Developing a theory-based anti-drug communication campaign for Hispanic children and parents.

Recent research suggests some alarming substance abuse trends among Hispanic/Latino adolescents. Children in this age group are at a particularly vulnerable juncture in their lives, and early prevention efforts are warranted. For a national anti-drug campaign targeting this young Hispanic/Latino audience and their parents, the White House Office of National Drug Control Policy and the Partnership for a Drug-Free America are incorporating culturally appropriate messages based on behavioral science research and theories. The purpose of this article is to provide information and recommendations on relevant factors and influences in the Hispanic/Latino culture that should be addressed in designing and implementing this campaign.     

Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) 18–74 years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.     

Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk

PurposeThis article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.MethodsPublic health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.ResultsThe Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.ConclusionsMuch research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.     

Access to health care among Hispanic or Latino women: United States, 2000-2002

OBJECTIVE: This report presents national estimates on access to health care for the following five subgroups of Hispanic or Latino women aged 18 years and over in the United States: Mexican, Puerto Rican, Cuban, Central or South American, and other Hispanic. For comparison, estimates are also presented for non-Hispanic white women and non-Hispanic black women. METHODS: Data for persons of all ages in the U.S. civilian noninstitutionalized population are collected each year in the National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Each year, data are collected for approximately 100,000 persons in 40,000 households. In the 2000-2002 surveys combined, data were collected for 54,763 women aged 18 years and over (9,082 Hispanic or Latino women), with an overall response rate of 73.4%. Estimates in this report are presented as annual estimates, averaged over the 3 survey years. Estimates were age adjusted to the 2000 U.S. standard population to permit comparison among the various race and ethnic subgroups. RESULTS: Among the 33.4 million Hispanic or Latino women in the United States, 31% lacked health insurance coverage at the time of interview, 20% had no usual place to go for medical care during the past year, and 22% experienced unmet health care needs during the past year due to cost. Of the five subgroups of Hispanic or Latino women, Mexican women (35%) and Central or South American women (36%) were more likely than Puerto Rican women (14%) and Cuban women (23%) to lack health insurance coverage. Mexican women (78%) and Central or South American women (78%) were less likely to have a usual place to go for health care compared with Puerto Rican women (90%), Cuban women (82%), and other Hispanic women (90%). The percentage of Hispanic or Latino women who had an unmet medical need due to cost was highest among Mexican women (24%) and lowest among Cuban women (14%). Lack of access to health care was most prevalent among Hispanic or Latino women who had poor or near poor poverty status, had less than a high school diploma, or were foreign born. CONCLUSION: Access to health care varied among subgroups of Hispanic or Latino women. Understanding these subgroup differences may help community-based programs improve access to care among Hispanic or Latino women.     

Enrolling Pregnant Women: Issues in Clinical Research

BackgroundDespite the fact that many pregnant women are affected by a range of serious health conditions and take medications for these conditions, there is widespread reticence to include them in clinical intervention research. Hence, their clinical care is typically not informed by evidence derived from pregnant populations.MethodIn October 2010, the National Institutes of Health Office of Research on Women's Health convened a workshop to address ethical, regulatory, and scientific issues raised by the enrollment of pregnant women in clinical research. This report summarizes three areas that emerged from that meeting as important next steps to be taken to promote ethically responsible and scientifically sound research during pregnancy.FindingsThe three areas are: 1) Reclassify pregnant women from their current status in regulations as a “vulnerable” population to a scientifically “complex” population and change the presumption of exclusion to one of inclusion; 2) examine the institutional review boards' (IRB) gatekeeper role in interpreting regulations governing pregnancy research and identify steps to facilitate IRB approval of ethically informed pregnancy research; and 3) develop a pregnancy-focused research agenda that addresses pressing clinical needs, identifies opportunities to gather information from existing resources and studies, and encourages important new research areas.ConclusionResearch is needed to address the therapeutic needs of pregnant women and to study pregnancy as it may shed light on a pregnant woman's later health and the health of her child.     

Access to health care among Hispanic/Latino children: United States, 1998-2001

OBJECTIVE: This report presents national estimates on access to health care for five subgroups of Hispanic/Latino children in the United States: Mexican, Puerto Rican, Cuban, Central or South American, and other Hispanic. For comparison, estimates are also presented for non-Hispanic white children. METHODS: Data for persons of all ages in the U.S. civilian noninstitutionalized population are collected each year in the National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Each year, data are collected for approximately 100,000 persons in 40,000 households. In the 1998-2001 surveys combined, 53,510 interviews (14,284 Hispanic/Latino children) were completed by knowledgeable adults for a subsample of children under age 18 years, with an overall response rate of 80.2%. RESULTS: Each year, an estimated 3.0 million (25.7%) Hispanic/Latino children lacked health insurance coverage at the time of interview, 1.6 million (14.1%) had no usual place to go for health care during the past year, and 1.4 million (17.6%) experienced unmet health care needs during the past year due to cost. Of the five Hispanic/Latino subgroups, Mexican children were most likely (30.4%) to lack health insurance coverage, followed by Central or South American children (23.8%) and other Hispanic children (18.6%). The percentage of children having a usual place to go for health care was highest for Cuban children (93.5%) and lowest for Mexican children (83.3%). The percentage of children who experienced unmet medical needs due to cost in the past year was 18.3% for Mexican children, 16.3% for Puerto Rican children, 12.8% for Central or South American children, and 8.3% for Cuban children. Lack of access to health care was most prevalent among Hispanic/Latino children who had poor or near poor poverty status, whose parents had less than a high school diploma, and who were foreign born. CONCLUSION: Access to health care varied among subgroups of Hispanic/Latino children. Understanding subgroup differences may help community-based programs improve access to care among Hispanic/Latino children.     

The Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth): design,objectives, and procedures

PurposeThis article describes the design and methodology of the Study of Latino Youth (SOL Youth) study, a multicenter study of Hispanic/Latino children living in the United States.MethodsParticipants are children aged 8–16 years whose parents/legal guardians participated in the Hispanic Community Health Study/Study of Latinos, a large community-based cohort study of Hispanic/Latino adults living in the United States.ResultsBetween 2012 and 2014, 1600 children recruited from four field centers (Bronx, Chicago, Miami, and San Diego) will undergo a 3.5-hour examination to collect biospecimens, obtain anthropometric measures, blood pressure, fitness level, dietary intake, and physical activity. Psychosocial and environmental characteristics are assessed by questionnaire. Primary study aims are to examine associations of youth's lifestyle behaviors and cardiometabolic risk factors with (1) youth's acculturation and parent-child differences in acculturation; (2) parenting strategies, family behaviors, and parental health behaviors; and (3) youth's psychosocial functioning.ConclusionsSOL Youth will determine the prevalence and distribution of obesity-promoting lifestyle behaviors, cardiometabolic risk profiles, and novel biomarkers associated with obesity and insulin resistance. This article describes the study methodology and considers advantages and limitations of embedding a cohort of children within a well-characterized cohort of adults.     

Nutrition at school: preparing for the future. The Thirteenth Annual Nutrition Symposium.

Two of the best ways to improve the quality of childhood nutrition are (a) more collaboration at the national, State, and local levels and (b) adoption of innovative and multimedia learning methods, according to the leaders of nutrition education. These themes were discussed at the 13th Annual Nutrition Symposium, which was held March 9, 1994, in Washington, DC. In recognition of National Nutrition Month, a collaborative effort of the Public Health Service''s Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention, the meeting was attended by more than 300 public and private sector nutrition educators and public health professionals. Their assignment was to analyze school-based nutrition education programs and the research being conducted on nutrition. Keynote speaker Surgeon General M. Joycelyn Elders, MD, issued the challenge for all Federal and State agencies to work with schools and nutrition education professionals to overcome limited resources and children''s current eating habits to improve the nutritional status of children. Responding to that challenge, speakers from the Department of Health and Human Services, the agency sponsoring the meeting, the Department of Agriculture, the Department of Education, as well as from the Congress, business, and public schools addressed several initiatives.     

Social science and health research: growth at the National Institutes of Health

Programs within the National Institutes of Health (NIH) have recently taken steps to enhance social science contributions to health research. A June 2000 conference convened by the NIH Office of Behavioral and Social Sciences Research highlighted the role of the social sciences in health research and developed an agenda for advancing such research. The conference and agenda underscored the importance of research on basic social scientific concepts and constructs, basic social science research on the etiology of health and illness, and the application of basic social science constructs in health services, treatment, and prevention research. Recent activities at NIH suggest a growing commitment to social science research and its integration into interdisciplinary multilevel studies of health.     

The Scottish Centre for Infection and Environmental Health (SCIEH)

The Scottish Centre for Infection and Environmental Health has four core functions: the monitoring and surveillance of communicable diseases and environmental hazards in Scotland; operational advice and support at national and local level; research; and education and training. Its work is determined by a specification drawn up by the Public Health Policy Unit of the Scottish Office Department of Health. To fulfill its remit it works closely with a wide range of professionals, including those in the Scottish Office Department of Health, the health service, local government, and in organisations concerned with the environment. It also has close relationships with the Communicable Disease Surveillance Centre, Public Health Laboratory Service, London, the World Health Organization and other international bodies.     

Vital Signs: HIV Infection,Diagnosis, Treatment,and Prevention Among Gay,Bisexual, and Other Men Who Have Sex with Men — United States, 2010–2019

BackgroundMen who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population.MethodsCDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma.ResultsThe estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25–34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13–24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0–100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18–24 years had the lowest adherence to ART (45%) and the highest median stigma score (39).ConclusionImproving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States.     

Use of cooperative health statistics system physician data in small area manpower needs assessment: the case of rural Colorado.

Maldistribution with respect of medical practice location and specialty continues to present barriers to quality care for many Americans. Residents of rural communities in Colorado often lack access to health care services appropriate in number and nature to their needs. A valid determination of the severity of inaccessibility of medical care is a prerequisite to effective programming for alleviating the problem. Any such needs assessment must be predicated on the use of a reliable, detailed physician manpower data base. Physician data used in evaluating the adequacy of health care delivery systems serving small or sparsely populated rural areas have traditionally proved inadequate, causing loss of credibility in the findings derived from those efforts. A concerted attempt was made in rural Colorado to establish a physician inventory for identifying health manpower shortage areas and assessing the degree of medical underservice. This undertaking was organized and directed by staff members of the Statewide Educational Activities for Rural Colorado''s Health (SEARCH) program, the area health education center program of the University of Colorado Health Sciences Center. Cooperative Health Statistics Systems (CHSS) physician data, collected in an annual survey conducted by the Colorado Department of Health, were determined to be exceptionally accurate in describing the physician manpower practicing in the State''s federally designated medically underserved counties. CHSS proved to be an outstanding source of physician data upon which small area manpower needs assessment can be based for the purpose of designating medically underserved or health manpower shortage areas.     

Creating the Climate for Diversity and Race Equality in Health Care

In 1997 the Department of Health funded eight projects to demonstrate 'mainstreaming' responses to minority ethnic health in the NHS. 'Mainstreaming' is understood to require cultural, organisation and practice change; sustaining such change is a major challenge. Evaluation of the projects identified that leadership was a critical factor in encouraging change that was lasting. Other important issues were maintaining the desire changes in a turbulent organisational context and linking changes in practice with other priorities and initiatives. The agenda for the New NHS presents an opportunity for learning from this programme to be put into practice across the Department of Health and the NHS.     

Development of a linguistically and culturally appropriate booklet for Latino cancer survivors: lessons learned

In response to the need for linguistically and culturally appropriate cancer survivorship materials for Latinos, the Office of Education and Special Initiatives and the Office of Cancer Survivorship at the National Cancer Institute (NCI) set out to test, adapt, and refine a Spanish translation of an English-language booklet for adult cancer survivors titled Facing Forward: Life After Cancer Treatment (Siga adelante: la vida después del tratamiento del cáncer). The authors used a process called "transcreation," which involves translating existing English-language materials into Spanish and then adapting them for Latino audiences. The Spanish version of the booklet was reviewed by nine Spanish-speaking reviewers who were cancer survivors. The multistage transcreation process reinforced the importance of conducting formative research as well as adjusting the methodology to address the needs of changing demographics.     

HIV Positive Hispanic/Latinos Who Delay HIV Care: Analysis of Multilevel Care Engagement Barriers

This article overviews a Health Resources and Services Administration (HRSA) study with a sample population consisting of 470 Hispanic/Latino persons living with HIV/AIDS who received primary HIV/AIDS medical services from one of five HRSA Special Projects of National Significance (SPNS) Border Health demonstration projects. The study purpose was to identify multilevel barriers that affect delayed entry into HIV/AIDS medical care among Hispanic/Latino persons living along the U.S.–Mexico border. Multilevel variables along individual, community/cultural, and structural/systems were assessed relative to delayed care entry. The results of this examination indicate that individual and structural/system-level variables affect delayed care entry, whereas support was not found for community/cultural-level barriers. Study findings inform treatment engagement strategies aimed to decrease HIV disease progression by bringing Hispanic/Latinos into care sooner.     

HIV positive Hispanic/Latinos who delay HIV care: analysis of multilevel care engagement barriers

This article overviews a Health Resources and Services Administration (HRSA) study with a sample population consisting of 470 Hispanic/Latino persons living with HIV/AIDS who received primary HIV/AIDS medical services from one of five HRSA Special Projects of National Significance (SPNS) Border Health demonstration projects. The study purpose was to identify multilevel barriers that affect delayed entry into HIV/AIDS medical care among Hispanic/Latino persons living along the U.S.-Mexico border. Multilevel variables along individual, community/cultural, and structural/systems were assessed relative to delayed care entry. The results of this examination indicate that individual and structural/system-level variables affect delayed care entry, whereas support was not found for community/cultural-level barriers. Study findings inform treatment engagement strategies aimed to decrease HIV disease progression by bringing Hispanic/Latinos into care sooner.     

Exploratory cluster analysis of behavioral risks for chronic disease and injury: Implications for tailoring health promotion services

Identifying population subgroups with similar behavioral risks could assist in the social marketing of health promotion programs by providing target segments to whom services and outreach could be specifically matched. In this paper we describe an exploratory application of cluster analysis to health behavior data from a representative telephone sample of Michigan adults (n=2,285). In addition to replication of the cluster solution through cross validation, we found significant between cluster demographic differences further confirming cluster validity. Demographic and risk profiles of four clusters are presented, and key health promotion services appropriate to each cluster are discussed. Although further research on the construct validity of the clusters is critical, we conclude that this approach can be useful in tailoring health promotion messages, materials, and services.Jeffrey P. Mayer Ph.D. is Health Policy Project Manager, Program Evaluation and Methodology Division, U.S. General Accounting Office, Jeffrey R. Taylor Ph.D. is Chief, Division of Research and Development, Michigan Department of Public Health. John C. Thrush M.P.H. is Chief, Health Surveillance Section, Michigan Department of Public Health.This work was supported by the Center for Health Promotion, Michigan Department of Public Health. The views and opinions expressed herein do not reflect the position of the General Accounting Office. We acknowledge the assistance of Vincent Chan with the data analysis.     

Health issues in remote and rural areas

In March 1996 a conference on the theme health issues in remote and rural areas was held in Inverness. Sponsored by the Scottish Office, Highland Health Board and the Department of General Practice and Primary Care, University of Aberdeen, participants included representatives from the Scottish Office, the seven Health Boards with areas designated as remote and rural, the Health Education Board for Scotland, The Royal College of General Practitioners, voluntary sector organisations and academics. In this paper we introduce the theme and outline the debates detailed in the following three papers.     

Engaging Intergenerational Hispanics/Latinos to Examine Factors Influencing Childhood Obesity Using the PRECEDE–PROCEED Model

Maternal and Child Health Journal - Introduction Hispanics/Latinos are disproportionately affected by obesity in the U.S. Multiple factors place Hispanic/Latino children at risk for overweight,...     

Trends in folic acid supplement intake among women of reproductive age--California, 2002-2006

Daily intake of 400 microg of folic acid before conception can reduce by approximately 80% the risk for having an infant with a neural tube defect (NTD) such as spina bifida or anencephaly. Although other risk factors for NTDs exist, such as diabetes, obesity, and family history of NTDs, prevention measures have focused predominantly on promoting folic acid consumption. Women can ensure they are consuming the recommended amount of folic acid by eating one serving of breakfast cereal fortified with 100% of the recommended daily value of folic acid or by taking a supplement with 400 microg folic acid daily. Annual surveys conducted for the March of Dimes (MOD) Birth Defects Foundation indicate that 40% of all U.S. women of reproductive age (i.e., aged 15-45 years) took supplements containing folic acid in 2007 (MOD, unpublished data, 2007), up from 28% in 1995. To analyze trends in folic acid-containing supplement intake among California women aged 18-44 years during 2002-2006, the California Department of Public Health conducted trend analyses of data from the California Women's Health Survey (CWHS). This report summarizes the results of those analyses, which indicated that although the overall prevalence of intake of folic acid-containing supplements remained stable from 2002 (40%) to 2006 (41%) in California, use of such supplements decreased among Hispanic women and women with less education. Downward trends among Hispanic women are of particular concern because 1) Hispanic women are at increased risk for having a fetus or an infant with an NTD compared with women of other races/ethnicities, 2) the number of births to Hispanics in California increased during 1993-2003, and 3) Hispanics accounted for nearly 52% of all births in California in 2005 (California Department of Public Health, unpublished data, 2005). Development of additional targeted and evidence-based public health interventions for increasing folic acid intake among these populations is needed.