Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.

Hispanic health disparities and housing: Comparing measured and self-reported health metrics among housed and homeless Latin individuals

Previous studies argue that Hispanics are healthier and less likely to experience homelessness than other populations in their same socioeconomic position. However, earlier studies have not explored the relationship between housing status and health for Latin individuals. This study examines 1) the health disparities between homeless and housed Hispanics in El Paso, Texas, and 2) the Hispanic health and homelessness paradoxes using an intersectional framework to understand health risks. A large number of Hispanic residents of El Paso (N = 1152) were surveyed. Demographic, health, and housing data were collected. We contribute to the literature by providing detailed health indicators for homeless Hispanics. To our knowledge, this is the first study to examine health disparities between housed and homeless Hispanics. Bivariate analysis, as well as data coded from interviews, indicated that homeless Hispanics were more likely to have barriers to care, less likely to have health insurance, slightly more likely than housed Hispanics to experience mental illness, alcoholism, and addiction, and more likely to be underdiagnosed for health problems, including hypertension. This study shows how certain traditional methods for collecting health data, including self-rated health and reported diagnoses, can be ineffective at revealing health disparities. This paper calls for innovative, mixed-methods approaches to understand the social and structural determinants of health for marginalized populations.

A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border

INTRODUCTION

Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border.

METHODS

Researchers at the Arizona Prevention Research Center conducted the Linking Individual Needs to Community and Clinical Services (LINKS) study during 2017-2018. Clinic-based CHWs referred participants to community-based CHWs who met with participants monthly for 6 months to assess participant needs, provide support for emotional well-being, and link them to resources. Two community-based CHWs collaborated to maximize participant care; they also administered an emotional well-being questionnaire at baseline and at 3-month and 6-month follow-up. We estimated changes in emotional well-being outcomes.

RESULTS

Scores for social support, perceived hopefulness, and quality-of-life measures among 189 LINKS participants increased significantly during the study period, especially among men and participants with low baseline scores. For each of the 3 outcomes, the standardized change was approximately 0.28 per 3 months of intervention, a decrease of more than half an SD (0.56) during 6 months of follow-up.

CONCLUSION

A CHW-led community-clinical linkage intervention can result in positive emotional well-being outcomes. We encourage policy makers, funders, and public health practitioners to further investigate such interventions as a solution to reduce disparities in emotional well-being.

Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome

Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites – a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16–1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75–0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.

Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms

BACKGROUND AND PURPOSE

Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects.

METHODS

We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories.

RESULTS

Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity.

CONCLUSIONS

This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.

Ethnicity and Language Differences in Patient Experience: an Analysis of the HCAHPS Survey

BACKGROUND

Although there has been a rising emphasis on patient-centered care, limited research has assessed differences in patient experience based on ethnicity and language.

METHODS

This study examined differences in quality of care (N = 6945) using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Data were collected between January 2014 and April 2019. Bivariate and multivariate analyses assessed relationships between ethnicity/language with individual items capturing specific components of care and global hospital evaluations using regression modeling.

RESULTS

Compared to English-speaking non-Hispanic White patients, Spanish-speaking Hispanic/Latinx patients reported more positive interactions with nurses, physicians, and the hospital environment and reported a better understanding of care after discharge. Findings also indicated that Spanish-speaking Hispanic/Latinx patients were more satisfied with their experience compared to non-Hispanic White patients.

DISCUSSION

Spanish-speaking Hispanic/Latinx patients were more satisfied with specific components of care and also scored higher in a measure of the global patient experience. Findings suggest the need for setting clear expectations for health care encounters and adapting health system responses to better capture factors driving Hispanic/Latinx patient satisfaction.

Social Support and Religiosity as Contributing Factors to Resilience and Mental Wellbeing in Latino Immigrants: A Community-Based Participatory Research Study

Latino immigrants are at increased risk for mental disorders due to social/economic disadvantages and stressful conditions associated with migration. Resilience-the ability to recover from stress-may provide protection given its association with lower rates of anxiety and depression. This study examines the relationship between protective factors, resilience, and psychological distress in Latino immigrants. A community-based participatory research study conducted with a Latino agency using in-person surveys to obtain the following data: Brief Resilience Scale, Brief Symptom Inventory, Duke University Religion Index, Multi-group Ethnic Identity measure, and the Interpersonal Support Evaluation List. Linear regression, and mediation analysis was performed using SPSS. There are 128 participants. Resilience was positively related to social support (p = 0.001) and religiosity (p = 0.006); inversely related to psychological distress (p = 0.001); and mediated the relationship between the two (p = 0.006). Promoting social support and religion in Latino communities can improve wellbeing by increasing resilience and reducing distress.

The Hispanic paradox in the prevalence of obesity at the county-level

Objective

The percentage of Hispanics in a county has a negative association with prevalence of obesity. Because Hispanic individuals are unevenly distributed in the United States, this study examined whether this protective association persists when stratifying counties into quartiles based on the size of the Hispanic population and after adjusting for county‐level demographic, socioeconomic, healthcare, and environmental factors.

Methods

Data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into quartiles based on their percentage of Hispanics, 0%–5% (n = 1794), 5%–20% (n = 962), 20%–50% (n = 283), and >50% (n = 99). For each quartile, univariate and multivariate regression models were used to evaluate the association between prevalence of obesity and demographic, socioeconomic, healthcare, and environmental factors.

Results

Counties with the top quartile of Hispanic individuals had the lowest prevalence of obesity compared to counties at the bottom quartile (28.4 ± 3.6% vs. 32.7 ± 4.0%). There was a negative association between county‐level percentage of Hispanics and prevalence of obesity in unadjusted analyses that persisted after adjusting for all county‐level factors.

Conclusions

Counties with a higher percentage of Hispanics have lower levels of obesity, even after controlling for demographic, socioeconomic, healthcare, and environmental factors. More research is needed to elucidate why having more Hispanics in a county may be protective against county‐level obesity.

Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data

Simple Summary

This study assessed renal cell carcinoma disparities in American Indians/Alaska Natives and Hispanic Americans using the National Cancer Database and the Arizona Cancer Registry, focusing on advanced-stage and mortality. Renal cell carcinoma disparities in American Indians/Alaska Natives have been partially explained by neighborhood socioeconomic factors and residence (rural or urban) pattern, but not in Hispanic Americans. Greater health disparities in renal cell carcinoma stage and mortality for Hispanic Americans and renal cell carcinoma mortality for American Indians/Alaska Natives were observed at the Arizona state level compared to national levels.

Abstract

Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.

Insight Into the Hispanic Paradox: The Language Hypothesis

Hispanics have a lower burden of heart disease than would be predicted from their risk factors. Explanations for this phenomenon, the Hispanic paradox, focus on specific characteristics of the culture that affect stress appraisal and accumulation, including social connections. Features of culture evolve in the context of language, which influences the way emotions are appraised and expressed. The Spanish language, a unifying component defining Hispanic cultures, has unique features that may promote emotional expression, expand the emotional concepts implicated in the construction of emotion, and influence the appraisal of stress. Under chronic stress conditions, sustained responses can become maladaptive, leading to disease. Features of the Spanish language allow its speakers a wide range of emotion schemas by virtue of its emotion lexicon, the ability to easily minimize or exaggerate expressions, and ease in considering hypothetical situations with the use of the subjunctive. The hypothesis here proposes that the Spanish language is directly and indirectly (via culture) responsible for mitigating some of the effects of acute stress responses in Hispanics and, therefore, limits stress accumulation and is partly responsible for the Hispanic paradox.

Examining Psychological Distress Across Intersections of Immigrant Generational Status, Race, Poverty, and Gender

While many studies have documented the health outcomes of immigrants, little is known about the direct and intersectional influences of generational status on mental health. We conducted a population-based cross-sectional study using data from the California Health Interview Survey from 2015 to 2016 (N = 41,754) to compare the prevalence of psychological distress among first-generation immigrants and non-immigrants relative to second-generation immigrants, overall and across intersections of race, poverty status, and gender. Second-generation and non-immigrant respondents had a significantly higher prevalence (10.1% and 9.4%, respectively) of psychological distress compared to first-generation immigrants (5.9%). Prevalence ratios comparing first-generation to second-generation immigrants were suggestive of an association where first-generation immigrants had lower prevalence of psychological distress compared to second-generation, though not statistically significant (0.81, 95% Confidence interval 0.63, 1.04). Prevalence ratios of non-immigrants relative to second-generation immigrants were not statistically significant (1.12, 95% Confidence interval 0.84, 1.50).

The Role of Socioeconomic Status in Latino Health Disparities Among Youth with Type 1 Diabetes: a Systematic Review

PURPOSE OF REVIEW

Type 1 diabetes (T1D) incidence is growing faster among Latino than non-Latino White youth, but ethnic disparities in self-management behaviors and HbA1c are unclear. Socioeconomic status (SES) is a key factor in T1D, which may confound or contribute to disparities in Latino pediatric T1D management. A systematic review examined whether ethnic differences in pediatric T1D outcomes occur and are independent of socioeconomic status (SES).

RECENT FINDINGS

Latino youth displayed lower self-management and higher HbA1c in approximately half of the identified studies prior to including SES in analyses. Ethnic differences in self-management were found for objective (i.e., frequency of blood glucose checks), but not subjective measures. Ethnic differences were often eliminated when SES was statistically controlled. SES moderated some differences, suggesting complex sociocultural processes. Articles varied widely in SES measures and the analytic methods used to evaluate ethnic disparities. Pediatric Latino T1D disparities are inconsistent and at least partially dependent on the SES context. Recommendations for future research to systematically evaluate SES and Latino T1D disparities are made.

Screen media use and sleep disturbance symptom severity in children

OBJECTIVES

Few studies have sought to evaluate how screen media use relates to symptoms of sleep-wake disturbances. To extend these prior studies in a large sample of children, this study examined associations of different types of screen media with symptom severity of different classes of sleep-wake disturbances. This study was preregistered here.

DESIGN

This study utilized the baseline cross-sectional survey administered within the Adolescent Brain Cognitive Development Study (ABCD; Release 2.0).

PARTICIPANTS

ABCD recruited over 11,000 U.S. children age 9-10 across 21 study sites using an epidemiologically-informed school-based recruitment strategy.

MEASUREMENTS

Children reported typical weekend and weekday use of TV, video, video game, social media, texting, and video chat, and parents completed reports of the child's symptom severity of sleep-wake disturbances via the Sleep Disturbance Scale for Children.

RESULTS

Greater screen media use, TV, video, and video game use, was associated with decreased sleep duration, increased sleep onset latency as well as greater excessive sleepiness, insomnia, and overall sleep disturbance symptom severity. Use of these screen medias were also associated with clinically relevant sleep problems. Ethnoracial differences emerged in screen use and sleep, but did not moderate the association between screen use and sleep.

CONCLUSIONS

Greater use of screen medias was not just associated with longer sleep onset latency and shorter sleep duration, but also increased severity of multiple types of sleep-wake disturbances. Future research should use longitudinal designs to determine the direction of these associations in adolescent populations.

Acculturation as a Moderator of HIV Risk Behavior Correlates Among Latino Men Who Have Sex with Men

Acculturation is associated with increased sexual risk behaviors among heterosexual Latinos, but its influence among Latino gay, bisexual, and other men who have sex with men (MSM) remains less clear. Elements of acculturation may create distinct lived experiences among sexual minority Latinos, moderating how beneficial and adverse influences contribute to their sexual risk behaviors. Latino MSM living in New York City (n = 412) were recruited using a modified time-space venue- and web-based sampling method. Negative binomial regression models estimated associations between indicators of acculturation (i.e., language use, nativity status, ethnic identification), sexual minority stressors (i.e., internalized homophobia, sexual orientation-based discrimination), peer condom use norms, and the number of serodiscordant condomless anal intercourse (SDCAI) encounters. Acculturation indicators were then tested as simultaneous moderators of the influence of each predictor variable on the outcome. The association between internalized homophobia and SDCAI was significant only among English language speakers (aIRR = 3.05 [2.13, 4.37]) and those born outside of the U.S. (foreign-born = 0, aIRR = 0.17 [0.08, 0.36]). Sexual orientation-based discrimination and SDCAI were also positively associated among both English-speaking (aIRR = 1.82 [1.22, 2.72]) and foreign-born men (aIRR = 0.34 [0.14, 0.84]). Stronger ethnic identification also moderated the protective effects of peer condom use norms on SDCAI (aIRR = 0.28 [0.15, 0.52]). Results suggest that different dimensions of acculturation help shape how both stressors and protective factors influence HIV risk among Latino MSM. Future research is needed to examine the mechanisms through which these differences in acculturation may act on sexual risk behaviors among Latino MSM.

Parent engagement in an original and culturally adapted evidence-based parenting program, Legacy for Children™

Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.

Racial Differences in the Effectiveness of Internet-Delivered Mental Health Care

BACKGROUND

Computerized cognitive behavioral therapy (cCBT) can improve mental health outcomes in White populations; however, it is unknown whether racial and ethnic minority populations receive clinical benefits from cCBT.

OBJECTIVE

To study race differences in the impact of cCBT use on mental health outcomes among White and African American primary care patients.

DESIGN

Secondary analysis of a three-arm randomized controlled clinical trial.

PARTICIPANTS

Primary care physicians (PCPs) referred 2,884 patients aged 18-75; 954 met eligibility criteria (including elevated mood and/or anxiety symptoms indicated as a score ≥ 10 on Patient Health Questionnaire or Generalized Anxiety Disorder scale); 704 were randomized in 3:3:1 ratio to receive either (1) the cCBT program (cCBT-only), (2) cCBT plus access to an Internet Support Group (cCBT+ISG), or (3) their PCP's usual care (UC). After exclusions, this study analyzed 689 patients: 590 receiving cCBT, in the combined cCBT-only and cCBT+ISG groups (91 African American, 499 White), and 99 receiving UC (22 African American, 77 White).

INTERVENTION(S)

We used the Beating the Blues cCBT program that consisted of eight 50-min Internet-delivered interactive sessions and "homework" assignments to complete between weekly sessions. College graduate-level care coaches provided six months of remote support.

MAIN MEASURE(S)

After prior analyses demonstrated no effect of the ISG program, we combined the cCBT-only and cCBT+ISG groups (cCBT) to compare to UC at 6-month follow-up. Controlling for sociodemographic factors, baseline symptoms, and treatment arm, we examined race differences for impact of cCBT versus UC on the mental health-related quality-of-life (Short-form 12 Health Survey), and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety, and depression.

RESULTS

Compared to UC, cCBT had no effect on quality of life (d = 0.10; p = 0.40), depression (d = - 0.19; p = 0.10), or anxiety (d = - 0.16; p = 0.18) for Whites. However, for African American patients, cCBT was associated with significant 6-month decrease in depression (d = - 0.47, p < 0.01) and anxiety scores (d = - 0.54, p < 0.01).

CONCLUSIONS

cCBT may be an efficient and scalable first step to eliminating disparities in mental health care.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01482806. https://www.clinicaltrials.gov/ct2/show/NCT01482806?term=rollman&rank=4.

Elucidating the Multidimensionality of Socioeconomic Status in Relation to Metabolic Syndrome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model.

METHODS

A community-based cross-sectional probability sample (2008-2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy's education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually.

RESULTS

In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P < .001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps < .001). The income-MetSyn association was only significant for women and those with current health insurance.

CONCLUSIONS

Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population.

Correlates of Resilience in Hispanic Young Adults

Research on health disparities among Hispanic/Latino populations has begun to look at resiliency as a key component to the health risk profile of Hispanics. However, there are still gaps in the research about the specific factors. This study sought to examine the relationship between factors in 4 primary domains-behavioral, psychological, social, and cultural-and resilience in Hispanic young adults. We used data from Project RED, which included 1503 Hispanic young adults. Results indicate that cultural factors (acculturation and cultural identity), psychological factors (depression, stress, and coping), and social connectedness are important determinants of resilience among Hispanic young adults.

"Abrazame Que Ayuda" (Hug Me, It Helps): Social Support and the Effect of Perceived Discrimination on Depression among US- and Foreign-Born Latinxs in the USA

BACKGROUND

Higher level of social support is known to mitigate the effect of ethnic discrimination on depression symptoms, yet little is known as to which type of social support may be most effective for ameliorating the negative health effects of perceived ethnic discrimination among Latinxs varying in nativity status. The purpose of this study is to examine the association between perceived ethnic discrimination and depression among US- and foreign-born Latinxs, and to identify specific types of social support that may buffer the aforementioned association in this population.

METHODS

Data from 1340 Latinx respondents (70% US-born; 30% foreign-born) collected from the Texas City Stress and Health Study (TCSHS) was used in this study. The primary outcome was depression, and it was measured using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R).

RESULTS

Findings showed that higher perceived ethnic discrimination were associated with higher depressive symptoms for both foreign-born and US-born Latinxs, with higher levels of social support, specifically positive interaction support, being associated with lower depressive symptoms for both groups. Importantly, results also showed that regardless of nativity status, higher levels of affectionate support mitigated the adverse association between ethnic discrimination and depressive symptoms.

CONCLUSION

This study provides evidence that higher levels of positive interactions and affective support may be significant factors in helping Latinxs cope with ethnic discrimination. This information is essential to inform the development of interventions aimed at building resilience in the face of discrimination among the largest and fastest growing ethnic group in the USA.

Variability of Pain Outcomes and Physical Activity Among a Diverse Sample of Older Men: Is It More Than Just Race?

There is a compendium of data documenting the increasing number of older adults. This suggests the continued need to understand identified health outcomes across domains of pain and physical activity, particularly among older men. Therefore, the aim of this study was to evaluate race similarities and/or differences in pain and rates of physical activity among White, Black, and Hispanic men 60+ years of age. Data were taken from the Health and Retirement Study, a longitudinal panel study surveying a representative sample of people in the United States. Logistic regression analysis was used to examine associations between race and pain and the odds of regular physical activity. Results showed that Black men were less likely to participate in light or moderate/vigorous physical activity. Similarly, pain increased the odds of physical activity among Hispanics, but decreased the odds of physical activity among White men. Findings may reflect a number of factors that impact the well-being of what it means to experience pain and physical functioning, while also assuming a masculine identity. This perspective may allow for a better understanding of short- and long-term implications of the pain experience and the pain and physical functioning dyad among this group of men.

Religion and Health Among Hispanics: Exploring Variations by Age

The purpose of this study is to see whether there are age differences in the relationship between church-based social ties and Epstein-Barr virus (EBV) antibodies among Hispanics (250) and non-Hispanic Whites (N = 602). The data indicate that emotional support that is received from fellow church members is associated with lower EBV values among Hispanics of all ages, but not among Whites of all ages. In contrast, emotional support that is received outside religious institutions failed to provide similar protective effects for Hispanics. No age differences emerged from the data.

Colon-Gonzalez M. Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants

Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.

Differences in social and physical dimensions of perceived walkability in Mexican American and non-hispanic white walking environments in Tucson, Arizona

INTRODUCTION

Physical activity patterns within the U.S. vary greatly across ethnicity, with data generally indicating lower rates among Hispanic/Latino adults. At the same time, Hispanic/Latino pedestrians face higher rates of injury and fatalities. Despite the importance of supportive physical activity environments on both health and safety outcomes, limited attention has been paid to ethnic or cultural differences in perceptions of supportive environments for walking. To fill this gap, we explore differences in physical and social environment contributors to perceived walkability between pedestrians in predominantly (> 70%) Mexican American and predominantly non-Hispanic white areas in Tucson, Arizona.

METHODS

In early 2017 the research team conducted brief on-street intercept interviews with pedestrians (N = 190) to learn about the environmental attributes associated with pedestrian perceptions of walkability. Study locations were matched for similar physical walkability metrics, income, and poverty rates. Consensus-based thematic coding identified 14 attributes of the built and social environment that contributed, positively and negatively, to perceptions of walkability.

RESULTS

Attributes of the social environment, both positive (i.e., social interaction, social cohesion, and community identity) and negative (i.e., crime/security), were more frequently expressed as components of walkability in Mexican American study areas while physical environment attributes (i.e., infrastructure, street crossings, and aesthetics) were more frequently mentioned in non-Hispanic white areas.

CONCLUSIONS

Contributors to perceived walkability in non-Hispanic white study areas were largely consistent with existing built environment-focused walkability metrics. Differences seen in Mexican American areas suggest a need to better understand differences across populations, expand the construct of walkability to consider social environment attributes, and account for interactions between social and physical environments. Results highlight the need for collaboration between public health and planning professionals, to evaluate walkability using culturally relevant measures that account for the social environment, particularly in Mexican American and other communities of color.

Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers

Latinx smokers in the United States (U.S.) represent an understudied health disparities group in terms of tobacco use. Despite scientific interest to elucidate individual difference risk factors for smoking, there is limited understanding of how emotional dysregulation relates to smoking outcomes among Spanish-speaking Latinx smokers. The purpose of the present investigation was therefore to explore emotion dysregulation in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Results indicated that emotion dysregulation was significantly related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Notably, the effects accounted for 7% to 15% of variance and were evident after adjusting for gender, income, education, number of medical conditions, depression symptoms, non-alcohol drug use, and alcohol consumption. The findings provide novel evidence that emotion dysregulation may represent an important individual difference factor for better understanding smoking-related outcomes among Latinx smokers and supports the need for greater attention to this affective vulnerability during smoking cessation treatment.

The impact of cardiovascular risk factors on cognition in Hispanics and non-Hispanic whites

Among non-Hispanic whites, cardiovascular risk factors are associated with increased mortality and poorer cognition. Prevalence of cardiovascular risk factors among aging Hispanics is also high and Hispanics generally have poorer access to healthcare, yet they tend to have advantageous cardiovascular disease rates and outcomes and live longer than non-Hispanic whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. Although robust data support these ethnic benefits on physical health and mortality, it is unknown if it extends to include cognition resilience advantages in older adulthood. The present study compared relationships between cardiovascular risk and cognition (executive functions and episodic memory) in late middle age and older Hispanics (n = 87) and non-Hispanic whites (n = 81). Participants were selected from the National Alzheimer's Coordinating Center and Alzheimer's Disease Neuroimaging Initiative databases. Hispanics and non-Hispanic white groups were matched on age (50-94 yr, mean age = 72 yr), education, gender, cognitive status (i.e., cognitively healthy versus mildly cognitively impaired), and apolipoprotein E4 status. History of hypertension and higher body mass index were both associated with poorer executive functions among Hispanics but not non-Hispanic whites. Our findings suggest greater vulnerability to impairments in executive functions among Hispanics with hypertension and obesity, contrary to the notion of a Hispanic health paradox for cognitive aging.

High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population

BACKGROUND

Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital.

METHODS

This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term.

RESULTS

Participants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26-0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16-0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07-12.9).

CONCLUSION

In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients' social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study.

TRIAL REGISTRATION

NIH trials registry number ClinicalTrials.gov: NCT01221532 .

Trauma and cultural values in the health of recently immigrated families

This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.

No laughing matter: Latinas' high quality of conversations relate to behavioral laughter

Latinx in the United States have greater life expectancy than other groups, in spite of their socioeconomic and psychosocial disadvantage. This phenomenon has been described as the Latinx health paradox. This investigation observed the interplay of cultural processes and social networks to shed light on this paradox. Latina (N = 26) and White-European (N = 24) mothers wore a digital recorder as they went about their daily lives. Four conversation styles were characterized from the recordings to measure the mothers' quality of their conversations (small talk and substantive conversations) within different social networks (with the father vs. other adults). As a positive indicator of well-being, laughter was assessed during the conversations. Results demonstrated that Latina mothers tend to laugh more than White-European mothers; and that this relation is mediated by substantive conversations with others. This suggests that Latinas' cultural processes afford meaningful conversations, which relates to more behavioral laughter, a process that may have positive implications on well-being.

Feeding decision-making among first generation Latinas living in non-metropolitan and small metro areas

BACKGROUND

Worldwide, overweight and obesity rates have more than tripled over the past three decades. Overweight and obesity rates are particularly high among Latinos. In order to determine some of the potential reasons, it is imperative to investigate how first-generation Latina mothers living in non-metropolitan and small metro areas decide how and what to feed their children. Using the Socio-Ecological Model, this study aimed to understand how Latina immigrant mothers make feeding decisions for their children.

METHODS

A total of 29 semi-structured interviews were conducted with a purposive sample of immigrant mothers from Latin American countries whose preschoolers were enrolled in a Women, Infant, and Children supplemental nutrition program located in non-metropolitan and small metro areas. All interviews were recorded and transcribed verbatim in Spanish, and analyzed by a bilingual team.

RESULTS

Multi-stage qualitative analysis was employed to analyze the data. Nineteen participants originated from Mexico, four from Central America, and six from South America. Five themes emerged that helped illuminate mother's decision-making around feeding choices: 1) culture as all-encompassing, 2) location and access to fresh and traditional foods, 3) disjunction between health provider advice and cultural knowledge 4) responsiveness to family needs and wants as determinants of food choices, 5) intrapersonal conflict stemming from childhood poverty and food insufficiency.

CONCLUSION

Findings suggest that Latina immigrant mothers engage in a difficult and even conflicting process when deciding how to feed their children. Future interventions should focus on implementing hands-on activities that can help consolidate, promote, and encourage healthy feeding choices.

The role of racial/ethnic identity in the association between racial discrimination and psychiatric disorders: A buffer or exacerbator?

The present study tests whether and how racial/ethnic identity moderates the psychological burden associated with racial discrimination. The theoretical concept of identity-relevant stressors suggests that racial discrimination will be associated with stronger psychological burden for people who put more values on their racial/ethnic backgrounds (i.e., racial/ethnic identity as an exacerbator). Conversely, racial/ethnic identity may be a protective resource to buffer any negative mental health consequences of racial discrimination (i.e., racial/ethnic identity as a buffer). We adjudicate these two competing hypotheses, while also examining whether the moderating effect of racial/ethnic identity varies by race/ethnicity or nativity. The data are from the 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Our findings reveal a race/ethnicity-dependent pattern: High racial/ethnic identity functions as an exacerbator for Whites, American Indians/Alaska Natives, and Latinxs, but moderate racial/ethnic identity functions as a buffer for Asians and Blacks in handling racial discrimination. In addition, the moderating effect of racial/ethnic identity is more pronounced among the U.S.-born than the foreign-born. The present study contributes to the knowledge base by showing that racial/ethnic identity does not universally protect-nor does it universally exacerbate-the psychiatric burden of racial discrimination. Rather, whether it mitigates or intensifies the mental burden of racial discrimination depends on its level and race/ethnicity.

Caught in the Middle: Spanish-Speaking Bilingual Mental Health Counselors as Language Brokers

Literature regarding language brokering has primarily focused on family and community members serving as language brokers. However, bilingual mental health counselors often find themselves serving as language brokers as well. In this article we focus on bilingual mental health counselors who work with the growing Spanish-speaking immigrant population in the United States. We examine bilingual counselors without formal training in Spanish who serve as language brokers, and examine the ethical and professional challenges they face. Such challenges highlight the complexities of living in two worlds and providing psychological services in two languages. In examining their roles as language brokers, we discuss implications for future mental health counseling practice, training, and research. We present the ¡BIEN! Bilingual and Bicultural Counseling Services model for training counselors to deliver services to Spanish-speaking clients, along with recommendations for training programs.

Racial and Ethnic Disparities in Dementia Risk Among Individuals With Low Education

INTRODUCTION

As higher dementia prevalence in ethnic minority groups could be attributed to low education, we studied individuals with low education and explored potential factors driving dementia disparities.

METHODS

We examined differences in dementia risk between low-educated non-Hispanic whites, Hispanics, and African Americans, and the impact of lifetime risk factors using data from the nationally representative Aging, Demographics, and Memory Study (N = 819).

RESULTS

As indicated by Cox regression modeling, dementia risk of low-educated individuals was not significantly different between ethnic groups but was related to having an APOE e4 allele (hazard ratio [HR] 1.89), depression (HR 1.67), stroke (HR 1.60), and smoking (HR 1.32). Further, even in people with low education, every additional year of education decreased dementia risk (HR 0.95).

DISCUSSION

Our findings imply that higher dementia prevalence in ethnic minorities may be attributable to low education, especially among Hispanics, in addition to other risk factors.

Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.

Aging in Puerto Rico: A Comparison of Health Status Among Island Puerto Rican and Mainland U.S. Older Adults

OBJECTIVE

To characterize the health status of older island Puerto Ricans, a segment of the U.S. population that has been largely overlooked in aging research.

METHOD

Data from the 2002 Puerto Rican Elderly Health Conditions Project and the 2002 Health and Retirement Study are used to examine differences in disease, disability, and self-rated health among island Puerto Ricans and the mainland U.S.-born older adult population. Differences are further examined by gender.

RESULTS

Island Puerto Ricans were less likely to have heart disease, stroke, lung disease, cancer, activities of daily living (ADL) limitations, and poor self-rated health, but more likely to have hypertension and diabetes. Island Puerto Rican women had worse health relative to island Puerto Rican men.

DISCUSSION

Recent challenges in the funding and provision of health care in Puerto Rico are worrisome given the large number of aging island adults, many of whom have hypertension and diabetes, two conditions that require long-term medical care.

Diverse Aging and Health Inequality by Race and Ethnicity

Although gerontologists have long embraced the concept of heterogeneity in theories and models of aging, recent research reveals the importance of racial and ethnic diversity on life course processes leading to health inequality. This article examines research on health inequality by race and ethnicity and identifies theoretical and methodological innovations that are transforming the study of health disparities. Drawing from cumulative inequality theory, we propose greater use of life course analysis, more attention to variability within racial and ethnic groups, and better integration of environmental context into the study of accumulation processes leading to health disparities.

Immigration and Mental Health

Purpose of review

While the experience of migration and resettlement in a new country is associated with mental health risks, immigrants generally demonstrate better mental health than expected. This review describes patterns in mental health outcomes among immigrants. We discuss a conceptual model of the potential underlying mechanisms that could buffer the stress and disadvantage experienced by this substantial and growing population.

Recent findings

While epidemiological studies have established a general pattern of lower risk for mental health disorders among first-generation (foreign-born) immigrants in the U.S., recent studies highlight how this pattern varies substantially by the intersection of race, ethnicity, national origin, gender, and socioeconomic status. Contextual factors including the family and neighborhood context; an immigrant's social position; experiences of social support and social exclusion; language competency and ability; and exposure to discrimination and acculturative stress further influence the relationship between immigration and mental health.

Summary

We conclude with an emphasis on social resilience processes, with a focus on how immigrants develop social relations, social capital and social networks. We recommend future directions for research that prioritize identifying and understanding social adaptation strategies adopted by immigrant groups to cope with immigration stressors.

Hispanic health in the USA: a scoping review of the literature

Hispanics are the largest minority group in the USA. They contribute to the economy, cultural diversity, and health of the nation. Assessing their health status and health needs is key to inform health policy formulation and program implementation. To this end, we conducted a scoping review of the literature and national statistics on Hispanic health in the USA using a modified social-ecological framework that includes social determinants of health, health disparities, risk factors, and health services, as they shape the leading causes of morbidity and mortality. These social, environmental, and biological forces have modified the epidemiologic profile of Hispanics in the USA, with cancer being the leading cause of mortality, followed by cardiovascular diseases and unintentional injuries. Implementation of the Affordable Care Act has resulted in improved access to health services for Hispanics, but challenges remain due to limited cultural sensitivity, health literacy, and a shortage of Hispanic health care providers. Acculturation barriers and underinsured or uninsured status remain as major obstacles to health care access. Advantageous health outcomes from the "Hispanic Mortality Paradox" and the "Latina Birth Outcomes Paradox" persist, but health gains may be offset in the future by increasing rates of obesity and diabetes. Recommendations focus on the adoption of the Health in All Policies framework, expanding access to health care, developing cultural sensitivity in the health care workforce, and generating and disseminating research findings on Hispanic health.

Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review

Recent evidence suggests that one possible cause of disparities in health outcomes for stigmatized groups is the implicit biases held by health care providers. In response, several health care organizations have called for, and developed, new training in implicit bias for their providers. This review examines current evidence on the role that provider implicit bias may play in health disparities, and whether training in implicit bias can effectively reduce the biases that providers exhibit. Directions for future research on the presence and consequences of provider implicit bias, and best practices for training to reduce such bias, will be discussed.

How group processes influence, maintain, and overcome health disparities

This special issue of Group Processes and Intergroup Relations presents new theory and research on how group processes influence, maintain, and overcome health disparities. We present eight papers that document the causes and consequences of health disparities from the perspective of stigmatized and disadvantaged groups, health care providers, and during the course of interaction between patients and providers. Several papers describe interventions and other factors that have the potential to reduce differences in health and well-being. We hope the research in this collection inspires more investigators to consider how their work on group processes and intergroup relations can address, and help to eliminate, disparities in health outcomes for the disadvantaged.