Pregnancy-Related Deaths by Hispanic Origin, United States, 2009-2018.

Objective: To describe pregnancy-related mortality among Hispanic people by place of origin (country or region of Hispanic ancestry), 2009-2018. Materials and Methods: We conducted a cross-sectional descriptive study of pregnancy-related deaths among Hispanic people, stratified by place of origin (Central or South America, Cuba, Dominican Republic, Mexico, Puerto Rico, Other and Unknown Hispanic), using Pregnancy Mortality Surveillance System data, 2009-2018. We describe distributions of pregnancy-related deaths and pregnancy-related mortality ratios (number of pregnancy-related deaths per 100,000 live births) overall and by place of origin for select demographic and clinical characteristics. Results: For 2009-2018, the overall pregnancy-related mortality ratio among Hispanic people was 11.5 pregnancy-related deaths per 100,000 live births (95% confidence intervals [CI]: 10.8-12.2). In general, pregnancy-related mortality ratios were higher among older age groups (i.e., 35 years and older) and lower among those with higher educational attainment (i.e., college degree or higher). Approximately two in five pregnancy-related deaths among Hispanic people occurred on the day of delivery through 6 days postpartum. Place of origin-specific pregnancy-related mortality ratios ranged from 9.6 (95% CI: 5.8-15.0) among people of Cuban origin to 15.3 (95% CI: 12.4-18.3) among people of Puerto Rican origin. Hemorrhage and infection were the most frequent causes of pregnancy-related deaths overall among Hispanic people. People of Puerto Rican origin had a higher proportion of deaths because of cardiomyopathy. Conclusions: We identified differences in pregnancy-related mortality by place of origin among Hispanic people that can help inform prevention of pregnancy-related deaths.

Geographic Origin may Affect Outcomes for Hispanic Patients with Non-Small Cell Lung Cancer in the United States.

BACKGROUND: Social determinants of health thoroughly explored in the literature include insurance status, race, and ethnicity. There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogeneous population. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with non-small cell lung cancer (NSCLC) in the Unites states, by geographic region of origin. MATERIALS AND METHODS: We identified a cohort of Hispanic patients in the Unites states with NSCLC for which region of origin was documented within the 2004 to 2016 National Cancer Database (NCDB) registry. This included patients from Cuba, Puerto Rico, Mexico, South and Central America, and the Dominican Republic. We performed multivariate logistic regression modeling to determine whether origin was a significant predictor of cancer staging at diagnosis, adjusting for age, sex, histology, grade, insurance status, and facility type. Race was not included due to a nonsignificant association with stage at diagnosis at the bivariate level in this cohort. Subsequently, we used Kaplan-Meier modeling to identify whether overall survival (OS) of Hispanic patients differed by origin. RESULTS: A total of 12,557 Hispanic patients with NSCLC were included in this analysis. The breakdown by origin was as follows: n = 2071 (16.5%) Cuban, n = 2360 (18.8%) Puerto Rican, n = 4950 (39.4%) Mexican, n = 2329 (18.5%) from South or Central America, and n = 847 (6.7%) from the Dominican Republic. After controlling for age, sex, histology, grade, insurance status and treating facility type, we found that geographic origin was a significant predictor of advanced stage at diagnosis (P = .015). Compared to Cubans, patients of Puerto Rican origin were less likely to present with advanced disease (68.4% vs. 71.9%; OR: 0.82; 95%CI: 0.69-0.98; P = .026). We also identified a significant (log-rank P-value<.001) difference in OS by geographic origin, even at early-stages of diagnosis. Dominican patients with NSCLC exhibited the highest 5-year OS rate (63.3%), followed by patients from South/Central America (59.7%), Puerto Rico (52.3%), Mexico (45.9%), and Cuba (43.8%). CONCLUSION: This study showed that for Hispanic individuals living in the Unites states, region/country of origin is significantly associated with outcomes, even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.

Heterogeneity in Cardiovascular Disease Risk Factors Among Latino Immigrant Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey.

Background The Latino population is a growing and diverse share of the US population. Previous studies have examined Latino immigrants as a homogenous group. The authors hypothesized that there would be heterogeneity in cardiovascular disease risk factors among Latino immigrant subgroups (from Mexico, Puerto Rico, Cuba, Dominican Republic, Central America, or South America) compared with non-Latino White adults. Methods and Results A cross-sectional analysis of the 2010 to 2018 National Health Interview Survey (NHIS) among 548 739 individuals was performed. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self-reported hypertension, overweight/obesity, diabetes, high cholesterol, physical inactivity, and current smoking, adjusting for known confounders. The authors included 474 968 non-Latino White adults and 73 771 Latino immigrants from Mexico (59%), Puerto Rico (7%), Cuba (6%), Dominican Republic (5%), Central America (15%), and South America (9%). Compared with White adults, Mexican immigrants had the highest prevalence of overweight/obesity (prevalence ratio [PR], 1.17 [95% CI, 1.15-1.19]); Puerto Rican individuals had the highest prevalence of diabetes (PR, 1.63 [95% CI, 1.45-1.83]); individuals from Central America had the highest prevalence of high cholesterol (PR, 1.16 [95% CI, 1.04-1.28]); and individuals from the Dominican Republic had the highest prevalence of physical inactivity (PR, 1.25 [95% CI, 1.18-1.32]). All Latino immigrant subgroups were less likely to be smokers than White adults. Conclusions The authors observed advantages and disparities in cardiovascular disease risk factors among Latino immigrants. Aggregating data on Latino individuals may mask differences in cardiovascular disease risk and hinder efforts to reduce health disparities in this population. Study findings provide Latino group-specific actionable information and targets for improving cardiovascular health.

Misinformation on COVID-19 origin and its relationship with perception and knowledge about social distancing: A cross-sectional study.

Despite the vast scientific evidence obtained from the genomic sequencing of COVID-19, controversy regarding its origin has been created in the mass media. This could potentially have a long-term influence on the behavior among individuals, such as failure to comply with proposed social distancing measures, leading to a consequent rise in the morbidity and mortality rates from COVID-19 infection. Several studies have collected information about knowledge, attitudes, and practices regarding COVID-19; however, very little is known about the relationship of the perceptions of the individuals regarding the origin of the virus with the knowledge and perception about social distancing. This study aimed at ascertaining this relationship. For such purpose, a web-based cross-sectional study was conducted among a sample population from five provinces of the Dominican Republic from June to July of 2020. The data collection instrument exploited in the study was a self-designed questionnaire distributed throughout different social media platforms. A purposive sampling strategy was implemented and a total of 1195 respondents completed the questionnaire. The collected data was analyzed using SPSS. Descriptive statistics, stepwise multiple linear regression, and one-way multivariate analysis were implemented to test the hypotheses. The level of education was significantly associated (P = .017) with individuals' perception about the origin of COVID-19, whilst only age (P = .032) and education level (P < .001) statistically significantly predicted 'knowledge about social distancing'. Perception of COVID-19 origin was statistically significant associated (P = < .001) with the measures of the dependent variables (knowledge and perception on social distancing). The present study has established a possible link between the 'perception of COVID-19 origin' and 'the perception and knowledge about social distancing'.

Rapid ethnographic assessment for potential anti-malarial mass drug administration in an outbreak area of Santo Domingo, Dominican Republic.

BACKGROUND: In the Dominican Republic, a recent outbreak of malaria in the capital, Santo Domingo, threatens efforts to eliminate the disease. Mass drug administration (MDA) has been proposed as one strategy to reduce transmission. The success of MDA is contingent upon high levels of acceptance among the target population. To inform the design of future MDA campaigns, this rapid ethnographic assessment examined malaria-related knowledge and attitudes toward malaria MDA among residents of a transmission focus in Santo Domingo. METHODS: In October 2019, a rapid ethnographic assessment was conducted in the Los Tres Brazos transmission focus, which had not previously received MDA. National malaria programme staff conducted 61 structured interviews with key informants, recorded observations, and held 72 informal conversations. Using a grounded theory approach, data were analysed during three workshop sessions with research team members. RESULTS: Among those who had heard of malaria in the structured interviews (n = 39/61; 64%), understanding of the disease was largely based on personal experience from past outbreaks or through word-of-mouth. Community health workers (promotores) were trusted for health information and malaria diagnosis more so than professional clinicians. No participant (0%) was familiar with malaria MDA. After learning about MDA, almost all study participants (92%) said that they would participate, seeing it as a way to care for their community. Reasons for not participating in future MDA included not trusting drug administrators, feeling reluctant to take unprescribed medicine, and fear of missing work. Additional identified challenges to MDA included reaching specific demographic groups, disseminating effective MDA campaign messages, and managing misinformation and political influence. CONCLUSION: Residents appear accepting of MDA despite a lack of prior familiarity. Successful MDA will depend on several factors: fostering relationships among community-based health workers, clinicians, community leaders, and others; developing clear health messages that use local terms and spreading them through a variety of media and social networks; and contextualizing MDA as part of a broader effort to promote community health.

Ethnic Restaurant Nutrition Environments and Cardiovascular Health: Examining Hispanic Caribbean Restaurants in New York City.

Objective: To adapt and apply the Nutrition Environment Measures Survey for Restaurants (NEMS-R) to Hispanic Caribbean (HC) restaurants and examine associations between restaurant characteristics and nutrition environment measures. Methods: We adapted the NEMS-R for HC cuisines (Cuban, Puerto Rican, Dominican) and cardiovascular health-promoting factors, and applied the instrument (NEMS-HCR) to a random sample of HC restaurants in New York City (NYC) (N=89). Multivariable linear regression was used to assess independent associations between NEMS-HCR score and restaurant characteristics (cuisine, size, type [counter-style vs sit-down] and price). Results: None of the menus in the restaurants studied listed any main dishes as "healthy" or "light." More than half (52%) offered mostly (>75%) nonfried main dishes, and 76% offered at least one vegetarian option. The most common facilitator to healthy eating was offering reduced portion sizes (21%) and the most common barrier was having salt shakers on tables (40%). NEMS-HCR scores (100-point scale) ranged from 24.1-55.2 (mean=39.7). In multivariable analyses, scores were significantly related to cuisine (with Puerto Rican cuisine scoring lower than Cuban and Dominican cuisines), and size (with small [<22 seats] restaurants scoring lower than larger restaurants). We found a significant quadratic association with midpoint price, suggesting that scores increased with increasing price in the lowest price range, did not vary in the middle range, and decreased with increasing price in the highest range. Conclusions: Our application of the NEMS-R to HC restaurants in NYC revealed areas for potential future interventions to improve food offerings and environmental cues to encourage healthful choices.

Caribbean Diaspora Healthy Nutrition Outreach Project (CDHNOP): A Qualitative and Quantitative Approach to Caribbean Health.

Background: Obesity prevention and its associated co-morbidities such as diabetes require a multi-tiered, culturally sensitive, population-based approach. South Florida's tri-county area is home to approximately 75% of Florida's total Caribbean immigrant population. This project is the first Caribbean-focused intervention using the Go-Slow-Whoa or GSW format which designates whether a food or beverage should be chosen frequently (Go - green), less often (Slow - yellow), or rarely (Whoa - red) based on the content of nutrients, sodium, fat, and sugar. Specific Aims: 1. To create and evaluate culturally appropriate nutrition materials for the Caribbean diaspora population in Broward County (i.e. tailor existing GSW evidence-based materials for this population). 2. To quantify which social determinants of health are most relevant to this population. Methods: Mixed methods were utilized in this study. The qualitative, exploratory arm consisted of semi-structured focus groups that included 38 subjects from five Caribbean countries most represented in South Florida: Jamaica, Haiti, Trinidad and Tobago, Cuba and Dominican Republic. The quantitative arm employed descriptive and inferential statistics to analyze social determinants of health (SDOH) obtained from a modified National Association of Community Health Centers' PRAPARE survey. Intercept survey data was also collected from a convenience sample of 24 Caribbean immigrants in Broward County. Findings: Analysis revealed a lack of culturally appropriate foods and exercise examples in the current GSW materials. At 92% and 82% respectively, an overwhelming majority of our intercept surveys indicated that our revised, culturally appropriate materials were helpful in making positive food and beverage choices. Further study is required to determine which SDOH variables are relevant to this population. Conclusions: Health disparities and inequity in the healthy living education of our Caribbean subpopulation are best addressed using an inclusive research frame that captures the cultural essence and preferences of this understudied community.

Maternal Place of Birth, Socioeconomic Characteristics, and Child Health in US-Born Latinx Children in Boston.

OBJECTIVE: Among US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence in the United States; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation. METHODS: Cross-sectional survey of 2145 Latina mothers of publicly insured US-born children 0 to 48 months old in a Boston emergency department (ED) 2004 to 2013. Predictors were FBM versus USBM and duration of residence in the United States. Outcomes were mothers' report of child health, history of hospitalization, developmental risk, and hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification. RESULTS: FBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor versus good/excellent health (adjusted odds ratios 1.9, 95% confidence interval [1.4, 2.6]), with highest odds for children of FBM with shortest duration of residence, and to be admitted to the hospital on the day of the ED visit (adjusted odds ratios 1.7, 95% confidence interval [1.3, 2.2]). SNAP and FI did not fully explain these outcomes. CONCLUSION: When providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.

A Single-Center Experience with a Pregnant Immigrant Population and Zika Virus Serologic Screening in New York City.

OBJECTIVE: Our institution is in an area of New York City with a large population of immigrants from Zika virus endemic areas. With the recent Zika virus outbreak, we sought to examine our center's experience with screening for Zika virus and outcomes among patients who tested positive for the disease during pregnancy. STUDY DESIGN: We performed a chart review of all pregnant patients who tested positive (positive serum or urine polymerase chain reaction [PCR]) or presumed positive (immunoglobulin M [IgM] enzyme-linked immunosorbent assay [ELISA] positive or IgM ELISA equivocal with positive plaque reduction neutralization test) for Zika virus. All tests were performed by the Department of Health (DOH) and followed Centers for Disease Control and Prevention guidelines in effect at the time of specimen collection. Testing of cord blood, placenta, and/or neonatal blood were/was performed by the DOH for New York County. Prenatal ultrasounds for fetal head size and surveillance for calcifications were performed by maternal-fetal medicine specialists. Infant head ultrasound results were included when available. RESULTS: Between March 2016 and April 2017, 70 pregnant patients were positive or presumed positive for Zika infection during pregnancy. Of those, 16 women had positive urine or serum PCR and the remaining 54 were presumed positive. Among positive cases, five women tested positive via urine PCR only, nine women tested positive via serum PCR only, and two women had both positive urine and serum PCR. Fifteen of 67 infants (22%) born during the study period were born to mothers with positive urine or serum PCR testing. Sixty-five newborns were clinically normal with normal head measurements. Of the intracranial ultrasound performed, one infant had a grade 1 intraventricular hemorrhage, four had incidental choroid plexus cysts, and one had severe ventriculomegaly that was also noted antenatally. There were 2 positive and 15 equivocal infant serum IgM samples and 1 positive placental PCR from these pregnancies. There were four pregnancy terminations and two cases with fetal anomalies in this population that were split evenly between patients who tested positive and those who tested presumed positive for Zika virus during pregnancy. CONCLUSION: We found no differences in pregnancy or neonatal outcomes between women who tested positive and presumed positive for Zika virus during pregnancy. Testing of infants and placenta tissue after delivery was largely inconclusive. Improvement in testing for Zika virus infection is needed to determine which pregnancies are at risk for congenital anomalies. Further research is still needed to determine which children are at risk for poor neurodevelopmental outcomes related to Zika virus and how to best coordinate care among the immigrant population during a new disease epidemic.

Do, say, learn: the functions of mothers' speech to infants.

We examined the functions of mothers' speech to infants during two tasks - book-sharing and bead-stringing - in low-income, ethnically diverse families. Mexican, Dominican, and African American mothers and their infants were video-recorded sharing wordless books and toy beads in the home when infants were aged 1;2 and 2;0. Mothers' utterances were classified into seven categories (labels/descriptions, emotion/state language, attention directives, action directives, prohibitions, questions, and vocal elicitations) which were grouped into three broad language functions: referential language, regulatory language, and vocalization prompts. Mothers' ethnicity, years of education, years living in the United States, and infant sex and age related to mothers' language functions. Dominican and Mexican mothers were more likely to use regulatory language than were African American mothers, and African American mothers were more likely to use vocalization prompts than were Latina mothers. Vocalization prompts and referential language increased with mothers' education and Latina mothers' years living in the United States. Finally, mothers of boys used more regulatory language than did mothers of girls. Socio-cultural and developmental contexts shape the pragmatics of mothers' language to infants.

Prescription Opioid Use Among Hispanics/Latinos With Arthritis Symptoms: Results From the Hispanic Community Health Study/Study of Latinos.

INTRODUCTION: To determine the prevalence of prescription opioid (PO) use among Hispanics/Latinos with arthritis symptoms and to characterize how demographic and cultural factors are associated with PO use. METHOD: Cross-sectional analysis of baseline visit data during 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of 16,415 Hispanics/Latinos living in Chicago, Illinois, Miami, Florida, Bronx, New York, and San Diego, California. Included participants self-reported painful inflammation or swelling in one or more joints. Multivariate models controlling for physical and mental health scores were constructed to assess how demographic and cultural factors were associated with PO use. RESULTS: A total of 9.3% were using POs at the time of the baseline visit. In multivariate models, persons of Cuban background (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI; 0.21, 0.81]) and of Dominican background (AOR = 0.38, 95% CI [0.18, 0.80]) were significantly less likely to use POs compared with a reference group of persons of Mexican background. Greater language acculturation was also negatively associated with PO use (AOR = 0.68, 95% CI [0.53, 0.87]). CONCLUSION: POs were used relatively uncommonly, and use showed marked variation between Hispanic/Latino groups. Future study should determine mechanisms for why greater use of English among Hispanics/Latinos might influence PO use.

Prepregnancy obesity is associated with cognitive outcomes in boys in a low-income, multiethnic birth cohort.

BACKGROUND: Maternal obesity and high gestational weight gain (GWG) disproportionally affect low-income populations and may be associated with child neurodevelopment in a sex-specific manner. We examined sex-specific associations between prepregnancy BMI, GWG, and child neurodevelopment at age 7. METHODS: Data are from a prospective low-income cohort of African American and Dominican women (n = 368; 44.8% male offspring) enrolled during the second half of pregnancy from 1998 to 2006. Neurodevelopment was measured using the Wechsler Intelligence Scale for Children (WISC-IV) at approximately child age 7. Linear regression estimated associations between prepregnancy BMI, GWG, and child outcomes, adjusting for race/ethnicity, marital status, gestational age at delivery, maternal education, maternal IQ and child age. RESULTS: Overweight affected 23.9% of mothers and obesity affected 22.6%. At age 7, full-scale IQ was higher among girls (99.7 ± 11.6) compared to boys (96.9 ± 13.3). Among boys, but not girls, prepregnancy overweight and obesity were associated with lower full-scale IQ scores [overweight ß: - 7.1, 95% CI: (- 12.1, - 2.0); obesity ß: - 5.7, 95% CI: (- 10.7, - 0.7)]. GWG was not associated with full-scale IQ in either sex. CONCLUSIONS: Prepregnancy overweight and obesity were associated with lower IQ among boys, but not girls, at 7 years. These findings are important considering overweight and obesity prevalence and the long-term implications of early cognitive development.

Exploring HIV concern in a population of Dominican American women midlife and older.

BACKGROUND: The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS: We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS: Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS: Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.

At risk alcohol consumption with smoking by national background: Results from the Hispanic community health study/study of Latinos.

INTRODUCTION: Tobacco smoking and binge or excess drinking are unhealthy behaviors that frequently co-occur. Studies of Hispanics/Latinos have mostly been of Mexican Americans although there are substantial differences in smoking and drinking by heritage background. Associated with co-use by 5 subpopulations. METHODS: Cross-sectional data of 16,412 Hispanics/Latinos from Miami, the Bronx, Chicago and San Diego collected between 2008 and 2011 as part of the HCHS/SOL were analyzed. Smoking and alcohol consumption and demographic data were measured by self-report. Prevalence of smoking and alcohol consumption and co-use were reported. Logistic regression models examined the odds of co-use of smoking and binge or excess alcohol use by Hispanic/Latino background group. RESULTS: Men of Cuban (10.3%), Puerto Rican (8.9%), and Mexican (8.9%) background had the highest prevalence of co-use of smoking and binge drinking compared to men of Central American (6.1%) and Dominican (6.6%) background. Women of Dominican (16.4%) and Puerto Rican (19.7%) background had the highest prevalence of binge drinking compared to women of Central American (10%) and Cuban (8%) background and Puerto Rican (34.1%) and Cuban (21.8%) women were the most likely to report current smoking compared to women of Central American (8.3%) and Mexican (10.4%) background. Acculturation was not associated with co-use among men and women. Elevated depressive symptoms were positively associated with smoking and binge drinking among men, OR = 1.5 [1.2-2.0], and women, OR = 1.5 [1.1-2.2]. Puerto Rican women had increased odds of co-use of smoking and binge or excess drinking compared to Mexican American women, OR = 3.2 [1.5-6.6]. CONCLUSIONS: Puerto Rican and Dominican Latinas and Central American and South American men have a higher prevalence of co-use.

Prescription opioid misuse among U.S. Hispanics.

BACKGROUND: As a risk factor for addiction, heroin use, and overdose, the misuse of prescription opioids represents a critical public health challenge. While public attention has primarily centered on opioid misuse among White individuals, less attention has been devoted to opioid misuse among one of the United States' fastest-growing demographic groups: Hispanic immigrants and their descendants. This study therefore examined prescription opioid misuse among U.S. Hispanic adults, with attention to within-group differences and the role of acculturation-related characteristics. METHODS: Data were derived from the 7037 U.S. Hispanic adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). Weighted proportions, adjusted odds ratios, and 95% confidence intervals were computed for past-year and lifetime prescription opioid misuse. Binomial logistic regression models examined the association between acculturation-related characteristics and prescription opioid misuse. RESULTS: Past-year prevalence of prescription opioid misuse among U.S. Hispanic adults was lower in the first generation (1.6%), compared with the second (4.1%), third (6.8%), and higher-than-third (6.2%) generations, and a similar pattern was observed for lifetime prevalence. Higher generation, greater English language orientation, and length of time living in the United States were significantly associated with higher odds of past-year and lifetime prescription opioid misuse. CONCLUSIONS: Relying solely on comparisons of prevalence between ethnic groups may obscure significant variations within ethnic groups. Second, third, and higher generation Hispanics are higher-risk subgroups, with rates of prescription opioid misuse approaching or surpassing the rates reported among non-Hispanic Whites.

Smoking expectancies and health perceptions: An analysis of Hispanic subgroups.

Research suggests different patterns of cigarette smoking behaviors across Hispanic subgroups. However, research examining differences in known cognitive correlates of smoking behavior (e.g., beliefs about smoking and perceived consequences of smoking) is lacking. The purpose of this study was two-fold. First, given the dearth of research examining cigarette smoking across Hispanic subgroups, we sought to replicate previous findings related to disparities in smoking behavior across four subgroups (i.e., Mexican American, Puerto Rican, Cuban American, and Dominican American). Second, we sought to extend previous work by examining Hispanic subgroup differences across a range of smoking-related cognitive factors (i.e., positive and negative beliefs, perceived health risks, and perceived social consequences). This study used data from 1021 Hispanic individuals from four universities in the U.S. (i.e., Texas, California, New York, Florida) in a project funded by the American Legacy Foundation. Results indicated that Cuban Americans reported more current smoking than any other subgroup and the most positive beliefs about smoking, although Puerto Ricans endorsed the fewest negative beliefs about smoking out of all the groups. There were also differences across subgroups on some perceived health risks of smoking (e.g., Cubans were most likely to believe that smoking was a risk factor for diabetes) and perceived social consequences of smoking (e.g., Mexican Americans were less likely to perceive negative social consequences from not smoking). This study underscores the need to account for heterogeneity within the Hispanic population in tobacco research to more effectively inform future research and prevention practices.

Cholera control and anti-Haitian stigma in the Dominican Republic: from migration policy to lived experience.

As cholera spread from Haiti to the Dominican Republic, Haitian migrants, a largely undocumented and stigmatized population in Dominican society, became a focus of public health concern. Concurrent to the epidemic, the Dominican legislature enacted new documentation requirements. This paper presents findings from an ethnographic study of anti-Haitian stigma in the Dominican Republic from June to August 2012. Eight focus group discussions (FGDs) were held with Haitian and Dominican community members. Five in-depth interviews were held with key informants in the migration policy sector. Theoretical frameworks of stigma's moral experience guided the analysis of how cholera was perceived, ways in which blame was assigned and felt and the relationship between documentation and healthcare access. In FGDs, both Haitians and Dominicans expressed fear of cholera and underscored the importance of public health messages to prevent the epidemic's spread. However, health messages also figured into experiences of stigma and rationales for blame. For Dominicans, failure to follow public health advice justified the blame of Haitians and seemed to confirm anti-Haitian sentiments. Haitians communicated a sense of powerlessness to follow public health messages given structural constraints like lack of safe water and sanitation, difficulty accessing healthcare and lack of documentation. In effect, by making documentation more difficult to obtain, the migration policy undermined cholera programs and contributed to ongoing processes of moral disqualification. Efforts to eliminate cholera from the island should consider how policy and stigma can undermine public health campaigns and further jeopardize the everyday 'being-in-the-world' of vulnerable groups.

Obstetric Violence as Reproductive Governance in the Dominican Republic.

A human rights violation, obstetric violence encompasses numerous forms of mistreatment against women giving birth in health care facilities. Based on this framework, we conducted open-ended exit interviews with 43 women who had given birth at either one of the two largest public maternity hospitals in the Dominican Republic. Women's narratives revealed a contrast between scholarly definitions of obstetric violence and their own perceptions of receiving abusive care. Analyzing obstetric violence as a form of reproductive governance and the adaptive preference that ensues helps explain why most women accepted with endurance the poor quality of care that they received.

Coping with mental health issues among older Hispanic adults.

Access to mental health services for older Hispanic adults is limited and often older Hispanic adults must rely on their own resources in dealing with mental health issues. The aim of this study was to understand how older Hispanic immigrants cope mental health issues (e.g. stress, anxiety, and/or depression). A qualitative, descriptive approach was used to interview 17 older Hispanic immigrants from Guatemala, Dominican Republic and Colombia. Interviews were audio recorded, transcribed and translated verbatim by bilingual research assistants. Data were analyzed using content analysis with a combination of immersion/crystallization, editing and template organizing styles. Ways of coping included spiritual beliefs and religious practices, social support, distraction, medications and professional help. Primary care providers may be more effective if they build upon the cultural constructs that undergird older Hispanic immigrants' ways of coping in addressing emotional distress and mental health issues in this population.

Are Dominicans in Favor of Xenotransplantation? A Study of the Attitude of Dominican Immigrants Residing in Spain and the United States.

Xenotransplantation carries many social and cultural implications. The immigrant population in countries with xenotransplantation programs, such as Spain and the United States, will play an important role in accepting such therapy. The objective of the study is to analyze the attitude toward xenotransplantation among the Dominican population residing in the United States and Spain. METHODS: The study population was born in the Dominican Republic and resides in the southeastern United States and Spain. A sample population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTx-Ríos). A random selection of people to be surveyed was carried out. Assistance from immigration support associations was needed to advise on the location of potential respondents. RESULTS: A total of 123 respondents were included in the study: A sample was taken of residents of the population from the Dominican Republic residing in Florida, United States (n = 66), and in Spain (n = 57). If it was assumed that xenotransplanted organs functioned as well as human ones, 30% would be in favor. If the results were worse, only 7% would be in favor. This favorable attitude was related to the following variables (P < .05): level of education, an attitude in favor of deceased and living organ donation, and having spoken about donation and transplantation within the family. CONCLUSIONS: The attitude toward xenotransplantation among the population from the Dominican Republic who are residing in the southeastern United States and Spain is unfavorable.