Arriba por la Vida Estudio: a randomized controlled trial promoting standing behavior to reduce sitting time among postmenopausal Latinas.

Postmenopausal Hispanic/Latina (N = 254) women with a body mass index (BMI) ≥ 25 kg/m2 were randomized to an intervention to reduce sitting time or a comparison condition for 12 weeks. The standing intervention group received three in-person health-counseling sessions, one home visit, and up to eight motivational interviewing calls. The heart healthy lifestyle comparison group (C) received an equal number of contact hours to discuss healthy aging. The primary outcome was 12-week change in sitting time measured via thigh-worn activPAL. Group differences in outcomes were analyzed using linear mixed-effects models. Participants had a mean age of 65 (6.5) years, preferred Spanish language (89%), BMI of 32.4 (4.8) kg/m2, and sat for an average of 540 (86) minutes/day. Significant between-group differences were observed in reductions of sitting time across the 12-week period [Mdifference (SE): C - 7.5 (9.1), SI - 71.0 (9.8), p < 0.01]. Results demonstrate that coaching models to reduce sitting are feasible and effective.

Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes.

We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.

Colorectal cancer screening among Hispanics/Latinos in the HCHS/SOL sociocultural ancillary study.

Latino adults are more likely to be diagnosed with colorectal cancer (CRC) at later stages compared to white adults which may be explained by disparities in screening rates. The aim of this study was to examine factors associated with three CRC screening indicators [i.e., 1) any CRC screening ever (via, fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy); 2) FOBT in last year, 3) sigmoidoscopy/colonoscopy in last 10 years) among US Hispanics/Latinos. We analyzed population-based data collected in 2008-2011 from 2265 adults aged 50-75 from San Diego, Bronx, Miami and Chicago from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Based on the Behavioral Model of Health Services Use, the following correlates of CRC screening were examined: predisposing (i.e., age, education, income, acculturation), enabling (i.e., recent physician visit, insurance, recent mammogram), and need (i.e., health-related quality of life and family/personal history of cancer) factors. Separate logistic regression models were analyzed for the three CRC screening indicators. Enabling factors associated with all CRC screening indicators included: health insurance, a recent physician visit, and a mammogram in the last year (women only). For women, being older, more acculturated (i.e., English language or foreign-born but in the US for 10 or more years), and having a personal history of cancer was associated with at least one CRC screening. Findings suggest that improving access and utilization of care among Hispanics/Latinos may be critical for earlier CRC diagnosis and survival.

Alcohol use, acculturation and socioeconomic status among Hispanic/Latino men and women: The Hispanic Community Health Study/Study of Latinos.

The objective of this study was to examine the prevalence and patterns of alcohol use among U.S. Hispanic/Latino adults of diverse backgrounds. The population-based Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 years at time of recruitment, from four US metropolitan areas between 2008-11. Drinking patterns and socio-demographics questionnaires were administered as part of the baseline examination. The relationship between age, sex, socio-demographics, acculturation, current alcohol use, and alcohol risk disorder, defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [no risk (i.e., never drinker), low risk (i.e., women<7 drinks/week; men<14 drinks/week), and at-risk (i.e., women>7 drinks/week; men>14 drinks/week)] were assessed in unadjusted and adjusted multinomial logistic regression analyses. Men reported a higher prevalence than women of at-risk drinking. For women, increased odds of at-risk alcohol use was associated with: a younger age, greater education, full-time employment, and acculturation after adjustment. For men, having a lower income (vs. higher income) or a higher income (vs. not reported) and being employed fulltime (vs. retired) was associated with at-risk alcohol use. For both men and women, there were variations in odds of at-risk drinking across Hispanic/Latino heritage backgrounds, after adjustment. Exact values, odds ratios and p-values are reported within the text. Common factors across sex associated with at-risk drinking included being of Mexican background and being employed full-time. Intervention strategies should consider diversity within the Hispanic/Latino community when designing alcohol abuse prevention programs.

Socioeconomic Adversity, Social Resources, and Allostatic Load Among Hispanic/Latino Youth: The Study of Latino Youth.

OBJECTIVE: We examined associations among socioeconomic adversity, social resources, and allostatic load in Hispanic/Latino youth, who are at high risk for obesity and related cardiometabolic risks. METHODS: Participants were 1343 Hispanic/Latino youth (51% male; ages 8-16 years) offspring of Hispanic Community Health Study/Study of Latinos participants. Between 2012 and 2014, youth underwent a fasting blood draw and anthropometric assessment, and youth and their enrolled caregivers provided social and demographic information. A composite indicator of allostatic load represented dysregulation across general metabolism, cardiovascular, glucose metabolism, lipid, and inflammation/hemostatic systems. Socioeconomic adversity was a composite of caregiver education, employment status, economic hardship, family income relative to poverty, family structure, and receipt of food assistance. Social resources were a composite of family functioning, parental closeness, peer support, and parenting style variables. RESULTS: Multivariable regression models that adjusted for sociodemographic factors, design effects (strata and clustering), and sample weights revealed a significant, positive, association between socioeconomic adversity and allostatic load (ß = .10, p = .035), and a significant, inverse association between socioeconomic adversity and social resources (ß = -.10, p = .013). Social resources did not relate to allostatic load and did not moderate or help explain the association of adversity with allostatic load (all p values > .05). CONCLUSIONS: Statistically significant, but small associations of socioeconomic adversity with both allostatic load and social resources were identified. The small effects may partially reflect range restriction given overall high socioeconomic adversity and high social resources in the cohort.