Avanzando Caminos (Leading Pathways): Design and Procedures of The Hispanic/Latino Cancer Survivorship Study

PURPOSE

Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study aims to examine the influence of sociocultural, medical, stress, psychosocial, lifestyle, behavioral, and biological factors on symptom burden, health-related quality of life, and clinical outcomes among Hispanics/Latinos who have been previously treated for cancer.

METHODS

Avanzando Caminos is a prospective, cohort-based study of 3,000 Hispanics/Latinos who completed primary cancer treatment within the past five years that is representative of the general Hispanic/Latino population in the U.S. Participants will complete self-report measures at baseline (T1), 6 months (T2), 1 year (T3), 2 years (T4), 3 years (T5), 4 years (T6), and 5 years (T7). Blood draws to assess leukocyte gene expression, cardiometabolic markers, and genetic admixture will be collected at baseline (T1), 1 year (T3), 3 years (T5), and 5 years (T7). Medical and cancer characteristics and clinical outcomes will be extracted from the electronic medical record and/or state cancer registry at each time point. Data analysis will include general latent variable modeling and latent growth modeling.

CONCLUSIONS

Avanzando Caminos will fill critical gaps in knowledge to guide future secondary and tertiary prevention efforts to mitigate cancer disparities and optimize health-related quality of life among Hispanic/Latino cancer survivors.

Liderando juntos y revueltos: A collectivistic leadership approach to address Latinx immigrant health and psychological needs

Psychologists are positioned to help address societal and public health crises in beneficial ways, including collectively working with public sectors to serve marginalized communities. This article highlights the relevance of helping to address societal and public health crises with collectivistic psychological leadership approaches and uses Latinx psychology leaders for addressing the current immigrant needs among Latinx communities. We draw attention to the domains needed for collectivistic psychological leadership that are culturally nuanced and equity, diversity, and inclusion-focused to advance the well-being of historically marginalized immigrant communities. Finally, the article highlights how our collectivistic approach operates in the public sector by describing the creation of the Latinx Immigrant Health Alliance (LIHA) and targeted outcomes. Briefly, the LIHA informally started in 2017 and was founded in 2020 to fill a gap in Latinx immigrant health at the heart of systemic inequalities during the global pandemic, explicit anti-immigrant rhetoric, and anti-Latinx policies. The LIHA aims to collectively work with community organizations to promote Latinx immigration health research, policy, education, training, and effective interventions. We include future directions and opportunities for collectivistic psychological leadership to address today's complex social issues. In particular, we call for the translation of psychological methods and other skills (e.g., research, clinical skills, policy, quantitative and qualitative methodology) into public action for better wellness of our communities, as well as the advancement of social justice, health equity, and inclusion for historically marginalized communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Buscando la Calma Dentro de la Tormenta: A Brief Review of the Recent Literature on the Impact of Anti-Immigrant Rhetoric and Policies on Stress Among Latinx Immigrants

The mental health burden associated with anti-immigrant rhetoric and ever-changing immigration policies is undeniable, though the psychological and emotional sequalae may remain invisible for years to come. Exclusionary immigration policies, as a form of structural racism, have also led to an epidemic of stress-related health within the Latinx community, particularly the Latinx immigrant community, across the United States. Recent examples of anti-Latinx and anti-immigrant rhetoric and policies include the 45th President's implementation of the Zero Tolerance policy, Migrant Protection Protocols, and Title 42. The recognition of previous and existing anti-immigrant policies, and the impact on Latinx immigrants, is critical in understanding the manifestation of psychological stress to prevent it from becoming chronic. For mental health providers, attention to existing policies that can be detrimental to the Latinx immigrant community is essential to understanding their mental health trajectory and applying frameworks that honor an individual's psychological stress to prevent pathologizing the immigrant experience and negative health outcomes. The objective of the present brief review is to shed light on recent research and offer recommendations for practice (eg, educating the Latinx community about the link between the immigrant experience and psychological stress) and policy (eg, drafting of legislation aimed at rescinding harmful immigration policies) regarding the relation between aggressive anti-immigration rhetoric and psychological stress among Latinx immigrants in the United States.

Trauma in the American asylum process: Experiences of immigrant families under the migrant protection protocols

OBJECTIVE

Latinx asylum-seeking families report posttraumatic distress that is 161-204% higher than in nonimmigrants, with adverse consequences for health and well-being. Recent U.S. policies have further embedded trauma in the asylum-seeking process by forcing families to remain in Mexico, enduring dire living conditions in tent encampments near the border while awaiting processing. These families are now entering the United States in large numbers. This article sheds light on their recent experiences and mental health needs, using a mixed methods-grounded theory design, presenting quantitative and qualitative data to describe the experiences of six asylum-seeking families who waited for 1-2 years in the refugee camp in Mexico.

METHOD

Quantitative data was obtained from the Brief Symptom Inventory-18 and the Harvard Trauma Questionnaire while qualitative interviews provided insight into reasons for migration and trauma at different stages of the migration process.

RESULTS

All participants experienced multiple traumas and endorsed trauma related symptoms. Important themes of psychological distress and trauma emerged, including unending suffering, hunger, and worry for the safety of their children while living in the refugee camp. Asylum-seeking families experienced substantial distress and trauma secondary to their stay in Mexico and COVID-19.

CONCLUSION

Families arriving to the United States have experienced significant trauma, separation, and loss before and during their journey. Interactions with an unprepared and overwhelmed immigration system further compromises their psychological well-being. It is imperative that first-person narratives inform policy that addresses their complex needs and protects their human rights. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

VALOR: Cultural considerations when assessing Central American immigrant women in behavioral health settings

The topic of immigration is timely yet polarizing. By definition, to be an immigrant implies being in a state of transition and transformation. The eventual outcome is likely to be influenced by a series of contextual factors starting in the country of origin, continuing during the migration journey, and culminating in receiving communities. The authors use a fictional case example of a Central American immigrant woman to illustrate VALOR, the Spanish word for courage, as an acronym that identifies five key areas for clinical consideration in behavioral health settings: Values, Arrival in the United States, Losses, Obstacles to care, and Resources. VALOR offers guidance for a culturally informed assessment critical for mental health clinicians. Implications for culturally affirming treatment directions including advocacy, community linkage, and attention to trauma and unresolved grief are woven into the discussion.

'Remain In Mexico': Stories Of Trauma And Abuse

Two families' stories-a separation at the border and an assault in a migrant shelter-show the horrific dimensions of US migration policy.

Protective Factors to the Wellbeing of Undocumented Latinx Immigrants in the United States: A Socio-Ecological Approach

Undocumented immigrants often experience multiple chronic stressors that over time can increase health risk. This qualitative study used data from 7 focus groups and 15 key informant interviews to identify relevant protective factors to the heath of undocumented immigrants in the U.S. Findings showed that at the individual level, undocumented immigrants rely primarily on motivation to cope with adversity, while also relying on family support and community cohesion at the interpersonal level. At the policy level, safe neighborhoods and non-stigmatizing environments, protection from abuse/exploitation, and activism were identified as protective factors. English proficiency was also identified as important.

HPVs Vaccination among Racial/Ethnic Minority College Students: Current Status and Future Direction

OBJECTIVES

College is an important period for catch-up vaccination for Human Papillomaviruses (HPVs), but HPVs vaccination rates are low among college students. Given that racial/ethnic minorities are disproportionately affected by HPVs-related cancers, the aim of the present study is to conduct a scoping review about HPVs and HPVs vaccination conducted among racial/ethnic minority college students. Specifically, we examined: 1) the prevalence of HPVs vaccination among racial/ethnic minority college students in the US and 2) the correlates of HPVs vaccination or vaccination intention/interest.

METHODS

We searched three database (PubMed, PsycINFO, and CINAHL) for relevant articles. Of 58 articles initially identified, 23 articles met all inclusion/exclusion criteria.

RESULTS

Racial/ethnic minority college women (especially Black and Asian/Pacific Islander) were less likely to be vaccinated compared to their non-Hispanic white counterparts. Racial/ethnic minority college men reported lower knowledge of HPVs and HPVs vaccination compared with their women counterparts. However, overall, a majority of racial/ethnic minority college students appeared to have high knowledge about HPVs and intention to vaccinate. Age, doctor recommendation, and psychosocial and cultural factors (e.g., HPVs/HPVs vaccine knowledge, perceived benefits of vaccination, social norms and values, mistrust of health care providers, and cultural norms) were associated with vaccination and individuals' intention to be vaccinated.

DISCUSSION

Significant racial/ethnic disparities in HPVs vaccination exist among both college men and women. Interventions to increase vaccine awareness, access, and uptake among racial/ethnic minority college students are lacking and warranted. Interventions targeting only knowledge and/or intention might not be sufficient. Theory-based studies that examine unique factors involved in vaccine uptake during college across multiple levels of influence including psychosocial, provider, health care, and culture are needed.

Attachment orientations and loss adjustment among bereaved spouses

Stressful life events such as losing a spouse can enhance inflammation. Responses to loss may depend, in part, on individual differences in attachment anxiety and avoidance. An individual's attachment orientation (i.e., an individual's levels of attachment anxiety and avoidance) reflects how an individual relates to others-- specifically, whether they feel their trusted others will reliably be there for them, and whether they feel comfortable opening up to and depending on their relationship partners. This study investigated the association between attachment orientations and poor loss adjustment in recently bereaved individuals (N = 100). Poor loss adjustment was operationalized as greater levels of inflammation and grief symptoms, as well as poorer self-reported mental and physical health. Attachment anxiety was associated with increased stimulated monocyte IL-6 and CCL4 production, but not TNFα. Likewise, attachment anxiety was associated with greater grief symptoms as well as poorer mental and physical health. In contrast, attachment avoidance was not associated with inflammation; it was, however, associated with less grief symptoms as well as better self-reported mental and physical health. Our findings provide evidence that attachment orientations may be associated with loss adjustment and adverse health outcomes following the recent loss of a spouse.

The link between border crossing and obesity

Research examining border crossing and health has focused on substance abuse, healthcare utilization and air pollution. Living in border communities allows for frequent crossing and exposure to different sociocultural and structural environments. Given high rates of obesity among Latinos and the large percentage living in border communities, it is important to consider the relationship between border crossing and obesity. This study explored the relationship between frequency of border crossing, obesigenic behaviors, measured obesity, and chronic disease. Multistage sampling methods were used to recruit 397 Latino adults living in border communities in South San Diego County. Selected participants completed a face-to-face interview and height and weight measurements. More frequent border crossing was associated with more fast food consumption and a greater reported diagnosis of high cholesterol. Understanding the extent to which border crossing is associated with obesigenic behaviors and chronic disease is important for developing relevant interventions along the border.

Latinos and political advocacy for cancer control in a United States-Mexico border community

Health policy interventions provide powerful tools for addressing health disparities. The Latino community is one of the fastest growing communities in the United States yet is largely underrepresented in government and advocacy efforts. This study includes 42 Latino adults (M age = 45 years) who participated in focus group discussions and completed a brief questionnaire assessing their experiences with political health advocacy. Qualitative analyses revealed participants considered cancer a concern for the Latino community, but there was a lack of familiarity with political advocacy and its role in cancer control. Participants identified structural, practical, cultural, and contextual barriers to engaging in political health advocacy. This article presents a summary of the findings that suggest alternative ways to engage Latinos in cancer control advocacy.

Focus group discussions in community-based participatory research to inform the development of a human papillomavirus (HPV) educational intervention for Latinas in San Diego

The purpose of this paper is to demonstrate the usefulness of formative focus groups as a community-based participatory research (CBPR) method in developing cancer education programs. Two focus groups were conducted according to CBPR principles, in order to develop a community-competent human papillomavirus (HPV)/cervical cancer educational program for Latinas living in the USA/Mexico border region. Focus group participants were 18 female Mexican American community health advisors. Participants reported that there is limited information and many myths about HPV and the vaccine in the Latino/Latina community, along with many barriers to acceptance of HPV/cervical cancer-related information. Furthermore, participants discussed their recommendations for the development of a culturally appropriate HPV educational program. From these data, we have a better understanding of the HPV/cervical cancer educational approach that will be most accepted in the community and what key information needs to be provided to women who participate in the program, which reinforces the importance of the CBPR approach to the formative phase of cancer education program development.

Abstract A16: Development of a community-based intervention for human papillomavirus vaccine education in the San Diego Latino/a community

Latinas have higher incidence and mortality rates due to cervical cancer than non-Latina white women (American Cancer Society, 2009; Downs et al., 2008; Jemal et al., 2009). The human papillomavirus (HPV) vaccine can significantly reduce cervical cancer disparities; however, Latinas are less likely to know about HPV and the vaccine (Jain et al., 2009), and are less likely to complete the 3 dose series than non-Latinas (Neubrand et al., 2009). These disparities instigate the need for culturally competent HPV vaccination educational programs in the Latino/a community.

An HPV advisory committee (HPVAC) consisting of multicultural researchers and experienced community health advisors (CHA) who conduct cancer education sessions for the Por la Vida program (PLV; “For Life;” Navarro et al., 1995; Navarro et al., 2007) was formed to assess the needs of the San Diego Latino/a community with regard to HPV and the vaccine. PLV was developed in San Diego in 1988 using a community-based participatory model that has evolved and expanded over time. PLV serves low-income, low acculturated Latino communities with limited access to health care services in the San Diego border region and beyond. PLV “consejeras” (CHA) conduct cancer education classes in small groups, which have been found to increase cancer screenings, healthy behaviors, and knowledge about cancer risk factors (Navarro et al., 1995; Navarro et al., 2007); however, there has not been an educational session about HPV and the vaccine.

Focus groups were conducted with18 experienced CHA, to identify the needs of the community with regard to education about the HPV vaccine, and what would be needed to make an HPV vaccine education program successful. The focus groups revealed: 1) There are many myths and limited information about HPV and cervical cancer in the community, 2) Participants’ HPV and HPV vaccine knowledge is also limited, 3) There are barriers to learning about HPV/cervical cancer, and the HPV vaccine in the Latino/a community, and 4) Participants had many recommendations for the development of a culturally competent HPV/cervical cancer program.

The HPVAC used the information from the focus groups to guide their development of a 2-hour HPV vaccine education intervention with Latinas in San Diego County. Following the principles of community-based participatory methodology, which has been at the core of the PLV programs for several years, the HPVAC created an educational curriculum that will address HPV and the HPV vaccine in a way that builds on the strengths of the community. Focus group participants clearly expressed the need to have the sessions be conducted face-to-face, in small settings, led by CHA. Moreover, interactive skill building programs that stimulate discussion among the women participating in the groups was thought to be an approach that would be most accepted and successful in the Latino community.

According to community-based participatory principles (Israel et al., 2005) and evidence from previous PLV programs (Navarro et al., 1995; Navarro et al., 2007), providing women with knowledge and skills to communicate accurate information may influence more than just the individual engaged in the program. The aims of this program are to inform women about HPV and the HPV vaccine, where to obtain the vaccine, and how to talk to their family members/friends about the vaccine. The program was developed in a way that respects and honors the cultural beliefs of this community. The proposed presentation will discuss the findings of the focus groups with the CHA, some of the challenges in program development, and the elements of the program to be implemented in fall 2011.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A16.