"It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos.

Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.

Patterns of Avoidance Behavior in Response to Fear of Victimization in the Mexican Context: A Latent Class Analysis.

Fear of victimization (FOV) is a powerful determinant of behavior and prompts behavioral responses such as avoidance, associated with a decline in health-promoting activities and quality of life. Avoidance behaviors, which include constraining activities to perceived safe areas and avoiding areas regarded as unsafe, are of particular interest due to their high prevalence as a coping response to FOV and their link to adverse physical and mental health. Most research on FOV-related avoidance treats it as a single construct and have yet to elucidate the potential heterogeneity within this set of behaviors. We argue that such approach could mask potential heterogeneity among people who respond to FOV through avoidance and how they adapt to manage perceived risk. Our analysis extends the foundational knowledge regarding FOV-related avoidance using a person-centered approach. We attempted to capture distinct profiles across avoidance behaviors and how they are shaped by physical and social vulnerabilities. Data from the 2021 Mexico's National Survey of Victimization and Perception of Security Survey (n = 83,696) was analyzed using Latent Class Analysis focusing on 15 avoidance behaviors (e.g., stopped using public transportation). We conducted multinomial logistic regression to test whether age, gender, education, and neighborhood deprivation significantly predicted class membership. Findings revealed three classes: avoidant (most behavioral adjustments across the board), cautious (only adapted some behaviors), and protective (least behavioral adjustments, but more concerned about minors in their households). The results supported the hypothesized associations between age, gender, education, and neighborhood deprivation with group membership, but the significance differed by group. This research underscores the role of environmental context in shaping individual perceptions of safety and avoidance behavior. Finally, contrary to the approach of treating avoidance behavior as a single category, these findings present a more complex picture as distinct and meaningful patterns emerged across the three groups.

Health Insurance Access Among US Citizen Children In Mexico: National And Transborder Policy Implications.

More than 500,000 US citizen migrant children were residing in Mexico in 2015, and more than half of them had limited, inadequate health insurance despite their citizenship status. The majority of these children lived in Mexican states near the US border. Despite these numbers, knowledge regarding these children and their health has been scarce. To address these knowledge gaps, we analyzed data from the 2015 Mexican Intercensal Survey to examine whether the health insurance status of US citizen migrant children in Mexico is linked to individual, household, and state factors. We compared rates of insured US citizen migrant children with rates among those who were underinsured. We found high rates of underinsurance among US citizen migrant children, especially in northern Mexican border states. Parental education, labor-force participation, urban residence, and border residence partially accounted for these children's probability of being insured. Our results have implications for binational policies that extend health care protection to US citizen migrant children through reintegration assistance for their parents, an expedited dual-citizenship application process, and exempting these children from the automatic cancellation of US-based health benefits.

Adverse childhood experiences to adult adversity trends among parents: Socioeconomic, health, and developmental implications.

Exposures to adverse childhood experiences compromise the early developmental foundation of people long before they become parents. These exposures partly take place within the family environment - a context tightly shared by parents and children. Despite considerable evidence regarding effects of adverse childhood experiences (ACEs), differential patterns of childhood and adulthood adversity accumulation among currently parenting adults is relatively less understood. The present study helps address this gap using the 2011 Behavioral Risk Factor Surveillance System Washington State data of respondents ages 18 and older who are currently parenting a minor child. Results demonstrate the proliferative nature of adversities, increasing risk of elevated life course stress, as well as parental socioeconomic, health and functioning outcomes that affect the family environment. Findings also suggest the resilience of some parents who, despite exposures to ACEs, were able to avoid heightened adversities in later life that could pose risk to their children's developmental environments.

Adverse Childhood Experiences, Coping Resources, and Mental Health Problems among Court-Involved Youth.

Background: Mental health problems are gaining attention among court-involved youth with emphasis on the role of childhood adversity, but assessment lags. Objective: The present study uses a commonly delivered assessment tool to examine mental health problems (current mental health problem, mental health interfered with probation goals, and suicide ideation) as a function of an expanded set of adverse childhood experiences (ACEs; childhood maltreatment, family dysfunction, and social disadvantage). Adaptive coping resources-impulse control, aspirations, and social support-were tested as both direct contributors and moderators of the influence of ACEs on mental health. Methods: Using a diverse sample of youth on probation (N=5,378), this study utilized logistic regression models to test contributions of the three domains of childhood adversity-childhood maltreatment, family dysfunction, and social disadvantage. These models also examined the moderating roles of coping resources. Results: Childhood maltreatment emerged as the strongest contributor to mental health problems, with significant moderation from social support. Youth aspirations were inversely related to mental health problems and moderated the relation with ACEs and mental health problems that interfered with probation. Conclusion: Assessment and mitigation of the detrimental effects of childhood maltreatment are important considerations in the intervention programs that target mental health outcomes of court-involved youth. Intervention programs to prevent recidivism and improve mental health should improve impulse control and aspirations.

Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis.

Growing evidence suggests that toxic stressors early in life not only convey developmental impacts but also augment risk of proliferating chains of additional stressors that can overwhelm individual coping and undermine recovery and health. Examining trauma within a life course stress process perspective, we posit that early childhood adversity carries a unique capacity to impair adult psychological well-being both independent of and cumulative with other contributors, including social disadvantage and stressful adult experiences. This study uses data from a representative population-based health survey (N=13,593) to provide one of the first multivariate assessments of unique, cumulative, and moderated effects of adverse childhood experiences (ACEs) toward explaining 3 related yet distinct measures of adult mental health: perceived well-being, psychological distress, and impaired daily activities. Results demonstrate support for each set of hypothesized associations, including exacerbation and amelioration of ACEs effects by adult stress and resilience resources, respectively. Implications for services and future research are discussed.

Adversity Across the Life Course of Incarcerated Parents: Gender Differences.

More than half of the 1.6 million adults in U.S. prions are parents. Despite growing knowledge regarding the life course adversities of corrections-involved populations, less is known regarding incarcerated parents per se and the implications of cumulative adversities both on their needs and those of their children. Using a gender-balanced (41% minority) sample of incarcerated parents (N=357) from a randomized controlled trial of an in-prison parent training program, this study examines differences between incarcerated mothers and fathers in their exposures to adversities across the life course. Mothers and fathers shared similar patterns of adversity exposure in their families of origin, but differed in their experiences of juvenile justice and child welfare systems involvement, as well as in their adult experiences of victimization and related adult social and mental health outcomes. Implications for gender-responsive parent support and prevention programs for their children of incarcerated mothers and fathers are discussed.