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1.
JAMA Netw Open ; 3(12): e2029230, 2020 12 01.
Article in English | MEDLINE | ID: mdl-33306118

ABSTRACT

Importance: Knowledge about use of health care services (health care utilization) and expenditures among unauthorized immigrant populations is uncertain because of limitations in ascertaining legal status in population data. Objective: To examine health care utilization and expenditures that are attributable to unauthorized and authorized immigrants vs US-born individuals. Design, Setting, and Participants: This cross-sectional study used the data on documentation status from the Los Angeles Family and Neighborhood Survey (LAFANS) to develop a random forest classifier machine learning model. K-fold cross-validation was used to test model performance. The LAFANS is a randomized, multilevel, in-person survey of households residing in Los Angeles County, California, consisting of 2 waves. Wave 1 began in April 2000 and ended in January 2002, and wave 2 began in August 2006 and ended in December 2008. The machine learning model was then applied to a nationally representative database, the 2016-2017 Medical Expenditure Panel Survey (MEPS), to predict health care expenditures and utilization among unauthorized and authorized immigrants and US-born individuals. A generalized linear model analyzed health care expenditures. Logistic regression modeling estimated dichotomous use of emergency department (ED), inpatient, outpatient, and office-based physician visits by immigrant groups with adjusting for confounding factors. Data were analyzed from May 1, 2019, to October 14, 2020. Exposures: Self-reported immigration status (US-born, authorized, and unauthorized status). Main Outcomes and Measures: Annual health care expenditures per capita and use of ED, outpatient, inpatient, and office-based physician care. Results: Of 47 199 MEPS respondents with nonmissing data, 35 079 (74.3%) were US born, 10 816 (22.9%) were authorized immigrants, and 1304 (2.8%) were unauthorized immigrants (51.7% female; mean age, 47.6 [95% CI, 47.4-47.8] years). Compared with authorized immigrants and US-born individuals, unauthorized immigrants were more likely to be aged 18 to 44 years (80.8%), Latino (96.3%), and Spanish speaking (95.2%) and to have less than 12 years of education (53.7%). Half of unauthorized immigrants (47.1%) were uninsured compared with 15.9% of authorized immigrants and 6.0% of US-born individuals. Mean annual health care expenditures per person were $1629 (95% CI, $1330-$1928) for unauthorized immigrants, $3795 (95% CI, $3555-$4035) for authorized immigrants, and $6088 (95% CI, $5935-$6242) for US-born individuals. Conclusions and Relevance: Contrary to much political discourse in the US, this cross-sectional study found no evidence that unauthorized immigrants are a substantial economic burden on safety net facilities such as EDs. This study illustrates the value of machine learning in the study of unauthorized immigrants using large-scale, secondary databases.


Subject(s)
Data Collection/methods , Emigrants and Immigrants , Health Expenditures/statistics & numerical data , Machine Learning , Patient Acceptance of Health Care , Undocumented Immigrants/statistics & numerical data , Cross-Sectional Studies , Databases, Factual/statistics & numerical data , Emigrants and Immigrants/legislation & jurisprudence , Emigrants and Immigrants/statistics & numerical data , Family Characteristics , Female , Humans , Los Angeles/ethnology , Male , Middle Aged , Minority Health/economics , Patient Acceptance of Health Care/ethnology , Patient Acceptance of Health Care/statistics & numerical data , Population Groups/statistics & numerical data
2.
Cancer Causes Control ; 31(12): 1093-1103, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32964365

ABSTRACT

PURPOSE: While cancer mortality has declined by 27% between 1991 and 2016 in the United States, there are large disparities in cancer mortality by racial/ethnic groups, socioeconomic status and access to care. The purpose of this analysis is to compare trends in cancer mortality among regions (Service Planning Areas, SPAs) in Los Angeles (LA) County that vary with respect to racial/ethnic distribution and social determinants of health, including poverty, education and access to care. METHODS: We estimated age- and race/ethnicity-standardized mortality for lung, colorectal (CRC) and breast cancer for eight SPAs from 1999 to 2013. We calculated three recommended measures of disparities that reflect absolute, relative and between-group disparities. RESULTS: In all of LA County, statistically significant declines in age- and race/ethnicity-standardized mortality ranged from 30% for lung cancer to 20% for CRC to 15% for breast cancer. Despite some of the largest declines in the most under-resourced SPAs (South LA, East LA, South Bay), disparities between the lowest and highest mortality by SPA did not significantly change from 1999 to 2013. CONCLUSIONS: Despite significant declines in cancer mortality in LA County from 1999 to 2013, and in racial/ethnic groups, there was little progress toward reducing disparities among SPAs. Highest mortalities for the three cancers were observed in Antelope Valley, San Fernando Valley, San Gabriel Valley, South LA and East LA. Findings demonstrate the importance of examining regional differences in cancer mortality to identify areas with highest needs for interventions and policies to reduce cancer disparities.


Subject(s)
Breast Neoplasms/mortality , Colorectal Neoplasms/mortality , Lung Neoplasms/mortality , Adult , Breast Neoplasms/ethnology , Colorectal Neoplasms/ethnology , Female , Health Resources , Health Status Disparities , Humans , Los Angeles/epidemiology , Los Angeles/ethnology , Lung Neoplasms/ethnology , Male , Social Class
3.
Dev Psychol ; 56(6): 1220-1232, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32223295

ABSTRACT

Although many facets of social status (i.e., socioeconomic status, gender, race) are fairly stable, limited work has assessed how youths' identification with their status changes over time. Subjective social status (SSS) refers to one's perception of standing or rank relative to others, and for youth status is generally in the context of society or school. The current study assessed how adolescents' SSS in American society and in their school changes and predicts health and well-being during and after high school. A total of 336 adolescents (Mage = 16.40 at Wave 1) reported their SSS at up to three time points, each 2 years apart, such that youth provided data between the 10th grade and 3 years following the transition from high school. Piecewise multilevel modeling was used, including discontinuities to assess the importance of the transition from high school. Society SSS decreased across the period, especially among youth with lower family income, youth whose parents reported lower SSS, and youth who did not attend college. School SSS was stable during high school, declined after 12th grade, and remained stable thereafter. Moderation analyses revealed that school SSS declines more consistently among female adolescents than male adolescents and Latinos relative to other ethnic groups. Lower society and school SSS were associated with more depressive symptoms and greater likelihood of obesity, highlighting the relevance of SSS for health during this important developmental transition. Results suggest declines in SSS are especially common among disadvantaged groups as they age, and that lower SSS may indicate risk for poorer health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Depression/ethnology , Health Status , Human Development , Obesity/ethnology , Self Concept , Social Class , Adolescent , Adult , Asian , Body Mass Index , Female , Hispanic or Latino , Humans , Longitudinal Studies , Los Angeles/ethnology , Male , Sex Factors , White People , Young Adult
4.
J Lesbian Stud ; 24(2): 77-93, 2020.
Article in English | MEDLINE | ID: mdl-31258009

ABSTRACT

Mainstream research on lesbian, gay, bisexual, transgender Los Angeles (LA) has ignored Latinx queer communities until recently, and lesbian Latinas, particularly those who are migrants and/or refugees, have been especially marginalized. Building on scholarship and creative work by Chicana, Latina, women of color feminist, queer of color, and queer migration activists and scholars, this essay contributes to research on Mexican, Central American, and Latina lesbians in LA. In her research on sexually non-conforming Latinas, Katie L. Acosta argues that to better understand Latinas' sexualities in all their complexities, future scholarly work should address the pleasures and desires of Latina lesbians, as well as the quality and stability of the relationships they nurture in the borderlands. Building on queer migration research and using what Nan Alamilla Boyd and Horacio Roque Ramírez call "queer oral history," this article focuses on two everyday lesbians in LA whose stories add depth to our understandings of LA queer history and to the lives of queer migrants in the city. The narratives of Luna and Dulce, migrant lesbians from Mexico and Guatemala, respectively, provide a context for better understanding diverse experiences of migrant Latina lesbians in LA. Situating their lives within ongoing research on lesbian Latinas, this essay focuses on three themes-migration, leisure spaces, and family-to explore how these inform the women's everyday choices and shape their practices of freedom. Their stories and perspectives have been instrumental in enabling me to develop an interdisciplinary theoretical framework that I call "finding sequins in the rubble," through which we can recognize and understand how queer Latinx communities engage in processes of queer-world making and radical possibility through everyday acts of resilience and self-care in the midst of familial, institutional, and state violence.


Subject(s)
Hispanic or Latino , Homosexuality, Female/ethnology , Sexual and Gender Minorities , Transients and Migrants , Adult , Female , Guatemala/ethnology , Humans , Los Angeles/ethnology , Mexico/ethnology
5.
PLoS One ; 14(7): e0219425, 2019.
Article in English | MEDLINE | ID: mdl-31276540

ABSTRACT

OBJECTIVE: Latino immigrants experience acculturative stress and increased depression risk. Mindfulness meditation improves depressive symptoms, yet the vast majority of research has focused on English speaking populations. METHODS: In this randomized clinical trial with 2 parallel treatment groups, adults with moderate levels of perceived stress (n = 76) were recruited from the Los Angeles community from October 2015 to March 2016, stratified into Spanish- (n = 36) and English speaking (n = 40) language groups, and randomized for 6 weeks of treatment with standardized mindful awareness practices (MAPs) or health education (HE). Main outcome measure was depressive symptoms, measured by the Beck Depression Inventory. RESULTS: Using an intent-to-treat analysis, the primary outcome, depressive symptoms as indexed by the Beck Depression Inventory, showed greater improvement in MAPs vs. HE, with a between-group post-intervention mean difference of -2.2 (95% CI -4.4 - -0.07) and effect size of 0.28; similar effect sizes were found in the the Spanish- (0.29) and English speaking (0.30) groups. MAPs showed significant improvement relative to HE on secondary outcome of mindfulness with between group difference of 10.7 (95% CI4.5-16.9), but not perceived stress. CONCLUSION: The comparable efficacy of Spanish and English formats of mindfulness meditation in improving depressive symptoms suggests that this community based intervention may mitigate depression risk in Latino adults who are experiencing social adversity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03545074.


Subject(s)
Depression/epidemiology , Depression/therapy , Ethnicity , Meditation , Mindfulness , Adult , Aged , Humans , Intention to Treat Analysis , Los Angeles/epidemiology , Los Angeles/ethnology , Meditation/methods , Middle Aged , Mindfulness/methods , Outcome Assessment, Health Care
6.
Article in English | MEDLINE | ID: mdl-31064059

ABSTRACT

Background. Despite the prevalence of multimorbidity among African American (AA) older adults, little information exists on correlates of polypharmacy (using 5+ medications) in AA older adults. There is more information available regarding the link between polypharmacy and physical aspects of health than subjective ones. Aims. In a local sample of AA older adults in Los Angeles, this study investigated the association of polypharmacy with self-rated health (SRH) and depression. We also explored gender differences in these links. Methods. This community-based study was conducted in south Los Angeles. A total number of 708 AA older adults (age ≥ 55 years) were entered into this study. From this number, 253 were AA men and 455 were AA women. Polypharmacy was the independent variable. Self-rated health (SRH) and depression were the dependent variables. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), and marital status were covariates. Gender was the moderator. Multimorbidity, measured as the number of chronic diseases (CDs), was the mediator. Logistic regressions were applied for data analysis. Results. Polypharmacy was associated with worse SRH and depression. Multimorbidity fully mediated the association between polypharmacy and depressive symptoms. Multimorbidity only partially mediated the association between polypharmacy and poor SRH. Gender moderated the association between polypharmacy and SRH, as polypharmacy was associated with poor SRH in women but not men. Gender did not alter the association between polypharmacy and depression. Conclusions. AA older women with polypharmacy experience worse SRH and depression, an association which is partially due to the underlying multimorbidity. There is a need for preventing inappropriate polypharmacy in AA older adults, particularly when addressing poor SRH and depression in AA older women with multimorbidity.


Subject(s)
Black or African American/statistics & numerical data , Depression/epidemiology , Health Status , Polypharmacy , Aged , Aged, 80 and over , Depression/ethnology , Female , Humans , Los Angeles/epidemiology , Los Angeles/ethnology , Male , Middle Aged , Multimorbidity , Self Report
7.
Article in English | MEDLINE | ID: mdl-31126049

ABSTRACT

Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age ≥ 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities' diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.


Subject(s)
Alcohol Drinking/psychology , Black or African American/psychology , Cigarette Smoking/psychology , Health Behavior/ethnology , Social Class , Vulnerable Populations/psychology , Black or African American/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , Alcohol Drinking/ethnology , Cigarette Smoking/ethnology , Female , Humans , Logistic Models , Los Angeles/ethnology , Male , Vulnerable Populations/statistics & numerical data
8.
Pediatrics ; 143(2)2019 02.
Article in English | MEDLINE | ID: mdl-30679379

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence-based parenting programs prevent the onset and escalation of youth conduct problems. However, participation rates in such programs are low among hard-to-reach populations, including Filipino individuals. Compared with other ethnic groups, Filipino adolescents have significant mental health disparities. We evaluated the effectiveness of a theory-based, culturally tailored video versus a usual-care mainstream video on enrollment in an evidence-based parenting program among Filipino caregivers of children ages 6 to 12 years and tested theoretical mediators of intervention effect. METHODS: We randomly assigned 215 Filipino participants to view either a theory-based, culturally tailored video based on the Health Belief Model and Theory of Planned Behavior or a control video. The primary outcome was actual enrollment in an evidence-based parenting intervention. Mediators (knowledge and perceived susceptibility) were modeled as latent variables in a structural equation model. RESULTS: After the intervention, participants in the intervention group had significantly higher knowledge of Filipino adolescent behavioral health disparities and higher perceived susceptibility to adolescent risky sexual activity and illegal drug use. Controlling for child sex, parents in the intervention group had significantly greater odds of actual enrollment in the Incredible Years program (odds ratio = 2.667; 95% confidence interval: 1.328-5.354; P = .006). The intervention effects were mediated by increased knowledge and perceived susceptibility. CONCLUSIONS: Results demonstrated the effectiveness of a theory-based, culturally tailored intervention aimed at increasing participation of a hard-to-engage population in parenting interventions. Videos that include parents and health professionals with whom audiences can identify can be used to produce shifts in knowledge and behavior.


Subject(s)
Healthcare Disparities/ethnology , Parent-Child Relations/ethnology , Parenting/ethnology , Population Surveillance , Video Recording/methods , Adult , Child , Evidence-Based Practice/methods , Female , Humans , Los Angeles/ethnology , Male , Middle Aged , Parenting/psychology , Philippines/ethnology , Population Surveillance/methods
9.
Am J Geriatr Psychiatry ; 27(1): 53-61, 2019 01.
Article in English | MEDLINE | ID: mdl-30409550

ABSTRACT

OBJECTIVES: To test a culturally tailored intervention to improve Alzheimer's disease (AD) literacy among African Americans. DESIGN: A 3-arm randomized comparative effectiveness trial. SETTING: Community sites in Los Angeles, CA. PARTICIPANTS: 193 African American community-dwelling adults, ages 45 to 95 years old. INTERVENTION: All groups attended BrainWorks Live, a culturally tailored, 60-minute talk show and received standard printed educational materials on AD. From there: a) the BrainWorks Live group received no further contact until the post-test; b) one intervention group received a 1-month, culturally tailored, unidirectional, daily text-message program; and c) a second intervention group received daily text messages based on the printed educational materials that the general public would receive. AD literacy was measured at baseline and one month post intervention. MEASUREMENTS: Alzheimer's disease literacy and demographic and health covariates. RESULTS: At one month, participants who received culturally tailored text messages had the highest increase in AD literacy levels, followed by those in the BrainWorks Live arm. Participants who received general text messages had a lower overall increase in AD literacy levels compared to the other arms, but had higher mean AD literacy levels than the BrainWorks Live arm. There was a significantly greater increase in AD literacy levels among participants who received culturally tailored text messages compared with those who attended BrainWorks Live only. There were no other statistically significant differences between arms. CONCLUSIONS: AD literacy among African Americans can be improved after only one month through culturally competent, economically feasible educational formats.


Subject(s)
Alzheimer Disease , Black or African American , Cultural Competency , Health Knowledge, Attitudes, Practice , Health Literacy/methods , Text Messaging , Black or African American/ethnology , Aged , Aged, 80 and over , Female , Health Knowledge, Attitudes, Practice/ethnology , Humans , Independent Living , Los Angeles/ethnology , Male , Middle Aged
10.
Int J Cancer ; 143(2): 263-268, 2018 07 15.
Article in English | MEDLINE | ID: mdl-29441528

ABSTRACT

This analysis examined type 2 diabetes (T2D) as a predictor of colorectal cancer (CRC) survival within the Multiethnic Cohort Study. Registry linkages in Hawaii and California identified 5,284 incident CRC cases. After exclusion of cases with pre-existing cancer diagnosis within 1 year and systemic disease, the analytic dataset had 3,913 cases with 1,800 all-cause and 678 CRC-specific deaths after a mean follow-up of 9.3 ± 5.2 years. Among CRC cases, 707 were diagnosed with T2D 8.9 ± 5.3 years before CRC. Cox regression with age as time metric was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for T2D status as predictor of CRC-specific and all-cause survival while adjusting for known confounders. Overall, CRC-specific survival was not associated with pre-existing T2D (HR = 0.84; 95% CI = 0.67-1.07). However, a significant interaction was seen for comorbidity (pinteraction  = 0.03) with better survival among those without pre-existing conditions (HR = 0.49; 95% CI = 0.25-0.96) while no association was seen in patients with comorbid conditions. All-cause mortality was also not related to pre-existing T2D (HR = 1.11; 95% CI = 0.98-1.27), but significantly elevated for individuals with T2D reporting comorbid conditions (HR = 1.36; 95% CI = 1.19-1.56). Stratification by T2D duration suggested higher CRC-specific and all-cause mortality among participants with a T2D history of ≥10 than <10 years. The findings were consistent across sex and ethnic subgroups. In contrast to previous reports, pre-existing T2D had no influence on disease-specific and all-cause survival among CRC patients. Only participants with additional comorbidity and possibly those with long T2D duration experienced higher mortality related to T2D.


Subject(s)
Colorectal Neoplasms/ethnology , Colorectal Neoplasms/mortality , Diabetes Mellitus, Type 2/ethnology , Aged , Body Mass Index , Cohort Studies , Comorbidity , Female , Hawaii/ethnology , Humans , Los Angeles/ethnology , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Survival Analysis
11.
J Clin Neurosci ; 49: 22-25, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29273423

ABSTRACT

The objective of this study is to shed light on racial disparities among Hispanic and African American adult brain tumor patients treated at Harbor-UCLA Medical Center compared to the general populations of Los Angeles County (LAC) and Torrance, California (CA). A retrospective review of patients admitted to the neurosurgery service at Harbor-UCLA Medical Center during years 2006 through 2010 was performed. Government census data was queried and pertinent national statistics were retrieved. Brain tumor patients at Harbor-UCLA were compared to the general populations of LAC and Torrance. A total of 271 patients were included in the study. The mean age was 46.9 years. Hispanics comprised the majority of neurosurgical patients (n = 151, 55.7%), followed by African Americans (n = 35, 12.9%). A greater percentage of Hispanic patients were treated at Harbor-UCLA relative to the general Hispanic populations of LAC and Torrance (p < .001). A greater percentage of African American patients were treated at Harbor-UCLA relative to the general African American populations of LAC and Torrance (p = .035 and p < .001, respectively). Our data revealed significant racial disparities amid the Harbor-UCLA Hispanic and African American patient populations compared to the general Angeleno populations of LAC and Torrance.


Subject(s)
Academic Medical Centers/trends , Black or African American/ethnology , Brain Neoplasms/ethnology , Brain Neoplasms/surgery , Healthcare Disparities/trends , Hispanic or Latino , Academic Medical Centers/standards , Adult , Aged , Female , Healthcare Disparities/standards , Humans , Los Angeles/ethnology , Male , Middle Aged , Retrospective Studies , Treatment Outcome
12.
Aging Ment Health ; 22(12): 1548-1555, 2018 12.
Article in English | MEDLINE | ID: mdl-28914547

ABSTRACT

OBJECTIVES: This study sought to identify challenges and protective factors for resilience related to the process of aging among older Chinese immigrants in the United States. METHODS: This study used qualitative methods and involved 24 in-depth interviews with Chinese immigrants aged 65 or older in Los Angeles. Content analysis was employed to analyze qualitative data. RESULTS: Three major themes emerged regarding challenges older Chinese immigrants encountered in aging in the United States: language barriers, loneliness and social isolation, and insufficient use of social services. Four themes were identified regarding resilience protective factors: acceptance and optimism; independence and autonomy; informal social support; and use of the formal social welfare system. CONCLUSION: This study provides several implications for future human services to build relational and societal resilience and enhance Chinese older immigrants' personal resilience. Cultural strengths should be taken into consideration by practitioners and policy makers.


Subject(s)
Adaptation, Psychological , Aging/ethnology , Asian/statistics & numerical data , Resilience, Psychological , Social Welfare , Stress, Psychological/ethnology , Aged , Aged, 80 and over , China/ethnology , Female , Humans , Loneliness , Los Angeles/ethnology , Male , Qualitative Research , Social Isolation , Social Support
13.
Transl Psychiatry ; 7(5): e1134, 2017 05 16.
Article in English | MEDLINE | ID: mdl-28509902

ABSTRACT

Identifying data-driven subtypes of major depressive disorder (MDD) is an important topic of psychiatric research. Currently, MDD subtypes are based on clinically defined depression symptom patterns. Although a few data-driven attempts have been made to identify more homogenous subgroups within MDD, other studies have not focused on using human genetic data for MDD subtyping. Here we used a computational strategy to identify MDD subtypes based on single-nucleotide polymorphism genotyping data from MDD cases and controls using Hamming distance and cluster analysis. We examined a cohort of Mexican-American participants from Los Angeles, including MDD patients (n=203) and healthy controls (n=196). The results in cluster trees indicate that a significant latent subtype exists in the Mexican-American MDD group. The individuals in this hidden subtype have increased common genetic substrates related to major depression and they also have more anxiety and less middle insomnia, depersonalization and derealisation, and paranoid symptoms. Advances in this line of research to validate this strategy in other patient groups of different ethnicities will have the potential to eventually be translated to clinical practice, with the tantalising possibility that in the future it may be possible to refine MDD diagnosis based on genetic data.


Subject(s)
Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/genetics , Exome/genetics , Mexican Americans/genetics , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/ethnology , Anxiety Disorders/genetics , Cluster Analysis , Depersonalization/diagnosis , Depersonalization/ethnology , Depersonalization/genetics , Depressive Disorder, Major/classification , Female , Genotype , Humans , Los Angeles/ethnology , Male , Middle Aged , Paranoid Behavior/diagnosis , Paranoid Behavior/ethnology , Paranoid Behavior/genetics , Polymorphism, Single Nucleotide/genetics , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/ethnology , Sleep Initiation and Maintenance Disorders/genetics , Young Adult
14.
J Nerv Ment Dis ; 205(5): 372-379, 2017 May.
Article in English | MEDLINE | ID: mdl-28230564

ABSTRACT

This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.


Subject(s)
Aggression/physiology , Amphetamines/therapeutic use , Attention Deficit Disorder with Hyperactivity/physiopathology , Crack Cocaine/therapeutic use , Self Medication , Substance-Related Disorders/etiology , Adult , Aggression/drug effects , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/ethnology , Black People/ethnology , Female , Hispanic or Latino/statistics & numerical data , Humans , Los Angeles/ethnology , Male , Middle Aged , Substance-Related Disorders/ethnology , White People/ethnology
15.
J Sex Res ; 54(4-5): 619-630, 2017.
Article in English | MEDLINE | ID: mdl-27135138

ABSTRACT

This analysis assessed patterns of sexual experience, the order in which behaviors were initiated, and associated factors, among Latino and African American ninth grade students (average age 15.2) who self-administered audio-computer-assisted surveys on netbooks in classes at 10 Los Angeles-area public high schools. Lifetime experiences with vaginal and oral sex were most common (19% and 16%, respectively); fewer reported anal sex (6%). Of the 23% reporting any sex, 91% fell into four categories: 36% reporting both oral and vaginal sex; 23% vaginal only; 18% all three; and 13% oral only. Most sexually experienced students (88%) initiated with vaginal or oral sex (46% vaginal, 33% oral, 9% both same day). No dominant pathway of sexual onset emerged for those reporting all three types of sex. We found no evidence that oral or anal sex substituted for or delayed vaginal sex. Males, those with a current partner, and those reporting multiple partners were more likely than others to report all three sexual behaviors versus vaginal only (odds ratios [ORs] 2.0, 1.5, 3.0; p = .02, .06, < .01, respectively). Although vaginal intercourse dominated their early sexual behavior, one-fifth of sexually experienced students reported anal intercourse, highlighting the need for specific prevention messages surrounding this higher-risk behavior.


Subject(s)
Adolescent Behavior/ethnology , Black or African American/ethnology , Hispanic or Latino/statistics & numerical data , Sexual Behavior/ethnology , Sexual Partners , Adolescent , Female , Humans , Los Angeles/ethnology , Male
16.
Psychiatr Serv ; 68(4): 368-374, 2017 Apr 01.
Article in English | MEDLINE | ID: mdl-27842468

ABSTRACT

OBJECTIVE: This study examined use of depression care provided by faith-based organizations (FBOs) by African Americans and Hispanics and factors associated with the receipt of such care, including mental illness severity and use of traditional mental health services. METHODS: The study used baseline data from the Community Partners in Care study, a group-randomized trial comparing a community-partnered approach with a technical-assistance approach to improving depression care in underresourced communities in Los Angeles. A sample of 947 individuals (48% African American, 27% non-U.S.-born Hispanic, 15% U.S.-born Hispanic, and 10% non-Hispanic white) were surveyed about recent visits to a religious or spiritual place and receipt of FBO depression care. Descriptive analyses compared racial-ethnic, sociodemographic, and health service use variables for three groups: those who did not attend a religious place, those who attended a religious place and did not receive FBO depression services, and those who received FBO depression services. Multinomial logistic regression was used to identify predictors of receipt of FBO depression care. RESULTS: A larger proportion of African Americans and non-U.S.-born Hispanics received FBO faith-based depression services compared with non-Hispanic whites and with U.S.-born Hispanics. Receipt of FBO depression services was associated with younger age, lifetime diagnosis of mania, use of primary care depression services, and receipt of a mental health service from a substance abuse agency. CONCLUSIONS: FBO depression services were used in the community, especially by persons from racial-ethnic minority groups. Collaborative efforts between FBOs and traditional health services may increase access to depression services for African Americans and Latinos.


Subject(s)
Black or African American/ethnology , Depressive Disorder, Major/therapy , Faith-Based Organizations/statistics & numerical data , Hispanic or Latino/statistics & numerical data , Mental Health Services/statistics & numerical data , Adult , Anxiety Disorders/ethnology , Bipolar Disorder/ethnology , Comorbidity , Depressive Disorder, Major/ethnology , Female , Humans , Latin America/ethnology , Los Angeles/ethnology , Male , Middle Aged , Psychotic Disorders/ethnology , Self Report
17.
Female Pelvic Med Reconstr Surg ; 22(6): 460-466, 2016.
Article in English | MEDLINE | ID: mdl-27636216

ABSTRACT

OBJECTIVES: The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). METHODS: Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. RESULTS: Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. CONCLUSIONS: The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care.


Subject(s)
Communication Barriers , Healthcare Disparities/ethnology , Pelvic Organ Prolapse/therapy , Disclosure , Exercise Therapy/statistics & numerical data , Fear , Female , Focus Groups , Hispanic or Latino , Hospitals, Private , Hospitals, Public , Humans , Los Angeles/ethnology , Mexico/ethnology , Middle Aged , Neoplasms/psychology , New Mexico/ethnology , Patient Education as Topic , Patient Satisfaction , Pelvic Organ Prolapse/ethnology , Pessaries/statistics & numerical data , Physician-Patient Relations , Retrospective Studies , Treatment Refusal/ethnology
18.
Drug Alcohol Depend ; 163: 261-4, 2016 Jun 01.
Article in English | MEDLINE | ID: mdl-27141841

ABSTRACT

PURPOSE: Electronic cigarettes (e-cigarettes) could have a multifaceted effect on public health by changing the likelihood that: (a) non-smokers and non-users of marijuana subsequently transition to cigarette and marijuana use, respectively, and/or: (b) cigarette smokers subsequently quit smoking. We analyzed data from a longitudinal study of Hispanic young adults in Los Angeles, California to determine whether e-cigarette use is associated with subsequent cigarette or marijuana use over a one-year period. METHODS: Survey data were collected from 1332 Hispanic young adults (59% female, mean age=22.7 years, SD=0.39 years) in 2014 and 2015. Logistic regression analyses examined the association between e-cigarette use in 2014 and cigarette/marijuana use in 2015, controlling for age, sex, and other substance use. RESULTS: In 2014, prevalence of past-month use was 9% for e-cigarettes, 21% for cigarettes, and 23% for marijuana. Among past-month cigarette nonsmokers in 2014, those who were past-month e-cigarette users in 2014 were over 3 times more likely to be past-month cigarette smokers in 2015, compared with those who did not report past-month e-cigarette use in 2014 (26% vs. 7%; OR=3.32, 95% CI=1.55, 7.10). Among past-month marijuana non-users in 2014, those who were past-month e-cigarette users in 2014 were nearly 2 times more likely to be past-month marijuana users in 2015 (24% vs. 12%;OR=1.97, 95% CI=1.01, 3.86). Among past-month cigarette and marijuana users in 2014, e-cigarette use in 2014 was not associated with a change cigarette and marijuana use, respectively, in 2015. CONCLUSIONS: Among Hispanic young adults, e-cigarettes could increase the likelihood of transitioning from non-user to user of cigarettes or marijuana and was not associated with smoking cessation.


Subject(s)
Electronic Nicotine Delivery Systems/statistics & numerical data , Hispanic or Latino/psychology , Marijuana Smoking/ethnology , Smoking/ethnology , Smoking/psychology , Adolescent , Adult , Electronic Nicotine Delivery Systems/trends , Female , Humans , Longitudinal Studies , Los Angeles/ethnology , Male , Marijuana Smoking/psychology , Marijuana Smoking/trends , Smoking/trends , Smoking Cessation/ethnology , Smoking Cessation/psychology , Surveys and Questionnaires , Tobacco Products , Young Adult
19.
Child Dev ; 87(3): 770-81, 2016 May.
Article in English | MEDLINE | ID: mdl-27189404

ABSTRACT

Cultural transmission is often viewed as a domain-general process. However, a growing literature suggests that learnability is influenced by content and context. The idea of a learnability landscape is introduced as a way of representing the effects of interacting factors on how easily information is acquired. Extending prior work (Barrett & Broesch, ), learnability of danger and other properties is compared for animals, artifacts, and foods in the urban American children (ages 4-5) and in the Shuar children in Ecuador (ages 4-9). There is an advantage for acquiring danger information that is strongest for animals and weakest for artifacts in both populations, with culture-specific variations. The potential of learnability landscapes for assessing biological and cultural influences on cultural transmission is discussed.


Subject(s)
Cross-Cultural Comparison , Culture , Fear , Learning , Child , Child, Preschool , Ecuador/ethnology , Female , Humans , Los Angeles/ethnology , Male
20.
Child Dev ; 87(4): 1079-89, 2016 07.
Article in English | MEDLINE | ID: mdl-27224903

ABSTRACT

This study examined whether Mexican-American parents' experiences with discrimination are related to adolescent psychological adjustment over time. The extent to which associations between parent discrimination and adolescent adjustment vary as a function of parents' ethnic socialization of their children was also examined. Participants included 344 high school students from Mexican or Mexican-American backgrounds (primarily second generation; ages 14-16 at Wave 1) and their primary caregivers who completed surveys in a 2-year longitudinal study. Results revealed that parent discrimination predicted internalizing symptoms and self-esteem among adolescents 1 year later. Additionally, adolescents were more likely to report low self-esteem in relation to parents' increased experiences of discrimination when parents conveyed ethnic socialization messages to them.


Subject(s)
Adolescent Behavior/ethnology , Emotional Adjustment , Mexican Americans/psychology , Parents/psychology , Prejudice/psychology , Self Concept , Socialization , Adolescent , Female , Humans , Longitudinal Studies , Los Angeles/ethnology , Male
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