The practice and use of picuristes (lay injectionists) among Haitian immigrants in Miami -Dade County, Florida

This exploratory study examined use of picuristes among Haitian immigrants in Miami-Dade County, Florida. It describes how this health-seeking behavior is socially constructed among Haitian immigrants in terms of benefits. (b) risks, (c) sex, (d) gender, (e) acculturation proxies, and (f) transnational influences. It is conducted within the frameworks of Symbolic Interactionism, the Health Belief Model and the Explanatory Model of Illness. ^ Purposive sampling and a mixed-method design were used to obtain semistructured interviews of 10 picuristes and 25 users. The same methods were employed to select survey respondents so as to obtain a descriptive estimate of picuriste use and covariates of picuriste use within the sample. ATLAS.ti 5.0 and SPSS 14.0 were used to analyze the data. ^ The findings indicate an interconnection of elements from Vodou, traditional Haitian health beliefs and picuriste practice and use. ^ Rekonnèt, a relationship based on a history of trust with individuals related by blood or who share close personal and social ties was identified as a sufficient and necessary reason for picuriste practice and use. ^ Benefits reported are that the picuriste injections directly impact the blood, and that they represent affordable and convenient access to health care. Risks include rashes, abscesses and fevers. The reuse of injection equipment, routine injection of antibiotics and unknown substances and the improper discard of syringes and needles were reported, implying unrecognized risks of preventable infectious disease. No participant described a process that adheres to established international standards for safe injections. ^ There is no clear evidence that biological sex, gender, length of time in U.S. or language of interview influence picuriste practice or use. Transnational ties facilitate transport of substances from Haiti and the practice and use of picuristes locally. ^ Recommendation by a relative or trusted friend and believing that the benefits of picures outweigh risks were covariates of picuriste use. ^ This study highlights values and priorities of Haitian immigrants seeking healthcare, and cultural forces that shape their decisions about wellness and treatment. Future studies should test the application of Symbolic Interactionism to picuriste use in larger epidemiological studies that examine picuriste use in relation to health status.^

Obesity Indicators by Race/Ethnicity for Diagnosis of Cardiometabolic Diseases for a US Representative Sample of Adults

Background: Obesity, a growing epidemic, is a preventable risk factor for cardiometabolic diseases. Obesity and cardiometabolic diseases affect Hispanics and African Americans more than non-Hispanic Caucasians. This study examined the relationship among race/ethnicity, obesity diagnostic measures (body mass index, waist circumference, subscapular and triceps skinfold thickness), and cardiometabolic risk factors (hyperglycemia, high, non-high-density lipoprotein cholesterol, low, high-density lipoprotein cholesterol, and hypertension) for adults across the United States. Methods: Using data from two-cycles of the National Health and Examination Survey (NHANES) 2007-2010, and accounting for the complex sample design, logistic regression models were conducted comparing obesity indicators in Mexican Americans, other Hispanics, and Black non-Hispanics, with White non-Hispanics and their associations with the presence of cardiometabolic diseases. Results: Differences by race/ethnicity were found for subscapular skinfold thickness and hyperglycemia. Waist circumference and subscapular skinfold were positively associated with the presence of hyperglycemia; dyslipidemia, and hypertension across race/ ethnicity, adjusting for age, gender, smoking, physical activity, education, income to poverty index, and health insurance. Race/ ethnicity did not influence the association of any obesity indicators with the tested cardiometabolic diseases. All obesity measures except triceps skinfold were associated with hyperglycemia. Conclusions: We suggest that subscapular skinfold thickness be considered as an inexpensive non-intrusive screening tool for cardiometabolic risk factors in an adult US population

Learning Data-Driven Models of Non-Verbal Behaviors for Building Rapport Using an Intelligent Virtual Agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness. Evidence-based patient-centered Brief Motivational Interviewing (BMI) interven- tions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary. Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems. To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].

Learning data-driven models of non-verbal behaviors for building rapport using an intelligent virtual agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness.^ Evidence-based patient-centered Brief Motivational Interviewing (BMI) interventions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary.^ Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems.^ To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].^