Vaccine Uptake and Perspectives Among Latina Immigrant Mothers in Rural Communities in a Midwestern State.

PURPOSE: Examine the prevalence of and characteristics related to COVID-19 vaccine uptake. DESIGN: Quantitative and qualitative data collected at two-time points via phone interviews. SETTING: Rural Midwestern communities. SAMPLE: 109 Latina mothers with incomes < 185% FPL, at least one child < age 12 recruited from a Midwestern state based on two previous studies. MEASURES: Mothers responded to the following variables through a survey: Vaccine uptake measured by responses to, Have you received a vaccination shot for COVID-19. Tested predictors of vaccine uptake included: income, gender, education, immigration status, confidence in vaccine, belief the pandemic is over). Mothers' perspectives regarding the vaccine explored via responses to Why haven't you received COVID-19 vaccine?. ANALYSIS: Binary logistic regression analysis was conducted. Demographic variables and attitudes toward the vaccine served as predictors of mothers' vaccine uptake. Qualitative data were analyzed to shed light on mothers' perspectives on receiving the vaccine. RESULTS: Mother's confidence in the vaccine predicted vaccine uptake in 2021 (aOR=1.332, 95% CI: 1.07-1.65) and 2022 (aOR=1.48, 95%CI: 1.11-1.97). In 2021, income also predicted vaccine uptake (aOR=1; 95% CI: 1-1.002). Overarching themes: "vaccination is not necessary","mistrust of the vaccine", and "vaccine as protector". CONCLUSION: Vaccinated mothers viewed the vaccine as a protection from being infected or gravely ill. For unvaccinated mothers, messages are needed that communicate the vaccine can protect them from virus transmission from household members who unknowingly are infected, as well as from different virus strains.

Causal effects of mental health on food security.

Although mental health conditions are known to be associated with socioeconomic hardships, their causal effects remain largely unexplored. Using a sample of low-income families in the National Health Interview Survey (NHIS), we assess causal effects of serious mental illness (SMI) and related mental health conditions on family food security. We apply partial identification methods to account for fundamental endogeneity and measurement identification problems in a unified framework. To implement these methods, we combine a proxy measure of SMI in the NHIS with an estimate of the true rate of SMI from the Substance Abuse and Mental Health Services Administration. We also develop an innovative approach to approximate true prevalence rates when only self-reported prevalence rates are available. Applying relatively weak monotonicity assumptions on latent food security outcomes, we find that alleviating SMI would improve the food security rate by at least 9.5 percentage points, or 15 %. JEL codes: C21, I10, I38.

Hope for Latino immigrant youth: A longitudinal test of Snyder's Children's Hope Scale.

Objective: To examine the psychometric properties of Snyder's Children's Hope Scale (CHS) with first- and second-generation Latino immigrant youth, using item response theory, exploratory and confirmatory factor analysis, and measurement invariance tests. Background: Stress experienced by youth in 2020 has heightened interest in resilience factors such as hope. The CHS is widely used to measure hope but has not been validated for longitudinal assessments with immigrant populations. Methods: Participants were 233 low socioeconomic status first- and second-generation Latino immigrant youth (50.43% female, 62% U.S.-born, and 81% of Mexican heritage). Data were collected at two timepoints spanning 4 weeks. Results: Rather than the original six-item two-dimensional scale, our results supported a four-item one-dimensional scale, with excellent model fit, strong invariance across time, by gender and generation status, good reliability (α = .81), and the expected negative association with stress. Conclusions: The four-item Hope scale is suitable for longitudinal assessments with first- and second-generation Latino immigrant populations and can be used for examining differences by gender and generation status in research and practice to assess youth resilience. Implications: This study underscores the need for practitioners and researchers to rigorously investigate the psychometric properties of a measure before its use with diverse populations.

Validation of the Family Fear of Deportation Scale for youth.

Objective: This study reports on the psychometric properties of a new instrument to assess family fear of deportation in two versions (binary and polytomous response options). Background: The impact of fear of deportation extends beyond foreign-born youth to U.S. citizen children in families with unauthorized members, and negatively affects their academic achievement and their physical, mental, and behavioral health. A measure assessing levels of fear of deportation among youth is lacking. Methods: Participants were first- and second-generation Latino immigrant youth (N = 145 in Study 1 and N = 107 in Study 2). Item response theory (IRT), confirmatory factor analysis (CFA), correlation analysis, and reliability tests were used to assess the scale's psychometric properties. Results: The results supported a five-item binary version and a six-item polytomous version of the scale. Both demonstrated excellent model fit, good reliability, and criterion validity. Conclusions: The six-item polytomous version is slightly more parsimonious than the five-item binary version scale, has better internal consistency, and captures a modestly wider range of the construct. The binary version may be preferable for immigrant youth who prefer straightforward response options. Implications: Researchers and practitioners can use either version of the Family Fear of Deportation Scale with confidence to assess deportation-related fear among Latino immigrant youth.

PROMIS Pediatric Psychological Stress Measure: Validity for immigrant Latino youth.

Objective: This study assesses the psychometric properties of the four- and eight-item versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Psychological Stress Measure (PPSM) for use with Latino immigrant adolescents. Background: Immigrant Latino youth are exposed to numerous stressors that can have consequences affecting health well into adulthood. However, few studies have assessed the suitability of psychosocial measures for this group. Methods: Participants included 286 first- and second-generation immigrant Latino youth in middle school in an urban school district in the United States. Analyses included tests for reliability, validity, item characteristics, and measurement invariance across differing levels of acculturation and gender groups. Results: Both the four- and the eight-item PPSM are internally consistent, have strong construct validity, and strict factorial invariance across differing levels of acculturation. The four-item PPSM demonstrates strict invariance, but the eight-item version shows only configural invariance by gender. Conclusion: The PPSM is a rigorous measure when assessing immigrant Latino youth stress level. The four-item PPSM is brief, simple to administer, and appropriate for use with Latino youth across differing levels of acculturation and gender groups. Implications: The four-item PPSM lessens respondent fatigue and may be incorporated into tools practitioners and researchers use to assess perceived stress among immigrant Latino youth.

Randomized control trial of a childhood obesity prevention family-based program: "Abriendo Caminos" and effects on BMI.

Background: Hispanic individuals are at increased risk for obesity and other chronic health conditions. This article evaluates the effect of a family-based, childhood obesity primary prevention intervention in a community setting. Methods: A multi-site, randomized controlled trial community program with assessments at pre (T0), post-program (T1), and 6-months post-program (T2). Participating families were recruited from five sites. Only families of Mexican or Puerto Rican heritage with a least one child between 6 and 18 years were included in the study, without weight restrictions. Families were randomized to the intervention and control arms. Intervention families received six-2 h weekly workshops. Control families received printed generic nutrition and wellness information. Heights and weights were measured at the 3-time points to calculate BMI z-scores, BMI-percentiles, and weight status using age- and sex-specific growth charts, according to the CDC guidelines. Results: There were no differences in BMI-z scores between children in the intervention (n = 239) and control groups (n = 187) at T0. BMI z-scores decreased in the intervention group (-0.03, 95% CI, -0.066, -0.003, p = 0.032) at T1, but not in the control group at T1. Changes in BMI z-scores were not statistically significant at T2. Conclusion: The Abriendo Caminos intervention effectively prevented unhealthy weight gain in Hispanic children in the short-term, but not at 6-months post-intervention. Younger children and girls benefited more from the program at 6-months post-intervention. Additional efforts are needed to sustain long-term changes. Culturally-tailored programs can provide families with the knowledge to produce short-term changes and a potential pathway for sustainable changes in implementing healthy behaviors.

Economic Pressure and Parent Acculturative Stress: Effects on Rural Midwestern Low-Income Latinx Child Behaviors.

Contrary to the visible Latinx population growth in rural America, rural Latinx households have experienced far greater economic disparities compared to Whites. Family economic stress predicts parents' emotional distress, lower family functioning, and places children at high risk for behavior problems. However, few studies have examined the combined effects of economic and acculturative stress on rural Latinx child behaviors, nor the family stress process among rural Latinx immigrant families in the Midwest, a new settlement area for Latinx and other immigrants (Kandel & Cromartie, 2004). Guided by the family stress model (FSM), we examined the relationships among economic pressure, parent acculturative stress, maternal depressive symptoms, parenting competence and child internalizing and externalizing behaviors using a sample of 148 rural low-income Latinx immigrant mothers in a Midwestern state. Structural equation modeling was performed to test these relationships. Results revealed that higher levels of economic pressure and parent acculturative stress were related to higher levels of maternal depressive symptoms, which in turn were associated with lower parenting competence and eventually linking to higher levels of child externalizing behaviors. Maternal depressive symptoms were positively associated with child internalizing behaviors. Parent acculturative stress was also found to be directly linked to child internalizing and externalizing behaviors. Intervention programs that aim to promote health and well-being among rural Latinx immigrant mothers and their children may find it beneficial to incorporate information and strategies that lessen parent acculturative stress and depression, promote parenting competence, and connect families to resources to help reduce economic pressure.

Impact of hair type, hair sample weight, external hair exposures, and race on cumulative hair cortisol.

The biomarker cortisol assesses the impact of biopsychosocial stressors that activate the stress response system. Hair has emerged as a valid and non-invasive means of gauging cumulative cortisol deposited over month-long periods of time. Established protocols for the extraction of hair cortisol are being validated and refined in humans, yet methodological information about hair characteristics on cortisol remains limited. In addition to external hair exposures (e.g. dye, time spent outside), we examined hair categorization or type (e.g. kinky, straight) by extending a hair typing methodology for scientific use that is currently popular among hair care professionals. We then examined the interaction between hair type and race on cortisol levels with a hair questionnaire. Three studies were pooled to investigate how sample weight, hair type, race, heat exposures, and hair treatments impacted cumulative hair cortisol concentrations. Study 1 consisted of Adult Kenyan Medical Workers (N = 44); Study 2 Mexican and Mexican Americans (N = 106); and Study 3 American Youth (N = 107). We found significantly higher cortisol in 5 mg of hair when compared to larger sample weights, and higher cortisol in those who spent more time outdoors. Cortisol concentrations differed between racial groups and varied by hair type; moreover, there were directional differences in cumulative cortisol from straighter to curlier hair types which depended on racial group. In addition to demonstrating the impact of relatively novel control factors like hair sample weight, outdoor exposure, and hair type, the present study illustrates the importance of disentangling hair type and race to understand variability in cumulative hair cortisol. These influences should be included in future studies that measure hair cortisol.

Reducing Obesogenic Eating Behaviors in Hispanic Children through a Family-Based, Culturally-Tailored RCT: Abriendo Caminos.

Family-based interventions that incorporate culturally-tailored multi-component curricula and are grounded on evidence-based information and theoretical frameworks can help reduce the prevalence of obesity among Hispanic children. Abriendo Caminos: Clearing the Path to Hispanic Health is a multi-site culturally-tailored randomized control trial that aims to reduce obesity rates in Hispanic families by delivering education on nutrition, family wellness, and physical activity. This study evaluated the effect of the Abriendo Caminos six-week intervention on dietary behaviors of Hispanic children (6-18 years). Mothers (n = 365) reported their child's eating behavior intake using the U.S. Department of Education's Early Childhood Longitudinal Study protocol (ECLS). Pre/post dietary changes were evaluated using separate generalized estimating equation models adjusted for site, child sex, and child age group. Findings indicate a reduction in the frequency of sugar-sweetened beverages (OR 0.55, 95% CI 0.35, 0.87, p = 0.01), French fries (OR 0.56, 95% CI 0.36, 0.86, p = 0.009), and fast food (OR 0.55, 95% CI 0.36, 0.84, p = 0.006) consumption among children in the intervention arm. Additionally, children in the intervention arm increased their frequency of vegetable consumption (OR 1.84, 95% CI 1.08, 3.12, p = 0.03). The Abriendo Caminos intervention effectively improved four of eight eating behaviors in a short-term intervention.

Preventing substance use among Latino youth: Initial results from a multistate family-based program focused on youth academic success.

Background: Early initiation of alcohol or other substance use places adolescents at high risk for subsequent substance use disorders. Research on preventing substance use among Latino youth significantly lags behind the growth of this population.Objectives: To assess the effects of a family-based intervention on past 30-day substance use in a population of Latino early adolescents (ClinicalTrials.gov Identifier: NCT03642106).Methods: A first study followed a sample of 265 Latino adolescents (51% female) over 4 years (7th thru 10th grades) using an interrupted time series design to compare pre- to post-intervention trajectories. The second study compared post-trajectory slopes from the intervention group to a subsample of participants from the National Longitudinal Study of Youth (NLSY) who identified as Latino and were matched on age and gender. Both studies used a zero-inflated Poisson modeling approach.Results: A piecewise random intercept growth model showed non-significant differences between pre- to post-intervention trajectories for both the probability and frequency of alcohol (p = .30, .47) and tobacco use (p = .10, .37), and a significant increase in the probability of illegal drug use (p < .01) but not frequency (p = .65). The NLSY group significantly increased their probability of use across substances (all p < .01), and increased their frequency of use for alcohol (p < .05) and tobacco (p < .01).Conclusion: Longitudinal assessments comparing Latino youth to a non-equivalent control group indicate that strengthening family involvement in youths' schooling and promoting youth personal agency can prevent and/or reduce substance use during a developmental period in which use traditionally increases.

Shared Language Erosion: Rethinking Immigrant Family Communication and Impacts on Youth Development.

In this paper we make the case for Shared Language Erosion as a potential explanation for the negative outcomes described in the immigrant paradox for second- and third- generation immigrants (e.g., declines in physical, mental, and behavioral health). While not negating the important role of cultural adaptation, we posit that parent-child communication difficulties due to a process we are calling Shared Language Erosion is driving the observed affects previously attributed to changes in cultural values and beliefs. Shared Language Erosion is the process during which adolescents improve their English skills while simultaneously losing or failing to develop their heritage language; at the same time their parents acquire English at a much slower rate. This lack of a common shared language makes it difficult for parents and their adolescent children to effectively communicate with each other, and leads to increased parent-child conflict, reduced parental competence, aggravated preexisting flaws in parent-child attachment, and increased adolescent vulnerability to deviant peer influences.

Rural Midwestern Mexican Fathers' Perspectives on Family Food, Mealtimes, and Physical Activity.

Two focus group interviews with eight low-income Mexican fathers in two communities in a rural Midwestern state explored fathers' perceptions, behaviors, and roles related to child and family food consumption, mealtimes, and physical activity. On average, fathers were 34 years of age, had 10 years of formal education, and annual household incomes ranged from $36,250 to $46,249. Findings include the identification of fifteen themes through the process of thematic analysis that are organized by five thematic areas of interest (family food patterns, strategies for healthy eating, family roles in food shopping and preparation, family mealtimes, physical activity among families). Findings revealed ways fathers contributed to their children's and families' health and well-being, and challenges they faced. Health promotion efforts aimed at rural, low-income Mexican immigrant families can benefit from embracing fathers' perspectives and how they influence the health and well-being of their children and families.

The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers.

BACKGROUND: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. OBJECTIVE: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. METHODS: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. RESULTS: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. CONCLUSIONS: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone's tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives.

Procuring Health: Experiences of Mexican Immigrant Women in Rural Midwestern Communities.

Thematic analysis was used to analyze interview data from 15 first-generation Mexican immigrant women who resided in two rural Midwestern communities. Ten themes were identified and aligned with four thematic areas of interest ( meaning of being healthy, strategies to promote health, challenges to health, and supports for health). This study provides insights into the complexities and realities faced by Mexican immigrant women, as they strove to obtain optimal health in rural America, and contributes to the growing literature focused on health disparities among ethnic and racial minorities. Implications for research, professional practice, and public policy are discussed. Ethnographic and longitudinal studies that include the perspectives of populations that are difficult to reach such as first-generation Latino immigrant families are needed to further explore the nuances of achieving health in growing, diverse areas of rural America.

Health, Well-being, and Health Care Access in Rural Communities: Comparing Latino and Non-Latino White Low-income Families.

This study explores how low-income rural Latino children and their mothers differ from their non-Latino white counterparts in terms of health, well-being, and health care access. A subsample of non-Latino white (n = 201) and Latino (n = 157) children and their mothers was drawn from the Rural Families Speak about Health Project, a multistate, cross-sectional data set developed through mixed purposive sampling methods. Findings suggest that Latino children's families were disadvantaged in terms of child health and access to health care, whereas non-Latino white children's families were disadvantaged in terms of child behavior problems and maternal health and depression.