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Abstract Introduction: Community-Engaged Research (CEnR) and Community-Based Participatory Research (CBPR) require validated measures and metrics for evaluating research partnerships and outcomes. There is a need to adapt and translate existing measures for practical use with diverse and non-English-speaking communities. This paper describes the Spanish translation and adaptation of Engage for Equity’s Community Engagement Survey (E2 CES), a nationally validated and empirically-supported CEnR evaluation tool, into the full-length “Encuesta Comunitaria,” and a pragmatic shorter version “Fortaleciendo y Uniendo EsfueRzos Transdisciplinarios para Equidad de Salud” (FUERTES). Methods: Community and academic partners from the mainland US, Puerto Rico, and Nicaragua participated in translating and adapting E2 CES, preserving content validity, psychometric properties, and importance to stakeholders of items, scales, and CBPR constructs (contexts, partnership processes, intervention and research actions, and outcomes). Internal consistency was assessed using Cronbach’s alpha and convergent validity was assessed via a correlation matrix among scales. Results: Encuesta Comunitaria respondents (N = 57) self-identified as primarily Latinos/as/x (97%), female (74%), and academics (61%). Cronbach’s alpha values ranged from 0.72 to 0.88 for items in the context domain to 0.90–0.92 for items in the intervention/research domain. Correlations were found as expected among subscales, with the strongest relationships found for subscales within the same CBPR domain. Results informed the creation of FUERTES. Conclusions: Encuenta Comunitaria and FUERTES offer CEnR/CBPR practitioners two validated instruments for assessing their research partnering practices, and outcomes. Moreover, FUERTES meets the need for shorter pragmatic tools. These measures can further strengthen CEnR/CBPR involving Latino/a/x communities within the US, Latin America, and globally.

Abstract Introduction The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group‐specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities. It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population. Methods We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles. Results This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S‐residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials. Conclusions The recommendation and research efforts proposed should help to pave the way for the development of community‐engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally‐informed intervention to the U.S.‐residing Brazilian communities. HIGHLIGHTS The Brazilian population in the United States is growing but is underrepresented in U.S. health research. Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities. Mental health is reported as a central health priority by Brazilian immigrants in the United States. There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States. Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States.

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.

Abstract Background Diabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Racial/ethnic disparities in diabetes care are pervasive, including the provision of care for prevention of complications. Prevention efforts should be focused on the time that immediately follows a diagnosis of diabetes. The aim of this study was to assess racial/ethnic differences in the receipt of guideline-directed diabetes care for complication prevention by individuals recently diagnosed with diabetes. Methods We used repeated cross-sections of individuals recently diagnosed with diabetes (within the past 5 years) from the National Health Interview Survey from 2011 to 2017. Multivariate regression was used to estimate the associations between race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic) and guideline-directed process measures for prevention of diabetes complications (visits to an eye and foot specialist, and blood pressure and cholesterol checks by a health professional - each in the prior year). We assessed effect modification of these associations by socioeconomic status (SES). Results In a sample of 7,341 participants, Hispanics had lower rates of having any insurance coverage (75.9 %) than Non-Hispanic Whites (93.2 %) and Blacks (88.1 %; p

Introduction Predialysis education for patients with advanced chronic kidney disease (CKD) typically focuses narrowly on haemodialysis and peritoneal dialysis as future treatment options. However, patients who are older or seriously ill may not want to pursue dialysis and/or may not benefit from this treatment. Conservative kidney management, a reasonable alternative treatment, and advance care planning (ACP) are often left out of patient education and shared decision-making. In this study, we will pilot an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education—COPE) to improve knowledge of conservative kidney management and ACP among patients with advanced CKD who are older and/or have poor functional status.Methods and analysis This is a single-centre pilot randomised controlled trial at an academic centre in Philadelphia, PA. Eligible patients will have: age ≥70 years and/or poor functional status (as defined by Karnofsky Performance Index Score

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.

BackgroundStructural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use.MethodsData were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent–child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use.ResultsPreliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p

Increases in anti-Asian COVID-19 related discriminatory behaviors have been observed, many of which targeted older adults. Studies demonstrate that racial discrimination is associated with worse health outcomes, including anxiety, depression, and sleep difficulties. No previous studies have examined the impact of day-to-day experiences of discrimination before and during COVID-19 on both Asian and non-Asian older adults within the same sample. We examined whether everyday discrimination was associated with increased anxiety and depression symptoms, decreased levels of functioning, and increased sleep difficulties among Asian and non-Asian US older adults before and during the pandemic. Data came from the Positive Minds-Strong Bodies randomized clinical trial, an evidence-based mental health and disability prevention intervention for racially and ethnically diverse older adults with elevated depression or anxiety symptoms and minor to moderate disability. We conducted secondary data analyses in a cohort of 165 older adults (56 Asian and 109 non-Asian) assessed before COVID-19 (May 2015-May 2018) and during COVID-19 (March 2021-July 2022). Regression models examined whether everyday discrimination impacted health outcomes differently before and during COVID-19, and whether this effect was stronger among Asian compared to non-Asian older adults. Non-Asian older adults reported the same levels of everyday discrimination before and during COVID-19. Consistent with literature suggesting that social distancing has inadvertently kept US Asian populations from experiencing discrimination, Asian older adults reported marginally lower levels of everyday discrimination during the pandemic compared with pre-pandemic. We found that everyday discrimination was not associated with health outcomes before COVID-19. In contrast, during the pandemic, everyday discrimination was associated with worse anxiety and depression symptoms and worse levels of functioning, although only the impact on depression was significantly stronger compared with before the pandemic. This negative impact of everyday discrimination on health outcomes during the pandemic appeared to affect both Asian and non-Asian older adults similarly. Social support and social cohesion buffered against the negative effect of everyday discrimination on depression and level of functioning during the pandemic. Results suggest that public health interventions aimed at reducing everyday discrimination and emphasizing social support and cohesion can potentially improve health outcomes for all US older adult populations.Clinical trial registrationwww.ClinicalTrials.gov; identifier: NCT02317432.

Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. A variety of innovative federal, state, and local programs have combined social services with mental health interventions. To explore the potential effects of such supports for addressing poverty and disadvantage on mental health outcomes, we simulated improvements in three social determinants--education, employment, and income. We used two large data sets: one from the National Institute of Mental Health that contained information about people with common mental disorders such as anxiety and depression, and another from the Social Security Administration that contained information about people who were disabled due to severe mental disorders such as schizophrenia and bipolar disorder. Our simulations showed that increasing employment was significantly correlated with improvements in mental health outcomes, while increasing education and income produced weak or nonsignificant correlations. In general, minority groups as well as the majority group of non-Latino whites improved in the desired outcomes. We recommend that health policy leaders, state and federal agencies, and insurers provide evidence-based employment services as a standard treatment for people with mental disorders. [ABSTRACT FROM AUTHOR]

Abstract Background By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. Methods Positive-Minds–Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. Results Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency’s ability to address the health and well-being of elders, capacity-building strategies such as a “train-the-trainer” initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. Conclusions Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. Trial registration ClinicalTrials.gov, NCT02317432 .

(1) Background: Few qualitative studies address diverse older adults’ perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults’ perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community’s fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.

Background: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. Method: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. Results: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p

Population aging in the US and its increase in racial/ethnic diversity has resulted in a growing body of literature aimed at measuring health disparities among minority older adults. Disparities in health outcomes are often evaluated using self-reported measures and, to attend to linguistic diversity, these measures are increasingly being used in languages for which they were not originally developed and validated. However, observed differences in self-reported measures cannot be used to infer disparities in theoretical attributes, such as late-life depression, unless there is evidence that individuals from different groups responded similarly to the measures—a property known as measurement invariance. Using data from the Positive Minds-Strong Bodies randomized controlled trial, which delivered evidence-based mental health and disability prevention services to a racially/ethnically diverse sample of minority older adults, we applied invariance tests to two common measures of anxiety and depression (the GAD-7 and the HSCL-25) and two measures of level of functioning (the Late-Life FDI and the WHODAS 2.0) comparing four different languages: English, Spanish, Mandarin, and Cantonese. We found that these measures were conceptualized similarly across languages. However, at the item-level symptom burden, we identified a non-negligible number of symptoms with some degree of differential item functioning. Spanish speakers reported more worry symptoms and less somatic symptoms for reasons unrelated to their psychological distress. Mandarin speakers reported more feelings of restlessness, and both Mandarin and Cantonese speakers reported no interest in things more often for reasons unrelated to their psychological distress. Mandarin and Cantonese speakers were also found to consistently report more difficulties performing physical activities for reasons unrelated to their level of functioning. In general, invariance tests have been insufficiently applied within psychological research, but they are particularly relevant as a prerequisite to accurately measure health disparities. Our results highlight the importance of conducting invariance testing, as we singled out several items that may require careful examination before considering their use to compare symptoms of psychological distress and level of functioning among ethnically and linguistically diverse older adult populations.

In an Editorial, Guest Editors Alexander Tsai, Margarita Alegria and Steffanie Strathdee discuss the accompanying Special Issue on Substance Use, Misuse and Dependence.

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

Sánchez Guevara, Graciela y Sánchez Guevara, Irene (coords.) (2015) Miradas críticas a la complejidad de la violencia universitaria, México, Fontamara/UACM.

This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences exist in coverage between Latinos and Asians, with Latinos more likely to be uninsured. Potential explanations include the type of occupations available to Latinos and Asians, reforms in immigration laws, length of time in the United States, and regional differences in safety-net coverage. Policy implications are discussed.

Algunos poetas de la primera mitad del siglo XIX adoptaron la retórica de la sublimidad del griego Dionisio Casio Longino (siglo II d.C.) como molde literario. Quizá porque éste les brindaba los recursos para expresar sus preocupaciones y deseos en el contexto de una caótica nación en ciernes, heredera del sincretismo cultural hispano-indígena. Fue el caso, sobre todo, de Ignacio Rodríguez Galván, uno de los poetas más acabados, y de algún otro como Andrés Quintana Roo. Las historias literarias de los siglos XIX y XX no consignan ese dato; es por eso que estas notas explican las características de la retórica de referencia y analizan algunos poemas selectos.

Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. A variety of innovative federal, state, and local programs have combined social services with mental health interventions. To explore the potential effects of such supports for addressing poverty and disadvantage on mental health outcomes, we simulated improvements in three social determinants-education, employment, and income. We used two large data sets: one from the National Institute of Mental Health that contained information about people with common mental disorders such as anxiety and depression, and another from the Social Security Administration that contained information about people who were disabled due to severe mental disorders such as schizophrenia and bipolar disorder. Our simulations showed that increasing employment was significantly correlated with improvements in mental health outcomes, while increasing education and income produced weak or nonsignificant correlations. In general, minority groups as well as the majority group of non-Latino whites improved in the desired outcomes. We recommend that health policy leaders, state and federal agencies, and insurers provide evidence-based employment services as a standard treatment for people with mental disorders., (Project HOPE—The People-to-People Health Foundation, Inc.)