealth utilization included having more than one provider (OR = 2.33, CI [1.30, 4.18]), more physical (OR = 1.12, CI [1.00, 1.25]) and mental (OR 1.53, CI [1.24, 1.88]) health conditions, and changes in healthcare delivery during the pandemic (OR = 3.49, CI [2.78, 4.38])., Conclusions: The results illustrate that disparities exist in Arkansans' utilization of telehealth services during the pandemic. Future research should explore the disparities in telehealth utilization and how telehealth may be used to address disparities in care for Black Arkansans and those with low socioeconomic status., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2022 Jennifer A. Andersen et al.)
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- 2022
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31. Barriers to routine checkups use among Saudis from the perspective of primary care providers: A qualitative study.
- Author
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Alzahrani AM, Quronfulah BS, Felix HC, and Khogeer AA
- Subjects
- Adult, Humans, Qualitative Research, Saudi Arabia, Physical Examination, Primary Health Care methods
- Abstract
Objectives: To explore the perspectives of primary care providers (PCPs) on the low use of and barriers to routine checkups among Saudi adults., Methods: A qualitative phenomenological study design was used. Interviews were carried out between (December 2020 and February 2021) with 19 PCPs working at 5 primary healthcare centers (PHCs) operated by the Ministry of Health (MOH) in Makkah, Saudi Arabia. Descriptive statistics were performed to characterize participants, and a directed content analysis was carried out to examine major themes., Results: Primary care providers identified a number of barriers that contributed to a low uptake of routine checkup among Saudis. These barriers to routine checkups were classified into 3 main themes: patient-related barriers, provider-related barriers, and healthcare system-related barriers. Lack of knowledge of patients, crowdedness at PHCs, and busy staff at PHCs were the most frequently mentioned barriers that hamper the use of routine checkups., Conclusion: This study presented new insight into the low use of routine checkups by obtaining the perspective of PCPs. Although results point to potential targets for interventions to increase routine checkups, additional research is recommended with a representative sample of PCPs randomly selected from the healthcare system to inform future policy and decision making related to improving use of routine care available through the Saudi Healthcare System., (Copyright: © Saudi Medical Journal.)
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- 2022
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32. Assessment of Colorectal Cancer Screening Disparities in U.S. Men and Women Using a Demographically Representative Sample.
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Shah SK, Narcisse MR, Hallgren E, Felix HC, and McElfish PA
- Subjects
- Male, Adult, Humans, Female, Aged, United States epidemiology, Early Detection of Cancer, Surveys and Questionnaires, Health Services, Medicare, Colorectal Neoplasms diagnosis
- Abstract
Timely receipt of colorectal cancer (CRC) screening can reduce morbidity and mortality. This is the first known study to adopt Andersen's model of health services use to identify factors associated with CRC screening among US adults. The data from National Health Interview Survey from 2019 was utilized to conduct the analyses. Multivariable logistic regression was used to separately analyze data from 7,503 age-eligible women and 6,486 age-eligible men. We found similar CRC screening levels among men (57.7%) and women (57.6%). Factors associated with higher screening odds in women were older age, married/cohabitating with a partner, Black race, >bachelor's degree, having a usual source of care, and personal cancer history. Factors associated with lower odds for women were American Indian/Alaska Native race, living in the US for ≤10 years, ≤138% federal poverty level (FPL), uninsured or having Medicare, and in fair/poor health. For men, factors associated with higher screening odds were older age, homosexuality, married/cohabitating with a partner, Black race, >high school/general educational development education, having military insurance, having a usual source of care, and personal cancer history. Factors associated with lower odds for men were being a foreign-born US resident, living in the South or Midwest, ≤138% FPL, and being uninsured or having other insurance. Despite lower screening rates in the past, Black adults show a significantly higher likelihood of CRC screening than White adults; yet, screening disparities remain in certain other groups. CRC screening efforts should continue to target groups with lower screening rates to eliminate screening disparities., Competing Interests: Conflict of interest: The authors declare no potential conflicts of interest.
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- 2022
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33. Relationship between Sociodemographic Factors, Perceived COVID-19 Risk, and Engagement with Health Protective Behaviors.
- Author
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Andersen JA, Rowland B, Ratcliff SM, Felix HC, and McElfish PA
- Subjects
- Female, Health Behavior, Humans, Male, Pandemics, Sociodemographic Factors, Surveys and Questionnaires, Young Adult, COVID-19 epidemiology, COVID-19 prevention & control
- Abstract
Objectives: This study describes the relationship between sociodemographic factors, chronic conditions, coronavirus disease 2019 (COVID-19) fears and stressors, and the perception of risk from COVID-19 and the use of health protective behaviors among Arkansans during the COVID-19 pandemic., Methods: Data collected from an online survey, administered in Arkansas between July and August 2020 (n = 1205), were used to estimate regressions. The data analysis was completed in April 2021., Results: Wearing a face mask was the most commonly reported behavior (97.4%), followed by handwashing (97.2%). Protective behaviors increased with higher levels of fear (β = 0.030, P < 0.001), more stressors (β = 0.057, P = 0.002), and age (β = 0.006, P = 0.030). Female (β = 0.510, P < 0.001) and Black (β = 0.268, P = 0.039) respondents reported engaging in more protective behaviors than males or other races/ethnicities., Conclusions: In future pandemic planning, there will be a need to create messaging and interventions to increase health protective behaviors directed at young adults, men, and those with lower education levels. Providers will need to address fears related to COVID-19 and help their patients to manage those fears and anxieties.
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- 2022
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34. Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults.
- Author
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McElfish PA, Rowland B, Scott AJ, Boyers J, Long CR, Felix HC, Kaholokula JK, Sinclair K, Bursac Z, and Riklon S
- Subjects
- Adult, Humans, Male, Exercise psychology, Exercise statistics & numerical data, Obesity prevention & control, Obesity psychology, United States, Native Hawaiian or Other Pacific Islander psychology, Native Hawaiian or Other Pacific Islander statistics & numerical data, Overweight prevention & control, Overweight psychology, Self Efficacy
- Abstract
This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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35. Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults.
- Author
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Purvis RS, Moore RA, Ayers BL, Felix HC, Riklon S, Andersen JA, Hudson JS, O'Connor G, Kelen M, Heely-Rolston LN, Shields X, and McElfish PA
- Subjects
- Adult, Humans, Language, Pandemics, SARS-CoV-2, Self Care, COVID-19, Diabetes Mellitus epidemiology
- Abstract
Purpose: The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic., Methods: A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences., Results: Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss., Conclusions: The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.
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- 2022
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36. Association of psychological distress and current cigarette smoking among Native Hawaiian and Pacific Islander adults and compared to adults from other racial/ethnic groups: Data from the National Health Interview Survey, 2014.
- Author
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Narcisse MR, Shah SK, Felix HC, Dobbs PD, and McElfish PA
- Abstract
Cigarette smoking is the leading cause of preventable deaths worldwide. Research has documented an association between psychological distress and smoking among certain racial/ethnic groups but has not examined this association among Native Hawaiian and Pacific Islander (NHPI) adults. Data from the 2014 general and the NHPI-specific National Health Interview Surveys were analyzed at the University of Arkansas for Medical Sciences Regional Campus (Fayetteville, AR) in April 2021 to determine the association between current cigarette smoking and levels of psychological distress among NHPI adults and to assess the difference in the magnitude of that association among NHPI adults compared to adults of other racial/ethnic groups in the United States. The final analytic sample (n = 34,782) included 1,916 NHPI, 20,430 White, 4,725 Black, 2,001 Asian, and 5,710 Hispanic adults. A significant association between current cigarette smoking and psychological distress levels was found among NHPI adults as well as among adults from other racial/ethnic groups. There was no significant difference in the magnitude of the detected association among NHPI adults compared to the magnitude of the same association detected among adults of other racial/ethnic groups. However, this finding indicates race/ethnicity does not moderate the association between psychological distress and current cigarette smoking. Future studies should explore factors that may further explain the variation in current cigarette smoking within and across all racial/ethnic groups., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)
- Published
- 2021
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37. COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear.
- Author
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Willis DE, Andersen JA, Bryant-Moore K, Selig JP, Long CR, Felix HC, Curran GM, and McElfish PA
- Subjects
- Adolescent, Adult, Black or African American psychology, Black or African American statistics & numerical data, Aged, Aged, 80 and over, COVID-19 epidemiology, COVID-19 psychology, Fear, Female, Hispanic or Latino psychology, Hispanic or Latino statistics & numerical data, Humans, Male, Middle Aged, Pandemics prevention & control, Patient Acceptance of Health Care psychology, Surveys and Questionnaires statistics & numerical data, Trust, White People psychology, White People statistics & numerical data, Young Adult, COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Mass Vaccination psychology, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Understanding and minimizing coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic. We investigate questions regarding vaccine hesitancy in a sample (n = 1205) of Arkansas adults surveyed online in July/August of 2020. We examine relationships among sociodemographics, COVID-19 health literacy, fear of COVID-19 infection, general trust in vaccines, and COVID-19 vaccine hesitancy using bivariate analysis and a full information maximum likelihood (FIML) logistic regression model. One in five people (21,21.86%) reported hesitancy to take a COVID-19 vaccine. Prevalence of COVID-19 vaccine hesitancy was highest among Black/African Americans (50.00%), respondents with household income less than $25K (30.68%), some college (32.17%), little to no fear of infection from COVID-19 (62.50%), and low trust in vaccines in general (55.84%). Odds of COVID-19 vaccine hesitancy were 2.42 greater for Black/African American respondents compared to White respondents (p < 0.001), 1.67 greater for respondents with some college/technical degree compared to respondents with a 4-year degree (p < 0.05), 5.48 greater for respondents with no fear of COVID-19 infection compared to those who fear infection to a great extent (p < 0.001), and 11.32 greater for respondents with low trust in vaccines (p < 0.001). Sociodemographic differences in COVID-19 vaccine hesitancy raise concerns about the potential of vaccine implementation to widen existing health disparities in COVID-19 related infections, particularly among Black/African Americans. Fear of infection and general mistrust in vaccines are significantly associated with vaccine hesitancy., (© 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics.)
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- 2021
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38. Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020.
- Author
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McElfish PA, Rowland B, Porter A, Felix HC, Selig JP, Semingson J, Willis DE, Smith M, Riklon S, Alik E, Padilla-Ramos A, Jasso EY, and Zohoori N
- Subjects
- Arkansas epidemiology, Humans, COVID-19 ethnology, Community-Based Participatory Research organization & administration, Health Status Disparities, Hispanic or Latino statistics & numerical data, Native Hawaiian or Other Pacific Islander statistics & numerical data
- Abstract
Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .
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- 2021
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39. Factors Associated with First-Time Telehealth Utilization for Marshallese Living in the United States.
- Author
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Andersen JA, Felix HC, Eswaran H, Payakachat N, Willis DE, Bogulski C, and McElfish PA
- Abstract
Background: Mitigation efforts to prevent the spread of COVID-19 included the robust utilization of telehealth. However, racial/ethnic minority populations have demonstrated low telehealth utilization in the past. The aim of this study was to examine the first-time use of telehealth by Marshallese adults during the COVID-19 pandemic, using online survey data collected from 109 Marshallese respondents between July and November of 2020. Methods: To evaluate the relationships between sociodemographic characteristics, health care access, physical/mental health, and COVID-19-specific measures and the decision to use telehealth, we use bivariate analyses, including t -tests and chi-square analysis. Results: Eighteen respondents (16.5%) indicated they utilized telehealth for the first time during the pandemic. The number of chronic conditions reported was positively associated with the first-time use of telehealth ( p = 0.013). Although not statistically significant, a higher proportion of Marshallese first-time telehealth users reported limited English proficiency, changes in health status, and changes in health insurance. Discussion: Although telehealth has been shown to reduce the absolute gaps in health disparities for minority populations, there is limited utilization by Marshallese communities. Conclusions: Significant research remains on the utilization of telehealth by Marshallese during the COVID-19 pandemic and to increase utilization in the future., Competing Interests: No competing financial interests exist., (© Jennifer A. Andersen et al., 2021; Published by Mary Ann Liebert, Inc.)
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- 2021
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40. Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA.
- Author
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McElfish PA, Narcisse MR, Felix HC, Cascante DC, Nagarsheth N, Teeter B, and Faramawi MF
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Health Care Surveys, Healthcare Disparities ethnology, Humans, Male, Sex Factors, United States, Young Adult, Emigrants and Immigrants statistics & numerical data, Healthcare Disparities statistics & numerical data, Papillomavirus Vaccines administration & dosage, Racial Groups statistics & numerical data, Vaccination statistics & numerical data
- Abstract
Research has demonstrated that the human papillomavirus (HPV) vaccine is a safe and effective way to decrease HPV-related cervical cancers; however, the vaccination rate in the USA is suboptimal. The current study examined racial and ethnic disparities in HPV vaccination among a nationally representative sample, including Native Hawaiian and Pacific Islanders (NHPI). This study also investigated the associations between nativity and vaccination, and sex differences between race/ethnicity and vaccination and nativity and vaccination. A cross-sectional study was conducted with a sample of adults aged 18-26 years drawn from the 2014 NHPI National Health Interview Survey (n = 2590) and the general 2014 National Health Interview Survey (n = 36,697). Log-binomial models were fitted to examine differences in vaccination. There was a statistically significant racial/ethnic difference in HPV vaccination (p = 0.003). More women than men were vaccinated (41.8% vs. 10.1%) (p < 0.001). There was a significant difference in HPV vaccination based on nativity: 27.4% of adults aged 18 to 26 years who were born in the USA and 27.7% born in a US territory received the HPV vaccine compared with 14.3% among those not born in the USA or a US territory (p < 0.001). The association of HPV vaccination with nativity and race/ethnicity differed by sex and showed several nuanced differences. Overall, the prevalence of HPV vaccination was low. The study's findings demonstrate the need for public health strategies to increase vaccination rates among all populations, with the critical need to identify strategies that are effective for men, racial/ethnic minorities, and immigrant women born outside the USA., (© 2020. W. Montague Cobb-NMA Health Institute.)
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- 2021
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41. Control of type 2 diabetes mellitus during the COVID-19 pandemic.
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Felix HC, Andersen JA, Willis DE, Malhis JR, Selig JP, and McElfish PA
- Subjects
- Adult, Cross-Sectional Studies, Humans, Pandemics, SARS-CoV-2, COVID-19, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Aims: Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition that can lead to significant complications if not well controlled. The COVID-19 pandemic created disruptions in daily life; however, it is unknown whether the pandemic's disruptions affected the ability for adults with T2DM to control their condition. This study aims to fill the knowledge gap with the experiences of adults with T2DM in Arkansas, U.S. during the COVID-19 pandemic., Methods: This study analyzed cross-sectional, observational survey data collected from adults (≥18 years) who live, work, or receive healthcare in Arkansas; self-reported a diagnosis of T2DM; and completed the diabetes module of the Impact of COVID-19 online survey (n = 131) fielded in July-August 2020. Descriptive statistics were used to characterize the sample and survey responses, and multivariate regression was used to identify demographics, self-care behaviors, and access issues associated with uncontrolled T2DM (HbA1c ≥ 9% or 74.9 mmol/mol) or with an increase in HbA1c., Results: 28.2% reported an increase in their HbA1c since the pandemic began, and 18.2% had uncontrolled T2DM. Educational level, eating healthily, and weight gain were negatively associated with uncontrolled T2DM. Eating less healthily and having difficulty accessing diabetes related medication were positively associated with an increase in HbA1c., Conclusions: Adults with T2DM in Arkansas were reasonably able to maintain control of their T2DM during the five months post the first case of COVD-19 diagnosed in the state. However, T2DM self-management interventions targeting those with lower educational levels that are focused on eating habits and/or that improve access to diabetes medication should be considered for future public health emergencies., (Copyright © 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)
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- 2021
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42. Effects of Race and Poverty on Sleep Duration: Analysis of Patterns in the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey and General National Health Interview Survey Data.
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McElfish PA, Narcisse MR, Selig JP, Felix HC, Scott AJ, and Long CR
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- Female, Health Surveys, Humans, Male, Middle Aged, Native Hawaiian or Other Pacific Islander statistics & numerical data, Race Factors, Time Factors, United States, Poverty ethnology, Racial Groups statistics & numerical data, Sleep
- Abstract
Background: There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon race/ethnicity and socioeconomic status. Prior studies have suffered from inadequate measures of poverty and have not included Native Hawaiians and Pacific Islanders (NHPI)., Methods: Using the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS, the effect of race/ethnicity and poverty was examined for associations with sleep duration., Results: Significant differences among race/ethnicity groups and sleep duration were found in adjusted associations. Compared with Whites, NHPIs and Blacks were twice as likely to experience very short sleep; NHPI, Hispanic, and Blacks were more likely to experience short sleep; Blacks were also more likely to experience long sleep. Asians were less likely to experience unhealthy sleep (very short, short, or long sleep). Persons living in poverty were significantly more likely to experience very short sleep compared with persons not living in poverty., Conclusion: This is the first population-based study that has examined the relationship between sleep duration and poverty with a large sample that included NHPI in relation to other races/ethnicities. The difference in sleep duration between NHPI and Asians provides a strong rationale for not aggregating Asian and NHPI data in population-based studies., (© 2020. W. Montague Cobb-NMA Health Institute.)
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- 2021
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43. Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults.
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McElfish PA, Andersen JA, Felix HC, Purvis RS, Rowland B, Scott AJ, Chatrathi M, and Long CR
- Subjects
- Adult, Body Mass Index, Cross-Sectional Studies, Female, Glycated Hemoglobin analysis, Humans, Male, Self Report, Sleep, Diabetes Mellitus, Type 2
- Abstract
Objective: To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population., Design: Cross-sectional analysis of a staff-administered survey., Setting: Thirty Marshallese churches in Arkansas and Oklahoma., Participants: The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m
2 ., Measures: Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors., Results: Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors., Conclusion: This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m2 . This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community., (Copyright © 2021. Published by Elsevier Inc.)- Published
- 2021
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44. Food insecurity and depression among low-income adults in the USA: does diet diversity play a role? Findings from the 2013-2014 National Health and Nutrition Examination Survey.
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Narcisse MR, Felix HC, Long CR, English ES, Bailey MM, and McElfish PA
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- Adult, Cross-Sectional Studies, Diet, Food Supply, Humans, Nutrition Surveys, United States epidemiology, Depression epidemiology, Depression etiology, Food Insecurity
- Abstract
Objective: Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression., Design: Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity-depression link., Setting: Cross-sectional data from the National Health and Nutrition Examination Survey (2013-2014)., Participants: 2636 low-income adults aged 18 years and older., Results: There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults., Conclusions: Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.
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- 2021
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45. Improving quality of life assessments for high-need adult Medicaid service users with mental health conditions.
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Nevola A, Morris ME, Felix HC, Hudson T, Payakachat N, and Tilford JM
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- Humans, Mental Disorders psychology, Outcome Assessment, Health Care, Quality of Life psychology, Surveys and Questionnaires, United States, Medicaid standards, Mental Disorders therapy, Mental Health standards, Mental Health Services standards
- Abstract
Purpose: There is a lack of consensus on how to evaluate health and social service programs for people with mental health (MH) conditions. Having service users be the primary decision makers in selecting outcome measures can inform a meaningful evaluation strategy. We sought to identify the quality of life (QoL) survey preferences of high-need adult service users with MH conditions., Methods: A systematic review identified generic, self-reported QoL surveys with evidence of validity in MH populations of interest. An advisory panel selected the most promising surveys to assess the success of programs like Medicaid for MH service users. Three groups of high-need, adult service users with MH conditions and one group of direct care staff ranked the surveys from the advisory panel, and generated and ranked characteristics that were desirable or undesirable in a QoL survey., Results: Twenty-two surveys met the inclusion criteria. Of the six surveys selected by the advisory panel, groups of service users and direct care staff most preferred the Warwick-Edinburg Mental Well-being Scale (WEMWBS). The WEMWBS best embodied the features prioritized by the groups: to have a user-friendly format and positive focus, to be clearly worded and brief, and to avoid presumptive or unrealistic items. Service user groups appreciated survey topics most amenable to self-report, such as satisfaction with relationships., Conclusion: Using QoL surveys that service users prefer can reduce the chance that deteriorating QoL is going unchecked, and increase the chance that decisions based on survey findings are meaningful to service users.
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- 2021
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46. Description of Variation in Age of Onset of Functional Limitations of Native Hawaiian and Pacific Islanders Compared to Other Racial and Ethnic Groups.
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Walter CS, Narcisse MR, Vincenzo JL, McElfish PA, and Felix HC
- Subjects
- Adult, Age of Onset, Hawaii, Humans, Middle Aged, Minority Groups, United States, Disabled Persons, Ethnicity, Native Hawaiian or Other Pacific Islander
- Abstract
(1) Background: The purpose of this exploratory study was to describe variation in age of onset of functional limitations of Native Hawaiian and Pacific Islanders (NHPI) compared to other racial and ethnic groups. (2) Methods: Adults age 45 years and older who responded to the Functioning and Disability module within the 2014 National Health Interview Survey (NHIS) were included ( n = 628 NHPI; 7122 non-Hispanic Whites; 1418 Blacks; 470 Asians; and 1216 Hispanic adults). The NHIS Functioning and Disability module included 13 items, which we organized into three domains of functional limitations using factor analysis: Mobility, Gross Motor Skills, and Fine Motor Skills. Responses were summed within each domain. (3) Results: After adjusting for age and sex, we found that racial/ethnic minority groups, with the exception of Asians, experience more functional limitations than Whites. Results further indicate that NHPI adults experienced an earlier surge in all three domains of functional limitations compared to other racial/ethnic groups. (4) Conclusions: These findings are novel and provide additional evidence to the existence of disparities in functional health outcomes across racial/ethnic groups. Future studies are needed to develop targeted and culturally tailored interventions for those most in need.
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- 2021
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47. The impact of severe obesity on home health care agency admission: An organizational perspective.
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Schuldt RF, Felix HC, and Bradway CK
- Subjects
- Arkansas epidemiology, Cross-Sectional Studies, Home Care Agencies organization & administration, Humans, Obesity, Morbid epidemiology, Pennsylvania epidemiology, Surveys and Questionnaires, Home Care Agencies statistics & numerical data, Obesity, Morbid complications, Patient Admission statistics & numerical data
- Abstract
Home health care is a growing treatment option for older adults who wish to remain in their homes and communities. However, the growing number of older adults with severe obesity presents a challenge for home health professionals. This study utilizes survey data from 128 home health care agencies in Arkansas and Pennsylvania to explore home health care agencies' decision-making in admitting patients with severe obesity. The responding agencies indicated that concerns about adequate staffing levels were the primary barriers to entry for severe obesity patients. Existing research on the intersection of obesity and home health care is sparse, and this study adds an organizational perspective to the scant literature on the topic. Additional research on this topic is advised to accommodate the expected growth in home health care utilization and rising obesity rates among older adults.
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- 2021
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48. Investigating the Association between English Proficiency and General Health among Marshallese Adults in the United States.
- Author
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McElfish PA, Scott AJ, Rowland B, Felix HC, Narcisse MR, Kaminicki KF, Long CR, and Selig JP
- Subjects
- Adult, Arkansas, Cross-Sectional Studies, Educational Status, Humans, United States epidemiology, Communication Barriers
- Abstract
Prior studies have not examined the association between English proficiency and health among Marshallese adults. Cross-sectional data from 378 Marshallese adults enrolled in a Diabetes Prevention Program study in Arkansas and Oklahoma were used to document English proficiency, assess the relationship between sociodemographic health-related characteristics and English proficiency, and examine the association between English proficiency and general health. Approximately one-fifth of participants reported limited English proficiency (LEP). One-fifth of participants reported being in fair or poor health. General health, age group, education, household food insufficiency, inability to afford necessities, and comorbidities were significantly associated with LEP. Participants with LEP were 78% less likely to report better general health compared with those who reported speaking English very well. Limited English proficiency was high among this sample of Marshallese adults. Findings highlight the need for additional Marshallese clinical interpretation and translation services.
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- 2021
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49. County-level Variation in Low Birthweight and Preterm Birth: An Evaluation of State Medicaid Expansion Under the Affordable Care Act.
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Brown CC, Moore JE, Felix HC, Stewart MK, and Tilford JM
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- Black or African American statistics & numerical data, Health Services Accessibility statistics & numerical data, Health Surveys, Hispanic or Latino statistics & numerical data, Humans, Infant, Newborn, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Spatial Analysis, United States epidemiology, White People statistics & numerical data, Infant, Low Birth Weight, Medicaid statistics & numerical data, Patient Protection and Affordable Care Act legislation & jurisprudence, Premature Birth ethnology, Racial Groups statistics & numerical data
- Abstract
Background: Rates of low birthweight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations., Objective: The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low birthweight and preterm births, overall and stratified by race/ethnicity., Research Design: We compared changes in the coefficient of variation and the ratio of the 80th-to-20th percentiles using bootstrap samples (n=1000) of counties drawn separately for all births and for white, black, and Hispanic births, separately., Measures: County-level rates of low birthweight and preterm birth., Results: Before Medicaid expansion, counties in expansion states were concentrated among quintiles with lower rates of adverse birth outcomes and counties in nonexpansion states were concentrated among quintiles with higher rates. In expansion states, county-level variation, measured by the coefficient of variation, declined for both outcomes among all racial/ethnic categories. In nonexpansion states, geographic variation reduced for both outcomes among Hispanic births and for low birthweight among white births, but increased for both outcomes among black births., Conclusions: The decrease in county-level variation in adverse birth outcomes among expansion states suggests improved equity in these states. Further reduction in geographic variation will depend largely on policies or interventions that reduce racial disparities in states that did and did not expand Medicaid.
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- 2020
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50. Effects of a family diabetes self-management education intervention on the patients' supporters.
- Author
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Felix HC, Narcisse MR, Long CR, and McElfish PA
- Subjects
- Adult, Diabetes Mellitus psychology, Family psychology, Family Health standards, Family Health trends, Female, Humans, Male, Micronesia, Middle Aged, Patient Education as Topic methods, Self-Management methods, Self-Management psychology, Diabetes Mellitus therapy, Patient Education as Topic standards, Self-Management education, Social Support
- Abstract
Introduction: Diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients. The health effects of these "family models" of DSME on participating family members are rarely studied. Opportunity exists for the participating family members to benefit from the healthy lifestyle recommendations offered through such programs., Method: Using data from a randomized controlled trial to assess the effect of family DSME compared to standard DSME among Marshallese adults with Type 2 diabetes, this study examined baseline to 12-month changes in A1c, body mass index (BMI), food consumption, and physical activity among participating family members, comparing outcomes of family members based on attended at least 1 (n = 98) versus attended no (n = 44) DSME sessions., Results: Overall, family member attendance was low. There were no differences in the level of change from baseline to 12 months for A1c, BMI, food consumption, and physical activity between groups. After controlling for attendance and sociodemographic measures, lowering of BMI was the only significant predictor of not having an A1c level indicative of diabetes at 12 months., Discussion: Future research on family DSME should consider ways to improve family member attendance; have them set their own health improvement goals; and integrate healthy lifestyle education, such as healthy eating and being physically active, along with the DSME core content to create an added benefit of diabetes prevention for participating family members. The limitations of this study and recommendations for future research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
- Published
- 2020
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