Maren J. Coffman

Demands of Immigration, Health Literacy, and Depression in Recent Latino Immigrants

Latino immigrants have unique stressors that can influence mental health. The challenges of adapting to a new society include language barriers, separation from family, and feelings of loss, which can lead to depression. Low health literacy may make it difficult to obtain health care services, and depression may then go untreated. This secondary data analysis examined the relationships of immigration demands, health literacy, and depression in a sample of recent Latino immigrants. Depressive symptoms were a significant problem; 26% of the participants reported symptoms that were suggestive of depression. Furthermore, low health literacy and greater immigration demands predicted higher depression scores. The study suggests that recent Latino immigrants would benefit from health literacy training, education on depressive symptoms, and better access to mental health services. Latinos who do access health care services need to be screened for depression; furthermore, home health care nurses can promote access to support and health care services.

Self-Prescription Practices in Recent Latino Immigrants

OBJECTIVE Self-prescription involves the purchase and use of restricted medications without medical advice. Although common in Central and South American countries, little is known about this practice among Latino immigrants in the United States. The purpose of this study, therefore, was to explore how Latino immigrants obtain and use prescription medications without accessing the formal health care system. DESIGN This exploratory descriptive study used focus groups to gain an understanding of the use of prescription medications without medical care. SAMPLE Three focus group discussions were held with 19 adult Latino immigrants who were new residents in the United States, and did not have health insurance; most were undocumented. RESULTS Analysis of the data revealed 4 major themes: (a) health care barriers, (b) cultural norms, (c) self-care, and (d) self-prescription. CONCLUSIONS The data indicate that this population experiences significant barriers to accessing health care, forcing them to seek treatment alternatives including the purchase and use of drugs manufactured in Mexico. There are many public health and safety concerns related to self-prescription practices. Nurses need to be aware of the barriers to health care that lead to these potentially dangerous medication practices, and to recognize and understand self-prescription.

A trans-disciplinary approach to the evaluation of social determinants of health in a hispanic population

BackgroundIndividual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants.Methods/designThis project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services.DiscussionThe results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.

Perceived Infant Feeding Preferences of Significant Family Members and Mothers’ Intentions to Exclusively Breastfeed

Background: Breastfeeding intention is a significant predictor of initiation and duration. The decision to breastfeed may be influenced by the opinions of family and friends. Objective: This study aimed to examine the relationship between maternal perception of the infant feeding preferences of the baby’s father and the maternal grandmother and the woman’s intention to breastfeed. Methods: This study analyzed data from the Infant Feeding Practices Survey II (2005-2007). Results: The sample included 4690 women, of whom approximately 82% were white, 67% were married, 68% were multiparous, and 66% had some college education or beyond. In adjusted analyses, the odds of intending to exclusively breastfeed in the first few weeks postpartum were higher among mothers who perceived that the baby’s father or the maternal grandmother preferred exclusive breastfeeding (vs preferred other feeding) (fathers: odds ratio [OR] = 7.44; 95% confidence interval [CI], 6.20-8.92; maternal grandmothers: OR = 2.45; 95% CI, 2.01-2.99). Mothers in each of the racial/ethnic groups examined were more likely to intend to exclusively breastfeed in the first few weeks postpartum if they perceived that the expectant father preferred exclusive breastfeeding (vs preferred other feeding methods) (white: OR = 7.67; 95% CI, 6.25-9.41; black: OR = 11.76; 95% CI, 4.85-28.51; Hispanic: OR = 7.01; 95% CI, 3.44-14.28; other: OR = 7.51; 95% CI, 3.39-16.67). Conclusion: These results suggest that significant family members should be counseled on the benefits of breastfeeding and the risks of formula feeding along with pregnant mothers.

Achieving the American Dream: Facilitators and Barriers to Health and Mental Health for Latino Immigrants

Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed.

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program

BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.

The Robert Wood Johnson Foundation Nurse Faculty Scholars Program: An opportunity for junior nurse faculty

The Robert Wood Johnson Foundation Nurse Faculty Scholars program provides promising junior faculty extramural funding, expert mentoring, and the training needed to be successful in the academic role. The Nurse Faculty Scholars program, which admitted its first cohort in 2008, is designed to address the nursing faculty shortage by enhancing leadership, educational, and research skills in junior nursing faculty. This article provides an overview of the program, its purpose, and its eligibility requirements. The authors give strategies for selecting mentors, developing the written application, and preparing for an oral interview. Finally, the authors provide an analysis of funded institutions, research design and methods from current and recently funded projects, and rank and positions held by nursing mentors.

A Health Education Pilot for Latina Women with Diabetes

The purpose of this study was to develop and pilot test nutrition and physical activity educational tools for immigrant Latina women who have type 2 diabetes and low health literacy levels. Participants’ ability to use the tools was assessed and a focus group was conducted (n = 26). During two classes, the women were taught diabetes concepts related to nutrition and physical activity and were given a pedometer. The women recorded in a log vegetables consumed and steps taken. Nearly all participants (n = 24) completed the nutrition log, and most used the pedometer (n = 25) and completed the step log for 5 or more days (n = 19). The women reported that the pedometer and logs helped them increase vegetable consumption and physical activity. Interventions for this population should use plain language, tools that are easy to use, and strategies that encourage behavioral change.

Using CBPR to Decrease Health Disparities in a Suburban Latino Neighborhood

Introduction: This project tested the feasibility of using a community-based participatory research (CBPR) approach to deliver health and social resources in two high-risk, suburban neighborhoods. Method: An established research network was used to engage stakeholders to design and deliver a neighborhood-based intervention targeting a Latino immigrant population. The intervention provided screenings for hypertension, diabetes, and depression; primary care provider visits; and information about navigating health care delivery systems and related community-based resources. Participants (N = 216) were consented for participation and their subsequent use of health and social services were measured at baseline and 1 year post intervention. Results: At baseline, 5.1% of participants had health insurance, 16.7% had a primary care provider, and 38.4% had a chronic illness. SF-12 scores showed a majority of participants with low perceived health status (56%) and high risk for clinical depression (33%). Self-reported use of primary care services increased from 33.8% at baseline to 48% 1 year after the intervention, and 62% reported use of social services. Conclusion: Neighborhood-based interventions informed by a CBPR approach are effective in both identifying community members who lack access to health care–related services and connecting them into needed primary care and social services.

Accuracy of the Yamax CW-701 Pedometer for measuring steps in controlled and free-living conditions

Objective The Yamax Digi-Walker CW-701 (Yamax CW-701) is a low-cost pedometer that includes a 7-day memory, a 2-week cumulative memory, and automatically resets to zero at midnight. To date, the accuracy of the Yamax CW-701 has not been determined. The purpose of this study was to assess the accuracy of steps recorded by the Yamax CW-701 pedometer compared with actual steps and two other devices. Methods The study was conducted in a campus-based lab and in free-living settings with 22 students, faculty, and staff at a mid-sized university in the Southeastern US. While wearing a Yamax CW-701, Yamax Digi-Walker SW-200, and an ActiGraph GTX3 accelerometer, participants engaged in activities at variable speeds and conditions. To assess accuracy of each device, steps recorded were compared with actual step counts. Statistical tests included paired sample t-tests, percent accuracy, intraclass correlation coefficient, and Bland–Altman plots. Results The Yamax CW-701 demonstrated reliability and concurrent validity during walking at a fast pace and walking on a track, and in free-living conditions. Decreased accuracy was noted walking at a slow pace. Conclusions These findings are consistent with prior research. With most pedometers and accelerometers, adequate force and intensity must be present for a step to register. The Yamax CW-701 is accurate in recording steps taken while walking at a fast pace and in free-living settings.