Predictors of Physical Activity in a Predominantly Hispanic Sample of Adolescents.

In the United States, the vast majority of Hispanic high school students do not meet physical activity recommendations. This prospective, observational study tested the Theory of Planned Behavior (TPB) to predict physical activity in a convenience sample of 232 high school students from a predominantly Hispanic, rural-fringe, lower-income community in Southwestern United States. Mindfulness was tested as a moderator of the intention-physical activity relationship. Data were collected via self-report questionnaires. Statistical analysis included structural equation modeling (SEM) and moderation analysis. The model explained 60% and 43% of the variance in intention and physical activity, respectively. Attitude (ß = 0.49, p < 0.001) and subjective norm (ß = 0.44, p < 0.001) predicted intention. Intention (ß = 0.58, p < 0.001) and perceived behavioral control (ß = 0.13, p < 0.027) predicted physical activity. Mindfulness did not moderate the intention-physical activity relationship. The results support using the TPB to predict physical activity in this population and may inspire ideas for targeted interventions.

Prevalence and correlates of "popper" (amyl nitrite inhalant) use among HIV-positive Latinos living in the U.S.-Mexico border region.

Poppers (nitrite inhalants) are legal, commonly used by men who have sex with men, and associated with HIV acquisition, yet research is lacking on popper use and associated adverse outcomes. People living with HIV (PLWH) in the U.S.-Mexico border region lead binational lives, including accessing care and having sex and drug use partners on both sides of the border, with broad personal and public health implications. Understanding popper use provides crucial information to guide policy and develop targeted interventions for binational PLWH. We examine prevalence and correlates of popper use among HIV-positive Latinos in the border region, an underserved population at risk for poor health outcomes. This cross-sectional study recruited a convenience sample from agencies in San Diego and Tijuana to complete quantitative surveys. Participants (N = 121) were primarily male (82.6%) and gay/bisexual (62%). Lifetime substance use (excluding cannabis) was reported by 72% of participants, and 25.6% reported lifetime popper use. Individuals recruited in the U.S. were significantly more likely to report use of poppers than were participants recruited in Mexico. Our regression model found that identifying as gay/bisexual and having bought, sold, or traded sex for money, drugs, or other goods were independently associated with popper use. Findings shed light on the profile of individuals who use poppers and lay the foundation for further research to understand the context of popper use as it relates to high-risk behavior among PLWH in this region of high transborder mobility. Binational collaborative approaches are needed to improve regional HIV care outcomes and reduce transmission risk.

Evaluating the Validity of the DSM-5 Alcohol Use Disorder Diagnostic Criteria in a Sample of Treatment-seeking Native Americans.

OBJECTIVE: Despite high rates of alcohol use disorder (AUD) and alcohol-induced deaths among Native Americans, there has been limited study of the construct validity of the AUD diagnostic criteria. The purpose of the current study was to examine the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) AUD criteria in a treatment-seeking group of Native Americans. METHODS: As part of a larger study, 79 Native Americans concerned about their alcohol or drug use were recruited from a substance use treatment agency located on a reservation in the southwestern United States. Participants were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID for DSM-IV-TR) reworded to assess 11 DSM-5 criteria for AUD. Confirmatory factor analysis (CFA) was used to test the validity of the AUD diagnostic criteria, and item response theory (IRT) was used to examine the item characteristics of the AUD diagnostic criteria in this Native American sample. RESULTS: CFA indicated that a 1-factor model of the 11 items provided a good fit of the data. IRT parameter estimates suggested that "withdrawal," "social/interpersonal problems," and "activities given up to use" had the highest magnitude of discrimination. "Much time spent using" and "activities given up to use" were associated with the greatest severity. CONCLUSIONS: The current study provided support for the validity of the AUD DSM-5 criteria and a unidimensional latent construct of AUD in this sample of treatment-seeking Native Americans. IRT analyses replicate findings from previous studies. To our knowledge, this is the first study to examine the validity of the DSM-5 AUD criteria in a treatment-seeking sample of Native Americans. Continued research in other Native American samples is needed.

THE INITIAL ASSESSMENT OF A COMMUNITY-BASED INTERVENTION WITH MEXICAN-HERITAGE PARENTS IN BOOSTING THE EFFECTS OF A SUBSTANCE USE PREVENTION INTERVENTION WITH YOUTH.

Drawing from an ecodevelopmental framework, this article examines if adding a parenting component, Families Preparing the New Generation (Familias Preparando la Nueva Generación), to an efficacious classroom-based drug abuse prevention intervention, keepin'it REAL, will boost the effects of the youth intervention in preventing substance use for middle school Mexican-heritage students. Youth attending schools in a large urban area in the Southwestern U.S. (N = 462) were randomly assigned to 1 of 3 conditions: parent and youth, youth only, or control. Using ordinary least squares regression, changes in youth substance use outcomes were examined. Results indicate that youth whose parents also participated in prevention programming exhibited significantly lower use of alcohol, cigarettes, marijuana, and inhalants compared to youth who received only keepin'it REAL. These initial effects indicate that involving parents in prevention efforts can strengthen the overall efficacy of a youth prevention intervention. This article discusses specific implications for the design of prevention interventions, policy, and future research.

Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain.

Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N = 137) -51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals. Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.

Peripheral Endocannabinoids Associated With Energy Expenditure in Native Americans of Southwestern Heritage.

Context: The endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG), as well as the related acylethanolamide oleoylethanolamide (OEA), have been implicated in energy expenditure (EE) regulation and metabolic diseases. Muscle (fat-free mass) and fat (fat mass) are metabolically active compartments and main determinants of EE. Objective: To assess whether human muscle, adipose, and plasma endocannabinoids correlate with EE. Design: Muscle, adipose, and plasma AEA, 2-AG, and OEA concentrations were measured via liquid chromatography-mass spectrometry. EE was assessed by indirect whole-room calorimetry. Setting: Clinical trial. Participants: Obese/overweight Native Americans of full (n = 35) and at least half (n = 21) Southwestern heritage. Main Outcome Measures: Twenty-four-hour EE, sleeping EE (SLEEP), resting EE (REE), respiratory quotient (RQ), and macronutrient oxidation. Results: In full Natives, muscle AEA concentration correlated with SLEEP (r = -0.65, P = 0.004) and REE (r = -0.53, P = 0.02). Muscle 2-AG was associated with SLEEP (r = -0.75, P = 0.0003). Adipose OEA concentration correlated with RQ (r = -0.47, P = 0.04) and lipid oxidation (r = 0.51, P = 0.03). Plasma OEA concentration was associated with SLEEP (r = -0.52, P = 0.04). After adjustment for major determinants, these lipids explained nearly 20% of the additional variance of the respective measure. Similarly, in Native Americans of at least half Southwestern heritage, investigated lipids correlated with EE measures. Conclusion: Endocannabinoids in metabolically relevant peripheral tissues explained a large part of EE variation and may be involved in regulating EE. Dysregulation of peripheral endocannabinoids may predispose people to metabolic diseases via an effect on EE and lipid oxidation.

A Small-Scale Randomized Efficacy Trial of the Identity Project: Promoting Adolescents' Ethnic-Racial Identity Exploration and Resolution.

Adolescents' ethnic-racial identity (ERI) formation represents an important developmental process that is associated with adjustment. The Identity Project intervention, grounded in developmental theory, was designed to engage adolescents in the ERI processes of exploration and resolution. The current small-scale efficacy trial involved an ethnic-racially diverse sample of adolescents (N = 215; Mage  = 15.02, SD = .68) from eight classrooms that were randomly assigned by classroom to the intervention or attention control group. Differences between conditions in ERI exploration at Time 2 were consistent with desired intervention effects; furthermore, higher levels of ERI exploration at Time 2 predicted increases in ERI resolution at Time 3 only for youth in the treatment condition. Findings provide preliminary evidence of program efficacy.

Relationships Between Smoking Behaviors and Cotinine Levels Among Two American Indian Populations With Distinct Smoking Patterns.

Introduction: Smoking prevalence, cigarettes per day (CPD), and lung cancer incidence differ between Northern Plains (NP) and Southwest (SW) American Indian populations. We used cotinine as a biomarker of tobacco smoke exposure to biochemically characterize NP and SW smokers and nonsmokers and to investigate factors associated with variation in tobacco exposure. Methods: American Indians (N = 636) were recruited from two different tribal populations (NP and SW) as part of a study conducted as part of the Collaborative to Improve Native Cancer Outcomes P50 project. For each participant, a questionnaire assessed smoking status, CPD, second-hand smoke exposure, and traditional ceremonial tobacco use; plasma and/or salivary cotinine was measured. Results: Cotinine levels were (mean ± 95% confidence interval [CI]) 81.6 ± 14.1 and 21.3 ± 7.3 ng/ml among NP smokers and non-mokers, respectively, and 44.8 ± 14.4 and 9.8 ± 5.8 ng/ml among SW smokers and nonsmokers, respectively. Cotinine levels correlated with CPD in both populations (p < .0001). Cotinine ≥15 ng/ml was measured in 73.4% of NP smokers and 47.8% of SW smokers and in 19.0% of NP nonsmokers and 10.9% of SW nonsmokers. Ceremonial traditional tobacco use was associated with higher cotinine among NP smokers only (p = 0.004). Second-hand smoke exposure was associated with higher cotinine among NP non-smokers (P < 0.02). More secondhand smoke exposure was associated with smoking more CPD in both populations (p = 0.03-0.29). Linear regression modeling mirrored these findings. Conclusions: High prevalence of smoking in the Northern Plains and high cotinine levels among nonsmokers in both regions highlights the tribal populations' risk for tobacco-related disease. Implications: There is a high prevalence of smoking in Northern Plains American Indians. Among Northern Plains and Southwest nonsmokers, relatively high cotinine levels, representative of high tobacco exposure, suggest considerable exposure to second-hand smoke. It is critical to highlight the extent of second-hand smoke exposure among the Northern Plains and Southwest American Indians and to enhance efforts to initiate smoke-free policies in tribal communities, which are not subject to state-level polices.

A Model of Maternal and Paternal Ethnic Socialization of Mexican-American Adolescents' Self-Views.

Data from a sample of 462 Mexican-American adolescents (M = 10.4 years, SD = .55; 48.1% girls), mothers, and fathers were used to test an ethnic socialization model of ethnic identity and self-efficacy that also considered mainstream parenting styles (e.g., authoritative parenting). Findings supported the ethnic socialization model: parents' endorsement of Mexican-American values were associated with ethnic socialization at fifth grade and seventh grade; maternal ethnic socialization at fifth grade and paternal ethnic socialization at seventh grade were associated with adolescents' ethnic identity exploration at 10th grade and, in turn, self-efficacy at 12th grade. The findings support ethnic socialization conceptions of how self-views of ethnicity develop from childhood across adolescence in Mexican-American children.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women.

BACKGROUND: Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age. PURPOSE: The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women. METHODS: Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year. RESULTS: Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain. CONCLUSIONS: Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Peer Influence on Ethnic-Racial Identity Development: A Multi-Site Investigation.

The peer context features prominently in theory, and increasingly in empirical research, about ethnic-racial identity (ERI) development, but no studies have assessed peer influence on ERI using methods designed to properly assess peer influence. We examined peer influence on ERI centrality, private, and public regard using longitudinal social network analysis. Data were drawn from two sites: a predominantly Latina/o Southwestern (SW) school (N = 1034; Mage = 12.10) and a diverse Midwestern (MW) school (N = 513; Mage = 11.99). Findings showed that peers influenced each other's public regard over time at both sites. However, peer influence on centrality was evident in the SW site, whereas peer influence on private regard was evident in the MW site. Importantly, peer influence was evident after controlling for selection effects. Our integration of developmental, contextual, and social network perspectives offers a fruitful approach to explicate how ERI content may shift in early adolescence as a function of peer influence.

Aggression behavior and substance use among immigrant children: Mediating effect of antisocial attitudes.

In 2010, approximately one out of four youths in the United States were immigrant children. Hispanics and Asians comprised the largest groups (58% and 16%), respectively. Today, the Hispanic population is the largest ethnic minority in the United States (15%) and is a majority of the U.S. foreign-born population (47%). While immigration is a positive process for most immigrants, resettlement into a new country has challenges, including acculturation adjustments. Youth engage in risky behaviors such as substance use and antisocial behaviors. For immigrant youth with limited supportive opportunities, however, the acculturation process can be difficult. Stress, alienation, and stigma often manifest and cause behavioral problems, including aggression. This pilot study examines the mediating effect of antisocial attitudes using sociocultural, developmental, and environmental factors to understand Hispanic youth problem behaviors. We sampled 136 youths, ages 6-12, from predominantly Hispanic elementary schools in the southwestern United States to ascertain the role of aggression and antisocial behavior in substance use attitudes. The results show significant differences in aggression, antisocial attitudes, and substance use according to (1) age, (2) years in the United States, (3) English level, and (4) relationship with mother. Aggression significantly predicted antisocial attitudes and substance use, with antisocial attitudes having a mediating effect on the relationship between aggression and substance use. In developing social service programs to prevent substance use among children from immigrant families, social work educators and practitioners may consider addressing the role of aggression in Hispanic adolescents' future behavior.

"There Were Rapes!": Sexual Assaults of African American Women and Children in Jim Crow.

Using data from 92 interviews, this article examines the narratives of African Americans' experiences as children and young adults during Jim Crow in the Southeast and Southwest. It gives voice to the realities of sexual assaults committed by ordinary White men who systematically terrorized African American families with impunity after the post-Reconstruction south until the 1960s. The interviewees discuss the short- and long-term impact of physical, mental, emotional, and sexual assaults in their communities. We discuss the top four prevalent themes that emerged related to sexual assault, specifically (a) the normalization of sexual assaults, (b) protective measures to avoid White violence, (c) the morality of African American women, and (d) the long-term consequences of assaults on children.

Testing the efficacy of a brief sexual risk reduction intervention among high-risk American Indian adults: study protocol for a randomized controlled trial.

BACKGROUND: American Indian adults are more likely to experience co-occurring mental health and substance use disorders than adults of other racial/ethnic groups and are disproportionately burdened by the most common sexually transmitted infections, namely chlamydia and gonorrhea. Several behavioral interventions are proven efficacious in lowering risk for sexually transmitted infection in various populations and, if adapted to address barriers experienced by American Indian adults who suffer from mental health and substance use problems, may be useful for dissemination in American Indian communities. The proposed study aims to examine the efficacy of an adapted evidence-based intervention to increase condom use and decrease sexual risk-taking and substance use among American Indian adults living in a reservation-based community in the Southwestern United States. METHODS/DESIGN: The proposed study is a randomized controlled trial to test the efficacy of an adapted evidence-based intervention compared to a control condition. Participants will be American Indian adults ages 18-49 years old who had a recent episode of binge substance use and/or suicide ideation. Participants will be randomized to the intervention, a two-session risk-reduction counseling intervention or the control condition, optimized standard care. All participants will be offered a self-administered sexually transmitted infection test. Participants will complete assessments at baseline, 3 and 6 months follow-up. The primary outcome measure is condom use at last sex. DISCUSSION: This is one of the first randomized controlled trials to assess the efficacy of an adapted evidence-based intervention for reducing sexual risk behaviors among AI adults with substance use and mental health problems. If proven successful, there will be an efficacious program for reducing risk behaviors among high-risk adults that can be disseminated in American Indian communities as well as other rural and under-resourced health systems. TRIAL REGISTRATION: Clinical Trials NCT02513225.

Harassment Due to Gender Nonconformity Mediates the Association Between Sexual Minority Identity and Depressive Symptoms.

The visibility of a stigmatized identity is central in determining how individuals experience that identity. Sexual minority status (e.g., identifying as gay, lesbian, or bisexual) has traditionally been identified as a concealable stigma, compared with race/ethnicity or physical disability status. This conceptualization fails to recognize, however, the strong link between sexual minority status and a visible stigma: gender nonconformity. Gender nonconformity, or the perception that an individual fails to conform to gendered norms of behavior and appearance, is strongly stigmatized, and is popularly associated with sexual minority status. The hypothesis that harassment due to gender nonconformity mediates the association between sexual minority status and depressive symptoms was tested. Heterosexual and sexual minority-identified college and university students (N = 251) completed questionnaires regarding their sexual minority identity, experiences of harassment due to gender nonconformity, harassment due to sexual minority status, and depressive symptoms. A mediational model was supported, in which the association between sexual minority identity and depressive symptoms occurred via harassment due to gender nonconformity. Findings highlight harassment due to gender nonconformity as a possible mechanism for exploring variability in depressive symptoms among sexual minorities.

The Association of Panic Disorder, Posttraumatic Stress Disorder, and Major Depression With Smoking in American Indians.

INTRODUCTION: Rates of cigarette smoking are disproportionately high among American Indian populations, although regional differences exist in smoking prevalence. Previous research has noted that anxiety and depression are associated with higher rates of cigarette use. We asked whether lifetime panic disorder, posttraumatic stress disorder, and major depression were related to lifetime cigarette smoking in two geographically distinct American Indian tribes. METHODS: Data were collected in 1997-1999 from 1506 Northern Plains and 1268 Southwest tribal members; data were analyzed in 2009. Regression analyses examined the association between lifetime anxiety and depressive disorders and odds of lifetime smoking status after controlling for sociodemographic variables and alcohol use disorders. Institutional and tribal approvals were obtained for all study procedures, and all participants provided informed consent. RESULTS: Odds of smoking were two times higher in Southwest participants with panic disorder and major depression, and 1.7 times higher in those with posttraumatic stress disorder, after controlling for sociodemographic variables. After accounting for alcohol use disorders, only major depression remained significantly associated with smoking. In the Northern Plains, psychiatric disorders were not associated with smoking. Increasing psychiatric comorbidity was significantly linked to increased smoking odds in both tribes, especially in the Southwest. CONCLUSIONS: This study is the first to examine the association between psychiatric conditions and lifetime smoking in two large, geographically diverse community samples of American Indians. While the direction of the relationship between nicotine use and psychiatric disorders cannot be determined, understanding unique social, environmental, and cultural differences that contribute to the tobacco-psychiatric disorder relationship may help guide tribe-specific commercial tobacco control strategies.

Perceived Maternal Parenting Styles, Cultural Values, and Prosocial Tendencies Among Mexican American Youth.

The present study aimed to extend research on parenting and positive development of Latino youth. Participants were 207 Mexican American adolescents (M age = 10.9 years, SD = 0.83 years; 50% girls) who completed measures of their parents' supportive and firm parenting, their own endorsement of respect and traditional gender role values, and their tendency to engage in six forms of prosocial behaviors. Maternal nativity was also considered as an initial predictor of parenting, adolescents' cultural values, and adolescents' prosocial behaviors. Overall, the results demonstrated that maternal nativity was associated with traditional gender roles and specific forms of prosocial behaviors. Parenting dimensions were differentially associated with respect and traditional gender role values and prosocial behaviors. Cultural values, in turn, were associated with multiple forms of prosocial behaviors. Gender differences in the processes were also explored.

Cultural adaptation, psychometric properties, and outcomes of the Native American Spirituality Scale.

Spirituality is central to many Native Americans (NAs) and has been associated with recovery from substance use disorders (SUDs). However, no published questionnaire uniquely taps tribal-specific spiritual beliefs and practices. This hinders efforts to integrate traditional NA spirituality into SUD treatment and track spiritual outcomes. As part of a randomized controlled trial examining SUD treatment for NAs, we adapted the Daily Spiritual Experience Scale (DSES) in collaboration with members of a Southwest tribe to create the Native American Spirituality Scale (NASS) and measured changes in the NASS over the course of treatment. The 83 participants (70% male) were from a single Southwest tribe and seeking SUD treatment. They completed the NASS at baseline, 4, 8, and 12 months. Exploratory factor analysis of the NASS was conducted and its temporal invariance, construct validity, and longitudinal changes in the factor and item scores were examined. The NASS yielded a 2-factor structure that was largely invariant across time. Factor 1 reflected behavioral practices, while Factor 2 reflected more global beliefs. Both factors significantly increased across 12 months, albeit at different assessment points. At baseline, Factor 1 was negatively related to substance use and positively associated with measures of tribal identification while Factor 2 was unrelated to these measures. Given the importance of tribal spirituality to many NAs, the development of this psychometrically sound measure is a key precursor and complement to the incorporation of tribal spirituality into treatment, as well as research on mechanisms of change for SUD treatment among NAs and assessment of NA spirituality in relation to other aspects of health.

Community engagement approach: developing a culturally appropriate intervention for Hispanic mother-child dyads.

Childhood obesity affects approximately 20% of U.S. preschool children. Early prevention is needed to reduce young children's risks for obesity, especially among Hispanic preschool children who have one of the highest rates of obesity. Vida Saludable was an early childhood obesity intervention designed to be culturally appropriate for low-income Hispanic mothers with preschool children to improve maternal physical activity and reduce children's sugar-sweetened beverage consumption. It was conducted at a large southwestern United States urban health center. Presented here are the methods and rationale employed to develop and culturally adapt Vida Saludable, followed by scoring and ranking of the intervention's cultural adaptations. An empowered community helped design the customized, culturally relevant program via a collaborative partnership between two academic research institutions, a community health center, and stakeholders. Improved health behaviors in the participants may be attributed in part to this community-engagement approach. The intervention's cultural adaptations were scored and received a high comprehensive rank. Postprogram evaluation of the intervention indicated participant satisfaction. The information presented provides investigators with guidelines, a template, and a scoring tool for developing, implementing, and evaluating culturally adapted interventions for ethnically diverse populations.