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Research Interests: Medicine, Community Health Workers, Population, Humans, Blood Glucose, and 15 moreDiabetes mellitus, United States, Female, Florida, Male, Psychological Intervention, Glycemic Index, Aged, Middle Aged, Adult, Randomized Controlled Trial, Type 2 Diabetes Mellitus, Self monitoring of blood glucose, Clinical Pharmacology and Therapeutics, and Pharmacology and pharmaceutical sciences
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Background: Haitian Immigrant women, the largest growing Black ethnic group in Miami, experience the highest rates of cervical cancer and account for one of the largest populations diagnosed with HIV/AIDS in South Florida. Objective:... more
Background: Haitian Immigrant women, the largest growing Black ethnic group in Miami, experience the highest rates of cervical cancer and account for one of the largest populations diagnosed with HIV/AIDS in South Florida. Objective: Using community-based participatory research methods, we examined HPV/cervical cancer knowledge and intervention preferences among HIV positive Haitian women. This data was used to develop and pilot test a culture-specific educational intervention among HIV positive and sexually active HIV negative Haitian women in Miami, Florida. The pilot study was conducted in two phases. Methods: Phase 1: Qualitative, August 2011: Three focus groups with 21 HIV-positive Haitian women living in Miami, Florida were completed in Haitian Kreyol, digitally recorded, and later interpreted and transcribed into English. The first focus group assessed HPV Knowledge; the second session explored HPV considerations specific to HIV positive women, and the third focus group discussed HPV Screening and intervention preferences. Phase 2: Quantitative, July 2012 – Nov 2012: Using feedback from the focus groups, a flip-chart with educational illustrations was developed. Five small group (3-10 participants) HPV/Cervical Cancer education sessions led by a community health worker were conducted with 25 sexually active Haitian women (8 HIV + and 13 HIV –). Surveys assessing HPV/Cervical Cancer knowledge, screening behaviors, and research participation were administered at baseline and 3 months post-study. Results: Three month follow up data was collected on 21 of the 25 women who participated in Phase 2 of the study. Participants' mean age was 52+8yrs, 71% lived in US > 5 years, and 71% were uninsured. At post study, the percent of women answering > 4/6 questions correct increased from 10% to 28% and the number of women who heard of HPV increased from 48% to 81%. All (100%) of participants were willing to participate in a research study. Conclusions: An intensive one time small group educational intervention was associated with small improvements in cervical cancer / HPV knowledge at 3 months. Our findings show strong support for increased clinical research targeting low SES Haitian women. Citation Format: Sonjia Kenya, Marie Fatil, Tulay Koru-Sengul, Erin Kobetz, Olveen Carrasquillo. HPV awareness prevents positive infections. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A45. doi:10.1158/1538-7755.DISP13-A45
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Objective:To examine the association of acculturation with various cardiovascular risk factors (CRFs) among Latinos with diabetes in South Florida.Methods:In a cross-sectional analysis of data collected from 300 Latinos with poorly... more
Objective:To examine the association of acculturation with various cardiovascular risk factors (CRFs) among Latinos with diabetes in South Florida.Methods:In a cross-sectional analysis of data collected from 300 Latinos with poorly controlled diabetes we measured acculturation using the Marin Short Acculturation Scale. We examined correlations between acculturation and the following 7 CRFs: hemoglobin A1C, low-density lipoprotein, systolic blood pressure, body mass index, smoking status, physical activity, and fruit and vegetable intake.Results:Cubans made up 38% of our population; no other Latino subgroup represented over 17% of the sample. Of the 8 outcomes examined, only smoking was associated with increased acculturation; 12% of Latinos in the 2 lowest acculturation groups were current smokers versus 25% in the highest acculturation group (P=0.02). Furthermore, Cuban Americans from our sample had over double the prevalence of smoking compared with non-Cubans in both the lowest and highest acculturation groups.Conclusions:With the exception of smoking, our data does not support a link between increased acculturation and higher prevalence of CRFs in Latinos with diabetes. Smoking prevention and cessation programs targeting Latinos and particularly among Cubans are needed.
Research Interests: Demography, Health Behavior, Acculturation, Medicine, Applied Economics, and 15 moreHumans, Diabetes mellitus, Blood Pressure, Female, Florida, Male, Body Mass Index, Medical Care, Prevalence, Middle Aged, Public health systems and services research, Cardiovascular Diseases, Risk Factors, Cross sectional Study, and Cross Sectional Studies
Research Interests: Program Evaluation, Health Psychology, Medication Adherence, Public Health, Adolescent, and 15 moreMedicine, Community Health Workers, Humans, Female, Florida, Male, Patient Satisfaction, African Americans, Middle Aged, Questionnaires, Adult, Public health systems and services research, Highly Active Antiretroviral Therapy, Home Care Services, and HIV infections
Research Interests: Medicine and Low Income
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Objectives. To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes.Methods. We conducted a single-blind randomized trial of 300 adults with poorly... more
Objectives. To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes.Methods. We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records.Results. Participants randomized to the community health worker intervention self-reported fewer problems accessing needed care and prescriptions than did those in the usual care group (30% vs 43% and 28% vs 41%, respectively; P < .05 for both). Adjusting for age, gender, education, depression, and comorbidities showed similar results (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.93 and OR = 0.45; CI = 0.24, 0.82, respectively). We found no significant utilization differences in primary care visits, emergency department utilization, or hospitalization between the 2 groups.Conclusions. Among Latinos with poorly controlled diabetes, a 1-year community health worker intervention was associated with improvements in self-reported access to care but not service utilization.
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Sixty percent of African Americans have had an HIV test, yet this population disproportionately contributes to AIDS mortality, suggesting that testing is not occurring early enough to achieve optimal outcomes. OraQuick, the first Food and... more
Sixty percent of African Americans have had an HIV test, yet this population disproportionately contributes to AIDS mortality, suggesting that testing is not occurring early enough to achieve optimal outcomes. OraQuick, the first Food and Drug Administration-approved home-based HIV rapid test (HBHRT) could potentially increase testing rates. We assessed whether community health workers (CHWs) paired with HBRHT could improve HIV screening and health care access among African Americans in Miami, Florida. In October-November 2013, 60 African Americans were enrolled and randomized to the experimental condition, which received CHW assistance to complete HBHRT, or the control condition, which were instructed to complete HBHRT independently. Intervention participants were significantly (p≤ .05) more likely than control participants to complete HBHRT and, if positive, get linked to HIV care (100% vs. 83%) χ(2)(1,N= 60) = 5.46,p≤ .02. We concluded that CHW-assisted HBHRT may be a promising strategy to improve HIV testing and care among African Americans.
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Research Interests: Nursing, Gerontology, Focus Groups, Cultural Competency, Adolescent, and 15 moreMedicine, Community Based Participatory Research, Community Health Workers, Population, Humans, Female, Feasibility Studies, Florida, Male, African Americans, Miami, Middle Aged, Adult, mass Screening, and HIV infections
Research Interests: Business and Health Care
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Miami-Dade leads the nation in new HIV infections, and its Black communities experience the greatest disparities in outcomes. Our prior research found that street-based HIV testing facilitated by community health workers improved access... more
Miami-Dade leads the nation in new HIV infections, and its Black communities experience the greatest disparities in outcomes. Our prior research found that street-based HIV testing facilitated by community health workers improved access to testing and care among Black adults in a controlled trial setting. Herein, we describe our efforts translating this CHW-led intervention into a community service for diverse Blacks in Miami. From December 2016 through August 2017, CHWs educated 1672 individuals about HIV transmission, prevention methods, and risk factor modification; 529 received HIV testing and/or linkage to care services. Approximately 5% of participants (n = 26) had rapid reactive results. This efficacious and culturally-acceptable model represents a powerful change in the delivery of HIV care and demonstrates how public health leaders can foster community engagement in the transition from research to service.
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Research Interests: Business and Health Care
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We created a faculty development programme of virtual peer-led discussion groups for medical school faculty called CIRCLE groups (Colleague Involved in Reaching Colleagues through Listening and Empathy). The programme was delivered... more
We created a faculty development programme of virtual peer-led discussion groups for medical school faculty called CIRCLE groups (Colleague Involved in Reaching Colleagues through Listening and Empathy). The programme was delivered through synchronous virtual (talk groups) and asynchronous text-based (text groups) communication platforms. We obtained accreditation for Continuing Medical Education (CME) by highlighting the links between professional wellbeing and quality of care and evidence of benefits of peer discussion groups. Conferring CME credits represents a novel way to acknowledge the educational value of peer-based programmes to enhance professional well-being and is innovative for text-based activities. We offered the programme to faculty of two medical schools as open enrolment. The self-formed groups of five to nine individuals selected between meeting synchronously on a virtual platform for 1 h or communicating asynchronously over 1 week using an encrypted text messaging platform. Twice a month for 6 months, participants were e-mailed an evidence-informed topic and prompts to conduct discussions. Topics included meaning in medicine, adverse clinical outcomes, patient encounters, mindfulness, burnout and resilience, presented in context of COVID-19. Each topic conferred 1 h of CME credit. We encouraged participants to listen/read texts attentively, avoid trying to ‘fix’ their colleagues' problems, tolerate silence/pauses and uphold confidentiality. Demographic information was obtained through the schools' faculty affairs offices. A short online anonymous survey was administered at the beginning, mid-point and end of the programme including measures of interpersonal disengagement and professional fulfilment from the Professional Fulfillment Index by Trockel et al (2018). We conducted focus groups about participants' experiences.
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Research Interests: Medicine, Humans, Blood Glucose, Diabetes mellitus, New York City, and 15 moreFemale, Aged, Middle Aged, Family Health, Adult, Abdominal Fat, Risk Factors, Cross Sectional Studies, Glucose Intolerance, Early Diagnosis, Electric Impedance, Diabetes Technology, Adiposity, Community health services, and prediabetic state
Research Interests: Communication, Health Behavior, Medication Adherence, Medicine, Humans, and 14 moreFemale, Alcohol Drinking, Florida, Male, Aged, Middle Aged, Questionnaires, Adult, Binge drinking, Public health systems and services research, Pilot Projects, Cross Sectional Studies, professional patient relations, and HIV infections
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The authors administered the National College Health Risk Behavior Survey to 1,219 college students who were attending a historically Black college located in New York City. They assessed the US-born Black students and Black students who... more
The authors administered the National College Health Risk Behavior Survey to 1,219 college students who were attending a historically Black college located in New York City. They assessed the US-born Black students and Black students who emigrated to the United States for differences in risky sexual behaviors, risky dietary behaviors, and physical inactivity. They used bivariate and multiple regression analyses to analyze the data and observed significant differences between the US-born and non-US-born students in the behavioral domains of risky sexual behaviors (p = .003), risky dietary behaviors (p = .001), and physical inactivity (p = .010). They conclude that immigration is associated with health protective behavior in the domains of sexual behavior and physical activity among the Black college students attending this particular institution. However, in the domain of dietary intake, immigration status was associated with increased risk in these Black college students.
Research Interests: Health Behavior, Immigration, Diet, Adolescent, Immigrants, and 15 moreCultural Differences, Humans, Correlation, New York City, Female, College Students, Male, Exercise, American, Comparative Analysis, African Americans, Adult, Public health systems and services research, Health surveys, and Health risk
Latinos are the largest minority population in the United States and are diagnosed with diabetes at nearly twice the rate of non-Hispanic whites. Latinos not only suffer disproportionately from diabetes but also from diabetes related... more
Latinos are the largest minority population in the United States and are diagnosed with diabetes at nearly twice the rate of non-Hispanic whites. Latinos not only suffer disproportionately from diabetes but also from diabetes related complications, including sexual dysfunction. Much of the existing literature on sexual dysfunction among Latinos with diabetes has focused on erectile dysfunction (ED). There is a dearth of information on sexual functioning among Latina women with diabetes or information on both genders in other sexual domains. Our study examined the prevalence of sexual dysfunction among a cohort of 106 poorly controlled Latino diabetics in South Florida who participated in the Miami Healthy Heart Initiative, an NIH/NLBI sponsored clinical trial addressing diabetes management among Latinos. We explored gender differences in various domains of sexual health and examined the role of poor glycemic control and depression on sexual dysfunction. A large proportion of both ge...
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BACKGROUND Hispanic-Latino populations face a disproportionate stroke burden and are less likely to have sufficient control over stroke risk factors in comparison with other ethnic populations. A promising approach to improving chronic... more
BACKGROUND Hispanic-Latino populations face a disproportionate stroke burden and are less likely to have sufficient control over stroke risk factors in comparison with other ethnic populations. A promising approach to improving chronic health outcomes has been the use of community health workers (CHWs). OBJECTIVE The objective of this randomized controlled trial is to evaluate the effectiveness of a CHW intervention among Latino patients at risk of recurrent stroke. METHODS The Hispanic Secondary Stroke Prevention Initiative (HiSSPI) is a randomized clinical trial of 300 Latino participants from South Florida who have experienced a stroke within the last 5 years. Participants randomized into the CHW intervention arm receive health education and assistance with health care navigation and social services through home visits and phone calls. The intervention also includes a mHealth component in which participants also receive daily text messages (short message service). The primary out...
Research suggests that educational initiatives addressing health inequity through a historical lens can help providers better understand the root causes of disparities; however, extensive clinical demands severely limit the time that... more
Research suggests that educational initiatives addressing health inequity through a historical lens can help providers better understand the root causes of disparities; however, extensive clinical demands severely limit the time that providers can dedicate to nonmedical learning. This article describes a film-based pedagogical strategy and its capacity to influence physician knowledge and perceptions of how healthcare delivery among marginalized communities is affected by their sociocultural history. Abstract Racial minorities will account for >50% of the United States population by 2045, yet race and ethnicity persist as leading predictors of morbidity. Although minorities achieve better outcomes when treated by racially concordant providers, the number of minority physicians is disproportionately low compared with the rapidly growing minority population. This imbalance creates a cultural gap between many minority patients and their healthcare providers. Research suggests that e...
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Background Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among... more
Background Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among underserved communities is due to lack of preventive care, including screening. Barriers to disease screening include low awareness, lack of access to care and health insurance, and cultural beliefs regarding disease prevention. Our current trial aims to examine community health worker (CHW)-delivered, home-based multi-modality screening for HIV, HCV, CRC, and cervical cancer simultaneously. Design We are conducting a randomized pragmatic trial among 900 Haitian, Hispanic, and African-American participants from diverse underserved communities in South Florida. People between the ages of 50 and 65 who have not had appropriate HIV, HCV, CRC, and cervical cancer screening per United States Preventive Services Task Force (USPSTF) recommendations are el...
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Miami-Dade leads the nation in new HIV infections, and its Black communities experience the greatest disparities in outcomes. Our prior research found that street-based HIV testing facilitated by community health workers improved access... more
Miami-Dade leads the nation in new HIV infections, and its Black communities experience the greatest disparities in outcomes. Our prior research found that street-based HIV testing facilitated by community health workers improved access to testing and care among Black adults in a controlled trial setting. Herein, we describe our efforts translating this CHW-led intervention into a community service for diverse Blacks in Miami. From December 2016 through August 2017, CHWs educated 1672 individuals about HIV transmission, prevention methods, and risk factor modification; 529 received HIV testing and/or linkage to care services. Approximately 5% of participants (n = 26) had rapid reactive results. This efficacious and culturally-acceptable model represents a powerful change in the delivery of HIV care and demonstrates how public health leaders can foster community engagement in the transition from research to service.
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Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient... more
Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient education for improving chronic disease management, but none have focused on Latino stroke patients. The Hispanic Secondary Stroke Prevention Initiative is a randomized study of 200 stroke patients designed to evaluate the impact of a 12-month multi-modal Community Health Worker (CHW) and mHealth intervention on blood pressure control. Eligible participants were Latinos who experienced a mild-moderate stroke within the last five years. The CHW component included home visits, telephone calls, and daily text messages to obtain home blood pressure readings and provide patient navigation and health education. Feasibility was defined as the proportion of patients that responded to at least half the messages. Pre-post paired t-tests assessed improvements in qu...
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To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes. We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes... more
To determine whether a 1-year community health worker intervention improves access to care and service utilization among Latinos with diabetes. We conducted a single-blind randomized trial of 300 adults with poorly controlled diabetes treated in 2 public hospital clinics in Miami, Florida. We began enrollment in 2010 and completed follow-up in 2015. We examined access and utilization using self-reported measures and data from electronic medical records. Participants randomized to the community health worker intervention self-reported fewer problems accessing needed care and prescriptions than did those in the usual care group (30% vs 43% and 28% vs 41%, respectively; P < .05 for both). Adjusting for age, gender, education, depression, and comorbidities showed similar results (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.93 and OR = 0.45; CI = 0.24, 0.82, respectively). We found no significant utilization differences in primary care visits, emergency department u...
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Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited. To compare a CHW intervention with enhanced usual care. This... more
Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited. To compare a CHW intervention with enhanced usual care. This 52-week, single-blind, randomized clinical trial included 300 Latino adults aged 18 to 65 years who were treated in 2 public hospital outpatient clinics in Miami-Dade County, Florida, from July 1, 2010, through October 31, 2013. Eligible participants had a hemoglobin A1c (HbA1c) level of 8.0 or greater. Follow-up was completed January 31, 2015, and data were analyzed from March 10, 2015, to June 6, 2016. A 1-year CHW intervention consisted of home visits, telephone calls, and group-level activities. Primary outcomes included systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLC) levels, and HbA1c levels. Secondary outcomes included body mass index, medication regimen intensification, and self-reported measures of diet, physical activit...