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.

Documentation Status and Self-Rated Physical Health Among Latinx Young Adult Immigrants: the Mediating Roles of Immigration and Healthcare Stress.

Previous research has demonstrated that undocumented Latinx immigrants in the USA report worse physical health outcomes than documented immigrants. Some studies suggest that immigration-related stress and healthcare related-stress may explain this relationship, but none have tested it empirically. The purpose of this study was to determine if immigration-related stress and healthcare-related stress in the USA explain the relationship between documentation status and physical health among Latinx immigrants in North Carolina. The conceptual model was tested utilizing baseline data from a longitudinal, observational, community-engaged research study of young adult (18-44 years) Latinx immigrants residing in North Carolina (N = 391). Structural equation modeling was used to determine relationships among documentation status, healthcare, and immigration stress in the past six months, and self-rated physical health. Goodness-of-fit measures indicated that data fit the model well (RMSEA = .008; CFI = 1.0; TLI = .999; SRMR = .02; CD = .157). Undocumented individuals were more likely to experience immigration stress than their documented counterparts ([Formula: see text] = - 0.37, p < 0.001). Both immigration stress ([Formula: see text] = - 0.22, p < 0.01) and healthcare stress ([Formula: see text] = - 0.14, p < 0.05) were negatively related to physical health. Additionally, immigration stress was positively related to healthcare stress ([Formula: see text] = 0.72, p < 0.001). Results demonstrate that documentation status is an important social determinant of health. Passage of inclusive immigration and healthcare policies may lessen the stress experienced by Latinx immigrants and subsequently improve physical health.

Learner Response to an Activity Introducing Adverse Childhood Experiences as a Social Determinant of Health.

BACKGROUND: Threading content on the social determinants of health into the nursing curricula is a best practice recommended by certifying bodies; however, introducing content on social determinants of health can overwhelm learners, who may have difficulty relating the information to their nursing practice. METHOD: A learning strategy was developed that used film and an experiential activity to introduce content on adverse childhood experiences, a social determinant of health, and resilience into nursing course-work. A total of 130 first-semester nursing students viewed a film in class and participated in a focused debriefing and subsequent clinical exercise. RESULTS: The majority of participants (97%) believed the film appropriately introduced the content. Learners reported the debriefing was helpful in relieving distress, and 95% found the content relevant to their future nursing practice. CONCLUSION: Early introduction of key concepts related to adverse childhood experiences may assist prelicensure nursing students in developing a trauma-informed professional practice. [J Nurs Educ. 2022;61(11):650-653.].

Promoting Health Equity in the Latinx Community, Locally and Globally: The Duke University School of Nursing Model.

It is imperative that nurses are equipped to promote the health and well-being of diverse populations in United States, including the growing Latinx community, which experiences significant health disparities. This article summarizes the values, programs, and impact of the Duke University School of Nursing Latinx Engagement Health Equity Model. Collaborative partnerships with diverse community partners addressing Latinx populations across the life span were developed, spanning the education, research, and service missions of the university. Programs were rooted in cultural values and were delivered through diverse interprofessional teams and with support from the university. Programs included local and global immersion programs, volunteer work, courses in Medical Spanish, community engaged research projects, and leadership in coalitions. These models have resulted in favorable outcomes for learners, faculty and staff, and the Latinx community more broadly and can serve as a model for strategies to promote health equity at schools of nursing.

LATIN-19: A Grassroots Coalition to Mitigate the Effect of COVID-19 on the Latinx Community in North Carolina.

BACKGROUND: Social inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities. OBJECTIVE: We describe the creation and work of the Latinx Advocacy Team and Interdisciplinary Network for COVID-19 (LATIN-19; http://latin19.org/), a multisector coalition in North Carolina created to address the unique challenges of COVID-19 in the Latinx community. METHODS: We discuss challenges and solutions that LATIN-19 addressed and the impact of LATIN-19 on community partners and members. RESULTS: LATIN-19 learned of challenges including, lack of awareness, need for data systems to track disparities, the need to increase access to resources, the need for policy changes, and the need to coordinate services by community organizations. CONCLUSIONS: LATIN-19 represents a grassroots organization that has had an impact on community and community organizations that spans beyond COVID-19.

Better together: Coalitions committed to advancing health equity.

The Future of Nursing 2020-2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations' needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.

Reusable sanitary napkins in rural India: a remote quality improvement project for adolescent girls promoting menstrual hygiene health during the COVID-19 pandemic.

Medical and public health research supports an ongoing need for health promotion in meeting menstrual hygiene needs, including menstrual hygiene management (MHM) education and the adoption of reusable sanitary napkins. This quality improvement project focuses on menstruation education for adolescent girls in rural Tamil Nadu, India and the promotion of reusable sanitary napkins. Results indicate a significant improvement in MHM knowledge, confidence in managing menstruation, adoption of reusable sanitary napkins, and a decrease in missed school days. These findings support global recommendations for health promotion in India.

Improving the Health of Public Housing Residents Through a Housing Authority and Nursing School Partnership.

The connection between health and housing is well-established. People who are precariously housed have worse health than those who have stable housing arrangements.- Persons moving into public housing have a higher illness burden than the general population, and public housing residents engage in less healthy behaviors, which contribute to public housing residents having poorer health than persons living in other housing situations. Public housing authorities and residents can benefit from authentic and constructive relationships with academic partners; academicians and students can benefit from engaging in partnerships with housing authorities and residents to better understand the connection between housing and health. This article describes the well-established relationship between the Duke University School of Nursing (DUSON) and the Durham Housing Authority (DHA), the evolution of that relationship, our collaborative work in improving the health of DHA residents while advancing nursing education and science, and lessons learned.

A Continued Professional Development Nursing Partnership in a Remote Bolivian Hospital.

Bolivia's recent enactment of universal health care to increase access and delivery of health services can increase health care demands in underresourced, rural communities. We describe how a global intradisciplinary partnership assessed changing health care needs in a recently expanded hospital in the Bolivian Amazon Basin. The collaboration resulted in designing and implementing an evidence-based triage training program to improve rapid assessment and health outcomes. The interdisciplinary triage training of 19 nurses and physicians showed a significant improvement in their knowledge and implementation capacity, as demonstrated by pre- and posttest scores. As an intradisciplinary team, trainees significantly increased consistency in triage assignments in nine of 10 clinical triage posttraining vignettes. We share insights to overcome unseen challenges and improve future data-driven, evidence-based global implementation projects. [J Contin Educ Nurs. 2021;52(3):142-149.].

Improving Self-Care Management in Low-Income Latinos With Type 2 Diabetes Using Peer-Led U.S. Conversation Maps: A Quality Improvement Project in a Free Clinic.

A culturally sensitive Healthy Interactions Conversations Maps program was implemented for teaching diabetes self-management education (DSME) to Latinos with type 2 diabetes using peer-led educators in a community health center. Patients were invited to participate in a group care setting to improve access to providers and DSME. Goals were to improve diabetes distress, self-efficacy, and glycemic control as measured by A1C. Significant improvements were found for mean diabetes self-efficacy scores from before (2.53 ± 0.59) to after (2.91 ± 0.50) DSME (P <0.001). Mean A1C decreased significantly from before (9.51 ± 1.72%) to after (8.79 ± 1.68%) DSME (P = 0.043) at the end of the 6-month intervention. Thus, this program was found to be a useful tool for providing DSME in community health clinics serving low-income Latinos.

Measuring Distress Levels of Refugee Women to Enhance Community-Based Psycho-social Interventions.

The purpose of this investigation was to gain an understanding of the levels of distress in resettled refugee women as a basis for the development of improved community based interventions to enhance the resettlement experience. A convenience sample of female refugees (n = 23) in a southern US city were interviewed using a socio-demographic questionnaire; the Refugee Health Screener-15 (RHS-15); and semi-structured, exploratory questions. Results showed consistently high levels of distress, indicated by responses to the RHS-15. Women ages 19-25 and over 50 displayed the highest risk. Categories of stressors included a lack of access to health and psycho-social support services, difficulty with communicating in the English language, and social isolation. In addition, women reported that a lack of trained interpreters contributes to reduced access to health and social service, causing further distress.

Supporting Health and Well-Being for Resettled Refugee Women: The Global Women's Group.

Women refugees arrive in the United States often having experienced extreme levels of poverty, deprivation, and violence, including gender-based violence, which can severely affect their physical and psychological health and well-being. A women's group was initiated to improve the health and well-being of refugee women in Durham, North Carolina, through a collaboratively designed, culturally appropriate health literacy intervention for women based on mutually identified needs; to empower them to seek preventive health services and screening through knowledge and skills about health needs and access to care; and to create an environment for the development of a supportive social/peer network for the prevention of social isolation and mental health issues related to the refugee experience.