Immigrant Latinas Research Articles

Unveiling Cervical Cancer Inequities Among Georgia Immigrant Latinas: A Robust Qualitative Examination of the Facilitators and Barriers to Prevention, with Emphasis on the Impact of Community-Based Organizations.

This qualitative study delves into the facilitators and barriers surrounding cervical cancer prevention among Latina women in Georgia, with a specific focus on the impact of community-based organizations (CBOs). Employing semi-structured interviews with healthcare providers and representatives from CBOs, faith-based organizations, and other key stakeholders, the study uncovers key themes and subthemes shaping cervical cancer disparities. Themes such as challenges in cross-cultural healthcare access, difficulties due to lack of US citizenship, and limited mobility emerge as significant barriers, while community and family support stand out as crucial facilitators to cancer prevention. Additionally, the study examines community intervention methods from CBOs to target cervical cancer disparity, highlighting the importance of public awareness campaigns, building trust within the Latina community, and providing medical support tailored to immigrant populations. Through this comprehensive examination, the study not only offers invaluable insights into the intricate web of issues surrounding cervical cancer prevention but also endeavors to serve as a catalyst for targeted interventions and evidence-based policies aimed at ameliorating cervical cancer disparities among immigrant Latinas in Georgia and beyond.

Childhood Racism and Cardiometabolic Risk in Latina Mothers Across the First Postpartum Year.

Immigrant Latinas, particularly of Mexican descent, initially achieve healthy perinatal outcomes. Although this advantage wears off across generations in the United States (US), the early life psychosocial mechanisms that may initiate a cascade of biological vulnerabilities remain elusive. The current investigation aimed to understand the extent to which childhood experiences of racism may contribute to elevated levels of C-reactive protein (CRP), an early indicator of cardiometabolic risk, during the first postpartum year. Latinas from the Community and Child Health Network ( N = 457) retrospectively reported experiences of childhood racism and childhood country of residence via structured questionnaires. Interviewers collected CRP bloodspots and height and weight measurements for body mass index at 6 months and 1 year postpartum. Latinas who grew up in the US experienced a steeper increase of CRP levels across the first postpartum year ( β = 0.131, p = .009) and had higher CRP levels 1 year postpartum than Latinas who grew up in Latin America. Based on Bayesian path analyses, Latinas who grew up in the US reported higher levels of childhood racism than Latinas who immigrated after childhood ( β = 0.27; 95% credible interval = 0.16-0.37). In turn, childhood racism mediated the relationship between country of childhood residence and elevated CRP at 6 months and 1 year postpartum, even after adjusting for sociodemographic and behavioral covariates. After adjusting for body mass index, mediational relationships became nonsignificant. This study is an important first step toward understanding how childhood racism may contribute to postmigratory health patterns among Latinas, particularly cardiometabolic risk 1 year after childbirth.

Adapting for Well-Being: Examining Acculturation Strategies and Mental Health among Latina Immigrants

This study investigates how assimilation and integration, two commonly studied acculturation forms, help immigrant Latinas cope with acculturative stress and related psychological distress. It employs the Ecological Framework for Understanding Immigration (EFUI), merging Bronfenbrenner’s Ecological Systems Theory and the Socioecological Model as a comprehensive approach. Through multigroup analysis, various factors significantly affect the psychological distress of immigrant Latinas, including financial constraints, contentment with migration decisions, age, and adherence to familial values. Acculturative stress relates to English proficiency, racial discrimination experiences, U.S. residency duration, and contentment with the migration choice. The moderating effects of assimilation and integration vary, influencing psychological distress and acculturative stress differently in each group. In conclusion, this study uncovers complex coping mechanisms used by immigrant Latina individuals facing acculturative stress and highlights the protective role of assimilation, the importance of familismo, the impact of financial constraints, and the significance of racial discrimination. This finding underscores the need for mental health interventions to respect and incorporate Latinx individuals’ cultural values and beliefs, promoting positive mental health outcomes.

A qualitative study understanding immigrant Latinas, violence, and available mental health care.

Women from Latin American countries experience high levels of psychological and physical abuse and violence. Immigrant Latina women are often subjected to a patriarchal system in both family and government, which has resulted in a variety of complex and far-reaching outcomes. This qualitative study sought to understand the experiences of immigrant Latina women who were exposed to violence, as well as their access to mental health care. This study used 20 interviews with immigrant Latina women from El Salvador, Guatemala, and Mexico who had accessed mental health services in California. The primary themes that emerged from analysis of the data included motivating factors for seeking services (e.g., motherhood, community, hope, and mental health needs), barriers to accessing services (e.g., fatalism, marianismo, stigma, finances, language barriers, threats, abuse, and systemic insensitivity), and treatment and solutions (e.g., empathy, advocacy, and community approaches). These results appeared to be indicative of the importance of addressing sociopolitical, historical, and cultural trauma as an imperative component of effective treatment. In this context, the authors explore liberation psychology, a concept and approach that promotes social justice values and emphasizes the empowerment of immigrant Latina women in clinical practice. It is recommended that the historical sociocultural abuse of immigrant Latina women be thoughtfully considered and discussed in the therapeutic process to create lasting psychological change. Future research, policy efforts, and program development, including psychotherapeutic treatment modalities, should focus specifically on marginalized groups facing barriers to mental health care in order to increase access and effectiveness of treatment.

“¿Y tu novio? Where’s Your Boyfriend?”: A Cultural-Ecological Analysis of Latinas’ Narratives of Teen Dating Experiences

There is a dearth of research examining the dating experiences of Latina teens—a large and rapidly growing population in the U.S. that reports high rates of teen dating violence. The purpose of this qualitative research was to explore Latinas’ teen dating experiences and the familial and sociocultural factors that impact them using a cultural-ecological perspective. Twenty-five first-, second-, and third-generation immigrant Latinas between the ages of 18 and 23 participated in the research. A purposive sample was drawn from the New York City (NYC) metropolitan area. We applied a critical narrative inquiry methodology to conduct in-depth narrative interviews with participants, following protocols approved by the IRB. We employed an inductive and iterative analytic process that combined holistic- and categorical-content approaches to identify themes within and across narratives. We identified the following themes: (1) cultural expectations and norms, (2) parents’ rules and expectations, (3) covert relationships, and (4) violence and control. This study’s findings highlight the importance of considering the cultural-ecological context in examinations of Latina teens’ dating experiences, with particular attention to how gendered power dynamics shape Latina teens’ dating experiences across multiple levels.

A Mixed Methods Evaluation of Virtually Delivered Group-based Mothers and Babies for Latina Immigrant Mothers.

Immigrant Latinas are at higher risk for postpartum depression (PPD) than the general perinatal population, yet face numerous barriers to accessing mental health services. The goal of this study was to pilot an enhanced, virtual group delivery of a PPD prevention program, Mothers and Babies (MB), among immigrant Latinas engaged in early childhood programming. Forty-nine Spanish-speaking mothers participated in one of four MB virtual groups, facilitated by trained bilingual staff at affiliated early learning centers. MB was enhanced to also target social determinants of health. A mixed-methods design was used to evaluate MB using participant interviews and pre-post surveys measuring depressive symptoms, parenting distress, and self-efficacy to manage emotions. On average, participants attended 69% of MB virtual sessions and rated group cohesiveness at a 4.6 on a 5-point scale. Paired-samples t tests showed significant reductions in depressive symptoms (Cohen's d=0.29; p=.03) and parenting distress (Cohen's d=0.31; p=.02), and improved self-efficacy to manage emotions (Cohen's d=-0.58; p<.001). Participants reported both benefits and drawbacks of the virtual format and provided largely favorable feedback on program enhancements. Results provide initial evidence for the acceptability, feasibility, and effectiveness of an enhanced virtual group PPD prevention program for immigrant Latinas, delivered in partnership with local early learning centers. These findings have important implications for extending the reach of preventive interventions among a population that faces many structural and linguistic barriers to traditional forms of mental health service delivery.

Immigrant Latinas' Experiences with Intimate Partner Violence, Access to Services, and Support Systems During a Global Health Crisis (COVID-19).

This study examines immigrant Latinas' (ILs') help-seeking behaviors, types of support systems, and access to intimate partner violence (IPV) services during a global health crisis (COVID-19) at a community-based agency in a Northeastern state. Nineteen immigrant Latinas who had prior IPV-related services such as legal aid, advocacy, and support within 1-3 years were recruited for the study. Spanish-speaking telephone interviews averaging between 30 and 45min were conducted with each participant. Content analysis was the method employed to review the data and generate themes of the participants' experiences. Participants' qualitative responses included an increase of intimate partner violence during the pandemic. Types of support systems included reaching out to police departments, hospitals and health-care settings, and community-based agencies. Findings indicated a 47% positive response rate when working with police officers (e.g., bilingual Spanish-English speaking police officers), and the participants reported being supported by the agency staff where they received services. Recommendations are provided to the community-based agency and other service providers regarding ongoing delivery of services and best practices for ILs throughout the pandemic transitions and beyond.

A Study of Immigrant Latinas Perspectives of Caring for their Diabetes

Hispanic–Americans are disproportionately affected by type 2 diabetes compared to non-Hispanic Whites. Five million adult Hispanic Americans are estimated to have been diagnosed with T2D. Among US Hispanics, Mexicans have the highest rate (14.4%) of diabetes. Further, Hispanics are also twice as likely as non-Hispanics Whites to die from diabetes, making it the fifth leading cause of their death and a serious health problem in Hispanic communities. Yet, little is understood of what rural immigrant Latinas do to care for their diabetes health. In-depth interviews (3 focus groups) and thematic analysis found 16 Latinas had T2D on average for 9 years; all emigrated to the USA from Mexico, lived in the USA for an average of 27 years, and worked (60%). Within the domain of “What do you do to take care of your health?” Latinas desired to adhere to exercise, controlled diet, and medications, but perceived a powerful barrier to a healthy life was the American lifestyle that included long work days, more money to purchase unhealthy foods and a desire for them, and a lack of time for other forms of exercise. Despite the Latina participants’ years of experience about living with T2D in the US, they still struggled to adhere to healthy behaviors. Future research should address the longer time Hispanic immigrants live in the US with the more at-risk they become for diminished health.

Therapeutic Landscapes For Immigrant Latina Survivors of Intimate Partner Violence

The purpose of this study was to identify the therapeutic landscapes of immigrant Latina survivors of intimate partner violence (IPV). The rate of IPV among Latinas is alarming and research has documented the effects of IPV on the survivor’s mental health. Immigrant Latina women possess vulnerability factors that compound their ability to receive treatment. Notably, therapeutic landscapes serve to foster recovery yet research has not identified these places for immigrant Latinas. Our qualitative study aimed to fill this gap. Our findings include four themes: Places of worship, places of social support, places of empowerment, places of freedom. Implications for practice within a cultural context are discussed.

Long-term impact of the Sí, Yo Puedo curriculum and empowerment program on immigrant Latinas: follow-up groups at a police department

ABSTRACT Immigrant Latinas (IL) experiencing incidences of intimate partner violence (IPV) require services from police departments. This study builds upon a previously mixed-method study conducted at a police department between 2015 and 2018 in the US. Thirty-three IL participated in five educational groups (ns = 7, 7, 6, 6, 7) in a culturally specific curriculum and program, Sí, Yo Puedo, designed to foster self-esteem and provide education on IPV and healthy relationships. Two follow-up groups (ns = 8, 5) were conducted in December 2020 to assess IL’s experiences post completion of the Si, Yo Puedo empowerment program. Content analysis was the method employed to review the data and generate themes of the participants experiences. Participants’ qualitative responses included positive feelings of increased confidence and self-esteem, and reports of learning about legal rights and the dynamics of IPV. Findings implicate this curriculum as a service tool for police departments working with this population.

Not a Country or a Stereotype: Latina LDS Experiences of Ethnic Homogenization and Racial Tokenism in the American West

The Church of Jesus Christ of Latter-Day Saints (LDS), also called Mormonism, has experienced rapid changes in its US demographics due to an influx of Latinx membership. The most recent growth in the US church body has been within Spanish-speaking congregations, and many of these congregant members are first or 1.5-generation immigrant Latinas. Using ethnographic data from 27 interviews with immigrant members living in Utah, Nevada, and California, LDS Latinas reported that while US Anglo members did seem to appreciate certain aspects of their cultural customs or practices, they also reported frequently experiencing ethnic homogenization or racial tokenization within US Church spaces and with White family members. Our findings indicate that the contemporary LDS church, despite some progressive policy implementations within its doctrinal parameters, still struggles in its ever-globalizing state to prioritize exposing White US members to the cultural heterogeneity of non-White, global LDS identities and perspectives. Latina LDS experiences and their religious adjacency to Whiteness provide a useful lens by which researchers can better understand the ways in which ethnic identity, gender, legal status, and language create both opportunities and challenges for immigrant incorporation and inclusion within US religious spaces and add to the existing body of scholarship on migration and religion.

Thick trust, thin trust, social capital, and health outcomes among trans women of color in New York City

Introduction: Many trans women of color communities experience high HIV seroprevalence, extreme poverty, high rates of victimization and substance use, and poor mental health. Greater knowledge of trans women of color social capital may contribute toward more effective services for this marginalized population. Methods: These data come from a mixed-methods study that examined trans/gender-variant people of color who attended transgender support groups at harm reduction programs in NYC. The study was conducted from 2011 to 12, total N = 34. The qualitative portion was derived from six focus group interviews. Results: Two support groups stood out as exhibiting very strong alternative kinship structures. One group was comprised of immigrant trans Latinas, and the other group were trans women of African descent living with HIV. Both groups demonstrated ample cultivation of “trust capital” in the form of “thick trust” (bonding capital) and “thin trust” (bridging/linking capital) both inside and outside/beyond the support groups. Thick trust included the cultivation of intimacy, support in primary romantic relationships, and community leadership. Thin trust included networking with a variety of organizations, increased educational opportunities, and cultural production. Discussion: Participants “opened up to social capital” through the process of trusting as a series of (1) risks; (2) vulnerabilities; and (3) reciprocities. A solid foundation of thick trust resulted in a social, psychological, and emotional “base.” Upon this foundation, thin trust was operationalized resulting in positive material, economic, and quality-of-life outcomes, leading to an expanded space of capabilities.

Intimate Partner Violence Prevention and Intervention Group-Format Programs for Immigrant Latinas: a Systematic Review.

Immigrant Latinas (IL) experiencing intimate partner violence (IPV) often experience barriers to accessing formal support systems due to immigration-related issues (e.g., fear of deportation, language proficiency, lack of family support in the U.S.). This paper contains a systematic review of peer-reviewed published articles within the past 25 years addressing IPV prevention and intervention programming designed for this vulnerable population. We examined specific group-format programs and curricula conducted at community-based agencies with social services across the country. Qualitative analysis of the 10 articles that met search criteria (i.e., programs must be culturally specific, designed to serve IL, conducted in group-format, focused on IPV intervention or prevention) generated information regarding the nature of group interventions addressing this issue and population. Several themes emerged upon completion of the qualitative review describing key characteristics of each intervention. All reviewed articles reported generally positive outcomes using a variety of methods. Studies using quantitative methods found statistically significant outcomes for constructs including depression, self-esteem, and knowledge of wellness. Professionals from diverse practice settings working with IL would likely benefit by developing intervention and prevention group-format programming to address this problem.

Exploring experiences and expectations of prenatal health care and genetic counseling/testing in immigrant Latinas

As the Latino population of the United States continues to increase, the specific needs of Latinos in genetic counseling continue to be unmet. Using culturally tailored genetic counseling responsive to the needs of the patient can assist in building rapport in genetic counseling sessions. We aimed to investigate the relationship between acculturation, prenatal care, genetic testing experiences, and expectations for prenatal care in an immigrant Latino population. A total of 20 Spanish-speaking, pregnant Latinas from various Latin American countries were interviewed after completing a prenatal genetic counseling session. The semi-structured phone interview included questions about the participants' experiences with genetic counseling/testing, prenatal health care in their home country, their current prenatal care in the United States, and information they felt to be important to know during their pregnancy. Although this study showed no statistically significant associations between acculturation, prenatal care, and genetic counseling/testing experiences, six significant content domains were identified as relevant to the participants. Overall, we found that immigrant Latinas desire to know prenatal risk information to help them prepare, relieve guilt, and help make screening/testing/family planning decisions. These Latinas reported the genetic counselor provided confidence, a sense of autonomy, and empowerment, for them to make their own decisions regarding prenatal screening/testing. The participants also spoke about stressors unique to the immigrant population, most notably being away from their older children and other family members. Identifying relevant factors about the lived experience of this population can help genetic counselors better address possible needs, feelings of guilt, and/or isolation and identifying women who could benefit from group-based prenatal care, support groups, or referrals to social work.

Contraceptive Decision Making Among Latina Immigrants: Developing Theory-Based Survey Items.

Contraception is important for reproductive autonomy, yet many Latinas do not use contraception consistently despite research reporting a desire to do so. Factors varying in priority and value come into play during contraceptive decision making. When measuring these, relevant survey items may vary by populations. This study focused on developing an ethnically responsive, patient-centered, content-valid survey for measuring factors that influence contraceptive decision making among immigrant Latinas. Nonpregnant self-identified Latinas ages 15 to 24 years in Baltimore, MD, were recruited from a family planning facility. Using the theory of planned behavior as a theoretical framework and prior formative research, initial survey items were drafted (Step 1). Content validation and cognitive interviewing procedures (Step 2 and Step 3) were used to develop final items. Final items (27) were content-validated by the target population; items reflect important factors and relevant contexts affecting contraceptive decision making among Latinas in Baltimore. These theory-based items provide an important contribution to the literature because they measure and explore factors related to contraceptive decision making in an understudied population. Providers might consider these factors during counseling to build patient-centered communication. These items might serve to measure responses to theory of planned behavior-based interventions designed to improve the contraceptive counseling of Latinas.

Sí, Yo Puedo (Yes, I Can) Curriculum and Empowerment Program for Immigrant Latina Women in Group Settings: Utilization of the Program at a Police Department

Immigrant Latinas experiencing incidences of interpersonal violence require services from police departments. This study builds upon a previous mixed-method study conducted at a police department between 2016 and 2017 in a Midwestern state. This study examines immigrant Latinas’ experiences with a culturally specific curriculum, Si, Yo Puedo, designed to foster self-esteem and provide education on interpersonal violence and healthy relationships. Nineteen immigrant Latinas participated in three educational groups undergoing the curriculum. Pre/post 36-item surveys inclusive of nine demographic questions and two measurement scales were used to examine differences in self-esteem and attitudes and knowledge toward interpersonal violence. Open-ended qualitative items assessed participants’ overall experiences with the Si, Yo Puedo program. No statistically significant differences between the mean pre- and post-test self-esteem scores were detected. Significant differences were noted regarding participants’ disagreements that disapprove or show better knowledge about IPV in the attitudes and knowledge toward interpersonal violence scores. Participants reported positive feelings of increased confidence and self-esteem and reports of learning about legal rights and the dynamics of interpersonal violence. Findings implicate this curriculum as a culturally competent service tool for police departments working with this population.

Information behavior and ICT use of Latina immigrants to the U.S. Midwest

Latina immigrants to the U.S. Midwest are a vibrant, complex, and resilient population of women with intersectional identities stemming from their participation in at least three distinct but interrelated communities: (1) women [in a family-centric culture defined by strong gender roles], (2) immigrants [potentially with linguistic and socioeconomic status disadvantages] and (3) residents of the U.S. Midwest [a low-population/rural area with lesser access to resources and an increasingly xenophobic host community]. Given the potential for marginalization, Latina immigrants to the Midwest represent a population vulnerable to digital exclusion. The current research is the first to investigate systematically ICT use by immigrant Latinas to the U.S. Midwest. Specifically, as consumers and users of technology-mediated information, Latina immigrants to the U.S. Midwest navigate a complex and understudied social environment. To develop a strategy to begin to break down technology barriers for these women, first the complex and interconnected nature of their social environment and information practices needs to be understood; the current article presents that foundational research.

Pilot Study Exploring Migration Experiences and Perinatal Depressive and Anxiety Symptoms in Immigrant Latinas.

Migration-related experiences can increase Latinas' risk of perinatal depression and anxiety. Few studies have investigated these associations among Latinas due to a lack of survey instruments explicitly assessing migration experiences. This study assessed the feasibility and acceptability of the Migration Experiences Survey (MES), a newly-developed measure of migration and deportation fears and explored associations between those experiences and mental health in a sample of immigrant Latinas in the perinatal period. This cross-sectional study recruited women from community health clinics in Chapel Hill, NC between July 2013 and 2014. Twenty-five immigrant women were enrolled in the study during their third trimester of pregnancy. Women were interviewed in English or Spanish during pregnancy and at 8weeks postpartum. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and the Spielberger State-Trait Anxiety Inventory was used to determine anxiety symptoms. The MES was administered at 8weeks postpartum. Nonparametric tests were conducted to determine associations between deportation fears and maternal mood. Results show that the MES is acceptable for collecting data on migration experiences and assessing deportation fears among immigrant Latinas, regardless of depressive or anxiety symptoms. More than 40% had migration safety concerns and fears of deportation. Self or family-related fears of deportation were significantly associated with prenatal state anxiety and trait anxiety (p < .05). No significant associations between deportation fears and depressive symptoms were observed. The MES is a useful tool for gathering information about migration experiences associated with perinatal anxiety.

Highlighting Global Issues in Women's Health

Despite progress made by the World Health Organization (WHO) Millennium Development Goals, women's health continues to be identified as one of the major challenges for the Sustained Development Goals (SDGs). Specifically, the SDGs Goal 3 reaffirms that women and men have different health-care needs, and that both sexes have an equal right to live healthily. Unfortunately, despite all the progress to date, globally many women and girls suffer discrimination and limited access to health care. Women are constrained by lack of financial resources and limited mobility opportunities. In many countries, women spend long hours on domestic work, and suffer from poor working conditions and gender-based violence, all of which affects their health outcomes. Pregnancy and childbirth continue to pose many risks, including infections, malnutrition, and inadequate pre- and postpartum care leading to unnecessary morbidity and mortality. The Editors issued a call for manuscript submission in this important area of health promotion, which generated many submissions, some of which have already been published in World Medical & Health Policy. In this issue, we continue to explore some of the health issues faced by women around the world. Stapleton and Skinner's article on “Cross-Border Reproductive Care: Two Lenses in Political Science” presents an overview of institutional legitimacy and capacity in global governance, understanding patient motivation in seeking cross-border reproductive services, and the role social scientists can play in promoting relevant policies. In “Managing Religion and Morality Within the Abortion Experience: Qualitative Interviews With Women Obtaining Abortions in the U.S.,” Frohwirth, Coleman, and Moore explore the science and advocacy to reduce abortion stigma, and to help millions of women as they navigate their abortion experiences, urging researchers, clinicians, and advocates to remain aware of the strong connection between religion and abortion. Summer and Walker, in “Recommendations for Sustainable Midwifery in Guatemala,” provide an overview of the lessons learned from Guatemala's midwifery program; utilizing this framework can inform the design of other midwifery programs and midwifery education around the world. An original study on “Gender-Role Attitudes Among Immigrant Latinas: Empowering Women” by Villalba et al. provides insight into how to formulate policies that would protect reproductive and other human rights of immigrant Latina women. We also feature a commentary by Harris et al. on the incidence of endometriosis in a clinic-based sample of low-income women in Mexico City. Two other topics of enduring interest to WMHP—preparedness and addiction—are the subject of one additional commentary and one additional editorial in this issue. Harris et al. seek to bring attention to and promote public-private collaboration in global health preparedness to encourage effective partnerships. And we maintain focus on our interest in mitigating in considering “The Medical and Public Health Challenges of Addiction.” The editors would like to thank the contributors who help us to keep focus on these important issues in medical and health policy, and our reviewers and advisory board members for their support in 2018 as we look forward to a productive 2019.

Gender‐Role Attitudes Among Immigrant Latinas: Empowering Women

In general Latinos hold more conservative attitudes regarding gender roles when compared to Whites. However, Latinos born in the United States with higher education are more likely to have egalitarian gender role attitudes compared to Latino immigrants. The aim of this study was to analyze the relationship between gender role attitudes and acculturation, marianismo, and relationship control, among Latina immigrants living in the United States. A hierarchical regression and correlation analysis were used to measure the outcome of this study. A total of 234 women were included in the study with a mean age of 34 years old. The education level was less than high school (53 percent), with the majority employed (54 percent). The average time living in the United States was 8 years (SD = 2.0). Acculturation, marianismo, and relationship control were significantly associated with gender‐role, R2 = .207, F (3, 95) = 11.3, p = 0.001. The correlation analysis showed an inverse relationship between egalitarian attitudes and marianismo (r = −.304, p &lt; .0005) and a positive relationship with acculturation (r = .295, p &lt; .0005). Egalitarian gender role attitudes were observed with an inverse bidirectional relationship between marianismo and acculturation among Latino immigrant women living in the United States.