Finding voice in a year of collective trauma: Case study of an online photovoice project with youth.

In this article, we share findings from a qualitative case study of a virtual youth photovoice program implemented across three regions of the United States. The purpose of the program was to engage youth in research on a social issue relevant to them during an unprecedented year marked by two public health crises, COVID-19 and anti-Black racial violence. Results of an analysis of curriculum and archival program materials lend support for online strategies for youth engagement including individualized support and online audiovisual presentations with avatars. Racial justice and trauma-informed adaptations were designed to be responsive to youth needs for flexible programming and safe spaces. Themes captured in the first online gallery of youth photos include (1) tools for mental health, (2) meaningful connection, and (3) community advocacy, bringing attention to structural issues as well as family and community strengths. Findings suggest photovoice can be thoughtfully adapted for youth researchers and support individual and group storytelling in response to collective trauma.

Después de la tormenta: Collective trauma following Hurricane Maria in a northeastern Puerto Rican community in the United States.

Hurricane Maria was the largest disaster in Puerto Rico's history, affecting Puerto Rican communities throughout the United States. We conducted focus groups using a grounded theory approach with adults displaced from Puerto Rico to a northeastern community 12 (n = 5) and 17 months (n = 7) postdisaster. Key informant interviews were also conducted with nine community advocates working with displaced hurricane survivors. Emerging themes reflect narrative and social identity processes following collective trauma. Findings emphasize the need for timely and long-term disaster responses that build on community strengths without leaving communities to cope on their own. We discuss how incorporating group storytelling in postdisaster research is a culturally sensitive practice that can promote resiliency among survivors.

Self-Empowerment of Immigrant Latina Survivors of Domestic Violence: A Promotora Model of Community Leadership.

This article presents the results of a self-empowerment leadership intervention program for Latina immigrant survivors of domestic violence in Atlanta, Georgia. It builds on the literature base of the Promotora model, a public health model using peer information sharing as a tool for health promotion. This study used an embedded mixed-methods design with quantitative and qualitative components to evaluate the impact of a peer community leadership program called Líderes Results of single-subject analyses show that the participants experienced change in three components of self-empowerment: intrapersonal, interactional, and behavioral. The qualitative findings revealed that they overcame fear and gained knowledge as well as a sense that they could promote change in their community. These findings add support to a growing literature base that demonstrates how peer model programs can not only positively influence the well-being of the communities they serve but also have transformative effects on peer leaders themselves. Study findings can also inform future efforts to empower survivors through promotora approaches specifically in the context of domestic violence prevention.

Correlates associated with the desire for PEG tube placement at the end of life among community-dwelling older Mexican Americans: a pilot study.

BACKGROUND AND AIMS: Use of percutaneous endoscopic gastrostomy (PEG) tubes in older adults remains controversial. This cross-sectional study examines community-dwelling Mexican American older adults' attitudes toward PEG tube placement in the hypothetical event of a terminal illness. METHODS: Interviews were conducted with 100 community-dwelling Mexican American (MA's) adults, age 60 and over, in San Antonio, Texas. Subjects were screened for cognitive competence using Folstein's mini-mental examination. This was followed by an evaluation of socioeconomic status, depressive symptoms, religiosity, health status and attitudes toward end-of-life care, including PEG tube feeding. RESULTS: Higher income MA's, professionals, those without a living will, those who saw religious belief as not important and those who attended church less than once a month were more likely to agree with PEG placement (all P < 0.05). Logistic regression analysis revealed that higher income (OR = 3.16, CI = 1.13-8.83), lack of a living will (OR = 3.34, CI = 1.03-20.87) and low importance of religious beliefs (OR = 7.14, CI = 1.25-41.67) were all independently associated with the desire for insertion of a PEG tube at the end of life. CONCLUSIONS: This is the first community-based study to describe older Mexican American's attitudes toward PEG tube placement at the end of life. Older community-dwelling Mexican Americans with higher incomes, lack of a living will or low religious involvement might be more likely to choose PEG tube placement even in the context of a terminal condition.

Age and physical health as predictors of family contact among adults with severe psychiatric illness.

We assessed the association of frequency of family contact with age and physical health for a sample of adults with severe psychiatric illness (N = 171). This cross-sectional, observational study measured frequency of face-to-face and telephone contact with family members; satisfaction with family relations; and severity of participants' chronic or permanent physical health conditions. In this sample of adults with severe psychiatric illness, having a physical health condition and advancing age correlated negatively with frequency of face-to-face contact with family members. However, a hierarchical regression analysis controlling for residence in a family member's home, and participants' ratings of satisfaction with family relations, showed that the combination of being older and having more severe health conditions was associated with a more frequent rate of family contact than would be expected based on age or physical health considered alone. Because almost all older participants in this heterogeneous sample had serious physical health conditions, as well as frequent telephone and face-to-face contact with their family members, we recommend the recruitment of family members as collaborators in illness management interventions for aging and mid-life adults with psychiatric illness.

Attitudes regarding the use of ventilator support given a supposed terminal condition among community-dwelling Mexican American and non-Hispanic white older adults: a pilot study.

PURPOSE: To determine the factors that are associated with Mexican Americans' preference for ventilator support, given a supposed terminal diagnosis. METHODS: 100 Mexican Americans, aged 60-89, were recruited and screened for MMSE scores above 18. Eligible subjects answered a questionnaire in their preferred language (English/Spanish) concerning ventilator use during terminal illness. Mediator variables examined included demographics, generation, religiosity, occupation, self-reported depression, self-reported health, and activities of daily living. RESULTS: Being first or second generation American (OR = 0.18, CI = 0.05-0.66) with no IADL disability (OR = 0.11, CI = 0.02-0.59) and having depressive symptoms (OR = 1.43, CI = 1.08-1.89) were associated with preference for ventilator support. IMPLICATIONS: First and second generation older Mexican Americans and those functionally independent are more likely to prefer end-of-life ventilation support. Although depressive symptoms were inversely associated with ventilator use at the end of life, scores may more accurately reflect psychological stress associated with enduring the scenario. Further studies are needed to determine these factors' generalizability to the larger Mexican American community.

Physician-assisted suicide attitudes of older Mexican-American and non-Hispanic white adults: does ethnicity make a difference?

Little is known about attitudes toward physician-assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non-Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non-Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community-based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity. Older Mexican Americans (52.7%) reported stronger agreement than non-Hispanic whites (33.7%) with PAS. Male sex (odds ratio (OR)=2.62, 95% confidence interval (CI)=1.09-6.35) predicted agreement with legalization in Mexican Americans, whereas lower religiosity scores (OR=0.84, 95% CI=0.75-0.94) were predictive of agreement in older non-Hispanic whites. This study is the first to find positive attitudes among community-dwelling older Mexican Americans toward PAS that are higher than those of older non-Hispanic white adults. Sex and religious views were important determinants of positive attitudes toward PAS. Larger, more-generalizable studies should be conducted to confirm the attitudinal patterns that have been identified in this study.