Somos Esenciales, We are Essential: Our Mental Health is Essential. Research for, by and of the Latinx Community in the Mission District during the Pandemic.

We are Latinx immigrants and children of Latinx immigrants. We provided emergency volunteer services at the Mission Food Bank during the pandemic to provide food assistance to low-income families in the Mission District and the city of San Francisco. In March 2021, we were invited to lead a research project that we call "We are Essential". Here we share our process and a few of our findings on the mental health of San Francisco's Latinx community during the pandemic, with a focus on our children and youth. A full report of our findings will be published in 2024.

Exploration of Stress and Inflammatory Biomarkers Among Non-Hispanic Black and Hispanic Cancer Survivors.

OBJECTIVES: To evaluate associations among social determinants of health (SDOH), stress, interleukin-6 (IL-6), and quality of life among non-Hispanic Black and Hispanic cancer survivors. SAMPLE & SETTING: Individuals who had completed cancer treatment and did not identify as White (N = 46) were recruited through community partnerships in western Massachusetts and a state cancer registry. METHODS & VARIABLES: This descriptive cross-sectional study used questionnaires and morning salivary samples to collect data between June 2022 and September 2023. RESULTS: Most participants were breast cancer survivors, were female, identified as African American or Black, and reported moderate levels of stress and low physical activity. Cortisol levels were higher among African American or Black participants, those with lower body mass index, and those with less consumption of fruit and vegetables. Higher symptom experience was associated with higher IL-6 levels. No associations were identified between IL-6 and cortisol or perceived stress and cortisol levels. IMPLICATIONS FOR NURSING: Incorporating SDOH in self-reported outcomes, including health behaviors and associated biologic indicators, can facilitate early identification and interventions to improve symptom experience and health outcomes of cancer survivors.

Community-Derived Recommendations for Improving Gender Affirmation of Black and Latine Transgender/Nonbinary Youth.

BACKGROUND: Gender affirmation is a process by which gender-diverse individuals are supported in their gender identity. Parents are critical in how gender-diverse youth, including Black and Latine transgender/nonbinary youth (BLTY), access various forms of gender affirmation-for example, social and medical transition. Culturally relevant supports are needed to bolster how BLTY and their parents navigate gender affirmation. PURPOSE: This study aimed to explore recommendations for aiding BLTY and parents in navigating the youth's gender journey. METHODS: Semi-structured interviews were conducted with parents of BLTY, BLTY, and BLT young adults (BLTYAs) recruited from clinics, community organizations, and social media. Interviews focused on gender affirmation and recommendations to promote BLTY's gender affirmation. Primary and secondary analysts coded transcripts using a priori and emergent codes. For this analysis, excerpts pertaining to recommended supports were analyzed to identify themes. RESULTS: Ten parents of BLTY, 10 BLTY (14-18 years), and 23 BLTYAs (18-30 years) participated. Participants provided recommendations at different socio-ecological levels. On the societal level, participants recommended improvements in media representation of racial and ethnic minority gender-diverse individuals. For organizations, participants recommended more clinicians who shared minoritized identities, clinicians knowledgeable in gender-affirming care, affordability of gender-affirming services, and school-based education regarding gender diversity. On interpersonal/individual levels, they suggested culturally informed peer support among BLTY and parents, including support groups, peer mentors, and camps with individuals who share their minoritized identities. CONCLUSIONS: Participants provided salient insights to supporting gender affirmation of BLTY, which can inform intervention development for BLTY and their families.

Black and Latine transgender/nonbinary youth (BLTY) have multiple minoritized identities as they are both racial/ethnic minorities and are gender diverse. These youth face unique challenges in being supported in their gender identity, and their parents face barriers to supporting their gender journey. Unfortunately, approaches to assisting BLTY and their parents in navigating this journey are poorly understood. We interviewed 10 BLTY, 10 related parents of the BLTY, and 23 Black and Latine transgender/nonbinary young adults (BLTYAs) recruited from clinics, community organizations, and social media. In this study, we explored their recommendations for better supporting and affirming BLTY. These recommendations targeted different areas of BLTY's lives. On a broader societal level, participants advocated media representation of gender-diverse individuals of color. For medical and mental health organizations, participants recommended more clinicians knowledgeable in supporting gender-diverse youth and more clinicians who share similar backgrounds with BLTY. For interpersonal and individual relationships, they recommended peer support groups and mentors for BLTY and parents of BLTY. These comprehensive recommendations from BLTY, parents, and BLTYAs can be implemented to better support BLTY in their gender identity through culturally based interventions in different domains.

Clinic Staff Perceptions of Implementing a Sexual and Reproductive Health Entertainment-Education Program for Young Women of Color.

Objective: Entertainment-education interventions remain underutilized in sexual and reproductive health (SRH) despite evidence that they can be effective and place a low burden on staff. This study explores perceived facilitators and barriers for implementing an entertainment-education video intervention for 18- to 19-year-old African American and Latina women in SRH clinics. Design: Cross-sectional online survey (n=100) and telephone interviews (n=19) were completed May through August 2018. Setting: SRH clinics were located across 32 US states and 1 Canadian province. Participants: SRH clinic staff were diverse in type of clinic, role, and geography and were recruited using purposive sampling. Methods: Bivariate analyses were used for quantitative data, and thematic analysis was used for qualitative data. Main Outcome Measures: Intervention acceptability, perceived feasibility, and likely uptake were assessed using agreement statements (survey) and open-ended questions (interviews and survey). Results: Interviewed clinic staff described the intervention as engaging, educational, and promising for improving client SRH knowledge and behaviors. Nearly all (95%) survey respondents said showing the video would be feasible. Most (56%) indicated likely uptake, which was significantly associated with perceived feasibility (P=.000), acceptability (P≤.001), and working at a public health clinic (P=.023). Implementation barriers included the video's potential relevance to only certain clients and the need for additional information or staff and/or management buy-in. Conclusions: This is the first study to assess perceived implementation facilitators and barriers of an entertainment-education video intervention among SRH clinic staff. The intervention was well received, with certain barriers potentially alleviated by offering information about entertainment-education and multiple implementation methods. These findings can help improve dissemination efforts for video-based entertainment-education interventions in clinics serving young women of color.

Identifying social determinants of health in populations exposed to structural inequities: a qualitative study of the COVID-19 pandemic experiences of Black and Latinx people living with HIV and cardiovascular risks.

Introduction: Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities. Methods: Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains. Results: Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines. Discussion: This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.

Neighborhood Safety and Neighborhood Police Violence Are Associated with Psychological Distress among English- and Spanish-Speaking Transgender Women of Color in New York City: Finding from the TURNNT Cohort Study.

Transgender women of color (TWOC) experience high rates of police violence and victimization compared to other sexual and gender minority groups, as well as compared to other White transgender and cisgender women. While past studies have demonstrated how frequent police harassment is associated with higher psychological distress, the effect of neighborhood safety and neighborhood police violence on TWOC's mental health is rarely studied. In this study, we examine the association between neighborhood safety and neighborhood police violence with psychological distress among TWOC. Baseline self-reported data are from the TURNNT ("Trying to Understand Relationships, Networks and Neighborhoods among Transgender Woman of Color") Cohort Study (analytic n = 303). Recruitment for the study began September 2020 and ended November 2022. Eligibility criteria included being a TWOC, age 18-55, English- or Spanish-speaking, and planning to reside in the New York City metropolitan area for at least 1 year. In multivariable analyses, neighborhood safety and neighborhood police violence were associated with psychological distress. For example, individuals who reported medium levels of neighborhood police violence had 1.15 [1.03, 1.28] times the odds of experiencing psychological distress compared to those who experienced low levels of neighborhood police violence. Our data suggest that neighborhood safety and neighborhood police violence were associated with increased psychological distress among TWOC. Policies and programs to address neighborhood police violence (such as body cameras and legal consequences for abusive officers) may improve mental health among TWOC.

The Power of Tailoring a Government-Funded Heart Health Program for Marginalized Women: Lessons from WISEWOMAN and Mujer Poderosa/Powerful Woman.

The Centers for Disease Control and Prevention's DP18-1816 Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) award to the Pennsylvania Department of Health combats the leading cause of death in Pennsylvania, cardiovascular disease. Pennsylvania's program (PA-WISE) includes an innovative approach to engage low-income women in cardiovascular disease prevention. PA-WISE collaborated with Latino Connection to pilot Mujer Poderosa/Powerful Woman (MP/PW), utilizing bilingual community health workers to engage, educate, and empower marginalized women to improve their health. Latino Connection discovered different approaches were needed by each community for engaging women and connecting with resources. MP/PW tailored outreach and intervention approaches to women's needs and expectations, responding to differences in education levels, acculturation, immigration status, and levels of trust. The experiences of MP/PW provide lessons on the importance of having and maintaining flexibility in responding to women's backgrounds and community characteristics and tailoring to meet the needs of marginalized women.

Immigration stress and internalizing symptoms among Latinx and Asian American students: The roles of school climate and community violence.

Immigration-related problems and stressors are prevalent and pressing concerns among Latinx and Asian American school-age youth. Youth fears related to family deportation have been associated with adverse mental health outcomes. This study used an ecological framework to examine the impact of immigration stress and school- and community-level resources and protective factors on Latinx and Asian American youth internalizing symptoms. The sample included 1309 Asian American and 701 Latinx students (N = 2010) who participated in a routine school-based mental health needs assessment survey. Multilevel regressions analyses revealed that first-generation youth, Latinx youth, and female youth were more vulnerable to experiencing immigration-related problems and worry. Student perceptions of negative school climate and community violence were associated with greater internalizing symptoms regardless of immigration worry. Moderation analyses revealed that immigration-related problems and worry were positively associated with internalizing symptoms and that this relationship did not differ by race/ethnicity. However, immigration worry was a particular risk factor for students who perceived their neighborhood community as safe. Findings highlight that a sociopolitical climate that sows immigration-related challenges fuels youth distress and that students' experiences of their community environment can play an essential role as a psychological resource.

Prenatal Iodine Intake and Maternal Pregnancy and Postpartum Depressive and Anhedonia Symptoms: Findings from a Multiethnic US Cohort.

Objective: Emerging evidence suggests that essential trace elements, including iodine, play a vital role in depressive disorders. This study investigated whether prenatal dietary iodine intake alone and in combination with supplemental iodine intake during pregnancy were associated with antepartum and postpartum depressive and anhedonia symptoms. Methods: The study population included 837 mothers in the PRogramming of Intergenerational Stress Mechanisms (PRISM) study. The modified BLOCK food frequency questionnaire was used to estimate prenatal dietary and supplemental iodine intake, while the 10-item Edinburg Postpartum Depression Scale (EPDS) ascertained depressive symptoms. Analyses considered the global EPDS score and the anhedonia and depressive symptom subscale scores using dichotomized cutoffs. Logistic regression estimating odds ratios and 95% confidence intervals (CIs) assessed associations of iodine intake in the second trimester of pregnancy and 6-month postpartum depressive and anhedonia symptoms considering dietary intake alone and combined dietary and supplementary intake in separate models. Results: Most women were Black/Hispanic Black (43%) and non-Black Hispanics (35%), with 39% reporting a high school education or less. The median (interquartile range, IQR) dietary and supplemental iodine intake among Black/Hispanic Black (198 (115, 337) µg/day) and non-Black Hispanic women (195 (126, 323) µg/day) was higher than the overall median intake level of 187 (116, 315) µg/day. Relative to the Institute of Medicine recommended iodine intake level of 160-220 µg/day, women with intake levels < 100 µg/day, 100-<160 µg/day, >220-<400 µg/day and ≥400 µg/day had increased adjusted odds of 6-month postpartum anhedonia symptoms (aOR = 1.74 (95% CI: 1.08, 2.79), 1.25 (95% CI: 0.80, 1.99), 1.31 (95% CI: 0.82, 2.10), and 1.47 (95% CI: 0.86, 2.51), respectively). The corresponding estimates for postpartum global depressive symptoms were similar but of smaller magnitude. Conclusions: Prenatal iodine intake, whether below or above the recommended levels for pregnant women, was most strongly associated with greater anhedonia symptoms, particularly in the 6-month postpartum period. Further studies are warranted to corroborate these findings, as dietary and supplemental iodine intake are amenable to intervention.

Racism in obstetric care: a psychometric study of the Gendered Racial Microaggressions Scale among Global Majority birthing people in obstetric contexts.

In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.

"You Aren't Alone": An Analysis of Trans Latinas' Use of Instagram.

Social media platforms, such as Instagram, provide space for marginalized groups to connect, learn about and express themselves, and cultivate community. Trans Latinas, a group target of violence and discrimination, resist by expressing themselves and building community through social media. As cisgender researchers, we explored how trans Latinas use #translatina on Instagram as a shared space to present themselves and their identities, to leverage this knowledge in our fields. We analyzed 134 posts in February and March of 2020 employing basic and interpretive content analyses while considering Goffman's theory of presentation of self. Results showed that trans Latinas mostly presented individually through posed selfies taken near the camera, using a straight camera angle, standing, not smiling, and making eye contact. Most users wore makeup, styled hair, and accessories. Analyzing written captions and photos, four themes were constructed to understand how trans Latinas presented their identities and connected with others: (1) expressions of beauty and femininity, (2) fostering community, (3) commercial or work, and (4) feeling good and confident. These results have implications for mental health and health promotion practices, as social media could serve as affirming spaces for trans Latinas to reinforce their self-determination, maintain a sense of self, and build community.

A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States.

BACKGROUND: While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness. METHODS: We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools. RESULTS: A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results. CONCLUSION: Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health. REGISTRATION: PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).

The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study.

BACKGROUND: The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE: The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS: The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS: Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS: Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55216.

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol.

INTRODUCTION: Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality, presenting a growing public health concern as the United States (US) population ages. These inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, gaps in transportation and safety-net services, and disparities in access to policy-making processes rooted in colonialism. This constellation of factors renders racial-minority and ethnic-minority older adults 'structurally vulnerable' to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as social support, community attachment and a meaningful sense of place. Scholarship on the social determinants of health widely recognises the importance of such place-based factors. However, little research has examined how they shape disparities in depression and treatment specifically, limiting the development of practical approaches addressing these factors and their effects on mental well-being for rural minority populations. METHODS AND ANALYSIS: This community-driven mixed-method study uses quantitative surveys, qualitative interviews and ecological network research with 125 rural American Indian and Latinx older adults in New Mexico and 28 professional and non-professional social supporters to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among older adults. Data will serve as the foundation of a community-driven plan for a multisystem intervention focused on the place-based causes of disparities in depression. Intervention Mapping will guide the intervention development process. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board. All participants will provide informed consent. Study results will be disseminated within the community of study through community meetings and presentations, as well as broadly via peer-reviewed journals, conference presentations and social media.

Skin tone ideologies, body shame, and sexual risk in Latinx young adults: The role of self-esteem.

Latinx young adults in the U.S. experience significant disparities related to body image and sexual health. These challenges partly stem from the intersections of racism, ethnocentrism, and colorism perpetuated through Eurocentric beauty standards and norms surrounding sexuality. Despite the salience of skin tone within the Latinx community, the impact of skin tone ideologies on body shame and sexual risk remains unexplored. Addressing this gap, the present study examined the influence of skin tone ideologies (i.e., colorist attraction and skin tone self-concept) on sexual risk and body shame among a sample of 539 Latinx young adults. The study also explored the potential moderating effect of self-esteem on colorist attraction and skin tone self-concept on body shame and sexual risk. Results revealed that both colorist attraction and skin-tone self-concept were positively associated with body shame. Colorist attraction was positively associated with sexual risk, whereas skin tone self-concept was not associated. Furthermore, self-esteem moderated the positive significant association between skin tone self-concept and body shame, such that the association was only significant among Latinx young adults who reported mean and high levels of self-esteem; self-esteem did not moderate any of the other study's associations. These findings inform the development of tailored mental and sexual health interventions to reduce health disparities among Latinx young adults, considering the influence of skin tone socialization.

Who do patients depend on as they age and for what medical needs? An exploratory study of Chinese and Latino primary care patients.

BACKGROUND: As the U.S. population ages, family members increasingly act as informal caregivers, particularly for minority patients and those with limited English proficiency (LEP). However, physicians often do not identify or engage caregivers until there is a health crisis. This study aims to further our understanding of characteristics associated with having a caregiver present at a primary care visit, and better understand the specific roles family caregivers engage in to support older Chinese and Latino primary care patients. METHODS: Primary care patients were surveyed by telephone in a study of language access and communication. Participants included Chinese and Latino primary care patients (≥ 65 years old) from an academic general medicine practice. We asked patients if anyone was in the room with them during their most recent primary care visit (yes = caregiver accompanied). We asked about caregiving support for various needs, and examined associations of patient and visit characteristics with being accompanied, and frequency of caregiver support roles overall and by caregiver accompaniment. RESULTS: Among 906 participants, 80% preferred a non-English language, 64% were women, 88% had Medicare, and mean age was 76 years (range 65-97). 43% were accompanied to their most recent visit. Speaking English 'not at all' vs. 'very well' was associated with being caregiver accompanied (OR 3.5; 95% CI 1.3-9.7), as was older age ≥ 75 vs. 65-74 (OR 2.7; 95% CI 2.0-3.7). The most common roles being supported by caregivers included: transportation to medical appointments (63%), helping with medical decisions (60%), and talking with the doctor about the patient's medical care (54%). Even among unaccompanied patients, substantial proportions reported caregiver support with medical decisions (45%), talking with the doctor (33%), and medical needs at home (26%). CONCLUSIONS: Opportunities for physicians to engage caregivers who have active support roles may be missed, especially if those caregivers are not present at the visit. Future interventions should aim to help physicians identify which patients have caregivers and for what needs, so they may effectively engage caregivers before a health crisis occurs.

Financial Well-Being Among US Adults with Vascular Conditions: Differential Impacts Among Blacks and Hispanics.

Background: The ability to meet current and ongoing financial obligations, known as financial well-being (FWB), is not only associated with the likelihood of adverse health events but is also affected by unexpected health care expenditures. However, the relationship between FWB and common health outcomes is not well understood. Using data available in the Financial Well-Being Scale from the Consumer Financial Protection Bureau, we evaluated the impact of four vascular conditions-cardiovascular disease (CVD), stroke, high blood pressure (BP), and high cholesterol-on FWB and how these impacts varied between racial and ethnic groups. Methods: Using the Understanding America Survey-a nationally representative, longitudinal panel-we identified adults with self-reported diagnoses between 2014 and 2020 of high cholesterol, high BP, stroke, and CVD. We used stratified, longitudinal mixed regression models to assess the association between these diagnoses and FWB. Each condition was modeled separately and included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, and an indicator of the condition. Racial and ethnic differentials were captured using group-condition interactions. Results: On average, Whites had the highest FWB Scale score (69.0, SD=21.8), followed by other races (66.7, SD=21.0), Hispanics (59.3, SD=21.6), and Blacks (56.2, SD=21.4). In general, FWB of individuals with vascular conditions was lower than that of those without, but the impact varied between racial and ethnic groups. Compared with Whites (the reference group), Blacks with CVD (-7.4, SD=1.0), stroke (-8.1, SD=1.5), high cholesterol (-5.7, SD=0.7), and high BP (6.1, SD=0.7) had lower FWB. Similarly, Hispanics with high BP (-3.0, SD=0.6) and CVD (-6.3, SD=1.3) had lower FWB. Income, education, insurance, and marital status were also correlated with FWB. Conclusions: These results indicated differences in the financial ramifications of vascular conditions among racial and ethnic groups. Findings suggest the need for interventions targeting FWB of individuals with vascular conditions, particularly those from minority groups.

A qualitative exploration of facilitators and barriers to adopting a healthy lifestyle among Black, Hispanic, and American Indian males with diabetes or at risk for type 2 diabetes.

OBJECTIVES: Higher prevalence of several chronic diseases occurs in men in the United States, including diabetes and prediabetes. Of the 34 million adults with diabetes and 88 million with prediabetes there is a higher prevalence of both conditions in men compared to women. Black, Hispanic, and American Indian men have some of the highest rates of diabetes and diabetes complications. Adopting a healthy lifestyle including healthy eating and physical activity, is important in preventing type 2 diabetes and diabetes complications. DESIGN: This study included six focus groups that explored facilitators and barriers to adopting a healthy lifestyle in Black, Hispanic, and American Indian men with diabetes or at risk for type 2 diabetes. Thematic analysis was used to identify facilitators and barriers to adopting a healthy lifestyle. RESULTS: Participants included males 18 years of age and older identifying as Black, Hispanic, or American Indian and diagnosed with prediabetes, diabetes, hypertension, or otherwise at risk for type 2 diabetes. Thirty-seven men participated, 19 diagnosed with diabetes and 18 at risk for type 2 diabetes. Fourteen Black, 14 Hispanic, and 9 American Indian men participated. The themes of facilitators to a healthy lifestyle included: family and the social network; psychosocial factors; health status, health priorities and beliefs about aging; knowledge about health and healthy behavior; and healthy community resources. Themes of barriers to a healthy lifestyle also included: mistrust of the health care system, cost, and low socioeconomic status. CONCLUSIONS: This study underscores the complexity of factors involved in adopting a healthy lifestyle for some racial and ethnic minority men with diabetes or at risk for type 2 diabetes.

Characterizing the Communication Networks of Spanish- and English-Speaking Latinx Sexual Minority Men and Their Roles in Pre-Exposure Prophylaxis Uptake.

While pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV transmission, disparities in access persist in the United States, especially among Hispanic/Latinx sexual minority men (SMM). Language barriers and differences in how Latinx SMM obtain information may impact access to PrEP and HIV prevention. This study used data from the 2021 American Men's Internet Survey (AMIS) to examine differences in communication networks and PrEP use among Latinx SMM by primary language (Spanish vs. English). We examined the associations between Latinx SMM's individual- and meso-level communication networks and PrEP-related outcomes using modified Poisson regression with robust variances. Spanish-speaking Latinx SMM in the study were less likely to test for HIV, be aware of PrEP, and use daily PrEP, compared to English-speaking participants. Sexuality disclosure to a healthcare provider was positively associated with PrEP uptake among all participants and predicted STI testing over the past 12 months among English-speaking Latinx SMM. Findings highlight disparities in PrEP awareness and uptake among Latinx SMM, especially among those whose primary language is Spanish. Addressing these disparities through targeted interventions, including improved communication with healthcare providers, may help facilitate PrEP access and use in this population.

The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits.

Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.