mHealth Tool for Alcohol Use Disorders among Latinos in Emergency Department

Latino drinkers experience a disparate number of negative health and social consequences. Emergency Department Alcohol Screening Brief Intervention and Referral to Treatment (ED-SBIRT) is viable and effective at reducing harmful and hazardous drinking. However, barriers (e.g. readily available language translators, provider time burden, resources) to broad implementation remain and account for a major lag in adherence to national guidelines. We describe our approach to the design of a patient-centered bilingual Web-based mobile health ED-SBIRT App that could be integrated into a clinically complex ED environment and used regularly to provide ED-SBIRT for Spanish speaking patients.

Below:  AB-CASI Language Selection Screen

Below:  AB-CASI Frequency of Drinks Screen

Below:  Architecture of ED-SBIRT Mobile App Bilingual Text-to-Speech Generation

Below:  AB-CASI Ruler Screen

Full article at:   http://goo.gl/3r2GIa

By:  Fuad Abujarad and Federico E. Vaca

Department of Emergency Medicine Yale University, School of Medicine New Haven, Connecticut

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Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

PURPOSE:

Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities.

METHODS:

We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps.

RESULTS:

Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents.

CONCLUSIONS:

This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented.

...Summit participants pointedly appealed for “realistic action steps” that could lead to “immediate improvements” for LGBTQ patient-centered care:

• Create a safe, welcoming environment
• Post LGBTQ-positive visual representations, for example, images of people/families of differing gender/sexual, cultural, ethnic/racial backgrounds, in lobbies/examination rooms
• Use culturally appropriate, culturally specific terms on intake forms; that is, recognize that some patients may prefer local terminologies such as Native American use of “Two-Spirit,” patient preference for “queer” over “lesbian,” “gay” or “bisexual,” and/or use of “they” as a preferred gender pronoun by people across the sexual/gender minority spectrum
• Include gender/sexual difference in displayed antidiscrimination policies

Develop culturally competent medical staff

• Invite local LGBTQ community members/leaders to clinic meetings to discuss the experiences/treatment needs of LGBTQ patients
• Encourage respectful, direct, open-ended questions using culturally relevant terminology in provider–patient interactions regarding identity, sexual history, and risk factors
• Use local university/community-based safe zone training¹⁵ centered on how to be an LGBTQ ally while enhancing understanding of anti-LGBTQ stigma/phobias and microaggressions for all providers and staff to encourage patient feelings of security

Update medical training

• Deploy technologies in rural settings, for example, video/Web conferencing for consulting LGBTQ specialists
• Acquire information on LGBTQ-specific health, for example, hormone therapies and associated risks for transgender patients, gender-sensitive cancer screenings
• Participate in research to improve LGBTQ health care

Full article at:   http://goo.gl/ujDiCq

By:  Kano M1, Silva-Bañuelos AR2, Sturm R2, Willging CE2.

• 1From the Department of Family and Community Medicine, University of New Mexico, Albuquerque (MK); the University of New Mexico LGBTQ Resource Center (http://lgbtqrc.unm.edu/), Albuquerque (ARS-B); the New Mexico Community AIDS Partnership, Santa Fe (RS); and the Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM (CEW). mkano@salud.unm.edu.
• 2From the Department of Family and Community Medicine, University of New Mexico, Albuquerque (MK); the University of New Mexico LGBTQ Resource Center, Albuquerque (ARS-B); the New Mexico Community AIDS Partnership, Santa Fe (RS); and the Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM (CEW). 

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The Collateral Consequences of Prisonization: Racial Sorting, Carceral Identity, and Community Criminalization

In this paper, I employ analyses of the collateral consequences of mass incarceration to consider how high-incarceration communities are impacted by socializing processes instilled in the prison. Collateral consequences researchers have found that neighborhoods with high rates of incarceration suffer cumulative disadvantage, intensified policing, and the criminalization of residents. But overlooked in this literature is how socializing processes that are institutionalized in the prison shape the criminalization of community residents as gang-involved. 

For example, I argue that the fallout of sorting imprisoned Latinos into gang-associated groups has been the emergence of prison-based Norteña/o, Sureña/o, and Bulldog identities in criminalized Chicana/o neighborhoods, complicating the implications mass incarceration has for marginalized communities of color. The geographic concentration of both mass incarceration and its collateral consequences not only directs aggressive policing into these residential spaces but also structures a relationship between prison and neighborhood that reinforces the recognition of community members as criminal. 

The appearance of Norteña/o, Sureña/o, and Bulldog identities in Latina/o neighborhoods represents some of the unanticipated consequences mass incarceration has for high-incarceration communities, both in terms of the exportation of prison culture to the street and in terms of the extension of the prison's ability to define and construct criminality.

Full article at:   http://goo.gl/pn6sqh

By:  Patrick Lopez-Aguado

Correspondence address: Patrick Lopez-Aguado, Department of Sociology, Santa Clara University, Santa Clara, CA, USA. E-mail: plopezaguado@scu.edu

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Community Connectedness, Challenges, and Resilience among Gay Latino Immigrants

To date, relatively little psychological research has focused on the experiences of lesbian, gay, bisexual, and transgender (LGBT) Latino/a immigrants to the United States. 

This qualitative study used face-to-face semi-structured interviews to explore the unique sources of stress, challenges, as well as opportunities and factors related to resilience among 13 gay Latino first- and second-generation immigrants. Iterative coding of interview transcripts revealed four key themes, each of which is illustrated with verbatim quotes: 1) feelings of connectedness to the LGBT community, 2) feelings of connectedness to the Latino/a community, 3) intersectional challenges and strategies, and 4) well-being, strength, and resilience. 

As suggested by these themes, gay Latino immigrants have distinct sources of stress and conflict, many of them associated with community memberships, but also draw on unique sources of support and adaptive thoughts and behaviors in facing stressors. 

Implications for studying risk and resilience factors among stigmatized populations, including LGBT individuals and immigrants, are discussed.

...As Hector, a 42-year-old second-generation gay man who adopted a more masculine gender presentation noted:

I guess because I'm not flamboyant a lot of people don't realize [I’m gay] in just general public settings. So I guess if I was more effeminate it would be more obvious and then it might've been an issue for me… because of that I also stay away from gay culture more.

Hector recalled that the only gay role models he had growing up were extremely feminine and that he never identified or saw commonality with them. Presently, he stated that he chooses to affiliate with more masculine men, and wishes to be seen by others and by mainstream society as “just a regular guy.”

Another source of disconnection involved the perceived tension between ethnic groups within the LGBT community or between an ethnic community and the “mainstream” gay community. Some participants felt that being an ethnic minority member of the LGBT community was difficult at times; they perceived the LGBT community as largely White and privileged. Perhaps reflecting this, many also felt that ethnic minorities were poorly represented within the community, including in community spaces, in discussions of activism, and in the media. Ernesto, a 49-year-old Peruvian who moved to the U.S. as an adult, described his perception of the LGBT community as narrowly focused, and as having an agenda that was mainly driven by White, gay men. Having lived in several multicultural communities throughout his lifetime, he was particularly attuned to what he felt was a one-dimensional approach to defining the priorities of the LGBT community:

I think their interests are very, like I said, self-serving. It’s about what interests them. It’s like this whole Prop 8 thing…everyone's fighting for that. That's fine, but you know minorities are fighting for other things. But, but still the White elite, they think that gay minorities should be fighting for the same thing they are fighting. But it’s like what about when they are fighting about immigration, or, you know, the Dream Act, or other stuff? We don't see them. You know, they’re, they’re just not there, you know? They're totally out of touch...

Sample demographics (n = 13).

Pseudonym	Age	Sexual Orientation	Generation (Birth Country)	Primary Language	Employment Status	Education	Income
Humberto	51	Gay	1st (Venezuela)	Spanish	Full time	Graduate	$75k-$100k
Jorge	21	Queer	1st (Mexico)	English	Student	Some College	<$20k
Ernesto	49	Gay	1st (Peru)	English	Unemployed	Bachelor's	<$20k
Jose Luis	37	Gay	1st (Mexico)	English & Spanish	Full time	Graduate	$75k-$100k
Manuel	32	Gay	1st (Mexico)	English	Full time	Bachelor's	$100k+
David	19	Gay	2nd (Mexico/Mexico)	English	Part time	High School	<$20k
Carlos	26	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Oscar	53	Gay	2nd (U.S./Mexico)	English	Unemployed	Some College	<$20k
Hector	42	Gay	2nd (U.S./Mexico)	English	Self-employed	Some College	<$20k
Gabriel	29	Gay	2nd (Mexico/Mexico)	English	Full time	Some College	$20k - $30k
Edgar	23	Gay	2nd (El Salvador/Guatemala)	English	Part time	Some College	<$20k
Raul	33	Gay	2nd (Mexico/Mexico)	English	Unemployed	Associate's	<$20k
Hugo	48	Gay	2nd (Venezuela/Italy)	English	Part time	Graduate	N/A

Note: Birth country for 2nd-generation is represented as (Mother’s Birth Country/Father’s Birth Country.)

Full article at:   http://goo.gl/KL9XCL

By:  Nicole N. Gray, David M. Mendelsohn, and Allen M. Omoto

Nicole N. Gray, Department of Psychology, Claremont Graduate University;

Contributor Information.

Correspondence concerning this article should be addressed to Nicole N. Gray, Department of Psychology, Claremont Graduate University (http://www.cgu.edu/pages/1.asp), 123 E. 8^th Street, Claremont, CA 91711. Email: ude.ugc@yarg.elocin

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More about this artist: https://goo.gl/CIIXv9 

HIV Testing Patterns among Urban YMSM of Color

The heightened level of risk for HIV infection among African-American and Latino young men who have sex with men (YMSM) is driven by multi-level influences. \

Using cross-sectional data, we examined HIV testing patterns among urban YMSM of color in a high HIV sero-prevalence area (ages 16 to 21 years). Self-reported frequency of testing was high with 42% of youth reporting testing at a greater frequency than recommended guidelines. There were no differences between less frequent and high frequent testers on sexual risk behaviors. Most (80%) youth cited reassurance of HIV-negative status as a reason for testing. Further, over half of the sample reported numerous other reasons for HIV testing, which spanned individual, partner, social, and structural levels of influence. Approximately half of respondents indicated that peers, family members, and counselors influenced their motivation to get tested. Of concern, youths’ first HIV test occurred approximately two years after their first sexual experience with another male. 

These results indicate the need to consider developmental issues as well as for comprehensive, multi-level efforts to ensure that YMSM of color test at the CDC-recommended frequency, but not less than this or too frequently.

Reasons for HIV Testing by HIV Testing Frequency

	Minimum Frequency HIV Testers % (N = 43)	High Frequency HIV Testers % (N = 37)	Total % (N = 80)
Individual Influences
Want to be reassured not HIV positive (n = 79)	73.8	83.8	78.5
Feel anxious or worried about being HIV positive (n = 80)	48.8	64.9	56.3
Feel at risk due to own behavior * (n = 80)	37.2	62.1	48.8
Diagnosed with an STD (n = 79)	31.0	37.8	34.2
Wanted to stop using condoms (n = 80)	25.6	40.5	32.5
Want to have children† (n = 80)	16.3	35.1	25.0
Partner Level Influences
Have a new sexual partner (n = 80)	46.5	54.1	50.0
My partner’s sexual behavior	42.9	54.1	48.1
Suspect my partner is HIV positive† (n = 79)	35.7	56.8	45.6
A new partner asked† (n = 80)	20.9	37.8	28.8
Risk from my partner’s HIV status (n = 79)	19.0	32.4	25.3
Risk from my partner’s drug use (n = 79)	19.0	21.6	20.3
Might have exposed partner to HIV (n = 79)	11.9	24.3	17.7
Social Influences
Friends or family members were getting tested * (n = 80)	34.9	62.2	47.5
Friends or family were HIV positive (n = 80)	11.6	24.3	17.5
Structural Influences
A counselor or other professional suggested (n = 80)	48.8	56.8	53.8
Offered as part of my regular medical care† (n = 79)	58.1	38.9	49.4
Research study (n = 80)	20.9	27.0	23.8
Received a stipend (n = 80)	20.9	27.0	21.3
In foster care (n = 80)	9.3	18.9	13.8

*p < .05.

†p < .10

Full article at:   http://goo.gl/7Een9u

By:  Noelle R. Leonard,^* Sonali Ragan, Marya V. Gwadz, and Temi Aregbesola

Noelle R. Leonard, New York University, College of Nursing;

Contributor Information.

Noelle R. Leonard: ude.uyn@4lrn

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Posttraumatic Stress among Victimized Latino Women: Evaluating the Role of Cultural Factors

Research examining victimization and posttraumatic symptomatology among Latinos is lacking in the extant literature. This analysis used the victimized subsample (N = 752) of the Sexual Assault Among Latinas Study. The aim was to evaluate victimization prevalence and test the following hypotheses:

1. that victimization would be associated with higher levels of posttraumatic symptoms,
2. that cultural factors that move away from traditional Latino culture would be associated with higher levels of posttraumatic symptomatology, and
3. that cultural factors associated with traditional Latino culture would be related to lower posttraumatic symptomatology. 

Average age of the sample was 44.57 years, with three fourths having a high school education or higher, and two thirds having a household income below $30,000. 

Of exposure types, adulthood threats were most likely to result in Criterion A traumatic events (23.4%). Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) based PTSD Checklist, between 8.8% and 45.5% of individuals met presumed PTSD diagnosis based on various PCL cut scores or algorithm criteria. 

Regression analyses indicated that the combined different types of adult and childhood victimizations, masculine gender role, and negative religious coping were associated with increased symptoms (βs ranging from .16 to .27). 

The results suggested a role of culture in posttraumatic symptoms for Latinas.

Purchase full article at:  http://goo.gl/HMfWcb

By:  Cuevas CA1, Sabina C2, Picard EH3.

• 1School of Criminology and Criminal Justice, Northeastern University, Boston, Massachusetts, USA.
• 2School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown, Pennsylvania, USA.
• 3Department of Psychology, Fordham University, Bronx, New York, USA. 

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Latino Mother/Daughter Dyadic Attachment as a Mediator for Substance Use Disorder & Emotional Abuse

To date, no studies have investigated emotional abuse of adult Latina women by their mothers despite evidence that emotional maternal abuse may significantly contribute to the emotional abuse experienced by Latina women in their lifetime. 

Cross-sectional data including 316 women was analyzed using mediation and logistic regression. Overall, 7.1 % of mothers and 24.1 % of daughters abused drugs; and, 19.5 % of daughters were emotionally abused by their mothers. 

Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (indirect effect: 0.863). Latina women can serve as perpetrators of emotional abuse of their adult children. Since drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, drug-rehabilitation practitioners should incorporate a family abuse component into rehabilitation programs.

Purchase full article at:   http://goo.gl/GDxxDg

By:  Kanamori M1, Weissman J2, De La Rosa M2, Trepka MJ2, Rojas P2, Cano MA3, Melton J2, Unterberger A4.

• 1Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th Street. AHC5 422, Miami, FL, 33199, USA. mkanamor@fiu.edu.
• 2Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th Street. AHC5 422, Miami, FL, 33199, USA.
• 3Department of Epidemiology, College of Public Health and Social Work, Florida International University, Miami, FL, USA.
• 4Center for Labor Research and Studies, Florida International University, Miami, FL, USA. 

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