Acculturation and HPV infection among Latinas in the United States

Differential item functioning of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) by race/ethnicity

Background

Acculturation is a complex multidimensional construct that plays in important role in various outcomes across many domains (e.g., psychological, behavioral, social, and developmental). While there are many acculturation measures for specific racial/ethnic groups, few multigroup measures exists. Even fewer have been psychometrically evaluated for differential item functioning (DIF; e.g., measurement invariance). This is a critical step in determining whether item properties are equivalent across groups and thus, whether scores obtained from different groups are in fact comparable.

Methods

The Acculturation, Habits, and Interests, Multicultural Scale for Adolescents (AHIMSA) was completed by first and second generation participants identifying as White, Hispanic, or Asian (n = 1,399). The scale can be used to compute scores on four acculturation orientation subscales: Assimilated, Separated, Integrated, and Marginalized. Racial/ethnic DIF was evaluated for the Assimilation, Integration, and Separation subscales.

Results

Analyses revealed racial/ethnic DIF was present for two items on the Separation scale based on McFadden's pseudo R2. No DIF was identified for the Assimilation and Integration scales. Supplemental analyses revealed no evidence of longitudinal DIF or by generation status and some DIF by sex for Assimilation and Integration. Based on evaluation of test characteristic curves and DIF plots, it was determined that DIF was trivial and could likely be ignored.

Conclusions

Psychometric properties were generally equivalent across the three racial/ethnic groups for each of the subscales evaluated. This indicates that scores obtained from each subscale could be compared across racial/ethnic groups. By establishing cross-group usability of the scale, racial/ethnic differences in acculturation orientation can be examined, and, more importantly, used in the context of research on related mental, physical, and behavioral health outcomes.

Dietary Vitamin K Intake and HPV-Infection Status Among American Women: A Secondary Analysis From National Health and Nutrition Examination Survey Data From 2003 to 2016

Objective: Cervical cancer is a serious potential risk to women’s health, and is closely related to persistent HPV infection. Vitamin K mainly existed in green vegetables, fruit, and dairy products. This research aims to observe the association between vitamin K and HPV-infection.

Methods: 13,447 participants from the NHANES were selected. Dietary vitamin K intake was used as the objective independent variable and continuous variable, HPV-infection status was used as the outcome variable, and characteristics of selected participants were used as the covariates.

Results: There was a nonlinearity between vitamin K intake and HPV-infection, and the inflection point is 3.81 of log2 vitamin K intake. In a range of 0–3.81, Each one-unit increase in log2 vitamin K intake was associated with a 43% reduction in the risk of HPV infection. When log2 vitamin K intake excess of 3.81, the risk of HPV infection did not continue to decline. The HPV-subtype was not associated with vitamin K intake.

Conclusion: There is a nonlinearity between vitamin K intake and HPV-infection status. But HPV-subtype was not associated with vitamin K intake.

Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review

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Nine studies intervened on vaccination in racial/ethnic and sexual and gender minorities.

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Education and reminders increased HPV vaccine series initiation and completion.

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Lack of high-quality, adequately powered studies warrants further investigation.

Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9–26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries.

Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent–child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.

Dietary Calcium Intake and HPV Infection Status Among American Women: A Secondary Analysis from National Health and Nutrition Examination Survey (NHANES) Data Set of 2003 - 2016

Background

The evidence on the link of dietary calcium (DCa) to human papillomavirus (HPV) infection is limited. Thus, this research was conducted to explore whether DCa is independently associated with HPV infection status in American women with age of 18 to 59 years old.

Material/Methods

We performed a secondary analysis from the National Health and Nutrition Examination Survey (NHANES) data set including 7 cycles from 2003 to 2016. A total of 13 475 selected participants were used for data analysis. The interested independent and the outcome variable were DCa and HPV infection status (HPV infection; HPV subtype). Sociodemographic, dietary, laboratory, questionnaire, and physical examination data were covariates. Weighted binary logistic regression and generalized additive model (GAM) were used for the investigation of both linear and non-linear relationships between DCa and HPV infection status.

Results

Weighted multivariable binary logistic regression indicated DCa was not associated with HPV infection and subtype (OR: 0.93; 95% CI: 0.82–1.05 for HPV infection; OR: 1.09; 95% CI: 0.93–1.28 for HPV subtype). For HPV infection, a non-linear correlation was detected, whose inflection points were 9.78 of log2 DCa. The OR values and the confidence intervals on both sides of inflection point were 0.83 (95% CI: 0.70–0.98) and 1.18 (95% CI: 0.91–1.52), respectively.

Conclusions

At the range of 3.32–9.78 of log2 calcium intake, DCa intake was negatively correlated with HPV infection. After this interval, DCa intake was not associated with the risk of HPV infection.

Brazilian Immigrant Parents' Awareness of HPV and the HPV Vaccine and Interest in Participating in Future HPV-Related Cancer Prevention Study: an Exploratory Cross-Sectional Study Conducted in the USA

This exploratory community-based study assessed Brazilian immigrant parents' awareness of HPV and the HPV vaccine, HPV information sources, and their interest in participating in a future HPV-related cancer prevention study. This study is a cross-sectional analysis of data from a convenience sample of Brazilian immigrant parents living in selected cities in Massachusetts. Participants completed a brief survey in their language of preference (English or Portuguese) administered by bilingual interviewers. Forty-seven Brazilian immigrant parents, each representing a unique family, participated in the study. All participants completed the survey in Portuguese. Although the majority reported being aware of HPV (93.6%, n = 44), only 74.5% (n = 35) were aware of the HPV vaccine. Fewer fathers than mothers had heard of the HPV vaccine (61.9%; n = 13 vs. 84.6%, n = 22; p = 0.04). Of those who were aware of the HPV vaccine (n = 35), 82.6% (n = 29) reported hearing about the HPV vaccine from their child's physician. Additionally, nearly all participants (97.9%, n = 46) reported being interested in participating in future HPV-related cancer prevention study. Findings of this exploratory study indicate parents' low to moderate awareness of the HPV vaccine and high interest in participating in future HPV-related cancer prevention study. These findings are important and serve as a valuable first step toward building a knowledge foundation that is critically needed for developing future studies targeting Brazilians immigrant parents and adolescents living in the USA.

Food insecurity, cigarette smoking, and acculturation among Latinos: data from NHANES 1999-2008

Prevalence of food insecurity (FI) among Latinos in the United States is almost double the national average. To better understand FI among Latinos, potential risk factors beyond poverty, including acculturation indicators and smoking status, were explored. Cross-sectional data from 6,681 Latino adults from the 1999-2008 National Health and Nutrition Examination Surveys were used. Partial proportional odds (PPO) models were used to estimate associations of FI, including cigarette smoking and acculturation. The PPO models indicated that compared with never smokers, current smokers had significantly higher odds of FI (odds ratios ranged from 1.32 to 1.51 across models). Lower levels of acculturation and poverty and being a younger or middle-aged adult were also significantly associated with FI. Among Latinos, current smoking and low acculturation are important risk factors for FI. Current smoking and low acculturation may exacerbate nutritional deprivation in a population that is already disproportionally affected by poverty and poor health outcomes.

Awareness and knowledge of Human papillomavirus (HPV) among ethnically diverse women varying in generation status

Although Human papillomavirus (HPV) is a common sexually transmitted infection, there is limited knowledge of HPV with ethnic/racial minorities experiencing the greatest disparities. This cross-sectional study used the most recent available data from the California Health Interview Survey to assess disparities in awareness and knowledge of HPV among ethnically/racially diverse women varying in generation status (N = 19,928). Generation status emerged as a significant predictor of HPV awareness across ethnic/racial groups, with 1st generation Asian-Americans and 1st and 2nd generation Latinas reporting the least awareness when compared to same-generation White counterparts. Also, generation status was a significant predictor of HPV knowledge, but only for Asian-Americans. Regardless of ethnicity/race, 1st generation women reported lowest HPV knowledge when compared to 2nd and 3rd generation women. These findings underscore the importance of looking at differences within and across ethnic/racial groups to identify sub-groups at greatest risk for poor health outcomes. In particular, we found generation status to be an important yet often overlooked factor in the identification of health disparities.

Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children

OBJECTIVE

Latino populations, particularly Mexican-Americans who comprise 65% of the Latinos in the U.S., are disproportionately affected by HPV-related diseases. The HPV vaccination completion rates remain low, well below the Healthy People 2020 goal. In this study we assessed the effect of parental education and a text messaging reminder service on HPV vaccine completion rates among eligible children of Mexican American parents.

STUDY DESIGN

Nonequivalent group study of Mexican parents of HPV vaccine eligible children attended the Health Window program at the Mexican Consulate in New York City, a non-clinical, trusted community setting, during 2012-2013. 69 parents received HPV education onsite, 45 of whom also received a series of text message vaccination reminders. We measured HPV vaccination completion of the youngest eligible children of Mexican parents as the main outcome.

RESULTS

98% of those in the education plus text messaging group reported getting the first dose of the vaccine for their child and 87% among those in the educational group only (p = 0.11). 88% of those receiving the 1st dose in the text messaging group reported completing the three doses versus 40% in the educational group only (p = 0.004).

CONCLUSIONS

Parental text messaging plus education, implemented in a community based setting, was strongly associated with vaccine completion rates among vaccine-eligible Mexican American children. Although pilot in nature, the study achieved an 88% series completion rate in the children of those who received the text messages, significantly higher than current vaccination levels.

Unsafe sexual behaviour in domestic and foreign migrant male workers in multinational workplaces in Jordan: occupational-based and behavioural assessment survey

OBJECTIVES

To examine the prevalence of unsafe sexual behaviour, sexually transmitted infection (STI)-related knowledge, health and work-related conditions, and correlates of practising unsafe sex among domestic and foreign male workers in multinational workplaces in Jordan.

DESIGN

Cross-sectional behavioural assessment survey.

SETTING

Multinational workplaces in Jordan.

PARTICIPANTS

230 Jordanian and 480 foreign male workers aged ≥ 18 years who had worked in a Qualified Industrial Zone (QIZ) for 12 months or more.

OUTCOMES

The primary outcome was the prevalence of practising unsafe sex. 'Unsafe sex' was defined as sex with a non-regular sexual partner with inconsistent condom usage.

RESULTS

Overall, 74.3% of workers reported lifetime sexual experience. The proportion of lifetime unsafe sex was similar among domestic (31.8%) and foreign (35.6%) workers. Of those, 59.2% of domestic and 68.1% of foreign workers started practising unsafe sex after joining the QIZ. Rates of lifetime unsafe sex were significantly higher among those who had their sexual debut after joining the QIZ in domestic (aOR, 2.2, 95% CI 1.1 to 4.4) and foreign workers (aOR, 2.4, 95% CI 1.4 to 4.1). Among the domestic workers, being 18-24 years old (aOR, 4.9), unmarried (aOR, 4.8), working in the QIZ for 5-8 years (aOR, 5.0), sometimes/frequently shopped with foreign workers (aOR, 2.1) or were current/ex-alcohol drinkers (aORs, 3.4) were independently significantly associated with higher odds of practising unsafe sex.

CONCLUSIONS

A significant proportion of domestic and foreign male workers had been practising unsafe sex. The findings indicated that not only foreigners but also domestic male workers associating with foreign workers are at high risk of unsafe sex. Tailored interventions to promote safer sex in multinational workplaces in Jordan are needed.

Policy dilemmas in Latino health care and implementation of the Affordable Care Act

The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion;

Acculturation and HIV-related sexual behaviours among international migrants: a systematic review and meta-analysis

This review examines the global literature regarding the relationship between acculturation and HIV-related sexual behaviours among international migrants. Seventy-nine articles published in English-language journals prior to July 2012 met the criteria for inclusion. We conducted a systematic review and subset meta-analysis of correlations between acculturation and five types of sexual behaviours including condom use, multiple partnerships, early sexual initiation, sexually transmitted diseases (STDs) and other unsafe sexual practices. Immigrants high in mainstream acculturation were more likely to have multiple partnerships, early sexual initiation, STDs and unsafe sex (rs ranged from 0.10 to 0.16), but acculturation was not associated with condom use (r = 0.02). Gender moderated the relationships between acculturation and multiple partnerships, STDs and unsafe sex. The relationship between acculturation and unsafe sex also varied across ethnicity. These findings suggest that acculturation may serve as a risk factor towards immigrants' HIV-related sexual health. We offered a theoretical framework and suggested applying cross-cultural and longitudinal designs in future research on acculturation and health behaviours.

Pain among older Hispanics in the United States: is acculturation associated with pain?

BACKGROUND

Previous studies suggest that acculturation may influence the experience of pain.

STUDY DESIGN

We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States.

METHODS SUBJECTS

Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008.

MEASURES

We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain.

ANALYSIS

We applied logistic regression using generalized estimating equations, with NHW as the reference category.

RESULTS

Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9).

CONCLUSION

Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.

Developmental trajectories of acculturation in Hispanic adolescents: associations with family functioning and adolescent risk behavior

This study examined longitudinal acculturation patterns, and their associations with family functioning and adolescent risk behaviors, in Hispanic immigrant families. A sample of 266 Hispanic adolescents (Mage  = 13.4) and their primary parents completed measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five timepoints. Mixture models yielded three trajectory classes apiece for adolescent and parent acculturation. Assimilated adolescents reported the poorest family functioning, but adolescent assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex indirectly through family functioning. Follow-up analyses indicated that discrepancies between adolescent and parent family functioning reports predicted these adolescent outcomes. Results are discussed regarding acculturation trajectories, adolescent risk behavior, and the mediating role of family functioning.

Substance use and sexual behavior among recent Hispanic immigrant adolescents: effects of parent-adolescent differential acculturation and communication

OBJECTIVES

To ascertain the effects of parent-adolescent acculturation gaps, perceived discrimination, and perceived negative context of reception on adolescent cigarette smoking, alcohol use, sexual activity, and sexual risk taking. We used an expanded, multidimensional model of acculturation.

METHOD

A sample of 302 recently immigrated parent-adolescent dyads (152 from Miami and 150 from Los Angeles) completed measures of acculturation (Hispanic and American practices and identifications, and individualist and collectivist values) and parent-adolescent communication. Adolescents completed measures of recent cigarette smoking, alcohol use, sexual behavior, and sexual risk taking.

RESULTS

Parent-adolescent gaps in American practices and ethnic identity, and perceptions of a negative context of reception, predicted compromised parent-adolescent communication. In Miami only, adolescent-reported communication negatively predicted odds of cigarette smoking, occasions of drunkenness, and number of sexual partners. Also in Miami only, parent-reported communication positively predicted these outcomes, as well as occasions of adolescent binge drinking, drunkenness, number of sexual partners, and odds of unprotected sex. The only significant findings in Los Angeles were protective effects of parent-reported communication on frequency of alcohol use and of binge drinking. Mediational effects emerged only in the Miami sample.

CONCLUSIONS

Effects of parent-adolescent acculturation gaps vary across Hispanic groups and receiving contexts. The especially strong parental control in many Mexican families may account for these differences. However, other important differences between Hispanic subgroups and communities of reception could also account for these differences. Prevention efforts might encourage Hispanic youth both to retain their culture of origin and to acquire American culture.