Spanish Language Preference Research Articles

Dyslipidemia Patterns among Hispanics/Latinos of Diverse Background in the United States

BackgroundThe prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known. MethodsLipid and lipoprotein data were used from the Hispanic Community Health Study/Study of Latinos–a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74 years. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, and biological and acculturation characteristics were compared among those with and without dyslipidemia. ResultsMean age was 41.1 years, and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated low-density lipoprotein cholesterol was 36.0%, and highest among Cubans (44.5%; P < .001). Low high-density lipoprotein cholesterol (HDL-C) was present in 41.4% and did not significantly differ across Hispanic background groups (P = .09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; P < .001). Elevated non-HDL-C was seen in 34.7%, with the highest prevalence among Cubans (43.3%; P < .001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index, and low physical activity. Older age, female sex, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence. ConclusionDyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds, with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population.

The psychometric properties of the generalized anxiety disorder-7 scale in Hispanic Americans with English or Spanish language preference.

The Generalized Anxiety Disorder-7 scale (GAD-7) is a self-report questionnaire that is widely used to screen for anxiety. The GAD-7 has been translated into numerous languages, including Spanish. Previous studies evaluating the structural validity of the English and Spanish versions indicate a unidimensional factor structure in both languages. However, the psychometric properties of the Spanish language version have yet to be evaluated in samples outside of Spain, and the measure has not been tested for use among Hispanic Americans. This study evaluated the reliability, structural validity, and convergent validity of the English and Spanish language versions of the GAD-7 for Hispanic Americans in the United States. A community sample of 436 Hispanic Americans with an English (n = 210) or Spanish (n = 226) language preference completed the GAD-7. Multiple-group confirmatory factor analysis (CFA) was used to examine the goodness-of-fit of the unidimensional factor structure of the GAD-7 across language-preference groups. Results from the multiple-group CFA indicated a similar unidimensional factor structure with equivalent response patterns and item intercepts, but different variances, across language-preference groups. Internal consistency was good for both English and Spanish language-preference groups. The GAD-7 also evidenced good convergent validity as demonstrated by significant correlations in expected directions with the Perceived Stress Scale, the Patient Health Questionnaire-9, and the Physical Health domain of the World Health Organization Quality of Life-BREF assessment. The unidimensional GAD-7 is suitable for use among Hispanic Americans with an English or Spanish language preference.

Psychometric Evaluation of the Brief Acculturation Scale for Hispanics.

This study examined the psychometric properties of the Brief Acculturation Scale for Hispanics (BASH), a four-item, language-based measure of acculturation. Participants in the study were 435 Hispanic Americans from a large metropolitan area with English or Spanish language preference. Internal consistency reliability was strong in both language-preference groups. Multiple-group confirmatory factor analysis was used to evaluate the structural validity of the measure. A unidimensional factor structure was found for both English and Spanish language-preference groups and items loaded equivalently across groups, demonstrating measurement invariance. The BASH had good convergent validity and incremental validity. Overall, this study provides further evidence that the BASH offers a brief, reliable, and valid measure of acculturation to be used among Hispanic Americans.

The Differential Relationship Between Parental Worry and Adolescent Outcomes by Linguistic Preference Among Low-Income Mexican American Families

This study examined the moderating effects of parents’ linguistic preference, as a proxy for acculturation, on the relationship between parental worry and problem behaviors among 130 Mexican American early adolescents (M age = 13; 51 % male) living in public housing neighborhoods in the Southwestern United States. Based on the family stress model we hypothesized that adolescents whose parents reported more general worry would have higher rates of delinquency and substance use and those who reported higher levels of parental supervision would have lower rates of delinquency and substance use. We hypothesized that these relationships would differ by linguistic preference, with Spanish language being equated to less acculturation and more risky. Hierarchal linear models controlling for multiple children in the same family indicated that worry among parents predicted higher rates of delinquency and substance use for adolescents whose parents were more acculturated whereas no relationship was found for less acculturated parents. No support was found for the protective effect of parental supervision and parental worry did not predict levels of supervision. These findings suggest that global worry among parents may impact delinquency and substance use among adolescents in families with parents who prefer Spanish through pathways other than supervision. The protective effect of Spanish language preference, which may indicate lower parental acculturation among Mexican American youth, indicates the need for more research examining possible mediators of the relationship between living in high-risk environments such as public housing and adolescent delinquency and substance use in this population.

The Accuracy and Trends of Smoking History Documentation in Electronic Medical Records in a Large Managed Care Organization

The accuracy of smoking history documentation in the electronic medical records was examined at a large managed care organization among 36,494 male members who self-reported smoking history in mailed surveys. The sensitivity of electronic smoking history documentation for ever-smoking status was 0.19 in years 2003–2005 (using ICD-9/CPT code only), 0.80 in 2006–2008 and 0.84 in 2009–2010 (combination of ICD-9/CPT codes and risk factor module used after 2006). The positive predictive value was 0.96, 0.90, and 0.95 in these periods, respectively. Among self-reported ever-smokers, increased healthcare utilization and smoking intensity/duration were associated with higher likelihood of having electronic smoking history documentation, while Asian race and Spanish language preference were associated with lower likelihood. These data suggest that enhanced efforts may be needed to screen for and document smoking among racial/ethnic minorities.

Racial/ethnic disparities in Medicare Part D experiences.

To examine racial/ethnic differences in Medicare beneficiary experiences with Medicare Part D prescription drug (PD) coverage. 2008 Consumer Assessment of Health Care Providers and Systems survey of U.S. Medicare beneficiaries. Surveys were administered by mail with phone follow-up to a nationally representative sample (61% response rate). This study examines 201,496 beneficiaries of age 65 and older with PD coverage [6% Hispanic, 7% non-Hispanic Black, 3% non-Hispanic Asian or Pacific Islander (API)]. Key variables are self-reported race/ethnicity and Consumer Assessment of Health Care Providers and Systems getting information and needed PDs measures. We generated weighted case-mix adjusted means for 4 racial/ethnic groups and for Hispanics separately by English-language or Spanish-language preference status. We calculated within-plan disparities using a linear mixed-effect model, with fixed effects for race/ethnicity, coverage type and case-mix variables, and random effects for contract and contract by race/ethnicity interactions. Disparities for Hispanic, Black, and API beneficiaries on obtaining needed PDs and information regarding coverage range from -2 to -11 points (0-100 scale) relative to non-Hispanic Whites, with the greatest disparities observed for Spanish-preferring Hispanics and API beneficiaries, especially those with low income. There is wide variation in disparities across contracts, and contracts with the largest disparities for Hispanics have higher proportions of beneficiaries with lower education and income. Quality improvement efforts may be needed to reduce racial/ethnic disparities in beneficiary experience with PD coverage. Cultural, language, and health literacy barriers in navigating Medicare's Part D program may partially explain the observed disparities.

Depressive symptomatology among Latina breast cancer survivors

Healthcare professionals are providing care for a growing number of Latinas who are breast cancer survivors (BCS) and at greater risk for distress. This study reports on the prevalence of depressive symptomatology among a cohort of Latina BCS. This study reports the outcomes of a population-based sample of 232 Latina BCS recruited via case ascertainment from the California-Cancer and hospital registries. Fifty-three percent had elevated depressive symptoms. In the regression model, education, physical functioning, social support, family stress, functional stress, social functioning, and Spanish language preference were significantly associated with depressive symptoms. Among Latina BCS, the prevalence of depressed mood may be higher than European-Americans and presents a formidable clinical challenge. These findings underscore the need for timely, appropriate assessment of distress and its contributing factors including patients' socio-ecological contexts and family strain to inform effective patient-centered and family-centered psychosocial referrals and intervention strategies to reduce distress and the undue burden of cancer among Latinos. Latino survivors constitute an increasing proportion of patients in community medical practices. Thus, the requisite to perform follow-up cancer care that addresses the needs of the whole person is rapidly emerging in prominence as a component of medical practice. Therefore, primary care providers and oncology and mental health specialists must work collaboratively via the sharing of electronic medical records, survivorship care plans, and consultations to implement the Institute of Medicine and National Comprehensive Cancer Network recommendations by attending to the psychological status of cancer patients to optimize patient outcomes.

Are patient characteristics associated with quality of depression care and outcomes in collaborative care programs for depression?

Objective To determine whether demographic or clinical characteristics of primary care patients are associated with depression treatment quality and outcomes within a collaborative care model. Methods Collaborative depression care, based on principles from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, was implemented in six community health organizations serving disadvantaged patients. Over 3 years, 2821 patients were treated. Outcomes were receipt of quality treatment and depression improvement. Results Logistic regression analyses revealed that patients who were older, more depressed or more anxious were more likely to be retained in treatment and to receive appropriate pharmacotherapy. Whereas gender and depression severity were unrelated to depression outcomes, significantly more patients who preferred Spanish (59.1%) than English (48.5%, P<.01) improved within 12 weeks in multivariate analyses. High baseline anxiety was associated with a lower probability of improvement, and older age showed a similar trend. Survival analyses demonstrated that patients who preferred Spanish or were less anxious improved significantly more rapidly than their counterparts ( P<.001). Conclusions Patients with more anxiety received higher quality care but experienced worse depression outcomes than less anxious patients. Spanish language preference was strongly associated with depression improvement. This collaborative care program attained admirable outcomes among disadvantaged Spanish-speaking patients without extensive cultural tailoring of care.

Is Spanish Language a Barrier to Domestic Violence Assessment?

Domestic violence is the leading cause of injury to premenopausal women and fatal in over 1000 women annually, but few healthcare providers ask about it, citing numerous barriers, including language. This study tested the hypothesis that language does, in fact, pose a barrier to screening and that Spanish-speaking women report lower lifetime screening rates. This study was part of an ongoing, multiclinic site, cervical cancer prevention trial in which patients completed a baseline survey, available in both Spanish and English, with the question: "Has a doctor or other healthcare provider ever asked you about domestic violence?" as well as other questions. Of 2591 women, 1017 (39%) chose to complete the survey in Spanish and 1574 (61%) in English. Within the entire group, 1137 (44%) reported having been asked about domestic violence. Among those completing the Spanish survey, this rate was 47% (lifetime assessment), and among English-language respondents, it was surprisingly lower at 42% (p=0.011). In multivariate analyses, however, this language effect was reduced to nonsignificance. Instead, age (particularly the 28-34-year quartile), having been pregnant, clinic site, and type of medical visit (postpartum) were positively associated with lifetime assessment. This study found a Spanish language preference is not a barrier to domestic violence assessment.

An Analysis of Language as a Barrier to Receiving Influenza Vaccinations among an Elderly Hispanic Population in the United States

Background. The Hispanic population in the United States is growing, and disparities in the receipt of healthcare services as a result of limited English proficiency have been demonstrated. We set out to determine if Spanish language preference was a barrier to receiving influenza vaccinations among Hispanic persons 65 years and older in the USA. Methods. Differences in the receipt of vaccinations by language preference were tested with both Chi-square analyses and adjusted logistic regression analyses. Results. Findings suggest that elderly Hispanic persons, 65 years of age and older, who prefer to communicate in Spanish instead of English, are significantly less likely to have received influenza vaccinations when compared to their Hispanic counterparts who prefer to communicate in English. Conclusions. Influenza infections can more often be fatal in older persons and may disparately affect minority populations such as Hispanic persons. Therefore, understanding barriers to the receipt of effective preventive health measures is necessary.

Self-efficacy for Coping With Cancer in a Multiethnic Sample of Breast Cancer Patients: Associations With Barriers to Pain Management and Distress

This study examined the interrelations of self-efficacy for coping with cancer, perceived barriers to pain management, distress, and pain outcomes in a multiethnic sample of breast cancer patients. The extent to which ethnicity (Black, Latina, or White), language (English or Spanish), and level of education and income predicted these variables was also assessed. Participants were breast cancer patients with persistent pain (N=87) who were recruited from oncology clinics in New York City. Patients completed an assessment battery that included measures of self-efficacy for coping with cancer, barriers to pain management, distress, and pain outcomes. Greater self-efficacy for coping with cancer was associated with older age, less time since diagnosis, and less distress. In addition, less self-efficacy for seeking and understanding medical information, Spanish language preference, and greater distress predicted greater barriers to pain management. Average pain severity was higher among Spanish-speaking individuals and those with lower incomes. Findings point to the potential importance of self-efficacy for seeking and understanding medical information and perceived barriers to pain management in understanding the psychologic well-being of breast cancer patients with pain, especially those who are Spanish-speaking.

431: Describing the Characteristics of Non-Border Patient Populations That Utilize Cross Border Health Services

Medical tourism has become a buzzword in the mass media. Typically it refers to patients who travel abroad to receive specialized health services. However, these are not the only patients traveling abroad for care. Another group of patients, mainly from low-income populations, receive much more routine health services in other countries. Studies in the southwestern US where health systems in Mexico and the United States abut have shown that 41.2% of a low-income border population use cross-border physician health services. In this population, Spanish language preference and ease of obtaining prescription medications were the most common reported reasons for seeking cross-border care. To date, little is known about the characteristics and motivations of non-border populations who travel to other countries to receive routine health services. Economic, social and cultural motivations have been postulated, but not yet tested. Also, it is unknown if these patients receive health services abroad because they choose to or because they feel like they have to.

Spanish Language Immersion and Reinforcement During Residency: A Model for Rapid Acquisition of Competency

Background: Residencies serving non-English-speaking populations face the challenge of language training in addition to usual resident education issues. The clinic for the Lawrence Family Medicine residency is based in a 45,000-person Community Health Center serving a majority Spanish-language preference population. Although translators are available, they increase visit time for patients. Description: Three successive intern classes and one faculty member (n = 24) participated in a preresidency, 10-day immersion program at a nearby language institute; thrice-monthly classroom instruction for a year; and personal instruction during continuity clinics by a teacher/translator during the R1 year. Results: An independent examiner tested participants (average age = 29.5; 15 female) using a competency examination based on American Council of Teachers of Foreign Languages scoring. Prior Spanish preparation averaged 2 years in high school and 1 year of college, but was variable. Results were compared with Tukey's Honestly Significant Differences test of repeated measures. All individuals improved following immersion, 4.8 to 6.3, (p <.01), and 6 months of reinforcement, 6.3 to 7.4 (p <.05). The first cohort (n = 7), including those entering with little Spanish ability, scored at a level permitting use of five verb tenses after 2 years (cost = $5,035.00/resident). Conclusions: This study demonstrates significant improvement in Spanish competency after 10-day immersion, and continued improvement following 6 months of reinforcement.

Language Spoken and Differences in Health Status, Access to Care, and Receipt of Preventive Services Among US Hispanics

We examined self-reported health status, health behaviors, access to care, and use of preventive services of the US Hispanic adult population to identify language-associated disparities. We analyzed 2003 to 2005 Behavioral Risk Factor Surveillance System data from 45 076 Hispanic adults in 23 states, who represented 90% of the US Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics. Physical activity and rates of chronic disease, obesity, and smoking were significantly lower among Spanish-speaking Hispanics than among English-speaking Hispanics. Spanish-speaking Hispanics reported far worse health status and access to care than did English-speaking Hispanics (39% vs 17% in fair or poor health, 55% vs 23% uninsured, and 58% vs 29% without a personal doctor) and received less preventive care. Adjustment for demographic and socioeconomic factors did not mitigate the influence of language on these health indicators. Spanish-language preference marks a particularly vulnerable subpopulation of US Hispanics who have less access to care and use of preventive services. Priority areas for Spanish-speaking adults include maintenance of healthy behaviors, promotion of physical activity and preventive health care, and increased access to care.

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.

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BackgroundFew studies have examined predictors of meeting health guidelines in pregnancy among Latina women. ObjectiveWe assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients. DesignSelf-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings. ResultsApproximately 13% of women met physical activity guidelines [≥10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9). ConclusionFactors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.

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.

Illicit drug use among Mexicans and Mexican Americans in California: the effects of gender and acculturation.

To examine the effects of gender and acculturation on illicit drug use among the Mexican-origin population in California. The 3012 subjects between 18 and 59 years of age were selected under a stratified, multi-stage cluster sampling method. Fresno County in California is primarily agricultural, with only one metropolitan area. Over 30% of the total population of 764,800, are Hispanics, of Mexican origin. A modified version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI) was used to ascertain drug use. Respondents were considered drug users if they had ever used marijuana, cocaine, hallucinogens, heroin or inhalants. Acculturation was measured with a Likert scale, assessing English vs. Spanish language preference. Other covariates of interest were nativity and place of residence. Men had higher rates of use than women for every drug (men = 46.3%, women = 23.2%). Urban rates were higher than rural rates, for both women (urban = 32.8% vs. rural = 16.6%) and men (urban = 57.0% vs. rural = 36.8%). In logistic regression models, men were more likely than women to have ever used illicit drugs or inhalants (adjusted OR = 4.8), cocaine (adjusted OR = 5.3) or marijuana (OR = 4.3). However, the combined effect of United States nativity and acculturation, on drug use, was greater among women (adjusted OR = 29.3) than among men (adjusted OR = 7.4). The effect of acculturation was stronger among urban, than among town or rural residents. Acculturation and United States nativity are risk factors for illicit drug use among Mexican origin men and women. However, women have increased vulnerability compared with men. Findings reinforce the need for culturally based public health interventions.

Desired Family Size and Son Preference Among Hispanic Women of Low Socioeconomic Status

Among 432 Hispanic women aged 18-50 interviewed at a Los Angeles obstetrics and gynecology clinic, respondents reported wanting an average of 2.8 sons but only 0.1 daughters. Being older than 30, having no more than an eighth grade education, being separated, divorced or widowed, being Spanish-speaking or having been born outside the United States, and having a large family of origin were all positively associated with a desire for a greater number of sons. A multivariate analysis indicated that women who preferred to speak Spanish were 10.9 times as likely as those who preferred English to desire a greater number of sons, and those with more children were 2.5 times as likely as those with fewer children to have a strong desire for sons. Family planning programs for Hispanics may be more effective if they acknowledge this important motive for childbearing.

Neuropsychological performance among agricultural pesticide applicators

To assess the potential effects on neuropsychiatric performance of chronic occupational exposure to organophosphate insecticides, we performed a prospective longitudinal study of a cohort of apple orchard pesticide applicators and a comparison cohort of beef slaughter-house workers. The study group consisted of 49 applicators and 40 comparison subjects who completed both an initial evaluation (preseason) prior to the onset of the approximately 6-month pesticide spraying season and a follow-up evaluation (postseason) about 1 month following the end of spraying season. The applicator cohort had a greater number (n = 22, 45%) of individuals who identified primary preference for Spanish-language testing than did the comparison cohort (n = 5, 13%). Stratification by language preference revealed no significant differences in background characteristics between the two cohorts, except for fewer years of education in the Spanish-language preference applicators versus control subgroups (5.0 +/- 3.1 vs 7.8 +/- 3.7 years, respectively). After controlling for language preference, there were no statistically significant differences between the applicators and control cohorts on neuropsychological subtests of the computerized test battery. Preseason baseline performance on individual tests was a significant predictor of postseason test performance. After controlling for baseline performance, the only statistically significant exposure related across-season changes in neuropsychological performance was for one subtest (Symbol Digit Substitution) and was confined to the Spanish language preference subgroups, with worse adjusted postseason performance among applicators versus controls (P = 0.001). This study found no clear evidence of clinically significant decrements in neuropsychological performance following one 6-month season of pesticide exposure in a cohort of applicators who were felt to have generally low, intermittent, and well-controlled organophosphate exposures.