Addressing Teenage Pregnancy and Reproductive Health Among Latinx Adolescents and Young Adults.

Despite a national decline in teenage pregnancy rates, Latinx and Black individuals continue to have higher teenage birth rates compared with White teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared with non-Latinx White teens. With an increasingly diverse nation, a shift toward culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventive care, workforce diversity, and insurance coverage will lead to cost-savings and help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically toward Latinx women will be provided, including culturally competent birth control counseling and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes toward contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework, family engagement is encouraged, and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

Gender and substance use among Latinx college students: An application of social structure social learning theory.

Social structure social learning theory (SSSL) is a theoretical framework that has been used to understand gender differences in substance use. However, the Latinx community remains understudied in this body of research. Drawing on a Latinx college student sample, we tested the extent to which four social learning mechanisms specified by SSSL theory (positive definitions, neutralizing definitions, differential association, and differential reinforcement) explained gender differences in three substance use outcomes: alcohol intoxication, marijuana use, and illicit prescription drug use. We found that men reported greater levels of all three substance use outcomes, and that the social learning mechanisms mediated between 24% to 44% of these gender effects. We also found some evidence that the effects of differential association and differential reinforcement were stronger for men than women, suggesting that women may exhibit greater resilience when exposed to peer influence. We discuss the implications for SSSL theory and the study of substance use and gender differences in substance use among Latinx populations.

An analysis of metaphor in COVID-19 TV news in English and Spanish.

BACKGROUND: Latinxs lack equitable access to science-based, accessible, trustworthy, and bilingual health information and rely heavily on TV news as a source of health information. This study examines how TV news media convey COVID-19 health- and safety-related information to the public, focusing on communications that target Latinxs in the US, a group disproportionately affected by COVID-19. METHOD: To understand how information targets Latinxs, we analyzed conceptual metaphors used in Spanish and English descriptions of the COVID-19 pandemic using TV news archive. Metaphor is an integral part of daily communication that can help people explain what is abstract in terms of what is concrete. Our analysis focused on prominent COVID-19 metaphors in both languages: war, journey, and natural disaster. RESULTS: Similar to previous studies, we found that war metaphors were pervasive in English, for instance, as in 'Diagnostic testing is the only weapon that allows you to fight COVID-19' and 'a 15-day battle with COVID-19.' A new finding was that war metaphors were even more common in Spanish than in English. The journey metaphor had similar rates of use in both languages, while the natural disaster metaphors were more common in English than in Spanish. CONCLUSIONS: Our work provides novel insights into how TV news reports use metaphor to convey information about COVID-19 to viewers in English and Spanish. We also offer implications on using culturally informed language and conclude with directions for future research to guide health communications serving linguistic minority communities such as Latinxs.

A systematic review of persons of color participation in first episode psychosis coordinated specialty care randomized controlled trials in North America.

The population of persons of color (POC) are increasing in the United States. Unfortunately, POC are significantly impacted by serious mental illness; psychosis represents a mental health disparity among POC. Fortunately, first episode coordinated specialty care (CSC) is an effective treatment for individuals who are in the early phases of a psychotic disorder. This systematic review of the literature examined POC inclusion rates in randomized controlled trials (RCT) examining First Episode Psychosis (FEP) programs. Our review yielded seven articles that met inclusion criteria. Our findings were mixed-researchers conducting RCTs on FEP programs did an excellent job including African American participants suggesting that findings from RCTs on FEP programs may generalize to African American participants. Regarding Latines, they were broadly underrepresented in RCTs on FEP CSC. Based on the data, we cannot definitively conclude to what extent findings from RCTs on FEP CSC generalize to Latines although results from studies that included a reasonable number of Latines offer promising results. Asians were overrepresented in three of the seven studies included in this review; thus it seems that the findings from RCTs on FEP CSC generalize to the Asian population in the United States.

Sanctuary city policies and Latinx immigrant mental health in California.

This quasi-experimental study examined whether "sanctuary city" policies are an effective mechanism for reducing mental health inequalities by immigrant origin status in Latinx populations in California. Ample evidence indicates that people experience mental health problems when restrictive immigration policies are imposed. It remains unclear whether sanctuary city policies can improve population mental health in the groups targeted by restrictive immigration policies: undocumented immigrant Latinxs, documented immigrant Latinxs, and native-born Latinxs. We combined data on California's 482 cities concerning whether and when they implemented a sanctuary policy with health data on approximately 142,000 adults, 6400 adolescents and 13,000 children from the multi-year California Health Interview Survey. After using propensity score matching to identify non-sanctuary cities comparable to sanctuary cities, we estimated respondent-level difference-in-differences models to determine whether sanctuary city policies had beneficial mental health effects on three age groups: adults, adolescents, and children during the period 2007-2018. There was a trend toward improved mental health in sanctuary cities after policy enactment, but the patterns of mental health in the three Latinx immigration sub-groups of each age group did not conform to our hypotheses. Buffering the adverse effects of harsh federal immigration policies may need to involve other approaches, such as expanded local mental health care access. We discuss these results in terms of alternative treatment interference, residents' policy awareness, the policy's capacity to address past health impacts, methodological issues, and potential policy momentum.

Association Between Optimism and Negative Emotional Eating in Caribbean Latinx Adults in the Northeast US.

BACKGROUND: Negative emotional eating (EE) is associated with unfavorable behavioral and health outcomes. Understanding its association with positive factors, such as optimism, may shed light into novel interventions. We examined the association between optimism and negative EE in US Caribbean Latinx adults, a population disproportionately exposed to adversity. METHOD: This cross-sectional analysis used data from the Latino Health and Well-being Study (21-84 years; n = 579). Optimism was measured with the Life Orientation Test-Revised version. EE was measured with the Three-Factor Eating Questionnaire R18-V2. Adjusted Poisson models with robust error variance estimated prevalence ratios (PR). RESULTS: The proportion of individuals reporting high EE was greater in the low (39.0%) and moderate (36.8%) optimism groups than that in the high optimism group (24.8%; p = 0.011). Individuals with high optimism (vs. low) were less likely to report high EE over no EE (PR = 0.68; 95% CI = 0.53-0.88). CONCLUSION: High optimism was negatively associated with high EE. Future studies are needed to confirm our findings and test interventions promoting optimism for preventing negative EE in US Caribbean Latinx adults.

Discrimination and Sleep: Differential Effects by Type and Coping Strategy.

BACKGROUND: Discrimination has been posited as a contributor of sleep disparities for Latinxs. The strategy used to cope with discrimination may reduce or exacerbate its effects on sleep. This study examined whether different types of discrimination (everyday and major lifetime discrimination) were associated with sleep indices (quality, disturbances, efficiency) and whether coping strategy used moderated associations. METHOD: Data of Latinx adults (N = 602; 51% women, 65% Dominican, Mage = 46.72 years) come from the Latino Health and Well-being Project, a community-based, cross-sectional study of Latinxs in Lawrence, MA. Multiple linear regressions were estimated separately for each sleep outcome. RESULTS: Everyday discrimination was significantly associated with poorer sleep quality and greater disturbances; major lifetime discrimination was significantly associated with worse sleep across the three sleep indices. Coping strategy moderated associations between discrimination and sleep. Compared with Latinxs who used passive coping, those who used passive-active coping strategies had poorer sleep quality the more they experienced everyday discrimination. Latinxs who used any active coping strategy, compared with passive coping, had greater sleep disturbances the more frequently they experienced major lifetime discrimination. CONCLUSIONS: Findings show that everyday discrimination and major lifetime discrimination are associated with different dimensions of sleep and suggest that coping with discrimination may require the use of different strategies depending on the type of discrimination experienced.

Experiencing discrimination can negatively affect sleep. But some coping strategies may reduce the negative impact of discrimination on sleep. This study investigated the link between multiple forms of discrimination (i.e., everyday and major lifetime) and various aspects of sleep, including quality, efficiency, and sleep disturbances. We also investigated whether the use of active coping (e.g., discussing discriminatory experiences) and passive coping (e.g., keeping discriminatory experiences to oneself) improved or worsened sleep outcomes. The study analyzed survey data from 602 Latinx adults. Individuals reported on their sleep, discrimination, and the coping strategies they used in response to discriminatory experiences. Everyday discrimination was related to poor sleep quality and more sleep disturbances. Lifetime discrimination was related to all sleep outcomes. Among those reporting more everyday discrimination, using both active and passive coping strategies was associated with poor sleep quality. Using any type of active coping was related to more sleep disturbances among individuals who reported more major lifetime discrimination. Selecting a coping strategy that is protective may depend on the frequency and type of discrimination.

"We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut.

Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.

Acceptability of Behavioral Activation for Depression Among Latinas: A Mixed Methods Study.

Latinxs represent the largest ethnoracial minority population in the United States. Despite having significant rates of depression, Latinxs underutilize behavioral health services. This, combined with the association between gender and depression (women have higher rates of depression than men), underscores the importance of developing an improved understanding of how Latinas view behavioral activation (BA), an empirically supported treatment for depression. In this mixed methods study, participants consisted of 77 Latinas; participants were provided with a vignette depicting a fictional character that underwent BA for depression. Participants in the quantitative study completed a measure of treatment acceptability of BA (n = 60); participants in the qualitative study completed a semistructured interview assessing their views on BA (n = 17). Latinas had generally positive attitudes about BA, although they also identified some elements that they perceived might act as barriers to treatment success. Because we were interested in the interplay of cultural factors and treatment acceptability, we also examined enculturation and acculturation as predictors of treatment acceptability-enculturation only was a significant predictor treatment acceptability. Our sample was relatively small, social desirability may have influenced our responses, and it is not known to what extent our results generalize to Latinx men. Latina women find BA to be an acceptable treatment for depression, which suggests promise with regard to clinical outcomes for depressed Latinas receiving BA. Addressing potential barriers to treatment engagement may improve outcomes for depressed Latinas receiving BA.

Linguistic analysis of Latinx patients' responses to a text messaging adjunct during cognitive behavioral therapy for depression.

Cognitive behavioral therapy (CBT) is efficacious to treat depression, however more research is needed to understand its functions among Latinxs. This study analyzed qualitative responses that were paired with a mood rating (1-9 scale) from daily ecological momentary assessments via text-messaging of 52 low-income, Spanish-speaking patients to assess the relationship between word use and changes in mood during group CBT. Based on previous research, we chose 11 linguistic dimensions from the Linguistic Inquiry and Word Count text analysis software that conceptually related to core CBT treatment elements and sociocultural factors of depression in Latinxs. Results showed that the use of words from the categories of Friends, Religion, Positive Emotions, and Leisure (proxy for behavioral activation) were significantly associated with a significant increase in mood. The use of Negative Emotions and Health words were significantly associated with a significant decrease in mood. Post-hoc analysis revealed that Certainty (proxy for cognitive inflexibility) words were related to a significant decrease in mood when Negative Emotional words were present. Findings contribute to our understanding of the role of sociocultural factors and core CBT elements in changes in mood among Latinxs. Lastly, this paper demonstrates the potential for analyzing language content during a digital health intervention to better understand user experiences.

Undocumented immigrants and mental health: A systematic review of recent methodology and findings in the United States.

This study reviewed the methodology and findings of 44 peer-reviewed studies on psychosocial risk factors associated with mental health outcomes among undocumented immigrants (UIs) in the United States. Findings showed a considerable advancement over the past seven years in the methods and measures used in the included studies. Nonetheless, there is a need for continued methodological rigor, innovative study designs, greater diversity of samples, and in-depth exploration of constructs that facilitate resilience. Identifying avenues to reduce risk in this population is essential to inform intervention and advocacy efforts aimed at overcoming distress from the current U.S. anti-immigrant and socio-political climate.

Racial/Ethnic Group Differences and Sociocultural Factors Associated With Implicit and Explicit Attitudes Toward Undocumented Latino Immigrants.

In the context of recent policies aimed at deterring immigration and criminalizing undocumented Latino immigrants, we examined factors predicting implicit and explicit attitudes toward this population. We hypothesized that more positive implicit and explicit attitudes toward undocumented Latino immigrants would be displayed by Latinxs (compared to non-Hispanic Whites) and by individuals having personal connections to undocumented immigrants or a high level of intercultural sensitivity. Latinx (n = 376) and non-Hispanic White (n = 214) college students (70% female, M age = 21) participated in this cross-sectional study and completed two Implicit Association Tests and measures of explicit attitudes, personal connections, and intercultural sensitivity. As predicted, Latinx participants held more positive implicit and explicit attitudes than non-Hispanic White participants. Intercultural sensitivity and personal connections to undocumented immigrants were associated with more positive explicit attitudes. Identifying factors that increase a sense of commonality and cultural sensitivity with undocumented Latino immigrants may be helpful in diminishing the profiling and criminalization of this community.

Structural racism and reflections from Latinx heavy drinkers: Impact on mental health and alcohol use.

BACKGROUND: Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption. METHODS: Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis. RESULTS: Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood. CONCLUSIONS: Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.

Identifying Gaps in Oral Care Knowledge, Attitudes, and Practices of Latinx Parents/Caregivers of Children With and Without Autism Spectrum Disorders.

Purpose: This pilot study used data from a survey to examine the knowledge, attitudes, and practices about oral care of Latinx parents/caregivers of children with or without autism spectrum disorder (ASD) to identify gaps to focus future intervention. Methods: Sixty English-speaking Latinx parents/caregivers who had a child between 4 and 14 years with or without ASD (n=31 ASD, n=29 typically developing [TD]) completed a questionnaire on oral health knowledge, practices, access to care, and demographics. Caregiver responses were compared, and gaps in knowledge and practices were identified. Results: There were no significant differences in parent age, child age, income, insured status, or overall knowledge scores, only a significant difference in education (p=0.02), with the ASD group reporting less. Scores for knowledge, attitudes, access and practice were all nonsignificantly positively correlated, as was attitudes with access and practice. However, knowledge and attitudes were significantly negatively correlated. Additional significant findings were parents who had lower income and education, had lower oral knowledge scores, decreased frequency of dental visits, increased feelings of being discriminated against, children with increased fear of the dentist, and decreased ease of finding a dentist. Conclusion: Factors such as income, education, ethnicity, and having a child with ASD can influence what Latinx parents and caregivers know about oral health and how their children experience receiving dental care. Latinx parents/caregivers of children with and without ASD report barriers to dental care, including difficulty attending visits or feeling stigmatized by their dental provider due to their ethnicity. Fear of the dentist is significantly correlated with ASD diagnosis and lower social demographics of the parent, and may contribute to a reduction in preventative oral care visits as well. Health care providers should consider these perspectives when providing care to this population to mitigate further oral health inequities.

Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health.

Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child's diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents' perceptions of their child's diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child's oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families.

Exploring network derived indicators of acculturation among college enrolled Latinxs: Examining language use and homophily in support networks.

Acculturation measures focus on the perceived composition of a person's social networks as a characteristic of cultural change but have not focused on specific social relationships as sources of evaluation. The current study explores network-derived indicators of acculturation and determines the viability of network acculturation as a related, but distinct, construct from enculturation. A first-order ego network electronic survey design was used to gather social network and traditional survey data from a sample of college-enrolled Latinxs using name generator and name interpreter questions. Findings indicate low but statistically significant correlations between network indicators of acculturation and enculturation as hypothesized. No group differences in network acculturation were observed between generational statuses despite demonstrated differences in psychological enculturation. The low but statistically significant relationships between enculturation and network acculturation suggest conceptually related but distinct indicators of acculturation. Latinx homophily was the strongest predictor of enculturation, revealing the importance of network characteristics.

Sólo Se Vive Una Vez: Evaluation of a Social Marketing Campaign Promoting HIV Screening and Prevention for Immigrant Latinxs.

Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website ( www.solovive.org ) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.

RESUMEN: Los latinos en los Estados Unidos están desproporcionadamente afectados por el VIH y es más probable que sean diagnosticados más tarde que pacientes no latinos. Desarrollamos e implementamos Sólo Se Vive Una Vez, la primera campaña en español dirigida a mejorar la detección y prevención del VIH entre los inmigrantes latinos en Baltimore, Maryland. Sólo Se Vive Una Vez consiste en un sitio web (www.solovive.org) y una campaña en las redes sociales que promueve la prueba gratuita de VIH a través de la clínica del Departamento de Salud de la Ciudad de Baltimore así como la unidad móvil operada por nuestro equipo latino de promotores de salud. La campaña no se asoció con un cambio en el número absoluto de latinos que hicieron la prueba del VIH. Sin embargo, los latinos expuestos a la campaña que se hicieron la prueba del VIH tenían tasas más altas de conductas sexuales de alto riesgo, de parejas sexuales, y de uso de sustancias. La campaña también se asoció con un aumento de referidos a PrEP a través del equipo de promotores de salud latinos.

Empiric evidence of ethnic disparities in coronavirus positivity in Washington State.

OBJECTIVES: Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization. DESIGN: An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020). RESULTS: A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45-0.74), Blacks (r = 0.51, 95% CI 0.32-0.66), or Asians (r = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites (r = -0.63, 95% CI -0.75, -0.45). CONCLUSIONS: We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.

A review of current strategies to improve HIV prevention and treatment in sexual and gender minority Latinx (SGML) communities.

INTRODUCTION: The HIV epidemic continues to disproportionately impact sexual and gender minority Latinxs (SGML). Several syndemic conditions have been linked with HIV acquisition and transmission among SGML including immigration, discrimination, environmental racism, substance use, and mental health. AREAS COVERED: We provide a summary of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum among SGML. We also discuss intervention approaches and opportunities that respond at the intersection of HIV and COVID-19 prevention and treatment. EXPERT OPINION: There is a dire need for the combination of biomedical, behavioral, and social/structural interventions to reduce risks for acquiring HIV and improve outcomes along the HIV care continuum. Interventions and combination approaches should be driven by community-based participatory action research. The inclusion of community members in all stages of the research process can assure successful implementation of program activities and deliverables, including the provision of culturally and linguistically appropriate services. Given the current COVID-19 pandemic, which is disproportionately impacting individuals living with HIV and other comorbidities, the elderly, and under-resourced communities with a ferocity not seen in other communities, intervention approaches that respond at the intersection of HIV and COVID-19 prevention and treatment are also urgently needed.

After the Affordable Care Act: the Effects of the Health Safety Net and the Medicaid Expansion on Latinxs' Use of Behavioral Healthcare in the US.

This study investigated the association between the implementation of the Affordable Care Act (ACA) and Latinxs' use of behavioral health services in the US. Organizational responses from the 2010, 2014, and 2016 National Mental Health Service Survey were used to examine the number and proportion of outpatient Latinx admissions over time, as well as the role of Medicaid expansion and health safety net funding on Latinxs' admissions. Findings showed that there was an increase in Latinx admissions post-ACA (2014). However, 2 years post-implementation (2016), Latinx admissions were at levels lower than prior to the healthcare reform. Despite this overall decrease, behavioral health safety net organizations, particularly those located in states that adopted the expansion of Medicaid, served more Latinxs than behavioral health service organizations outside the safety net. Policy and practice implications to strengthen behavioral safety net organizations that serve Latinxs are discussed.