Spirituality, Coping, and HIV Risk and Prevention in a Sample of Severely Mentally Ill Puerto Rican Women

Hispanics have been disproportionately impacted by HIV/AIDS. Although HIV risk is significantly elevated among severely mentally ill persons (SMI), the risk of infection appears to be even greater among those SMI who are Hispanic, reflecting the increased risk of HIV among Hispanics. We report on findings from the first 41 participants in a qualitative study examining the context of HIV risk and risk reduction strategies among severely mentally ill Puerto Rican women residents in northeastern Ohio. Individuals participated in a baseline interview, two follow-up interviews, and up to 100 hours of shadowing. Interviews and shadowing activities were recorded and analyzed using a grounded theory. The majority of individuals reported using identification with a religious faith. A large proportion of the participants reported that their religious or spiritual beliefs were critical to their coping, had influenced them to reduce risk, and/or provided them with needed social support. Several participants also reported having experienced rejection from their faith communities. The emphasis on spirituality among Puerto Rican SMI is consistent with previous research demonstrating the importance of spirituality in the Hispanic culture and reliance on spiritual beliefs as a mean of coping among SMI. Our results support the incorporation of spiritual beliefs into secular HIV prevention efforts. Loue is with the Department of Epidemiology and Biostatistics, Center for Minority Public Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Sajatovic is with the Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.     

Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women

To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth. We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified version of the Kaiser physical activity survey in early (mean = 15 weeks) and mid pregnancy (mean = 28 weeks). Physical activity (i.e., sports/exercise, household, occupational, and active living) in pre, early and mid pregnancy was categorized in quartiles. SGA was classified as <10th percentile of birth weight for gestational age. Pre- and early-pregnancy physical activity were not associated with SGA. In multivariable analyses, women with high total activity in mid-pregnancy had a decreased risk of SGA [risk ratio (RR) = 0.42; 95% confidence interval (CI) 0.21–0.82; p _trend = 0.003] as compared to those with low total activity. Findings were similar for high household activity (RR = 0.69; 95% CI = 0.34–1.40; p _trend = 0.26), active living (RR = 0.63; 95% CI = 0.35–1.13; p _trend = 0.04), and occupational activity (RR = 0.79, 95% CI = 0.47–1.34; p _trend = 0.26). High levels of sports/exercise were associated with an increased SGA risk without a significant dose–response association (RR = 2.14, 95% CI 1.04–4.39; p _trend = 0.33). Results extend prior studies of physical activity and SGA to the Hispanic population.     

Preliminary Evidence for the Integration of Music into HIV Prevention for Severely Mentally Ill Latinas

Background Individuals with severe mental illness (SMI) may be at increased risk of HIV infection. Prevention programs designed specifically for SMI have relied primarily on principles of cognitive-behavior change theories delivered in a small group format and in venues and services utilized by SMI. Most intervention effects have not been shown to be sustainable over time. We report on our findings relating to the importance of music to Puerto Rican women with SMI and the implications for HIV prevention interventions with this population. Methods We interviewed and shadowed over a 2-year period 53 women of Puerto Rican ethnicity between the ages of 18 and 50, residing in northeastern Ohio, who had been diagnosed with schizophrenia, bipolar disorder, or major depression. Results Nearly one-half of the participants listened to music regularly. Some reported that music was essential to their lives. Participants reported that music improved their mental and social well-being by facilitating expression and reflection of their emotions and increasing their energy levels. Discussion Music may affect the core negative symptoms and compensate for neuropsychological deficits in women with schizophrenia and related conditions by facilitating the articulation of emotion and allowing individuals to better attend to and potentially incorporate external activities into their lives. The use of music in HIV prevention efforts with SMI Latinas may facilitate their emotional expression and assist them in integrating the educative efforts into their life style choices.     

Research with Severely Mentally Ill Latinas: Successful Recruitment and Retention Strategies

Individuals from minority groups in the United States have been found less likely than non-Hispanic whites to participate in research studies. The recruitment and retention of individuals from minority groups has also proved challenging. We describe the challenges that we encountered in recruiting and retaining a sample of severely mentally ill Mexican and Puerto Rican ethnicity for a study of the context of HIV risk. We recruited women in San Diego County, California and northeastern Ohio who were between the ages of 18 and 50 and who had diagnoses of schizophrenia, bipolar disorder, or major depression. We identified challenges to recruitment and retention at the macro, mediator, and micro levels. We were able to retain 81.1% of the Puerto Rican cohort and 26.7% of the Mexican cohort over a 5-year period. The vast majority of barriers to recruitment and retention within the Puerto Rican cohort occurred at the micro (individual) level. Macro level barriers occurred more frequently and impacted retention to a greater extent within the cohort of Mexican women. Our experience underscores the importance of outreach to the community and the interaction between staff and individual participants. Diverse strategies are required to address the impact of migration on follow-up, which may vary across groups.     

The Association between Patient Activation and Outcomes among Severely Mentally Ill Patients

Little is known about the association between patient activation, health, service utilization, and cost among mental health (MH) patients. Patients aged 18 to 64 with schizophrenia (Sz, n =?43), bipolar disorder (BD, n =?59), or major depressive disorder (MDD, n =?34) completed the Patient Activation Measure for Mental Health (PAM-MH), the Colorado Symptom Index, demographic, socioeconomic, treatment, and social support questionnaire items. Average PAM-MH score indicated BD patients the most activated (66.6?±?17.5), Sz (57.4?±?10.4) less activated, and MDD the least activated (55.4?±?14.6). The MDD cohort had the highest ($27,616?±?26,229) and the BD had the lowest total annual healthcare cost ($18,312?±?25,091). PAM-MH score was inversely correlated with healthcare costs and regression analysis showed a PAM-MH score × gender interaction. The strongest negative relationship between PAM and cost was for males. These analyses support the inverse association between PAM-MH and healthcare service utilization and cost.

     

Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia

Maternal and Child Health Journal - Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may...     

HIV risk among a sample of Mexican and Puerto Rican men and women

HIV/AIDS has disproportionately affected the Hispanic communities in the United States. Consequently, Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education efforts. Although such efforts ideally consider variations across subpopulations, including differences in high-risk behaviors and routes of transmission by national origin, gender, and acculturation levels, relatively few studies of risk behavior have considered such differences. This paper reports on an interview-based study of HIV knowledge, risk behavior, and protective behaviors among a sample of 143 men and women of Mexican ethnicity in San Diego County, California and 189 men and women of Puerto Rican ethnicity in Cuyahoga County, Ohio. The authors' findings indicate that individuals who have been in the United States for longer periods of time and who are younger in age are at increased risk of HIV infection. Increased perceived risk may also be predictive of increased actual risk.     

HIV knowledge among a sample of Puerto Rican and Mexican men and women

This study assessed levels of HIV knowledge and identified factors associated with HIV knowledge among a sample of heterosexual Puerto Rican and Mexican men and women, ages 18 to 45. The sample consisted of 144 men and women living in San Diego County, California, who self-identified as being of Mexican ethnicity and 209 men and women living in Cuyahoga County, Ohio, who self-identified as Puerto Rican. Interviews were conducted by trained, bilingual interviewers. Data were collected on demographic variables, attitudes towards decision-making in relationships, and HIV knowledge and risk behaviors. Puerto Rican individuals were significantly more likely than Mexican individuals to respond correctly to almost one-half of the 12 HIV knowledge items. Multiple logistic regression analysis indicated that higher levels of education, greater U.S. acculturation, legal status and birth in the United States, a self-focused locus of control in relationships, and being male were predictors of higher knowledge.     

Psychosocial Correlates of HIV Sexual Protective Behavior Among Puerto Rican Women Residing in the Bronx,New York

In this study, correlates of HIV sexual protective behavior, in the form of condom use, were examined within a population of urban women identified as at increased heterosexual risk for HIV infection. Hierarchical regression analyses were used to analyze data collected via structured interviews for 187 Puerto Rican women recruited from the waiting areas of a comprehensive health clinic in the Bronx, New York. Increased condom use with primary partners was associated with higher levels of mastery, more non-Hispanic acculturation, and greater adherence to traditional female gender roles. Increased condom use with nonprimary partners was associated with higher HIV/AIDS prevention self-efficacy. Thus, primary versus nonprimary relationships appeared to represent distinct contexts for HIV sexual risk behavior, with implications for different intervention strategies based upon relationship contexts for Latina women.     

Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico

OBJECTIVES: We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not. METHODS: We recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were "newcomers," having previously injected in Puerto Rico; of the latter, 14% were "returnees," having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location. RESULTS: Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of "shooting gallery" use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables. CONCLUSIONS: Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.     

Locus of control and HIV risk among a sample of Mexican and Puerto Rican women

The disproportionate impact of HIV/AIDS on Hispanic women in the United States has been variously attributed to a failure to utilize protective measures due to low levels of HIV knowledge, a denial or minimization of risk, and conflicts with cultural norms. It has been hypothesized that women's relative lack of power in relationships may be associated with higher risk sexual behavior. We examined the relationship between higher risk sexual behavior and perceived locus of control in sexual relationships among a sample of Puerto Rican and Mexican women. We interviewed 71 women of self-reported Mexican ethnicity in San Diego, California, and 79 women of self-reported Puerto Rican ethnicity in Cleveland, Ohio, to examine the relationship between HIV risk, HIV knowledge, and locus of control. Univariate logistic regression indicates that among Puerto Rican women, the perception that locus of control in a sexual relationship resides in the male partner was significantly associated with increased HIV risk, while younger age was significantly associated with increased risk among Mexican women only. In a combined sample of both Puerto Rican and Mexican women, multiple logistic regression analysis indicates that younger age, increased length of residence in the United States, and an other-focused locus of control are significantly associated with increased HIV risk. Women who have been in the United States for relatively longer periods of time may be more likely to integrate U.S. sexual norms into their own behavior and may, as a consequence, be at higher risk of HIV infection. Increased HIV prevention efforts must be made available to Mexican and Puerto Rican women born outside of the United States. These prevention efforts must necessarily focus not only on HIV prevention strategies, but also on the dynamics within male-female intimate relations. Increased attention to younger Puerto Rican and Mexican women is also needed.     

Depression During Pregnancy and Adverse Birth Outcomes Among Predominantly Puerto Rican Women

Maternal and Child Health Journal - Objectives To examine associations between depression and preterm birth and small-for gestational age (SGA) among women of predominantly Puerto Rican descent, a...     

Rehabilitation of the Wandering Seriously Mentally Ill (WSMI) Women

Abstract

Started in 1993, in a small way, by a social worker as a response to the growing destitution of mentally ill women and with the objective of giving shelter, treatment and mainstreaming them, The Banyan has so far given ‘Adaikalam’ (refuge) to 413 women, of whom 252 have been rehabilitated. The entire care process starts from the time the women are picked from the streets in a disheveled and deranged state and brought to the home after much difficulty. On arrival they are spruced up and clinically assessed by a psychiatrist and put on medication. Slowly and steadily they return to the world of reality. Simultaneously, the inmates are put through various therapies like individual counseling, music, art, yoga, and vocational training. Finally, the address of the inmates is traced, and a team from The Banyan accompanies them, and they are rehabilitated. The family is enlightened about the illness, the woman's stay at The Banyan, need for continuous medication. The Banyan is a lifetime service provider of medicines, keeping track by regular follow up and above all a friend to whom they can seek any help at any time. The role played by the social workers is so vital that the success of the programme hinges on their repertoire of skill and commitment.     

Depressive Symptomatology in African-American, Dominican, Irish-American, and Puerto Rican Women

The present study examined the influence(s) of race/ethnicity, socioeconomic status, and substance abuse on depressive symptomatology in a sample of African-American, Dominican, Irish-American, and Puerto Rican women of child-bearing age. While the initial analyses indicated ethnic differences in depressive symptomatology, these differences, with the exception of the difference observed in positive affect, disappeared when socioeconomic status and substance use were controlled. Thus the observed differences between the four groups of women in overall CES-D scores, somatic complaints and negative affect resulted, in large measure, from the divergent socioeconomic circumstances of the four groups.     

STD and HIV testing behaviors among black and Puerto Rican young adults

CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007–2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self‐reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18–25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority—86%—perceived their risk of STD infection in the next year as “not at all likely.” Sixty‐one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.     

Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia

Maternal and Child Health Journal - The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively...     

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents.

PURPOSE: To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents. METHODS: The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups. RESULTS: In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex." CONCLUSIONS: To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.     

Prenatal and Perinatal Factors Associated with Breast-Feeding Initiation among Inner-City Puerto Rican Women

Objective To identify factors associated with the initiation of breast-feeding in a predominantly Puerto Rican population living in inner-city Hartford, Conn.Design Retrospective study of 144 Latino women (mean±standard deviation age=26.3±5.7 years) with children at least 1 year old but younger than 6 years old (mean±standard deviation age=3.0±1.2 years) at the time of the survey. Women were recruited from agencies sponsoring health programs for mothers and children. They were interviewed in their homes (69%) or at the Hispanic Health Council, Hartford, Conn (31%).Subjects/setting Low-income Latino women who had at least 1 preschooler at the time of the interview. The women lived in inner-city Hartford, and the overwhelming majority were Puerto Rican and received welfare assistance and food stamps. Seventy-eight percent of the women chose to be interviewed in Spanish; the other 22% were interviewed in English.Statistical analyses Explanatory variables that related to breast-feeding initiation (P≤.2) in bivariate χ² analyses were entered into a multivariate logistic regression model that was reduced using backward stepwise elimination procedures.Results Multivariate analyses indicated that breast-feeding the previous child, shorter length of maternal residence in the United States, not receiving prenatal bottle-feeding advice, more recent birth, and higher birth weight were positively associated with breast-feeding initiation. A major reason for choosing not to breast-feed was that women felt socially uncomfortable doing it.Applications Breast-feeding initiation was more likely in Latino women who received prenatal breast-feeding counseling and postpartum support. Mothers of low-birth-weight infants and women breast-feeding for the first time may need additional help. These findings can be used by programs like the Special Supplemental Nutrition Program for Women, Infants, and Children to increase breast-feeding initiation. J Am Diet Assoc. 1998;98:657–663.