Spanish-speaking Population Research Articles

Availability of Specific Programs and Medications for Addiction Treatment to Vulnerable Populations: Results from the Addiction Treatment Locator, Assessment, and Standards (ATLAS) Survey.

This study aimed to describe addiction treatment facilities by their offerings of medications for alcohol use disorder (MAUD) and/or for opioid use disorder (MOUD), and by their offering services to groups with barriers to care: uninsured and publicly insured, youth, seniors, individuals preferring to receive care in Spanish, and sexual minority individuals. We examined addiction treatment facility survey data in 6 US states. We performed bivariate analyses comparing facilities that offered MAUD, MOUD, and both (main outcomes). We then constructed a multivariable model to identify predictors of offering MAUD, MOUD, or both, including exposures that demonstrate programming for special populations. Among 2474 facilities, 1228 (50%) responded between October 2019 and January 2020. Programs were offered for youth (30%), elderly (40%), Spanish-speaking (37%), and sexual minority populations (39%), with 58% providing MAUD, 67% providing MOUD, and 56% providing both. Among those providing MAUD, MOUD, or both, a majority (>60% for all exposures) offered programming to vulnerable populations. With Delaware as reference, Louisiana (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.12-0.67) and North Carolina (aOR, 0.33; 95% CI, 0.15-0.72) facilities had lesser odds of offering both MAUD and MOUD. All exposures identifying facilities offering treatment to vulnerable groups were associated with offerings of MAUD and/or MOUD except for offerings to youth; these facilities had less odds of offering MOUD (aOR, 0.31; 95% CI, 0.31-0.62). There are facility-level disparities in providing MAUD and MOUD by state, and facilities with youth programming have lesser odds of offering MOUD than other facilities.

Medical Spanish in Pharmacy Education: A Call to Action

The Spanish-speaking population in the United States is large, growing, and diverse. There is an increasing need for pharmacists to be linguistically and culturally equipped to provide safe and effective care to this population. Therefore, pharmacy educators should help prepare and train students for this responsibility. Although there are a variety of noteworthy initiatives within pharmacy education relating to medical Spanish, a need exists for a more consistent, robust, and evidence-based approach. Collaboration and innovation are needed to overcome this challenge and meet this need. A call to action is issued for pharmacy education programs to evaluate the demographics, need, and feasibility of offering experiences in Spanish and other relevant foreign languages, expand opportunities in medical Spanish, emphasize key content areas within medical Spanish education, and encourage the use of evidence-based practices in language acquisition and professional use.

Evaluating the Spanish readability of American Society for Metabolic and Bariatric Surgery (ASMBS) Centers of Excellence (COE) websites.

Healthcare disparities continue to be an ongoing struggle in Bariatrics. Limited availability of Spanish online material may be a correctible barrier for accessibility to Hispanic patients. We sought to evaluate accredited Bariatric Centers of Excellence (COE) for Spanish readability via their websites to determine accessibility for Spanish speakers. This was an internet research study. 103 COE accredited by American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) were evaluated and assigned one of five Spanish Visibility Categories. The United States was divided into 4 regions. Regional Spanish visibility was calculated by dividing each category count by the number of institutions in each region. County Spanish-speaking populations were obtained from the US Census Bureau's 2009-2013 American Community Survey. Differences in their distributions across the Spanish Visibility Categories were investigated using the Mann-Whitney U test. 25% of websites were translatable to Spanish, and a regional discrepancy was found with 61% translatable in the West, 19% in Northeast, 19% in Midwest, and 15% in South. Median Spanish-speaking population was higher in counties where websites were translatable to Spanish than where websites were not translatable. Healthcare disparities in Bariatrics continue to be an ongoing struggle. We suggest that Spanish readability for ASMBS ACS COE websites should be improved regardless of geographic differences in Spanish-speaking populations. We believe it would be valuable for these websites to have standards for readability of Spanish and other languages.

Impact of a Digital Atopic Dermatitis Educational Intervention on Hispanic Patients and Family Members.

With the increasing incidence of atopic dermatitis (AD) in the U.S., the highest prevalence of AD being found in Hispanic countries, and the rising Hispanic-American population, educational resources on eczema focused on Spanish-speaking populations are needed more than ever. As such, the primary goal of this project was to assess the beneficial impact of an educational intervention conducted through a virtual platform for Hispanic individuals living with atopic dermatitis. Utilizing WhatsApp, the study enrolled 55 participants diagnosed with AD and/or parents of children diagnosed with AD. Participants were enrolled in a seven-day educational module with daily topics on AD health knowledge. A health knowledge survey was administered before the educational program, upon completion of the program, and one month after completion. The program found a 14% increase in AD health knowledge upon completion of the program (p < 0.001). Most importantly, there was no significant difference found between the health knowledge survey submitted at program completion and one month after completion, signaling that health knowledge taught through the course was successfully retained by participants (p = 0.29). Qualitative themes involving atopic disease were additionally explored through group discussions, including mental health and peer stigma. This study is the first of its kind in dermatology utilizing the WhatsApp format. The success of retained health knowledge regarding AD demonstrates that future virtual endeavors can be effective and accessible methods of patient education overall for populations that might not have ease of access to major medical centers.

Translated article] Translation, validation, and cultural adaptation of the HSS-ES scale (Hospital for Special Surgery's [HSS] Shoulder Surgery Expectations Survey)

IntroductionThe questionnaire Hospital for Special Surgery Shoulder Surgery Expectations Survey (HSS-ES) is a tool used to assess the preoperative expectations of patients with shoulder pathologies. The purpose of this study is to translate, culturally adapt, and validate the Spanish version of the HSS-ES questionnaire to assess preoperative expectations in Spanish-speaking patients. MethodologyQuestionnaire validation study, using a structured method where a survey-type tool was processed, evaluated and validated. The study involved 70 patients from the shoulder surgery outpatient clinic of a tertiary care hospital, with shoulder pathologies requiring surgery. ResultsThe version of the questionnaire translated into Spanish presented a very good internal consistency with a Cronbach's Alpha of 0.94 and a very good reproducibility with an Intraclass Correlation Coefficient (ICC) of 0.99. ConclusionThe HSS-ES questionnaire presents an adequate intragroup validation and a strong intergroup correlation according to the internal consistency analysis of the questionnaire and the ICC. Therefore, it is considered an adequate questionnaire to use in the Spanish-speaking population.

Monuments to Midwestern Pioneer Mothers and Native Women

Monuments to Midwestern Pioneer Mothers and Native Women Cynthia C. Prescott (bio) Local sculptor John K. Daniels's 1936 monument for Minneapolis, Minnesota's new Pioneer Park bore striking similarities in style and meaning to other early midwestern pioneer monuments. Click for larger view View full resolution Fig 1. John K. Daniels, Pioneers Monument, Minneapolis, Minnesota, as of March 2013. Photo by author. [End Page 21] Figurative sculptures honored Euro-American settler men's hard work hewing farms out of the wilderness, accompanied by a self-sacrificing "pioneer mother" symbolizing the arrival of White Christian culture on the frontier. A bas relief on the reverse of the monument nodded to French settlement of the region by depicting Native American men—but no women—welcoming French explorers to their homelands. While dozens of monuments erected across the United States by women's clubs in the early twentieth century emphasized women's roles carrying White "civilization" westward, Daniels's placing of his pioneer mother figure in a supporting role was typical of many midwestern monuments. Most midwestern statues glorified White men for conquering the wilderness that Native men yielded, portrayed White settler women as supporting players to their men, and erased Native women's presence from the region altogether. This essay will argue that in contrast to better-known monuments in the Far West, which largely featured "cowboys and Indians" memories of the Old West or solo pioneer mothers embodying Euro-American civilization, most midwestern monuments erected between the 1890s and 1930s emphasized the process of U.S. westward expansion or White homemaking.1 Midwestern pioneer monuments, which outnumbered those in the Far West, celebrated the family values long associated in popular memory with America's supposed rural heartland. Monuments erected in the Midwest early in the twentieth century—like Minneapolis's 1936 Pioneers Monument—tended to emphasize White settler men's hard work establishing new farms and communities. Midwestern pioneer mothers typically appeared as self-sacrificing supporting characters—again like the female figure in Minneapolis's Pioneers—emphasizing pioneer men's good intentions. Contemporaneous monuments erected in former Spanish and Mexican territories (including California, Arizona, and Texas) grappled in various ways with the persistence of Indigenous and Spanish-speaking populations. A few in the Midwest portrayed Native men yielding to White male explorers or settlers prior to the arrival of White women, or hinted at European immigrant influences, but most ignored non-Anglo-American residents. Native women appeared only rarely as symbols of Indigenous acquiescence to White manhood. Recent decades have seen a resurgence in interest in public statuary throughout the United States. Midwestern communities are once again erecting monuments to the region's nineteenth-century residents. But instead of passive, self-sacrificing White mothers standing by their men, [End Page 22] Click for larger view View full resolution Fig 2. Dale Lamphere, Dignity of Earth and Sky, Chamberlain, South Dakota, as of October 2021. "Woman standing near tall Dignity statue on a bluff overlooking the Missouri River off Interstate 90 near Chamberlain, South Dakota." Photo by Glenn Nagel/Alamy Stock Photo. twenty-first-century pioneer monuments portray more active and vibrant female characters. Moreover, some Midwesterners are vocally challenging the racial implications of earlier imagery. Calls for more inclusive monuments have begun to bear fruit. In 2016, Chamberlain, South Dakota, erected Dignity of Earth & Sky, a sculpture of a solo Native American woman. Far from yielding or disappearing in [End Page 23] the face of White settlement, the Native woman stands proudly, actively displaying a star quilt representing Lakota and Dakota culture that adapted and responded to Euro-American influences. While not as imposing as Chamberlain's fifty-foot-tall Dignity, other midwestern communities have also begun to honor both Native and White women as community leaders. Early midwestern pioneer monuments erased the region's Indigenous, Métis, and other non-Anglo populations to an even greater extent than did those installed in the Far West. Most midwestern frontier-themed monuments depict middle-class White family values made possible by masculine persistence and maternal sacrifice. But, like western pioneer monuments, midwestern monuments have grown more diverse and inclusive in recent decades. Monuments to European immigrant groups portray their subjects as...

Spanish-Speaking Patients Have Limited Access Scheduling Outpatient Orthopaedic Appointments Compared With English-Speaking Patients Across the United States

To evaluate whether Spanish-speaking patients can obtain appointments to outpatient orthopaedic surgery clinics across the United States at a similar rate as English-speaking patients and to examine the language interpretation services available at those clinics. Orthopaedic offices nationwide were called by a bilingual investigator to request an appointment with a pre-established script. The investigators called in English asking for an appointment for an English-speaking patient (English-English), called in English requesting an appointment for a Spanish-speaking patient (English-Spanish), and called in Spanish asking for an appointment for a Spanish-speaking patient (Spanish-Spanish) in a random order. During each call whether an appointment was given, the number of days to the offered appointment, the mechanism of interpretation available in clinic, and whether the patient's citizenship or insurance information was requested was collected. A total of 78 clinics included in the analysis. There was a statistically significant decrease in access to scheduling an orthopaedic appointment in the Spanish-Spanish group (26.3%) compared with English-English (61.3%) or English-Spanish (58.8%) groups (P < .001). There was no significant difference in access to appointment between rural and urban areas. Patients in the Spanish-Spanish group who made an appointment were offered in-person interpretation 55% of the time. There was no statistically significant difference in time from call to offered appointment or the request for citizenship status between the 3 groups. This study detected a considerable disparity regarding access to orthopaedic clinics nationwide in the individuals who called to establish an appointment in Spanish. Patients in the Spanish-Spanish group were able to make an appointment less often but had in-person interpreters available for interpretation services. With a large Spanish-speaking population in the United States, it is important to understand how lack of proficiency with the English language may affect access to orthopaedic care. This study uncovers variables associated with difficulties scheduling appointments for Spanish-speaking patients.

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era.

(1) Background: In the "post-COVID-19 era", there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The "Electronic Mental Wellness Tool" (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool's sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.

Applying National Diabetic Care Standards for the Management of a Hispanic Population Attending a Free Clinic.

National quality measures set goals for diabetes management. Hispanic populations are higher risk for diabetes and associated complications, especially low-income communities. Research suggests free clinics provide suboptimal diabetes management. Our quality improvement project aims to improve diabetes management in the Hispanic free clinic population. Clínica Latina's volunteer medical students and physicians serve predominantly uninsured Spanish-speaking patients. Established diabetes patients that attended clinic during the study were included. Data was collected regarding patients' diabetes care for two months, then analyzed compared to quality metrics. We implemented paper checklists and electronic medical record (EMR) smart phrases for volunteers to utilize in managing diabetes. 32 patients were included in the study. At baseline, 78% had an A1C check in the past 3 months, 81% were on a statin. In the past year, 81% had a lipid panel, 19% had an eye exam, 63% had a diabetic foot exam, 53% had a urine microalbumin-creatinine screening. After interventions, 97% had an A1C check, 93% were on a statin, 91% had a lipid panel, 31% had an eye exam, 75% had a foot exam, 63% had a urine microalbumin-creatinine. Patients with an LDL < 100 increased from 62 to 66%. The mean A1C did not statistically significantly change. Volunteer smart phrase utilization increased from 37 to 59.1%. We implemented a checklist and EMR smart phrase to optimize diabetes management in a student-run Hispanic free clinic, which improved quality metrics. Low-resource clinics serving Spanish-speaking populations may benefit from similar interventions to improve diabetic care.

Development of a Scale to Measure Healthy Behaviors in Spanish-Speaking University Students.

Chronic non-communicable diseases (NCDs) are a public health problem that affect the quality of life and well-being of people, especially the youth, who have been identified as a high-risk population. Physical inactivity is a key risk factor for NCDs, and an unhealthy diet is a significant driver of NCDs. On the other hand, physical exercise and healthy habits are effective methods of prevention. Although there are scales that measure different behaviors related to NCDs, most of them have been developed in another language (e.g., English) or only focus on one aspect of NCDs. The present study aimed to develop a scale to assess healthy behaviors (i.e., healthy eating and physical exercise) in Spanish-speaking university students, using an instrumental design, with a sample of 369 Chilean university students between 18 and 25 years of age. The results presented show evidence of validity through an exploratory structural equation model (ESEM), reliability estimation through McDonald's omega and Cronbach's alpha, evidence of invariance by sex, and evidence of validity in relation to other variables with an SEM model. It is concluded that the Healthy Behavior Scale, consisting of nine items to measure healthy eating and physical exercise, is a brief instrument with evidence of reliability and validity (CFI = 0.998; TLI = 0.995; and RMSEA = 0.063) for application in a Spanish-speaking university population, offering potential applications in research instruments, screening studies, and the development of new studies for other contexts.

PERMA-Profiler for the Evaluation of well-being: Adaptation and Validation in a Sample of University Students and Employees in the Mexican Educational Context

Well-being research has increased in recent years, making it essential to have validated tools that allow its measurement. The objective of this study was to adapt and validate the PERMA-Profiler in a sample of university students and employees in the Mexican educational context. Through a back-translation, an adaptation of the PERMA-Profiler questionnaire into Spanish was obtained. This version and other well-being measures were administered to a sample of 23,723 students (mean age = 21.50) and further to 2,783 employees (mean age = 36.08). Results showed acceptable reliability and good convergent and discriminant validity between well-being variables. PERMA score was strongly correlated with general well-being, positive affect, and life satisfaction, and slightly correlated with growth mindset and physical well-being. Confirmatory factor analysis using exploratory structural equation modeling revealed a better fit for the original structure of five factors, both in the sample of students and employees. Also, the results provide first indications for measurement invariance for gender and age. Validation of the PERMA-Profiler in the Mexican context showed good psychometric properties. It can be recommended as a valid tool for assessing well-being in the Spanish-speaking population.

A Historical-Variationist Analysis of Subject Pronoun Expression in 19th and Early 20th Century Arizonan Spanish

This diachronic study is a variationist analysis of subject pronoun expression (SPE) in two key Spanish-language Arizonan newspapers, El Fronterizo (1878–1914) and El Tucsonense (1915–1957), following Tucson’s annexation to the United States through the Gadsden Purchase, a period of great social change during which the Spanish-speaking population in the city underwent a gradual process of anglicization. Since some research on SPE in Spanish in the United States suggests that English-Spanish bilingualism increases the use of overt subject personal pronouns (SPPs) because of their almost categorical use in English, this study’s main aim is to track the initial stages of such progression in a period when social bilingualism was steadily extending in Tucson. In this respect, our results show that the presence of overt SPPs does increase over time in the data analyzed; however, lower rates of overt SPPs in contemporary Tucson and Phoenix spoken Spanish raise the possibility that the percentage surge in the aforementioned period is rather due to the offline written nature of the newspapers, which, for instance, weakens the effect of online constraints, such as switch reference, ambiguous TAM endings, and non-reflexive verbs. Even so, regression analyses with the mixed-effects statistical software Rbrul reveal that the linguistic factor groups shaping SPE in the diachronic data are essentially the same ones found operating in contemporary varieties of Spanish.

Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population

Populations at high risk for COVID-19- including Spanish speakers—may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

Post-COVID-19 perceived stigma-discrimination scale: psychometric development and evaluation

The study aimed to adapt and evaluate a scale to measure COVID-19-CED in COVID-19 survivors. A sample of 330 COVID-19 survivors filled out the COVID-19 Perceived Discrimination Scale (C-19-PDS). C-19-PDS was adapted from the Tuberculosis Perceived Discrimination Scale (11 items). Confirmatory factor analysis showed poor goodness-of-fit indicators. However, the 5-item version of the C-19-PDS showed better goodness-of-fit indicators, high internal consistency, and non-gender DIF. This instrument is recommended to evaluate COVID-19-CED in Colombian and other Spanish-speaking populations.

The completion of indicated paternal prenatal genetic and carrier testing at a public hospital in Los Angeles, California

PurposePregnant individuals are routinely advised to undergo genetic carrier screening, followed by carrier screening in the reproductive partner if the patient’s screen is positive. The objective of our study was to identify completion rates of and barriers to partner carrier screening or genetic testing. MethodsWe conducted a retrospective cohort study examining the completion of indicated partner genetic screening or testing at the Los Angeles General Medical Center Genetics clinic from January 1, 2017, to October 31, 2022. We examined factors linked to completing partner genetic screening or testing, including sociodemographic factors for patients and their partners, testing indications, and pregnancy characteristics via bivariate analyses (eg, t test, χ2, and Fisher’s exact tests). ResultsIn this primarily low-income, publicly insured, Spanish-speaking population, we identified 98 pregnancies for which partner genetic screening or testing was indicated. Only 26.5% (n = 26) completed testing, which did not vary by indication, parental age, parental race, parity, or primary language. Completion of partner genetic screening or testing was significantly linked to earlier gestational age at referral for genetic counseling (19.1 versus 21.5 weeks, P = .006). In 4 cases, being unable to obtain partner test results led to invasive diagnostic testing of the pregnant patient. ConclusionLess than one-third of pregnancies received indicated partner genetic screening or testing. Early referral to genetic counseling may improve partner testing completion rates, which could avoid invasive and unnecessary diagnostic testing in the pregnant patient.

Development and validation of a Spanish-language spatial release from masking task in a Mexican population.

This study validates a new Spanish-language version of the Coordinate Response Measure (CRM) corpus using a well-established measure of spatial release from masking (SRM). Participants were 96 Spanish-speaking young adults without hearing complaints in Mexico City. To present the Spanish-language SRM test, we created new recordings of the CRM with Spanish-language Translations and updated the freely available app (PART; https://ucrbraingamecenter.github.io/PART_Utilities/) to present materials in Spanish. In addition to SRM, we collected baseline data on a battery of non-speech auditory assessments, including detection of frequency modulations, temporal gaps, and modulated broadband noise in the temporal, spectral, and spectrotemporal domains. Data demonstrate that the newly developed speech and non-speech tasks show similar reliability to an earlier report in English-speaking populations. This study demonstrates an approach by which auditory assessment for clinical and basic research can be extended to Spanish-speaking populations for whom testing platforms are not currently available.

Hispanic Colonial Footprint and Hubris in the Philippines: The Case of Zamboanga City’s Creole Spanish-Speaking Population

Hispanic Colonial Footprint and Hubris in the Philippines: The Case of Zamboanga City’s Creole Spanish-Speaking Population

Telehealth as a potential tool for outreach among women in Puerto Rico

Access to the full spectrum of healthcare should be available to all individuals. After the revocation of the constitutional right to abortion, women have fewer alternatives to unplanned pregnancy. Telehealth provides an additional option for such pregnancies through its remote provision of services. This could benefit women of all social strata. However, data regarding telehealth among underserved populations are limited. This study aimed to evaluate the use of contraception, awareness of abortion services, and receptiveness to telehealth among women in Puerto Rico, a Spanish-speaking minority population. This was a cross-sectional study of women living in Puerto Rico aged between 21 and 65 years. Data were collected with a self-administered survey via SurveyMonkey from March to December of 2021. Recruitment was done through social media and at the gynecology clinics of the University of Puerto Rico, Medical Sciences Campus and San Juan City Hospital. Analysis was done with Stata, version 14.2.Chi-square and Cochran-Armitage tests were used to evaluate the unadjusted relationship between variables. A P value ≤.05 was considered statistically significant. A total of 286 women were recruited. Of these, 73.3% (189/258) were sexually active, 89.1% (229/257) were heterosexual, and 62.7% (163/260) were not using contraception. In addition, 63.3% (157/248) knew about emergency contraception, yet 42.4% (103/243) were unaware of any sources of access to it; 76.6% (197/257) were unaware of nearby abortion services. A higher education level was associated with knowing about emergency contraception (P<.05) and awareness of sources of access to it (P<.05). However, no significant association was found between a higher education level and awareness of nearby abortion services (P=.799). Regarding telehealth, 65.2% (176/270) were willing to use the service for future gynecologic visits, yet only 18.9% (51/269) were offered telehealth services. No association was found between previous telehealth experiences and willingness to use telehealth for future gynecologic visits (P=.325). The lack of contraceptive use and unawareness of nearby abortion services place women at increased risk of unplanned pregnancy and unsafe practices. The gap between knowledge about and access to emergency contraception also calls for action. Telehealth may be of benefit given that most women showed interest in using it, and could be used for educating and providing women in Puerto Rico with contraception and medical abortions, further increasing their access to reproductive healthcare. Clarifying misconceptions and instructing women about safe practices is essential to our role as physicians. Ensuring women's access to adequate services is also vital for upholding their rights to healthcare.

ADVANCE CARE PLANNING FOR SPANISH-LANGUAGE SPEAKERS: PATIENT, FAMILY, AND INTERPRETER PERSPECTIVES

Abstract Language access is a challenge to advance care planning (ACP). Spanish-language speakers are the largest non-English speaking population in the US. While ACP tools have been translated into Spanish, it is unclear how heterogeneity in country of origin may affect the generalizability of translations across diverse US Spanish-speaking populations. The study objective is to describe challenges and facilitators to ACP for diverse populations of Spanish-language speakers. We conducted 3 focus groups with a total of 29 participants from members of Spanish-language speaking communities whose countries of origin were predominantly from the Caribbean, Central, and South America. Eligibility included being 18 years or older, being a native Spanish-speaker, and having direct experience with ACP as a patient, caregiver, or medical interpreter. We conducted thematic analysis with axial coding. Themes include: 1. Linguistic Challenges with Current ACP Translations; 2. Effect of Country of Origin and Culture on ACP Understanding; 3. Impact of Local Healthcare System Cultural on ACP; and 4. Need for ACP to be Normalized into the Local Community. ACP is both a cultural practice and a clinical practice. Recommendations for improving ACP completion for non-English speakers extend far beyond translation, since simply translating ACP tools without a cultural context is neither equitable nor inclusive. A key step is normalizing ACP into the local community. Understanding the intersection of local healthcare systems of ACP practice with the patient’s and family’s cultures of origin will facilitate introducing ACP in a culturally sensitive manner.

ASSESSING THE NIH TOOLBOX EMOTION BATTERY AMONG PEOPLE AGING WITH HIV AND WHO USE METHAMPHETAMINES

Abstract Measurement of social relationships is challenging because constructs have dimensions that can be assessed at multiple levels. Consequently, researchers often operationalize social relationships differently, making it difficult to compare results with the same outcome across studies. The National Institutes of Health (NIH) commissioned the Toolbox Assessment of Neurological and Behavioral Function to create a set of harmonized measures to use across studies. The NIH Toolbox-Emotions Battery (NIHTB-EB) was normed in English and Spanish-speaking populations, which found support for a three-factor structure (negative affect, social satisfaction, and psychological well-being). Here we investigated the factor structure of the NIHTB-EB among a sample of 862 people aged 17 to 82 with and without HIV and methamphetamine use in comparison to the factor structure found in the NIH Toolbox norming project. Initial confirmatory factor analysis did not support the three-factor structure identified previously for the full sample or subsamples. Subsequent exploratory factor analyses showed a good model fit for a four-factor solution for the full sample, with slight variations in factor loading across subgroups. In addition to the three factors described in the norming project, our solution contains an additional factor, “rejection and hostility,” which includes scores from social satisfaction and negative affect in the normative population. The four-factor solution will be utilized for subsequent analyses using the NIHTB-EB in these study samples. Our analyses highlight the importance of assessing measures in distinct sub-populations to understand possible challenges to measurement invariance and ultimately allow the use of NIHTB-EB across groups.