Preventive medicine
-
Preventive medicine · Feb 2023
Impact of limited English proficiency on the control of diabetes and associated cardiovascular risk factors. The National Health and Nutrition Examination Survey, 2003-2018.
Language barriers pose a challenge to managing health conditions for various personal, interpersonal, and structural reasons. This study estimates the impact of limited English proficiency (LEP) on diabetes mellitus control and associated cardiovascular risk factors in a large representative sample of United States adults. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2003-18) was used to estimate the impact of language proficiency on glycemic control (glycated hemoglobin [HbA1c]) and cardiovascular risk status (blood pressure [BP] and low-density lipoprotein [LDL]) in adult participants with known diabetes disease. ⋯ Compared to English-speaking participants, LEP-interpreter participants were more likely to have HbA1c ≥ 7% (OR = 1.6, 95% CI = 1.1, 2.4) or a combination of HbA1c ≥ 7%, LDL ≥ 2.6 mmol/L, and BP ≥ 130/80 mmHg (OR = 3.1; 95% CI = 1.2, 8.2). We observed no differences in the odds of diabetes control. between English-speaking and LEP-Spanish participants, whereas LEP-interpreter participants had worse diabetes control, possibly owing to the greater likelihood of patient-provider language discordance for non-English non-Spanish-speaking patients. Given that many patients, yet few providers, speak languages other than English or Spanish, innovative ways are needed to facilitate patient-provider communications (e.g., digital communication assistance tools).
-
Preventive medicine · Feb 2023
Anticipatory concerns about violence within social networks: Prevalence and implications for prevention.
Most research on exposure to violence focuses on direct victimization, offending, or witnessed violence, yet many people also experience concerns about potential violence in their environments and social networks. Using a state-representative survey of California adults (n = 2870) administered in July 2020, we estimate the prevalence of anticipatory concerns about violence within respondents' social networks and describe characteristics of the persons at perceived risk of violence, reasons for respondents' concerns, and actions undertaken by respondents to reduce that risk. Approximately 1 in 5 respondents knew at least one person, usually a friend or extended family member, whom they perceived to be at risk of other- or self-directed violence. ⋯ Most respondents reported having taken action to reduce the risk of violence, including providing resources and asking family or friends to help; few acted to reduce access to lethal means. The most common reasons for inaction were the perception that a dangerous situation was unlikely and that it was a personal matter. Our findings can help inform a broader understanding of exposure to violence and interventions that leverage the knowledge of those close to persons at risk to prevent violence.
-
Preventive medicine · Feb 2023
Cluster analysis of adults unvaccinated for COVID-19 based on behavioral and social factors, National Immunization Survey-Adult COVID Module, United States.
By the end of 2021, approximately 15% of U. S. adults remained unvaccinated against COVID-19, and vaccination initiation rates had stagnated. We used unsupervised machine learning (K-means clustering) to identify clusters of unvaccinated respondents based on Behavioral and Social Drivers (BeSD) of COVID-19 vaccination and compared these clusters to vaccinated participants to better understand social/behavioral factors of non-vaccination. ⋯ This study identified, described, and compared the characteristics of the three unvaccinated subgroups. Public health practitioners, healthcare providers and community leaders can use these characteristics to better tailor messaging for each sub-population. Our findings may also help inform decisionmakers exploring possible policy interventions.
-
Preventive medicine · Feb 2023
Concurrent participation in breast, cervical, and colorectal cancer screening programmes in Denmark: A nationwide registry-based study.
Women in Denmark are invited to breast, cervical, and colorectal cancer screening in their fifties and sixties. We determined the patterns of concurrent participation in the three programmes. Participation in organised cancer screening was determined using the highly complete Danish population and health care registers for all women aged 53-65 years on 31 March 2018 who continuously resided in Denmark since 1 April 2012. ⋯ Cancer-specific patterns were highly heterogeneous across the population but changed little after accounting for women's medical history. A significant proportion of women who are screened for a specific cancer remain unscreened for other cancers. The consistency of these data at the international level requires a reconsideration of invitational practices for organised screening.
-
The concept of well-being offers researchers an alternative to understanding inequality and poverty primarily through income and consumption, and recent research has emphasized the importance of examining well-being inequality. Food insecurity has been identified as an important driver of average levels of well-being; in this paper, we show it also predicts changes in the distribution of well-being. We use individual-level data from the Gallup World Poll for 135 countries between 2014 and 2017 (N = 446,741) and apply a flexible moments-based approach. ⋯ Findings indicate that higher food insecurity is associated with higher inequality in well-being in middle- and high-income countries, but not in low-income countries. We also find that being severely food insecure correlates with peoples' well-being inequality in every income group. Understanding disparities in peoples' lives offers important, policy-relevant information that cannot be inferred from mean values alone and offers important insights to achieve SDG Goals 2 and 3 for all people.