Ana F. Abraído-Lanza

Toward a Theory-Driven Model of Acculturation in Public Health Research

Interest in studying the impact of acculturation on immigrant health has increased in tandem with the growth of the Latino population in the United States. Linear assimilation models continue to dominate public health research despite the availability of more complex acculturation theories that propose multidimensional frameworks, reciprocal interactions between the individual and the environment, and other acculturative processes among various Latino groups. Because linear and unidimensional assessments (e.g., nativity, length of stay in the United States, and language use) provide constricted measures of acculturation, the rare use of multidimensional acculturation measures and models has inhibited a more comprehensive understanding of the association between specific components of acculturation and particular health outcomes. A public health perspective that incorporates the roles of structural and cultural forces in acculturation may help identify mechanisms underlying links between acculturation and health among Latinos.

Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis

CONTEXT To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists and psychologists). This collaboration is designed to (1) improve routine screening and diagnosis of depressive disorders; (2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and (3) improve clinical and community support for active client/patient engagement in treatment goal-setting and self-management. EVIDENCE ACQUISITION A team of subject matter experts in mental health, representing various agencies and institutions, conceptualized and conducted a systematic review and meta-analysis on collaborative care for improving the management of depressive disorders. This team worked under the guidance of the Community Preventive Services Task Force, a nonfederal, independent, volunteer body of public health and prevention experts. Community Guide systematic review methods were used to identify, evaluate, and analyze available evidence. EVIDENCE SYNTHESIS An earlier systematic review with 37 RCTs of collaborative care studies published through 2004 found evidence of effectiveness of these models in improving depression outcomes. An additional 32 studies of collaborative care models conducted between 2004 and 2009 were found for this current review and analyzed. The results from the meta-analyses suggest robust evidence of effectiveness of collaborative care in improving depression symptoms (standardized mean difference [SMD]=0.34); adherence to treatment (OR=2.22); response to treatment (OR=1.78); remission of symptoms (OR=1.74); recovery from symptoms (OR=1.75); quality of life/functional status (SMD=0.12); and satisfaction with care (SMD=0.39) for patients diagnosed with depression (all effect estimates were significant). CONCLUSIONS Collaborative care models are effective in achieving clinically meaningful improvements in depression outcomes and public health benefits in a wide range of populations, settings, and organizations. Collaborative care interventions provide a supportive network of professionals and peers for patients with depression, especially at the primary care level.

En las Manos de Dios [in God's Hands]: Religious and Other Forms of Coping Among Latinos With Arthritis.

This study tested a theoretical model concerning religious, passive, and active coping; pain; and psychological adjustment among a sample of 200 Latinos with arthritis. Respondents reported using high levels of religious coping. A path analysis indicated that religious coping was correlated with active but not with passive coping. Religious coping was directly related to psychological well-being. Passive coping was associated with greater pain and worse adjustment. The effects of active coping on pain, depression, and psychological well-being were entirely indirect, mediated by acceptance of illness and self-efficacy. These findings warrant more research on the mechanisms that mediate the relationship between coping and health. This study contributes to a growing literature on religious coping among people with chronic illness, as well as contributing to a historically under-studied ethnic group.

Breast and Cervical Cancer Screening Among Latinas and Non-Latina Whites

OBJECTIVES We examined whether Latinas differ from non-Latinas in having undergone recent mammography, clinical breast examination, or Papanicolaou testing, as well as the contribution of sociodemographic and health care variables to screening. METHODS We used data from the 1991 National Health Interview Survey Health Promotion and Disease Prevention supplement. RESULTS Latinas were less likely than non-Latina Whites to have undergone mammography (odds ratio [OR] = 0.71; 95% confidence interval [CI] = 0.57, 0.88), but this difference was attenuated when we controlled for socioeconomic factors (OR = 0.90; 95% CI = 0.70, 1.15). Latinas did not differ from Whites on Papanicolaou tests or clinical breast examinations. Quality of and access to health care predicted screening. CONCLUSIONS Latina ethnicity does not predict breast and cervical cancer screening behavior independent of sociodemographic and structural factors.

Fatalism or Destiny? A Qualitative Study and Interpretative Framework on Dominican Women’s Breast Cancer Beliefs

Background A growing literature on Latino’s beliefs about cancer focuses on the concept of fatalismo (fatalism), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women’s views on breast cancer and screening within a cultural framework of destino (“destiny”), or the notion that both personal agency and external forces can influence health and life events. Methods Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over. Results Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated. Discussion In contrast to simplistic notions of “fatalism”, our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.

Latinas with Arthritis: Effects of Illness, Role Identity, and Competence on Psychological Well‐Being

Tested a theoretical model on the effects of social role identity, illness intrusion, and competence on psychological well-being among 109 low-income Latinas with arthritis. All six roles studied were rated as highly important identities. Sex-role nontraditionalism was associated with less importance of the homemaker, mother, and grandmother roles. Negative affect increased as a function of intrusions into valued identities. Having important role identities contributed to feelings of competence (i.e., self-esteem and self-efficacy), which in turn, contributed to psychological well-being. Competence also mediated the effects of pain, identity, and illness intrusions on psychological well-being. Results suggest competence processes play an important role in well-being.

A further analysis of race differences in the National Longitudinal Mortality Study

OBJECTIVES The purpose of this study was to investigate associations between race and specific causes of mortality among adults 25 years and older in the National Longitudinal Mortality Study. METHODS Mortality hazard ratios between races during 9 years of follow-up were estimated with Cox proportional hazards models, with control for multiple indicators of socioeconomic status (SES) and SES-relevant variables. RESULTS Black persons younger than 65 years were at higher risk than others for all-cause and cardiovascular mortality; the strongest effects were observed among persons aged 25 through 44 years. CONCLUSIONS Race, independent of SES, is related to mortality in American society, but these effects vary by age and disease categories.

Latino Immigrants, Acculturation, and Health: Promising New Directions in Research

This article provides an analysis of novel topics emerging in recent years in research on Latino immigrants, acculturation, and health. In the past ten years, the number of studies assessing new ways to conceptualize and understand how acculturation-related processes may influence health has grown. These new frameworks draw from integrative approaches testing new ground to acknowledge the fundamental role of context and policy. We classify the emerging body of evidence according to themes that we identify as promising directions--intrapersonal, interpersonal, social environmental, community, political, and global contexts, cross-cutting themes in life course and developmental approaches, and segmented assimilation--and discuss the challenges and opportunities each theme presents. This body of work, which considers acculturation in context, points to the emergence of a new wave of research that holds great promise in driving forward the study of Latino immigrants, acculturation, and health. We provide suggestions to further advance the ideologic and methodologic rigor of this new wave.

Satisfaction with Health Care among Latinas

Despite growing interest in disparities in access to health care, relatively little is known about different facets of care among Latinas, their satisfaction with the care they receive, and the predictors of satisfaction. This study examined whether various health care access and context factors, the quality of the patient-physician interaction, and medical mistrust predict satisfaction with health care among Latina immigrants in New York City. Structured interviews were conducted with 220 Latinas predominantly from the Dominican Republic and aged 40 years or over. Of the access to health care variables examined, greater waiting time predicted dissatisfaction with health care. Greater quality of the patient-physician interaction predicted less dissatisfaction. The effect of the patient-physician interaction on dissatisfaction was mediated, in part, by waiting time. The results illustrate the important role of specific health care factors in satisfaction with care.

Opening a Window on Systems Science Research in Health Promotion and Public Health

Very few health scholars and professionals, and fewer still in health education, would have encountered during their academic or professional preparation any of the concepts, principles, or methodologies of what is now called “systems science.” Characterized by analytic approaches that accommodate, for example, nonlinear relationships, bidirectional feedback loops, and time-delayed effects, systems science is concerned with how we understand and act effectively within complex systems. With such a broad purview, the very notion of systems science itself often raises puzzling questions about its scope, depth, and potential value for health promotion and public health work. Thus, it may seem surprising that within just a few month’s notice, more than 40 teams of investigators responded to a call for papers on “Systems Science Applications in Health Promotion and Public Health” that Health Education & Behavior (HE&B) issued in March 2012. Systems science has intellectual origins in general systems theory and research dating back to the 1930s. Often associated with the seminal work of the Austrian biologist Ludwig von Bertalanffy, there are in fact scores of other strands of inquiry that have combined and complemented one another to yield what is now a phenomenally rich space of thinking and practice (International Institute for General Systems Studies, 2001; von Bertalanffy, 1968; Weckowicz, 1989). Studies using a systems perspective have opened important frontiers in disciplines such as anthropology, biology, psychology, and the social sciences, as well as in applied sciences such as cybernetics, engineering, medicine, and public health, where applications anchored in a systems view have become increasingly prominent (Institute for Systems Biology, 2012; Milstein, 2008; Richardson, 1991). Interest in systems science and its implications for improving public health has been building for several decades. This wave of interest stems in large part from the growing recognition that traditional research methods in the behavioral and social sciences, which typically feature narrow problem definitions and linear analytic representations, are by themselves insufficient to adequately address the complexity of the most pressing population health challenges (Livingood et al., 2011; Mabry, Marcus, Clark, Leischow, & Mendez, 2010; Sterman, 2006). Systems science offers a complementary approach, capable of addressing more complex, interactive phenomena, while also attending to the practical constraints and opportunities that shape the contours of the social, physical, and organizational settings in which responses to those health challenges must occur (Leischow & Milstein, 2006; Luke & Stamatakis, 2012; Mabry, Olster, Morgan, & Abrams, 2008). Both governmental and nongovernmental health agencies, including the National Institutes of Health (NIH), Centers for Disease Control and Prevention, the Institute of Medicine, and many others, have formally acknowledged the value of systems science (Best, Clark, Leischow, & Trochim, 2007; Gerberding, 2005; Hussey et al., 2013; Institute of Medicine, 2012; Mabry et al., 2008; Milstein, 2008; NIH Office of Behavioral and Social Sciences Research, 2013). Accordingly, investments in understanding the potential of systems science and its applications to public health problems have been growing through a widening array of funded research and training programs (Mabry & Kaplan, 2013). Several of the authors whose work is published in this supplement, in fact, were recipients of those investments, and their pioneering work has already begun to enhance programs and policies such that the public may be the ultimate beneficiaries of those investments. 503343 HEB401S10.1177/1090198113503343Health Education & Behavior 40(1S)Mabry et al. research-article2013