RESUMO
Objective: Completion of human papillomavirus (HPV) vaccine series among Texas Hispanic adolescents is low compared to national data. We examined the association between HPV vaccine initiation and completion among Hispanic adolescents in a rural, Texas-Mexico border county and specific individual and neighborhood-level characteristics. Design: Cross-sectional analysis of data from a broader cancer prevention program. Setting: Underserved colonias communities in a Texas-Mexico border county. Participants: Hispanic mothers or caregivers (n=712) and adolescents aged 11-17 years (n=1120) linked to publicly available data about their neighborhood. Main Outcome Measures: HPV vaccine adherence (ie, initiation and completion) as reported in either the Texas Immunization Registry or adolescents' electronic medical records, measured at the end of the cancer prevention program. Methods: Logit and multi-level mixed-effects logistic regression of individual- and neighborhood-level data. Results: Factors associated with HPV vaccine initiation and completion were female gender (P<.01), adolescent insurance status (P<.001), and receipt of required vaccines (P<.001). After controlling for neighborhood-level characteristics, only receipt of required vaccines remained significant. Conclusions: Findings indicate a relationship between Hispanic adolescents' receiving the required vaccine series for school admission and HPV vaccine initiation and completion. In resource-limited settings like federally qualified health centers, further efforts should focus on implementing best practices at both the provider level (eg, education on bundled vaccine recommendation) and practice-level (eg, outreach and support by trained immunization navigators).
Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adolescente , Feminino , Humanos , Masculino , Vacinas contra Papillomavirus/uso terapêutico , Texas , Infecções por Papillomavirus/prevenção & controle , Estudos Transversais , México , Hispânico ou LatinoRESUMO
PURPOSE: Type 2 diabetes mellitus (T2DM) is an urgent public health problem and disproportionately affects Mexican Americans. The gut microbiome contributes to the pathophysiology of diabetes; however, no studies have examined this association in Mexican-Americans. The objective of this study was to compare gut microbiome composition between Mexican-Americans with and without T2DM. METHODS: This was a cross-sectional study of volunteers from San Antonio, TX. Subjects were 18 years or older and self-identified as Mexican American. Subjects were grouped by prior T2DM diagnosis. Eligible subjects attended a clinic visit to provide demographic and medical information. Thereafter, subjects recorded their dietary intake for three days and collected a stool sample on the fourth day. Stool 16s rRNA sequences were classified into operational taxonomic units (OTUs) via the mothur bayesian classifier and referenced to the Greengenes database. Shannon diversity and bacterial taxa relative abundance were compared between groups using the Wilcoxon rank sum test. Beta diversity was estimated using Bray-Curtis indices and compared between groups using PERMANOVA. RESULTS: Thirty-seven subjects were included, 14 (38%) with diabetes and 23 (62%) without diabetes. Groups were well-matched by body mass index and comorbid conditions. Shannon diversity was not significantly different between those with and without T2DM (3.26 vs. 3.31; p = 0.341). Beta diversity was not significantly associated with T2DM diagnosis (p = 0.201). The relative abundance of the most common bacterial phyla and families did not significantly differ between groups; however, 16 OTUs were significantly different between groups. CONCLUSIONS: Although alpha diversity was not significantly different between diabetic and non-diabetic Mexican Americans, the abundance of certain bacterial taxa were significantly different between groups.
Assuntos
Diabetes Mellitus Tipo 2/microbiologia , Microbioma Gastrointestinal/genética , Idoso , Bactérias/genética , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/metabolismo , Ingestão de Alimentos , Fezes/microbiologia , Feminino , Microbioma Gastrointestinal/fisiologia , Humanos , Masculino , Americanos Mexicanos/genética , Pessoa de Meia-Idade , Obesidade/metabolismo , RNA Ribossômico 16S/genética , TexasRESUMO
BACKGROUND: Health literacy is a requisite skill for making personal health and health care decisions. Low health literacy may contribute to lower cervical cancer screening rates and cervical cancer health disparities among Mexican-American women in South Texas. OBJECTIVE: To explore older Mexican-American women's health literacy related to cervical cancer from the perspective of Zarcadoolas, Pleaseant, and Greer's health literacy model. METHODS: We conducted five focus groups and seven individual interviews with 30 Mexican and Mexican-American women in South Texas. We analyzed demographic data using descriptive statistics and conducted thematic analysis of focus group and individual interview data. KEY RESULTS: Several themes reflected the domains of health literacy, including fundamental literacy ("speaking of language"), science literacy (cancer prevention), cultural literacy ("we are different"), civic literacy (the availability of "consejos" [advice]), and media literacy (e.g., "telenovelas" [soap-operas] teach a lot). In this article, we present findings related to culture and language under the domains of fundamental and cultural literacy. CONCLUSIONS: Mexican-American women's cultural values and language use may serve as both deterrents and incentives to cervical cancer screening. The meaning of words can be lost in translations. Health care providers can use this information to provide cervical cancer screening education congruent with Mexican-American's culture, language, and code switching. [HLRP: Health Literacy Research and Practice. 2019;3(1):e1-e8.]. PLAIN LANGUAGE SUMMARY: The understanding of culture and language can help health care providers improve cervical cancer screening practices among Mexican-American women. The results from this study can be used to individualize patient care and to develop education and communication strategies that are similar to the population we serve, including Mexican-American women.