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Background: Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM., Methods: Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment., Results: Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR 5 years vs 0 years 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR ≥2 vs 0 declines 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR 5 years vs 0 years 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86)., Conclusion: Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.

Vaccine hesitancy is an attitude of indecision toward vaccination that is related to but not determinative of vaccination behaviors. Although theories of vaccine hesitancy emphasize it is often vaccine-specific, we do not know the extent to which this is true across sociodemographic groups. In this study, we asked: What latent classes of vaccine hesitancy might exist when examining parents' attitudes toward vaccines in general and COVID-19 and human papillomavirus (HPV) vaccination specifically? Which sociodemographic, health access, and health-related variables are predictive of membership in those classes? To answer those questions, we analyze online survey data from parents of pediatric patients recruited through eight clinics within the University of Arkansas for Medical Sciences Rural Research Network. Data were collected between September 16, 2022 and December 6, 2022. Latent class analysis revealed three underlying classes of vaccine hesitancy, or hesitancies: The "Selectively Hesitant," the "COVID-Centric Hesitant," and the "Pervasively Hesitant." Significant predictors of class membership were age, education, health insurance status, and usual source of care. Vaccine hesitancy may be specific to certain vaccines for some parents and more generalized for others. The distinct classes of vaccine hesitancy revealed in this study suggest the need for distinct approaches to addressing vaccine hesitancy depending on the population., (© 2025 The Author(s). Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Purpose: To examine the association between adherence to sleep, dietary, screen time, and physical activity (PA) (8-5-2-1-0) guidelines and risk of high body mass index (BMI ≥ 85 percentile) among U.S. adolescents and to assess for racial inequities and age-varying effects in these associations., Methods: Data from the 2019 Youth Risk Behavior Surveillance System survey were used to conduct multivariable logistic regression models and moderation analysis by race/ethnicity and age using time-varying varying effect models (TVEM) and estimate associations of interest., Results: Of the 13,518 adolescents aged ≥ 14 years, only 0.5% met all guidelines. Adolescents adhering to sleep guidelines had a 21% reduction in their odds of having a high BMI (OR 0.79, 95% CI 0.67-0.93). Those adhering to PA guidelines had a 34% reduction in their odds of having a high BMI (OR 0.66, 95% CI 0.56-0.79), and those adhering to screen time guidelines had a 17% reduction in their odds of having a high BMI (OR 0.83, 95% CI 0.72-0.95). TVEM showed associations between adherence to sleep and screen time guidelines with high BMI fluctuate and are at specific ages. TVEM revealed substantial racial/ethnic differences in the age-varying association between adherence to 8-5-2-1-0 guidelines and high BMI throughout adolescence., Conclusions: Associations between adherence to sleep and screen time guidelines and high BMI fluctuate with age, highlighting the need for nuanced interventions targeting 24-h movement guidelines (sleep, PA, and screen time) across adolescence, particularly given racial/ethnic disparities., (© 2024. W. Montague Cobb-NMA Health Institute.)

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.

Background and Aims: Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D)., Methods: Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders., Results: High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results., Conclusions: Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: To examine associations between walkability, metropolitan size, and physical activity (PA) among cancer survivors and explore if the association between walkability and PA would vary across United States metropolitan sizes., Methods: This study used data from the 2020 National Health Interview Survey to examine independent associations of walkability and metropolitan size with engaging in moderate-to-vigorous PA (MVPA) and to explore the effect modification of metropolitan size using log-binomial regression. The dependent variable was dichotomized as < vs. ≥ 150 min/week of MVPA. The predictors were perceived walkability, a total score comprising eight neighborhood attributes, and metropolitan size. Covariates included sociodemographic and health characteristics, geographic region, cancer type, and time since cancer diagnosis., Results: Engaging in 150 + min/wk of MVPA significantly increased among cancer survivors (n = 3,405) who perceived their neighborhoods as more walkable (prevalence ratio:1.04; p = 0.004). Engaging in 150 + min/wk of MVPA significantly increased among cancer survivors living in medium and small metropolitan areas vs. those living in large central metropolitan areas (prevalence ratio:1.12; p = 0.044). Perceived walkability levels were similar among cancer survivors in nonmetropolitan areas vs. those living in large central metropolitan areas. Association between walkability and PA did not significantly vary across metropolitan sizes., Conclusions: Perceived neighborhood walkability is positively associated with MVPA among cancer survivors, regardless of metropolitan size., Implications for Cancer Survivors: Findings highlight the importance of investing in the built environment to increase walkability among this population and translating lessons from medium and small metropolitan areas to other metropolitan areas to address the rural-urban disparity in PA among cancer survivors., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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.)

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.)

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.)

Importance: Understanding the association between job characteristics and mental health can inform policies and practices to promote employee well-being., Objective: To investigate associations between job characteristics and mental health, work absenteeism, and mental health care use among US adults., Design, Setting, and Participants: This cross-sectional study analyzed data from the 2021 National Health Interview Survey and included adults aged 18 years or older who reported employment during the past 12 months. Data were analyzed from May 2023 to January 2024., Exposures: Job flexibility was assessed as a summative variable to 3 questions: perceived ease of changing one's work schedule to do things important to oneself or their family, regularity of work schedule changes, and advance notice of work hours. Job security was measured as perceived likelihood of losing one's job., Main Outcomes and Measures: Mental health outcomes included self-reported serious psychological distress and frequency of anxiety. Work absenteeism was assessed using the number of missed workdays due to illness. Mental health care use was examined for both current and past year use. Multivariable logistic and binomial regression analyses were used to examine associations of interest., Results: The analytic sample consisted of 18 144 adults (52.3% [95% CI, 51.5%-53.2%] male; mean age, 42.2 [95% CI, 41.9-42.6] years). Greater job flexibility was associated with decreased odds of serious psychological distress (odds ratio [OR], 0.74 [95% CI, 0.63-0.86]; P < .001) and lower odds of weekly anxiety (OR, 0.89 [95% CI, 0.81-0.97]; P = .008) or daily anxiety (OR, 0.87 [95% CI, 0.79-0.96]; P = .005). Greater job security was associated with decreased odds of serious psychological distress (OR, 0.75 [95% CI, 0.65-0.87]; P < .001) and lower odds of anxiety weekly (OR, 0.79 [95% CI, 0.71-0.88]; P < .001) or daily (OR, 0.73 [95% CI, 0.66-0.81]; P < .001). Greater job flexibility (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.96]; P = .008) and job security (IRR, 0.75 [95% CI, 0.65-0.87]; P < .001) were each associated with decreased number of days worked despite feeling ill over the past 3 months. Greater job security was associated with decreased absenteeism in the past year (IRR, 0.89 [95% CI, 0.82-0.98]; P < .014)., Conclusions and Relevance: Organizational policies that enhance job flexibility and security may facilitate a healthier work environment, mitigate work-related stress, and ultimately promote better mental health.

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.

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.

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.)

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.)

Background: Some cancer survivors experience medical financial hardship, which may reduce their food security. The purpose of this study was to explore whether medical financial hardship is related to food security among cancer survivors., Methods: The study was based on cross-sectional data from the 2020 National Health Interview Survey. We used ordinal logistic regression to examine the relationship between material, psychological, and behavioral medical financial hardships and household food security (i.e., high, marginal, low, or very low) among individuals ages ≥18 years who reported a cancer diagnosis from a health professional (N = 4,130)., Results: The majority of the sample reported high household food security (88.5%), with 4.8% reporting marginal, 3.6% reporting low, and 3.1% reporting very low household food security. In the adjusted model, the odds of being in a lower food security category were higher for cancer survivors who had problems paying or were unable to pay their medical bills compared with those who did not [OR, 1.73; 95% confidence interval (CI), 1.06-2.82, P = 0.027], who were very worried about paying their medical bills compared with those who were not at all worried (OR, 2.88; 95% CI, 1.64-5.07; P < 0.001), and who delayed medical care due to cost compared with those who did not (OR, 2.56; 95% CI, 1.29-5.09; P = 0.007)., Conclusions: Food insecurity is rare among cancer survivors. However, medical financial hardship is associated with an increased risk of lower household food security among cancer survivors., Impact: A minority of cancer survivors experience medical financial hardship and food insecurity; social needs screenings should be conducted., (©2023 American Association for Cancer Research.)

Objective: This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association., Design: Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria., Setting: The USA, including all 50 states and the District of Columbia., Participants: 383 NHPI adolescents aged 12-17 in the USA., Results: A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families., Conclusions: The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.

Objective: This study examined associations among perceived neighborhood walkability, physical activity (PA), and obesity among United States adults., Methods: Data from the 2020 National Health Interview Survey were analyzed. Walkability was assessed using a summative scale and was categorized as low, medium, or high. PA was categorized as insufficient (0-149 min/wk) or sufficient (150+ min/wk). Multivariable regressions estimated an association between obesity and BMI and PA/walkability. Mediation analysis was used to partition contribution of PA as a mediator. Effect modification by race and ethnicity in the association between walkability and BMI was explored., Results: The sample included N = 31,568 adults. Compared with those in low-walkability neighborhoods, participants in high-walkability neighborhoods had increased odds of sufficient PA (odds ratio [OR] = 1.48; 95% CI: 1.30-1.69) and decreased obesity odds (OR = 0.76; 95% CI: 0.66-0.87). PA partially mediated the association between walkability and BMI (23.4%; 95% CI: 14.6%-62.7%). The association between walkability and BMI was modified by race and ethnicity (F [5,567]  = 2.75; p = 0.018). Among White, Black, Hispanic, and Asian adults, BMI decreased with increasing walkability; among American Indian/Alaska Native and multiracial/other adults, BMI increased with increasing walkability., Conclusions: The findings highlight the importance of investing in the built environment to improve perceptions of walkability and promote PA and healthy weight, as well as developing interventions to target racial and ethnic disparities in these outcomes., (© 2022 The Obesity Society.)

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.

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.)

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.

Data from the 2014 Native Hawaiian and Pacific Islander (NHPI) National Health Interview Survey were used to examine associations between food security and individual chronic diseases, total number of chronic diseases, and general health status among 637 NHPI adults with income below 200 percent federal poverty level. Very low food security was associated with hypertension, diabetes, and asthma. Very low food security and marginal food security were associated with having any chronic disease and with having a higher number of chronic diseases. Risk for food insecurity increased as health status decreased. These associations had not previously been documented for NHPI., Competing Interests: Conflict of Interest: None

Characterizing food pantry (FP) clients' FP usage patterns may provide opportunities to tailor health-related interventions. Respondents (n=245) at seven FPs reported their frequency and reliance on FPs and their sociodemographics, health status, and health-related trade-offs. Clients were categorized via latent class analysis. Higher FP usage was associated with being older, having a household member with heart disease, and putting off buying medicine to buy food. Lower FP usage was associated with higher levels of education and having a household member with cancer. Findings highlight the potential importance of measuring FP clients' degree of FP use.

Objective: Native Hawaiian and Pacific Islander (NHPI) individuals report high obesity rates and low physical activity (PA) levels. This study examined associations between neighborhood social cohesion, obesity, and PA among NHPI adults., Methods: Cross-sectional data from the 2014 NHPI National Health Interview Survey were analyzed. Social cohesion was assessed using a summative scale and categorized as low, medium, and high. PA was measured via self-report and categorized as insufficiently active (0-149 min/wk) or sufficiently active (150+ min/wk). Obesity status was based on self-reported height and weight measures converted into standard BMI categories. Multivariable logistic regression models estimated odds of obesity and sufficient PA associated with social cohesion level., Results: The study sample included n = 2,590 NHPI adults. Compared with those in low social cohesion neighborhoods, participants in high social cohesion neighborhoods had increased sufficient PA odds (odds ratio [OR] = 1.59, 95% CI: 1.19-2.12; p = 0.003) and decreased obesity odds (OR = 0.57, 95% CI: 0.40-0.83; p = 0.005). No associations were observed between social cohesion and obesity and PA outcomes comparing individuals in medium versus low social cohesion neighborhoods., Conclusions: High social cohesion was associated with reduced obesity odds and increased sufficient PA odds. Findings highlight the importance of enhancing social connectivity as a potential strategy to promote PA and healthy weight among NHPI individuals., (© 2021 The Obesity Society.)

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.)

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.)

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.)

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.

Introduction: Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders., Methods: This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants' blood pressure, comparing an Adapted-Family DSME with a Standard DSME., Results: Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm., Conclusion: This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM., Competing Interests: The authors have declared that no competing interests exist.

Objective: We examined barriers to accessing medical care for migrant US-residing Marshallese Islanders., Methods: Cross-sectional analyses were conducted to identify potential inequities. Surveys from largely migrant diabetic Marshallese Islanders (n = 255) were compared with nationally representative data. Two major outcomes were assessed including 1-whether or not one reported having forgone medical care in the past year because of cost-and 2-whether or not one reported not having a usual source of care., Results: Overall, 74% and 77% of Marshallese Islanders reported forgone care and no usual source of care, respectively, versus 15% and 7% of the US diabetic population. In multivariable analyses, being younger; uninsured; unemployed; male; of lower education; Native American or Hispanic (versus White); and residing in the South were associated with forgone care nationwide, whereas only lacking insurance was associated with forgone care among Marshallese Islanders. Nationwide being younger; uninsured; unmarried; female; of lower education; Native American or Hispanic (versus White); and residing in the South were associated with not having a usual source of care, whereas only being younger and uninsured were associated with not having a usual source of care among Marshallese Islanders., Conclusion: The largest group of diabetic Marshallese Islanders in the continental US faces severe healthcare access inequities necessitating policies that increase access to health insurance options and associated resources.

(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.

Native Hawaiians and other Pacific Islanders (NHPI) suffer disproportionate rates of death from heart attack and stroke; however, little is known about NHPI heart attack and stroke symptoms knowledge. We used multivariable logistic regression to examine associations between heart attack and stroke symptoms knowledge and electronic health (eHealth) use, education, engaging in health risk behaviors, and having an at-risk diagnosis or a past heart attack and/or stroke. The analytic sample included 2,172 NHPI adults responding to the 2014 NHPI-National Health Interview Survey. NHPI reported moderate to high levels of heart attack and stroke symptoms knowledge. NHPI with an at-risk diagnosis were significantly more likely to know three of five heart attack symptoms. Engaging in health risk behaviors increased the odds of knowing one heart attack symptom. Neither a prior heart attack nor a prior stroke increased the likelihood of recognizing most symptoms of heart attack or stroke. eHealth use was associated with increased likelihood for knowing heart attack and stroke symptoms. The findings of this study can be used to inform interventions that support the Healthy People 2020 goals to increase the proportion of adults who are aware of the symptoms of heart attack and stroke and to reduce heart attack and stroke disparities.

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.

Background: Increased availability of evidence-based practices (EBPs) is essential to alleviating the negative public health and societal effects of behavioral health problems. A major challenge to implementing and sustaining EBPs broadly is the limited and fragmented nature of available funding., Method: We conducted a scoping review that assessed the current state of evidence on EBP financing strategies for behavioral health based on recent literature (i.e., post-Affordable Care Act). We defined financing strategies as techniques that secure and direct financial resources to support EBP implementation. This article introduces a conceptualization of financing strategies and then presents a compilation of identified strategies, following established reporting guidelines for the implementation strategies. We also describe the reported level of use for each financing strategy in the research literature., Results: Of 23 financing strategies, 13 were reported as being used within behavioral health services, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies reported being used include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. No strategies had been evaluated in ways that allowed for strong conclusions about their impact on EBP implementation outcomes., Conclusion: The existing literature on EBP financing strategies in behavioral health raises far more questions than answers. Therefore, we propose a research agenda that will help better understand these financing strategies. We also discuss the implications of our findings for behavioral health professionals, system leaders, and policymakers who want to develop robust, sustainable financing for EBP implementation in behavioral health systems., Plain Language Abstract: Organizations that treat behavioral health problems (mental health and substance use) often seek to adopt and use evidence-based practices (EBPs). A challenge to adopting EBPs broadly is the limited funding available, often from various sources that are poorly coordinated with one another. To help organizations plan effectively to adopt EBPs, we conducted a review of recent evidence (i.e., since the passage of the 2010 Affordable Care Act) on strategies for financing EBP adoption in behavioral health systems. We present definitions of 23 identified strategies and describe each strategy's reported (in the research literature) level of use to fund EBP adoption in behavioral health services. Of the 23 financing strategies, 13 strategies had evidence of use, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies with evidence of use include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. This comprehensive list of EBP financing strategies may help guide decision-making by behavioral health professionals, system leaders, and policymakers. The article also presents a research agenda for building on the current research literature by (1) advancing methods to evaluate financing strategies' effects, (2) partnering with stakeholders and decision-makers to examine promising financing strategies, (3) focusing on strategies and service systems with the greatest needs, (4) improving methods to guide the selection of financing strategies, and (5) paying greater attention to sustainable long-term financing of EBPs., 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) 2020.)

Objective: To document food insecurity prevalence among a nationally representative sample of Native Hawaiian and Pacific Islander (NHPI) adults and compare differences in food security status across races/ethnicities in the US., Methods: Using 2014 National Health Interview Survey and 2014 NHPI-National Health Interview Survey data, food insecurity among the NHPI population is described and food security status across racial/ethnic groups is compared using Rao-Scott chi-square and multinomial logistic regression., Results: Food insecurity prevalence was 20.5% among NHPI adults, and NHPI had significantly higher odds of experiencing low and very low food security than white individuals. Food insecurity among Hispanic individuals, black people, and other races/ethnicities was also significantly higher than that among white people. Significant variation in food security status was observed by race/ethnicity (P < .001)., Conclusions and Implications: This study provides documentation of food insecurity prevalence among NHPI adults and will inform chronic disease and nutrition research and programs conducted with NHPI communities in the US., (Copyright © 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors., Methods: One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65 years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights., Results: Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P = .001), psychological MFH (36% vs 22%; P = .040), and behavioral MFH (27% vs 9%; P = .004) than NHWs. Among survivors aged <65 years, NHPIs reported less MFH (46% vs. 65%; P = .034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH., Conclusions: A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation., (© 2020 American Cancer Society.)

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).

Background: Millions of food-insecure households in the United States obtain food from food pantries each year. These foods are often of insufficient nutritional quality., Objective: Our aim was to describe the frequency with which Arkansas food pantries offer foods included in Feeding America's Detailed Foods to Encourage (F2E) framework, and examine food pantry characteristics associated with increased frequency of offering F2E and other foods., Design: This was a 27-item cross-sectional online survey that assessed food pantries' characteristics (eg, storage capacities, number of clients served) and typical food offerings., Participants/setting: Partnering with five of Arkansas's six food banks, 764 e-mail invitations were sent to food agency managers across the state. A final sample of 357 food pantries was included in the analyses., Main Outcome Measures: The primary outcomes of interest were the frequencies of offering specific F2E and F2E in general. The F2E framework was developed by Feeding America to more accurately assess food banks' inventories, and its categories (Fruits and Vegetables; Protein; Dairy; and Grains) are generally consistent with MyPlate., Statistical Analyses Performed: Descriptive statistics were computed for all food pantry characteristics and frequency of foods offered. Associations between food pantry characteristics and the frequency of offering F2E were examined via multiple linear regression and path analysis., Results: Only 18.5% of food pantries had written nutrition guidelines, and only 19.3% offered client choice distribution. The F2E most commonly offered were meat/poultry/seafood without breading and not fried (59.6%) and peanut butter (58.2%). The least commonly offered F2E were nuts/seeds with nothing added (3.8%) and low-fat/1%/skim cheese (8.2%). Written nutrition guidelines (P<0.001), client choice distribution (P=0.003), and adequate refrigerator storage (P=0.010) were associated with more frequently offering F2E., Conclusions: This study fills a gap in knowledge by documenting food pantry characteristics that are associated with the frequencies of offering specific types of healthy foods., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Document the prevalence of electronic cigarette (E-cigarette) use among the native Hawaiian and other Pacific Islander (NHPI) adults compared with other racial/ethnic groups, and examine associations between psychological distress and E-cigarette use. 2014 National Health Interview Survey (NHIS) and 2014 NHPI-NHIS were combined for comparisons. Data were analyzed using descriptive statistics, Rao-Scott χ 2 test, and multivariable logistic regression. E-cigarette use among NHPI (5.6%) was significantly higher than among Blacks (2.1%), Hispanics (2.2%), and Asians (1.7%; p < .001). NHPI with Kessler 6 (K6) score of 11-24 had greater odds of using E-cigarettes (odds ratio [OR]: 3.90; 95% confidence intervals [CI]: 1.81-8.42) as compared to those with a K6 score of 0. Associations between having a K6 score of 11-24 and using E-cigarettes were also found for Whites (OR: 3.49; CI: 2.44-4.99), Asians (OR: 5.29; CI: 1.29-21.70), and Hispanics (OR: 6.14; CI: 2.72-13.83). E-cigarette use was higher among NHPI relative to other racial/ethnic groups. NHPI with K6 score of 11-24 had greater odds of using E-cigarettes as compared to those with a K6 score of 0. Policies and strategies to reduce E-cigarette use among NHPI should give careful consideration to the associations between E-cigarette use and psychological distress in the NHPI population., (© 2019 Wiley Periodicals, Inc.)

Objectives: To examine whether adherence to US sleep, dietary, screen time, and physical activity (8-5-2-1-0) guidelines is associated with reduced risk of overweight/obesity in adolescents., Design: Multivariable log-binomial regressions were estimated using the 2017 Youth Risk Behavior Surveillance System data., Results: Of the 8194 adolescents aged 13 years and older, only 0.6% (49) met all guidelines. Meeting the recommended 8 hours of sleep per day was associated with reduced risk of overweight/obesity (risk ratio [RR]: 0.90; confidence interval [CI]: 0.81-0.99). Having ≤2 hours of screen time per day was associated with reduced risks of overweight/obesity (RR: 0.85; CI: 0.77-0.95). One hour of daily physical activity was associated with reduced risk of overweight/obesity (RR: 0.80; CI: 0.73-0.87). No significant associations were found between daily consumption of ≥5 fruits and vegetables or consumption of zero sugar-sweetened beverages and overweight/obesity. The 8-5-2-1-0 constitutes an improved prediction model to explain the risk of overweight/obesity among adolescents compared with the 5-2-1-0 model (F 1,36  = 4.80; P = .035)., Conclusions: Findings from this study suggest that meeting recommendations for sleep, screen time, and physical activity is associated with decreased risk of overweight/obesity in a large sample of adolescents. These are important factors to consider in the prevention and treatment of overweight/obesity in adolescents., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA 1c )., Research Design and Methods: A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes ( n = 221) received either standard DSME in a community setting ( n = 111) or adapted DSME in a home setting ( n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models., Results: Participants in the adapted DSME arm showed significantly greater declines in mean HbA 1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA 1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) ( P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA 1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005)., Conclusions: Participants receiving the adapted DSME showed significantly greater reductions in mean HbA 1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members., (© 2019 by the American Diabetes Association.)

Little is known about health limitations and service utilization among the Native Hawaiian and Pacific Islander (NHPI) children with developmental disabilities (DDs) due to limited data. Our study examined the prevalence of DDs, health limitations, services used, and the unmet needs of NHPI children aged 3 to 17 years using cross-sectional data from the 2014 NHPI National Health Interview Survey. Results showed that prevalence of DDs among NHPI children was lower than American children of other races. DDs were negatively associated with health and functioning of NHPI children. There is a need to promote understanding of DDs among NHPI families and to inform public policy makers to identify appropriate intervention services for NHPI children.

Objectives: In this study, we assessed the effect of Family Diabetes Self-Management Educa- tion (DSME) intervention on changes in self-care behaviors among Marshallese adults with type 2 diabetes. Methods: Marshallese adults (N = 211) with type 2 diabetes were randomized to a Family DSME intervention or a Standard DSME intervention. We assessed changes in diabetes- related self-care behaviors from baseline to 12 months within and between study arms using descriptive statistics and mixed effects logistic regression models adjusted for demographic characteristics and use of diabetes medication. Results: Family DSME participants had increased engagement in glucose monitoring and doctor visits, whereas Standard DSME participants had increased engagement in glucose monitoring. Family DSME participants increased engagement in glucose monitoring more than Standard DSME participants. Conclusions: DSME can improve some diabetes related self-care behaviors. Future studies on diabetes management should consider developing and testing interventions that seek to improve long-term rates of engagement in self-care behaviors.

In this report we examine the level of knowledge about heart attack symptoms and what action to take if a heart attack is suspected among Native Hawaiian and Pacific Islander (NHPI) adults in the United States using data from the 2014 NHPI-National Health Interview Survey. Analyses include summary statistics to describe levels of heart attack knowledge and multivariate logistic regression to identify characteristics associated with having the recommended heart attack knowledge. Less than half (44.4%) of NHPI adults have the recommended heart attack knowledge. Significant differences in knowledge levels were found based on age; those aged 45-64 years and those aged 65 years and older were 68% and 78% more likely, respectively, to have the recommended heart attack knowledge compared those aged younger than 45 years. The level of recommended heart attack knowledge among NHPI is lower than that of the general population. Improving the heart attack knowledge of all Americans should continue to be a national priority, but efforts to target this group for heart attack knowledge improvement should be made given their high risk for heart attack., Competing Interests: None of the authors identify any conflicts of interest.

Following publication of the original article [1], the author reported the following errors in Table 1 and Table 2.

Marshallese experience high rates of type 2 diabetes. Proper management of diabetes requires multiple self-care behaviors, yet little is known about Marshallese's diabetes-related self-care behaviors. Survey data from 111 Marshallese adults with diabetes were used to examine relationships between self-care behaviors and socio-demographic characteristics. The most common self-care behavior was attending annual doctor visits, while the least common was maintaining a normal weight. Age group, education level, and having a regular doctor were significantly associated with engaging in self-care behaviors. Having a regular doctor had the most effect on performing self-care behaviors (p = 0.006); although, only 38.7% reported having a regular doctor. To minimize diabetes-related complications, efforts to improve self-care behaviors among the Marshallese should be developed. Alternatives to traditional healthcare providers, such as community health workers, may be a viable strategy with this population given only one-third reported having a regular doctor.

Prior research suggests that rural and minority communities participate in research at lower rates. While rural and minority populations are often cited as being underrepresented in research, population-based studies on health research participation have not been conducted. This study used questions added to the 2015 Behavioral Risk Factor Surveillance System to understand factors associated with i) health research participation, ii) opportunities to participate in health research, and iii) willingness to participate in health research from a representative sample (n = 5,256) of adults in Arkansas. Among all respondents, 45.5% would be willing to participate in health research if provided the opportunity and 22.1% were undecided. Only 32.4% stated that they would not be willing to participate in health research. There was no significant difference in participation rates for rural or racial/ethnic minority communities. Furthermore, racial/ethnic minority respondents (Black or Hispanic) were more likely to express their willingness to participate., (© 2018 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Objective: The objective of the study was to examine the mediating role of sleep quality and quantity in the relationship between food insecurity and obesity across races/ethnicities., Methods: Bivariate negative binomial regression and multinomial logistic regression were used to examine direct associations between food insecurity and sleep quality and quantity among non-Hispanic Native Hawaiian and other Pacific Islanders (NHPI) relative to non-Hispanic White, Black, Asian, and Hispanic individuals with obesity. The potential outcomes approach and adjusted Wald test were used to explore the mediating role of sleep quality and quantity and the moderating role of race/ethnicity, respectively., Results: Among adults with obesity, the study found a positive and direct relationship between food insecurity and trouble falling asleep in each racial/ethnic group. Trouble staying asleep was associated with food insecurity in each racial/ethnic group, except in the Asian group. Positive and direct associations were observed between food insecurity and short/very short sleep. A positive and direct relationship was found between food insecurity and having obesity in each racial/ethnic group, except in the Black group. Sleep quality and sleep quantity partially mediated the relationship between food insecurity and obesity in non-Hispanic NHPI, White, Asian, and Hispanic individuals. Race/ethnicity moderated the indirect effects of food insecurity on sleep quality and quantity., Conclusions: Food security and sleep hygiene should be an integral part of the fight against obesity., (© 2018 The Obesity Society.)

Background: Native Hawaiians and Pacific Islanders (NHPIs) are one of the fasting growing racial groups in the United States (US). NHPIs have a significantly higher disease burden than the US population as a whole, yet they remain underrepresented in research. The purpose of this study is to examine factors associated with health care utilization among NHPIs., Methods: Drawing from the 2014 NHPI-National Health Interview Survey, we used stereotype logistic regressions to examine utilization of emergency department (ED) and outpatient services among 2172 individuals aged 18 and older., Results: NHPIs with chronic diseases were twice as likely to be multiple ED users and nearly four times as likely to be frequent-users of outpatient services. Social support played a protective role in preventing multiple use of ED. Having a usual source of care made it more than eight times as likely to be a frequent-user of outpatient services. Use of eHealth information increased the odds of using ED and outpatient services. Ability to afford health care increased the odds of using outpatient services. There was no association between health insurance coverage and use of ED and outpatient services among NHPIs., Conclusions: This research provides the first available national estimates of health services use by NHPIs. Efforts to improve appropriate use of health services should consider leveraging the protective factors of social support to reduce the odds of frequent ED use, and having a usual source of care to increase use of outpatient services.

Purpose: Examine sleep deficiency, factors, and associations with cardiometabolic diseases in United States Native Hawaiian/Pacific Islanders (NHPI), Blacks, and Whites., Design: Data from the 2014 National Health Interview Survey and NHPI National Health Interview Survey household interviews of adults were analyzed., Participants: Of 31,724 participants, 7% were NHPI, 14% were Black, and 79% were White., Methods: Habitual sleep duration and quality, sociodemographic/economic covariates, health behaviors, psychological distress, and chronic diseases were self-reported. Sleep duration was coded as very short (VSS; <5 hours), short (SS; 5-6 hours), long (LS; >8 hours), or healthy (7-8 hours). Using multivariate logistic regressions, the association between sleep duration and diseases was assessed after adjusting for covariates., Results: NHPI were more likely to report sleep <7 hours compared to Whites (40.2% NHPI, 29.3% White) and less LS than Blacks (7% NHPI, 9.2% Black), report poor sleep quality, and use fewer sleep medications. VSS was related to smoking and psychological distress in NHPI men. VSS was associated with hypertension and SS with diabetes in NHPI, even in adjusted models. The relationship between SS and diabetes was higher in NHPI (risk ratio [RR]: 1.40, 95% confidence interval [CI]: 1.03-1.90) than Whites (RR: 1.01, 95% CI: 0.90-1.14, P = .027) and Blacks (RR: 1.02, 95% CI: 0.85-1.23, P = .043) even after adjusting for other covariates., Conclusions: NHPI reported suboptimal sleep duration that was linked to hypertension and diabetes even after controlling for covariates. Additional prospective studies in NHPI are needed to understand biological, behavioral, and psychological factors of sleep deficiency and its impact on chronic diseases., (Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)