The Crisis Migration Experience Scale: Developing and validating a tool for Venezuelan youth and adults residing in Colombia.

OBJECTIVE: Although prior research has shown that an array of distinct experiences related to crisis migration are associated with mental health, there is a pressing need for a theory-driven, multidimensional measure to assess the broad spectrum of crisis migration experiences. As such, the present study focused on developing and validating the Crisis Migration Experience Scale (CMES) with a sample of Venezuelan migrants in Colombia. METHOD: Participants were adolescent (ages 12-17; n = 430) and adult migrants from Venezuela (ages 18+; n = 569). Randomly splitting the adolescent and adult samples in half, exploratory factor analysis and confirmatory factor analyses were conducted with 26 original items. After identifying a satisfactory factor structure to generate a 16-item CMES (CMES-16), we examined the associations of the CMES-16 with mental health outcomes. RESULTS: We provide evidence for reliability, factorial validity, and concurrent validity of scores generated by the CMES-16 in a sample of Venezuelan crisis migrants in Colombia. Whereas our a priori conceptualization included seven domains, the exploratory and confirmatory factor analyses indicated that four are especially salient: material hardship, desperation, danger, and unplanned departure. CONCLUSIONS: Crisis migration is an increasingly important construct frequently referenced in the literature on migrant health and by international humanitarian organizations. The number of crisis migrant groups worldwide is increasing, with Ukrainians and Afghans recently added to the list of such groups, along with Venezuelans, Syrians, South Sudanese, Iraqis, and Central Americans. Developing and validating the CMES-16 with Venezuelan crisis migrants opens up important avenues of research, including work that incorporates other crisis migrant populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Online xenophobia and mental health among Venezuelan migrant youth in Colombia: The interplay with "in-person" discrimination.

Emerging research provides insights into migration-related cultural stress experiences and mental health among Venezuelan migrants; however, prior studies have not considered the critical distinction between online xenophobia and in-person discrimination. To address this gap, we assess the psychometric properties of an abbreviated version of the Perceived Online Racism Scale (PORS) with Venezuelan migrant youth and examine the interplay between online xenophobia, in-person discrimination, and mental health. Survey data were collected from Venezuelan migrant youth (N = 319; ages 13-17, 49.5% female) in Colombia in April-July 2023. Confirmatory factor analysis (CFA) was used to examine the PORS, and multiple regression was conducted to examine key associations. The CFA showed excellent model fit: χ²(7) = 13.498, p = .061; comparative fit index = .989; Tucker-Lewis index = .977; root-mean-square error of approximation = .055; standardized root-mean-square residual = .026. Controlling for demographic factors, online xenophobia was associated with depressive symptoms (ß = .253, p < .001) and anxiety (ß = .200, p = .001). The online xenophobia-mental health association weakened when controlling for in-person discrimination but remained nevertheless significant (depression: ß = .181, p = .002, anxiety: ß = .135, p = .026). Interaction effects (Online × In-Person) revealed a pattern in which greater exposure to online xenophobia was associated with greater distress, but only at relatively low levels of in-person discrimination. Findings provide new insights regarding (a) the properties of an increasingly relevant measure of cultural stress, (b) how online xenophobia relates to mental health, and (c) the interplay of online and in-person cultural stressors vis-à-vis mental health among Venezuelan migrant youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring Anxiety Among Latino Immigrant Populations: Within-Country and Between-Country Comparisons.

Anxiety is the most prevalent mental health disorder among adults worldwide. Given its increased prevalence among migrants due to their marginalized position in the societies where they reside, psychometric evaluations of anxiety measures such as the Generalized Anxiety Disorder-7 (GAD-7) are needed for use with migrants. The present study is the first attempt to compare the structure of GAD-7 scores for (a) different Latino groups in the same country and (b) the same Latino group in two different countries. Using three samples of Mexican and Venezuelan migrants (total N = 933), we provide reliability and validity evidence of the GAD-7 for use with adult Latino migrants. Utilizing confirmatory factor analysis and item response theory, we demonstrate that the GAD-7 is internally consistent, possesses a strong single-factor structure, and generates scores with equivalent psychometric properties. GAD-7 is appropriate for use with Mexican and Venezuelan migrants across differing gender groups and education levels.

Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru.

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

Evaluating effects of IBEM-U on decreasing alcohol consumption and heavy episodic drinking among university students in Colombia: Protocol for a randomized control trial.

Background: Alcohol misuse is a serious problem among university students in Colombia as well as in other Latin American countries. Studies show consistently that this population presents the highest rates of alcohol use. Despite such a situation, there is a lack of preventive programs for university students in this region of the world. The purpose of this paper is to present the protocol to evaluate a preventive strategy called IBEM-U, based on Motivational Interviewing and the I-Change Model. Method: This protocol shows how the evaluation of the effectiveness of the IBEM-U program will be carried out. A randomized control trial with a within-subjects design with one follow-up at six months after the post-test will be implemented. The comparison group will receive an alternative program similar in length but focusing on another issue. Around 1000 participants over 18 years of age, from at least six different universities around the country, will be recruited. Results: It is expected that the program will be effective in reducing past month alcohol consumption up to 15% in the experimental group as the main outcome. Secondary and tertiary outcomes include decreasing heavy episodic drinking and increasing knowledge, awareness, risk perception, attitude, self-efficacy, intention, and action planning, regarding heavy episodic drinking. Conclusion: IBEM-U can be considered a highly appropriate approach for reducing alcohol misuse among university students. The main reasons for these results are the self-imposed goals based on long-term purposes, that could be seriously affected by the ingestion of high amounts of alcohol.

Protocol for a process evaluation of SCALA study - Intervention targeting scaling up of primary health care-based prevention and management of heavy drinking and comorbid depression in Latin America.

This paper describes the plan for a process evaluation of a quasi-experimental study testing the municipal level scale-up of primary health care-based measurement and brief advice programmes to reduce heavy drinking and comorbid depression in Colombia, Mexico, and Peru. The main aims of the evaluation are to assess the implementation of intervention components; mechanisms of impact that influenced the outcomes; and characteristics of the context that influenced implementation and outcomes. Based on this information, common drivers of successful outcomes will be identified. A range of data collection methods will be used: questionnaires; interviews; observations; logbooks; and document analysis. All participating providers will complete a pen-and-paper questionnaire at recruitment and two time points during the implementation period. Providers attending training will complete post-training questionnaires. Additionally, 1080 patients will be invited to self-complete a patient questionnaire. One-in-ten participating providers and fifteen other key stakeholders will participate in semi-structured interviews. Training sessions and community advisory board meetings will be observed by a neutral observer. Logbooks will be kept by local research teams to document events affecting the implementation. Project related documentation and other relevant reports describing the context will be examined.

Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol.

Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.

The Venezuelan diaspora: Migration-related experiences and mental health.

Since 2015, the Venezuelan diaspora has poured forth from the Venezuelan sending context into an array of (mostly) middle-income receiving countries and into the United States (US) as well. For many Venezuelan migrants, post-migration reception has been mixed, and multiple studies suggest that mental health is an important challenge with discrimination and negative context reception contributing to mental health burden in terms of depression, anxiety, and posttraumatic stress. Cross-national research points to important sociodemographic differences between Venezuelan migrants resettled in South American contexts and in the US, and suggests that-on average-migration-related cultural stress is lower and mental health outcomes are better among those resettling in South Florida and elsewhere in the US.

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico.

Background: During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico. Methods: Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients' alcohol consumption with the three item 'Alcohol Use Disorders Identification Test' (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C). Results: Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico. Conclusions: Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.

Costs of an Alcohol Measurement Intervention in Three Latin American Countries.

Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.

Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America.

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.

A validation of the Perceived Negative Context of Reception Scale with recently-arrived Venezuelan immigrants in Colombia and the United States.

OBJECTIVES: Millions of Venezuelans have left their country in search of safety and stability in the United States (U.S.) and Colombia, two countries where recent increases in anti-immigrant rhetoric and sentiment have occurred. The Perceived Negative Context of Reception Scale captures the degree to which immigrants report feeling that people from their country are unwanted/marginalized within their new receiving context. In the present study, we examine the psychometric properties of the Perceived Negative Context of Reception Scale with recent Venezuelan immigrant adolescents and adults in the U.S. and Colombia. METHOD: We conducted confirmatory factor analysis using data from the Colombia and Miami's Newest Arrivals (CAMINAR) Study, which collected data from Venezuelan adults in Bogotá, Colombia, and South Florida in October-November 2017, and the Venezolanos en Nuevos Entornos (VENE) Youth Project which surveyed Venezuelan youth living in Florida between November 2018 and July 2019. RESULTS: We found that the negative context of reception evidenced strong psychometric properties among immigrants in both the U.S. and in Colombia, among adolescents and adults, and among male and female respondents. We also found that negative context of reception scores was associated with elevated scores on criterion-related factors-that is, perceived discrimination and depressive symptoms-in ways that are theoretically coherent and support measure validity. CONCLUSION: We provide new evidence that the Perceived Negative Context of Reception scale is reliable and valid for use with Venezuelan immigrants in the U.S. and Colombia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors associated with primary health care providers' alcohol screening behavior in Colombia, Mexico and Peru.

Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

A Comparison of Cut Points for Measuring Risk Factors for Adolescent Substance Use and Antisocial Behaviors in the U.S. and Colombia.

As the identification and targeting of salient risk factors for adolescent substance use become more widely used globally, an essential question arises as to whether U.S.-based cut points in the distributions of these risk factors that identify "high" risk can be used validly in other countries as well. This study examined proportions of youth at "high" risk using different empirically derived cut points in the distributions of 18 measured risk factors. Data were obtained from large-scale samples of adolescents in Colombia and the United States. Results indicated that significant (p < 0.05) differences in the proportions of "high" risk youth were found in 38.9% of risk factors for 6th graders, 61.1% for 8th graders, and 66.6% for 10th graders. Colombian-based cut points for determining the proportion of Colombian youth at "high" risk were preferable to U.S.-based cut points in almost all comparisons that exhibited a significant difference. Our findings suggest that observed differences were related to the type of risk factor (e.g., drug specific vs. non-drug specific). Findings from this study demonstrate the need for collecting large-scale national data on risk factors for adolescent substance use and developing country-specific cut points based on the distributions of these measures to avoid misidentification of youth at "high" risk.

Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care - a cross-sectional survey.

BACKGROUND: Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). METHODS: An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. RESULTS: Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). CONCLUSIONS: The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial.

PURPOSE: We aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured. METHODS: We undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage). RESULTS: The combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5). CONCLUSIONS: Training of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.

Community utilization of risk and protective factor data for prevention planning in Chile and Colombia.

Many effective community health service delivery systems implemented in the USA assess risk and protective factors (RPFs) for youth problem behaviors in a community, and report these data back to local coalitions for prevention planning. This study examined whether community prevention coalitions in Chile and Colombia perceived these reports of RPFs-based on the results of the Communities That Care Youth Survey-to be understandable, valid, useful, and worth disseminating. Thematic content analysis was used to analyze qualitative data collected from 7 focus groups with 75 coalition members. Results indicated heterogeneity between and within coalitions in terms of participants' understanding of RPFs. However, most participants found reports of RPFs to be easy to understand, thorough, 'true' to their communities, and useful for diagnosing and prioritizing needs, action planning, and mobilizing others in their communities. Findings suggest the viability of preventive systems that rely on community-level RPF data, for use in Latin America.

Health risk behavior and cultural stress among Venezuelan youth: a person centered approach.

BACKGROUND: In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited. OBJECTIVES: Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support). METHOD: Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male). RESULTS: We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US. CONCLUSION: It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.

Assessing Community Readiness for Preventing Youth Substance Use in Colombia: A Latent Profile Analysis.

The growing use of evidence-based preventive interventions for youth substance use in Latin American countries has prompted governments, researchers, and practitioners to ask if communities are ready for implementing these interventions, especially in light of the elevated costs and long-term commitment necessary for successful implementation. This study explores the construct validity of a measure of community readiness for prevention, using confirmatory factor and latent profile analyses of 7 measures theorized to be indicators of community readiness for implementing preventive interventions for youth substance use. Data were obtained from 211 community leaders in 16 communities in Colombia. Results indicate that community readiness can be represented as a unidimensional construct with multiple profiles of varying levels of readiness. Findings suggest community readiness can be measured adequately as a latent construct and that its indicators can be used diagnostically to assess areas where readiness could be improved for better implementation of evidence-based preventive interventions.