"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.

Mental health help-seeking in Mexico.

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico.

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Predictors of Stigma toward Alcohol Misuse in Mexico.

Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.

Predictors of Help-Seeking for Mental Health Treatment Among Latinos.

OBJECTIVES: Despite mental health disorders being a leading cause of disability among Latinos, treatment-seeking behaviors are very low. Latinos are confronted with significant disparities in mental health treatment. This research study sought to examine (1) what are the attitudes toward professional help-seeking for mental health concerns among Latino individuals and (2) what participant characteristics and demographic factors are associated with Latino individuals' help-seeking attitudes. METHODS: Employing a cross-sectional sampling strategy, 469 participants were recruited for a community-based survey study in the greater Houston area measuring mental health stigma and help-seeking attitudes. Structural equation modeling was used to estimate the associations between Latinos' help-seeking attitudes and sociodemographic characteristics of participants. RESULTS: Findings indicate that openness towards seeking professional help for mental health concerns is influenced by participants' age, marital status, gender, region of origin, education, public stigma, and self-stigma towards mental health problem. Findings support future research to examine broader systemic factors associated with help seeking and how they interact with sociodemographic characteristics and stigma. CONCLUSIONS: Latinos, even in parts of the country where they reside in high concentrations, continue to have low levels of mental health service utilization. Understanding the specific pathways that predict help-seeking for mental health issues is essential to systematically promoting early detection and entry into evidence-based treatments for Latinos.

Predictors of stigma toward alcohol misuse in Latino communities: a path model.

This study explores stigma-related beliefs within the Latino community concerning alcohol misuse. A community-based convenience sample of 251 self-identified Latino adults were recruited to participate in a research study using an experimental vignette methodology. Participants were randomly assigned one of four vignettes about alcohol misuse and asked to share their attitudes and stigma-related beliefs about the problem and the person in the vignette. Sociodemographic characteristics of participants differentially predicted alcohol-related stigma. These data may be used to inform health literacy and stigma reduction interventions within the Latino community.

An Exploratory Study on the Role of Burnout and Devaluation among Staff in Psychiatric Correctional Facilities.

Correctional staff work in demanding job environments that can lead to increased burnout. Research aims were to determine the prevalence of burnout and devaluation of consumers (i.e., individuals in their care) and their families among correctional staff, examine associations between burnout and devaluation of consumers and their families, and determine significant predictors of burnout. This exploratory study investigated 30 correctional staff in a specialized psychiatric correctional facility for individuals with mental illness in Mexico City. Correctional staff experienced low to moderate burnout, reported high levels of devaluation of consumers (DCS), and low levels of devaluation of consumers' families (DCFS). The implications of burnout on DCS and DCFS warrant large scale research and should compare burnout and devaluation in specialized psychiatric correctional facilities versus general correctional facilities.

Integrating morphological and genetic limits in the taxonomic delimitation of the Cuban taxa of Magnoliasubsect.Talauma (Magnoliaceae).

An accurate taxa delimitation, based on a full understanding of evolutionary processes involved in taxa differentiation, can be gained from a combination of ecological, morphological, and molecular approaches. The taxonomy of Magnoliasubsect.Talauma in Cuba has long been debated and exclusively based on traditional morphological study of a limited number of individuals. A more accurate description of leaf morphology variation using geometric morphometrics combined with genetic data could bring consistency to taxa delimitation in this group. Leaf samples for the morphological (243) and genetic (461) analyses were collected throughout the entire distribution range. The variability of each taxon was analyzed through multivariate and geometric morphometry, and 21 genetic markers (SSR). The observed leaf morphological variability was higher than previously described. Morphological and genetic classifications were highly congruent in two out of four taxa. Our data brought evidence that Magnoliaorbiculata can be considered a true species with very clear genetic and morphological limits. The main taxonomic issues concern the north-eastern Cuban populations of Magnoliasubsect.Talauma. The data supported the existence of two clear groups: corresponding mainly to M.minor-M.oblongifolia and T.ophiticola. However, these two groups cannot be considered fully delimited since genetic markers provided evidence of genetic admixture between them. Due to the likely absence of, at least strong, reproductive barriers between these three taxa, we propose therefore to consider them as a species complex.

Immigration Policy Changes and the Mental Health of Mexican-American Immigrants.

In recent years, significant policy changes focused on immigrants migrating through the southern United States border have been implemented. To determine if there was an association between time since immigration and increases in negative mental health symptomology, 249 Mexican-American immigrants ages 18-65 were field recruited to participate in a survey exploring their physical and mental health. Results indicate that inconsistent with the Hispanic Health Paradox, the psychological health of immigrants arriving since 2015 was significantly worse than that of more established immigrants. New arrivals had a .38 increased risk of experiencing clinically significant depression and a .47 increased risk of experiencing global psychological distress. Time since immigration was not significantly related to past 30-day alcohol use. Implications for future research and clinical practice with immigrants are explored, and suggestions on how better identify and assist Mexican-American immigrants with mental health concerns are offered.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study.

The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18-35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

The Intersection of the "Opioid Crisis" with Changes in US Immigration Policy: Contextual Barriers to Substance Abuse Research with Latinx Communities.

One of the 12 Grand Challenges facing contemporary social work is to close the health gap experienced by those in historically marginalized communities (Uehara et al., 2013). As social workers, we seek to understand the individual, interpersonal, social, and environmental factors along with the structural inequities leading to initiation and continuation of substance misuse. We are constantly contextualizing the circumstances under which substance misuse occurs, as well as contextualizing our approaches to addressing this issue from both a public health and social justice perspective. In order to adequately meet this challenge, considerably more research-based knowledge on the substance use treatment needs and preferences of America's largest ethnic/cultural group, Latinx, is needed. This brief report outlines current challenges associated with substance use research focusing on active Latinx heroin users living in a border state in a time of rapidly evolving social policy related to immigration, substance regulation, and public health.

Depression in the barrio: An analysis of the risk and protective nature of cultural values among Mexican American substance users.

Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.

SMART Cougars: Development and Feasibility of a Campus-based HIV Prevention Intervention.

University campuses are promising sites for service implementation because they have the infrastructure to support services, offer access to an otherwise difficult to reach population, and prioritize knowledge sharing among all entities. As HIV rates continue to rise among minority young adults, the need to implement innovative programs at the university level also increases. The University of Houston's (UH) Substance Use, Mental Health, and HIV/AIDS Risk Assessment and Testing (SMART Cougars) program provides HIV testing and education, mental health, and substance abuse services and referrals to students on campus and in surrounding communities. The aim of this paper is to describe development and examine feasibility of SMART Cougars (SC). Using Bowen's feasibility framework, we found that SC produced a demand, was acceptable and appropriate, implemented without many challenges, and integrated among university and community settings. Combined, these factors and processes changed social norms around sexual health messages on campus.

The Perceived Role of Family in Heroin Use Behaviors of Mexican-American Men.

The influence of the family is not well understood as it relates to drug use behaviors of Hispanic male adults. We examined the family's influence on drug use behavior, as perceived by Hispanic men who use heroin. One-time qualitative interviews were conducted with 21 current and former heroin users who participated in a larger study on long-term heroin use in Mexican-American men. Data were analyzed using a thematic analysis approach. Three main themes emerged: family as a supportive environment for heroin use; heroin as a family legacy; and, the family's strategies for helping to stop using heroin. A sub-theme emerged on the paradox of family involvement, which spanned the three main themes. This research lays a foundation for future work to disentangle the risks and benefits of family involvement to inform culturally-centered therapies and cultural adaptations to traditional therapeutic approaches with Mexican-American men who abuse drugs.

Hispanic Perspectives on Recovery High Schools: If We Build Them, Will They Come?

Recovery High Schools (RHSs) have been among the continuum of care for adolescents experiencing addiction since 1979 (Moberg & Finch, 2008). Outcome studies for RHSs are limited, and even less is known about RHS engagement of Hispanics. RHS students are overwhelmingly middle-class non-Hispanic White students with prior formal treatment (Moberg & Finch, 2008). Hispanic youth are more likely to live in discordant low-income ethnic enclaves, placing them at high risk for addictive disorders (Torres, Kaplan, & Valdez, 2011). The individualized approach of RHSs could make them a culturally relevant continuing care intervention. This paper reviews the literature to explore the use of RHSs by Hispanics.

The Integration of Clients' Religion and Spirituality in Social Work Practice: A National Survey.

This article describes the results of a cross-sectional study of licensed clinical social workers' (LCSWs') views and behaviors related to integrating clients' religion and spirituality in clinical practice. A total of 442 LCSWs from across the United States who advertised their services on the Internet provided anonymous responses to an online administration of the Religious/Spiritually Integrated Practice Assessment Scale. The results indicate that LCSWs have positive attitudes, high levels of self-efficacy, and perceive such integration as feasible, but report low levels of engagement in integrating clients' religious and spiritual beliefs into practice. Moreover, two variables emerged as significant predictors for LCSWs' overall orientation toward integrating clients' religion and spirituality in practice: practitioners' intrinsic religiosity and prior training (prior course work or continuing education). Implications and next steps for social work education and continuing training efforts are discussed.

High proportion of cactus species threatened with extinction.

A high proportion of plant species is predicted to be threatened with extinction in the near future. However, the threat status of only a small number has been evaluated compared with key animal groups, rendering the magnitude and nature of the risks plants face unclear. Here we report the results of a global species assessment for the largest plant taxon evaluated to date under the International Union for Conservation of Nature (IUCN) Red List Categories and Criteria, the iconic Cactaceae (cacti). We show that cacti are among the most threatened taxonomic groups assessed to date, with 31% of the 1,478 evaluated species threatened, demonstrating the high anthropogenic pressures on biodiversity in arid lands. The distribution of threatened species and the predominant threatening processes and drivers are different to those described for other taxa. The most significant threat processes comprise land conversion to agriculture and aquaculture, collection as biological resources, and residential and commercial development. The dominant drivers of extinction risk are the unscrupulous collection of live plants and seeds for horticultural trade and private ornamental collections, smallholder livestock ranching and smallholder annual agriculture. Our findings demonstrate that global species assessments are readily achievable for major groups of plants with relatively moderate resources, and highlight different conservation priorities and actions to those derived from species assessments of key animal groups.

From "Kickeando las malias" (kicking the withdrawals) to "Staying clean": The impact of cultural values on cessation of injection drug use in aging Mexican-American men.

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

Spatial accessibility of drug treatment facilities and the effects on locus of control, drug use, and service use among heroin-injecting Mexican American men.

BACKGROUND: This study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users. METHODS: Secondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from one's place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from one's place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase. RESULTS: Participants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization. CONCLUSION: The findings showed that the presence of outpatient treatment facilities-particularly services in Spanish-may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.

"El lado oscuro": "the dark side" of social capital in Mexican American heroin using men.

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.