Challenges in the Transition from Acute Hospital Care to Home for Spanish-Speaking Latino Patients with TBI and Families: Perspectives of Healthcare Providers and Interpreters.

Language-based disparities negatively impact patient outcomes. Spanish-speaking Latino patients with traumatic brain injury (TBI) transitioning home from acute hospital care and their families have poor TBI-related outcomes; further, they have significant difficulties navigating the healthcare system due to care fragmentation and limited provider support. These challenges are exacerbated by language barriers. There are disproportionately fewer bilingual providers and interpreters in the U.S. healthcare system for patients with TBI for whom English is not their primary language. Although Spanish-speaking Latino patients with TBI and their families communicate with healthcare providers using interpreters on a regular basis, limited research has explored the healthcare delivery perspective. The purpose of this study was to understand the perspectives of healthcare providers and interpreters regarding their experience caring for or supporting Spanish-speaking Latino patients with TBI and their families during the transition home from acute hospital care. This qualitative descriptive study included 10 bilingual (English and Spanish-speaking) participants: 7 interdisciplinary providers and 3 interpreters; findings were analyzed using rapid qualitative analysis to inform intervention adaptation. Four themes were identified: 1) language misalignment decreases health literacy and increases length of stay; 2) TBI-related cognitive impairments, coupled with language differences, make communication challenging; 3) unique social contributors to health directly decrease health equity; and 4) recommendations to improve access and justice in transitional care. There are multiple opportunities to improve transitional care support provided to Spanish-speaking Latino patients with TBI and their families in a manner that is not currently being addressed in research or in practice.

Barriers and Facilitators Along the PrEP Continuum of Care Among Latinx Sexual Minoritized Men and Transgender Women: A Systematic Review.

Latinx cisgender sexually minoritized men (SMM) and transgender women (TW) in the U.S. are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is a highly effective strategy for HIV prevention, rates of PrEP use among Latinx SMM and TW remain suboptimal. The main purpose of this systematic review was to (1) describe engagement in the various stages of the PrEP care continuum among Latinx SMM and TW, and (2) identify multilevel determinants that function as barriers or facilitators to engagement in the PrEP continuum of care for Latinx SMM and TW. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Five databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus) were searched to examine the available qualitative, quantitative, and mixed method studies relevant to the research question. A total of 56 studies were included, with the majority focusing on SMM and being cross-sectional in design. Barriers included PrEP knowledge, risk perception, intersecting stigma, and structural conditions. Community resources, social support, and PrEP navigation services facilitated engagement in the PrEP continuum of care. This review highlights the complex factors that influence PrEP care engagement among Latinx SMM and TW. These findings call for comprehensive, multilevel approaches to address inequities disparities in PrEP care engagement among these groups.

RESUMEN: Los hombres cisgénero sexualmente minorizados (SMM) y las mujeres transgénero (TW) latinx en EE. UU. son desproporcionadamente afectados por el VIH. Aunque la profilaxis previa a la exposición (PrEP) es una estrategia efectiva para la prevención del VIH, el uso de la PrEP entre SMM y TW latinx siguen siendo deficiente. El propósito principal de esta revisión sistemática fue describir la participación en las etapas del continuo de atención de la PrEP entre SMM y TW latinx, e identificar factores de multinivel que funcionan como barreras o facilitadores para la participación en el continuo de atención de la PrEP en estos grupos. Esta revisión se realizó de acuerdo con la Declaración de los Elementos de Informes Preferidos para Revisiones Sistemáticas y Metaanálisis (PRISMA). Cinco bases de datos (MEDLINE, CINAHL, PsycINFO, Embase, Scopus) se utilizaron para examinar los estudios cualitativos, cuantitativos y de métodos mixtos relevantes para la pregunta de esta investigación. Se incluyeron un total de 56 estudios, la mayoría se enforcaron en SMM y usaron diseño transversal. Las barreras incluyeron falta de conocimiento sobre PrEP, percepción de riesgo, estigma interseccional y condiciones estructurales. Los recursos comunitarios, el apoyo social y los servicios de navegación de PrEP facilitaron la participación en el continuo de atención de PrEP. Esta revisión resplandece los factores complejos que influyen en la participación del continuo de atención de PrEP entre SMM y TW latinx. Estos descubrimientos exigen enfoques holistas y de multinivel para abordar las disparidades en uso y acceso a de la PrEP entre estos grupos.

Acculturation, acculturative stress, and tobacco/nicotine use of Latin American immigrants.

OBJECTIVE: US Hispanics have several health disparities, greater tobacco/nicotine-related illnesses, lower access to smoking cessation, and lower rates of cessation. Understanding cultural constructs linked to tobacco/nicotine use may provide a greater understanding of future cultural adaptations of cessation interventions. This study used a multidimensional acculturation framework, with cultural practices, identity, and values, to test links between measures of acculturation stress, multidimensional acculturation (language-based enculturation and acculturation, cultural identity, familism), and tobacco/nicotine use, and interactions with gender. DESIGN: Participants were 391 adult Latin American immigrants (69% women); 12% self-reported tobacco/nicotine use in the past six months. RESULTS: Path analysis showed acculturative stress, ß = .16, and acculturation, ß = .20, were positively related to tobacco/nicotine use. Enculturation, familism, and Hispanic cultural identity were not related to tobacco/nicotine use. There were no significant acculturation by enculturation or gender interactions, but women were less likely to use tobacco/nicotine than men, ß = -.36. CONCLUSION: Findings suggest that tobacco/nicotine cessation interventions for Latino immigrants may be enhanced with an emphasis on the mitigation of acculturative stress, attention to the adoption of US cultural practices, and gender. Future research should examine specific sources of acculturative stress or social norms related to tobacco/nicotine use.

Cost-A Hidden Aspect of Equity-Grounded Implementation Science.

This JAMA Forum discusses the cost of health inequities, the lack of attention to implementation science and the costs in the research enterprise, and provides recommendations for targeting cost in equity-grounded implementation science.

Determining the role of acculturative stress in predicting mental health service use among Latinx immigrants.

OBJECTIVES: Acculturative stress is an important factor that affects health for Latinx immigrants in the US, with multiple studies identifying a link between depression and acculturative stress in this population. However, far fewer studies have examined the specific role and relationship of acculturative stress on mental health service use in this population. Through the lens of Yang's 2016 Model of Immigrant Health Service Use, this study aimed to examine the role of acculturative stress in predicting mental health service use in a sample of Latinx immigrants in the Southeast US. DESIGN: We conducted a secondary data analysis from a longitudinal study of Latinx immigrant health (n = 391). RESULTS: Our study found that while total acculturative stress was not significantly associated with mental health service use in this sample, parenting stress was a significant predictor of mental health service use in the past six months when controlling for covariates (OR: 1.043, 95% CI [1.009, 1.078]). Additionally, important Predisposing and Need for Healthcare factors were significantly associated with mental health service use, specifically: males were less likely to utilize mental health services than females (OR: 0.401, 95% CI [0.166-0.968]), English language acculturation was positively associated with mental health service use (OR: 1.953, 95% CI [1.130, 3.377]), and depression was positively associated with mental health service use (OR: 1.107, 95% CI [1.027, 1.194]). CONCLUSION: These findings support the need for more culturally sensitive mental health services, and the need to develop strategies to engage males and less acculturated individuals in mental health services to promote health equity among Latinx immigrants.

Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities.

This JAMA Forum discusses systemic racism and racialized violence, promising approaches to address inequities in firearm violence, and ways to treat the trauma of gun violence.

Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background.

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.

Burned Out on Burnout-The Urgency of Equity-Minded Structural Approaches to Support Nurses.

This JAMA Forum discusses a health equity framework to address burnout and professional fulfillment among nurses.

Growing Up in an Era of Storms and Stress-Promoting Hope Among Adolescents in the Face of Climate Change.

This JAMA Forum discusses climate change efforts to promote hope among adolescents.

Acculturative Stress, Resilience, and a Syndemic Factor Among Latinx Immigrants.

BACKGROUND: The process of immigration and subsequent adaptation can expose Latinx immigrants to chronic and compounding challenges (i.e., acculturative stress), but little is known about how resilience factors and these stressors interact to influence syndemic conditions, intertwined epidemics that disproportionally affect historically marginalized communities. OBJECTIVES: The purpose of this study was to describe the influence of acculturative stress and resilience on the syndemic factor underlying substance abuse, intimate partner violence, HIV risk, and mental conditions. METHODS: Baseline cross-sectional data from a community-engaged, longitudinal study of 391 adult (ages 18-44 years) Latinx immigrants in North Carolina were obtained using standardized measures available in English and Spanish. Structural equation modeling tested the syndemic model, and random forest variable importance identified the most influential types of acculturative stressors and resilience factors, including their interactions, on the syndemic factor. RESULTS: Results indicated that a single syndemic factor explained variations in heavy drinking, drug use, intimate partner violence, depression, and anxiety and fit the data well. Age, being a woman, acculturative stress, acculturation to the United States, and emotional support were significantly related to the syndemic factor. The relationship between acculturative stress and the syndemic factor was buffered by ethnic pride, coping, enculturation, social support, and individual resilience. The most influential acculturative stressors were marital, family, and occupation/economic stress. DISCUSSION: Findings from this study underscore the importance of considering the co-occurrence of behavioral and mental health conditions among Latinx immigrants. Health promotion programs for Latinx immigrants should address acculturative stress and bolster ethnic pride, social support, and coping as sources of resilience.

Applying Lessons From Major Public Health Accomplishments to Firearm Injuries in the US.

This JAMA Forum discusses policies that reduce access to guns, reengineering to improve firearm safety, and hyperlocal community-led responses in marginalized communities.

An exploration of language: How nurses describe social factors that contribute to health.

BACKGROUND: Over the last two centuries nurses have been practicing, teaching, and conducting research on social factors that contribute to health and the language has evolved over this time. PURPOSE: To explore how social factors that contribute to health are described by nurse authors and how that use has changed over time. METHODS: A scoping review using the JBI Manual for Evidence Synthesis, Cochrane Handbook, and PRISMA guidelines was completed. FINDINGS: From 1967 to 2021, nurses used the term "social factors" most commonly and there was a shift from demographic to social factors. DISCUSSION: As the language that nurses use has shifted from demographic descriptions to the social factors that may be associated with those descriptions, nurses have an opportunity to promote the use of non-deterministic language for health promotion and research.

Targeted Strategies for Recruitment and Engagement of Latinx Immigrants in Longitudinal Biobehavioral Research.

Introduction: Racial/ethnic minority communities are underrepresented in research. Medical mistrust and mistreatment, discrimination, and a lack of diverse research workforce may influence recruitment and engagement. Engaging Latinx immigrants for research presents unique recruitment challenges, especially for biobehavioral research which is not well explored. The purpose of this paper is to examine the effect of targeted strategies for recruiting young adult, Latinx immigrants. Methods: Recruitment occurred from 2018 to 2019 in an ongoing, longitudinal, community-engaged research study examining risk and resilience factors for health outcomes in Latinx immigrants. Strategies included active recruitment (e.g., community-based events and public events) and passive recruitment (e.g., word-of-mouth and radio and flyer advertisements). Logistic regression analysis was conducted to examine the influence of type of recruitment on participant enrollment. Results: The study enrolled 391 participants of 701 interested individuals (55%). Greater odds of enrollment were among participants recruited through radio and flyer advertisements (adjusted odds ratio [AOR]=2.90, 95%CI [1.59, 5.27], p=.001), word-of-mouth (AOR=2.50, 95% CI [1.55, 4.03], p<.000), or community-based organization events (AOR=1.68, 95% CI [1.19, 2.38], p=.003). Conclusions: Passive recruitment strategies through trusted sources increased the odds of enrollment of Latinx immigrants in biobehavioral research. Future recruitment efforts should leverage trusted sources to disseminate recruitment materials addressing barriers to recruiting Latinx participants for research.

Trapped in My Roles as a Woman With No Help: Experiences of Intimate Partner Violence Against Chinese Women.

An understanding of intimate partner violence (IPV) experiences is a crucial first step toward shaping effective responses. However, relevant knowledge among Chinese women is scant. This study described Chinese women's IPV experiences by analyzing 46 posts shared by 42 women on a public online forum. Five overarching themes were identified using conventional qualitative content analysis: being trapped in my roles, no power in the relationship, the struggles are real but I need to tolerate, I want to leave but have no help, and hope for the future. This study has important implications for future research, practice, and education.

Age of Immigration and Depressive Symptoms Among Young Adult Latinx Immigrants: A Test of Explanatory Models.

Introduction: Latinx immigrants who migrate to the United States (US) as young children are more likely to experience depression than those who migrate later in life. Our purpose is to test three models that may explain the relationship between age of immigration and depressive symptoms among Latinx immigrants. Methods: A secondary analysis of baseline data from a community-based, longitudinal study of Latinx young adults in the US Southeast was conducted. Latinx immigrants who migrated before the age of 19 years (n = 157) were included, and path analysis was conducted. Results: Age of immigration and depressive symptoms were negatively related (b = -0.19, S = 0.08, p = .015), while acculturative stress and depressive symptoms were positively related (b = 0.04, SE = 0.01, p < .001). No significant indirect effects were found. Conclusion: Our results highlight the importance of assessing acculturative stress and age of immigration as social drivers of mental health in Latinx immigrant children.

Risk and Protective Factors Associated With Intimate Partner Violence Against Chinese Women: A Systematic Review.

Intimate partner violence (IPV) is a global health challenge leading to various detrimental health outcomes. Chinese women are a vulnerable population often overlooked in IPV research. Guided by the social-ecological model, this systematic review aims to synthesize literature on the risk and protective factors for IPV among Chinese women. A comprehensive search was conducted in nine major English and Chinese databases for articles with data collected since 2006 on adult Chinese women, leading to 29 papers in the final analysis. Risk and protective factors associated with IPV identified in this review include factors at the individual level such as demographics (e.g., a younger age, unplanned pregnancy, abortion, having children, and migration), socioeconomic status (e.g., income and partners' education level), attitudinal factors (e.g., attitudes justifying IPV and traditional beliefs about gender roles), behavioral factors (e.g., alcohol use of women, partners' alcohol use and frequency, and partners' high frequency of gambling), adverse childhood experiences (e.g., witnessed violence in childhood), and other personal characteristics (e.g., chronic illness and good health status). Factors at the relationship level include conflicts, power in intimate relationships, and social capital (e.g., the size of social networks, network participation of women and their partners, and social control). Community-level factors related to geographic locations were also explored while no factors were identified at the societal level. None of the included studies examined the intersections of factors within the same level or across different levels. Recommendations for future research, practice, and policy are also discussed.

Acculturation, Acculturative Stress, Adverse Childhood Experiences, and Intimate Partner Violence Among Latinx Immigrants in the US.

Latinx immigrants bear a disproportionate burden associated with intimate partner violence (IPV); however, efforts to develop evidence-based IPV prevention strategies and address health disparities have been impeded by a lack of understanding of the unique cultural (i.e., acculturation and acculturative stress) and socio-environmental (i.e., adverse childhood experiences [ACEs]) factors that contribute to IPV in this historically marginalized population. Guided by a contextual framework for IPV and a life-course perspective viewed through a gendered lens, this study aims to (a) identify relationships among acculturation, acculturative stress, ACEs, and IPV victimization and perpetration; and (b) explore whether profiles of IPV risk factors differ by gender (women vs. men) among Latinx immigrants. This cross-sectional, descriptive, correlational study was a secondary analysis of data from the baseline assessment of 331 ever-partnered Latinx immigrants aged 18 to 44 in a longitudinal study named Salud (Health), Estrés (Stress), y Resilencia (Resilency) (SER) Hispano. Logistic regressions adjusting for individual characteristics and gender subgroup analyses were used to address study aims. The majority of the participants were women (71.30%). More than half of all participants had experienced IPV victimization (57.70%) or IPV perpetration (60.73%). Latinx immigrants with higher family stress (adjusted odds ratio [aOR] = 1.16; p < .001) had an elevated risk for IPV victimization; those with more ACEs (aOR = 1.08; p = .005) had an increased risk for IPV perpetration. Women had a lower risk of IPV victimization (aOR = 0.45; p = .03) and a higher risk for IPV perpetration (aOR = 3.26; p = .001) compared to men. Although further research is warranted, the profiles of risk factors for IPV perpetration were different for women than for men. Culturally tailored preventions focused on acculturative stress and ACEs are needed to help Latinx immigrant communities minimize exposure to life-course adversities, improve positive adaptation to the US, and eliminate IPV-relevant health disparities.