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Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016-2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior.

Prevalence of certain disordered eating behaviors is higher among Hispanic youth compared to non-Hispanics. Understanding the role of body image and social attitudes towards weight in disordered eating may inform treatment in Hispanic youth.We analyzed data from the Hispanic Community Health Study/Study of Latino Youth (SOL Youth). Our sample included 1,463 children aged 8-16 years from four sites (Bronx, Chicago, Miami, San Diego) assessed in 2011-2014. Body image discrepancy score was calculated as the difference between perceived ideal body image and actual body image using two numbered visual graphs: adolescent (n = 728) or child (n = 735), each with slightly different scales. Questionnaires measured influences from social attitudes toward weight and disordered eating behaviors. Three disordered eating behaviors (dieting, overeating, and compensatory behaviors) were analyzed as the dependent variable. Logistic regression models adjusted for age, sex, acculturative stress, and field center to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).Mean body image discrepancy score was -0.79 for adolescents (SE = 0.08) and -0.50 for children (SE = 0.05), with a negative score signifying a perceived actual body image larger than their ideal. Body image discrepancy was strongly associated with dieting (dieting ≥5 times/year aOR = 0.64, 95% CI 0.53, 0.77) and compensatory behaviors (aOR = 0.65, 95% CI 0.50, 0.85) among adolescents, and was strongly associated with overeating among children (aOR = 0.74, 95% CI 0.61, 0.91). Significant associations were not observed with social attitudes towards weight.Associations observed with body image discrepancy and disordered eating behaviors can inform interventions in Hispanic/Latino youth, which should consider acculturative stress.

Background Human mobility among residential locations can drive dengue virus (DENV) transmission dynamics. Recently, it was shown that individuals with symptomatic DENV infection exhibit significant changes in their mobility patterns, spending more time at home during illness. This change in mobility is predicted to increase the risk of acquiring infection for those living with or visiting the ill individual. It has yet to be considered, however, whether social contacts are also changing their mobility, either by socially distancing themselves from the infectious individual or increasing contact to help care for them. Social, or physical, distancing and caregiving could have diverse yet important impacts on DENV transmission dynamics; therefore, it is necessary to better understand the nature and frequency of these behaviors including their effect on mobility. Methodology and principal findings Through community-based febrile illness surveillance and RT-PCR infection confirmation, 67 DENV positive (DENV+) residents were identified in the city of Iquitos, Peru. Using retrospective interviews, data were collected on visitors and home-based care received during the illness. While 15% of participants lost visitors during their illness, 22% gained visitors; overall, 32% of all individuals (particularly females) received visitors while symptomatic. Caregiving was common (90%), particularly caring by housemates (91%) and caring for children (98%). Twenty-eight percent of caregivers changed their behavior enough to have their work (and, likely, mobility patterns) affected. This was significantly more likely when caring for individuals with low “health-related quality of well-being” during illness (Fisher’s Exact, p = 0.01). Conclusions/Significance Our study demonstrates that social contacts of individuals with dengue modify their patterns of visitation and caregiving. The observed mobility changes could impact a susceptible individual’s exposure to virus or a presymptomatic/clinically inapparent individual’s contribution to onward transmission. Accounting for changes in social contact mobility is imperative in order to get a more accurate understanding of DENV transmission., Author summary Dengue is the most important mosquito-borne viral disease of humans worldwide. Due to the limited mobility of the mosquitoes that transmit dengue virus, human mobility is a key variable to understanding the spread of dengue through a population. Recently it was shown that individuals with symptomatic dengue have significantly reduced mobility patterns. To better understand how dengue illness affects the behavior of visitors and caregivers, we examined the nature and frequency of a symptomatic individual’s social contacts to determine if their behaviors changed due to social distancing or caregiving. While many participants had a drop off in visitor frequency when ill, almost all participants received help from their housemates. These caregivers were most likely to have their work impacted when helping participants whose quality of life was most negatively affected by illness. We quantified how often these behavioral changes had a discernable effect on the social contact’s mobility patterns. Accounting for mobility changes by social contacts provides a more accurate understanding of infection risk and potential for virus spread through a population. Dengue transmission models that incorporate mobility changes of symptomatic individuals and their social contacts will add currently missing epidemiologically relevant detail for evaluating different disease prevention strategies.

With increased globalization, Latin America is experiencing transitions from traditional lifestyle and dietary practices to those found in higher income countries. Healthy diets, physical activity and optimal body fat can prevent approximately 15% of cancers in low-income and 20% in high-income countries. We discuss links between diet, obesity, physical activity and cancer, emphasizing strategies targeting children to decrease risk of obesity, control obesity-related risk factors, and reduce sedentary lifestyles, as this will have high impact on adult cancer risk. We focus on individual behaviors, economic, cultural and societal changes that may guide future interventions in the Americas.América Latina está experimentando transiciones desde estilos de vida tradicional y prácticas dietéticas a las de países de ingresos altos. Las dietas saludables, la actividad física y la grasa corporal óptima pueden prevenir aproximadamente el 15% de cánceres en países de bajos ingresos y 20% en países de ingresos altos. Discutimos los vínculos entre la dieta, obesidad, actividad física y cáncer; haciendo hincapié en estrategias dirigidas a niños, para disminuir el riesgo de obesidad y reducir la vida sedentaria. Nos enfocamos en comportamientos individuales, cambios económicos, culturales y sociales que pueden guiar futuras intervenciones en las Américas.

Previous studies measuring the health-related quality of life (HRQoL) of individuals with dengue focused on treatment seeking populations. However, the vast majority of global dengue cases are unlikely to be detected by health systems. Representative measurements of HRQoL should therefore include patients with disease not likely to trigger treatment-seeking behavior. This study based in Iquitos, Peru used the Quality of Wellbeing Scale-Self Administered, a survey that enquires about not only physical health, but also psychological health, self-care, mobility, and usual social activities, and rates HRQoL between 0 (death) and 1 (optimum function), to evaluate the impact of dengue on HRQoL. In order to enroll treatment and non treatment-seeking participants, three modalities of participant recruitment were used. In addition to clinic and community-based febrile surveillance, a contact-cluster methodology was also employed to identify infected individuals less likely to seek treatment. We measured changes in HRQoL and identified common areas of health impairment in 73 virologically confirmed dengue cases at 3 time points during the participant’s illness; the early-acute (days 0–6 post symptom onset), late-acute (days 7–20), and convalescent illness phases (days 21 +). Participants reported HRQoL related impairments at significantly higher frequency during the early-acute versus convalescent illness phase (Fisher’s exact: P, Author summary Dengue, a viral illness occurring following the bite of an infected mosquito, is common in tropical urban areas of the globe. Using a survey that enquires about not only physical health but also psychological health, self-care, mobility and usual social activities, this study assesses the overall impact of dengue on the well-being of those with the disease. Of the estimated 390 million annual infections, approximately 75 percent do not cause individuals to attend medical facilities, possibly because many infections do not result in significant symptoms or because access to healthcare is limited. Unlike previous studies, this study recruited those who would have been unlikely to seek healthcare as well as individuals who attended health facilities. This study adds to the growing body of evidence that healthcare professionals should regard dengue as a disease that affects not only physical, but also psychological health and aspects of social functioning. Furthermore, it suggests that those not seeking treatment may also have a substantial reduction in quality of life during their infection. Given the millions of dengue infected people who do not attend healthcare facilities annually this could amount to a very meaningful societal impact.

Peer support provides benefits across varied health concerns. As opposed to simple offer of support, however, predictors of and importance of levels of participation are not well understood. Analyses of 7 peer support interventions, with 1,612 participants address these questions, first identifying characteristics that predict participation, and then examining whether, controlling for those characteristics, participation itself predicts benefit, using reduced HbA1c as an indicator of benefit. From the U.S. (5 sites), Hong Kong, and the UK, interventions shared emphases on peer supporters helping adults with type 2 diabetes improve disease management. Common data included pre/post hemoglobin A1c (HbA1c), contacts of participants with peer supporters, health literacy, availability/satisfaction with support for diabetes management from family/clinical team, and gender, age, education, and years with diabetes. From structural equation modeling, significant findings indicated 1) older age and lower levels of support for diabetes management predicted more contacts with peer supporters, and 2) more contacts predicted lower levels of final HbA1c. Effects of contacts on HbA1c included those with baseline HbA1c > 7.5% or > 9%. No contacts and tertiles of low, moderate, and high contacts showed a linear, dose-response relationship with final HbA1c (p < 0.001). Baseline and covariate-adjusted, final HbA1c was 8.19% versus 7.85% for those with no and high contacts, respectively. Among those using insulin (29.7%), only those in the high group achieved greater benefit than those with no contacts. Reflecting other findings that peer support reaches/benefits those at greater disadvantage, those reporting less social support for diabetes management were more likely to participate in peer support. Participation in turn predicted better glycemic control across levels of baseline glycemic control and in a dose response relationship across levels of participation. Disclosure G.X. Ayala: None. J.C. Chan: None. A. Cherrington: None. J.P. Elder: None. E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. M. Heisler: None. A. Howard: None. H. Parada: None. M. Safford: None. D. Simmons: None. T.S. Tang: None. Funding Merck Foundation; Eli Lilly and Company Foundation; Bristol-Myers Squibb Foundation

Author(s): Schaber, Kathryn L; Paz-Soldan, Valerie A; Morrison, Amy C; Elson, William HD; Rothman, Alan L; Mores, Christopher N; Astete-Vega, Helvio; Scott, Thomas W; Waller, Lance A; Kitron, Uriel; Elder, John P; Barker, Christopher M; Perkins, T Alex; Vazquez-Prokopec, Gonzalo M | Abstract: [This corrects the article DOI: 10.1371/journal.pntd.0007756.].

Dengue is one of the most important vector-borne diseases, resulting in an estimated hundreds of millions of infections annually throughout the tropics. Control of dengue is heavily dependent upon control of its primary mosquito vector, Aedes aegypti. Innovative interventions that are effective at targeting the adult stage of the mosquito are needed to increase the options for effective control. The use of insecticide-treated curtains (ITCs) has previously been shown to significantly reduce the abundance of Ae. aegypti in and around homes, but the impact of ITCs on dengue virus (DENV) transmission has not been rigorously quantified. A parallel arm cluster-randomized controlled trial was conducted in Iquitos, Peru to quantify the impact of ITCs on DENV seroconversion as measured through plaque-reduction neutralization tests. Seroconversion data showed that individuals living in the clusters that received ITCs were at greater risk to seroconverting to DENV, with an average seroconversion rate of 50.6 per 100 person-years (PY) (CI: 29.9–71.9), while those in the control arm had an average seroconversion rate of 37.4 per 100 PY (CI: 15.2–51.7). ITCs lost their insecticidal efficacy within 6 months of deployment, necessitating re-treatment with insecticide. Entomological indicators did not show statistically significant differences between ITC and non-ITC clusters. It’s unclear how the lack of protective efficacy reported here is attributable to simple failure of the intervention to protect against Ae. aegypti bites, or the presence of a faulty intervention during much of the follow-up period. The higher risk of dengue seroconversion that was detected in the ITC clusters may have arisen due to a false sense of security that inadvertently led to less routine protective behaviors on the part of households that received the ITCs. Our study provides important lessons learned for conducting cluster randomized trials for vector control interventions against Aedes-transmitted virus infections., Author summary Dengue is one of the most important mosquito-borne diseases affecting humans, resulting in an estimated hundreds of millions of infections annually throughout the tropics. To control dengue, most public health programs use a variety of methods to kill the primary mosquito vector, Aedes aegypti. Water holding containers that harbor larvae (and other immature stages) are treated or eliminated. During emergencies, large insecticide spray campaigns are deployed to kill infected adult mosquitoes. Innovative interventions that are effective at targeting adult mosquitoes in sustainable ways are needed to increase the options for control of dengue and other Aedes borne virus diseases. The use of insecticide-treated curtains (ITCs) has previously been shown to significantly reduce Ae. aegypti numbers in and around homes, but the impact of ITCs on dengue virus (DENV) transmission has not previously been quantified. Using a rigorous study design in which 10 clusters (~90 houses per cluster) were provided multiple ITCs to place in their homes was compared to 10 clusters of homes without ITCs. Assignment of which clusters received ITCs was randomized. Blood samples were obtained at 9-month intervals from residents living in all the clusters, so that people with serological evidence of a DENV infection could be identified by comparing paired samples. Seroconversion data showed that individuals living in the clusters that received ITCs were at greater risk to DENV seroconverting, with an average seroconversion rate of 50.6 per 100 person-years (PY) (CI: 29.9–71.9). Conversely, those in the control arm had an average seroconversion rate of 37.4 per 100 PY (CI: 15.2–51.7). ITCs lost their insecticidal efficacy within 6 months of deployment, necessitating re-treatment with insecticide. Ae. aegypti populations did not show statistically significant differences between ITC and non-ITC clusters. The reason for higher transmission in the ITC treated clusters could be attributable to failure of the curtains (loss of efficacy) and/or that the curtains were not sufficiently effective at protecting against mosquito bites. The higher risk of DENV seroconversion in ITC clusters may be due to a false sense of security that inadvertently led to less routine protective behaviors on the part of households that received the ITC.

BACKGROUND Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic-based approaches in this population. OBJECTIVE The purpose of this study was to test the efficacy of a clinic-based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. METHODS A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5-10 years old) and their parents. The 12-month family-based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid-level providers. The primary study outcome was child BMI (kg m-2 ) assessed at baseline, 6-month (n = 191) and 12-month (n = 201) post-baseline. A subsample of the children was examined for overall and site-specific adiposity using dual-energy X-ray absorptiometry (n = 79). RESULTS There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p

The purpose of this paper was to review multiple levels of risk factors related to obesity among older Latino adults aged 65 years and over. Obesity disproportionately affects Latino older adults. Multiple obesity-related risk factors among Latino older adults have been identified through qualitative and quantitative research. Risk factors at each of the levels of the socio-ecological model include biological predispositions, lifestyle and behaviors, social support from family members, access to recreational facilities, and public policies that support tailored and effective prevention and treatment programs. This review outlines several key obesity-related risk factors among Latino older adults which can be targeted for future research and for tailoring obesity prevention clinical practice.

Objectives. To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. Methods. We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. Results. Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. Conclusions. A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.

AIMS: We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes. METHODS: Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/ economic- related factors and low medication adherence stratified by sex. RESULTS: More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p < 0.05). We found significant differences between levels social support and medication adherence (p < 0.05). In hierarchical models, being US born and higher levels of social support were associated with low adherence among males (p < 0.05, and p < 0.001). CONCLUSIONS: Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males.

Heterogeneous exposure to mosquitoes determines an individual’s contribution to vector-borne pathogen transmission. Particularly for dengue virus (DENV), there is a major difficulty in quantifying human-vector contacts due to the unknown coupled effect of key heterogeneities. To test the hypothesis that the reduction of human out-of-home mobility due to dengue illness will significantly influence population-level dynamics and the structure of DENV transmission chains, we extended an existing modeling framework to include social structure, disease-driven mobility reductions, and heterogeneous transmissibility from different infectious groups. Compared to a baseline model, naïve to human pre-symptomatic infectiousness and disease-driven mobility changes, a model including both parameters predicted an increase of 37% in the probability of a DENV outbreak occurring; a model including mobility change alone predicted a 15.5% increase compared to the baseline model. At the individual level, models including mobility change led to a reduction of the importance of out-of-home onward transmission (R, the fraction of secondary cases predicted to be generated by an individual) by symptomatic individuals (up to -62%) at the expense of an increase in the relevance of their home (up to +40%). An individual’s positive contribution to R could be predicted by a GAM including a non-linear interaction between an individual’s biting suitability and the number of mosquitoes in their home (>10 mosquitoes and 0.6 individual attractiveness significantly increased R). We conclude that the complex fabric of social relationships and differential behavioral response to dengue illness cause the fraction of symptomatic DENV infections to concentrate transmission in specific locations, whereas asymptomatic carriers (including individuals in their pre-symptomatic period) move the virus throughout the landscape. Our findings point to the difficulty of focusing vector control interventions reactively on the home of symptomatic individuals, as this approach will fail to contain virus propagation by visitors to their house and asymptomatic carriers., Author summary Human mobility patterns can play an integral role in vector-borne disease dynamics by characterizing an individual’s potential contacts with disease-transmitting vectors. Dengue virus is transmitted by a sedentary vector, but human mobility allows individuals to have contact with mosquitoes at their home and other houses they frequent (their activity space). When accounting for the decreased mobility of symptomatic dengue cases in an agent-based simulation model, however, we found a severely diminished role of the activity space in onward transmission. Those who received the majority of their mosquito contacts outside their home experienced decreases in expected bites and onward transmission when mobility changes were accounted for. Onward transmission was driven by a synergistic relationship between the number of mosquitoes in an individual’s home and their biting suitability, where even those with the highest biting suitability would have limited contribution to transmission given a low number of household mosquitoes. Reactive vector control, which often targets symptomatic cases, could be effective for slowing onward transmission from these cases, but will fail to control virus transmission due to the disproportionate contribution of asymptomatic infections.

Favorable perceptions of the built and social neighborhood environment may promote outdoor physical activity (PA). However, little is known about their independent and interactive effects on neighborhood-specific outdoor PA. We examined associations of perceived built and social neighborhood environment factors, and their interactions, with objectively-measured neighborhood outdoor moderate-to-vigorous physical activity (MVPA) among a sample of Latina women in San Diego, CA. Analyses included baseline data collected in 2011-2013 from 86 Latinas with ≥ 2 days of combined accelerometer and global positioning system data and complete survey measures. We examined objective neighborhood outdoor MVPA within 500-meter home buffers. Generalized linear mixed models examined associations of 3 perceived built (e.g., sidewalk maintenance) and 3 social environmental (e.g., safety from crime) factors with engaging in any daily neighborhood outdoor MVPA. Models tested interactions between the built and social environmental factors. Although the perceived neighborhood environmental factors were not significantly related to daily neighborhood outdoor MVPA, we found 2 significant interactions: perceived sidewalk maintenance x safety from crime (p = 0.05) and neighborhood aesthetics x neighborhood social cohesion (p = 0.03). Sidewalk maintenance was positively related to daily neighborhood outdoor MVPA only among Latinas that reported low levels of safety from crime. Neighborhood aesthetics was positively related to daily neighborhood outdoor MVPA only among Latinas with high neighborhood social cohesion. Findings suggest several built and social environmental factors interact to influence Latinas’ neighborhood outdoor MVPA. Interventions are needed targeting both built and social neighborhood environmental factors favorable to outdoor PA in the neighborhood., Highlights • We tested social x built environment interactions on outdoor physical activity (PA). • Among Latinas perceiving low safety, sidewalk maintenance was (+) related to PA. • Among Latinas perceiving high social cohesion, aesthetics was (+) related to PA. • Findings may inform interventions to promote Latinas’ neighborhood outdoor PA.

The purpose of this study was to examine the “buffering hypothesis” of social network characteristics in the association between chronic conditions and depression among Latinos. Cross-sectional self-report data from the San Diego Prevention Research Center’s community survey of Latinos were used (n = 393). Separate multiple logistic regression models tested the role of chronic conditions and social network characteristics in the likelihood of moderate-to-severe depressive symptoms. Having a greater proportion of the network comprised of friends increased the likelihood of depression among those with high cholesterol. Having a greater proportion of women in the social network was directly related to the increased likelihood of depression, regardless of the presence of chronic health conditions. Findings suggest that network characteristics may play a role in the link between chronic conditions and depression among Latinos. Future research should explore strategies targeting the social networks of Latinos to improve health outcomes.

Anemia is a public health problem in Mexico. This study sought to determine the prevalence and correlates of anemia among women and children residing in a rural farming region of Baja California, Mexico. An existing partnership between universities, non-governmental organizations, and an underserved Mexican community was utilized to perform cross-sectional data collection in 2004-2005 (Wave 1) and in 2011-2012 (Wave 2) among women (15-49 years) and their children (6-59 months). All participants completed a survey and underwent anemia testing. Blood smears were obtained to identify etiology. Nutrition education interventions and clinical health evaluations were offered between waves. Participants included 201 women and 99 children in Wave 1, and 146 women and 77 children in Wave 2. Prevalence of anemia significantly decreased from 42.3 to 23.3 % between Waves 1 and 2 in women (p

This study systematically reviewed the methodology and findings of 24 peer-reviewed studies on psychosocial risk factors associated with the mental health of undocumented immigrants (UIs) in the United States. Of these studies, 14 included quantitative data and 13 were qualitative. The most common recruitment methods were snowball techniques, and most studies used convenience samples of recent UI Latinos. The method of assessing legal status varied, including current versus retrospective undocumented status. Psychological distress, depression, anxiety, and substance use/abuse were identified as prevalent themes. Studies with enhanced methodological rigor are needed.

Few children consume sufficient servings of fruits and vegetables. Interventions aiming to improve children’s dietary intake often target parent level factors, but limited research has examined the mediating role of parental factors on children’s dietary intake. This study examined 10-month follow up data from the Entre Familia: Reflejos de Salud (Within the Family: Reflections of Health) trial to investigate (1) intervention effects on children’s dietary intake, both sustained and new changes, and (2) whether changes in mothers’ dietary intake, her parenting strategies, and behavioral strategies to promoting healthy eating in the home mediated changes in children’s dietary intake. Participants were 361 Mexican-origin families living in Imperial County, California. Families were randomly assigned to a 4-month dietary intervention or a delayed treatment control group. The intervention was delivered by promotoras (community health workers) via home visits and telephone calls. Assessments occurred at baseline, and 4- and 10-months post-baseline. At 10-months post-baseline, sustained intervention effects were observed on children’s reported intake of varieties of vegetables, with differences getting larger over time. However, differential intervention effects on fast food were not sustained due to significant reductions in the control group compared with smaller changes in the intervention group. New intervention effects were observed on servings of sugar-sweetened beverages. However, the intervention continued to have no effect on children’s reported fruit and vegetable servings, and varieties of fruits consumed. Mother-reported behavioral strategies to increase fiber and lower fat mediated the relationship between the intervention and children’s intake of varieties of vegetables. Mothers’ percent energy from fat and behavioral strategies to lower fat were mediators of children’s daily servings of sugar-sweetened beverages. This study suggests that a promotora-led family based intervention can provide mothers with skills to promote modest changes in children’s diet. Examining the parent related mechanisms of change will inform future interventions on important targets for improving children’s diet. https://clinicaltrials.gov/ . NCT02441049 . Retrospectively registered 05.06.2015.

The effectiveness of community health workers (CHWs) as health educators and health promoters among Latino populations is widely recognized. The Affordable Care Act created important opportunities to increase the role of CHWs in preventive health. This article describes the implementation of CHW-led, culturally specific, faith-based program to increase physical activity among churchgoing Latinas. This study augments previous research by describing the recruitment, selection, training, and evaluation of CHWs for a physical activity intervention targeting multiple levels of the Social Ecological Model.

Background:Greater neighborhood social cohesion is linked to fewer depressive symptoms and greater physical activity, but the role of physical activity on the relationship between neighborhood social cohesion and depression is poorly understood. The purpose of the study was to examine the effects of physical activity on the association between neighborhood social cohesion and depressive symptoms.Methods:Multivariate logistic regression tested the moderation of self-reported leisure-time moderate-to-vigorous physical activity (LTMVPA) and active use of parks or recreational facilities on the association between neighborhood social cohesion and depressive symptoms among 295 randomly selected Latino adults who completed a face-to-face interview.Results:After adjusting for age, gender, and income, neighborhood social cohesion and depressive symptoms were inversely related (OR = 0.8; 95% CI: 0.5–1.2). Active use of parks or recreational facilities moderated the association between neighborhood social cohesion and depressive symptoms but meeting the recommendations for LTMVPA did not. Latinos who reported active use of parks or recreational facilities and higher levels of neighborhood social cohesion had fewer depressive symptoms than peers who did not use these spaces.Conclusions:Future studies are needed to test strategies for promoting active use of parks or recreational facilities to address depression in Latinos.

Peer support can promote diabetes control, yet research on feasible and effective peer support models is lacking. This randomized controlled trial tested a volunteer-based model of peer support for diabetes control.Thirty-four volunteer peer leaders were recruited and trained to provide support to 5 to 8 patients each through telephone contact, in-person, individual, and group support. Planned dose was 8 contacts, preferably in the first 6 months. Patients with uncontrolled diabetes were randomly sampled from the medical records of 3 community clinics. After a baseline interview and medical records review to obtain baseline values for the primary outcome, HbA1c, 336 patient participants were randomly assigned to a 12-month peer support intervention or usual care. The assessment protocol was repeated at 6 and 12 months after baseline.Thirty peer leaders delivered an average of 4 contacts each per assigned participant (range 1-24). Despite the lack of intervention fidelity, the intervention was effective at reducing glycated hemoglobin (HbA1c) among intervention as compared with usual care participants (P=0.05). Similar trends were observed in frequency of meeting fruit and vegetable guidelines (P =0.09), a secondary outcome. Counterintuitively, usual care participants reported checking their feet more days out of 7 than intervention participants (P =0.03).Given the modest changes we observed, combined with other evidence for peer support to promote diabetes control, additional research is needed on how to modify the system of care to increase the level of peer support delivered by volunteers.

SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.

A model frequently used to implement community-based research involves engaging local community health workers who are trusted members of the community and familiar with local customs, language, and culture. In Spanish-speaking communities, the CHWs are also known as promotores de salud (“health promoters”). Depending on the study design and nature of the research, promotores facilitate research through community outreach, instrument design, participant recruitment, intervention delivery, data collection, and other research-related tasks. In 2000, the National Institutes of Health published a regulation requiring training of “key personnel” named on NIH-supported research involving human subjects. Regardless of whether promotores are technically designated as key personnel on a particular study, they may benefit from training in research ethics. Unfortunately, the educational programs designed for academic researchers in response to the NIH mandate were poorly aligned with the needs of promotores and not suited for learning about human research ethics applied to the community health setting. For example, many promotores in our California-Mexico border region are monolingual Spanish speakers who have no formal academic research training. Therefore, we set out to develop a training alternative appropriate to our local CHWs. In this essay, we provide overviews of the relevant instructional design principles and our formative research process, including examples of key findings.

2015 Copyright © SHAPE America Purpose: The study aims were to determine: (a) how class structure varies by dance type, (b) how moderate-to-vigorous physical activity (MVPA) and sedentary behavior vary by dance class segments, and (c) how class structure relates to total MVPA in dance classes. Method: Participants were 291 boys and girls ages 5 to 18 years old enrolled in 58 dance classes at 21 dance studios in Southern California. MVPA and sedentary behavior were assessed with accelerometry, with data aggregated to 15-s epochs. Percent and minutes of MVPA and sedentary behavior during dance class segments and percent of class time and minutes spent in each segment were calculated using Freedson age-specific cut points. Differences in MVPA (Freedson 3 Metabolic Equivalents of Tasks age-specific cut points) and sedentary behavior (&nbsp

Aims. Examine intervention effects among mothers involved in a healthy eating randomized controlled trial. Furthermore, examine the mediating roles of individual and familial influences on observed outcomes. Methods. Between 2009 and 2011, 361 families were recruited; half were assigned to an 11-session community health worker–delivered family-based intervention targeting Spanish-speaking Latino families in Imperial County, California. The intervention was delivered over a 4-month period. Home visits and telephone calls were delivered approximately weekly, with tapering near the end of the intervention to promote independence from the promotora. In this article, mothers’ self-reported dietary intake was the primary outcome. Evaluation measures were taken at baseline, 4 months, and 10 months. Results. Daily servings of fruits were higher among intervention versus control mothers (mean = 1.86 vs. mean = 1.47; effect size [ES] = 0.22) at 10 months post-baseline. Mothers in the intervention versus control condition also reported consuming a lower percent energy from fat (mean = 30.0% vs. 31.0%; ES = 0.30) and a higher diet quality (mean = 2.93 vs. mean = 2.67; ES = 0.29). Mediators of improvements were behavioral strategies to increase fiber and lower fat intake, family support for vegetable purchasing, and decreased unhealthy eating behaviors and perceived family barriers to healthy eating. Discussion and Conclusion. Family-based behavioral interventions are effective for changing the skills and family system needed to improve diet among Latina mothers. Health care providers and other practitioners are encouraged to target skill development and fostering a socially supportive environment.

Female adolescents are less active than male peers in certain contexts including the neighborhood. Adolescents' physical activity can be explained by interactions between environmental and psychosocial factors, but few studies have tested such interactions in relation to context-specific behaviors. This study tested interactions between neighborhood environmental and psychosocial factors in relation to adolescents' context-specific physical activity. Data were collected in 2009–11 from 910 adolescents and a parent/guardian residing in the Baltimore/Seattle regions. Measures included adolescent-reported neighborhood leisure-time physical activity (LTPA) and non-neighborhood LTPA, accelerometer-based non-school moderate-to vigorous-physical activity (MVPA), psychosocial factors, and objective and parent-perceived neighborhood environmental factors. Gender-stratified mixed effects linear models tested associations of 6 environmental and 4 psychosocial factors and their interactions in relation to each physical activity outcome. The psychosocial factors had consistent associations with the physical activity outcomes but the environmental correlates were context-specific. Decisional balance (weighing of pros and cons of physical activity) moderated the association between recreation facility density and neighborhood LTPA among females, with a negative association only among those with high decisional balance (pros outweighed cons). Decisional balance also moderated associations of neighborhood walkability with non-school MVPA among females and non-neighborhood LTPA among males, with positive associations only among those with high decisional balance. Results support context-specific ecological models of physical activity. Targeting environmental factors that may promote opportunities for physical activity in specific contexts as well as adolescent decision-making may help promote their physical activity in those contexts, potentially leading to increased overall physical activity.

Purpose: This study tested whether a multilevel physical activity (PA) intervention had differential effects on PA according to participants’ perceptions of their neighborhood environment. Design: Two-group cluster randomized controlled trial. Setting: San Diego, California. Subjects: Analytical sample included 319 Latinas (18-65 years) from churches randomized to the following conditions: PA (n = 8 churches, n = 157 participants) or attention control (n = 8 churches, n = 162 participants). Intervention: Over 12 months, PA participants were offered free PA classes (6/wk), while attention control participants were offered cancer prevention workshops. Measures: Baseline and 12-month follow-up measures included self-report and accelerometer-based moderate to vigorous physical activity (MVPA), sociodemographics, and perceived neighborhood environment variables. Analysis: Mixed-effects models examined each PA outcome at 12-month follow-up, adjusted for church clustering, baseline PA, and sociodemographics. We tested interactions between 7 baseline perceived environment variables and study condition. Results: Neighborhood esthetics was the only significant moderator of intervention effects on accelerometer-based MVPA and self-report leisure-time MVPA. Participants in the PA intervention had significantly higher PA at follow-up than attention control participants, only when participants evaluated their neighborhood esthetics favorably. Conclusion: Perceived neighborhood esthetics appeared to maximize the effectiveness of a multilevel PA intervention among Latinas. For sustainable PA behavior change, the environments in which Latinas are encouraged to be active may need to be evaluated prior to implementing an intervention to ensure they support active lifestyles.

Author(s): Moor, Molly A; Fraga, Miguel A; Garfein, Richard S; Rashidi, Hooman H; Alcaraz, John; Kritz-Silverstein, Donna; Elder, John P; Brodine, Stephanie K | Abstract: IntroductionAnemia is a public health concern among women in rural Baja California, Mexico. The purpose of this study was to identify the individual and community factors contributing to the disproportionately high prevalence of anemia among women in this region.MethodsA cross-sectional study of 118 women (15-49 years) was performed in a rural colonia (small settlement) in Baja California, Mexico in 2012. Participants completed a survey comprised of demographic, socioeconomic, health, and dietary questions and provided a capillary blood sample. A portable HemoCue was used to measure hemoglobin and diagnose anemia. Anemic participants provided a venous blood sample for laboratory testing to elucidate the etiology of anemia. Anemic participants received vitamin supplements and nutritional counseling. Assessments of six local tiendas (community grocery stores) were performed to ascertain the types of food available for purchase within the community.ResultsPrevalence of anemia was 22% among women; laboratory tests revealed iron deficiency was the primary etiology in 80.8% of anemia cases. Other causes of anemia in women included vitamin B-12 deficiency (11.5%) and combined iron and vitamin B-12 deficiency (7.7%). Women from low SES households and women enrolled in the government assistance program Prospera were significantly more likely to be anemic (OR = 3.48, 95% CI 1.35-8.98 and OR = 2.49, 95% CI 1.02-6.09, respectively). Vitamin supplementation was significantly more common among non-anemic women (OR = 0.12, 95% CI 0.02-0.94). Dietary assessments showed limited consumption of iron absorption enhancing foods such as fruits and vegetables. Assessments of local tiendas revealed at least one type of meat and citrus fruit available for purchase at each store; however, leafy green vegetables were only available for purchase at one store.ConclusionAll cases of anemia were due to nutritional deficiencies. While vitamin supplementation is a temporary solution, improved individual nutrition knowledge and community access to iron absorption enhancing foods, particularly produce, is needed. Promoting government assistance programs like Prospera and implementing additional programs designed to improve nutrition and health literacy, in conjunction with ensuring access to nutritious foods, might reduce the high prevalence nutritional anemia within the community.

Background: Associations between the built environment and physical activity (PA) may vary by sociodemographic factors. However, such evidence from international studies is limited. This study tested the moderating effects of sociodemographic factors on associations between perceived environment and self-reported total PA among adults from the International Prevalence Study. Methods: Between 2002 and 2003, adults from 9 countries (N = 10,258) completed surveys assessing total PA (International Physical Activity Questionnaire-short), perceived environment, and sociodemographics (age, gender, and education). Total PA was dichotomized as meeting/not meeting (a) high PA levels and (b) minimum PA guidelines. Logistic models tested environment by sociodemographic interactions (24 total). Results: Education and gender moderated the association between safety from crime and meeting high PA levels (interaction P P Conclusions: The limited number of moderating effects found provides support for population-wide environment–PA associations. International efforts to improve built environments are needed to promote health-enhancing PA and maintain environmental sustainability.

This study tested whether socio-demographic factors moderated associations between psychological factors and Latinas' breast cancer screening behaviors. 222 churchgoing Latinas (40-65years) in San Diego, CA completed surveys assessing socio-demographics (e.g., income and acculturation), psychological factors (e.g., perceived barriers to screening), and cancer screening behaviors. Multilevel models examined associations of socio-demographic and psychological factors (and their interactions) with adherence to annual mammography or clinical breast exam (CBE) screening. Although no main effects were found, there were moderation effects. Acculturation moderated associations between perceived barriers to screening and both screening outcomes, with inverse associations only among the high-acculturation group. Education moderated the relationship between perceived barriers to screening and CBE screening, with an inverse association only among the low-education group. Marital status moderated the relationship between depressive symptoms and CBE screening, with an inverse association only among single/non-partnered participants. Interventions are needed targeting psychological barriers to breast cancer screening among Latinas.

Cancer screening rates among Latinas are generally low, reducing the likelihood of early cancer detection in this population. This article examines the effects of a community intervention (Fe en Accion/Faith in Action) led by community health workers (promotoras) on promoting breast, cervical and colorectal cancer screening among churchgoing Latinas. Sixteen churches were randomly assigned to a cancer screening or a physical activity intervention. We examined cancer knowledge, barriers to screening and self-reported mammography, clinical breast exam, Pap test, fecal occult blood test and sigmoidoscopy or colonoscopy at baseline and 12 months follow-up. Participants were 436 adult Latinas, with 16 promotoras conducting a cancer screening intervention at 8 out of 16 churches. The cancer screening intervention had a significant positive impact on self-reported mammography (OR = 4.64, 95% CI: 2.00-10.75) and breast exams in the last year (OR= 2.82, 95% CI: 1.41-5.57) and corresponding reductions in perceived (87.6%) barriers to breast cancer screening (P < .008). Cervical and colorectal cancer screening did not improve with the intervention. These findings suggest Fe en Accion church-based promotoras had a significant impact on promoting breast cancer screening among Latinas. Colon cancer screening promotion, however, remains a challenge.

Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.

In June of 2012, representatives from more than 80 countries promulgated a Child Survival Call to Action, which called for reducing child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035. To address the problem of ending preventable child deaths, the U.S. Agency for International Development and the United Nations Children's Fund convened, on June 3-4, 2013, an Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. Six evidence review teams were established on different topics related to child survival and healthy development to identify the relevant evidence-based interventions and to prepare reports. This article was developed by the evidence review team responsible for identifying the research literature on caregiver change for child survival and development. This article is organized into childhood developmental periods and cross-cutting issues that affect child survival and healthy early development across all these periods. On the basis of this review, the authors present evidence-based recommendations for programs focused on caregivers to increase child survival and promote healthy development. Last, promising directions for future research to change caregivers' behaviors are given.

Pedestrians waiting to cross into the US from Mexico at Ports of Entry experience long wait times near idling vehicles. The near-road environment is associated with elevated pollutant levels and adverse health outcomes. This is the first exposure assessment conducted to quantify northbound pedestrian commuter exposure to traffic-related air pollutants at the U.S.–Mexico border San Ysidro Port of Entry (SYPOE). Seventy-three persons who regularly crossed the SYPOE in the pedestrian line and 18 persons who did not cross were recruited to wear personal air monitors for 24-h to measure traffic pollutants particulate matter less than 2.5 μm (PM2.5), 1-nitropyrene (1-NP) - a marker for diesel exhaust - and carbon monoxide (CO). Fixed site concentrations were collected at SYPOE and occurred during the time subjects were crossing northbound to approximate their exposure to 1-NP, ultrafine particles (UFP), PM2.5, CO, and black carbon (BC) while standing in line during their border wait. Subjects who crossed the border in pedestrian lanes had a 6-fold increase in exposure to 1-NP, a 3-fold increase in exposure to CO, and a 2-fold increase in exposure to gravimetric PM2.5, vs. non-border commuters. Univariate regression analysis for UFP (median 40,000 # cm−3) found that border wait time for vehicles explained 21% of variability and relative humidity 13%, but when modeled together neither predictor remained significant. Concentrations at the SYPOE of UFP, PM2.5, CO, and BC are similar to those in other near-roadway studies that show associations with acute and chronic adverse health effects. Although results are limited by small sample numbers, these findings warrant concern for adverse health effects experienced by pedestrian commuters waiting in a long northbound queue at SYPOE and demonstrates a potential health benefit of reduced wait times at the border.