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1.  “Boys Must be Men, and Men Must Have Sex with Women”: A Qualitative CBPR Study to Explore Sexual Risk among African American, Latino, and White Gay Men and MSM 
American Journal of Men's Health  2010;5(2):140-151.
Men who have sex with men (MSM) continue to be disproportionately impacted by HIV and sexually transmitted diseases (STD). This study was designed to explore sexual risk among MSM using community-based participatory research (CBPR). An academic-community partnership conducted nine focus groups with 88 MSM. Participants self-identified as African American/Black (n=28), Hispanic/Latino (n=33), white (n=21), and bi-racial/ethnic (n=6). Mean age was 27 (range 18–60) years. Grounded theory was used. Twelve themes related to HIV risk emerged, including low HIV and STD knowledge particularly among Latino MSM and MSM who use the Internet for sexual networking; stereotyping of African American MSM as sexually “dominant” and Latino MSM as less likely to be HIV infected; and the eroticization of “barebacking.” Twelve intervention approaches also were identified, including developing culturally congruent programming using community-identified assets; harnessing social media used by informal networks of MSM; and promoting protection within the context of intimate relationships. A community forum was held to develop recommendations and move these themes to action.
PMCID: PMC3299539  PMID: 20413391
2.  Disparities in Outcomes for African American and Latino Subjects in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) Trial 
AIDS Patient Care and STDs  2010;24(5):287-295.
To benefit maximally from antiretroviral therapy, patients with HIV infection must enter care before their disease is advanced and adhere to care. We sought to determine if and where on this continuum of care racial/ethnic disparities were evident. Data from the Flexible Initial Retrovirus Suppressive Therapies (FIRST) trial, which evaluated three strategies for initial HIV therapy, were compared for White, African American, and Latino subjects. Outcomes included progression of disease and death, HIV viral suppression, and change in CD4+ cell count. Multivariate Cox proportional hazard models adjusted for known predictors of survival. There were 1357 subjects, including 368 non-Latino white, 751 non-Latino African American, and 238 Latino subjects. At baseline, the two latter groups were more likely to have had AIDS and had lower CD4+ cell counts than white subjects. In follow-up, African American subjects had lower self-reported adherence to therapy, lower CD4+ cell count increases, and lower odds of viral suppression. African American and Latino subjects had unadjusted hazard ratios of progression of disease or death of 1.57 (1.17, 2.10; p = 0.0025) and 1.57 (1.09, 2.26; p = 0.02), respectively. Adjusting for baseline differences and differences in adherence, CD4+ cell count change, and viral suppression accounted for the disparities in outcomes. Opportunities to reduce disparities in outcomes for African American and Latino patients exist along the continuum of HIV care. Efforts to promote access to HIV testing and care and to improve adherence have the potential to reduce racial/ethnic disparities in outcomes of patients with HIV infection.
PMCID: PMC2933555  PMID: 20438378
3.  Racial/ethnic disparities in overdose mortality trends in New York City, 1990–1998 
Racial/ethnic disparities in health and disease have been present in the United States for the past century. Although differences such as individual access to health care and health-related behaviors account for some of these health disparities, it is likely that a combination of individual and contextual-level factors determine the differential rates of disease between racial/ethnic groups. We studied fatal accidental drug overdose in New York City between 1990 and 1998 to describe differences in racial/ethnic patterns over time and to develop hypotheses about factors that might contribute to these differences. During this period, rates of overdose death were consistently higher among blacks and Latinos compared to whites. In addition, cocaine was more common among black decedents, while opiates and alcohol were more common among Latino and white decedents. Differences in situational factors, such as differential likelihood of activating emergency medical response, may in part explain the consistently higher overdose mortality rates observed among minorities. Further study to determine the individual and contextual factors that explain these observed disparities in overdose death may identify effective areas for public health intervention and provide insight into factors underlying racial/ethnic disparities in other health outcomes.
PMCID: PMC3456270  PMID: 12791796
Disparities; Drugs; Ethnic; Mortality; Overdose; Race
4.  Is there a legacy of the U.S. Public Health Syphilis Study at Tuskegee in HIV/AIDS-related beliefs among heterosexual African-Americans and Latinos? 
Ethics & behavior  2012;22(6):461-471.
Knowledge of the US Public Health Syphilis Study at Tuskegee is sometime cited as a principal reason for the relatively low participation rates seen among racial/ethnic minorities, particularly African Americans, in biomedical research. However, only a few studies have actually explored this possibility. We use data from a random digit dial telephone survey of 510 African-Americans and 253 Latinos, age 18 to 45 years, to investigate associations between knowledge of the USPHS Syphilis Study at Tuskegee and endorsement of HIV/AIDS conspiracy theories. All respondents were drawn from an area of low-income, predominantly race-segregated inner city households in Los Angeles. Results indicate that African Americans were significantly more likely than Latinos to endorse HIV/AIDS conspiracy theories. Further, African Americans were more aware of the USPHS Syphilis Study at Tuskegee (SST). Nevertheless, 72% of African Americans and 94% of Latinos reported that they have never heard of the Syphilis Study at Tuskegee. Further, while awareness of the Syphilis Study at Tuskegee was a significant predictor of endorsing HIV/AIDS conspiracy theories, results suggest that other factors may be more important in accounting for low biomedical and behavioral study participation rates.
PMCID: PMC3539790  PMID: 23308036
5.  The Role of Race in Diagnostic and Disposition Decision-making in a Pediatric Psychiatric Emergency Service (PES) 
General hospital psychiatry  2008;30(3):269-276.
We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES).
Medical records were reviewed for 2991 child and adolescent African American, Hispanic/Latino, and White patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were employed to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.
Binomial logistic regression analyses reveal that African American (OR=2.28, p<.001), and Hispanic/Latino (OR=2.35, p<.05) patients are more likely to receive a psychotic disorder and behavioral disorders diagnoses (African American:OR=1.66, p<.001; Hispanic/Latino:OR=1.36, p<.05) than White children/adolescents presenting to PES. African American youth compared to White youth are also less likely to receive depressive disorder (OR=0.78, p<.05), bipolar disorder (OR=.44, p<.001), and alcohol/substance abuse disorder (OR=.18, p<.01) diagnoses. African American pediatric PES patients are also more likely to be hospitalized (OR=1.50, p<.05), controlling for other socio-demographic and clinical factors (e.g., GAF).
The results highlight that non-clinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.
PMCID: PMC2388247  PMID: 18433660
psychiatric emergency services; decision-making; race; diagnosis; disposition
6.  Racial/Ethnic- and Education-Related Disparities in the Control of Risk Factors for Cardiovascular Disease Among Individuals With Diabetes 
Diabetes Care  2012;35(2):305-312.
There is limited information on whether recent improvements in the control of cardiovascular disease (CVD) risk factors among individuals with diabetes have been concentrated in particular sociodemographic groups. This article estimates racial/ethnic- and education-related disparities and examines trends in uncontrolled CVD risk factors among adults with diabetes. The main racial/ethnic comparisons made are with African Americans versus non-Latino whites and Mexican Americans versus non-Latino whites.
The analysis samples include adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and the NHANES 1999–2008 who self-reported having diabetes (n = 1,065, NHANES 1988–1994; n = 1,872, NHANES 1999–2008). By use of logistic regression models, we examined the correlates of binary indicators measuring 1) high blood glucose, 2) high blood pressure, 3) high cholesterol, and 4) smoking.
Control of blood glucose, blood pressure, and cholesterol improved among individuals with diabetes between the NHANES 1988–1994 and the NHANES 1999–2008, but there was no change in smoking prevalence. In the NHANES 1999–2008, racial/ethnic minorities and individuals without some college education were more likely to have poorly controlled blood glucose compared with non-Latino whites and those with some college education. In addition, individuals with diabetes who had at least some college education were less likely to smoke and had better blood pressure control compared with individuals with diabetes without at least some college education.
Trends in CVD risk factors among individuals with diabetes improved over the past 2 decades, but racial/ethnic- and education-related disparities have emerged in some areas.
PMCID: PMC3263918  PMID: 22190677
7.  Are Health-care Relationships Important for Mammography Adherence in Latinas? 
Journal of General Internal Medicine  2008;23(12):2024-2030.
Latinas are the fastest growing racial ethnic group in the United States and have an incidence of breast cancer that is rising three times faster than that of non-Latino white women, yet their mammography use is lower than that of non-Latino women.
We explored factors that predict satisfaction with health-care relationships and examined the effect of satisfaction with health-care relationships on mammography adherence in Latinas.
Design and Setting
We conducted a cross-sectional survey of 166 Latinas who were ≥40 years old. Women were recruited from Latino-serving clinics and a Latino health radio program.
Mammography adherence was based on self-reported receipt of a mammogram within the past 2 years. The main independent variable was overall satisfaction with one’s health-care relationship. Other variables included: self report of patient-provider communication, level of trust in providers, primary language, country of origin, discrimination experiences, and perceptions of racism.
Forty-three percent of women reported very high satisfaction in their health-care relationships. Women with high trust in providers and those who did not experience discrimination were more satisfied with their health-care relationships compared to women with lower trust and who experienced discrimination (p < .01). Satisfaction with the health-care relationship was, in turn, significantly associated with mammography adherence (OR: 3.34, 95% CI: 1.47–7.58), controlling for other factors.
Understanding the factors that impact Latinas’ mammography adherence may inform intervention strategies. Efforts to improve Latina’s satisfaction with physicians by building trust may lead to increased use of necessary mammography.
PMCID: PMC2596511  PMID: 18839258
Latinas; immigrants; mammograms; satisfaction; adherence
8.  Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States 
General Hospital Psychiatry  2012;34(4):323-331.
Physical symptoms are common and a leading reason for primary care visits, however data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino, and Asian Americans, and examine the association of symptoms and acculturation.
We analyzed data from the National Latino and Asian American Study, a nationally-representative survey of 4864 White, Latino, and Asian Americans adults. We compared the age- and gender-adjusted prevalence of fourteen physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status, and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans.
After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian-Americans (0.60, p < 0.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported 3 or more symptoms, whereas significantly fewer Asian-Americans (7.7%, p<0.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions, and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms.
The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a ‘healthy immigrant’ effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.
PMCID: PMC3383871  PMID: 22460006
Acculturation; Asian Americans; Epidemiology; Hispanic Americans; Signs and Symptoms
9.  Retention in Depression Treatment among Ethnic and Racial Minority Groups in the United States 
Depression and anxiety  2010;27(5):485-494.
Premature discontinuation of psychiatric treatment among ethnic-racial minorities is a persistent concern. Prior research on identifying factors associated with ethnic-racial disparities in depression treatment has been limited by the scarcity of national samples with adequate representation of minority groups and especially non-English speakers. In this article we aim to identify variations in the likelihood of retention in depression treatment among ethnic-racial minority groups in the US as compared to non-Latino whites. Secondly, we aim to identify factors which are related to treatment retention.
We use data from the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences and correlates of depression treatment retention among a representative sample (n=564) of non-Latino whites, Latinos, African American and Asian respondents with last 12 month depressive disorder and who report receiving formal mental health treatment in the last year. We define retention as attending at least four visits or remaining in treatment over a 12 month period.
Being seen by a mental health specialist as opposed to being seen by a generalist and having received medication are correlates of treatment retention for the entire sample. However, after adjusting for demographics, clinical factors including number of co-occurring psychiatric disorders and level of disability, African Americans are significantly less likely to be retained in depression treatment as compared to non-Latino whites.
Availability of specialized mental health services or comparable treatment within primary care could improve treatment retention. Low retention suggests persistent problems in the delivery of depression treatment for African Americans.
PMCID: PMC2927223  PMID: 20336808
Depression; Retention in Care; Ethnic-Racial Minorities
10.  Identifying Individual, Cultural and Asthma-Related Risk and Protective Factors Associated With Resilient Asthma Outcomes in Urban Children and Families 
Journal of Pediatric Psychology  2012;37(4):424-437.
Objective The goal of this study is to identify individual, family/cultural, and illness-related protective factors that may minimize asthma morbidity in the context of multiple urban risks in a sample of inner-city children and families. Methods Participating families are from African-American (33), Latino (51) and non-Latino white (47) backgrounds. A total of 131 children with asthma (56% male), ages 6–13 years and their primary caregivers were included. Results Analyses supported the relationship between cumulative risks and asthma morbidity across children of the sample. Protective processes functioned differently by ethnic group. For example, Latino families exhibited higher levels of family connectedness, and this was associated with lower levels of functional limitation due to asthma, in the context of risks. Conclusions This study demonstrates the utility of examining multilevel protective processes that may guard against urban risks factors to decrease morbidity. Intervention programs for families from specific ethnic groups can be tailored to consider individual, family-based/cultural and illness-related supports that decrease stress and enhance aspects of asthma treatment.
PMCID: PMC3415979  PMID: 22408053
asthma outcomes; cultural factors; inner city; pediatric asthma; protective factors
11.  The Relationship between Obesity and Psychiatric Disorders across Ethnic and Racial Minority Groups in the United States 
Eating behaviors  2010;12(1):1-8.
Epidemiologic studies of obesity have not examined the prevalence and relationship of mental-health conditions with obesity for diverse ethnic and racial populations in the United States.
(1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking, sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations.
Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models.
The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans.
The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.
PMCID: PMC3052947  PMID: 21184966
obesity; depression; anxiety; ethnic/racial minority groups
12.  House Poor in Los Angeles: Examining Patterns of Housing-Induced Poverty by Race, Nativity, and Legal Status* 
Housing policy debate  2012;22(4):605-631.
Housing affordability in the United States is generally operationalized using the ratio approach, with those allocating more than thirty percent of income to shelter costs considered to have housing affordability challenges. Alternative standards have been developed that focus on residual income, whether income remaining after housing expenditures is sufficient to meet non-housing needs.
This study employs Los Angeles Family and Neighborhood Survey data to consider racial/ethnic, nativity and legal status differences in one residual income standard. Logistic regression analyses of housing-induced poverty focus on whether there are differences among five distinct groups: U.S.born Latinos, Non-Hispanic Whites, and African Americans, authorized Latino immigrants, and unauthorized Latino immigrants. Results suggest that: 1) Latino natives are significantly more likely to be in housing-induced poverty than African Americans and Latino immigrants, and 2) unauthorized Latino immigrants are not more likely to experience the outcome than other groups.
The present work extends previous research. First, the results provide additional evidence of the value of operationalizing housing affordability using a residual income standard. Alternatives to the ratio approach deserve more empirical attention from a wider range of scholars and policymakers interested in housing affordability. Second, housing scholarship to date generally differentiates among Latinos by ethnicity, nativity, and citizenship. The present study contributes to emerging research investigating heterogeneity among Latinos by nativity and legal status.
PMCID: PMC3620202  PMID: 23585711
Affordability; Immigration; Minorities; Residual Income
13.  Preventing HIV infection among young immigrant Latino men: results from focus groups using community-based participatory research. 
Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). Using a community-based participatory research (CBPR) approach to problem identification and exploration, a total of 74 Latino men (mean age 22.3, range 18-37) residing in an urban city in northwest North Carolina participated in one of eight focus groups on sexual health. Among the findings of this study, >75% of participants reported Mexico as their country of origin; other participants reported being from Central and South American countries. Qualitative data analysis identified 13 themes, which were grouped into the following three domains: 1) psychosocial factors identified as influencing sexual risk health behaviors; 2) system-level barriers to sexual health; and 3) characteristics of potentially effective HIV prevention intervention approaches. The study findings suggest that community-based, male-centered interpersonal networks that provide individual and group education and skill-building and incorporate curanderos (Latino healers) and bilingual experts may be important elements of potentially effective intervention approaches to reach Latino men, who have been inaccessible to conventional HIV prevention programs.
PMCID: PMC2569251  PMID: 16623070
14.  Racial/Ethnic Differences in the Use of Psychotropic Medication in High-Risk Children and Adolescents 
To investigate rates of psychotropic medication use by youths served in public service sectors as a function of race/ethnicity.
Logistic regression models were used to examine racial/ethnic differences in caregiver report of psychotropic medication use for a random stratified sample of 1,342 children who were served in public service sectors during the second half of fiscal year 1996–97.
Race/ethnicity predicted caregiver report of past-year and lifetime psychotropic medication use when all other factors were held constant. Specifically, caregivers of African-American and Latino children were less likely to report past-year use compared to white children; caregivers of Latino children and “others” were less likely to report lifetime use. Additional factors predictive of medication use in regression models included younger age, male gender, higher household income, insurance type, active to mental health sector at time of enumeration into the study, impairment and diagnosis of mood, and anxiety or attentional disorder.
Racial/ethnic differences in use of psychotropic medication occur in children served in public service sectors and need to be considered in clinical diagnosis and treatment.
PMCID: PMC1550705  PMID: 14627878
psychotropics; pediatrics; race; ethnicity
15.  Cultural Factors and Family-Based HIV Prevention Intervention for Latino Youth 
Journal of Pediatric Psychology  2009;34(10):1041-1052.
Latino youth are the fastest growing ethnic group in the United States and are at considerable risk for HIV and other sexually transmitted infections (STIs), given that they have an earlier onset of sexual activity and use condoms less consistently than European American adolescents. Theorists and scholars have emphasized the importance of taking culture into account in sexuality interventions with Latino adolescents, yet few culturally tailored interventions have been developed for this population. Given the emphasis on familismo and collectivism among Latinos, family-based programs are likely to be well received and could contribute to long-term maintenance of adolescent safety. In this synthesis of the relevant literature, cultural factors that have been identified as relevant to Latino sexuality are reviewed and implications for family-based intervention with Latinos are addressed.
PMCID: PMC2773531  PMID: 19181820
adolescents; culture; health promotion and prevention; HIV/AIDS; parents; risk behavior
16.  Late Entry to HIV Care Among Latinos Compared With Non-Latinos in a Southeastern US Cohort 
Among new patients entering HIV care from 1999 to 2009 in a North Carolina observational clinical cohort, Latinos initiated HIV care at lower CD4 cell counts and were more likely to have several specific AIDS-defining clinical conditions, compared with non-Latinos.
(See the Editorial Commentary by Rio on pages 488–489.)
Background. Late diagnosis of human immunodeficiency virus (HIV) infection remains common despite advances in therapy and prognosis. The southeastern United States is a rapidly growing Latino settlement area where ethnic disparities may contribute to late presentation to care.
Methods. We assessed demographic and clinical factors between racial/ethnic groups at the time of HIV care initiation in the University of North Carolina Center for AIDS Research Clinical Cohort. We identified independent predictors of late presentation, defined as a CD4+ T lymphocyte (CD4) count <350 cells/mm3 or an AIDS-defining event (ADE), using log-linear binomial regression.
Results. During the period 1999–2009, 853 patients initiated HIV care, of whom 11% were Latino, 28% were white, and 61% were black. Median initial CD4 counts were lower for Latino patients (186 cells/mm3) than white patients (292 cells/mm3; P = .006) and black patients (302 cells/mm3; P = .02). Latino persons were more likely to be late presenters than white or black persons (76% vs 58%; P < .001) and accounted for 86%, 75%, and 50% of all presenting cases of active tuberculosis, histoplasmosis, and toxoplasmosis, respectively. Latino ethnicity, older age, male sex, and earlier entry year were independently associated with late presentation (P < .05 for all). In multivariable analyses, Latino persons were 1.29 times more likely to present to care late than white or black persons (95% confidence interval, 1.15–1.45).
Conclusions. Latinos are more likely to initiate HIV care later in the course of illness than are black and white persons and account for a majority of several ADEs. Strategies to improve earlier HIV testing among Latinos in new settlement areas are needed.
PMCID: PMC3156142  PMID: 21844031
17.  Using colorectal trends in the U.S. to identify unmet primary care needs of vulnerable populations 
Preventive medicine  2012;55(2):131-136.
Colorectal cancer screening (CRC) disparities have worsened in recent years.
To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups.
Multivariate logistic regressions examined associations between ethnicity/race and primary outcomes of self-reported guideline-concordant CRC screenings considering time trends for 65,947 respondents of the Medical Expenditure Panel Survey from 2000–2007 age 50-years and older from six groups (non-Latino White, non-Latino Black, Puerto Rican, Cuban, Mexican, and Other Latino). We also tested for modification effects by education, income, and health insurance.
Most groups approached Healthy People 2010 CRC screening rate goals, including non-Latino Whites (47%), non-Latino Blacks (42%) and Puerto Ricans (40%), while Mexicans remained disparately lower (28%). Higher education, income and insurance coverage, partially attenuated this lower likelihood, but Mexican rates remained significantly lower than non-Latino Whites for receiving endoscopy in the past 5 years {OR(95% CI) =0.68(0.59–0.77)} and having received any CRC screening {0.70(0.62–0.79)}.
Among ethnic/racial groups examined, only Mexicans met healthcare disparity criteria in CRC screening. Findings suggest that healthcare equity goals can be attained if resources affecting continuity of care or ability to pay for preventive services are available, and targeted populations are adequately identified.
PMCID: PMC3786063  PMID: 22659226
18.  Circulating adiponectin levels are lower in Latino versus non-Latino white patients at risk for cardiovascular disease, independent of adiposity measures 
Latinos in the United States have a higher prevalence of type 2 diabetes than non-Latino whites, even after controlling for adiposity. Decreased adiponectin is associated with insulin resistance and predicts T2DM, and therefore may mediate this ethnic difference. We compared total and high-molecular-weight (HMW) adiponectin in Latino versus white individuals, identified factors associated with adiponectin in each ethnic group, and measured the contribution of adiponectin to ethnic differences in insulin resistance.
We utilized cross-sectional data from subjects in the Latinos Using Cardio Health Actions to reduce Risk study. Participants were Latino (n = 119) and non-Latino white (n = 60) men and women with hypertension and at least one other risk factor for CVD (age 61 ± 10 yrs, 49% with T2DM), seen at an integrated community health and hospital system in Denver, Colorado. Total and HMW adiponectin was measured by RIA and ELISA respectively. Fasting glucose and insulin were used to calculate the homeostasis model insulin resistance index (HOMA-IR). Variables independently associated with adiponectin levels were identified by linear regression analyses. Adiponectin's contribution to ethnic differences in insulin resistance was assessed in multivariate linear regression models of Latino ethnicity, with logHOMA-IR as a dependent variable, adjusting for possible confounders including age, gender, adiposity, and renal function.
Mean adiponectin levels were lower in Latino than white patients (beta estimates: -4.5 (-6.4, -2.5), p < 0.001 and -1.6 (-2.7, -0.5), p < 0.005 for total and HMW adiponectin), independent of age, gender, BMI/waist circumference, thiazolidinedione use, diabetes status, and renal function. An expected negative association between adiponectin and waist circumference was seen among women and non-Latino white men, but no relationship between these two variables was observed among Latino men. Ethnic differences in logHOMA-IR were no longer observed after controlling for adiponectin levels.
Among patients with CVD risk, total and HMW adiponectin is lower in Latinos, independent of adiposity and other known regulators of adiponectin. Ethnic differences in adiponectin regulation may exist and future research in this area is warranted. Adiponectin levels accounted for the observed variability in insulin resistance, suggesting a contribution of decreased adiponectin to insulin resistance in Latino populations.
PMCID: PMC3141565  PMID: 21736747
19.  Prevalence and Correlates of Everyday Discrimination among U.S. Latinos 
Journal of community psychology  2008;36(4):421-433.
This study reports on the prevalence and correlates of perceived discrimination among a national sample of Latinos in the U.S. Understanding the prevalence and correlates of discrimination can help us better address disparities in the healthcare system. We define perceived discrimination as self-reported everyday experiences of unfair treatment.
Logistic regression analyses were used to assess rates of perceived discrimination among Latinos and identify correlates of discrimination. Data came from the National Latino and Asian American Study (NLAAS).
The prevalence of perceived discrimination among Latinos was 30%. Cubans and Latinos with high ethnic identity were less likely to perceive discrimination compared to other Latino subgroups or Latinos with low ethnic identity. U.S.-born Latinos and Latinos arriving to the U.S. at younger ages were more likely to perceive discrimination compared to immigrants arriving at older ages.
Perceived discrimination among Latinos is less prevalent than what has been reported for other minorities. Variations in perceived discrimination are related to sociodemographic and cultural differences across ethnic subgroups.
PMCID: PMC2786077  PMID: 19960098
20.  Ethnic Differences in Perception of Lung Function 
Rationale: Disparities in pediatric asthma exist in that Latino children have higher prevalence and greater morbidity from asthma than non–Latino white children. The factors behind these disparities are poorly understood, but ethnic-related variations in children's ability to accurately recognize and report their pulmonary functioning may be a contributing process.
Objectives: To determine (1) if differences exist between Latino and non–Latino white children's perceptual accuracy and (2) whether these differences are related to asthma outcomes.
Methods: Five hundred and twelve children, aged 7–16 years (290 island Puerto Ricans, 115 Rhode Island Latinos, and 107 Rhode Island non-Latino white children) participated in a 5-week home-based protocol in which twice daily they entered subjective estimates of their peak expiratory flow rate into a hand-held, programmable spirometer and then performed spirometry. Their accuracy was summarized as three perceptual accuracy scores. Demographic data, asthma severity, intelligence, emotional expression, and general symptom-reporting tendencies were assessed and covaried in analyses of the relationship of perceptual accuracy to asthma morbidity and health care use.
Measurements and Main Results: Younger age, female sex, lower intelligence, and poverty were associated with lower pulmonary function perception scores. Island Puerto Rican children had the lowest accuracy and highest magnification scores, followed by Rhode Island Latinos; both differed significantly from non–Latino white children. Perceptual accuracy scores were associated with most indices of asthma morbidity.
Conclusions: Controlling for other predictive variables, ethnicity was related to pulmonary function perception ability, as Latino children were less accurate than non–Latino white children. This difference in perceptual ability may contribute to recognized asthma disparities.
PMCID: PMC2902755  PMID: 20299534
childhood asthma; symptom recognition; disparities
21.  Prevalence and Correlates of Lifetime Suicidal Ideation and Attempts among Latino Subgroups in the United States 
Limited data is available to understand the prevalence and correlates of suicidal behavior among U.S. Latino subgroups. This paper compares the prevalence of lifetime suicide ideation and suicide attempts among major U.S. Latino ethnic subgroups and identifies psycho-sociocultural factors associated with suicidal behaviors.
The National Latino and Asian American Study (NLAAS) includes Spanish and English speaking Mexicans, Puerto Ricans, Cubans and other Latinos. Descriptive statistics and logistic models were used to determine demographic, clinical, cultural and social correlates of lifetime suicide ideation and attempts.
The lifetime prevalence of suicidal ideation and attempts among Latinos was 10.2% and 4.4%, respectively. Puerto Ricans were more likely to report ideation as compared to other Latino subgroups but this difference was eliminated after adjustments for psychiatric and sociocultural factors. Most lifetime suicidal attempts described by Latinos were reported as occurring when they were under the age of 18 years. Any lifetime DSM-IV diagnoses, including dual diagnoses, were associated with an increased risk of lifetime suicidal ideation and attempts among Latinos. In addition, female gender, acculturation (born in U.S. and English speaking) and high levels of family conflict were independently and positively correlated with suicide attempts among Latinos, even among those without any psychiatric disorder.
These findings reinforce the importance of understanding the process of acculturation, the role of family and sociocultural context for suicide risk among Latinos. These should be considered in addition to psychiatric diagnoses and symptoms in Latino suicide research, treatment and prevention, especially among young individuals.
PMCID: PMC2774123  PMID: 17474813
22.  Quality of life among Latina breast cancer patients: a systematic review of the literature 
Journal of Cancer Survivorship  2011;5(2):191-207.
The Latino population is the most rapidly growing ethnic minority in the United States and Latinas have higher rates of advanced breast cancer and more rigorous treatments than White women. However, the literature lacks reviews on quality of life among this population of breast cancer patients.
A systematic review of the breast cancer quality of life (QOL) literature was conducted among studies that provided a comparison of mental, physical, social, or sexual QOL between Latinas and other racial/ethnic groups. Of the 375 studies reviewed, 20 quantitative studies and two qualitative studies met criteria for inclusion.
Latinas were more likely to report poor mental, physical, and social QOL, relative to non-Latinas. Only four studies assessed sexual QOL, making it difficult to draw any conclusions. Of these four QOL domains, the largest disparity was found in the area of mental health in which Latinas reported poorer QOL compared to non-Latina Whites and Blacks.
Most quantitative studies revealed either that Latinas consistently evidenced significantly lower QOL than non-Latinas on all measures (6 studies) or reported mixed findings in which Latinas generally demonstrated significantly worse QOL on most, but not all, measures (12 studies) included in the study. Explanatory mechanisms including socio-demographic, treatment-related, and culturally-relevant factors are discussed. Implications for research design, measurement, and clinical work are also included.
Implications for cancer survivors
Although not entirely consistent, data suggest that Latina breast cancer survivors on average experience worse QOL than non-Latina Whites.
Understanding ethnic differences in QOL among breast cancer survivors can inform interventions targeted at improving health status for Latinas.
PMCID: PMC3096762  PMID: 21274649
Latina; Literature review; Quality of life; Breast cancer; Cancer survivorship
23.  Interpersonal Processes of Care Survey: Patient-Reported Measures for Diverse Groups 
Health Services Research  2007;42(3 Pt 1):1235-1256.
To create a patient-reported, multidimensional physician/patient interpersonal processes of care (IPC) instrument appropriate for patients from diverse racial/ethnic groups that allows reliable, valid, and unbiased comparisons across these groups.
Data Source/Data Collection
Data were collected by telephone interview. The survey was administered in English and Spanish to adult general medicine patients, stratified by race/ethnicity and language (African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino whites) (N = 1,664).
Study Design/Methods
In this cross-sectional study, items were designed to be appropriate for diverse ethnic groups based on focus groups, our prior framework, literature, and cognitive interviews. Multitrait scaling and confirmatory factor analysis were used to examine measurement invariance; we identified scales that allowed meaningful quantitative comparisons across four race/ethnic/language groups.
Principal Findings
The final instrument assesses several subdomains of communication, patient-centered decision making, and interpersonal style. It includes 29 items representing 12 first-order and seven second-order factors with equivalent meaning (metric invariance) across groups; 18 items (seven factors) allowed unbiased mean comparison across groups (scalar invariance). Final scales exhibited moderate to high reliability.
The IPC survey can be used to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes of quality improvement efforts to reduce health care disparities.
PMCID: PMC1955252  PMID: 17489912
Quality of care; race; ethnicity; measurement; measurement invariance; factorial invariance; physician-patient communication; physician-patient interaction
24.  Predictors of HIV Transmission Risk Behavior and Seroconversion Among Latino Men Who have Sex with Men in Project EXPLORE 
AIDS and behavior  2012;16(3):608-617.
In the US, Latino MSM are disproportionately affected by HIV, yet there is a paucity of data for this risk group. To this end, we examined data on Latino and non-Latino white MSM who participated across six cities in a 2-year randomized behavioral intervention study—Project EXPLORE. At baseline, Latinos reported significantly more serodiscordant unprotected anal intercourse (SDUA) than non-Latinos. Longitudinal predictors of SDUA included marijuana, poppers, amphetamines and heavy drinking, as well as lower self-efficacy, poorer communication skills, weaker safe-sex norms and more enjoyment of risky sex. For HIV infection, Latinos had significantly higher seroconversion rate over follow-up than non-Latinos. Longitudinal predictors of seroconversion among Latinos included poppers and SDUA. Intervention effects did not significantly differ between Latino and non-Latinos. Findings support HIV intervention work with Latino MSM that includes skills training/counseling to address attitudes about safe sex and impact of substance use on HIV-risk behavior and acquisition.
PMCID: PMC3632284  PMID: 21390540
Hispanic/Latino; MSM; HIV prevention; AIDS/HIV; High-risk sexual behavior; Substance use
25.  Correlates of depressive symptoms among Latino and Non-Latino White adolescents: Findings from the 2003 California Health Interview Survey 
BMC Public Health  2007;7:21.
The prevalence of depression is increasing not only among adults, but also among adolescents. Several risk factors for depression in youth have been identified, including female gender, increasing age, lower socio-economic status, and Latino ethnic background. The literature is divided regarding the role of acculturation as risk factor among Latino youth. We analyzed the correlates of depressive symptoms among Latino and Non-Latino White adolescents residing in California with a special focus on acculturation.
We performed an analysis of the adolescent sample of the 2003 California Health Interview Survey, which included 3,196 telephone-interviews with Latino and Non-Latino White adolescents between the ages of 12 and 17. Depressive symptomatology was measured with a reduced version of the Center for Epidemiologic Studies Depression Scale. Acculturation was measured by a score based on language in which the interview was conducted, language(s) spoken at home, place of birth, number of years lived in the United States, and citizenship status of the adolescent and both of his/her parents, using canonical principal component analysis. Other variables used in the analysis were: support provided by adults at school and at home, age of the adolescent, gender, socio-economic status, and household type (two parent or one parent household).
Unadjusted analysis suggested that the risk of depressive symptoms was twice as high among Latinos as compared to Non-Latino Whites (10.5% versus 5.5 %, p < 0.001). The risk was slightly higher in the low acculturation group than in the high acculturation group (13.1% versus 9.7%, p = 0.12). Similarly, low acculturation was associated with an increased risk of depressive symptoms in multivariate analysis within the Latino subsample (OR 1.54, CI 0.97–2.44, p = 0.07). Latino ethnicity emerged as risk factor for depressive symptoms among the strata with higher income and high support at home and at school. In the disadvantaged subgroups (higher poverty, low support at home and at school) Non-Latino Whites and Latinos had a similar risk of depressive symptoms.
Our findings suggest that the differences in depressive symptoms between Non-Latino Whites and Latino adolescents disappear at least in some strata after adjusting for socio-demographic and social support variables.
PMCID: PMC1805430  PMID: 17313675

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