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Accelerometers are widely adopted for physical activity (PA) measurement. Accelerometry data require pre-processing before entering formal statistical analyses. Many pre-processing criteria may influence PA outcomes and the processed sample, impacting results in subsequent statistical analyses. To study the implications of pre-processing criteria for accelerometer data on outputs of interest in physical activity studies. We used the ActiGraph hip-worn accelerometry data from 538 adult Latino participants. We studied four most important domains of pre-processing criteria (wear-time, minimum wear-time, intensity level, and modified bouts). We examined the true sample size in pre-processed data, the moderate-to-vigorous physical activity (MVPA) outcome, and regression coefficients of age and gender predicting MVPA. Many pre-processing criteria have minimum impact to the output of interest. However, requirements for minimum wear-time can have high influence on subsequent analyses for MVPA. High requirements for wear-time (e.g., minimum of 5 days with more than 12 hours of wear-time per day) lead to weakened statistical efficiency in estimating the relationship between potential predictors and the MVPA outcome. Intensity levels using vector magnitude triaxial counts yielded drastically different results than those using conventional vertical axis counts. Moderate changes in minimum wear-time can yield notably different output data and subsequently influence analyses assessing the impacts of interventions on MVPA behaviors. Processed data using vector magnitude and conventional vertical axis counts are not directly comparable. Sensitivity analyses using alternative pre-processing scenarios are highly recommended to verify the robustness of analyses for accelerometry data.

HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.

People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.

Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity. We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes. Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress. Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.

Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants ( 45) and qualitative data from a purposive sample of participants ( 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. An HIV clinic in the northwest-central part of the Dominican Republic. The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.

Healthcare discrimination is an important barrier to accessing services among Latino populations in the United States. However, few validated scales have been developed to systematically examine this issue. In this study, we evaluated the validity and reliability of a bilingual healthcare discrimination scale in a sample of churchgoing Latino adults in Los Angeles, California. The study sample included 336 participants (foreign-born: 250; US-born: 86) who attended 12 Catholic churches in Los Angeles. Psychometric testing of the 7-item healthcare discrimination (HCD) scale included internal consistency; split-half reliability; convergent, discriminant, and predictive validity; and confirmatory factor analyses. The HCD had relatively high internal consistency (full sample Cronbach’s α = 0.92; foreign-born: 0.91; US-born: 0.92) and showed good convergent and discriminant validity, as it was moderately correlated with the depression scale (full sample r = 0.28, p < 0.001) and weakly correlated with the acculturation scale (full sample r = 0.15, p = 0.008). Confirmatory factor analyses yielded further support for a one-factor solution. Our study finds that the HCD is a valid and reliable scale for use among churchgoing Latino adult populations in the United States. Future studies should examine the psychometric properties of the HCD among Latinos of diverse backgrounds, geographic locations, religious beliefs, and languages.

Background The increasing proportion of women in the medical profession is a worldwide phenomenon often called the “feminization of medicine.” However, it is understudied in low and middle-income countries, particularly in Latin America. Methods Using a qualitative, descriptive design, we explored the influence of gender and other factors on physician career decision-making and experiences, including medical specialty and public vs. private practice, in Quito, Ecuador, through in-depth, semi-structured interviews ( n =  31) in 2014. Theoretical sampling was used to obtain approximately equal numbers of women and men and a range of medical specialties and practice settings; data saturation was used to determine sample size. Transcripts were analyzed using content coding procedures to mark quotations related to major topics and sub-themes included in the interview guide and inductive (grounded theory) approaches to identify new themes and sub-themes. Results Gendered norms regarding women’s primary role in childrearing, along with social class or economic resources, strongly influenced physicians’ choice of medical specialty and practice settings. Women physicians, especially surgeons, have had to “pay the price” socially, often remaining single and/or childless, or ending up divorced; in addition, both women and men face limited opportunities for medical residency training in Ecuador, thus specialty is determined by economic resources and “opportunity.” Women physicians often experience discrimination from patients, nurses, and, sometimes, other physicians, which has limited their mobility and ability to operate independently and in the private sector. The public sector, where patients cannot “choose” their doctors, offers women more opportunities for professional success and advancement, and the regular hours enable organizing work and family responsibilities. However, the public sector has generally much less flexibility than the private sector, making it more difficult to balance work and family responsibilities. Conclusion Women may outnumber men in medicine in Ecuador and across many parts of the world, but a number of structural issues-economic, social, and cultural-must be addressed for women to establish themselves in a wide variety of medical specialties and practice settings and for countries to realize the benefit of the investments being made to train and employ them.

This paper explores the ways in which Mexican immigrants experience, narrate, and describe stress and the extent to which it impacts their efforts at engaging in physical activity using a biocitizenship framework. Data were derived from a mixed-method study among Mexicans living in New York City recruited from a large Catholic church. The qualitative sample of 25 participated in quantitative and qualitative components of the study and as such we include some of these quantitative indicators as descriptors. Our main qualitative findings reveal that study participants experience stress and time constraint as factors that contribute to the waning of their physical and mental well-being. As such, time constraints for many of our participants were among the factors that contributed to high perceived levels of stress. They attributed this to their difficulty maintaining a physically active lifestyle due to factors like the fast-paced lifestyle in New York, working long hours, and not having enough time to exercise, though some important differences in narratives were noted across gender. Findings have implications for interventions aimed at improving the health of immigrants in general and Mexican immigrants in New York City specifically. Plain Language Summary Stress is a common reaction we all experience in our daily lives, both physically and emotionally. However, when stress persists, it can have negative effects on our health. To better understand the experiences of Mexican immigrants living in NYC, we conducted individual interviews with 25 participants. We explored their thoughts on stress, physical activity, and life in NYC, as well as how the people around them influenced their efforts. The narratives shared by the participants revealed that Mexican immigrants perceive stress as having a significant impact on their physical and mental well-being. Specifically, discussions about stress affecting their health were linked to factors such as time constraints, long working hours, and not having enough time to exercise. These findings indicate that although participants desired a healthy lifestyle, they encountered barriers that hindered their ability to engage in physical activity. Additionally, our study highlighted that men and women experience stress differently. Women often felt stressed due to household responsibilities like cooking, whereas men experienced stress related to financial obligations. Despite these gender differences, both men and women described how stress negatively affected their overall health. These findings suggest that public health interventions and programs could focus on promoting physical activity to enhance the physical and mental well-being, but these would need to be tailored to fit the needs of Mexican immigrants in New York City and other similar communities.

Background Public parks serve as spaces within neighborhoods for encouraging a variety of physical and mental health-related behaviors. Over the past decade, there have been a number of interventions conducted in public parks, often aimed at improving an aspect of mental or physical health. A common type of park-based interventions is aimed at increasing physical activity among adults and children. Methods We will conduct a systematic review of peer-reviewed articles on the effects of park-based interventions on physical and mental health outcomes of adults and youth (children and adolescents). An electronic search will be conducted in four electronic databases: Web of Science, PubMed/MEDLINE, Cochrane Library, and Scopus. Manual hand-searching of reference lists from studies identified as relevant by experts and of systematic reviews resulting from the search strategy will be conducted to further identify articles of interest. Inclusion criteria are peer-reviewed, quantitative studies, studies detailing an intervention conducted in a park setting, which was at the person-level or place-level, and studies published in English or Spanish. A three-stage approach will be used to screen title and abstracts and full-text articles against the inclusion and exclusion criteria and, lastly, extract data from eligible studies. Study quality will be assessed by the Cochrane Risk of Bias and the Community Guide’s Guide to Community Preventive Services tools. Extracted data will be summarized narratively and meta-analysis will be conducted, if appropriate. Discussion We aim to find relevant studies proving evidence for park-based intervention studies and their effects on health-related outcomes for youth and adults. The evidence obtained from the included studies will help guide future studies on park-based interventions. The study results will be submitted to a peer-reviewed journal for electronic dissemination. Systematic review registration Systematic review registration: PROSPERO CRD42018109165 .

Latinos face healthcare access barriers and are highly religious. Church-based health interventions could help address these disparities. We conducted a systematic review of church-based health interventions among Latinos using multiple search terms and databases. The 21 articles reviewed represented 19 interventions. Only six were tested through full-scale randomized controlled trials and five had statistically significant improvements in health-related outcomes. Most (16) utilized groups classes, eight promoted screening or preventive services, and three provided these on-site. Few intervened at multiple levels (e.g., individual, group, and community) and only three utilized pastors’ sermons to deliver health-related messages. Church-based health interventions among Latinos are nascent, with only a handful of full-scale trials. Various pilot studies demonstrating feasibility across diverse health conditions suggest model adaptability. Larger studies with objectively measured outcomes and interventions that address multiple levels and structural issues are needed to ensure improvements in Latinos’ access and health.