Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices

BACKGROUND

Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations.

METHODS

Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model.

RESULTS

Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores.

CONCLUSIONS

Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.

Evaluating the psychometric properties of the Hispanic Stress Inventory-2 Simplified version among a diverse sample of Latinos who smoke

OBJECTIVE

Acculturation stress can negatively impact Latinos immigrant mental and physical health related behaviors such as smoking. It is essential to have validated and updated instruments that allow the evaluation of acculturation stress on this population. This study aims to evaluate the psychometric properties of an abbreviated version of the Hispanic Stress Inventory Version 2 (HSI2) immigration scale among Latinos who smoke.

METHODS

The study consisted of a secondary data analysis from a baseline assessment of Decídetexto, a mobile health (mHealth) smoking cessation randomized clinical trial. Of 457 Latinos included in the parent study, 352 immigrants who smoke were included. Construct validity was analyzed by completing a Pearson correlation coefficient matrix. Structural validity was analyzed using an Exploratory Factor Analysis (EFA). Cronbach alpha analysis was used to estimate the internal consistency of the items constituting a factor.

RESULTS

The results included an abbreviated version of the HSI2 including 52 items. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 of the 52 items were excluded. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 items were excluded. Exploratory Factor Analysis (EFA) results in six factors extracted, explaining 69.1% of the variance. According to the EFA, two items were relocated in different factors from the original scale. The HSI2 30 items scale reflected excellent reliability with a Cronbach's alpha coefficient of 0.93. The six factors reflect acceptable to excellent reliability, ranging from 0.77-0.93 across factors. The median for the HSI2 total score was 34.00 (25-45) out of a possible total score of 150.

CONCLUSION

Results confirmed acceptable psychometric properties of the HSI2 simplified 30-item version and provided a reliable and shorter measure of acculturation stress for Latinos groups. Having a valid and reduced measure of acculturation stress is the first step in understanding diverse ethnic groups of Latinos that are at higher risk of presenting health risk behaviors such as smoking. The present results provided the possibility of assessing the impact of acculturation stress among adults who smoke.

The Relative Influence of Perceived Immigration Laws and Consequences on HIV Testing Among US Latino Immigrants

The CDC recommends that persons aged 13-64 receive an HIV test at least once in their lifetime and that some groups test annually or more frequently. Nearly one-half of US Latino immigrants have never been tested for HIV. To the extent that immigration-related laws deter documented and undocumented immigrants from engaging in communicable disease control measures, these laws undermine public health efforts. 1750 noncitizen adult, sexually active, Spanish-speaking Latino immigrants across four cities in the US completed a cross-sectional survey assessing perceptions of immigration-related laws and immigration consequences related to HIV testing and diagnosis. Participants were recruited in-person by staff in community settings, through flyers posted in places frequented by Latino immigrants, and by word-of-mouth through snowball sampling. Outcomes were whether participants had ever received an HIV test and whether they tested in the previous 12 months. Multivariable analyses examined the relative contribution of perceived immigration laws and consequences on HIV testing behaviors when considering established predictors of HIV testing. Perceptions of HIV-related immigration laws and immigration consequences was a significant predictor of never having had an HIV test even when considered relative to common predictors of HIV testing. The influence of perceived immigration laws and consequences on testing in the previous 12 months was not significant in multivariable analysis. Perceived HIV-related immigration laws and consequences appear to be a substantial contributor to reluctance to be tested for HIV among Latino immigrants who have never been tested. Effective interventions should be developed to address these.

The Role of Documentation Status Concerns, Perceived Discrimination, and Social Support on Latinx Adults' Physical and Mental Health

There is a growing number of immigrants arriving in the USA, with the majority being of Latinx descent. Coupled with this increase, there has also been growing anti-immigration legislation which impacts the experiences this group faces and creates additional concerns for those who are residing in this country without documentation. Experiences of overt and covert discrimination and marginalization have been shown to relate to poorer mental and physical health outcomes. Drawing from Menjivar and Abrego's Legal Violence Framework, this paper explores the impact of perceived discrimination and social support on the mental and physical health of Latinx adults. We further observe whether these relationships differ based on participants' concerns about their documentation status. This data comes from a community-based participatory study conducted in a Midwestern County. Our analytic sample was comprised of 487 Latinx adults. We found social support to be related to fewer self-reported days of mental health symptoms for all participants regardless of documentation status concern. Perceived discrimination was found to be related to worse physical health for participants with concerns about their status. These findings point to the pernicious role of discrimination for Latinx's physical health and the importance of social support as an asset beneficial for their mental health.

A machine learning approach using migration-related cultural stress to classify depression and post-traumatic stress disorder among hurricane survivors

BACKGROUND

Data science approaches have increasingly been used in behavioral health research and may be useful for addressing social factors contributing to disparities in health status. This study evaluated the importance of cultural stress-related factors in classifying depression and post-traumatic stress disorder (PTSD) among adult survivors (N = 319) of Hurricane Maria who migrated from Puerto Rico to the United States mainland.

METHODS

We evaluated the performance of random forests (RF) and logistic regression (LR) for classifying PTSD and depression. Models included demographic, hurricane exposure, and migration-related cultural stress variables. We inspected area under the receiver operating characteristic curve (AUC), accuracy, balanced accuracy, F1 score, precision, recall, and specificity.

RESULTS

Negative context of reception and language-related stressors were moderately important for accurately classifying depression and PTSD. For classifying depression, RF showed higher accuracy, balanced accuracy, specificity, precision, and F1. For classifying PTSD, RF showed higher accuracy, specificity, precision, and F1.

LIMITATIONS

A more thorough classification model would also include biomarkers (e.g., of allostatic load), family, community, or neighborhood-level attributes. Findings may not generalize to other groups who have experienced crisis-related migration.

CONCLUSIONS

Findings underscore the importance of culturally and linguistically appropriate and trauma-informed clinical services for recent migrants. Use of assessments to identify pre-migration and post-migration stressors could inform clinical practice with migrants presenting with behavioral health-related difficulties.

Effects of Auriculo-Acupuncture on Sleep and Emotional Stress in Hispanic Immigrants: A Small Randomized Clinical Trial

Objectives: To investigate whether Hispanic immigrants with sleep disturbance showed improvements with auriculo-acupuncture mediated by emotional stress. Design: Single-blind randomized clinical trial. Settings/Location: Community. Subjects: Sixteen Hispanic male (N = 4) and female (N = 12) volunteers. Interventions: Bi-weekly intervention for eight total treatments of National Acupuncture Detoxification Association (NADA) auriculo-acupuncture or sham. Outcome Measures: Emotional distress and sleep measures were completed Baseline, Mid- (four treatments), and Follow-up (eight treatments). Comparisons between Groups and within sessions using Mixed-Model ANOVA; linear regression assessed emotional stress and sleep association. Results: Significant within-subjects effect of Session (p's <.05) with significant differences Baseline/Mid-Way and Baseline/Final (p's <.05). Linear Regression showed significant positive associations at Baseline. Conclusions: Community auriculo-acupuncture may improve sleep and emotional stress in Hispanic immigrants.

Cross-Cultural Validation of the Barcelona Immigration Stress Scale

The concept of acculturative stress has been the subject of debate, resulting in contradictory arguments regarding its measurement. Many of the existing acculturative stress instruments have been developed for use with specific migrant groups. The objective of the current study is to revisit the psychometric properties of the Barcelona Immigration Stress Scale, an instrument aimed at measuring stress levels associated with the migration trajectory in any migrant group. Using a sample of 915 migrants who consulted in primary care, we carried out principal component and confirmatory factor analyses as well as item response theory analyses applied both to the entire sample and to different migratory groups separately. The new reduced version of the scale has very good psychometric properties both in general and applied to the Latino migratory group, the largest in the area where the study was carried out. Results were acceptable among sub-Saharan, North African, and Asian groups but not among Eastern Europeans. These results are discussed through the specificities of each migratory group and the limitations of psychometrics to capture the complexity of immigration-related and acculturative stress.

Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment

Introduction

The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress.

Methods

The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149).

Results

Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive).

Conclusions

These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.

Latino migrants' healthcare use in the US and perceived immigration laws and consequences: A multivariable analysis

BACKGROUND

Using healthcare, whether for routine preventative examinations, chronic condition management, or emergent conditions, is an essential element of achieving and maintaining health. Over 44 million migrants live in the US today and nearly half (44.6 %) are Latino. To the extent that immigration law-related concerns deter US Latino migrants from using healthcare, they jeopardize the health of a substantial though marginalized US subpopulation.

METHODS

A multistate sample (N = 1750) of noncitizen adult, Spanish speaking Latino migrants (both undocumented and documented) living in the US completed a cross-sectional survey comprising a scale assessing perceptions of immigration laws and consequences related to healthcare use and whether they had received and/or needed but did not receive healthcare in the previous 12-months. Participants were recruited in community settings and by word-of-mouth. Univariate analyses examined associations among study outcomes and common predictors of healthcare use. Multivariable analyses examined the relative contribution of perceived immigration laws and consequences on healthcare use and unmet need.

RESULTS

Perceptions of immigration laws and immigration consequences were a significant predictor of not having received healthcare in the previous 12-months and having needed and not received healthcare in the same period, even when considered relative to common predictors of healthcare use. Immigration documentation status and preferred language predicted healthcare use in univariate analyses but not in the multivariable model.

CONCLUSIONS

Perceived immigration laws and consequences related to healthcare use may influence migrants' healthcare use. Effective interventions should be developed to address immigration-related concerns.

Correlates of Alcohol Use Likelihood for Latino Immigrant Youth in an Emerging Context

Using a three-wave prospective longitudinal design spanning 3 years, we assessed alcohol use likelihood trajectories and their correlates among a community sample of Latino immigrant adolescents in the emerging immigrant context of Western Oregon. Results from growth mixture modeling revealed two distinct classes: lower risk youth who reported little likelihood of alcohol use but whose trajectory was increasing, and higher risk youth who reported higher likelihood of alcohol use and whose trajectory was stable. We found significant differences between the two classes such that lower risk youth reported greater levels of Latino cultural orientation and parental monitoring, whereas higher risk youth reported greater levels of family cultural stress and delinquency. Results are discussed in terms of prior research and theory.

Associations of Work-Related Injuries and Stress to Family and Youth Wellbeing among U.S. Latino/a Immigrant Cattle Feedyard Workers

Based on the Ecological Stress-Based Model of Immigrant Worker Safety and Health, we hypothesized that occupational stress and physical safety would be negatively linked to workers' depression, which in turn, would increase family conflict and decrease youth prosocial behaviors. A total of 242 Latino immigrant cattle feedyard workers from Nebraska and Kansas (90.9% male; M age = 37.7 years) answered questions assessing depression, occupational stress, whether they had ever been injured at work, familial conflict, and youth prosocial behaviors. All four indirect relations among occupational stress and injury and the outcomes (family conflict and youth prosocial behaviors) via depressive symptomatology were significant. Additionally, ever injured was negatively related to youth prosocial behaviors and occupational stress was positively related to youth prosocial behaviors. The findings support our model and suggest that increased stress and work-related injuries on cattle feedyards are linked to mental health problems, which in turn, is linked to more conflict experienced at home and less youth prosocial behaviors. Feedyard employers should focus on improving safety culture including providing robust training in the workplace. Practical implications to improve availability and access to mental and behavioral health resources to mitigate negative family outcomes are provided.

Familias Unidas Prevents Youth Internalizing Symptoms: a Baseline Target Moderated Mediation (BTMM) Study

Family-based preventive interventions have been found to prevent youth internalizing symptoms, yet they operate through diverse mechanisms with heterogeneous effects for different youth. To better target preventive interventions, this study examines the effects of the Familias Unidas preventive intervention on reducing internalizing symptoms with a universal sample of Hispanic youth in a real-world school setting (i.e., effectiveness trial). The study utilizes emerging methods in baseline target moderated mediation (BTMM) to determine whether the intervention reduces internalizing symptoms through its impact on three distinct mechanisms: family functioning, parent stress, and social support for parents. Data are from a randomized controlled effectiveness trial of 746 Hispanic eighth graders and their parents assessed at baseline, 6-, 18-, and 30-month post-baseline. BTMM models examined three moderated mechanisms through which the intervention might influence 30-month adolescent internalizing symptoms. The intervention decreased youth internalizing symptoms through improvements in family functioning in some models, but there was no evidence of moderation by baseline level of family functioning. There was some evidence of mediation through increasing social support for parents for those intervention parents presenting with lower baseline support. However, there was no evidence of mediation through parent stress. Post hoc analyses suggest a possible cascading of effects where improvements in support for parents strengthened parental monitoring of youth and ultimately reduced youth internalizing symptoms. Findings support the intervention's effects on internalizing symptoms in a universal, real-world setting, and the value of BTMM methods to improve the targeting of preventive interventions. ClinicalTrials.gov Identifier: NCTO1038206, First Posted: December 23, 2009.

The Relationship Between Latinxs' Acculturative Experiences and Mental and Behavioral Disorder in the National Latino and Asian American Study

Mental and behavioral disorders are among the leading contributors to disability among US-residing Latinxs. When treated as a homogeneous group, important disparities in the prevalence of such disorders among Latinx subgroups (e.g., by ethnic heritage) are obscured. However, Latinxs may also be characterized by their acculturative experiences while living in the USA, such as discrimination, neighborhood context and family conflict. Latent Profile Analysis with distal outcomes was used to estimate differences in psychiatric disorder prevalence across acculturative subgroups. Data from 2,541 Latinx participants (age 18 +) in the National Latino and Asian American Study (NLAAS) were used to estimate differences in the proportion of three categories of DSM-IV disorder: depressive, anxiety and substance use by four latent subgroups of Latinxs based on their acculturative experiences. Latinxs reporting more positive acculturative experiences had the lowest prevalence of all three disorders (14.8%, 13.6% and 7.1%, respectively). Those whose lives were characterized by high levels of family conflict and discrimination combined with low levels of social cohesion and neighborhood safety had the highest disorder prevalence (34.0%, 26.6% and 22.5%; all p < 0.01 compared to positive experiences subgroup). Latinxs with moderate levels of discrimination and conflict, along with those with high conflict and cohesion, were better off as compared to those with high negative experiences and low cohesion. These latent subgroups of Latinxs according to their acculturative experiences hold important implications for identifying high-risk groups for developing a psychiatric disorder. Findings also point to the protective role of family and neighborhood cohesion when facing high levels of adversity, which may inform prevention and intervention efforts.

The differential relationship of common health comorbidities with acculturative experiences in United States Latinxs

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A novel conceptualization of acculturation and related experiences is related to comorbidity.

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Different patterns emerge in the relationship between acculturative experiences and health.

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Toxic stress and social support may play differential roles in the risk for health comorbidities.

The impact of discrimination on binge eating in a nationally representative sample of Latine individuals

OBJECTIVE

Latines have higher rates of eating disorders characterized by binge eating compared to their non-Latine white counterparts, yet culturally and socially relevant factors related to binge eating in Latines have been largely understudied. The purpose of the current study was to examine how discrimination and acculturative stress were associated with binge eating in a nationally representative sample of Latines. An additional aim was to test the extent to which family cohesion and social support could buffer against the effects of discrimination and acculturative stress on binge eating.

METHOD

Participants (56% female, N = 2550) were Latines enrolled in the National Latino and Asian American Study. Structural equation modeling using 1000 re-sampled data sets built from machine learning iterative sampling procedures was used to examine the effects of discrimination, acculturative stress, family cohesion, and social support on binge eating.

RESULTS

Results indicated that only discrimination was significantly associated with binge eating. Neither the direct effect of acculturative stress, interaction of family cohesion and acculturative stress, interaction of social cohesion and acculturative stress, nor the interaction of social support and discrimination were significantly associated with binge eating.

DISCUSSION

This study highlights the need for mental-health providers to understand and assess discrimination among Latines presenting with concerns of binge eating. Treatments that effectively provide coping strategies to manage discriminatory experiences and reduce binge eating could improve both effectiveness of treatment and retention rates for Latine individuals with binge eating.

PUBLIC SIGNIFICANCE

This study examined the association of discrimination, acculturative stress, family cohesion, and social support with binge eating in Latines. Only discrimination was significantly associated with binge eating, highlighting the importance for providers to assess discrimination among Latines with binge-eating concerns and to improve equity, inclusion, and belonging at a societal level. Modifying existing treatments to address coping with discrimination could improve the effectiveness for Latines with binge-eating concerns.

Whose self-control development suffers or benefits in the face of adversity? A longitudinal study of Mexican-origin youth followed from age 10 to 16

This study assessed the co-development of adversity and effortful control based on a sample of Mexican-origin youth (N = 674) and their parents. We used a four-wave longitudinal design and followed target participants from age 10 to 16. At each time point, we measured adversity experienced by the children and their parents and children's effortful control (self- and parent-reported). We also assessed children's shift-and-persist coping strategies at ages 14 and 16. Across time, we found slight decreases in child-adversity and slight increases in parent-adversity. Based on bivariate LGC analyses, we found that the strongest effects surfaced for child- (vs. parent-) adversity. Specifically, we found that greater increases in child-adversity were associated with greater decreases in effortful control from ages 10 to 16. Moreover, we found a positive association between initial levels of child-adversity and the slope of effortful control, as well as a cross-sectional negative association between child- and parent-adversity and effortful control (at age 10). We found no evidence of moderation by shift-and-persist coping strategies. In sum, our results suggest that, on average, Mexican-origin youth exposed to more adversity might experience more maladaptive change with respect to effortful control.

How Ethnic Minority Context Alters the Risk for Developing Mental Health Disorders and Psychological Distress for Latinx Young Adults

Policy Points In low-income communities in the South Bronx and Puerto Rico, Puerto Rican youth are exposed to many of the same risk and protective factors for developing depression, anxiety, or psychological distress; yet it is unclear how the ethnic minority context of the South Bronx and ethnic majority context of Puerto Rico influence risk. Results from our quasi-experimental, longitudinal study demonstrate the importance of addressing social factors (parent-child relationships, youth peer relationships) for youth living in the majority context, and neighborhood and cultural factors (residential mobility, perceived discrimination, perceived social position in the neighborhood) for youth living in the minority context. Our findings support the need for tailoring programs specific to the needs of youth who reside in an ethnic majority or a minority context, since some of the risk factors might operate differently depending on context. Housing and neighborhood environment policies that address discrimination and eliminate structural inequities for ethnic minority groups may protect against the harm of minoritization on young people's mental health.

CONTEXT

Puerto Rican youth growing up in low-income communities in the South Bronx and Puerto Rico are exposed to many of the same risk factors for major depressive disorder, generalized anxiety disorder, and psychological distress. One potentially powerful factor differs: Puerto Ricans have been socially marginalized as an ethnic minority group in the South Bronx, but are the ethnic majority of the population in Puerto Rico. A growing body of literature demonstrates the influence of neighborhood, cultural, and social factors and parental psychopathology in the development of mental health problems. An important unanswered question is whether these risk and protective factors have the same impact for youth raised as members of an ethnic majority versus minority group.

METHODS

Using a population-based cohort study, with four waves of assessment from early childhood into young adulthood, we investigated whether ethnic minority context alters risk and protective factors for depression, anxiety, and psychological distress. Our longitudinal data set includes 2,491 young children at baseline (82.8% retained at wave 4). Using a quasi-experimental design, we examine how ethnic minority context can alter the development of mental health disorders as Latinx children transition to late adolescence and young adulthood.

FINDINGS

Some risk and protective factors operated differently across minority and majority contexts. Higher discrimination and social position were more powerful risk and protective factors, respectively, in the minority context, whereas positive peer relationships mattered more in the majority context. Children of mothers with depression were significantly more likely to develop anxiety in late adolescence and young adulthood in the majority context (60.0%) compared to the minority context (4.5%).

CONCLUSIONS

Preventing depression and anxiety disorders in Latinx young adults may require targeting different childhood factors depending on whether they reside within the ethnic majority or minority context. People in the ethnic minority context may benefit more from policies aimed at reducing discrimination and improving economic opportunity, while people in the majority context may benefit more from opportunities for strengthening family and peer relationships.

The association of acculturative stress with self-reported sleep disturbance and sleep duration among Asian Americans

STUDY OBJECTIVES

This study aims to examine associations between acculturative stress-defined as the psychological impact, or stress reaction, of adapting to a new cultural context-and self-reported sleep outcomes among Chinese and Korean immigrants in the United States.

METHODS

In this cross-sectional study, acculturative stress was assessed using a 9-item scale, and sleep disturbance was measured using the 8-item scale. Sleep duration was self-reported. Poisson and linear regression analyses were conducted to examine the associations between acculturative stress, sleep disturbance, and sleep duration.

RESULTS

Our sample consists of 400 participants (females: 52%, Chinese: 50%, Koreans: 50%, the mean of age = 58.4). 81.8% of them were classified as having no sleep disturbance, whereas 18.2% were classified as having sleep disturbance. Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (Prevalence Ratio (PR): 1.18, 95% confidence interval (CI): 1.06% to 1.31%). In linear models, a one-unit increase in acculturative stress was associated with 0.08 hr less sleep (p < .05). Interaction tests indicated effect modification for sleep disturbance by sex and ethnic identity: only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13 to 1.49), while the association was significant for individuals identifying as "very Asian" (PR: 1.21; 95% CI: 1.08 to 1.35), but not for those identifying as "mostly Asian" or "bicultural/western".

CONCLUSIONS

If findings are replicated, we suggest developing intervention programs for Asian immigrants to minimize acculturative stress and bolster protective factors that decrease the risk for poor sleep outcomes.Information on Clinical Trial: Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.

Depressive symptoms among recent Latinx immigrants in South Florida: The role of premigration trauma and stress, postimmigration stress, and gender

In the past decade, recent Latinx immigrants (RLIs) from South and Central America have arrived in the United States seeking asylum from countries affected by war, political upheaval, and high crime and poverty rates. The premigration stress and trauma they experience are further compounded by postimmigration stress due to discrimination, lack of access to health care, and financial instability. Evidence suggests RLIs who experience such stress and trauma have an increased risk of developing depressive symptoms. We examined the combined effect of premigration stress and trauma and postimmigration stress on postimmigration depressive symptoms; we also explored the moderating effect of gender. Hierarchical multiple regression and moderation analyses were conducted on a cross-sectional sample of 540 young adult RLIs (age range: 18-34 years, 50.2% men) in South Florida. Higher levels of postimmigration stress, β = .37, p < .001, were associated with increased postimmigration depressive symptoms. No significant associations emerged between premigration stress and trauma and postimmigration depressive symptoms. Moderation analyses revealed no significant interaction effect of gender. Post hoc analyses indicated that country/region of origin moderated the relation between postimmigration stress and depressive symptoms such that the association was stronger among Venezuelan, β = 1.51, p < .001; other South American, β = 1.06, p < .001; and Central American/Mexican RLIs, β = 1.38, p < .001, compared with Caribbean RLIs, β = .45, p  = .122. These findings suggest that interventions focused on addressing postimmigration stress early in the immigration process can potentially lower subsequent depressive symptoms among RLIs.

Acculturation Stress, Age at Immigration, and Employment Status as Predictors of Sleep Among Latinx Immigrants

Sleep is important for physical and mental health. Latinx individuals are thought to experience worse sleep and associated health outcomes, resulting in health disparities. There is a dearth of research on the factors (e.g., employment status, age at immigration) that predict poor sleep among Latinx immigrants. The present study aimed to (1) examine the link between demographic factors, immigration-related factors, and acculturation stress, and sleep, and (2) identify factors that either attenuate or intensify the link between acculturation stress and sleep among Latinx immigrants in the US South, an immigrant-hostile area that is home to an increasing Latinx population that remains understudied. Hierarchical regressions were used to analyze data from 391 Latinx adult immigrants, examining the link between demographic factors, immigration-related factors, acculturation stress, and two sleep variables (sleep quality, difficulty falling asleep). Employment status and age at immigration were examined as moderators of the link between acculturation stress and sleep. Data were collected through in-person surveys. Regressions showed that acculturation stress was significantly linked to worse sleep quality (β = 0.30, p = 0.001) and more difficulty falling asleep (β = 0.41, p < 0.001), while controlling for participant characteristics. Younger age at immigration (β = - 0.14, p = 0.005) and being unemployed (β = - 0.13, p = 0.006) were associated with more difficulty falling asleep. Age at immigration intensified the relationship between acculturation stress and sleep quality (β = 0.14, p = 0.005), difficulty falling asleep (β = 0.15, p = 0.002). Reducing acculturation stress is a meaningful intervention focus, with important implications for sleep health, particularly for recent Latinx immigrants. Age at immigration and employment status are also important factors to consider when designing targeted interventions.

Spanish Translation and Psychometric Validation of a Measure of Acculturative Stress among Latinx Immigrants in the USA

BACKGROUND

In the United States, the Latinx community is growing at a faster rate than any other racial or ethnic minority group. Members of this community have been found to experience a number of acculturative stressors after immigrating, including xenophobia, racism, and discrimination. Although several scales have been created in recent years to measure acculturative stress in Spanish-speaking immigrants, they are long, do not have nuanced subscales, or have not been validated in an extremely diverse sample of Latinx immigrants.

OBJECTIVE

The purpose of the current study was to translate and psychometrically validate the Riverside Acculturative Stress Inventory (RASI) in a diverse sample of Spanish-speaking immigrants.

METHODS

A sample of 202 Latinx immigrants in the United States completed the RASI as well as measures of depression and anxiety.

RESULTS

An initial confirmatory factor analysis suggested that the overall subscale factor structure was not an ideal fit for the data. An exploratory factor analysis suggested the retention of four subscales, each with three items, forming a 12-item Spanish RASI short form. As indices of convergent validity, the RASI total score was positively associated with depression and anxiety.

CONCLUSIONS

The findings from the study contribute to the literature a brief and valid assessment of acculturative stress in Spanish-speaking immigrants. The RASI Spanish short form holds promise to stimulate research on the unique adversities experienced by Latinx immigrants.

What do We Know About Acculturation? A Measurement Invariance Examination of Acculturation Domains Between Asian and Latinx Populations

Objectives

Acculturation has emerged as a key variable in racial/ethnic minorities and immigrant research. Although findings generally conclude acculturation leads to adverse outcomes (e.g., risk behaviors), scholars often find contradicting results. This increased attention to the core definitional questions about what acculturation is and how it should be measured, specifically across different racial/ethnic groups.

Methods

This study examined the measurement invariance using Multigroup Confirmatory Factor Analysis (MG-CFA) by comparing three common domains of acculturation measures across Asian and Hispanic populations (i.e., Ethnic Identification, Language Proficiency and Preference, and Acculturative Stress) using the National Latino and Asian American Study (NLAAS).

Results

A total sample of 4,649 (nLatinx=2,554 and nAsian=2,095) was used. The results suggested that aspects of ethnic identification and acculturative stress measures significantly varied between groups. For example, Latinxs had higher factor loadings in certain Acculturative Stress items related to government and legal status. In contrast, Asians had higher factor loadings in an item related to Ethnic Identification.

Conclusions

The results suggested that aspects of acculturation do not necessarily measure the same way across all populations; researchers/clinicians should consider racial/ethnic specific scales when using acculturation related measures. Future research should test universal acculturation scales across other ethnic subgroups and include more complex acculturation measures like cultural values and norms.

Sleep Health, Acculturation, and Acculturative Stress in Immigrants in the United States: A Scoping Review

INTRODUCTION

Poor sleep health has been widely associated with chronic illnesses, and immigrant populations in the United States do not experience optimal sleep, putting them at increased risk of such illnesses. The purpose of this scoping review was to synthesize published literature on the influence of acculturation and acculturative stress on the sleep health of immigrant populations in the United States.

METHOD

This scoping review was guided by Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline, and 16 research articles were included in its synthesis of results.

RESULTS

Findings indicated that immigrants in the United States have poor sleep health and that acculturation and acculturative stress may be major influencing factors. In addition, demographic and socio-contextual factors such as gender, economic status, education, and employment characteristics influenced immigrants' sleep. Race and ethnicity were additional factors influencing sleep, but the limited number of studies in this area precludes determination of which groups are most affected. Chronic stress, depressive symptoms, and language influenced immigrants' sleep health, but mixed results were observed for generational status.

DISCUSSION

Future sleep studies should include vulnerable and understudied immigrant groups and consider all socio-contextual and psychological factors potentially affecting sleep health. In health settings serving immigrant groups, nurses should emphasize screening for these factors. Also, comparative studies are needed to identify specific factors that may affect sleep health in particular immigrant ethnic groups.

Emotion dysregulation and hazardous drinking in relation to suicidal ideation among Spanish-speaking Latinx daily-smokers

OBJECTIVE

Suicidal ideation has increased among Latinx individuals in the last decade. Smoking increases the likelihood of suicidal ideation but work on Latinx smokers is minimal. Hazardous drinking and emotion dysregulation could be factors related to suicidal ideation among Latinx smokers, as has been evident in non-Latinx White samples. The current study sought to examine the main and interactive effects of emotion dysregulation and hazardous drinking in relation to suicidal ideation among Latinx daily-smokers.

METHODS

Participants were 371 Spanish-speaking daily-smokers (58.8% female; M_age = 33.3; SD_age = 9.8) recruited from the United States through Qualtrics. We used structural equation modeling (SEM) to test an interactive model of emotion dysregulation and hazardous alcohol consumption in relation to suicidal ideation; we also tested the effect of emotion dysregulation on suicidal ideation as a function of hazardous drinking status.

RESULTS

Results indicated that latent emotional dysregulation was associated with greater suicidal ideation (p < 0.001); however, hazardous drinking was not related to suicidal ideation (p = 0.186). The interactive term of emotional dysregulation and hazardous drinking was significantly related to suicidal ideation (p = 0.017). Specifically, greater emotion dysregulation was significantly related to suicidal ideation among Latinx smokers who engaged in hazardous drinking (p < 0.001) but not those who did not engage in hazardous drinking (p = 0.123).

CONCLUSIONS

The current findings suggest that smoking combined with hazardous drinking may be related to increased suicidal ideation among Latinx smokers. Findings are discussed in relation to the potential role of intervention strategies that focus on emotion dysregulation and hazardous drinking among Latinx current daily smokers to mitigate suicidal risk among this established health disparities population.

Prescription Drug and Cannabis Use among Recent Latinx Immigrants Pre- and Post-Immigration to the US

Introduction: Shifts in the sociopolitical context of Latin America have led to steep increases in recent Latinx immigrants (RLI) arriving in the US within the context of forced migration. Yet, little is known about how adverse experiences of RLIs before and after immigration may impact their health including drug use. The purpose of this study was to examine prescription drug and cannabis use before and just after immigration among RLIs and how this drug use is influenced by pre-and post-immigration factors. Methods: This study utilized baseline data from a study examining pre- to post-immigration drinking and driving trajectories among RLI in the United States (US). Baseline criteria included: self-identifying as a Latinx immigrant, 18 - 34 years old, who recently immigrated from a Latin American country. Multivariate logistic regression was conducted to determine predictors of drug use both prior to and after immigrating. Results: There were 540 RLI, 50.2% male and 47.8% subjected to forced migration. Prescription and illicit drug use decreased post-immigration with sedatives being the most common. Higher levels of education was associated with increased odds of pre-immigration prescription drug use and cannabis use. Those experiencing forced migration were more likely to engage in prescription drug use before and after immigration, while no associations were found for cannabis use. Conclusion: Findings suggest a need for increased substance use and mental health services among RLIs arriving within the context of forced migration. More research is needed to understand the trajectories of drug use among RLI as their time in the US increases.

Anxiety sensitivity and acculturative stress: Concurrent relations to mental health among Spanish-speaking Latinx in primary care

The Latinx population suffers from mental health inequalities. Although past work has implicated acculturative stress and anxiety sensitivity as important individual difference factors for anxiety and depression in this group, it is presently unclear how they work together to influence more severe anxiety and depressive symptom expression among Latinx. To help address this gap in the existing literature, the current study evaluated the role of concurrent anxiety sensitivity and acculturative stress, in terms of anxiety and depressive symptoms and disorders, in a Latinx population in a primary care setting. Participants included 142 Latinx individuals (86.7% female; M_age = 39.66, SD = 11.34). After accounting for shared variance, the results indicated that both anxiety sensitivity and acculturative stress were significantly associated with anxious arousal symptoms, social anxiety, and depressive symptoms. However, anxiety sensitivity, but not acculturative stress, was significantly related to a number of mood and anxiety disorders. These findings suggest the importance of assessing both anxiety sensitivity and acculturative stress in routine mental health screening, as both factors may be related to poorer psychological health among this group.

Prenatal Neighborhood Ethnocultural Context and the Mental Health of Mothers and Children in Low-Income Mexican American Families

Socioeconomically disadvantaged neighborhoods increase the risk for poor mental health among residents, yet protective factors may operate alongside risk. This study evaluated the influence of the prenatal neighborhood ethnocultural context on child behavior problems and maternal depressive symptoms. Prenatal maternal role expectations, prenatal culture-specific stress, and postpartum depression (PPD) symptoms were evaluated as mediators. Participants included 322 low-income, Mexican American mother-child dyads. Women (Mage  = 27.8) reported on proposed mediators, maternal depressive symptoms, and child behavior problems at 4.5 years. Neighborhood Latinx concentration was obtained from census data. Higher Latinx concentration predicted fewer maternal depressive symptoms and child behavior problems, mediated through role expectations and PPD symptoms. Results suggest prenatal neighborhood context to impact later maternal and child mental health.

An ecological expansion of the adverse childhood experiences (ACEs) framework to include threat and deprivation associated with U.S. immigration policies and enforcement practices: An examination of the Latinx immigrant experience

The Adverse Childhood Experiences (ACEs) framework has contributed to advances in developmental science by examining the interdependent and cumulative nature of adverse childhood environmental exposures on life trajectories. Missing from the ACEs framework, however, is the role of pervasive and systematic oppression that afflicts certain racialized groups and that leads to persistent threat and deprivation. In the case of children from immigrant parents, the consequence of a limited ACEs framework is that clinicians and researchers fail to address the psychological violence inflicted on children from increasingly restrictive immigration policies, ramped up immigration enforcement, and national anti-immigration rhetoric. Drawing on the literature with Latinx children, the objective of this conceptual article is to integrate the ecological model with the dimensional model of childhood adversity and psychopathology to highlight how direct experience of detention and deportation, threat of detention and deportation, and exposure to systemic marginalization and deprivation are adverse experiences for many Latinx children in immigrant families. This article highlights that to reduce bias and improve developmental science and practice with immigrants and with U.S.-born children of immigrants, there must be an inclusion of immigration-related threat and deprivation into the ACEs framework. We conclude with a practical and ethical discussion of screening and assessing ACEs in clinical and research settings, using an expanded ecological framework that includes immigration-related threat and deprivation.

Assessment of COVID-19-Related Immigration Concerns Among Latinx Immigrants in the US

IMPORTANCE

Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored.

OBJECTIVE

To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted.

MAIN OUTCOMES AND MEASURES

Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed.

RESULTS

A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56).

CONCLUSIONS AND RELEVANCE

In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.

Acculturation Mitigates the Negative Impact of Perceived Stress on Depressive Symptoms Among U.S. Chinese Older Adults

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants' acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.

Mothers' Narratives on their Immigration Experiences: Associations with Maternal Relatedness and Adolescent Adjustment

We examined the hypothesis that lower maternal relatedness mediates the associations of immigrant mothers' acculturative stress and lack of benefit finding in immigration with poorer adjustment of their adolescents in terms of more externalizing problems and lower school achievements and self-worth. Participants were 93 adolescents (47.31% girls, M_age  = 16.04) and their mothers (M_age  = 45.83) from middle-class families. Mothers immigrated to Israel from the Former Soviet Union or Western countries (M_{years-in-Israel}  = 19.75). We used a multimethod multi-informant approach that included a novel narrative procedure for assessing acculturative stress and benefit finding. Structural Equation Modeling supported the hypothesis, suggesting that research on and practice with adolescents in immigrant families should consider the meaning parents derive from their immigration experiences.

Differences in reporting food insecurity and factors associated with differences among Latino fathers and mothers

BACKGROUND

Food security status has been assessed as a representative score for households; however, different members in the same household may perceive and report food insecurity differently. A high prevalence of food insecurity has been reported among Latino households, therefore understanding differences in reporting food insecurity by Latino father-mother dyads may improve accuracy of assessment and plans to address food insecurity. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino father-mother dyads, and 2) identify factors associated with discordance in perceptions of food insecurity between dyads.

METHODS

Baseline data were used from a community-based, youth obesity prevention program among Latino families (n = 106 father-mother dyads). Food security was assessed with a 2-item food insecurity screen. Logistic regression models were used to evaluate associations between reporting food security status and predictor variables for fathers, mothers, and dyad-discordant responses.

RESULTS

Food insecurity was reported by 39% of fathers and 55% of mothers. Adjusted odds of reporting food insecurity were significantly higher for fathers perceiving their neighborhood was unsafe vs. safe (OR: 3.7, p < 0.05) and reporting lower vs. higher household income (OR: 3.2, p < 0.05). Adjusted odds of reporting food insecurity were significantly higher for mothers perceiving their neighborhood was unsafe vs. safe (OR: 4.1, p < 0.01) and reporting lower vs. higher home availability of fruit and vegetable (OR: 5.5, p < 0.01). Dyad discordance in reporting food security status occurred in 24% of the dyads. Adjusted odds of dyad discordant reports of food insecurity status were significantly higher for dyads reporting discordant responses regarding previous nutrition education (OR: 3.4, p < 0.05) and higher home fruit and vegetable accessibility (OR: 3.1, p < 0.05) compared to dyads reporting concordant responses. Among the 28 dyads who reported discordant nutrition education participation, 21 reported that fathers had never participated but mothers had participated more than once.

CONCLUSIONS

Differential factors were associated with reporting food security among Latino father-mother dyads. Nutrition education for fathers that improves awareness of home food supplies and a better understanding of how food accessibility influences maternal perceptions may improve dyad discordance in reporting household food security.

Violence, Place, and Strengthened Space: A Review of Immigration Stress, Violence Exposure, and Intervention for Immigrant Latinx Youth and Families

Latinx immigrant families are greatly impacted by US policies and practices that limit immigrant families' and children's rights. This article reviews the effects of such policies and the growing literature examining migration experiences. Latinx immigrant youth and parents may encounter multiple stressors across the stages of migration, including physical and structural violence, fear, poverty, and discrimination, which contribute to higher rates of mental health problems in this population. Despite significant trauma exposure, immigrants demonstrate incredible resilience within themselves, their families, and their communities and through movements and policies aimed at protecting their rights. Numerous culturally relevant universal, targeted, and intensive interventions were developed to magnify these protective factors to promote healing, advance immigration reform, and provide trauma-informed training and psychoeducation. Psychologistsplay a crucial role in implementing, evaluating, and advocating for accessible and collaborative approaches to care so that Latinx immigrant families have the resources to combat the harmful sequelae of immigration stress.

Challenges and Barriers to HIV Care for Mexican Born Men Living in Chicago

BACKGROUND

Latinx men are disproportionately impacted by HIV. Research often looks at Latinx people as a heterogeneous population. This paper describes baseline characteristics and barriers to HIV care among Mexican born men enrolled in an HIV care engagement intervention at a public health clinic in Chicago.

METHODS

Survey and medical chart data were collected.

RESULTS

66 Mexican born men enrolled in the project. Over half (60%) were newly diagnosed; 40% were reengaging in care or establishing care for the first time. Participants reported significant pre and postmigration concerns including poverty, social stigma, late entry to care, and concurrent health concerns, including 47% screening positive for depression. Barriers to care and mental health concerns were significantly related to Stage 3 HIV.

DISCUSSION

More prevention and intervention research is needed to ameliorate the negative socioeconomic and health ramifications of immigration and bolster mental and sexual health, reduce HIV transmission, and increase testing, linkage and care retention.

Refining acculturation measures for health research: Latina/o heterogeneity in the National Latino and Asian American Study

OBJECTIVES

This study factor analyzes six scales relating to acculturation and related experiences among a nationally representative sample of United States-residing Latina/os (n = 2,541) from the National Latino and Asian American Study (NLAAS), using measurement invariance (MI) testing to explore differences in latent constructs by Latina/o subgroup.

METHODS

Factor Analysis (FA) within an Exploratory Structural Equation Modeling framework was used to analyze the factor structure of six scales measuring acculturation and related experiences (i.e., acculturation [language use and preference], enculturation [ethnic identity], discrimination, neighborhood context, and family environment). We tested for MI by two important Latina/o subgroups: ethnic heritage and generational status.

RESULTS

The underlying latent factors resulting from FA strongly aligned with the NLAAS subscales. No scale achieved full MI, yet the degree to which MI held varied greatly by scale and by subgroup.

CONCLUSIONS

Findings show that Latina/os are heterogeneous, but that this often depends on the construct and subgrouping of interest. Future research should use these scales in a latent framework, accounting for the lack of MI, to ensure that the underlying acculturative constructs of interest are validly measured when investigating their association with mental health outcomes in this population.

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers

OBJECTIVE

Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators.

METHODS

Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates.

RESULTS

Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months).

CONCLUSIONS

Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.

The home air in agriculture pediatric intervention (HAPI) trial: Rationale and methods

BACKGROUND

Data addressing air quality effects on children with asthma in rural U.S. communities are rare. Our community engaged research partnership previously demonstrated associations between neighborhood NH3 and ambient PM2.5 and asthma in the agricultural lower Yakima Valley of Washington. As a next step, the partnership desired an intervention approach to address concerns about pediatric asthma in this largely Latino immigrant, farm worker community.

OBJECTIVE

The Home Air in Agriculture Pediatric Intervention (HAPI) sought to examine the effectiveness of enrichment of an existing asthma education program with portable high-efficiency particulate air (HEPA) cleaners designed to reduce PM2.5 and NH3. We investigated the effect of this enriched approach on these exposures and asthma health measures.

DESIGN

We randomized children with poorly controlled asthma to a control arm (current asthma education program) or an intervention arm (current asthma education program + placement of two indoor air cleaners in the family's home). Outcomes included (1) 14-day integrated samples of indoor air contaminants (PM2.5 and NH3) at baseline and one-year follow-up and (2) child asthma health metrics at baseline, midpoint (4-6 months) and one-year follow-up. These included the Asthma Control Test, symptoms days, clinical utilization, oral corticosteroid use, pulmonary function, fractional exhaled nitric oxide, and urinary leukotriene E4 concentration.

DISCUSSION

To our knowledge, this is the first randomized HEPA cleaner intervention designed to assess NH3 as well as PM2.5 and to evaluate health outcomes of children with asthma in an agricultural region.

Addressing Immigration-Related Stress in a Culturally Adapted Parenting Intervention for Mexican-Origin Immigrants: Initial Positive Effects and Key Areas of Improvement

Culturally adapted evidence-based parenting interventions constitute a key strategy to reduce widespread mental health disparities experienced by Latinx populations throughout the United States. Most recently, the relevance of culturally adapted parenting interventions has become more prominent as vulnerable Latinx populations are exposed to considerable contextual stressors resulting from an increasingly anti-immigration climate in the country. The current study was embedded within a larger NIMH-funded investigation, aimed at contrasting the differential impact of two culturally adapted versions of the evidence-based parenting intervention known as GenerationPMTO©. Specifically, a sample of low-income Mexican-origin immigrants was exposed either to a culturally adapted version of GenerationPMTO primarily focused on parent training components, or to an enhanced culturally adapted version in which parenting components were complemented by sessions focused on immigration-related challenges. The sample for the study consisted of 103 Mexican-origin immigrant families (190 individual parents). Descriptive analysis and generalized estimating equations (GEEs) indicated that exposure to the enhanced intervention, which included context- and culture-specific sessions, resulted in specific benefits for parents. However, the magnitude of the impact was not uniform for mothers and fathers and differed according to the type of immigration-related stress being examined (i.e., intrafamilial vs. extrafamilial stress). Overall, findings indicate the relevance of overtly addressing contextual (e.g., discrimination) and cultural challenges in culturally adapted interventions, as well as the need to increase precision according to the extent to which immigration-related stressors impact immigrant mothers and fathers in common and contrasting ways. Implications for family therapy practice and research are discussed.

Employment status and the association of sociocultural stress with sleep in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

STUDY OBJECTIVES

We examined the association of sociocultural stress severity (i.e. acculturation stress, ethnic discrimination) and chronic stress burden with multiple dimensions of sleep in a population-based sample of US Hispanics/Latinos. We also explored whether employment status modified stress-sleep associations.

METHODS

We conducted survey linear regressions to test the cross-sectional association of sociocultural stress severity and stress burden with sleep dimensions using data collected between 2010 and 2013 from individuals who participated in both the Hispanic Community Health Study/Study of Latinos Sueño and Sociocultural Ancillary studies (N = 1192).

RESULTS

Greater acculturation stress (B = 0.75, standard error [SE] = 0.26, p < .01) and chronic psychosocial stress burden (B = 1.04, SE = 0.18, p < .001) were associated with greater insomnia symptoms but were not associated with actigraphic measures of sleep. Ethnic discrimination was not associated with any of the sleep dimensions. The association of acculturation stress with insomnia severity was greater in unemployed (B = 2.06, SE = 0.34) compared to employed (B = 1.01, SE = 0.31) participants (p-interaction = .08).

CONCLUSIONS

Acculturation stress severity and chronic stress burden are important and consistent correlates of insomnia, but not actigraphically measured sleep dimensions. If replicated, future research should test whether interventions targeting the resolution of sociocultural stress improve sleep quality in Hispanics/Latinos.

Predictors of Adherence to Treatment in Behavioral Health Therapy for Latino Immigrants: The Importance of Trust

A complex array of barriers to care influence patients' adherence to behavioral healthcare services. Understanding barriers to care is critical to ensure sufficient dosage of treatment. This study assessed the influence of perceived barriers on Latino migrants' prospective adherence to treatment for co-occurring mental health and substance use disorders as part of a clinical trial. Eligible participants (18-70 years-old) were recruited from community-based settings and classified according to their intervention session attendance. Baseline assessments included socio-demographic factors, clinical characteristics (i.e., depression, anxiety, post-traumatic stress disorder, substance use), psychosocial and cultural factors (i.e., ethnic identity, health literacy, discrimination), and perceived attitudinal and structural barriers to care. Treatment involved 10-sessions of cognitive-behavioral therapy, psychoeducation, and mindfulness (Integrated Intervention for Dual problems and Early Action) and emphasized participant's engagement in treatment. We used multinomial logistic regression models to examine the association between barriers to care reported at baseline, sociodemographic characteristics, psychosocial and cultural factors, clinical factors, and treatment adherence. Mistrust in previous behavioral health treatment(s) was the reported barrier significantly associated with completion of the program after adjusting for clinical, psychosocial, and cultural factors, with those expressing mistrust in previous treatment(s) showing higher rates of completion compared to those who did not report this barrier. Evidence-based and culturally-tailored interventions provided by ethnically matched providers may overcome cultural mistrust and increase adherence to behavioral health care among Latino immigrants.

Heterogeneity of Latina/os' acculturative experiences in the National Latino and Asian American Study: a latent profile analysis

PURPOSE

This study characterized unobserved subgroups of acculturative experiences among a nationally representative sample of U.S.-residing Latina/os (n = 2541) from the National Latino and Asian American Study.

METHODS

Latent profile analysis was used to characterize the sample by acculturative experiences using nine-factor score indicators regarding discrimination, neighborhood context, family environment, acculturation (language use and preference), and enculturation (ethnic identity). Predictors of profile membership are also examined, including sociodemographics, Latina/o heritage (i.e., ethnic group), generational status, and two acculturative stress domains (legal and interpersonal).

RESULTS

Four Latina/o subgroups were identified based on acculturative experiences. Profiles were differentiated by family context, neighborhood context, and discrimination: (1) positive experiences (n = 1,743, 69%), (2) cohesive conflict (n = 424, 17%), (3) marginalized conflict (n = 237, 9%), and (4) marginalized (n = 137, 5%). Generational status, heritage, and marital status were the salient predictors of profile membership. Among the foreign-born sample (n = 1617), legal acculturative stress also predicted profile membership.

CONCLUSIONS

Latina/os have heterogeneous experiences living in the United States. Discrimination, family context, and neighborhood environment are more related to varying experiences as opposed to traditional measures of acculturation and enculturation. Future research should characterize Latina/o heterogeneity using these experiences rather than strictly by observed demographics, such as heritage or generational status.

Predictors of Participation in an eHealth, Family-Based Preventive Intervention for Hispanic Youth

The Familias Unidas intervention is an efficacious family-based preventive intervention for reducing substance use and other health risks among Hispanic youth. A current randomized controlled trial (RCT) is examining this intervention's efficacy when delivered via the Internet (eHealth). eHealth interventions can overcome logistical barriers to participation, yet there is limited information about the feasibility of these interventions, especially among ethnic minorities. This paper examines participation and predictors of participation in the eHealth Familias Unidas intervention in a sample of 113 Hispanic families whose adolescent had behavioral problems. Analyses examined multidimensional ways of characterizing participation, including the following: (1) total intervention participation, (2) initial engagement (participating in at least one of the first three intervention sessions), (3) completing the pre-recorded, eHealth parent group sessions, and (4) participating in the live, facilitator-led, eHealth family sessions. Participation in this eHealth intervention was comparable to, and in most cases higher than, previous, face-to-face Familias Unidas interventions. High levels of baseline family stress were associated with lower initial engagement and lower family session participation. Greater parental Hispanicism was associated with more participation in eHealth parent group sessions and across the total intervention. Higher levels of baseline effective parenting, in other words less intervention need, were significantly associated with lower levels of total intervention participation and lower levels of family session participation. Implications for preventive interventions delivered via Internet are discussed.

Acculturation stress and allostatic load among Mexican immigrant women

OBJECTIVES

this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US ( n =19) and Mexico ( n = 40).

METHOD

measures of stress included the Perceived Stress Scale (PSS) and the Hispanic Women's Social Stressor Scale (HWSSS). A composite measure of 8 indicators of AL (systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, total cholesterol, glycated hemoglobin (hemoglobin A1C), triglycerides and C-reactive protein) was calculated.

RESULTS

there were no significant group differences in AL between Mexican and Mexican immigrant women ( t = 1.55, p = .126). A principal component factor analysis was conducted on the 8 AL indicators; a 2-factor solution explained 57% of the variance. Group differences in the two AL factors were analyzed using MANOVA. BMI and waist-to-hip ratios were lower, but blood pressure and triglycerides were higher in the US group and were mediated by time in the US. Greater acculturation stress was significantly related to increased waist-to-hip ratio ( r = .57, p = .02).

FINAL REMARKS

findings suggest some measures of AL increased with time in the US, and acculturation stress may be a significant factor.

Immigration Stress among Recent Latino Immigrants: The Protective Role of Social Support and Religious Social Capital

Religious institutions can be a source of support for recent Latino immigrants struggling to adjust to a new culture. For undocumented immigrants, who are often marginalized from other formal institutions, they may symbolize a place of refuge and hope through supportive social networks that mitigate common challenges such as social isolation and other forms of immigration stress. This cross-sectional study examined the impact of religious social capital and social support on immigration stress among documented and undocumented recent Latino immigrants (N = 408). Religious social capital was associated with higher levels of social support, while social support was protective against immigration stress. Social support mediated associations between religious social capital and immigration stress, but only among undocumented immigrants. Findings suggest religious social capital may be a particularly useful resource for undocumented immigrants, aiding in the provision of social support and in decreasing levels of immigration stress. Future research directions and implications for culturally tailored service delivery are presented.

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response

Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent-adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.

High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems

Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.

Miles over mind: Transnational death and its association with psychological distress among undocumented Mexican immigrants

Objective: This study examined the association between transnational death and psychological distress among undocumented Mexican immigrants. The Minority Stress Model and a disenfranchised grief perspective were used as frameworks for this study.Method: Respondent driven sampling (RDS) was used to collect data from clinical interviews with 248 undocumented Mexican immigrants residing near the US-Mexico border.Results: After controlling for relevant covariates, experiencing transnational death was a significant predictor of clinically significant distress in this at-risk population.Conclusions: Our findings underscore the need to contextualize transnational death among undocumented immigrants from a perspective of disenfranchised grief that requires the development of contextually and culturally sensitive interventions aimed at addressing the high prevalence of transnational death and its associated distress in this marginalized population.

HIV Testing and Mistaken Beliefs about Immigration Laws

Evidence suggests that migrants may underutilize USA health care because of misconceptions about immigration-related consequences of health care use. This study aimed to explore whether common misconceptions about the immigration consequences of seeking health care, receiving an HIV test, and being diagnosed with HIV were associated with participant self-report of never having received an HIV test. The study sample comprised 297 adult, sexually active, documented and undocumented Spanish-speaking Latino migrants. Participants completed a cross-sectional survey via ACASI. In multiple logistic regression analyses controlling for sociodemographic variables and HIV stigma, misconceptions about laws emerged as a strong predictor of never having received an HIV test (p < .001). Associations between participants' endorsement of misconceptions and their HIV testing history suggest that incorrect perceptions of laws do deter some subgroups of USA Latino migrants from HIV testing. Identifying misconceptions about negative immigration consequences of engaging in important health behaviors should be a community health research priority.