Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey

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.

Caregiver reports of physician risk counseling for adolescents with special health care needs

BACKGROUND

Research has indicated disagreement between physicians, caregivers, and adolescents with special health care needs regarding appropriate risk counseling.

OBJECTIVE

The study examines caregivers' perceptions of adolescent risk counseling. We hypothesize caregivers of adolescents with special healthcare needs will perceive a lower rate of risk counseling.

METHODS

Data come from the 2016 National Survey of Children's Health. The sample included 13,542 adolescents. Analysis completed using logistic regression with odds ratios.

RESULTS

The results indicate no difference in caregiver perceptions of risk counseling for adolescents with special healthcare needs. Gender, race/ethnicity, and relationship between caregiver and provider influenced perception of receipt of risk counseling, regardless of health status.

CONCLUSIONS

Although adolescents with special healthcare needs perceive their risk behavior counseling to be lacking in quantity/quality, caregivers perceive such counseling does occur. These results highlight the need for comprehensive risk counseling for groups at risk of known health disparities.

PRACTICE IMPLICATIONS

Physicians and providers should be provided with the training and resources needed to be comfortable to engage in risk counseling. Adolescents need the opportunity to see their provider privately, and education to advocate for information risky behaviors. Parents, providers, and adolescents should be included in future risk counseling intervention plans.

Stressful life events and social support among pregnant Marshallese women

Introduction

Women from racial and ethnic minority groups in the United States are disproportionately likely to experience adverse perinatal outcomes such as preterm birth, low birthweight infants, and infant mortality. Previous research has demonstrated that exposure to stressful life events and social support may influence perinatal outcomes. Although studies have documented stressful life events and social support for the general United States population and minority groups, less is known about the experiences of Pacific Islander women in the United States, and no prior studies have documented these experiences in Marshallese Pacific Islander women.

Methods

The present study examined data collected from pregnant Marshallese women (n = 67) in northwest Arkansas participating in a women’s health program using descriptive analyses (means, standard deviations, proportions).

Results

Results indicated a high prevalence of three stressful life events: experiencing a family member going into the hospital (35.8%), someone close to them dying (29.9%), and being unable to pay bills (53.7%). Food insecurity was higher than previously reported for pregnant women or Pacific Islanders (83.7%). Social support was high among the sample. A majority of women reported receiving help with daily chores (86.6%), help when sick (88.1%), and support on how to deal with personal problems (85.1%).

Discussion

This study is the first to document the prevalence of stressful life events and social support in a sample of pregnant Marshallese women living in the United States. The findings provide important information to guide efforts to reduce adverse perinatal outcomes in a Pacific Islander population.

Parent/guardian intentions to vaccinate children against COVID-19 in the United States

Vaccination is critical for protecting adults and children from COVID-19 infection, hospitalization, and death. Analyzing subsamples of parent/guardians of children age 0–11 (n = 343) and 12–17 (n = 322) from a larger national survey of US adults (n = 2,022), we aimed to assess intentions to vaccinate children and how intentions might vary across parent/guardian sociodemographic characteristics, healthcare coverage, vaccination status, political affiliation, prior COVID-19 infection, exposure to COVID-19 death(s) of family or friends, perceived norms of vaccination, and COVID-19 vaccine hesitancy. We also report the prevalence of vaccinated children for parents whose oldest child was eligible for vaccination at the time of the survey. More than one third of parents whose oldest child was not yet eligible for vaccination (11 or younger) planned to get them vaccinated right away when a vaccine became available to them. Among parents whose child was eligible to be vaccinated (age 12–17 years), approximately a third reported their child had already been vaccinated and approximately a third planned to do so right away. Intentions to vaccinate children age 0 to 11 were significantly associated with age, gender, race/ethnicity, education, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. Intentions to vaccinate children age 12 to 17 were significantly associated with age, education, healthcare coverage, COVID-19 vaccination, political affiliation, social norms, and COVID-19 vaccine hesitancy. We discuss implications for public health officials and for future research.

Relationship between Sociodemographic Factors, Perceived COVID-19 Risk, and Engagement with Health Protective Behaviors

OBJECTIVES

This study describes the relationship between sociodemographic factors, chronic conditions, coronavirus disease 2019 (COVID-19) fears and stressors, and the perception of risk from COVID-19 and the use of health protective behaviors among Arkansans during the COVID-19 pandemic.

METHODS

Data collected from an online survey, administered in Arkansas between July and August 2020 (n = 1205), were used to estimate regressions. The data analysis was completed in April 2021.

RESULTS

Wearing a face mask was the most commonly reported behavior (97.4%), followed by handwashing (97.2%). Protective behaviors increased with higher levels of fear (β = 0.030, P < 0.001), more stressors (β = 0.057, P = 0.002), and age (β = 0.006, P = 0.030). Female (β = 0.510, P < 0.001) and Black (β = 0.268, P = 0.039) respondents reported engaging in more protective behaviors than males or other races/ethnicities.

CONCLUSIONS

In future pandemic planning, there will be a need to create messaging and interventions to increase health protective behaviors directed at young adults, men, and those with lower education levels. Providers will need to address fears related to COVID-19 and help their patients to manage those fears and anxieties.

COVID-19 Vaccine Hesitancy and Experiences of Discrimination Among Black Adults

Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older (n = 350) between July 12^th and July 30^th, 2021, as part of a larger survey of Arkansans (N = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.

Associations among Self-Reported Mental Health, Physical Activity, and Diet during the COVID-19 Pandemic

Background: Understanding the relationship between physical activity, diet, and mental health during the COVID-19 pandemic may help inform resources encouraging healthy lifestyle choices during the time of an increased threat to health and wellbeing. Aim: Our objective was to examine how self-rated mental health was associated with engagement in physical activity and consumption of fruits and vegetables during the COVID-19 pandemic. Methods: The study utilized cross-sectional survey data from adults (≥18 years of age) living, working, and/or receiving healthcare in Arkansas (n  =  754). Multivariable regression models were used to examine the associations between self-rated mental health and the number of days respondents engaged in 30 min of physical activity and the number of days respondents consumed five or more servings of fruits and vegetables. Results: Respondents who reported somewhat poor/poor mental health reported engaging in at least 30 min of physical activity fewer days per week (β  =  -.77, p  =  .018) compared with those reporting excellent mental health, after controlling for sociodemographic factors and self-rated health. The significant association observed in the first two models between mental health and number of days consuming five or more servings of fruits and vegetables became non-significant after inclusion of self-rated health. Conclusion: The relationship between mental health and physical activity and diet reaffirms a need for healthcare providers to promote the importance of maintaining both a healthy physical activity level and a nutrient-rich diet in the face of challenging circumstances, such as a global pandemic.

Best of Intentions: Influential Factors in Infant Feeding Intent among Marshallese Pregnant Women

The purpose of this study is to explore the beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding intent among Marshallese pregnant women in the United States (US). The study used a descriptive qualitative design. In total, 36 Marshallese women in their third trimester of pregnancy participated. Participants described exclusive breastfeeding as the preferred method of infant feeding, from both individual and community perspectives. Exclusive breastfeeding was viewed as the healthiest for the infant, viewed as offering protection against sickness, and viewed as better for the overall development of the infant. Of the 36 participants, 28 participants (77.8%) stated that their infant feeding intentions included a hybrid of breastfeeding and formula feeding. The dominant barrier to exclusive breastfeeding was the need to work outside of the home. Unexpected barriers to exclusive breastfeeding were the desire for autonomy and a preference to exclusively breastfeed female infants more than male infants. Exclusive breastfeeding facilitators included support from the Special Supplemental Nutrition Program for Women, Infants, and Children and support and encouragement from female family/community members. This study is the first to document beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding among Marshallese pregnant women residing in the US.

Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults

PURPOSE

The purpose of the study was to explore experiences of Marshallese adults related to diabetes self-care behaviors during the COVID-19 pandemic.

METHODS

A qualitative descriptive design was utilized to understand participants' diabetes self-care behaviors during the pandemic. Nine focus groups with 53 participants were held via videoconference and conducted in English, Marshallese, or a mixture of both languages. A priori codes based on diabetes self-care behaviors provided a framework for analyzing and summarizing participant experiences.

RESULTS

Both increases and decreases in healthy eating and exercise were described, with improvements in health behaviors attributed to health education messaging via social media. Participants reported increased stress and difficulty monitoring and managing glucose. Difficulty obtaining medication and difficulty seeing their health care provider regularly was reported and attributed to health care provider availability and lack of insurance due to job loss.

CONCLUSIONS

The study provides significant insight into the reach of health education campaigns via social media and provides important information about the reasons for delays in care, which extend beyond fear of contracting COVID-19 to structural issues.

Gestational weight gain influences, beliefs, and goals among Marshallese pregnant women in Arkansas: a mixed-methods analysis

Despite the high rate of maternal and child health disparities among the Marshallese, there are no studies documenting gestational weight gain influences, beliefs, and goals among the Marshallese. From March 2019 to March 2020, a purposive sample of 33 participants took part in the mixed methods study. Two themes emerged: (1) Gestational Weight Gain Influences and (2) Excessive Gestational Weight Gain Perceptions. In the first theme there were three subthemes: (a) Church and Familial Influence on Gestational Weight Gain; (b) Healthy Gestational Weight Gain; and (c) Lack of Healthcare Provider Influence on Gestational Weight Gain. In the second theme there were three subthemes: (a) Excessive Weight Gain and Pregnancy; (b) Excessive Gestational Weight Gain and Labor; and (c) Gestational Weight Gain Goals. This study will be used to culturally tailor interventions to help Marshallese women reduce maternal and infant health disparities in Marshallese communities.

COVID-19 Vaccine Willingness and Hesitancy Among Marshallese Pacific Islanders

COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders': willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.

Experiences of Marshallese Food Processing Workers during the COVID-19 Pandemic

The goal of this study was to conduct an exploratory assessment of COVID-19 mitigation steps and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher's Exact tests. Of those employed at the time of the survey (n = 113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English-speaking ability, and health literacy. More food processing workers reported that their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. This is the first study to examine Marshallese food processing workers' experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.

COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear

Understanding and minimizing coronavirus disease 2019 (COVID-19) vaccine hesitancy is critical to population health and minimizing health inequities, which continue to be brought into stark relief by the pandemic. We investigate questions regarding vaccine hesitancy in a sample (n = 1205) of Arkansas adults surveyed online in July/August of 2020. We examine relationships among sociodemographics, COVID-19 health literacy, fear of COVID-19 infection, general trust in vaccines, and COVID-19 vaccine hesitancy using bivariate analysis and a full information maximum likelihood (FIML) logistic regression model. One in five people (21,21.86%) reported hesitancy to take a COVID-19 vaccine. Prevalence of COVID-19 vaccine hesitancy was highest among Black/African Americans (50.00%), respondents with household income less than $25K (30.68%), some college (32.17%), little to no fear of infection from COVID-19 (62.50%), and low trust in vaccines in general (55.84%). Odds of COVID-19 vaccine hesitancy were 2.42 greater for Black/African American respondents compared to White respondents (p < 0.001), 1.67 greater for respondents with some college/technical degree compared to respondents with a 4-year degree (p < 0.05), 5.48 greater for respondents with no fear of COVID-19 infection compared to those who fear infection to a great extent (p < 0.001), and 11.32 greater for respondents with low trust in vaccines (p < 0.001). Sociodemographic differences in COVID-19 vaccine hesitancy raise concerns about the potential of vaccine implementation to widen existing health disparities in COVID-19 related infections, particularly among Black/African Americans. Fear of infection and general mistrust in vaccines are significantly associated with vaccine hesitancy.

Control of type 2 diabetes mellitus during the COVID-19 pandemic

AIMS

Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition that can lead to significant complications if not well controlled. The COVID-19 pandemic created disruptions in daily life; however, it is unknown whether the pandemic's disruptions affected the ability for adults with T2DM to control their condition. This study aims to fill the knowledge gap with the experiences of adults with T2DM in Arkansas, U.S. during the COVID-19 pandemic.

METHODS

This study analyzed cross-sectional, observational survey data collected from adults (≥18 years) who live, work, or receive healthcare in Arkansas; self-reported a diagnosis of T2DM; and completed the diabetes module of the Impact of COVID-19 online survey (n = 131) fielded in July-August 2020. Descriptive statistics were used to characterize the sample and survey responses, and multivariate regression was used to identify demographics, self-care behaviors, and access issues associated with uncontrolled T2DM (HbA1c ≥ 9% or 74.9 mmol/mol) or with an increase in HbA1c.

RESULTS

28.2% reported an increase in their HbA1c since the pandemic began, and 18.2% had uncontrolled T2DM. Educational level, eating healthily, and weight gain were negatively associated with uncontrolled T2DM. Eating less healthily and having difficulty accessing diabetes related medication were positively associated with an increase in HbA1c.

CONCLUSIONS

Adults with T2DM in Arkansas were reasonably able to maintain control of their T2DM during the five months post the first case of COVD-19 diagnosed in the state. However, T2DM self-management interventions targeting those with lower educational levels that are focused on eating habits and/or that improve access to diabetes medication should be considered for future public health emergencies.

Assessment of Diabetes-Related Health Disparities among the Marshallese Living in the Republic of the Marshall Islands

There is a high prevalence of type 2 diabetes mellitus (T2DM) among the Marshallese in the Republic of the Marshall Islands (RMI). However, no prior literature has examined self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. This study examined health indicators among participants with T2DM (n=41). Clinical measures included glycated hemoglobin (HbA1c) and fasting glucose level, blood pressure, pulse pressure, and cholesterol levels. Survey items included participants' self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. Clinical health indicators demonstrate the poor health status of the participants, including uncontrolled fasting glucose levels and HbA1c levels (61.9% had an HbA1c ≥9.0%), high blood pressure, elevated pulse pressure (65.9% had pulse pressure >40 mmHg), and high total cholesterol. Participants report limited knowledge and participation in diabetes self-management behaviors, limited family support, and faced numerous barriers to medical care, medications, and supplies. This study provides insight into the T2DM disparities experienced by Marshallese in the RMI. This study is the first to document the self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. The results highlight the need for T2DM management interventions and will be used to refine a culturally adapted intervention for delivery in the RMI.

Telehealth Utilization During COVID-19 Among People with Diagnosed Mental Health Conditions

Background: Despite the potential benefits and the demonstrated uptake throughout the coronavirus disease 2019 (COVID-19) pandemic, studies have found that telemental health is still underused. The objective of the study was to explore the associations between mental health diagnoses and telehealth utilization during the pandemic. Methods: The study utilized a cross-sectional survey among adult Arkansans (n = 754). Logistic regression was used to determine the association between a diagnosis of anxiety and/or depression and telehealth utilization. Results: Forty-two percent of respondents reported utilizing telehealth during the pandemic. Respondents with a diagnosis of anxiety and/or depression had three times greater odds of utilizing telehealth (odds ratio = 2.97) than those with no diagnoses. Discussion: Utilization of telehealth care during the COVID-19 pandemic was lower in our sample compared with other nationally representative surveys; however, utilization was higher among people with a diagnosis of anxiety and/or depression. Conclusions: The results indicate the need for outreach to increase telehealth utilization.

Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands

BACKGROUND

The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker.

METHODS

This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23).

RESULTS

The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet.

CONCLUSIONS

This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.

Arkansans' Preferred COVID-19 Testing Locations

Introduction:

A contributing factor to racial and ethnic disparities during the COVID-19 pandemic may be the accessibility and acceptability of COVID-19 testing. Previous studies found that access to testing has not been equitable across several sociodemographic indicators. This study documents the preferred testing locations and examines differences across sociodemographic factors with a specific focus on race and ethnicity.

Methods:

This study includes a primary analysis of cross-sectional data using a self-administered digital survey distributed to Arkansas residents using ARresearch, a volunteer research participant registry. The survey had 1288 responses, and 1221 met eligibility criteria for inclusion in the survey. Participants provided sociodemographic information and were asked to select up to 3 preferred testing locations from 12 options. Chi-square tests assessed differences in testing site preference across relevant sociodemographic groups.

Results:

Participants preferred drive-through clinics as their top location for COVID-19 testing, with 55% reporting this was their preferred method of testing. This pattern was consistent across all comparison groups (ie, age, sex, race/ethnicity, education, insurance status). Significant differences in testing location preference were observed across age, race and ethnicity, and education, with the most differences observed across race and ethnicity.

Conclusion:

This study reveals that race and ethnicity are important to consider when deciding where to offer COVID-19 testing. The preferences for testing locations among the most vulnerable demographics will be used to develop targeted responses aimed at eliminating disparities in COVID-19 in Arkansas.

Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults

OBJECTIVE

To document sleep duration and sleep quality among a sample of Marshallese adults and to examine if sleep duration and quality are associated with type 2 diabetes, body mass index (BMI), and self-reported health in the Marshallese population.

DESIGN

Cross-sectional analysis of a staff-administered survey.

SETTING

Thirty Marshallese churches in Arkansas and Oklahoma.

PARTICIPANTS

The study includes 378 Marshallese participants, 56.6% female, with a mean age of 42.4 years (±11.6). Recruitment was limited to participants who were considered overweight, with a BMI >25 kg/m².

MEASURES

Staff-administered surveys were used to collect data on sleep duration, sleep quality, and self-reported health. Clinical measures were collected by trained research personnel using standard tools and protocols. Kruskal-Wallis tests, Spearman's correlations, and nonparametric tests of trends were used to evaluate differences in HbA1c, BMIc, and self-reported health by sleep duration and quality. Multivariable analyses were used to test the associations, controlling for sociodemographic factors.

RESULTS

Fifty-four percent of the participants reported something other than normal sleep duration and 52.4% reported at least 1 night of difficult or interrupted sleep in the previous 2-week period. Longer sleep duration was associated with lower HbA1c and poorer sleep quality was associated with higher HbA1c. Poor sleep quality was associated with lower self-reported health. However, neither sleep duration nor quality was associated with BMI. The associations were found independent of sociodemographic factors.

CONCLUSION

This is the first study to document sleep duration and sleep quality, as well as the first study to examine the relationship between sleep and HbA1c, BMI, and self-reported health in Marshallese adults with a BMI >25 kg/m². This research will be used to help develop sleep interventions to address type 2 diabetes health disparities in the Marshallese community.

Perceived Barriers to COVID-19 Testing

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.

Factors Associated with First-Time Telehealth Utilization for Marshallese Living in the United States

Background: Mitigation efforts to prevent the spread of COVID-19 included the robust utilization of telehealth. However, racial/ethnic minority populations have demonstrated low telehealth utilization in the past. The aim of this study was to examine the first-time use of telehealth by Marshallese adults during the COVID-19 pandemic, using online survey data collected from 109 Marshallese respondents between July and November of 2020. Methods: To evaluate the relationships between sociodemographic characteristics, health care access, physical/mental health, and COVID-19-specific measures and the decision to use telehealth, we use bivariate analyses, including t-tests and chi-square analysis. Results: Eighteen respondents (16.5%) indicated they utilized telehealth for the first time during the pandemic. The number of chronic conditions reported was positively associated with the first-time use of telehealth (p = 0.013). Although not statistically significant, a higher proportion of Marshallese first-time telehealth users reported limited English proficiency, changes in health status, and changes in health insurance. Discussion: Although telehealth has been shown to reduce the absolute gaps in health disparities for minority populations, there is limited utilization by Marshallese communities. Conclusions: Significant research remains on the utilization of telehealth by Marshallese during the COVID-19 pandemic and to increase utilization in the future.

Racial Disparities in Diabetes Management Outcomes: Evidence from a Remote Patient Monitoring Program for Type 2 Diabetic Patients

Introduction: Despite growing documentation of the efficacy of telemedicine in diabetes management, racial disparities in telemedicine-facilitated diabetes management remain underexplored. This study examined disparities in diabetes management outcomes between black and white patients with type 2 diabetes (T2D) in a remote monitoring program. Methods: The analysis sample included 914 white T2D patients and 365 black T2D patients in Nebraska who completed a 3-month remote patient monitoring and coaching after hospital discharge from 2014 to 2017. Ordinary least squares regression was estimated to examine racial differences in hemoglobin A1c (HbA1c), and logistic regression was used to determine the odds of HbA1c > 9% at the end of the program, controlling for demographics, baseline health conditions, and patient activation and engagement with the program. Results: The proportion of white patients with HbA1c > 9% was reduced from 16% at the baseline to 7% at program completion, and the corresponding reduction among black patients was from 30% to 18%. After adjusting for the effects of baseline HbA1c and other covariates, the average HbA1c among black patients at the end of the program was 0.23 points higher than that among white patients (p < 0.01), and the adjusted odds of black patients having HbA1c > 9% was 1.68 times that of white patients (95% confidence interval [1.07-2.63]). Discussion: The remote patient monitoring and coaching program reduced the absolute gap between black and white T2D patients. However, substantial racial disparities in HbA1c still remained at the end of the program and warranted further research.

Amyotrophic Lateral Sclerosis and a "Death With Dignity"

The Oregon "Death With Dignity" Act (DWD Act) allows a terminally ill patient with 6 months to live to ask a physician for medication to end their life. To receive the medication, the DWD Act requires the patient to verbally request the prescription twice 2 weeks apart as well as in writing. Patients with amyotrophic lateral sclerosis have three main barriers to using DWD: (a) the ability to communicate their informed consent as the disease progresses further, (b) the possibility of dementia which may affect their decisional capacity, and (c) given the nature and speed of amyotrophic lateral sclerosis, limited time is available for patients to self-administer the prescription and may rush the time line for the death. This article reviews the current knowledge and addresses the need for adjustments to existing law and recommendations for states considering a DWD law.

Does insulin therapy matter? Determinants of diabetes care outcomes

OBJECTIVE

To evaluate adherence to care standards for people with diabetes (PWDs) on insulin therapy versus PWDs who are not on insulin therapy, controlling for social determinants.

RESEARCH DESIGN AND METHODS

Utilizing the United States 2015 Behavioral Risk Factor Surveillance System Survey, this study used logistic regression analyses to estimate differences in self-care behaviors, healthcare provider quality of care, and diabetic complications for individuals on insulin therapy and individuals not on insulin therapy.

RESULTS

PWDs on insulin therapy are more likely to adhere to self-care measures (self-glucose checks [OR: 7.57], self-foot checks [OR: 1.27], diabetes class participation [OR: 1.96]), adherence to provider care standards (diabetes-related doctor visits [OR: 1.24], comprehensive foot exam [OR: 1.80], dilated eye exam [OR: 1.34]), and to self-report diabetic complications (retinopathy [OR: 2.77], kidney disease [OR:2.14]), controlling for sociodemographic variables.

CONCLUSION

PWDs on insulin and their healthcare providers are more likely to meet the treatment goals set by the American Diabetes Association. PWDs on insulin therapy may have better overall relationships with providers due to a reduction in stigmatization based on the social construction of diabetes.