Social Ecology of Adherence to Hypertension Treatment in Latino Migrant and Seasonal Farmworkers.

PURPOSE: This study explored Latino migrant/seasonal farmworkers' (MSFWs') adherence to hypertension treatment. DESIGN: A cross-sectional correlational study was conducted. METHOD: Forty-five Latino MSFWs from two farmworker health clinics completed Spanish versions of the Morisky Medication Adherence Scale, the Blood Pressure Knowledge Scale and Blood Pressure Self-Care Scale, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II, the Short Assessment of Health Literacy for Spanish-Speaking Adults, health care access questions, and blood pressure measurements. RESULTS: MSFWs had poor medication adherence (51%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and health care access accounted for 49% of the variance in blood pressure self-care. Higher acculturation level and health literacy were associated with better blood pressure control (p = .01). DISCUSSION: MSFWs had poor medication adherence and blood pressure control. Blood pressure knowledge and acculturation played a role in blood pressure self-care. IMPLICATIONS: Culturally appropriate educational programs are needed to help MSFWs' adherence to hypertension treatment.

Filial responsibility, perceived fairness, and psychological functioning of Latino youth from immigrant families.

The contributions of filial responsibility to psychological functioning were examined longitudinally among Latino young adolescents from immigrant families. Participants included 199 7th and 8th Grade Latino boys and girls (M age = 13.8) who were either immigrants (79%) or children of immigrants (21%). The term, filial responsibility, refers to children's family caregiving efforts (e.g., household chores, caring for siblings). Perceived fairness, which refers to perceptions of equity, reciprocity, and acknowledgment, was examined as an important corollary describing the familial context in which youths' responsibilities are enacted. Over the course of this 1-year longitudinal study, a significant decline was observed in mean levels of caregiving, whereas a significant increase was observed in perceived fairness. Consistent with a conceptualization of filial responsibility as contributing to psychological development in positive and, in some contexts, negative ways, caregiving activities predicted increases in cooperative behavior and interpersonal self-efficacy, whereas perceived fairness predicted declines in psychological distress. Implications for practitioners and policymakers working with this population are discussed.

Alcohol use and misuse in urban Mexican men and women: an epidemiologic perspective.

Consumption patterns and misuse of alcohol were examined in adults sampled from three cities in Mexico (n=1933). The sample was divided into groups of persons who abstained from alcohol, drank but endorsed no misuse, or drank and endorsed at least some misuse of alcohol. Half of the entire sample was categorized as drinkers (12 or more drinks in lifetime). Mexican men drank more per occasion and reported more problems with alcohol rather than did Mexican women. Low socioeconomic resources, not being married, and female gender were related to whether Mexicans abstained from alcohol rather than drank without misuse. Lifetime posttraumatic stress disorder (PTSD) or depression increased the likelihood of misusing alcohol versus drinking without misuse, as did greater amount of drinks consumed per occasion and male gender. Younger age and not being married were also related to misuse, although this was true mostly for women. The number of traumatic experiences in childhood and lower socioeconomic resources also predicted misuse, although mostly for men. Specific traumatic experiences and their relationship to alcohol use and misuse were also examined.

Epidemiology of major depression in four cities in Mexico.

Analyses were conducted to estimate lifetime and current prevalence of major depressive disorder (MDD) for four representative cities of Mexico, to identify variables that influence the probability of MDD, and to further describe depression in Mexican culture. A multistage probability sampling design was used to draw a sample of 2,509 adults in four different regions of Mexico. MDD was assessed according to DSM-IV criteria by using the Composite International Diagnostic Interview collected by trained lay interviewers. The prevalence of MDD in these four cities averaged 12.8% for lifetime and 6.1% for the previous 12 months. MDD was highly comorbid with other mental disorders. Women were more likely to have lifetime MDD than were men. Being divorced, separated, or widowed (compared to married or never married) and having experienced childhood trauma were related to higher lifetime prevalence but not to current prevalence. In addition, age and education level were related to current 12-month MDD. Data on the profile of MDD in urban Mexico are provided. This research expands our understanding of MDD across cultures.

Violence and PTSD in Mexico: gender and regional differences.

OBJECTIVE: We examined the lifetime prevalence of violence in Mexico and how different characteristics of the violent event effect the probability of meeting criteria for lifetime post-traumatic stress disorder (PTSD). METHOD: We interviewed a probability sample of 2,509 adults from 4 cities in Mexico (Oaxaca, Guadalajara, Hermosillo, Mérida) using the Composite International Diagnostic Interview (CIDI). RESULTS: Lifetime prevalence of violence was 34%. Men reported more single-experience, recurrent, physical, adolescent, adulthood, and stranger violence; women more sexual, childhood, family, and intimate partner violence. Prevalence was generally higher in Guadalajara, though the impact was greater in Oaxaca compared to other cities. Of those exposed, 11.5% met DSM-IV criteria for PTSD. Probabilities were highest after sexual and intimate partner violence, higher for women than men, and higher in Oaxaca than other cities. CONCLUSIONS: It is important to consider the characteristics and the context of violence in order to develop effective prevention and intervention programs to reduce the exposure to and impact of violence.

Postdisaster PTSD over four waves of a panel study of Mexico's 1999 flood.

Samples of adults representative of Tezuitlán, Puebla and Villahermosa, Tobasco (combined N = 561), were interviewed 6, 12, 18, and 24 months after the devastating 1999 floods and mudslides in Mexico. Current DSM-IV PTSD and major depressive disorder (MDD) were assessed with the Composite International Diagnostic Interview. At Wave 1, PTSD was highly prevalent (24% combined), especially in Tezuitlán (46%), which had experienced mass casualties and displacement. Both linear and quadratic effects of time emerged, as PTSD symptoms initially declined but subsequently stabilized. Differences between cities lessened as time passed. Comorbidity between PTSD and MDD was substantial. The findings demonstrate that the international health community needs to be prepared for epidemics of PTSD when disasters strike developing areas of the world.

Epidemiology of trauma and posttraumatic stress disorder in Mexico.

Prevalence rates of trauma and posttraumatic stress disorder (PTSD) were estimated from a probability sample of 2,509 adults from 4 cities in Mexico. PTSD was assessed according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) criteria using the Composite International Diagnostic Interview (CIDI; WHO, 1997). Lifetime prevalence of exposure and PTSD were 76% and 11.2%, respectively. Risk for PTSD was highest in Oaxaca (the poorest city), persons of lower socioeconomic status, and women. Conditional risk for PTSD was highest following sexual violence, but nonsexual violence and traumatic bereavement had greater overall impact because of their frequency. Of lifetime cases, 62% became chronic; only 42% received medical or professional care. The research demonstrates the importance of expanding the epidemiologic research base on trauma to include developing countries around the world.

Severity, timing, and duration of reactions to trauma in the population: an example from Mexico.

Normative data describing acute reactions to trauma are few. Of 2509 Mexican adults interviewed with the Composite International Diagnostic Interview, 1241 met trauma exposure criteria for index events occurring more than 1 year previously. The modal response, describing 45%, was a reaction to trauma that was mild (present but below levels of posttraumatic stress disorder symptom criteria), immediate (within the first month), and transient (over within a year). Nonetheless, 29% experienced immediate and serious reactions. Of these, 44% had chronic posttraumatic stress disorder symptoms. Those whose reactions were serious and chronic differed in many ways from those whose reactions were serious but transient. They had more traumatic events during their lives, and their index events were more likely to have occurred in childhood and to have involved violence. They had more symptoms and functional impairment after the trauma and higher levels of depressive and somatic symptoms when data were collected. Psychiatrically significant reactions to trauma persist often enough to justify their detection and treatment. Persons in need of acute intervention can be identified on the basis of the nature and severity of the initial response as well as characteristics of the stressor.