Luz M. Garcini

Human Papillomavirus Vaccination Awareness and Acceptability Among U.S.-Born and U.S. Foreign-Born Women Living in California.

We examined human papillomavirus vaccine awareness and acceptance between U.S.-born and U.S. foreign-born women by utilizing California Health Interview Survey data from 1,672 women (ages 18–27) and 2,994 mothers (ages 28–65). Foreign-born women and mothers had lower vaccine awareness. Foreign-born young adult Latinas had greater vaccine acceptance than U.S.-born Latinas. Other factors associated with young adult womens vaccine acceptability were being younger, unmarried, and sexually active in the past year; having poorer self-reported health; and having heard of the vaccine. Variables associated with mothers’ vaccine acceptability were being White, insured, and unmarried; having had a Pap test in past 3 years; being less educated; and being impoverished.

Mental disorders among undocumented Mexican immigrants in high-risk neighborhoods: Prevalence, comorbidity, and vulnerabilities.

Objective: This study aimed to: (a) provide population-based estimates for the prevalence of mental disorders, including substance use, among undocumented Mexican immigrants; (b) assess for relevant comorbidities; and (c) identify sociodemographic, immigration and contextual vulnerabilities associated with meeting criteria for a disorder. Method: This cross-sectional study used Respondent Driven Sampling (RDS) to collect and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing near the California–Mexico border. The M.I.N.I. Mini International Neuropsychiatric Interview was used as the primary outcome of interest. For all analyses, inferential statistics accounted for design effects and sample weights to produce weighted estimates. Logistic regression was used in multivariate analyses. Results: Overall, 23% of participants met criteria for a disorder (95% CI = 17.1; 29.0). The most prevalent disorders were Major Depressive Disorder (14%, 95% CI = 10.2; 18.6), Panic Disorder (8%, 95% CI = 5.0; 11.9) and Generalized Anxiety Disorder (7%, 95% CI = 3.4; 9.8). Approximately 4% of participants met criteria for a substance use disorder (95% CI = 1.2; 6.1). After controlling for covariates, being 18 to 25 years and experiencing distress from postmigration living difficulties were significantly associated with meeting criteria for a disorder. Conclusion: Undocumented Mexican immigrants are an at-risk population for mental disorders, particularly depression and anxiety disorders. Given that distress from postmigration living difficulties is associated with meeting criteria for a disorder, revisiting policies and developing new alternatives to facilitate access and provision of context-sensitive mental health services for this population is necessary to protect the human rights of these immigrants and that of their U.S. families.

Grief, depressive symptoms, and inflammation in the spousally bereaved

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.

Kicks hurt less: Discrimination predicts distress beyond trauma among undocumented Mexican immigrants.

Objective: This study aimed to assess for the prevalence of interpersonal discrimination among undocumented Mexican immigrants residing in high-risk neighborhoods near the California–Mexico border, identify relevant vulnerabilities, and determine its association with clinically significant psychological distress after controlling for sociodemographics, immigration characteristics, and history of trauma. Method: Respondent-driven sampling was used in this cross-sectional study to collect and analyze data from clinical interviews with 246 undocumented Mexican immigrants. The 53-item Brief Symptom Inventory was used as the primary outcome measure to assess for clinically significant psychological distress. For all analyses, inferential statistics accounted for design effects and sample weights to produce weighted estimates. Logistic regression was used in the multivariate analyses. Results: In all, 69% of the participants reported interpersonal discrimination due to being undocumented with significant differences observed across sex, educational attainment, and income. Among participants with a history of interpersonal discrimination due to their undocumented status, 52% met criteria for clinically significant psychological distress with significant differences observed across age groups, years living in the United States, and history of trauma. After controlling for relevant covariates, having experienced interpersonal discrimination due to being undocumented was the strongest significant predictor of clinically significant psychological distress, odds ratio = 5.47, 95% confidence interval [2.56, 11.7], p < .001, even beyond history of trauma. Conclusion: Overall, our findings emphasize the need for policies, advocacy, and the development and provision of contextually sensitive interventions to address the high prevalence of interpersonal discrimination and its negative health effects among undocumented Mexican immigrants.

Pathways linking racial/ethnic discrimination and sleep among U.S.-born and foreign-born Latinxs

This study examined the association between racial/ethnic discrimination and sleep through psychological distress and body mass index (BMI), and determined whether the aforementioned associations vary between U.S. and foreign-born Latinxs. Participants were 1332 Latinx adults enrolled in the Texas City Stress and Health Study. Multistage sampling methods were used to select participants. A model linking racial/ethnic discrimination with sleep disturbances through direct and indirect (i.e., psychological distress and BMI) paths demonstrated good fit. Greater racial/ethnic discrimination was associated with greater psychological distress and higher BMI. Psychological distress and BMI were also significant predictors of sleep disturbances. The indirect path from racial/ethnic discrimination to sleep disturbances via psychological distress was significant. A model with parameters constrained to be equal between U.S.-born and foreign-born Latinxs suggested associations were comparable between these groups. Our study demonstrated the relevance of racial/ethnic discrimination to sleep disturbances, particularly its association via psychological distress among Latinxs.

Low childhood subjective social status and telomere length in adulthood: The role of attachment orientations

Low subjective social status (SSS) in childhood places one at greater risk of a number of health problems in adulthood. Theoretical and empirical evidence indicates that exposure to supportive parenting may buffer the negative effects of low childhood SSS on adult health. Given the importance of supportive caregivers and close others for the development of attachment orientations throughout the lifespan, attachment theory may be important for understanding why some individuals are resilient to the negative effects of low childhood SSS on adult health while others are not. We examined if attachment anxiety and attachment avoidance altered the association between childhood subjective social status (SSS) and length of telomeres in white blood cells in adulthood. Shorter telomere length is associated with increased risk of age-related diseases including cancer, type 2 diabetes, and cardiovascular disease. Participants (N = 128) completed self-report measures of childhood SSS and attachment orientations, as well as a blood draw. We found that among those with low childhood SSS, low attachment anxiety was associated with longer telomere length in white blood cells in comparison to high attachment anxiety controlling for participant age, sex, race, body mass index, and adult SSS. Among those with high childhood SSS, low attachment anxiety was associated with a slight decrease in telomere length. Attachment avoidance was unrelated to length of telomeres. Such findings provide further evidence for the role that close relationships may have on buffering SSS related health disparities.

“One Scar Too Many:” The Associations Between Traumatic Events and Psychological Distress Among Undocumented Mexican Immigrants

Undocumented immigration often presents with multiple stressors and contextual challenges, which may diminish mental health. This study is the first to provide population-based estimates for the prevalence of traumatic events and its association to clinically significant psychological distress among undocumented Mexican immigrants in the United States. This cross-sectional study used respondent-driven sampling to obtain and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing in high-risk neighborhoods near the California-Mexico border. Overall, 82.7% of participants reported a history of traumatic events, with 47.0% of these meeting the criteria for clinically significant psychological distress. After controlling for relevant covariates, having experienced material deprivation, odds ratio (OR) = 2.26, 95% CI [1.18, 4.31], p = .013, and bodily injury, OR = 2.96, 95% CI [1.50, 5.83], p = .002, and not having a history of deportation, OR = 0.36, 95% CI [0.17, 0.79], p = .011, were associated with clinically significant psychological distress. These results support the need to revisit health and immigration policies and to devise solutions grounded in empirical evidence aimed at preventing the negative effects of trauma and psychological distress in this population.

Racial/Ethnic Disparities in Breast Cancer Incidence, Risk Factors, Health Care Utilization, and Outcomes in the USA

Purpose of the ReviewThis review examines racial/ethnic disparities in female breast cancer within the USA. Specifically, differences in breast cancer incidence, risk factors, health care utilization use, and outcomes among Caucasians and non-Caucasians are explored.FindingsIn the USA, there are striking racial/ethnic disparities for female breast cancer. The etiology of these disparities is likely multi-factorial, including genetic, behavioral, socio-cultural, and environmental elements. Relative to Caucasian women, African American, Hispanic, and Asian/Pacific Islander breast cancer patients generally have a lower survival rate and worse prognosis despite lower incidence rates. They also tend to have more associated health problems and unmet psychosocial needs.SummaryBreast cancer patients are heterogeneous with respect to their race, cultural background, socioeconomic status, behavioral profile, and disease pathophysiology, and these factors impact health outcomes and health care needs. To reduce disparities and improve health outcomes in minority women, a multifaceted approach is required that includes efforts to minimize barriers to health care access, enhance cancer screening rates, and increase the use of culturally sensitive interventions designed to reduce symptom burden and enhance quality of life.

Abstract 3264: Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application

Introduction Cancer-related fatigue (CRF) is one of the most prevalent and debilitating problems in breast cancer survivors (BCS) that can persist many years beyond successful cancer treatment. Parasympathetic nervous system activity (measured via heart-rate variability; HRV), cortisol dysregulation and decreased physical activity are plausible, but understudied contributors to CRF. Repeated daily measurements of CRF and tracking daily physical activity over a 12-week period should give more information regarding temporal patterns of CRF among BCS. Objective The purpose of this study is 1) to investigate patterns of CRF in fatigued BCS over time; 2) to assess HRV, salivary cortisol and level of physical activity as predictors of cancer-related fatigue (CRF) in BCS over a 12-week period; and 3) to explore whether a smartphone application intervention results in increased daily physical activity, as well as improved HRV, salivary cortisol and CRF in BCS relative to healthy female controls over a 12 week period. Methods A total of 30 fatigued breast cancer survivors (FACIT-F score ≤ 34) and 30 aged-matched female controls will be randomly assigned to either an intervention or control group. Both groups will receive a smartphone application tracking daily physical activity. While the intervention group will receive this application with feedback regarding their daily physical activity, the control groups will receive the application without feedback. Behavioral data will be collected by means of GPS and Wi-Fi for localization, and accelerometer, barometer, magnetometer and gyroscope for activity recognition. HRV and salivary cortisol will be collected at rest, as well as during and after a significant stressor (Trier Social Stress Test). Fatigue will be measured by the FACIT-F Scale, which will be completed at baseline (T1), 4 weeks (T2) and 12 weeks (T3). Group differences will be tested by one-way analysis of variance (ANOVA) and intervention effects will be analyzed using mixed models with repeated measurements. Hypotheses We hypothesize that HRV, cortisol dysregulation and level of physical activity at baseline can predict CRF-recovery over a 12-week period. The smartphone application will be associated with improved physical activity in the BCS intervention group and that changes of physiological correlates of CRF can be observed (i.e., HRV and salivary cortisol). Conclusion This study will examine associations between HRV, salivary cortisol, physical activity and CRF in BCS over time. The results of this study may provide insight into factors that contribute to the development, persistence and/or consequences of CRF by use of an innovative mobile application. Citation Format: Annina Julia Seiler, Vanessa Klaas, Gerhard Troster, Kyle W. Murdock, Diana A. Chirinos, Luz M. Garcini, Christopher P. Fagundes. Evaluating heart-hate variability, salivary cortisol and physical activity as predictors of cancer-related fatigue recovery in breast-cancer survivors over a 12 week period by use of a smartphone application [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3264. doi:10.1158/1538-7445.AM2017-3264

DREAMers Living in the United States: A Contextual Perspective and Clinical Implications

Undocumented immigration is a controversial issue at the forefront of currentU.S. politicaldiscussion.Among themore than 11 million undocumented immigrants residing in the United States, more than 1 million are acculturated undocumented youths who were brought to the United States as children by their parents (2) and whomeet the requirements “Mr. A,” an 18-year-old undocumented immigrant from Mexico, was referred for consultation to a communitybased psychology outpatient clinic after presenting to urgent care for symptoms of a severe ataque de nervios, or panic-like symptoms with no organic etiology. Mr. A was brought to the United States at age 2 by his undocumented parents and has never returned to Mexico. His father had been the primary provider for their family, but he had recently been deported, and Mr. A is now working multiple jobs to provide for the family, including his ill mother and his two younger U.S.-born siblings. The patient, a graduating high school senior with an excellent academic record, is a recipient of the Deferred Action for Childhood Arrivals (DACA) program. He is interested in going to college, but given the limited financial aid and employment opportunities available to DACA recipients, he does not think he’ll be able to afford it. As a result, he is feeling anxious, worried, depressed, and hopeless. Moreover, since his father’s deportation, Mr. A has had a substantial increase in intrapersonal and interpersonal stressors, including experiencing variations in self-perception and internalization of the undocumented stereotype, which includes feeling inferior to others, regarding himself as a hindrance to the community, and feeling undeserving of social and economic opportunity. As a result, he has experienced decreased self-esteem, a sense of being burdensome, and feelings of guilt and shame. He is also having trouble coping with the self-imposed burden imposedbyhis sense of an inability to repayhis parents and other family members who have made sacrifices for his future in the United States. Despite his academic success in high school, he often feels sad and disappointed at the limited educational and employment opportunities available to him and his inability to help his family advance along the social and economic ladder. He also reports constant fearandworryaboutdeportation, andsymptoms of anxiety, including an inability to concentrate at school, trouble sleeping at night, and multiple unexplained somatic symptoms that have increased in frequency and severity since his father’s deportation. Additionally, he reports a recent increase in fear and avoidanceofpublicplacesanddistrust in others, which he described as disabling. His symptoms are significantly impairing his academic performance, work capacity, and social relationships, and he mentioned feeling at risk for drinking to cope with distress. To emphasize the influence of context and culture on the patient’s symptom presentation, an adapted version of the Cultural Formulation Interview from DSM-5 (1, pp. 749–759) was used in diagnosis. A diagnosis of other specified anxiety disorder was made, with nervios and ataque de nervios as specifiers. Moreover, it was recognized that the patient was facing multiple and chronic psychosocial and environmental stressors requiring clinical attention, including disruption of family by separation, family illness, social exclusion, target of (perceived) adverse discrimination, academic and occupational problems, low income, limited access to health care, and legal difficulties associated with undocumented status. Although the patient attended a few therapy sessions, he was ambivalent about mental health treatment because of stigma, lack of time, and limited transportation. As a result, he terminated treatment prematurely, stating that it was more convenient for him to receive the support that was provided by his church community.