Stephanie L. McFall

Acculturation and depressive symptoms among pregnant and postpartum Latinas

Objectives Among childbearing Latinas, higher acculturation has been found to be significantly associated with increased risk for mental health problems (Acevado (Child Abuse Neglect, 24:11–127, 2000)), although these findings have been inconsistent (Beck (Maternal Child Nurs, 31(2), 114–120, 2006)). The aims of this study are to assess and compare the prevalence of elevated depressive symptoms among pregnant and postpartum U.S.- and Mexican-born Latinas, and to describe the relation of elevated depressive symptoms and acculturation indicators. Methods A convenience sample of 439 pregnant and postpartum Latinas attending Public Health Clinics in San Antonio, Texas was screened for depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) Scale. Women with a score of 21 or greater were classified as having elevated depressive symptoms. Sociodemographic data, including birth country and language of interview, were collected as indicators of acculturation. Results 21% of the sample had moderate depressive symptoms; 15% met the threshold for high depressive symptoms. Bivariate analysis showed Latinas who were U.S.-born, single, preferred English or were pregnant were more likely to express elevated levels of depressive symptoms. Being U.S.-born, pregnant and single was significantly associated with moderate levels of depressive symptoms in logistic regression analyses controlling for other variables in the model. Controlling for other variables, being pregnant and single was significantly associated with high levels of depressive symptoms. Conclusions Higher acculturation, pregnancy and single status were positively associated with elevated depressive symptoms. Screening for depression during pregnancy is important for this population group, given Latinas’ high rates of fertility and births to single women, particularly among more acculturated, U.S.-born Latinas.

Contraceptive use and contraception type in women by Body Mass Index category

BACKGROUND Obese women who become pregnant have increased risk of pregnancy complications for mother and fetus. This study assessed whether body mass index (BMI) category is related to contraception use and type of contraception used in women of reproductive age. METHODS This is a secondary data analysis of data from seven states participating in the Family Planning Module of the 2006 Behavioral Risk Factor Surveillance System (BRFSS). The subsample was 4,757 women who were sexually active with a male partner and not trying to get pregnant. Outcomes were use and type of contraception. Covariates included sociodemographic characteristics and health access variables. The relationship of BMI category and contraception use was examined using logistic regression and multinomial logit analyses for the outcome of type of contraception among users. Survey analysis procedures were used to account for the complex sampling design. RESULTS Nonuse of contraception was reported by 13.8% of women. BMI category was not associated with contraceptive use (p = .860). The relationship between BMI category and contraceptive method was significant (p = .0001). Use of procedural contraception was highest among women with a BMI greater than 25 and increased with age. Hormonal contraception use was highest for women with a BMI of 15 to 25 and decreased with age. Use of barrier methods was lower than other methods, and decreased with age. CONCLUSION The reasons why heavier women choose procedural methods along with the timing of weight gain and contraceptive procedures needs to be further explored. Understanding the relationship between weight and contraceptive behaviors is important for the development of health promotion programs to improve pregnancy outcomes and decrease obesity.

A community-based intervention to promote informed decision making for prostate cancer screening among Hispanic American men changed knowledge and role preferences: A cluster RCT

OBJECTIVE We assessed the short-term effects of a community-based intervention for Hispanic men to encourage informed decision making (IDM) about prostate cancer screening with prostate specific antigen (PSA). METHODS All senior social and housing centers in El Paso, TX were randomized to intervention, a group-based Spanish language educational program facilitated by promotores (12 centers; 161 men) [Is], or to control, promotores-facilitated diabetes video and discussion (13 centers; 160 men) [Cs]. RESULTS Participants had low levels of schooling and baseline knowledge; 44% reported previous PSA testing. At post-test, the Is made large knowledge gains, increased their understanding that experts disagree about testing, shifted toward more active decision making roles, were more likely to believe that it is important to weigh the advantages and disadvantages of screening and to anticipate potential screening outcomes in making a decision, and were less likely to consider the screening decision easy. The Is did not change in their screening intention or the belief that choosing not to be screened could be a responsible choice. CONCLUSIONS A community-based intervention to support IDM for prostate cancer screening can increase knowledge and may promote more active involvement in decision making about prostate cancer screening. Such an approach can increase knowledge and may promote more active involvement in decision making about prostate cancer screening. PRACTICE IMPLICATIONS It is feasible to develop and implement a community-based intervention program to promote IDM for prostate cancer screening.

Gender, Social Ties, and Cancer Screening Among Elderly Persons

Objective: This study examines the association of social ties and cancer screening. Method: Data from the Longitudinal Study on Aging II include 4,419 respondents (70 to 85) who completed Wave 2. The dependent variable is receipt of screening within the past 2 years, measured at Wave 2. Social network variables include marital status, interaction with friends, relatives, and children, and church attendance. Results: Women were higher on most social tie measures, except marriage, and less likely to have mammography than men were to have prostate cancer screening. Also, the decline of screening with age was greater for women. For women, screening was related to contact with friends, relatives, and children but not marital status or church attendance. For men, screening was higher in the married and church attendees, but contact with friends, relatives, and children was not associated with screening. Discussion: Cancer screening interventions that use interpersonal communication channels should target distinct relationships for older women and men.

What is needed for informed decisions about prostate cancer screening : perspectives of African-American and Hispanic men

Professional guidelines suggest that men should learn about risks and benefits of screening to make informed decisions consistent with their preferences. We used concept mapping to investigate views of informed decision making (IDM) of minority men. Statements about what men need for IDM about prostate cancer screening were sorted by similarity and rated for importance by 16 Hispanic and 15 African-American men. Multidimensional scaling and cluster analysis were used to develop a concept map for IDM. The 10-cluster solution was selected. The clusters rated most important were labeled Future Considerations, What to Know and Decision to Make. Clusters labeled Social Support and Sharing Perspectives depicted social aspects of the decision and were intermediate in importance. There was strong correlation in relative importance ratings of clusters by African-American and Hispanic men. However, African-American men gave higher importance ratings than Hispanic men. Concept mapping, a method with strong participatory elements, was useful in identifying conceptual frameworks for IDM of African-American and Hispanic men. Health education to support IDM requires some shifts in focus and strategy. It is important that interventions with minority men build upon a strong conceptual framework.

Treatment decisions for localized prostate cancer: A concept mapping approach

Few decision aids emphasize active surveillance (AS) for localized prostate cancer. Concept mapping was used to produce a conceptual framework incorporating AS and treatment.

Is "Active Surveillance" an Acceptable Alternative?: A Qualitative Study of Couples' Decision Making about Early-Stage, Localized Prostate Cancer

The objective of our study was to describe decision making by men and their partners regarding active surveillance (AS) or treatment for early-stage, localized prostate cancer. Fifteen couples were recruited from a cancer center multispecialty clinic, which gave full information about all options, including AS. Data were collected via individual, semi-structured telephone interviews. Most patients were white, non-Hispanic, had private insurance, had completed at least some college, and were aged 49–72 years. Ten chose AS. All partners were female, and couples reported strong marital satisfaction and cohesion. All couples described similar sequences of a highly emotional initial reaction and desire to be rid of the cancer, information seeking, and decision making. The choice of AS was built on a nuanced evaluation of the man’s condition in which the couple differentiated prostate cancer from other cancers and early stage from later stages, wanted to avoid/delay side effects, and trusted the AS protocol to identify negative changes in time for successful treatment. Treated couples continued to want immediate treatment to remove the cancer. We concluded that having a partner’s support for AS may help a man feel more comfortable with choosing and adhering to AS. Using decision aids that address both a man’s and his partner’s concerns regarding AS may increase its acceptability. Our research shows that some patients want to and do involve their partners in the decision-making process. Ethical issues are related to the tension between desire for partner involvement and the importance of the patient as autonomous decision-maker. The extended period of decision making, particularly for AS, is also an ethical issue that requires additional support for patients and couples in the making of fully informed choices that includes AS.

Understanding Society – The UK Household Longitudinal Survey: A Resource for Demographers

Many demographers are already familiar with the British Household Panel Survey (BHPS), conducted from 1991 forward (Buck et al. 1994). The BHPS has been heavily used by researchers within and outside the United Kingdom (UK) and by government departments, resulting in more than 150 publications per year. The potential for scientific advance has led to the UK Household Longitudinal Survey- (UKHLS). This new survey was modeled on the BHPS and is the largest and most ambitious panel survey in the world. We describe this new social and health survey and some of the opportunities it offers for research in demography and health.

Access to Health Care on the International Border of Texas

Barriers to access contribute to adverse health outcomes and so are of strong policy interest. We use the 2007 Texas Behavioral Risk Factor Surveillance System to examine three measures of access: health insurance, usual source of care, and being unable to obtain care because of cost. This survey had an over-sample of residents from the Texas Border Region. We compare the 32 county Border Region to the rest of Texas. The Border Region has a higher proportion of Hispanics, fewer resources to obtain health care, both insurance and income, and poorer self-rated health than the rest of Texas. Border residents were less likely to have health insurance or a regular source of care. However, these differences were dwarfed by the effect of population characteristics, particularly income, but also education. Having health insurance was a major influence on source of care and being able to afford needed care. Policy initiatives to address gaps in insurance coverage are important, particularly in Texas, among the states with the lowest rates of coverage in the United States. However, mechanisms to increase care, e.g., community health centers, will also be needed, since eligibility restrictions may limit their impact.

State Estimates of Cause and Condition-Specific Mortality Rates for Diabetes Mellitus

Official vital statistics report the death rates due to diabetes in the general population. These are only an indirect indicator of mortality among diabetics since these rates measure deaths due to diabetes in the whole population. A higher rate can mean greater prevalence of diabetes or greater mortality among diabetics or a combination of both. Condition and cause specific death rates directly identify deaths caused by diabetes with the diabetic sub-population in which they occur, giving more specific, focused information since persons diagnosed with diabetes are those most at risk of dying from the disease.