Racialization of Latinos and Implications for Health Following September 11th: Findings From a Northern Border Community.

Few studies have investigated the health implications of post-9/11 restrictive immigration policies, practices, and sentiments for Latinos living in northern border communities. This dissertation examines implications of this environment for the health for Latinos in Detroit, MI. First, I examined experiences of first, 1.5, and second generation Mexican and Central American women with racialization processes. Second, I examined women’s responses to racialization and pathways through which these experiences may be associated with health. Third, drawing on data from the Healthy Environments Partnership surveys, 2002 and 2008, I examined changes in everyday and acute unfair treatment by race and ethnicity for 219 Detroit adults. I tested the association of these changes in discrimination with blood pressure. The first analysis suggests that women navigated dynamic racialization processes. Their descriptions depict social agents engaged in unequal interactions with women, and with members of their social networks, in domains in which they had power. Social statuses and the contexts in which racialization occurred shaped women’s experiences with these processes and influenced their access to social and economic resources. Results from the second analysis suggested that women’s responses to racialization were contingent upon the resources on which they could draw to prevent, mitigate, or resist these processes. Implications for health are multifaceted and apparent in multiple life domains. The third analysis found that Latinos reported significantly greater increases in lifetime acute unfair treatment, but not everyday or acute unfair treatment in the past year, compared to non-Latino whites (NLWs). Changes in lifetime acute unfair treatment were not associated with differential changes in blood pressure for Latinos relative to NLWs. In models restricted to Latinos, change in lifetime acute unfair treatment was positively associated with blood pressure, suggesting that these experiences manifest in a short time period (6 years) in compromised health. Together, these results suggest that Latinos have encountered increasing discrimination over the past decade, that these changes are associated with restrictions in access to resources that are essential to health, and with objective indicators of health. Multilevel interventions and policies that support the full inclusion of Latinos will promote health and health equity.PHDHealth Behavior and Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111428/1/alanamw_1.pd

Podcast Interview Transcript - Beyond the Manuscript post-study interview

In each volume of the Journal, the editors select one article for our Beyond the Manuscript post-study interview with the authors. Beyond the Manuscript provides the authors the opportunity to tell listeners what they would want to know about the project beyond what went into the final manuscript. The associate editors who handled the articles conduct our Beyond the Manuscript interviews. Suzanne Grieb: My name is Suzanne Grieb. I’m a research fellow at the Center for Child and Community Health Research at the Johns Hopkins School and Medicine and I’m an associate editor with the journal. Today we will be discussing your paper Storytelling and Community Intervention Research: Lessons Learned from the Walk Your Heart to Health Intervention published in the Works in Progress in Lessons Learned section of the journal. So welcome

Identifying Barriers To Health Maintenance In Medically-Underserved Patients With IBD: A Qualitative Study

BACKGROUND: Disparities in adherence to health maintenance recommendations have been well-documented in patients with IBO. Solutions to address these issues remain under-described or evaluated. We sought to engage at-risk patients with IBO for a qualitative assessment of their barriers to health maintenance targets. The goal of this endeavor is to inform the design of interventions to address these disparities in practice

Storytelling in Community Intervention Research: Lessons Learned From the Walk Your Heart to Health Intervention

BackgroundContextually and culturally congruent interventions are urgently needed to reduce racial, ethnic, and socioeconomic inequities in physical activity and cardiovascular disease.ObjectivesTo examine a community-based participatory research (CBPR) process that incorporated storytelling into a physical activity intervention, and consider implications for reducing health inequities.MethodsWe used a CBPR process to incorporate storytelling in an existing walking group intervention. Stories conveyed social support and problem-solving intervention themes designed to maintain increases in physical activity over time, and were adapted to the walking group context, group dynamics, challenges, and traditions.Lessons learnedAfter describing of the CBPR process used to adapt stories to walking group sites, we discuss challenges and lessons learned regarding the adaptation and implementation of stories to convey key intervention themes.ConclusionsA CBPR approach to incorporating storytelling to convey intervention themes offers an innovative and flexible strategy to promote health toward the elimination of health inequities

An Exploratory Study of the Impact of Gender on Health Behavior Among African American and Latino Men With Type 2 Diabetes

This study explores gender values and beliefs among Latino and African American men with diabetes and examines how these values and beliefs may influence their health behaviors. Participants were recruited from individuals who participated in one of three Racial and Ethnic Approaches to Community Health Detroit Partnership diabetes self-management interventions. One focus group was conducted with African American men (n = 10) and two focus groups were conducted with Latino men (n = 12) over a 3-month period. Sessions lasted 90 minutes, were audiotaped, and analyzed using thematic content analysis techniques. Two themes emerged that characterize gender identity and its relationship to health behavior in men: (a) men’s beliefs about being men (i.e., key aspects of being a man including having respect for themselves, authority figures, and peers; fulfilling the role as breadwinner; being responsible for serving as the leader of the family; and maintaining a sense of chivalry) and (b) influence of gender values and beliefs on health behavior (i.e., the need to maintain a strong image to the outside world, and the need to maintain control of themselves served as barriers to seeking out and engaging in diabetes self-management behaviors). Results suggest that gender values and beliefs may have implications for how health behaviors among men with diabetes. Future research should study the direct impact masculine identity has on health behaviors among men with diabetes.National Institute of Diabetes and Digestive and Kidney Disease (#R18 DK 078558-02).National Institutes of Health/NIDDK and Diversity Supplement (#R18 DK 078558-02).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153294/1/Hawkins Watkins Kieffer Spencer Piatt Nicklett et al 2017 An Exploratory Study of the Impact.pdfDescription of Hawkins Watkins Kieffer Spencer Piatt Nicklett et al 2017 An Exploratory Study of the Impact.pdf : Main articl

Using Path Analysis and Linear Regression to Test for Gender and Participation: Effects in a Culturally Tailored Diabetes Intervention for Latino Adults.

While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender

Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults

ObjectiveThis study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months.Research design and methodsThe study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.ResultsParticipants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.ConclusionsThis study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes

Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults.

ObjectiveThis study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months.Research design and methodsThe study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months.ResultsParticipants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months.ConclusionsThis study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes