Associations among familism, language preference, and education in Mexican-American mothers and their children

Qualitative assessment of uptake retention and evaluation of prevention materials for skin cancer among Hispanics

OBJECTIVE

Examine retention and evaluation of incorporating melanocortin-1 receptor genetic risk information materials in a skin cancer prevention intervention conducted in Hispanics living near Tampa, Florida and Ponce, Puerto Rico.

METHODS

Two researchers applied thematic content analysis to identify major themes of open-ended responses (n = 1689) from 489 participants.

RESULTS

Five major thematic categories emerged: 1) intervention comments; 2) tips and tricks; 3) cancer prevention; 4) general information; and 5) risk factors and genetics. Responses captured under intervention comments (e.g., information was clear, easy to understand) and tips and tricks for sun protection (e.g., using sunscreen, wearing protective clothing) were most frequent. Participants noted the importance of conducting skin exams professionally or at home. English-preferring Tampa residents stated their individual risk factors, especially race and/or ethnicity, more frequently than Ponce residents and Spanish-preferring Tampa residents. Ponce residents were more likely to comment on wanting to share intervention materials with family and friends.

CONCLUSION

Findings suggest Hispanic participants implemented sun safety activities.

Spanish Language Use Across Generations and Depressive Symptoms Among US Latinos

Acculturation markers, such as language use, have been associated with Latino depression. Language use may change between generations; however, few studies have collected intergenerational data to assess how language differences between generations impact depression. Using the Niños Lifestyle and Diabetes Study (2013-2014), we assessed how changes in Spanish language use across two generations of Mexican-origin participants in Sacramento, California, influenced offspring depressive symptoms (N = 603). High depressive symptoms were defined as CESD-10 scores ≥ 10. We used log-binomial and linear-binomial models to calculate prevalence ratios and differences, respectively, for depressive symptoms by language use, adjusting for identified confounders and within-family clustering. Decreased Spanish use and stable-equal English/Spanish use across generations protected against depressive symptoms, compared to stable-high Spanish use. Stable-low Spanish use was not associated with fewer depressive symptoms compared to stable-high Spanish use. Exposure to multiple languages cross-generationally may improve resource access and social networks that protect against depression.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters

BACKGROUND

Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention.

PURPOSE

Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes.

METHODS

Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group.

RESULTS

The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention.

CONCLUSION

Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02741037.

Exploring How the Home Environment Influences Eating and Physical Activity Habits of Low-Income, Latino Children of Predominantly Immigrant Families: A Qualitative Study

Latinos are the largest and fastest growing minority population group in the United States, and children in low-income Latino families are at elevated risk of becoming overweight or having obesity. A child’s home is an important social environment in which he/she develops and maintains dietary and physical activity (PA) habits that ultimately impact weight status. Previous research suggests the parents are central to creating a home environment that facilitates or hinders the development of children’s early healthy eating and PA habits. Therefore, the purpose of this study was to explore low-income Latino parents’ beliefs, parenting styles, and parenting practices related to their children’s eating and PA behaviors while at home. Methods: Qualitative study using focus group discussions (FGDs) with 33 low-income Latino parents of preschool children 2 to 5 years of age. FGDs were transcribed verbatim and analyzed using thematic analysis. Results: Data analyses revealed that most parents recognize the importance of healthy eating and PA for their children and themselves. However, daily life demands including conflicting schedules, long working hours, financial constraints, and neighborhood safety concerns, etc., impact parents’ ability to create a home environment supportive of these behaviors. Conclusions: This study provides information about how the home environment may influence low-income Latino preschool children’s eating and PA habits, which may be useful for health promotion and disease prevention efforts targeting low-income Latino families with young children, and for developing home-based and parenting interventions to prevent and control childhood obesity among this population group. Pediatric healthcare providers can play an important role in facilitating communication, providing education, and offering guidance to low-income Latino parents that support their children’s development of early healthy eating and PA habits, while taking into account daily life barriers faced by families. Moreover, pediatric healthcare providers also can play an important role in the integration and coordination of home-visitations to complement office-based visits and provide a continuum of care to low-income Latino families.

A Behavioral Process Model of Familism

Familismo, or familism, an important Latino cultural construct associated with youth adjustment, describes the importance of family regarding support, comfort, and services. Increased research on familism among Latino families in the past decade has called for a theoretical process model of familism that can guide research on familism, family processes, and youth development. In this article, we propose the behavioral process model of familism (BPMF), which identifies proximal mechanisms through which familism is expected to promote youth psychological adjustment. Specifically, we propose that parenting behaviors (e.g., monitoring, discipline strategies) are a mechanism by which parent familism relates to youth familism and psychological adjustment both directly and via their familism-consistent behaviors. We hypothesize direct and mediated pathways in the BPMF and consider how sociodemographic variables modify the described processes.

Strength Factors Among Women of Mexican Descent

Whereas few studies with Latina samples include strength factors (resilience, mastery, life satisfaction, and perceived energy level) as variables, even fewer include strength factors together with acculturation in the same study. As part of a larger study, the purpose of this analysis is to describe and examine the relationships between strength factors, risk factors such as acculturation and substance use, resource factors including financial adequacy and education, and the health and illness factor of perceived health status among a convenience sample of 315 lowincome women of Mexican descent, ages 21 to 40. Cross-sectional survey data were collected and analyzed. Results show intragroup differences related to the well-being of women of Mexican descent living with low incomes in urban settings.

Alcohol Use among Mexican Youths: Is Familismo Protective for Moderate Drinking?

The construct of familismo has been identified as a potential protective cultural value in Hispanic cultures. This paper considers familismo and alcohol use among young people in Mexico. We conducted a qualitative study using ethnographic open ended interviews with 117 first year students at a large free public university in Mexico City between April-May 2011. The findings indicate that dimensions of familismo can act as protective factors against misuse of alcohol among Mexican youths and may be protective for moderate drinking. Future research should explore the relationship of familismo to gender roles and other cultural values during adolescence. Given the enduring influence of Mexican cultural values among Mexican Americans the research has implications for prevention programs for both Mexican and Mexican American youths.

Immigrant family skills-building to prevent tobacco use in Latino youth: study protocol for a community-based participatory randomized controlled trial

Background

Despite declines over recent years, youth tobacco and other substance use rates remain high. Latino youth are at equal or increased risk for lifetime tobacco, alcohol, marijuana, and other illicit drug use compared with their white peers. Family plays an important and influential role in the lives of youth, and longitudinal research suggests that improving parenting skills may reduce youth substance use. However, few interventions are oriented towards immigrant Latino families, and none have been developed and evaluated using a community-based participatory research (CBPR) process that may increase the effectiveness and sustainability of such projects. Therefore, using CBPR principles, we developed a randomized clinical trial to assess the efficacy of a family-skills training intervention to prevent tobacco and other substance use intentions in Latino youth.

Methods/Design

In collaboration with seven Latino community-serving agencies, we will recruit and randomize 336 immigrant families, into intervention or delayed treatment conditions. The primary outcome is youth intention to smoke 6 months post intervention. The intervention consists of eight parent and four youth sessions targeting parenting skills and parent–youth relational factors associated with lower smoking and other substance use in youth.

Discussion

We present the study protocol for a family intervention using a CBPR randomized clinical trial to prevent smoking among Latino youth. The results of this trial will contribute to the limited information on effective and sustainable primary prevention programs for tobacco and other substance use directed at the growing US Latino communities.

Trial registration

ClinicalTrials.gov: NCT01442753

Psychosocial preventive interventions for obesity and eating disorders in youths

Abstract The rates of paediatric obesity have risen dramatically. Given the challenge of successful weight loss and maintenance, preventive interventions are sorely needed. Furthermore, since a substantial proportion of individuals do not respond to traditional behavioural weight loss therapy, alternative approaches are required. Psychological treatments for binge eating disorder have been generally effective at reducing binge episodes and producing weight maintenance or modest weight loss in obese adults. Given the strong link between loss of control eating and obesity in youths, binge eating disorder treatment may serve as a viable form of excess weight gain prevention. An adapted version of interpersonal psychotherapy for binge eating disorder is one such intervention that we have considered. A description of the theoretical basis and proposed mechanism is described. Adaptations of interpersonal psychotherapy and other established therapies for binge eating disorder may serve as platforms from which to develop and disseminate obesity and eating disorder prevention programs in children and adolescents.

The impact of familism on physical and mental health among Hispanics in the United States

The rapidly expanding number of Hispanics living in USA has increased the need for their inclusion in research on physical and mental health. Current studies that have explored health outcomes among Hispanics have often noted an 'epidemiological paradox', in which there is a discrepancy between their minority status and positive health outcomes when compared with other racial/ethnic groups. Certain socio-cultural variables, in particular the value placed on family, have been largely implicated in these findings. This review will provide a summary of the literature exploring familism within the structure of the Hispanic family and its potential impact on health. We will focus on research exploring the plausible impact that family and familism values may have on the physical health (particularly within the HIV, diabetes, and breast cancer literature) and also on health behaviours of Hispanics, as well as its effect on mental health (particularly related to acculturative stress and caregiver stress). Throughout the review, we highlight some of the potential mechanisms by which familism may impact on the health status of Hispanics. We conclude the review by noting some of the clinical and ethical implications of this research, and by offering suggestions for future work in this area.

Project Wings, a coping intervention for Latina adolescents: a pilot study

The authors examined the feasibility and preliminary outcomes of Project Wings Girls' Groups, a school-based mental health promotion program designed to improve well-being in Latina adolescents, as observed in outcomes, including perceived stress, depressive symptoms, coping, and connectedness. This pilot randomized controlled trial compared outcomes over 9 months postintervention for 42 9th and 10th grade adolescents attending two urban high schools. Girls were randomized to Project Wings Girls' Groups, a 16-session facilitated curriculum, including sharing circles, mind-body exercises, and coping skills building or the attention control (i.e., similar format but focused on general health topics). Feasibility of retention and long-term follow-up data collection was demonstrated, with lessons learned for future study. Although not statistically powered, this trial demonstrated findings in the expected direction, including reduced perceived stress and depression and increased connectedness. A trial with sufficient power is warranted to examine Project Wings' effects on mental health problems among Latina adolescents.

Acculturation Influences on AAPI Adolescent-Mother Interactions and Adolescents’ Sexual Initiation

The purpose of this secondary analysis of data is to examine relationships among Asian American Pacific Islanders (AAPI) adolescents’ level of acculturation, maternal influences, and age of sexual initiation. Selected predictive variables are based on the theoretical frameworks and literature review. The results indicate that for these adolescents speaking English at home was positively associated with maternal sexual discussion, mothers’ perceptions of connectedness with their adolescents, adolescents’ perceived maternal sexual expectations, and later sexual initiation at Wave 1. Adolescents’ years of U.S. residency are positively associated with adolescents’ level of perceived connectedness with their mothers and later sexual initiation at Wave 2. Adolescents’ level of acculturation influence how they interacted with their mothers, perceived their mothers’ sexual expectations, and when they decided to initiate sexual intercourse. Interventions to delay AAPI adolescents’ sexual debut should consider factors related to AAPI adolescents’ and their mothers’ levels of acculturation.

Intergenerational associations between a consensual childhood sexual experience and adult substance abuse among Latina mothers and daughters

Purpose:

Early onset of sexual activity has been linked to later substance abuse. Our study aimed to further describe the associations between Latina mothers’ and daughters’ early sexual activity and adult substance abuse.

Methods:

A survey was conducted with 92 Latina mother–daughter dyads whose members never experienced sexual abuse. Childhood sexual experience was defined as the occurrence of a consensual sexual encounter at the age of 15 years or younger. Substance abusers were identified by the extent of substance use during the 12 months prior to the interview. Path analysis was used to fit our conceptual models to the data.

Main findings:

Daughters’ current, adult substance abuse was associated independently with: their own childhood sexual experience (odds ratio [OR] = 6.0) and mothers’ current, adult substance abuse (OR = 2.0). Compared with daughters who first experienced sex after the age of 19, the odds of using substances were 17.7 times higher among daughters who had childhood sexual experience and 3.8 times higher among daughters who first experienced sex between the age of 16–19 years. Explicitly, sexual experiences between the ages of 16–19 years were also risk factors for later adult substance abuse. Mothers’ childhood sexual experience (OR = 7.3) was a strong predictor for daughters’ childhood sexual experience.

Conclusions:

Our study supported a link between mother and daughter childhood sexual experience among Latinas, and indicated it is a correlate of adult substance abuse. Family based substance abuse prevention efforts and future longitudinal studies should consider maternal childhood sexual experience as a potential indication of risk for Latina daughters.

Culturally Specific Youth Substance Abuse Resistance Skills: Applicability across the U.S.-Mexico Border

This study tests the applicability among adolescents in Mexico of the keepin' it REAL (refuse, explain, avoid, and leave) strategies that are common and effective ways that U.S. youth resist substance use. Following a social learning, communication competence and ecological theory integrated approach, the study draws on self-reported questionnaire data from a non-probability sample of 327 adolescents attending two public high schools in Monterrey, Nuevo León. Multivariate regressions were used to test whether the respondents' use of the REAL strategies by the participants could be predicted by key demographic variables. Separate models were estimated for the frequency of use of each strategy and for different substances. Findings indicate that most adolescents in this sample utilized each of the REAL strategies as well as other strategies to respond to offers of alcohol, cigarettes, or marijuana. Mexican and U.S. youth residing close to the US border appear to use similar drug resistance strategies. Use of the strategies varied considerably by the level of exposure to offers, but only minimally by gender and age. There were no notable differences by socioeconomic status or academic performance. Implications for prevention science, social work practice and social work research are discussed in the context of the bi-national border region and the applicability and prospect for dissemination of U.S. evidence based youth substance use prevention interventions.

The relationship between Spanish language use and substance use behaviors among Latino youth: a social network approach

PURPOSE

Greater acculturation is associated with higher rates of substance use among Latino adolescents, but the reasons are poorly understood. One potential explanation is that social networks change with acculturation, leading to decreased protection and increased risk. Our objective was to identify Spanish language-sensitive individual and social network attributes associated with substance use in Latino adolescents.

METHODS

Latino eighth-grade students in a Los Angeles public middle school completed a computerized, self-administered survey about tobacco, alcohol, drug use, and parental monitoring; and description of 30 social network members. Regression analyses were used to estimate the independent associations of network-level Spanish language use and other factors with a substance use behavior scale. Mediation analysis identified Spanish language-sensitive attributes.

RESULTS

Network-level Spanish language use was associated with a substance use scale in bivariate but not multivariate models. Protective Spanish language-sensitive attributes included greater numbers of extended family members in the network, less substance use among network members, and greater perceived parental monitoring. Risky Spanish language-insensitive attributes include more high school aged network members.

CONCLUSIONS

These results suggest that parental monitoring and some characteristics of social networks account for the relationship between Spanish language use and substance use among Latino adolescents. Clinic- or community-based interventions that enhance protective characteristics of social networks in Latino adolescents may be effective.

Cultural Values and Racial Identity Statuses Among Latino Students

The authors investigated the content and structure of cultural value orientations associated with how cultural groups view relationships, time, nature, and activity in a group of 107 Latino college and graduate students. The study employed the Visible Racial Ethnic/Identity Attitude Scale and Intercultural Values Inventory. A regression analysis revealed racial identity status attitudes predict value orientation preferences of human nature as evil, lineal and collateral social relationships, and a belief in harmony with nature. Five repeated measures multivariate analysis of variance revealed a mixed and good view of human nature, a sense of harmony with nature and a future preference. More complex preferences were found with respect to the activity and social relations orientations, reflecting a blending of Eurocentric and Latino cultural values.

Bicultural stress and adolescent risk behaviors in a community sample of Latinos and non-Latino European Americans

OBJECTIVES

The study examined the relation between adolescent risk behaviors and bicultural stress due to discrimination, immigration, and acculturation factors. We hypothesized bicultural stress would be related to increased risk behavior and depressive symptoms independent of socioeconomic status, ethnic self-identification, and acculturation.

DESIGN

Middle school student participants (n=519; median age 14) completed a self-report questionnaire on their risk behaviors, psychosocial antecedents, and socio-demographic factors. Latino (304) and non-Latino European American (215) students were surveyed through a large, urban, West Coast US school district.

RESULTS

More bicultural stress was significantly related to reports of all risk behaviors (i.e. smoking, drinking, drug use, and violence) and depressive symptoms. Further, bicultural stress was a robust explanatory variable across sub-groups, and appears largely independent from depressive symptoms.

CONCLUSION

The hypotheses were supported. Bicultural stress appears to be an important underlying factor for health disparities among US adolescents. Future research may consider promoting well-being in majority, as well as minority adolescents, through targeting sources of bicultural stressors or examining ways to moderate their effects on adolescent risk behaviors.

Social cohesion, social support, and health among Latinos in the United States

The role of individual versus community level social connections in promoting health is an important factor to consider when addressing Latino health. This analysis examines the relationships between social support, social cohesion, and health in a sample of Latinos in the United States. Using data from the National Latino and Asian American Study, the analysis uses ordered logistic regression to explore the relationships of family support, friend support, family cultural conflict, and neighborhood social cohesion with self-rated physical and mental health, taking into account language proficiency and use, nativity, and sociodemographic variables. Family support, friend support, and neighborhood social cohesion were positively related to self-rated physical and mental health, and family cultural conflict was negatively related when controlled only for sex and age. After controlling for education, income, and other demographic measures, only family support was found to have a weak association with self-rated physical health; however, the relationship seemed to be mediated by language. In contrast, family support and family cultural conflict were strongly associated with self-rated mental health, after controlling for language, education, income, and other demographic measures. The study did not find neighborhood social cohesion to be significantly related to either self-rated physical or mental health, after accounting for the effects of the other social connection variables. Language of interview did not explain the highly significant effects of language proficiency and use. Social connections are important for health and mental health, but language and other sociodemographic factors seem to be related to how Latinos establish these social linkages. Further investigation into the role of language in the development and maintenance of social connections may help unravel the mechanisms by which they promote or decrease health.

Ethnic identity and risky health behaviors in school-age Mexican-American children

The study examined the relationship between ethnic identity and risky health behaviors in 1,892 Mexican-American students (M age= 14.6, SD= 1.35; 50.3% male) in South Texas. The Ethnic Identity Scale assessed ethnic identity and questions from the Youth Risk Behavior Survey measured risky health behaviors (mixed use of alcohol and drugs, heavy drinking, driving under the influence, regular marijuana use, regular cigarette smoking, lack of regular exercise, not eating breakfast regularly, and carrying a gun or knife to school). Logistic regression tested the relationships between ethnic identity and report of risky health behaviors controlling for potential confounders (sex, free school lunch status, grade, and self-reported school grade). Adjusted odds ratio (AOR) and confidence intervals were calculated. Results indicated that being associated with Mexican-American cultural identity was significantly associated with a decreased mixed use of alcohol and drugs (AOR= .97), heavy drinking (AOR= .98), and regular marijuana use (AOR= .97). A stronger ethnic identity was protective against engaging in risky health behaviors among these Mexican-American adolescents.

Multi-level support for physical activity and healthy eating

AIM

This paper reports a study evaluating the relationship between social and community level supports and physical activity and dietary behaviours among a low-income Latino population with multiple chronic conditions.

BACKGROUND

With consistently lower physical activity than whites and documented nutritional deficiencies, Latinos in the United States of America represent a disproportionate share of the population with chronic illness. This pattern of health disparities is seen across countries, where there is a struggle to raise the health status of low-income, immigrant and aboriginal communities. Social-ecological theories of health behaviour stress the importance of considering social and community support for health behaviour, and represent a useful framework for considering ways to improve physical activity and nutrition for immigrant and aboriginal groups.

METHOD

We report here on data from a baseline assessment of 200 patients from a health clinic in the United States of America serving a low-income, primarily Latino population. Participants were enrolled in Resources for Health, a randomized controlled trial to promote multi-level support for chronic illness self-management. Measures included self-reported physical activity, dietary behaviour and multi-level support for chronic illness management as well as demographic data. Baseline data reported on here were collected between February 2002 and September 2003.

FINDINGS

Use of multi-level supports (e.g. family, individual and healthcare provider) was statistically significantly associated with meeting physical activity guidelines and better dietary behaviours. Being female and having multiple chronic conditions were also associated with better dietary behaviour. These variables explained 20% of the variance in dietary behaviour.

CONCLUSION

Results support a social-ecological approach for promoting healthy behaviour in this low-income, primarily Latino sample with multiple chronic conditions. Addressing multiple levels of support for healthy behaviour is important in interventions to improve physical activity and diet, and nurses may be particularly well placed to address such issues for low-income, aboriginal and immigrant patients with chronic conditions.

Workplace, household, and personal predictors of pesticide exposure for farmworkers

In this article we identify factors potentially associated with pesticide exposure among farmworkers, grade the evidence in the peer-reviewed literature for such associations, and propose a minimum set of measures necessary to understand farmworker risk for pesticide exposure. Data sources we reviewed included Medline, Science Citation Index, Social Science Citation Index, PsycINFO, and AGRICOLA databases. Data extraction was restricted to those articles that reported primary data collection and analysis published in 1990 or later. We read and summarized evidence for pesticide exposure associations. For data synthesis, articles were graded by type of evidence for association of risk factor with pesticide exposure as follows: 1 = association demonstrated in farmworkers; 2 = association demonstrated in nonfarmworker sample; 3 = plausible association proposed for farmworkers; or 4 = association plausible but not published for farmworkers. Of more than 80 studies we identified, only a third used environmental or biomarker evidence to document farmworker exposure to pesticides. Summaries of articles were compiled by level of evidence and presented in tabular form. A minimum list of data to be collected in farmworker pesticide studies was derived from these evidence tables. Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to test directly the association of behavioral and environmental factors with pesticide exposure in this population. Future studies should attempt to use similar behavioral, environmental, and psychosocial measures to build a body of evidence with which to better understand the risk factors for pesticide exposure among farmworkers.

Latino sibling knowledge and adjustment to chronic disability

Forty matched healthy Latino and non-Latino siblings (ages 8-14 years) of children with developmental and physical disabilities completed interviews and questionnaires assessing sibling knowledge of and adjustment to disability and sibling global psychological functioning. One-way analyses of variance revealed Latino siblings to have significantly less accurate information about the disability and more internalizing problems than non-Latino siblings. Sibling and parent wishes for the healthy sibling reflected cultural values. The results indicate that Latino siblings of children with chronic disabilities may be at risk for internalizing psychological problems. Future research regarding cultural factors affecting sibling adaptation to childhood disability is encouraged.