A Review of Acculturation Measures and Their Utility in Studies Promoting Latino Health

Multiple Dimensions of Machismo: Linguistic Considerations for Latino Sexual Minority Men in the United States

The literature differentiates between two domains of machismo: traditional machismo and caballerismo. Research has largely focused on measuring machismo among English speakers. We evaluated whether Estrada's (2011) 2-factor model of machismo was invariant across languages (English versus a direct Spanish translation). A series of multigroup confirmatory factor analyses were conducted between respondents who completed the survey in English (n = 428) and Spanish (n = 102). Analyses suggested the hypothesized 2-factor model did not fit across language groups. While the traditional 2-factor structure emerged in the English language data, exploratory factor analysis indicated a 3-factor structure of machismo among Spanish-speaking respondents. One of the new factors (inherent machismo), among Spanish-speaking respondents, was associated with Internalized Heterosexism, suggesting that the new factor structure may capture the belief that masculine men are superior. These findings suggest there is a need for the development of culturally appropriate Spanish language assessment.

Acculturation and Disparities in Telemedicine Readiness: A National Study

Telemedicine provided older adults the ability to safely seek care during the coronavirus disease (COVID-19) pandemic. This study aimed to evaluate the potential impact of acculturation factors in telemedicine uptake between ethnic groups. As part of the National Health and Aging Trends Study 2018 survey, 303 participants (≥65 years) were interviewed. We assessed the impact of acculturation on telemedicine readiness by race and ethnicity. Compared to the white non-Hispanic immigrant population, Hispanic and Asian/Pacific Islander (API) populations had significantly lower telemedicine readiness and uptake. Limited English proficiency or older age at the time of migration was associated with telemedicine unreadiness and uptake in the Hispanic and API populations. Our findings suggested that acculturation factors play a substantial role in telemedicine uptake among older adult immigrants in the United States. Therefore, acculturation factors should be considered when promoting and adopting telemedicine technologies in older adults.

Acculturation and clinical symptoms of schizophrenia among Latine adults in the United States

BACKGROUND

Research on acculturation and schizophrenia spectrum disorders has yielded inconsistent findings. This study aimed to clarify the influence of acculturation on symptomatology in Latine individuals with schizophrenia in the United States.

METHODS

The analysis involved cross-sectional data from Latine (n = 120) and non-Latine White (n = 60) adults with schizophrenia in San Diego, California. Participants completed the Short Acculturation Scale for Hispanics (SASH), Positive and Negative Symptom Scale, and Hamilton Depression Rating Scale in their preferred language. Univariate linear regressions were implemented to identify proxy measures as predictors of acculturation scores. Analyses of variance were conducted to analyze the relationship of SASH scores and proxy measures of acculturation to symptom severity.

RESULTS

Latine participants presented more symptom severity than non-Latine Whites. When categorized by acculturation status (Spanish-preferring, bicultural, and English-preferring), Spanish-preferring participants presented similar psychiatric symptoms to the non-Latine group and less severe symptoms than both other Latine groups. Analyses identified study language as the strongest proxy measure for the SASH. Latine participants assessed in English had significantly worse positive and depressive symptoms than those assessed in Spanish. Nativity status moderated the relationship between study language and symptomatology.

CONCLUSIONS

Findings support an association between acculturation and symptom severity among Latine individuals with schizophrenia. The use of proxy measures of acculturation may be useful in settings where time is constrained. Future research should continue to explore acculturation and symptomatology in Latine communities.

The Role of Social Support and Acculturation Factors on Postpartum Mental Health Among Latinas in the MADRES Pregnancy Cohort

We examined the associations between social support and postpartum mental health in 137 U.S. and foreign-born Latinas in the MADRES pregnancy cohort. We also examined whether language, years in the U.S., and country of birth moderates these relationships. Participants were administered PROMIS support measures 1 month postpartum; the Perceived Stress and Postpartum Distress Measure 3, 6, and 12 months postpartum; and the CESD scale 12 months postpartum. Perceived stress was lower at 6 months postpartum for women reporting higher emotional (p = 0.01), informational (p = 0.03), and instrumental support (p < 0.001); and lower at 12 months postpartum for women reporting higher emotional support (p = 0.01). Distress at 6 months was lower in women reporting higher emotional support (p = 0.03). Interactions suggest that associations were stronger for mothers that speak Spanish, spent fewer years in the U.S., and were born in Central America.

The Migration Experience: A Conceptual Framework and Systematic Scoping Review of Psychological Acculturation

ACADEMIC ABSTRACT

One of the key challenges to researching psychological acculturation is the immense heterogeneity in theories and measures. These inconsistencies make it difficult to compare past literature, hinder straightforward measurement selections, and stifle theoretical integration. To structure acculturation, we propose to utilize the four basic aspects of human experiences (wanting, feeling, thinking, and doing) as a conceptual framework. We use this framework to build a theory-driven assessment of past theoretical (final N = 92), psychometric (final N = 233), and empirical literature (final N = 530). We find that the framework allows us to examine and compare past conceptualizations. For example, empirical works have understudied the more internal aspects of acculturation (i.e., motivations and feelings) compared with theoretical works. We, then, discuss the framework's novel insights including its temporal resolution, its comprehensive and cross-cultural structure, and how the framework can aid transparent and functional theories, studies, and interventions going forward.

PUBLIC ABSTRACT

This systematic scoping review indicates that the concept of psychological acculturation can be structured in terms of affect (e.g., feeling at home), behavior (e.g., language use), cognition (e.g., ethnic identification), and desire (e.g., independence wish). We find that the framework is useful in structuring past research and helps with new predictions and interventions. We, for example, find a crucial disconnect between theory and practice, which will need to be resolved in the future.

Evolution of COVID-19 Health Disparities in Arizona

COVID-19 burdens are disproportionally high in underserved and vulnerable communities in Arizona. As the pandemic progressed, it is unclear if the initial associated health disparities have changed. This study aims to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerging vulnerable subpopulations. Findings from this study can inform interventions to increase health equity among minoritized communities in the Southwest, other regions of the US, and globally. We compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, a time spanning multiple waves of COVID-19 case growth. Within each biweekly period, we tested the associations between the growth rate of COVID-19 cases and the population composition in a ZCTA including race/ethnicity, income, employment, and age using multiple regression analysis. We then compared the associations across time periods to discover temporal patterns of health disparities. The association between the percentage of Latinx population and the COVID-19 growth rate was positive before April 2021 but gradually converted to negative afterwards. The percentage of Black population was not associated with the COVID-19 growth rate at the beginning of the study but became positive after January 2021 which persisted till the end of the study period. Young median age and high unemployment rate emerged as new risk factors around mid-August 2021. Based on these findings, we identified 37 ZCTAs that were highly vulnerable to future fast escalation of COVID-19 cases. As the pandemic progresses, vulnerabilities associated with Latinx ethnicity improved gradually, possibly bolstered by culturally responsive programs in Arizona to support Latinx. Still communities with disadvantaged social determinants of health continued to struggle. Our findings inform the need to adjust current resource allocations to support the design and implementation of new interventions addressing the emerging vulnerabilities at the community level.

Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States

To explore the association between acculturation among foreign-born (FB) women, gestational diabetes (GDM) and GDM-associated adverse birth outcomes, we conducted a retrospective cohort study of 34,696 singleton pregnancies from Houston, TX, between 2011 and 2022. FB women (n = 18,472) were categorized based on years of residence in US (0-5, 6-10, and > 10 years), while US-born women (n = 16,224) were the reference group. A modified Poisson regression model determined the association between acculturative level and GDM within the entire cohort and stratified by race/ethnicity. Compared to US-born women, FB women with 0-5 years [adjusted relative risk (RRadj.) 1.27, 95% confidence interval [CI] 1.14-1.42)], 6-10 years (RRadj. 1.89, 95%CI 1.68-2.11) and > 10 years in the US (RRadj. 1.85, 95%CI 1.69-2.03) had higher risk of GDM. Results were consistent for all racial/ethnic groups, although associations were not significant at 0-5 years. FB women had lower risk of other adverse pregnancy outcomes, except for preeclampsia with severe features at higher levels of acculturation. Results were similar among those with and without GDM. In conclusion, FB status increases risk of GDM among all racial/ethnic groups but is elevated with higher acculturation levels.

The relationship between political efficacy and self-rated health: An analysis of Mexican, Puerto Rican, and Cuban subgroups compared to non-Latinx whites in the United States

Latinx represent a growing population in the United States (US) that continue to experience a disproportionate burden of disease. However, health disparities vary across Latinx subgroups, including Mexican, Puerto Rican, and Cuban communities, particularly when assessing self-rated health. Given the nature of political exclusion in the US, these differences may be associated with underexplored political factors, or political determinants of health, within the social environment that distinctly shape health among racial and ethnic minorities. To explore potential pathways that connect the political environment to individual-level health outcomes among Latinx subgroups, political efficacy (or one's perceptions about one's power to influence political affairs) was assessed as a correlate of self-rated health. We used secondary data from the 2016 Collaborative Multiracial Post-election Survey to conduct ordered logistic regression analysis to determine whether two domains of political efficacy, internal and external political efficacy, were correlates of self-rated health among Mexican, Puerto Rican, and Cuban subgroups as compared to non-Latinx whites in the US. We also tested for differential associations across Latinx subgroups as compared to non-Latinx whites. The sample consisted of 3156 respondents (1486 Mexicans, 484 Puerto Ricans, 159 Cubans and 1027 non-Latinx whites). Among Puerto Ricans, results revealed that lower levels of internal political efficacy were associated with higher levels of self-rated health. Conversely, among other subgroups, positive associations between internal political efficacy and self-rated health were observed. This study provides empirical evidence of a relationship between internal political perceptions and health perceptions that has not previously been established within the Latinx health disparities literature. Future investigations should continue to examine pathways that connect political determinants to individual-level health outcomes, particularly among communities that disproportionately experience political exclusion.

A Gene-Acculturation Study of Obesity Among US Hispanic/Latinos: The Hispanic Community Health Study/Study of Latinos

OBJECTIVE

In the United States, Hispanic/Latino adults face a high burden of obesity; yet, not all individuals are equally affected, partly due in part to this ethnic group's marked sociocultural diversity. We sought to analyze the modification of body mass index (BMI) genetic effects in Hispanic/Latino adults by their level of acculturation, a complex biosocial phenomenon that remains understudied.

METHODS

Among 11,747 Hispanic/Latinos adults in the Hispanic Community Health Study/Study of Latinos aged 18 to 76 years from four urban communities (2008-2011), we a) tested our hypothesis that the effect of a genetic risk score (GRS) for increased BMI may be exacerbated by higher levels of acculturation and b) examined if GRS acculturation interactions varied by gender or Hispanic/Latino background group. All genetic modeling controlled for relatedness, age, gender, principal components of ancestry, center, and complex study design within a generalized estimated equation framework.

RESULTS

We observed a GRS increase of 0.34 kg/m 2 per risk allele in weighted mean BMI. The estimated main effect of GRS on BMI varied both across acculturation level and across gender. The difference between high and low acculturation ranged from 0.03 to 0.23 kg/m 2 per risk allele, but varied across acculturation measure and gender.

CONCLUSIONS

These results suggest the presence of effect modification by acculturation, with stronger effects on BMI among highly acculturated individuals and female immigrants. Future studies of obesity in the Hispanic/Latino community should account for sociocultural environments and consider their intersection with gender to better target obesity interventions.

The spiral of disadvantage: Ethnolinguistic discrimination, acculturative stress and health in Nahua indigenous communities in Mexico

OBJECTIVES

The aim of this study was to test the hypothesis that ethnic and ethnolinguistic discrimination, and Post-Traumatic Stress Disorder (PTSD) related to being Indigenous as well as different aspects of acculturative stress, are associated with poorer health and higher levels of depression among the Nahua Indigenous communities.

MATERIALS AND METHODS

Our quantitative survey was carried out in four different regions inhabited by the Nahua people in Mexico. Self-rated health and depression, the symptoms of PTSD, two facets of acculturative stress and ethnolinguistic discrimination were assessed by questionnaires. The data were analyzed using binary logistic regression models.

RESULTS

The symptoms of PTSD and acculturative stress experienced in the workplace were significantly associated with a higher risk of poor self-rated health, adjusted for various socio-demographic characteristics. Acculturative stress, discouragement of language use, language avoidance and ethnolinguistic discrimination were related to a higher risk of depression and PTSD.

DISCUSSION

Our research implies that ethnic and linguistic discrimination, acculturative stress and the memory of harm linked to being Indigenous reflected in the symptoms of PTSD, are important predictors of poorer health and depression among Nahua groups in Mexico. These adverse effects could be significantly counteracted by effective dealing with stigmatization and discrimination against Indigenous people in Mexico and by replacing strong assimilation pressures with integrational approaches that respect ethnolinguistic diversity and reduce socioeconomic marginalization.

Public Stigma Toward Schizophrenia Within Latino Communities in the United States

Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.

The COVID-19 Pandemic Contributed to Disparities in Housing-Cost Burden Among WIC-Participating Households in the Most Populous County in California

Affordable housing is necessary for the health and well-being of children and families. The coronavirus disease 2019 (COVID-19) pandemic affected the ability of low-income families to pay for housing. The aim of this study is to evaluate associations between household characteristics of participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and housing-cost burden during the pandemic. WIC is a federally-funded nutrition assistance program for low-income mothers, infants, and children up to the age of 5. Data were from a 2020 survey of a random sample of WIC households (n = 5815) in Los Angeles County. Ordinal logistic regression determined the odds of being housing-cost burdened by parent respondent's race/ethnicity, household composition, employment, residence, and housing cost. Logistic regression determined if the pandemic contributed to the housing-cost burden. A total of 61% of households reported housing-cost burden, with two-thirds attributing the burden to the pandemic. Spanish-speaking Hispanic parents and white parents reported a higher prevalence of pandemic-related burden, while Asian, Black, and English-speaking Hispanic parents reported a higher prevalence of burden unrelated to the pandemic. Single-parent households, those experiencing residential instability, and those with high housing costs had higher odds of burden. Spanish-speaking Hispanic parents, white parents, homeowners, and those with high housing costs were more likely to attribute the burden to the pandemic. To ensure that existing inequities are not exacerbated, it is vital that housing assistance be available to low-income households that were disproportionately affected by the pandemic.

Smoking prevalence among Asian Americans: Associations with education, acculturation, and gender

There is evidence that smoking prevalence rates are related to acculturation, education, and gender among Asian Americans. However, no studies have examined how smoking rates among Asian Americans vary based on acculturation, education, and gender together. This study used National Health Interview Survey (NHIS) data (2010-2018) to examine cigarette smoking prevalence among Asian American men and women aged 18 and older (N = 14,680). Multivariate logistic regression models were used to estimate associations between educational attainment (i.e., college graduate or higher vs some college or lower), years spent in the United States (U.S.) as a proxy for acculturation (i.e., less than 10 years (less acculturated) vs 10 years or more (more acculturated) vs U.S.-born), and cigarette smoking prevalence across gender controlling for age, marital status, poverty (at/above vs below poverty threshold), country of origin (Chinese vs Filipino vs Asian Indian vs Other Asian), and the survey year. Current smoking prevalence was 9.0 % among all Asian Americans - 5.0 % among women and 13.5 % among men. Among respective gender-specific subgroups, U.S.-born Asian women without a college degree and more acculturated Asian immigrant men without a college degree had the highest odds of smoking (OR: 4.096 [95 % CI: 2.638, 6.360] and 1.462 [95 % CI: 1.197, 1.774], respectively). Findings indicated that less educated U.S.-born Asian women and less educated Asian immigrant men are at greatest risk for smoking. Smoking prevalence among Asian Americans is highly related to acculturation, education, and gender. Findings may inform development of policies and programs that are targeted toward smoking cessation among Asian Americans.

Proportion of life spent in Canada and stroke incidence and outcomes in immigrants

BACKGROUND

To evaluate the association between the proportion of life spent in a host nation and stroke incidence and outcomes among Canadian immigrants.

METHODS

We conducted a retrospective cohort study of 1.2 million adult Canadian immigrants (mean age 40 [±14.6] years, 50.5% women) who were followed between 2003 and 2018 using linked administrative health data. Using multivariable cause-specific hazard models, we evaluated the overall and sex-specific associations between the proportion of life spent in Canada (φ), modeled as restricted cubic splines, and ischemic stroke incidence and outcomes.

RESULTS

Compared to the median proportion of life in Canada (φ = 0.2), a J-shaped association between the proportion of life in Canada and ischemic stroke incidence and outcomes was observed. The adjusted hazard ratios of stroke incidence increased with both progressively lower and higher levels of φ [e.g., (HR_{φ =0.05 vs.φ = 0.20}, 1.15; 1.09-1.21) and (_{HRφ = 0.50 vs. φ = 0.20}, 1.45; 1.27-1.66)]. In sex-stratified analyses, the associations between φ and stroke incidence and outcomes were significant in men, but not in women.

CONCLUSIONS

Stroke incidence and outcomes among immigrants varies with the proportion of life spent in Canada. Future work should identify factors driving the observed associations and the sex differences.

Cannabis Use Patterns and Related Health Outcomes Among Spanish Speakers in the United States and Internationally

Cannabis and health research continue to largely ignore the usage patterns, perceptions, and medically related use in Spanish-speaking communities. The primary aim of this study was to collect data among Spanish-speaking communities on cannabis use that specifically characterizes granular demographic information, medically motivated and recreational use patterns including potency of products, medical motivations for use, and what perceptions are held as to risks and benefits. Secondarily, exploratory analyses were made to investigate potential effects of location or acculturation status. Five hundred forty-nine individuals completed the survey, including 294 residing in the United States (US) (Mage =31.8, SD=9.72; 154 women, 137 men, 3 non-binary and self-described individuals), 174 residing outside of the US (International) (Mage =26.6, SD=8.75; 77 women, 96 men, 1 non-binary and self-described individuals), and 81 who did not report country of residence (Unknown location) (Mage =26.7, SD=7.37; 17 women, 61 men, 3 non-binary and self-described individuals). Overall use was mostly recreational, while the US group was significantly more motivated by medical or combined medical and recreational reasons than the other two groups (p=0.02). The most common reason for medical use was anxiety or depression (14% of sample). The US group also smoked or vaporized significantly more often than the other two groups and was more likely to include daily users (p<0.001). The sample generally viewed the effects of cannabis use more favorably than negatively, but there were significant differences in these views between users and non-users. The rich heterogeneity suggested by these data belies the importance of taking an equity focused approach to cannabis research and will help to improve representation in the field.

Successful recruitment of monolingual Spanish speaking Latinos to university phase II and III outpatient COVID-19 clinical treatment trials in Northern California

Through a public County/University partnership, we employed a Spanish/English bilingual research coordinator to increase awareness of newly available treatments with FDA Emergency Use Authorization and clinical trial opportunities for Latino outpatients with mild to moderate COVID-19. Out of the 550 San Mateo County outpatients with COVID-19 referred to Stanford University between July 2020 and April 2022, 9.5% elected to receive monoclonal antibody EUA treatment. COVID-19 treatment trial enrollment of County patients, 5% of those recruited, was commensurate with non-County populations enrollment. Recruitment models such as ours have the potential to increase US Latino populations' recruitment in outpatient COVID-19 treatment trials and contribute to decreasing COVID-19 health disparities.

Cultural factors related to neuropsychological performance and brain atrophy among Hispanic older adults with amnestic Mild Cognitive Impairment (aMCI): A pilot study

OBJECTIVES

This study examined the association of cultural factors and literacy to neuropsychological performance and measures of regional brain atrophy among Hispanic elders diagnosed with amnestic Mild Cognitive Impairment (aMCI).

METHOD

Acculturation and literacy levels were measured among 45 subjects tested in Spanish; their primary language. Scores for measures of memory, executive functioning, and verbal fluency, as well as volumetric analysis of MRI scans of left hemisphere structures commonly affected by Alzheimer's disease (AD) were examined. Linear regression models were employed to examine the association of acculturation and literacy to neuropsychological performance and MRI measures.

RESULTS

After controlling for age, higher literacy levels were associated with better performance on phonemic verbal fluency (r = 0.300, p < .05), while higher levels of acculturation to the U.S. was associated with poorer performance on category verbal fluency (r = 0.300, p < .05). There was a significant inverse relationship after controlling for age between literacy and the left entorhinal cortex (r = -0.455, p < .05), left precuneus (r = -0.457, p < .05), and left posterior cingulate (r = -0.415, p < .05).

CONCLUSIONS

Results of the current pilot study indicate that high acculturation to the U.S. among aMCI immigrants from Latin-American countries may hinder performance on verbal learning measures when they are administered in one's primary language. Moreover, in this cohort, a higher literacy level, which is indicative of greater cognitive reserve, was associated with better performance in language measures, but with greater atrophy in brain regions susceptible to neurodegenerative disease. These preliminary findings should be further examined among larger cohorts and using more diverse measures, which capture other cultural constructs.

Predictors of stigma toward alcohol misuse in Latino communities: a path model

This study explores stigma-related beliefs within the Latino community concerning alcohol misuse. A community-based convenience sample of 251 self-identified Latino adults were recruited to participate in a research study using an experimental vignette methodology. Participants were randomly assigned one of four vignettes about alcohol misuse and asked to share their attitudes and stigma-related beliefs about the problem and the person in the vignette. Sociodemographic characteristics of participants differentially predicted alcohol-related stigma. These data may be used to inform health literacy and stigma reduction interventions within the Latino community.

Findings from the Hispanic Community Health Study/Study of Latinos on the Importance of Sociocultural Environmental Interactors: Polygenic Risk Score-by-Immigration and Dietary Interactions

Introduction: Hispanic/Latinos experience a disproportionate burden of obesity. Acculturation to US obesogenic diet and practices may lead to an exacerbation of innate genetic susceptibility. We examined the role of gene-environment interactions to better characterize the sociocultural environmental determinants and their genome-scale interactions, which may contribute to missing heritability of obesity. We utilized polygenic risk scores (PRSs) for body mass index (BMI) to perform analyses of PRS-by-acculturation and other environmental interactors among self-identified Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: PRSs were derived using genome-wide association study (GWAS) weights from a publicly available, large meta-analysis of European ancestry samples. Generalized linear models were run using a set of a priori acculturation-related and environmental factors measured at visit 1 (2008-2011) and visit 2 (2014-2016) in an analytic subsample of 8,109 unrelated individuals with genotypic, phenotypic, and complete case data at both visits. We evaluated continuous measures of BMI and waist-to-hip ratio. All models were weighted for complex sampling design, combined, and sex-stratified. Results: Overall, we observed a consistent increase of BMI with greater PRS across both visits. We found the best-fitting model adjusted for top five principal components of ancestry, sex, age, study site, Hispanic/Latino background genetic ancestry group, sociocultural factors and PRS interactions with age at immigration, years since first arrival to the United States (p < 0.0104), and healthy diet (p < 0.0036) and explained 16% of the variation in BMI. For every 1-SD increase in PRS, there was a corresponding 1.10 kg/m² increase in BMI (p < 0.001). When these results were stratified by sex, we observed that this 1-SD effect of PRS on BMI was greater for women than men (1.45 vs. 0.79 kg/m², p < 0.001). Discussion: We observe that age at immigration and the adoption of certain dietary patterns may play a significant role in modifying the effect of genetic risk on obesity. Careful consideration of sociocultural and immigration-related factors should be evaluated. The role of nongenetic factors, including the social environment, should not be overlooked when describing the performance of PRS or for promoting population health in understudied populations in genomics.

Rural Latino parent and child physical activity patterns: family environment matters

Background

Rural Latino children and adults are less active than urban and non-Latino counterparts. We examined physical activity (PA) patterns of rural Latino children and their parents, and explored parental beliefs about and reported barriers of Latino family physical activity. Latino families in a rural area in eastern Washington state, with children in grades 3–5 were included.

Methods

We used mixed methods. Children (n = 27) and parents (n = 25) wore an accelerometer for 5 days; parents (n = 31) participated in a semi-structured interview and completed a demographic survey. Parent and child activity levels were compared using paired t-tests; interviews were analyzed with qualitative content analysis.

Results

Although 100% children and 46% parents met physical activity guidelines, parents and children spent most of the day in sedentary behaviors. Parent-reported PA barriers included their long work hours, lack of transportation, and their child’s screen-time.

Conclusion

Addressing barriers and reducing sedentary time could increase PA of rural Latino families.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12085-w.

Acculturation and use of traditional medicine among African migrant women in Sydney: a mixed method study

Background

More than 80% of the African population depend on traditional medicine as a primary healthcare. Although the African migrant community is increasing in Australia, there is no research documenting if and how African migrant communities have maintained or changed their use of traditional health practices after migration. This study aims to answer the following research questions: does acculturation influence the use of traditional medicine? and how are cultural health practices or beliefs manifested among African migrant women in Australia?

Method

A mixed methods design which involved a cross-sectional survey (n = 319) and individual interviews (n = 15) was conducted. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants’ responses. The study was informed by acculturation theory.

Result

Both the survey and the interview data indicated that cultural health practices were retained as an important form of healthcare for African migrant women in Sydney. The findings indicated that African migrants continued to use traditional medicines as part of their cultural identity and to build cohesive ethnic community to share traditional values and cultural practices. Women who relatively stayed for shorter period of time in Australia and migrated at a later age were more likely to use TM.

Conclusion

Acculturation proxy measures increased the likelihood of TM use suggesting African migrant women retain their cultural health practices in Australia and use of TM was manifested as part of their cultural identity. The findings have implications to improve the provision of culturally sensitive and responsive health services when caring for African migrant women.

Older immigrants perceived health after migration to the United States: Influence of age and level of acculturation

OBJECTIVES

To determine the age-related differences in the association between level of acculturation and perceptions about change in health status after migration in mid- to late-life immigrants.

DESIGN

Cross-sectional study.

SETTING

Nationally representative cohort of legal U.S. immigrants.

PARTICIPANTS

Legal immigrants ≥50 years of age.

MEASUREMENTS

The outcome was perceived change in health status, determined by the survey question, "compared with your health right before you most recently came to the United States to live, would you say that your health is better now, about the same or worse?" The main predictor included age group (50-64, 65-74, and ≥75 years) and secondary variable of interest was level of acculturation. Analyses were adjusted for demographic characteristics, medical, and functional comorbidities.

RESULTS

Immigrants age ≥75 years were more likely to report worse health after migration [RRR 1.93, 95% CI (1.17, 3.17), p < 0.01] compared with immigrants of 50-64 years, but this difference was not statistically significant in the adjusted model. Acculturation level was associated with increased likelihood of reporting worse health status, [RRR 2.10, (1.02, 4.35), p < 0.05] for somewhat acculturated and [RRR 2.55, (1.10, 5.88), p < 0.05] for most acculturated, compared with participants who were not acculturated.

CONCLUSION

The oldest immigrant group (≥75 years) was more likely to report worse health after migration, but this association was no longer significant after accounting for acculturation level and other covariates. Future work should be undertaken to identify specific health needs across older immigrant age groups and identify acculturative stressors that negatively impact health.

Exploring network derived indicators of acculturation among college enrolled Latinxs: Examining language use and homophily in support networks

Acculturation measures focus on the perceived composition of a person's social networks as a characteristic of cultural change but have not focused on specific social relationships as sources of evaluation. The current study explores network-derived indicators of acculturation and determines the viability of network acculturation as a related, but distinct, construct from enculturation. A first-order ego network electronic survey design was used to gather social network and traditional survey data from a sample of college-enrolled Latinxs using name generator and name interpreter questions. Findings indicate low but statistically significant correlations between network indicators of acculturation and enculturation as hypothesized. No group differences in network acculturation were observed between generational statuses despite demonstrated differences in psychological enculturation. The low but statistically significant relationships between enculturation and network acculturation suggest conceptually related but distinct indicators of acculturation. Latinx homophily was the strongest predictor of enculturation, revealing the importance of network characteristics.

Weight Loss Interventions for Hispanic Women in the United States: A Systematic Review

Background

Obesity rates in Hispanic women residing in the United States (U.S.) are disproportionately high, increasing the risk of obesity-related disease and mortality. The effectiveness of interventions targeting weight loss in this population remains largely unknown.

Purpose

The purpose of this review was to systematically evaluate the evidence related to the effectiveness of weight loss interventions conducted among U.S. Hispanic women and provide guidance for future research.

Methods

Bibliographic databases (n = 10, from each database's inception to July 2, 2019) were searched using the PRISMA guidelines for systematic reviews. Randomized controlled trials (RCTs) and quasi-experimental studies with weight change outcomes were included. Results were described in a narrative synthesis.

Results

5,423 articles were assessed for eligibility based on inclusion criteria; 15 studies were included in the final review. Nine trials were RCTs and six were quasi-experimental studies; all but six were pilot studies. Most studies recruited overweight or obese women with no existing medical conditions and did not follow participants beyond the intervention. All trials were delivered in-person. Intervention strategies and content and weight change outcomes were highly variable.

Conclusions

RCTs with statistically powered sample sizes are needed to robustly test the effects of weight loss interventions in this population.

Measurement challenges for childhood obesity research within and between Latin America and the United States

Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.

Body composition outcomes of Healthy Fit and the role of acculturation among low-income Hispanics on the US-Mexico border

BACKGROUND

Hispanic immigrants continue to experience higher rates of overweight and obesity compared to their non-Hispanic counterparts. Acculturation may contribute to unhealthy weight gain among immigrant populations by shifting dietary patterns from high fruit and vegetable consumption to unhealthier high fat diets. Healthy Fit, a culturally tailored community health worker (CHW) intervention, aims to reduce obesity related outcomes by providing physical activity and nutrition education and resources in a low-income Hispanic population. This study aims to evaluate outcomes of Healthy Fit participants and examine changes in body composition in relation to level of acculturation at baseline and follow-up.

METHOD

In this longitudinal observational study, CHWs recruited 514 participants from community events and agencies serving low-income Hispanic populations in El Paso, Texas from 2015 to 2016. Following an in-person health screening, eligible participants received nutrition and physical activity education guided by fotonovelas, comic-like educational books. Telephone follow-ups made at 1, 3, and 6 months by CHWs encouraged follow-through on referrals. 288 participants completed the screening again during the 12-month follow-up.

RESULTS

The sample was predominantly Hispanic (96%), female (82%), uninsured (79%), had a household income of less than $19,999 (70%), foreign-born (79%), preferred Spanish (86%) and few rated themselves as good or excellent for English proficiency (27%). Overall, Healthy Fit participants significantly improved (i.e., decreased) BFP by 0.71% (t = 2.47, p = 0.01) but not BMI (b = .01, t = - 0.14, p = .89). Contrary to expectations, acculturation was not associated with lower BMI (b = 0.09, p = 0.84) or BFP (b = 0.13, p = 0.85) at baseline. However, acculturation predicted changes in both BMI (b = 0.30, p = 0.03) and BFP (b = 1.33, p = 0 .01) from baseline to follow-up. Specifically, the low acculturation group improved in body composition measures over time and the high acculturation group did not improve in either measure.

CONCLUSION

Findings suggest Healthy Fit was most effective among less acculturated individuals. The influence of acculturation on the efficacy of nutrition and exercise interventions suggests that Hispanics should not be treated as a homogenous subgroup.

Associations of Self-Reported Sleep Quality with Demographic and Other Characteristics in Older Korean Immigrants

Poor sleep is common among older adults, affecting a wide range of health outcomes. However, little is known about sleep issues among older Korean immigrants, the fastest growing Asian American subgroup in the United States. We aimed to explore multiple factors associated with sleep among this group. We analyzed cross-sectional survey data from 43 older immigrants living in two large Korean communities in Southern California. Perceived sleep quality was significantly associated with gender, living arrangement, employment status, mental health, and sleep-related beliefs (all p-values < 0.05). Living with someone and being employed for wages were significantly uniquely associated with better sleep quality, accounting for demographic and health-related factors (R² = 51.8%, adjusted R² = 38.7%, p = 0.002). These findings suggest a potential role of sociocultural factors on sleep. Further studies are needed to confirm these findings and to inform a sleep intervention program tailored to the characteristics of older Korean immigrants.

Transcultural adaptation of cognitive behavioral therapy (CBT) in Asia

BACKGROUND

Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted.

AIMS

This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned.

METHODS

An environmental scan of the literature, description of local CBT associations and perspectives from these organizations.

RESULTS

Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques.

CONCLUSIONS

The last decade has seen an increase in culturally adapted CBT in Asia, however, more work needs to be done to improve access to CBT in Asia.

Severe acute respiratory syndrome coronavirus 2 infection in asymptomatic pediatric dental patients

BACKGROUND

Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are typically asymptomatic but contagious. The authors investigated the positivity rate of asymptomatic SARS-CoV-2 infection in pediatric dental patients.

METHODS

The authors reviewed consecutive charts of children younger than 18 years scheduled for elective dental procedures from April 1, 2020, through August 1, 2020. All patients were screened for signs and symptoms of SARS-CoV-2 infection. Asymptomatic patients scheduled for dental procedures underwent polymerase chain reaction (PCR) testing for SARS-CoV-2. Sociodemographic characteristics were abstracted, and positivity rates were calculated. Variables for patients who were SARS-CoV-2 positive and SARS-CoV-2 negative were compared using Fisher exact and Mann-Whitney U tests.

RESULTS

The sample size was 921. The median age was 6 years, and 50.9% were boys. The overall SARS-CoV-2 positivity rate was 2.3%. Age, insurance status, medical history, and dental diagnosis were comparable in patients who were SARS-CoV-2 positive and SARS-CoV-2 negative. Positivity rates were statistically higher for Hispanic or Latinx patients than other groups (P = .038).

CONCLUSIONS

Although the yield of testing was low, the systematic evaluation of asymptomatic pediatric dental cases via PCR resulted in the identification of SARS-CoV-2 carriers who could have been infectious. In this study, Hispanics or Latinx had a higher positivity rate than other demographic groups.

PRACTICAL IMPLICATIONS

PCR testing for SARS-CoV-2 of asymptomatic patients in pediatric dentistry adds value to the use of screening questionnaires for the identification of infected people who could be contagious.

Risk factor control across the spectrum of cardiovascular risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Presence of cardiovascular disease (CVD) risk factors (RFs) should prompt patients and their providers to work aggressively towards controlling those that are modifiable. The extent to which a greater CVD RF burden is related to CVD RF control in a contemporary and diverse Hispanic/Latino population is not well-understood.

Methods

Using multicenter community-based data from the Hispanic Community Health Study/Study of Latinos, we assessed the self-reported prevalence of hypertension, hypercholesterolemia, diabetes, and prevalent CVD (ischemic heart disease or stroke). We used contemporaneous guidelines to define RF control. Multivariable logistic regression for complex survey sampling was used to examine whether having more CVD RFs was associated with CVD RF control (adjusting for age, sex, Hispanic background group, education, and health insurance).

Results

Our sample included 8521 participants with at least one CVD RF or prevalent CVD. The mean age in HCHS/SOL target population was 49 (SE 0.3) years and 56% were women. Frequency of one, two, or three self-reported CVD RFs was 57%, 26%, 8%, respectively, and overall 9% of participants had prevalent CVD. After adjusting for sociodemographic factors, compared to those reporting one CVD RF, individuals with three CVD RFs were the least likely to have blood pressure, cholesterol, and glucose optimally controlled (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.40-0.80). However, those with prevalent CVD were more likely to have all three risk factors controlled, (OR: 1.43; 95% CI: 1.01-2.01).

Conclusion

Hispanic/Latino adults with three major CVD RFs represent a group with poor overall CVD RF control. Secondary CVD prevention fares better. The potential contributors to inadequate CVD RF control in this highly vulnerable group warrants further investigation.

THE ASSOCIATION BETWEEN BEHAVIORAL AND ATTITUDINAL ACCULTURATION ON LATINX IMMIGRANTS AND U.S.-BORN LATINXS: A MULTIDIMENSIONAL ACCULTURATION MODEL

Disparities in access and utilization of substance abuse treatment (SAT) among Latinxs, accentuated by this population's rapid growth, create a public health issue. Although substance abuse literature has given more consideration to environmental factors and social support concerning treatment outcomes, current substance abuse models fail to address important contextual and cultural aspects for Latinxs in recovery, including acculturation. The proposed study aims to test out a multidimensional acculturation model on a sample of 131 Latinxs (M_age= 36.3; SD±10.4, 117 males, 49% immigrants) who recently completed SAT. Specifically, the proposed study employed a conditional process model using the PROCESS Macro for SPSS to examine the association between behavioral acculturation and substance use behavior in the past six months on nativity status at different levels of attitudinal acculturation. Results yielded that, after controlling for age and substance use, higher endorsement of U.S. mainstream cultural practices was associated with a higher frequency of days using alcohol among Latinx immigrants, specifically those reporting high and very high affiliation to the U.S. mainstream culture. Also, a negative association between U.S. mainland-born Latinx and frequency of days using illicit drugs in the past six months was observed, but only among those who endorse very high affiliation of U.S. mainstream culture.

A Meta-Analysis of Latinx Acculturation and Intimate Partner Violence

OBJECTIVE

Intimate partner violence (IPV) is a serious public health concern that affects many Latinx couples. The present study conducted a systematic review and meta-analysis to quantitatively assess acculturation as a predictor of IPV among Latinxs and subgroup analyses to evaluate the effect size by gender and type of acculturation measure.

METHOD

The meta-analysis implemented the preferred reporting items for systematic reviews and meta-analyses guidelines to retrieve studies assessing the relationship between acculturation and intimate partner victimization among foreign-born and U.S.-born Latinx adults. A fixed effects model (FEM) and a random effects model (REM) were employed. Additional subgroup analyses examined the strength of the relationship by gender and type of acculturation measure.

RESULTS

The meta-analysis included 27 independent effect sizes across 21 studies. An REM yielded a weighted average correlation of .11 (95% confidence interval [.02, .20]). The strength of the correlation differed by scale and ranged from -.003 to .47. For both men and women, higher acculturation was associated with increased IPV.

CONCLUSIONS

Our results yielded three important findings: (1) the overall effect of acculturation on IPV is relatively small, (2) acculturation differentially influences male-to-female and female-to-male partner violence, and (3) the strength of the correlation between acculturation and IPV differs by scale. This body of work provides evidence for the effect of acculturation on IPV, with potential implications for interventions targeting Latinxs.

The Association of Spanish Language Preference with Advance Directive Completion

BACKGROUND/OBJECTIVES

Hispanics have lower advance directive (AD) completion than non-Hispanic Whites. Few studies have assessed the role of language preference in end-of-life planning. We investigated whether language preference and needing an interpreter affected AD completion among older adults in an integrated health system.

DESIGN

Retrospective cohort investigation of electronic medical records.

SETTING

Northern California integrated health system.

PARTICIPANTS

A total of 620,948 Hispanic and non-Hispanic White patients, aged 55 years and older, between January 1, 2013, and December 31, 2017.

MEASUREMENTS

Descriptive statistics and bivariate analysis were performed to compare AD completion among non-Hispanic Whites, Hispanics, and Hispanic subgroups by language preference (English speaking, Spanish speaking, and needed interpreter). We conducted multivariable logistic regression to determine the relationship between language preference and having an AD while controlling for demographic, clinical, and utilization factors.

RESULTS

We found 20.3% of non-Hispanic Whites (n = 512,577) and 10.9% of Hispanics (n = 108,371) had completed an AD. Among Hispanics, after controlling for demographic, clinical, and utilization factors, compared with Spanish speakers requiring an interpreter, English speakers had nearly two-fold increased odds of completing an AD (adjusted odds ratio (aOR) = 2.6; 95% confidence interval (CI) = 2.4-2.9), whereas Spanish speakers not requiring an interpreter had 20% increased odds (aOR = 1.2; 95% CI = 1.1-1.3). Additional predictors of successful AD completion were being female, being older, having more comorbidities, having more hospital and emergency department visits, and having higher socioeconomic status. There were no differences associated with primary care provider characteristics.

CONCLUSION

These findings indicate the need for a tailored outreach to Hispanics, particularly among those subgroups who require the need of an interpreter, to reduce AD completion disparities.

Conceptualizing Ethnicity: How Dimensions of Ethnicity Affect Disparities in Health Outcomes Among Latinxs in the United States

Methods

Using regression methods to analyze data from the 2006 Portraits of American Life Study, we examined how attributional and relational dimensions of ethnicity affect: 1) intragroup differences in Latinx mental and physical health status, as measured by feelings of worthlessness and self-rated health, respectively; and 2) intergroup differences between Latinxs and non-Hispanic Whites in these health outcomes.

Results

Latinxs have higher odds of feelings of worthlessness and lower odds of self-reporting good/excellent health compared with non-Hispanic Whites. Additionally, intragroup differences in health are observed among Latinxs, conditioned on attributional or relational dimensions of ethnicity.

Conclusion

Multidimensional measures of ethnicity that distinguish between characteristics associated with ethnicity (attributional) or race (relational) offer a nuanced explanation of health disparities by revealing aspects of ethnicity that shape health outcomes differently, contributing to the goals of health equity.

Exploring experiences and expectations of prenatal health care and genetic counseling/testing in immigrant Latinas

As the Latino population of the United States continues to increase, the specific needs of Latinos in genetic counseling continue to be unmet. Using culturally tailored genetic counseling responsive to the needs of the patient can assist in building rapport in genetic counseling sessions. We aimed to investigate the relationship between acculturation, prenatal care, genetic testing experiences, and expectations for prenatal care in an immigrant Latino population. A total of 20 Spanish-speaking, pregnant Latinas from various Latin American countries were interviewed after completing a prenatal genetic counseling session. The semi-structured phone interview included questions about the participants' experiences with genetic counseling/testing, prenatal health care in their home country, their current prenatal care in the United States, and information they felt to be important to know during their pregnancy. Although this study showed no statistically significant associations between acculturation, prenatal care, and genetic counseling/testing experiences, six significant content domains were identified as relevant to the participants. Overall, we found that immigrant Latinas desire to know prenatal risk information to help them prepare, relieve guilt, and help make screening/testing/family planning decisions. These Latinas reported the genetic counselor provided confidence, a sense of autonomy, and empowerment, for them to make their own decisions regarding prenatal screening/testing. The participants also spoke about stressors unique to the immigrant population, most notably being away from their older children and other family members. Identifying relevant factors about the lived experience of this population can help genetic counselors better address possible needs, feelings of guilt, and/or isolation and identifying women who could benefit from group-based prenatal care, support groups, or referrals to social work.

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery

OBJECTIVE

To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model.

DESIGN

A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program.

SETTING

Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State.

PARTICIPANTS

Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states.

INTERVENTIONS

FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum.

MAIN OUTCOME MEASURES

Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation.

ANALYSIS

Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Somatic symptoms in treatment-naïve Hispanic and non-Hispanic patients with major depression

BACKGROUND

Somatic complaints are a major driver of health care costs among patients with major depressive disorder (MDD). Some epidemiologic and clinical data suggest that Hispanic and non-Hispanic Black patients with MDD endorse higher levels of somatic symptoms than non-Hispanic White patients.

METHODS

Somatic symptoms in 102 Hispanic, 61 non-Hispanic Black, and 156 non-Hispanic White patients with treatment-naïve MDD were evaluated using the somatic symptom subscale of the Hamilton anxiety rating scale (HAM-A). The other seven items of the HAM-A comprise the psychic anxiety subscale, which was also evaluated across ethnicities.

RESULTS

Hispanic patients reported significantly greater levels of somatic symptoms than non-Hispanic patients, but levels of psychic anxiety symptoms did not differ by ethnicity. Levels of somatic symptoms did not significantly differ between Black and White non-Hispanic patients. Within the Hispanic sample, somatic symptom levels were higher only among those who were evaluated in Spanish; Hispanics who spoke English showed no significant differences versus non-Hispanics.

CONCLUSIONS

In this medically healthy sample of patients with MDD, monolingual Spanish-speaking Hispanic patients endorsed high levels of somatic symptoms. Clinicians should be mindful that the depressive experience may manifest somatically and be judicious in determining when additional medical work-up is warranted for somatic complaints.

Acculturation and the oral health of a nationally representative sample of Hispanic children in the United States: an analysis of 2011-2012 National Survey of Children's Health data

BACKGROUND

Oral disease is a serious public health issue, and Hispanic children in the United States (US) are more likely than children of other racial/ethnic groups to experience dental caries. Although Hispanic children are a growing segment of the US population there is limited research on the association between acculturation and oral health outcomes in this population. This study examined the associations between household acculturation and pediatric oral health in the Hispanic population using a nationally representative sample of children.

METHODS

Data from the 2011-2012 National Survey of Children's Health were analyzed; analyses included Hispanic children ages 1 to 17. Household acculturation was assessed with a combination of language and parental nativity, while oral health was assessed via parents'/guardians' reports of children's dental caries. Logistic regression was used to examine the association between acculturation and oral health, adjusting for other demographic and social determinants of pediatric oral health. We assessed significance at the p < 0.05 level, and all analyses accounted for the survey's complex sample design.

RESULTS

Analyses included 9143 Hispanic children. In total, 24.9% (95% CI: 22.9-27.0%) experienced dental caries, and there were significant associations between household acculturation and oral health. In unadjusted analyses, 32.0% (95% CI: 28.9-35.4%) of children in low acculturation households, 20.3% (95% CI: 16.0-25.4%) of children in moderate acculturation households, and 16.9% (95% CI: 14.2-20.0%) of children in high acculturation households experienced dental caries (p < 0.001). In adjusted analyses, children in high acculturation households were significantly less likely than those in low acculturation households to experience dental caries (p < 0.001; OR = 0.50; 95% CI: 0.35-0.70). The difference between children in moderate and low acculturation households approached but did not reach statistical significance (p = 0.057; OR = 0.69; 95% CI: 0.48-1.01).

CONCLUSIONS

A dose-response relationship was observed between household acculturation and the oral health of Hispanic children in the US. As acculturation increases, the likelihood of a child experiencing dental caries decreases. These findings suggest that public health and community-based interventions intended to reduce oral health disparities in Hispanic children would likely be most impactful if the acculturation levels of the children's households are considered during program development.

Exploring Latinidad, Migration Processes, and Immigrant Experiences: Experiences Influencing Latino Health

INTRODUCTION

Over the last few decades, Latino migration to the U.S. has re-shaped the ethnic composition of the country, and influenced the meaning of "ethnic" and "racial" identity. The purpose of this qualitative study was to explore the definition and meaning of being Latino and how this may guide the development of interventions to promote their health.

METHODS

Twenty-six Latino immigrants living in Kansas completed a socio-demographic survey and semi-structured interviews to assess and explore personal immigration experiences and perspectives on the meaning of being Latino in the U.S.

RESULTS

Participant reports were grouped into eight themes on Latino identity that were organized by geographic origin, family roots/ties, and acculturation. Immigration experiences were described as both positive and negative with most participants experiencing discrimination and loneliness, but also reports of improved quality of life. Further, most participants reported a strong sense of Latinidad; that Latino immigrant communities in the U.S. are interdependent and supportive of each other.

CONCLUSIONS

The experience of being a member of a minority group might contribute to the development of a cohesive sense of Latino identity as participants acculturate to the U.S. while preserving a sense of attachment to their culture of origin. Future interventions should be sensitive to migration experiences as they might influence changes in health behaviors.

Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017

BACKGROUND

Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.

METHODS

Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors.

RESULTS

Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14).

CONCLUSIONS

Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.

Neighborhood Environment Perceptions among Latinos in the U.S

In the U.S., immigrants and racial/ethnic minorities (e.g., Latinos) often report unfavorable neighborhood environments, which may hinder physical activity (PA). Among Latinos, PA levels are disproportionately lower in foreign-born, female, older, and low-education individuals. It is unclear whether these subgroups, including those from multiple disadvantaged backgrounds (e.g., low education, foreign-born), perceive worse neighborhood environments for PA. This cross-sectional study aimed to examine differences in neighborhood environment perceptions among Latinos in the 2015 National Health Interview Survey (N = 4643; 59% foreign-born). Logistic regression models examined nativity—and its interactions with age, gender, and education—in relation to the perceived presence of transportation infrastructure (two items) and destinations (four items), controlling for self-reported walking. Models used sample weights and accounted for the complex survey design. Nativity was not significantly associated with neighborhood environment perceptions. However, nativity interactions with age and education showed the greatest inequities (lowest perceptions) of neighborhood infrastructure (e.g., fewer sidewalks) or destinations (e.g., fewer places to relax) among disadvantaged U.S.-born (older or low education) and advantaged foreign-born (higher education) Latinos. Findings suggest neighborhood perceptions are shaped by complex interactions of nativity with structural (education) and contextual (age) factors. Additional research is needed to complement our findings and inform environmental interventions targeting Latinos.

Family weight teasing, ethnicity and acculturation: Associations with well-being among Latinx, Hmong, and Somali Adolescents

OBJECTIVE

This study examines the prevalence of weight-based teasing by family members and associations with unhealthy weight control behaviors, body satisfaction, self-esteem, and depressive symptoms among adolescents from three immigrant communities (Latinx, Hmong, and Somali).

METHODS

Data come from EAT 2010, a population-based study of weight and related behaviors (N = 1577, mean age = 14.5 years). Adjusted models tested associations between weight-based teasing and well-being, controlling for BMI and ethnic group; effect modification by ethnic group and acculturation were also explored.

RESULTS

Family weight-based teasing was common (12.1%-42.9% reporting this experience across gender and ethnic groups) and was associated with all four measures of well-being in the expected direction. Associations were statistically equivalent in all ethnic groups and were not modified by acculturation.

CONCLUSION

Youth from immigrant communities experience family weight-based teasing and associated threats to well-being. Additional research is needed to further understand the cultural context of weight-based teasing and develop relevant prevention messages.

Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations

Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.

The Relationship Between Culture, Quality of Life, and Stigma in Hispanic New Mexicans With Dysphagia: A Preliminary Investigation Using Quantitative and Qualitative Analysis

Purpose The purpose of this investigation was to (a) identify the relationship between level of acculturation, and quality of life (QOL) and stigma and (b) explore the QOL experiences for Hispanic New Mexicans with dysphagia. Method This study includes 7 New Mexicans who self-identified as Hispanic. This prospective investigation was completed in 2 phases. In the quantitative phase, all participants completed the (a) the SWAL-QOL ( McHorney et al., 2000 ), (b) the Neuro-QoL Stigma subtest ( Gershon et al., 2012 ), and (c) the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II; Cuellar, Arnold, & Maldonado, 1995 ). In the qualitative phase, 3 participants were selected from the quantitative phase to complete the qualitative phase. These participants were selected to allow for distribution across levels of acculturation, and each of them participated in interviews designed to explore QOL experiences. Interviews were analyzed to identify themes. The occurrence of themes is discussed as a function of level of acculturation. Results There is no clear relationship between acculturation and QOL. A strong nonsignificant correlation was observed between acculturation and stigma. QOL experiences, as identified from the interviews, were classified into 2 broad categories: emotional experiences (stigma, distrust, fear, frustration, religion, and impact) and swallow safety (symptoms, treatment, triggers, and compensatory strategies). Conclusions Level of acculturation did not relate to measures of mental health or fatigue. Yet, both quantitative and qualitative analyses support a relationship between level of acculturation, and symptom reporting and religion, as well as patient perception of stigma.

How Have You Been? or ¿Como estás?: Does Language of Interview Influences Self-Rated Health Among Hispanic Subgroups?

This paper reports language differences in poor/fair self-rated health (SRH) among adults from six Hispanic groups in the United States. Data are from the cross-sectional 1997-2013 National Health Interview Survey (NHIS). The total sample of Hispanic adults with valid information for the variables considered in the study (n = 156,374) included Mexican-Americans (Mex-Am; n = 43,628), Mexicans (n = 55,057), Puerto Ricans (n = 14,631), Cubans (n = 8,041), Dominicans (from Dominican Republican, n = 4,359) and Other Hispanics (n = 30,658). We compared percentage of the population that reported poor/fair SRH among Hispanic individuals by language of interview and across origins using bivariate tests of association. Multivariable logistic regression analysis was used to study the odds of reporting poor/fair SRH based on language among the overall population and each group. Among the six Hispanic origins Puerto Ricans (15.92%), Cubans (16.36%) and Dominicans (15.32%) reported poor/fair SRH at higher levels than the overall sample (12.32%). In the logistic regression model adjusting potential covariates, those interviewed in Spanish were at higher odds of reporting poor/fair SRH than those interviewed in English (OR = 1.47, p < 0.0001). In the stratified analysis, Mexican-Americans were the only group where language of interview did not affect the odds of reporting poor/fair SRH. There are differences by Hispanic origin for reporting poor/fair SRH, and also by language of interview. Achieving accurate measurement of health status among Hispanics is a concern for all researchers, in particular those who study differences in health status by race/ethnicity in the United States. Future, research should account for Hispanic background and language of interviews.

Wellness in Sickness and Health (The W.I.S.H. Project): Advance Care Planning Preferences and Experiences Among Elderly Latino Patients

OBJECTIVE

To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos.

METHODS

Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey.

RESULTS

Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner.

CONCLUSIONS

Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language.

CLINICAL IMPLICATIONS

Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.

Cultural adaptation of cognitive–behavioural therapy

The study of cultural factors in the application of psychotherapy across cultures – ethnopsychotherapy – is an emerging field. It has been argued that Western cultural values underpin cognitive–behavioural therapy (CBT) as they do other modern psychosocial interventions developed in the West. Therefore, attempts have been made to culturally adapt CBT for ethnic minority patients in the West and local populations outside the West. Some frameworks have been proposed based on therapists’ individual experiences, but this article describes a framework that evolved from a series of qualitative studies to culturally adapt CBT and that was field tested in randomised controlled trials. We describe the process of adaptation, details of methods used and the areas that need to be focused on to adapt CBT to a given culture. Further research is required to move the field forward, but cultural adaptation alone cannot improve outcomes. Access to evidence-based psychosocial interventions, including CBT, needs to be improved for culturally adapted interventions to achieve their full potential.

LEARNING OBJECTIVES

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Nicotine and addiction beliefs and perceptions among the US-born and foreign-born populations

Little is known about nicotine and addiction beliefs held by those who are foreign-born in the US and how these beliefs are associated with acculturation and race/ethnicity. This study attempts to address these research gaps. Data were analyzed from two cycles of the Health Information National Trends Survey, HINTS-FDA 2015 (n = 3738) and HINTS-FDA 2017 (n = 1736). HINTS-FDA is a tobacco-focused, cross-sectional, nationally representative survey of US non-institutionalized civilian adults aged 18 years or older. We first assessed associations between foreign-born status and beliefs about nicotine and addiction using weighted chi-square analyses. Then, using only the foreign-born sample, we examined the associations of nicotine and addiction beliefs with race/ethnicity and acculturation (i.e., English proficiency and U.S. tenure) using weighted multiple linear regression. Results showed that, compared to US-born respondents, foreign-born respondents were more likely to be concerned with being addicted to nicotine and to believe that low nicotine cigarettes would have much lower lung cancer risk than a typical cigarette. Among the foreign-born, NH-Black and Hispanic respondents were more likely to see low nicotine cigarettes as harmful and addictive compared to NH-White respondents. The relationship between acculturation and nicotine beliefs was complex with lower acculturation associated with elevated misperceived risk of nicotine and also ratings of addictiveness. Further research among key subpopulations may inform communication, education and dissemination strategies, especially among vulnerable populations.

Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.