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OBJECTIVE: The aim of this study was to assess race and sex disparities in use and outcomes of various interventions in patient with acute pulmonary embolism (PE). METHODS: We included 129,445 patients with acute PE from the NIS from January 2016 to December 2019. Rates of inferior vena cava (IVC) filter placement, catheter-directed thrombolysis (CDT), CDT with ultrasound, systemic thrombolysis, surgical embolectomy, percutaneous thrombectomy, extracorporeal membrane oxygenation, and mechanical ventilation were compared between race and sex subgroups, along with length of hospital stay, major bleeding events, mortality, and other adverse events. Multivariate linear regression analysis was used to adjust for variables that were significantly different between race and sex, including demographic factors, comorbidities, socioeconomic factors, and hospital characteristics. RESULTS: Compared with White male patients, all subgroups had significantly higher odds of in-hospital mortality highest in Hispanic male patients (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.090-1.640; P < .01). All subgroups also had a higher odds of major bleeding events and increased length of stay. All subgroups also had lower odds of receiving CDT, lowest in Black female patients (OR, 0.740; 95% CI, 0.660-0.820; P < .001) and Hispanic female patients (0.780; 95% CI, 0.650-0.940; P < .001) compared with White male patients. There was no significant difference in the use of systemic thrombolysis among subgroups. CONCLUSIONS: Black and Hispanic patients and female patients are less likely to undergo CDT compared with White male patients, in addition to having higher odds of mortality, major bleeding, and increased length of stay after management of PE. Further efforts are needed to mitigate disparate outcomes of PE management at not only an institutional, but at a national, level to promote health care equality.

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BACKGROUND: Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE: We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS: Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS: Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS: ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.

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ABSTRACT OBJECTIVE To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. METHODS This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. RESULTS Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. CONCLUSIONS There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.

RESUMO OBJETIVO Sintetizar evidências científicas para caracterizar a atenção à saúde para travestis e transexuais no Brasil. MÉTODOS Trata-se de uma revisão sistemática, conduzida de julho de 2020 a janeiro de 2021 e atualizada em setembro de 2021, cujo protocolo está registrado na plataforma International Prospective Register of Systematic Reviews (PROSPERO), sob o código CRD42020188719. O levantamento das evidências foi realizado em quatro bases de dados e os artigos elegíveis foram avaliados perante a qualidade metodológica, sendo incluídos aqueles com baixo risco de viés. RESULTADOS 15 artigos foram selecionados e os achados, de acordo com as suas aproximações temáticas, foram agrupados em seis categorias: Possibilidades para transformar a atenção à saúde; Travestifobia e transfobia: violações dentro e fora do Sistema Único de Saúde (SUS); Despreparo profissional para a atenção às travestis e transexuais; Busca por alternativas para a atenção à saúde; Direito à saúde para travestis e transexuais: utopia ou realidade?; O Processo Transexualizador: avanços e desafios. CONCLUSÕES As evidências revelam que a atenção à saúde para travestis e transexuais no Brasil ainda é excludente, fragmentada, centralizada no cuidado especializado e pautada por ações curativas, assemelhando-se aos modelos de atenção que antecedem o SUS e que são fortemente criticados desde a Reforma Sanitária Brasileira.

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ABSTRACT Objective: To map the educational technologies implemented for HIV prevention in black people. Method: Scope review, performed according to the recommendations of The Joanna Briggs Institute, in Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane and PsycINFO databases, using the Preferred Reporting Items for Systematic reviews and Meta- Analyses extension for Scoping Reviews (PRISMA-ScR). Results: There were 14 studies published between 1999 and 2020. The main health impacts for black people involved a reduction in rates of unprotected sex, greater use of condoms, a decrease in risky behaviors, a minimization of the number of partners, a greater request for HIV testing and an increase in the use of Pre-exposure prophylaxis (PrEP). Conclusion: The educational technologies mapped were: workshops, courses, messages, dramatization, videos, application, pamphlet, media and radio campaigns, Facebook groups, website, computer programs and multimedia software.

RESUMEN Objetivo: Mapear las tecnologías educativas implementadas para la prevención del VIH en negros. Método: Revisión de alcance, realizada de acuerdo con las recomendaciones de The Joanna Briggs Institute, en las bases de datos Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane y PsycINFO, utilizando Preferred Reporting Items for Systematic reviews y Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Resultados: Se publicaron 14 estudios entre 1999 y 2020. Los principales impactos en la salud de los negros involucraron una reducción en las tasas de sexo sin protección, mayor uso de condones, una disminución en los comportamientos de riesgo, una minimización del número de parejas, una mayor solicitud de pruebas de VIH y un aumento en el uso de Pre-exposición profilaxis (PrEP). Conclusión: Las tecnologías educativas mapeadas fueron: talleres, cursos, mensajes, dramatización, videos, aplicación, folleto, campañas en medios y radio, grupos de Facebook, sitio web, programas informáticos y software multimedia.

RESUMO Objetivo: Mapear as tecnologias educativas implementadas para prevenção do HIV em negros. Método: Revisão de escopo, realizada conforme as recomendações do The Joanna Briggs Institute, nas bases de dados Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane e PsycINFO, utilizando-se do instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Resultados: Encontraram-se 14 estudos publicados entre 1999 e 2020. Os principais impactos para saúde dos negros envolveram a redução das taxas de relações sexuais desprotegidas, o maior uso de preservativos, a diminuição de comportamentos de risco, a minimização do número de parceiros, a maior solicitação de testagens para HIV e o aumento do uso de Profilaxia Pré-exposição (PrEP). Conclusão: As tecnologias educativas mapeadas foram: workshops, cursos, mensagens, dramatização, vídeos, aplicativo, panfleto, campanhas de mídia e de rádio, grupos de Facebook, site, programas de computadores e softwares multimídia.

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Resumo Este artigo objetiva refletir sobre os desafios da saúde de pessoas lésbicas, gays, bissexuais, travestis, transexuais, intersexuais e outras minorias sexuais e de gênero (LGBTI+) no cenário brasileiro atual. Baseado no método de triangulação, incluiu análise de políticas, pesquisa qualitativa sobre percepções de atores-chave do Sistema Único de Saúde (SUS) - pessoas usuárias LGBTI+, profissionais e gestores(as) - a partir de dois projetos desenvolvidos no Sudeste e Sul do Brasil, analisados por equipe interdisciplinar de pesquisadores(as). Foram elencados os principais problemas enfrentados pela população LGBTI+, sinalizando alguns dos avanços necessários. Alguns desses desafios incluem: o acesso de LGBTI+ ao SUS; a necessidade de capacitação de profissionais; a interiorização e descentralização de serviços sensíveis à LGBTI+; as distintas formas de violências e discriminação; lacunas de pesquisas em saúde de segmentos específicos, como de lésbicas, bissexuais, intersexos e outras minorias sexuais. Os resultados corroboram a urgência da implementação plena da "Política Nacional de Saúde Integral de LGBT". O reconhecimento das demandas dessa população contribui para alcançar os princípios que norteiam o SUS.

Abstract This article aims to reflect on the current health challenges of lesbians, gays, bisexuals, transgenders, intersex, and other sexual and gender minorities (LGBTI+) within the Brazilian scenario. This study adopted a triangulation approach, based on two studies developed in the Southeast and South of Brazil, which included policy analysis and qualitative research on the perceptions of key actors from the Brazilian Unified Health System (SUS) - LGBTI+ users, workers, and managers. All data were analyzed by an interdisciplinary team of researchers. The main problems faced by the LGBTI+ population were registered, indicating some of the necessary progress. Some of these challenges include: access of the LGBTI+ population to SUS; the need to train health professionals; the decentralization of health services sensitive to the LGBTI+ population; the distinct forms of violence and discrimination; the lack of research in health care conducted with specific groups, such as lesbians, bisexuals, intersex, and other sexual minorities. The results reinforce the urgency for the complete implementation of the "National Policy for the Comprehensive Health of LGBT". The recognition of the LGBTI+ health needs will aid in achieving the principles which are the guiding principles of SUS.

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BACKGROUND: Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization. OBJECTIVES: This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups. METHODS: Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression. RESULTS: CHL compared to OHL were similar in age, body mass index, poverty status, blood eosinophils, and fractional exhaled nitric oxide but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (odds ratio [OR]: 1.84; 95% CI: 1.4-2.4), ED/UC visits (OR: 1.88; 95% CI: 1.4-2.5), hospitalization (OR: 1.98; 95% CI: 1.06-3.7), and health care utilization (OR: 1.91; 95% CI: 1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ED/UC visits, hospitalizations, and health care utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ED/UC and health care utilization. CONCLUSIONS: CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.

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Sleep duration affects physiological functioning and mental health outcomes among Hispanics/Latinos. The limited research reports that Hispanic/Latino subpopulations like Puerto Ricans carry a disproportionate burden. To understand this burden, we identified profiles of sleep duration by psychological distress among Puerto Rican adults (N = 4443) using latent class analysis on 2010-2019 National Health Interview Survey data. The outcome of sleep was constructed from self-reports of sleep duration and difficulties falling and staying asleep. Sleep duration was categorized as short sleep (≤6 h), normal sleep (7 to 8 h), and long sleep (≥9 h). Mental health indicators included psychological distress items from the Kessler-6 scale. Health behaviors (nicotine and alcohol use), weight (calculated body mass index), food security, acculturative factors (language use), and socio-economic/socio-demographic covariates were considered to further differentiate profiles. Six profiles were identified: troubled shortest sleep (5.0% of sample) with high psychological distress; highly troubled short sleep (8.0%) with little psychological distress; some disturbed and shortened sleep (10.0%) with moderate psychological distress; undisturbed and shortened sleep (28.0%) with little psychological distress; normal/average sleep (49.0%); and long sleep (1.0%) with moderate psychological distress. While our study is among the first to identify profiles that are at the highest mental health risk due to sleep issues, the findings and approach help examine the complex disparity among Puerto Ricans to then leverage complex survey data for interventional designs.

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BACKGROUND: Lesbian, Gay, Bisexual, Transgender, Queer, and Asexual (LGBTQA+) youth have a greater chance of experiencing stressful life events when compared to cisgender heterosexual peers, which can lead to mental health problems. We aimed to estimate the prevalence of mental disorders among LGBTQA+ youths from two large cities in Brazil. METHODS: Participants were 13-22 years old youths from the 3rd wave of the Brazilian High-Risk Cohort for Psychiatric Disorders (n = 1475). Mental disorders were assessed using the Development and Well-Being Behavior Assessment. Sexual orientation and gender identity were assessed using a self-report confidential questionnaire. Data were analyzed through logistic regressions (adjusting for sociodemographic) using sampling weights to account for attrition and our oversampling high-risk design. RESULTS: 15.18% of the sample described themselves as LGBTQA+. The LGBTQA+ group presented higher rates of anxiety disorders (30.14% vs. 13.37%; OR = 3.37; 95%CI:2.51-4.50), depressive disorders (27.75% vs. 15.34%; OR = 2.17; 95%CI:1.60-2.93) and post-traumatic stress disorder (4.98% vs. 2.25%; OR = 4.20; 95%CI:2.24-7.82), if compared with the cisgender heterosexual group. No difference was found for conduct disorders (2.97% vs. 5.21%; OR = 0.82; 95%CI:0.35-1.65) or attention deficit hyperactivity disorder (5.92% vs. 3.28%; OR = 1.56; 95%CI:0.83-2.79). LIMITATIONS: Although recruitment was performed at 57 schools in the two cities, sampling was non-probabilistic and included only urban areas, which might bias prevalence estimates and group comparisons. CONCLUSIONS: Our results elucidate the mental health disparities between LGBTQA+ people and cisgender heterosexuals in Brazil. It highlights the need to promote the inclusion of this population in policy formulation and support actions to mitigate the suffering related to sexual orientation and gender identity.

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Despite evidence that chronic care management improves outcomes, a framework designed for low income, uninsured populations is still needed to improve health disparities and guide further replication. We describe the Innovative Care for Chronic Conditions framework implemented by a coalition of clinics and agencies to address chronic care management for Mexican Americans with Type 2 diabetes mellitus who have low income and primarily uninsured. The core elements of the framework are described by clinic, home and community settings with community health workers playing an essential role in the delivery of community-based services that address the social determinants of health. Promising results are described. This framework expands the understanding of chronic care management approaches and contributes to further replication of the framework in diverse settings.

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Na atenção à saúde brasileira, as questões relacionadas à identidade de gênero devem ser consideradas marcadores sociais e determinantes estruturais do processo saúde-doença. Todavia, pessoas em situação de vulnerabilidade, como travestis e transexuais, ainda enfrentam desafios para ter o direito à saúde de forma integral, visto que as suas necessidades de saúde e identitárias não são reconhecidas por completo. Diante disso, esta Tese de Doutorado em Saúde Coletiva objetiva caracterizar a atenção à saúde para pessoas travestis e transexuais no Sistema Único de Saúde. Para tanto, optou-se pela realização de um estudo envolvendo três desenhos metodológicos: análise bibliométrica, protocolo de revisão sistemática e revisão sistemática. Os achados da análise bibliométrica de teses e dissertações brasileiras revelam que os estudos sobre a tríade travestilidade, transexualidade e saúde estão em ascensão nos últimos vinte anos, com diminuição no enfoque sobre o adoecimento de travestis e transexuais e aumento do foco nos aspectos sociais, organizacionais e políticos que interferem no acesso dessas pessoas aos serviços de saúde. Apesar da existência do programa Processo Transexualizador no Sistema Único de Saúde, os artigos incluídos na revisão sistemática evidenciam que a atenção à saúde para pessoas travestis e transexuais é composta por uma série de violações, incluindo o despreparo de profissionais da saúde para acolher e cuidar de pessoas travestis e transexuais. Dentro das suas limitações, a tecitura dos resultados da Tese contribui para caracterizar a atenção à saúde para as pessoas travestis e transexuais no âmbito do sistema de saúde brasileiro como excludente, fragmentada, centrada no cuidado especializado e pautada por ações curativas, assemelhando-se aos modelos de atenção que antecedem o Sistema Único de Saúde e que são fortemente criticados desde o surgimento do Movimento da Reforma Sanitária Brasileira (AU).

Brazilian health, as attention to gender identity in the attention to issues related to social issues and determinations of the health-disease process. However, people in vulnerable situations, such as crossings and exuals, still do not face challenges for the right to health in an integral way, since their health needs are fully recognized. Therefore, this Doctoral Thesis in Public Health aims to characterize health care for transvestites and transsexuals in the Unified Health System. Therefore, it was decided to carry out a study on the methodological designs: bibliometrics, systematic and systematic review protocol. The bibliometric findings of the analysis and Brazilian dissertations of theses that studies on transvestism, transsexuality and health have been on the rise in recent years, with an increase in the focus on the illness of transvestites and transsexuals and an increase in the focus of social, organizational and policies that interfere in these people's access to health services. Despite the existence of the Transsexualizing Process program in the Unified Health System, the articles included in the systematic show that health care for transvestites and transsexuals is composed of a series of violations, including the lack of health preparation to welcome and care for transvestites and transsexuals. transsexuals. From their specific health, the weaving of the characterization results, the weaving of the characterization results to contribute to the attention to care for people as caregivers, within the Brazilian health system as fragmented, non-specialized and guided by curative actions, delimiting care Models of care that precede the Unified Health System that are selected by critics since the Brazilian Sanitary Reform Movement (AU).

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Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH). Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence. Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups. Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = -0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)-a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04). Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.

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Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

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RESUMO Objetiva validar um plano de indicadores para a avaliação da implementação da Política Nacional de Saúde Integral da População Negra nos municípios brasileiros. O estudo empregou procedimentos teóricos e metodológicos para o alcance da validade de conteúdo, por meio da aplicação da taxa de concordância e do Índice de Validade de Conteúdo. Participaram do estudo especialistas das áreas de saúde da população negra e avaliação em saúde. Dos 36 indicadores, na avaliação de concordância, 35 alcançaram o ponto de corte e 32 alcançaram Índice de Validade de Conteúdo superior a 0,80. Na análise geral desse índice, o plano de indicadores obteve 0,86 como pontuação, considerado como válido em seu conteúdo por ter superado o ponto de corte estabelecido (0,80). Conclui-se que o plano de indicadores ora apresentado possui a concordância, a pertinência e a clareza necessárias para a sua utilização nos municípios brasileiros, contudo, se faz necessária a continuidade de seu aperfeiçoamento nas fases subsequentes à sua validação.

ABSTRACT The aim was to validate a plan of indicators to evaluate the implementation of the National Comprehensive Health Policy for the Black Population in Brazilian municipalities. The study used theoretical and methodological procedures to reach the validity of content, through the application of the concordance rate and the Content Validity Index. Experts from the black population's health areas and health assessment participated in the study. Of the 36 indicators, in the agreement assessment, 35 reached the cut-off point, and 32 reached Content Validity Index higher than 0.80. In the general analysis of this index, the indicator plan obtained the score 0.86, considered validated in its content because it exceeded the cutoff point of the 0.80. It is concluded that the indicators plan has the agreement, pertinence and clarity necessary for its use in the Brazilian municipalities, however, it is necessary to continue its improvement in the phases subsequent to its validation.

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Objective: Asthma is the most common chronic disease in children. Short-acting bronchodilator medications are the most commonly prescribed asthma treatment worldwide, regardless of disease severity. Puerto Rican children display the highest asthma morbidity and mortality of any US population. Alarmingly, Puerto Rican children with asthma display poor bronchodilator drug response (BDR). Reduced BDR may explain, in part, the increased asthma morbidity and mortality observed in Puerto Rican children with asthma. Gene-environment interactions may explain a portion of the heritability of BDR. We aimed to identify gene-environment interactions associated with BDR in Puerto Rican children with asthma. Setting: Genetic, environmental, and psycho-social data from the Genes-environments and Admixture in Latino Americans (GALA II) case-control study. Participants: Our discovery dataset consisted of 658 Puerto Rican children with asthma; our replication dataset consisted of 514 Mexican American children with asthma. Main Outcome Measures: We assessed the association of pairwise interaction models with BDR using ViSEN (Visualization of Statistical Epistasis Networks). Results: We identified a non-linear interaction between Native American genetic ancestry and air pollution significantly associated with BDR in Puerto Rican children with asthma. This interaction was robust to adjustment for age and sex but was not significantly associated with BDR in our replication population. Conclusions: Decreased Native American ancestry coupled with increased air pollution exposure was associated with increased BDR in Puerto Rican children with asthma. Our study acknowledges BDR's phenotypic complexity, and emphasizes the importance of integrating social, environmental, and biological data to further our understanding of complex disease.

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Ethnic and sexual minority young adults in El Paso, Texas, are at high risk for substance use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV). In 2014, a Hispanic-serving higher education institution partnered with two community-based organizations to implement integrated substance use interventions and HIV and HCV prevention among young adults on campus and in surrounding communities. Among the 95 young adults, aged 18-24 years, who responded to a needs assessment survey, 91.5% were Hispanic, 53.7% were female, and 27.4% were sexual or gender minorities (SGMs) as defined by behavior and identity. SGMs had significantly higher rates of current smoking, drinking when bored, and of being told they had a drinking problem. Compared with the other young adult survey respondents, SGMs had lower health risk perceptions for tobacco, alcohol, and marijuana use and reported similar or higher rates of lifetime drug use during sex and higher rates of HIV risk behaviors. Study findings have implications for including measures for sexual orientation and gender identity in substance use studies, examining regional and cultural norms that may intersect to shape substance use among SGMs, and incorporating unique risk contexts for SGMs in interventions for substance use.

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This analysis describes beliefs about secondhand smoke and its health effects held by Mexican and Central American immigrants in North Carolina. Data from 60 semistructured, in-depth interviews were subjected to saliency analysis. Participant discussions of secondhand smoke centered on four domains: (1) familiarity and definition of secondhand smoke, (2) potency of secondhand smoke, (3) general health effects of secondhand smoke, and (4) child health effects of secondhand smoke. Secondhand smoke was generally believed to be more harmful than primary smoke. Mechanisms for the potency and health effects of secondhand smoke involved the smell of secondhand smoke, secondhand smoke being an infection and affecting the immune system, and personal strength being protective of secondhand smoke. Understanding these health beliefs informs a framework for further health education and intervention to reduce smoking and secondhand smoke exposure in this vulnerable population.

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OBJECTIVE: This secondary data analysis examined associations among perceived neighborhood environmental factors, physical activity (PA), and the presence of metabolic syndrome (MS) in Mexican-American (MA) adults. Seventy-five MA adults (mean age of 37.9 ± 9.3 years) provided anthropometric, biomarker, and survey data. The Neighborhood Scales Questionnaire evaluated six perceived neighborhood factors: walking environment, aesthetic quality, safety, violence, social cohesion, and activities with neighbors. The Rapid Assessment of PA questionnaire assessed PA. MS was determined according to ATP III criteria. RESULTS: PA was significantly associated with MS (OR = .338, CI .204-.738). Neighborhood factors of safety (B = .255, p = .024), walking environment (B = .384, p = .001), and social cohesion (B = .230, p = .043) were positively associated with PA. No other neighborhood factors were significantly related to PA. Analyses examining whether neighborhood factors moderated the relationship between PA and MS were not significant.

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BACKGROUND: Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans. METHODS: Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72 years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remain pre-frail, 3) remain frail, 4) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail) and 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail). The outcomes for the one-year follow-up period (2000-2001) were: (a) healthcare use (hospitalization, emergency room [ER] admission and physician visit); and (b) Medicare payments (total payment and outpatient payment). RESULTS: Mean age was 78.8 (SD = 5.1) years and 60.3% were female in 1998/99. Males who remained pre-frail (Odds Ratio [OR] = 3.49, 1.13-10.8, remained frail OR = 6.92, 1.61-29.7) and transitioned to worse frail status (OR = 4.49, 1.74-11.6) had significantly higher hospitalization risk compared to individuals who remained non-frail. Males in the 'worsened' groups, and females in the 'improved' groups, had significantly higher Medicare payments than individuals who remained non-frail (Cost Ratio [CR] = 2.00, 1.30-3.09; CR = 1.53, 1.12-2.09, respectively]. CONCLUSIONS: Healthcare use and Medicare payments differed by frailty transition status. The differences varied by sex. Research is necessary to elucidate the relationship between frailty transitions and outcomes, sex difference and Medicare payment for older Mexican Americans living in the community.

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ABSTRACT Objectives: to understand the life stories and itineraries of transvestites and transsexuals in health services. Methods: study with a qualitative approach, anchored in the methodological framework of Oral History. Interviews were conducted and thematically analyzed. Results: two themes emerged: 1) gender and sexuality in life stories; and 2) the trajectories in health services. These revealed the challenges in the process of recognizing gender identity before the family and society. The reports show the dilemmas that transsexuals and transvestites face in health care, which ends up generating the removal of this population from services. Final Considerations: it has been demonstrated that Oral History can increase knowledge, especially about life histories and trajectories in the health services of transvestites and transsexuals; in addition, information was offered that can assist managers and health professionals in making decisions or caring for these people.

RESUMEN Objetivos: comprender las historias de vida y el itinerario de travestis y transexuales en los servicios de salud. Métodos: estudio de abordaje cualitativo, basado en el referencial metodológico de la Historia Oral. Han sido realizadas entrevistas, siendo temáticamente analizadas. Resultados: emergieron dos temas: 1) género y sexualidad en las historias de vida; y 2) las trayectorias en los servicios de salud. Estos revelaron los desafíos en el proceso de reconocimiento de la identidad de género delante la familia y sociedad. Los relatos muestran los dilemas que transexuales y travestis enfrentan en la atención a la salud, lo que acaba por generar el alejamiento de esa población de los servicios. Consideraciones Finales: se ha demostrado que la Historia Oral puede ampliar el conocimiento, especialmente, sobre las historias de vida y trayectorias en los servicios de salud de travestis y transexuales; además, han sido ofrecidas informaciones que pueden auxiliar gestores y profesionales de salud en la toma de decisión o en el cuidado en relación a esas personas.

RESUMO Objetivos: compreender as histórias de vida e o itinerário de travestis e transexuais nos serviços de saúde. Métodos: estudo de abordagem qualitativa, ancorada no referencial metodológico da História Oral. Foram realizadas entrevistas, sendo tematicamente analisadas. Resultados: emergiram dois temas: 1) gênero e sexualidade nas histórias de vida; e 2) as trajetórias nos serviços de saúde. Estes revelaram os desafios no processo de reconhecimento da identidade de gênero perante a família e sociedade. Os relatos mostram os dilemas que transexuais e travestis enfrentam no atendimento à saúde, o que acaba por gerar o afastamento dessa população dos serviços. Considerações Finais: demonstrou-se que a História Oral pode ampliar o conhecimento, especialmente, sobre as histórias de vida e trajetórias nos serviços de saúde de travestis e transexuais; além disso, foram oferecidas informações que podem auxiliar gestores e profissionais de saúde na tomada de decisão ou no cuidado em relação a essas pessoas.

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This article describes changes made to the menu served during the 2015 Marshallese May Day celebration in Northwest Arkansas, an annual Marshallese community event. The menu changes were part of a community-based participatory collaborative to improve nutrition and health in the Marshallese community. The 2015 May Day menu significantly reduced the 2014 May Day menu amount of calories, fat, carbohydrates, sodium, and cholesterol of foods offered by incorporating healthier ingredients and reducing portion sizes. Compared to the 2014 May Day menu, the total caloric value of the revised menu was reduced by more than 63%, declining from 1369 calories to 499 calories. The menu change affected an estimated 1,800 Marshallese in attendance for the 2015 May Day celebration. The successful implementation of the menu changes, which resulted in reductions in calories, fat, carbohydrates, sodium, and cholesterol offered to participants demonstrates the effectiveness of community-based participatory approaches in the implementation of policy, systems, and environmental strategies to promote health.

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