The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities.

OBJECTIVES: This study assessed the relation between experiences of social discrimination (homophobia, racism, and financial hardship) and symptoms of psychologic distress (anxiety, depression, and suicidal ideation) among self-identified gay and bisexual Latino men in the United States. METHODS: Data were collected from a probability sample of 912 men (self-identified as both Latino and nonheterosexual) recruited from the venues and public social spaces identified as both Latino and gay in the cities of Miami, Los Angeles, and New York. RESULTS: The study showed high prevalence rates of psychologic symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). In both univariate and multivariate analyses, experiences of social discrimination were strong predictors of psychologic symptoms. CONCLUSIONS: The mental health difficulties experienced by many gay and bisexual Latino men in the United States are directly related to a social context of oppression that leads to social alienation, low self-esteem, and symptoms of psychologic distress.

Self-efficacy to use condoms in unmarried Latino adults.

Measures of self-efficacy to use condoms can clarify the barriers to condom use Latinos encounter. A 20-item scale, that differed slightly for men and women, and was based on extensive elicitation interviews, was used in a random digit dial household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Self-efficacy was related to condom use for both men and women. Factor analyses revealed five correlated factors: Regular Partner, Impulse Control, Partner Resistance, STD Thoughts, and Condom Discussion. Both men and women reported lowest self-efficacy for impulse control and using condoms with a regular partner. Less-educated men and women had lower self-efficacy to discuss condoms, to manage partner resistance, to use condoms with a regular partner, and to control impulses, but there were few other demographic differences in self-efficacy. The scale can be helpful in the design and evaluation of HIV prevention.

Young people and the structure of sexual risks in Lima.

OBJECTIVES: (1) To describe psychosocial variables related to sexual activity and the prevalence of contextual factors (e.g. coercion, paid sex and drug/alcohol use) and various sexual experiences among young men and women in Lima; and (2) to assess the relationship between psychosocial, contextual and behavioral factors on one hand and negative sexual health events such as unplanned pregnancies and sexually transmitted diseases (STDs) on the other hand. DESIGN: A cross-sectional serosurvey complemented with focus groups and in-depth interviews. SUBJECTS AND METHODS: A total of 611 adolescents (16-17 years old) and 607 young adults (19-30 years old) were recruited randomly from among those registering for military service (adolescents) or seeking work/study permits (young adults). These subjects were asked to fill out a self-administered questionnaire with detailed information on sexual experiences and psychosocial variables. The response rates were 98% (adolescents) and 82% (young adults). A subsample of 858 subjects provided blood specimens, which were analyzed for antibodies to HIV-1, the hepatitis B virus and syphilis. The relationship between the main study variables and sociodemographic indicators was also assessed, and multivariate analysis was used to identify those variables associated with sexual health problems. A preliminary qualitative phase helped in the questionnaire design and in interpreting survey findings. RESULTS: Thirty-four percent of adolescents and 75% of young adults were sexually experienced. The prevalence of bisexual behavior was high, particularly among males (12%). The males often reported paid sex (47%) and the females often reported sexual coercion (47%). Among the heterosexually active, only 11% reported consistent use of condoms. While 22% of the heterosexually active reported an unplanned pregnancy in self (females) or partner (males), 18% of the sexually active reported a history of STD symptoms or diagnoses. Among the sexually active who gave a blood sample, 0.2% were positive for HIV, 6.7% for hepatitis B and 1.5% for syphilis. Those who experienced an unplanned pregnancy or STD symptoms or, for the subsample, were seropositive for HIV or other STDs, were more likely to perceive social norms as restricting condom use to casual sex, to be older, to combine sex with alcohol or drugs and to report a history of sexual coercion or of having paid or been paid for sex. For females only, engaging in sex at a younger age was a risk marker, while engaging in any homosexual activity was protective. CONCLUSIONS: Cultural norms that restrict condoms to casual sex may place many young people in Lima at risk of an unplanned pregnancy or STDs. Sexual behavior may be especially risky in a context of sexual coercion and paid sex, when sex is combined with drugs and alcohol, and when engaged in by younger females. Sexual health education should work to change such cultural norms and these risky contexts.

Condom use in unmarried Latino men: a test of cultural constructs.

The effects of cultural factors on condom use were assessed in a random digit-dialing household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Measures of traditional gender-role beliefs, sexual coercion, sexual comfort, and self-efficacy in using condoms were developed specifically for this population. A multisample structural equation model analysis included 594 men who reported one or more heterosexual partners in the 12 months before interview. As predicted, men with more traditional gender-role beliefs reported more sexual coercion and less sexual comfort. Men reporting more sexual coercion and less sexual comfort had lower condom self-efficacy. Men with more condom self-efficacy and stronger condom social norms reported more condom use.

Mood management mail intervention increases abstinence rates for Spanish-speaking Latino smokers.

A self-administered mood management intervention program for smoking cessation provided through the mail to Spanish-speaking Latinos resulted in a 23% abstinence rate at 3 months compared to an 11% abstinence rate for a smoking cessation guide alone. Participants (N = 136) were randomly assigned to receive either the cessation guide (the Guía), or the Guía plus a mood management intervention (Tomando Control de su Vida) presented in writing and in audiotape format. At 3 months after random assignment, 16 out of 71 of those assigned to the Guía-plus-mood management condition reported being abstinent (not smoking for at least 7 days) compared to 7 out of 65 in the Guía-only condition (z = 1.8; p = .04, one-tailed). Moreover, those with a history of major depressive episodes, but not currently depressed, reported an even higher abstinence rate in the Guía-plus-mood management condition, compared to the Guía-only condition (31 vs. 11%, z = 1.8, p = .04, one-tailed). We conclude that the mood management mail intervention substantially increases abstinence rates, especially for those with a history of major depressive episodes.

Effects of a community intervention to change smoking behavior among Hispanics.

Our purpose was to evaluate the effects of the Program Latino para Dejar de Fumar (PLDF), a community-wide smoking cessation intervention developed for Spanish-speaking Hispanics. PLDF community intervention was based on research to identify culture-specific aspects of smoking cessation for Hispanics and included targeted distribution of a self-help cessation guide, an electronic and printed media campaign, raffles for smokers who quit, and participation in community activities. The main outcome measures were smoking cessation and associated behaviors. Exposure to the intervention, the primary predictor variable, was defined as affirmative responses to questions about recognizing the PLDF name, having the PLDF smoking cessation guide, having heard or seen messages about PLDF on various media, and knowing about a PLDF-sponsored $500 raffle. Four cross-sectional telephone surveys of Hispanic adults 18 to 65 years of age, living in neighborhoods in San Francisco, California, defined as having at least 10% Hispanics in the 1980 U.S. Census, were conducted preceding (1986-1987) and following (1988-1989) start of PLDF (total n = 7,667). Although smoking prevalence decreased over the four years, smoking cessation in the 12 months prior to the survey was unrelated to exposure to PLDF. For the two surveys conducted after PLDF was started (n = 3,551), nonsmokers, women, older adults, and less acculturated persons were more likely to report exposure to PLDF.(ABSTRACT TRUNCATED AT 250 WORDS)

Acculturation, sexual behavior, and alcohol use among Latinas.

We explored the relationship of alcohol use to unsafe sex in Latinas. Telephone interviews were conducted with 523 currently sexually active Latinas aged 18-49 years. Only 7.5% of these women used alcohol half of the time or more prior to sex. "Regular" alcohol users had more sexual partners, but also had more experience with condom use, used condoms with primary partners as frequently as nonusers of alcohol, and used condoms more with secondary partners. While Latinas who use alcohol prior to sex more often have multiple sexual partners, alcohol use does not appear to interfere with condom use.

Behavioral risk factors: a comparison of Latinos and non-Latino whites in San Francisco.

OBJECTIVES: The purpose of the study was to evaluate differences between Latino and non-Latino White adults in health-related behavioral risk factors. METHODS: Telephone interviews were conducted with 652 Latinos and 584 non-Latino Whites in San Francisco selected by random-digit dialing. RESULTS: Latino men and women, compared with their non-Latino White counterparts, were less likely to have consumed any alcoholic beverage in the previous month (59% and 29% vs 77% and 75%, respectively), consumed fewer drinks per week (6.6 and 3.0 vs 8.9 and 5.1, respectively), and were more likely to be sedentary (40% and 46% vs 17% and 23%). Latina women were less likely than non-Latina Whites to smoke cigarettes (8% vs 29%), to have ever had a Pap smear (76% vs 93%), and to have ever had a clinical breast examination (81% vs 96%). Multivariate analyses adjusting for sex, age, education, and employment confirmed univariate findings. CONCLUSIONS: Behavioral risk factor profiles by ethnicity help emphasize priorities of health promotion programs for a community. Latino needs include maintenance of limited consumption of alcohol and cigarettes, promotion of regular physical activity, and increasing use of low-cost cervical and breast cancer screening tests.

Acculturation and gender differences in sexual attitudes and behaviors:Hispanic vs non-Hispanic white unmarried adults.

Understanding how acculturation and gender affect Hispanics' sexual behavior is needed to prevent infection with the human immunodeficiency virus. We examined differences in and correlates of condom use among 398 Hispanics and 540 non-Hispanic Whites in San Francisco who were part of a random probability sample of unmarried adults. Hispanic women reported fewer sexual partners than all other groups. Condom use was low in all groups, but Spanish-speaking Hispanic women reported lower condom use than White women. Hispanics, generally, had poorer attitudes toward condoms and were less likely than non-Hispanic Whites to believe they could avoid acquired immunodeficiency syndrome. Hispanics need targeted prevention interventions.

Condom use among Hispanic men with secondary female sexual partners.

Greater understanding of psychosocial predictors of the use of condoms among Hispanics is needed in prevention efforts related to the human immunodeficiency virus and sexually transmitted disease epidemics among Hispanics in the United States. A telephone survey was carried out in nine States that have large populations of Hispanics, using a stratified clustered random digit dialing sampling strategy. The survey yielded interviews with 968 Hispanic men ages 18-49 years. Of them, 361 (37.8 percent) reported at least one secondary female sexual partner in the 12 months prior to the interview. Predictors were identified of condom use by those men with their secondary sex partners. Key predictors of the subjects' condom use with secondary partners included carrying condoms; self-efficacy, or a measure of the subject's perceived ability to use condoms under difficult circumstances; positive attitude toward condom use; having friends who used condoms; and lack of symptoms of depression in the week before the interview (R2 = 0.35). Significant predictors of condom carrying were being comfortable in sexual situations, positive attitude toward condom use, and self-efficacy to use condoms. Less acculturated men had more positive attitudes toward condom use and carried them more than did more acculturated men. The researchers found encouraging levels of condom use with secondary sexual partners among Hispanic men with multiple partners. Because of the large proportion of Hispanic men who have multiple partners and the severity of the sexually transmitted disease epidemics in the Hispanic community,health care providers should recommend to Hispanic men that they carry and use condoms,point out the acceptability of men using condoms,and assess and teach basic sexual information in that group. Referral may be appropriate for high risk Hispanic men with symptoms of depression.

A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar.

Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention.

Predictors of condom accessibility among Hispanics in San Francisco.

Ready access to condoms can be an important means of slowing the spread of sexually transmitted diseases and human immunodeficiency virus. We identified the factors associated with keeping or carrying condoms in a random-digit dialing survey of 522 Hispanic adults aged 18 to 65 years in San Francisco. Overall, more Hispanic men reported having condoms than Hispanic women (55.2% vs 23.8%). Hispanic men also reported much higher levels of risky sexual behavior than Hispanic women. Condom promotion efforts with Hispanics will require different approaches for each gender.

Misclassification of smoking status by self-reported cigarette consumption.

To evaluate possible misclassification of smokers and nonsmokers, we compared self-reported cigarette consumption and serum cotinine levels in a sample of 743 Mexican American participants in the Hispanic Health and Nutrition Examination Survey (HHANES). The study sample was stratified by sex and self-reported cigarettes consumed per day (0, 1 to 9, 10 to 19, and greater than or equal to 20) and selected from those with available serum. We defined biochemical smokers as persons with serum cotinine levels greater than or equal to 0.084 microM/L (14 ng/ml). Misclassification was defined as a discrepancy between self-reported smoking and the serum cotinine level used to define a biochemical smoker. Of 189 self-reported nonsmokers, 12 (6.3%) were defined as biochemical smokers and possibly misclassified by self-report. Among 124 never smokers only 5 (4%) were biochemical smokers compared with 7 of 65 (10.8%) self-reported former smokers. Only 1 of the 12 misclassified nonsmokers reported living with a current smoker. In 9 of the 12 misclassified nonsmokers, serum cotinine levels were consistent with light smoking. Among the 547 self-reported smokers, 66 (12.1%) were found to have serum cotinine levels less than or equal to 0.084 microM/L (14 ng/ml) and possibly misclassified by self-report. Of these, one person reported 20 or more cigarettes per day. We conclude that self-reported cigarette consumption may be an insufficient measure of the risks associated with tobacco use and measurement of serum cotinine may be important to assess the magnitude of misclassification of smoking status in epidemiologic studies.

Evaluation of "Guia para Dejar de Fumar," a self-help guide in Spanish to quit smoking.

Because of the absence of culturally appropriate self-help smoking cessation materials for Latinos, a new Spanish language cessation guide, "Guia para Dejar de Fumar," was developed and evaluated. It was distributed as part of a community-wide intervention to decrease the prevalence of smoking. The "Guia" is an attractive full-color booklet written in universal Spanish that uses simple text and numerous photographs. Motivation to quit smoking is emphasized, and graphic demonstrations of the adverse health effects of smoking are included. A menu of quitting and maintenance techniques is presented. A total of 431 smokers were identified for evaluation at approximately 3, 6, and 12 months after receiving the "Guia." Self-reported quit rates declined from 21.1 percent at 2.5 months to 13.7 percent at 14 months; 8.4 percent of the sample had a validated quit status by saliva cotinine test at 1 year. Persons older than 44 years were more likely to remain nonsmokers, but sex, education, acculturation score, and cigarettes smoked per day did not predict smoking cessation. The components of the "Guia" most mentioned by those who were surveyed were the graphic photographs, the health emphasis, and the overall format. The authors concluded that the "Guia" is an appropriate self-help smoking cessation booklet for Spanish-speaking Latinos in the United States.

Depressive symptoms and cigarette smoking among Latinos in San Francisco.

We administered the Center for Epidemiological Studies Depression (CES-D) Scale to 547 San Francisco Latinos as part of a random digit dialing telephone survey to evaluate smoking behavior. Both men and women current smokers had the highest mean CES-D levels (9.7 and 14.3, respectively). Logistic regression analysis adjusting for gender, acculturation, education, age, and employment showed that current smokers had an odds ratio of 1.7 (95% CI = 1.3, 2.2) for significant depressive symptoms compared to former smokers (OR = 1.1;95% CI = .8, 1.6) and never smokers (OR = 1).

Changes in information as a function of a culturally appropriate smoking cessation community intervention for Hispanics.

Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period.

Apparent underreporting of cigarette consumption among Mexican American smokers.

To determine the accuracy of self-report of cigarette consumption among Mexican American smokers, we compared self-reported cigarette use and serum cotinine concentrations in a sample of 547 participants in the Hispanic Health and Nutrition Examination Survey (HHANES). We defined underreporting of cigarette use as a cotinine to cigarette-per-day ratio of greater than 0.142 microM/l which represented a substantial discrepancy between self-reported consumption and serum cotinine. Of the 98 men and 97 women who reported smoking one to nine cigarettes/day, 20.4 percent and 24.7 percent, respectively, underreported their cigarette consumption. Underreporting was less common among men and women smoking 10 to 19 cigarettes/day (8.3 percent and 10.8 percent, respectively) and 20 or more cigarettes/day (2.2 percent and 2.9 percent, respectively). Comparison of underreporters to other smokers by demographic characteristics within sex and cigarettes/day categories showed no differences. Differences in cotinine metabolism and extremely efficient smoking are alternative explanations that can not be ruled out with these data. We believe, however, that a proportion of Mexican American light smokers may underreport the quantity of cigarettes smoked per day, and may truly be moderate or heavy smokers.

Attitudes and behaviors of Hispanic smokers: implications for cessation interventions.

The smoking behavior of Hispanics, especially Mexican Americans, has been reported to differ from that of non-Hispanic whites, in both large gender differences in prevalence as well as a lower self-reported number of cigarettes smoked per day. This study compared the responses of a convenience sample of 263 Hispanic (44% Mexican American and 38% Central American) and 150 non-Hispanic white smokers, in order to identify other ethnic; gender, and acculturation differences in smoking behaviors. Hispanic women smoked fewer cigarettes and initiated smoking at a comparatively later age than Hispanic men; they were also less likely to smoke during pregnancy than non-Hispanic white women. Hispanics smoked more cigarettes on Saturday than other days, but this was not true for non-Hispanic whites. Will power (voluntad propia) and knowing the negative effects of smoking were considered the most helpful techniques for quitting by Hispanics. Considering that light smokers are able to quit with less intensive cessation techniques, these data suggest that a properly developed health education community intervention may have an impact on smoking rates among Hispanics.