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Promotores or community health workers are trusted community members who offer information and support to marginalized groups in society. Latinx immigrants in new growth communities or emerging communities (areas with a small yet growing Latinx population) confront many challenges in their settling processes. De la Mano con la Salud was a community-based participatory project that trained Latino immigrant men as promotores. Promotores recruited 182 Latino immigrant men helped them to attain their own goals, connected them with health and social services and connected them to the larger community. We present data from 23 in-depth interviews with project participants conducted after six months of enrollment. Qualitative analysis confirmed participants' vulnerabilities and showed that promotores addressed many of the health, legal, and occupational needs of participants. Emerging themes showed that 1) participants had a thirst for a united Latinx community; and 2) felt that promotores had their back (respaldo). The need for community may reflect the current invisibility of this Latinx population, as well as the desires for recognition and ethnic identity affirmation. Respaldo strongly resembles perceived social support, which is the kind of support most associated with health outcomes. Future research can determine what intervention components best foster respaldo.

RESUMEN

OBJECTIVE: To determine the association of social support with alcohol abuse, depression, and health care access among Latino immigrant men in an emerging Latino community (an area with a small yet growing Latino population). METHODS: Cross-sectional baseline data of 140 men prior to a participatory male-to-male community health worker intervention among Latino immigrants were analyzed using logistic regression. Community health workers recruited community participants in Western Pennsylvania between 2011 and 2013. RESULTS: Participants constituted a vulnerable group: 47% had not finished high school, 36% had moderate to severe depression, and 30% reported binge drinking in the past month. Health care access was low (insurance = 6%, usual source = 20%). In multivariable logistic regression high social support was associated with less binge drinking (odds ratio [OR] = 0.44; 95% confidence interval [CI] [0.20, 0.98]) and lower depression (OR = 0.22; 95% CI [0.09-0.54]). Social support was associated with having a dentist visit but not with other health care access measures. CONCLUSIONS: Results indicate that the role of social support seems important for drinking and depression but remains controversial for health care access. It raises the hypothesis that low social support may be one of the mechanisms for the increase in drinking that happens after immigration.

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Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all promotores starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become promotores to help others, yet appreciated being paid. 2) Promotores' learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for promotores 3) Promotores experienced difficulty separating their personal lives form their role as a promotor We conclude that paying promotores facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of promotores' training curricula. Finally, it is advisable to build a project with many opportunities for promotores and project staff to share professional and non-professional time and discuss their challenges.

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Low-income and minority women are less likely to be screened for breast and cervical cancer and less likely than others to be diagnosed at an early stage in the cancer's growth. We consulted women and providers to understand how social, economic, and health care environments affect screening among African American, Amish, Appalachian, and Latina women, and to outline possible solutions. Women participated in 31 focus groups. Providers completed a mail survey (n=168) and follow-up interviews (n=12). We identified barriers women face: not always following recommendations; feeling intimidated during appointments; having incorrect information about risks, screening guidelines, and programs; and receiving information in ways they cannot understand or accept. Women indicated a strong desire for accurate information and, like the providers, identified strategies for reducing barriers to screening. In the terms of a social ecological model, our results point to three avenues along which to approach cultural competence: 1) policy, 2) health care provision, and 3) clinical care.

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