Acculturation, family cohesion, and mental health among Latinos living with HIV on the U.S.-Mexico border.

OBJECTIVE: The objective of the study was to investigate whether acculturation to U.S. culture is associated with greater posttraumatic stress disorder (PTSD) symptomatology through diminished family cohesion among Latinos living with HIV on the U.S.-Mexico border. METHOD: Baseline survey data were analyzed from a sample of Latinos seeking HIV care from a publicly funded HIV clinic in El Paso, Texas. We used a regression-based bootstrapping approach to test our mediation hypothesis. RESULTS: A total of 248 Latinos living with HIV completed the survey, with 96.4% being of Mexican descent, 19.4% female (gender self-identification), and 63.7% nonheterosexual (sexual orientation self-identification). Family cohesion mediated the relationship between U.S. acculturation and PTSD symptom scores (a1 ⁎ b1 = .03, 95% confidence interval [.01-.06]), an effect independent of acculturation to Latino culture. CONCLUSIONS: Acculturation to U.S. culture may negatively impact mental health through weakening family bonds in this vulnerable population. (PsycINFO Database Record

Factors Associated with Sexual Risk of HIV Transmission Among HIV-Positive Latino Men Who have Sex with Men on the U.S.-México Border.

We present results from a cross-sectional, clinic-based survey of border-region Latino men who have sex with men (MSM) and who also are living with HIV in the El Paso-Ciudad Juárez area. Among the 66 participants who reported serodiscordant anal or vaginal intercourse, we examined levels of psychological distress and substance use and the association of these variables with condomless sex. Bivariate analyses indicated that MSM who reported condomless sex with a serodiscordant partner were more likely to report higher scores on measures of anxiety, depression, and trauma. These men were also more likely to report more days of alcohol use to the point of intoxication. In multivariate logistic regression, no variables were independently associated with sexual risk behavior, but symptoms of anxiety trended toward statistical significance. Our study is one of few reports aimed at understanding the HIV epidemic among Latino MSM living with HIV in the El Paso-Ciudad Juárez border region. Although we found no evidence of a relation between our measures of psychological distress and substance use and sexual risk behavior in multivariate analyses, psychological distress and problematic alcohol use were common in the sample and are important targets for intervention in their own right.

Simultaneous Development of a Multidimensional Fatalism Measure in English and Spanish.

Fatalism has been shown to predict several health behaviors, but researchers often find inconsistent results for the same behaviors across studies. This may be partially attributable to the diversity of fatalism measures that have been used in previous studies. A review of the literature revealed 51 different scales, all purported to measure fatalism, but often with heterogeneous content (Esparza 2005). A study done by Esparza (2005) retrieved 29 scales, including the most frequently used scales, and performed an exploratory factor analysis, obtaining as a result five factors: fatalism, helplessness, internality, luck, and divine control. The purpose of this study was to develop a multidimensional fatalism scale based on the previous findings by Esparza (2005). This scale was developed simultaneously in English and Spanish in order to linguistically "decenter" item content. The factor structure was cross-validated and measurement invariance was assessed across language versions. According to the measurement invariance analysis, this test is invariant across English and Spanish in its factor structure, loadings, variances, and covariances. This study results suggest that this scale may be used interchangeably in both English and Spanish.

A preliminary RCT of CBT-AD for adherence and depression among HIV-positive Latinos on the U.S.-Mexico border: the Nuevo Día study.

We conducted a preliminary RCT among 40 HIV-positive Latinos of Mexican descent on the U.S.-Mexico border who indicated imperfect adherence and depressive symptomatology. Participants were randomly assigned to culturally adapted cognitive-behavioral therapy for adherence and depression with an alarmed pillbox or usual care. Outcomes were depressive symptoms (self-report and blind clinician ratings), adherence (self-report and electronic pillbox), and biological markers. The intervention, delivered in English and Spanish, proved feasible and acceptable. Generalized estimating equations in intent-to-treat analyses showed some effects of "moderate" to "large" size, with maintenance over time. For example, intervention (vs. control) participants demonstrated at post-intervention a greater drop in BDI scores (OR = -3.64, p = 0.05) and greater adherence according to the electronic pillbox (OR = 3.78, p = 0.03). Biological markers indicated some relative improvement for CD4 count but not VL. The promising results suggest a larger trial to determine efficacy is warranted.

The role of prospective memory in medication adherence: a review of an emerging literature.

Although neurocognitive impairment is an established risk factor for medication nonadherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one's ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.

Medication literacy in Spanish and English: psychometric evaluation of a new assessment tool.

OBJECTIVE: To evaluate the psychometric properties of a newly developed Medication Literacy Assessment in Spanish and English (MedLitR xSE). DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: El Paso, TX, from December 2006 to June 2009. PARTICIPANTS: 181 English- or Spanish speaking adults. INTERVENTION: Survey administered in two phases. MAIN OUTCOME MEASURES: Descriptive statistics, internal consistency, confirmatory factor analysis (CFA) and fit indices, and criterion-related validity. RESULTS: The 20-item MedLitR xSE tool showed adequate internal consistency and reliability, and CFA revealed overall good model fit. In phase 2, the shorter 14-item MedLitR xSE showed good total test reliability and correlated well with the Short Test of Functional Health Literacy in Adults. Item response theory analyses showed no language bias and a one-dimensional (i.e., one factor) model of medication literacy. CONCLUSION: The initial and latest shorter version of the MedLitR xSE tool demonstrated good psychometric properties. This tool may provide a new option to assess "medication literacy" in English and Spanish.

Culture and Probability Judgment Accuracy: The Influence of Holistic Reasoning.

A well-established phenomenon in the judgment and decision-making tradition is the overconfidence one places in the amount of knowledge that one possesses. Overconfidence or probability judgment accuracy varies not only individually but also across cultures. However, research efforts to explain cross-cultural variations in the overconfidence phenomenon have seldom been made. In Study 1, the authors compared the probability judgment accuracy of U.S. Americans (N = 108) and Mexican participants (N = 100). In Study 2, they experimentally primed culture by randomly assigning English/Spanish bilingual Mexican Americans (N = 195) to response language. Results of both studies replicated the cross-cultural variation of probability judgment accuracy previously observed in other cultural groups. U.S. Americans displayed less overconfidence when compared to Mexicans. These results were then replicated in bilingual participants, when culture was experimentally manipulated with language priming. Holistic reasoning did not account for the cross-cultural variation of overconfidence. Suggestions for future studies are discussed.

An event-level analysis of condom use as a function of mood, alcohol use, and safer sex negotiations.

Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use.

Can language prime culture in Hispanics? The differential impact of self-construals in predicting intention to use a condom.

The highly influential theory of planned behavior suggests that norms and attitudes predict an important antecedent of behavior: intention. Cross-cultural research suggests that culturally influenced self-construals can be primed and differentially affect behaviors that are influenced by norms and attitudes. The purpose of this experiment was twofold: (1) To investigate whether language functions as a prime for culture in Hispanics, and (2) if so, if norms and attitudes differentially predict condom use intention. Fluent English-Spanish bilingual participants (N = 145) of Mexican descent were randomly assigned to answer questionnaires in English and Spanish. Subjective norms and private evaluations towards condom use were assessed and their relative strength in predicting condom use intention was evaluated. Results suggest that language can prime culture and affect the relative accessibility of culture-relevant norms and self-construals in Hispanics. Moreover, consistent with our expectations, norms and attitudes differentially predicted condom use intention.

Childhood sexual abuse and depression in Latino men who have sex with men: Does resilience protect against nonadherence to antiretroviral therapy?

This study tested depression as a mediator between childhood sexual abuse and adherence to antiretroviral therapy, an effect moderated by resilience. In total, 149 HIV+ Latino men who have sex with men were recruited for this study. Using a regression-based bootstrap approach, depression mediated the relationship between childhood sexual abuse and antiretroviral therapy adherence, with worse adherence for participants at lowest percentiles of the resilience index. The prevalence of childhood sexual abuse and depression in HIV+ men who have sex with men is high and must be addressed to better prevent disease progression and reduce transmission, especially in expanding Latino populations.

A psychometric comparison of the Beck Depression Inventory-II in English and Spanish.

The Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) is a widely used measure of depressive symptomatology originally authored in English and then translated to Spanish. However, there are very limited data available on the Spanish translation. This study compared the psychometric characteristics of the BDI-II in Spanish and English in a sample of 895 college students. The instrument was administered twice with a 1-week interval, either in the same language on both occasions or in a different language on each occasion. Results show strong internal consistency and good test-retest reliability in both languages. Confirmatory factor analysis demonstrated that the published English-language factor structure showed good fit with data from the Spanish instrument. Among bilingual participants who took the BDI-II in both languages, there was no significant language effect. These data provide initial evidence of comparable reliability and validity between the English and Spanish BDI-II in a nonclinical sample.

Assessing the Gender Invariance of the Modern Homonegativity Scale.

The measurement invariance of the Modern Homonegativity Scale (MHS) was examined among heterosexual female (n = 449) and male (n = 329) university students who were predominantly Mexican American. The MHS demonstrated full invariance of factor loadings and partial invariance of latent intercepts. At the latent mean level, heterosexual men compared to heterosexual women held more negative attitudes toward both gay men and lesbian women. There were no latent mean differences in attitudes toward gay men and lesbian women when rated by either heterosexual men or heterosexual women. The MHS can be used by heterosexual men and heterosexual women to assess their homonegativity.

Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis.

The present study examined the efficacy of a behavioral intervention designed to increase adherence to fluid-intake restrictions among hemodialysis patients. Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points. The Group x Time interaction was significant, indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period. The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up. The observed group differences were, in part, due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period.

Patient personality and mortality: a 4-year prospective examination of chronic renal insufficiency.

The present study examined the role of personality as a predictor of mortality among patients with chronic renal insufficiency. A prospective evaluation of the influence of personality on patient survival was conducted over an average 49-month period. Cox regression was used to evaluate the effects of 5 dimensions of personality in a sample of 174 patients (100 male and 74 female). At follow-up, 49 patients had died. Significant demographic and clinical predictors of survival included age, diabetic status, and hemoglobin level. After these predictors were controlled for, 2 personality traits, conscientiousness and neuroticism, predicted patient mortality. Patients with high neuroticism scores had a 37.5% higher estimated mortality rate. Patients with low conscientiousness scores had a 36.4% increased mortality rate.

Psychometric properties of the Spanish Beck Depression Inventory-II in a medical sample.

The authors examined the psychometric properties of the Spanish Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a sample of individuals undergoing hemodialysis. They performed a confirmatory factor analysis of a previously reported 2-factor solution for the English BDI-II derived from a medical sample. Results indicate that the established model for the English-speaking medical sample provided adequate fit in the present sample. Spanish BDI-II scores were not significantly associated with age or gender in their sample, but they were significantly associated with disease severity. Bilingual participants completed the inventory in both Spanish and English, and their data revealed that BDI-II total scores were similar across language administration. The preliminary data suggest that the Spanish BDI-II can be reliably used in medical samples.

Interactive Voice Response Technology applied to sexual behavior self-reports: a comparison of three methods.

We tested the feasibility and performance of the Interactive Voice Response Technology (IVR) in the assessment of sexual behavior self-reports, relative to self-administered questionnaire (SAQ) and Timeline Followback (TLFB) methods. The sample consisted of 44 sexually active Hispanic students recruited at the University of Texas at El Paso who reported daily about sexual behaviors and substance use. Thirty-three participants (75%, 18 women, 15 men) were retained for at least 80 days of the 91-day IVR. At follow-up, sexual behaviors and substance use were assessed by questionnaire (summary) reports and by TLFB, referring to the same 3-month interval. ANOVAs with normalized variables indicated less reporting in the TLFB and over-reporting of substance use in the questionnaire relative to the daily IVR self-reports. Gender moderated the effects of assessment mode, which were observed among women only. HLM analyses indicated a significant decrease in self-reports over time, suggesting reactivity of self-monitoring via IVR on behavior.

The association of coping to physical and psychological health outcomes: a meta-analytic review.

We performed a series of meta-analyses examining the associations between coping and health-related outcomes in nonclinical adult samples. Results revealed that problem-focused coping was positively correlated with overall health outcomes, whereas confrontive coping, distancing, self-control, seeking social support, accepting responsibility, avoidance, and wishful thinking were each negatively correlated with overall health outcomes. Neither planful problem solving nor positive reappraisal was significantly associated with overall health outcomes in our analyses. However, type of health outcome (i.e., physical vs. psychological) and situational characteristics (i.e., stressor type, controllability, and duration) moderated many of the overall associations.