Latino Subgroups Research Articles

Birth characteristics and risk of meningioma in a population-based study in California.

We evaluated the potential role of birth characteristics in the etiology of early-onset meningioma. Leveraging a population-based linkage of California birth records (from 1978 to 2015) and cancer registry data (from 1988 to 2015), we identified 362 nonmalignant meningioma cases aged 0-37 years and selected 18 100 controls matched on year of birth. Cases and controls were compared with regard to birth characteristics, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) estimated from unconditional multivariable logistic regression models. We also conducted stratified analyses by race/ethnicity and age. Female sex (compared to male: OR = 1.43, 95% CI: 1.16 to 1.79; P < .01) and Black race (compared to White: OR = 1.46, 95% CI: 1.02 to 2.07; P = .04) were associated with higher risk of meningioma. Higher birth order (OR = 0.90, 95% CI: 0.81 to 0.99 per additional birth position; P = .04) was associated with a lower risk. No significant associations were observed between birthweight, gestational age, delivery mode, maternal age, or maternal education and meningioma risk. In the non-Latino White subgroup, higher birthweight was associated with a higher risk of meningioma (OR = 1.20, 95% CI: 1.02 to 1.41 per 500 grams; P = .03), but this was not recapitulated in the Latino subgroup. In age-stratified analyses, female sex was a risk factor for those diagnosed at the age of 20-37 years but not among younger individuals. In this large population-based study less prone to selection and recall bias, higher birth order was associated with a reduced risk of early-onset meningioma, while female sex and Black race were linked to an increased risk. There were also indications of differential associations by race/ethnicity and age of diagnosis.

Eating disorders' instruments validated and adapted for the Hispanic/Latino population in the United States.

The instruments to explore eating disorders (ED) have been developed and evaluated mainly for the Caucasian population. This situation has limited the availability of instruments validated and adapted for the Latino/Hispanic population. Due to the challenge it represents for researchers in the United States who study ED in Latinos/Hispanics, this article aims to review the instruments in Spanish that have been validated and adapted for the Latino/Hispanic population living in the United States. In addition, psychometric and cultural considerations that should be incorporated when using an instrument that has been constructed and evaluated for a specific population or sub-population will be discussed. Four instruments, two to establish diagnoses of ED (S-EDE and EDE-Q) and two to explore symptoms associated with body dissatisfaction (BSQ and BICI) were identified. The availability of instruments in Spanish for use with Latinos in the United States is very limited and has not been evaluated in all the subgroups of Latinos / Hispanics that comprise the population in the United States. This is a challenge for clinicians and researchers working with the Latino / Hispanic community with ED in the United States. (Words count: 186).

A Genome-Wide Association Study of Severe Asthma Exacerbations in Latino Children and Adolescents

Asthma is the most common chronic respiratory disease among children, and, although, in genome-wide association studies, researchers have identified specific loci related to asthma, there is little known about genetic determinants of asthma exacerbations. Recent evidence suggests some susceptibility variants for asthma-related outcomes are ethnicity specific. The purpose of this study was to investigate the effect of these susceptibility variants in Latino subgroups by performing a meta-analysis of genome-wide association studies of severe asthma exacerbations among Hispanic youth with asthma.This meta-analysis involved 4 separate studies (Hartford Puerto Rico study, the Genetics of Asthma in Latino Americans study, the Genetics of Asthma in Costa Rica study, and the Social Change, Asthma and Allergy in Latin America study) with a population of 4010 Latino children (1693 Puerto Ricans, 1019 Costa Ricans, 640 Mexicans, 256 Brazilians, and 402 members from other Latino subgroups). A total of 2509 individuals with asthma and ≥1 severe asthma exacerbation were included as cases, and 1501 individuals with asthma but no severe asthma exacerbation were included as controls.Methylation quantitative trait locus, expression quantitative trait locus, and expression quantitative trait methylation analyses were conducted to assess if the top single-nucleotide polymorphism (SNP) identified in the meta-analysis was linked to DNA methylation and gene expression in airway epithelium.In this meta-analysis, researchers found 1 SNP (rs2253681) in the FLJ22447 locus on chromosome 14q23.2 that was significantly associated with severe asthma exacerbations (P < 5 × 10−8). Each copy of the minor allele of SNP rs2253681 was associated with 1.55 times increased odds of severe asthma exacerbations (95% confidence interval: 1.34 to 1.79; P = 6.3 × 10−9).SNP rs2253681 was found to be significantly associated with severe asthma exacerbations in Latino children and adolescents with asthma.This study reveals the potential utility of genomics in the counseling and management of asthma. As more genetic mutations associated with asthma and asthma outcomes are identified, the better we can understand genetic components of this disease and can develop targeted therapies on the basis of gene-specific changes. Further genomic studies are needed to identify mutations associated with airway function and severe asthma exacerbations to identify those at risk for worse outcomes and those who may respond better to certain therapies on the basis of genetics.

Age Patterns in Self-Reported Cognitive Impairment Among Older Latino Subgroups and Non-Latino Whites in the United States, 1997-2018: Implications for Public Health Policy.

Background and ObjectivesU.S. Latinos are a heterogeneous population with unique characteristics related to individual-level socioeconomic and contextual factors based on nativity status and country of origin. Population aging and greater public awareness of dementia may contribute to an increasing prevalence of self-reported cognitive impairment. However, population-level trends in self-reported cognitive impairment among Latinos are unclear and it is unknown whether there are differences among Latino subgroups. Thus, this study aims to examine heterogeneity in self-reported cognitive impairment among older U.S. Latino subgroups.Research Design and MethodsWe used data from the 1997–2018 National Health Interview Survey to document age-specific patterns in self-reported cognitive impairment among U.S.-born Mexican, foreign-born Mexican, island-born Puerto Rican, foreign-born Cuban, and U.S.-born non-Latino Whites aged 60 and older. We estimated hierarchical age–period–cohort cross-classified random effects models (HAPC-CCREM) to isolate age patterns in self-reported cognitive impairment across disaggregated Latino subgroups and U.S.-born non-Latino Whites.ResultsThe overall prevalence of self-reported cognitive impairment increased from 6.0% in 1997 to 7.1% in 2018. This increase was evident among U.S.-born non-Latino Whites and U.S.-born and foreign-born Mexicans but not other Latino subgroups. Fully adjusted HAPC-CCREM estimates indicated that Latinos were more likely to self-report cognitive impairment than U.S-born non-Latino Whites (b = 0.371, p < .001). When disaggregated by Latino subgroup, the difference in the likelihood for self-reported cognitive impairment compared to U.S.-born non-Latino Whites was greatest for island-born Puerto Ricans (b = 0.598, p < .001) and smallest for foreign-born Cubans (b = 0.131, p > .05).Discussion and ImplicationsWe found evidence of considerable heterogeneity in the age patterns of self-reported cognitive impairment among U.S. Latino subgroups. We also detected large differences in the likelihood for self-reported cognitive impairment between U.S. Latino subgroups compared to U.S.-born non-Latino Whites. These results underscore the importance of differentiating between unique Latino subpopulations when studying population-level trends in cognitive function.

The Other US Border: Health Insurance Coverage Among Latino Immigrants In Puerto Rico.

Puerto Rico is a US territory and a popular destination for Latino immigrants in the Caribbean. Even with few language and cultural barriers, however, many Latino immigrants in Puerto Rico are uninsured. Using data from the 2014-19 Puerto Rico Community Survey, we examined inequities in health insurance coverage for non-Puerto Rican Latinos ages 18-64 living in Puerto Rico according to citizenship status and Latino subgroup (Dominican, Cuban, Mexican, and other Latino). After controlling for potential confounders, we found that noncitizen Dominicans had a significantly lower probability of having any health insurance (57.2percent) and having any private insurance (31.5percent). Regardless of similarities in culture and language, Latino immigrants on the island, particularly Dominicans, experience major health insurance coverage inequities. Considering that Puerto Rico's immigration system is regulated by US federal statute, both federal and local policy makers should acknowledge and focus on reducing these immigrant disparities in health insurance coverage.

Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder.

The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n=30), ABBT (n=30), or treatment as usual (TAU) (n=30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.

Healthcare Needs of U.S. Rural Latinos: A Growing, Multicultural Population.

From 2000 to 2050, the Latino population in the United States (U.S.) is expected to grow by 273%. Health outcomes vary widely among Latino subgroups and health disparities more adversely affect rural residents. The commonly used "one-size-fits-all" approach assumes that the U.S. Latino population is homogeneous. Rural Latinos in four study states: Arizona (AZ), California (CA), Florida (FL) and Texas (TX) were the focus of this study. This research describes changes in the Latino population in rural counties of the U.S. in two dimensions: 1) change in population by number, and 2) change in population by country of origin using data from 2000-2017. The following themes emerged: 1) the overall Latino population grew in each state; 2) rural Latino populations in each state also increased but at a higher rate; 3) there is a variety of diversity in the countries of origin of rural Latinos based in each state; and 4) a considerable proportion of Latinos living in rural areas are of unknown Latino origins. As the largest racial or ethnic minority in rural populations and as the second largest group in the nation, Latino health has a significant influence on the U.S. healthcare system. For nurses, evidence-based strategies can be tailored to address diverse Latino subpopulations to reduce specific disparities for various ethnic populations.

Heterogeneity in Self-Reported Cognitive Impairment Life Expectancies Among Older Latino Subgroups in the United States

Research suggests the prevalence of cognitive impairment among older U.S. Latinos is increasing relative to the older U.S. population which has experienced and overall decline. This has been attributed in part to extended longevity, lower educational attainment, and a higher prevalence of diabetes and cardiovascular disease among older Latinos. However, less is known regarding the number of years and proportion of late life spent with self-reported cognitive impairment among this rapidly aging group and whether cognitive impairment life expectancy outcomes vary across U.S. Latino subgroups by country of origin. To fill this gap, our investigation uses data from the National Health Interview Survey (1997-2015) to estimate Sullivan-based life tables of cognitively normal and cognitively impaired life expectancies for adults 50 years and older. Results indicate significant heterogeneity among Latinos, with island-born Puerto Rican women spending the most years, and foreign-born Cuban men the fewest years lived with self-reported cognitive impairment.

Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study

This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life.

Cultural stress in the age of mass xenophobia: Perspectives from Latin/o adolescents

During the last four years, xenophobic rhetoric directed toward Latino immigrants in U.S. media outlets and political forums has greatly increased. Using a general inductive approach, this qualitative study examined the forms of cultural stress, with a focus on discrimination and xenophobia, experienced by Latino adolescents in urban U.S. settings in 2018 and 2019. Six focus groups were conducted in Miami and Los Angeles (three groups per city) with first- and second-generation tenth-grade Latino students (n = 34). The following four themes emerged from the data: perceived discrimination from other Latino subgroups (in-group discrimination), perceived discrimination from non-Latino groups (out-group discrimination), internalization of stressors and discrimination experienced by participants' parents, and the current U.S. political rhetoric surrounding immigration. Understanding cultural stress among Latino adolescents provides valuable insight for future interventions to offset negative health outcomes associated with cultural stress.

A genome-wide association study of severe asthma exacerbations in Latino children and adolescents.

Severe asthma exacerbations are a major cause of school absences and healthcare costs in children, particularly those in high-risk racial/ethnic groups.To identify susceptibility genes for severe asthma exacerbations in Latino children and adolescents, we conducted a meta-analysis of genome-wide association studies (GWAS) in 4010 Latino youth with asthma in four independent cohorts, including 1693 Puerto Ricans, 1019 Costa Ricans, 640 Mexicans, 256 Brazilians and 402 members of other Latino subgroups. We then conducted methylation quantitative trait locus, expression quantitative trait locus and expression quantitative trait methylation analyses to assess whether the top single nucleotide polymorphism (SNP) in the meta-analysis is linked to DNA methylation and gene expression in nasal (airway) epithelium in separate cohorts of Puerto Rican and Dutch children and adolescents.In the meta-analysis of GWAS, an SNP in FLJ22447 (rs2253681) was significantly associated with 1.55 increased odds of severe asthma exacerbation (95% CI 1.34-1.79, p=6.3×10-9). This SNP was significantly associated with DNA methylation of a CpG site (cg25024579) at the FLJ22447 locus, which was in turn associated with increased expression of KCNJ2-AS1 in nasal airway epithelium from Puerto Rican children and adolescents (β=0.10, p=2.18×10-7).SNP rs2253681 was significantly associated with both DNA methylation of a cis-CpG in FLJ22447 and severe asthma exacerbations in Latino youth. This may be partly explained by changes in airway epithelial expression of a gene recently implicated in atopic asthma in Puerto Rican children and adolescents (KCNJ2-AS1).

Older Latino Mental Health: A Complicated Picture.

The aggregation of Latino subgroups in national studies creates an overly simplistic narrative that Latinos are at lower risk of mental illness and that foreign nativity seems protective against mental illness (i.e., immigrant paradox). This broad generalization does not hold up as the Latino population ages. Given that social inequalities for risk appear to widen with age, the social disadvantages of being Latino in the United States increase the risk for mental illness across the life span. This review focuses on the mental health of older Latinos, specifically the 3 subgroups with the longest residential history in the United States—Mexicans, Puerto Ricans, and Cubans. We examine relevant epidemiological and clinical psychopathology studies on aging in these Latino populations and present evidence of the heterogeneity of the older Latino population living in the United States, thus illustrating a limitation in this field—combining Latino subgroups despite their diversity because of small sample sizes. We address the migration experience—how intraethnic differences and age of migration affect mental health—and discuss social support and discrimination as key risk and protective factors. We conclude with a discussion on meeting the mental health needs of older Latinos with a focus on prevention, a promising approach to addressing mental illness in older Latinos, and future directions for mental health research in this population. Success in this endeavor would yield a substantial reduction in the burden of late-life depression and anxiety and a positive public health impact.

Factorial invariance of the Marianismo Beliefs Scale among Latinos in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

The Marianismo Beliefs Scale (MBS) assesses five components of marianismo, a cultural script of Latina gender role expectations. This study evaluated the MBS's psychometric properties across language, sex, and Latino subgroups (Mexican American, Central American, Cuban American, Dominican American, Puerto Rican, and South American). Study sample was derived from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study which consisted of a community sample of 4879 Latino adults aged 18-64 from four field centers (Miami, FL, USA; San Diego, CA, USA; Bronx, NY, USA; Chicago, IL, USA). Confirmatory factor analyses supported five factors. English and Spanish versions demonstrated equivalence of factor loadings and error variances across Latino subgroups and sex. Although the MBS English and Spanish versions are psychometrically sound measures for male and female Latino adults, future research is needed to determine whether direct scale scores are comparable.

Age of Migration and Cognitive Function Among Older Latinos in the United States.

Age of migration has been shown to have a robust association with Latino immigrant health outcomes; however, the relationship between timing of migration and cognition is less understood. To examine associations between race/ethnicity, nativity, age of migration, and cognitive aging among US-born (USB) non-Latino Whites (NLW) and USB and foreign-born Latinos 50 years and older. We used longitudinal biennial data from the Health and Retirement Study (HRS; 2006-2014) to fit generalized linear and linear latent growth curve models for: 1) global cognition (Modified Telephone Interview for Cognitive Status; TICS-M); 2) memory and attention subdomains of TICS-M; and 3) cognitive dysfunction. We also tested for sex modifications. In age and sex adjusted models, all Latino subgroups, independent of nativity and age of migration, had lower global and domain-specific cognitive scores and higher propensity of cognitive impairment classification compared to USB-NLWs. Differences between USB Latinos, but not other Latino subgroups, and USB-NLWs remained after full covariate adjustment. Latinas, independent of nativity or age of migration, had poorer cognitive scores relative to NLW females. Differences between all Latinos and USB-NLWs were principally expressed at baseline. Racial/ethnic, nativity, and age of migration grouping was not associated with slope (nor explained variance) of cognitive decline. Older US-born Latinos, regardless of sex exhibit poorer cognitive function than older USB-NLWs and foreign-born Latinos. Social determinants that differentially affect cognitive function, particularly those that compensate for education and sex differences among US-born Latinos and foreign-born Latinos, require further exploration.

Abstract A094: The relationship between migration and integration stressors and tobacco use in a migrant Mixteco community

Abstract Cigarette smoking is one of the leading causes of chronic disease morbidity and mortality across the world. In the U.S., Latinos have a lower prevalence of smoking when compared to other ethnic/racial groups, but when disaggregated there exist significant differences within Latino subgroups (Bandeira et al., 2015). In the scientific literature, little attention has been given to tobacco use among indigenous Mexican migrants. This study analyzes the relationship between experiences (stressors) linked to migration and tobacco use in an indigenous Mixteco migrant community. Migration stressors include the negative experiences on an individual's journey to the United States while integration stressors are the negative experiences of integrating into society once arriving in the U.S. We hypothesize that there is a significant relationship between the level of migration and integration stressors and tobacco use. A sample of 901 indigenous Mixteco participants from a high-emigrating town in the southern Mexican state of Oaxaca completed structured questionnaires focused on migration history, demographics, and health outcomes. In the US, cross-sectional data were collected in the corresponding satellite communities in southern California. Statistical analyses were conducted using Stata 15 and R version 3.4.3. We generated descriptive statistics for sample characteristics, which are stratified by gender (men/women) and tested for association. A series of logistic regression models were used to predict the association between migration stressors and integration stressors and cigarette smoking. This study yields new information on the relationship between migration, integration, and tobacco use among indigenous Mexican migrants. Although the primary predictor of interest showed no significant association with our outcome, certain findings add to the existing literature on migration and health. These findings include gendered differences in smoking, higher odds of smoking among return migrants, and higher odds of smoking among English language speakers. Citation Format: Gilberto Lopez, Heather Mattie, Vaughan Rees, David R. Williams. The relationship between migration and integration stressors and tobacco use in a migrant Mixteco community [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 A094.

Emerging Bicultural Views of Fatherhood

Puerto Rican fathers remain an understudied population despite the growing Latino community in the U.S. Understanding how Puerto Rican fathers perceive their roles as fathers can inform our conceptualization of their engagement with children as well as the development of culturally-specific parenting interventions. In this qualitative study, focus groups were conducted with Puerto Rican men to identify their perceptions of their role as a father and how individual, child, and cultural influences may relate to these roles. Parenting roles identified by fathers in the study were: being there, maintaining open communication, building confidence, preparing for adulthood, teaching culture/values, and providing a role model for their children. The study also explored father and child characteristics, history with their own father, and a hybrid cultural perspective as influences on Puerto Rican fathers’ perceptions of their parenting roles. Due to the increasing population of Puerto Rican and other Latino sub-groups, providers and social workers working with Puerto Rican families should understanding the perceived parenting roles within families to better engage and support fathers and families within this growing population.

Nativity and Country of Origin Variations in Life Expectancy With Functional Limitations Among Older Hispanics in the United States.

This study examined racial/ethnic, nativity, and country of origin differences in life expectancy with and without functional limitations among older adults in the United States. We used data from the National Health Interview Survey (1999-2015) to estimate Sullivan-based life tables of life expectancies with functional limitations and without functional limitations by sex for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and U.S.-born Whites. We find that Latinos exhibit heterogeneous life expectancies with functional limitations. Among females, U.S.-born Mexicans, foreign-born Mexicans, and foreign-born Cubans spend significantly fewer years without functional limitations, whereas island-born Puerto Ricans spend more years with functional limitations. For men, U.S.-born Puerto Ricans were the only Latino subgroup disadvantaged in the number of years lived with functional limitations. Conversely, foreign-born Cubans spend significantly fewer years without functional limitations. To address disparities in functional limitations, we must consider variation in health among Latino subgroups.

Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Background: Prior research shows inconsistent associations between socioeconomic status (SES) and alcohol outcomes, particularly for immigrant populations. Conventional markers of SES may not fully capture how social position affects health in these groups. Objective: We examine: (1) the associations of two alternative indicators, subjective social status (SSS) and financial hardship, with problem drinking outcomes, heavy episodic drinking (HED) and alcohol use disorder (AUD), for Asian Americans and Latinos; and (2) moderation of these relationships by educational level and nativity status. Methods: Multiple logistic regression modeling was performed using nationally-representative Asian American (n = 2,095) and Latino samples (n = 2,554) from the National Latino and Asian American Study. Age, gender, nativity, individual-level SES (income and education), unfair treatment, racial discrimination, and social support were adjusted. Results: Financial hardship was independently associated with AUD in both Asians and Latinos. Lower SSS was associated with increased AUD risk among individuals with college degrees or with US nativity in both populations. The association between financial hardship and HED was positive for US-born Latinos and foreign-born Asians, and negative for foreign-born Latinos. Conclusions: SSS and financial hardship are indicators of SES that may have particular relevance for immigrant health, independently of education and income, with SSS particularly meaningful for AUD in the more conventionally advantaged subgroups. There may be underlying processes affecting Asian and other Latino subgroups with similar socioeconomic and nativity profiles and exposing them to common risk/protective factors of AUD.

Gender Differences in End-of-Life Care in Older Mexican American Adults.

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults' gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.

Breaking the Paradox: Comparing Food Allergy Prevalence Among Latino Sub-Groups in the United States

Breaking the Paradox: Comparing Food Allergy Prevalence Among Latino Sub-Groups in the United States