Maurice Junior Chery

Across the US, increasingly prevalent heat extremes pose diverse threats to population health and well-being, specifically among populations who bear the impacts of structural inequities. Due to sensitivities from age-related declines in thermoregulation, elevated prevalence of comorbidities, drug-induced dehydration and fatigue, as well as decreased disposable income, people with cancer are recognized as particularly susceptible to heat impacts. Yet, little empirical research has focused on this population. Our objective was to understand heat impacts, coping mechanisms, and adaptation practices among people with cancer. This qualitative study used semi-structured interviews of adults with a history of cancer in South Florida. Between May 2024 and January 2025, a total of 20 participants across 18 unique zip codes were interviewed, and data were analyzed using rapid qualitative methodology. Four key themes reflected ongoing challenges related to how people with cancer experience and adapt to heat: (1) heat interacts with health status to adversely affect quality of life among people with cancer, (2) increased cooling needs result in significant lifestyle adjustments, (3) patient-provider communications are underutilized opportunities to discuss heat risks and heat-responsive health-promoting behaviors, and (4) social support facilitates heat adaptation. Our findings indicate prevalent heat impacts among people with cancer, as well as a prioritization of access to cooling despite financial, social, and lifestyle consequences. This need to stay cool often decreased quality of life due to social withdrawal, but quality of life impacts were mitigated by social support. Our findings indicate that heat exposure may differentially affect people with preexisting conditions such as cancer, leading to social withdrawal and maladaptive behaviors, which indicates a need for heat adaptation policy tools to be tailored to the unique needs of medically vulnerable populations. Future research should seek to further our understanding of behavioral changes among people with chronic disease in response to heat exposure, specifically across regions with chronic heat and humidity.

Background: Endometrial cancer outcomes differ among Black women when examined by nativity, and timely evaluation of postmenopausal bleeding (PMB), the most common presenting symptom, may contribute to these disparities. Methods: This qualitative study explored cultural, societal, and behavioral factors shaping PMB appraisal and anticipated care-seeking among US-born Black, Caribbean-born Black, and Haitian Creole-speaking women in South Florida, guided by the Safer–Andersen Model of Total Patient Delay. Ten focus groups were conducted with 55 Black women aged ≥50 years recruited through purposive and snowball sampling. Discussions were held in English or Haitian Creole, audio-recorded, professionally transcribed, translated when needed, and analyzed thematically using a hybrid deductive–inductive approach. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. Results: Three themes emerged: limited awareness and information-seeking regarding menopause and PMB; cultural and societal influences, including faith-based coping, traditional remedies, and limited family discussion of health history; and healthcare system barriers, including cost, lack of insurance, distrust, and communication challenges with providers. Subgroup differences were noted in preferred information sources, perceived susceptibility, and the role of religion in care-seeking. Conclusions: Findings suggest that PMB appraisal and anticipated care-seeking vary by nativity and language among Black women. Nativity- and language-tailored community education and navigation strategies may improve symptom recognition and support timely evaluation, but future quantitative studies are needed to test whether these approaches reduce pre-diagnostic intervals for endometrial cancer.

Background: Haitian immigrants in the United States face health literacy challenges related to recent migration, language discordance, and unfamiliar healthcare systems, yet no general health literacy instrument has been psychometrically validated in Haitian Creole. This study translated, culturally adapted, and evaluated the Haitian Creole HLS₁₉-Q12 (HLS₁₉-Q12-HC). Methods: Haitian Creole-speaking adults without cancer diagnoses in South Florida (n = 168) completed the HLS₁₉-Q12-HC and the Haitian Creole Brief Health Literacy Screen. Translation included forward–backward procedures, expert review, and cognitive interviews (n = 7). Psychometric evaluation used confirmatory factor analysis, reliability testing, and assessment of convergent and known-groups validity. Results: Cognitive interviews supported clarity and cultural appropriateness with minor refinements. Reliability was excellent (ω = 0.949; α = 0.944; AVE = 0.584). The unidimensional model showed good fit (CFI = 0.951; TLI = 0.944; RMSEA = 0.065; SRMR = 0.048), whereas multi-factor models showed limited discriminant validity. Convergent and known-groups validity were supported. Using provisional European-derived cutpoints, 70.2% of participants were classified as having inadequate or problematic health literacy. Conclusions: The HLS19-Q12-HC showed evidence of reliability and validity as a unidimensional measure of general health literacy and may support research, needs assessment, and culturally responsive interventions for Haitian Creole-speaking populations. Findings should be interpreted in light of the convenience sample from South Florida and the predominantly female composition of the cohort.

PURPOSE: Financial barriers remain a critical issue for adolescent and young adults (AYAs, 18-39 years) with cancer, who face unique challenges because of their life stage and transitional care needs. Therefore, this study examined disparities in health care delays because of cost among AYA cancer survivors compared with older cancer survivors. METHODS: We used a nationally representative sample (taken from the National Health Interview Survey) contextualizing these trends within the evolving insurance landscape following the Affordable Care Act implementation. RESULTS: Despite an overall decline in delays across all age groups, AYAs consistently reported the highest rates of delays compared with middle-age (40-64 years) and older adult (65 years or older) survivors. Logistic regression analysis revealed that middle-age and older adults had lower odds of delays compared with AYAs (adjusted odds ratio [AOR], 0.53 [95% CI, 0.47 to 0.59], P < .0001; AOR, 0.15 [95% CI, 0.12 to 0.18], P < .0001), potentially because of their greater financial stability and insurance access, although cost-related barriers persisted for some. CONCLUSION: Our findings highlight persistent disparities in health care access because of cost among AYA cancer survivors compared with their older counterparts and emphasize the need for targeted interventions to reduce financial barriers to health care for AYAs.

Previous studies have identified racial-ethnic disparities in modifiable risk factors for cancers. However, the impact of US nativity on these risks is understudied. Hence, we assessed the association between US nativity and length of time in the US on modifiable cancer risk factors. Utilizing the 2010 and 2015 National Health Interview Survey datasets, we analyzed 8,861 US-born and non-US-born adults. Key variables included age, sex, race-ethnicity, education, income, diet, body mass index, physical activity, alcohol consumption, and smoking. Statistical methods included descriptive statistics and regression. Most respondents were US-born (n = 7,370), followed by long-term (≥15 years, n = 928), and recent (<15 years, n = 563) immigrants. Moderate-to-vigorous physical activity was higher among US-born individuals (342.45 minutes/week), compared to recent (249.74 minutes/week) and long-term immigrants (255.19 minutes/week). Recent immigrants consumed more fruits (1.37 cups/day) and long-term immigrants more vegetables (1.78 cups/day) than US-born individuals. Multivariate analyses found recent immigrants had lower odds of consuming alcohol (AOR: 0.33, 95% CI: 0.21–0.50) and smoking (AOR: 0.30, 95% CI: 0.19–0.46), and higher odds of meeting fruit consumption guidelines (AOR: 2.80, 95% CI: 1.76–4.45) compared to US-born individuals. Long-term immigrants had lower odds of alcohol consumption (AOR: 0.56, 95% CI: 0.37–0.84) and smoking (AOR: 0.42, 95% CI: 0.30–0.59), and higher odds for meeting fruit (AOR: 1.87, 95% CI: 1.22–2.86) and fiber (AOR: 2.03, 95% CI: 1.02–4.05) consumption guidelines. Our findings illustrate the importance of considering the impact nativity and length of US residency has on health. Our findings underscore the need for culturally tailored public health strategies.

Purpose: The COVID-19 pandemic has had a profound impact on mental health worldwide, with depression and sleep problems among the most common issues experienced by many individuals. Depression can lead to sleep problems, which can increase the risk of developing depressive symptoms. However, it is unclear which United States (US) sub-population was most affected by depression and sleep problems during the pandemic. Methods: We conducted a secondary analysis using self-reported data from the 2021 National Health Interview Survey (NHIS), focusing on adults aged 18 years and above (n=29,763). We utilized self-reported responses to questions about prescription medication and frequency of depressive feelings to determine participants’ depression status. Appropriate weights were applied to account for the sampling design of the surveys. Our analysis involved descriptive statistics and chi-squared tests to compare sociodemographic, clinical, behavioral, and sleep-related characteristics between US adults with and without depression. Additionally, logistic regression was used to examine the associations between sleep duration, sleep quality and depression. Results: The overall prevalence of depression in our sample was 44.4%. It were higher in certain demographic groups, including younger adults (18– 39 years, 47.7%), non-Hispanic whites (47.9%), females (50.1%), those at the lower income bracket (52.2%), those with no college or degree (48.7%) uninsured individuals (45.2%), and those reporting poor general health (71.9%). Individuals with depression had a 12% increased odds of experiencing short sleep (aOR: 1.12, 95% CI:1.04– 1.20, p< 0.001), 34% increased odds of experiencing long sleep (aOR: 1.34, 95% CI: 1.20– 1.50, p < 0.001) and more than 2.5 fold increased odds of reporting poor sleep quality (aOR:2.57, 95% CI: 2.40– 2.78; p< 0.0001). In the multivariate analysis, all variables (sex, race/ethnicity, education, health insurance coverage, marital status, general health status and use of sleep medications, smoking and alcohol use status) were significantly predictors of poor sleep quality, with the exceptions of age and family income. Conclusion: The findings emphasize the need to address sleep health in treating depression, especially during times of public health crises.

Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian communities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.

Haiti is confronting an 8-year-long cholera epidemic, which until 2017 caused at least 27000 cases annually, with over half of them being severe enough to require hospitalization. Since its emergence in October 2010, the disease has cumulatively sickened more than 810000 Haitians, killed nearly 10000, and become endemic [ 1]. Other estimates indicate a considerably higher burden, uncaptured by official numbers due to the underreporting of infections and deaths managed outside the healthcare system [ 2, 3]. Still, between 2010 and 2011, the country accounted for 57% of all cholera incidents and 45% of all related fatalities registered globally, making this epidemic one of the largest in recent history [ 4].