Interventions for Hispanic/Latino gay, bisexual, and men who have sex with men: Critical appraisal.

OBJECTIVE: Some interventions have been developed and tested to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and men who have sex with men (MSM). The purpose of this paper is to critically appraise published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM. DESIGN/SAMPLE/MEASUREMENT: A critical appraisal of published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM was conducted. Using guidelines established by the Johns Hopkins Nursing Evidence-Based Practice Rating Scale published research articles were categorized and evaluated using these guidelines. RESULTS: The critical appraisal identified nine intervention studies that met all inclusion criteria. The critical appraisal of these interventions highlighted strengths and weaknesses of these interventions which should be considered when developing future interventions to decrease high risk sexual practices among Hispanic/Latino gay, bisexual, and MSM. CONCLUSION: While several interventions have been created to specifically address HIV infection among Hispanic/Latino gay, bisexual, and MSM, these interventions were varied. Suggestions for future intervention development to decrease high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM based on the findings of the critical appraisal of the literature are included.

Impulsivity, Sexual Compulsivity, and Sexual Risk Behaviors among Hispanic Men Who Have Sex with Men in a US-Mexico Border City.

Hispanic men who have sex with men (HMSM) experience HIV risk-related and mental health disparities. The relationship of mental health (i.e., depressive symptoms and anxiety) on sexual risk behaviors of HMSM has been reported. However, little is known about the influence of impulsivity and compulsivity on sexual risk behaviors. A cross-sectional study explored these factors among 150 HMSM in the El Paso, Texas area utilizing standardized measures, in a cross-sectional study. Regression analysis determined the influence of sexual impulsivity and compulsivity, and demographic variables on sexual risk behaviors, indicating interventions should target these behaviors to mitigate sexual risk among HMSM.

Stress and Health in Nursing Students: The Nurse Engagement and Wellness Study.

BACKGROUND: Evidence suggests that behavioral, social, and environmental factors may modify the effects of life stress on health and performance of new nurses as they transition to hospitals. OBJECTIVES: The aim of this study was to describe the methods of a project designed to investigate the role of social, behavioral, and environmental factors in modifying the adverse effects of stress on new nurses and to discuss demographic, health, and life stress characteristics of the cohort at baseline. METHODS: A prospective cohort design was used to conduct a comprehensive assessment of health endpoints, life stress, behaviors, personal traits, social factors, indicators of engagement and performance, and environmental exposures in nursing students. Adjusted odds ratios and analyses of covariance were used to examine associations between these factors at baseline. RESULTS: Health indicators in the cohort were comparable or better than in the broader United States population, and lifetime stress exposure was lower than among students from other majors. Exposure to more lifetime stressors was associated with greater risk for various health conditions, including hypertension, diabetes, and depression. Conversely, better social, environmental, behavioral, and personal profiles were associated with protective effects for the same health conditions. DISCUSSION: These data comprehensively summarize the lives of predominately Hispanic nursing students and highlight risk and resilience factors associated with their health and well-being. The findings are timely, as the nursing field diversifies in preparation to care for a diverse and aging population. Comprehensively assessing stress-health relationships among student nurses ought to inform the policies, practices, and curricula of nursing schools to better prepare nurses to thrive in the often-strenuous healthcare environment.

The Relationship of Hispanic Cultural Factors and Sexual Behaviors of Hispanic Men who have Sex with Men.

Background/Significance: Hispanics are the largest ethnic minority group in the U.S., and account for 21% of new cases of HIV infection. Previous researchers have examined the relationship of Hispanic cultural factors and the sexual behaviors of Hispanic men who have sex with men (HMSM). However, the exact influence of Hispanic culture factors on the sexual behaviors of these men is currently unclear. Objective: The purpose of this study was to investigate the relationship of selected Hispanic cultural factors and the sexual behaviors of a sample of HMSM. Method: A descriptive, cross-sectional design was used to collect data from 125 Hispanic men in Miami-Dade County, FL. Participants completed standardized measures of Hispanic cultural factors, sexual behaviors, and a demographic questionnaire. Results: Statistically significant positive correlations were noted between age and total cultural constructs, familism, personalism, and machismo. Statistically significant negative correlations were noted between education and total cultural constructs, and education and fatalism. No statistically significant correlation coefficients were noted between total cultural constructs and total sexual behaviors. However, statistically significant positive correlations were noted between condom use and personalism, and assertiveness and personalism. A statistically significant negative correlation was noted between familism and anal sex. Implications: Nurses and other clinicians providing care for HMSM need awareness of certain Hispanic cultural factors (personalism and familism) that may be related to sexual behaviors among HMSM. More research is needed to understand how personalism and familism may be used as protective factors to decrease sexual risk of HMSM.

HIV Risk Perception, HIV Knowledge, and Sexual Risk Behaviors among Transgender Women in South Florida.

OBJECTIVES: Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. DESIGN AND SAMPLE: A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. MEASURES: Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. RESULTS: Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. CONCLUSIONS: More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk.

A Comparison of Sexual Relationships among Hispanic men by Sexual Orientation: Implications for HIV/STI Prevention.

Background: Hispanic men experience high rates of HIV infection and other sexually transmitted infections (STIs) when compared to non-Hispanic whites. Many factors contribute to HIV/STI risk among Hispanic men. Some researchers have suggested that primary relationships may be a source of HIV/STIs because some men engage in sexual relationships outside of the primary relationship. However, little is known about this among Hispanic men, and less is known about how sexual relationships differ by sexual orientation. Purpose: The purpose of this study was two-fold: 1) to determine if Hispanic men engage in sexual relationships outside of primary relationships; and 2) to compare sex outside of primary relationships by sexual orientation. Methods: Data for this study were obtained from a larger study that investigated health risks of Hispanic men residing in the U.S.-Mexico border community. Participants were recruited from agencies that provided services to Hispanic men. Participants completed a structured interview that included questions about primary relationships and sex outside of primary relationships. The sample consisted of 103 Hispanic men (50 heterosexual, 43 gay, and 10 bisexual Hispanic men), but two participants refused to answer relationship questions, resulting in a sample of 101 Hispanic men. Results: About one-third of the participants (n =29) reported sex outside of the primary relationship, but no differences were found between the gay/bisexual and heterosexual men, X 2 (2, N = 101) = 9.91, p = .128. More gay/bisexual men reported sex with the primary partner and another person at the same time than heterosexual men, X 2 (2, N = 101) = 13.32, p = .010. More gay/bisexual men reported open relationships when compared to heterosexual men, X 2 (2, N = 101) = 17.23, p = .008, and more gay/bisexual men reported sex outside the primary relationship without the primary partner's knowledge, X 2 (2, N = 101) = 15.09. p = .020. However, more heterosexual men reported that condoms were not used for sex outside the primary relationship when compared to gay/bisexual men, X 2 (2, N = 101) = 14.01, p = .029. Implications for Practice: Sex outside of primary relationships presents some implications for HIV/STI prevention among Hispanic men. Because gay/bisexual men experience higher rates of HIV/STI, more attention needs to be focused on all forms of relationships to prevent acquisition of HIV/STIs. Among heterosexual Hispanic men more attention needs to be given to reinforcement of safer sex practices both outside the primary relationship, and within the primary relationship if high risk sex is occurring outside the primary relationship. More research is needed on the reasons for sex outside the primary relationship among Hispanic men, as well as research to promote safer sex practices when sex occurs outside of the primary relationship.

The contribution of stress, cultural factors, and sexual identity on the substance abuse, violence, HIV, and depression syndemic among Hispanic men.

OBJECTIVES: The purpose of this study was to confirm the substance abuse, violence, HIV, and depression syndemic among Hispanic men, and to test whether stress and sociocultural factors, including acculturation, family support, and sexual orientation, predict this syndemic. METHOD: A cross-sectional survey was administered to 164 Hispanic men using standardized measures for Hispanic Stress (Cervantes, Padilla, & Salgado de Snyder, 1991), substance abuse (Kelly et al., 1994), violence (Peragallo et al., 2005), risk for HIV (González-Guarda, Peragallo, Urrutia, Vasquez, & Mitrani, 2008), and depression (Center for Epidemiologic Studies Scale, CES-D; Radloff, 1977). RESULTS: Results from Structural Equation Modeling (SEM) supported the syndemic factor among Hispanic men. While family/cultural stress and homosexual identity were risk factors for the syndemic factor, family support was protective. CONCLUSIONS: More longitudinal research is needed to identify influences on the syndemic factor among diverse Hispanic communities. Interventions that address stress and enhance family supports may show promise in addressing and preventing syndemics among Hispanic men. (PsycINFO Database Record

Meeting The Future of Nursing Report Recommendations: A Successful Practice-Academic Partnership.

In collaboration with the University of Texas at El Paso, nurse leadership at Del Sol Medical Center implemented an internship program for nursing students in the final semester of a bachelor of science in nursing (BSN) program. The medical center experienced an increase in the proportion of BSN-prepared nurses, decreased orientation full-time equivalents (FTE), and lowered operating costs. The university experienced highly satisfied and competent new graduate nurses. The nurse interns averaged a 91.9% in-hospital registered nurse (RN) competency completion rate during the internship. All interns accepted a RN position at the medical center. Total savings for salaries, benefits, and recruitment fees at the medical center were $599,040 with a total FTE savings of 23.4 FTEs per week, over 10 weeks.

Modeling particle number concentrations along Interstate 10 in El Paso, Texas.

Annual average daily particle number concentrations around a highway were estimated with an atmospheric dispersion model and a land use regression model. The dispersion model was used to estimate particle concentrations along Interstate 10 at 98 locations within El Paso, Texas. This model employed annual averaged wind speed and annual average daily traffic counts as inputs. A land use regression model with vehicle kilometers traveled as the predictor variable was used to estimate local background concentrations away from the highway to adjust the near-highway concentration estimates. Estimated particle number concentrations ranged between 9.8 × 103 particles/cc and 1.3 × 105 particles/cc, and averaged 2.5 × 104 particles/cc (SE 421.0). Estimates were compared against values measured at seven sites located along I10 throughout the region. The average fractional error was 6% and ranged between -1% and -13% across sites. The largest bias of -13% was observed at a semi-rural site where traffic was lowest. The average bias amongst urban sites was 5%. The accuracy of the estimates depended primarily on the emission factor and the adjustment to local background conditions. An emission factor of 1.63 × 1014 particles/veh-km was based on a value proposed in the literature and adjusted with local measurements. The integration of the two modeling techniques ensured that the particle number concentrations estimates captured the impact of traffic along both the highway and arterial roadways. The performance and economical aspects of the two modeling techniques used in this study shows that producing particle concentration surfaces along major roadways would be feasible in urban regions where traffic and meteorological data are readily available.

Living in Stealth: A Grounded Theory Study of Transgender Women's Barriers to HIV-Prevention Services and Interventions.

Background and Purpose: HIV infection is a health disparity among transgender women. Despite availability of HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers. Methods: Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20-69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding. Results: A theory grounded in the data named Living in Stealth emerged that described this central phenomenon that underpinned the other main categories of Encountering Social Barriers and Encountering Structural Barriers. Generating Ideas for Restructuring HIV-Prevention for Transgender Women was the final category in which participants provided ideas to overcome HIV-prevention barriers. Implications: Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.

HIV-Related Stigma and Multidimensional Frailty Among Older Latinos With HIV.

Introduction: Frailty is a geriatric syndrome of increased vulnerability to stressors marked by a higher risk for poor health outcomes. HIV-related stigma is a stressor for Latino people with HIV (PWH) and an important barrier to HIV care. This study examines the association between HIV-related stigma and multidimensional frailty among older Latino PWH. Methods: A cross-sectional design with 120 Latino PWH aged 50 and older was used. Self-reported questionnaires were administered to assess multidimensional frailty (Tilburg Frailty Indicator) and HIV-related stigma (HIV stigma scale). Results: Participants were 59.1 ± 7.0 years old, primarily White-Hispanic (85.00%, n = 102), single (48.33%, n = 58), and male (73.30%, n = 88). Nearly half of the participants were frail (45.85%, n = 55). Compared to non-frail, frail individuals had significantly higher scores in the total HIV-related stigma (M = 98.5 ± 24.7 vs. M = 85.3 ± 25.6, p = .020) and all subscales. The odds of multidimensional frailty were 1.021 times higher for people with higher HIV-related stigma scores (p = .007). This association remained significant after adjustment for income and comorbidities (p = .049). Conclusions: HIV-related stigma among older Latino PWH was significantly associated with their odds of being frail. Efforts to prevent multidimensional frailty should consider addressing HIV-related stigma through age-appropriate and culturally tailored resources for this group.

Transgender women's satisfaction with healthcare services: A mixed-methods pilot study.

BACKGROUND: Many transgender women are dissatisfied with healthcare services PURPOSE: (a) To describe satisfaction/dissatisfaction with healthcare services; and (b) to describe barriers/facilitators of satisfaction with healthcare services among a sample of transgender women. DESIGN AND METHODS: A mixed methods design collected quantitative data (n = 50) and qualitative data (n = 25) from transgender women. FINDINGS: Quantitatively, satisfaction with healthcare services was high among the participants, with lower areas related to healthcare systems issues. Qualitatively, participants identified barriers and facilitators of healthcare satisfaction. IMPLICATIONS: This study provides clinical, research, educational, and policy implications for improving healthcare satisfaction among transgender women.

The Relationship of Childhood Adversity on Burnout and Depression Among BSN Students.

BACKGROUND: Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood. PURPOSE: To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression. METHODS: 211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout. RESULTS: The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males. CONCLUSION: Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services.

Accessing and Recruiting a Community-Based Sample of Men of Mexican Origin to Explore Intimate Partner Violence.

INTRODUCTION: Vulnerable populations are at greater risk for the burden of disease and negative health outcomes including alcohol abuse, high-risk sexual behavior, and intimate partner violence (IPV). Moreover, health disparities experienced by vulnerable populations are mediated by socioeconomic, ethnic, and racial factors. Risk factors for IPV perpetration are exacerbated by cultural and gender norms, particularly among men of Mexican origin. PURPOSE: To discuss research methods used in a community-based sample of men of Mexican origin and ways to overcome recruitment barriers through community engaged approaches. DISCUSSION: Barriers can impede sampling, recruitment, and enrollment of vulnerable populations (e.g., IPV) but can be overcome. Strategies include: qualitative research methods, identifying key informants, and community engagement approaches, such as listening to the concerns of the community, incorporating the community's knowledge to inform and improve the study, and building rapport to establish trust. CONCLUSION: Conducting research within vulnerable populations can be challenging but can be mitigated by incorporating multiple strategies. Thus, allowing researchers to gain access and valuable insight into traditionally underrepresented and understudied populations.

Reflections of Men of Mexican Origin: A Grounded Theory Study of Intimate Partner Violence Risk Factors.

Intimate partner violence (IPV) is a societal problem with many repercussions for the health care and judicial systems. In the United States, women of color are frequently affected by IPV and experience negative, physical, and mental ramifications. Increasing IPV perpetration and perpetration recurrence rates among men of Mexican origin (MMO) warrants a better understanding of unique risk factors that can only be described by these men. Qualitative studies regarding MMO and distinct IPV risk factors among this populace are few and infrequent. The purpose of this study was to describe IPV risk factors among men of MMO and to describe the process by which these men are able to overcome IPV perpetration risk factors. Fifty-six men of Mexican origin from a low-income housing community in far-west Texas were recruited for participation in audiotaped focus groups. Grounded theory (GT) methodology techniques were utilized to analyze, translate, and transcribe focus group data. Data collection ended when saturation occurred. Participants described risk factors for IPV. Emerging themes included: environment as a context, societal view of MMO, family of origin, normalcy, male and female contributing factors to IPV, and breaking through. Theme abstractions led to the midrange theory of Change Through Inspired Self-Reflection which describes the process of how MMO move from IPV perpetration to nonviolence. The results of the study provide insight on what MMO believe are IPV risk factors. There are implications for clinicians who provide services to MMO, and provide the impetus for future research among this population.

Contemplating Co-Occurring Cultures: A Grounded Theory Study of Sexual Decision Making Among Hispanic Men Who Have Sex With Men.

Introduction HIV infection continues to be a serious health concern globally. Of the 1.2 million people with HIV infection in the United States, men who have sex with men (MSM) account for 57% of cases. Hispanic/Latino individuals accounted for 24% of new HIV diagnoses, with male-to-male sexual contact responsible for the majority of cases. A factor in HIV prevention is the sexual decision-making process. The purpose of this study was to describe the process by which sexual decision making occurs among Hispanic MSM. Method Utilizing a grounded theory approach, 19 in-depth, semistructured interviews were conducted from participants ages 25 to 65 years living in South Florida. After consent, participants completed an in-depth interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed to identify categories and subcategories. Findings A theory grounded in the data called Contemplating Co-Occurring Cultures (Hispanic, gay, and health cultures) emerged that described the central phenomenon. These co-occurring cultures were the foundation of sexual decision making among participants. Conclusion Clinicians providing care to this population should be aware of the complexity of the sexual decision-making process. Awareness of these factors may provide the opportunity for HIV risk reduction strategies developed specifically for Hispanic MSM.

Risk Factors for Hispanic Male Intimate Partner Violence Perpetration.

The literature review analyzed 24 studies that explored male intimate partner violence (IPV) perpetration risk factors among men, in particular Hispanics, using the socioecological model framework composed of four socioecological levels for violence prevention. Six databases were reviewed within the EBSCO search engine for articles published from 2000 to 2014. Articles reviewed were specific to risk factors for IPV perpetration among Hispanic men, focusing particularly on Mexican American men. Many key factors have previously been associated with risk for IPV perpetration; however, certain determinants are unique to Hispanics such as acculturation, acculturation stress, and delineated gender roles that include Machismo and Marianismo. These risk factors should be incorporated in future targeted prevention strategies and efforts and capitalize on the positive aspects of each to serve as protective factors.

Depression, Self-Esteem, and Childhood Abuse Among Hispanic Men Residing in the U.S.-Mexico Border Region.

Hispanics experience health disparities in mental health and HIV infection when compared to non-Hispanic Whites, which may be related to childhood abuse. The purpose of our cross-sectional study was to examine the relationship between childhood abuse and depressive symptoms in a sample of Hispanic men (N = 103) living in a metropolitan U.S.-Mexico border area. Secondarily, we examined the role of self-esteem in mediating this relationship, and the moderating role of sexual orientation. Gay/bisexual men (n = 53) were more likely to report childhood abuse than heterosexual (n = 50) counterparts (47.2% vs. 32%). Self-esteem mediated the relationship between childhood abuse and depression for men who have sex with men, but not heterosexual men. Nurses should increase knowledge of mental health disparities that impact Hispanic men to ensure that appropriate treatment can be provided to reduce the risk of co-occurring health risks to these men, including risk for HIV infection.

Depression and Co-Occurring Health Determinants of Hispanic Men with HIV Infection in the U.S.-Mexico Border Region: A Pilot Study.

HIV infection among Hispanic men is a public health concern. Certain factors have been identified that may contribute to the high rates of HIV infection among Hispanic men such as migration, acculturation, poverty, and depression. Hispanic men with HIV infection are at risk for additional co-occurring health issues. Given limited research few studies have focused specifically on Hispanic men with HIV infection residing in a U.S.-Mexico border community. This pilot study surveyed participants (n = 39), to better understand co-occurrence of health determinants, especially depression among Hispanic men with HIV infection. The study's findings indicate that clinicians need to be aware that factors may influence depression among people with Hispanic men with HIV infection. Clinicians also need awareness of the impact of depression on adherence to HIV care and treatment among Hispanic men with HIV infection. More research is needed to explore the relationship of HIV-related stigma, HIV disclosure, social support, and depression among Hispanic men with HIV infection.

Health Risk and Protective Factors Among Hispanic Women Living in the U.S.-Mexico Border Region.

As the Hispanic population continues to flourish in areas such the U.S.-Mexico border region, more attention needs to be focused on health factors among Hispanics. The purpose of this study was (1) to determine what specific health protective and health risk factors exist among Mexican/Mexican American women residing along the U.S.-Mexico border and (2) to determine the relationship between the protective and risk factors among these women. A sample of Mexican/Mexican American women (N = 98) participated in a structured interview that collected data on familism, Hispanic stress, depression, violence, and sexual risk and demographic variables. Religious factors had the largest influence on the health risk behaviors of alcohol intoxication and drug intoxication (p < .05), while familism influenced only condom use (p = .002) and a lifetime history of intimate partner violence (p = .039). Health care access also influenced the health risks of alcohol intoxication (p = .013), drug intoxication (p = .012), and condom use (p = .019). The study's results provide implications for clinical care and directions for future research.