A Person-Centered Analysis of Adolescent Multicultural Socialization Niches and Academic Functioning.

Despite the growing cultural diversity worldwide, there is scarce research on how socialization processes prepare youth to respond to increasing multicultural demands and the degree to which these socialization opportunities inform youth academic functioning. This study used a person-centered approach to identify profiles or niches based on the degree and consistency of multicultural socialization experiences across school, peer, and family settings and to examine the associations between identified niches and markers of academic functioning (i.e., emotional and behavioral academic engagement, academic aspirations and expectations) in a sample of adolescents (N = 717; Mage = 13.73 years). Participants (49.9% girls) were from the U.S. Southwest and represented multiple ethno-racial backgrounds (31.8% Hispanic/Latinx, 31.5% Multiethnic, 25.7% White, 7.3% Black or African American, 1.4% Asian American or Pacific Islander, 1.4% American Indian or Alaska Native, and 1% Arab, Middle Eastern, or North African). Six distinct multicultural socialization niches were identified. Three niches had similar patterns across school-peer-family but ranged in the degree of socialization. The cross-setting similar higher socialization niche (Niche 6) demonstrated greater socialization than the cross-setting similar moderate (Niche 5) and lower socialization (Niche 4) niches, which had moderate and lower socialization, respectively. Three niches demonstrated cross-setting dissimilarity which ranged in the type of cross-setting contrast and the degree of socialization. The cross-setting dissimilar school contrast socialization niche (Niche 3) had greater dissimilarities between socialization opportunities in the school setting compared to the peer and family settings and demonstrated the lowest levels of socialization of all niches. The other two niches, the cross-setting dissimilar peer contrast (Niche 1) and greater peer contrast socialization (Niche 2) niches had larger dissimilarities between socialization opportunities in the peer setting than the school and family settings. In the former, however, the contrast was lower, and socialization ranged between very low to low. In the latter, the contrast was higher and socialization ranged from very low to moderate. Most adolescents were in the cross-setting similar lower socialization niche or in the cross-setting dissimilar niches. Adolescents in the cross-setting similar higher multicultural socialization demonstrated greater emotional and behavioral academic engagement than adolescents in most of the other niches. Adolescents in the cross-setting dissimilar school contrast niches demonstrated lower emotional and behavioral academic engagement and lower academic expectations than adolescents in some of the other niches. The results emphasize the collective role of school, peer, and family multicultural socialization on emotional and behavioral academic engagement.

Sex Differences in Stroke Hospitalization Incidence, 30-Day Mortality, and Readmission in a Regional Medical Center in the Southwestern United States.

OBJECTIVES: This study explores sex differences in ischemic stroke hospitalization incidence, 30-day mortality, and 30-day readmission in a southwestern US medical center. METHODS: Ischemic stroke admissions in a regional medical center in the southwestern United States were obtained for a 6.5-year time frame (N = 1968). Logistic regression models examine the adjusted effects of sex on 30-day mortality and 30-day readmission outcomes among individuals hospitalized for ischemic stroke. RESULTS: Findings confirm that although women experience higher mortality than men (9.1% vs 6.7%), the sex disparity in mortality is explained by the age distribution of strokes. Women experience far more strokes and deaths because of stroke at older ages. No differences in principal procedure or 30-day readmission emerged. CONCLUSIONS: Men experienced higher stroke hospitalization incidence, although women exhibited higher 30-day mortality. Age composition explained sex differences in mortality, but higher male stroke hospitalization incidence represents a larger public health issue that suggests the need for behavioral change at the population level. No meaningful sex differences emerged in treatment, mortality, or readmission.

Worry Among Latinx Young Adults: Relations to Pain Experience, Pain-Related Anxiety, and Perceived Health.

Latinx are one of the largest and most rapidly growing segments of the United States (U.S.) population that is significantly impacted by health disparities, including somatic health problems. Young Latinx adults (ages 18-25 years) are at a greater risk for being affected by such health inequalities and there is a need to understand individual-based differences that may contribute to and maintain somatic symptoms, including pain experience, pain beliefs, and perceptions of health. Thus, the current study investigated the explanatory role of worry in association between pain intensity, pain disability, pain-related anxiety, and perceived health among Latinx college students. Participants included 401 (Mage = 21 years; SD = 2.02; 83% female) Latinx students at a large, southwestern university. Results indicated that greater levels of worry were related to increased levels of pain intensity, pain disability, pain-related anxiety, and lower levels of perceived health. These findings were evident above and beyond variance accounted for by gender, age, physical functioning, and subjective social status. Overall, the results from the present investigation suggest that there is greater risk for more severe pain experiences, maladaptive beliefs regarding pain, and worse perceptions of health status among Latinx young adults who experience elevated levels of worry.

Perceived Stress in Black and Latino Male Firefighters: Associations with Risk and Protective Factors.

Objective: To compare the prevalence of work-related protective and risk factors among Black and Latino male firefighters and to examine the association of these factors to perceived stress among both ethnic groups. Design Setting Participants: Participants included 1,036 male, career firefighters who self-identified as Black (n=477) or Latino (n=559) from a large fire department in a major metropolitan city in the southwestern United States. As part of a department-wide suicide prevention program conducted in 2008, participants completed an anonymous and voluntary mental health needs survey. Measures: The needs survey included questions regarding prevalence of work-related protective and risk factors, the RAPS-4 to assess substance abuse problems, and the 10-item Perceived Stress Scale. Results: Results of regression analyses indicated that for both Black and Latino male firefighters, alcohol abuse (ß =.13, ß =.22), self-reported good health (ß = -.23, ß =-.24) and a positive partner/spouse relationship (ß =-.14, ß = -.15) were related to perceived stress. In addition, having a second job (ß = .12) and a sense of life calling (ß =-.10) were related to perceived stress only among Latino firefighters. All associations were in the expected direction as indicated by the signs of the standardized beta coefficients (ß). Conclusion: Black and Latino male firefighters reported relatively high levels of perceived stress. However, there were both differences and similarities in the factors associated to perceived stress among the ethnic groups. Therefore, interventions to help firefighters reduce or manage stress need to take into account that factors associated with perceived stress may vary by ethnic group.

Comprehensive Assessment of Health Needs of Young Minority Males Attending a Family Planning Clinic.

The objective of this study was to assess the overall health, including sexual and reproductive health (SRH) knowledge and needs, sexual behaviors, and testicular health practices among young minority males. Anonymous questionnaires were administered to 18- to 25-year-old males receiving services at health clinics in a large southwestern U.S. city. The survey was completed by 258 males with a mean age of 20.8 years. Most young males (67.1%) identified as African American, and 32.9% as Hispanic. Results suggest study participants lack SRH knowledge related to pregnancy and condom effectiveness, and engage in risky sexual behavior including not using birth control at their last sexual encounter. Although 21.6% of participants had a sexually transmitted infection (STI) in the past year, approximately 80% perceived their STI/HIV risk as very low or low. Respondents had low engagement and lack of knowledge of testicular health practices. The majority of respondents (71.1%) reported having been in a physical fight one or more times and 18.1% reported being victims of intimate partner violence. These data support a need for comprehensive health services for minority young males.

Transitions in Living Arrangements Among Older Mexican Americans.

This study examines the transition from independent living to a coresidential living arrangement across the late life course among older unmarried (i.e., widowed, divorced/separated, and single) Mexican Americans. Using 18 years' worth of panel data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, event history analyses revealed that age at migration, physical disability, and cognitive impairment were strong predictors of the transition to a coresidential living arrangement. Importantly, a decline in physical and cognitive abilities heightened the risk of transition to a coresidential living arrangement, net of time-variant measures of disability and impairment. These findings provide evidence for incorporating a dynamic approach to examining living arrangements across the late life course for Mexican-origin Hispanics living in the United States, with implications for policy and service providers.

Spatial analysis of drug poisoning deaths in the American West, particularly Utah.

BACKGROUND: Most states in the Western US have high rates of drug poisoning death (DPD), especially New Mexico, Nevada, Arizona and Utah (UT). This seems paradoxical in UT where illicit drug use, smoking and drinking rates are low. To investigate this, spatial analysis of county level DPD data and other relevant factors in the Western US and UT was undertaken. METHODS: Poisson kriging was used to smooth the DPD data, populate data gaps and improve the reliability of rates recorded in sparsely populated counties. Links between DPD and economic, environmental, health, lifestyle, and demographic factors were investigated at four scales using multiple linear regression. LDS church membership and altitude, factors not previously considered, were included. Spatial change in the strength and sign of relationships was investigated using geographically weighted regression and significant DPD clusters were identified using the Local Moran's I. RESULTS: Economic factors, like the sharp social gradient between rural and urban areas were important to DPD throughout the west. Higher DPD rates were also found in areas of higher elevation and the desert rural areas in the south. The unique characteristics of DPD in UT in terms of health and lifestyle factors, as well as the demographic structure of DPD in the most LDS populous states (UT, Idaho, Wyoming), suggest that high DPD in heavily LDS areas are predominantly prescription opioid related whereas in other Western states a larger proportion of DPD might come from illicit drugs. CONCLUSION: Drug policies need to be adapted to the geographical differences in the dominant type of drug causing death. Educational materials need to be marketed to the demographic groups at greatest risk and take into account differences in population characteristics between and within States. Some suggestions about how such adaptations can be made are given and future research needs outlined.

Associations of Eating Two Breakfasts With Childhood Overweight Status, Sociodemographics, and Parental Factors Among Preschool Students.

BACKGROUND: School breakfast may contribute to increased risk for obesity because children may be consuming two breakfasts: at home and at school. The purpose of this study is to determine the prevalence of preschoolers consuming two breakfasts and to assess relationships with overweight/obesity and other factors. METHOD: Head Start parents (n = 273, 84.6% Hispanic) in the southwest completed cross-sectional surveys on child breakfast patterns and parental perceptions of school breakfast and personal breakfast consumption habits. Surveys were linked with sociodemographics and body mass index in Head Start databases in 2013. General estimating equation binomial models (schools as a random effect) were used to assess the relationship between two breakfasts (at home and school) and key variables, adjusting for gender, race, ethnicity, and household income. RESULTS: The prevalence of consuming two breakfasts was 34%. Children's overweight/obesity status was inversely related to two-breakfast consumption, but it was significant only for the Hispanic subgroup; the odds of being overweight/obese was 60% lower among those who ate two breakfasts (p < .05). The likelihood of consuming a second breakfast increased over twofold among children who woke up before 7 a.m. (p = .004). Among Hispanic families, a significant association was observed between children's two-breakfast consumption and parental perceptions about whether they perceived the breakfast at Head Start was culturally appropriate (p = .040). CONCLUSIONS: Not only was eating two breakfast not associated with obesity, the association was in the opposite of the expected direction and significant for Hispanic participants. Factors such as earlier wake-up time were related to reports of two breakfast intake. While more research is needed, these findings provide information for policy makers and practitioners; caution should be exercised when suggesting that breakfast programs may be related to the consumption of two breakfasts and the risk for childhood obesity, particularly among the preschool students in this study.

The Emergence of Zoonotic Onchocerca lupi Infection in the United States--A Case-Series.

This case-series describes the 6 human infections with Onchocerca lupi, a parasite known to infect cats and dogs, that have been identified in the United States since 2013. Unlike cases reported outside the country, the American patients have not had subconjunctival nodules but have manifested more invasive disease (eg, spinal, orbital, and subdermal nodules). Diagnosis remains challenging in the absence of a serologic test. Treatment should be guided by what is done for Onchocerca volvulus as there are no data for O. lupi. Available evidence suggests that there may be transmission in southwestern United States, but the risk of transmission to humans is not known. Research is needed to better define the burden of disease in the United States and develop appropriately-targeted prevention strategies.

Diabetes among Latinos in the Southwestern United States: border health and binational cooperation / Diabetes en la población de origen latino del sudoeste de los Estados Unidos: salud fronteriza y cooperación binacional

This analysis reviews cooperation between the four border states of the United States of America (Arizona, California, New Mexico, and Texas) and international partners in Mexico with regard to type 2 diabetes among Latinos. Binational cooperation, academic collaboration, preventative health initiatives, and efforts to improve health care access for the border population are highlighted. This meta-analysis of the literature points out causative factors of the increased type 2 diabetes prevalence among Latinos in the United States; an inverse correlation between diabetes and education and socioeconomic level; contributing factors, including barriers with language, health care payment, transportation, and underestimating diabetes implications; and a lack of social and environmental support for disease management. Medical and indirect costs in socioeconomic terms are also included. Cooperation between the United States and Mexico may be beneficial to promoting further collaborative efforts between these nations, and serve as a template for greater cooperative efforts to mitigate the substantial public health and socioeconomic implications of type 2 diabetes globally.

Este análisis examina la cooperación de los cuatro estados fronterizos de los Estados Unidos de América (Arizona, California, Nuevo México y Texas) y los socios internacionales de México con respecto a la diabetes de tipo 2 en la población de origen latino. Se destacan la cooperación binacional, la colaboración académica, las iniciativas de prevención en salud, y las actividades orientadas a mejorar el acceso a la atención de salud por parte de la población de la frontera. Este metanálisis de la bibliografía señala los factores causales del aumento de la prevalencia de la diabetes de tipo 2 en la población de origen latino de los Estados Unidos; una correlación inversa entre la diabetes y el grado de formación y el nivel socioeconómico; los factores contribuyentes, incluidas las barreras relacionadas con el idioma, el pago de la atención de salud, el transporte, y la infravaloración de las consecuencias de la diabetes; y una falta de apoyo social y ambiental para el tratamiento de la enfermedad. También se incluyen los costos médicos y los indirectos en términos socioeconómicos. La cooperación entre los Estados Unidos y México - podría ser beneficiosa para promover nuevas iniciativas de colaboración entre estas naciones y servir como mo-delo a otras iniciativas más amplias de cooperación dirigidas a mitigar las sustanciales consecuencias de salud pública y socioeconómicas de la diabetes de tipo 2 a escala mundial.

Latent variables may be useful in pain's assessment.

BACKGROUND: Unobserved "latent" variables have the potential to minimize "measurement error" inherent to any single clinical assessment or categorical diagnosis. OBJECTIVES: To demonstrate the potential utility of latent variable constructs in pain's assessment. DESIGN: We created two latent variables representing depressive symptom-related pain (Pd) and its residual, "somatic" pain (Ps), from survey questions. SETTING: The Hispanic Established Population for Epidemiological Studies in the Elderly (H-EPESE) project, a longitudinal population-based cohort study. PARTICIPANTS: Community dwelling elderly Mexican-Americans in five Southwestern U.S. states. The data were collected in the 7th HEPESE wave in 2010 (N = 1,078). MEASUREMENTS: Self-reported pain, Center for Epidemiological Studies Depression Scale (CES-D) scores, bedside cognitive performance measures, and informant-rated measures of basic and instrumental Activities of Daily Living. RESULTS: The model showed excellent fit [χ2 = 20.37, DF = 12; p = 0.06; Comparative fit index (CFI) = 0.998; Root mean statistical error assessment (RMSEA) = 0.025]. Ps was most strongly indicated by self-reported pain-related physician visits (r = 0.48, p ≤0.001). Pd was most strongly indicated by self-reported pain-related sleep disturbances (r = 0.65, p <0.001). Both Pd and Ps were significantly independently associated with chronic pain (> one month), regional pain and pain summed across selected regions. Pd alone was significantly independently associated with self-rated health, life satisfaction, self-reported falls, Life-space, nursing home placement, the use of opiates, and a variety of sleep related disturbances. Ps was associated with the use of NSAIDS. Neither construct was associated with declaration of a resuscitation preference, mode of resuscitation preference declaration, or with opting for a "Do Not Resuscitate" (DNR) order. CONCLUSION: This analysis illustrates the potential of latent variables to parse observed data into "unbiased" constructs with unique predictive profiles. The latent constructs, by definition, are devoid of measurement error that affects any subset of their indicators. Future studies could use such phenotypes as outcome measures in clinical pain management trials or associate them with potential biomarkers using powerful parametric statistical methods.

Diabetes among Latinos in the Southwestern United States: border health and binational cooperation.

This analysis reviews cooperation between the four border states of the United States of America (Arizona, California, New Mexico, and Texas) and international partners in Mexico with regard to type 2 diabetes among Latinos. Binational cooperation, academic collaboration, preventative health initiatives, and efforts to improve health care access for the border population are highlighted. This meta-analysis of the literature points out causative factors of the increased type 2 diabetes prevalence among Latinos in the United States; an inverse correlation between diabetes and education and socioeconomic level; contributing factors, including barriers with language, health care payment, transportation, and underestimating diabetes implications; and a lack of social and environmental support for disease management. Medical and indirect costs in socioeconomic terms are also included. Cooperation between the United States and Mexico may be beneficial to promoting further collaborative efforts between these nations, and serve as a template for greater cooperative efforts to mitigate the substantial public health and socioeconomic implications of type 2 diabetes globally.

Border health in the shadow of the Hispanic paradox: issues in the conceptualization of health disparities in older Mexican Americans living in the Southwest.

Mexican Americans have demonstrated lower than what would be expected mortality rates and disease prevalence, given their overrepresentation among those living in poverty. However, Mexican Americans living along the US-Mexico border have been documented as carrying a higher burden of disease and disability that seems to contradict or at least challenge evidence in support of a "Hispanic Paradox". The purpose of this paper is to evaluate the concept of border health as it relates to the conceptualization and measurement of health outcomes in older Mexican Americans living in the Southwest United States. Data for this study comes from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (Hispanic EPESE) wave 1 and mortality files up to wave 5. Border residence was determined using La Paz Agreement county and distance from a port of entry classifications. Statistical analysis was conducted to assess border versus non-border differences in cause of death, disability, disease prevalence and premature mortality. Adjusted regression models were used to predict cause of death, disability and disease-free life expectancy and premature mortality (i.e. occurring before life expectancy). Interaction models between border/non-border and median income were also performed. Finally, distance from the US-Mexico border was used to determine the effect of distance to the US-Mexico border in border-residing participants. The findings from this study indicate that participants in the HEPESE were more likely to be alive at Wave 5 if they resided in a border county, however more likely to transition into ADL disability status. These findings were not explained by behaviors, duration in the US or sociocultural characteristics of where they lived. Additionally, Hispanic EPESE subjects that lived in the border region were more likely to have died from old age and were less likely to be lost to follow up. Interaction models revealed significant effects for diabetes as a cause of death. Moreover, distance from a US-Mexico port of entry was significant for being alive at wave 5 for border-residing participants. Relative to non-border residing participants, border residing Mexican Americans in the Hispanic EPESE did not carry a uniformly higher burden of disease, however had a significantly greater odds of 10 year survival. These findings bring up issues of measurement and the importance of geographic location when it comes to evaluating disease burden and mortality in Mexican Americans.

A multivariable assessment quantifying effects of cohort-level factors associated with combined mortality and culling risk in cohorts of U.S. commercial feedlot cattle.

Economic losses due to cattle mortality and culling have a substantial impact on the feedlot industry. Since criteria for culling may vary and may affect measures of cumulative mortality within cattle cohorts, it is important to assess both mortality and culling when evaluating cattle losses over time and among feedlots. To date, there are no published multivariable assessments of factors associated with combined mortality and culling risk. Our objective was to evaluate combined mortality and culling losses in feedlot cattle cohorts and quantify effects of commonly measured cohort-level risk factors (weight at feedlot arrival, gender, and month of feedlot arrival) using data routinely collected by commercial feedlots. We used retrospective data representing 8,904,965 animals in 54,416 cohorts from 16 U.S. feedlots from 2000 to 2007. The sum of mortality and culling counts for each cohort (given the number of cattle at risk) was used to generate the outcome of interest, the cumulative incidence of combined mortality and culling. Associations between this outcome variable and cohort-level risk factors were evaluated using a mixed effects multivariable negative binomial regression model with random effects for feedlot, year, month and week of arrival. Mean arrival weight of the cohort, gender, and arrival month and a three-way interaction (and corresponding two-way interactions) among arrival weight, gender and month were significantly (P<0.05) associated with the outcome. Results showed that as the mean arrival weight of the cohort increased, mortality and culling risk decreased, but effects of arrival weight were modified both by the gender of the cohort and the month of feedlot arrival. There was a seasonal pattern in combined mortality and culling risk for light and middle-weight male and female cohorts, with a significantly (P<0.05) higher risk for cattle arriving at the feedlot in spring and summer (March-September) than in cattle arriving during fall, and winter months (November-February). Our results quantified effects of covariate patterns that have been heretofore difficult to fully evaluate in smaller scale studies; in addition, they illustrated the importance of utilizing multivariable approaches when quantifying risk factors in heterogeneous feedlot populations. Estimated effects from our model could be useful for managing financial risks associated with adverse health events based on data that are routinely available.

Prevalence and type of BRCA mutations in Hispanics undergoing genetic cancer risk assessment in the southwestern United States: a report from the Clinical Cancer Genetics Community Research Network.

PURPOSE: To determine the prevalence and type of BRCA1 and BRCA2 (BRCA) mutations among Hispanics in the Southwestern United States and their potential impact on genetic cancer risk assessment (GCRA). PATIENTS AND METHODS: Hispanics (n = 746) with a personal or family history of breast and/or ovarian cancer were enrolled in an institutional review board-approved registry and received GCRA and BRCA testing within a consortium of 14 clinics. Population-based Hispanic breast cancer cases (n = 492) enrolled in the Northern California Breast Cancer Family Registry, negative by sequencing for BRCA mutations, were analyzed for the presence of the BRCA1 ex9-12del large rearrangement. RESULTS: Deleterious BRCA mutations were detected in 189 (25%) of 746 familial clinic patients (124 BRCA1, 65 BRCA2); 21 (11%) of 189 were large rearrangement mutations, of which 62% (13 of 21) were BRCA1 ex9-12del. Nine recurrent mutations accounted for 53% of the total. Among these, BRCA1 ex9-12del seems to be a Mexican founder mutation and represents 10% to 12% of all BRCA1 mutations in clinic- and population-based cohorts in the United States. CONCLUSION: BRCA mutations were prevalent in the largest study of Hispanic breast and/or ovarian cancer families in the United States to date, and a significant proportion were large rearrangement mutations. The high frequency of large rearrangement mutations warrants screening in every case. We document the first Mexican founder mutation (BRCA1 ex9-12del), which, along with other recurrent mutations, suggests the potential for a cost-effective panel approach to ancestry-informed GCRA.

Sugar, stress, and the Supplemental Nutrition Assistance Program: early childhood obesity risks among a clinic-based sample of low-income Hispanics.

The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white children. Recent literature suggests that obesity has early origins, leading scholars to call for interventions in pregnancy and infancy. However, there is little theoretical or empirical research to guide the development of early prevention programs for Hispanics. The present study seeks to identify risk factors for early childhood obesity among a low-income, predominately Hispanic sample. Data were gathered to inform the design of a primary care childhood obesity prevention program targeting pregnancy through age 12 months. Baseline data were gathered on 153 women attending the clinic for prenatal care or for their child's 2, 6 or 12 month well-check. All women completed surveys on diet, exercise, social support, food security, stress, infant feeding practices, health, and demographics. For women with children (n = 66), survey data were matched with medical records data on infant weight. Results reveal that 55 % of women in the sample had an infant profiling in the 85th percentile or higher, confirming the need for an early childhood obesity intervention. While mothers exhibited several potential risk factors for childhood obesity (e.g. fast food consumption), only maternal consumption of sweets and sugar-sweetened beverages, stress, and SNAP (food stamp receipt) were associated with infant overweight. Findings further reveal that stress and SNAP relate to child overweight, in part, through mothers' sugar-sweetened beverage consumption. Results suggest that obesity prevention efforts must address specific individual choices as well as the external environment that shapes these consumption patterns.

Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk.

A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.

Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites.

BACKGROUND: The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old. OBJECTIVE: To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. METHODS: This study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004-2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations. RESULTS: Heart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA. CONCLUSION: Health-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.

Psychosocial and health impacts of uranium mining and milling on Navajo lands.

The uranium industry in the American Southwest has had profoundly negative impacts on American Indian communities. Navajo workers experienced significant health problems, including lung cancer and nonmalignant respiratory diseases, and psychosocial problems, such as depression and anxiety. There were four uranium processing mills and approximately 1,200 uranium mines on the Navajo Nation's over 27,000 square miles. In this paper, a chronology is presented of how uranium mining and milling impacted the lives of Navajo workers and their families. Local community leaders organized meetings across the reservation to inform workers and their families about the relationship between worker exposures and possible health problems. A reservation-wide effort resulted in activists working with political leaders and attorneys to write radiation compensation legislation, which was passed in 1990 as the Radiation Exposure Compensation Act (RECA) and included underground uranium miners, atomic downwinders, and nuclear test-site workers. Later efforts resulted in the inclusion of surface miners, ore truck haulers, and millworkers in the RECA Amendments of 2000. On the Navajo Nation, the Office of Navajo Uranium Workers was created to assist workers and their families to apply for RECA funds. Present issues concerning the Navajo and other uranium-impacted groups include those who worked in mining and milling after 1971 and are excluded from RECA. Perceptions about uranium health impacts have contributed recently to the Navajo people rejecting a resumption of uranium mining and milling on Navajo lands.

Hopelessness, family stress, and depression among Mexican-heritage mothers in the southwest.

This article reports on the findings of a study conducted with a sample of 136 Mexican-heritage mothers residing in a large southwestern metropolitan area. From a risk-and-resiliency perspective, hopelessness was approached as a culturally specific response to family stress and other challenges encountered by Mexican immigrants. Although Mexican-heritage women and other Latinas have higher prevalence rates of psychiatric disorders than their male counterparts, they experience disparity in accessing mental health services. Multiple regression analysis was used to explore the relationships among hopelessness, depression, social support, and other variables. Culturally rooted resiliency and a sense of optimism connected to immigration appear to shelter Mexican-heritage mothers from hopelessness and depression. A very large households and nonworking status were found to elevate the risk of hopelessness. Because poverty and acculturation levels were not related to hopelessness or depression, further culturally specific research distinguishing hopelessness from depression is recommended. Given that hopelessness sometimes presents itself independently from depression, implications for practice include the need to refine mental health assessment tools to capitalize on the resiliency among immigrant mothers and avoid misdiagnosis.