Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population

Internet use for health information, health service utilization, and quality of care in the U.S

BACKGROUND

Increased internet use for health information in the United States enhances interactions with healthcare professionals, but its effects on healthcare utilization and care quality are still being investigated. We explored the association between internet use for health information, patient-centered communication (PCC), and sociodemographic factors on the likelihood of visiting a health care provider and quality of care. We also examined if PCC mediates this association.

METHODS

We conducted a secondary data analysis using the National Cancer Center Institutes (NCI) Health Information National Trends Survey (HINTS) 2018-2020. Multinomial logistic regression and path analyses assessed variable interrelationships and mediating effects.

RESULTS

Individuals using the internet for health information for themselves were 2.40 times more likely (P <.001) to have frequent provider visits and 1.18 times more likely (P <.022) to rate their care as very good/good compared to excellent, compared to those who did not use the internet for health information for themselves. In contrast, individuals using the internet for discussion with their providers were 2.05 times more likely (P <.001) to have increased visits, and they were 40% less likely (P <.001) to rate their care as fair/poor compared to excellent, relative to those who did not use the internet for discussions. Path analysis indicated that individuals using the internet for health information for themselves may negatively impact PCC, resulting in lower quality ratings, while those who use the internet for discussions with healthcare providers had a positive effect on PCC, leading to higher care ratings.

CONCLUSION

This study enhances our understanding of how PCC and internet use for health information impact US healthcare. Using the internet for provider discussions positively impacts perceived care quality, highlighting PCC's vital role.

Epidemiology and clinical outcomes of hospitalized Hispanic patients with IBD: results of a large national cohort study

INTRODUCTION

Inflammatory bowel disease (IBD) has historically been seen as predominantly affecting non-Hispanic Whites (NHW). Hispanics are the largest minority group in the USA, yet they remain grossly underrepresented in studies of IBD. With this study, we aimed to better understand the epidemiology of hospitalized Hispanic patients with IBD in the US.

METHODS

This was a retrospective cohort study utilizing the National Inpatient Sample, the largest publicly available all-payer inpatient care database in the United States. We compared demographics, hospitalization characteristics, clinical outcomes, and year-to-year trends from 2016 to 2020 in Hispanic and NHW with a primary diagnosis of inflammatory bowel disease, Crohn's disease, or ulcerative colitis.

RESULTS

NHWs hospitalized with a primary diagnosis of IBD had significantly higher rates of hospitalization than Hispanics (122.67 vs 71.12, P < 0.01). While hospitalized Hispanics with IBD are more likely to be in the lowest quartile for household income (31.6% vs 19.3%, P < 0.01), have a younger median age (37.0 vs 45.0, P < 0.01), and be uninsured (4.3% vs 8.8%, P < 0.01) compared to NHW. Length of admission was similar, yet NHWs had higher rates of mortality (0.3% vs 0.2%, P = 0.01), while total charges for hospitalizations were significantly higher for Hispanic patients (P < 0.01).

DISCUSSION

To our knowledge, this is one of the largest US-based studies of Hispanics with IBD. Our findings suggest that among hospitalized IBD patients, Hispanics are more likely to be younger, uninsured, have a lower household income, and are less likely to undergo surgery while having higher hospital charges.

A Public Health Ethics Framework for Populations with Limited English Proficiency

25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.

Identification of Priorities for Colorectal Cancer Screening Interventions Among US Hispanic/Latino Populations

Objectives. To identify nationwide census tract‒level areas where improving colorectal cancer (CRC) screening uptake via targeted local preventive intervention may benefit Hispanic or Latino/a (H/L) groups defined by region or country of origin. Methods. Using 2021 Centers for Disease Control and Prevention PLACES and American Community Survey data, we applied geographically weighted regression and Getis-Ord Gi* hot spot procedures to identify CRC screening priority zones for H/L groups in the United States. Priority zones can be conceptualized as census tracts with strong inverse associations between percentage of a particular H/L group in the population and CRC screening rate, after adjusting for socioeconomic deprivation and lack of insurance. Results. We identified 6519, 3477, 3522, 1069, and 1424 census tract CRC screening priority zones for H/L communities of Mexican, Puerto Rican, Central/South American, Dominican, and Cuban heritage, respectively. Priority zones for H/L groups had strong spatial heterogeneity, and overlap of geographic patterns among H/L groups varied by region. Conclusions. Our findings and interactive web map may serve as a translational tool for public health authorities, policymakers, clinicians, and other stakeholders to target investment and interventions to increase guideline-concordant CRC screening uptake benefitting specific H/L communities in the United States. (Am J Public Health. 2024;114(S6):S515-S524. https://doi.org/10.2105/AJPH.2024.307733) [Formula: see text].

Talents, Tears, Stories of Our Identities, and Community Building: Toward Community-Based Ecosystems of Latiné Health Driven by Promotores

This essay describes a process for integrating US Latiné communities as drivers of a grassroots vision for healthy Latiné communities and health equity planning that addresses racial injustices. Transforming structural conditions to promote Latiné community health happens alongside creating conditions for community-level self-determination to foster community-based ecosystems of health. Integrating a life course perspective, we describe a vision for community-based ecosystems of Latiné health that is rooted in forging connections and cultivating community; building community power to address structural drivers of health; leveraging the expertise and assets of promotores to reach, engage, and mobilize communities; scaling solutions through policy, system, and environment changes; and grounding research processes in community-driven priorities. Such processes must affirm the expertise of promotores and Latiné communities and recognize the interconnectedness of communities and systems (e.g., food, housing, living wages) to nurture health at local levels. Research can advance the science and evidence-based models that support community-based ecosystems of Latiné health. (Am J Public Health. 2024;114(S6):S525-S533. https://doi.org/10.2105/AJPH.2024.307763) [Formula: see text].

Caring for Individuals with Alzheimer's Disease: A Spotlight on Hispanic Caregivers

 A caregiver is a constantly evolving role that an individual most likely undertakes at some point in their lifetime. With discoveries and research in increasing life expectancy, the prevalence of neurological-related diseases, such as Alzheimer's disease (AD) and dementia, is certainly likely to require more caregivers. The demand for AD caregivers is escalating as the prevalence of the disease continues to rise. The projected rise in AD within the Hispanic population in the United States over the next few decades is expected to be the most significant among all ethnic groups. The Hispanic population faces unique dementia risks due to cultural factors like language barriers, lower education, and limited healthcare access. Higher rates of conditions such as diabetes and cardiovascular disease further elevate dementia risk. Family dynamics and caregiving responsibilities also differ, affecting dementia management within Hispanic households. Addressing these distinct challenges requires culturally sensitive approaches to diagnosis, treatment, and support for Hispanic individuals and their family's facing dementia. With AD and other dementia becoming more prevalent, this article will attempt to expand upon the status of caregivers concerning their economic, health, and cultural statuses. We will attempt to focus on the Hispanic caregivers that live in Texas and more specifically, West Texas due to the lack of current literature that applies to this area of Texas. Lastly, we discuss the ramifications of a multitude of factors that affect caregivers in Texas and attempt to provide tools that can be readily available for Hispanics and others alike.

Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States

PURPOSE

Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals.

METHODS

Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC.

RESULTS

Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001).

CONCLUSION

Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.

County-level variation in healthcare coverage and ischemic heart disease mortality

BACKGROUND

Healthcare coverage has been shown to have implications in the prevalence of coronary artery disease. We explore the impact of lack of healthcare coverage on ischemic heart disease (IHD) mortality in the US.

METHODS

We obtained county-level IHD mortality and healthcare coverage data from the CDC databases for a total of 3,119 US counties. The age-adjusted prevalence of current lack of health insurance among individuals aged 18 to 64 years were obtained for the years 2018 and 2019 and were placed into four quartiles. First (Q1) and fourth quartile (Q4) had the least and highest age-adjusted prevalence of adults without health insurance, respectively. IHD mortality rates, adjusted for age through the direct method, were obtained for the same years and compared among quartiles. Ordinary least squares (OLS) regression for each demographic variable was conducted with the quartiles as an ordinal predictor variable and the age-adjusted mortality rate as the outcome variable.

RESULTS

We identified a total of 172,942 deaths related to ischemic heart disease between 2018 and 2019. Overall AAMR was higher in Q4 (92.79 [95% CI, 92.35-93.23]) compared to Q1 (83.14 [95% CI, 82.74-83.54]), accounting for 9.65 excess deaths per 100,000 person-years (slope = 3.47, p = 0.09). Mortality rates in Q4 for males (126.20 [95% CI, 125.42-126.98] and females (65.57 [95% CI, 65.08-66.05]) were higher compared to Q1 (115.72 [95% CI, 114.99-116.44] and 57.48 [95% CI, 57.04-57.91], respectively), accounting for 10.48 and 8.09 excess deaths per 100,000 person-years for males and females, respectively. Similar trends were seen among Hispanic and non-Hispanic populations. Northeastern, Southern, and Western regions had higher AAMR within Q4 compared to Q1, with higher prevalence of current lack of health insurance accounting for 49.2, 8.15, and 29.04 excess deaths per 100,000 person-years, respectively.

CONCLUSION

A higher prevalence of adults without healthcare coverage may be associated with increased IHD mortality rates. Our results serve as a hypothesis-generating platform for future research in this area.

Critical analyses of Latina mortality: disentangling the heterogeneity of ethnic origin, place, nativity, race, and socioeconomic status

Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.

Vestibular Vertigo and Disparities in Healthcare Access Among Adults in the United States

OBJECTIVE

Vertigo and dizziness have a high lifetime prevalence with significant impacts on daily life. We sought to explore differences in access to and ability to afford care among adults with vestibular vertigo by race/ethnicity, income, and insurance type.

DESIGN

This is a cross-sectional study using the 2016 National Health Interview Survey. A total of 32,047 adults who completed the 2016 National Health Interview Survey Balance Supplement were analyzed. We used a previously validated definition of vertigo defined as (1) positional vertigo, (2) rotational vertigo, or (3) recurrent dizziness with nausea and either oscillopsia or imbalance. We examined several self-reported measures of healthcare utilization and access.

RESULTS

Among adults with vestibular vertigo, African Americans had significantly increased odds of delayed care due to lack of transportation; Hispanic ethnicity was associated with decreased odds of skipping medication doses and asking a doctor for a lower-cost medication. Adults with public insurance had significantly lower odds of reporting delayed care due to worry about cost, not receiving medical care due to cost, and delayed filling of a prescription, but had greater odds of reporting delayed care due to lack of transportation. Lack of insurance and lower income were associated with increased odds of delaying and not receiving care due to cost.

CONCLUSION

These findings demonstrate significant differences in access to care among adults with vestibular vertigo in the United States based on race, income, and health insurance status.

Understanding the role of access in Hispanic cancer screening disparities

BACKGROUND

Hispanic populations in the United States experience numerous barriers to care access. It is unclear how cancer screening disparities between Hispanic and non-Hispanic White individuals are explained by access to care, including having a usual source of care and health insurance coverage.

METHODS

A secondary analysis of the 2019 National Health Interview Survey was conducted and included respondents who were sex- and age-eligible for cervical (n = 8316), breast (n = 6025), or colorectal cancer screening (n = 11,313). The proportion of ever screened and up to date for each screening type was compared.  Regression models evaluated whether controlling for reporting a usual source of care and type of health insurance (public, private, none) attenuated disparities between Hispanics and non-Hispanic White individuals.

RESULTS

Hispanic individuals were less likely than non-Hispanic White individuals to be up to date with cervical cancer screening (71.6% vs. 74.6%) and colorectal cancer screening (52.9% vs. 70.3%), but up-to-date screening was similar for breast cancer (78.8% vs. 76.3%). Hispanic individuals (vs. non-Hispanic White) were less likely to have a usual source of care (77.9% vs. 86.0%) and more likely to be uninsured (23.6% vs. 7.1%). In regressions, insurance fully attenuated cervical cancer disparities. Controlling for both usual source of care and insurance type explained approximately half of the colorectal cancer screening disparities (adjusted risk difference: -8.3 [-11.2 to -4.8]).

CONCLUSION

Addressing the high rate of uninsurance among Hispanic individuals could mitigate cancer screening disparities. Future research should build on the relative successes of breast cancer screening and investigate additional barriers for colorectal cancer screening.

PLAIN LANGUAGE SUMMARY

This study uses data from a national survey to compare cancer screening use those who identify as Hispanic with those who identify as non-Hispanic White. Those who identify as Hispanic are much less likely to be up to date with colorectal cancer screening than those who identify as non-Hispanic White, slightly less likely to be up to date on cervical cancer screening, and similarly likely to receive breast cancer screening. Improving insurance coverage is important for health equity, as is further exploring what drives higher use of breast cancer screening and lower use of colorectal cancer screening.

Caregivers with Cancer Patients: Focus on Hispanics

Cancer is a public health concern and causes more than 8 million deaths annually. Cancer triggers include population growth, aging, and variations in the prevalence and distribution of the critical risk factors for cancer. Multiple hallmarks are involved in cancer, including cell proliferation, evading growth suppressors, activating invasion and metastasis, resisting cell death, enabling replicative immortality, reprogramming energy metabolism, and evading immune destruction. Both cancer and dementia are age-related and potentially lethal, impacting survival. With increasing aging populations, cancer and dementia cause a burden on patients, family members, the health care system, and informal/formal caregivers. In the current article, we highlight cancer prevalence with a focus on different ethnic groups, ages, and genders. Our article covers risk factors and genetic causes associated with cancer and types of cancers and comorbidities. We extensively cover the impact of cancer in Hispanics in comparison to that in other ethnic groups. We also discuss the status of caregivers with cancer patients and urgent needs from the state and federal support for caregivers.

Healthcare utilization among pre-frail and frail Puerto Ricans

Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model

Purpose

We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population.

Patients and Methods

This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic.

Results

Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation.

Conclusion

The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.

Unequal outcomes: The effects of the COVID-19 pandemic on mental health and wellbeing among Hispanic/Latinos with varying degrees of 'Belonging'

BACKGROUND

The COVID-19 pandemic has brought disparities in mental and physical health faced by ethnic minorities to the forefront. In the U.S., Hispanic/Latino communities are plagued by elevated rates of psychiatric conditions and trauma. Exacerbating this burden, common discourse often implicates Hispanic/Latino ethnicity as a causal factor, despite clear evidence of systemic causes, including lack of access to resources, and discrimination.

AIMS

To parse apart Hispanic/Latino ethnicity from determinants of wellbeing (such as trauma, financial status, and loneliness), we examined mental and physical health during COVID-19 via an online, anonymous survey available in both English and Spanish.

METHODS

We examined wellbeing across three participant groups, including two groups of Hispanic/Latino adults with varying degrees of 'belonging' to the dominant culture in their country of residence: Hispanic/Latino individuals living in Spanish-speaking and/or Central or Latin American countries (Group 1), Hispanic/Latino individuals living in the U.S. (Group 2), and non-Hispanic/Latino individuals living in the U.S. (Group 3).

RESULTS

Results demonstrated there were significant differences between groups in specific aspects of wellbeing. Most importantly, results showed Hispanic/Latino ethnicity does not significantly predict psychosocial wellbeing or psychosis risk, and identified several predictors of these outcomes, including U.S. residence, trauma, loneliness, and age.

CONCLUSION

Our results demonstrate that Hispanic/Latino ethnicity itself is not a causal factor of poor psychosocial wellbeing or elevated psychosis risk and instead identify several social and systemic causal factors commonly faced by Hispanic/Latino Americans. We suggest that language reporting on minority mental health acknowledge systemic factors as contributing to poor outcome rather than referring to ethnicity as if it were a causal factor.

Disparities in Primary Breast Cancer Stage at Presentation Among Hispanic Subgroups

BACKGROUND

Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups.

METHODS

Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status.

RESULTS

Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease.

CONCLUSION

Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.

Geriatric conditions and healthcare utilisation in older adults living with HIV

BACKGROUND

older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population.

SETTING

outpatient safety-net HIV clinic in San Francisco.

METHODS

in 2013, HIV-positive adults ≥50 years of age underwent geriatric assessment including functional impairment, fall(s)in past year, cognitive impairment (MOCA <26) and low social support (Lubben social network scale ≤12). We reviewed medical records from 2013 through 2017 to capture healthcare utilisation (emergency room (ER) visits and hospitalisations) and used Poisson models to examine the association between geriatric conditions and utilisation events over 4 years.

RESULTS

among 192 participants, 81% were male, 51% were white, the median age was 56 (range 50-74), and the median CD4 count was 508 (IQR 338-688) cells/mm3. Sixteen percent of participants had ≥1 activities of daily living (ADL) dependency, 58% had ≥1 instrumental activities of daily living IADL dependency, 43% reported ≥1 falls, 31% had cognitive impairment, and 58% had low social support. Over 4 years, 90 participants (46%) had ≥1 ER visit (total of 289 ER visits), 39 (20%) had ≥1 hospitalisation (total of 68 hospitalisations), and 15 (8%) died. In unadjusted and adjusted analyses, IADL dependency and falls were associated with healthcare utilisation (adjusted incidence rate ratios IADL (95%CI): 1.73 (1.33-2.25); falls: 1.51 (1.21-1.87)).

CONCLUSION

IADL dependency and history of falls were associated with healthcare utilisation among older HIV-positive adults. Although our results are limited by sample size, improved understanding of the association between geriatric conditions and healthcare utilisation could build support for geriatric HIV care models.

Facilitating Engagement on Family-Centered Rounds for Families With Limited Comfort With English

OBJECTIVE

Conducting family-centered rounds (FCR) for families with limited comfort with English (LCE) presents communication challenges. The objective of this study was to characterize the preferences of Spanish-speaking parents with LCE around interpretation and communication with the medical team during FCR to promote family engagement during rounds.

METHODS

This qualitative study was conducted at a tertiary care children's hospital in New York, New York. Eighteen Spanish-speaking parents of patients admitted to the hospital medicine service participated. Bilingual investigators conducted semistructured interviews over a secure virtual platform. Interview transcriptions were coded and analyzed by using a grounded theory approach and constant comparative method. Parents were recruited until thematic saturation was achieved.

RESULTS

Most participants were mothers (72%) from the Dominican Republic (61%). Responses from participants yielded a conceptual model depicting parents' perspectives on family engagement and bidirectional communication during FCR. Three major themes emerged: (1) importance of interpreter use, (2) understanding of medical information, and (3) participation in FCR. Within each theme, factors that facilitate or impede engagement in FCR were identified. Interpreters facilitated information sharing and parent understanding of medical care, increasing parent appreciation of FCR. Lack of language-concordant care and parents' perceived responsibility for the language barrier limited engagement.

CONCLUSIONS

Families with LCE value involvement during FCR, but face difficulties due to language barriers. Providers can support these families by empowering families' participation and by consistently using an interpreter. Understanding the preferences of families with LCE for participation in FCR will help providers deliver more equitable family-centered care.

Hispanic/Latinx ethnic subgroup differences in sociodemographic, sociocultural, and smoking characteristics in a cessation trial: An exploratory study

INTRODUCTION

Hispanic/Latinx smokers in the United States are often treated as a homogeneous group. However, population-based studies suggest cigarette use differs among Hispanic/Latinx subgroups by sociodemographic or sociocultural characteristics. This secondary analysis aimed to advance the limited literature by examining differences in smoking-related variables.

METHODS

We used baseline data from a randomized controlled trial testing a self-help Spanish-language smoking cessation intervention. Puerto Rican (PR), Mexican, and Cuban, the three largest Hispanic/Latinx subgroups in the sample (N=1028), were first compared on sociodemographic and sociocultural variables (acculturation and familism). Primary analyses assessed subgroup differences in cigarette use variables [e.g., cigarettes per day (CPD), nicotine dependence (Fagerström Test for Nicotine Dependence), daily smoking] and smoking-related cognitive constructs (motivation to quit, smoking outcome expectancies and abstinence self-efficacy) controlling for sociodemographic and sociocultural variables. Additional analyses explored differences between men and women within subgroups.

RESULTS

Mexicans exhibited the lowest levels of daily smoking (90% vs. 95% Cubans and 96% PR; p=.001), CPD (M=13.5, SD=9.5 vs. M=20.1, SD=9.9 Cubans and M=16.7, SD=10.1 PR; p=.016), and nicotine dependence (M=4.2, SD=2.3 vs. M=6.0, SD=2.1 Cubans and M=5.7, SD=2.2 PR; p< .001), with no differences between PRs and Cubans. Within-subgroup comparisons between men and women showed the most differences among PRs [e.g., men were more nicotine dependent (M=6.0, SD=1.9) than women (M=5.4, SD=2.3; p=.041)] and Cubans [e.g., men smoked more CPD (M=22.2, SD=12.2) than women (M=19.3, SD=12.0; p=.042)], and the fewest among Mexicans.

CONCLUSIONS

Findings support heterogeneity within Hispanic/Latinx smokers and highlight the potential utility of examining sociodemographic, sociocultural, and smoking characteristics important for developing salient cessation interventions.

IMPLICATIONS

Findings demonstrate that treatment-seeking Hispanic/Latinx smokers in the US differ in sociodemographic, sociocultural, and smoking-related variables (cigarette use and smoking-related cognitive constructs) by subgroup (i.e., Puerto Rican, Mexican, Cuban) and within subgroups by sex. These differences suggest that heterogeneity among subgroups should be considered when developing cessation interventions for Hispanics/Latinxs. Future research should examine how differences in sociodemographic and smoking-related variables impact intervention outcomes and explore the role of sociocultural factors (e.g., acculturation and familism) as determinants of cessation.

Reducing healthcare disparities using multiple multiethnic data distributions with fine-tuning of transfer learning

Healthcare disparities in multiethnic medical data is a major challenge; the main reason lies in the unequal data distribution of ethnic groups among data cohorts. Biomedical data collected from different cancer genome research projects may consist of mainly one ethnic group, such as people with European ancestry. In contrast, the data distribution of other ethnic races such as African, Asian, Hispanic, and Native Americans can be less visible than the counterpart. Data inequality in the biomedical field is an important research problem, resulting in the diverse performance of machine learning models while creating healthcare disparities. Previous researches have reduced the healthcare disparities only using limited data distributions. In our study, we work on fine-tuning of deep learning and transfer learning models with different multiethnic data distributions for the prognosis of 33 cancer types. In previous studies, to reduce the healthcare disparities, only a single ethnic cohort was used as the target domain with one major source domain. In contrast, we focused on multiple ethnic cohorts as the target domain in transfer learning using the TCGA and MMRF CoMMpass study datasets. After performance comparison for experiments with new data distributions, our proposed model shows promising performance for transfer learning schemes compared to the baseline approach for old and new data distributation experiments.

Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida

HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.

Racial/ethnic disparities in emergency department wait times in the United States, 2013-2017

BACKGROUND

Previous research shows that Black and Hispanic patients have longer ED wait times than White patients, but these data do not reflect recent changes such as the Affordable Care Act. In addition, previous research does not account for the non-normal distribution of wait times, wherein a sizable subgroup of patients seen promptly and those not seen promptly experience long wait times.

METHODS

We utilized National Hospital Ambulatory Medical Care Survey (NHAMCS) datasets (2013-2017) to examine mean ED wait time comparing visits by Black, Hispanic, and Asian patients to White patients. Using a two-part regression model, we adjusted for patient, hospital, and health system factors, and estimated differences, for each of five triage levels, in (a) likelihood of waiting at least 5 min and (b) difference in wait time among those not seen promptly.

RESULTS

Our cohort included 38,800 White, 14,838 Black, 10,619 Hispanic, and 1257 Asian patient visits. Black (triage level 3) and Hispanic (triage levels 3 and 4) patients had longer mean wait times than White patients. Adjusted likelihood of not being seen promptly was lower among Blacks (triage levels 3, 4 and 5), Hispanics (triage level 5) and Asians (triage level 5) compared to Whites. Among those waiting at least 5 min, adjusted wait time was longer among Blacks in triage level 3 (5.2 min, 95% CI, 1.3 to 9.0) and level 4 (2.5 min, 95% CI, 0.2 to 4.9), Hispanics in triage level 4 (4.7 min, 95% CI, 1.7 to 7.7) and Asians in triage level 5 (16.3 min, 95% CI, 0.6 to 31.9) compared to Whites.

CONCLUSIONS

Minority patients were less likely to wait to be seen, but waited longer if not seen promptly. These data exhibit that ED wait time disparities persist for African American and Hispanic patients and extend this observation to Asian patients.

Decídetexto: Feasibility and Acceptability of a Mobile Smoking Cessation Intervention in Puerto Rico

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch >75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p < 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.

Regional variation in COVID-19 disparities: connections with immigrant and Latinx communities in U.S. counties

PURPOSE

To evaluate associations between counties' COVID-19 cases and racial-ethnic and nativity composition, considering heterogeneity across Latin American-origin subgroups and regions of the United States.

METHODS

Using county-level data and multilevel negative binomial models, we evaluate associations between COVID-19 cases and percentages of residents that are foreign-born, Latinx, Black, or Asian, presenting estimates for all counties combined and stratifying across regions. Given varying risk factors among Latinx, we also evaluate associations for percentages of residents from specific Latin American-origin groups.

RESULTS

Percentage of foreign-born residents is positively associated with COVID-19 case rate (IRR = 1.106; 95% CI: 1.074-1.139). Adjusted associations for percentage Latinx are nonsignificant for all counties combined, but this obscures heterogeneity. Counties with more Central Americans have higher case rates (IRR = 1.130; 95% CI: 1.067-1.197). And, in the Northeast and Midwest, counties with more Puerto Ricans have higher case rates. Associations with percentage Asians are nonsignificant after adjusting for percentage foreign-born. With the confirmation of prior evidence, the percentage of Black residents is positively and robustly associated with COVID-19 case rate (IRR = 1.031; 95% CI: 1.025-1.036).

CONCLUSIONS

Counties with more immigrants, as well as more Central American or Black residents, have more COVID-19 cases. In the Northeast and Midwest, counties with more Puerto Rican residents also have more COVID-19 cases.

Differing interpretations of health care encounters: A qualitative study of non-Latinx health care providers' perceptions of Latinx patient behaviors

INTRODUCTION

Due to provider shortages, it is probable that non-Latinx health care providers (HCPs) will treat Latinx patients. Because of this discrepancy, both providers and patients are likely to experience barriers and cultural differences during medical encounters. This article discusses select cultural factors and behaviors such as language, communication styles, and health care practices of Latinx families through the lens of their non-Latinx HCPs. The purpose of this study was to examine how non-Latinx HCPs perceive and describe certain behaviors they observe during healthcare visits with Latinx patients and families, and to illustrate how those behaviors can alternatively be interpreted as representing Latinx cultural norms.

METHODS

This qualitative study used a template coding approach to examine narrative interviews conducted with 18 non-Latinx HCPs to report how they described interactions with and the behaviors of their Latinx patients. Template codes were based on well-established Latinx cultural norms (e.g., familismo, respeto, personalismo, simpatía, confianza).

RESULTS

Many HCP descriptions of Latinx patient behaviors were coded into the Latinx cultural values categories (familismo, personalismo, simpatía, respeto, and confianza) by the research team. Results suggest that HCPs were not aware of how several of their patients' behaviors may be culturally grounded, and that cultural differences between HCPs and their Latinx patients may exist.

DISCUSSION

Understanding how Latinx-specific cultural norms may be exhibited by Latinx patients and their families during healthcare encounters has potential to improve providers' understanding of patient behavior, helping to promote culturally congruent care for Latinxs.

Cultural Considerations for Psychologists in Primary Care

Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients' health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers' cultural sensitivity, patient-provider cultural congruency, and patients' health literacy) can be applied in primary care using the Five A's Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.

Immigration, Deportation, and Discrimination: Hispanic Political Opinion Since the Election of Donald Trump

Both the campaign and subsequent election of Donald Trump have brought about marked changes in the overall tone of American political discourse. It is thought that these changes have been particularly disruptive to the public’s view of Hispanic immigration. To evaluate the current state of Hispanic political opinion regarding immigration, this study draws upon data from a survey conducted in January 2018 of 1,080 people of Hispanic descent currently living in the United States or Puerto Rico. Researchers looked at the impact of age, gender, language preference, time lived in the United States, and knowing an undocumented immigrant on participants’ views of immigration. Taking the survey in Spanish and knowing an undocumented immigrant were found to be the most influential factors in determining a favorable view of undocumented immigrants as well as a perceived increase in discrimination toward Hispanics since Trump’s election.

Understanding Complex Roles of Family for Latina Health: Evaluating Family Obligation Stress

We developed a measure of family obligation stress and compared its relationship to health and unmet health care needs relative to social support among a sample of US-based Latinas. Data come from a randomized controlled trial within 4 clinics to increase mammography among Latinas (n = 539). The 1-factor measure had acceptable reliability and construct validity. Family obligation stress was associated with worse health and greater unmet health care needs. Family obligation stress varied by years in the United States and country of origin. Our measure of family obligation stress contributes new venues to family research among Latino populations.

Perceptions of Cancer Risk/Efficacy and Cancer-Related Risk Behaviors: Results From the HCHS/SOL Sociocultural Ancillary Study

This study evaluated the associations among perceived risk, perceived efficacy, and engagement in six cancer-related risk behaviors in a population-based Hispanic/Latino sample. Interviews were conducted with 5,313 Hispanic/Latino adults as part of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Participants were recruited from the study's four field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) between February 2010 and June 2011. Perceived risk and perceived efficacy were assessed with questions drawn from the Health Interview National Trends Survey. More than half of the sample endorsed perceived risk of cancer associated with the six evaluated behaviors, as well as general perceived efficacy for preventing cancer. Adjusted logistic regression analyses demonstrated significant differences across Hispanic/Latino background groups for perceived risk associated with high consumption of alcohol and saturated fat, low consumption of fruits and vegetables, and insufficient exercise but not with smoking or low consumption of fiber. Differences were also found for the belief, "It seems like everything causes cancer" but not for other perceived efficacy items. Perceived cancer risk and perceived efficacy for preventing cancer were neither independently nor interactively associated with engagement in cancer-related risk behaviors after controlling for sociodemographic covariates. Results suggest that perceptions of risk and efficacy with regard to cancer vary across Hispanic/Latino background groups, and therefore background group differences should be considered in prevention efforts. Perceived risk and perceived efficacy were not related to cancer-related risk behaviors among Hispanics/Latinos. Further work is needed to evaluate determinants of cancer-related risk in this population.

Temporal trends and characteristics of clinical trials for which only one racial or ethnic group is eligible

BACKGROUND

Increasing diversity in clinical trials may be worthwhile. We examined clinical trials that restricted eligibility to a single race or ethnicity.

METHODS

We reviewed 19,246 trials registered on ClinicalTrials.gov through January 2013. We mapped trial ZIP-codes to U.S. Census and American Community Survey data. The outcome was whether trials required participants to be from a single racial or ethnic group.

RESULTS

In adjusted analyses, the odds of trials restricting eligibility to a single race/ethnicity increased by 4% per year (95% CI 1.01-1.08, p = .024). Behavioral (5.79% with single race/ethnicity requirements), skin-related (4.49%), and Vitamin D (6.14%) studies had higher rates of single race/ethnicity requirements. Many other trial-specific characteristics, such as funding agency and region of the U.S. in which the trial opened, were associated with eligibility restrictions. In terms of neighborhood characteristics, studies with single race eligibility requirements were more likely to be located in ZIP-codes with greater percentages of those self-reporting the characteristic. For example, 35.2% (SD = 24.9%) of the population self-reported themselves as Black or African American in ZIP-codes with trials requiring participants to be Black/African American, but only 5.9% (SD = 6.9%) self-reported themselves as Black/African American in ZIP-codes with trials that required Asian ethnicity. In ZIP-codes with trials requiring Asian ethnicity, 24.6% (SD = 16.2%) self-reported as Asian. In ZIP-codes with trials requiring Hispanic/Latino ethnicity, 33.3% (SD = 28.5%) self-reported as Hispanic/Latino. Neighborhood level poverty rates and reduced English language ability were also associated with more single race eligibility requirements.

CONCLUSIONS

In selected fields, there has been a modest temporal increase in single race/ethnicity inclusion requirements. Some studies may not fall under regulatory purview and hence may be less likely to include diverse samples. Conversely, some eligibility requirements may be related to health disparities research. Future work should examine whether targeted enrollment criteria facilitates development of personalized medicine or reduces trial access.

What's Your "Street Race"? Leveraging Multidimensional Measures of Race and Intersectionality for Examining Physical and Mental Health Status Among Latinxs

Using the 2015 Latino National Health and Immigration Survey (N= 1,197) we examine the relationship between physical and mental health status and three multidimensional measures of race: 1) "street race," or how you believe other "Americans" perceive your race at the level of the street; 2) socially assigned race or what we call "ascribed race," which refers to how you believe others usually classify your race in the U.S.; and 3) "self-perceived race," or how you usually self-classify your race on questionnaires. We engage in intersectional inquiry by combining street race and gender. We find that only self-perceived race correlates with physical health and that street race is associated with mental health. We also find that men reporting their street race as Latinx1 or Arab were associated with higher odds of reporting worse mental health outcomes. One surprising finding was that, for physical health, men reporting their street race as Latinx were associated with higher odds of reporting optimal physical health. Among women, those reporting their street race as Mexican were associated with lower odds of reporting optimal physical health when compared to all other women; for mental health status, however, we found no differences among women. We argue that "street race" is a promising multidimensional measure of race for exploring inequality among Latinxs.

Integrative Review of the Literature on Hispanics and Hospice

The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, “hospicio,” has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance. This systematic integrative review examines the research literature on Hispanics and hospice to report on the state of the science for this topic. Reviewed articles were identified systematically using computer research databases and inclusion and exclusion criteria. Of the 21 reviewed articles, many are survey and low-inference qualitative designs with limited validity and trustworthiness. Most survey instruments were not validated for Spanish language or Hispanic culture. None of the qualitative studies included theoretical sampling or follow-up interviews. Few study designs considered heterogeneity within the Hispanic population. Interpreting results cautiously, there is evidence that some Hispanics find some satisfaction with hospice care in spite of cultural incongruities and socioeconomic challenges. Future research calls for intervention studies and high-inference qualitative designs to gain insight into hospice experiences and what constitutes quality hospice care from the perspectives of Hispanic subgroups. Assessing quality and designing interventions for these end-of-life cultural and socioeconomic issues will improve end-of-life care and facilitate the hospice philosophy of promoting emotional growth at end of life.

Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial

Background

Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up.

Methods

We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies.

Discussion

This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities.

Trial registration

ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.

Parents' Traditional Cultural Values and Mexican-Origin Young Adults' Routine Health and Dental Care

PURPOSE

To investigate the prospective associations between Mexican-origin mothers' and fathers' traditional cultural values and young adults' health and dental care utilization and to test the moderating role of youth gender.

METHODS

Mexican-origin parents and youth (N = 246 families) participated in home interviews and provided self-reports of parents' cultural values (time 1) and young adults' health status and routine health and dental care (time 2; 5 years later). Logistic regressions tested parents' traditional cultural values as predictors of routine health and dental care, accounting for parent nativity, parent acculturation, family socioeconomic status, youth gender, youth age, and youth physical health status. We also tested whether youth gender moderated the associations between parents' cultural values and young adults' routine care.

RESULTS

Young adults whose mothers endorsed strong familism values when they were in mid-to-late adolescence were more likely to report at least one routine physician visit in the past year as young adults (odds ratio [OR] = 3.47, 95% confidence interval [CI]: 1.23-9.83, p = .019). Furthermore, for females only, mothers' more traditional gender role attitudes predicted reduced odds of receiving routine health (OR = .22; 95% CI: .08-.64, p = .005) and dental care (OR = .26; 95% CI: .09-.75, p < .012) in young adulthood.

CONCLUSIONS

Our findings highlight the importance of examining intragroup variability in culturally specific mechanisms to identify targets for addressing ethnic/racial disparities in health care utilization among Mexican-origin young adults, during a period of increased risk for health-compromising behaviors and reduced access to care.

Predictors of Suboptimal Follow-up in Pediatric Cancer Survivors

Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.

Factors Influencing Mexican Women's Decisions to Vaccinate Daughters Against HPV in the United States and Mexico

Mexican and Mexican-American women bear high cervical cancer burdens, yet relationships between mothers' experiences of vaccinating daughters against cervical cancer-causing human papillomavirus (HPV) on both sides of the border are unknown. We surveyed 400 Mexican-born women in Oxnard, California, United States and Cuernavaca, Morelos, Mexico, about their beliefs and practices regarding daughters' HPV vaccination, conducting in-depth interviews with 35 participants. Contextualizing interview findings in survey data, we identify key factors influencing mothers' experiences regarding daughters' HPV vaccination in both countries. Although US acculturation influenced some participants' concerns, US and Mexico participants overwhelmingly desired eventual vaccination; structural rather than cultural barriers limited vaccine uptake.

Racial/ethnic differences moderate associations of coping strategies and posttraumatic stress disorder symptom clusters among women experiencing partner violence: a multigroup path analysis

BACKGROUND

Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).

METHODS

Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.

RESULTS

The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.

CONCLUSION

Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.

"Experience Keeps a Dear School": the Effects of Ethnicity and Caregiving Experience on Hiring a Healthcare Advocate

In the present study, ethnic differences in evaluating the severity and associated needs of medical complications experienced by an elderly man and the likelihood of seeking professional assistance (i.e., hire a healthcare advocate [HCA]) to care for him, and for one's own family or parent should they become ill, as a function of previous caregiving experience, were investigated. The 974 participants were White, Black, Hispanic, or Asian/Pacific Islander. They read a hypothetical vignette about a 75-year-old man, Daryl, who was experiencing health problems. Participants were instructed to imagine that they were James, Daryl's son, and asked to indicate how severe his condition(s) were, how much medical assistance he would require, and how likely they would be to hire an HCA to assist him. They were also asked to report whether they previously had assisted a parent with activities of daily living (Assistance) and whether they would be likely to hire an HCA in the future if 1) a family member or 2) a parent, specifically, became ill. Two, 2 (Assistance) × 4 (Ethnicity) multivariate analyses of covariance (MANCOVA) were performed to assess differential responses among individuals of different ethnicities as a function of previous caregiver experience. A priori interaction contrasts were examined to determine whether Black, Hispanic, or Asian/Pacific Islander participants differed on the outcomes from White participants as a function of previous caregiver experience. There were no significant differences between Black or Asian/Pacific Islander and White participants, but Hispanic participants assigned significantly higher severity and need for medical assistance ratings and were significantly more likely to indicate that they would seek assistance from an HCA with respect to the vignette and for their own parents in the future if they had provided caregiving to a parent in the past, whereas White participants were less likely to seek assistance from an HCA if they had provided caregiving in the past to a parent. Although ethnic differences in evaluations of Daryl's condition and in the reported likelihoods of hiring an HCA in various contexts as a function of previous caregiving experience were limited, there are important inter-cultural differences to recognize. It may be important in future research to assess ethnic differences in the expectations and experiences of caregiving.

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.

Factors Associated with HPV Vaccine Awareness in a Population-Based Sample of Hispanic Women in Puerto Rico

OBJECTIVES

The objective of this study was to investigate the factors associated with HPV awareness among women aged 16 to 64 years, among underserved minority Hispanic women living in Puerto Rico.

METHODS

A population-based, cross-sectional sample of 566 women, ages 16 to 64 years, living in the San Juan metropolitan area were surveyed regarding sexual behavior, HPV knowledge, and HPV vaccine uptake. Data was analyzed using descriptive statistics and multivariate logistic regression.

RESULTS

Overall, 64.8 % of the women in the sample had heard about the HPV vaccine. Among those in the recommended catch-up vaccination age range (16-26 years, n = 86), 4.7 % had received at least one dose of the HPV vaccine. Of those aware of the availability of the HPV vaccine, most had learned about it through the media, whereas, only 39.6 % had learned about it from a physician. Multivariate logistic regression analysis showed that HPV awareness (OR 8.6; 95 % CI 5.0-14.8) and having had an abnormal Pap smear (OR 2.0; 95 % CI 1.2-3.4) were associated with HPV vaccine awareness (p < 0.05).

CONCLUSION

HPV vaccine awareness among Hispanic women in the San Juan metropolitan area of Puerto Rico continues to be low. Strong recommendations from physicians and participation in HPV vaccine educational efforts are essential if the rate of HPV vaccination is to increase in the targeted population. Compared to the USA, and to their US Hispanic counterparts, a health disparity with regard to HPV vaccine awareness and coverage is evident in Puerto Rico; targeted action to deal with this disparity is urgently needed.