Grettel Castro

Mental health impact of the 2010 Haiti earthquake on the Miami Haitian population: A random-sample survey

This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2–3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N = 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of post-traumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as “direct” if the interviewee was in Haiti during the earthquake. Exposure was classified as “indirect” if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondents household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as “lower” exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.

Factors affecting compliance with colorectal cancer screening among households residing in the largely Haitian community of Little Haiti, Miami-Dade County, Florida: an observational study.

AbstractThe United States Black population is disproportionately affected by colorectal cancer (CRC) in terms of incidence and mortality. Studies suggest that screening rates are lower among Blacks compared with non-Hispanic Whites (NHWs). However, studies on CRC screening within Black subgroups are lacking. This study examined disparities in blood stool test (BST) compliance and colonoscopy use by race/ethnicity (Haitian, NHW, non-Hispanic Black [NHB], and Hispanic) among randomly selected households in Little Haiti, Miami-Dade County, Florida.This study used cross-sectional, health and wellness data from a random-sample, population-based survey conducted within 951 households in Little Haiti between November 2011 and December 2012. BST compliance and colonoscopy use were self-reported and defined, conservatively, as the use of BST within the past 2 years and the ever use of colonoscopy by any household member. Factors associated with BST compliance and colonoscopy use were identified using logistic regression models. Analyses were restricted to households containing at least 1 member ≥50 years (n = 666).Nearly half of the households were compliant with BST (rate [95% confidence interval (CI)] = 45% [41%–49%]) and completed colonoscopy (rate [95% CI] = 53% [49%–58%]). Compliance with BST was not associated with race/ethnicity (P = 0.76). Factors independently associated with BST compliance included low educational attainment (adjusted odds ratio [AOR] = 0.63, P = 0.03), being single (AOR = 0.47, P = 0.004), retirement (AOR = 1.96, P = 0.01), and the presence of diagnosed health problems (AOR = 1.24, P = 0.01). Colonoscopy use was lower among Haitian households (46%) compared with NHW (63%), NHB (62%), and Hispanic households (54%) (P = 0.002). Factors independently associated with colonoscopy use included identifying as NHB (compared with Haitian) (AOR = 1.80, P = 0.05), being single (AOR = 0.44, P = 0.001), retirement (AOR = 1.86, P = 0.02), lack of continuous insurance (AOR = 0.45, P < 0.001), and the presence of diagnosed health problems (AOR = 1.44, P < 0.001) and physical limitations/disabilities (AOR = 1.88, P = 0.05).Compliance with BST and use of colonoscopy are low within households in the Little Haiti community. Significant disparities in the use of colonoscopy exist between Haitian and NHB households. Barriers and facilitators of colonoscopy within each racial/ethnic group need to be identified as the next step to developing culturally appropriate, community-based interventions aimed at increasing colonoscopy use in this large minority population.

Random sample community-based health surveys: does the effort to reach participants matter?

Objectives Conducting health surveys with community-based random samples are essential to capture an otherwise unreachable population, but these surveys can be biased if the effort to reach participants is insufficient. This study determines the desirable amount of effort to minimise such bias. Design A household-based health survey with random sampling and face-to-face interviews. Up to 11 visits, organised by canvassing rounds, were made to obtain an interview. Setting Single-family homes in an underserved and understudied population in North Miami-Dade County, Florida, USA. Participants Of a probabilistic sample of 2200 household addresses, 30 corresponded to empty lots, 74 were abandoned houses, 625 households declined to participate and 265 could not be reached and interviewed within 11 attempts. Analyses were performed on the 1206 remaining households. Primary outcome Each household was asked if any of their members had been told by a doctor that they had high blood pressure, heart disease including heart attack, cancer, diabetes, anxiety/ depression, obesity or asthma. Responses to these questions were analysed by the number of visit attempts needed to obtain the interview. Results Return per visit fell below 10% after four attempts, below 5% after six attempts and below 2% after eight attempts. As the effort increased, household size decreased, while household income and the percentage of interviewees active and employed increased; proportion of the seven health conditions decreased, four of which did so significantly: heart disease 20.4–9.2%, high blood pressure 63.5–58.1%, anxiety/depression 24.4–9.2% and obesity 21.8–12.6%. Beyond the fifth attempt, however, cumulative percentages varied by less than 1% and precision varied by less than 0.1%. Conclusions In spite of the early and steep drop, sustaining at least five attempts to reach participants is necessary to reduce selection bias.

The association between pregnancy intendedness and experiencing symptoms of postpartum depression among new mothers in the United States, 2009 to 2011: A secondary analysis of PRAMS data.

Abstract Postpartum depression (PPD) is a form of major depressive disorder affecting approximately 13% of women worldwide. Unintended pregnancies, reaching close to 50% of the pregnancies in the United States, have become a major health concern. While many physiologic and psychosocial causes have been analyzed, few studies have examined the relationship between unintended pregnancy and symptoms of PPD. A cross-sectional study was conducted using surveillance data from the Centers for Disease Control and Preventions Pregnancy Risk Assessment Monitoring System (PRAMS) from 2009 to 2011. The PRAMS population-based random sample included women who have had recent live births and is representative of 78% of the United States population. The chi-squared test was used to examine bivariate associations. Binary logistic regression was utilized to study unadjusted and adjusted associations between PPD and pregnancy intendedness, as well as other demographic and clinical characteristics of mothers in the sample. Multicollinearity in the adjusted model was evaluated using variance inflation factors. Sampling weights were used to account for PRAMS’ complex sampling design. Of the 110,231 mothers included in the sample, only 32.3% reported desiring the pregnancy at the time of conception. Women with pregnancies categorized as mistimed: desired sooner, mistimed: desired later, or unwanted were 20% (adjusted odds ratio [AOR] = 1.2; 95% confidence interval [CI]: 1.1–1.3), 30% (AOR = 1.3; 95% CI: 1.2–1.4), and 50% (AOR = 1.5; 95% CI: 1.3–1.7) more likely to experience symptoms of PPD, respectively, compared to women with desired pregnancies. Other factors found to be associated with experiencing symptoms of PPD were a gestational age of <27 weeks (AOR = 3.1; 95% CI: 2.5–4.0), having a previous history of depression (AOR = 1.8; 95% CI: 1.6–2.0), and being abused during or before pregnancy (AOR = 1.6; 95% CI: 1.4–2.0). We found that women with mistimed or unwanted pregnancies were more likely to experience symptoms of PPD. Our findings support the current US Preventive Services Task Force and American Academy of Pediatrics recommendations for an integrated approach to screening for depression, aiding in the maximization of intervention and early referral for women at risk for PPD.

Mental Health Impact of Hosting Disaster Refugees: Analyses from a Random Sample Survey Among Haitians Living in Miami.

Objectives Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts. Methods A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and friends and whether they hosted earthquake refugees. Using standardized scores and thresholds, they were evaluated for symptoms of three common mental disorders (CMDs): posttraumatic stress disorder, generalized anxiety disorder, and major depressive disorder (MDD). Results Participants who hosted refugees (n = 51) had significantly higher percentages of scores beyond thresholds for MDD than those who did not host refugees (n = 365) and for at least one CMD, after adjusting for participants’ earthquake exposures and effects on family and friends. Conclusions Hosting refugees from a natural disaster appears to elevate the risk for MDD and possibly other CMDs, independent of risks posed by exposure to the disaster itself. Families hosting refugees deserve special attention.

Examining the association between possessing a regular source of healthcare and adherence with cancer screenings among Haitian households in Little Haiti, Miami-Dade County, Florida.

Abstract Immigrant minorities regularly experience higher incidence and mortality rates of cancer. Frequently, a variety of social determinants create obstacles for those individuals to get the screenings they need. This is especially true for Haitian immigrants, a particularly vulnerable immigrant population in South Florida, who have been identified as having low cancer screening rates. While Haitian immigrants have some of the lowest cancer screening rates in the country, there is little existing literature that addresses barriers to cancer screenings among the population of Little Haiti in Miami-Dade County, Florida. The objective of this study was to evaluate the association between having a regular source of healthcare and adherence to recommended cancer screenings in the Little Haiti population of Miami. This secondary analysis utilized data collected from a random-sample, population-based household survey conducted from November 2011 to December 2012 among a geographic area approximating Little Haiti in Miami-Dade County, Florida. A total of 421 households identified as Haitian. The main exposure of interest was whether households possessed a regular source of care. Three separate outcomes were considered: adherence with colorectal cancer screening, mammogram adherence, and Pap smear adherence. Analysis was limited to households who met the age criteria for each outcome of interest. Bivariate associations were examined using the chi square test and Fisher exact test. Binary logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). After adjusting for the head of households education and household insurance status, households without a regular source of care were significantly less likely to adhere with colorectal cancer screening (OR = 0.33; 95% CI: 0.14–0.80) or mammograms (OR = 0.28; 95% CI: 0.11–0.75). Households with insurance coverage gaps were significantly less likely to adhere with mammograms (OR = 0.40; 95% CI: 0.17–0.97) or Pap smears (OR = 0.28; 95% CI: 0.13–0.58). Our study explored adherence with multiple cancer screenings. We found a strong association between possessing a regular source of care and adherence with colorectal cancer screening and mammogram adherence. Targeted approaches to improving access to regular care may improve adherence to cancer screening adherence among this unique immigrant population.

Incidence of Acute Myocardial Infarction in Patients with Diabetes and Its Association with Mortality and Cardiopulmonary Complications in Puerto Rico

Diabetes mellitus (DM) patients are at an increased risk of acute myocardial infarction (AMI). Adequate DM control may reduce in-hospital mortality and cardio-pulmonary complications after an AMI. The objective of this study was to determine whether uncontrolled DM in patients with an incidental AMI was associated with an increased risk of in-hospital mortality and selected cardio-pulmonary complications. A secondary data analysis of the Puerto Rican Cardiovascular Surveillance System during 2007, 2009, and 2011 was conducted. The study included men and women living in Puerto Rico who were hospitalized due to an incidental AMI and had information on HbA1c measurement (n=220). Patients were divided according to their HbA1c levels into two groups (i) 7% (uncontrolled). Mortality and complications were defined according to ICD-9 codes. Univariate and multivariate logistic regression models were used to test for associations between HbA1c and mortality and cardio-pulmonary outcomes. The model was adjusted for gender, obesity (BMI >30kg/m2), hyperlipidemia, hypertension, chronic obstructive pulmonary disease, smoking, insurance and age. The results revealed no statistically significant association between the controlled and the uncontrolled DM patients and mortality, respectively cardiopulmonary complications (unadjusted OR 2.1; 95% CI: 0.7-6.4; adjusted OR 2.4; 95% CI: 0.5-10.5). The uncontrolled DM group was statistically significantly younger than those with controlled DM (mean age 65.2 vs. 71.1 years; p-value 0.002). There was no statistically significant difference in the prevalence of uncontrolled DM between patients with complications (80%) and those without complication (66%; p=value 0.203). AMI patients with uncontrolled DM did not have an increased risk of mortality and cardiopulmonary complications compared to patients with controlled DM. This needs further evaluation in a larger study population and DM patients with an AMI should have HbA1c measured to estimate their risk of complications.

Factors Associated with Compliance of Blood Stool Test and Use of Colonoscopy in Underserved Communities of North Miami-Dade County, Florida

Introduction. Only two-thirds of U.S. adults are compliant with screening for colorectal cancer. This study identified factors of blood stool test (BST) compliance and colonoscopy use among randomly selected households in Miami-Dade County, Florida. Methods. This study used cross-sectional data collected 10/2009–04/2010. Analyses were restricted to 1,118 single-family homes containing a minimum of one member ≥ 50 years. Results. Half of households were compliant with BST (55%) or completed colonoscopy (55%). Factors associated with BST compliance included retirement (adjusted odds ratio[AOR]=1.57**), being uninsured (AOR=0.64**), diagnosed morbidities (AOR=1.68**), fruit/vegetable consumption (AOR=1.60**), and using alternative medicines (AOR=1.36*). Factors associated with colonoscopy included Hispanic ethnicity (AOR=0.56**), lower education (AOR=0.66*), being single (AOR=0.65*), retirement (AOR=2.01***), being uninsured (AOR=0.61**), diagnosed morbidities (AOR=2.13***), former smoking (AOR=1.94**), and fruit/vegetable consumption (AOR=1.75***)(*p<.05;**p<.01;***p<.001). Conclusion. This is the first study of factors of BST and colonoscopy in Miami-Dade County. These findings provide a basis for community-based interventions aimed at increasing screening within this population.