RESUMEN
OBJECTIVE: This study examined the factor validity of health risk behaviors and resilience indicators and their covariation across a large racially/ethnically diverse adolescent population. DESIGN: The study subsample (47% Hispanic, 31% White Non-Hispanic, 17% American Indian) was derived from the 2013 New Mexico Youth Risk Resilience Survey (YRRS; N-19,033). We conducted a confirmatory factor analysis on the 6 health risk domains identified by the CDC as contributing most to adolescent morbidity/mortality: (1) cigarette use, (2) alcohol and other illicit drug use, (3) marijuana use, (4) sexual activity, (5) nutrition habits, and (6) physical activity. RESULTS: A 4-factor CFA model of adolescent health risk behaviors was replicated, and a hypothesized 6-factor structure based on behaviors that contribute most to adolescent morbidity/mortality was confirmed. The pattern of covarying risk behaviors differed by Hispanic, Native American, and Non-Hispanic White groups. We also confirmed a single external resilience-interference factor (decreased parental support, low school/community engagement, negative peer associations) that positively correlated with all six risk behaviors. CONCLUSION: This study described the structure of adolescent health risk behaviors within a context of psychosocial resilience for American Indian and Hispanic adolescents in contrast to Non-Hispanic White adolescents. Our findings provided evidence for the construct validity of six health-risk behavior dimensions within a large racially/ethnically diverse adolescent sample, which reveal different patterns of loadings, degrees of model fit, and factor inter-correlations across the three racial/ethnic groups. Patterns of covarying risk behaviors differed in strength and direction by racial/ethnic group. Results suggest that interventions should target multiple behaviors and be tailored for different racial/ethnic groups. Targeting health risk and resilience indicators supports the use of multi-level health interventions at the individual, school, family, and community level by identifying individuals based on external resilience scores.
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Drogas Ilícitas , Trastornos Relacionados con Sustancias , Adolescente , Etnicidad , Conductas de Riesgo para la Salud , Humanos , New Mexico , Grupos RacialesRESUMEN
BACKGROUND: A minimum dataset (MDS) can be determined ad hoc by an investigator or small team; by a metadata expert; or by using a consensus method to take advantage of the global knowledge and expertise of a large group of experts. The first method is the most commonly applied. OBJECTIVE: Here, we describe a use of the third approach using a modified Delphi method to determine the optimal MDS for a dataset of full body computed tomography scans. The scans are of decedents whose deaths were investigated at the New Mexico Office of the Medical Investigator and constitute the New Mexico Decedent Image Database (NMDID). METHODS: The authors initiated the consensus process by suggesting 50 original variables to elicit expert reactions. Experts were recruited from a variety of scientific disciplines and from around the world. Three rounds of variable selection showed high rates of consensus. RESULTS: In total, 59 variables were selected, only 52% of which the original resource authors selected. Using a snowball method, a second set of experts was recruited to validate the variables chosen in the design phase. During the validation phase, no variables were selected for deletion. CONCLUSION: NMDID is likely to remain more "future proof" than if a single metadata expert or only the original team of investigators designed the metadata.
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Proyectos de Investigación , Consenso , Bases de Datos Factuales , Técnica Delphi , New MexicoRESUMEN
Although national colorectal cancer (CRC) incidence rates have steadily decreased, the rate for New Mexico Hispanics has been increasing, and screening rates are low. We conducted an exploratory qualitative study to determine barriers to CRC screening for New Mexico Hispanics. We found that machismo served as a dynamic influence on men's health-seeking behaviors; however, it was conceptualized differently by two distinct Hispanic subpopulations, and therefore appeared to play a different role in shaping their screening attitudes and behaviors. Machismo emerged as more of an influence for Mexican men, who expressed concern over colonoscopies being potentially transformative and/or stigmatizing, but was not as salient for Hispanos, who viewed the colonoscopy as "strictly medical," and were more concerned with discomfort and pain. Findings from the study highlight the importance of identifying varying characteristics among subpopulations to better understand screening barriers and provide optimal CRC screening counseling in primary care settings.
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Neoplasias Colorrectales/psicología , Detección Precoz del Cáncer/psicología , Hispánicos o Latinos/estadística & datos numéricos , Masculinidad , Salud del Hombre , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Cultura , Detección Precoz del Cáncer/estadística & datos numéricos , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Hispánicos o Latinos/psicología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , New Mexico/epidemiología , Satisfacción del Paciente , Investigación Cualitativa , Población Rural , Factores SocioeconómicosRESUMEN
INTRODUCTION: Colorectal cancer (CRC) screening rates are low in New Mexico. We used statewide surveys of primary care physicians and the general population to characterize CRC screening practices and compare perceptions about screening barriers. METHODS: In 2006, we surveyed 714 primary care physicians in New Mexico about their CRC screening practices, beliefs, and perceptions of patient, provider, and system barriers. A 2004 state-specific CRC screening module for the Behavioral Risk Factor Surveillance System (BRFSS) survey asked 3,355 participants aged 50 years or older why they had not ever or had not recently completed a fecal occult blood test (FOBT) or lower endoscopy. RESULTS: The 216 physicians (30% response rate) reported offering screening to a median 80% of their average-risk patients in the past year and estimated that a median 50% were current with screening. They attributed low screening proportions mainly to patient factors (embarrassment, fear of pain, lack of insurance). However, just 51% of physician respondents used health maintenance flow sheets, and only 13% used electronic medical records to identify patients due for CRC screening. The BRFSS respondents most often reported that lack of physician discussion was responsible for not being current with screening (45% FOBT, 34% endoscopy); being asymptomatic was also often cited as an explanation for lack of screening (22% FOBT, 36% endoscopy). CONCLUSION: Physicians and adults in the general population had markedly different perspectives on barriers to CRC screening. Increasing screening may require system supports to help physicians readily identify patients due for CRC testing and interventions to educate patients about the rationale for screening.
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Actitud del Personal de Salud , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/psicología , Aceptación de la Atención de Salud/psicología , Sistema de Vigilancia de Factor de Riesgo Conductual , Neoplasias Colorrectales/prevención & control , Miedo , Femenino , Promoción de la Salud , Accesibilidad a los Servicios de Salud , Hispánicos o Latinos , Humanos , Seguro de Salud , Masculino , Persona de Mediana Edad , New Mexico , Médicos , Población BlancaRESUMEN
The range of symptoms experienced by refugees of war has not been empirically assessed. The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) was developed utilizing established guidelines and evaluated for its psychometric properties. Community-dwelling Kurdish and Vietnamese refugees reported 48 (SD = 31) persistent and bothersome somatic and psychological symptoms on the NMRSCL-121. Internal consistency and test-retest reliability for the total scale and for most subscales were acceptable, and construct and concurrent validity for the NMRSCL-121 data was shown. There were modest ethnic group differences on symptom severity and psychometric properties of NMRSCL-121 subscales. The NMRSCL-121 produces reliable and valid assessments of a wide range of symptoms in 2 broad community samples of displaced adult refugees.
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Trastornos de Ansiedad/diagnóstico , Trastorno Depresivo/diagnóstico , Etnicidad/psicología , Inventario de Personalidad/estadística & datos numéricos , Refugiados/psicología , Trastornos por Estrés Postraumático/diagnóstico , Guerra , Adulto , Anciano , Trastornos de Ansiedad/etnología , Trastornos de Ansiedad/psicología , Comparación Transcultural , Trastorno Depresivo/etnología , Trastorno Depresivo/psicología , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , New Mexico , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Factores Sexuales , Trastornos por Estrés Postraumático/etnología , Trastornos por Estrés Postraumático/psicología , Tortura/psicología , Adulto JovenRESUMEN
This study examines attitudes of Mexican female immigrants to Albuquerque, New Mexico, regarding barriers to health care access in the United States and Mexico for stigmatizing and non-stigmatizing illnesses and moderating effects of social support. Native Spanish speakers conducted three focus groups (in Spanish) lasting two hours with seven to eight participants. Focus groups were transcribed, translated, and coded. Frequency data were calculated by number of times concepts or themes were raised. Comparisons of barriers to health care access were made between U.S. and Mexican cultures. The majority (86%) of comments on barriers for non-stigmatizing illnesses implicated U.S. culture; the majority (90%) for stigmatizing illnesses implicated Mexican culture. Social support for stigmatizing illnesses was discussed. Participants discussed important issues of health care access for stigmatizing illnesses that may have implications for this population's health status. Greater attention should be paid to stigma and social support in future empirical studies.
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Actitud Frente a la Salud/etnología , Emigrantes e Inmigrantes/psicología , Accesibilidad a los Servicios de Salud , Americanos Mexicanos/psicología , Aceptación de la Atención de Salud/etnología , Adulto , Comparación Transcultural , Cultura , Femenino , Grupos Focales , Humanos , México/etnología , New Mexico , Prejuicio , Investigación Cualitativa , Apoyo Social , Estereotipo , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD: An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS: Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS: The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.
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Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Servicios Urbanos de Salud/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Alaska/epidemiología , Análisis de Varianza , Niño , Preescolar , Diversidad Cultural , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , New Mexico/epidemiología , Características de la Residencia/clasificación , Características de la Residencia/estadística & datos numéricos , Servicios de Salud Rural/provisión & distribución , Factores Socioeconómicos , Servicios Urbanos de Salud/provisión & distribuciónRESUMEN
OBJECTIVE: To identify the preferences of practicing licensed psychiatrists in two rural states regarding ethics training. METHOD: All licensed psychiatrists in Alaska and New Mexico were mailed a survey exploring differences in ethical and practice issues between rural and urban health care providers. Data were collected from 97 psychiatrists. RESULTS: Findings indicated a moderate level of interest in training related to a diverse set of ethics topics. Although women expressed greater interest in most topics than did men, ranking of topics was similar across genders. Level of interest in training was inversely related to number of years in practice. CONCLUSIONS: The psychiatrists in this study indicated some interest in professionalism and ethics training, but did not express the level of need or enthusiasm documented in many studies of physicians-in-training. Creating continuing medical education initiatives that are attuned to the distinct needs and preferences of psychiatrists in clinical practice thus poses many challenges. This may be particularly true for certain aspects of practice, such as ethics and professionalism, that have long been recognized as vital to clinical care, but now are viewed as core competency areas.
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Actitud del Personal de Salud , Ética Profesional/educación , Competencia Profesional , Psiquiatría/educación , Psiquiatría/ética , Alaska , Análisis de Varianza , Recolección de Datos/métodos , Recolección de Datos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , New Mexico , Rol Profesional , Población Rural , Distribución por SexoRESUMEN
Compared to their urban counterparts, rural residents face numerous disparities in obtaining health care, including limited access to care providers. We assessed disparities in provider availability in rural versus urban Alaska and New Mexico, with emphasis on professionals likely to provide mental health care. Using lists of licenses, we categorized physical and mental health care providers into rural versus urban and calculated rural versus urban disparity ratios. Rural residents had significantly less access to health care providers and discrepancies grew with level of required provider education and specialization. Addressing disparities via creative strategies is crucial to improving rural care delivery.
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Accesibilidad a los Servicios de Salud , Salud Rural , Salud Urbana , Alaska , Humanos , Servicios de Salud Mental/provisión & distribución , New MexicoRESUMEN
To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.