Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own."

INTRODUCTION: Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization. METHODS: The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking. RESULTS: Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma. CONCLUSIONS: The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.

Sociodemographic and treatment-related determinants of recent substance use among adults with comorbid substance misuse and psychotic disorders discharged from substance use treatment.

INTRODUCTION: Rates of alcohol and illicit substance use are higher among persons with psychotic disorders relative to the general population. The adverse health and psychological effects of substance use behaviors disproportionately impact persons with psychotic disorders. Prior research has shown that persons with psychotic disorders experience increased difficulty in reducing substance use behaviors, and interventions targeting substance use behavior change among this population have demonstrated limited effectiveness. One reason for this is that little is known about the factors that influence substance use and behavior change among this population. To address these disparities, the present study investigated sociodemographic and treatment-related factors of substance use recurrence among persons with psychotic disorders who received substance use treatment services. METHODS: Data came from the 2015-2018 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D collects annual data on adolescent and adult discharges from state-certified substance use treatment centers in the United States. The study conducted all analyses with a subsample of 1956 adult discharges with a psychotic disorder who received services from an outpatient substance use treatment center for at least one month. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with substance use recurrence while in treatment (α < 0.05 analyses). The study presents results from multivariable logistic regression models as adjusted odds ratios (AORs) with 95 % confidence intervals (CI). RESULTS: Those who were age 50 or older, were referred to treatment by the criminal justice system, and attended substance use self-help groups had lower odds of substance use recurrence while in treatment. Sex, educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with substance use recurrence. CONCLUSIONS: In designing treatment services, providers should consider whether focusing on sociodemographic, including cultural, factors can affect more positive substance use behavior change and other desired treatment outcomes among those with psychotic disorders and comorbid substance misuse. Further study is needed to identify these factors among specific subpopulations of those with psychotic disorders and substance misuse.

Impact of Trauma-Informed Care Training on Attitudes Among Emergency Department Personnel, Staff Advocates, and Nursing Students.

BACKGROUND: Health care providers may risk retraumatizing patients and intensifying patient distress unless they practice trauma-informed care. As the first line of defense in assisting trauma survivors' physical and emotional recovery, health care providers must use a strengths-based framework that promotes resilience and expands on the trauma survivor's existing resources. OBJECTIVE: This study aimed to compare the effect of trauma-informed care training on the attitudes of emergency department personnel, staff advocates, and nursing students toward trauma-informed care. METHODS: This study used a pretest-posttest design. Assessment of attitudes toward trauma-informed care was done before and after trauma-informed care training. Data collection occurred from February 2021 through August 2021. Participants included three cohorts of emergency department staff, advocates for trauma survivors, and nursing students. Attitudes toward trauma-informed care were measured using the Attitudes Related to Trauma-Informed Care (ARTIC) Scale. RESULTS: A total of 433 participants were studied, including 88 emergency department staff, 123 staff advocates, and 222 nursing students. All three cohorts significantly increased ARTIC Scale scores posttraining (p < .001). At preintervention, all three cohorts significantly differed from each other on ARTIC Scale scores (p < .01). In contrast, postintervention, ARTIC Scale scores did not significantly differ between nursing students and advocates (p = .99). Nursing students showed a significant increase in scores from pre- to postintervention compared with either advocates or emergency department staff. CONCLUSION: The results strongly suggest that health care providers can improve attitudes toward trauma-informed care after completing training on the principles and application of trauma-informed care.

Processes of change in preventing alcohol-exposed pregnancy: Replication of a mediation analysis.

OBJECTIVE: Further test mechanisms of the CHOICES intervention by replicating analyses of the experiential and behavioral processes of change (POC) for alcohol and for contraception as mediators of the intervention for reducing risk of alcohol-exposed pregnancy (AEP) using data from a more recent trial, CHOICES Plus (CP). METHOD: As in the prior study, replication models examined indirect paths from intervention to experiential POC for alcohol at 3 months, to behavioral POC at 9 months, to risky drinking and risk of AEP at 9 months and experiential POC for contraception at 3 months, to behavioral POC at 9 months, and to ineffective contraception and risk of AEP at 9 months. To test the temporal relationship, additional models examined the indirect path from behavioral POC for alcohol and POC for contraception at 3 months, to the experiential POC at 9 months, and to risk of AEP at 9 months. A final model tested the mediation of experiential and behavioral POC assessed at 3 months. RESULTS: There was an indirect effect of the intervention on risky drinking (total indirect effect = -.13, 95% confidence interval [CI] [-.32, -.02]) but not AEP via the alcohol POC. There was an indirect effect of the intervention on ineffective contraception (total indirect effect = -.27, 95% CI [-.55, -.07]) and AEP (total indirect effect = -.22, 95% CI [-.46, -.06]) via the contraception POC. CONCLUSIONS: This study completely replicated the prior indirect effects of the CHOICES intervention on the targeted risk behaviors through the experiential and behavioral POC for each behavior. Findings support the utility of the POC for informing health behavior change interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Inequalities in Multiple Chronic Disease Risk Factors among a population-based Sample of Latinas in California.

Data from 1,248 Latina mothers who participated in the Geographic Research on Wellbeing (GROW) study were used to examine associations between SES, neighborhood-level Latinx concentration, neighborhood-level poverty and having two or more modifiable behavioral risk factors (e.g., smoking, drinking) for chronic disease. Logistic regression models were estimated stratified by nativity and adjusted for age and marital status. Among immigrants, low SES was associated with higher odds of multiple risk factors (Adjusted Odds Ratio [AOR] = 1.66, 95% Confidence Interval [CI] = 1.17-2.38). Among US-born women, low neighborhood-level Latinx concentration was associated with lower odds of multiple risk factors (AOR = 0.43, 95% CI = 0.22-0.84), and high neighborhood-level poverty (AOR = 2.83, 95% CI = 1.61-4.99) and low SES (AOR = 1.72, 95% CI = 1.02-2.92) were associated with higher odds, respectively. Heterogeneous effects between nativity and social factors may produce risk for chronic disease among Latinas.

Reasons and obstacles for changing risky drinking behavior among Latinas at risk of an alcohol-exposed pregnancy.

This study examined reasons and obstacles for changing risky alcohol use behavior among Latina adults at risk of an alcohol-exposed pregnancy. Using qualitative methods, data from CHOICES Plus intervention sessions of Latinas (N = 59) were analyzed. Reasons for wanting to change risky alcohol use centered on health, parenting, interpersonal conflict, control, and risk of harm. Obstacles included social obstacles, belief that drinking was not risky, and drinking to manage mood. Differences were found across level of acculturation. Knowledge about salient motives and obstacles is critical to addressing the needs and strengths of Latinas at risk of an alcohol-exposed pregnancy.

Associations of Acculturation and Gender with Obesity and Physical Activity among Latinos.

Objective: Latinos disproportionately experience overweight/obesity (OWOB) and insufficient physical activity (PA), which are risk factors for numerous health conditions. Whereas numerous studies investigate acculturation as a determinant of OWOB and PA, few have examined acculturation multidimensionally, and none has examined its interaction with gender. Methods: Participants were 140 Latino adults. Primary outcomes were status as OWOB and endorsement of insufficient PA. Acculturation was measured with the Multidimensional Acculturation Scale II. Logistic regression analyses were used to examine the moderating effect of gender on the relationship between each acculturation scale and outcome, controlling for education, nativity, and smoking status. Results: Greater Spanish proficiency was significantly associated with lower odds of insufficient PA. Greater American Cultural Identity was significantly associated with higher odds of OWOB. Women had significantly higher odds of endorsing insufficient PA compared to men. Gender did not moderate the relationship between acculturation and either OWOB or PA. Conclusions: Acculturation is similarly associated with OWOB and insufficient PA for Latino men and women. Cultural identity may need to be considered to target OWOB interventions. Acculturation may be less important, and gender more important, to consider for appropriate targeting of PA interventions.

Associations of positive and negative affect on health risk behaviors among Latinos.

OBJECTIVE: Negative affect is widely emphasized in behavior modification interventions. However, positive affect is associated with smoking cessation, physical activity, and healthy dietary habits and may be an important treatment target. Few studies have examined the relationship between positive affect and health behaviors among Latinos, who disproportionately experience modifiable health risk behaviors. This study examined the independent associations of positive affect and negative affect on modifiable health risk behaviors among Latino adults. METHOD: Data came from 432 persons who participated in one of two studies examining determinants of modifiable health risk behaviors among Latino adults. Primary outcomes were current smoking, at-risk drinking, insufficient physical activity, and insufficient fruit and vegetable consumption. Predictors were positive and negative affect as measured by the Positive and Negative Affect Schedule. Associations between positive and negative affect and health risk behaviors were examined using multiple logistic regression. RESULTS: Positive affect was associated with lower odds of insufficient physical activity and insufficient fruit and vegetable consumption and lower odds of engaging in multiple health risk behaviors. Negative affect was associated with higher odds of at-risk drinking and current smoking. CONCLUSIONS: Emphasis on increasing positive affect may be warranted for multiple health risk behavior interventions targeting Latinos. Intervention development efforts may also consider prioritizing positive affect for physical activity and dietary interventions, and negative affect for at-drinking and smoking cessation interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A brief report examining the stereotype content model with blind Americans.

PURPOSE/OBJECTIVE: The stereotype content model is a unifying theory of the makeup of stereotypes and their consequences on emotions and behaviors. There is a need to study this theory from the perspectives of those most affected by them-targets of stereotypes. RESEARCH METHOD/DESIGN: Blind adults (n = 264) living in the United States completed the stereotype content measure asking participants to rate the extent to which they believed members of wider society held certain beliefs about Blind persons. RESULTS: Confirmatory factor analyses showed good fit for the four-factor model of stereotype content: warmth, competence, status, and competition. CONCLUSIONS: This study confirms the stereotype content model and begins to extend the stereotype content model to be inclusive of the perspectives of those who are the targets of stereotypes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving Spanish translations of tobacco dependence measures using cognitive interviewing.

BACKGROUND: Cognitive interviewing is the practice of systematically collecting feedback about survey items from members of the priority population, with the goal of identifying and rectifying problems to increase the comprehensibility of the survey. Evidence is limited on the extent to which this method of pretesting improves survey items. OBJECTIVE: The current study examined the utility of incorporating cognitive interviewing to improve the Spanish translations of two measures of tobacco dependence. METHODS: Items from the Spanish versions of the Wisconsin Inventory of Smoking Dependence Motives (68 items) and Nicotine Dependence Syndrome Scale (19 items) were subjected to cognitive interviews with Spanish-speaking smokers. Problematic items were revised based on participant feedback and re-assessed in a second round of interviews (N = 23, 78.3% male; 21.7% female). RESULTS: Twenty-three of the 87 items demonstrated comprehension problems, and 67 items elicited at least one problem report. Number of problems were significantly fewer pre- vs. post-revision (t [90] = 6.55, p < .001). CONCLUSIONS: In combination with standard translation procedures, cognitive interviewing with the priority population appears to be a useful method for ensuring comprehensible and relevant item content.

RESUMEN Contexto: La entrevista cognitiva es la práctica de recopilar sistemáticamente información sobre los elementos de la encuesta de los miembros de la población prioritaria, con el objetivo de identificar y rectificar problemas para aumentar la comprensibilidad de la encuesta. La literatura científica existente es limitada en la medida en que este método de pruebas preliminares mejora los elementos de la encuesta. Objetivo: El estudio actual examinó la utilidad de incorporar entrevistas cognitivas para mejorar las traducciones al español de dos medidas de dependencia del tabaco. Métodos: Los elementos de las versiones en español del Inventario de Motivos de Dependencia del Fumar de Wisconsin (68 elementos) y la Escala del Síndrome de Dependencia de Nicotina (19 elementos) fueron sometidos a entrevistas cognitivas con fumadores hispanohablantes. Los ele-mentos problemáticos se revisaron basándose en la retroalimentación de los participantes y se reevaluaron en una segunda ronda de entrevistas (N = 23, 78,3% hombres; 21,7% mujeres). Resultados: Veintitrés de los 87 elementos demostraron problemas de comprensión, y 67 elementos presentaron por lo menos un reporte de problemas. El número de problemas fue significativamente menos antes y después de la revisión (t [90] = 6,55, p < 001). Conclusión: En combinación con los procedimientos de traducción estándar, las entrevistas cogni-tivas con la población prioritaria parecen ser un método útil para garantizar un contenido com-prensible y relevante para cada elemento.

The contribution of positive affect and loneliness on readiness and self-efficacy to quit smoking among Spanish-speaking Mexican American smokers.

BACKGROUND: The existing research on affective and interpersonal determinants of smoking cessation largely under-represents minority smokers, such as Latinos. OBJECTIVE: The current study examined associations between affective and interpersonal factors with intermediary smoking cessation variables among Mexican-American smokers (N = 290; 60% male). METHODS: Measures of positive and negative affect, social support, and loneliness were each examined for associations with measures of motivational readiness to quit smoking, and smoking abstinence self-efficacy. Significant predictors were entered into models simultaneously to examine their unique associations. Covariates included gender, age, and educational attainment. RESULTS: Negative affect (b = .68, SE b = .14, p < .001) and loneliness (b = .20, SE b = .09, p < .05) were independently associated with motivation. Negative affect (b = .20, SE b = .06, p < .01) and positive affect (b = .34 SE b = .07, p < .001) were independently associated with self-efficacy. In the final models, only negative affect was associated with motivation (b = .68, SE b = .17, p < .001); whereas negative (b = .17, SE b = .06, p < .01) and positive (b = . 32, SE b = .07, p < .001) affect were associated with self-efficacy. CONCLUSION: Results highlight the importance of resilience factors (e.g., positive affect) among Mexican-American smokers. Cessation interventions regularly target negative affect among smokers; additional focus on positive affect in cessation interventions with this population may be warranted.

Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization.

PURPOSE: Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. DESIGN: Cross-sectional telephone survey. SETTING: All United States and Territories. SUBJECTS: 246 801 adults aged 18-64. MEASURES: The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. ANALYSIS: Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. RESULTS: The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25-35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. CONCLUSION: Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

A brief report of the prevalence of chronic and acute health conditions among blind American adults.

BACKGROUND: Prior research demonstrates disparities in the prevalence of certain chronic and acute health conditions among persons who are blind (PWB) compared to non-blind persons, such as diabetes and infectious diseases. However, a comprehensive understanding of the prevalence of chronic and acute health conditions among PWB is currently lacking. OBJECTIVE: The present study addressed this gap by examining the prevalence of chronic and acute conditions among blind persons, and examining differences by gender. METHODS: The present study surveyed 410 PWB residing in the U.S. about their health conditions and activities. Lifetime prevalence for eight chronic and six acute health conditions were estimated separately for men and women. Engagement in physical activity, regular use of medication, and satisfaction with health were also estimated. RESULTS: We found that men more often reported their health conditions interfered with daily activities compared to women, as well as higher prevalence of stroke and arthritis compared to women. CONCLUSION: The current study contributes information that is vital to understanding the burden of specific health conditions on this population and necessary to understand the extent to which this burden disproportionately affects PWB.

Mechanisms of change in drinking following an alcohol-related injury: A qualitative examination of the sentinel event effect.

Background: Sentinel events are negative health-related events that trigger change in risky health behaviors. Despite its presumed major role in behavior change, the sentinel event effect has received little empirical attention. Through analysis of qualitative interviews, we explored how sentinel events trigger behavior change. Methods: Thematic analysis and concept mapping were used to develop a preliminary model of the sentinel event effect among a sample of 24 adult heavy drinking Mexican-origin men previously admitted to a hospital due to injury. The model was checked against cases that did versus did not report change in alcohol use following an alcohol-related negative event. Results: Findings suggest that sentinel events may arouse negative emotional reactions, encourage reflection on the negative consequences of drinking, and cause reevaluation of the severity and significance of drinking. These processes may increase motivation to change. Conclusions: Findings support the concept of the sentinel event as a natural intervention, and identifies potential social-cognitive and motivational mechanisms through which it influences change. Findings stand to inform research on mechanisms underlying brief intervention effects, and research that seeks to identify treatment targets.

The Effects of a Brief Motivational Intervention for Alcohol Use through Stages of Change among Nontreatment Seeking Injured Patients.

BACKGROUND: Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients' alcohol use severity (i.e., moderated mediation). METHODS: The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3-, 6-, and 12-month follow-up assessments that included self-report measures of the stages of change, alcohol use, and alcohol-related problems, as well as other variables of interest. RESULTS: The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3-month follow-up leading to reduced likelihood of at-risk drinking, less alcohol use, and fewer alcohol problems at both 6- and 12-month follow-up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients' alcohol use severity. CONCLUSIONS: This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.

Women's Barriers to Specialty Substance Abuse Treatment: A Qualitative Exploration of Racial/Ethnic Differences.

To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5 years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.

Associations of Multiple Acculturation Domains with Smoking Status among Latino Adults.

Few efficacious interventions for tobacco use exist for Latinos. Identification of cultural factors relevant to smoking among Latinos can inform the development of efficacious interventions for Latino smokers. Acculturation is associated with smoking, especially among Latinas, but extant research is limited by operationalization of acculturation with unidirectional, single-domain proxies. We examined associations of multiple domains of acculturation with gender and smoking status among Latino adults. Cross-sectional data from 140 bilingual Latino adults was utilized. Acculturation was measured with the 4 subscales of the Multidimensional Acculturation Scale II (MAS-II). Logistic regression analyses tested interaction effects between MAS-II American and Latino Cultural Identification subscales, English and Spanish Proficiency subscales, and their interactions with gender, on smoking status. Higher English Proficiency was associated with greater odds of being a smoker at Spanish Proficiency scores of 4.5 or higher. Higher Latino Cultural Identification was associated with lower odds of being a smoker among women, but not men. Acculturation toward American culture, per se, may not be a risk factor for smoking; rather, its influence depends on Latino culture maintenance. Unlike in other areas of mental/behavioral health among Latinos, biculturalism may not be protective against smoking. The association between acculturation and smoking among Latinas may be a function of loss of Latino culture identification. Intervention programs should consider targeting these at-risk individuals. Longitudinal work that corroborates current findings and identifies mechanisms underlying these associations is needed.

Associations of Acculturation with English- and Spanish-Language Health Literacy Among Bilingual Latino Adults.

BACKGROUND: Low health literacy (HL) is associated with poor health status and outcomes. Racial/ethnic minorities in the United States disproportionately experience low HL and HL-related health disparities. Among Latinos, acculturation is associated with health outcomes, but little is known about the relationship between acculturation and HL. OBJECTIVE: We examined associations of sociodemographic and acculturation variables with English- and Spanish-language HL among 142 bilingual Latino adults with adequate HL. METHODS: HL was assessed in English using the Rapid Estimate of Adult Literacy in Medicine (REALM) and in Spanish with the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). Acculturation was assessed using the four subscales of the Multidimensional Acculturation Scale-II. Associations of sociodemographic data and acculturation with HL were examined using linear regression. KEY RESULTS: Higher education, higher income, higher English proficiency, and lower Latino cultural identification predicted REALM scores (ps <.05) in univariate models. When these variables were entered into a single model, only education and Latino cultural identification were associated with REALM scores. In univariate analyses, the following characteristics were associated with SAHLSA scores: female gender, being partnered, higher education, higher income, being non-US born, lower English proficiency, and higher Spanish proficiency (ps < .05). Education, being non-US born, English proficiency, and Spanish proficiency were each significant in the multivariate model. CONCLUSIONS: Results revealed a significant association between acculturation and English- and Spanish-language HL among bilingual Latino adults with adequate HL, suggesting that HL should be assessed in the language in which individuals are most proficient. HL assessed in a nonprimary language may be confounded with language proficiency. [HLRP: Health Literacy Research and Practice. 2019;3(2):e81-e89.]. PLAIN LANGUAGE SUMMARY: The results of this investigation revealed a significant association between acculturation and English- and Spanish-language health literacy among bilingual Latino adults. This suggests that health literacy should be assessed in the language in which individuals are most proficient. Health literacy assessed in a nonprimary language may be influenced by language proficiency.