Neighborhood Collective Efficacy: A Longitudinal Social Determinant of Access to Medical Care Among Recently Immigrated Latina Young Adults

The present longitudinal study examined changes in perceived access to health care among a recently immigrated cohort of Latina young adults who were assessed annually during their first 3 years in the United States. A parallel process growth model of perceived access to health care and neighborhood collective efficacy was examined, accounting for socioeconomic indicators and immigration status. Five hundred thirty Latina young adults (ages 18-23) participated at baseline assessment, and approximately 95% were retained over three annual assessment time points. Participants' mean level of perceived access to health care increased during their initial 3 years in the United States. Women who reported more of an increase in perceived access to health care tended to also indicate increased neighborhood collective efficacy relative to their peers during their first 3 years in the United States. Findings offer important information about the individual- and community-level factors that influence recently immigrated Latinas' health care access.

Exploration of the effects of incarceration on the health of Latina women and their children using the life course theory

OBJECTIVE

Use the Life Course Theory (LCT) to explore the effects of involvement with the justice system on the health of Latina women and their children.

DESIGN

A supplementary analysis was conducted using data collected from the original study to answer a new research question.

SETTING

South Central Texas.

PARTICIPANTS

A primary qualitative data set from 12 Latina women involved with the justice system.

METHODS

We applied LCT principles and used thematic content analysis as such we employed categoric distinction: lifespan development, time and place in individuals' lives, the timing of lives, human agency, and linked lives to analyze participants' narratives.

RESULTS

Five themes emerged that aligned with LCT principles: (1) It feels like I'm living in my own prison; (2) What do I have to live for now; (3) It is like double punishment; (4) They made my choices; and (5) People didn't really understand. Participants felt helpless with few options to overcome their prior adversities, which affected their ability to make positive future choices.

CONCLUSIONS

Findings highlight the potential, long-term, negative health consequences that may result from incarceration. Considering that justice system involvement can lead to more profound maternal and child health disparities, our findings suggest that greater advocacy from the nursing profession would increase accessibility to equitable and respectful maternity and women's health care services. Key points Involvement with the justice system can result in negative health consequences for women and their children. Maternal and child health disparities are often more profound after involvement with the justice system. Greater advocacy is needed from the nursing profession to ensure access to equitable and respectful maternity and women's health care services.

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.

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Association of social network characteristics with HIV knowledge, stigma, and testing: findings from a study of racial and ethnic minority women in a small Western city

Black and Latina women are disproportionately impacted by HIV/AIDS. Despite existing research linking social networks and HIV risk among men who have sex with men (MSM) and other high-risk populations, little research has examined how ethnic/racial minority women's social networks shape HIV prevention and intervention targets. Using interviews with a sample of 165 predominantly Black and Latina-identifying women from a small city in the Western U.S., this research examines the relationship between egocentric network characteristics and HIV knowledge, attitudes, and testing history. Results reveal that network characteristics play a significant role in shaping HIV-related knowledge, prejudice, and testing intention but not HIV testing history. Individual-level factors like homelessness and perceptions of testing barriers are more salient for explaining testing behaviors than network characteristics. Intervention efforts to improve knowledge and reduce prejudice among Black and Latina women may benefit from mobilizing network ties.

Health Information Source Characteristics Matter: Adapting the Dissemination of an HPV Vaccine Intervention to Reach Latina and Vietnamese Women

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute’s evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women’s interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women’s online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

"I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema

Objective:

Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema.

Methods:

Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology.

Results:

The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices.

Conclusions:

Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.

Developing Culturally Tailored mHealth Tools to Address Sexual and Reproductive Health Outcomes Among Black and Latina Women: A Systematic Review

BACKGROUND

In addressing the sexual and reproductive health (SRH) disparities for Black and Latina women, there is a need for the development of innovative programs, framed using theoretical underpinnings that are culturally and contextually tailored so that they align with lived experiences. Mobile health (mHealth) interventions offer considerable potential as a means of providing effective SRH education and services. However, there has been a lack of research assessing culturally and contextually tailored mHealth SRH interventions for Black and Latina women.

METHOD

A comprehensive literature search was undertaken using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature was reviewed to evaluate whether a culturally and contextually tailored approach was utilized in the development and implementation of mHealth interventions for Black and Latina women.

RESULTS

A total of 12 articles were included in our synthesis, which encompassed mobile phone-, telephone-, and computer-based mHealth interventions for Black and Latina women. Cultural and/or gender-specific tailoring was included in 10 studies. Reduction of risky sexual behaviors and increased contraception usage were reported in 92% (n = 11) of the studies. Interventions that incorporated tailored content and fostered interaction reported high rates of follow-up.

CONCLUSIONS

Tailored mHealth interventions can be effective in promoting behavior change and improving SRH outcomes for Black and Latina women. However, there is a need for more research assessing user engagement and retention for Black and Latina women, and whether improvements in SRH outcomes are sustainable over the long term.

Emotional Eating Mediates the Relationship Between Food Insecurity and Obesity in Latina Women

OBJECTIVE

To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women.

DESIGN

A secondary analysis of a cross-sectional study.

PARTICIPANTS

Women (n = 297) were recruited from a community health center in Lawrence, MA.

VARIABLES MEASURED

The 6-item US Department of Agriculture Household Food Security Scale was used to measure FI. The Three-Factor Eating Questionnaire Revised 18-item, version 2 was used to measure EE. Measured height and weight were used to calculate body mass index. Covariates included: age, education, marital status, number of children in the house, physical activity, and country of birth.

ANALYSIS

Multivariable logistic and linear regressions. Mediation was tested and the mediated proportion was calculated.

RESULTS

Overall, 36.7% of women experienced FI. In adjusted regression models, FI was positively associated with obesity (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.08-2.97; P = 0.02) and EE (β = 0.22; 95% CI, 0.001-0.44; P = 0.05), and EE was positively associated with obesity (OR = 1.82; 95% CI, 1.37-2.42; P < 0.01). When EE was included in the main effects model, FI was not significantly associated with obesity (OR = 1.64; 95% CI, 0.97-2.76; P = 0.06) and EE explained 21% of the association.

CONCLUSIONS AND IMPLICATIONS

Longitudinal studies are needed to confirm the findings. If the findings are confirmed, future studies can explore interventions to ameliorate EE among Latina women experiencing FI, and providers can screen for EE in Latinas experiencing FI.

Depression and Physical Activity Affect Diet Quality of Foreign-born Latina Women Living on the U.S.-Mexico Border

There is increasing evidence that depression may affect diet. However, little is known about the association between depression and diet quality among foreign-born Latinas. We hypothesized that depressive symptoms would be associated with poorer diet quality in foreign-born Latinas. Furthermore, we believed that physical activity (PA) would have a protective effect on diet quality for individuals experiencing depressive symptoms. Our study evaluated the diet (Healthy Eating Index) and PA (Actigraph GT3X activity monitors) of 534 foreign-born Latinas with and without depressive symptoms (Center for Epidemiological Studies Depression Scale). A series of logistic regression models were estimated to examine our hypotheses. As predicted, Latinas who were depressed had significantly lower odds of having a high-quality diet than non-depressed Latinas. Unexpectedly, among Latinas who met PA guidelines, depressed Latinas had a significantly lower probability of having higher-quality diets than their non-depressed counterparts. Our findings support current research stating that depressive symptoms are associated with lower Healthy Eating Index scores. More research is necessary to elucidate the relationship between PA and dietary quality of depressed Latinas. Innovative approaches to address mental health and the stressors that can compound its severity are needed to improve diet quality among foreign-born Latina women.

Preferences of Underserved Chilean Women on a Mobile Technology Intervention for Cervical Cancer Screening: Qualitative Study

BACKGROUND

In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations.

OBJECTIVE

The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates.

METHODS

We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)-based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis.

RESULTS

Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates.

CONCLUSIONS

This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Latina Women and Cervical Cancer Screening: Decisional Balance and Self-Efficacy

BACKGROUND

Latina women in the United States have greater cervical cancer mortality rates than non-Latina women because of their low rates of Papanicolau (Pap) smear screening.

OBJECTIVES

The purpose of this article is to assess differences in perceived benefits, perceived barriers, and self-efficacy among Latina women to obtain Pap smears using the framework of the Transtheoretical Model.

METHODS

A descriptive design with a snowball sample was used. The researchers assessed demographics, three perceived benefits, 12 barriers, and seven self-efficacy measures for 121 Latina women in northern Nevada.

FINDINGS

Participants in precontemplation and relapse perceived greater barriers than those in action and maintenance for three items.

Parks as Social and Cultural Spaces Among U.S.- and Foreign-Born Latinas

Parks provide opportunities for people to engage in activities that can promote physical and emotional well-being. Using focus groups and personal interviews conducted in select neighborhoods of a Northeastern city with a high rate of obesity, we examined perceptions of barriers and facilitators regarding the use of parks and park features that would promote physical activity among Latina women ( N = 39). Foreign-born Latinas emphasized the environmental characteristics of parks and the types of amenities that can support preferred cultural and social activities, while U.S.-born Latinas emphasized the use of parks for physical activity and weight management. Most striking were the different ways in which foreign-born participants conceptualized parks as sociocultural family centers, extending more common conceptualizations centered on exercise or individual health gain. These findings suggest the need for new policies that incorporate culturally specific park programming to promote national goals of increasing levels of physical activity for health.

Prepregnancy Obesity Class Is a Risk Factor for Failure to Exclusively Breastfeed at Hospital Discharge among Latinas

BACKGROUND

Suboptimal infant feeding practices, including the failure to exclusively breastfeed, are modifiable risk factors that affect multiple maternal and child health outcomes. Women who are overweight or obese prenatally are more likely to fail to exclusively breastfeed. In the United States, Latinas represent a high-risk population with respect to overweight, obesity, and suboptimal infant feeding practices.

OBJECTIVES

Examine whether exclusive breastfeeding status at hospital discharge among overweight and obese Latinas was associated with (1) prepregnancy body mass index (BMI) and gestational weight gain and (2) sociodemographic, psychosocial, and maternal/infant biomedical factors.

METHODS

An electronic medical records review was conducted to determine exclusive breastfeeding status at hospital discharge among Latinas who gave birth at Hartford Hospital, Hartford, Connecticut, USA (N = 480). Eligible participants were ≥ 16 years, Latina, overweight or obese (BMI ≥ 25.0 kg/m(2)) and delivered a healthy full-term (≥ 37 weeks) singleton.

RESULTS

In the multivariable model, obese class II (BMI, 35.0-39.9 kg/m(2)) women had increased odds of failing to exclusively breastfeed at hospital discharge compared with overweight women. Planned formula use/partial breastfeeding was the single strongest predictor of nonexclusive breastfeeding status. Other risk factors included Puerto Rican ethnicity and parity.

CONCLUSION

Maternal prepregnancy obesity class is an important predictor of exclusive breastfeeding status at hospital discharge among overweight and obese Latinas. Future research should examine why in-hospital exclusive breastfeeding behaviors differ by obesity class to subsequently inform the design of breastfeeding promotion and support interventions tailored to the needs of Latinas by obesity class. Culturally appropriate prenatal breastfeeding promotion interventions emphasizing action and coping planning should be considered.

Improving Exercise Adherence and Physical Measures in English-Speaking Latina Women

BACKGROUND

Epidemiological data have established that lack of physical activity increases risk factors for chronic diseases. Data also suggests that physical activity participation is lowest in minority women, particularly Latinas, and that the nature of the exercise and attitudes toward exercise may influence exercise adherence. The purpose of this study was to determine the effect of hypertrophy training (HT) or power training (PT) used concomitantly with evaluative conditioning (EC) or neutral conditioning (NC) on exercise adherence as well as in physical and psychosocial variables in Latina women. EC is a behavioral method using paired stimuli to develop and strengthen new associations in memory.

METHODS

Two hundred thirty-one English-speaking Latina women (mean ± SD, age 36.8 ± 15.9 years) were randomly assigned to standard HT or high-speed circuit PT and then further stratified to receive EC or NC.

RESULTS

One hundred forty-two Latina women completed pre- and posttesting. For HT, EC produced significantly greater exercise time across the training period than NC. HT and PT both significantly improved all physical, functional, and psychosocial variables, with exception of leg extension and usual gait speed (p < 0.05).

CONCLUSION

EC can positively impact exercise adherence during HT in Latina women; while body composition, neuromuscular, and functional performances can be increased using HT and PT independent of psychological conditioning.