Injecting drug use is associated with HIV risk perception among Mexican Americans in the Rio Grande Valley of South Texas, USA.

OBJECTIVES: Injecting drug use (IDU) remains an actual risk variable in human immunodeficiency virus (HIV) infection in most ethnic populations, and the association between actual risk and individual perception of HIV risk varies across studies and samples. This study aimed to examine the relationship between IDU and HIV risk perception among Mexican Americans residing in Rio Grande Valley, South Texas. STUDY DESIGN: A cross-sectional study of IDU as a predictor of HIV risk perception. METHODS: Two hundred and seventy-five participants [IDUs 11.9%, non-IDUs 88.1%] were assessed for an association between IDU and individual risk perception for HIV infection, as well as history of drug use and HIV risk perception, using Chi-squared statistic for independence and a logistic regression model for the prevalence odds ratio (POR). RESULTS: There was no statistically significant difference between IDUs and non-IDUs with respect to the sociodemographic variables, except for income and gender (P<0.05). The results indicated a statistically significant decrease in HIV risk perception among IDUs compared with non-IDUs, after adjustment for age, gender, sexual preference, history of drug use and marital status [POR 0.26, 95% confidence intervals (CI) 0.11-0.65]. Likewise, history of drug use was associated with decreased HIV risk perception (POR 0.44, 95% CI 0.22-0.98). CONCLUSIONS: These results suggest an inverse correlation between actual risk of HIV infection, such as IDU, and HIV risk perception. Therefore, assessment of HIV risk perception, which is a significant determinant of behaviour change, is essential to reduce the prevalence of HIV infection in the targeted population.

Repeated Pap smear screening among Mexican-American women.

The factors that influence repeated cervical cancer screening among Latina women are not well understood. Studies of compliance in this population over-emphasize initial or recent screening and under-emphasize how this practice is repeated over time. The purpose of this study was to identify the demographic and psychosocial factors associated with repeated Pap smear screening among low-income Mexican-American women living in two urban communities in Texas. A total of 1804 Mexican-American women were interviewed as part of a community survey. Multiple regression results indicate that demographic characteristics such as age, marital status, level of acculturation and health insurance were associated with the total number of Pap smears reported for the 5 years prior to the interview. Pap smear beliefs were the strongest predictor of repeated screening, while global beliefs about cancer did not significantly explain the results. Health promotion interventions should take into consideration the cultural and psychosocial needs of Mexican-American women, placing emphasis on their specific screening-related beliefs, if they are to succeed in promoting repeated compliance with Pap smear screening guidelines.

The importance of psychosocial factors in the prevention of HPV infection and cervical cancer.

This article presents a review of psychosocial factors associated with the primary and secondary prevention of cervical cancer. Current research evidence convincingly links the presence of the human papillomavirus (HPV) to the development of cervical cancer suggesting that bringing together knowledge from the Papanicolau smear screening and HPV infection research may help formulate a new approach that bridges primary and secondary prevention strategies. Bringing together these 2 areas of research involves an understanding of the psychosocial factors that underlie both. This review will specifically focus on 3 areas of psychosocial research: (1) sexual behaviours associated with HPV infection; (2) knowledge, attitudes and beliefs associated with Pap smear and HPV screening; and (3) the role of the medical provider in facilitating prevention activities.

Coping with partner abuse among Mexican American and Anglo women: ethnic and socioeconomic influences.

This exploratory study examines the influence of ethnic group membership and socioeconomic status on the coping strategies reported by women victims of partner abuse. Ninety-three Mexican American and Anglo women recruited from the general community were interviewed after being screened for the presence of partner abuse. Individual coping tactics reported by the respondents were coded as internal focus or external focus coping strategies. Multiple regression results indicate that only socioeconomic status significantly predicts internal focus coping beyond the contribution of ethnicity.

Is being Hispanic a risk factor for non-insulin dependent diabetes mellitus (NIDDM)?

The objective of this paper is to critically assess the basis of the hypothesis that the ethnicity of Hispanics is by itself a risk factor of NIDDM. Showing that the definition of the term Hispanics has both operational and methodological problems, it is argued that in the United States, a group identified by this term is genetically, as well as culturally, heterogeneous. Further, the actual risk factors of NIDDM may simply co-vary with the ethnicity of Hispanics, so that the notion that this ethnicity is a stand-alone independent risk factor of NIDDM may be too simplistic.

Increased use of mammography among Hispanic women: baseline results from the NCI Cooperative Group on Cancer Prevention in Hispanic Communities.

BACKGROUND: The Healthy People 2000 report set the objective of increasing the percentage of women 40 or older who had ever received a mammogram and clinical breast examination to 80% by the year 2000. The report used a baseline of 36% for all American women and 20% for Hispanic women. The purpose of this study was to compare baseline estimates with data obtained in five Hispanic communities. METHODS: Common survey measures were administered in five studies participating in a National Cancer Institute Cooperative agreement. The surveys evaluated history of mammography in five Hispanic communities in the southwestern Unites States. RESULTS: Across the five communities, the rates of mammography use were significantly higher than the national baseline. Among women 40-49 years of age, 55% had completed mammography (95% confidence interval [CI] = 52%, 57%). Among women 50 years of age or older, 64% had received a mammogram (95% CI = 62%, 66%). Older women (above age 50) were significantly more likely to have completed the test than younger women (younger than age 50), and mammography was obtained less often among women who were uninsured and those who had lower levels of acculturation. CONCLUSIONS: We conclude that the rate of mammography use among Hispanic women has increased significantly over the last few years and that we are on track to reach the goal of 80% mammography compliance for Hispanic women 40 years and older by the year 2000.

The psychological and medical sequelae of war in Central American refugee mothers and children.

OBJECTIVE: To investigate the physical and mainly psychological sequelae of exposure to war in Central American children and their mothers who immigrated to the United States on average 4 years before the study began. DESIGN: Interview study. PARTICIPANTS: Twenty-two immigrant Central American women caretakers and 1 of their children aged 5 to 13 years. MAIN OUTCOME MEASURES: Standardized and new measures were administered to assess children's physical and mental health symptoms and exposure to political violence. RESULTS: Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had observed traumatic events, including bombings and homicides. Thirteen of the children showed mental health symptom profiles above established norms, although only 2 met the criteria for posttraumatic stress disorder according to their own reports. Many of the caretakers were unaware of their child's psychological distress. Four of the mothers exhibited posttraumatic stress disorder, and their symptoms predicted their child's mental health. CONCLUSIONS: Pediatricians are sometimes the first and only contacts these families have with health care providers. Caretakers' reports of children's mental health are often incomplete. It is therefore important for physicians to probe for "hidden" symptoms in refugee children. These family members may need referrals to social and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that maternal mental health influences the child's, the child's interests are well served when pediatricians also encourage the mother to contact services for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.

Relationship between safe sex and acculturation into the gay subculture.

There is some evidence, although conflicting, to suggest that socialization or acculturation into the gay community is associated with lower levels of unsafe sex. We attempted to determine the relationship between acculturation and sexual safety. We examined data from 282 men (from the Dallas AIDS Community Demonstration Project) who had sex with men and were not in a monogamous relationship to determine the associations between safer sex and indices of acculturation. The indices of acculturation included regular reading of local and national gay newspapers and magazines, and belonging to an organization for gay men. The data indicated that there were significant relationships between acculturation, talking to sexual partners about HIV risk reduction and sexual identity, and the dependent variable of frequency of condom use for anal sex. A regression equation indicated that 21% of the variance of anal condom use was predicted by these variables. These data suggest that acculturation into the gay community is associated with safer sexual behaviour, and we discuss the implications of these data for using role models and normative beliefs in HIV prevention programmes.

Community level cancer control in a Texas barrio: Part II--Base-line and preliminary outcome findings.

In a quasiexperimental demonstration study, screening rates for breast and cervical cancers were measured among Mexican-American women in selected areas of San Antonio and Houston, Tex. This research was primarily designed to evaluate a cancer-screening promotion program in San Antonio by comparing changes in screening rates in panels from the two barrio communities. In a base-line population survey, we found a small, but significant, proportion of women (10%-15%) lacking Pap smears and a larger proportion (30%-40%) lacking mammography. In a panel study following women who lacked screening at base line, there was a trend toward greater Pap smear use among younger women and a significant increase in mammography for all age groups in San Antonio compared with groups in Houston. Although there was a difference in language use between the communities, rates of newly initiated screening within the communities were similar among monolingual Spanish speakers and among those who used English, supporting the hypothesis that the program increased both groups' participation in breast-cancer screening.

Predictors of bleach use among current African-American injecting drug users: a community study.

One hundred seventeen African-American current injecting drug users were interviewed in a closely matched pair of census tract communities in Dallas, Texas. A brief street intercept interview was administered that included an eligibility screener and questions on sexual behaviors with main or other partners and on injection drug paraphernalia bleaching behavior. Multiple regressions were conducted to determine significant predictors of frequency and duration of cleaning needles with bleach using different models (risk, attitude, exposure, and full). The variables measuring risk behaviors were age, frequency of sharing, exchanging sex for money, and sexual partner's use of injecting drugs. The predictors for the attitude model included normative, attitudinal, and self-efficacy items. The exposure to HIV information variables included seeing/hearing information; talking to someone about HIV, condoms, cleaning needles; and antibody testing for HIV. The full model combined predictors from each of the other models. Overall, bleach use is best explained in terms of specific attitudes rather than risk behaviors or information about HIV.