Maria Eugenia Fernandez-Esquer

Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups

Background There is a discrepancy between self-reported sexual identity and sexual behavior. The magnitude of this discrepancy is unclear, as is its variation across race/ethnicity and gender. Goal The goal of the study was to assess the range of discrepancy in self-reported sexual identity and sexual behavior in men and women of four racial/ethnic groups. Study Design Self-reported data on sexual identity (homosexual, bisexual, heterosexual) and sexual behavior in the past 3 months were collected from 1494 African American, Hispanic, Asian, and white men and women in public congregation places in Houston, Texas. Results Data indicated that concordance rates between self-reported sexual identity and sexual behavior varied widely across racial/ethnic groups, with the highest rates of concordance in Asian males and females and the lowest in African American females and white males. The largest discordant category was in those self-described heterosexuals who reported partners of both genders. Breakdown of data to exclude those who reported sex trade work or illegal sources of income improved the concordance rates for African American and Hispanic subsamples. Conclusion Data indicate the importance of designing and targeting HIV risk interventions and clinical screening, based on behavior and not reported sexual identity.

AMIGAS: A Multicity, Multicomponent Cervical Cancer Prevention Trial Among Mexican American Women

Considerable efforts have been undertaken in the United States to reduce cervical cancer incidence and mortality by increasing screening; however, disparities in screening rates continue to exist among certain racial and ethnic minority groups. The objective of the current study was to determine the effectiveness of a lay health worker‐delivered intervention—AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud [helping women with information, guidance, and love for their health])—to increase Papanicolaou (Pap) test screening among 3 populations of women of Mexican origin.

Relationship between safe sex and acculturation into the gay subculture

There is some evidence, although conflicting, to suggest that socialization or acculturation into the gay community is associated with lower levels of unsafe sex. We attempted to determine the relationship between acculturation and sexual safety. We examined data from 282 men (from the Dallas AIDS Community Demonstration Project) who had sex with men and were not in a monogamous relationship to determine the associations between safer sex and indices of acculturation. The indices of acculturation included regular reading of local and national gay newspapers and magazines, and belonging to an organization for gay men. The data indicated that there were significant relationships between acculturation, talking to sexual partners about HIV risk reduction and sexual identity, and the dependent variable of frequency of condom use for anal sex. A regression equation indicated that 21% of the variance of anal condom use was predicted by these variables. These data suggest that acculturation into the gay community is associated with safer sexual behaviour, and we discuss the implications of these data for using role models and normative beliefs in HIV prevention programmes.

A su salud: a quasi-experimental study among Mexican American women.

OBJECTIVES To test the effectiveness of a community intervention program to promote breast and cervical cancer screening. METHOD Low-income Mexican American neighborhoods located in 2 Texas cities were assigned to intervention or comparison conditions. A 2-year community intervention was delivered via local mass media and reinforced by indigenous volunteers. RESULTS There were higher Pap smear completion rates for women under 40 years of age in the intervention community. CONCLUSION Although it is important to address the cultural needs of all Mexican American women, it is also important to understand the tangible environmental barriers faced by the older women.

Condom use self‐efficacy among U.S.‐ and foreign‐born Latinos in Texas

The objective of this study was to assess the influence of condom use self‐efficacy on the reported condom use of Latinos. We conducted a rapid needs assessment study among U.S. and foreign‐born Latinos living in Houston, TX, to identify behavioral and psychosocial factors that influence their risk for HIV. Bilingual Latino interviewers conducted confidential face‐to‐face interviews with individuals living in apartment complexes or residential areas primarily populated by Latinos. A total of 152 participants completed the survey. Regression results indicate that education and gender influenced condom use self‐efficacy, which in turn influenced condom use in the last sexual encounter and with the primary sexual partner. However, gender and relationship risk were stronger predictors of condom use. Study results indicate that there are differences in condom use self‐efficacy and sexual risk behaviors between Latino men and women that need further exploration.

Using Intervention Mapping as a Participatory Strategy: Development of a Cervical Cancer Screening Intervention for Hispanic Women

Cervical cancer is preventable with treatment of precancerous lesions and treatable at early stages. Hispanics have higher rates of cervical cancer and lower rates of screening. Ayndando a las Mujeres con Informaccion, Guia, y Amor para su Salud (AMIGAS) is an intervention to increase cervical cancer screening in U.S. women of Mexican origin. AMIGAS was developed with the participation of the community using intervention mapping (IM). Following the IM process, the authors completed a needs assessment, development of program objectives, selection of intervention methods and strategies, and program design. A benefit of IM is its linkage with community-based participatory research as it includes engagement of community members to identify and refine priority areas. The success of this strategy suggests it a useful tool for other populations. The resulting intervention program is currently being tested for efficacy and cost-effectiveness in three sites: El Paso, Texas; Houston, Texas; and Yakima, Washington.

Reported condom use and condom use difficulties in street outreach samples of men of four racial and ethnic backgrounds.

The epidemiology of the HIV/AIDS epidemic in the United States has focused research attention on lesbian, gay, bisexual and transgendered communities as well as on racial and ethnic minorities. Much of that attention has, however, been focused on specific racial and ethnic groups, and specific sexual minorities. We report on the results of a study that examined the association between condom use and partnership types among men from four major racial/ethnic groups. Self-reported data on sexual identity (homosexual, bisexual, and heterosexual) and condom use in the past three months were collected from 806 African Americans, Hispanic, Asian, and white men intercepted in public places in Houston, TX. Data indicated that condom use was lowest in African Americans and Hispanic men, bisexual men reported the highest levels of use, with heterosexual men reporting the lowest use. African Americans and Hispanic men reported generally that it was very difficult to use a condom during sexual contact, although the patterns for self-identified homosexual, heterosexual, and bisexual men varied across race/ethnicity. Homosexual African American men reported the least difficulty, and white homosexual men the most difficulty compared with heterosexual and bisexual peers. For homosexually identified men, there were considerable differences across race/ethnicity in the proportion of partners who never or rarely disagreed to use condoms, with Asians disagreeing least, and African Americans most. Within racial/ethnic groups, the levels of condom use and difficulty were similar for male and female partners, suggesting that it is sexual identity, rather than partner gender, that has impacted condom-use messages. These data suggest that racial/ethnic targeting of condom use is likely to be most efficacious in increasing condom use in men.

The importance of psychosocial factors in the prevention of HPV infection and cervical cancer

This article presents a review of psychosocial factors associated with the primary and secondary prevention of cervical cancer. Current research evidence convincingly links the presence of the human papillomavirus (HPV) to the development of cervical cancer suggesting that bringing together knowledge from the Papanicolau smear screening and HPV infection research may help formulate a new approach that bridges primary and secondary prevention strategies. Bringing together these 2 areas of research involves an understanding of the psychosocial factors that underlie both. This review will specifically focus on 3 areas of psychosocial research: (1) sexual behaviours associated with HPV infection; (2) knowledge, attitudes and beliefs associated with Pap smear and HPV screening; and (3) the role of the medical provider in facilitating prevention activities.

Coping with Partner Abuse among Mexican American and Anglo Women: Ethnic and Socioeconomic Influences

This exploratory study examines the influence of ethnic group membership and socioeconomic status on the coping strategies reported by women victims of partner abuse. Ninety-three Mexican American and Anglo women recruited from the general community were interviewed after being screened for the presence of partner abuse. Individual coping tactics reported by the respondents were coded as internal focus or external focus coping strategies. Multiple regression results indicate that only socioeconomic status significantly predicts internal focus coping beyond the contribution of ethnicity.

Unpacking acculturation: cultural orientations and educational attainment among Mexican-origin youth.

Given educational risks facing Mexican-origin children of immigrant parents, it is important to understand how aspects of the acculturation process influence Mexican-origin youth’s educational success. Drawing from selective assimilation theory, this study examined how cultural orientations across myriad facets of acculturation were associated with the educational attainment of second-generation Mexican immigrant youth. The sample included 755 Mexican-origin youth (50% female) in the “Children of Immigrants Longitudinal Study.” Results from structural equation models indicated that youth reporting greater facility in the English language and a stronger value on familism attained higher levels of education in young adulthood than did other youth. Parents’ U.S. social ties and youth’s value on early paid work were associated with less educational attainment. Innovative findings from this study indicate the importance of considering both Mexican and American cultural orientations across myriad facets of acculturation for understanding second-generation immigrant Mexican youth’s educational attainment.