Health conditions and lifestyle risk factors of adults living in Puerto Rico: a cross-sectional study

Abstract

BackgroundPuerto Rico is experiencing an economic and healthcare crisis, yet there are scarce recent and comprehensive reports on the population’s health profile. We aimed to describe prevalent risk factors and health conditions of adults living in Puerto Rico and assess their interrelationship.MethodsParticipants (n = 380) aged 30-75y recruited from a 2015 convenience sample in primary care clinics in the San Juan, Puerto Rico metropolitan area answered cross-sectional interviewer-administered questionnaires on sociodemographic characteristics, lifestyle behaviors, self-reported medically-diagnosed diseases, health services, and psychosocial factors. Anthropometric measures were obtained. Logistic regression models assessed factors associated with having ≥2 cardiometabolic conditions or ≥ 2 chronic diseases.ResultsMost participants had completed ≥college education (57%), had household income <$10,000/y (60%), received government-assisted food benefits (51%), and had health insurance (93%). Nearly 20% reported smoking, 27% alcohol use, 74% light/sedentary physical activity, 51% sleeping difficulties, and 36% self-rated fair/poor diet. Social support was moderate, and 53% screened positive for depressive symptomatology. Abdominal obesity was observed in 33% of men and 76% of women (p < 0.0001). Self-reported medically-diagnosed conditions included hypertension (39%), anxiety (30%), obesity (28%), arthritis (26%), hypercholesterolemia (24%), depression (22%), respiratory problems (21%), and diabetes (21%). Higher odds of having ≥2 cardiometabolic conditions (37%) was observed among participants aged ≥50y, with sedentary physical activity, and self-rated fair/poor diet. Odds of having ≥2 chronic diseases (62%) were higher among ≥50y, sleeping difficulties, > 2 h/day television, and self-rated fair/poor diet. Participants obtained (79%) and trusted (92%) health information from physicians. While most participants with a cardiometabolic condition reported receiving medical recommendations on diet (> 73%) and physical activity (> 67%), fewer followed them (< 67% and < 53%, respectively), yet most adhered to medication treatments (> 73%). Participants following medical recommendations were more likely to report healthy vs. poor behaviors (90% vs. 75%, self-rated diet); (73% vs. 56%, physical activity).ConclusionsAdults living in Puerto Rico have multiple lifestyles risk factors and high prevalence of chronic diseases, namely cardiometabolic and psychological conditions. Comprehensive epidemiological studies are needed to identify contributors to chronic disease, including lifestyle behaviors. Concerted multi-level public health and clinical programs should be prioritized to help this population improve their health.

Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico

“…Among women enrolled in the Boston Puerto Rican Health Study, the mean CES-D score was 24.4, which is markedly increased compared to those in PROTECT [20]. Similar high scores on the CES-D (mean score of 21.8) were observed among a convenience sample of women recruited from primary care clinics in San Juan, PR [40]. Among women enrolled in the Pregnancy Study Online, an online-based preconception cohort study of women in the U.S. and Canada, the mean PSS score was 15.8, which is also slightly higher than the mean PSS score in PROTECT [41].…”

Strategies for Healthy Eating Promotion and Behavioral Change Perceived as Effective by Nutrition Professionals: A Mixed-Methods Study

“…The role of doctors in elevating nutrition was mentioned, and having doctors support and advocate for evidenced-based nutrition practice has been deemed as crucial to achieving the World Health Organization's Decade of Action on Nutrition (53). Primary prevention of chronic disease through a healthy diet may help reduce morbidity in PR, as adults in PR with a self-rated fair/poor diet (vs. excellent/good) had twice the odds of having two or more chronic diseases (vs. > 2) (11).…”

“…In PR, 62% of adults reported obtaining health and nutrition information from a non-physician healthcare professional, such as a nutritionist or dietitian, and 78% of those reported trusting this information (11). Thus, residents of PR may trust and benefit from individual and population-based strategies to improve healthy eating recognized by nutrition professionals.…”

Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico

“…In 2016, the Department of Health of PR published statistics demonstrating a high prevalence of such CHCs as hypertension (39.4%), obesity (30.5%), and diabetes (13.7%) in the local population; these rates indicate that a significant number of people (in PR) are physically vulnerable to disaster. 28,29,57 Regarding mental health, the needsassessment study of mental health and substance-use disorders and service usage in the adult population of PR reported that 23.7% of that population met the criteria for at least 1 diagnosis of a mental health problem (including substance-use disorders). 28,29,57 Most of the patients who requested the support of the THCU did so because they lived in areas that had suffered the long-term loss of electricity or water (usually both); without those critical resources, these patients were unable to satisfy the treatment needs of their pre-existing medical conditions.…”

“…Regarding individuals in PR who had pre-existing mental health disorders, a needs-assessment study of mental health and substance-use disorders and service usage in this (adult) population, reported that 23.7% met the criteria for at least 1 diagnosis of mental health problems (including substance-use disorders). 28,29 This report provided an estimation of the number of individuals who were most likely to require post-disaster psychological care.…”