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1.  Using colorectal trends in the U.S. to identify unmet primary care needs of vulnerable populations 
Preventive medicine  2012;55(2):131-136.
Background
Colorectal cancer screening (CRC) disparities have worsened in recent years.
Objective
To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups.
Methods
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.
Results
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)}.
Conclusions
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.
doi:10.1016/j.ypmed.2012.05.016
PMCID: PMC3786063  PMID: 22659226
2.  Medical Expenditures among Immigrant and Non-Immigrant Groups in the U.S.: Findings from the Medical Expenditures Panel Survey (2000–2008) 
Medical Care  2012;50(3):233-242.
Objective
To examine time trends and differences in medical expenditures between non-citizens, foreign-born, and U.S.-born citizens.
Methods
We used multi-year Medical Expenditures Panel Survey (2000–2008) data on non-institutionalized adults in the U.S. (N=190,965). Source specific and total medical expenditures were analyzed using regression models, bootstrap prediction techniques, and linear and non-linear decomposition methods to evaluate the relationship between immigration status and expenditures, controlling for confounding effects.
Results
We found that the average health expenditures between 2000 and 2008 for non-citizens immigrants ($1,836) were substantially lower compared to both foreign-born ($3,737) and U.S.-born citizens ($4,478). Differences were maintained after controlling for confounding effects. Decomposition techniques showed that the main determinants of these differences were the availability of a usual source of healthcare, insurance, and ethnicity/race.
Conclusion
Lower healthcare expenditures among immigrants result from disparate access to healthcare. The dissipation of demographic advantages among immigrants could prospectively produce higher pressures on the U.S. healthcare system as immigrants age and levels of chronic conditions rise. Barring a shift in policy, the brunt of the effects could be borne by an already overextended public healthcare system.
doi:10.1097/MLR.0b013e318241e5c2
PMCID: PMC3279567  PMID: 22222383
3.  Breast cancer screening trends in the United States and ethnicity 
Background
The study objectives were to compare and examine mammography use trends among ethnic/racial women in the context of United States Healthy People 2010 goals.
Methods
We analyzed pooled, multistage probability sample data from the 1996–2007 Medical Expenditure Panel Survey. Included in the sample were female respondents ages 40–75 years (n=64,811) from six ethnic/racial groups (Black, White, Mexican, Other Latinas, Puerto Rican and Cuban). The primary outcome was self-reported, past two-year mammography use consistent with screening practice guidelines.
Results
We found that for most U.S. women, the Healthy People 2010 mammography goal (70%) was achieved between 1996 and 2007. Puerto Rican and White women, respectively, had the highest mammography rates, and Black and Cuban women had rates that approached the 2010 goal.
Conclusion
Mexican Latinas reported the lowest rates of past two-year mammography; however, factors enabling healthcare access markedly moderated this lower likelihood. From 2000, Mexican Latinas’ mammography use was markedly below (10%) the Healthy People 2010 goal and remained there for the duration.
Impact
Our findings indicate that healthcare equity goals are attainable if efforts are made to reach a sizeable portion of vulnerable populations.
doi:10.1158/1055-9965.EPI-11-0873
PMCID: PMC3415267  PMID: 22147364
4.  Gender differences in sociodemographic and behavioral influences of physical activity in Mexican-origin adolescents 
Background
Understanding the factors that contribute to physical activity (PA) in Mexican-origin adolescents is essential to the design of effective efforts to enhance PA participation in this population.
Methods
Multivariable logistic regression was used to identify sociodemographic and behavioral correlates of self-reported PA in school and community settings in 1,154 Mexican-origin adolescents aged 12–17 years in Houston, TX.
Results
The majority of adolescents were born in the US (74%), approximately half (51%) were overweight or obese, and nearly three-quarters (73%) watched more than 2 hours of weekday television. Similarities and differences by setting and gender were observed in the relationships between sociodemographic and behavioral characteristics and PA. In boys, parental education and attending physical education (PE) were positively associated with PA across multiple PA outcomes. Adolescent linguistic acculturation was inversely associated with participation in community sports, whereas parental linguistic acculturation was positively associated with PA at school. In girls, PA in school and community settings was inversely associated with TV viewing and positively associated with PE participation.
Conclusions
These findings highlight similarities and differences in correlates of PA among boys and girls, and point towards potential sources of opportunities as well as disparities for PA behaviors in Mexican-origin adolescents.
PMCID: PMC3250565  PMID: 21952224
Mexican American; acculturation; physical education
5.  Context of Entry and Number of Depressive Symptoms in an Older Mexican-Origin Immigrant Population  
We examined the association between context of entry into the United States and symptoms of depression in an older age Mexican-origin population. We found that context of entry was associated with the number of depressive symptoms reported in this population. Specifically, immigrants who arrived to the U.S. following the Mexican Revolution (1918–1928) reported significantly fewer depressive symptoms, and those who arrived following enactment of the Immigration Reform Control Act (1965–1994) reported significantly more symptoms of depression, compared to those who arrived in the Bracero era (1942–1964). These findings suggest that sociopolitical context at the time of immigration may be associated with long-term psychological well-being. They contribute to a growing body of literature that suggests that the context of immigration may have long-term implications for the health of immigrant populations. We discuss implications of our findings for understanding relationships between immigration policies and the health of Mexican immigrant populations.
doi:10.1007/s10903-010-9317-9
PMCID: PMC2916036  PMID: 20130999
Latino; Sociopolitical context; Context of entry; Depressive symptoms
6.  Protective neighborhoods: Neighborhood proportion Mexican American and depressive symptoms among very old Mexican Americans 
Research indicates that neighborhood context can have a significant effect on the health of elders. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods. However, few studies have considered the impact of neighborhood ethnic density on mental health outcomes in older adults. This study evaluates the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms among very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004–2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). Subjects included 1,875 community-dwelling Mexican Americans aged 75 and older living in 386 neighborhoods across five states in the Southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D, α =0.88). Results showed that among very old men, there was a significant negative association between percent Mexican Americans in the neighborhood and depressive symptoms (P=.011). Although among women the direction of the association was the same, the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally tailored programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.
doi:10.1111/j.1532-5415.2010.03244.x
PMCID: PMC3278336  PMID: 21314653
Neighborhood context; gender; Mexican Americans; depressive symptoms
7.  Policy implications of early onset breast cancer among Mexican-origin women 
Cancer  2011;117(2):390-397.
Overall, Latinas are more likely to be diagnosed with a more advanced stage of breast cancer, and are 20% more likely to die of breast cancer than non-Hispanic white women. It is estimated that from 2003–2006, $82.0 billion in direct medical care expenditures, in addition to 100,000 lives annually, could be saved by eliminating health disparities experienced by Latinos and increasing the use of up to five preventive services in the U.S. An additional 3,700 lives could be saved if 90% of women ≥40 years were recently screened for breast cancer. We examined risk for breast cancer in a case-control population-based sample of Mexican-origin women in Harris County, TX (n=714), where rates of breast cancer mortality for Latina women have doubled since 1990. Half of breast cancer cases (n=119) were diagnosed before the age of 50. In a multivariable model, women with a family history of breast cancer (OR=4.3), born in Mexico and having high levels of language acculturation (OR=2.5), and without health insurance (OR=1.6) were found to have the highest risk of breast cancer. Because Mexican-origin women were found to be of high-risk for early onset pre-menopausal breast cancer, we recommend policies targeting screening, education and treatment to prevent increased disparities in mortality. The inclusion of community members and policymakers as partners in these endeavors would further safeguard against an increase in cancer health disparities, and aid in formulating a policy agenda congruent with scientifically-based, community-driven policy efforts addressing breast cancer screening, education and treatment in this vulnerable population.
doi:10.1002/cncr.25397
PMCID: PMC3071526  PMID: 21319396
8.  Strategies for Recruitment of Healthy Premenopausal Women into the African American Nutrition for Life (A NULIFE) Study 
Journal of Women's Health  2010;19(5):855-862.
Abstract
Background
Although African American women have an overall lower incidence of breast cancer, African American women <40 years of age are more likely than Caucasian women of all ages and postmenopausal African American women to be diagnosed with breast cancer and exhibit tumor characteristics associated with poorer survival. To begin to address this disparity, studies must be conducted to examine breast cancer preventive factors in this subpopulation of women. However, the strategies needed to recruit younger African American women have not been well defined.
Methods
In this study, we assessed methods used for recruiting and retaining healthy premenopausal African American women into the African American Nutrition for Life (A NULIFE) Study. The number of women contacted, enrolled, and retained by each recruitment strategy and the efficiency of individual strategies were calculated.
Results
Overall, recruitment through social networking was most effective in contacting large numbers of healthy premenopausal African American women. The worksite recruitment method was the most efficient recruitment strategy employed, with a ratio of 40%. The study participants (n = 164) were more likely to be ≥35 years of age and have completed some college. Additionally, the interpersonal relationships recruitment approach proved most efficient (33%) in retaining participants who completed the yearlong study.
Conclusions
The findings from this study add to the evolving research literature on minority recruitment strategies for research studies but specifically address effective recruitment of healthy young premenopausal African American women. The results demonstrate the need to use multiple recruitment strategies when recruiting this subgroup of African American women.
doi:10.1089/jwh.2009.1682
PMCID: PMC2940542  PMID: 20392156
9.  Antidepressant Use among Asians in the United States 
Depression and anxiety  2010;27(1):46-55.
Objectives
We examined the prevalence and predictors of past-year antidepressant use in a nationally representative sample of Asian Americans and non-Latino Whites.
Methods
Analyses of 12-month antidepressant medication use were based on data from the Collaborative Psychiatric Epidemiology Surveys (CPES) that surveyed Asian (Chinese, Filipino, Vietnamese and others; N=2,284) and non-Latino White (N= 6,696) household residents ages 18 years and older in the 48 contiguous United States and Hawaii.
Results
Prevalence rates for 12-month antidepressant use for Asians with major depression ranged from 8.7% among Vietnamese to 17% among Chinese respondents. Compared to non-Latino Whites (32.4%), all Asians (10.9%) meeting criteria for 12-month depressive and anxiety disorders, but especially Filipinos (8.8%) were less likely to report past-year antidepressant use.
Conclusions
We found disparities in past-year antidepressant use among all the examined major Asian groups meeting criteria for 12-month depressive and anxiety disorders. These disparities were not explained by mental health need or socioeconomic factors that enable access to care.
doi:10.1002/da.20636
PMCID: PMC2805045  PMID: 20013960
Asian American; Chinese Americans; Filipinos; Vietnamese; Major Depressive Disorder; Depression; Antidepressive agents

Results 1-9 (9)