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Determinants of parental HPV vaccine hesitancy, including medical mistrust and exposure to negative vaccine information, are understudied in racial/ethnic minority communities where vaccine uptake is low. We conducted a cross-sectional survey (March 2021) among parents of adolescents, ages 9–17 years, from an academic enrichment program serving low-income, first-generation, underrepresented minority families in Los Angeles to understand determinants of parental HPV vaccine hesitancy. Parents completed self-administered surveys, including a 9-item HPV vaccine hesitancy scale, in either English, Spanish, or Chinese. Logistic regression was used to identify individual and interpersonal factors associated with parental hesitancy and adolescent HPV vaccination. One-fifth of parents (n = 357) reported high HPV vaccine hesitancy and > 50% reported concerns about safety or side effects. High medical mistrust was associated with high parental HPV vaccine hesitancy (adjusted-OR 1.69, 95% CI: 1.13, 2.37). Community-tailored and multilevel strategies to increase vaccine confidence are needed to improve HPV and other adolescent vaccinations. [ABSTRACT FROM AUTHOR]

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states—Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington—allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking. We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues. States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health. [ABSTRACT FROM AUTHOR]

Although personal identity development has been conceptualized as a source of psychological stability and protective against depressive symptoms among Hispanic immigrants, there remains ambiguity regarding the directional relationship between identity development and depression. To address this limitation, the current study sought to establish directionality between identity development and depressive symptoms. The sample consisted of 302 recent (<5 years) immigrant Hispanic adolescents (53.3% boys; Mage = 14.51 years at baseline; SD = 0.88 years) from Miami and Los Angeles who participated in a longitudinal study. The findings suggested a bidirectional relationship between identity and depressive symptoms such that identity coherence negatively predicted depressive symptoms, yet depressive symptoms also negatively predicted coherence and positively predicted subsequent identity confusion. Findings not only provide further evidence for the protective role of identity development during times of acute cultural transitions, but also emphasize the need for research to examine how depressive symptoms, and psychopathology more broadly, may interfere with establishing a sense of self. [ABSTRACT FROM AUTHOR]

Introduction: Young adulthood (aged 18-24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined whether vulnerability factors moderated the association between tobacco advertisement liking and tobacco use in the United States.Methods: Analyses were conducted among 9109 US young adults in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013-14). Participants viewed 20 randomly selected sets of tobacco advertisements (five each for cigarettes, e-cigarettes, cigars, and smokeless tobacco) and indicated whether they liked each ad. The outcome variables were past 30-day cigarette, e-cigarette, cigar, and smokeless tobacco use. Covariates included tobacco advertisement liking, age, sex, race or ethnicity, sexual orientation, education, poverty level, military service, and internalizing and externalizing mental health symptoms.Results: Liking tobacco advertisements was associated with tobacco use, and this association was particularly strong among those with lower educational attainment (cigarettes, cigars) and living below the poverty level (e-cigarettes, smokeless tobacco).Conclusions: The association between tobacco advertisement liking and tobacco use was stronger among young adults with lower educational attainment and those living below the poverty level. Policies that restrict advertising exposure and promote counter-marketing messages in this population could reduce their risk.Implications: This study shows that liking tobacco advertisements is associated with current tobacco use among young adults, with stronger associations for vulnerable young adults (ie, lower education levels and living below the poverty level). Findings suggest a need for counter-marketing messages, policies that restrict advertising exposure, and educational interventions such as health and media literacy interventions to address the negative influences of tobacco advertisements, especially among young adults with a high school education or less and those living below the poverty level. [ABSTRACT FROM AUTHOR]

Prosocial behaviors (i.e., actions that benefit others) are important markers of healthy social functioning, and understanding the factors that predict such outcomes among recent immigrant Latino adolescents is important. The current study examines the longitudinal associations between maternal involvement and prosocial behaviors via collectivism values. Data comes from a longitudinal project (Construyendo Oportunidades Para los Adolescentes Latinos) of 302 recently immigrated U.S. Latina/o adolescents (53.3% male, average age = 14.51 years old). The current study uses data from three times points across 2 years. The results demonstrated that maternal involvement was positively associated with collectivism values. Collectivism was positively associated with changes in prosocial behaviors. There was also partial support for a reverse-causal model. Discussion focuses on the links among parenting, cultural values, and prosocial behaviors among immigrant U.S. Latina/o adolescents. [ABSTRACT FROM AUTHOR]

The present study was designed to examine trajectories of personal identity coherence and confusion among Hispanic recent-immigrant adolescents, as well as the effects of these trajectories on psychosocial and risk-taking outcomes. Personal identity is extremely important in anchoring young immigrants during a time of acute cultural change. A sample of 302 recently immigrated (5 years or less in the United States at baseline) Hispanic adolescents (M = 14.51 years at baseline; SD = 0.88 years, range 14-17) from Miami and Los Angeles (47 % girls) completed measures of personal identity coherence and confusion at the first five waves of a six-wave longitudinal study; and reported on positive psychosocial functioning, depressive symptoms, and externalizing problems at baseline and at Time 6. Results indicated that identity coherence increased linearly across time, but that there were no significant changes in confusion over time and no individual differences in confusion trajectories. Higher baseline levels of, and improvements in, coherence predicted higher levels of self-esteem, optimism, and prosocial behavior at the final study timepoint. Higher baseline levels of confusion predicted lower self-esteem, greater depressive symptoms, more aggressive behavior, and more rule breaking at the final study timepoint. These results are discussed in terms of the importance of personal identity for Hispanic immigrant adolescents, and in terms of implications for intervention. [ABSTRACT FROM AUTHOR]

This study evaluated the immigrant paradox by ascertaining the effects of multiple components of acculturation on substance use and sexual behavior among recently immigrated Hispanic adolescents primarily from Mexico (35 %) and Cuba (31 %). A sample of 302 adolescents (53 % boys; mean age 14.51 years) from Miami ( n = 152) and Los Angeles ( n = 150) provided data on Hispanic and US cultural practices, values, and identifications at baseline and provided reports of cigarette use, alcohol use, sexual activity, and unprotected sex approximately 1 year later. Results indicated strong gender differences, with the majority of significant findings emerging for boys. Supporting the immigrant paradox (i.e., that becoming oriented toward US culture is predictive of increased health risks), individualist values predicted greater numbers of oral sex partners and unprotected sex occasions for boys. However, contrary to the immigrant paradox, for boys, both US practices and US identification predicted less heavy drinking, fewer oral and vaginal/anal sex partners, and less unprotected vaginal/anal sex. Ethnic identity (identification with one's heritage culture) predicted greater numbers of sexual partners but negatively predicted unprotected sex. Results indicate a need for multidimensional, multi-domain models of acculturation and suggest that more work is needed to determine the most effective ways to culturally inform prevention programs. [ABSTRACT FROM AUTHOR]

Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn-Lew Asian Self-Identity Acculturation Scale, acculturation clusters, language preference, length of residency in the US, and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the US were about 2-4 times [odds ratio (OR) and 95 % confidence interval (CI) colorectal: 2.41 (1.52-3.82); cervical: 1.79 (1.07-3.01); and breast: 2.11 (1.25-3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer [OR 1.72 (1.05-2.81)] was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening. [ABSTRACT FROM AUTHOR]

Objectives. We examined the relationship between acculturation and sun safety among US Latinos. Methods. We used linear regression models to analyze data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Using sunscreen, seeking shade, and wearing protective clothing were the primary outcomes and were assessed by frequency scales. Acculturation was assessed with a composite index. Results. In bivariate models, acculturation was negatively associated with use of shade and protective clothing and positively associated with sunscreen use (all, P<.004). In adjusted models, acculturation was negatively associated with seeking shade and wearing protective clothing across gender and region of residence (all, P<.05). Conclusions. Our results demonstrated both adverse and beneficial effects of acculturation on Latinos' risk behaviors relating to skin cancer. Education about sun safety is needed for all Latinos and should be tailored to different levels of acculturation. Initiatives for Latinos who are not yet acculturated could focus on reinforcing existing sun-safe behaviors and presenting new ones, such as use of sunscreen; initiatives for highly acculturated Latinos might require more resources because the objective is behavior modification. (Am J Public Health. 2009;99:734-741. doi:10.2105/AJPH.2007.122796) [ABSTRACT FROM AUTHOR]

The associations between stressful life events and smoking have been established among adolescents in the United States. However, whether these relationships are similar in adolescents from other non-Western cultures is unknown. Understanding these relationships in adolescents may help to provide opportunities to reduce the smoking rates in those cultures by providing positive coping methods that do not include smoking. In this longitudinal study, the associations between nine stressful life events scales and smoking behaviors were examined in a sample of Chinese adolescents. Six of these scales, positive school-related, negative school-related, positive family-related, positive peer-related, negative peer-related, and negative health-related had significantly different means among females and males. Among males, positive school-related stress was a protective factor for smoking susceptibility. Among females, positive school-related stress was a protective factor and negative school-related stress was a risk factor for lifetime smoking, and negative family-related stress was a risk factor for smoking susceptibility. Findings indicate that smoking among male adolescents in China may not be the result of stress; however, in females stress may contribute to the decision to smoke. Future directions are discussed. [ABSTRACT FROM AUTHOR]

Much research on the etiology of adolescent drug use has focused on posited risk and protective factors at the level of the individual or small group. However, those proximal influences exist within a cultural context that also influences drug use. To prevent drug use in the diverse population of the United States, research is needed on the influence of the cultural context on adolescent drug use, including the effects of immigrating from one cultural or sociodemographic context to another, as well as the effects of living within two different cultural systems simultaneously. Theoretical models and research methods from cultural psychology and cultural sociology are well-suited to examine the cultural context of drug use. We examine causal mechanisms by which acculturation might affect drug use by using two paradigms to conceptualize culture: a stress/coping paradigm and a cultural values paradigm. Implications of cultural risk and protective factors for transdisciplinary research on drug abuse prevention are also discussed. [ABSTRACT FROM AUTHOR]

This paper describes how cancer awareness programs are introduced and sustained in South Asian communities in Los Angeles County. The model used to plan this program consists of several phases: 1) an assessment of community readiness, 2) sharing of data, development of partnerships, building a sustainable, infrastructure through culturally specific technical assistance, 3) training and sharing of the most up-to-date and accurate cancer information from the National Cancer Institute. This collaboration was the first step in improving the community's capacity to introduce and sustain breast cancer awareness programs among South Asians in Los Angeles. [ABSTRACT FROM AUTHOR]

Context of reception has been discussed widely in the sociological and anthropological literature, but no measures of this construct exist. We designed a measure of perceived context of reception and provide initial support for the factorial validity, internal consistency reliability, and incremental and discriminant validity of scores generated by this measure. A sample of 302 recent-immigrant Hispanic parent-adolescent dyads from Miami and Los Angeles completed the new perceived context of reception measure, as well as measures of perceived discrimination; Hispanic/American cultural practices, values, and identifications; and depressive symptoms. In Phase 1, exploratory and confirmatory factor analyses extracted a factor for negative perceived context of reception. A subscale corresponding to this factor was used in Phase 2; for parents and adolescents, negative perceived context of reception and perceived discrimination were differentially associated with acculturation-related variables--suggesting discrimi-nant validity between perceived discrimination and negative perceived context of reception. For adoles-cents at both sites and for parents in Los Angeles only, the negative perceived context of reception dimensions were significantly associated with depressive symptoms 6 months later, over and above the contribution made by perceived discrimination--suggesting incremental validity. Results are discussed in terms of perceived context of reception as a new and emerging construct. [ABSTRACT FROM AUTHOR]

Objective: The 2016 FDA's "Deeming Rule" prohibited free samples of vaping products. The purpose of this study was to investigate compliance with or adaptation to this newly established FDA policy.Methods: Vape shops were recruited in Southern California between November 2017 and December 2018. Data collectors interviewed 121 vape shop employees who responded to questions pertaining to the sampling protocol at their shop. Nicotine levels used for sampling were also assessed for consideration of future policy adoption.Results: Only 7.4% of shops were non-compliant to federal sampling rules. The remaining shops either: 1) charged a fee for samples (58.7%); 2) deducted the fee from the final purchase price (5.8%); or 3) eliminated product sampling (28.1%). Of the shops that charged for sampling (including membership fees), 94.4% initiated a minimal cost protocol (≤$1) for sampling. Half (50.0%) the shops that allowed sampling offered nicotine-containing samples.Conclusion: There was high compliance (92.6%) to the change in policy among vape shops. However, minimal modification of sampling protocol was observed due in part to the lack of specificity on parameters of compliance, which lessened the potential impact of the policy. To further protect consumers, policymakers must develop unambiguous and comprehensive policies to achieve intended results and true compliance. At minimum, future tobacco product sampling policies should consider standardized pricing; alternatively, total elimination of tobacco product sampling is suggested. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles., Methods: We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9-17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination., Results: Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels., Conclusion: Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities., (© 2023. The Author(s).)

Importance: There is empirical evidence that social determinants of health (SDOH) impact health outcomes in Black and Hispanic and Latinx individuals in the US. Recently, SDOH have risen to the top as essential intervention targets that could help alleviate racial and ethnic disparities. Neuromyelitis optica spectrum disorder (NMOSD) disproportionately affects Black individuals, and multiple sclerosis (MS) has seen a recent shift in select racial groups. It is unclear to what degree SDOH have been investigated and contribute to racial and ethnic health disparities and inequities., Observations: This narrative review provides a contemporary synthesis of SDOH associated with racial and ethnic health disparities and inequities in MS, NMOSD, and other autoimmune disorders, such as myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease. These immune-mediated neurological diseases were chosen for their capacity to be a high burden to society and because of complementary SDOH-associated challenges among minority populations. A paucity of research addressing inequities and the role of SDOH in MS and NMOSD was noted despite findings that Black individuals have a higher risk of developing MS or NMOSD and associated mortality compared with White individuals. Greater health disparities were also found for those with lower income and education, lower health literacy, and negative illness perceptions in MS. No studies in MOG-Ab disorders were found., Conclusions and Relevance: Increased efforts are needed to better understand the role of SDOH in racial and ethnic health disparities and inequities in MS, NMOSD, and emerging autoimmune disorders. This includes developing research frameworks aimed at understanding the magnitude and interrelationships of SDOH to better develop system-based multilevel interventions across the spectrum of care for these neurological conditions.

Introduction: Sales of menthol cigarettes continue to increase, accounting for a third of the US cigarette market. Retail marketing of menthol cigarettes is a contributing factor to tobacco-related health disparities. To inform regulation to address associated disparities, we examined retail marketing strategies for menthol cigarettes and their features and characteristics in relation to neighborhood racial/ethnic composition., Methods: We used multilevel regression models to examine associations of neighborhood racial/ethnic composition and store type with menthol cigarette sales outcomes, including availability, exterior advertising, price promotions, and price in a sample of tobacco retailers (N = 673) in Los Angeles County neighborhoods with a median or below-median household income. We also recorded the prices of Newport cigarettes (the highest selling menthol cigarette brand in the United States) and blu disposable menthol e-cigarettes., Results: Overall, 94.5% of retailers sold menthol cigarettes, 31.2% displayed menthol cigarette price promotions, and 30.2% displayed at least one menthol cigarette advertisement on their exterior. Adjusting for racial/ethnic zip code cluster and store type, stores located in predominantly African American neighborhoods showed significantly higher odds in the availability of Newport cigarettes than stores in Hispanic neighborhoods (OR = 0.21; 95% CI, 0.09-0.53; P = .001) or non-Hispanic White (OR = 0.12; 95% CI, 0.05-0.31; P < .001) neighborhoods. Stores located in predominantly African American neighborhoods displayed significantly higher odds of having price promotions for menthol cigarettes and storefront advertisements than those in Hispanic neighborhoods (OR = 0.51; 95% CI, 0.30-0.88; P = .02 and OR = 0.25; 95% CI, 0.13-0.48; P < .001, respectively)., Conclusion: In 2016 and 2017, menthol cigarettes were widely available in Los Angeles County across racial/ethnic neighborhoods. We found a disproportionate number of storefront advertisements and price promotions for menthol cigarettes in stores located in predominantly African American neighborhoods along with the lowest advertised pack price. This evidence supports tobacco control policies that restrict menthol cigarette sales in the retail environment.

The objective of this study was to determine the feasibility and effectiveness of translating films, and whether the use of narrative is an effective vehicle for producing changes in knowledge, attitudes, and behaviors regarding cervical cancer compared with a nonnarrative film. A randomized controlled telephone trial surveyed the effectiveness of two films our team produced among a sample of 300 monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin. Participants were recruited using random digit dialing (RDD) procedures from 2013 to 2014 in Los Angeles County and were randomly selected to view either a narrative or nonnarrative film. Data were collected by phone at baseline, 2 weeks, and 6 months after viewing. On average, participants arrived in the USA 25 years ago. The majority reported having less than high school education and limited English proficiency. Compared with their nonnarrative counterparts, women who received the cervical cancer-related information in the narrative film showed a significantly greater increase in new knowledge (p = 0.01) and in supportive attitudes about Pap tests expense (p = 0.05). Importantly, at 6 months, although not statistically significant, women who viewed the narrative film were also more likely to have had or scheduled a Pap test (62% vs 42%). Narratives are a useful and underutilized tool to communicate information about cancer prevention. These findings have important implications for the delivery of health education among Spanish-speaking, low-literacy immigrant women, and for the reduction of cancer-related disparities.

Background: The Acculturative Process and Context Framework (Ward & Geeraert, 2016) proposes that acculturative stressors influence psychological well-being over time. In fact, extant literature has linked bicultural stress with psychological functioning; yet, no studies have explored the causal dominance of bicultural stress. The purpose of the present study was to evaluate the directionality of prospective relations among bicultural stress and psychosocial functioning (i.e., depressive symptoms, hopefulness, and self-esteem) in Latinx immigrant adolescents across 5 waves., Method: There were 303 Latinx adolescents who were recruited for this study from Los Angeles and Miami and were assessed across 5 waves at 6-month intervals. Adolescents were 14.50 years old on average ( SD = .88) and 53.16% were male. Adolescents reported living in the United States for 2.07 years on average ( SD = 1.87). A Random-Intercept Cross-Lagged Panel Model (RI-CLPM) was used to examine the between- and within-person relations among bicultural stress, depressive symptoms, hopefulness, and self-esteem in a comprehensive model., Results: The comprehensive RI-CLPM including bicultural stress, depressive symptoms, hopefulness, and self-esteem exhibited excellent model fit. Between-person, trait-like relations among constructs ranged from small to large, as expected. Within-person, cross-lagged estimates among constructs were overall inconsistent, with some evidence that, within individuals, self-esteem influences later hopefulness., Conclusion: Findings from this study indicate that the RI-CLPM is an effective strategy to examine bicultural stress and well-being processes among adolescents. There is a need for further research examining bicultural stress among Latinx immigrant youth, particularly within prevention and intervention studies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Introduction. Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. Method . Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. Results . All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). Discussion . To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.

Background : Non-Hispanic American Indians and Alaska Natives (NH AI/AN) have the highest commercial tobacco use (CTU) among U.S. racial/ethnic groups. Tobacco marketing is a risk factor, however few studies examine it among NH AI/AN. Objective : We identified prevalence of tobacco industry marketing exposure and correlates of CTU among NH AI/AN compared to other racial/ethnic groups. Methods : Data were from wave 1 (2013-2014; N  = 32,320) of the Population Assessment of Tobacco and Health Study, analyzing self-reported exposure to tobacco ads from stores, tobacco package displays, direct mail and email marketing. Correlates of CTU were identified and interactions between racial/ethnic groups and tobacco marketing were assessed. Results : NH AI/AN ( n  = 955) had a higher prevalence of exposure to retail tobacco ads (64.5% vs 59.3%; p  < 0.05), mail (20.2% vs.14.3%; p  < 0.001) and email (17.0% vs.10.6%; p  < 0.001) marketing than NH Whites ( n  = 19,297). Adjusting for tobacco use and related risk factors, exposure to email marketing remained higher among NH AI/AN than NH Whites. Interactions between racial/ethnic groups and marketing exposures on CTU were nonsignificant. CTU was higher among NH AI/AN than NH Whites and among adults who reported exposure to tobacco ads, mail, and email marketing. Conclusions/importance : There is higher tobacco marketing exposure in stores and via mail for NH AI/AN. Email marketing exposure was higher, even after controlling for tobacco-related risk factors. The tobacco industry may be targeting NH AI/AN through emails, which include coupons and other marketing promotions. Culturally relevant strategies that counter-act tobacco industry direct marketing tactics are needed to reduce disparities in this population.

In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Although diabetes is a nationwide epidemic, US Latinos are a particularly vulnerable population. Culturally appropriate interventions can combat this disparity, especially those that increase social support. However, these interventions face significant cost and time barriers, which mHealth (mobile health) may overcome. This trial examines the benefit of adding social support to an existing text-message based, patient-focused mHealth intervention for emergency department patients with poorly controlled diabetes. Family members and friends of patients were randomized to mHealth augmented social support training (daily text-messages that synchronize with the patient messages) or a pamphlet based training (the same content mailed to their house.) We hypothesize that patients who received mHealth augmented social support will have a larger improvement in diabetes management (glycosylated hemoglobin or A1C) than those receiving standard support at six-months, and that improvement will be sustained at twelve-months. Secondary patient outcomes are clinical (weight, blood pressure), behavioral (medication adherence, self-care activities) and psychosocial (general and diabetes-specific social support, self-efficacy, diabetes-related distress, depression, fatalism and quality of life). We screened 2004 patients and enrolled 166 patient/supporter dyads. 70% of patients are Spanish-speaking, 51% female, with a mean A1C of 10.8. We employed innovative measures to remotely enroll family members and support a bilingual population, which will assist other investigators in design of similar trials. The findings of our trial will have real-world applicability for clinicians, health system administrators, health educators and mHealth developers who aim to improve the health of this vulnerable population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico., Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011⁻2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors., Results: Analyses showed that even among those in the category with the lowest risk behavior, &ldquo;physically active and low sedentary&rdquo;, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico., Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity.

Background: Epidemiological studies have described an "acculturation paradox." Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables., Objective: To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition., Design: We utilized embedded mixed methods (in-depth interviews; survey)., Participants/setting: We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs., Results: Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating., Conclusions: This study raises questions about the nature of the "dietary acculturation paradox." While food-the eating of Mexican foods-is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American women's self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos' diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for "traditional" diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

U.S. Latino parents can face cultural stressors in the form of acculturative stress, perceived discrimination, and a negative context of reception. It stands to reason that these cultural stressors may negatively impact Latino youth's emotional well-being and health risk behaviors by increasing parents' depressive symptoms and compromising the overall functioning of the family. To test this possibility, we analyzed data from a six-wave longitudinal study with 302 recently immigrated (<5 years in the United States) Latino parents (74% mothers, M age  = 41.09 years) and their adolescent children (47% female, M age  = 14.51 years). Results of a cross-lagged analysis indicated that parent cultural stress predicted greater parent depressive symptoms (and not vice versa). Both parent cultural stress and depressive symptoms, in turn, predicted lower parent-reported family functioning, which mediated the links from parent cultural stress and depressive symptoms to youth alcohol and cigarette use. Parent cultural stress also predicted lower youth-reported family functioning, which mediated the link from parent cultural stress to youth self-esteem. Finally, mediation analyses indicated that parent cultural stress predicted youth alcohol use by a way of parent depressive symptoms and parent-reported family functioning. Our findings point to parent depressive symptoms and family functioning as key mediators in the links from parent cultural stress to youth emotional well-being and health risk behaviors. We discuss implications for research and preventive interventions., (© 2016 Family Process Institute.)

The links between discrimination and adjustment in U.S. Latino/a immigrant adolescents is an important but understudied phenomenon. We aimed to investigate the longitudinal associations (across 1 year) among discrimination, prosocial behaviors, and depressive symptoms in U.S. Latino immigrant adolescents using two competing models: associations between discrimination and prosocial behaviors via depressive symptoms (mental health strain model), and associations between discrimination and depressive symptoms via prosocial behaviors (prosociality strain model). Participants were 302 Latino/a recent immigrant adolescents (53.3 % boys, M age = 14.51 years at Time 1, SD = .88 years) who completed measures of discrimination, depressive symptoms, and prosocial behaviors at 6-month intervals. The results provided support for both proposed models. The discussion examines the importance of prosocial behaviors in understanding adjustment and effects of discrimination among recently immigrated U.S. Latino adolescents.

Drawing from a theory of bicultural family functioning 2 models were tested to examine the longitudinal effects of acculturation-related variables on adolescent health risk behaviors and depressive symptoms (HRB/DS) mediated by caregiver and adolescent reports of family functioning. One model examined the effects of caregiver-adolescent acculturation discrepancies in relation to family functioning and HRB/DS. A second model examined the individual effects of caregiver and adolescent acculturation components in relation to family functioning and HRB/DS. A sample of 302 recently immigrated Hispanic caregiver-child dyads completed measures of Hispanic and U.S. cultural practices, values, and identities at baseline (predictors); measures of family cohesion, family communications, and family involvement 6 months postbaseline (mediators); and only adolescents completed measures of smoking, binge drinking, inconsistent condom use, and depressive symptoms 1 year postbaseline (outcomes). Measures of family cohesion, family communications, and family involvement were used to conduct a confirmatory factor analysis to estimate the fit of a latent construct for family functioning. Key findings indicate that (a) adolescent acculturation components drove the effect of caregiver-adolescent acculturation discrepancies in relation to family functioning; (b) higher levels of adolescent family functioning were associated with less HRB/DS, whereas higher levels of caregiver family functioning were associated with more adolescent HRB/DS; (c) and only adolescent reports of family functioning mediated the effects of acculturation components and caregiver-adolescent acculturation discrepancies on HRB/DS., ((c) 2016 APA, all rights reserved).)

Prime-time broadcast television provides health information and establishes norms for millions of people in the United States (Beck, 2004; Brodie et al., 2001; Murphy & Cody, 2003; Rideout, 2008). To understand what people may be learning about reproductive and sexual health, a content analysis was conducted of story lines from the 10 most popular prime-time television programs in 2009, 2010, and 2011. Variables that were measured included the frequency of reproductive and sexual health issues, the level of health information, the type of information portrayed, the gain and loss frames, the presence of stigma, the tone, and the type of role model portrayed. Eighty-seven of the 589 health story lines dealt with reproductive and sexual health, and the most common issues were pre- and postterm pregnancy complications. The majority of these story lines had a moderate or weak level of information and included specifics about treatment and symptoms but not prevention. Just over half of the issues were framed in terms of losses, meaning nonadoption of a behavior change will result in negative outcomes. Twenty-four percent of reproductive and sexual health story lines involved stigma-usually stigma related to sexually transmitted infections (STIs). Most story lines were portrayed as serious and the majority of issues happened to positive role models. The implications of these portrayals for the viewing public are discussed.

The risk for depression increases as Hispanic youth acculturate to U.S. society. This association is stronger for Hispanic girls than boys. To better understand the influence of culture and family on depressive symptoms, we tested a process-oriented model of acculturation, cultural values, and family functioning. The data came from Project RED, which included 1,922 Hispanic students (53 % girls; 86 % were 14 years old; and 84 % were U.S. born) from Southern California. We used data from 9th to 11th grade to test the influence of acculturation-related experiences on depressive symptoms over time. Multi-group structural equation analysis suggested that both family conflict and cohesion were linked with depressive symptoms. Hispanic cultural values were associated with family cohesion and conflict but the strength and direction of these relationships varied across cultural values and gender. For girls and boys, familismo and respeto were associated with higher family cohesion and lower family conflict. Moreover, gender roles were linked with higher family cohesion in girls but not in boys. These results indicate that improving family functioning will be beneficial for boys' and girls' psychological well-being. This may be achieved by promoting familismo and respeto for boys and girls and by promoting traditional gender roles for girls.

There are compelling reasons to conduct studies of cancer in Hispanics, the fastest growing major demographic group in the United States (from 15% to 30% of the U.S. population by 2050). The genetically admixed Hispanic population coupled with secular trends in environmental exposures and lifestyle/behavioral practices that are associated with immigration and acculturation offer opportunities for elucidating the effects of genetics, environment, and lifestyle on cancer risk and identifying novel risk factors. For example, traditional breast cancer risk factors explain less of the breast cancer risk in Hispanics than in non-Hispanic whites (NHW), and there is a substantially greater proportion of never-smokers with lung cancer in Hispanics than in NHW. Hispanics have higher incidence rates for cancers of the cervix, stomach, liver, and gall bladder than NHW. With respect to these cancers, there are intriguing patterns that warrant study (e.g., depending on country of origin, the five-fold difference in gastric cancer rates for Hispanic men but not Hispanic women). Also, despite a substantially higher incidence rate and increasing secular trend for liver cancer in Hispanics, there have been no studies of Hispanics reported to date. We review the literature and discuss study design options and features that should be considered in future studies., (©2011 AACR.)

Objective: To examine perceived discrimination and substance use among Latino high school students., Methods: Latino 9(th) graders (N = 1332) completed self-report measures of perceived discrimination and substance use behavior., Results: Perceived discrimination was associated with lifetime use measures of smoking (OR = 1.73, P < 0.01), alcohol (OR = 1.53, P < 0.01), marijuana (OR = 1.70, P < 0.01), and inhalants (OR = 1.50, P < 0.05); and past 30 day measures of smoking (OR = 2.54, P < 0.01), alcohol (OR = 1.63, P < 0.01), marijuana (OR = 1.95, P < 0.01), and inhalants (OR = 1.64, P < 0.01), and binge drinking (OR = 1.84, P < 0.01)., Conclusions: Latino adolescents who have higher perceptions of discrimination are at risk for substance use. Interventions to help Latino adolescents cope with feelings of discrimination may be a useful addition to substance use prevention programs.

Focus groups were conducted with adolescents and parents as part of a larger study to understand the connection between acculturation and Hispanic/Latino adolescent substance use. Parents (n = 18) were all mothers and had an average age of 42 years. Students (n = 16) were 62% female and had an average age of 14 years. Results are summarized in five categories: culture/ethnic identity, acculturation, parent-child conflict/relationships, gender, and adolescent substance use. Parents and adolescents held similar views in some areas (e.g., pride in ethnic identity and changes in language use), but diverged in others (e.g., indicators of acculturation, gender differences in parenting, and ideas of freedom and independence). Participants in the focus groups did not endorse the association between acculturation and substance use that has been detected in quantitative studies. Implications for substance use prevention and treatment programs are discussed.

Study Objective: Recognition of the health consequences of exposure to environmental tobacco smoke has led government agencies and many employers to establish policies that restrict cigarette smoking in public and workplaces. This cross sectional study examines the association of workplace smoking policies and home smoking restrictions with current smoking among women., Design: Participants were employed US women ages 18-64 who were self respondents to the 1998-1999 or 2000-2001 tobacco use supplement to the current population survey supplements. Cross tabulations and multivariate logistic regression analyses examine the association of selected demographic characteristics, occupation, income, workplace and home smoking policies/restrictions with current smoking, consumption patterns, and quit attempts among women by poverty level for five race/ethnic groups., Main Results: The prevalence of either having an official workplace or home smoking policy that completely banned smoking increased with increased distance from the poverty level threshold. A complete ban on home smoking was more frequently reported by African American and Hispanic women although Hispanic women less frequently reported an official workplace smoking policy. In general, policies that permitted smoking in the work area or at home were associated with a higher prevalence of current smoking but this varied by poverty level and race/ethnicity. Home smoking policies that permitted smoking were associated with lower adjusted odds of having a least one quit attempt for nearly all poverty level categories but there was no association between having one quit attempt and workplace policies., Conclusion: Home smoking policies were more consistently associated with a lower prevalence of current smoking irrespective of poverty status or race/ethnicity than workplace policies. These findings underscore the importance of examining tobacco control policies in multiple domains (work and home) as well as by race/ethnicity and socioeconomic position.

To better understand social and structural changes needed to maximize community-based participation in emergency preparedness, 27 organizations, representing 12 states, participated in a study of the National Alliance for Hispanic Health. The study assessed social change needs (social will, community readiness, assets, and barriers) and structural needs (organizational capacity to integrate services into emergency management efforts locally). Results show high social will but little community readiness. Most non-governmental organizations (NGOs; 96%) were willing, but ill-prepared (65%) to face large-scale emergencies. Assets include bilingual/bicultural personnel, cultural competency, local knowledge, and public trust. Barriers include lack of culturally appropriate training and resources. Structurally, most NGOs want to link with voluntary organizations (79%) and public health departments (74%), but lack integration and coordination. Maximizing timely participation of these underutilized stakeholders in emergency planning can ensure culturally-proficient, community-tailored emergency plans, increased public confidence, and timely compliance with evacuation orders, thus helping to save lives.

This article examines state Master Settlement Agreement (MSA) funding of tobacco control in communities of color. The primary research question was whether MSA monies resulted in dedicated funding for communities of color at the state level. This article also explores some of the historical factors that shape the relationship of communities of color to MSA funding as well as some of the institutional barriers to implementing comprehensive tobacco control programs in these communities. Three model approaches to funding parity in tobacco control programs were examined as case studies. Because of the limited amount of research available in this area, the data on tobacco control funding for communities of color was collected in interviews with state tobacco control agencies during October 2003. Findings supported our hypothesis that there were few dedicated resources at the state level for tobacco control and prevention in communities of color.

Schools offer a convenient setting for research on adolescents. However, obtaining active written parental consent is difficult. In a 6th-grade smoking study, students were recruited with two consent procedures: active consent (parents must provide written consent for their children to participate) and implied consent (children may participate unless their parents provide written refusal). Of 4,427 invited students, 3,358 (76%) provided active parental consent, 420 (9%) provided active parental refusal, and 649 (15%) provided implied consent (parental nonresponse). The implied consent procedure recruited more boys, African Americans, students with poor grades, and smokers. This dual-consent procedure is useful for collecting some limited data from students who do not provide active consent or refusal.