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Fabius CD, Parikh R, Wolf JM, Giordano S, Fashaw-Walters S, Jutkowitz E, Shippee T. Racial and ethnic differences in unmet needs among older adults receiving publicly-funded home and community-based services. J Am Geriatr Soc 2024. [PMID: 39210674 DOI: 10.1111/jgs.19153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/12/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS. METHODS We analyzed the National Core Indicators-Aging and Disability survey data (2015-2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types. RESULTS Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services. CONCLUSIONS Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Romil Parikh
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jack M Wolf
- Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | | | - Shekinah Fashaw-Walters
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric Jutkowitz
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
| | - Tetyana Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Robison J, Cano MÁ, de Dios M, Correa-Fernández V. Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke. J Behav Med 2024; 47:581-594. [PMID: 38409553 DOI: 10.1007/s10865-024-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Jillian Robison
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, 77204, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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Wang Y, Lee JS, Pollack LM, Kumar A, Honeycutt S, Luo F. Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults. Am J Prev Med 2024:S0749-3797(24)00228-9. [PMID: 39002890 DOI: 10.1016/j.amepre.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION This study seeks to estimate health care expenditures and use associated with hypertension, focusing on differences among racial and ethnic groups. METHODS Data were from the 2019 Medical Expenditure Panel Survey, analyzed in 2023. The study sample included noninstitutionalized U.S. adults aged ≥18 years. Outcome variables were health care expenditures and events. Hypertension was determined by a self-reported diagnosis or diagnosis codes. Race and ethnicity were self-reported. A 2-part model was used to estimate expenditures associated with hypertension. A zero-inflated negative binomial model was used to estimate events associated with hypertension. Sampling designs were applied to generate nationally representative estimates. RESULTS Hypertension was associated with $2,759 (95% confidence interval [CI]: $2,039, $3,479) in health care expenditures and 10.3 (95% CI: 9.3, 11.3) health care events, including prescriptions filled, in 2019 per person. Compared with non-Hispanic White adults, hypertension-associated health care expenditures were significantly lower among Hispanic adults (difference: -$1,877; 95% CI: -$3,389, -$364) and Asian adults (difference: -$2,452; 95% CI: -$4,093, -$811), and hypertension-associated health care events were significantly lower among Hispanic adults (difference: -3.8; 95% CI: -6.1, -1.6) and non-Hispanic Asian adults (difference: -4.1; 95% CI: -6.9, -1.2). Differences between non-Hispanic White adults and non-Hispanic Black adults were not statistically significant in health care expenditures (difference: -$954; 95% CI: -$2,849, $941) and events (difference: 0.3; 95% CI: -2.1, 2.8). CONCLUSIONS This study reveals differences in health care expenditures and use associated with hypertension among racial and ethnic groups. Future studies are needed to examine potential drivers of these differences.
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Affiliation(s)
- Yu Wang
- Division of Workforce Development, Public Health Infrastructure Center, Centers for Disease Control and Prevention, Atlanta, Georgia; Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Jun S Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashutosh Kumar
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Bizzell US, New Carrollton, Maryland
| | - Sally Honeycutt
- Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Chang JC, Liu JP, Berbert LM, Chandler MT, Patel PN, Smitherman EA, Weller EA, Son MBF, Costenbader KH. Racial and Ethnic Composition of Populations Served by Freestanding Children's Hospitals and Disparities in Outcomes of Pediatric Lupus. Arthritis Care Res (Hoboken) 2024; 76:926-935. [PMID: 38374576 PMCID: PMC11209814 DOI: 10.1002/acr.25314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Health disparities may be driven by hospital-level factors. We assessed whether racial and ethnic composition of populations hospitals serve explain or modify disparities in hospital outcomes of children with systemic lupus erythematosus (SLE). METHODS In this retrospective cohort study of patients 5 to 26 years old with SLE at 47 children's hospitals in the Pediatric Health Information System (2006-2021), race and ethnicity were assessed at the patient level and hospital level (proportion of total admissions composed of Black or Hispanic patients, respectively). Outcomes included intensive care unit (ICU) admission or adverse renal outcome (end-stage renal disease, dialysis, or transplant) during follow-up. We estimated racial and ethnic disparities, adjusted or stratified by hospital racial or ethnic composition. RESULTS Of 8,125 patients with SLE, 2,293 (28%) required ICU admission, and 698 (9%) had an adverse renal outcome. Black and non-Hispanic White disparities in ICU admission were observed only at hospitals serving higher proportions of Black patients (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.04-1.59 vs OR 1.07, 95% CI 0.83-1.38). Larger Black and non-Hispanic White disparities in adverse renal outcomes were observed at hospitals with higher Black racial composition (OR 2.0, 95% CI 1.4-2.8 vs OR 1.7, 95% CI 1.1-2.4). Conversely, Hispanic versus non-Hispanic disparities in renal outcomes persisted after adjustment for hospital-reported Hispanic ethnic composition but were observed only at hospitals with lower proportions of Hispanic patients. CONCLUSION Worse Black and White disparities in SLE outcomes are observed at children's hospitals serving more Black children, whereas distinct patterns are observed for Hispanic and non-Hispanic disparities. Reporting of hospital characteristics related to populations served is needed to identify modifiable drivers of hospital-level variation.
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Affiliation(s)
- Joyce C Chang
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica P Liu
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura M Berbert
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mia T Chandler
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pooja N Patel
- Lurie Children's Hospital and Northwestern University, Chicago, Illinois
| | | | - Edie A Weller
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary Beth F Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Puleo BK, Dillon FR, Ertl MM, Da Silva N, Cabrera Tineo YA, Verile M, De La Rosa M. Neighborhood Collective Efficacy: A Longitudinal Social Determinant of Access to Medical Care Among Recently Immigrated Latina Young Adults. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:83-91. [PMID: 37455338 DOI: 10.1177/15404153231187394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The present longitudinal study examined changes in perceived access to health care among a recently immigrated cohort of Latina young adults who were assessed annually during their first 3 years in the United States. A parallel process growth model of perceived access to health care and neighborhood collective efficacy was examined, accounting for socioeconomic indicators and immigration status. Five hundred thirty Latina young adults (ages 18-23) participated at baseline assessment, and approximately 95% were retained over three annual assessment time points. Participants' mean level of perceived access to health care increased during their initial 3 years in the United States. Women who reported more of an increase in perceived access to health care tended to also indicate increased neighborhood collective efficacy relative to their peers during their first 3 years in the United States. Findings offer important information about the individual- and community-level factors that influence recently immigrated Latinas' health care access.
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Affiliation(s)
- Blair K Puleo
- School of Counseling and Counseling Psychology, Arizona State University, Tempe, AR, USA
| | - Frank R Dillon
- School of Counseling and Counseling Psychology, Arizona State University, Tempe, AR, USA
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Nicole Da Silva
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - Yajaira A Cabrera Tineo
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - Michael Verile
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
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Oh H, Pickering TA, Martz C, Lincoln KD, Breslau J, Chae D. Ethno-racial differences in anxiety and depression impairment among emerging adults in higher education. SSM Popul Health 2024; 26:101678. [PMID: 38737143 PMCID: PMC11081800 DOI: 10.1016/j.ssmph.2024.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/05/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Background Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their White counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox. Methods We analyzed data from the Healthy Minds Study (2020-2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression. Results Black students reported lower mean impairment scores relative to White students at moderate and severe anxiety. Hispanic/Latine students only reported lower impairment relative to White students at severe anxiety. Asian students reported relatively lower mean impairment than White students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression. Conclusion Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to White students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.
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Affiliation(s)
- Hans Oh
- School of Social Work, University of Southern California, USA
| | - Trevor A. Pickering
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Connor Martz
- Population Research Center, University of Texas, Austin, USA
| | - Karen D. Lincoln
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, USA
| | | | - David Chae
- Department of Social, Behavioral, and Population Science, Tulane School of Public Health & Tropical Medicine, USA
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Barajas CB, Rivera-González AC, Vargas Bustamante A, Langellier BA, Lopez Mercado D, Ponce NA, Roby DH, Stimpson JP, De Trinidad Young ME, Ortega AN. Health Care Access and Utilization and the Latino Health Paradox. Med Care 2024:00005650-990000000-00220. [PMID: 38598667 DOI: 10.1097/mlr.0000000000002004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. METHODS The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. RESULTS After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. CONCLUSIONS In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.
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Affiliation(s)
- Clara B Barajas
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Alexandra C Rivera-González
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management and the Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Damaris Lopez Mercado
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ninez A Ponce
- Department of Health Policy and Management and the Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Dylan H Roby
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, Irvine, CA
| | - Jim P Stimpson
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA
| | - Alexander N Ortega
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI
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Brooks CV, Maupomé G. Social support associated with restorative treatment, professionally applied fluoride and flossing: A cross-sectional analysis including recent immigrants from Central America and Mexico in the Midwest USA. Community Dent Oral Epidemiol 2024; 52:187-195. [PMID: 37779340 PMCID: PMC10939981 DOI: 10.1111/cdoe.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/08/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID-19 pandemic. METHODS Using baseline wave data from the 2017-2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants. RESULTS Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist. CONCLUSIONS While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes.
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Affiliation(s)
- Caroline V. Brooks
- Indiana University, Department of Sociology, 1020 E. Kirkwood Ave., Bloomington, IN 47405, USA
| | - Gerardo Maupomé
- Indiana University-Purdue University Indianapolis, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd., Indianapolis, IN 46202, USA
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Stickel AM, Tarraf W, Kuwayama S, Wu B, Sundermann EE, Gallo LC, Lamar M, Daviglus M, Zeng D, Thyagarajan B, Isasi CR, Lipton RB, Cordero C, Perreira KM, Gonzalez HM, Banks SJ. Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL-INCA. Alzheimers Dement 2024; 20:1944-1957. [PMID: 38160447 PMCID: PMC10947951 DOI: 10.1002/alz.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women. METHODS Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos-Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7-year change, and mild cognitive impairment [MCI] prevalence). RESULTS Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence. DISCUSSION Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women.
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Affiliation(s)
- Ariana M. Stickel
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Sayaka Kuwayama
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Benson Wu
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
- Rush Alzheimer's Disease Research Center and the Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Carmen R. Isasi
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | - Krista M. Perreira
- Department of Social MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Hector M. Gonzalez
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Sarah J. Banks
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
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Errisuriz VL, Zambrana RE, Parra-Medina D. Critical analyses of Latina mortality: disentangling the heterogeneity of ethnic origin, place, nativity, race, and socioeconomic status. BMC Public Health 2024; 24:190. [PMID: 38229037 PMCID: PMC10790397 DOI: 10.1186/s12889-024-17721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.
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Affiliation(s)
| | - Ruth Enid Zambrana
- Harriet Tubman Department of Women, Gender and Sexuality Studies, University of Maryland, Susquehanna Hall 4200 Lehigh Rd. Room 4117, College Park, MD, 20742, USA
| | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th Street, GWB 1.102, Austin, TX, 78712, USA
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April-Sanders AK, Karaboyas A, Yunes M, Norris KC, Dominguez M, Kim RS, Isasi CR, Golestaneh L. Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study. BMC Nephrol 2023; 24:263. [PMID: 37670225 PMCID: PMC10478353 DOI: 10.1186/s12882-023-03297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis. METHODS A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011-2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering. RESULTS Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78-1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49-0.90). Null associations were observed among patients ≥ 64 years. CONCLUSIONS Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.
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Affiliation(s)
- Ayana K April-Sanders
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, 683 Hoes Lane West Piscataway, 08854, NJ, USA.
| | | | - Milagros Yunes
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Keith C Norris
- Division of General Internal Medicine and Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mary Dominguez
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Ladan Golestaneh
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Canales B, Laud PW, Tarima S, Zhou Y, Bikomeye JC, McGinley EL, Yen TWF, Bemanian A, Beyer KMM. Isolation and survival: The impact of local and MSA isolation on survival among non-Hispanic Black women diagnosed with breast cancer in the United States using a SEER-Medicare cohort. Health Place 2023; 83:103090. [PMID: 37531804 PMCID: PMC10528833 DOI: 10.1016/j.healthplace.2023.103090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Residential segregation is an important factor that negatively impacts cancer disparities, yet studies yield mixed results and complicate clear recommendations for policy change and public health intervention. In this study, we examined the relationship between local and Metropolitan Statistical Area (MSA) measures of Black isolation (segregation) and survival among older non-Hispanic (NH) Black women with breast cancer (BC) in the United States. We hypothesized that the influence of local isolation on mortality varies based on MSA isolation-specifically, that high local isolation may be protective in the context of highly segregated MSAs, as ethnic density may offer opportunities for social support and buffer racialized groups from the harmful influences of racism. METHODS Local and MSA measures of isolation were linked by Census Tract (CT) with a SEER-Medicare cohort of 5,231 NH Black women aged 66-90 years with an initial diagnosis of stage I-IV BC in 2007-2013 with follow-up through 2018. Proportional and cause-specific hazards models and estimated marginal means were used to examine the relationship between local and MSA isolation and all-cause and BC-specific mortality, accounting for covariates (age, comorbidities, tumor stage, and hormone receptor status). FINDINGS Of 2,599 NH Black women who died, 40.0% died from BC. Women experienced increased risk for all-cause mortality when living in either high local (HR = 1.20; CI = 1.08-1.33; p < 0.001) or high MSA isolation (HR = 1.40; CI = 1.17-1.67; p < 0.001). A similar trend existed for BC-specific mortality. Pairwise comparisons for all-cause mortality models showed that high local isolation was hazardous in less isolated MSAs but was not significant in more isolated MSAs. INTERPRETATION Both local and MSA isolation are independently associated with poorer overall and BC-specific survival for older NH Black women. However, the impact of local isolation on survival appears to depend on the metropolitan area's level of segregation. Specifically, in highly segregated MSAs, living in an area with high local isolation is not significantly associated with poorer survival. While the reasons for this are not ascertained in this study, it is possible that the protective qualities of ethnic density (e.g., social support and buffering from experiences of racism) may have a greater role in more segregated MSAs, serving as a counterpart to the hazardous qualities of local isolation. More research is needed to fully understand these complex relationships. FUNDING National Cancer Institute.
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Affiliation(s)
- Bethany Canales
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA.
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Jean C Bikomeye
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Emily L McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Tina W F Yen
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA; Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
| | - Amin Bemanian
- Department of Pediatrics, University of Washington Medicine, Seattle Children's Hospital, PO Box 5371, OC.7.830, Seattle, WA, 98145-5005, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3596, USA
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13
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McSorley AMM, Thomas Tobin CS, Kuhn R. 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. SSM Popul Health 2023; 22:101390. [PMID: 37251508 PMCID: PMC10214832 DOI: 10.1016/j.ssmph.2023.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/02/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
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.
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Affiliation(s)
- Anna-Michelle Marie McSorley
- New York University, School of Global Public Health, Center for Anti-racism, Social Justice, and Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Courtney S. Thomas Tobin
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
| | - Randall Kuhn
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA
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14
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Woodall AM, Driscoll AK, Mirzazadeh A, Branum AM. Disparities in Mortality Trends for Infants of Teenagers: 1996 to 2019. Pediatrics 2023; 151:e2022060512. [PMID: 37035875 PMCID: PMC10178899 DOI: 10.1542/peds.2022-060512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although mortality rates are highest for infants of teens aged 15 to 19, no studies have examined the long-term trends by race and ethnicity, urbanicity, or maternal age. The objectives of this study were to examine trends and differences in mortality for infants of teens by race and ethnicity and urbanicity from 1996 to 2019 and estimate the contribution of changes in the maternal age distribution and maternal age-specific (infant) mortality rates (ASMRs) to differences in infant deaths in 1996 and 2019. METHODS We used 1996 to 2019 period-linked birth and infant death data from the United States to assess biennial mortality rates per 1000 live births. Pairwise comparisons of rates were conducted using z test statistics and Joinpoint Regression was used to examine trends. Kitagawa decomposition analysis was used to estimate the proportion of change in infant deaths because of changes in the maternal age distribution and ASMRs. RESULTS From 1996 to 2019, the mortality rate for infants of teens declined 16.7%, from 10.30 deaths per 1000 live births to 8.58. The decline was significant across racial and ethnic and urbanization subgroups; however, within rural counties, mortality rates did not change significantly for infants of Black or Hispanic teens. Changes in ASMRs accounted for 93.3% of the difference between 1996 and 2019 infant mortality rates, whereas changes in the maternal age distribution accounted for 6.7%. CONCLUSIONS Additional research into the contextual factors in rural counties that are driving the lack of progress for infants of Black and Hispanic teens may help inform efforts to advance health equity.
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Affiliation(s)
- Ashley M. Woodall
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Anne K. Driscoll
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Ali Mirzazadeh
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Amy M. Branum
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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15
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Ingram M, Dueñas KR, Castro I, Vázquez L, Crocker RM, Larson EK, Guernsey de Zapien J, Torres E, Carvajal SC. The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095703. [PMID: 37174221 PMCID: PMC10177960 DOI: 10.3390/ijerph20095703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.
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Affiliation(s)
- Maia Ingram
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Karina R Dueñas
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | | | - Luis Vázquez
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA
| | - Rebecca M Crocker
- Cancer Center, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Emily K Larson
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Jill Guernsey de Zapien
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Emma Torres
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA
| | - Scott C Carvajal
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
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16
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Maldonado A, Villavicencio EA, Vogel RM, Pace TW, Ruiz JM, Alkhouri N, Garcia DO. The association between perceived stress, acculturation, and non-alcoholic fatty liver disease in Mexican-origin adults in Southern Arizona. Prev Med Rep 2023; 32:102147. [PMID: 36865397 PMCID: PMC9972566 DOI: 10.1016/j.pmedr.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/23/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Although available evidence indicates that Mexican-origin (MO) adults experience unique stressful life events, little is known about how stress may influence risk for developing non-alcoholic fatty liver disease (NAFLD) for this high-risk group. This study investigated the association between perceived stress and NAFLD and explored how this relationship varied by acculturation levels. In a cross-sectional study, a total of 307 MO adults from a community-based sample in the U.S-Mexico Southern Arizona border region completed self-reported measures of perceived stress and acculturation. NAFLD was identified as having a continuous attenuation parameter (CAP) score of ≥ 288 dB/m determined by FibroScan®. Logistic regression models were fitted to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for NAFLD. The prevalence of NAFLD was 50 % (n = 155). Overall, perceived stress was high (Mean = 15.9) for the total sample. There were no differences by NAFLD status (No NAFLD: Mean = 16.6; NAFLD: Mean = 15.3; p = 0.11). Neither perceived stress nor acculturation were associated with NAFLD status. However, the association between perceived stress and NAFLD was moderated by acculturation levels. Specifically with each point increase in perceived stress, the odds of having NAFLD were 5.5 % higher for MO adults with an Anglo orientation and 1.2 % higher for bicultural MO adults. In contrast, the odds of NAFLD for MO adults with a Mexican cultural orientation were 9.3 % lower with each point increase in perceived stress. In conclusion, results highlight the need for additional efforts to fully understand the pathways through which stress and acculturation may influence the prevalence of NAFLD in MO adults.
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Affiliation(s)
- Adriana Maldonado
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
| | - Edgar A. Villavicencio
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
| | - Rosa M. Vogel
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
| | - Thaddeus W. Pace
- College of Nursing, University of Arizona, Tucson, AZ 85724, USA
| | - John M. Ruiz
- College of Science, Department of Psychology, University of Arizona, Tucson, AZ 85724, USA
| | | | - David O. Garcia
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
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17
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Aran Ö, Phu T, Erhart A, Watamura S, Kim P. Neural activation to infant cry among Latina and non-Latina White mothers. Behav Brain Res 2023; 441:114298. [PMID: 36646254 PMCID: PMC9988217 DOI: 10.1016/j.bbr.2023.114298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Cultural neuroscience is an emerging framework positing that culture (for example, values, beliefs, practices, and modes of emotional expression) critically informs socialization goals and desired behaviors, which are perhaps accompanied by differential patterns of brain activation. Using fMRI, the current study examines brain activation to infant cry stimuli and matched white noise among 50 first-time biological mothers identifying as Latina or White in the United States. Results showed that brain activation to infant cries in the right posterior insula, left cerebellum, and left auditory were higher for White mothers compared to Latina mothers, p's < .05. White mothers showed greater activation to cry sounds compared to white noise in the right dorsolateral prefrontal cortex, left somatosensory, right and left premotor cortices, p's < .05, whereas Latina mothers did not. These brain regions are involved in motor planning, movement, sensory processing, and social information processing. It is important to note that mothers in the two groups did not show differences in stress and behavioral parenting measures. Therefore, Latina and White mothers differentially recruiting brain regions related to infant parenting behaviors indicates the potential role of cultural context in shaping patterns of neural activation. Our exploratory analysis suggests that this difference might be due to greater pre-parenting exposure among Latina mothers to children compared to White mothers. Taken together, although our data did not completely explain the differences in brain activation between groups, findings suggest potential culture-related influences in brain activation occurring in the postpartum period.
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Affiliation(s)
- Özlü Aran
- Department of Psychology, University of Denver, CO, USA.
| | - Tiffany Phu
- Department of Psychology, University of Denver, CO, USA.
| | - Andrew Erhart
- Department of Psychology, University of Denver, CO, USA; Colorado Department of Public Health and Environment, CO, USA
| | | | - Pilyoung Kim
- Department of Psychology, University of Denver, CO, USA
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18
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McSorley AMM, Bacong AM. Associations between Socioeconomic Status and Psychological Distress: An Analysis of Disaggregated Latinx Subgroups Using Data from the National Health Interview Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4751. [PMID: 36981660 PMCID: PMC10048719 DOI: 10.3390/ijerph20064751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014-2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.
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Affiliation(s)
- Anna-Michelle Marie McSorley
- Center for Anti-racism, Social Justice, and Public Health, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for the Study of Racism, Social Justice and Health, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - Adrian Matias Bacong
- Center for the Study of Racism, Social Justice and Health, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
- Stanford Center for Asian Health Research and Education, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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Abstract
OBJECTIVES We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans. DESIGN Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017. SETTING Older adults in Northern California. PARTICIPANTS Our cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8). MEASUREMENTS We used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education. RESULTS Generational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = -0.96; 95% CI: -1.12, -0.81) than immigration in adolescence (β = -0.68; 95% CI: -0.96, -0.41) or childhood (β = -0.28; 95% CI: -0.49, -0.06). Moreover, immigration in adulthood was associated with lower executive function (β = -0.63; 95% CI: -0.78, -0.48) than immigration in adolescence (β = -0.49; 95% CI: -0.75, -0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores. CONCLUSIONS Our study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.
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20
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Oh H, Koyanagi A. Immigrant status and psychotic experiences in the United States: revisiting an immigrant paradox. Psychol Med 2023; 53:301-303. [PMID: 33536106 DOI: 10.1017/s0033291720005462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, 1149 South Hill Street Suite #1422, Los Angeles, CA 90015, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
- ICREA, Barcelona, Spain
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21
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Duenas KR, Ingram M, Crocker RM, Pace TWW, de Zapien JG, Torres E, Carvajal SC. La vida en la frontera: protocol for a prospective study exploring stress and health resiliencies among Mexican-origin individuals living in a US-Mexico border community. BMC Public Health 2022; 22:2442. [PMID: 36575410 PMCID: PMC9794409 DOI: 10.1186/s12889-022-14826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies. METHODS La Vida en la Frontera is a mixed-methods participatory study linking a multi-disciplinary University of Arizona research team with Campesinos Sin Fronteras, a community-based organization founded by community health workers in San Luis, Arizona. This paper describes the current protocol for aims 2 and 3 of this multi-faceted investigation. In aim 2 a cohort of N≈300 will be recruited using door-to-door sampling of neighborhoods in San Luis and Somerton, AZ. Participants will be surveyed and undergo biomarker assessments for indicators of health and chronic stress at three time points across a year length. A subset of this cohort will be invited to participate in aim 3 where they will be interviewed to further understand mechanisms of resilience and wellbeing. DISCUSSION This study examines objective and subjective mechanisms of the relationship between stress and health in an ecologically diverse rural community over an extended timeframe and illuminates health disparities affecting residents of this medically underserved community. Findings from this investigation directly impact the participants and community through deepening our understanding of the linkages between individual and community level stress and chronic disease risk. This innovative study utilizes a comprehensive methodology to investigate pathways of stress and chronic disease risk present at individual and community levels. We address multiple public health issues including chronic disease and mental illness risk, health related disparities among Mexican-origin people, and health protective mechanisms and behaviors.
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Affiliation(s)
- Karina R. Duenas
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | - Maia Ingram
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | - Rebecca M. Crocker
- grid.134563.60000 0001 2168 186XHealth Sciences, University of Arizona, Tucson, USA
| | - Thaddeus W. W. Pace
- grid.134563.60000 0001 2168 186XCollege of Nursing, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, USA ,grid.134563.60000 0001 2168 186XDepartment of Psychology, College of Science, University of Arizona, Tucson, USA
| | - Jill Guernsey de Zapien
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | | | - Scott C. Carvajal
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
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22
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Color or money?: The impact of socioeconomic status and race/ethnicity on breast cancer mortality. Am J Surg 2022; 224:1403-1408. [PMID: 36115705 DOI: 10.1016/j.amjsurg.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/31/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the incidence of breast cancer is highest in White women, Black women die at a higher rate. Our aim was to compare the relative association between race/ethnicity and socioeconomic status on breast cancer mortality. METHODS We identified female breast cancer patients diagnosed between 2007 - 2011 and followed through 2016 in the SEER database. Patients were grouped into socioeconomic quartiles by a prosperity index. The primary outcome of interest was 5-year cancer-specific survival. RESULTS A total of 286,520 patients were included. Five-year survival was worst for Black women compared to other races/ethnicities in each socioeconomic quartile. When compared to White women in the lowest quartile, Black women in the lowest quartile, 2nd quartile, and 3rd quartile experienced the lowest 5-year survival rates (Hazard ratio 1.33, 1.23, 1.20; P < 0.01). CONCLUSION Regarding cancer mortality, only in the most prosperous quartile do Black women achieve a similar outcome to the poorest quartile White women.
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23
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Martinez VC, Turnage D. Social Support and Parenting Stress in Hispanic Parents of Children with Autism Spectrum Disorder. Issues Ment Health Nurs 2022; 43:1030-1040. [PMID: 35849744 DOI: 10.1080/01612840.2022.2100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this integrative review is to synthesize the literature examining the relationship between parenting stress and social support in Hispanic parents of children with autism spectrum disorder (ASD). A database search of studies that evaluated parenting stress and social support in this population was conducted. Fourteen studies met inclusion criteria. Despite high stress levels, both informal and formal social supports improved parenting stress among Hispanic families. Few studies evaluated culturally sensitive social support interventions. With the increasing prevalence of ASD, the development of culturally sensitive social support interventions is necessary to promote the well-being of Hispanic families.
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Affiliation(s)
- Valerie C Martinez
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Dawn Turnage
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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24
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Robles-Ramamurthy B, Sandoval JF, Tobón AL, Fortuna LR. Beyond Children's Mental Health: Cultural Considerations to Foster Latino Child and Family Mental Health. Child Adolesc Psychiatr Clin N Am 2022; 31:765-778. [PMID: 36182223 PMCID: PMC9529069 DOI: 10.1016/j.chc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinicians trained to assess and treat child psychopathology are facing an increasing need to expand their clinical expertise outside of traditional frameworks, which have historically focused largely on the child or the child-mother dyad. Clinicians treating children also need to be prepared to assess and address the systems of care that affect a child's mental health, starting with their family. There is a scarcity of Latino mental health providers and limited clinical opportunities or settings that serve this population by incorporating a developmental, cultural, and sociopolitical framework into high quality care of the whole family.
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Affiliation(s)
- Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA.
| | - Jessica F Sandoval
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
| | - Amalia Londoño Tobón
- National Institutes on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892-5465, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California in San Francisco, 1001 Potrero Avenue, 7M16, San Francisco, CA 94110, USA
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25
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Varley TF, Kaminski P. Untangling Synergistic Effects of Intersecting Social Identities with Partial Information Decomposition. ENTROPY 2022; 24:1387. [PMCID: PMC9611752 DOI: 10.3390/e24101387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The theory of intersectionality proposes that an individual’s experience of society has aspects that are irreducible to the sum of one’s various identities considered individually, but are “greater than the sum of their parts”. In recent years, this framework has become a frequent topic of discussion both in social sciences and among popular movements for social justice. In this work, we show that the effects of intersectional identities can be statistically observed in empirical data using information theory, particularly the partial information decomposition framework. We show that, when considering the predictive relationship between various identity categories such as race and sex, on outcomes such as income, health and wellness, robust statistical synergies appear. These synergies show that there are joint-effects of identities on outcomes that are irreducible to any identity considered individually and only appear when specific categories are considered together (for example, there is a large, synergistic effect of race and sex considered jointly on income irreducible to either race or sex). Furthermore, these synergies are robust over time, remaining largely constant year-to-year. We then show using synthetic data that the most widely used method of assessing intersectionalities in data (linear regression with multiplicative interaction coefficients) fails to disambiguate between truly synergistic, greater-than-the-sum-of-their-parts interactions, and redundant interactions. We explore the significance of these two distinct types of interactions in the context of making inferences about intersectional relationships in data and the importance of being able to reliably differentiate the two. Finally, we conclude that information theory, as a model-free framework sensitive to nonlinearities and synergies in data, is a natural method by which to explore the space of higher-order social dynamics.
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Affiliation(s)
- Thomas F. Varley
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN 47405, USA
- Department of Psychology & Brain Sciences, Indiana University, Bloomington, IN 47405, USA
- Correspondence:
| | - Patrick Kaminski
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN 47405, USA
- Department of Sociology, Indiana University, Bloomington, IN 47405, USA
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26
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Dessy A, Zhao AJ, Kyaw K, Vieira D, Salinas J. Non-Pharmacologic Interventions for Hispanic Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis. J Alzheimers Dis 2022; 89:769-788. [PMID: 35938246 DOI: 10.3233/jad-220005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population. Objective: A systematic review and meta-analysis was conducted to 1) provide an updated review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research. Methods: Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively. Results: Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = –0.31, 95% CI –0.46 to –0.16; I2 = 50.16%) and burden (SMD = –0.28, 95% CI –0.37 to –0.18; I2 = 11.06%). Conclusion: Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.
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Affiliation(s)
- Alexa Dessy
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda J. Zhao
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kay Kyaw
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Dorice Vieira
- New York University Health Sciences Library, New York University Grossman School of Medicine, New York, NY, USA
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
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27
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Fox M. How demographics and concerns about the Trump administration relate to prenatal mental health among Latina women. Soc Sci Med 2022; 307:115171. [PMID: 35803053 PMCID: PMC9542647 DOI: 10.1016/j.socscimed.2022.115171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
RATIONALE The 2016 U.S. presidential election and its aftermath involved political rhetoric and policies that especially targeted women, Latinos, and immigrants. It is possible that concerns about the political environment could affect mental health of individuals in targeted groups. OBJECTIVE In a cohort of 148 pregnant Latina women, this study investigated how demographics and political concerns related to each other and to maternal anxiety, depression, and perceived stress, which have been associated with adverse birth and child development outcomes. METHODS In this cross-sectional, self-report study, participants in Southern California completed a one-time questionnaire from January 2017 to May 2018. RESULTS The highest rates of endorsement were for concerns regarding President Trump's racism, attitude towards women, and deportation risk for family or friends. From several demographic variables, the only significant predictor of state anxiety was expectant parents' birthplaces. From several political concerns variables, the only significant predictor of state anxiety was President Trump's attitude towards women or women's rights. There were no significant effects on other mental health outcomes. CONCLUSIONS Results suggest that birthplace and women's issues may be particularly salient anxiety risk factors for Latina pregnant women in this context. Because of the cross-sectional study design, it is possible that, conversely, pregnant women with high anxiety levels are particularly sensitive to the issue of birthplace or women's rights. Results imply that the political climate and events in the U.S. could have deleterious consequences that may cascade across generations of Latino Americans via effects on pregnant women.
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Affiliation(s)
- Molly Fox
- Departments of Anthropology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, 90095, USA.
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28
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Gallegos ML, Segrin C. Family Connections and the Latino Health Paradox: Exploring the Mediating Role of Loneliness in the Relationships Between the Latina/o Cultural Value of Familism and Health. HEALTH COMMUNICATION 2022; 37:1204-1214. [PMID: 33853460 DOI: 10.1080/10410236.2021.1909244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aims to understand Latina/o health from a social relationships perspective. Specifically, a major goal of the study is to explain how despite disadvantages (e.g., lower income and less education), Latinas/os in some cases have superior health compared to non-Latina/o whites, a phenomenon known as the Latino Health Paradox. Based on the central role of familial relationships in Latina/o culture, and utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a foundation for the study, the premise underlying this research is that the Latina/o cultural value of familism has a beneficial impact on health via reduced loneliness. Participants were 255 adults who identified as Latina/o (N = 139) or non-Latina/o white (N = 116), ranging in age from 19-88. Results indicate that being Latina/o predicted strong endorsement of familism, that predicted lower loneliness, and lower loneliness subsequently predicted better overall health, mental health, and health practices. These results suggest that the cultural value of familism provides health-related benefits for Latinas/os, which contributes to understanding the Latino health paradox. Results also underscore the value of including loneliness in studies examining the impact of cultural values on health, as only loneliness had statistically significant direct associations with all three health outcomes.
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Affiliation(s)
- Monica L Gallegos
- Department of Communication Studies, California State University, Northridge
| | - Chris Segrin
- Department of Communication, University of Arizona
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29
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Abstract
Cross-cultural communication has many challenges due to the complexity of culture, communication, and language. Improving cross-cultural communication in health care is critical to reducing disparities and improving health equity. Specifically, improving cross-cultural communication must be prioritized to overcome systemic barriers and to eliminate disparities that stem from stigma and biases. Communication must be improved, ideally via a cultural humility framework. Unconscious bias and communication training must be intentional. Culture is an attribute and should be celebrated and incorporated into health practice at all levels to prioritize health equity.
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Affiliation(s)
- Carli Zegers
- University of Kansas, School of Nursing, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160, USA.
| | - Moises Auron
- Department of Hospital Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, M2 Annex, Cleveland, OH, USA; Department of Pediatric Hospital Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, M2 Annex, Cleveland, OH, USA
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30
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Guerra ZC, Moore JR, Londoño T, Castro Y. Associations of Acculturation and Gender with Obesity and Physical Activity among Latinos. Am J Health Behav 2022; 46:324-336. [PMID: 35794757 PMCID: PMC10877675 DOI: 10.5993/ajhb.46.3.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: Latinos disproportionately experience overweight/obesity (OWOB) and insufficient physical activity (PA), which are risk factors for numerous health conditions. Whereas numerous studies investigate acculturation as a determinant of OWOB and PA, few have examined acculturation multidimensionally, and none has examined its interaction with gender. Methods: Participants were 140 Latino adults. Primary outcomes were status as OWOB and endorsement of insufficient PA. Acculturation was measured with the Multidimensional Acculturation Scale II. Logistic regression analyses were used to examine the moderating effect of gender on the relationship between each acculturation scale and outcome, controlling for education, nativity, and smoking status. Results: Greater Spanish proficiency was significantly associated with lower odds of insufficient PA. Greater American Cultural Identity was significantly associated with higher odds of OWOB. Women had significantly higher odds of endorsing insufficient PA compared to men. Gender did not moderate the relationship between acculturation and either OWOB or PA. Conclusions: Acculturation is similarly associated with OWOB and insufficient PA for Latino men and women. Cultural identity may need to be considered to target OWOB interventions. Acculturation may be less important, and gender more important, to consider for appropriate targeting of PA interventions.
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Affiliation(s)
- Zully C Guerra
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, United States; zguerra@utexas. edu
| | - John R Moore
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, United States
| | - Tatiana Londoño
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, United States
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas, Austin, TX, United States
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31
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Coulter K, Ingram M, Lohr A, Figueroa C, Coronado G, Espinoza C, Esparza M, Monge S, Velasco M, Itule-Klasen L, Bowen M, Wilkinson-Lee A, Carvajal S. Adaptation of a Community Clinical Linkages Intervention to the COVID-19 Pandemic: A Community Case Study. Front Public Health 2022; 10:877593. [PMID: 35812475 PMCID: PMC9256923 DOI: 10.3389/fpubh.2022.877593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
In this community case study, we describe the process within an academic-community partnership of adapting UNIDOS, a community health worker (CHW)-led community-clinical linkages (CCL) intervention targeting Latinx adults in Arizona, to the evolving landscape of the COVID-19 pandemic. Consistent with community-based participatory research principles, academic and community-based partners made decisions regarding changes to the intervention study protocol, specifically the intervention objectives, participant recruitment methods, CHW trainings, data collection measures and management, and mode of intervention delivery. Insights from this case study demonstrate the importance of community-based participatory research in successfully modifying the intervention to the conditions of the pandemic and also the cultural background of Latinx participants. This case study also illustrates how a CHW-led CCL intervention can address social determinants of health, in which the pandemic further exposed longstanding inequities along racial and ethnic lines in the United States.
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Affiliation(s)
- Kiera Coulter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Kiera Coulter
| | - Maia Ingram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Abby Lohr
- Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Carlos Figueroa
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Gloria Coronado
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Cynthia Espinoza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Maria Esparza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Stacey Monge
- Pima County Health Department, Tucson, AZ, United States
| | - Maria Velasco
- El Rio Community Health Center, Tucson, AZ, United States
| | | | | | - Ada Wilkinson-Lee
- Department of Mexican American Studies, University of Arizona, Tucson, AZ, United States
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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32
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Fernandez JR, Montiel Ishino FA, Williams F, Slopen N, Forde AT. Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis. J Am Heart Assoc 2022; 11:e024594. [PMID: 35699190 PMCID: PMC9238649 DOI: 10.1161/jaha.121.024594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time. Methods and Results Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively). Conclusions Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.
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Affiliation(s)
- Jessica R. Fernandez
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Francisco A. Montiel Ishino
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Faustine Williams
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
| | - Natalie Slopen
- Department of Social and Behavioral SciencesHarvard University T. H. Chan School of Public HealthBostonMA
| | - Allana T. Forde
- Division of Intramural ResearchNational Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMD
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33
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Venta A, Alfano C. Sleep Duration Buffers The Effects of Adversity on Mental Health Among Recently Immigrated Latinx Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:235-247. [PMID: 35600519 PMCID: PMC9120277 DOI: 10.1007/s40653-021-00374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/03/2023]
Abstract
The rate of Latinx migration to the U.S. has risen rapidly over the last several decades. Recognizing that Latinx migrant youth are exposed to a high rate of adverse events and that sleep has potential buffering effects on mental health, the current study aimed to examine sleep duration as a moderator of the link between childhood adversity and emotional and behavioral symptoms among Latinx migrant youth. One hundred and twelve first-generation migrants of Latinx ethnicity (and 46 caregivers) participated in this study; the average age was 19 (SD = 2). Participants self-reported demographics: 59.8% of participants were male, with the racial breakdown as follows: 38.8% white, 6.1% black, 4.1% mixed race, and 51% marked "other." Data were collected from a public high school for immigrant youth in the Southwestern U.S. and included average sleep duration, Adverse Childhood Experiences; the Child PTSD Symptoms Scale and the Child Behavior Checklist. Findings indicated experiences of neglect in childhood were associated with youth-reported mental health symptoms, but this relation was significantly moderated by sleep duration such that the relation was weakened in the presence of high sleep duration. Both effects were statistically significant and of medium size. Caregiver reports supported the buffering effects of sleep; medium or large interactions between sleep and all three adversity variables (abuse, neglect, and household dysfunction) were noted in multivariate analyses. The current study takes an important first step in identifying that short sleep duration is prevalent among Central American immigrant youth. Findings suggest that sleep duration has important public health potential as a means of buffering the effects of childhood adversity on mental health in a vulnerable group.
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Affiliation(s)
- Amanda Venta
- Department of Psychology, University of Houston, Houston, Texas USA
| | - Candice Alfano
- Department of Psychology, University of Houston, Houston, Texas USA
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34
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Raez LE, Cardona AF, Lopes G, Arrieta O. Challenges in Genetic Testing and Treatment Outcomes Among Hispanics With Lung Cancer. JCO Oncol Pract 2022; 18:374-377. [PMID: 35544647 DOI: 10.1200/op.22.00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luis E Raez
- Thoracic Oncology Program, Memorial Cancer Institute/Florida International University, Miami, FL
| | - Andrés F Cardona
- Research and Education Direction, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Foundation for Clinical and Applied Cancer Research-FICMAC and Molecular Oncology and Biology Systems Group, Universidad El Bosque, Bogotá, Colombia
| | - Gilberto Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
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35
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Nnorom SO, Baig H, Akinyemi OA, Tran JH, Harris J, Sidhom F, Frederick WA, Cornwell EE, Wilson LL. Persistence of Disparity in Thyroid Cancer Survival After Adjustments for Socioeconomic Status and Access. Am Surg 2022; 88:1484-1489. [PMID: 35337204 DOI: 10.1177/00031348221082282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Thyroid cancer incidence has increased substantially in the past 4 decades, estimated at 3.5% annually. Incidence is highest in white patients, yet black patients have the worst survival. Racial/ethnic differences in presentation and outcomes are hypothesized to be a result of differences in access to care. Analyses delineating the relative contribution of access to racial/ethnic survival disparities are scarce. We aimed to explore the association of delay in access to care and early/increased detection with racial/ethnic disparities in thyroid cancer survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried from 2007 to 2011 for patients with a first primary thyroid cancer diagnosis and up to 5 years of follow-up. Composite scores were generated from county-level variables to capture socioeconomic status and screening habits. Kaplan-Meier analysis and Cox proportional hazards models were utilized for survival analysis. RESULTS We identified 46,970 patients (67% white, 7% black, 15% Hispanic, 10% Asian or Pacific Islander, and 1% unknown/other). Compared to white patients, black, Hispanic, and Asian or Pacific Islander patients were more likely to present with distant disease (3% vs 5%, 5%, and 6%, respectively; P < .001). After adjusting for sex, age, stage, subtype, tumor size, surgery, radiation, socioeconomics, and screening habits, black patients were the only race/ethnicity found to have increased odds of 5-year mortality compared to white patients (24%, P < .001). CONCLUSION Thyroid cancer survival is worst for black patients regardless of socioeconomic status or screening habits. Racial/ethnic disparities in survival are not attributable to early detection alone.
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Affiliation(s)
- Siobhan O Nnorom
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Hana Baig
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Oluwasegun A Akinyemi
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Joseph H Tran
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Jeduthun Harris
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Fady Sidhom
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Wayne A Frederick
- 20814Howard-Harvard Health Sciences Outcomes Research Center, Washington, DC, USA
| | - Edward E Cornwell
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
| | - Lori L Wilson
- Department of Surgery, 12232Howard University College of Medicine, Washington, DC, USA
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Hargrove TW, Gaydosh L, Dennis AC. Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics. Demography 2022; 59:267-292. [PMID: 34964867 PMCID: PMC9190239 DOI: 10.1215/00703370-9664206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Educational disparities in health are well documented, yet the education-health relationship is inconsistent across racial/ethnic and nativity groups. These inconsistencies may arise from characteristics of the early life environments in which individuals attain their education. We evaluate this possibility by investigating (1) whether educational disparities in cardiometabolic risk vary by race/ethnicity and nativity among Black, Hispanic, and White young adults; (2) the extent to which racial/ethnic-nativity differences in the education-health relationship are contingent on economic, policy, and social characteristics of counties of early life residence; and (3) the county characteristics associated with the best health at higher levels of education for each racial/ethnic-nativity group. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that Black young adults who achieve high levels of education exhibit worse health across a majority of contexts relative to their White and Hispanic counterparts. Additionally, we observe more favorable health at higher levels of education across almost all contexts for White individuals. For all other racial/ethnic-nativity groups, the relationship between education and health depends on the characteristics of the early life counties of residence. Findings highlight place-based factors that may contribute to the development of racial/ethnic and nativity differences in the education-health relationship among U.S. young adults.
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Affiliation(s)
- Taylor W. Hargrove
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lauren Gaydosh
- Department of Sociology, Population Research Center, University of Texas at Austin
| | - Alexis C. Dennis
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
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Salahuddin M, Matthews KJ, Elerian N, Lakey DL, Patel DA. Infant Mortality and Maternal Risk Factors in Texas: Highlighting Zip Code Variations in 2 At-Risk Counties, 2011-2015. Prev Chronic Dis 2022; 19:E02. [PMID: 35025729 PMCID: PMC8794266 DOI: 10.5888/pcd19.210266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Stark differences in the infant mortality rate (IMR) exist by geography in Texas. The Healthy Families initiative sought to understand how evidence-informed practices implemented in the community can improve pregnancy-related outcomes in 2 counties in Texas with a high prevalence of maternal chronic conditions. The objective of this study was to examine associations between maternal risk factors and infant deaths to inform strategies to improve outcomes. METHODS Two counties with high prevalence of maternal chronic conditions were selected as Healthy Families sites: one with lower prenatal care usage than other counties in the state but an IMR lower than Texas, and the other with a higher IMR among minority racial and ethnic groups compared with other women in the county and Texas overall. Cohort-linked birth and infant death records from 2011 through 2015 provided by the Texas Department of State Health Services were analyzed by using logistic regression to examine associations of maternal sociodemographic and pregnancy risk factors with infant death. The data were mapped at the zip code level. Analyses were limited to births to women aged 15 to 49 years who resided in Texas from 2011 through 2015 (n = 1,942,899 births). RESULTS The Texas IMR was 5.4 per 1,000 live births, compared with 4.6 and 7.5 per 1,000 live births for Hidalgo and Smith counties, respectively. Congenital malformations were the leading cause of infant death in both counties for infants born in 2015, which was similar to Texas overall. In both counties, maternal marital status, education, multiple gestation, and cesarean delivery were significantly associated with infant mortality. Wide zip code-level variations in IMR and maternal risk factors were observed in both counties. CONCLUSION Variations in IMR and key maternal risk factors observed at the zip code level helped drive local strategies to maximize outreach of services to disproportionately affected communities.
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Affiliation(s)
- Meliha Salahuddin
- University of Texas Health Science Center, Tyler, Texas.,University of Texas System Office of Health Affairs, Austin, Texas.,University of Texas Health Science Center at Houston, School of Public Health, Austin, Texas
| | - Krystin J Matthews
- University of Texas System Office of Health Affairs, Austin, Texas.,University of Texas Health Science Center at Houston, School of Public Health, Austin, Texas
| | - Nagla Elerian
- University of Texas System Office of Health Affairs, Austin, Texas
| | - David L Lakey
- University of Texas System Office of Health Affairs, Austin, Texas
| | - Divya A Patel
- University of Texas Health Science Center, Tyler, Texas.,University of Texas System Office of Health Affairs, Austin, Texas.,University of Texas Health Science Center at Houston, School of Public Health, Austin, Texas.,University of Texas System - Population Health, 210 W 7th St, Austin, TX 78701.
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Garcini LM, Rosenfeld J, Kneese G, Bondurant RG, Kanzler KE. Dealing with distress from the COVID-19 pandemic: Mental health stressors and coping strategies in vulnerable latinx communities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:284-294. [PMID: 33894080 PMCID: PMC8251305 DOI: 10.1111/hsc.13402] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 05/30/2023]
Abstract
Distress secondary to the COVID-19 pandemic has been substantial, especially in vulnerable Latinx communities who are carrying an undue share of the pandemic-related social, health and economic burden in the United States. In collaboration with 43 community health workers (CHWs) and Promotor/as serving the needs of underserved Latinx communities in South Texas and guided by principles of community-based participatory research (CBPR), the purpose of this study was to identify relevant mental health stressors and related consequences, and to identify strategies for coping with distress among underserved Latinx communities during the COVID-19 pandemic. Data were collected on July 2020 using mixed methods to obtain more in-depth information. Surveys were administered, and three focus groups were conducted. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed systematically by starting with a priori questions and themes followed by data categorisation, reduction, display and conclusion drawing. Results showed six themes related to mental health stressors including economics (e.g., job insecurity), immigration (e.g., undocumented status), misinformation, family stress (e.g., changes in family dynamics and the home environment), health (e.g., limited healthcare access) and social isolation. Coping skills of the community were categorised into four themes with multiple codes including behavioural strategies (e.g., identifying reliable information), cognitive strategies (e.g., collectivistic thinking), social support and spirituality. Findings indicate that underserved Latinx communities are dealing with substantial distress and mental health concerns secondary to the COVID-19 pandemic; yet these are resilient communities. Implications of these findings can inform development of resources, interventions, best practices and training avenues to address the mental health needs of underserved Latinx communities, while considering relevant cultural and contextual factors that may influence their effectiveness.
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Affiliation(s)
- Luz M. Garcini
- Center for Research to Advance Community Health (ReACH)University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Department of MedicineJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Department of Psychiatry and Behavioral SciencesJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Jason Rosenfeld
- Department of MedicineJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Joe R. and Teresa Lozano Long School of MedicineCenter for Medical Humanities and EthicsUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Garrett Kneese
- Department of MedicineJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Ruth G. Bondurant
- Department of MedicineJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Kathryn E. Kanzler
- Center for Research to Advance Community Health (ReACH)University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Department of Psychiatry and Behavioral SciencesJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Department of Family and Community MedicineJoe R. and Teresa Lozano Long School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Hussain M, Howell JL, Peek MK, Stowe RP, Zawadzki MJ. Psychosocial stressors predict lower cardiovascular disease risk among Mexican-American adults living in a high-risk community: Findings from the Texas City Stress and Health Study. PLoS One 2021; 16:e0257940. [PMID: 34618834 PMCID: PMC8496861 DOI: 10.1371/journal.pone.0257940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
The objective of this study was to examine the link between systemic and general psychosocial stress and cardiovascular disease (CVD) risk in a group of U.S. Latinos as a function of acculturation and education within the blended guiding conceptual framework of the biopsychosocial model of the stress process plus the reserve capacity model. We analyzed data from self-identifying Mexican-origin adults (n = 396, 56.9% female, Mage = 58.2 years, 55.5% < 12 years of education, 79% U.S.-born) from the Texas City Stress and Health Study. We used established measures of perceived stress (general stress), neighborhood stress and discrimination (systemic stress) to capture psychosocial stress, our primary predictor. We used the atherosclerotic CVD calculator to assess 10-year CVD risk, our primary outcome. This calculator uses demographics, cholesterol, blood pressure, and history of hypertension, smoking, and diabetes to compute CVD risk in the next 10 years. We also created an acculturation index using English-language use, childhood interaction, and preservation of cultural values. Participants reported years of education. Contrary to expectations, findings showed that higher levels of all three forms of psychosocial stress, perceived stress, neighborhood stress, and perceived discrimination, predicted lower 10-year CVD risk. Acculturation and education did not moderate the effects of psychosocial stress on 10-year CVD risk. Contextualized within the biopsychosocial and reserve capacity framework, we interpret our findings such that participants who accurately reported their stressors may have turned to their social networks to handle the stress, thereby reducing their risk for CVD. We highlight the importance of examining strengths within the sociocultural environment when considering cardiovascular inequities among Latinos.
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Affiliation(s)
- Maryam Hussain
- Department of Psychological Sciences, University of California-Merced, Merced, California, United States of America
| | - Jennifer L. Howell
- Department of Psychological Sciences, University of California-Merced, Merced, California, United States of America
| | - M. Kristen Peek
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch-Galveston, Galveston, Texas, United States of America
| | - Raymond P. Stowe
- Microgen Laboratories, La Marque, Texas, United States of America
| | - Matthew J. Zawadzki
- Department of Psychological Sciences, University of California-Merced, Merced, California, United States of America
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Price SN, Flores M, Hamann HA, Ruiz JM. Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review. JNCI Cancer Spectr 2021; 5:pkab062. [PMID: 34485813 PMCID: PMC8410140 DOI: 10.1093/jncics/pkab062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/29/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023] Open
Abstract
Background Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival. Methods Searches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for publications dated from January 1, 2000, to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival [OS], cancer-specific survival [CSS]) between NHW and Hispanic lung cancer patients. Results A final sample of 29 full-text articles were included, with 28 fully adjusted models of OS and 21 of CSS included. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (OS = 16, CSS = 11) or a Hispanic survival advantage (OS = 10, CSS = 9). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, and 2 studies of exclusively no-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics. Conclusions Hispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Center for Border Health Disparities, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - John M Ruiz
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Suk R, Hong YR, Wasserman RM, Swint JM, Azenui NB, Sonawane KB, Tsai AC, Deshmukh AA. Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016. JAMA Netw Open 2021; 4:e2129913. [PMID: 34665238 PMCID: PMC8527360 DOI: 10.1001/jamanetworkopen.2021.29913] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Studies suggest the risk of suicide among people with cancer diagnosis is higher compared with the general population. However, little is known about how suicide risk among people diagnosed with cancer might vary according to area-level income and rurality. OBJECTIVE To examine whether the risks and patterns of suicide mortality among people with a cancer diagnosis differ by US county-level median income and rural or urban status. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study following up individuals who were diagnosed with cancer between January 1, 2000, and December 31, 2016, was conducted. The Surveillance, Epidemiology, and End Results Program 18 registries (SEER 18) database was used to obtain data on persons diagnosed with a first primary malignant tumor. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were conducted from February 22 to October 14, 2020. EXPOSURES County-level median household income and urban or rural status. MAIN OUTCOMES AND MEASURES Standardized mortality ratios (SMRs) of suicide deaths and annual percentage changes (APCs) of SMRs. RESULTS The SEER 18 database included 5 362 782 persons with cancer diagnoses living in 635 counties. Most study participants were men (51.2%), White (72.2%), and older than 65 years (49.7%). Among them, 6357 persons died of suicide (SMR, 1.41; 95% CI, 1.38-1.44). People with cancer living in the lowest-income counties had a significantly higher risk (SMR, 1.94; 95% CI, 1.76-2.13) than those in the highest-income counties (SMR, 1.30; 95% CI, 1.26-1.34). Those living in rural counties also had significantly higher SMR than those in urban counties (SMR, 1.81; 95% CI, 1.70-1.92 vs SMR, 1.35; 95% CI, 1.32-1.39). For all county groups, the SMRs were the highest within the first year following cancer diagnosis. However, among people living in the lowest-income counties, the risk remained significantly high even after 10 or more years following cancer diagnosis (SMR, 1.83; 95% CI, 1.31-2.48). The comparative risk of suicide mortality within 1 year following cancer diagnosis significantly decreased over the years but then plateaued in the highest-income (2005-2015: APC, 2.03%; 95% CI, -0.97% to 5.13%), lowest-income (2010-2015: APC, 4.80%; 95% CI, -19.97% to 37.24%), and rural (2004-2015: APC, 1.83; 95% CI, -1.98% to 5.79%) counties. CONCLUSIONS AND RELEVANCE This cohort study showed disparities in suicide risks and their patterns among people diagnosed with cancer by county-level income and rural or urban status. The findings suggest that additional research and effort to provide psychological services addressing these disparities among people with cancer may be beneficial.
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Affiliation(s)
- Ryan Suk
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Health Promotion and Preventive Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UF Health Cancer Center, Gainesville, Florida
| | - Rachel M. Wasserman
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Orlando, Florida
| | - J. Michael Swint
- Center for Health Systems Research, Policy and Practice, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston McGovern School of Medicine
| | | | - Kalyani B. Sonawane
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
- Center for Healthcare Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health
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Song C, Marshall GL, Reed A, Baker TA, Thorpe RJ. Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States. Am J Mens Health 2021; 15:15579883211049605. [PMID: 34587818 PMCID: PMC8488413 DOI: 10.1177/15579883211049605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.
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Affiliation(s)
- Chiho Song
- School of Social Work, University of
Washington, Seattle, WA, USA
| | | | - Alyssa Reed
- School of Public Health, University of
Washington, Seattle, WA, USA
| | - Tamara A. Baker
- School of Medicine, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roland J. Thorpe
- Program for Research on Men’s Health,
Hopkins Center for Health Disparities Solutions, Johns Hopkins University,
Baltimore, MD, USA
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Castañeda E, Smith B, Vetter E. Hispanic health disparities and housing: Comparing measured and self-reported health metrics among housed and homeless Latin individuals. J Migr Health 2021; 1-2:100008. [PMID: 34405163 PMCID: PMC8352211 DOI: 10.1016/j.jmh.2020.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies argue that Hispanics are healthier and less likely to experience homelessness than other populations in their same socioeconomic position. However, earlier studies have not explored the relationship between housing status and health for Latin individuals. This study examines 1) the health disparities between homeless and housed Hispanics in El Paso, Texas, and 2) the Hispanic health and homelessness paradoxes using an intersectional framework to understand health risks. A large number of Hispanic residents of El Paso (N = 1152) were surveyed. Demographic, health, and housing data were collected. We contribute to the literature by providing detailed health indicators for homeless Hispanics. To our knowledge, this is the first study to examine health disparities between housed and homeless Hispanics. Bivariate analysis, as well as data coded from interviews, indicated that homeless Hispanics were more likely to have barriers to care, less likely to have health insurance, slightly more likely than housed Hispanics to experience mental illness, alcoholism, and addiction, and more likely to be underdiagnosed for health problems, including hypertension. This study shows how certain traditional methods for collecting health data, including self-rated health and reported diagnoses, can be ineffective at revealing health disparities. This paper calls for innovative, mixed-methods approaches to understand the social and structural determinants of health for marginalized populations.
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Affiliation(s)
- Ernesto Castañeda
- Department of Sociology, American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
- Corresponding author.
| | - Blaine Smith
- Boston University, 100 Cummington Mall, Room 260, Boston, MA 02215, United States
| | - Emma Vetter
- American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
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Lohr AM, Doubleday K, Ingram M, Wilkinson-Lee AM, Coulter K, Krupp K, Espinoza C, Redondo-Martinez F, David C, Carvajal SC. A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border. Prev Chronic Dis 2021; 18:E76. [PMID: 34351845 PMCID: PMC8388205 DOI: 10.5888/pcd18.210080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border. METHODS Researchers at the Arizona Prevention Research Center conducted the Linking Individual Needs to Community and Clinical Services (LINKS) study during 2017-2018. Clinic-based CHWs referred participants to community-based CHWs who met with participants monthly for 6 months to assess participant needs, provide support for emotional well-being, and link them to resources. Two community-based CHWs collaborated to maximize participant care; they also administered an emotional well-being questionnaire at baseline and at 3-month and 6-month follow-up. We estimated changes in emotional well-being outcomes. RESULTS Scores for social support, perceived hopefulness, and quality-of-life measures among 189 LINKS participants increased significantly during the study period, especially among men and participants with low baseline scores. For each of the 3 outcomes, the standardized change was approximately 0.28 per 3 months of intervention, a decrease of more than half an SD (0.56) during 6 months of follow-up. CONCLUSION A CHW-led community-clinical linkage intervention can result in positive emotional well-being outcomes. We encourage policy makers, funders, and public health practitioners to further investigate such interventions as a solution to reduce disparities in emotional well-being.
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Affiliation(s)
- Abby M Lohr
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724.
| | - Kevin Doubleday
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Maia Ingram
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Ada M Wilkinson-Lee
- Mexican American Studies Department, College of Social and Behavioral Sciences, University of Arizona, Tucson, Arizona
| | - Kiera Coulter
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Karl Krupp
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | | | | | - Scott C Carvajal
- Arizona Prevention Research Center at the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Liyanage-Don NA, Cornelius T, Romero EK, Alcántara C, Kronish IM. Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome. Prev Med Rep 2021; 23:101455. [PMID: 34194962 PMCID: PMC8237356 DOI: 10.1016/j.pmedr.2021.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/06/2022] Open
Abstract
Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites – a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16–1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75–0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.
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Affiliation(s)
- Nadia A Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Emily K Romero
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
| | - Carmela Alcántara
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th St, New York, NY 10032, USA
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Flores M, Ruiz JM, Butler EA, Sbarra DA. Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms. Ann Behav Med 2021; 56:21-34. [PMID: 33821886 DOI: 10.1093/abm/kaab014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects. METHODS We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories. RESULTS Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity. CONCLUSIONS This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.
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Affiliation(s)
- Melissa Flores
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, USA.,The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
| | - John M Ruiz
- The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
| | - Emily A Butler
- Norton School of Family and Consumer Sciences, College of Agricultural Life Sciences, University of Arizona, Tucson, AZ, USA
| | - David A Sbarra
- The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
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Donaldson CD, Bharadwaj A, Giafaglione B, Patton P, Fortier MA, Kain ZN. Ethnicity and Language Differences in Patient Experience: an Analysis of the HCAHPS Survey. J Racial Ethn Health Disparities 2021; 9:899-908. [PMID: 33770386 DOI: 10.1007/s40615-021-01029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although there has been a rising emphasis on patient-centered care, limited research has assessed differences in patient experience based on ethnicity and language. METHODS This study examined differences in quality of care (N = 6945) using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Data were collected between January 2014 and April 2019. Bivariate and multivariate analyses assessed relationships between ethnicity/language with individual items capturing specific components of care and global hospital evaluations using regression modeling. RESULTS Compared to English-speaking non-Hispanic White patients, Spanish-speaking Hispanic/Latinx patients reported more positive interactions with nurses, physicians, and the hospital environment and reported a better understanding of care after discharge. Findings also indicated that Spanish-speaking Hispanic/Latinx patients were more satisfied with their experience compared to non-Hispanic White patients. DISCUSSION Spanish-speaking Hispanic/Latinx patients were more satisfied with specific components of care and also scored higher in a measure of the global patient experience. Findings suggest the need for setting clear expectations for health care encounters and adapting health system responses to better capture factors driving Hispanic/Latinx patient satisfaction.
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Affiliation(s)
- Candice D Donaldson
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
| | - Archana Bharadwaj
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | | | | | - Michelle A Fortier
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
- Department of Pediatric Psychology, CHOC Children's, Orange, CA, USA
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA
- Health Policy Research Institution, University of California, Irvine, CA, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA.
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA.
- Department of Psychological Science, University of California, Irvine, CA, USA.
- Yale Child Study Center, Yale University, New Haven, CT, USA.
- Department of Pediatrics, CHOC Children's, Orange, CA, USA.
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48
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Revens KE, Gutierrez D, Paul R, Reynolds AD, Price R, DeHaven MJ. Social Support and Religiosity as Contributing Factors to Resilience and Mental Wellbeing in Latino Immigrants: A Community-Based Participatory Research Study. J Immigr Minor Health 2021; 23:904-916. [PMID: 33715112 DOI: 10.1007/s10903-021-01179-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
Latino immigrants are at increased risk for mental disorders due to social/economic disadvantages and stressful conditions associated with migration. Resilience-the ability to recover from stress-may provide protection given its association with lower rates of anxiety and depression. This study examines the relationship between protective factors, resilience, and psychological distress in Latino immigrants. A community-based participatory research study conducted with a Latino agency using in-person surveys to obtain the following data: Brief Resilience Scale, Brief Symptom Inventory, Duke University Religion Index, Multi-group Ethnic Identity measure, and the Interpersonal Support Evaluation List. Linear regression, and mediation analysis was performed using SPSS. There are 128 participants. Resilience was positively related to social support (p = 0.001) and religiosity (p = 0.006); inversely related to psychological distress (p = 0.001); and mediated the relationship between the two (p = 0.006). Promoting social support and religion in Latino communities can improve wellbeing by increasing resilience and reducing distress.
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Affiliation(s)
- Keri E Revens
- Camino Community Center, 133 Stetson Dr., Charlotte, 28262, USA.
| | | | - Rajib Paul
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Rusty Price
- Camino Community Center, 133 Stetson Dr., Charlotte, 28262, USA
| | - Mark J DeHaven
- University of North Carolina at Charlotte, Charlotte, NC, USA
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49
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Valencia A, Zuma BZ, Spencer-Bonilla G, López L, Scheinker D, Rodriguez F. The Hispanic paradox in the prevalence of obesity at the county-level. Obes Sci Pract 2021; 7:14-24. [PMID: 33680488 PMCID: PMC7909595 DOI: 10.1002/osp4.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/17/2020] [Accepted: 09/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective The percentage of Hispanics in a county has a negative association with prevalence of obesity. Because Hispanic individuals are unevenly distributed in the United States, this study examined whether this protective association persists when stratifying counties into quartiles based on the size of the Hispanic population and after adjusting for county‐level demographic, socioeconomic, healthcare, and environmental factors. Methods Data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into quartiles based on their percentage of Hispanics, 0%–5% (n = 1794), 5%–20% (n = 962), 20%–50% (n = 283), and >50% (n = 99). For each quartile, univariate and multivariate regression models were used to evaluate the association between prevalence of obesity and demographic, socioeconomic, healthcare, and environmental factors. Results Counties with the top quartile of Hispanic individuals had the lowest prevalence of obesity compared to counties at the bottom quartile (28.4 ± 3.6% vs. 32.7 ± 4.0%). There was a negative association between county‐level percentage of Hispanics and prevalence of obesity in unadjusted analyses that persisted after adjusting for all county‐level factors. Conclusions Counties with a higher percentage of Hispanics have lower levels of obesity, even after controlling for demographic, socioeconomic, healthcare, and environmental factors. More research is needed to elucidate why having more Hispanics in a county may be protective against county‐level obesity.
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Affiliation(s)
- Areli Valencia
- Stanford University School of Medicine Stanford California USA
| | - Bongeka Z Zuma
- Stanford University School of Medicine Stanford California USA
| | - Gabriela Spencer-Bonilla
- Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford California USA
| | - Lenny López
- School of Medicine University of California San Francisco San Francisco California USA.,The San Francisco VA Medical Center University of California San Francisco San Francisco California USA
| | - David Scheinker
- Department of Management Science and Engineering Stanford University School of Engineering Stanford California USA.,Clinical Excellence Research Center Stanford University School of Medicine Stanford California USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford California USA
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50
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Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data. Cancers (Basel) 2021; 13:cancers13050990. [PMID: 33673457 PMCID: PMC7956712 DOI: 10.3390/cancers13050990] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary This study assessed renal cell carcinoma disparities in American Indians/Alaska Natives and Hispanic Americans using the National Cancer Database and the Arizona Cancer Registry, focusing on advanced-stage and mortality. Renal cell carcinoma disparities in American Indians/Alaska Natives have been partially explained by neighborhood socioeconomic factors and residence (rural or urban) pattern, but not in Hispanic Americans. Greater health disparities in renal cell carcinoma stage and mortality for Hispanic Americans and renal cell carcinoma mortality for American Indians/Alaska Natives were observed at the Arizona state level compared to national levels. Abstract Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.
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