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Refugees face significantly worse mental health outcomes compared to the general population within their host country; however, few refugee-specific mental health programs exist within the United States. Utilizing Community-based Participatory Research methods, a community-based mental health intervention named Positive Minds for Refugees (PMR) is in development. In this preliminary study, we shared the in-development intervention with refugees (n = 8), holding a series of 3 focus groups to gain feedback on the intervention content and determine acceptability. Findings suggest that the intervention is generally acceptable and relevant to the refugee community. Mental health for refugees is closely linked with their ability to navigate new social, cultural, and physical environments during resettlement; therefore, to address unmet needs, additional content should be added on: American cultural norms, navigating US society, and coping with social isolation and self-care. This study highlights cultural considerations for presenting written intervention content and implementing sessions.

Minoritized racial and ethnic groups experience mental health issues yet persistently encounter systemic barriers to accessing mental health care. Disparities in mental health services are linked to structural racism, discrimination, and stigma. Social determinants of health also impact the risk of experiencing mental health issues and contribute to mental healthcare access. Community-based organizations (CBOs) can serve as vital linkages for delivering much-needed support across many domains (e.g., physical and mental health, housing, food, recreation, etc.) and provide opportunities for fostering connections with members of underserved communities. There is untapped potential in leveraging the skills and expertise offered by CBOs and their staff. Designing programs and interventions that incorporate the goals and ideals of the community served may facilitate sustainability and contribute to a reconceptualization of care delivery based on equity. Ensuring that community-informed initiatives are set up for success will require advocacy for multisector collaboration and innovative approaches and policies that facilitate community collaborations to improve mental health and well-being for communities of color to flourish.

IntroductionTransitional age youth (i. e., ages 16–24; TAY) use higher levels of substances than any age group in the United States. Understanding what factors increase substance use during TAY could suggest novel targets for prevention/intervention. Studies suggest that religious affiliation is inversely associated with substance use disorders (SUDs). However, the association of religious affiliation and SUD, including the role of gender and social context, has not been studied in TAY of Puerto Rican ethnicity.MethodsUsing data from N = 2,004 TAY of Puerto Rican ethnicity across two social contexts—Puerto Rico (PR) and the South Bronx, NY (SBx)—we tested the association of religious identity (Catholic, Non-Catholic Christian, Other/Mixed, and no religious affiliation, or “None”), and four SUD outcomes (alcohol use disorder, tobacco use disorder, illicit SUD, and any SUD). Logistic regression models were used to examine the association between religious identity and SUDs, then we tested for interaction by social context and gender.ResultHalf the sample identified as female; 30, 44, and 25% were 15–20, 21–24, and 25–29 years of age, respectively; 28% of the sample received public assistance. There was a statistically significant difference between sites for public assistance (22 and 33% in SBx/PR, respectively; p < 0.001); 29% of the sample endorsed None (38 and 21% in SBx/PR, respectively.) Compared to None, identifying as Catholic was associated with reduced risk of illicit SUD (OR = 0.51, p = 0.02), and identifying as Non-Catholic Christian with reduced risk for any SUD (OR = 0.68, p = 0.04). Additionally, in PR but not SBx, being Catholic or Non-Catholic Christian was protective for illicit SUD when compared to None (OR = 0.13 and 0.34, respectively). We found no evidence of an interaction between religious affiliation and gender.DiscussionThe percentage of PR TAY who endorse no affiliation is higher than the general PR population, reflective of increasing religious non-affiliation among TAY across cultures. Critically, TAY with no religious affiliation are twice as likely as Catholics to have illicit SUD, and 1.5 times as likely as Non-Catholic Christians to have any SUD. Endorsing no affiliation is more adverse for illicit SUD in PR than the SBx, underscoring the importance of social context.

Previous literature has demonstrated adverse patient outcomes associated with racial/ethnic disparities in health services. Because patients/parents and providers care about the duration of anesthesia, this study focuses on this outcome.To determine the association between race/ethnicity and duration under anesthesia.In this retrospective cohort study of data from the Multicenter Perioperative Outcomes Group, White non-Latino was the reference and was compared with Black non-Latino children, Latino, Asian, Native American, Other, and "Unknown" race children.Children aged 3 to 17 years.Induction duration (primary outcome), procedure-end duration, and total duration under anesthesia (secondary outcomes).Of 37,596 eligible cases, 9,610 cases with complete data were analyzed. The sample consisted of 6,894 White non-Latino patients, 1,021 Black non-Latino patients, 50 Latino patients, 287 Asian patients, 26 Native American patients, 57 "Other" race patients, and 1,275 patients of "Unknown" race. The mean induction time was 11.9 min (SD 5.6 min). In adjusted analysis, Black non-Latino patients had 5% longer induction and procedure-end durations than White non-Latino children (exponentiated beta coefficient [Exp (β)] 1.05, 95% CI: 1.02-1.08, p 0.01 and Exp (β) 1.08, 95% CI 1.04-1.13, p 0.01 respectively).White non-Latino children had shorter induction and procedure-end durations than Black children. The differences in induction and procedure-end time were small but may be meaningful on a population-health level.

Adverse childhood experiences (ACEs) may sensitize individuals to view situations in adulthood as more stressful, which may contribute to poor health outcomes. In populations facing disadvantage, ACEs may lead to the accumulation of stressors (stress proliferation or mediation hypothesis) throughout the life course. ACEs could also heighten perceived stress later in life due to its enduring impact (stress sensitization or effect modification hypothesis).We examine the associations between ACEs and perceived stress in early adulthood, considering concurrent life stressors, in a longitudinal cohort of Puerto Rican youth exposed to a high degree of disadvantage.A community-based sample of 1626 Puerto Rican children living in disadvantaged contexts was followed longitudinally in the Boricua Youth Study from 2000 to 2017.ACEs were measured prospectively during childhood (18 yrs), and life stressors and past year perceived stress were measured in early adulthood (EA; mean age = 23.4, sd 2.22). Causal mediation analysis tested ACEs' effects on EA perceived stress indirectly through life stressors including potential effect modification.ACEs influenced perceived stress in EA (standardized total effect = 0.13, p .001) with 35% mediated by increased exposure to life stressors in EA due to ACEs. There was no evidence of increased sensitization to EA life stressors among those with higher ACEs exposure.ACEs contribute to perceived stress in EA, albeit with small effect, partially through accumulating effects of ongoing stressors, supporting the stress proliferation hypothesis. Policies aimed at reducing exposure to adversity from childhood to EA are needed to reduce the experience of ACEs and negative sequelae.

"En el contexto de la situación socio-política mexicana al iniciar el siglo XIX y de la manera en que la nación fue sentando sus bases en ciertos paradigmas de identidad, en este texto se revisa el tópico del paisaje tanto natural como urbano a través de algunos poemas y relatos aparecidos en la revista El año nuevo. Presente amistoso, de la que se publicaron cuatro volúmenes entre 1837 y 1840."

OBJECTIVES/GOALS: To develop the Adherence to Medications In Latinx adults with Depression and Anxiety (AMILDA) intervention using community engaged research principles, AMILDA will integrate culturally tailored messaging to improve depression and anxiety symptoms and adherence to antidepressant medications. METHODS/STUDY POPULATION: Bilingual steering committee members representing primary care and behavioral health professionals from 2 primary care clinics, and 1 lay community member met monthly for 1 year to develop the intervention. One clinic is an academic health center and the other is a federally qualified health center. Members identified, developed, and voted on the interventions components, therapeutic goals, and the mechanisms underlying its effectiveness that needed to be studied. To evaluate AMILDAs components, we conducted an observational study of health care providers (N=13) and Latinx adults with depression and/or anxiety (patients; N=26) from both clinics, and community pharmacists (N=9) from surrounding pharmacies to gather feedback. Based on their input, we revised the intervention. RESULTS/ANTICIPATED RESULTS: AMILDA consists of culturally tailored collaborative drug therapy management with a collaborative practice agreement between the physician and pharmacist. Patients recently started on an antidepressant receive language and culturally concordant motivational interviewing, teach back, and infographics; AMILDA is designed to improve symptoms, adherence, and health determinants. Most provider, pharmacist, and patient participants reported that AMILDA could be beneficial. Several participants indicated a lack of understanding about a US pharmacists scope of practice. Recommendations included ensuing language concordance, incorporating more statistics and scientific data, using images that are relatable, avoiding idioms and stereotypes, taking the time to build rapport, and being friendly. DISCUSSION/SIGNIFICANCE: AMILDA will be tested in a pilot effectiveness randomized controlled study to determine if it improves depression and anxiety symptoms and adherence to antidepressants among Latinx adults compared with enhanced usual care. The mechanisms to be assessed include self-efficacy, antidepressant knowledge, and personal health literacy.

Sexual risk behaviors often co-occur. Understanding the heterogeneity in patterns of sexual behavior among youth and how context of majority and minoritized status may be related to these behaviors can inform targeted STIs/HIV interventions. Data are from the Boricua Youth Study, a longitudinal study of two probability samples of Puerto Rican youth recruited in the South Bronx (SBx) and the metropolitan area in Puerto Rico (PR). We identified patterns of sexual behaviors among young adults (ages 15-24) with sexual experience (N = 1,203) using latent class analysis. Analyses examined context differences and the prospective relationship between adverse childhood experiences (ACEs) (childhood maltreatment/violence, family/parental dysfunction) and patterns of sexual behaviors (age at first sex, number of sex partners, sex with a high-risk partner, condom use, sex while intoxicated, oral sex, anal sex). We identified five classes of sexual behaviors: (1) currently inactive (16.51%); (2) single partner, low activity (13.49%); (3) single partner, inconsistent condom use (32.19%); (4) single partner, sex without a condom (27.65%); and (5) multirisk (10.16%). Young adults from the SBx (minoritized context), those who identified as male, and those with higher child maltreatment/violence ACEs were more likely to be in the multi-risk class relative to the single partner, inconsistent condom use class. Those from the SBx were also more likely to be in the single partner, sex without condom class, relative to the single partner, inconsistent condom use class. Differences in young adults' patterns of sexual behaviors between the two contexts, one representing the minoritized context (SBx) contrasted to the majority context (PR), were not explained by ACEs. Findings highlight the heterogeneity in the patterns of sexual behaviors among Puerto Rican young adults as well as how such patterns vary based on sociocultural contexts. Exposure to child maltreatment/violence ACEs was related to the riskier patterns; however, they did not explain why riskier patterns of sexual behaviors were found in the SBx compared to PR. Results underscore the need for tailored interventions and more in-depth examination of differences across contexts.

This article describes a mixed methods study of community-based participatory research (CBPR) partnership practices and the links between these practices and changes in health status and disparities outcomes. Directed by a CBPR conceptual model and grounded in indigenous-transformative theory, our nation-wide, cross-site study showcases the value of a mixed methods approach for better understanding the complexity of CBPR partnerships across diverse community and research contexts. The article then provides examples of how an iterative, integrated approach to our mixed methods analysis yielded enriched understandings of two key constructs of the model: trust and governance. Implications and lessons learned while using mixed methods to study CBPR are provided.

While continuity of care becomes a more pressing issue given changes in the locus of medical care under reform initiatives, our ability to understand how socio-medical factors shape the continued use of medical care services is limited by current conceptual and measurement tools. In this paper, we reconsider the possibility of measuring continuity of care for individuals during the course of an episode of illness. We recognize the inherent heterogeneity in the notion of “continuity” and suggest that different scenarios produce breaks in the use and delivery of services. We lay out two crucial distinctions. The first targets the type of breaks in continuous care, distinguishing among provider, sector and system continuity. Second, we examine the source of provider continuity, separating breaks in health service use that result from the client's failure to remain in treatment and the health care system's failure to provide for continuous care. We suspect that these scenarios represent different soc...

Rising mental health costs have brought with them the pressing need to identify cost-effective treatments. Identifying cost-effective treatments for depression among Latinos is particularly relevant given substantial disparities in access to depression treatment for Latinos compared to non-Latino whites.The goal of this paper is to (i) compare the cost-effectiveness of telephone and face-to-face cognitive behavioral therapy (CBT) for depression to usual care received in primary care; (ii) compare the cost-effectiveness of telephone CBT directly to face-to-face CBT.As part of a randomized trial study, primary care patients with depression were randomized into three groups: usual care, telephone CBT and face-to-face CBT. Incremental cost-effectiveness ratios (ICER) between respective groups are computed by dividing the incremental difference in mental health care costs by the incremental difference in mental health outcomes. Mental health care costs are computed as the sum of intervention costs (cost of administering sessions) and non-intervention costs (cost of mental health services used that are not part of the intervention). Prices for different types of mental health services are taken from the 2010 Medical Expenditure Panel Survey. Mental health costs are estimated using two-part models. Mental health outcomes are measured by two depression scales: Patient Health Questionnaire (PHQ-9) and Hopkins Symptom Checklist (HSCL), and are estimated using multiple linear regression models. The standard errors for ICERs are computed using 1000 bootstrapped samples and the delta method.Each CBT intervention group is significantly more costly compared to usual care in terms of mental health care costs. Face-to-face CBT patients cost USD732 more than usual care, and phone CBT patients cost USD237 more than usual care. In terms of effectiveness, both intervention groups are associated with significantly reduced (improved) scores in PHQ9 and HSCL compared to usual care. Comparing the phone therapy directly to the same treatment offered face-to-face, we find that phone CBT is significantly less costly (by USD501) and more cost-effective than face-to-face when effectiveness is measured by improvement in PHQ9 scores. Specifically, for the phone CBT group, one score reduction in PHQ9 costs USD634 less than face-to-face.One limitation is that we observe the mental health service use of patients for only four months. Phone CBT might potentially lead to substantial savings or even cost-offset in the long-run. Additional studies with long-run service use data are needed to establish these findings.The finding that phone-based intervention is able to improve the depressive symptoms of patients just as effectively as face-to-face by spending less is crucial for policy makers and health institutions looking to adopt cost-effective depression treatments.

Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures.To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education.Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5 th, and 99 th expenditure quantiles of the full population using quantile regression, and at the 50 th, 75 th, and 95 th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education.Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5 th and 99 th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits.Disparities exist in any mental health care and among those that use the most mental health care resources, but much of disparities seem to be driven by lack of access. The data do not allow us to disentangle whether disparities were related to white respondent's overuse or underuse as compared to minority groups. The cross-sectional data allow us to make only associational claims about the role of insurance, income, and education in disparities. With these limitations in mind, we identified a persistence of disparities in overall expenditures even among those in the highest income categories, after controlling for mental health status and observable sociodemographic characteristics.Interventions are needed to equalize resource allocation to racial/ethnic minority patients regardless of their income, with emphasis on outreach interventions to address the disparities in access that are responsible for the no/low expenditures for even Latinos at higher levels of illness severity.Increased policy efforts are needed to reduce the gap in health insurance for Latinos and improve outreach programs to enroll those in need into mental health care services.Future studies that conclusively disentangle overuse and appropriate use in these populations are warranted.

We examine differential validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses assessed by the fully-structured Composite International Diagnostic Interview Version 3.0 (CIDI) among Latino, non-Latino Black, and non-Latino White adolescents in comparison to gold standard diagnoses derived from the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS). Results are based on the National Comorbidity Survey Replication Adolescent Supplement, a national US survey of adolescent mental health. Clinicians re-interviewed 347 adolescent/parent dyads with the K-SADS. Sensitivity and/or specificity of CIDI diagnoses varied significantly by ethnicity/race for four of ten disorders. Modifications to algorithms sometimes reduced bias in prevalence estimates, but at the cost of reducing individual-level concordance. These findings document the importance of assessing fully-structured diagnostic instruments for differential accuracy in ethnic/racial subgroups.

Current epidemiological data suggest that HIV disproportionately affects blacks in the United States, however, few studies have examined HIV trends among the immigrant black population (1, 2). Although Haitian-born persons have been historically stigmatized for introducing HIV to North America (3), no previous study has reported the U.S. national HIV surveillance trends amongst this foreign-born group. This is in stark contrast to the number of scientific reports published on native and foreign-born Hispanic communities that have described the personal and situational risk factors that place them at risk for acquiring HIV (4–11). In addition, reports on Haitians with AIDS have been primarily based on data from the homeland. The World Health Organization reports that Haiti faces the worst AIDS epidemic outside of Africa, and it has the highest prevalence of HIV (2.2%) in the Caribbean and Latin American region (12). Hence, studies describing HIV trends among Haitian-born persons living in the United States are of the utmost importance and long overdue. In the early 1980s at the beginning of the epidemic, the scientific community did not have an official name for HIV or AIDS (13, 14); however in the general press “the 4H disease” was coined standing for Haitians, Homosexuals, Hemophiliacs, and Heroin users – the the perceived risk factors at the time (15, 16). Reportedly for Haitians, linguistic and cultural issues were barriers to effective communication with caregivers and researchers (16). Historically this was also the period in the U.S. when Haitians were in the limelight seeking political asylum, dying at sea from sinking boats, their bodies washing ashore Florida beaches, with many incarcerated and transferred to immigration detention centers. Similar to other populations at this time some Haitians were diagnosed with a new syndrome. However, Federal officials placed Haitian immigrants in a separate risk category, asserting there was a higher incidence among Haitian-born persons than other groups (17). By 1990 Haitians were removed from the high-risk category because Federal officials recognized a need to eliminate the ban on blood donations based on geographical and national groups. Nevertheless, almost 27 years later a publication in the Proceedings of The National Academy of Sciences concluded that Haiti was the key conduit for the introduction of HIV to the North American continent (3). Despite these ongoing discussions linking Haitians with HIV over the past 20 years no study has previously reported on HIV surveillance trends amongst foreign-born Haitians living in the U.S., although country of birth information has been collected as part of the HIV/AIDS surveillance case report form by the Centers for Disease Control and Prevention (CDC) since 1982 (18). The primary objective of this paper is to report on the national trends for AIDS diagnoses among Haitian born-persons, and compare those trends to trends for the US population and non-Hispanic blacks. The secondary objective is to identify the major risk factors associated with HIV morbidity in Haitian-born persons, in an effort to provide up-to-date information to medical, mental and public health practitioners working with this population. These data are necessary to tailor culturally sensitive interventions as HIV risk factors may differ substantially between Haitian-born persons and native-born blacks.

This paper uses the National Comorbidity Survey - Replication to estimate the effects of recent psychiatric disorder on employment, hours worked, and earnings. We employ methods proposed in Altonji, Elder and Taber (2005) which use selection on observable traits to provide information regarding selection along unobservable factors. Among males, disorder is associated with reductions of 13-17 percentage points in labor force participation and employment, depending on the sample and the model. Among females, we find smaller, less consistent associations between disorder and labor force participation and employment. There are no effects of disorder on earnings or hours worked among employed individuals.

A clear understanding of the effectiveness of the thoracolumbosacral orthosis (TLSO) as a conservative treatment for idiopathic scoliosis is still necessary. In the past few years, the review of pertinent literature has emphasized the lack of properly matched control studies and erroneous interpretations of results due to the use of univariate analysis. Also, in a previous controlled study evaluating the bracing of idiopathic scoliosis, the researchers mixed different types of braces and patients. Therefore, their findings were not specific to any kind of orthosis. In our study, we responded to these criticisms by providing a homogeneous group of patients with a control group and by conducting a multivariate analysis to assess the effectiveness of the TLSO. All the patients at the University Pediatric Hospital Scoliosis Clinic aged 8 through 15 with initial Cobb's angle between 20 and 40 degrees and evidence of progression were assessed. All the patients who used the TLSO and showed full compliance with treatment (n = 54) were compared with a control group. The control group consisted of the patients who needed the treatment with the brace but did not use it for several reasons (n = 47). Neither group showed significant differences in sex, initial age, initial Cobb's angle, menarche, Risser sign, or curve pattern. The mean follow-up period was 3.3 years after skeletal maturity. The results were analyzed using a multivariate analysis because the natural history of scoliosis is determined by multiple factors.(ABSTRACT TRUNCATED AT 250 WORDS)