Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes.

We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.

RESUMEN: Diseñamos una intervención infográfica para ayudar a los médicos brindar información médica a personas viviendo con el VIH. En este estudio, evaluamos en qué medida nuestra intervención puede mejorar los resultados de salud (conteo de CD4, carga viral, y compromiso con el médico entre otros), medidos de una manera objetiva y subjetiva, cuando se incorpora en las visitas médicas de rutina en la República Dominicana. En este estudio de prueba previo y posterior, seguimos los participantes durante 9 meses a intervalos de 3 meses. Los médicos administraron la intervención durante las primeras 3 visitas de los participantes. Seleccionamos las medidas de resultado utilizando un marco conceptual y las evaluamos en los 4 puntos de tiempo. Evaluamos cambios a lo largo del tiempo usando regresiones lineales generales y pruebas de asociación de Wilcoxon Signed-Rank. Los participantes (N = 50) fueron mayormente mujeres (56%) y habían estado viviendo con el VIH durante una media de 6,3 años (DE = 6,1). Todos los resultados, aparte del conteo de CD4, demostraron mejoras estadísticamente significativas al final del estudio. Esto proporciona evidencia preliminar de que nuestra intervención puede mejorar los resultados de la salud, pero se justifican pruebas adicionales.

Childhood Adversity and Sleep Disturbances: Longitudinal Results in Puerto Rican Children.

BACKGROUND: Exposure to childhood adversities (CA) is associated with sleep disturbances; however, evidence has largely been drawn from cross-sectional data and has not addressed the relationship across developmental stages. Also, most studies have primarily focused on non-Hispanic White cohorts with a dearth of longitudinal evidence about racial/ethnic minorities. We examined the longitudinal association between CA and sleep disturbances in Puerto Rican youth. METHOD: The Boricua Youth Study is a longitudinal study of Puerto Rican youth living in San Juan, Puerto Rico, and the South Bronx, NY (N = 2491). Among youth 5-9 and 10-16 years old, sleep disturbances were assessed through three yearly interviews. Lifetime exposure to CA included parental loss, child maltreatment, parental maladjustment, and exposure to violence. Weighted generalized linear mixed models examined the longitudinal association between CA and sleep disturbances in youth adjusting for sociodemographic and contextual covariates. RESULTS: The prevalence of sleep disturbances was similar in both age groups (ages 5-9 and 10-16). In multivariable mixed models, CA were associated with sleep disturbance across three Waves among 10-16-year-olds. For example, having 2-3 or ≥ 4 types of CA were related to a higher prevalence of trouble falling/staying asleep in models adjusting for social context, gender, welfare status, or mother's education. No associations were observed among 5-9-year-olds. CONCLUSION: The results suggest that cumulative adversities in childhood may lead to sleep problems in adolescence. These findings highlight the utility of addressing CA during childhood to help reduce sleep-wake disorders throughout adolescence, a known risk factor for future mental and physical health problems.

Cross-border Ties as Sources of Risk and Resilience: Do Cross-border Ties Moderate the Relationship between Migration-related Stress and Psychological Distress for Latino Migrants in the United States?

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Beyond anxious predisposition: do padecer de nervios and ataque de nervios add incremental validity to predictions of current distress among Mexican mothers?

BACKGROUND: Nervios (PNRV) and ataque de nervios (ATQ) are culture-bound syndromes with overlapping symptoms of anxiety, depression, and dissociation, shown to have inconsistent associations to psychiatric disorder. Few studies test the basic assumption that PNRV and ATQ are uniformly linked to distress outcomes across Latina/o immigrant groups. This study examined: (a) the extent to which acculturative stress, Latino/US American acculturation, and anxious predisposition were associated with lifetime history of ATQ and PNRV, and (b) the extent to which ATQ and PNRV add incremental validity in explaining acculturative stress and psychological distress beyond measures of anxious predisposition. METHOD: Participants (n = 82) included Mexican mothers who completed surveys on acculturation, trait anxiety, anxiety sensitivity, lifetime ATQ/PNRV, psychological distress, and acculturative stress. RESULTS: Lifetime PNRV, but not lifetime ATQ, was significantly predictive of psychological distress. PNRV was also linked to trait anxiety. Psychometric measures of anxious predisposition (trait anxiety and anxiety sensitivity) were more robust predictors of distress outcomes than lifetime history of ATQ/PNRV. CONCLUSION: Inquiry into lifetime history of nervios may be a useful point of entry in talking to Mexican immigrant mothers about stress and distress. However, standard tools for assessing anxiety sensitivity and trait anxiety appear most useful in identifying and explaining the presence of psychological distress. Further research is needed to determine the cross-cultural relevance of trait anxiety and anxiety sensitivity, and its implications for the development of anxiety treatments that are effective across cultures.