Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis

A Pandemic of Misinformation: Understanding Influences on Beliefs in Health and Conspiracy Myths

BACKGROUND

Personal characteristics may be associated with believing misinformation and not believing in best practices to protect oneself from COVID-19.

OBJECTIVE

To examine the associations of a person's age, race/ethnicity, education, residence, health literacy, medical mistrust level, and sources of health-related information with their COVID-19 health and conspiracy myth beliefs.

DESIGN

We surveyed adults with hypertension in Maryland and Pennsylvania between August 2020 and March 2021. Incorrect responses were summed for eight health (mean = 0.68; range 0-5) and two conspiracy (mean = 0.92; range 0-2) COVID-19 questions. Higher scores indicated more incorrect responses. Statistical analyses included two-sample t-tests, Spearman's correlation, and log binomial regression.

PARTICIPANTS

In total, 561 primary care patients (mean age = 62.3 years, 60.2% female, 46.0% Black, 10.2% Hispanic, 28.2% with a Bachelor's degree or higher, 42.8% with annual household income less than $60,000) with a diagnosis of hypertension and at least one of five commonly associated conditions.

MAIN MEASURES

Sociodemographic characteristics, health literacy, medical mistrust level, source of health-related information, and COVID-19 conspiracy and health myth beliefs.

KEY RESULTS

In multivariable analyses, participants who did not get information from medical professional sources (prevalence ratio (PR) = 1.28; 95% CI = 1.06-1.55), had less than a bachelor's degree (PR = 1.49; 95% CI = 1.12-1.99), were less confident filling out medical forms (PR = 1.24; 95% CI = 1.02-1.50), and had higher medical mistrust (PR = 1.34; 95% CI = 1.05-1.69) were more likely to believe any health myths. Participants who had less than a bachelor's degree (PR = 1.22; 95% CI = 1.02-1.45), were less confident filling out medical forms (PR = 1.21; 95% CI = 1.09-1.34), and had higher medical mistrust (PR = 1.72; 95% CI = 1.43-2.06) were more likely to believe any conspiracy myths.

CONCLUSIONS

Lower educational attainment and health literacy, greater medical mistrust, and certain sources of health information are associated with misinformed COVID-19 beliefs. Programs addressing misinformation should focus on groups affected by these social determinants of health by encouraging reliance on scientific sources.

Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities: JACC: CardioOncology State-of-the-Art Review

Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient's perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.

Cardiorespiratory fitness and physical activity in the lens of social justice - Reporting on the disparities that exist

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differences in susceptibility to poor health outcomes, including non-communicable disease. Race and ethnic differences in CRF may partly be explained by social injustices rooted in persistent structural and systemic racism. These forces contribute to environments that are unsupportive for opportunities to achieve optimal CRF levels. This review aims to examine, through the lens of social justice, the inequities in key social ecological factors, including socioeconomic status, the built environment, and structural racism, that underly the systemic differences in CRF and PA in vulnerable communities. Further, this review highlights current public health initiatives, as well as opportunities in future research, to address inequities and enhance CRF through the promotion of regular PA.

Personal Health Literacy and Life Simple 7: The Multi-Ethnic Study of Atherosclerosis

Background

Personal Health literacy (PHL) is essential in cardiovascular risk management. Hindrances in PHL can lead to poor cardiovascular outcomes.

Purpose

To investigate whether limited PHL is associated with lower likelihoods of i) overall cardiovascular health and ii) individual cardiovascular health components as defined by the American Heart Association's Life Simple (LS7).

Methods

Multi-Ethnic Study of Atherosclerosis participants (N=3719; median age[range]: 59[45-84]) completed a PHL questionnaire in 2016-2018. PHL was classified as limited (score ≥10) or adequate (score <10). LS7 components were measured in 2000-2002. Robust Poisson regression was employed to compute prevalence ratios and 95% confidence intervals (PR[95%CI]) of LS7 measures.

Results

14.7% of participants had limited PHL. Limited PHL was associated with lower likelihoods of optimal LS7 (0.69[0.50, 0.95], p=0.02) and average LS7 (0.95[0.88, 1.02], p=0.15) after adjustment. Limited PHL was significantly associated with a 7% lower likelihood of ideal fasting blood glucose level after adjustment (0.93[0.89, 0.98], p<0.01).

Discussion

Limited PHL was modestly associated with suboptimal cardiovascular health and elevated blood glucose, independent of income and education.

Translation to Health Education Practice

Health educators and providers should equitably address PHL barriers to improve cardiovascular management and quality of care for patients and communities.

Assessing perceived and functional health literacy among parents in Cyprus: A cross-sectional study

BACKGROUND

Parents often must take decisions regarding their children's health, which requires certain skills and competences. Parental health literacy (HL) is important in establishing positive health-promoting behaviours and better health outcomes to their children. Limited parental HL has been associated with various negative children's health outcomes. The aim of the study was to explore perceived and functional HL among parents in Cyprus.

METHOD

A cross-sectional study was conducted with a convenience sample of 416 parents of children, aged 6 months to 15 years old, presenting in pediatric outpatient departments across three Cypriot cities. Participants completed the HLS-EU-Q47, a self-reported measure of HL, and the NVS (Newest Vital Sign), a performance-based measure of HL. Associations with socio-demographic characteristics and health behaviors were explored.

RESULTS

Based on suggested ranges, among 416 parents, mostly mothers (83.2%), almost half of parents (42.6%) were classified as having inadequate or problematic perceived HL. Consistently, 62.8% showed high likelihood or significant possibility of limited functional HL, based on the NVS with a mean score of 2.73 out of 6 (SD = 2.02). Nevertheless, no correlation was observed between the two measures of HL. Limited parental perceived HL was statistically significantly associated with lower educational attainment, lower number of children in the family, increased self-assessed health status, and limited exercise habits. Limited parental functional HL was statistically significantly associated with female gender, younger age, lower educational attainment, receiving financial aid, lower family income, and lower alcohol consumption.

CONCLUSION

Even though there was lack of agreement in the classification according to the HLS-EU-Q47 and the NVS, moderate-to-low levels of perceived HL appear consistent with a performance-based measure of HL. As a high number of parents may face challenges in assessing and applying health information to improve outcomes for their children, with evidence of social gradient, healthcare services should be oriented towards identifying problematic HL while Public Health interventions are needed to enhance parental HL.

Questionnaire and LGBM Model for Assessing Health Literacy levels of Mongolians in China

Background

It is difficult to accurately assess the health literacy(HL) level of Mongolians by using Chinese conventional HL questionnaire, due to their particularity in language, culture and living environment. Therefore, it is very important to design an exclusive HL questionnaire for them. In addition, the existing statistical models cannot meet the requirement of HL assessment with high precision, so it is necessary to study a new HL assessment model.

Methods

A HL questionnaire with 68 questions is designed by combing the HLS-EU-Q47and the characteristics of Mongolians in China. 742 Mongolians aged 18 to 87 in Inner Mongolia of China answered the questionnaire. A data set with 742 samples is constructed, where each sample has 68 features and 1 target. Based on it, the XGB and LGBM regression models are respectively constructed to assess the HL levels of respondents, and their evaluation effects are compared. The impact of each question on the HL level is quantitatively analyzed by using the feature-importance function in LGBM model to verify the effectiveness of the questionnaire and to find the key factors for affecting HL.

Results

The HL questionnaire has the high reliability, which is reflected by the high internal consistency (Cronbach’s coefficient=0.807) and test-retest reliability (Mutual Information Score= 0.803). The validity of the HL questionnaire is obtained by solving KMO and Bartlett Spherical Test Chi-square Value, which are 0.765 and 2486 (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p<0.001$$\end{document}p<0.001), respectively. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R^2$$\end{document}R2 index and the absolute error obtained by using the HL assessment model based on LGBM are 0.98347 and 11, which are better than ones by applying the model based-XGB, respectively. The quantitative analysis results show that all 68 questions have influence on HL level, but their degree are different. The first three factors are age, salary level, the judgment ability for the HL information in media, respectively. The HL level distribution of the respondents was 66.71\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}% excellent, 25.74\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}% good and 7.54\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}% poor, respectively.

Conclusions

The presented HL questionnaire with 68 questions and LGBM regression model can obtain the HL level assessment results with high precision for Mongolians in China. The impact of each question in the questionnaire on the final assessment results can be quantified by using the feature-importance function in LGBM model, which is better than the existing qualitative analysis methods.

COVID-19 Vaccine Uptake and Associated Factors Among Health Professionals in Ethiopia

BACKGROUND

Ethiopia has received 2.2 million doses of COVID-19 vaccine from the COVID-19 Vaccines Global Access (COVAX) facility and planned to vaccinate 20% of its population by the end of 2021. However, evidence on the current uptake of the vaccine in our country is scanty. Therefore, this study aimed to assess COVID-19 vaccine uptake and associated factors among health professionals in Ethiopia.

METHODS

A national online cross-sectional E-survey was conducted on COVID-19 vaccine Uptake and associated factors among health professionals in Ethiopia from June 1 to 30, 2021. A semi-structured questionnaire was created on Google forms and disseminated online. The snowball sampling technique through the authors' network with Ethiopian residents on the popular social media like Facebook, telegram, and email was used. Descriptive statistics were performed. Multivariable logistic regression analysis was performed using Statistical Package for Social Sciences version 25, and all variables with P-value <0.05 and adjusted odds ratio at 95% CI were used to declare the predictors of the outcome variable.

RESULTS

A total of 522 health professionals participated in the survey, of which about 324 (62.1%) of them were vaccinated with any of the COVID-19 vaccines at least once. The study indicated that COVID-19 vaccine uptake was associated with age range from 35 to 44 years [AOR = 12.97, 95% CI: 2.36-71.21], age beyond 45 years [AOR = 18.95, 95% CI = 2.04-36.29], being male [AOR = 2.91, 95% CI = 1.05,8.09], being only an academician [AOR = 0.23, 95% CI: 0.10-0.49], academicians working in University hospitals [AOR = 0.19, 95% CI: 0.05-0.83], perceiving their family as healthy [AOR = 4.40, 95% CI: 2.21-8.75], no history of receiving other vaccine before as an adult [AOR = 4.07, 95% CI: 2.07-8.01] and no history of contact with confirmed COVID-19 patients or clients [AOR = 0.42, 95% CI: 0.20-0.86].

CONCLUSION

The study found that COVID-19 vaccine uptake among health professionals was low. This was not sufficient to achieve herd immunity as at least nine out of ten health professionals are required for herd immunity. Ages, sex, place of work, perceived family health status, previous experience of receiving a vaccine as an adult and history of contact with COVID-19 clients or patients were the factors that influence the vaccine uptake among health professionals in Ethiopia. Hence, decision makers and health managers should consider instituting mandatory vaccination for health professionals and design strategies for the provision of the vaccine.

Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study

Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship. Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk. Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04-1.16] and 1.05 (95% CI: 0.99-1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98-1.12) and 1.04 (0.97-1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0-1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98-1.03) and 1.01 (0.98-1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics. Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.

COVID-19 vaccine hesitancy: misinformation and perceptions of vaccine safety

Despite COVID-19’s devastating toll, many Americans remain unwilling to receive the COVID-19 vaccine. The authors conducted a US national survey to understand the health literacy of adults regarding the vaccine, as well as their COVID-19 beliefs and experiences. People who believed the COVID-19 vaccine was unsafe were less willing to receive the vaccine, knew less about the virus and were more likely to believe COVID-19 vaccine myths. On average, they were less educated, lower income, and more rural than people who believed the vaccine is safe. The results highlight the importance of developing clear health communications accessible to individuals from varied socioeconomic and educational backgrounds.