Latina Participants Research Articles

Impact of Baseline BMI upon the Success of Latina Participants Enrolled in a 6-Month Physical Activity Intervention

High rates of obesity in Latinas highlight the need to determine if physical activity interventions are equally effective across the body mass index (BMI) range. Thus, this study assessed how BMI impacts success of Spanish-speaking Latinas in a culturally and linguistically adapted theory-based physical activity intervention (N = 45). Longitudinal regression models tested the relationship between baseline BMI and outcomes. Overall, a trend for a negative association was found between baseline BMI and self-reported physical activity and theoretical constructs targeted by the intervention over time. For example, someone with a 25 kg/m2 BMI would report, on average, 27.5 more minutes/week of activity compared to someone with a 30 kg/m2 BMI at followup. Furthermore, higher baseline BMI was significantly associated with lower self-efficacy, behavioral and cognitive processes of change, and family social support over time. These findings suggest that participants with higher BMI may need additional intervention to promote physical activity.

Abstract PR-6: Does racial/ethnic concordance between patients and their navigators increase identification of barriers to care?

Abstract Background: Racial/ethnic minority groups have higher cancer mortality rates and experience more barriers in receiving cancer care compared to their white counterparts. Recent literature, suggests patients receiving care from providers who are racially/ethnically concordant have improved patient satisfaction. Our long term hypothesis is that racial/ethnic concordant navigators would identify more barriers to care, and by addressing these identified barriers, improve patient outcomes. Study Intervention: Boston is part of the NCI CRCHD Patient Navigation Research Program (PNRP). Boston's aim is to develop and test patient navigation as an intervention to increase timely resolution after identification of a breast or cervical screening abnormality. We partnered with six of Boston's community health centers; three received breast navigation and three received cervical navigation, each serving as a control site for the other cancer type. Study Objective: The aim of this study was to examine the association of racial/ethnic concordance and barrier identification between participants and navigators. Study Design: Participants were included if they were enrolled in the navigation arm between January 2007 and May 2008, had an abnormal mammogram (BIRADS 0,3,4 or 5) or Pap test (ASCUS HPV+, LGSIL, or HGSIL). Racial/ethnic data was collected administratively. Navigators recorded identified barriers to care from a checklist of 19 predetermined categories. Measures: Participant and navigator race/ethnicity was collapsed into a single, mutually exclusive variable. Each participant was categorized as concordant or discordant with her navigator. For participants navigated by more than one navigator, the navigator with the most patient contacts was used. For this analysis, participants were dichotomized as having no versus any barriers identified. Language was also excluded as a potential barrier to remove potential confounding by concordance. Results: Preliminary results (N=870) indicate that 29% of the participants were white, 28% black, 31 % Latina, and 12% Asian; mean age 40 (± 14); 62% spoke English; 56% were on public insurance. Of the 17 navigators, 59% were white, 18% black, 18% Latina, and 5% Asian. Racial/ethnic minority participants had more identified barriers compared to whites (70% vs. 52%, p=.0001). More Asian participants had barriers identified with concordant than discordant navigators (100% vs. 71 %, p=.0001) while concordance and barrier identification was not associated among white, black, or Latina participants. Conclusion: Racial/ethnic minority participants had more barriers identified than white participants. Concordance was significantly associated with barrier identification for Asian participants but not white, black, or Latina participants. Our future research will explore clinical outcomes and concordance to understand the impact of racial/ethnic concordance among these groups. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):PR-6.

Abstract 983: United States (US)-Mexico border Latinas: Breast cancer knowledge, attitudes, and factors associated with early detection practices

Abstract Background: Evidence suggests Latinas residing along the US-Mexico border face higher breast cancer (BC) mortality rates compared to Latinas in the interior of either country. Due to similarities in these populations, risk factors associated with BC may be unique to Latinas along the US-Mexico border. Purpose: The purpose of this study was to describe early detection practices (EDP), BC knowledge, and attitudes among US Latina and Mexican women age 40 and older living along the US-Mexico border, and to identify factors associated with EDP in this population. Methods: For this binational cross-sectional study, 265 participants completed an interviewer-administered questionnaire that obtained information on sociodemographic characteristics, knowledge, attitudes, family history, and EDP. Differences between Mexican (n=128) and US Latina (n=137) participants were assessed by Pearson's χ2, Fischer's Exact test, t-tests, and multivariate regression analyses. Results: US Latinas had significantly increased odds of having ever received a mammogram/breast ultrasound (Odds Ratio (OR) = 2.81) and clinical breast exam (OR = 2.98) compared to their Mexican counterparts. Mexican women had significantly higher levels of BC knowledge (Knowledge Score (KS) = 0.84) compared to US Latinas (KS = 0.77, p<.05), although Mexican women were more likely to report that they did not need to worry about BC at their age (p < 0.05). Age, education, insurance, and KS were significantly associated with EDP among participants. Conclusion: Mexican women residing along the US-Mexico border are not receiving the recommended BC screening procedures, despite having high levels of BC knowledge. Further research is needed to examine other factors of EDP, and ultimately poorer survival rates, among US-Mexico border Latinas.Table 1.Results of multivariate regressiona Mammography/Breast UltrasoundClinical Breast ExamBreast Self ExamVariablebOR (95% CI)OR (95% CI)OR (95% CI)US Latina3.69 (1.61-8.48)d3.41 (1.44-8.12)d1.68 (0.68-4.17)Family History1.52 (0.72-3.22)0.79 (0.39-1.62)1.31 (0.62-2.79)Age1.07 (1.02-1.13)d1.04 (0.99-1.09)0.91 (0.87-0.96)dEducation1.12 (1.01-1.24)c1.14 (1.03-1.28)c1.21 (1.08-1.37)dIncome1.00 (0.99-1.00)1.00 (0.99-1.00)1.00 (0.99-1.00)Marital Status Married/Living w/ Intimate Partner---Single/Never Married0.79 (0.30-2.08)2.42 (0.72-8.12)1.50 (0.41-5.45)Divorced/Widowed/ Separated1.03 (0.42-2.55)0.64 (0.25-1.63)0.28 (0.10-0.77)cInsurance2.08 (1.04-.4.16)c2.83 (1.39-5.75)d12.3 (4.43-34.4)dKnowledge Score24.0 (3.30-175.5)d3.89 (0.53-28.5)1.39 (0.17-11.0)a Results are adjusted odds ratios; bAll variables adjusted for the remaining covariates; c p < 0.05; d p < 0.01 Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 983.

Cultural body shape ideals and eating disorder symptoms among White, Latina, and Black college women.

Previous studies have reported inconsistent relationships between body image, eating disorder symptoms, and acculturation-relevant variables. The current study examined these variables in a sample of White, Latina, and Black college women (N = 276). White and Latina participants selected slimmer personal body shape ideals than Black women. Among Black women, the discrepancy between perceived body shape and perceived ideal body shape for the United States was predictive of Eating Disorder Inventory Body Dissatisfaction (EDI-BD) and Drive for Thinness (EDI-DFT) scores. The discrepancy between perceived body shape and perceived ideal for their ethnic group also predicted EDI-BD scores. Among Latinas, the discrepancy between perceived body shape and perceived body shape ideal for their ethnic group was predictive of EDI-BD and EDI-DFT scores, whereas a discrepancy between perceived body shape and perceived ideal for the United States was not predictive of eating disorder symptoms. Finally, higher levels of acculturative stress, but not acculturation, were associated with EDI-BD scores among Black women and EDI-DFT scores among Latinas. Findings underscore the importance of considering cultural variables such as acculturative stress when conducting clinical work with ethnic minority women.

Skin Color and Self-Perceptions of Immigrant and U.S.-Born Latinas

Research has increasingly identified race as a salient characteristic that affects one's life experiences and psychological well-being. However, little is known about how skin color affects the emotional health of Latinos. The present study examined how skin color relates to the self-perceptions of immigrant (N = 26) and U.S.-born (N = 55) Latina college women. Results indicate that immigrant Latina participants with darker skin tend to have poorer self-perceptions than their U.S.-born peers, including lower self-esteem, lower feelings of attractiveness, and a desire to change their skin color to be lighter. Both racial socialization and ethnic identity served to buffer Latinas from the negative self-perceptions associated with darker skin. These findings suggest that skin color may be a particularly central risk factor for immigrant Latinas' well-being, and racial socialization and ethnic identity may serve as important protective factors.

Mental Health Need and Substance Abuse Problem Risk: Acculturation Among Latinas as a Protective Factor Among CalWORKs Applicants and Recipients

ABSTRACT Recipients of welfare benefits have elevated rates of mental health and substance-related problems relative to the general public; however, low acculturation among Latinos may be a protective factor for both conditions. Lower acculturation among Latinos is associated with lower levels of mental health and substance-related problems relative to highly acculturated individuals. To our knowledge, there are few published studies examining the potential protective effects of low acculturation, defined herein as Spanish language preference, among Latina participants in welfare programs. Screening and treatment of mental health and substance-related problems in this population are important because work requirements for benefits receipt have been implemented and mental health or substance-related problems may be barriers to meeting these requirements. This analysis assesses the prevalence of mental health and substance-related problems among female participants in California's response to 1990s federal welfare reform legislation—the California Work Opportunity and Responsibility to Kids (CalWORKs). Although mental health needs may be similar among CalWORKs recipients regardless of acculturation, substance-related problems may be less frequent among Spanish-speaking Latinas participating in the CalWORKs program. Low acculturation was not a significant predictor of mental health need but had a protective effect with regard to substance-problem risk after controlling for several other substance-problem risk variables.

Self‐Enhancement and Self‐Effacement in Reaction to Praise and Criticism: The Case of Multiethnic Youth

AbstractWe conducted research on the independent and interdependent self which points to cultural differences in self‐enhancing versus self‐effacing perspectives. We investigated members of multiethnic, high school, girls' sports teams and their tendencies to interpret praise or criticism in a self‐effacing or self‐enhancing manner. Our analysis is in the spirit of Bruner's conceptualization of narrative as cultural interpretation. This investigation differs from other studies on the independent and interdependent self in several respects: (1) it is naturalistic; (2) it focuses on ethnic differences within a multicultural society, rather than on cross‐national comparison; (3) primary data sources are qualitative (ethnography, journals); (4) we analyzed cultural perspectives of researchers and participants; and (5) its focus is on adolescence. Euro‐American and African American participants shared a more self‐enhancing perspective, while Asian American and Latina participants shared a more self‐effacing perspective. Differing cultural perspectives produced conflict when participants were faced with contrasting interpretations of praise and criticism. [individualism, independence, collectivism, interdependence, sport, adolescence]

Perceptions of Barriers and Facilitators to Participation in Clinical Trials in HIV-Positive Latinas: A Pilot Study

Women of color comprise a growing proportion of U.S. HIV/AIDS cases and are poorly represented in HIV/AIDS clinical trials. Improved understanding of reasons for low Latina representation in HIV/AIDS clinical trials is needed to promote participation and improve study generalizability. We studied barriers and facilitators to HIV/AIDS trial participation in HIV-positive Latinas in the U.S.-Mexico border region. Forty HIV-positive Latinas, 10 HIV/AIDS service providers, and 4 HIV/AIDS trial recruiters were consented and received interviewer-administered structured surveys. Fisher's exact tests were used to explore differences between women who had and who had not participated in clinical trials. Latinas were Mexican born (70%), preferred health information in Spanish (62.5%), had a mean age of 38 years (range 21-60), had a household income < or = 15,000 dollars/year (62.5%), crossed the border at least once/month (45%), and reported residing in Mexico (15%). We found no significant differences between women who participated in a clinical trial (60%) and those who had not (40%) across language, age, education, and border crossing (p > 0.05). Sixty-three percent of Latinas perceived individual-level barriers (e.g., fear, shame, and stigma), and 10% mentioned system-level barriers (e.g., lack of transportation or language-appropriate services); 70% of providers mentioned system barriers. HIV stigma was not reported as a barrier by providers. The role of stigma in recruitment of HIV-positive Latinas into clinical trials and differences in perceptions of barriers between Latina participants and service providers merit further exploration. Improved understanding of individual and system barriers to clinical trials participation in a binational context is warranted.

Genetic Ancestry and Risk Factors for Breast Cancer among Latinas in the San Francisco Bay Area

Genetic association studies using case-control designs are susceptible to false-positive and false-negative results if there are differences in genetic ancestry between cases and controls. We measured genetic ancestry among Latinas in a population-based case-control study of breast cancer and tested the association between ancestry and known breast cancer risk factors. We reasoned that if genetic ancestry is associated with known breast cancer risk factors, then the results of genetic association studies would be confounded. We used 44 ancestry informative markers to estimate individuals' genetic ancestry in 563 Latina participants. To test whether ancestry is a predictor of hormone therapy use, parity, and body mass index (BMI), we used multivariate logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) associated with a 25% increase in Indigenous American ancestry, adjusting for age, education, and the participant's and grandparents' place of birth. Hormone therapy use was significantly less common among women with higher Indigenous American ancestry (OR, 0.78; 95% CI, 0.63-0.96). Higher Indigenous American ancestry was also significantly associated with overweight (BMI, 25-29.9 versus <25) and obesity (BMI, > or =30 versus <25), but only among foreign-born Latina women (OR, 3.44; 95% CI, 1.97-5.99 and OR, 1.95; 95% CI, 1.24-3.06, respectively). Some breast cancer risk factors are associated with genetic ancestry among Latinas in the San Francisco Bay Area. Therefore, case-control genetic association studies for breast cancer should directly measure genetic ancestry to avoid potential confounding.

Protective Processes of Latina Adolescents

The purpose of this descriptive study was to explore the protective processes of Latina adolescents in the United States. Thirty Latina participants aged 15–19 self-administered an adolescent risk assessment event history calendar (EHC) as part of a clinical feasibility study. The 6–10 year temporaland contextlinked EHC histories of girls who did not report sexual intercourse and substance use were compared with the EHC data of girls who did report these behaviors. Descriptive statistics and the constant comparative method of analysis revealed that both groups of girls had protective processes, but number, type, and patterns varied by group and over time. During school age years, the girls in both groups reported academic achievement and participation in activities/sports, but during adolescence, girls with risk behaviors were more likely to report school failure and dropout of school and activities. Throughout school age and adolescence, girls with no risk behaviors were more likely to report family presence and mentoring, and goals for college. Implications for protection-focused clinical work with Latina adolescents are included.

Weight, Diet, and Physical Activity-Related Beliefs and Practices Among Pregnant and Postpartum Latino Women: The Role of Social Support

Eating and physical activity patterns may contribute to excessive pregnancy weight gain and postpartum retention that increase the risks of obesity and diabetes for both Latino mothers and their children. Social support is an important health determinant and may affect health-related beliefs and behaviors. The objective of this study was to investigate the influence of social support on weight, diet, and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas. A community-based participatory project, Promoting Healthy Lifestyles among Women, was conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and type 2 diabetes. Qualitative analyses of in-depth semistructured interviews with dyads of 10 pregnant and postpartum Latinas, and 10 people who influenced them were conducted. Husbands and some female relatives were primary sources of emotional, instrumental, and informational support for weight, diet, and physical activity-related beliefs and behaviors for Latina participants. Holistic health beliefs and the opinions of others consistently influenced Latinas' motivation and beliefs about the need to remain healthy and the links between behavior and health. Absence of mothers, other female relatives, and friends to provide childcare, companionship for exercise, and advice about food were prominent barriers that limited women's ability to maintain healthy practices during and after pregnancy. The findings support evidence that low-income, recently immigrated pregnant and postpartum Latinas could benefit from community-based, family-oriented interventions that provide social support necessary to promote and sustain healthy lifestyles.

Perceived disadvantages and concerns about abuses of genetic testing for cancer risk: differences across African American, Latina and Caucasian women

Participation in genetic testing for cancer risk is low among women of medically underserved ethnic groups and this is due, in part, to genetic testing attitudes, specifically perceived disadvantages of genetic testing and concerns about possible abuses of genetic testing. The goals of the current study were to: (a) explore genetic testing attitudes, and (b) determine the extent to which ethnicity, awareness of genetic testing, and medical mistrust are associated with genetic testing attitudes. African American, Latina, and Caucasian women ( N=273) completed an interview assessing sociodemographic information, genetic testing awareness, medical mistrust, and genetic testing attitudes. Latina participants more strongly agreed with disadvantages of testing than the other ethnic groups. Both Latina and African American women more strongly concurred with concerns about testing abuses compared to Caucasian women. In hierarchical linear regression analyses, Spanish language preference and medical mistrust were the only significant predictors of perceived disadvantages and medical mistrust was the only significant predictor of abuse concerns. These findings support the importance of identifying genetic testing attitudes that may be culturally specific in order to promote culturally competent care by genetic risk professionals.

Expanding conceptualizations of culturally competent care.

The aim of the study was to gain an understanding of cultural competence from the perspectives of non-mainstream nurse educators, specifically those of Latin heritage. Although the theoretical concepts of 'cultural diversity' and 'culturally competent care' have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to 'center the margins' and explore cultural competence from the margins of one particular non-mainstream nursing group, Latina nurse educators. A grounded theory research design was employed. A group of 10 doctoral, prepared, self-identified, Latina nurse educators participated in face- to-face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices. The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that 'difference' is not solely about specific cultural groups. For example, content about 'Hmongs' or 'Latinos'. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself. Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as 'culturally' different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.

Church-Based Telephone Mammography Counseling with Peer Counselors

Little is published about step-by-step implementation of telephone counseling interventions to promote community-based health activities. This article describes the authors' experience of implementing a church-based telephone mammography counseling intervention with peer counselors representing three principal racial or ethnic groups: African American, Latino, and Anglo (White). Twenty-six women from 12 churches in the Los Angeles area were recruited and trained to deliver the counseling annually over a two-year period to 570 women participants who were recruited from participating churches (n = 15). The counseling sessions were conducted from church-based telephone centers in key geographic locations in our program area. Training and supervision proved challenging: most of the Latino counselors had fewer than seven years of education and spoke only Spanish, while most of the other counselors had at least some college and spoke only English. Culturally specific and small group interactions, role plays, and a more modular approach to training were the most effective ways to enhance counselors' skills. Latina participants' mammography adherence rates were lowest, and their barriers reflected their low socioeconomic status; as Latina counselors shared basic information about mammograms and where to obtain them at little or no cost, the counseling exchanges tended to be nonconflictive and supportive. Black and White participants were generally more knowledgeable and adherent with screening guidelines than Latinas. We found that it was possible to implement this intervention with diverse groups and conclude with lessons learned that may inform others considering such a strategy.

A Psychometric Evaluation of the Six-Factor Self-Concept Scale in a Sample of Racial/Ethnic Minority Women

The Six-Factor Self-Concept Scale (SFSCS) is a multidimensional measure for adults developed and tested with primarily Euro-American samples. This study investigated the psychometric properties of the SFSCS in a diverse sample of racial/ethnic minority college women including African American, Asian American, Latina, and Native American participants. The study compared scale internal consistencies, intercorrelations, normative data, and factor structure for this sample to previously reported findings. This study also looked at the relationship of SFSCS scores to global self-esteem for both the sample as a whole and within ethnic group. Results supported the reliability and construct validity of the subscale scores of the instrument in use with American racial/ethnic minority college women as well as the potential usefulness of SFSCS for studying ethnic and cultural differences.

Mother-Infant Interaction and Breastfeeding Outcome 6 Weeks After Birth

This study explored the relationship of early postpartum maternal-infant interactions to breastfeeding outcome at 6 weeks postpartum. Prospective, comparative descriptive study. Women, Infants, and Children Supplemental Nutrition Program and Comprehensive Perinatal Services Programs in northern California. Forty-two Latina participants were recruited in the 3rd trimester of pregnancy. Eligibility criteria included age 18 years or older, primiparous at recruitment, antepartum desire to breastfeed 8 weeks or longer postpartum, planned hospital birth, full-term vaginal birth of a healthy newborn, and an uncomplicated, immediate postpartum course for mother and newborn, including being discharged together. The study examined breastfeeding dyads' early postpartum scores on Barnard's Nursing Child Assessment Feeding Scale (NCAFS) in relation to breastfeeding outcome 6 weeks postpartum. NCAFS tests were performed 28-90 hours postpartum in the participants' homes, and breastfeeding status was assessed by phone contact 6 weeks postpartum. Dyads continuing to breastfeed at 6 weeks postpartum had significantly higher early postpartum NCAFS scores than did dyads who had weaned from the breast by 6 weeks postpartum. Optimal maternal-infant interactions, as evidenced by higher scores on Barnard's NCAFS, were related to longer breastfeeding duration. Lower scores on the NCAFS, suggesting difficulties in maternal-infant interaction, were related to weaning earlier than planned.