Evaluation of a Spanish language version of the Asthma Trigger Inventory.

Background: Perceptions of asthma triggers provide important guidance for patients' disease management. A psychometrically valid instrument, the Asthma Trigger Inventory (ATI), is available in English and German language versions, however, a version in Spanish as major world language has been missing.Method: A Spanish-language version of the ATI was evaluated in 339 adult patients with asthma, 223 of these in Peru and 107 in the USA. Principal Component analysis (PCA) with Varimax rotation was used to identify coherent trigger domains across and within samples. Resulting subscales were evaluated for internal consistency.Results: PCA suggested differences in factor structures between sites. Whereas the USA sample largely replicated original factors for animal allergens, pollen allergens, physical activity, air pollution/irritants, infections, and psychology, the initial analysis of the Peru sample suggested substantial overlap of air pollution/irritant, infection, and allergen items. Subsequent analysis of an expanded research form of the ATI for the Peru site culminated in extraction of five factors related to psychology, climate/temperature, combined pollen and animal allergens, physical activity, and infection. Internal consistencies were in an acceptable to excellent range (α = 0.74 to 0.94). Additional free trigger responses confirmed the importance of climate variables for patients in Peru. Psychological triggers were reported by 26% (Peru) and 31% (USA) of patients.Conclusion: Coherent trigger domains are readily identified and measured reliably by a Spanish-language ATI version. However, factor structures vary between samples from different Hispanic/Latino cultural and geographic domains. Culturally adapted versions of this instrument are therefore required for Hispanic/Latino population studies.

Identification of novel common breast cancer risk variants at the 6q25 locus among Latinas.

BACKGROUND: Breast cancer is a partially heritable trait and genome-wide association studies (GWAS) have identified over 180 common genetic variants associated with breast cancer. We have previously performed breast cancer GWAS in Latinas and identified a strongly protective single nucleotide polymorphism (SNP) at 6q25, with the protective minor allele originating from indigenous American ancestry. Here we report on fine mapping of the 6q25 locus in an expanded sample of Latinas. METHODS: We performed GWAS in 2385 cases and 6416 controls who were either US Latinas or Mexican women. We replicated the top SNPs in 2412 cases and 1620 controls of US Latina, Mexican, and Colombian women. In addition, we validated the top novel variants in studies of African, Asian and European ancestry. In each dataset we used logistic regression models to test the association between SNPs and breast cancer risk and corrected for genetic ancestry using either principal components or genetic ancestry inferred from ancestry informative markers using a model-based approach. RESULTS: We identified a novel set of SNPs at the 6q25 locus associated with genome-wide levels of significance (p = 3.3 × 10- 8 - 6.0 × 10- 9) not in linkage disequilibrium (LD) with variants previously reported at this locus. These SNPs were in high LD (r2 > 0.9) with each other, with the top SNP, rs3778609, associated with breast cancer with an odds ratio (OR) and 95% confidence interval (95% CI) of 0.76 (0.70-0.84). In a replication in women of Latin American origin, we also observed a consistent effect (OR 0.88; 95% CI 0.78-0.99; p = 0.037). We also performed a meta-analysis of these SNPs in East Asians, African ancestry and European ancestry populations and also observed a consistent effect (rs3778609, OR 0.95; 95% CI 0.91-0.97; p = 0.0017). CONCLUSION: Our study adds to evidence about the importance of the 6q25 locus for breast cancer susceptibility. Our finding also highlights the utility of performing additional searches for genetic variants for breast cancer in non-European populations.

Latino parents' links to deportees are associated with developmental disorders in their children.

AIMS: To examine how Latino parent's personal connection to immigrants is linked to their children's risk of being referred/diagnosed with a developmental disorder. METHODS: Using the 2015 Latino National Health and Immigration Survey (n = 548), we asked adults about their connections to immigrants. We also asked if their child has been referred/diagnosed with a developmental disorder. We estimated a series of regressions to predict increases in the probability of a child being referred/diagnosed for a developmental disorder. RESULTS: Respondents who know a deportee are 2.4 times more likely (p = 0.009) to report that their child has been referred or diagnosed with a developmental disorder. Additionally, knowing more deportees, and having a closer family tie with deportees, are all statistically associated with developmental problems. CONCLUSIONS: This study adds to the emerging research on stress and child health, by examining the intersections of immigration policy, mental health, and child development.

Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes.

The United States is experiencing a renewed period of immigration and immigrant policy activity as well as heightened enforcement of such policies. This intensified activity can affect various aspects of immigrant health, including mental health. We use the Robert Wood Johnson Foundation 2015 Latino National Health and Immigration Survey (n = 1,493) to examine the relationship between immigration and immigrant policy and Latino health and well-being. We estimate a series of categorical regression models and find that there are negative health consequences associated with Latinos' perceptions of living in states with unfavorable anti-immigration laws, including reporting poor health and problems with mental health. This article builds on the work of public health scholars who have found a link between this heightened policy environment and the mental health of immigrants, yet expands on this research by finding that the health consequences associated with immigration policy extend to Latinos broadly, not just immigrants. These findings are relevant to scholars of immigration and health policy as well as policy makers who should consider these negative effects on the immigrant community during their decision-making process.

Language bias and self-rated health status among the Latino population: evidence of the influence of translation in a wording experiment.

PURPOSE: This research uses a translation experiment to assess the Spanish translation of the "fair" response in the self-rated health measure among a representative study of the Latino population in the USA. METHODS: Using a unique Latino-specific survey (n = 1200), researchers built in a split sample approach in the self-rated health status measure where half of the Spanish-speaking respondents (n = 600) were randomly given "regular" and the other half were given "Mas o Menos" in translating the English "fair" response. We first estimate a logistic regression model to estimate differences across language categories on the probability of reporting poor and fair health and then estimate a multinomial logistic regression to test whether respondents who took the survey in Spanish and given "regular" are more likely to rate their health as fair compared to English speakers and Spanish-speaking respondents who are given the "Mas o Menos" version. RESULTS: From our logistic regression model, we find that Spanish-speaking respondents given the "regular" response are more likely to report poor health relative to English-speaking respondents and Spanish-speaking respondents who were randomly given "Mas o Menos." The results from our multinomial logistic models suggest that Spanish respondents provided with "Mas o Menos" are more likely to rate their health as good relative to the base category of fair and relative to both English and Spanish speakers given "regular." CONCLUSION: This research informs the study of racial and ethnic disparities by providing a detailed explanation for mixed findings in the Latino health disparities literature. Researchers interested in self-rated health should translate the general self-rated health option "fair" to "Mas o Menos" as our wording experiment suggests that the current wording "regular" overinflates the reporting of poor health.

Botánicas Function as Health Care Safety Nets Among Hispanic American Immigrants: A Brief Report.

As the U.S. population becomes more racially/ethnically diverse, the Hispanic American immigrant population has slowly grown in recent years. In the face of anti-immigrant policies, limited access to care, fear of deportation, discrimination, stigmatization, poverty, and other stressors, Hispanic American immigrants seek services from botánicas for religious, spiritual, medical, and psychosocial health reasons, including the accessibility and affordability of services from folk practitioners in these herbal dispensaries. Hispanics are the primary consumers of herbal remedies and complementary and alternative medicines in the United States. The purpose of this article is to emphasize the critical role of botánicas in the health and wellness of Hispanic American immigrants. Recommendations for health professionals are provided in the care of Hispanic Americans who utilize folk, traditional, and herbal medicines for health and healing.

Implementing Strategies to Recruit and Retain a Diverse Sample of Heart Failure Patients.

Introduction: The increased prevalence, severity, and mortality of heart disease and specifically heart failure among Hispanic and Black populations are a concern for clinicians and researchers. Additionally, patients of poor socioeconomic status also have worse outcomes for cardiovascular disease. To address disparities, it is necessary to address the persistent lack of representation in clinical research of diverse populations, including the Hispanic and Black populations and individuals who are of low socioeconomic status. Method: This study was a pilot randomized trial of a medication adherence intervention for heart failure patients conducted at a safety net hospital and affiliated pharmacy with a diverse patient population. Using an evidence-based multifactorial approach, this investigation implemented and adapted best practices to support the inclusion of Hispanic, Black, and socioeconomically diverse participants. Results: A total of 40 participants were recruited, 58% were Hispanic, 38% Black, and 5% White. A total of 40% reported the need for socioeconomic assistance. At 30 days after discharge, follow-up data were obtained for 37 of 40 (93%) of participants either by interview, electronic record, or both. Conclusion: Findings suggest that a combination of strategies used in this trial can be applied to recruit and retain ethnically and socioeconomically diverse participants.

Successful Retention Strategies for Research Targeting Hispanic/Latinx (Including Recent Immigrants) in the Midwest Region of the United States.

Recruiting and retaining Hispanic/Latinx (H/L) participants, specifically undocumented immigrants, is challenging in part because of the mistrust and fear in participating in research studies. Additionally, only a few longitudinal studies describe the recruit and retention strategies among Mexican and Central American immigrants aiming to expand the knowledge base about those underprivileged groups; this was the objective of the 6-year longitudinal VidaSana study. In the present methods report, we specifically omit the presentation of results from the empirical data findings of the VidaSana study: the present report describes the process and offers a subjective appraisal of multiple and complementary approaches in the recruitment and retention strategies for Hispanics living in the Midwest region of the United States, including very recently arrived immigrants. This study was able to effectively recruit and retain (81.7%) a cohort of Mexican and Central American immigrants within a period of 36 months. Our recruitment and retention performance were successful in the context of the hostile environment against immigration that dominated the national landscape at the time of our study. The present methods report of the VidaSana study provides an insightful understanding in recruiting and, in particular, retaining H/Ls and H/L recent immigrants into longitudinal studies.

Latine Immigrant Perspectives on Trust of Clinical Research.

Introduction: Medical mistrust impedes minority group participation in research, but there are few studies assessing determinants of Latine immigrants' trust in the clinical research enterprise. This qualitative study explored Latine immigrants' perspectives of clinical research. Methods: We conducted telephonic interviews with 20 Latine immigrants receiving care at a Federally Qualified Health Center in Los Angeles, California. Interviews were conducted between December 2021 and April 2022, and resultant data were coded using thematic analysis. Results: Six main themes emerged across two domains. First, trust was influenced by perceptions of the investigators' intentions. These perceptions were primarily based on (1) adequacy of information provided about the research, (2) perceived intent of investigators to respect their humanity, and (3) opportunities to share personal experiences. Second, trust was influenced by perceptions of the study's potential impact, including (4) risk of adverse outcomes, including health risks and risk of immigration status exposure, (5) perceived personal benefits, and (6) perceived community-level benefits. Conclusion: Researchers can build trust and promote participation among Latine immigrants by effectively communicating study objectives, risk mitigation efforts, and personal and community benefits. Enhancing the trustworthiness of clinical research can increase the relevance of scientific findings, representing one pathway to achieving health equity.

Poverty and Suicidal Ideation Among Hispanic Mental Health Care Patients Leading up to the COVID-19 Pandemic.

Introduction: Suicide rates have risen in Hispanic communities since 2015, and poverty rates among Hispanics often exceed the national average. Suicidality is a complex phenomenon. Mental illness may not alone explain whether suicidal thoughts or behaviors will occur; it remains uncertain how poverty affects suicidality among Hispanic persons with known mental health conditions. Our objective was to examine whether poverty was associated with suicidal ideation among Hispanic mental healthcare patients from 2016 to 2019. Methods: We used de-identified electronic health record (EHR) data from Holmusk, captured using the MindLinc EHR system. Our analytic sample included 4,718 Hispanic patient-year observations from 13 states. Holmusk uses deep-learning natural language processing (NLP) algorithms to quantify free-text patient assessment data and poverty for mental health patients. We conducted a pooled cross-sectional analysis and estimated logistic regression models. Results: Hispanic mental health patients who experienced poverty had 1.55 greater odds of having suicidal thoughts in a given year than patients who did not experience poverty. Conclusion: Poverty may put Hispanic patients at greater risk for suicidal thoughts even when they are already receiving treatment for psychiatric conditions. NLP appears to be a promising approach for categorizing free-text information on social circumstances affecting suicidality in clinical settings.

Impact of COVID-19 on Depression, Anxiety, Stress, Coping, and Grief in Pre-Health Professional Students in Lima, Peru.

Introduction: Peru had the world's highest death rate of COVID-19 with 213,000+ deaths and counting (Beaubien, 2021). Hospitalization and care for COVID-19 patients with limited resources has added stress to the shortage of frontline workers and resulted in students filling in the gap in acute care clinical settings. The purpose of this study was to examine the impact of COVID-19 on mental health (e.g., depression, anxiety, stress, and coping) and grief on undergraduate nursing and pharmacy students in Lima, Peru. Methods: This was a quantitative, descriptive study that examined students' self-report of mental health and grief at baseline during data collection. Results: Significant findings were reported in coping based on death of family member of COVID-19 (p = .02). Anxiety was positively correlated with grief (Rho = 0.35, p < .001), stress (Rho = 0.53, p < .001), and depression (Rho = 0.76, p < .001). Grief was positively correlated with stress (Rho = 0.25, p < .001) and depression (Rho = 0.39, p < .001). Finally, stress was positively correlated with depression (Rho = 0.51, p < .001). Discussion: This is the first study to explore nursing and pharmacy students' perceptions on how the COVID-19 pandemic impacted their mental health.

Access to Contraceptives among Venezuelan Migrant Women Residing in Peru: Analysis on a Population-Based Survey.

Introduction: The emigration of Venezuelans has seen a significant increase in recent years. The aim of this study was to identify factors associated with access to contraceptives in migrant women from Venezuela residing in Peru. Methods: An exploratory cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru. Access to contraceptives (yes/no) was established as the dependent variable. A Poisson regression model was performed for complex samples, and crude (PRc) and adjusted (PRa) prevalence ratios were reported. Results: A total of 3617 migrant women were analyzed, with 50.12% reporting access to contraceptives. Factors associated with greater access to contraceptives included being between 20 to 29 years old, having a university education, the entry period after the declaration of COVID-19 quarantine was associated with lower access to contraceptives. Conclusions: Access to contraceptives for Venezuelan migrants should be provided to all, as it is a free service in Peru. Additionally, education and family planning should be provided from the basic or middle school level to prevent unintended pregnancies in the future. Complete coverage should be provided regardless of the time of entry into Peru.

Examining the "White Health Advantage" Effect among Latinos in the United States.

There is consensus regarding the socio-political roots of the concept of race (and ethnicity) in the United States (US). However arbitrary, the US societal constructions of race have meant racial/ethnic minorities experience disproportionate health burdens. The present study examined the so-called "white health advantage" effect in a large sample of US respondents, comparing Latinos (non-White and White) with non-Latino Whites. This cross-sectional study used deidentified data from the Dynata Global COVID Symptoms map project, collected between July 7-14, 2020 (n = 135,075). A dichotomous health status variable was created with respondents answering yes/no to any COVID-19 symptoms (difficulty breathing, coughing, fatigue, fever, and loss of taste or smell). We included relevant predisposing (age, gender, number of children, race, ethnicity, marital status, and education) and enabling factors (housing conditions, income, employment status, business ownership, and number of cars owned - a proxy measure for wealth). Multivariate logistic regression models showed significant differences in health status (as measured by COVID-19 symptoms) when comparing Latinos (non-White, White) and non-Latino Whites. For instance, higher socioeconomic status had a protective effect only among non-Latino Whites. In turn, being married/living with a partner was only associated with COVID-19 symptoms among White Latinos, indicating that the apparent benefits of this "improving" socio-political location are somewhat limited. Our study found significant differences in COVID-19 symptoms when comparing Latinos (non-White, White) and non-Latino Whites. Our findings underscore the importance of further examining health outcomes by racial identities of US Latinos, which can help inform future health equity efforts.

Ancestry-driven metabolite variation provides insights into disease states in admixed populations.

BACKGROUND: Metabolic pathways are related to physiological functions and disease states and are influenced by genetic variation and environmental factors. Hispanics/Latino individuals have ancestry-derived genomic regions (local ancestry) from their recent admixture that have been less characterized for associations with metabolite abundance and disease risk. METHODS: We performed admixture mapping of 640 circulating metabolites in 3887 Hispanic/Latino individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Metabolites were quantified in fasting serum through non-targeted mass spectrometry (MS) analysis using ultra-performance liquid chromatography-MS/MS. Replication was performed in 1856 nonoverlapping HCHS/SOL participants with metabolomic data. RESULTS: By leveraging local ancestry, this study identified significant ancestry-enriched associations for 78 circulating metabolites at 484 independent regions, including 116 novel metabolite-genomic region associations that replicated in an independent sample. Among the main findings, we identified Native American enriched genomic regions at chromosomes 11 and 15, mapping to FADS1/FADS2 and LIPC, respectively, associated with reduced long-chain polyunsaturated fatty acid metabolites implicated in metabolic and inflammatory pathways. An African-derived genomic region at chromosome 2 was associated with N-acetylated amino acid metabolites. This region, mapped to ALMS1, is associated with chronic kidney disease, a disease that disproportionately burdens individuals of African descent. CONCLUSIONS: Our findings provide important insights into differences in metabolite quantities related to ancestry in admixed populations including metabolites related to regulation of lipid polyunsaturated fatty acids and N-acetylated amino acids, which may have implications for common diseases in populations.

Barriers and Challenges Experienced by Latina Nurse Leaders.

Introduction: Leadership reflecting and representing the diversity of the workforce and patient population has been an ongoing challenge for healthcare institutions. As hospitals strategically plan to improve diversity, equity, and inclusion within their intuitions, especially in executive and other leadership roles, it must be acknowledged that only about 5.3% of the nursing workforce is Latinx and few serve in leadership positions. This study aims to learn about the barriers and challenges Latina nurse leaders have experienced in their ascension into leadership roles. Methods: Using a qualitative descriptive study approach, Latina nurse leaders were interviewed one-on-one about their nursing journey and the challenges experienced. A conventional thematic content analysis approach was used to identify common themes. Results: Seventeen Latina nurse leaders shared their experiences. The themes that emerged included: imposter syndrome being the only one, the need to work harder to be seen, age discrimination, racism and racial discrimination, lack of mentorship, and motherhood. Conclusion: Findings from this study help to highlight barriers to leadership development and success of Latina nurses. The findings can be used to encourage, mentor, and support Latina nurses throughout their careers, so they are provided with opportunities for advancement and nurtured as they become leaders.

Call for Inclusive and Diverse Suicide Prevention Strategies Among Cuban Americans: A Brief Report.

Suicide is a leading cause of death in Hispanics globally and nationally. Intentional death rates were higher in Cuba than Mexico in 2016. In the United States (US), suicide mortality rates were greater among Hispanics in rural than urban areas from 2001 to 2015. Although the US lacks suicide research in undocumented Hispanics, few studies have reported increased risk in immigrants. Limited research also indicates higher intentional death rates in Cuban Americans compared with other Hispanic American subgroups. However, suicide prevention strategies for at-risk Cuban Americans are lacking due to a scarcity of research among diverse Hispanics. Researchers could collaborate with health care providers to develop effective suicide prevention methods for Cuban Americans with suicidal problems. This report provides an overview of suicidal behavior in Hispanic Americans with a focus on Cuban Americans. Gaps related to the research topic, as well as recommendations for practice, research, and health policy, are provided in this report.

Spanish-Language Communication of COVID-19 Information Across US Local Health Department Websites.

The COVID-19 pandemic has brought new urgency to a longstanding problem: the US health system is not well-equipped to accommodate the country's large limited English proficient (LEP) population in times of national emergency. We examined the landscape of Spanish-language COVID-19 website information compared to information in English provided by health departments of the top 10 cities by population in the USA. For each city, coders evaluated three score measures (amount of information, presentation quality, and ease of navigation) for six content types (general information, symptoms, testing, prevention, vaccines, and live statistics) across six delivery modes (print resources, website text, videos, external links, data visualization, and media toolkits). We then calculated a grand average, combining all cities' values per score measure for each content type-delivery mode combination, to understand the landscape of Spanish-language information across the country. Overall, we found that, for all cities combined, nearly all content types and delivery modes in Spanish were inferior or non-existent compared to English resources. Our findings also showed much variability and spread concerning content type and delivery mode of information. Finally, our findings uncovered three main clusters of content type and delivery mode combinations for Spanish-language information, ranging from similar to worse, compared to information in English. Our findings suggest that COVID-19 information was not equivalently provided in Spanish, despite federal guidance regarding language access during times of national emergency. These results can inform ongoing and future emergency communication plans for Spanish-preferring LEP and other LEP populations in the USA.

Hispanic Suicides in Miami-Dade County, Florida, 2008-2018.

Suicide is a leading cause of death in Hispanic Americans. Although this population is growing rapidly, particularly in geographic areas such as Miami-Dade County, Florida, few studies have examined suicide in Hispanics. The purpose of this cross-sectional study was to examine associations between suicide and demographic characteristics among Hispanics in Miami-Dade County, Florida, between 2008 and 2018. A total of 1,601 Hispanics died from suicide. Cubans (n = 1,145) represented nearly three quarters of the suicides, while Central or South Americans (n = 119), Puerto Ricans (n = 59), and Mexicans (n = 29) accounted for lower intentional deaths. Furthermore, although no correlation between suicide and age was found, significantly more than half of the suicides were men, X2 (1, N = 1,600) = 361.894, p < .001 (p = .000). Hispanic male suicides were 4.52 more frequent than Hispanic female firearm suicides. Men were more likely to use firearms, while women were more likely to choose drugs, substances, or some other form of method. Intentional deaths were unequal across locations, Χ2 (3, N = 1,601) = 603.764, p < .001 (p = .000), with increased incidence occurring at the Hispanic's home. The second most common suicide location was health care facilities for drugs. Researchers should collaborate with health care providers to increase suicide research and eliminate disparities in at-risk Hispanic Americans.

Measuring media-related health and mental health information acquisition among Latino adults in the United States.

OBJECTIVES: We developed and evaluated new media-related health information acquisition measures for U.S.-based Latino populations. METHODS: In 2021, a sample of U.S.-based Latino adults (N = 1574) self-completed a 20-min survey of health information acquisition measures across three language/cultural dimensions: Spanish media, Latino-tailored media in English, and general media in English. Socio-demographics were also ascertained. Means and standard deviations for the health acquisition measures were adjusted for age and sex and reported across nativity status. RESULTS: The sample was diverse across age, gender, race, ethnicity, socioeconomic status, migration, and language competency. Internal consistency reliability of developed scales was excellent overall and within age, gender, race, ethnicity, and socioeconomic subgroups (Cronbach's alphas = 0.86-0.94). English media scales had higher means overall indicating higher prolonged quantity (i.e., dosage) than Spanish media scales. In contrast, standard deviations for Spanish media scales were higher overall indicating broader reach at lower doses than English media scales. CONCLUSIONS: Findings suggest English-language media is popular among Latino populations overall. However, Spanish-language media retains broad reach through both passive and active exposure. Our findings demonstrate the value of including more nuanced measurement of health information acquisition such as the scales developed in this study to improve health promotion among Latino populations.

A Feasibility Study to Examine Clinical Variables of Childhood Malnutrition in Guatemala.

Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.