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Objective: We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico. Methods: Participants were 2156 young adults, between the ages of 18-29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure. Results: Participants' mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, post-traumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13-1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25-2.13) and depression (OR = 1.30, 95 % CI = 1.03-1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal). Conclusion: Efforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.

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BACKGROUND: Cardiovascular health (CVH) in young adulthood is associated with CVD in later life, yet CVH in young adults in the United States falls below ideal levels, with noticeable sex differences. Research on CVH in young adults in Puerto Rico is scarce. This study examined CVH and sex differences in CVH in a large cohort of young adults in Puerto Rico. METHODS AND RESULTS: Data from 2162 Puerto Rican young adults aged 18 to 29 residing in PR were obtained from the PR-OUTLOOK (Puerto Rico Young Adults' Stress, Contextual, Behavioral, and Cardiometabolic Risk) study (2020-2023). Participants were recruited through various media and community outreach. CVH scores, graded on a 0 (worst) to 100 (best) scale, were derived from survey responses, physical exams, and laboratory assays. Linear regression with the margins postestimation command was used to determine adjusted means (95% CIs) for CVH scores by sex, controlling for age, marital status, education, childhood material deprivation, subjective social status, health insurance, and depressive symptoms. CVH was less than ideal (score<80) in 72.6% of the cohort (70.5% of women, 75.9% of men, P<0.05). Men had a significantly lower adjusted mean overall CVH score than women (70.7 versus 73.0) and lower adjusted mean scores for nicotine exposure (78.3 versus 86.7), non-high-density lipoprotein cholesterol (80.6 versus 86.4), and blood pressure (79.5 versus 92.2). Women had a significantly lower adjusted mean physical activity score compared with men (50.4 versus 59.5). CONCLUSIONS: Less-than-ideal CVH is notable among young adults, with men having worse CVH than women. These identified sex differences warrant further investigation and the design of interventions to enhance and preserve CVH.

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Background: There is scarcity of smoking cessation programs that take gender into account during its development, implementation, and evaluation. We evaluated the efficacy of a theory-based, culturally, and gender-relevant smoking cessation intervention delivered by Community Health Workers (CHWs) among Brazilian women that augments the smoking cessation program offered through the public health system (PHS). Materials and Methods: A total of 328 women current smokers (100% cigarette smokers) were recruited across 8 towns in a tobacco producing state in Brazil between 2014 and 2017. Four towns were randomly assigned to the intervention (12 home visits by a CHW and a scheduled appointment to attend the smoking cessation program at the PHS) and four towns to the control condition (scheduled appointment to attend the cessation program at the PHS). The primary outcome was self-reported 7-day smoked tobacco abstinence at 7-month follow-up with biochemical verification. Results: Retention at 7-month follow-up was 80.7% (intervention) and 85.1% (control). Using intention-to-treat analysis, abstinence at 7-month-follow-up was 20% in the intervention arm versus 11% in the control arm. Multivariable modeling showed that participants in the intervention arm had 1.88 times the odds of self-reported smoking cessation than control participants after adjustment for depressive symptomatology, self-efficacy, and having someone in the house who smokes. Besides the intervention, only self-efficacy remained significant in the full model as a predictor of cessation. Replication of these analyses using the objective measure of carbon monoxide at a cutoff score of 8 ppm yielded similar results. Conclusions: A theory-based, culturally, and gender-relevant intervention, delivered by CHWs, can successfully promote smoking cessation among women. Clinical Trial Registration No. NCT03845413.

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This research tests the independent contribution of social capital and the use of the internet to obtain health information to support maternal-child communication about peer pressure to have sex among Puerto Rican families. A sample of 413 Puerto Rican households in Springfield, MA provides the data to independently test these hypotheses. The results of a logistic regression model suggest that Puerto Rican mothers with increased social capital and who accessed the internet for health information are more likely to communicate with their adolescent children about peer pressure to have sex. The combination of these two mechanisms provide opportunities to convey culturally generated resources to Puerto Rican mothers to assist them in helping their children develop healthy sexual behaviors.

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INTRODUCTION: There is an increased need for capacity building of researchers and professionals in low- and middle-income countries with evidence-based approaches across the tobacco control continuum, particularly with regard to gender-relevant strategies. We describe the development, implementation, and evaluation of a Career Development and Research Training Program (CDRTP) in tobacco control. METHODS: The CDRTP is organized into two modules: Module I is open to the public and provides an overview of tobacco control; Module II, consists of a one-year program with multi-mode sessions toward the development of a pilot research project. Activities are implemented through co-learning to facilitate cross-fertilization of knowledge, collaborations, and team science. RESULTS: Between 2010 and 2015, 255 individuals participated in Module I with 57 applying for Module II's selective process. Out of these, 35 were selected, 29 completed the program (83%), 21 submitted pilot research projects that have undergone review, and 16 were approved for funding. Pre- and post-tests among the 29 participants who completed the training indicated improvement in scholars' perceived knowledge and skills on all of the components. CONCLUSION: In addition to attracting researchers and professionals who have not been working in tobacco control, the capacity building program has promoted knowledge, skills, and confidence among participants to pursue gender-relevant tobacco control research.

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OBJECTIVE : To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS : Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS : Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS : Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment. .

OBJETIVO : Analisar a associação entre as advertências gráficas nos maços de cigarro e seu impacto na intenção de parar de fumar entre mulheres. MÉTODOS : Estudo transversal de base populacional com 265 mulheres do estado do Paraná que fumaram diariamente no ano de 2010. O tamanho da amostra foi calculado por amostragem probabilística por cluster. As participantes foram questionadas se haviam visto as advertências gráficas nos maços de cigarro nos últimos 30 dias, se as advertências as fizeram pensar em cessar o uso do cigarro e em que intensidade. Os dados foram analisados usando regressão logística, e as variáveis independentes incluíram idade, anos de estudo, presença de filhos, tentativa de parar de fumar nos últimos 12 meses, idade quando começou a fumar, número de cigarros fumados por dia, cidade de residência e quanto tempo depois de acordar elas fumam o primeiro cigarro. RESULTADOS : Mais de 90,7% das participantes relataram ter visto as advertências nos últimos 30 dias. Mulheres que estudaram até o ensino fundamental ou médio apresentaram maior probabilidade de pensar em cessar de fumar depois de verem as advertências gráficas nos maços de cigarro do que mulheres com ensino superior (OR = 4,85; p = 0,0028 e OR = 2,91; p = 0,05, respectivamente). Mulheres que tentaram parar de fumar nos últimos 12 meses tiveram maior probabilidade de cessar de fumar do que as que não tentaram (OR = 2,49; p = 0,001). Nos últimos 12 meses, as tentativas de parar de fumar nos últimos 12 meses associaram-se à intensidade desses pensamentos (OR = 2,2; p = 0,03). CONCLUSÕES : Advertências gráficas nos maços de cigarro associaram-se à intenção de parar de fumar entre mulheres, sobretudo entre aquelas com menos anos de estudo e as ...

OBJETIVO : Analizar la asociación entre las advertencias gráficas en los paquetes de cigarro y su impacto en la intención de parar de fumar entre mujeres. MÉTODOS : Estudio transversal de base poblacional con 265 mujeres del estado de Paraná que fumaron diariamente en el año de 2010. El tamaño de la muestra fue calculada por muestreo probabilístico por cluster. Las participantes fueron interrogadas si habían visto advertencias gráficas en los paquetes de cigarro en los últimos 30 días, si las advertencias les hicieron pensar en dejar de usar el cigarro y en qué intensidad. Los datos fueron analizados usando regresión logística y las variables independientes incluyeron edad, años de estudio, presencia de hijos, intento de parar de fumar en los últimos 12 meses, edad cuando comenzó a fumar, número de cigarros fumados por día, ciudad de residencia y cuanto tiempo después de despertarse, ellas fuman el primer cigarro. RESULTADOS : Cerca de 91,7% de las participantes mencionaron haber visto las advertencias en los últimos 30 días. Mujeres que estudiaron hasta la primaria o secundaria, presentaron mayor probabilidad de pensar en parar de fumar después de ver las advertencias gráficas en los paquetes de cigarro en comparación con mujeres con educación superior (OR = 4,85; p = 0,0028 e OR = 2,91; p = 0,05, respectivamente). Mujeres que trataron de parar de fumar en los últimos 12 meses tuvieron mayor probabilidad de dejar el cigarro en comparación con las que no lo intentaron (OR = 2,49; p = 0,001). En los últimos 12 meses, los intentos de parar de fumar en ese período, se asociaron con la intensidad de tales pensamientos (OR = 2,2; p = 0,03).  CONCLUSIONES : Advertencias gráficas en los paquetes de cigarro se asociaron con la intención de dejar de fumar entre mujeres, ...

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OBJECTIVE: To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS: Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS: Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warnings than women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS: Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.

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