Providers\u27 Socioecological Perspectives on the Supports for and Challenges to Engagement in Care for Latino Youth Living with HIV: A Qualitative Study

INTRODUCTION: Among youth, marginalized groups, such as Latino YLWH (LYLWH), may face multiple social stigmas, including such concerns as limited English-language proficiency, sexual-minority status, and immigration status that impact engagement across the continuum of HIV care (van Servellen, Chang, & Lombardi, 2002). One necessary step toward increasing understanding of the facilitators and barriers to this group’s engagement in HIV care is to examine engagement in care through a socioecological framework to better understand each of the multiple factors impacting Latino youth’s engagement in HIV care (Bronfenbrenner, 1986; Hosek, Harper, Lemos et al., 2005; Mugavero, Norton & Saag, 2011). Through the use of key informants such as such as healthcare providers’ experiences and perceptions of barriers and facilitators we can yield important and insightful information on how to better address the needs of these youth. APPROACH: This study used a psychological phenomenological approach, through inductive and deductive analysis, to explore the socioecological factors that specifically affect engagement in care for LYLWH from providers’ perspective. I conducted qualitative interviews with 26 healthcare providers who provide services to LYLWH. RESULTS: The following themes emerged as important factors impacting engagement in care for LYLWH. Individual-level themes specific to LYLWH included mental health issues, substance use, adjustment to HIV diagnosis, and HIV education. Intrapersonal-level themes specific to LYLWH included the systematic impacts of family, providers, and one-on-one relationships with peers and romantic or sexual partners. Pertaining to community-level factors impacting engagement in care for LYLWH, providers discussed the role of compounded stigma surrounding HIV and LGBT issues, along with HIV-related stigma, poverty/unstable housing, and social-community norms. Sociocultural and policy-level factors include traditional Latino cultural beliefs, religious beliefs, acculturation, U.S. immigration policy, U.S. healthcare access and the healthcare system. In sum, study results reveal that individual (intrapersonal), interpersonal (microsystem), community (exosystem), and sociocultural/policy-level (macrosystem) factors are critical considerations for engagement in HIV care. IMPLICATIONS: It is clear from the current study that LYLWH engage across the continuum of care in distinctive ways, resulting from community-level factors and the sociocultural and policy-level factors that directly and indirectly affect their ability to maintain optimal engagement in their HIV care. Additionally, these macrosystemic factors relate to other syndemic experiences such as mental health disorders and substance abuse, poverty, and HIV and LGBT stigma affecting Latino youth in general in our current society. By addressing these factors, society can positively affect the health of youth, inclusive of LYLWH

Family-based Genome-wide Association Study of South Indian Pedigrees Supports WNT7B as a Central Corneal Thickness Locus

Purpose To identify genetic risk factors contributing to central corneal thickness (CCT) in individuals from South India, a population with a high prevalence of ocular disorders. Methods: One hundred ninety-five individuals from 15 large South Indian pedigrees were genotyped using the Omni2.5 bead array. Family-based association for CCT was conducted using the score test in MERLIN. Results: Genome-wide association study (GWAS) identified strongest association for single nucleotide polymorphisms (SNPs) in the first intron of WNT7B and CCT (top SNP rs9330813; β = −0.57, 95% confidence interval [CI]: −0.78 to −0.36; P = 1.7 × 10−7). We further investigated rs9330813 in a Latino cohort and four independent European cohorts. A meta-analysis of these data sets demonstrated statistically significant association between rs9330813 and CCT (β = −3.94, 95% CI: −5.23 to −2.66; P = 1.7 × 10−9). WNT7B SNPs located in the same genomic region that includes rs9330813 have previously been associated with CCT in Latinos but with other ocular quantitative traits related to myopia (corneal curvature and axial length) in a Japanese population (rs10453441 and rs200329677). To evaluate the specificity of the observed WNT7B association with CCT in the South Indian families, we completed an ocular phenome-wide association study (PheWAS) for the top WNT7B SNPs using 45 ocular traits measured in these same families including corneal curvature and axial length. The ocular PheWAS results indicate that in the South Indian families WNT7B SNPs are primarily associated with CCT. Conclusions: The results indicate robust evidence for association between WNT7B SNPs and CCT in South Indian pedigrees, and suggest that WNT7B SNPs can have population-specific effects on ocular quantitative traits

Addressing Social and Structural Determinants Affecting HIV Medical Care Among Adolescents Aged 13-24 in Georgia, 2013

BACKGROUND: Adolescents aged 13-24 account for a substantial number of new HIV infections every year in the United States. Timely linkage to care and continuous engagement is very imperative for effective medical interventions and overall improved health outcomes for HIV positive young adults. This thesis addresses and evaluates the factors affecting linkage to and retention in care for the newly diagnosed HIV positive adolescents in Georgia in 2013 and potential solutions to address the disparities. METHODS: The analysis assessed quantitative and qualitative data extracted from Georgia’s HIV Surveillance-Electronic HIV/AIDS Reporting System (eHARS), Grady Infectious Disease Program (IDP), Ryan White CAREWare, and Georgia HIV Testing Data System. The data analysis was carried out using MS Excel and SAS 9.4. A univariate analysis was used by cross tabulating variables such as linked to care, any care, retention in care, and stratified by race/ethnicity, age, and risk factors. Inferential data was obtained from narrative reports of de-identified client-level from the Anti-Retroviral Treatment Access to Services (ARTAS) Intervention. Descriptive statistics analysis and logistic regression were performed using SAS version 9.4 with significance set at p\u3c0.05. RESULTS: Of the total 2,555 newly diagnosed HIV infected persons in Georgia in 2013, 601 were adolescents aged 13-24 years old. In comparison to other age groups, adolescents had the second highest newly diagnosed rate. Of the HIV infected adolescents, only 58% were linked to care and 47% were retained in care. HIV infection was found prominently among Black MSM populations. CONCLUSION: The results of this study indicated differences in factors and barriers that are associated with HIV positive adolescents and linkage to medical care and retention in medical care provide evidence for developing public health interventions. Public health intervention programs that address sex education, effect of IV drug use, and the importance of health insurance may help curb the prevalence of both HIV and sexually transmitted diseases in at-risk groups

Registration and Familial Consent for Deceased Organ Donation Among Ethnic Minorities in Ontario, Canada: Opportunities for Improvement

Canadians on the transplant waiting list are dying every day because there are not enough available solid organs for transplantation. An important aspect of addressing this problem is to increase deceased organ donation consent rates. Consent rates are, in part, affected by the number of adults registering their commitment to deceased organ donation in the event of their death through a donor registry. In provinces such as Ontario, approximately 30% of the population is registered for deceased organ donation and approximately 60% of families consent to organ donation. These low figures have been attributed, without evidence, to the relatively high proportion of immigrants or ethnic minorities living in Ontario. This research uses Ontario’s large administrative databases to examine organ and tissue donor registration in the general population and familial consent among those referred for organ and tissue donation. Modified-Poisson regression was used to identify characteristics associated with donor registration and familial consent. The first manuscript examines deceased organ donor registration and familial consent among Chinese, South Asian and the remaining general public. Chinese and South Asian individuals registered and their families consented less for deceased organ donation than the general public. The second manuscript examines deceased organ donor registration among immigrants compared to long-term residents and identifies and quantifies characteristics associated with organ donor registration. Compared to long-term residents, immigrants as a group were much less likely to register for organ and tissue donation. Characteristics among the immigrant population associated with a higher likelihood of registration included economic immigrant status, living in a rural area (population \u3c 10 000), living in an area with a lower ethnic concentration, less material deprivation, a higher education, ability to speak English and French, and more years residing in Canada. The third manuscript examines familial consent among immigrants and identifies and quantifies characteristics associated with familial consent. Compared to long-term residents, families of immigrants as a group were less likely to consent for deceased organ donation. However, there was no statistical difference in consent rates among immigrants and long-term residents who had registered for organ and tissue donation. The information gained from this study will guide organ procurement organization’s strategies and approaches to organ and tissue donation. These results can be used to implement and design donor awareness campaigns targeted at groups with lower donor registration and consent rates that are culturally sensitive and effective

Exploring Factors Influencing Health Promoting Behaviors Among Latino Immigrants

Latinos immigrants may experience stress during acculturation to the U. S., which can influence their ability to engage in health-promoting behaviors, such as dietary intake and physical activity. Dietary intake and physical activity influence the prevention or development of pre-diabetes/Type 2 Diabetes (T2DM). The immigrant’s ability to perform health-promoting behaviors can also be influenced by their perceptions of self-efficacy to engage in health-promoting behaviors. Limited information is available in the literature on effective strategies for decreasing stress during the acculturation process of Latino immigrants, while also increasing self-efficacy on health-promoting behaviors. The purpose of this study was to explore the associations between stress, acculturation, self-efficacy and the health-promoting behaviors of Latino adults. An adapted theoretical model based on the Health Promotion Model by Pender will guide this study. Participants were adults (N = 195), 18 years or older, who were Latino immigrants. Participants completed 4 surveys with all questions in both Spanish and English, exploring perceptions of self-efficacy, exercise behavior, acculturation, and stress. Participants also completed pre-diabetes and demographic questionnaires. 61% of the respondents reported having at least one family member with T2DM. Having a family member with T2DM did not influence physical activity of the participants. Examination of physical activity levels by gender suggested that Latino men reported engaging in significantly more vigorous physical activity when compared to Latino women (p = 0.017). There were significant correlations between walking behaviors and vigorous physical activity (χ2 (137) = .380, p = .05). Significant correlations were also found between walking and moderate physical activity (χ2 (137) = .278, p = .01). Among Latinos without prediabetes/T2DM, self-efficacy level and stress predicted physical activity. Among Latinos with pre-diabetes/T2DM, only age predicted physical activity. When the sample was stratified by pre-diabetes/T2DM status, self-efficacy remained a significant predictor of physical activity among Latinos without pre-diabetes/T2DM. However, among Latinos with pre-diabetes/T2DM, gender was the only significant predictor of physical activity, and age no longer predicted physical activity. Assessing self-efficacy level may help recognize Latinos at risk for chronic illnesses, such as type 2 diabetes. Stress level can impact health-promoting behaviors among Latino immigrants and assessing stress is important for nurses to consider during interactions with Latinos in order to support health-promoting behaviors and lower risk for T2DM

Critical success factors of Latino entrepreneurs

Latino entrepreneurs in the U.S. face myriad challenges in their pursuits, with unique obstacles owing to their minority and, sometimes, immigrant status. This study investigated the critical success factors of Latino entrepreneurs in the United States. This study utilized a Delphi methodology to identify the critical success factors and thematic analysis of the identified success factors to create the theoretical model. An expert panel of individuals of Latino origin who identified either as active entrepreneurs or individuals with at least 2 years of experience working in a leadership role with an organization that serves or works with Latino entrepreneurs (e.g., Hispanic Chamber of Commerce, Small Business Development Center) were recruited using LinkedIn. Three survey rounds were administered based on 75 critical items identified in extant literature and 15 items suggested by panelists on the Round 1 survey. Across the three rounds, 74 of the 90 total items (82.2%) achieved consensus. A thematic analysis of the consensus items indicated four themes critical to Latino entrepreneurial success: competencies, work values and motivations, personal traits, and help-seeking behaviors. A new model for Latino entrepreneurial success entitled the Linares ImmiGrit Model was created based on the study results. When Latino entrepreneurs’ competencies, work values and motivations, and personal traits are applied and fortified through help-seeking and giving with relation to one’s interpersonal support network, culturally relevant institutions, and self-study and formal training, a generative cycle of both entrepreneurship and contribution may become possible. In this way, both individual accomplishments but beneficial community outcomes emerge. The dissertation contributes to the growing body of knowledge on entrepreneurship and provides a foundation for future research and policy development aimed at promoting entrepreneurial success among diverse populations. Based on these findings, Latino entrepreneurs are advised to (a) uncover their unique reasons for business ownership and use these to sustain them through the inevitable challenges, (b) be proactive in assessing their competencies and addressing any gaps through help-seeking, and (c) be deliberate about both seeking and offering help so that, collectively, Latino entrepreneurs advance in renewed strength together

“An Eye Opener” : The Meaning of Latin@ College Students’ Experiences in a Bilingual Latin@ Family Class

Despite an increasing representation of Latin@s in the college system and in Hispanic Serving Institutions (HSI); Latin@ college students’ in-class experiences have been overlooked, particularly in bilingual courses. A phenomenological study of the Latin@ college students’ experience in a Bilingual Latin@ Family Class that incorporated aspects of the Latin@ culture in the instructional process at a HSI, included ten participant and three one-to-one interviews. The study provided a perspective on the complex reciprocal interaction of the Bioecological systems, the Funds of Knowledge and the Latin@ college students’ experiences. Five themes and additional subthemes were identified: (1) “Eye Opener” (courage, encouragement, cognitive knowledge, awareness of others, and self-awareness), (2) “It was Real Stuff” (teacher, safe and secure), (3) “What We Know is the Real Deal” (diversity, familism, identity, and native language), (4) “A Lot to be Done”, (5) Socio-Historical Time (presidential election, generations). Findings highlighted that interdisciplinary and integrative focus of Bronfenbrenner’s theory and its explicit interest in application to policies and programs of development could be useful for Latin@ students at the higher education level. In addition, the use of Funds of Knowledge to promote personal development, enhance family relations, and to trigger broader social change in Latin@ college students advance their success in the American education and the U.S. society

National HIV Prevention Conference

CDC NPIN 2009 National HIV Prevention Conference Presentation Web Library: "The library is a resource for those that were unable to attend the conference and for those that attended and want to share information with their colleagues. The library houses PDF versions of Plenary presentations and other presentations made by CDC and other federal agencies that you are able to view and download by Population, Track, or Plenary session. Only presentations for which the authors have given their permission for posting are included."Conference Website -- Abstract book -- Conference program -- CDC NPIN 2009 National HIV Prevention Conference Presentation Web Library (NHPC 2009 Webcasts)Convened by the Centers for Disease Control and Prevention.Mode of access: World Wide Web

CHANGING AMERICA: THE IMPACT OF IMMIGRATION ON WELFARE ATTITUDES AND WELFARE REFORM

The purpose of my dissertation is to further our understanding of why some states restricted immigrant access to welfare in the 1990s while other states granted immigrants access to social programs. With the passage of the Personal Responsibility Work Opportunity Reconciliation Act (PRWORA), many states diverged from equal access to welfare programs, such as Temporary Assistance to Needy Families (TANF), for immigrants arriving after 1996. Very little scholarly work examines the variance in immigrants’ access to welfare programs. Current research studying welfare attitudes and policy has largely failed to investigate whether and how the influx of immigrants over the last three to four decades has decreased public support for welfare programs and resulted in policies that both decrease benefit levels and restrict access to programs based on citizenship. This is a serious shortcoming because immigration since the 1970s represents the largest population shift since the early 20th century, a change that has increased the size of the underclass and transformed the cultural and racial makeup of theUnited States. Accordingly, in my dissertation, I will examine how changes to the American political environment, immigration levels and the increasing number of immigration media stories, trigger authoritarian attitudes that in turn form a breeding ground supporting restrictive welfare programs. The results from the individual-level analysis provide strong evidence that authoritarians prefer less welfare spending, fewer immigrants, and a waiting period before immigrants can access welfare programs. In addition, authoritarians view immigrants as a threat due to their perceived failure to socially conform to American society. Building on these individual-level results, I find that states with large authoritarian populations are more likely to adopt restrictive welfare policies