Racial/Ethnic and Nativity Inequalities in Gestational Diabetes Mellitus: The Role of Psychosocial Stressors.

INTRODUCTION: Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM. METHODS: We used New York City Pregnancy Risk and Assessment Monitoring System data (2009-2014) linked with birth certificate items (n = 7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM. RESULTS: U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio, 2.18; 95% confidence interval, 1.53-3.11), Hispanic (adjusted risk ratio, 1.57; 95% confidence interval, 1.10-2.25), or Asian/Pacific Islander (adjusted risk ratio, 4.10; 95% confidence interval, 3.04-5.52) women compared with U.S.-born White women. CONCLUSIONS: Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant women and women from minoritized racial/ethnic groups. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.

Care Managers in the Aging Network: Increasing Self-Efficacy in Human Service Providers.

One in four older adults has Behavioral Health (BH) concerns, and over 63% are not receiving services. Older adults living in the community depend on the aging network for home- and community-based services and care managers are critical providers in this network. However, most care managers' current education and training are inadequate to care for older adults with BH needs. This study evaluated the effectiveness of training on the perceived self-efficacy of care managers working with older adults with BH needs. The study used a quasi-experimental design with a pre- and post-test approach and convenience sampling (n = 90). We found a significant difference in mean self-efficacy scores, from pre-test (M = 62.31, SD = 10.11) to post-test (M = 65.88, SD = 7.40) related to working with clients with mental health problems. In addition, we found a significant difference between the mean pre-test (M = 59.81, SD = 10.68) and post-test score (M = 65.60, SD = 9.85) related to working with clients with substance use problems.

Ethnic, Nativity and Country of Origin Inequities in Preterm Birth Among Hispanic and Non-Hispanic Whites in New York City: What's Stress Got to Do With It?

Hispanic populations experience good birth outcomes despite their socioeconomic disadvantage, a phenomenon referred to as the Hispanic paradox. This health advantage, however, deteriorates over time and understanding of this pattern is limited. Using data from the 2009-2013 New York City (NYC) PRAMS survey linked with birth certificate data, we tested whether stressful life events (SLEs) partially accounted for differences in preterm birth (PTB) between birthing parents across ethnicity, nativity and country of foreign birth (CFB). Experiencing 3+ SLEs in the prenatal period was associated with increased odds of PTB (OR = 1.49, 95% CI 1.13, 1.97). However, stressors were not associated with greater risk of PTB among US-born Hispanic participants, or differences across CFB. SLEs are associated with increased odds of PTB after a threshold of 3+, but do not explain greater PTB among US-born, or some Hispanic subgroups, despite differences in SLEs across ethnicity and CFB among Hispanic birthing parents.

Racial, ethnic and nativity inequalities in gestational diabetes mellitus: The role of racial discrimination.

Introduction: Racial/ethnic minority and foreign-born women in the United States are at high risk of experiencing racial discrimination, which is associated with adverse health outcomes. Although racial discrimination is associated with metabolic disturbances such as insulin resistance and type 2 diabetes, more studies should examine its effect on gestational diabetes mellitus (GDM), which is highest among racial/ethnic minority and foreign-born women. Methods: We used New York City Pregnancy Risk and Assessment Monitoring System survey data (2012-2014) linked with birth certificate items (N = 4084) in bivariate and multivariate analyses to examine racial/ethnic/nativity differences in racial discrimination, and to test if racial discrimination explains racial/ethnic/nativity inequalities in GDM. Results: The 12-month prevalence of racial discrimination (9.5%) varied across race/ethnicity and nativity status, with Black, Hispanic and foreign-born women having the highest prevalence. Interaction effects indicate that US-born Black and Hispanic women are at increased risk of racial discrimination compared to their foreign-born counterparts. Women with GDM had statistically higher prevalence of racial discrimination (14%) compared with women without GDM (9%). Racial discrimination was associated with a 57% increased unadjusted risk of GDM (RR = 1.57, 95% CI [1.19, 2.06]) that decreased to 24% after adjusting for all covariates (RR = 1.24, 95% CI [0.87, 1.78]). Discussion: The high proportion of racial/ethnic minority and foreign-born women experiencing racial discrimination, and its potential impact on GDM, underscores the importance of culturally informed screening and intervention approaches by trained professionals.

Preterm Birth Among US and Foreign-Born Non-Hispanic Black Birthing Parents in Massachusetts: Variation by Nativity, Region, and Country of Origin.

INTRODUCTION: Foreign-born non-Hispanic Black (NHB) birthing parents are less likely to have a preterm birth (PTB) than US-born NHBs. There is further variation by region and country of origin. We update previous studies by examining PTB rates by nativity, region and country of origin among NHBs in Massachusetts, a state with a heterogeneous population of foreign-born NHBs, including communities excluded from previous studies. METHODS: Using 2011-2015 natality data from the three largest metropolitan areas in Massachusetts, we documented associations between nativity, region, and 18 individual countries of origin and PTB, using multivariable logistic regression to adjust for individual-level risk factors. RESULTS: PTB was highest among US-born NHBs (9.4%) and lowest among those from Sub-Saharan Africa (SSA) (6.6%). Country-specific rates ranged from 4.0% among Angolans to 12.6% among those from Barbados and Trinidad and Tobago. While NHBs from SSA had significantly lower odds of PTB, risk among those from the Caribbean and Brazil was not different from US-born NHBs. The significantly lower risk among foreign-born NHBs and SSAs, in particular, remained robust in adjusted models. DISCUSSION: Individual-level factors do not explain observed variation among NHB birthing parents. Future research should investigate explanations for lower PTB risk among SSAs, and congruent risk among foreign-born Caribbeans, Brazilians and US-born NHBs. Exposure to racism, a known risk factor for PTB, likely contributes to these inequities in PTB and merits further exploration. Prenatal care providers should assess place of birth among foreign-born NHBs, as well as exposure to racial discrimination among all NLB birthing parents.

The Time has Come for All States to Measure Racial Discrimination: A Call to Action for the Pregnancy Risk Assessment Monitoring System (PRAMS).

INTRODUCTION: Racial/ethnic inequities in preterm birth (PTB) are well documented. Most of this research has focused on maternal behavioral and socio-demographic characteristics. However, the full magnitude of the racial/ethnic gap remains inadequately understood. Studies now point to the role of racial discrimination in producing PTB inequities, but limitations exist, namely the use of a single, dichotomous item to measures discrimination and the limited generalizability of most studies which have been conducted in single cities or states. METHODS: In this commentary we briefly review extant research on explanations for racial/ethnic inequities in PTB, and the role of racial discrimination in producing the racial/ethnic gap in adverse birth outcomes such as PTB. RESULTS: The Pregnancy Risk Assessment Monitoring System (PRAMS), a state-level, population-based survey, annually collects data from 51 states and cities ("states") on maternal behaviors and experiences in the perinatal period. The questionnaire consists of mandatory "Core" questions, and optional "Standard" questions. Currently 22 states include a "Standard" question on discrimination; 29 do not. PRAMS offers a unique opportunity to systematically assess discrimination among a diverse, population-based sample across the US. DISCUSSION: We urge PRAMS to at least include the current measure of discrimination as a mandatory "Core" question. Ideally, PRAMS should include a validated discrimination scale as a "Core" question. The time has come to name and assess the impact of discrimination on adverse birth outcomes. PRAMS can play a vital role in helping to close the racial/ethnic gap in PTB.

Why Adolescents Attempt Suicide: A Qualitative Study of the Transition from Ideation to Action.

To ameliorate the public health problem of adolescent suicide, it is imperative to go beyond simply establishing which factors increase risk. Multiple factors often interact in such a way that escalates suicide risk, and some combinations may be particularly perilous. Therefore, it is essential to examine the sequence and interplay of these various contributors to understand how they interact to confer risk. To enhance our understanding of this process, we used qualitative in-depth interviews with 20 psychiatrically hospitalized adolescents who had recently made a suicide attempt to investigate the factors that contributed to their attempts. In this qualitative analysis we 1) identified 16 separate factors that contributed to their suicide attempts, and 2) focused on the sequence and interplay between these factors in order to better understand why adolescents attempt suicide, with specific attention to which factors facilitated the transition from suicide ideation to action. Findings demonstrated that the strain caused by historical, sociocultural, and interpersonal factors alone was not enough to result in adolescents attempting suicide. For all but two participants, it was the interaction of intrapersonal factors that appeared to distort cognitions and/or elevate emotions to the point where they became intolerable and suicide became a viable option. These intrapersonal factors appeared to be the catalyst in the process from suicide ideation to action. Our findings suggest the need for specific strategies that address cognitive distortions, emotion dysregulation, and feelings of invalidation and entrapment as potential targets for interventions and prevention practices with adolescents at risk for suicide.

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs.

OBJECTIVE: This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. METHOD: Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. RESULTS: Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]). CONCLUSIONS: Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Function and progression of non-suicidal self-injury and relationship with suicide attempts: A qualitative investigation with an adolescent clinical sample.

AIM: To investigate the function and progression of non-suicidal self-injury (NSSI) and its relationship with suicide attempts. METHOD: Qualitative in-depth interviews were conducted with 15 adolescents psychiatrically hospitalized following a suicide attempt who reported NSSI. Applied thematic analysis was used to identify and examine themes from the interview data. RESULTS: Thematic analysis revealed that the primary function of NSSI was relief from emotional pain, though the function often changed over time. NSSI was often not directly related to patients' suicide attempts, yet risk of suicidal behavior seemed to increase once NSSI lost its effectiveness, and suicide became the only option. CONCLUSION: Clinicians need to understand and monitor the functions of NSSI, and its relationship with suicidality, to prevent suicide attempts among adolescents.

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress.

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol.

BACKGROUND: The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult. OBJECTIVE: The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI. METHODS AND DESIGN: CAMI2, a large, 12month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition. SUMMARY: The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.

Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial.

BACKGROUND: Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms. METHODS: Participants (N = 100) completed measures at baseline. RESULTS: Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men. DISCUSSION: Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.

The association between anti-immigrant policies and perceived discrimination among Latinos in the US: A multilevel analysis.

Research has found a strong inverse association between discrimination and health and well-being. Most of these studies have been conducted among African-Americans, and have examined the relationship at the individual-level. To fill these gaps in knowledge we estimated the prevalence of perceived discrimination among a nationally representative sample of Latino adults in the US, and investigated the association between state-level anti-immigrant policies and perceived discrimination. We merged survey data with a state-level anti-immigrant policy index. First, we fit hierarchical logistic regression models to test the crude and adjusted association between anti-immigrant policies and perceived discrimination. Second, we specified cross-level interaction terms to test whether this association differed by relevant individual characteristics. Almost 70% of respondents reported discrimination (68.4%). More anti-immigrant policies were associated with higher levels of discrimination (OR=1.62, 95% CI 1.16, 2.24, p=0.01). The association between anti-immigrant policies and discrimination differed by place of origin (p=0.001) and was marginally moderated by generation status (p=0.124). Anti-immigrant policies stigmatize both foreign and US-born Latinos by creating a hostile social environment which affects their experiences of discrimination. These non-health policies can adversely affect Latino health, in part through exposure to discrimination, and may help explain health patterns among Latinos in the US.

Obesogenic behaviors among adolescents: the role of generation and time in the United States.

OBJECTIVES: To examine how obesogenic behaviors (consumption of sugary drinks, physical activity, and/or sedentary behaviors) differ among adolescents within and across generation. DESIGN: Data come from the 2008 Boston Youth Survey, a population-based sample of 9th-12th-graders in 22 public high schools in Boston, MA. We used self-reported information to calculate generation and obesogenic behaviors (i.e. physical activity in past 7 days, consumption of sugar-sweetened beverages in past 7 days, and TV/computer/video game use on an average school day). Multivariable models were conducted to estimate the association between generation and obesogenic behaviors, adjusting for race/ethnicity, sex, age, family structure, and school. RESULTS: Relative to first generation youth, 1.5 generation (RR=1.74, 95% CI=1.10, 2.77) and second generation (RR=1.45, 95% CI=1.02, 2.07) youth were more likely to consume soda. Second (RR=1.60, 95% CI=1.20, 2.14) and third generation (RR=2.29, 95% CI=1.43, 3.65) youth were significantly more likely to consume other sugary drinks. Only third generation youth were more likely to watch ≥2 hours/day of TV when compared to first generation youth (RR=1.53, 95% CI=1.07, 2.18). No differences were seen by generation for levels of moderate-to-vigorous physical activity or computer/video games. CONCLUSIONS: Greater consumption of sugary drinks is seen across generation among adolescents. Sugary drinks, which are aggressively marketed to immigrant youth, may contribute to excess weight gain seen among foreign-born youth upon arrival in the United States.

Are first-generation adolescents less likely to be overweight? Results from a survey of Boston youth.

The effect of years of residence in the US on the weight of adolescents is unclear. We examined the association between generation (i.e. 1st, 1.5, 2nd, and 3rd) and weight indicators among Boston adolescents. Data are from a sample of 1,420 9-12th grade public school students in Boston, Massachusetts. We used self-reported information to calculate generation and weight characteristics (i.e., body mass index (BMI), BMI z-score, overweight status), and ran multivariate analyses to estimate the association between generation and weight characteristics, adjusting for race/ethnicity, gender, age and school. In pooled multivariate models, 1.5 generation, second generation, and third generation youth had significantly higher mean BMI scores and mean BMI z-scores than first generation youth. Second (RR 1.87, 95% CI 1.13-3.12) and third generation youth (RR 2.06, 95% CI 1.21-3.50) were also significantly more likely to be overweight than first generation youth. In multivariate models stratified by sex, this pattern persisted for females only. There is a positive, linear trend in BMI by generation that differs by gender. Mechanisms underlying this association should be addressed.

Does neighborhood collective efficacy for families change over time? The Boston Neighborhood Survey.

There is an increased interest in how neighborhood social processes, such as collective efficacy, may protect mental health. Yet little is known about how stable these neighborhood processes are over time, or how to change them to influence other downstream factors. We used a population-based, repeat cross-sectional study of adults (n=5135) to assess stability of collective efficacy for families in 38 Boston neighborhoods across 4 years (2006, 2008, 2010) (the Boston Neighborhood Survey). We test temporal stability of collective efficacy for families across and within neighborhoods using 2-level random effects linear regression, fixed effects linear regression, T-tests, and Wilcoxon rank tests. Across the different methods, neighborhood collective efficacy for families remained stable across 4 years, after adjustment for neighborhood composition. If neighborhood collective efficacy is measured within 4 years of the exposure period of interest, assuming temporal stability may be valid.

Racial/Ethnic and nativity differences in birth outcomes among mothers in New York City: the role of social ties and social support.

Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.