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BACKGROUND: Maladaptive patterns of alcohol consumption can lead to clinically significant impairment or distress and have been established as a partial cause of a wide variety of health conditions, including neuropsychiatric disorders, cardiovascular diseases, hepatic inflammations, certain cancers, and infectious diseases. In the United States, Hispanic and non-Hispanic white (NHW) men have comparable rates of moderate alcohol consumption, however, Hispanic men are more likely to consume higher volumes of alcohol and with more frequency and experience disproportionate levels of adverse health and social consequences of alcohol abuse when compared to NHW men. Further, Hispanic men face greater barriers than NHW men in accessing, engaging, and completing alcohol abuse treatment services despite the contrasting burden of alcohol-related consequences they face. OBJECTIVES: This dissertation is composed from three studies addressing the following aims to: 1) synthesize the culturally- and gender-responsive components of alcohol and substance abuse and dependence treatment programs designed for Hispanic males in the United States; 2) explore Hispanic male perspectives and opinions regarding alcohol use and abuse patterns that may lead to disparate rates of alcohol abuse in Hispanic males in the United States; and 3) examine U.S. Hispanic male perspectives regarding the barriers to alcohol abuse treatment-seeking related behaviors that lead to disparate treatment engagement and completion rates. METHODS: A systematic literature search was conducted for Aim 1 in which articles reporting on culturally- and/or gender-adapted alcohol and/or substance abuse interventions designed exclusively for Hispanic males were identified. Aim 2 and Aim 3 used semi-structured interviews to elicit Hispanic male perspectives of alcohol abuse and alcohol abuse treatment seeking behaviors. Separate thematic analyses were conducted as per the objectives of Aims 2 and 3. Data analysis was based

Background: Hispanic people with epilepsy, especially those who are primarily Spanish speaking, may be at an increased risk of disparities in managing their epilepsy. This may be due to limited communication between patients and healthcare providers (HCPs) and/or the scarcity of epilepsy self-management tools available to them. Self-management has been shown to help people with epilepsy increase their self-confidence and better cope with their disease. Despite advances in the field, educational interventions for epilepsy self-management are still limited. To help mitigate these challenges, this study renovated and translated into Spanish an existing epilepsy self-management support tool known as Management Information and Decision Support Epilepsy Tool (MINDSET). MINDSET is a tablet-based clinical aid designed for use by both patients and their HCPs to promote shared informed treatment and behavioral change decision-making. MINDSET uses information that the patient enters into a tablet-based application to create a patient profile and an action plan tailored to the patient’s self-management “at-risk” behaviors for review by the patient and their HCP during consultation. Purpose: The overarching goal of this study was to develop a theoretically-enhanced and empirically tested Spanish version of the MINDSET program tailored to the Hispanic community, taking into consideration a series of social, cultural, and economic factors unique to the community. This tool has been culturally tailored to help improve care to underserved Hispanics and address disparities in epilepsy care. A Spanish version of MINDSET will provide Hispanic patients with epilepsy with a tool that can help them acquire a better awareness of their health condition and to learn new skills to help them improve their epilepsy self-management, ultimately resulting in improved treatment compliance, fewer seizures, and reduced health care related costs. Methods: The usability study of this project consisted

BACKGROUND: School discipline—how schools manage and respond to student misbehavior—is a central component of how schools seek to create safe and productive learning environments. School suspensions have been a popular discipline strategy in recent decades. Yet, recent studies have demonstrated the association between punitive discipline strategies and poor outcomes in youth, including increased high school dropout rates, decreased odds of enrolling in postsecondary school, and increased mental health concerns. There is an urgent need to examine alternate mechanisms for addressing school discipline other than punitive exclusionary or reward-based systems. This dissertation seeks to develop an integrated model of promising approaches and define how such a system could work. OBJECTIVES: This dissertation is made up of three studies addressing three aims: (1) to synthesize the existing literature on how school discipline has been constructed and its impact on student well being; (2) to develop a novel conceptual model for an alternate discipline approach, "kind discipline," and; (3) to develop and validate a measure for assessing the practice of kind discipline in elementary and middle schools. METHODS: Study one is a theoretical review utilizing a social ecological model to frame how school discipline models address an individual, relational, or structural level. Study two is a formative evaluation that develops a novel conceptual model for an alternative discipline approach. This study utilized concept mapping to elicit and integrate perspectives on school discipline from teachers, administrators, school staff, and other stakeholders involved in school programming. The concept mapping included a brainstorming phase, a statement analysis phase, a sorting and rating phase, and multidimensional scaling and hierarchical cluster analysis of the collected data. It culminated in a map that visually represent the group's ideas and how they are interrelated. Study three valid

Background: Historically, US immigration policy, including border enforcement, has served to define national belonging and through this process, has constructed particular groups as undesirable or threatening to the nation. Such political-economic strategies contribute to oppression through gender, ethnic, and class discrimination and economic and political exclusion. This dissertation is based on three studies that collectivity explored these issues as structural determinants of health (SDH) and forms of structural and everyday violence. Objectives: These studies aimed to (1) examine the relations between immigration related mistreatment and practices of ethno-racial profiling by immigration officials on health of Mexican immigrants of the Arizona border (2) contextualize the structural and everyday violence of such institutional practices through mistreatment narratives and (3) evaluate the impact of an intensive Border Health Service Learning Institute (BHSLI) on public health students' ability to locate such forms of violence and identify the role of public health advocacy. Methods: Study one and two are a secondary analysis of quantitative and qualitative data drawn from a random household sample of 299 Mexican-origin farmworkers. Study three is a qualitative analysis of 25 BHSLI student reflection journals from 2010-2012. Results: Farmworkers were US permanent residents and citizens, employed in US agriculture for 20 years. Approximately 25% reported immigration related mistreatment, more than 50% were personally victimized and 75% of mistreatment episodes occurred in a community location while residents engaged in routine activities. Immigration mistreatment was associated with a 2.3-increased risk for stress in adjusted models (OR 2.3, CI 1.2, 4.1). After a week at the US-Mexico border, BHSLI students articulated aspects of immigration and economic policy impacting health. Students framed economic and immigration policies as health policy and found the role

The social determinants of health continue to impact health disparities among communities living along the U.S.-Mexico border. Because community health workers (CHWs) are recognized for promoting a variety of positive patient-centered health outcomes in their roles as educators and health system navigators, recent inquiry has focused on the role of the CHW in facilitating community-level changes through grassroots advocacy to impact the social determinants of health. Social capital theory, which posits that participation in groups has positive consequences for individuals and the community, is a useful lens through which CHW effectiveness in grassroots advocacy can be measured and replicated. Using quantitative and qualitative methods, this study investigated the social capital characteristics of fifteen CHWs working in border communities who were trained in grassroots advocacy. Participating CHWs reported high baseline levels of social capital, which was assessed using a social capital questionnaire. After one year of engagement in grassroots advocacy, participating CHWs reported statistically significant increases in one measure of bridging social capital (community engagement) and one measure of linking social capita (participation with political/civic leaders). Qualitative interviews with each CHW further explored the role of social capital in their grassroots advocacy, resulting in a social capital model elucidating six activities of CHW-driven grassroots advocacy. The mixed methods results provide measures for assessing CHWs' social capital in their traditional roles and as grassroots advocates, as well as a framework for understanding how CHWs use their social capital to take grassroots action addressing the social determinants of health.