Search

Objective: The effectiveness of a cognitive behavioural intervention to prevent perinatal depression in low-income Latina immigrant pregnant women and mothers receiving WIC services was evaluated i...

Objective: To investigate the efficacy of mobile health (mHealth) intervention strategies that delivered either personalized, culturally, and linguistically tailored cell phone voice messages or text messages related to breast cancer and prevention, compared to the control group, to determine which strategy is more likely to increase breast cancer knowledge and screening mammography among low-income Latina immigrants. Methods: This randomized controlled trial assigned 256 Latina immigrants 40 years of age or older to one of three groups: an automated cell phone voice message group, an automated text message group, or the control group (mail). The mHealth intervention employed a comprehensive approach that included breast cancer and prevention education and free mammography screening. Outcome measures included knowledge of breast cancer and breast cancer prevention, and adherence to screening mammography. Results: There was a general increase in breast cancer knowledge after the educational intervention for all the groups [p = 0.01, t(199) = 3.996]. Knowledge increase and mammography adherence did not differ based on group. Conclusion: More important than the actual method of communication is how breast cancer and prevention messages are constructed, who the messenger is, and the enabling factors that facilitate screening adherence. A breast cancer preventive intervention program that is personalized, culturally and linguistically tailored, and offers a free or low-cost mammogram holds promise to be an effective method in reaching an underserved Latina population with a high breast cancer burden.

Background Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95% CI 1.49-23.74; 2.45, 95% CI 1.01-5.93; and 3.30, 95% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95% CI 1.13-15.18; 6.43, 95% CI 1.45-28.39; and 2.53, 95% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions Although most participants met national PA guidelines (ie, ≥500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA.

Medical mistrust measures have not been validated in Latino immigrants. This study examined the psychometric properties of the Medical Mistrust Index and its association with health care satisfaction in a sample of Latina immigrants. Participants were 168 self-identified Latinas ≥40 years old. Women were recruited from three Latino-serving health clinics and through a Latino radio program. A bilingual interviewer administered the Medical Mistrust Index in Spanish along with items pertaining to sociodemographic and health care factors. Principal component extraction method was used to evaluate internal consistency reliability to examine Medical Mistrust Index underlying factors. Construct validity was assessed by analyzing the relationship between the Medical Mistrust Index with three related measures (racism, discrimination, trust in doctors). To assess the criterion validity of the Medical Mistrust Index, a logistic regression model examined whether medical mistrust was associated with Latina women's satisfaction with health care controlling for sociodemographic and health care factors. Participants were 51 years old on average, around half had completed High school or less and were uninsured. Most were monolingual Spanish speakers. Two factors

Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p &lt, 0.001), positive attitudes (p &lt, 0.05), anticipatory positive emotions (p &lt, 0.05), and intentions to participate in counseling (p &lt, 0.001). Importantly, the video also significantly reduced negative attitudes (p &lt, 0.05), and attitudinal ambivalence (p &lt, 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.

Latina immigrants are an underserved population with complex medical and mental health needs. This population has high rates of trauma exposure, compounding their health issues. However, little is ...

Introduction: The study hypothesized that sociocultural factors would be associated with breast cancer screening within the past 2 years among Latina immigrant women. Method: This study employed a survey design and included 82 Latina immigrant female participants 40 to 64 years of age for the analysis. Two multivariable binary logistic regression models were estimated, one for the sociocultural deterrents and the other for the symptomatic deterrents from the Cultural Cancer Screening Scale. Results: The results indicated two constructs of the Cultural Cancer Screening Scale, sociocultural deterrents (odds ratio = 2.00; 95% confidence interval = 1.04-3.86) and symptomatic deterrents (odds ratio = 1.65; 95% confidence interval = 1.08-2.54), were associated with screening in the past 2 years, when adjusting for sociodemographic and health-related characteristics. Conclusion: These findings provide evidence for the importance of sociocultural factors in Latina immigrant women’s timely mammography screening.

Background: Contraception is important for reproductive autonomy, yet many Latinas do not use contraception consistently despite research reporting a desire to do so. Factors varying in priority and value come into play during contraceptive decision making. When measuring these, relevant survey items may vary by populations. Aim: This study focused on developing an ethnically responsive, patient-centered, content-valid survey for measuring factors that influence contraceptive decision making among immigrant Latinas. Method: Nonpregnant self-identified Latinas ages 15 to 24 years in Baltimore, MD, were recruited from a family planning facility. Using the theory of planned behavior as a theoretical framework and prior formative research, initial survey items were drafted (Step 1). Content validation and cognitive interviewing procedures (Step 2 and Step 3) were used to develop final items. Results: Final items (27) were content-validated by the target population; items reflect important factors and relevant contexts affecting contraceptive decision making among Latinas in Baltimore. Discussion: These theory-based items provide an important contribution to the literature because they measure and explore factors related to contraceptive decision making in an understudied population. Providers might consider these factors during counseling to build patient-centered communication. These items might serve to measure responses to theory of planned behavior–based interventions designed to improve the contraceptive counseling of Latinas.

Drawing from 56 semi-structured interviews, this article details how undocumented Latina immigrants living in Atlanta, Georgia, in 2013 cultivated health and well-being in an insecure environment. In addition to the myriad challenges that immigrants face in accessing health care in their new communities, undocumented immigrants living in Atlanta at that time faced the legal barrier presented by Georgia’s new “show me your papers” law, which imbued public space with the risk of deportation for those who are undocumented. This law complicated health care access by making the trip to the doctor’s office risky. Immigrants’ health care decisions were thus shaped by the “geography of fear” that permeated their new communities. This fear presented itself not only in public space but also in clinics and hospitals, where many immigrants feared – and sometimes received – bad treatment. Despite the obstacles fear and immigrant policing presented, many of the women I interviewed showed boldness in their health care decisions, staking their claim to medical attention where they saw fit. Additionally, many maintained transnational networks and continued with familiar health practices from home. Combined, these strategies worked to create complex and shifting “therapeutic landscapes” in an environment permeated by insecurity and fear.

Latina immigrants in the farmworker community are a vulnerable and understudied population at risk of acquiring HIV. Employing a CBPR framework, this pilot study was the first to evaluate the efficacy of SEPA, a CDC evidenced-based and culturally tailored HIV risk reduction intervention on a cohort of N = 110 predominantly undocumented Latina immigrants in a farmworker community. Findings revealed SEPA was effective in increasing HIV knowledge and decreasing HIV risk behaviors. However, no changes in self-efficacy were found in the present sample. We posit specific socio-cultural and structural barriers specific to the farmworker community not targeted in the original intervention may have hindered the program's capacity to influence changes in self-efficacy among this less acculturated population. Possible socio-cultural adaptations of the intervention to the target population and policy implications are discussed.

This study examined how country of origin (Mexico or Guatemala) correlates with prenatal care utilization among unauthorized Latina immigrants, who encounter disparate access to health care. Logistic regression and negative binomial regression analyses were used to examine prenatal care adequacy and number of visits among a sample of 4188 unauthorized Latina immigrants. Findings suggest that originating from Guatemala predicted increased likelihood of inadequate prenatal care and fewer prenatal care visits. Implications can inform policy and practice to strengthen prenatal care utilization, especially for unauthorized Guatemalan immigrants. Future research should examine independent predictors of prenatal care for Mexican and Guatemalan women.

Latinos are the fastest growing minority group in the Southeastern USA. Latinos living in the USA have a higher prevalence of obesity, metabolic diseases, and physical inactivity compared to non-Latino Whites, particularly Latina women. The objective of this study is to assess the patterns of physical activity (PA) in overweight Latina immigrants in Alabama using a self-report and an accelerometer.Participants included foreign-born Latina women age ≥19 years with BMI ≥25 kg/m(2). The Global Physical Activity Questionnaire was used to assess self-reported physical activity. Accelerometers were used as an objective measure of physical activity.Among 44 overweight/obese Latina immigrants (mean age 36.6 years and BMI 33.3 kg/m(2)), 36.4 % met PA recommendations by self-report while only 20.5 % met recommendations according to the accelerometer. Self-report sedentary activity was underestimated (186 min/day self-report vs. 575 min/day accelerometer) while moderate activity was overestimated (34 min/day self-report vs. 15 min/day accelerometer). While the number of years living in the USA was positively associated with vigorous activity (r=0.32, p= 0.03), the number of years living in Alabama tended to be positively associated with sedentary activity and negatively associated with moderate activity.Latina immigrants living in Alabama overestimated the amount of time spent in moderate PA and underestimated time spent in sedentary activity.

We present a model of the drinking practices of Latina immigrants who work in bars or cantinas and are compensated for drinking 8 oz beer or ponies with customers, hence working the pony. A total of 358 women recruited from 61 randomly selected cantinas were interviewed as part of a community study conducted in a metropolitan area in the U.S. Southwest. Participants reported drinking an average of 21 beers on nights they worked for ponies. Multiple regression results indicate that drinking practices are related to sociodemographic, work history, drug use, and sexual risk characteristics. The drinking of cantineras is more than 4 times higher than the heavy episodic drinking of high risk Latino male drinkers and young male restaurant workers. The findings suggest that they may be at risk of multiple health problems and could benefit from alcohol risk-reduction interventions.

Acknowledgement The authors are grateful to all of the women who took time to participate in the study, Dr. Elmer Huerta and members of the Latin American Cancer Research Coalition. Funding for these activities were supported, in part, by ACS grants MRSGT-06-132-01-CPPB (VBS), Herbert W. Nickens, M.D., Junior Faculty Achievement Award, AAMC (VBS), and MRSGT-05-104-01-CPPB (JW), National Cancer Institute grants UO1 CA86114 (EH, JM), U01-CA114593 (JM), and KO5 CA96940 (JM). Background Understanding factors that are associated with perceived discrimination in Latina immigrants may provide opportunities to improve care for this growing population. Objective To examine the prevalence of discrimination experiences in urban Latina immigrants and identify socio-cultural and healthcare factors that predict discrimination experiences. Design Cross-sectional survey of 166 Latina immigrants. Measurements Socio-cultural: region of origin, primary language, and education. Healthcare factors: insurance, place of care, patient-provider communication, trust in provider, and satisfaction with care. Multivariable logistic regression was used to examine factors that predicted discrimination. Results 42% had at least one discrimination experience. Communication with providers was the factor most strongly associated with reporting having a discrimination experience while controlling for other variables (p Conclusion Better communication with providers may reduce Latinas’ perceptions of discrimination and thereby improve healthcare access and use of services.

This paper addresses the availability and use of mental health resources by Latina immigrants in rural western Pennsylvania. Findings suggest that few formal (i.e. counselors) or informal (i.e. religious figures) culturally sensitive resources for coping with depression are available to Latina immigrants in this area. When resources were available, informants often expressed a preference for seeking help from informal sources and many experienced obstacles when seeking help from formal sources. Drawing on findings, recommendations for making mental health resources more accessible to Latina immigrants in rural communities are discussed.

Trauma has been understudied among Latina immigrants from Central and South America. This study examined the types and context of trauma exposure experienced by immigrant women from Central America, South America, and Mexico living in the United States. Twenty-eight women seeking care in primary care or social service settings completed life history interviews. The majority of the women reported some type of trauma exposure in their countries of origin, during immigration, and/or in the United States. In the interviews, we identified types of trauma important to the experience of these immigrants that are not queried by trauma assessments typically used in the United States. We also identified factors that are likely to amplify the impact of trauma exposure. The study highlights the importance of utilizing a contextualized approach when assessing trauma exposure among immigrant women.

Despite growing interest in disparities in access to health care, relatively little is known about different facets of care among Latinas, their satisfaction with the care they receive, and the predictors of satisfaction. This study examined whether various health care access and context factors, the quality of the patient-physician interaction, and medical mistrust predict satisfaction with health care among Latina immigrants in New York City. Structured interviews were conducted with 220 Latinas predominantly from the Dominican Republic and aged 40 years or over. Of the access to health care variables examined, greater waiting time predicted dissatisfaction with health care. Greater quality of the patient- physician interaction predicted less dissatisfaction. The effect of the patient-physician interaction on dissatisfaction was mediated, in part, by waiting time. The results illustrate the important role of specific health care factors in satisfaction with care.

Little is known about vaginal douching among Latina immigrants in the U.S. Understanding factors associated with douching is important due to the negative reproductive outcomes associated with this practice. This study examined demographic and behavioral factors associated with vaginal douching among Latina immigrants. A cross-sectional anonymous survey was administered among a convenience sample of 206 Latina immigrants aged 19-44 years (mean = 28 years) living in the U.S. at least 6 months (mean = 4 years). Demographic and behavioral characteristics, history of regular douching (at least once a month for 6 months), and current regular douching (at least once a month for the last 6 months) were assessed. Adjusted odds ratios (adj. OR) were estimated using multiple logistic regression. Overall, 25% (n = 50) of women reported ever douching regularly and 15% (n = 31) reported current regular douching. Ever douching regularly was significantly associated with a woman's number of lifetime sex partners (adj. OR = 1.6 per additional partner over one, 95% CI: 1.1-2.5), hormonal contraceptive use (adj. OR = 0.3, 95% CI: 0.1-0.9), and healthcare seeking behavior (adj. OR = 2.3, 95% CI: 1.1-5.2). Regular vaginal douching is a common practice among Latina immigrants. Factors associated with douching in this population vary from those in other U.S. populations and, therefore, it needs to be addressed in a culturally appropriate manner.

Recent Latina immigrants are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. Existing social and health care policies often do not adequately address the mental health concerns of new Latino populations. Amigas Latinas Motivando el Alma, a community-partnered research project, seeks to improve immigrant Latinas’ mental health outcomes. Using Photovoice methodology, promotoras (lay health advisors) reflected on community factors affecting mental health through photography and guided discussion. Discussions were audio-recorded, transcribed, and coded using content analysis to identify salient themes. Promotoras reviewed codes to develop themes that they presented in community forums to reach local policy makers and to increase community awareness. These forums included an exhibit of the promotoras’ photographs and discussion of action steps to address community concerns. Themes included transitioning to life in the United States, parenting, education, and combating racism. Nearly 150 stakeholders attended the community forums and proposed responses to promotoras’ photographic themes. Our findings suggest that Photovoice provides an opportunity for Latinas and the larger community to identify issues that they find most important and to explore avenues for action and change by creating sustainable partnerships between the community and forum attendees.

We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama’s 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children’s access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women’s increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

Although domestic violence plagues communities of all races, socio-economic status and geographical locations, some communities within the U.S. are more vulnerable because victims' alternatives to living with their abuser are more limited and they face more obstacles to obtaining the assistance they need to escape the violence. A particularly vulnerable group are Hispanic immigrants residing in the U.S. who have been described as living in more difficult conditions. Latina immigrants and refugees face stresses of acculturation and language, in addition to the limited opportunities afforded to other ethnically diverse groups in the U.S. This article examines the prevalence of various forms of domestic violence experienced by Latina immigrant women, the nature of the battering and extreme cruelty they experience, and public policy implications of the findings. Undocumented and recently documented Latina women (n=280) were interviewed about their experiences relating to domestic violence. A large proportion of the survey participants in the three groups (48.0 percent) were undocumented, unpartnered (56.5 percent), and employed (52.9 per cent). Participants reporting being in the U.S. for an average of 5.1 years. Based on their responses, participants were identified as ‘Physically and/or Sexually Abused’ (n=136), ‘Psychologically Abused Only’ (n=33), or ‘Non-Abused’ (n = 107). Results showed that 49.3 percent of all participants reported having experienced physical abuse, 11.4 percent sexual abuse, 60.0 per cent dominance/isolation-type psychological abuse, and 40.7 percent emotional/verbal-type psychological abuse from an intimate partner. Physically and/or sexually abused women reported higher rates of several types of dominance/isolation compared to those in the psychologically abused only group. There were no differences between the two groups in emotional/verbal abuse. Physically and/or sexually abused women experienced more threats, including threats to harm children and other family members, to take the woman's money, to call Immigration and Naturalization Services (INS), and to kill her, compared to psychologically abused only women. The implication for policies related to battered immigrant women is discussed.

Latino children use fewer professional dental services and experience more dental decay than non-Hispanic White and non-Hispanic Black children. This study tested the association between four types of social support (information, influence, material aid, emotional aid) and dental use among children of Latina immigrants in North Carolina. Latina mothers age 15-44 years (N5174) were sampled from four counties using a multi- stage church-based sampling design. Each mother reported dental care use for her oldest child younger than 11 years of age. Instrumental aid (information) alone was not associated with dental care use, but receiving any of the other types of social support was associated with dental care use at the bivariate level (p,.01) and at the multivariate level (OR 5 3.13; 95% CI 5 1.67-5.87). Over half of the women (65.2%) received at least one of these forms of social support. Interventions expanding dental-related social support could help Latina immigrant mothers overcome barriers to dental care for their children.

This study examined the acceptability of preventive human papillomavirus (HPV) vaccination among Latina immigrants and African American women through eight focus groups (n = 55, 28 Latinas and 27 African Americans).Latinas were between 17 and 39 years old (x = 27.9) and African Americans between 19 and 39 (x = 24.3). Approximately 86% of Latinas and 7% of African Americans were married or living with a partner; 10.7% of Latinas and 53.8% of African Americans reported having health insurance; 60.7% of Latinas and 77.8% of African Americans had never heard about HPV. Following a brief presentation about cervical cancer and HPV, participants were questioned about the acceptability of a preventive HPV vaccine.Overall, both groups indicated that an HPV preventive vaccine would be acceptable. However, African Americans were more skeptical, citing concerns about effectiveness and side effects. Another African American concern was whether vaccinated women would perceive themselves as being protected from HPV, leading them to increased promiscuity or unprotected sex. African Americans' motivating factors for vaccine use included receiving education/information about the vaccine, affordable prices, good results in trials, and knowing others who had already gotten vaccinated. Latina immigrants, on the other hand, unanimously stated that they would get the vaccine. However, they believed that multiple credible sources of information (educational talks, doctor's office, television, churches, and other women) needed to promote the vaccine before the Latino community at large would accept it.These findings suggest that unique educational strategies need to be developed, based on the needs and perceptions of the targeted audience, in order to achieve wide-spread acceptability of this vaccine.

To assess Latina immigrants' beliefs about the role of sexual activities in cervical cancer etiology and the impact of the beliefs on Papanicolaou (Pap) smear use. Previous research has found that Latinas, particularly immigrants, believe that cervical cancer is related to 'unwise' sexual activities; however, their beliefs about the nature of the relationship are unclear.We conducted semi-structured face-to-face interviews with a non-probability purposive sample of 20 Mexican immigrant women who resided in Orange County, California regarding their beliefs about risk factors for cervical cancer and Pap smear use. We used qualitative content analysis to identify major themes. Three investigators independently reviewed transcripts of the audio-taped interviews to identify themes and came to a consensus about them.The women had a mean age of 39 years and had resided in the USA for an average of 16.3 years. We identified several themes. The majority of respondents had limited knowledge about cervical cancer and no knowledge about human papillomavirus (HPV); believed that infections caused by physical trauma, certain sexual activities, and poor hygiene caused cervical cancer; believed that they only needed a Pap smear if they developed symptoms of a pelvic infection; and felt that women who engaged in 'unwise' sexual behaviors, in particular, should receive regular Pap smear exams.The results suggest that culturally related beliefs about the etiology of cervical cancer play a role in the decision to obtain Pap smears for Latina immigrants. The findings may help to explain why researchers have found Latino ethnicity to be an independent predictor of Pap smear use. They also suggest that programs designed to improve cervical cancer screening, particularly among Latina immigrants, should stress the nature of HPV transmission, its role in the etiology of cervical cancer, and the importance of Pap smear screening in the absence of symptoms.