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Breton J, Foret JT, Hamlin AM, Ortega N, Clark AL. Health insurance coverage moderates the relationship between metabolic syndrome and baseline memory outcomes in Latino older adults. Clin Neuropsychol 2024:1-16. [PMID: 39158158 DOI: 10.1080/13854046.2024.2392303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
Objective: Latino adults are at increased risk of metabolic syndrome (MetS) and have lower rates of health insurance (HI) coverage. Although inadequate HI coverage and MetS have been independently linked to poor cognition, their potential interactive effects have not yet been examined. The present study explored whether HI moderated the association between MetS and cognition. We hypothesized that Latinos with MetS that did not have HI would demonstrate poorer cognition than those with HI, whereas there would be minimal differences in cognition across HI status in those without MetS. Methods: Cross-sectional data from 805 Latino older adults enrolled in the Health and Aging Brain Study-Health Disparities was utilized. Analysis of covariance adjusting for sociodemographics examined MetS x HI interactions on memory and attention/executive functions composites. Results: Results revealed a significant MetS x HI interaction on memory (F = 4.33, p = 0.037, ηp2 = .01); Latino adults with MetS and no HI coverage had worse memory performance than those with MetS who had HI coverage (p = 0.022, ηp2 = .01), whereas there was no significant difference in memory between HI coverage groups in those without MetS (p > .05, ηp2 = .002). No MetS x HI interaction was observed for the attention/executive functions composite (F = 0.29, p = 0.588, ηp2 < .001). Conclusion: Latino older adults with MetS that do not have HI coverage may be at risk for poorer memory outcomes. Increasing the accessibility of HI coverage may help reduce cognitive health disparities in Latino older adults with vascular health comorbidities.
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Affiliation(s)
- Jordana Breton
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Janelle T Foret
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Abbey M Hamlin
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Nazareth Ortega
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
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Held ML, Villarreal-Otálora T, McPherson J, Jennings-McGarity P. Politics, Pandemics, and Trauma: Understanding and Addressing Latino Health Needs Through a Culturally-Informed Lens. Front Public Health 2022; 10:877328. [PMID: 35910919 PMCID: PMC9337836 DOI: 10.3389/fpubh.2022.877328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Latino communities in the United States (U.S.) have long endured trauma due to multiple intersecting social and political forces. New restrictive immigration policies since 2016 and the COVID-19 pandemic have each created novel stressors for Latino communities, while escalating the risk of mental health disorders and highlighting the communities' vulnerabilities. The effects of these stressors have been particularly pronounced in southeastern states, such as Tennessee and Georgia, due to their state-level anti-immigrant legislation. Yet, we lack sufficient data to understand how these factors present among Latinos seeking services. To focus attention on the specific experiences of Latino communities living in the U.S. Southeast, the authors analyzed the perspectives of 44 service providers working with these communities in the region using qualitative data collected in an online survey administered during the COVID-19 pandemic and while President Trump's exclusionary immigration policies were in force. Four themes were identified: (1) Latino communities' strengths; (2) impact of the Trump administration on Latino communities; (3) impact of COVID-19's on Latino communities; and (4) strategies to enhance service delivery in Latino communities. Results provide meaningful data to inform micro- and macro-level service delivery in two exclusionary policy states and beyond. Findings suggest future research should include other new immigrant destinations and explore perceptions of Latino community members.
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Affiliation(s)
- Mary Lehman Held
- College of Social Work, University of Tennessee, Knoxville, Knoxville, TN, United States
| | | | - Jane McPherson
- School of Social Work, University of Georgia, Athens, GA, United States
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Amaya S, Gray MJ. Cultural Considerations in the Treatment of Latina Survivors of Sexual Assault. JOURNAL OF LOSS & TRAUMA 2021. [DOI: 10.1080/15325024.2021.1926175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephanie Amaya
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Matt J. Gray
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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Held ML, Villarreal-Otálora T, Jennings-McGarity P. Latino Immigrant Service Provision in Tennessee and Georgia: Provider Perceptions. J Immigr Minor Health 2021; 24:875-888. [PMID: 34654993 DOI: 10.1007/s10903-021-01286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Latinos and Latino immigrants are increasingly settling in new immigrant destinations, such as Tennessee and Georgia, that have historically lacked sufficient infrastructure for delivery of culturally and linguistically competent health and social services. This cross-sectional survey study was designed to assess providers' (n = 109) perspectives of the service provision landscape in each state. Descriptive analyses and t-tests (by state) were conducted to explore service concerns, access barriers, and organizational capacity to address concerns and barriers. Among most prevalently reported concerns were income/wages and fear of deportation. Key access barriers included language, lack of driver's license and insurance, and fear of deportation. Most (63%) organizations had sufficient Spanish language proficiency, though building trust was a notable barrier within 58% of organizations. Results provide meaningful data to inform existing strengths and service gaps in two exclusionary policy states. Future research should include perspectives of Latino community members.
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Affiliation(s)
- Mary Lehman Held
- College of Social Work, University of Tennessee, Knoxville, 193 Polk Avenue, Suite E, Nashville, TN, 37210, USA.
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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Caballero AE. The "A to Z" of Managing Type 2 Diabetes in Culturally Diverse Populations. Front Endocrinol (Lausanne) 2018; 9:479. [PMID: 30233490 PMCID: PMC6127640 DOI: 10.3389/fendo.2018.00479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes affects racial/ethnic minorities at an alarming rate in the US and in many countries around the world. The quality of health care provided to these groups is often suboptimal, resulting in worse patient-related outcomes when compared to those in mainstream populations. Understanding the complex biological elements that influence the development and course of the disease in high-risk populations is extremely important but often insufficient to implement effective prevention and treatment plans. Multiple factors must be addressed in routine diabetes clinical care. This paper discusses various key factors, organized in alphabetical order. These are acculturation, biology, clinician's cultural awareness, depression and diabetes-specific emotional distress, educational level, fears, group integration, health literacy, intimacy and sexual dysfunction, judging, knowledge of the disease, language, medication adherence, nutritional preferences, other forms of medicine (alternative), perception of body image, quality of life, religion and faith, socio-economic status, technology, unconscious bias, vulnerable groups, asking why?, exercise, "you are in charge" and zip it! Considering these factors in the development of type 2 diabetes prevention and treatment programs will help improve diabetes-related outcomes in culturally diverse populations and reduce health care disparities.
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Affiliation(s)
- A. Enrique Caballero
- Office for External Education, Harvard Medical School, Boston, MA, United States
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Valentine SE, Borba CPC, Dixon L, Vaewsorn AS, Guajardo JG, Resick PA, Wiltsey-Stirman S, Marques L. Cognitive Processing Therapy for Spanish-speaking Latinos: A Formative Study of a Model-Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting. J Clin Psychol 2017; 73:239-256. [PMID: 27378013 PMCID: PMC5215988 DOI: 10.1002/jclp.22337] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/18/2016] [Accepted: 05/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As part of a larger implementation trial for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish-speaking clients) and implementation outcomes (appropriateness and acceptability) for CPT. METHOD Qualitative data for the current study were gathered through multiple sources (providers: N = 6; clients: N = 22), including CPT therapy sessions, provider fieldnotes, weekly consultation team meetings, and researcher fieldnotes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual. RESULTS Data-driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish-speaking clients. CONCLUSION Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish-speaking clients.
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Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 70 Everett Ave., Suite 516, Chelsea, MA 02150, U.S.A.,
| | - Christina P. C. Borba
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, The Chester M. Pierce, MD Division of Global Psychiatry, 25 Staniford Street, 2nd floor Boston, MA 02114, U.S.A,
| | - Louise Dixon
- Department of Psychology, University of Californa Los Angeles, Franz Hall, 502 Portola Plaza, Los Angeles, CA, 90095, U.S.A.,
| | - Adin S. Vaewsorn
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave., Suite 516, Chelsea, MA 02150, U.S.A.,
| | - Julia Gallegos Guajardo
- Center for Anxiety Research and Treatment (CETIA), Department of Psychology, University of Monterrey, Avenida Ignacio Morones Prieto, 4500 Pte., San Pedro Garza García, Nuevo León C.P. 66238, México,
| | - Patricia A. Resick
- Division of Translational Neuroscience and Implementation, Duke University Medical Center, 411 West Chapel Hill St., Suite 200, Durham, NC 27701, U.S.A.,
| | - Shannon Wiltsey-Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA 94025, U.S.A.; Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Palo Alto, CA 94304, U.S.A.,
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 70 Everett Ave., Suite 516, Chelsea, MA 02150, U.S.A
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