Tu Amigo Pepe: Evaluation of a Multi-media Marketing Campaign that Targets Young Latino Immigrant MSM with HIV Testing Messages.

Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis in the United States. This paper describes the evaluation of a pilot of the Tu Amigo Pepe, a multimedia HIV testing campaign aimed at Latino MSM in Seattle, WA particularly targeting immigrants who may not identify as gay, ages 18-30 years old. The 16-week campaign included Spanish-language radio public service announcements (PSAs), a Web site, social media outreach, a reminder system using mobile technology, print materials and a toll-free hotline. In developing the PSAs, the Integrated Behavioral Model was used as a framework to reframe negative attitudes, beliefs and norms towards HIV testing with positive ones as well as to promote self-efficacy towards HIV testing. The campaign had a significant and immediate impact on attitudes, beliefs, norms and self-efficacy towards HIV testing as well as on actual behavior, with HIV testing rates increasing over time.

Content validity of Patient-Reported Outcomes Measurement Information System (PROMIS) items in the context of HIV clinical care.

PURPOSE: To assess content validity and patient and provider prioritization of Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and alcohol use items in the context of clinical care for people living with HIV (PLWH), and to develop and assess new items as needed. METHODS: We conducted concept elicitation interviews (n = 161), item pool matching, prioritization focus groups (n = 227 participants), and cognitive interviews (n = 48) with English-speaking (~75 %) and Spanish-speaking (~25 %) PLWH from clinical sites in Seattle, San Diego, Birmingham, and Boston. For each domain we also conducted item review and prioritization with two HIV provider panels of 3-8 members each. RESULTS: Among items most highly prioritized by PLWH and providers were those that included information regarding personal impacts of the concept being assessed, in addition to severity level. Items that addressed impact were considered most actionable for clinical care. We developed additional items addressing this. For depression we developed items related to suicide and other forms of self-harm, and for all domains we developed items addressing impacts PLWH and/or providers indicated were particularly relevant to clinical care. Across the 4 domains, 16 new items were retained for further psychometric testing. CONCLUSION: PLWH and providers had priorities for what they believed providers should know to provide optimal care for PLWH. Incorporation of these priorities into clinical assessments used in clinical care of PLWH may facilitate patient-centered care.

Discrimination and mental health problems among homeless minority young people.

OBJECTIVE: We examined the associations among perceived discrimination, racial/ethnic identification, and emotional distress in newly homeless adolescents. METHODS: We assessed a sample of newly homeless adolescents (n=254) in Los Angeles, California, with measures of perceived discrimination and racial/ethnic identification. We assessed emotional distress using the Brief Symptom Inventory and used multivariate linear regression modeling to gauge the impact of discrimination and racial identity on emotional distress. RESULTS: Controlling for race and immigration status, gender, and age, young people with a greater sense of ethnic identification experienced less emotional distress. Young people with a history of racial/ethnic discrimination experienced more emotional distress. CONCLUSION: Intervention programs that contextualize discrimination and enhance racial/ethnic identification and pride among homeless young people are needed.

Who is using emergency contraception? Awareness and use of emergency contraception among California women and teens.

INTRODUCTION: Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. METHODS: Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. RESULTS: Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. CONCLUSIONS: Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.

Impact of a chronic care coordinator intervention on diabetes quality of care in a community health center.

PURPOSE: To evaluate the impact of a clinic-based chronic care coordinator (CCC) intervention on quality of diabetes care, health outcomes and health service utilization within six community health centers serving predominantly low-income Hispanic and non-Hispanic white patients. METHODS: We used a retrospective cohort study design with a 12-month pre- and 12-month postintervention analysis to evaluate the effect of the CCC intervention and examined: (1) the frequency of testing for glycated hemoglobin (HbAIC), cholesterol LDL level, and microalbumin screen and frequency of retinal and foot exam; (2) outcomes for HbAIC levels, lipid, and blood pressure control; and (3) health care service utilization. Patients with diabetes who received the CCC intervention (n = 329) were compared to a propensity score adjusted control group who are not exposed to the CCC intervention (n = 329). All of the data came from Electronic Medical Record. Four separate sets of analyses were conducted to demonstrate the effect of propensity score matching on results. RESULTS: The CCC intervention led to improvements in process measures, including more laboratory checks for HbAIC levels, microalbuminuria screens, retinal and foot exams and also increased primary care visits. However, the intervention did not improve metabolic control. CONCLUSIONS: CCC interventions offer promise in improving process measures within community health centers but need to be modified to improve metabolic control.

An anomaly within the Latino epidemiological paradox: the Latino adolescent male mortality peak.

OBJECTIVE: To describe the anomaly of the Latino adolescent male mortality peak in relation to the overall Latino epidemiological paradox and in relation to the need for new conceptual models describing the health of a culturally diverse population. DESIGN: Population-based study using California's 1989 to 1997 summary death files for death-related information and the State of California Department of Finance population estimates for population denominators for corresponding years. PARTICIPANTS: California's general population for 1989 to 1997, including California's 15- to 19-year-old and 20- to 24-year-old populations. In 1997, those 2 age groups numbered 4.3 million. MAIN OUTCOME MEASURES: Mortality rates for Latinos and African Americans compared with non-Hispanic whites expressed as relative risk (RR). RESULTS: Overall, the Latino RR of mortality follows the Latino epidemiological paradox in that it is lower (RR, <1.00) than that of non-Hispanic whites for most age groups and both sexes. The anomaly within this paradox is seen in Latino males aged 15 to 19 years (RR, 1.77; 95% confidence interval, 1.55-2.02) and 20 to 24 years (RR, 1.79; 95% confidence interval, 1.58-2.02). CONCLUSIONS: This period of elevated mortality risk is labeled the Latino adolescent male mortality peak, and it is an anomaly within the overall Latino epidemiological paradox.

Risk among young gay and bisexual men living with HIV.

The influence of sexual orientation was examined on sexual risk behaviors, disclosure patterns, substance use, and stressful live events among 231 gay and bisexual youth living with HIV. Youth were mainly of ethnic minority heritage: 69.3% were Hispanic, African American, or biracial. Although there were significant differences in gay and bisexual youth's self-label and patterns of sexual attraction and sexual partners, there were few differences in other behavioral risk acts. The frequency of sexual risk acts, substance use, stressful life events, and child sexual abuse were similar for gay and bisexual youth and similar across ethnic groups. Disclosure of sexual orientation was significantly more common among gay youth compared with bisexual youth. Gay and bisexual identification appears to be a more critical factor than ethnicity in placing youth at risk for HIV. Care providers need to screen youth for sexual orientation and behaviors at a young age and inquire about age of partners, substance use, and history of sexual abuse.

HIV Prevention Messages Targeting Young Latino Immigrant MSM.

Young Latino immigrant men who have sex with men (MSM) are at risk for HIV and for delayed diagnosis. A need exists to raise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed through collaboration between University of WA researchers and Entre Hermanos, a community-based organization serving Latinos. Building from a community-based participatory research approach, the researchers developed a campaign that was executed by Activate Brands, based in Denver, Colorado. The authors (a) describe the development of HIV prevention messages through the integration of previously collected formative data; (b) describe the process of translating these messages into PSAs, including the application of a marketing strategy; (c) describe testing the PSAs within the Latino MSM community; and (c) determine a set of important factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay.

Attitudes towards and Beliefs about HIV Testing among Latino Immigrant MSM: A Comparison of Testers and Nontesters.

Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis. An exploratory study using qualitative interviews that assess the beliefs and attitudes of 54 Latino immigrant MSM in Seattle, Washington, is presented. The goal of this research is to determine whether attitudinal differences exist between participants who had and had not been tested and to use any insight into the development of a media campaign to promote testing. Over one-third of the men have never been tested for HIV. Nontesters are more likely to be men who have sex with men and women, have less knowledge about HIV risks, perceive their sexual behaviors as less risky, and deflect HIV-related stigma. Testers are more likely to be self-identified as being gays. Both groups believe that fear of a positive result is the main barrier to testing. Both groups believe that family members have negative attitudes towards HIV testing and that having Latino staff at HIV testing sites hinders confidentiality. Financial concerns with regard to the cost of testing were also expressed by both groups. Based on these insights, recommended strategies for the development of HIV prevention and testing campaigns are made.

Comparing Measures of Late HIV Diagnosis in Washington State.

As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4(+) results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis. We also conducted tests for trend to determine whether the proportion of cases diagnosed late has changed over time. Both measures lead us to similar conclusions about late HIV diagnosis, suggesting that being male, older, foreign-born, or heterosexual increase the likelihood of late HIV diagnosis. Our findings reaffirm the validity of a time-based definition of late HIV diagnosis, while at the same time demonstrating the potential value of a lab-based measure.

The "Latina epidemiologic paradox" revisited: the role of birthplace and acculturation in predicting infant low birth weight for Latinas in Los Angeles, CA.

The "Latina epidemiologic paradox" refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.

A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth.

PURPOSE: We evaluate the efficacy of a short family intervention in reducing sexual risk behavior, drug use, and delinquent behaviors among homeless youth. METHODS: A randomized controlled trial of 151 families with a homeless adolescent aged 12 to 17 years. Between March 2006 and June 2009, adolescents were recruited from diverse sites in Southern California and were assessed at recruitment (baseline), and at 3, 6, and 12 months later. Families were randomly assigned to an intervention condition with five weekly home-based intervention sessions or a control condition (standard care). Main outcome measures reflect self-reported sexual risk behavior, substance use, and delinquent behaviors over the past 90 days. RESULTS: Sexual risk behavior (e.g., mean number of partners; p < .001), alcohol use (p = .003), hard drug use (p < .001), and delinquent behaviors (p = .001) decreased significantly more during 12 months in the intervention condition compared with the control condition. Marijuana use, however, significantly increased in the intervention condition compared with the control condition (p < .001). CONCLUSIONS: An intervention to reengage families of homeless youth has significant benefits in reducing risk over 12 months.

Newly homeless youth typically return home.

Newly homeless adolescents from Melbourne, Australia (n = 165) and Los Angeles, United States (n = 261) were surveyed and followed for 2 years. Most newly homeless adolescents returned home (70% U.S., 47% Australia) for significant amounts of time (39% U.S., 17% Australia more than 12 months) within 2 years of becoming homeless.