Dr. Daudet Ilunga Tshiswaka

The influx of African immigrants and their offspring to United States has increased the heterogeneity of the Black communities. While COVID-19 has lay bare the disproportionate impact of the virus on Black communities, the perceptions and reactions of African immigrants’ offspring to the pandemic is yet to be explored. As part of an ongoing project on COVID-19 and African Immigrants and Refugees (AIR), interviews were conducted with participants that identified as African immigrant offspring and young adults who migrated to the US. Interview questions were guided by the Social Ecological Model, and data was analyzed using thematic analysis approach. Key findings highlight the prevalence of misinformation and key information sources, crystallized into four themes: (1) knowledge of COVID-19; (2) sources of information about COVID-19; (3) cultural self-identity and US healthcare system: and (4) spirituality, healing and COVID-19. Participants had adequate knowledge, and preventive measures about COVID-19, though earlier interviews among them during the early stage of the pandemic showed confusion about the nature of the virus. The value of family networks as sources of information and misinformation, especially through social media was salient in participants’ discussion, while the overload of news media was a source of concern leading to disengagement. Participants’ cultural self-identity served as lens in interpreting their interactions with the US healthcare system, while the value of spirituality and traditional remedies to healing were discussed as tools for coping with the pandemic. Efforts to increase COVID-19 vaccine should consider the multicultural values of this population.

This study aims to assess relationships between previous stroke diagnosis and demographic or disability status variables, stratified by U.S. citizenship status. The 2019 and 2021 National Health Interview Survey data were analyzed for both descriptive statistics and logistic regression models. Age, sex, income level, race/ethnicity, health insurance status, and indicators of disability common after stroke were predictor variables of interest. For each disability predictor variable, higher odds of having stroke were seen regardless of citizenship status, except for the 'difficulty remembering' variable. For U.S. citizens, increasing age corresponded with higher odds of stroke diagnosis. For noncitizens, odds ratios decreased from 40.3 (95% CI 38.88-41.82) for the 40-65 age group to 29.6 (95% CI 28.38-30.77) in the 80 + group, when compared with the 18-39 age reference group. Female noncitizens had higher odds of stroke, while male citizens had higher odds. Non-Hispanic Black citizens had higher odds of stroke, while the other racial/ethnic groups had higher odds for noncitizens. The results indicated the existence of several socio-demographic disparities in stroke. Notably, noncitizens experienced stroke at a younger age and reported more severe disability outcomes after stroke diagnosis than citizens.

[...]the Mann-Whitney U test was used to determine whether the number of primary stroke centers differed in urban and rural counties. Constraints to the use of telestroke, however, include the availability and affordability of technology, the need for ongoing technological support, logistical challenges related to the potential need for examination assistance by a participating bedside clinician or nurse, and several legal and ethical questions about provider credentials and patient safety and privacy (15,16).

The purpose of this study was to investigate the relationship between the transnational connections of West African women immigrants and stress factors. From our extensive research, there is a scarcity of studies investigating this matter concerning transnational immigrant health. We conducted three focus group interviews with 7 transnational West African immigrants living in Chicago, Illinois. The PEN-3 model, as a cultural framework, was applied to guide the thematic analysis to explore the phenomenon of stress in West African immigrant women who maintain transnational ties between their home countries and the United States. Participants noted that a primary factor around increased stress involved trying to maintain strong ties to their native customs while acculturating to a foreign land. In particular, these women face challenges around employment and domestic responsibilities while also attempting to manage transnational responsibilities such as sending remittances back to their native land. The West African immigrant women of this study face several challenges in maintaining their home, work and social life. However, when they are resettling in a new land, these challenges affect them multidimensionally, including cultural identity, relationships and expectations, and cultural empowerment, which are elements of the PEN-3 framework. For these reasons, health researchers and intervention planners would benefit from further research into the links between the transnational connections that female African immigrants experience and their stress related coping behaviors.

Background: Because early recognition of symptoms and timely treatment of stroke can reduce mortality and the long-term effects of such events, efforts to make many people both aware of these symptoms and knowledgeable about what to do when recognising them are critical for reducing impacts from stroke.
Objectives: To assess the impact of a stroke preparedness film (intervention) and stroke preparedness pamphlets (usual care) on self-efficacy for stroke recognition and action.
Design: Two-arm cluster randomised trial conducted between July 2013 and August 2018.
Setting: A total of 13 church sites located in economically disadvantaged urban neighbourhoods in New York. Of the 883 churchgoers approached, 503 expressed interest, 375 completed eligibility screening and 312 were randomised. Participant inclusion criteria were Black or Hispanic churchgoers, aged 34 years or older, without stroke history, but at a high risk for stroke. The intervention consisted of two 12-minute stroke films: Gospel of Stroke, in English for Black participants, and Derrame Cerebral, in Spanish for Hispanic participants.
Method: Participants were pre–post-tested (at baseline, 6-month follow-up and 12-month follow-up) for self-efficacy. Descriptive analysis, a linear mixed model and t tests were used to assess the effects of a stroke preparedness film and stroke preparedness pamphlets on self-efficacy.
Results: Findings are based on intention-to-treat analysis. A total of 310 participants completed the study (99% retention rate). About half (53.8%) of participants were Black and 46.2% Hispanic in the intervention group; 48.3% were Black and 51.7% were Hispanic in the usual care group. Overall, both groups evidenced higher self-efficacy (i.e. lower predicted means) over time (p < .0001), although a significant benefit was not observed for the intervention relative to usual care.
Conclusion: Both stroke preparedness films and stroke preparedness pamphlets improved self-efficacy with respect to stroke recognition and action among minority churchgoers.

Background: The incidence of stroke in Nigeria is unknown, but stroke literacy, defined here as awareness of stroke warning symptoms and risk factors may be poor in high-risk communities. Although there is growing recognition of the use of music as a conduit to promote health literacy, African music is often overlooked as a source of health information. We sought to understand community-level perspectives on using African music to promote acute stroke literacy.
Methods: A purposive sample of education, health and music professionals, high school and university students were recruited to participate in the qualitative study. Study participants completed a brainstorming exercise that elicited their perceptions of potential barriers and facilitators to the use of music to promote acute stroke literacy in Nigeria. Content analysis was used to identify key themes emerging from the brainstorming exercise.
Results: A total of 44 individuals, comprising of 25 students with a mean age of 15.9 ± 1.6 years (52% females) and 19 professionals with a mean age of39 ± 7.7 years (57.9% males) participated in the brainstorming exercise. Facilitators to the use of music to promote acute stroke literacy in Nigeria include the cultural relevance of music, the ubiquity of music, and government involvement. Key barriers include religious beliefs that discourage the use of “secular” music, cost-related barriers, and limited government support.
Conclusions: Findings from this study provide guidance aimed at improving acute stroke literacy in Nigeria, particularly the importance of government involvement in the development and implementation of stroke literacy interventions guided by African music. Future work should consider implementing interventions that leverage the cultural elements of African music and further assess the extent to which these identified facilitators and/or bar-riers may influence stroke literacy.

Over the past half century, the Democratic Republic of the Congo (DRC), a low-income and post-conflict country, has experienced several Ebola Virus Disease outbreaks, with different fatality rates. The DRC is currently experiencing the Coronavirus Disease 2019 (COVID-19) pandemic. Using the PEN-3 cultural model, we assessed the socio-cultural factors affecting public trust in the government and its health agencies. Results of this analysis revealed the perceptions, enablers, and nurturers that impacted public trust in the government and its health agencies among the Congolese population. Future interventions designed to address the COVID-19 in the DRC should account for these socio-cultural factors.

Background: Demographic and anthropometric factors associated with the age at diagnosis of diabetes have not been extensively studied. Much of the literature using anthropometric measures has been associated with other health factors such as obesity and coronary heart disease. The purpose of this study was to assess the relationship between different sets of anthropometric factors and age of diabetes diagnosis in the United States.
Methods: Using the NHANES 2015–2016 data set, weighted linear regression analysis was performed on observations from 600 qualified individuals with diabetes to study associations between anthropometric and demographic factors and the age of diabetes diagnosis.
Results: Results of our analysis support the evidence of significant relationships between the anthropometric characteristics and demographic factors and age at diabetes diagnosis. Specifically, age at diagnosis of diabetes is predicted to decrease by 1.03 (p < 0.01) and 0.91 (p < 0.01) years when BMI and upper leg length go up by one unit each, respectively. Similarly, age at diagnosis of diabetes decreases by 0.02 years and by 1.72 years when refrigerated glucose serum increases by 1 mg/dL (p<0.05) and when household size increases by one person, respectively. Male respondents were diagnosed with diabetes 3.41 years later than their female counterparts. Conversely, age at diagnosis of diabetes increases by 1.24 years when the average sagittal abdominal diameter goes up by 1 cm (p<0.05). In addition, Mexican American respondents were diagnosed 5.00years younger than the non-Hispanic White counterparts.
Conclusions: Our findings show that anthropometric factors, including BMI, refrigerated glucose serum and upper leg length increase have an inverse linear association with age of diabetes diagnosis. The results of this study can help improve the efficiency of the methods of health professionals attempting to lower the rate of diabetes diagnoses.

Introduction: System-level factors such as poor access to health services can help explain differential uptake in breast and cervical cancer screening between U.S.- and foreign-born women. However, few studies have explored the roles of family history and perceived risk of these cancers on screening rates. To address these gaps, this study investigates whether a family history of cancer, perceived risk, and system-level factors independently and additively predict differential screening rates of breast and cervical cancer between U.S.-born and foreign-born women living in the U.S. Methods: Data were analyzed in 2019 from the 2015 National Health Interview Survey. Descriptive and multivariable logistic regression modeling was performed to test whether there were differences in breast and cervical cancer screening within and between the 2 groups and whether family history of cancer and perceived risk of breast cancer were predictors of uptake. Results: The sample comprised women aged 21−74 years (n=14,047). The mean age of the sample was 45.5 (SD=14.8 years). The majority of the women were U.S.-born (77.5%). U.S.- and foreign-born women had more mammograms and Pap tests with a usual source of care (p<0.001) and insurance (p<0.001). Healthcare access and utilization factors were also predictive for both groups of women. Data analyses were conducted in 2019. Conclusions: These findings are consistent with previous work. Access and healthcare utilization were associated with screening uptake. However, differences in risk perception, family history of breast and cervical cancers, and screening uptake were found between U.S.- and foreign-born women.

Human immunodeficiency virus (HIV) testing is a cornerstone in preventing HIV infections and accessing treatment for HIV. However, HIV testing remains low among men in the Democratic Republic of Congo (DRC). The purpose of this study was to assess the correlates of HIV testing among men in the DRC. Data from the 2014 DRC Demographic Health Survey were analyzed to assess the relationships between HIV testing and the correlates of HIV testing among 7830 men aged 15-59 years. Although more than half (4763 or 63.7%) knew of an HIV testing site, only one-sixth (1187 or 16.6%) reported ever being tested for HIV. The multivariate logistic regression indicated that men aged between 25 and 34 years were more likely to have tested for HIV than those aged between 15 and 24 years (aOR = 1.70; 95% CI: [1.23-2.34]). In addition, men with college experience were 5.47 more likely to have tested for HIV than men with no formal education (aOR = 5.47; 95% CI: [2.53-11.84]). The results highlight the need for a national HIV testing awareness and uptake campaign for Congolese men to increase HIV testing among this group and prevent HIV infections.