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Martin JN, Pace TWW. Colonialism as a Social Determinant of Health in Puerto Rico: Using the Socioecological Model to Examine How the Jones Act Impacted Health After Hurricane María. J Transcult Nurs 2024:10436596241274123. [PMID: 39206586 DOI: 10.1177/10436596241274123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Puerto Rico is a territory of the United States, making Puerto Ricans vulnerable to damaging colonial policy. The purpose of this article is to utilize the socioecological model (SEM) to evaluate how the Jones Act impacted Puerto Rico after Hurricane María, examining colonialist policy as a social determinant of health (SDOH) in Puerto Rico. METHODS Levels of the SEM used in this examination included: individual, institutional, community, policy, and context. RESULTS Evaluation of the Jones Act using the model demonstrated relationships between all socioecological levels. The Jones Act caused delays and increased prices for goods needed to rebuild community utility infrastructure, which led to extended closures of institutions like workplaces, schools, and hospitals, and ultimately contributed to increased acute and chronic physical and mental illness among Puerto Ricans. DISCUSSION This evaluation establishes that colonialist policy negatively impacts the health of Puerto Ricans, positioning colonialism as an SDOH.
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Affiliation(s)
| | - Thaddeus W W Pace
- University of Arizona, Tucson, USA
- University of Arizona Cancer Center, Tucson, USA
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2
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Stimpson JP, Rivera-González AC, Mercado DL, Purtle J, Canino G, Ortega AN. Trends in hospital capacity and utilization in Puerto Rico by health regions, 2010-2020. Sci Rep 2024; 14:17849. [PMID: 39090232 PMCID: PMC11294551 DOI: 10.1038/s41598-024-69055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024] Open
Abstract
Like many under resourced, island communities, most of the municipalities in Puerto Rico are medically underserved. However, there is limited information about changes in hospital capacity and any regional disparities in availability of hospital services in Puerto Rico, especially given the multiple public health emergencies the island has faced in recent years (e.g. hurricanes, earthquakes, and COVID-19). This study described the trends in hospital capacity and utilization for the Island of Puerto Rico and by health regions from 2010 to 2020. We analyzed the 2021-22 Area Health Resource File (AHRF) and aggregated the data by seven health regions, which are groupings of municipalities defined by the Puerto Rico Department of Health. Ten-year estimates for hospital utilization were adjusted for population size by health region. During the more recent five-year period, there were decreases in hospitals, hospital beds, and surgeries, which represent a shift from the earlier five-year period. Over the 10 years of the study period, there was an overall decrease in population-adjusted measures of hospital utilization on the island of Puerto Rico-despite multiple disasters that would, theoretically, increase need for health care services. We also found variation in hospital capacity and utilization by health regions indicating the rate of change was not uniform across Puerto Rico. The capacity of Puerto Rico's hospital system has shrunk over the past decade which may pose a challenge when responding to recurrent major public health emergencies, especially within specific health regions.
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Affiliation(s)
- Jim P Stimpson
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | | | - Jonathan Purtle
- New York University, School of Global Public Health, New York, NY, USA
| | - Glorisa Canino
- University of Puerto Rico Medical Sciences Campus, Behavioral Sciences Research Institute, San Juan, Puerto Rico
| | - Alexander N Ortega
- University of Hawai'i at Mānoa, Thompson School of Social Work and Public Health, Honolulu, HI, USA
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3
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Padilla M, Varas-Diaz N, Rodríguez-Madera S, Vertovec J, Rivera-Custodio J, Rivera-Bustelo K, Mercado-Rios C, Matiz-Reyes A, Santiago-Santiago A, González-Font Y, Ramos-Pibernus A, Grove K. "They think we wear loincloths": Spatial stigma, coloniality, and physician migration in Puerto Rico. Med Anthropol Q 2024; 38:224-239. [PMID: 38642372 DOI: 10.1111/maq.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/10/2024] [Indexed: 04/22/2024]
Abstract
Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.
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Affiliation(s)
- Mark Padilla
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | - Nelson Varas-Diaz
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | | | - John Vertovec
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
- Research Department, Behavioral Science Research Institute, Coral Gables, Florida, USA
| | - Joshua Rivera-Custodio
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kariela Rivera-Bustelo
- Social Sciences Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Claudia Mercado-Rios
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Armando Matiz-Reyes
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | | | - Yoymar González-Font
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Alixida Ramos-Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kevin Grove
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
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Luna-Pinto SC, Ramos JI, Gonzalez Y, Cartagena NB, Taveras S. Factors that support public health infrastructure recovery in Puerto Rico and US Virgin Islands after Hurricanes Irma and Maria. JOURNAL OF EMERGENCY MANAGEMENT (WESTON, MASS.) 2024; 22:129-138. [PMID: 38695710 DOI: 10.5055/jem.0841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
This paper describes the factors that support recovery of public health infrastructure (PHI), including conditions that facilitated or hindered recovery in United States (US) territories impacted by hurricanes Irma and Maria. A deductive approach was used to categorize data from five organizations that received crisis hurricane recovery (CHR) funds from the Centers for Disease Control and Prevention.* Spending was grouped into five infrastructure gaps: (1) human resources, (2) informatic upgrades, (3) equipment, (4) minor repairs, and (5) preventive maintenance. Unanticipated PHI costs, facilitators, and hinderances to PHI recovery were identified. Most (72 percent) of the $53,529,823 CHR funding was used to address infrastructure gaps in (1) human resources (56 percent), (2) informatics (16 percent), (3) equipment (13 percent), (4) minor repairs (10 percent), and (5) preventive maintenance (5 percent). Most of the requests (56 percent) to redirect funds were associated with unanticipated costs in initial work plans and budgets. The use of administrative partners, planning tools, dedicated staff, streamlined procedures, eg, contracts, and cost sharing facilitated PHI recovery. The most common hindrance to PHI recovery were delays in procurement and shipping. In summary, investments in dedicated funding to upgrade, repair, or replace critical structures and systems for infectious disease surveillance, laboratory capacity, vector control, environmental health inspections, and vaccine storage and administration in Puerto Rico and the US Virgin Islands after Hurricanes Irma and Maria contributed to their recovery capacity. These findings may inform funding and resource allocation considerations for PHI recovery in the US territories.
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Affiliation(s)
- S Carolina Luna-Pinto
- Centers for Disease Control and Prevention/Office of Minority Health & Health Equity, Atlanta, Georgia
| | - Jessica Irizarry Ramos
- Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yanelis Gonzalez
- Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nairimer Berrios Cartagena
- Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel Taveras
- Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia
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Fortuna LR, Jimenez A, Porche MV. Climate Events, Displacement, and Mental Health-Uprooted. JAMA Psychiatry 2024; 81:5-6. [PMID: 37966826 DOI: 10.1001/jamapsychiatry.2023.3561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
This Viewpoint discusses the implications of climate event–related disasters and displacement as well as strategies for mitigating their mental health effects.
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Affiliation(s)
- Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
- now with Department of Psychiatry and Neuroscience, University of California, Riverside
| | - Aida Jimenez
- Department of Psychology, University of Puerto Rico, Río Piedras, Puerto Rico
| | - Michelle V Porche
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
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Sheftel MG, Heiland FW. The Role of Place of Birth and Residence in Puerto Rican Health Disparities: Evidence From Disability Prevalence Among Archipelago- Vs. Mainland-Born Puerto Ricans. J Aging Health 2024; 36:67-84. [PMID: 37115825 PMCID: PMC10693743 DOI: 10.1177/08982643231172643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Objectives: This paper provides new estimates of disability prevalence for the archipelago and mainland-residing Puerto Rican populations ages 40 and above and compares disability by place of birth and place of residence to investigate drivers of middle and older age health. Methods: Large nationally representative samples from 2013 to 2017 American Community Survey and Puerto Rico Community Survey data are used to estimate age-specific disability prevalence for archipelago-born/archipelago-residing, archipelago-born/mainland-residing, mainland-born/mainland-residing Puerto Ricans. Results: Mainland-born/mainland-residing Puerto Ricans have the lowest age-adjusted disability rates and archipelago-born/archipelago-residing Puerto Ricans have the highest rates. Differences in education explain part of this disparity. Discussion: Similarities in disability prevalence are strongest based on where one was born as opposed to current residence, pointing to early life as a critical period in the disablement process for later-life health. Early life socio-economic disadvantage on the archipelago may have an enduring impact on later-life disability prevalence for archipelago-born Puerto Ricans.
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Affiliation(s)
- Mara Getz Sheftel
- Population Research Institute, Pennsylvania State University, University Park¸ PA, USA
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Quashie NT, García C, Meltzer G, Andrade FCD, Matos-Moreno A. Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007. PLoS One 2023; 18:e0289170. [PMID: 37527246 PMCID: PMC10393176 DOI: 10.1371/journal.pone.0289170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.
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Affiliation(s)
- Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, United States of America
| | - Catherine García
- Department of Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion and Population Health, Syracuse University, Syracuse, NY, United States of America
| | - Gabriella Meltzer
- Departments of Epidemiology and Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Flavia C D Andrade
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States of America
| | - Amílcar Matos-Moreno
- Population Research Institute, The Pennsylvania State University, State College, PA, United States of America
- Clinical Psychology Department, Carlos Albizu University, San Juan, Puerto Rico
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Gorbea Díaz L, Chopel A, Fernós Sagebién A, Bonilla Marrero L, Rivera Figueroa G, Pecci Zegrí N, Cardona A, Mulero Oliveras J, La Santa L, Sánchez Rey P. Collecting and communicating perishable data in a post-disaster context: rapid research and rapid dissemination. FRONTIERS IN SOCIOLOGY 2023; 8:959765. [PMID: 37250439 PMCID: PMC10213553 DOI: 10.3389/fsoc.2023.959765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023]
Abstract
Context Puerto Rico experienced four natural disasters in 4 years (2017-2021): Hurricanes Irma and Maria, thousands of earthquakes reaching 6.4 magnitude, and the COVID-19 pandemic. In this context, our team sought to understand the impact of disaster aid distribution on poverty and economic inequality, and their relationship to the spread of COVID-19 across Puerto Rico. Rapid research was required to ensure we could collect perishable data within this ever-changing context. Challenges Our mixed methods design relied on both secondary and primary data. Because analyses of the former were to inform where and how to collect the latter, timing was of the essence. The data sources identified were not readily available to the public, and thus required gaining access through direct requests to government agencies. The requests coincided with a transition between administrations after an election. This resulted in unexpected delays. Once in the field, the team had to balance the rapid nature of the research with the mindful work to avoid compounding traumas experienced by participants, heightened risk for re-traumatization and fatigue, the risk of COVID-19, the digital divide, and intermittent electrical and telecommunication services. Adaptations In response to the delayed access to secondary data, we adjusted our research question. We continued to collect data as they became available, incorporating some immediately into analyses, and cleaning and storing others for future research opportunities. To overcome ongoing trauma challenges and prevent fatigue, we recruited and hired a large temporary team, including members of communities where we collected data. By recruiting participants and co-researchers at the same time and place, we both collapsed time between these activities and increased our team's contextual competency. To adapt to challenges presented by the pandemic, we created hybrid data collection procedures where some data were collected online, and some in person, while maintaining COVID-19 protections. We used similar adaptations for dissemination. Lessons Rapid research needs to be agile. Working within a convergence framework to investigate wicked problems had the unexpected added benefit of providing our team with a variety of disciplinary approaches which proved helpful in adapting to the changing conditions in the field. In addition to the resourcefulness of a transdisciplinary team, it is important to be willing to pivot in response to changes and to collect data where and when you can. To increase participation, opportunities need to be designed with flexibility, mindful of competing demands faced by individuals willing to collaborate. Collecting and analyzing data iteratively and utilizing local resources can enable rapid research that is rigorous and yields rich data. Contributions Our team applied the lessons learned to structure a rapid and iterative dissemination plan. We combined member-checking with community-level dissemination, enabling us to hone findings further before presenting to policy makers and media. Rapid research creates opportunities to make data-informed program and policy adjustments when they can be most impactful. Both the media and policy makers pay closer attention to research on current events. Hence, our recommendation is to do more rapid research! The more we do, the better we will get at it, and the more accustomed community leaders, policy makers, and program designers will become to using data to inform decisions.
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Affiliation(s)
- Laura Gorbea Díaz
- Puerto Rico Public and Applied Social Sciences Workshop, San Juan, PR, United States
| | | | - Antonio Fernós Sagebién
- Graduate School of Business, Interamerican University of Puerto Rico, San Juan, PR, United States
| | | | | | - Nicole Pecci Zegrí
- Puerto Rico Public and Applied Social Sciences Workshop, San Juan, PR, United States
| | - Anohiska Cardona
- Puerto Rico Public and Applied Social Sciences Workshop, San Juan, PR, United States
| | | | - Luis La Santa
- Puerto Rico Public and Applied Social Sciences Workshop, San Juan, PR, United States
| | - Paola Sánchez Rey
- Puerto Rico Public and Applied Social Sciences Workshop, San Juan, PR, United States
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Buckley TD, Burnette D. Psychological sense of community, self-rated health and quality of life among older adults in Puerto Rico two years after Hurricane María. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:512-529. [PMID: 36217794 DOI: 10.1080/01634372.2022.2133200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Older adults who experience natural disasters are at risk for immediate and longer-term negative health outcomes and diminished quality of life (QOL), in part due to disruptions to social relationships and protections. We use a risk and resilience framework to examine the protective effects of psychological sense of community (PSOC) on self-rated health (SRH) and QOL for older adults in Puerto Rico 2 years after the devastation of Hurricane María in 2017. Between September 2019 and January 2020, we conducted face-to-face interviews with a nonprobability sample of 154 community-dwelling adults aged 60+ in Puerto Rico. Controlling for covariates, we used multivariate regression to examine the association of PSOC and key social risk factors (mental health, social isolation, and loneliness) with SRH and QOL. Higher levels of PSOC were significantly associated with better SRH and QOL. Regarding risks, worse mental health was significantly associated with lower QOL and SRH, loneliness was significantly related to worse QOL, and social isolation was significantly associated with better SRH and better QOL. PSOC was a protective factor for older adults, suggesting that prevention and intervention efforts should focus on building and sustaining older adults' sense of community in the longer-term wake of natural disasters.
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Affiliation(s)
- Thomas D Buckley
- School of Social Work and Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Denise Burnette
- School of Social Work, Virginia Commonwealth University, Pittsburgh, PA, USA
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Purtle J, Rivera‐González AC, Mercado DL, Barajas CB, Chavez L, Canino G, Ortega AN. Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma. Health Serv Res 2023; 58:325-331. [PMID: 36310433 PMCID: PMC10012226 DOI: 10.1111/1475-6773.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. DATA SOURCES/STUDY SETTING National Mental Health Services Surveys conducted in 2016 and 2020. STUDY DESIGN Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services). DATA COLLECTION/EXTRACTION METHODS The proportion and per 100,000 population rate of facilities offering crisis services were calculated. PRINCIPAL FINDINGS The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria. CONCLUSIONS There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Director of Policy Research, Global Center for Implementation ScienceNew York University School of Global Public HealthNew York CityNew YorkUSA
| | - Alexandra C. Rivera‐González
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Damaris Lopez Mercado
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Clara B. Barajas
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Ligia Chavez
- Medical Sciences CampusBehavioral Sciences Research InstituteRio PiedrasPuerto Rico
| | - Glorisa Canino
- University of Puerto Rico, Medical Sciences CampusBehavioral Sciences Research InstituteRio PiedrasPuerto Rico
| | - Alexander N. Ortega
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
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Bezares N, McClain AC, Tamez M, Rodriguez-Orengo JF, Tucker KL, Mattei J. Consumption of Foods Away from Home Is Associated with Lower Diet Quality Among Adults Living in Puerto Rico. J Acad Nutr Diet 2023; 123:95-108.e10. [PMID: 35738537 PMCID: PMC9763551 DOI: 10.1016/j.jand.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Consuming foods away from home (FAFH) is ubiquitous, yet, it is unclear how it influences diet in diverse populations. OBJECTIVE The study aimed to evaluate the association between frequency and type of consumption of FAFH and diet quality. DESIGN The study had a cross-sectional design. Participants self-reported the frequency of consuming FAFH as "rarely" (≤1 time per week) vs "frequently" (≥2 times per week) at various commercial establishments or noncommercial FAFH (ie, friends' or relatives' homes). PARTICIPANTS/SETTING Participants were adults (aged 30 through 75 years) from the PRADLAD (Puerto Rico Assessment of Diet, Lifestyle, and Diseases) study conducted in San Juan, Puerto Rico metro area (n = 239) in 2015. MAIN OUTCOME MEASURES A validated food frequency questionnaire captured dietary intake. The Alternate Healthy Eating Index-2010 defined diet quality. Secondary outcomes included whether participants met 2015-2020 Dietary Guidelines for Americans recommendations for sodium, added sugars, saturated fat, dietary fiber, total energy, and alcohol. STATISTICAL ANALYSES PERFORMED Linear or logistic regression models adjusted for age, sex, employment, income, education, and food insufficiency tested differences in mean Alternate Healthy Eating Index-2010 scores or odds of meeting (vs not meeting) intake recommendations by FAFH type and frequency. RESULTS Overall, 54.4% and 37.2% of participants reported consuming commercial FAFH and noncommercial FAFH "frequently," respectively. Consuming FAFH "frequently" (vs "rarely") was associated with lower mean Alternate Healthy Eating Index-2010 scores for both commercial FAFH (57.92 vs 63.58; P = .001) and noncommercial FAFH (56.22 vs 62.32; P < .001). Consuming commercial FAFH "frequently" (vs "rarely") at any type of food establishment was associated with lower odds of meeting the dietary fiber Dietary Reference Intakes (odds ratio 0.43; 95% CI 0.23 to 0.81). Consuming noncommercial FAFH "frequently" was associated with lower odds of meeting recommendations for sodium (odds ratio 0.30; 95% CI 0.11 to 0.79) and added sugars (odds ratio 0.41; 95% CI 0.18 to 0.93). CONCLUSIONS Frequent consumption of FAFH is associated with lower diet quality and lower adherence to dietary recommendations in Puerto Rico. Future studies should explore whether diet quality can be improved by prioritizing healthy at-home meals and reformulating the quality of commercial FAFH.
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Affiliation(s)
- Nayla Bezares
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Amanda C. McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - Martha Tamez
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | | | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, Center for Population Health, University of Massachusetts, Lowell
| | - Josiemer Mattei
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
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Lemkow–Tovías G, Lemkow L, Cash‐Gibson L, Teixidó‐Compañó E, Benach J. Impact of COVID-19 inequalities on children: An intersectional analysis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:145-162. [PMID: 36181484 PMCID: PMC9538856 DOI: 10.1111/1467-9566.13557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
Societal concerns about the effects of the COVID-19 pandemic have largely focussed on the social groups most directly affected, such as the elderly and health workers. However, less focus has been placed on understanding the effects on other collectives, such as children. While children's physical health appears to be less affected than the adult population, their mental health, learning and wellbeing is likely to have been significantly negatively affected during the pandemic due to the varying policy restrictions, such as withdrawal from face to face schooling, limited peer-to-peer interactions and mobility and increased exposure to the digital world amongst other things. Children from vulnerable social backgrounds, and especially girls, will be most negatively affected by the impact of COVID-19, given their different intersecting realities and the power structures already negatively affecting them. To strengthen the understanding of the social determinants of the COVID-19 crisis that unequally influence children's health and wellbeing, this article presents a conceptual framework that considers the multiple axes of inequalities and power relations. This understanding can then be used to inform analyses and impact assessments, and in turn inform the development of effective and equitable mitigation strategies as well as assist to be better prepared for future pandemics.
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Affiliation(s)
- Gabriel Lemkow–Tovías
- Facultat de Ciències Socials de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Louis Lemkow
- Institut de Ciència i Tecnologia AmbientalsUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lucinda Cash‐Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
| | - Ester Teixidó‐Compañó
- Facultat de Ciències de la Salut de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
- Ecological Humanities Research Group (GHECO)Universidad AutónomaMadridSpain
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Jeffers NK, Wilson D, Tappis H, Bertrand D, Veenema T, Glass N. Experiences of pregnant women exposed to Hurricanes Irma and Maria in the US Virgin Islands: a qualitative study. BMC Pregnancy Childbirth 2022; 22:947. [PMID: 36528572 PMCID: PMC9759877 DOI: 10.1186/s12884-022-05232-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hurricanes Irma and Maria made landfall in the US Virgin Islands (USVI) in 2017. To date, there is no published literature available on the experiences of pregnant women in the USVI exposed to these hurricanes. Understanding how hurricanes affect pregnant women is key to developing and executing targeted hurricane preparedness and response policies. The purpose of this study was to explore the experiences of pregnancy and birth among women in the USVI exposed to Hurricanes Irma and Maria. METHODS We employed a qualitative descriptive methodology to guide sampling, data collection, and analysis. Semi-structured interviews of 30-60 min in length were conducted with a purposive sample of women (N = 18) in the USVI who were pregnant during or became pregnant within two months after the hurricanes. Interviews were transcribed verbatim and data managed in MAXQDA. Team members developed a codebook, applied codes for content, and reconciled discrepancies. We thematically categorized text according to a socioecological conceptual framework of risk and resilience for maternal-neonatal health following hurricane exposure. RESULTS Women's experiences were organized into two main categories (risk and resilience). We identified the following themes related to risk at 3 socioecological levels including: (1) individual: changes in food access (We had to go without) and stress (I was supposed to be relaxing); (2) household/community: diminished psychosocial support (Everyone was dealing with their own things) and the presence of physical/environmental hazards (I was really scared); and (3) maternity system: compromised care capacity (The hospital was condemned). The themes related to resilience included: (1) individual: personal coping strategies (Being calm); (2) household/community: mutual psychosocial and tangible support (We shared our resources); and (3) the maternity system: continuity of high-quality care (On top of their game). CONCLUSIONS A socioecological approach provides a useful framework to understand how risk and resilience influence the experience of maternal hurricane exposure. As the frequency of the most intense hurricanes is expected to increase, clinicians, governments, and health systems should work collaboratively to implement hurricane preparedness and response plans that address pregnant women's unique needs and promote optimal maternal-infant health.
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Affiliation(s)
- Noelene K. Jeffers
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Deborah Wilson
- grid.21107.350000 0001 2171 9311Johns Hopkins University School of Nursing, Baltimore, MD USA
| | - Hannah Tappis
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Jhpiego, MD Baltimore, USA
| | - Desiree Bertrand
- grid.410427.40000 0001 2284 9329Augusta University College of Nursing, GA Augusta, USA
| | - Tener Veenema
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Nancy Glass
- grid.21107.350000 0001 2171 9311Johns Hopkins University School of Nursing, Baltimore, MD USA
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Buckley TD, Becker TD, Burnette D. Validation of the abbreviated Lubben Social Network Scale (LSNS-6) and its association with self-rated health amongst older adults in Puerto Rico. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5527-e5538. [PMID: 36039906 DOI: 10.1111/hsc.13977] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Social isolation is a well-established determinant of late-life well-being, and it may be particularly relevant for older adults in Puerto Rico following Hurricane María. The abbreviated Lubben Social Network Scale (LSNS-6) is a widely used measure of social isolation, but it has not been validated with Spanish-speaking older adults. The objectives of this study were to (1) assess the psychometric properties of a Spanish-language LSNS-6 and (2) examine its association with self-rated health (SRH) and psychological sense of community (PSOC). Data came from face-to-face survey interviews with a nonprobability sample of 154 community-dwelling older adults in Puerto Rico 2 years after Hurricane María. We assessed the LSNS-6's internal consistency reliability and convergent validity. We then conducted structural equational modelling consisting of (1) a measurement model using confirmatory factor analysis to test the factor structure of the LSNS-6 and (2) a structural model using path analysis to examine the direct effect of social isolation on SRH and to test the role of PSOC as a mediator in this relationship. The LSNS-6 demonstrated acceptable internal consistency reliability (α = 0.74) and convergent validity, r(151) = -0.33, p < 0.001. A correlated two-factor model (Family and Friends) provided the best fit (comparative fit index = 0.986, Tucker-Lewis index = 0.975, root mean square error of approximation = 0.082, standardised root mean squared residual = 0.033). Path model results show the Friends factor was negatively associated with SRH (β = -0.31, p = 0.045), whilst the Family factor was nonsignificant. The Friends factor had a statistically significant indirect effect on SRH through PSOC (β = 0.08, 95% CI [0.01, 0.29]). Our findings provide insight into the effect of social isolation on health amongst older adults in Puerto Rico and highlight the potential role of PSOC for assessment and intervention with older adults in post-disaster settings.
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Affiliation(s)
- Thomas D Buckley
- School of Social Work and Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd D Becker
- School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Denise Burnette
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
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15
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Haverhals LM. How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13243. [PMID: 36293827 PMCID: PMC9603221 DOI: 10.3390/ijerph192013243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
In September 2017, Hurricane Maria devastated Puerto Rico, causing extensive infrastructure damage and a significant number of deaths. In the months and years since, recovery from Maria has been slow, hampered by delayed delivery of fiscal aid, corruption, economic hardships, and Puerto Rico's colonial status. Simultaneously, Puerto Rico's population is rapidly aging and hundreds of thousands of mostly younger Puerto Ricans are migrating out of Puerto Rico for more opportunities. Many Puerto Ricans who are older or disabled and need long-term care receive this care in home-based environments, as Puerto Rico has minimal institutionalized long-term care infrastructure and limited funding to expand it. The Department of Veterans Affairs (VA) offers several home-based long-term care options for Veterans in Puerto Rico. In this qualitative case study, veterans, VA staff, veterans' caregivers, caregivers' family members, and veterans' family members receiving or involved with providing this care were interviewed regarding their experiences during and after Hurricane Maria. Specifically, this study highlights how social determinants of health of those residing in or involved with VA home-based long-term care programs influenced recovery from Hurricane Maria, and how findings can inform disaster recovery and provision of home-based long-term care going forward.
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Affiliation(s)
- Leah M. Haverhals
- Denver-Seattle VA Center of Innovation for Value Driven & Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, 1700 N. Wheeling St., Aurora, CO 80045, USA; ; Tel.: +1-720-331-4176
- Department of Health Care Policy & Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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16
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Acosta-Coll M, Morales A, Zamora-Musa R, Butt SA. Cross-Evaluation of Reflectivity from NEXRAD and Global Precipitation Mission during Extreme Weather Events. SENSORS 2022; 22:s22155773. [PMID: 35957327 PMCID: PMC9370905 DOI: 10.3390/s22155773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023]
Abstract
During extreme events such as tropical cyclones, the precision of sensors used to sample the meteorological data is vital to feed weather and climate models for storm path forecasting, quantitative precipitation estimation, and other atmospheric parameters. For this reason, periodic data comparison between several sensors used to monitor these phenomena such as ground-based and satellite instruments, must maintain a high degree of correlation in order to issue alerts with an accuracy that allows for timely decision making. This study presents a cross-evaluation of the radar reflectivity from the dual-frequency precipitation radar (DPR) onboard the Global Precipitation Measurement Mission (GPM) and the U.S. National Weather Service (NWS) Next-Generation Radar (NEXRAD) ground-based instrument located in the Caribbean island of Puerto Rico, USA, to determine the correlation degree between these two sensors’ measurements during extreme weather events and normal precipitation events during 2015–2019. GPM at Ku-band and Ka-band and NEXRAD at S-band overlapping scanning regions data of normal precipitation events during 2015–2019, and the spiral rain bands of four extreme weather events, Irma (Category 5 Hurricane), Beryl (Tropical Storm), Dorian (Category 1 hurricane), and Karen (Tropical Storm), were processed using the GPM Ground Validation System (GVS). In both cases, data were classified and analyzed statistically, paying particular attention to variables such as elevation angle mode and precipitation type (stratiform and convective). Given that ground-based radar (GR) has better spatial and temporal resolution, the NEXRAD was used as ground-truth. The results revealed that the correlation coefficient between the data of both instruments during the analyzed extreme weather events was moderate to low; for normal precipitation events, the correlation is lower than that of studies that compared GPM and NEXRAD reflectivity located in other regions of the USA. Only Tropical Storm Karen obtained similar results to other comparative studies in terms of the correlation coefficient. Furthermore, the GR elevation angle and precipitation type have a substantial impact on how well the rain reflectivity correlates between the two sensors. It was found that the Ku-band channel possesses the least bias and variability when compared to the NEXRAD instrument’s reflectivity and should therefore be considered more reliable for future tropical storm tracking and tropical region precipitation estimates in regions with no NEXRAD coverage.
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Affiliation(s)
- Melisa Acosta-Coll
- Department of Computer Science and Electronic, Universidad de la Costa, Barranquilla 080002, Colombia
- Correspondence:
| | - Abel Morales
- Department of Electrical Engineering, University of Puerto Rico at Mayagüez, Mayagüez, PR 00681-9018, USA;
| | - Ronald Zamora-Musa
- Department of Industrial Engineering, Universidad Cooperativa de Colombia UCC, Barrancabermeja 687031, Colombia;
| | - Shariq Aziz Butt
- Department of Computer Science, The University of Lahore, Lahore 54000, Pakistan;
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17
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Buckley TD, Kim K, Burnette D. Psychometric testing of the Brief Sense of Community Scale with older adults in Puerto Rico. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2116-2129. [PMID: 34817078 DOI: 10.1002/jcop.22758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
The Brief Sense of Community Scale (BSCS) is a well-validated measure of psychological sense of community (PSOC), but it has yet to be tested with Spanish-speaking older adults. The current study uses data from face-to-face interviews with a non-probability sample of 154 community-dwelling older adults in Puerto Rico. We used confirmatory factor analysis (CFA) to test three competing factor structures. We also tested internal consistency reliability and convergent validity. CFA results show the second-order four-factor model was the best fit (χ2 (16) = 20.78, p = 0.187; CFI = 0.997, TLI = 0.995, SRMR = 0.026, RMSEA = 0.044, 90% CI [<0.001, 0.092]). The BSCS showed good reliability (α = 0.85) and was correlated in the expected direction with social network size (r = 0.34, p < 0.001) and loneliness (r = -0.27, p < 0.001). These findings indicate that the BSCS comprises the four domains (membership, needs fulfillment, emotional connection, and influence) from the original PSOC theory. These results inform theory development and can aid program planning, policy, and practice with older adults in Puerto Rico.
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Affiliation(s)
- Thomas D Buckley
- School of Social Work and Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyeongmo Kim
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Denise Burnette
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
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18
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Olivero-Lora S, Rojas-Sandoval J, Meléndez-Ackerman EJ, Orengo-Rolón JL. Hurricane driven changes in vegetation structure and ecosystem services in tropical urban yards: a study case in San Juan, Puerto Rico. Urban Ecosyst 2022. [DOI: 10.1007/s11252-022-01236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Rodríguez-Alejandro O, Torres-Lugo NJ, Mangual-Pérez D, Colón-Miranda R, Sánchez-Fernández H, López-Ventosa J, Pagán-Molderhauer C, Ramírez N, Otero-López A. Orthopaedic trauma epidemiology after Hurricane Maria in the Puerto Rico Trauma Centre. INTERNATIONAL ORTHOPAEDICS 2022; 46:1447-1453. [PMID: 35460368 DOI: 10.1007/s00264-022-05409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Hurricane Maria is the most devastating natural phenomenon in the recent history of Puerto Rico. Due to its destructive path through the island, the Puerto Rico Trauma Center (PRTC) remained the only hospital managing orthopaedic trauma in the immediate post-disaster period. We investigated the impact of this hurricane on the orthopaedic trauma epidemiology in the PRTC. METHODS We evaluated the admissions by the orthopaedic surgery service in terms of demographics, mechanisms of injury, and orthopaedic diagnoses for two months after the impact of Hurricane Maria (HM) on September 20, 2017. We compared our study group with the same two month period for two years prior (2015 and 2016) and after (2018 and 2019) as control periods. A p value of < 0.05 was considered statistically significant. RESULTS We included 384 admissions from September 20 to November 20, 2017. The majority were males (63%) and had an average age of 54 years. The most-reported mechanism of injury was fall from standing height (FFSH), showing a significant increment compared with the control periods. Contrarily, motor vehicle accidents (MVA) showed a significant reduction. Among the orthopaedic diagnoses, the hip + pelvis category showed a significant decline within the study group. CONCLUSIONS This study highlighted the impact of HM on the orthopaedic trauma epidemiology at the PRTC. Our findings provide valuable evidence to healthcare institutions to better prepare to manage the potential changes in the orthopaedic trauma epidemiology after a major atmospheric event.
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Affiliation(s)
- Omar Rodríguez-Alejandro
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
| | - Danny Mangual-Pérez
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Roberto Colón-Miranda
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Héctor Sánchez-Fernández
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - José López-Ventosa
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Norman Ramírez
- Department of Orthopaedic Surgery, Mayagüez Medical Centeu, Mayagüez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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20
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Liu MM, Crowe M, Telles EE, Jiménez-Velázquez IZ, Dow WH. Color disparities in cognitive aging among Puerto Ricans on the archipelago. SSM Popul Health 2022; 17:100998. [PMID: 35967472 PMCID: PMC9366965 DOI: 10.1016/j.ssmph.2021.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023] Open
Abstract
This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.
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Affiliation(s)
- Mao-Mei Liu
- Department of Demography, University of California Berkeley, 2232 Piedmont Avenue, Berkeley, CA, 94720, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama, Birmingham, Campbell Hall, Rm 334, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Edward E. Telles
- Department of Sociology, University of California Irvine, 4171 Social Science Plaza A, Irvine, CA, 92697-5100, USA
| | - Ivonne Z. Jiménez-Velázquez
- School of Medicine & Department of Medicine, University of Puerto Rico, Medical Sciences Campus PO Box 365067, San Juan, PR, 00936-5067, USA
| | - William H. Dow
- Department of Demography, University of California Berkeley, 2232 Piedmont Avenue, Berkeley, CA, 94720, USA
- School of Public Health, University of California Berkeley, 2121 Berkeley Way #5324, Berkeley, CA, 94720, USA
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21
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Roelofs C. Total Worker Health® Employer Preparedness: A Proposed Model and Survey of Human Resource Managers' Perceptions. Disaster Med Public Health Prep 2022; 17:e91. [PMID: 35179110 PMCID: PMC9385882 DOI: 10.1017/dmp.2021.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Recent disasters have demonstrated gaps in employers' preparedness to protect employees and promote their well-being in the face of disruptive events. Our objective was to develop a useful strategy for advancing comprehensive employer preparedness and to assess employer preparedness in a sample of employers. METHODS A Total Worker Health Employer Preparedness Model was developed to include seven domains: planning, human resources policies, hazard reduction, training, staffing, communications, and resources for resilience. A Survey and scoring Index based upon the Model were administered to human resources professionals in the northeast United States. RESULTS Seventy-six responded, representing diverse employment sectors. The mean Index score was 8.8 (out of 23), which is a moderate level of preparedness. Nine scored over 15, indicating greater preparedness. Thirteen scored 0. Employers were most prepared for severe weather events and least prepared for acts of violence. There were no significant differences by sector, size, or reach, although the health-care sector reported higher scores. CONCLUSIONS This unique attempt to assess TWH Employer Preparedness can serve as the basis of important further study that strengthens the empirical basis of the construct. Additionally, the Model, Survey, and Index can assist employers in advancing their preparedness for all hazards.
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Affiliation(s)
- Cora Roelofs
- Center for the Promotion of Health in the New England Workplace, Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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22
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Padilla M, Rodríguez-Madera SL, Varas-Díaz N, Grove K, Rivera S, Rivera K, Contreras V, Ramos J, Molina RV. Red tape, slow emergency, and chronic disease management in post-María Puerto Rico. CRITICAL PUBLIC HEALTH 2022; 32:485-498. [PMID: 36118129 PMCID: PMC9481060 DOI: 10.1080/09581596.2021.1998376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n=20) health care providers and administrators (n=42), and policy makers (n=5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as the manifestation of colonial legacies of disaster management and health care. They describe a precarious existence in perpetual "application pending" status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance.
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Affiliation(s)
- Mark Padilla
- Department of Global & Sociocultural Studies, Florida International University
| | | | - Nelson Varas-Díaz
- Department of Global & Sociocultural Studies, Florida International University
| | - Kevin Grove
- Department of Global & Sociocultural Studies, Florida International University
| | - Sergio Rivera
- Department of Community Health and Health Policy, City University of New York
| | - Kariela Rivera
- Social Sciences Department, Medical Sciences Campus, UPR
| | | | - Jeffrey Ramos
- School of Behavioral and Brain Sciences, Ponce Health Science University
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McClarty L, Lazarus L, Pavlova D, Reza-Paul S, Balakireva O, Kimani J, Tarasova T, Lorway R, Becker ML, McKinnon LR. Socioeconomic Burdens of the COVID-19 Pandemic on LMIC Populations with Increased HIV Vulnerabilities. Curr HIV/AIDS Rep 2021; 19:76-85. [PMID: 34822064 PMCID: PMC8614077 DOI: 10.1007/s11904-021-00591-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. Summary COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.
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Affiliation(s)
- Leigh McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Daria Pavlova
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Sushena Reza-Paul
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Ashodaya Samithi, Mysuru, India
| | - Olga Balakireva
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
- Institute for Economics and Forecasting, Ukrainian National Academy of Sciences, Kyiv, Ukraine
| | - Joshua Kimani
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, University of Nairobi, Nairobi, Kenya
| | - Tetiana Tarasova
- Ukrainian Institute for Social Research After Oleksandr Yaremenko, Kyiv, Ukraine
| | - Robert Lorway
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, 504-745 Bannatyne Ave, Winnipeg, MB, R3E 0J9, Canada.
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, University of Nairobi, Nairobi, Kenya.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
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24
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García C, Rivera FI, Garcia MA, Burgos G, Aranda MP. Contextualizing the COVID-19 Era in Puerto Rico: Compounding Disasters and Parallel Pandemics. J Gerontol B Psychol Sci Soc Sci 2021; 76:e263-e267. [PMID: 33112945 PMCID: PMC7665778 DOI: 10.1093/geronb/gbaa186] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The COVID-19 outbreak has worsened the ongoing economic crisis in Puerto Rico by creating "parallel pandemics" that exacerbate socioeconomic and health inequalities experienced by its most vulnerable residents. Unfortunately, conditions on the island have been largely overlooked by national media outlets and the mainland U.S. population. Thus, this research report aims to draw attention to the disparate burden multiple and compounding disasters have on older island-dwelling Puerto Rican adults' health and well-being. METHODS We characterize the lived experiences of the older population in Puerto Rico by incorporating data from multiple sources and contextualizing the effects of compounding disasters, the fiscal pandemic, and health care challenges to provide a more nuanced portrait of existing compounding factors that negatively affect the health and well-being of older adults in the era of COVID-19. RESULTS We highlight 2 main factors that exacerbate pre-pandemic inequities experienced by the older adult population amid the COVID-19 pandemic in Puerto Rico: (a) the impact of multiple and compounding disasters; and (b) health care challenges. DISCUSSION The human suffering of the Puerto Rican population is compounded by the consequences of fiscal austerity, increasing levels of income and wealth inequality, the debt crisis, significant emigration, and a dysfunctional health care system. Future governmental actions are required to lessen the burden of parallel pandemics on older adults in Puerto Rico.
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Affiliation(s)
| | - Fernando I Rivera
- Department of Sociology and Puerto Rico Research Hub, University of Central Florida, Orlando
| | - Marc A Garcia
- Department of Sociology and Institute for Ethnic Studies, University of Nebraska-Lincoln
| | - Giovani Burgos
- Department of Sociology and Criminal Justice, Adelphi University, Garden City, New York
| | - María P Aranda
- Suzanne Dworak-Peck School of Social Work and Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles
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25
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Cash-Gibson L, Pericàs JM, Martinez-Herrera E, Benach J. Health Inequalities in the Time of COVID-19: The Globally Reinforcing Need to Strengthen Health Inequalities Research Capacities. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2021; 51:300-304. [PMID: 33684016 PMCID: PMC8191151 DOI: 10.1177/0020731421993939] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and concern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society's unmet needs.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
- Institute for Research, Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín, Colombia
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
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26
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Vega Ocasio D, Pérez Ramos JG, Dye TDV. Conducting an immersive community-based assessment of post-hurricane experience among Puerto Ricans: lived experience of medical ecology in an environmental disaster and migration. BMC Public Health 2020; 20:1628. [PMID: 33121460 PMCID: PMC7596926 DOI: 10.1186/s12889-020-09735-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background Two devastating sequential hurricanes impacted Puerto Rico during September of 2017. The hurricanes were traumatic and created social and ecological upheaval throughout Puerto Rico, and subsequently in communities of Central Florida where affected Puerto Ricans migrated. The 2017 hurricane season exposed and exacerbated previous long-standing socio-political, economic, environmental, and health crises, generating a humanitarian emergency in the country. The consequences of these human-ecological disasters destroyed much of Puerto Rico’s residential and environmental infrastructure, displacing thousands of people and resulting in an unprecedented migration to the United States. We report on the lived experience of the investigator team and partnership in conducting community-based formative research subsequent to this disaster, research that aimed to identify salient issues relating to the impact of Hurricanes Irma and María on Puerto Rican communities both in Puerto Rico and in Central Florida. Discussion The challenges faced during the conduct of this research include but are not limited to (1) emotional distress of participants and team members, (2) access to affected populations, and (3) precarious environmental factors, such as unstable infrastructure. To address these challenges, the researchers applied a Critical Medical Ecological paradigm along with qualitative methods to assist constructing explanatory models while obtaining internally-valid (from the community perspective), cathartic narrative accounts of the lived experience of hurricane survivors. The experience of the research team may help inform other investigators conducting applied research during a humanitarian crisis. Conclusion Lessons learned in this research included: (1) usefulness of applying the Critical Medical Ecological model in the development of the project, (2) incorporating participation and methods that prioritize authenticity, (3) understanding the trauma experience and using study methods sensitive to it, and (4) innovating with best approaches to conduct the study given the challenges in post-hurricane Puerto Rico. These lessons could provide new insights on how to conduct in-depth participatory health research with community members who have been traumatized and – often – displaced. This research also demonstrates the value of pre-existing partnerships, critical consciousness in the field team, and medical ecological modeling as experiential for organizing complex, inter-related, multi-level variables that explain community and individual impact of environmental disasters.
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Affiliation(s)
- D Vega Ocasio
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
| | - J G Pérez Ramos
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - T D V Dye
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
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27
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Pérez-Ramos JG, McIntosh S, Barrett ES, Vélez-Vega CM, Dye TD. Qualitative Assessment of Environmental Health Risk Perceptions and Community Challenges in a Puerto Rican Community: Change and Continuity in Response to Hurricanes Irma and María. Behav Med 2020; 46:231-244. [PMID: 31860413 PMCID: PMC8783134 DOI: 10.1080/08964289.2019.1700894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Culebra, a geographically isolated island located 17 miles from the eastern coast of Puerto Rico's main island, suffers from an amalgam of significant environmental health risk and associated social determinants of health that are affecting the community. In 2017, two major Hurricanes (Irma and María) impacted Culebra, resulting in an increase of preexisting environmental health risk. The present study's primary aim was to explore community attitudes, beliefs, and perceptions of environmental health risk, and to describe the social priorities of Culebrenses in relation to these risks and challenges. Semi-structured interview guide and Rapid Qualitative Inquiry (RQI) focused on topics of environmental health risk was followed. Qualitative focus groups and individual interviews were conducted among community members in Culebra before and shortly after Hurricanes Irma and María affected the island. Environmental health factors identified included: presence of mosquitoes, trash disposal, water quality and tourism. Additionally, a strong sentiment of island pride was found potentially generating a sense of community that could facilitate solutions to the existing environmental health challenges. Preexisting environmental health risk magnified after the pass of Hurricanes Irma and María. Sustainable and community engagement approaches are needed to develop strategies that can assist in the mitigation and resolution of the identified environmental health risk and challenges, including factors associated with threats such as disasters and pollution.
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Affiliation(s)
- José G. Pérez-Ramos
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center
| | | | | | - Timothy D. Dye
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry
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