English-speaking Hispanics Research Articles

Abstract A122: Predictors of mailed fecal immunochemical test return for Hispanic patients receiving care at community health centers

Abstract Background and Purpose: Mailed fecal immunochemical testing (FIT) is an evidence-based strategy to increase colorectal cancer (CRC) screening. We have previously reported that a multi-level mailed FIT intervention resulted in higher CRC screening rates compared to usual care among Hispanic patients receiving care at Community Health Centers (CHCs). The objective of this study was to assess predictors of mailed FIT completion among Hispanic individuals. Methods: The San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) project tested a multi-level mailed FIT intervention in 3 CHC systems in Southern California. Using a cluster-randomized trial design, 9 clinics were randomized to mailed FIT and 16 to usual care. The intervention was delivered in Spanish and English and included an invitation letter, a mailed FIT kit with completion instructions, and phone and text-based reminders. Multi-level implementation strategies (i.e., training, centralized facilitation, etc.) were utilized to increase uptake. For this analysis, we assessed mailed FIT completion at 1 year among Hispanic participants ages 50-75 years not up-to-date with CRC screening at baseline and who were randomized to clinics in the mailed FIT intervention. We conducted logistic regression to assess relationships between sex, language preference, health insurance and mailed FIT return. Results: Among the 9 intervention clinics, 2,199 Hispanic patients who were age-eligible and not up-to-date with CRC screening at baseline were included in the present analysis. In this group, 1,457 (66.3%) were female, 1,449 (65.9%) were Spanish-speaking, and 769 (35.0%) returned the FIT kit. Variation in FIT return for Hispanic individuals was shown across CHC systems: 53.2% in CHC1, 31.4% in CHC2, and 24.7% in CHC3. The percentage of individuals who returned the mailed FIT was highest among 55 to 59-year-olds (39.4%) and lowest among 50 to 54-year-olds (30.6%). Results from univariate logistic regression showed that individuals who preferred Spanish language had higher return rate than those who preferred English (OR=1.44; 95% CI: 1.17-1.77). FIT return was higher among participants who were privately insured compared with Medicaid-insured individuals (OR=1.57; 95% CI: 1.20-2.06). Return rate was higher among females compared to males, but the difference was not statistically significant (OR=1.13, 95% CI: 0.98-1.29). Conclusions: Among Hispanic patients who receive care at CHCs, a regional mailed FIT intervention was effective at increasing screening rates. Mailed FIT completion among participants randomized to clinics in the intervention group varied by language preference and health insurance status. These results suggest that future efforts could be tailored to increase FIT return rates among English-speaking Hispanics and those with Medicaid insurance. Citation Format: Joshua Demb, Maria Elena Martinez, Scott Roesch, Samir Gupta, Valesca Largaespada, Sheila F. Castañeda, Borsika A. Rabin, Jennifer Covin, Kristine Ortwine, Yesenia Preciado-Hidalgo, Nicole Howard, James Schultz, Nannette Stamm, Daniel Ramirez, Michael T. Halpern, Jesse Nodora. Predictors of mailed fecal immunochemical test return for Hispanic patients receiving care at community health centers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A122.

A - 81 Gender Bias in Collateral Informant Ratings of the Lawton & Brody Instrumental Activities of Daily Living Scale Varies by Ethnolinguistic Group

Abstract Objective Building on our prior work showing that sociocultural factors influence the nature of one’s daily activities and the degree of assistance rendered once cognitive difficulties emerge, the present study aimed to examine gender differences in the frequency of abnormal IADLS ratings [Not Applicable (N/A), Requires Assistance (R/A), Dependent] in cognitively healthy older adults from different ethnic (Hispanic vs. Non-Hispanic) and linguistic (English vs. Spanish) groups. Method Baseline data from 1060 healthy older adults [Non-Hispanic English-speakers (NE) = 597; Hispanic English-speakers (HE) = 249; Hispanic Spanish-speakers (HS) = 214] 50–90 years of age enrolled in the Texas Alzheimer’s Research and Care Consortium were analyzed using univariate analyses of variance and multivariate chi-squares within each ethnolinguistic group. Results Women obtained significantly (p < 0.001) higher IADLS total scores (indicative of greater impairment) than men in each ethnolinguistic group. A significant difference (p < 0.01) was found between gender across the sample for items related to Food Preparation, Housekeeping, and Laundry, wherein 7–25% of all men vs. < 1% of all women received “N/A” ratings. Significantly more HE men vs. women also received “N/A” ratings for Finances (4:1) and Medications (7:1), while a similar trend was observed in the NH and HS groups but did not reach statistical significance. No participants received an “N/A” rating and no significant gender differences were observed for remaining IADLs. Conclusion(s) Obtained findings highlight considerable gender bias on the Lawton & Brody IADLS in healthy older adults, which clearly limits the utility of this instrument in the provision of patient-centered neuropsychological services and may confound the interpretation of clinical trial outcomes.

H - 02 Unveiling the Effects of Bilingualism on Autobiographical Memory in Hispanics: Implications for Cognitive Aging.

Episodic autobiographical memory (EAM) may be particularly sensitive to age-related cognitive decline and risk for Alzheimer's disease. Virtually nothing is known about EAM specificity in Hispanic individuals. Bilingualism is a cognitive factor that may influence EAM specificity among Hispanics. The present study aimed to 1) examine if EAM is sensitive to age in Hispanics and 2) reveal whether bilingualism influences EAM specificity in Hispanics. A sample of 150 young and middle-aged/older adults (50 English-Spanish bilingual Hispanics; 50 monolingual English-speaking Hispanics; 50 monolingual English speaking Non-Hispanic Whites) narrated EAMs using the established Autobiographical Interview (Levine et al., 2002). Using the scoring protocol of the Autobiographical Interview, we evaluated the narratives for episodic and non-episodic detail. We replicated the often-found age-related reduction in episodic detail generation in Hispanics. Bilingual Hispanics' memories were more episodically specific than monolingual Hispanics and Non-Hispanic Whites. We also found that, among bilingual Hispanics, the language used at encoding versus language used at memory retrieval was not associated with episodic specificity. Our findings suggest that episodic autobiographical memory is sensitive to age and bilingualism in Hispanics, making it a culturally appropriate cognitive measure among this population.

Pilot study of a Spanish language measure of financial toxicity in underserved Hispanic cancer patients with low English proficiency.

Financial toxicity (FT) reflects multi-dimensional personal economic hardships borne by cancer patients. It is unknown whether measures of FT-to date derived largely from English-speakers-adequately capture economic experiences and financial hardships of medically underserved low English proficiency US Hispanic cancer patients. We piloted a Spanish language FT instrument in this population. We piloted a Spanish version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure using qualitative cognitive interviews and surveys in un-/under-insured or medically underserved, low English proficiency, Spanish-speaking Hispanics (UN-Spanish, n = 23) receiving ambulatory oncology care at a public healthcare safety net hospital in the Houston metropolitan area. Exploratory analyses compared ENRICh FT scores amongst the UN-Spanish group to: (1) un-/under-insured English-speaking Hispanics (UN-English, n = 23) from the same public facility and (2) insured English-speaking Hispanics (INS-English, n = 31) from an academic comprehensive cancer center. Multivariable logistic models compared the outcome of severe FT (score > 6). UN-Spanish Hispanic participants reported high acceptability of the instrument (only 0% responded that the instrument was "very difficult to answer" and 4% that it was "very difficult to understand the questions"; 8% responded that it was "very difficult to remember resources used" and 8% that it was "very difficult to remember the burdens experienced"; and 4% responded that it was "very uncomfortable to respond"). Internal consistency of the FT measure was high (Cronbach's α = 0.906). In qualitative responses, UN-Spanish Hispanics frequently identified a total lack of credit, savings, or income and food insecurity as aspects contributing to FT. UN-Spanish and UN-English Hispanic patients were younger, had lower education and income, resided in socioeconomically deprived neighborhoods and had more advanced cancer vs. INS-English Hispanics. There was a higher likelihood of severe FT in UN-Spanish (OR = 2.73, 95% CI 0.77-9.70; p = 0.12) and UN-English (OR = 4.13, 95% CI 1.13-15.12; p = 0.03) vs. INS-English Hispanics. A higher likelihood of severely depleted FT coping resources occurred in UN-Spanish (OR = 4.00, 95% CI 1.07-14.92; p = 0.04) and UN-English (OR = 5.73, 95% CI 1.49-22.1; p = 0.01) vs. INS-English. The likelihood of FT did not differ between UN-Spanish and UN-English in both models (p = 0.59 and p = 0.62 respectively). In medically underserved, uninsured Hispanic patients with cancer, comprehensive Spanish-language FT assessment in low English proficiency participants was feasible, acceptable, and internally consistent. Future studies employing tailored FT assessment and intervention should encompass the key privations and hardships in this population.

Heterogeneity of Asthma Care Among Hispanic Subgroups: Lower Utilization of Hospital-based Care among Spanish-speaking Hispanics.

Studies found heterogeneity of asthma prevalence among Hispanic subgroups using survey data but addressed under-diagnosis issues due to limited access to health care and diagnosis bias. To examine heterogeneity by language in health care utilization for asthma among Hispanic subgroups. A retrospective, longitudinal cohort study of Medi-Cal claims data (2018-2019) using logistic regression to estimate the odds ratio of health care utilization for asthma. In all, 12,056 (ages 5-64) Hispanics living in Los Angeles were identified as having persistent asthma. Primary language is the predictor variable and outcome measures include ED visits, hospitalizations, and outpatient visits. The odds of ED visits among Spanish-speaking Hispanics were lower than English-speaking Hispanics in the subsequent 6 (95% CI=0.65-0.93) and 12 (95% CI=0.66-0.87) months. Spanish-speaking Hispanics were less likely than their English-speaking counterparts to utilize hospitalization in the 6 months (95% CI=0.48-0.98), while they were more likely to utilize outpatient care (95% CI=1.04-1.24). For Hispanics of Mexican origin, the odds of ED visits among Spanish-speaking Hispanics were also lower in the 6 and 12 months (95% CI=0.63-0.93, 95% CI=0.62-0.83), but their odds of outpatient visits were higher for outpatient visits in the 6 months (95% CI=1.04-1.26). Spanish-speaking Hispanics with persistent asthma were less likely than English-speaking Hispanics to utilize ED visits and hospitalizations but were more likely to utilize outpatient visits. The findings suggest the reduced burden of asthma among the Spanish-speaking Hispanic subgroup and contribute to explaining the protection effect, specifically among Spanish-speaking Hispanics living in highly segregated communities.

The Impact of Receiving Radiation Treatment on Financial Toxicity in Underserved Hispanic Cancer Patients with Limited English Proficiency

<h3>Purpose/Objective(s)</h3> Racial and ethnic minority cancer patients in the US are at high risk for financial toxicity (FT). Prior FT outcomes for Hispanic cancer patients is mixed, though risk factors including socioeconomic, insurance, and English language proficiency barriers may influence FT outcomes in this population, though available data are lacking for US Hispanic cancer patients with un/under-insurance and low English proficiency. Therefore, we examined factors associated with FT in Hispanic cancer patients treated with or without RT. We hypothesized that un/under-insured and Spanish-only speaking Hispanic cancer patients would have more severe FT and receipt of RT would increase FT. <h3>Materials/Methods</h3> We conducted a multi-institution survey of Hispanic cancer patients receiving ambulatory oncology care. Depending on reported language preference, respondents underwent a Spanish- or English-language version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure. Respondents were categorized in 3 groups: 1) un/under-insured Spanish-only speaking Hispanics (UN-Spanish) recruited from a public hospital for medically underserved patients 2) un/under-insured English-speaking Hispanics (UN-English, n=23) from the same facility and 3) insured English-speaking Hispanics (INS-English, n=31) from an academic comprehensive cancer center. Any receipt of RT, either pre- or post-survey, was recorded. Groups were compared via Fisher exact or Mann-Whitney U tests. <h3>Results</h3> A higher likelihood of severe overall FT occurred in UN-Spanish (OR=2.73, 95% CI 0.77-9.70; borderline P=0.12) and UN-English (OR=4.13, 95% CI 1.13-15.12; P=0.03) vs. INS-English Hispanics. However, the likelihood of FT did not differ between UN-Spanish and UN-English Hispanics in both models (P=0.59 and P=0.62 respectively). UN-Spanish Hispanics frequently identified completely lacking credit, savings, or income and food insecurity as key aspects of FT. Of 77 patients, 47 (61.0%) received RT as part of their cancer treatment. UN-Spanish (9/23, 39.1%) and UN-English (13/23, 56.5%) respondents were less likely to receive radiation as part of their treatment when compared to INS-English patients (25/31, 80.7%; p = 0.007). Respondents who received radiation treatment had similar overall FT score (median 3.8) when compared to those who had not (median 5.55; p = 0.214). Respondents who had already received RT demonstrated similar overall FT score (median 3.27) when compared with those who went on to receive RT (median 4.87; p = 0.559). <h3>Conclusion</h3> In this pilot study focused on medically underserved, un/under-insured Hispanics with cancer, inadequate insurance was a key predictor of FT regardless of language. Receipt of RT did not appear to impact overall FT. However, un- and under-insured Hispanic cancer patients were less likely to receive radiation as part of their treatment course, which may reflect a disparity in access to care based on insurance status.

Stress-Busting Program for Family Caregivers: Validation of the Spanish version using biomarkers and quality-of-lifemeasures.

Hispanic family caregivers of people with dementia experience higher levels of stress compared to non-Hispanic white caregivers. Long-term stress causes depression, caregiver burden, cellular aging, and dysregulation of the immune, nervous, and endocrine systems. The purpose of this study was to determine the validity of the Spanish version of the English Stress-Busting Program (SBP) for Family Caregivers by determining changes in quality-of-life measures and biomarkers. Thirty-six caregivers completed the SBP in the language of their choice (14 Spanish-speaking Hispanics [HS], 8 English-speaking Hispanics [HE], and 14 non-Hispanic English [NHE] speakers). Quality-of-life measures included the Perceived Stress Scale, the Screen for Caregiver Burden, and the Center for Epidemiologic Studies Depression Scale. Assessment of oral health and immunity included salivary flow rate, pH, buffer capacity, total protein, and secretory immunoglobulin A (sIgA). Indicators of stress (salivary cortisol), inflammation (C-reactive protein), and cellular aging (leukocyte telomere length) were assessed. Following completion of the SBP, the Spanish-speaking group had less depression and caregiver burden along with improved oral health and reduced cellular aging. When comparing baseline values to post-intervention, all three groups showed significant improvement in subjective caregiver burden. When the data from all three groups were combined, biomarkers that showed improvement after nine weeks of SBP included the stress hormone cortisol, salivary pH, and leukocyte telomere length. The results indicate that the Spanish SBP reduces caregiver stress as assessed by quality-of-life indicators and biomarkers. The Spanish SBP can help to mitigate health disparities in Hispanic Spanish-speaking caregivers.

Depression and suicidality among Hispanics with epilepsy: Findings from the Managing Epilepsy Well (MEW) Network integrated database

ObjectiveAlthough psychiatric disorders are more common among people with epilepsy,2Abbrev. PWE.2 depression and suicidal ideation among Hispanics with epilepsy remain understudied. We examined the prevalence and correlates of depression and suicidal ideation among Hispanic adults with epilepsy who participated in self-management studies in the Managing Epilepsy Well3Abbrev. MEW.3 Network. MethodsThis cross-sectional analysis of pooled data from ten studies used the Patient Health Questionnaire-94Abbrev. PHQ-9.4 or Neurological Disease Depression Inventory-Epilepsy5Abbrev. NDDI-E.5 to examine the prevalence of elevated depressive symptoms (PHQ ≥ 10, NDDI-E ≥ 15) and suicidal ideation (PHQ-9 item 9 ≥ 1, NDDI-E item 4 ≥ 2). Multilevel mixed-effects logistic regression models examined associations between ethnicity, elevated depressive symptoms, and suicidal ideation among PWE. Secondary analyses examined correlates of elevated depressive symptoms and suicidal ideation among Hispanic PWE. ResultsOf 559 participants, 49.6% (n = 277) were Hispanic. Elevated depressive symptoms were endorsed by 38.1% (n = 213) of all participants (32.5% of Hispanics); suicidal ideation was endorsed by 18.4% (n = 103) of all participants (16.3% of Hispanics). After adjustment for sociodemographic and health attributes, Hispanic PWE had a 44% lower prevalence of elevated depressive symptoms (OR = 0.56, CI 0.37–0.84, p = 0.0056) compared to non-Hispanics but similar rates of suicidal ideation (OR = 0.84, CI 0.45–1.58, p = 0.59). Acculturation measures were available for 256 (92.4%) of Hispanic PWE: language preference was Spanish for 62.9%, 46.1% were foreign-born. Spanish-speaking Hispanics were less likely than English-speaking Hispanics to report elevated depressive symptoms (OR = 0.43, CI 0.19–0.97, p = 0.041); however, Hispanics who reported fair or poor health status had a four-fold higher depression prevalence compared to those who reported excellent or very good health status [reference group] (OR = 4.44, CI 1.50–13.18, p = 0.0071). Of the Hispanics who provided prior 30-day seizure data, ≥1 monthly seizure was independently associated with higher depression prevalence (OR = 3.11, CI 1.29–7.45, p = 0.01). Being foreign-born was not associated with elevated depressive symptoms or suicidal ideation prevalence. ConclusionsIn a large, geographically diverse sample of PWE, elevated depressive symptoms were significantly lower in Hispanics compared to non-Hispanics. Spanish language preference was associated with a lower prevalence of elevated depressive symptoms among Hispanic PWE. Future studies should include acculturation data to better screen for depression and suicidal ideation risk and optimize interventions for Hispanic PWE.

Social determinants of health and the Barrio Advantage among Hispanics during the COVID-19 pandemic.

133 Background: Institutional data confirmed that despite Hispanics having a higher morbidity related to COVID19, mortality and outcomes were more favorable compared to other ethnic counterparts. We decided to study the role of the Barrio Advantage (BA), living in ethnically similar communities leading to health advantage, by taking into account acculturation in our patients in hopes of identifying potential avenues to educate our population and minimize healthcare delivery gaps. Methods: A 15-item IRB-approved questionnaire was administered to cancer patients receiving care at participating cancer centers in English and Spanish. Multivariable analysis was performed using Chi Square test to determine associations between examined variables which included socio-demographic information, fears and attitudes related to COVID19. Results: A total of 251 surveys were analyzed. 43.4% were Hispanic with 72% of them listing Spanish and 28% English as their preferred language. Similar amount of English Speaking Hispanics (ESH) and Spanish Speaking Hispanics (SSH) had no personal or family exposure to COVID19 (66.7% and 59.5%, respectively). SSH have a lower degree of education (33% with at least some college, vs 53.3%). More SSH depend on government issued insurance or have no insurance at all (78.5% vs 63.3%). COVID19 has disproportionately worsened fears in SSH (Table). The Barrio Advantage effect was evidenced by the fact that SSH rely more on faith-based institutions or family/friends for emotional support and healthcare inquiries (22.8% vs 13.3%) although more ESH would do so in the case of food security (53.3% vs 41.8%). Comparison of fears to financial, personal and community health based on English proficiency. Conclusions: Financial, personal and community health concerns are deepened in Hispanics, particularly for SSH, potentially due to the lack of acculturation process. Understanding Hispanics and other underrepresented populations are far from monolithic. Loco-regional social determinants of health must be studied in an attempt minimize health disparities including those related to COVID19. The BA, English proficiency and the acculturation process should be considered when developing interventions aimed at decreasing negative outcomes in this dynamic population.[Table: see text]

Parental Cancer-related Information Seeking, Health Communication and Satisfaction with Medical Providers of Childhood Cancer Survivors: Differences by Race/Ethnicity and Language Preference

For childhood cancer survivors (CCS), parents play an important role in communicating with providers and conveying patient’s needs. This exploratory study examined the prevalence of cancer-related information-seeking among parents of CCS and investigated the association between parents’ race/ethnicity and language preference with health communication and satisfaction with child’s medical providers. One hundred and sixty CCS and their parents from two hospitals in Los Angeles County were recruited from the SEER registry. Multivariable logistic regression analyses assessed associations between parents’ race/ethnicity and language preference and their health communication with their child and with their child’s medical care providers. Among the parents, 29% were Spanish-speaking Hispanics, 27% English-speaking Hispanics, and 43% English-speaking non-Hispanics. Regardless of language preference, Hispanic parents were more likely than non-Hispanic parents to receive health information about their CCS’s cancer from hospital sources versus the internet. There was no difference by ethnicity/language in parent satisfaction with their CCS’s medical provider. Spanish-speaking Hispanic parents were more likely to report talking to their CCS about the need for cancer-related follow-up care compared to non-Hispanic English-speaking parents. These findings point to the potential importance of parents’ ethnicity and language for sources of health information and frequency of communication with their CCS about their cancer care.

Do Hispanics prefer to be full code at the end of life? The impact of palliative care consults on clarifying code status preferences and hospice referrals in Spanish-speaking patients.

Hispanics often have disparities at the end of life. They are more likely to die full code and less likely to have discussions regarding prognosis and do not resuscitate (DNR)/do not intubate (DNI), despite studies showing Hispanic values comfort over the extension of life. Barriers to patient-centered care include language,socioeconomic status and health literacy. We evaluated the impact of palliative care (PC) consults on the change of code status and hospice referrals, comparing seriously ill Hispanic and non-Hispanic white patients. A retrospective cohort study of all white and Hispanic patients referred to the PC service of a county hospital from 2006 to 2012. We evaluated ethnicity, language, code status at admission and after PC consult, and hospice discharge. Chi-squared tests were used to analyze characteristics among three groups: non-Hispanic white, English-speaking Hispanic, and Spanish-speaking Hispanic patients. Of 925 patients, 511 (55%) were non-Hispanic white, 208 (23%) were English-speaking Hispanic, and 206 (22%) were Spanish-speaking Hispanic patients. On admission, there was no statistically significant difference in code status among the three groups (57%, 64%, and 59% were full code, respectively, p = 0.5). After PC consults, Spanish-speaking Hispanic patients were more likely to change their code status to DNR/DNI when compared with non-Hispanic white and English-speaking Hispanic patients (44% vs. 32% vs. 28%, p = 0.05). Spanish-speaking Hispanic patients were more likely to be discharged to hospice when compared with English-speaking Hispanics and non-Hispanic whites (33%, 29%, and 23%, respectively, p = 0.04). Spanish-speaking Hispanic patients were more likely to change from full code to DNR/DNI compared with non-Hispanic white and English-speaking Hispanic patients, despite similar code status preferences on admission. They were also more likely to be discharged to hospice. PC consults may play an important role in helping patients to align their care with their values and may prevent unwanted aggressive interventions at the end of life.

Abstract A013: Parental health communication and satisfaction with medical providers of childhood cancer survivors: Differences by race/ethnicity and language

Abstract Purpose: Among childhood cancer survivors (CCS), parents inherently take on the role of informal caregivers. Effective communication between patient and provider or caregiver contributes to better treatment decision making and patient health outcomes. However, few studies have examined the frequency and scope of communication among childhood cancer survivors, caregivers, and medical providers. The purpose of this study was to examine the association between Hispanic ethnicity and language spoken with communication and satisfaction with their CCS health care provider. We hypothesized that Spanish-speaking Hispanic parents would have more barriers with provider communication and would be less satisfied with medical providers than English-speaking Hispanics and non-Hispanic parents. We also hypothesized that Spanish-speaking Hispanic parents would have greater communication with their child about their diagnosis. Methods: We analyzed data from parents of CCS, who were selected from the Los Angeles Cancer Surveillance Program and had been diagnosed between 2000 and 2007 at Children's Hospital Los Angeles (CHLA) or Miller Children's Hospital, Long Beach. We used ANOVA and chi-square statistics to test for differences in demographic characteristics. Results: A total of 173 parents participated in this study, including 50 Spanish-speaking Hispanics, 49 English-speaking Hispanics, and 74 English-speaking non-Hispanics. Spanish-speaking Hispanics were younger, had less than high school education, were lower income, and were less likely to have health care coverage compared to English-speaking Hispanics and non-Hispanic parents. Spanish-speaking Hispanic parents were more likely to report talking to their child about his/her needs for cancer-related follow-up care (p&amp;lt;.001) and health insurance issues (p=.01). Regardless of language spoken, Hispanic parents were more likely to receive health information about their child's cancer from hospital sources. Spanish-speaking Hispanic parents were more likely than English-speaking Hispanics and non-Hispanic parents to report difficulties with written information (p=.02) and understanding doctors due to language barriers (p=.003). However, there was no statistically significant difference by ethnicity/language in parent satisfaction with their child's health care provider or in receiving a survivorship care plan. Conclusion: Despite reporting similar rates of satisfaction with CCS medical providers, Spanish-speaking parents were more likely to report communication barriers with providers. Nevertheless, in order to build sustainable relationships with providers, language barriers need to be addressed to improve communication effectiveness. In future studies, we will explore the role of parent-child and parent-provider communication on their health outcomes. Citation Format: Carol Y. Ochoa, Lourdes Baezconde-Garbanati, Joel Milam. Parental health communication and satisfaction with medical providers of childhood cancer survivors: Differences by race/ethnicity and language [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A013.

Differential Rates of Medicaid Uptake for Hispanic English Speakers and Hispanic Spanish Speakers under the Affordable Care Act

One provision of the Affordable Care Act was Medicaid expansion, which increased eligibility in two ways: it raised the income threshold from 100 to 138% of the poverty line, and removed categorical restrictions, such as being a pregnant woman, to include all low-income adults. We capitalize on this policy change to determine if eligible Hispanics and Spanish speakers are more or less likely than their non-Hispanic and English-speaking counterparts to enroll in Medicaid. We use National Health Interview Survey data and apply a theoretical framework of social capital acquisition. We find that Hispanic Spanish speakers and Hispanic English speakers are about twice as likely to have Medicaid after the ACA expansion. However, Spanish speakers are about 75% as likely to have enrolled in Medicaid than their English-speaking counterparts post-ACA. In the NHIS sample, about 28% of Hispanic Spanish speakers have Medicaid. We see considerable evidence that Hispanics who have more social capital are much more likely to enroll in Medicaid. Even though the ACA expansion reduced the uninsured gap for Hispanics, there is still a noteworthy disparity in rates of insurance coverage.

Oral health disparities: Racial, language and nativity effects.

This study examined racial oral health disparities among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics. For Hispanics, this study also examined the role of language in oral health disparities between English-speaking Hispanics and Spanish-speaking Hispanics. This study included 12, 307 adults older than 20 from the National Health and Nutrition Examination Survey (NHANES) 2011–2016. Oral health is measured by self-rated oral health, the frequencies of dentist visits, and the number of missed teeth. Exposures of interest referred to social gradients, which include education, annual family income, foreign born, and citizenship. Covariates included age, gender, and marital status. Ordinal logistic regression models were used to estimates the effects of social gradients on self-rated oral health and dentist visits. Negative binomial regression model was applied to estimate the effects of social gradients on the number of missed teeth. Overall, Spanish-speaking Hispanics presented the most disadvantaged social gradients and the worst oral health results. Non-Hispanic Blacks and English-speaking Hispanics reported disadvantaged oral health status when compared to Non-Hispanic Whites. Foreign-born, higher education levels and annual family income play protective role on oral health outcomes, while respondents who do not have citizenship are at higher risk of self-rated fair/poor oral health and dentist visits.

Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans.

To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES). The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013. We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls. This study links administrative data from a managed BH organization to a commercial marketing database. We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non-English speakers, Asian English speakers, Hispanic non-English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration. In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.

The Role of Language Use in Reports of Musculoskeletal Pain Among Hispanic and Non-Hispanic White Adolescents.

This study examined the role of English language use in the reported frequency of musculoskeletal pain among Hispanic and non-Hispanic White youth. This is a secondary data analysis using a cross-sectional sample of 12,189 Hispanic and non-Hispanic White adolescents recruited for the National Longitudinal Study of Adolescent to Adult Health. Respondents were classified into three groups: (a) English-speaking non-Hispanic Whites, (b) English-speaking Hispanics, and (c) Spanish-speaking Hispanics. After controlling for body mass index and demographic, socioeconomic, and behavioral variables, Spanish-speaking Hispanics reported the least frequent musculoskeletal pain ( OR = 0.415, 95% CI [0.361, 0.477]; p < .001), followed by English-speaking Hispanics ( OR = 0.773, 95% CI [0.690, 0.865]; p < .001). The experience of musculoskeletal pain is a physiological as well as a cultural phenomenon. Health care providers should consider the role of language use in reports of pain in Hispanic and non-Hispanic White adolescents.

Cost-Effectiveness Analysis of a Television Campaign to Promote Seasonal Influenza Vaccination Among the Elderly

BackgroundThe U.S. policy goals regarding influenza vaccination coverage rate among the elderly include the increase in the coverage rate and the elimination of disparities across racial/ethnic groups. ObjectiveTo examine the potential effectiveness of a television (TV) campaign to increase seasonal influenza vaccination among the elderly. MethodsWe estimated the incremental cost-effectiveness ratio (ICER, defined as incremental cost per additionally vaccinated Medicare individual) of a hypothetical nationwide TV campaign for influenza vaccination compared with no campaign. We measured the effectiveness of the nationwide TV campaign (advertised once a week at prime time for 30 seconds) during a 17-week influenza vaccination season among four racial/ethnic elderly groups (N=39 million): non-Hispanic white (W), non-Hispanic African American (AA), English-speaking Hispanic (EH), and Spanish-speaking Hispanic (SH). ResultsThe hypothetical campaign cost was $5,960,000 (in 2012 US dollars). The estimated campaign effectiveness ranged from −1.1% (the SH group) to 1.42% (the W group), leading to an increased disparity in influenza vaccination among non-Hispanic white and non-Hispanic African American (W-AA) groups (0.6 percentage points), W-EH groups (0.1 percentage points), and W-SH groups (1.5 percentage points). The estimated ICER was $23.54 (95% confidence interval $14.21–$39.37) per additionally vaccinated Medicare elderly in a probabilistic analysis. Race/ethnicity-specific ICERs were lowest among the EH group ($22.27), followed by the W group ($22.47) and the AA group ($30.55). The nationwide TV campaign was concluded to be reasonably cost-effective compared with a benchmark intervention (with ICER $44.39 per vaccinated individual) of a school-located vaccination program. Break-even analyses estimated the maximum acceptable campaign cost to be $14,870,000, which was comparable to the benchmark ICER. ConclusionsThe results could justify public expenditures on the implementation of a future nationwide TV campaign, which should include multilingual campaigns, for promoting seasonal influenza vaccination.

Neuropsychological Language Tests in Dementia Diagnosis in English-Speaking Hispanic and Non-Hispanic White Outpatients

Neuropsychological language tests have limitations (e.g., unrepresentative norms) when applied to “Hispanics” and clinicians are likely aware that these tests may lead to inaccurate dementia diagnoses. Therefore, it was hypothesized that language tests would be weaker diagnostic predictors in Hispanics versus “Non-Hispanic Whites.” Participants included 436 English-speaking Hispanic and 436 Non-Hispanic White (randomly selected from 10,937) outpatients classified as having dementia or normal cognition at initial evaluation. When covarying for age, sex, education, and functional abilities, vegetable fluency significantly predicted diagnosis among Non-Hispanic Whites (odds ratio = 0.80, 95% confidence interval [0.69, 0.94], p < .01). Animal fluency and an abbreviated (30-item) Boston Naming Test (BNT) comparably predicted diagnosis across groups. Results remained similar when covarying for primary language among Hispanics. Findings suggest that vegetable fluency, but not animal fluency, was relatively unimportant in diagnosis for the English-speaking Hispanics in this study possibly because of cultural influences on the familiarity, salience, and relevance of this category’s items. Additionally, clinicians may have informally adjusted Hispanics’ 30-item BNT and animal fluency scores and discounted vegetable fluency to account for their limitations. Animal fluency and BNT may be preferable language tests when assessing dementia in English across groups, as they comparably predicted diagnosis in both groups.

Decomposing racial/ethnic disparities in influenza vaccination among the elderly

While persistent racial/ethnic disparities in influenza vaccination have been reported among the elderly, characteristics contributing to disparities are poorly understood. This study aimed to assess characteristics associated with racial/ethnic disparities in influenza vaccination using a nonlinear Oaxaca–Blinder decomposition method. We performed cross-sectional multivariable logistic regression analyses for which the dependent variable was self-reported receipt of influenza vaccine during the 2010–2011 season among community dwelling non-Hispanic African–American (AA), non-Hispanic White (W), English-speaking Hispanic (EH) and Spanish-speaking Hispanic (SH) elderly, enrolled in the 2011 Medicare Current Beneficiary Survey (MCBS) (un-weighted/weighted N=6,095/19.2million). Using the nonlinear Oaxaca–Blinder decomposition method, we assessed the relative contribution of seventeen covariates – including socio-demographic characteristics, health status, insurance, access, preference regarding healthcare, and geographic regions – to disparities in influenza vaccination. Unadjusted racial/ethnic disparities in influenza vaccination were 14.1 percentage points (pp) (W–AA disparity, p<0.001), 25.7 pp (W–SH disparity, p<0.001) and 0.6 pp (W–EH disparity, p>.8). The Oaxaca–Blinder decomposition method estimated that the unadjusted W–AA and W–SH disparities in vaccination could be reduced by only 45% even if AA and SH groups become equivalent to Whites in all covariates in multivariable regression models. The remaining 55% of disparities were attributed to (a) racial/ethnic differences in the estimated coefficients (e.g., odds ratios) in the regression models and (b) characteristics not included in the regression models. Our analysis found that only about 45% of racial/ethnic disparities in influenza vaccination among the elderly could be reduced by equalizing recognized characteristics among racial/ethnic groups. Future studies are needed to identify additional modifiable characteristics causing disparities in influenza vaccination.