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ObjectiveTo examine the effects of the COVID-19 pandemic among Latino communities, with an emphasis on understanding barriers and facilitators to vaccine intention prior to the development of the vaccine.MethodsQualitative data were collected between April and June 2020 from 3 focus groups with Latino adults (n = 21) and interviews with administrators of community-based organizations serving Latino communities (n = 12) in urban (Los Angeles) and rural (Fresno) California, supplemented by Community Advisory Board input in May 2021to elucidate the findings. Data were analyzed with deductive content analysis.ResultsWe have identified four main themes that are barriers to vaccinating against COVID-19: 1) concerns about accessing appropriate healthcare services, 2) financial issues and 3) immigration matters, as well as 4) misinformation.ConclusionsFindings illustrate the pervasive role of addressable social determinants of health in the intention of rural and urban Latino communities in being vaccinated, which is a pressing public health issue. Policy implications: Findings provide evidence for a systemic shift to prioritize equitable access to COVID-19 vaccines to Latino communities.

IntroductionDespite evidence that Hispanic/Latino populations are 1.5 times more likely than non-Latino Whites to develop Alzheimer's disease and related dementias (ADRD), Latinos are underrepresented in clinical trials testing treatments for ADRD. Data are needed on facilitators of ADRD clinical trial participation in Latinos. We leveraged in-depth qualitative methods to elucidate barriers and facilitators to participating in ADRD clinical trials in a large and diverse sample of Latinos; and to provide timely and actionable strategies to accelerate representation of Latinos in clinical trials on ADRD.MethodsData were collected in California between January 2019 and June 2020 from 25 focus groups (FGs): eight with Latino adults ages 18 to 49 (n = 54), nine with Latino adults ages 50+ (n = 75), and eight with caregivers of Latino older adults with ADRD (n = 52). Twelve community-based organization administrators were also interviewed. Transcripts of FGs and interviews were entered into Atlas.ti software. Three independent team members analyzed the transcripts with inductive/deductive qualitative content analysis. We triangulated data from stakeholder groups across sites, we used collaborative coding, and used the Consolidated Criteria for Reporting Qualitative Research.ResultsAn overarching theme was a tension between wanting to learn more about ADRD and to participate in ADRD research but having limited awareness and opportunity. Five themes were identified: (1) remaining in limbo, (2) wanting information about ADRD, (3) wanting information on research about ADRD, (4) clearing researchers through trusted local organizations, and (5) practicing altruism through engagement in research opportunities.DiscussionTo increase representation of Latino communities in clinical trials on ADRD, bilingual information and education on ADRD and clinical trials needs to be better disseminated. Also, working with trusted local, regional, and national organizations can increase participation. Importantly, Latino participation can increase when research teams demonstrate altruistic actions and inform participants of public health reasons requiring their involvement.HighlightsParticipation in clinical trials on Alzheimer's disease and related dementias (ADRD) is limited among Latinos/Hispanics.Knowing the high prevalence of ADRD in Latinos increases willingness to participate.Observing altruism from researchers increases willingness to participate.Invitations from multiple organizations increases willingness to participate.Researchers should include public health reasons requiring Latinos' involvement.

We tested if a dance trial yielded improvements in physical function and cardiorespiratory fitness (CRF) in middle-aged/older Latino adults. Physical activity was assessed using the Community Healthy Activities Model Program for Seniors, physical function with the Short Physical Performance Battery (SPPB) protocol, and estimated CRF with the Jurca nonexercise test model. Multivariate analysis of covariance models found significant change in SPPB protocol total scores, F(1, 329) = 4.23, p =.041, and CRF, F(1, 329) = 5.16, p =.024, between the two study arms in favor of the dance group. Mediation models found moderate- to vigorous-intensity physical activity to mediate to mediate between group and SPPB scores (β = 0.054, 95% confidence interval [0.0142, 0.1247]). Moderate- to vigorous-intensity physical activity and total physical activity were found to partially mediate between group and CRF (β = 0.02, 95% confidence interval [−0.0261, 0.0751]), with the direct pathway no longer being significant (p >.05). This provides support for Latin dance programs to have an effect on SPPB protocol and CRF. [ABSTRACT FROM AUTHOR]

Older Latinxs engage in lower levels of leisure-time physical activity (PA) compared with non-Latinx Whites. Latin dance is a culturally relevant type of leisure-time PA that may engage older Latinx populations, particularly when coupled with mobile health technologies (mHealth). This single group pre-post feasibility study described the PA and health outcomes of middle-aged and older Latinxs participating in BAILA TECH--an intervention that combines the BAILAMOS Latin dance program with mHealth (Fitbit Charge 2, Fitbit app, and motivational text messages). Participants (n = 20, M[subscript age] = 67 ± 7.1, female n = 15, 75%) were enrolled in the 16-week BAILA TECH intervention held twice a week. Participants received a Fitbit Charge 2 to assess PA at baseline, during the intervention, and postintervention. An mHealth platform (iCardia) collected Fitbit data and staff delivered weekly motivational and informational text messages. Participants completed questionnaires about PA, sedentary behavior, cardiorespiratory fitness, social support, quality of life, and cognitive function at baseline and postintervention. Paired t tests evaluated change in pre-post measures. There was a significant increase in device-assessed moderate-to-vigorous PA (d = 0.69), self-reported light-leisure (d = 1.91) and moderate-to-vigorous PA (d = 1.05), moderate-to-vigorous leisure PA (d = 1.55), predicted cardiorespiratory fitness (d = 1.10), and PA social support (d = 0.81 [family]; d = 0.95 [friends]) from baseline to postintervention. Although nonsignificant, there was a small effect on physical health--related quality of life (d = 0.32) and executive function (d = 0.29). These data describe an increase in PA levels and health-related outcomes of middle-aged and older Latinxs from participation in an mHealth-infused Latin dance intervention. An adequately powered trial is necessary to establish efficacy.

BackgroundPhysical activity is a modifiable healthy behavior that has been shown to positively influence health-related quality of life. However, research examining the link between physical activity and health-related quality of life among Hispanic/Latino adults is limited and inconsistent. The purpose of this study is to assess whether accelerometer-measured moderate-vigorous physical activity (MVPA) is associated with self-reported (a) mental health-related quality of life, and (b) physical health-related quality of life among diverse Hispanic/Latino adults in the US.MethodsCross-sectional data from 12,379 adults ages 18-74 years in 2008-2011, who participated in HCHS/SOL and had complete data were analyzed using complex survey design methods. Accelerometer data were categorized into no MVPA, low, moderate, and high MVPA. Health-related quality of life was assessed with the Short-Form 12 and we used the mental and physical component subscales where higher scores indicate better health-related quality of life. Multivariate linear regression models were used to derive adjusted means with 95% confidence intervals and linear trends.ResultsWe observed no significant linear trend between accelerometer-measured MVPA and mental health-related quality of life (ptrend = 0.73). There was a significant positive association between MVPA and physical health-related quality of life (ptrend

This paper provides highlights from an expert meeting to explore opportunities to reduce cancer risk and promote health at older ages. Factors that increase cancer risk among older adults include exposure to carcinogens from multiple sources, chronic conditions such as obesity and diabetes, and unhealthy behaviors. Emerging research points to chronic social stressors - social isolation, loneliness, and financial hardship - as being linked to accelerated biological aging and increased cancer risk later in life. Older adults may disproportionately encounter these stressors as well as barriers to preventive health care services, accurate health information, and environments that promote health. Researchers can use existing cohort studies of older adults to deepen our understanding of the relative benefit of modifying specific behaviors and circumstances. The evidence points to the value of comprehensive, transdisciplinary approaches to promote health and reduce cancer risk across the entire lifespan, extending through older adulthood. Clinical encounters with older adults provide opportunities for psychosocial and behavioral screening and counseling. In the presence of multiple morbidities, preventive health services may offer greater health benefits than cancer-screening tests. Strategies that involve families and caregivers, promote positive attitudes about aging, and engage many different community sectors have the potential to prevent or delay the development of cancer at older ages.

Objectives Hispanic adults display a higher likelihood of early-stage cognitive decline than their White counterparts yet receive fewer clinical diagnoses. This troubling trend highlights the significance of longitudinal surveys like the National Social Life, Health, and Aging Project (NSHAP) in monitoring cognitive changes in aging Hispanics. Using NSHAP's Rounds 2 and 3, we observed notable cognitive score differences between English and Spanish speakers, as assessed by the survey-adapted version of the Montreal Cognitive Assessment (MoCA-SA). Our study aims to discern if statistical adjustments can reduce measurement variance in global cognition scores between these language groups. Methods We applied modification indexes, 2-parameter item response theory models, and split-sample testing to pinpoint items that exhibit resilience to language-related bias among our Hispanic sample. From this analysis, an abbreviated version of the MoCA-SA, termed MoCA-SAA, was introduced. Subsequently, we juxtaposed the performance and predictive validity of both MoCA versions against four consequential outcomes indicative of cognitive decline. Results Our refined methodologies enabled the identification of consistent items across both language cohorts. The MoCA-SAA demonstrated performance and predictive validity in line with the original MoCA-SA concerning outcomes linked to cognitive deterioration. Discussion The translated measures ensure the inclusion of Hispanic Spanish speakers in NSHAP, who might otherwise be overlooked. The statistical adjustment outlined in this study offers a means to mitigate potential measurement disparities when assessing overall cognition. Despite these advancements, we acknowledge persistent issues related to the translation of the MoCA-SA into Spanish that warrant further attention. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is limited evidence about factors related to the timeliness of dementia diagnosis in healthcare settings. METHODS: In five prospective cohorts at Rush Alzheimer's Disease Center, we identified participants with incident dementia based on annual assessments and examined the timing of healthcare diagnoses in Medicare claims. We assessed sociodemographic, health, and psychosocial correlates of timely diagnosis. RESULTS: Of 710 participants, 385 (or 54%) received a timely claims diagnosis within 3 years prior to or 1 year following dementia onset. In logistic regressions accounting for demographics, we found Black participants (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.21 to 3.82) and those with better cognition at dementia onset (OR = 1.48, 95% CI: 1.10 to 1.98) were at higher odds of experiencing a diagnostic delay, whereas participants with higher income (OR = 0.89, 95% CI: 0.81 to 0.97) and more comorbidities (OR = 0.94, 95% CI: 0.89 to 0.98) had lower odds. DISCUSSION: We identified characteristics of individuals who may miss the optimal window for dementia treatment and support. Highlights: We compared the timing of healthcare diagnosis relative to the timing of incident dementia based on rigorous annual evaluation.Older Black adults with lower income, higher cognitive function, and fewer comorbidities were less likely to be diagnosed in a timely manner by the healthcare system. [ABSTRACT FROM AUTHOR]

Consumer-based physical activity (PA) trackers, also known as wearables, are increasingly being used in research studies as intervention or measurement tools. One of the most popular and widely used brands of PA trackers is Fitbit. Since the release of the first Fitbit in 2009, hundreds of experimental studies have used Fitbit devices to facilitate PA self-monitoring and behavior change via goal setting and feedback tools. Fitbit’s ability to capture large volumes of PA and physiological data in real time creates enormous opportunities for researchers. At the same time, however, it introduces a number of challenges (eg, technological, operational, logistical), most of which are not sufficiently described in study publications. Currently, there are no technical reports, guidelines, nor other types of publications discussing some of these challenges and offering guidance to researchers on how to best incorporate Fitbit devices in their study design and intervention to achieve their research goals. As a result, researchers are often left alone to discover and address some of these issues during the study through “trial and error.” This paper aims to address this gap. Drawing on our cumulative experience of conducting multiple studies with various Fitbit PA trackers over the years, we present and discuss various key challenges associated with the use of Fitbit PA trackers in research studies. Difficulties with the use of Fitbit PA trackers are encountered throughout the entire research process. Challenges and solutions are categorized in 4 main categories: study preparation, intervention delivery, data collection and analysis, and study closeout. Subsequently, we describe a number of empirically tested strategies used in 4 of our interventional studies involving participants from a broad range of demographic characteristics, racial/ethnic backgrounds, and literacy levels. Researchers should be prepared to address challenges and issues in a timely fashion to ensure that the Fitbit effectively assists participants and researchers in achieving research and outcome goals.

Background: Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas' activity and sedentary levels are unclear. Aim: To examine associations of acculturation with Latinas' domain-specific and total PA as well as sedentary time. Method: We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA ("Fe en Acción"/"Faith in Action"). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions: Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas' PA and sedentary behaviors.

Older Latinos have low rates of physical activity (PA) and poor health outcomes. Focus groups and a single group, pre-post 3-month pilot of a culturally appropriate Latin dance program (BAILAMOS©) were conducted among older, inactive Latinos with a self-identified mobility limitation. Nine themes emerged from focus groups, including cultural influences of dance and barriers to dancing. In the pilot intervention, 9 of 13 older Latinos completed the program and attended 85% of the sessions. Self-reported PA significantly increased (p < 0.05; d = 1.39), but daily accelerometer-assessed PA decreased for moderate-intensity PA (p = 0.18; d = 0.29). Participants reported significantly greater enjoyment of PA (p < 0.05; d = 0.61) and improved physical quality of life (p = 0.23; d = 0.31). Improvements in mobility (p = 0.15; d = 0.56) and aspects of cognition were demonstrated. The BAILAMOS program appears to be feasible, culturally appropriate, and has the potential to improve psychosocial determinants of PA, self-reported PA, and aspects of health.

Background: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. Objective: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. Methods: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. Results: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d =0.54; P =.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d =0.47; P =.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean –35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d =0.74; P =.01). No group differences were observed in other cognitive measures. Conclusions: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Trial Registration: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5 [ABSTRACT FROM AUTHOR]

Background: Smart speakers, such as Amazon's Echo and Google's Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. Objective: This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. Methods: Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. Results: Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. Conclusions: Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention. [ABSTRACT FROM AUTHOR]