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Valentino K, Park IJK, Cruz-Gonzalez M, Zhen-Duan J, Wang L, Yip T, Lorenzo K, Dias D, Alvarez K, Alegría M. Family-level moderators of daily associations between discrimination and distress among Mexican-origin youth. Dev Psychopathol 2024:1-16. [PMID: 38584283 DOI: 10.1017/s0954579424000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The current study evaluated cultural values and family processes that may moderate associations between daily racial-ethnic discrimination and distress among Mexican-origin youth. Integrating micro-time (daily diary) and macro-time (longitudinal survey) research design features, we examined familism, family cohesion, and ethnic-racial socialization from youth-, mother-, and father- reports as potential buffers of daily associations between youth racial-ethnic discrimination and youth distress (negative affect and anger). The analytic sample, drawn from the Seguimos Avanzando study, included 317 Mexican-origin adolescents (Mage = 13.5 years) and their parents, recruited from the Midwestern United States. Results indicated that youth-reported familism and family cohesion significantly buffered daily associations between youth racial-ethnic discrimination and youth distress. In contrast, parent-reported familism and family cohesion and some aspects of ethnic-racial socialization exacerbated the discrimination to distress link. The implications of these results are discussed to inform efforts supporting the healthy development of Mexican-origin youth and their families.
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Affiliation(s)
| | - Irene J K Park
- Department of Psychiatry, Indiana University School of Medicine-South Bend, South Bend, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Lijuan Wang
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, New York, USA
| | - Kyle Lorenzo
- Department of Psychology, Fordham University, New York, USA
| | - David Dias
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Alegría M, Cruz-Gonzalez M, Yip T, Wang L, Park IJK, Fukuda M, Valentino K, Giraldo-Santiago N, Zhen-Duan J, Alvarez K, Barrutia XA, Shrout PE. Yearly and Daily Discrimination-Related Stressors and Mexican Youth's Mental Health and Sleep: Insights From the First Wave of a Three-Wave Family Study. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00066-2. [PMID: 38367767 DOI: 10.1016/j.jaac.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/14/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Research is needed to examine discrimination-related stressors and their social and psychological shaping of mental health and sleep outcomes of Latinx youth. The background, design, and methodology of a longitudinal study of Mexican families in Indiana and the initial findings of associations between discrimination-related stressors and youth mental health and sleep outcomes are presented. METHOD Initiating wave 1 of a 3-wave (yearly) longitudinal study, investigators surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (ages 12-15) and their primary caregivers, assessing risks and protective factors for mental health and sleep outcomes. Youth also completed a one-time 21-day daily diary after wave 1. Self-reported measures of youth mental health, sleep, and discrimination across wave 1 and the daily diary were evaluated to compare the cross-sectional (wave 1) and daily associations between discrimination and youth mental health and sleep outcomes. RESULTS Of youth, 88.1% reported at least one incident of lifetime discrimination. Almost one-third had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Between-youth correlations at wave 1 and in the daily diary were consistent in that perceived racial discrimination was positively correlated with worse mental health and poorer sleep quality. Smaller within-youth correlations were observed in the daily diary, but there was striking variability in the effect of discrimination across youth. CONCLUSION The present results illustrate the powerful methods of combining yearly and daily time data to investigate how and for whom discrimination-related stressors lead to adverse outcomes. DIVERSITY & INCLUSION STATEMENT We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. CLINICAL TRIAL REGISTRATION INFORMATION Seguimos Avanzando - Latino Youth Coping With Discrimination; https://clinicaltrials.gov/; NCT04875208.
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Affiliation(s)
- Margarita Alegría
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mario Cruz-Gonzalez
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Lijuan Wang
- University of Notre Dame, Notre Dame, Indiana
| | - Irene J K Park
- Indiana University School of Medicine-South Bend, South Bend, Indiana
| | - Marie Fukuda
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jenny Zhen-Duan
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kiara Alvarez
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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San Francisco CND, Zhen-Duan J, Fukuda M, Alegría M. Attitudes and perceptions toward the COVID-19 risk-mitigation strategies among racially and ethnically diverse older adults in the United States and Puerto Rico: a qualitative study. Ethn Health 2024; 29:25-45. [PMID: 37543717 PMCID: PMC10867780 DOI: 10.1080/13557858.2023.2243548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/10/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES There is limited qualitative research investigating how risk-mitigation strategies during the COVID-19 pandemic impacted the lives of diverse older adults, who met criteria for mild to severe generalized anxiety or depression and minor to moderate disability. This study aims to address this gap by examining how racially and ethnically diverse older adults with at least mild mental health symptoms and minor physical disability in the United States and Puerto Rico adapted to guidelines during COVID-19. It aims to inform the medical community and policymakers of potential threats to these older adults' well-being given the COVID-19 burden. DESIGN Based on descriptive qualitative inquiry and phenomenological perspectives, we conducted semi-structured interviews over the phone with a racially and ethnically diverse sample of older (age 60+), predominantly minoritized adults (N = 100) in four states and territories across the United States and Puerto Rico in 2021. Interviews were recorded, coded, and analyzed using a thematic analysis approach. RESULTS Findings centered on five themes: (1) Previous experiences with the healthcare system and cultural beliefs related to trust and distrust led to mixed attitudes toward COVID-19 risk-mitigation strategies; (2) Compliance with COVID-19 mitigation strategies ensured safety and addressed fear of illness; (3) Compliance led to isolation due to interrupted social relations; (4) Isolation and disrupted social networks negatively impacted mental health and finances, and (5) Coping strategies and embracing support reduced the effects of social isolation. CONCLUSION This study underscores the importance of increasing support and social connectedness during a pandemic and beyond to ensure the well-being of older adults in racially and ethnically diverse communities. It highlights the resiliency of older adults in identifying strategies to cope with negative impacts. We recommend safeguarding economic security through policy efforts toward financial safety nets during health crises and collaborative approaches with community-based organizations to mitigate social isolation.
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Affiliation(s)
- Carolina Nvé Díaz San Francisco
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Departamento de Antropología Social y Cultural, Universidad de Educación a Distancia, UNED, Madrid, Spain
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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Zhen-Duan J, Banks DE, Ferreira C, Zhang L, Valentino K, Alegría M. Mexican-origin parent and child reported neighborhood factors and youth substance use. Front Psychiatry 2023; 14:1241002. [PMID: 38107000 PMCID: PMC10722282 DOI: 10.3389/fpsyt.2023.1241002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use. Methods Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use. Results Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use. Conclusion The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Devin E. Banks
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, United States
| | - Caroline Ferreira
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MO, United States
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Falgas-Bague I, Zhen-Duan J, Ferreira C, Tahanasab SA, Cuervo-Torello F, Fukuda M, Markle SL, Alegría M. Uncovering Barriers to Engagement in Substance Use Disorder Care for Medicaid Enrollees. Psychiatr Serv 2023; 74:1116-1122. [PMID: 37070259 DOI: 10.1176/appi.ps.20220193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The authors aimed to uncover factors that affect engagement in substance use disorder treatment among Medicaid beneficiaries in New York State. METHODS The authors conducted 40 semistructured interviews with clients, plan administrators, health care providers, and policy leaders directly involved with substance use care in New York State. Data were analyzed with thematic analysis. RESULTS Main themes resulting from analysis of the 40 interviews showed that most stakeholders agreed that a need exists to better integrate psychosocial services into behavioral health care systems; that systemic stigma, stigma from providers, and lack of cultural responsiveness in the substance use care system hinder engagement in and provision of high-quality care; and that rural health care networks with coordinated models benefit clients' engagement in care. CONCLUSIONS Stakeholders involved in care for substance use disorder perceived a lack of integration of resources to meet clients' social needs, the presence of stigma, and low levels of cultural and linguistic capacity as key factors contributing to low engagement in and low quality of care for substance use disorder. Future interventions should address social needs within the therapeutic regimen and modify curricula in clinical training to reduce stigma and increase cultural competence.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Caroline Ferreira
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Sara A Tahanasab
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Fernando Cuervo-Torello
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Sheri L Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría)
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Zhen-Duan J, Nuñez M, Solomon MB, Geracioti T, Jacquez F. Adverse Childhood Experiences and alcohol use among U.S.-born and immigrant Latinx youth: the roles of social support and stress hormones. J Child Fam Stud 2023; 32:3568-3580. [PMID: 38404361 PMCID: PMC10888520 DOI: 10.1007/s10826-023-02550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/27/2024]
Abstract
The biobehavioral correlates of Adverse Childhood Experiences (ACEs) among Latinx youth have been strikingly understudied. The purpose of this study was to 1) examine the effects of T-ACEs (e.g., maltreatment, family dysfunction) and E-ACEs (e.g., family deportation, community violence) in alcohol use, 2) test whether social support moderated these associations and 3) explore whether ACEs and alcohol use were related via adrenocortical hormones (i.e., cortisol, dehydroepiandrosterone [DHEA]). A total of 100 Latinx youth, between the ages of 13 and 19, participated in this study (53% female). Community samples of United States (U.S.)-born (N = 54) and immigrant Latinx (N = 46) youth provided morning saliva samples and completed self-report questionnaires. Results highlighted that for immigrant youth, social support buffered the effects of E-ACEs on alcohol use, F(9,89)= 3.34, p = .01, R2 = .25. Although our mediation hypothesis was not supported, the direct effects of T-ACEs (β = .25, t (94) = 2.21, p = .03) and E-ACES (β = -.24, t (94) = -2.23, p = .03) on DHEA were significant for the entire sample. Preventing maltreatment and reducing community-level adversities seem critical for optimal child development, as exposure to these may increase alcohol use risk and affect HPA Axis functioning. Increasing extrafamilial support may be particularly salient for immigrant Latinx youth, as many experience extended immigration-related periods of separation from family members.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street Suite 830 Boston, MA 02114 United States
- Department of Psychiatry, Harvard Medical School, 401 Park Drive Boston, MA 02215 United States
| | - Miguel Nuñez
- Department of Psychology, University of Cincinnati, 66 Corry Blvd, Cincinnati, OH 45219 United States
| | - Matia B. Solomon
- Department of Psychology, University of Cincinnati, 66 Corry Blvd, Cincinnati, OH 45219 United States
| | - Thomas Geracioti
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, 2631 Erie Ave, Suite 3, Cincinnati, Ohio 45208 United States
| | - Farrah Jacquez
- Department of Psychology, University of Cincinnati, 66 Corry Blvd, Cincinnati, OH 45219 United States
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Valentino K, Zhen-Duan J, Padilla J, Bernard D. Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012). Child Maltreat 2023; 28:556-562. [PMID: 37491779 PMCID: PMC10543487 DOI: 10.1177/10775595231191395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.
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Affiliation(s)
- Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre
Dame, IN, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital,
Boston, MA, USA
| | - Jenny Padilla
- Department of Psychology, University of Notre Dame, Notre
Dame, IN, USA
| | - Donte Bernard
- Department of Psychological Sciences, University of
Missouri, Columbia, MO, USA
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Zhen-Duan J, Alvarez K, Zhang L, Cruz-Gonzalez M, Kuo J, Falgas-Bagué I, Bird H, Canino G, Duarte CS, Alegría M. Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices. J Child Psychol Psychiatry 2023:10.1111/jcpp.13902. [PMID: 37850715 PMCID: PMC11024057 DOI: 10.1111/jcpp.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations. METHODS Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model. RESULTS Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores. CONCLUSIONS Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Josephine Kuo
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Irene Falgas-Bagué
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Glorisa Canino
- Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Falgas-Bague I, Cruz-Gonzalez M, Zhen-Duan J, Nagendra A, Alvarez K, Canino G, Duarte CS, Bird H, M. De-Salazar P, Alegría M. Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study. Lancet Reg Health Am 2023; 24:100549. [PMID: 37485018 PMCID: PMC10362791 DOI: 10.1016/j.lana.2023.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/29/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Abstract
Background The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings. Methods We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders. Findings We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics. Interpretation Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset. Funding The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
| | - Arundati Nagendra
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Schizophrenia and Psychosis Action Alliance, Alexandria, VA 22301, USA
| | - Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, Office A928 9th Floor, Rio Piedras, 00935, Puerto Rico
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Hector Bird
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Pablo M. De-Salazar
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Suite 506, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
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10
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Hampton-Anderson JN, Novacek DM, Zhen-Duan J, Latimer S, Perry T, Renard D. Redefining the Role of Public Health Professionals Serving Black Youths Seeking Mental Health Care: Implications for Training and Mentoring. Am J Public Health 2023; 113:S140-S148. [PMID: 37339410 PMCID: PMC10282850 DOI: 10.2105/ajph.2022.307194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 06/22/2023]
Abstract
Attrition rates for Black youths in mental health treatment settings are high, and the extant literature suggests this may be because treatment is not meeting their unique needs. Public health professionals, defined here as all individuals who work to increase the well-being of youths, can play a major role in changing these outcomes. The purpose of this article is to suggest a broader scope of practice, or a redefined role, for public health professionals who work with Black youths seeking outpatient mental health care and to explicate ways in which training and mentoring can help accomplish this goal. Bolstered by a socioecological conceptual model, we suggest 3 standards of practice that we believe must be satisfied to meet the requirement for this redefined public health professional role: using a sociocultural framework, exercising flexibility in one's assigned role, and understanding and incorporating culturally specific strengths and protective factors into care. (Am J Public Health. 2023;113(S2):S140-S148. https://doi.org/10.2105/AJPH.2022.307194).
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Affiliation(s)
- Joya N Hampton-Anderson
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Derek M Novacek
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Jenny Zhen-Duan
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Saundra Latimer
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Tyler Perry
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Destini Renard
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
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11
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Zhen-Duan J, Colombo D, Alvarez K. Inclusion of Expanded Adverse Childhood Experiences in Research About Racial/Ethnic Substance Use Disparities. Am J Public Health 2023; 113:S129-S132. [PMID: 37339415 PMCID: PMC10282858 DOI: 10.2105/ajph.2023.307220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Jenny Zhen-Duan
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniella Colombo
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kiara Alvarez
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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12
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Zhen-Duan J, Colombo D, Cruz-Gonzalez MA, Hoyos M, Alvarez K. Adverse childhood experiences and alcohol use and misuse: Testing the impact of traditional and expanded adverse childhood experiences among racially/ethnically diverse youth transitioning into adulthood. Psychol Trauma 2023; 15:S55-S64. [PMID: 37476532 PMCID: PMC10356013 DOI: 10.1037/tra0001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objective Traditional Adverse Childhood Experiences (T-ACEs), such as abuse and neglect, have been associated with an increased risk of youth alcohol use and misuse. This study aims to compare associations of T-ACEs and Expanded ACEs (E-ACEs), an expanded set of ACEs that encompass community-level adversities, with alcohol use and misuse by race/ethnicity. Method Data came from a three-wave (1998-1999; 1999-2000; 2004-2005) community-based study in Houston, including youth transitioning into adulthood. We compared associations between ACEs at Wave 1 and past-year alcohol use, abuse, and dependence at Wave 3. Results Participants (n = 2,391) included White (n =908), Black (n = 898) and Latinx (n = 585) youth (M (SD) = 14.00 (2.04)) transitioning into young adulthood (M (SD) = 19.77 (2.34)). T-ACEs were associated with higher odds of alcohol use, abuse, and dependence (OR = 1.15, OR = 1.18, OR = 1.24, respectively) while E-ACEs increased the odds of alcohol dependence (OR = 1.23) in the total sample. No significant differences by race/ethnicity were found. Racial/ethnic differences in increased alcohol risk were observed for some ACE items, such as bullying and use for Latinx youth (OR = 2.13) and poverty and dependence for White youth (OR = 2.01). Conclusions T-ACES and E-ACEs increase the risk of alcohol use and misuse. Results highlight the importance of preventing ACEs exposure as a risk factor for youth alcohol use and misuse. Public policies must also focus on preventing ACEs through multi-level interventions aimed at reducing violence, bullying, and financial instability.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Mario A. Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mercedes Hoyos
- Department of Political Science, Boston College, Chestnut Hill, MA, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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13
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Oblath R, Oh A, Herrera CN, Duncan A, Zhen-Duan J. Psychiatric emergencies among urban youth during COVID-19: Volume and acuity in a multi-channel program for the publicly insured. J Psychiatr Res 2023; 160:71-77. [PMID: 36774833 PMCID: PMC9893801 DOI: 10.1016/j.jpsychires.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
This study sought to characterize changes in the utilization of psychiatric emergency services among children and adolescents during distinct phases of 2020, as compared with prior years. We conducted a retrospective review of electronic health records from January 2018 through December 2020 that included all encounters made by patients under age 21. We then analyzed data for the 15,045 youth psychiatric encounters during the study period. Encounter volume in 2020 was significantly lower than prior years in March through May (IRR, 0.44; 95% CI, 0.40-0.49), May through July (IRR, 0.63; 95% CI, 0.56-0.71), and October through December (IRR, 0.76; 95% CI, 0.70-0.83). Encounters for youth with primary psychotic disorders remained at typical levels throughout 2020. Among older adolescents and youth with anxiety disorders, pervasive developmental disorders, and substance use disorders, encounter volume was significantly lower than prior years only during the initial lockdown period. There were significantly more encounters than normal conducted by mobile crisis units, including via telehealth, in July through October (IRR, 1.31; 95% CI, 1.06-1.62) and October through December (IRR, 1.28; 95% CI, 1.05-1.55) of 2020. Differences in patterns of encounter volume based on sociodemographic and clinical characteristics highlight subgroups of youth who may have been particularly vulnerable to acute mental health problems during periods of social distancing and isolation. Proactive efforts to engage vulnerable youth in outpatient treatment during periods of increased infectivity may help prevent increasing symptoms from reaching the point of crisis.
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Affiliation(s)
- Rachel Oblath
- Boston University School of Medicine, Boston, USA; Department of Psychiatry, Boston Medical Center, Boston, USA; BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Alice Oh
- Department of Psychiatry, Boston Medical Center, Boston, USA
| | - Carolina N Herrera
- Department of Psychiatry, Boston Medical Center, Boston, USA; BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Alison Duncan
- Boston University School of Medicine, Boston, USA; Department of Psychiatry, Boston Medical Center, Boston, USA; BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Jenny Zhen-Duan
- Harvard Medical School, Boston, USA; Massachusetts General Hospital, Boston, USA
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14
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Valero-Martínez C, Martínez-Rivera C, Zhen-Duan J, Fukuda M, Alegría M. Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults. Geriatrics (Basel) 2023; 8:17. [PMID: 36826359 PMCID: PMC9956127 DOI: 10.3390/geriatrics8010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.
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Affiliation(s)
- Carla Valero-Martínez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychology, Faculty of Social Sciences, Río Piedras Campus, University of Puerto Rico, San Juan, PR 00925, USA
| | - Christopher Martínez-Rivera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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15
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Alegría M, Falgas-Bague I, Fukuda M, Zhen-Duan J, Weaver C, O’Malley I, Layton T, Wallace J, Zhang L, Markle S, Lincourt P, Hussain S, Lewis-Fernández R, John DA, McGuire T. Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography. Med Care 2022; 60:806-812. [PMID: 36038524 PMCID: PMC9588705 DOI: 10.1097/mlr.0000000000001768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). DATA SOURCE Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC. RESEARCH DESIGN We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. RESULTS We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. CONCLUSIONS Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Cole Weaver
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Isabel O’Malley
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Timothy Layton
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Sheri Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Pat Lincourt
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Shazia Hussain
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | | | - Thomas McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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16
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Alegría M, Falgas-Bague I, Fukuda M, Zhen-Duan J, Weaver C, O’Malley I, Layton T, Wallace J, Zhang L, Markle S, Neighbors C, Lincourt P, Hussain S, Manseau M, Stein BD, Rigotti N, Wakeman S, Kane M, Evins AE, McGuire T. Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York. JAMA Health Forum 2022; 3:e221771. [PMID: 35977217 PMCID: PMC9250047 DOI: 10.1001/jamahealthforum.2022.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/28/2022] [Indexed: 11/14/2022] Open
Abstract
Importance There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. Objective To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. Design Setting and Participants This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned. Exposures Plan assignment. Main Outcomes and Measures Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment. Results Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans. Conclusions and Relevance The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Cole Weaver
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Isabel O’Malley
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Timothy Layton
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jacob Wallace
- Yale School of Public Health, New Haven, Connecticut
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Sheri Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Charles Neighbors
- Grossman School of Medicine, New York University, New York
- Wagner School of Public Service, New York University, New York
| | - Pat Lincourt
- New York State Office of Alcoholism and Substance Abuse Services, Albany, New York
| | - Shazia Hussain
- New York State Office of Alcoholism and Substance Abuse Services, Albany, New York
| | - Marc Manseau
- Grossman School of Medicine, New York University, New York
- New York State Office of Mental Health, New York
| | | | - Nancy Rigotti
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Sarah Wakeman
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Substance Use Disorder Initiative, Massachusetts General Hospital, Boston
| | - Martha Kane
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Addictions Services Unit, Massachusetts General Hospital, Boston
| | - A. Eden Evins
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Addiction Medicine, Massachusetts General Hospital, Boston
| | - Thomas McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Abstract
The Biden-Harris Administration's FY22 budget includes $1.6 billion for the Community Mental Health Services Block Grant program, more than double the FY21 allocation, given the rising mental health crises observed across the nation. This is timely since there have been two interrelated paradigm shifts: one giving attention to the role of the environmental context as central in mental health outcomes, the other moving upstream to earlier mental health interventions at the community level rather than only at the individual level. An opportunity to reimagine and redesign the agenda of mental health research and service delivery with marginalized communities opens the door to more community-based care interventions. This involves establishing multisector partnerships to address the social and psychological needs that can be addressed at the community level rather than the clinical level. This will require a shift in training, delivery systems, and reimbursement models. The authors describe the scientific evidence justifying these programs and elaborate on opportunities to target investments in community mental health that can reduce disparities and improve well-being for all. They select levers where there is some evidence that such approaches matter substantially, are modifiable, and advance the science and public policy practice. They conclude with specific recommendations and the logistical steps needed to support this transformational shift.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Correspondence: Margarita Alegría, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, FL, USA
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18
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Abstract
In this framework, we synthesize the results of studies addressing racial/ethnic disparities in children's mental health through 4 domains hypothesized to impact minoritized children and their families: (1) policies, (2) institutional systems, (3) neighborhoods/community system, and (4) individual/family-level factors. We focus on children and adolescents, presenting findings that may impact mental health outcomes for major racial/ethnic groups in North America: Black/African American, Latinx, Asian, and American Indian youth. We conclude by suggesting areas for needed research, including whether certain domains of influence demonstrate differential impact for inequities reduction depending on the youth's race/ethnicity.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, 2 West, Room 305, Boston, MA 02215, USA.
| | - Isabel Shaheen O'Malley
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA
| | - Karissa DiMarzio
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St, AHC-1, Miami, FL 33199, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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19
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Zhen-Duan J, Chary A, NeMoyer A, Fukuda M, Markle SL, Hoyos M, Zhang L, Fuentes L, Pérez G, Chambers V, Rosenthal J, Mention N, Alegría M. Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States. Health Serv Res 2022; 57 Suppl 1:95-104. [PMID: 35243630 DOI: 10.1111/1475-6773.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Chary
- Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Houston, Texas, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda NeMoyer
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mercedes Hoyos
- Department of Political Science, Boston College, Chestnut Hill, Massachusetts, USA
| | - Liao Zhang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gilberto Pérez
- Bienvenido Community Solutions, LLC, Goshen, Indiana, USA
| | | | - Jill Rosenthal
- National Academy for State Health Policy, Portland, Maine, USA.,Center for American Progress, Washington, District of Columbia, USA
| | - Najeia Mention
- National Academy for State Health Policy, Portland, Maine, USA.,Counseling & Psychological Services (CAPS), University of Hartford, Hartford, Connecticut, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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20
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Alegría M, Alvarez K, NeMoyer A, Zhen-Duan J, Marsico C, O'Malley IS, Mukthineni R, Porteny T, Herrera CN, Najarro Cermeño J, Kingston K, Sisay E, Trickett E. Development of a Youth Civic Engagement Program: Process and Pilot Testing with a Youth-Partnered Research Team. Am J Community Psychol 2022; 69:86-99. [PMID: 34350588 DOI: 10.1002/ajcp.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although research suggests neighborhood-level factors influence youth well-being, few studies include youth when creating interventions to address these factors. We describe our three-step process of collaborating with youth in low-income communities to develop an intervention focused on civic engagement as a means to address neighborhood-level problems impacting their well-being. In the first step, we analyzed qualitative interviews from a project in which youth shared perceptions about their neighborhoods (e.g., interpersonal relations with neighbors and institutions). Three major themes were identified: pride in youth's communities, desire for change, and perceptions of power and responsibility. Based on these themes, we completed the second step: developing a civic engagement and leadership program, called LEAP, aimed at helping youth take an active role in addressing neighborhood problems. In the third step, we collaborated with youth who completed a pilot version of the civic program and provided feedback to finalize it for large-scale testing. While discussing our process, we highlight the importance of including youth voices when developing programs that affect them. Furthermore, we note the need for more research exploring whether civic engagement serves as a mechanism for encouraging youth involvement in addressing neighborhood-level health disparities and identifying potential psychological costs of such involvement.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Amanda NeMoyer
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christine Marsico
- Wheelock College of Education & Human Development, Boston University, Boston, MA, USA
| | - Isabel Shaheen O'Malley
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ravali Mukthineni
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thalia Porteny
- Department of Community Health and Occupational Therapy, Tufts University, Medford, MA, USA
| | - Carolina-Nicole Herrera
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Najarro Cermeño
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kyle Kingston
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emnet Sisay
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edison Trickett
- School of Education and Human Development, University of Miami, Coral Gables, FL, USA
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21
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Zhen-Duan J, DeJonckheere M, Bignall WJR, Galván J, Saavedra N, Gorn SB. Interpersonal Violence and Psychological Well-Being: Perspectives of Low-Income Patients, Social Workers, and Medical Doctors in Mexico City, Mexico. J Interpers Violence 2022; 37:681-704. [PMID: 32306834 PMCID: PMC10501303 DOI: 10.1177/0886260520915543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The violence epidemic in Mexico is becoming more widespread. Using a social-ecological framework, the current study sought to understand interpersonal violence among those impoverished communities in Mexico City, Mexico. Participants were recruited from Community Health Centers located within districts that were densely populated, had high rates of poverty and marginalization, and where people experience complex social needs. Semi-structured interviews were conducted with patients, social workers, and medical doctors (N = 15) who were either receiving or providing services in these centers. Data were analyzed using an inductive, thematic approach. Analysis resulted in three themes: (a) interpersonal violence permeates all settings in which people live and interact; (b) social and cultural factors increase the risk of becoming a perpetrator or victim of interpersonal violence; and (c) interpersonal violence is closely intertwined with mental health. Rapid changes within gender roles and expectations in Mexico, combined with widening income inequality, are shifting dynamics within families that may be inherently linked to interpersonal violence. Our findings support the conceptualization of interpersonal violence at the four levels of the social-ecological framework: individual, relationship, community, and societal. Prevention and interventions for violence reduction must be applied across the four levels simultaneously. Community-level efforts should go toward strengthening existing community health centers and equipping primary care providers with training and resources on the screening and triaging of patients encountering interpersonal violence.
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Affiliation(s)
| | | | | | - Jorge Galván
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
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22
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Rabin J, Lawlace M, Zhen-Duan J, Nuñez M, Jacquez F. A social interaction learning model approach to understand adverse childhood experiences and drug use among Latinx youth. J Ethn Subst Abuse 2021:1-15. [PMID: 34597244 DOI: 10.1080/15332640.2021.1982804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Latinx youth, members of an ethnic minority group growing faster than the national growth rate, are at increased risk of experiencing adverse childhood experiences (ACEs) but it remains unclear how ACEs relate to externalizing behaviors, such as substance use and behaviors leading to injury and violence, in this population. In a sample of 100 Latinx youth, the current study examined how ACEs related to drug use and behaviors leading to injury and violence. Exposure to ACEs was associated with increased drug use, and that association was significantly moderated by behaviors leading to injury and violence for Latina adolescents. Given these findings, more attention needs to be diverted to screening for ACEs and externalizing behaviors in Latina girls.
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Affiliation(s)
- Julia Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Margaret Lawlace
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Miguel Nuñez
- Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Farrah Jacquez
- Department of Psychology, University of Cincinnati, Cincinnati, OH
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23
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Falgas-Bague I, Ramos Z, del Cueto P, Kim E, Zhen-Duan J, Wong YJ, Chieng CK, Frontera W, Alegría M. Adaptation of an Evidence-Based Intervention for Disability Prevention, Implemented by Community Health Workers Serving Ethnic Minority Elders. Am J Geriatr Psychiatry 2021; 29:260-269. [PMID: 32855041 PMCID: PMC7855421 DOI: 10.1016/j.jagp.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Changing demographics have created substantial unmet needs for mental health and physical disability services for immigrant and racial/ethnic minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHWs) who speak the same language and share the culture of these elders. Yet, implementation of interventions offered by CHWs requires adaptations of content and delivery, ideally under clinical supervision. OBJECTIVE To culturally adapt two evidence-based interventions, offered in community settings, to address mental health and physical disability prevention for diverse minority elders. METHODS We followed the Castro-Barrera stepped model for cultural adaptation of two evidence-based interventions into one combined program of disability management and prevention delivered by CHWs. We used feedback from key stakeholders, including four clinical supervisors, 16 CHWs, 17 exercise trainers, and 153 participants, collected at three time points to further adapt the intervention to a diverse population of elders. RESULTS Adaptations for administration by CHWs/exercise trainers included: systematization of supervision process, increased flexibility in sessions offered per participants' needs, inclusion of self-care content, modification of materials to better reflect elders' daily life experiences, and greater focus on patient engagement in care. Areas for additional adaptation included enhancing examples with culturally relevant metaphors, incorporating visual aids, and training CHWs in the importance of building trust. CONCLUSION This study identifies key aspects of the cultural adaptation process that facilitates broader cultural sensitivity of service delivery by CHWs to diverse elders in community settings.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
| | - Zorangeli Ramos
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paola del Cueto
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Kim
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Yankau Josephine Wong
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ching-King Chieng
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Walter Frontera
- Departments of Physical Medicine, Rehabilitation and Sports Medicine and Physiology and Biophysics, University of Puerto Rico, Río Piedras, Puerto Rico
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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24
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DiMascio TC, Zhen-Duan J, Rabin J, Vaughn LM, Jacquez F. Intercultural differences in healthcare experiences of Latinos in a nontraditional destination area. Fam Syst Health 2020; 38:232-241. [PMID: 32955282 DOI: 10.1037/fsh0000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Disparities in health care access for Latinos are well documented, but little is known about how they may impact immigrants from diverse countries of origin differently. Immigrants in nontraditional destination areas face greater disparities, allowing more robust comparison of Latino heritage groups in such regions. Method: Mexican (N = 258) and Guatemalan (N = 143) participants were recruited for a community-based participatory research (CBPR) initiative in Cincinnati, Ohio: Latinos Unidos por la Salud (LU-Salud). Community partners recruited Latino immigrants to complete a brief survey about health care difficulties. Mixed methods data analysis was employed using t tests, Fisher's exact test, and a qualitative content analysis approach to analyze group differences. Results: Although both groups reported challenges, Guatemalans reported greater difficulty navigating health care. Conversely, Mexicans more commonly used local resources like health fairs to seek health information and described fewer language barriers. Qualitatively, Guatemalans and Mexicans had different perceptions of the biggest health problem for Latinos in Cincinnati. Notably, Mexicans identified major chronic diseases as community health problems. Discussion: Mexicans and Guatemalans show different patterns of health care engagement and express distinct concerns. Future work should consider the role of health literacy in informing the heterogenous experiences and needs of Latinos from diverse countries of origin. Further, interventions should train health care providers to provide culturally sensitive services, with interpreters available in multiple languages to address heterogenous language needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Julia Rabin
- Department of Psychology, University of Cincinnati
| | - Lisa M Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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25
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Zhen-Duan J, Engebretsen B, Laroche HH. Diet and physical activity changes among low-income families: perspectives of mothers and their children. Int J Qual Stud Health Well-being 2019; 14:1658700. [PMID: 31452465 PMCID: PMC6720015 DOI: 10.1080/17482631.2019.1658700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 10/28/2022] Open
Abstract
Purpose: The current study explored how mothers and their children influence each other's diet and physical activity. Methods: We conducted semi-structured interviews with women with diabetes and their children (N = 18) from eight low-income families. Results: Two approaches to changes emerged: collaborative and non-collaborative. Families using collaborative approaches believed they could sustain positive changes through accepting family changes, encouragement, abstaining from buying certain foods, modelling and compromise. Within families using non-collaborative approaches, some challenges included using more individualistic approaches and poor communication. Lack of information and resource constraints challenged all families. Conclusion: Interventions should reinforce family collaborative approaches and teach skills for families to work together towards a healthier lifestyle.
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Affiliation(s)
- Jenny Zhen-Duan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Helena H. Laroche
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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26
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Zhen-Duan J, Jacquez F, Sáez-Santiago E. Boricua de pura cepa: Ethnic identity, cultural stress and self-concept in Puerto Rican youth. Cultur Divers Ethnic Minor Psychol 2018; 24:588-595. [PMID: 29771548 PMCID: PMC6188835 DOI: 10.1037/cdp0000199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The available literature on ethnic identity among Puerto Ricans has focused on those living in the United States, with little to no attention placed on examining ethnic identity and psychological constructs among youth living in Puerto Rico. Using a colonial mentality framework, the current study examined the associations between ethnic identity, cultural stress, and self-concept among adolescent boys and girls living in Puerto Rico. METHOD The current cross-sectional study surveyed participants (N = 187) recruited from several junior high schools in the metropolitan area in Puerto Rico. RESULTS Relations between ethnic identity, cultural stress, and self-concept differed by gender. First, cultural stress was associated with self-concept for boys, such that higher cultural stress predicted lower self-concept. Second, among girls, cultural stress moderated the relation between ethnic identity and self-concept. Specifically, for girls experiencing high cultural stress, exploration and resolution of their ethnic identity was associated with higher ratings of self-concept. CONCLUSIONS Although cultural stress has been widely understood as a phenomena associated with immigrants, our study indicated that cultural stress is important in understanding self-concept of youth living in Puerto Rico. For boys, cultural stress, but not ethnic identity, is particularly important to their self-concept. Among girls experiencing high cultural stress, exploration and resolution of ethnic identity was associated with higher self-concept. Results suggested that the cultural stress associated with the colonial context of Puerto Rico is salient in ethnic identity and self-concept development, even though Puerto Rican youth are the ethnic majority in the island. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | - Emily Sáez-Santiago
- Institute for Psychological Research, University of Puerto Rico, Río Piedras Campus
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27
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Jacquez F, Vaughn L, Zhen-Duan J, Graham C. Health Care Use and Barriers to Care among Latino Immigrants in a New Migration Area. J Health Care Poor Underserved 2018; 27:1761-1778. [PMID: 27818437 DOI: 10.1353/hpu.2016.0161] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unlike regions with larger Latino populations, the health care infrastructure in Cincinnati does not include linguistically and culturally appropriate services to meet the need of the growing Latino immigrant community. In order to guide development of appropriate health care services, a team of academic and community researchers collaborated on a community-based participatory research project to understand health care use, barriers to health care, perceptions of health care, and health care needs of Latino immigrants. Co-researchers administered 518 surveys and conducted focus groups with 34 Latino immigrants. Participants relied on community clinics for care more often than is seen in nationwide Hispanic samples. Results revealed significant health care barriers, which Latino immigrants attribute to language, lack of quality interpreters, documentation status, and discrimination. Results suggest that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.
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28
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Vaughn LM, Jacquez F, Zhen-Duan J. Perspectives of Community Co-Researchers About Group Dynamics and Equitable Partnership Within a Community-Academic Research Team. Health Educ Behav 2018; 45:682-689. [PMID: 29618239 DOI: 10.1177/1090198118769374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Equitable partnership processes and group dynamics, including individual, relational, and structural factors, have been identified as key ingredients to successful community-based participatory research partnerships. The purpose of this qualitative study was to investigate the key aspects of group dynamics and partnership from the perspectives of community members serving as co-researchers. Semistructured, in-depth interviews were conducted with 15 Latino immigrant co-researchers from an intervention project with Latinos Unidos por la Salud (LU-Salud), a community research team composed of Latino immigrant community members and academic investigators working in a health research partnership. A deductive framework approach guided the interview process and qualitative data analysis. The LU-Salud co-researchers described relationships, personal growth, beliefs/identity motivation (individual dynamics), coexistence (relational dynamics), diversity, and power/resource sharing (structural dynamics) as key foundational aspects of the community-academic partnership. Building on existing CBPR and team science frameworks, these findings demonstrate that group dynamics and partnership processes are fundamental drivers of individual-level motivation and meaning making, which ultimately sustain efforts of community partners to engage with the research team and also contribute to the achievement of intended research outcomes.
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Affiliation(s)
- Lisa M Vaughn
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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29
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Vaughn LM, Jacquez F, Zhen-Duan J, Graham C, Marschner D. Latinos Unidos por la Salud: The Process of Developing an Immigrant
Community Research Team. ACTA ACUST UNITED AC 2017. [DOI: 10.33596/coll.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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Zhen-Duan J, Jacquez F, Vaughn L. Demographic Characteristics Associated With Barriers to Health Care Among Mexican and Guatemalan Immigrants in a Nontraditional Destination Area. Fam Community Health 2017; 40:101-111. [PMID: 28207673 PMCID: PMC5319434 DOI: 10.1097/fch.0000000000000141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to examine demographic factors associated with health care barriers among Mexican (n = 258) and Guatemalan (n = 143) immigrants in Cincinnati, a nontraditional destination (new migration area). Three primary results emerged: length of US residence was not associated with fewer health care barriers, Mexican women and younger Guatemalans endorsed fewer skills-related barriers, and childless Guatemalans reported more barriers to care the longer they reside in the United States, when compared with Guatemalans with children. Our study highlights the importance of disaggregating data to create more tailored interventions to eliminate health disparities for Latinos.
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Affiliation(s)
- Jenny Zhen-Duan
- University of Cincinnati, Department of Psychology, Cincinnati, OH, USA,
| | - Farrah Jacquez
- University of Cincinnati, Department of Psychology, Cincinnati, OH, USA,
| | - Lisa Vaughn
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Department of Educational Studies, Cincinnati, OH, USA,
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31
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Topmiller M, Zhen-Duan J, Jacquez FJ, Vaughn LM. Place Matters in Non-Traditional Migration Areas: Exploring Barriers to Healthcare for Latino Immigrants by Region, Neighborhood, and Community Health Center. J Racial Ethn Health Disparities 2016; 4:1214-1223. [PMID: 28039603 DOI: 10.1007/s40615-016-0329-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022]
Abstract
This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH, on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape Division, American Academy of Family Physicians, Leawood, KS, USA.
| | - Jenny Zhen-Duan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45220, USA
| | - Farrah J Jacquez
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45220, USA
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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32
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Zhen-Duan J, Taylor MJ. The use of an ecodevelopmental approach to examining substance use among rural and urban Latino/a youth: peer, parental, and school influences. J Ethn Subst Abuse 2014; 13:104-25. [PMID: 24853361 DOI: 10.1080/15332640.2013.873006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using an ecodevelopmental framework, we examined how peer, parent, and student variables influence substance (tobacco, alcohol, and marijuana) use among rural and urban Latino/a adolescents (N = 2,500). Generally speaking, Latino/a adolescents in rural areas endorsed higher levels of substance use. Among the primary variables of study, there were a number of nuanced differences noted based on location, gender, and type of substance. Peer use was related to individual substance use in both rural and urban areas. However, peer use was a significantly stronger predictor of tobacco use among rural Latinas than urban dwelling. Parental monitoring was not predictive of urban marijuana use, yet was negatively associated with substance use for all subgroups and was especially pronounced for female alcohol use. Parental emotional involvement predicted higher alcohol use among urban boys. School achievement was negatively associated with substance use for all subgroups while, conversely, school involvement was associated with higher alcohol use for rural boys. Cultural and contextual implications for intervention and prevention are discussed.
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