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Predictors of health across the life-course do not maintain the same significance in very late life and the role of financial strain in health outcomes of very old adults remain unclear. Data from adults aged 74 + in waves 5 and 7 of the Hispanic Established Population for the Epidemiological Study of the Elderly (n = 772) study was used to evaluate the role of financial strain on the health of older Mexican Americans who have the highest poverty rate of any racial or ethnic group in the United States. We evaluate the association between episodic (one wave) and persistent financial strain (two waves), with follow-up health outcomes (self-rated health, ADL (limitations in activities of daily living)/IADL (limitations in instrumental activities of daily living) disability, and depressive symptoms). Adults with persistent strain were twice as likely to experience depressive symptoms and three times more likely to experience IADL limitations than the unstrained. Our findings highlight the role of stress proliferation and allostatic load processes leading to deteriorated health over time.

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BACKGROUND: Physical activity (PA) is important because of its associated health benefits. However, many Americans remain inactive. The 2018 guidelines recognize that PA bouts of less than 10 min are beneficial. The U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion created the Move Your Way® (MYW) campaign to provide PA resources for communities and healthcare providers. This study aims to describe the reach of the MYW campaign, and assess whether having seen, heard, or read (SHR) about MYW, or having seen the MYW logo, was associated with PA knowledge, self-efficacy, and behavior among Hispanics residing in the Las Vegas, Nevada area. METHODS: Hispanics, aged 18-74, were surveyed at community events (n = 481) or via an online survey (n = 123). Respondents were asked if they had SHR of MYW, were aware of 2018 PA recommendations, and to report their personal PA behavior, PA knowledge, PA intentions, and demographics. RESULTS: Respondents (71% female) completed a 38-42-item survey. Approximately (12.4%) had SHR of the MYW campaign and 16.1% had seen the MYW logo. Only 3.4% and 15% identified, "150 minutes per week" and "75 minutes per week" as the 2018 guidelines for moderate physical activity (MPA) and vigorous physical activity (VPA), respectively. Those who had SHR of the MYW campaign were more likely to correctly identify 150 min per week as the MPA guideline and had greater confidence in overcoming selected PA barriers. Regression analysis showed that those who had seen the MYW logo were more likely to meet strength guidelines, and that those who had SHR of MYW or saw the logo were more likely to know the recommended minutes of MPA. CONCLUSIONS: Knowledge of the MYW program positively associates with some PA behaviors and PA correlates.

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Cardiovascular disease and metabolic disorders are disproportionately prevalent among Hispanic and Latino adults in the United States. We extracted a posteriori dietary patterns (DPs) among a nationally representative sample of 2049 Hispanic adults using the 2013-2018 National Health and Nutrition Examination Survey. Three primary DPs and their tertiles were identified, and their associations with cardiometabolic outcomes were examined. Those with higher levels of the Solids Fats, Cheeses, Refined Carbohydrates DP were more likely younger, male, and Mexican American. Those with higher levels of the Vegetables DP were more likely female, higher income, and long-term immigrant residents. Those with higher levels of The Plant-Based DP tended to have higher education levels. Higher levels of the Solid Fats, Cheeses, Refined Carbohydrates DP level were positively associated with body mass index (Tertile 2, ß: 1.07 [95%CI: 0.14, 1.99]) and negatively associated with lower high-density lipoprotein cholesterol (HDL-C) levels (Tertile 3, ß: -4.53 [95%CI: -7.03, -2.03]). Higher levels of adherence to the Vegetables DP were negatively associated with body fat (Tertile 3, ß: -1.57 [95%CI: -2.74, -0.39]) but also HDL-C (Tertile 2, ß: -2.62 [95%CI: -4.79, -0.47]). The Plant-Based DP showed no associations with cardiometabolic outcomes. Future research and interventions should consider these associations as well as the sociodemographic differences within each DP.

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BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with many types of cancers that disproportionately impact Hispanics. An HPV vaccine is available for individuals ages 9-45 that can prevent up to 90% of HPV-associated cancers. The current study investigates factors associated with accepting the HPV vaccine in a predominately Hispanic community. METHODS: A cross-sectional study design with an online questionnaire was used to collect data from a community sample of adults between the ages 18-65 residing in a U.S./Mexico border city, El Paso, Texas. Theory-based factors (e.g., the Health Belief Model), culture-based factors (e.g., familism), and trusted sources of information were examined as predictors of HPV-vaccine acceptance (HPV-VA) and HPV-vaccine uptake (HPV-VU). RESULTS: Community members (N = 602, Mage = 34.65, SD = 9.79) who were predominately Hispanic (89.4%) and female (79.6%) participated in the study. Linear regression models revealed that HPV-VA was associated with household size, primary language, engagement in organizational activities, health-related community stigma, government trust, and the HBM theory-based factors: perceived benefits, perceived harm, and perceived severity. Logistic regression analyses revealed that HPV-VU was associated with household size, engagement in non-organizational activities, HPV trusted sources of information, and perceived safety. CONCLUSIONS: Adequate HPV vaccination uptake among all vaccine-eligible Hispanics is an important step to lessen the HPV-attributed cancer burden. Our hypothesis that theory-based factors would be associated with HPV-VA and HPV-VU was supported. Our findings have implications for designing trusted, theory-based, and culturally sensitive health communications and interventions to promote vaccines in minority underrepresented communities.

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Introduction: While 9.5 million U.S. Hispanic adults have hearing loss, limited research has focused on their hearing care experiences. This study examines the attitudes, beliefs, behaviors, and barriers to hearing care among Hispanic adult patients with hearing loss (HL) and their caregivers. Methods: In a qualitative study, participants were recruited through community organizations, social media, and word of mouth. Participants were interviewed through virtual platforms and audio recorded. The recording was then transcribed verbatim in Spanish, translated to English, and analyzed using a hybrid deductive and inductive content approach. Results: The 12 participants (age 35-92, 83.3% female) comprised seven individuals with HL and three family caregivers. Most participants attributed HL to aging and genetics, and most shared a stigmatized community attitude toward HL that silenced any discussion of it. Barriers to hearing care included high cost, lack of insurance, and language barriers. These resulted in negative experiences with providers and poor access to hearing tests and auditory devices. Conclusions: The study's findings suggest a need to improve access to comprehensive low-cost hearing services and education in the Hispanic community. Additionally, unique challenges of this community should be addressed to promote hearing health and self-management.

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BACKGROUND: Limited information exists on how the family unit aids or impedes physical activity (PA) engagement within Hispanic populations. This qualitative study explored family-level influences on PA in dyads of adult Hispanic family members (eg, parent-adult child, siblings, spouses). METHODS: In-person interviews and brief surveys were conducted together with 20 dyads lasting 1.5 hours each. Two researchers coded and analyzed text using thematic analysis in NVivo (version 11.0). They resolved discrepancies through consensus and used matrix coding analysis to examine themes by participants' demographics. RESULTS: The participants were mainly women (70%), from Mexico (61.5%), and they reported low levels of acculturation (87.5%). Themed facilitators for PA included "verbal encouragement," "help with responsibilities," "exercising with someone," and "exercising to appease children." Themed challenges included "lack of support," "challenges posed by children," "sedentary behaviors," and "competing responsibilities." Women more so than men described family-level challenges and facilitators, and dyads where both study partners were physically active provided more positive partner interaction descriptions for PA support than other dyads. CONCLUSIONS: This study suggests that leveraging family support may be an important approach to promote and sustain PA, and that family-focused interventions should integrate communication-building strategies to facilitate family members' ability to solicit support from each other.

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BACKGROUND: Informed by Latino Critical Race Theory, the present study examined how intersections between English use/proficiency, Spanish use/proficiency, and heritage group shape the varying experiences of ethnic discrimination reported by US Hispanic adults. METHODS: The study utilized data from 7,037 Hispanic adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Multivariable binomial logistic regression modeled language use/proficiency, heritage, and demographic characteristics as predictors of past-year self-reported perceived ethnic discrimination, overall and in six different settings. RESULTS: Both English and Spanish use/proficiency were positively associated with increased adjusted odds of reporting ethnic discrimination overall, in public, or with respect to employment/education/ housing/courts/police; however, with respect to being called a racist name or receiving verbal/physical threats/assaults, a positive association was observed for English, yet not Spanish. Results also indicated a significant interaction between English use/proficiency and Spanish use/proficiency when predicting past-year ethnic discrimination overall or for any of the six types/settings examined, although the relationship between language use/proficiency and ethnic discrimination varied by Hispanic heritage group. CONCLUSION: Study findings emphasize that experiencing some form of ethnic discrimination is relatively common among US Hispanic adults, yet the prevalence and types or settings of ethnic discrimination vary widely on the basis of demographics, immigrant generation, heritage, and the interplay between English and Spanish use/proficiency.

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Insufficient water intake is associated with adverse health outcomes, including chronic disease prevalence and mortality. Adherence to Institute of Medicine total water intake (TWI) recommendations has been low in recent decades, and TWI has been consistently lower in Latinx adults compared with non-Hispanic (NH) white adults. While overall plain water intake is similar between Latinx and NH white adults, Latinx adults consistently consume significantly more bottled water and less tap water. The purpose of this review is to identify factors that may contribute to low water intake and low tap water intake, particularly in Latinx adults. The decision to drink water is complex and is influenced by a myriad of factors including context, environment, eating behaviors, geography, and beverage attributes. Plain water preferences appear to be related, in part, to perceptions of tap water safety as Latinx adults are significantly more likely to perceive their tap water as unsafe compared to NH white adults. Although recent investigations have not consistently or comprehensively evaluated the same factors, we have compiled their findings to describe the complex, interrelated determinants of tap water safety perceptions in Latinx adults. The present review proposes that perceptions are influenced by water insecurity, demographics, prior experiences, organoleptic (sensory) perceptions and availability and sources of information. Existing interventions designed to improve TWI primarily focus on improving access to water and/or educating individuals on the importance of hydration. However, this may not be sufficient in Latinx populations where water is not trusted. Future work should comprehensively assess these factors in Latinx samples and include validated plain water intake, TWI, and hydration status measures. A greater understanding of these relationships could inform interventions to improve TWI and hydration status in Latinx adults.

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This study tested whether the effect of self-referencing in a health-marketing message was amplified or attenuated when combined with message framing and narrative. Hispanic adults (N = 146) were randomly assigned to read and respond to an obesity prevention message. Self-referencing messages generated greater cognitive elaboration but only when placed in a narrative. Conversely, self-referencing messages highlighting health risks of obesity produced higher levels of involvement and intention to increase physical activity and healthy eating. Health marketing professionals can use these findings to enhance the effectiveness of obesity prevention messages that target Hispanic adults.

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This study aimed at examining trends in magnesium intake among U.S. Hispanic adults stratified by gender, Hispanic origins, age, and poverty income ratio (PIR) level. Data on 9304 Hispanic adults aged ≥20 years from eight National Health and Nutrition Examination Survey (NHANES) cycles (1999-2014) were included in this study. For each cycle, survey-weighted mean dietary and total magnesium intakes were estimated. The prevalence of dietary and total magnesium intake below the Recommended Dietary Allowance (RDA) was further estimated stratified by gender and age groups. Linear regression was used to test trend. Over the survey cycles, both dietary and total magnesium intakes were significantly increased among Hispanic adults. In the study period, magnesium intake tended to be lower in females, adults in other Hispanic-origin group, those aged ≥65 years old, and those with a PIR <1.0. The prevalence of magnesium intake inadequacy decreased among Hispanic adults; however, more than 70% of Hispanic males and females continued to have magnesium intake below the RDA in 2013-2014. From 1999/2000 to 2013/2014, despite several improvements in magnesium intake having been identified, additional findings showed insufficient intake in Hispanic males and females, suggesting the need to improve magnesium intake through diet and dietary supplementation for U.S. Hispanics.

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Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic, drug- and alcohol-related deaths might be contributing to the disparities in life expectancy. We sought to estimate life expectancy at age 20 years in key populations (and their comparison groups) in 3 time periods (2004-2007, 2008-2011, and 2012-2015) and the potential increase in expected life expectancy with a simulated 20% reduction in drug- and alcohol-related deaths using the novel Lives Saved Simulation model. Among 92,289 PLWH, life expectancy increased in all key populations and comparison groups from 2004-2007 to 2012-2015. Disparities in survival of approximately a decade persisted among black versus white men who have sex with men and people with (vs. without) a history of injection drug use. A 20% reduction in drug- and alcohol-related mortality would have the greatest life-expectancy benefit for black men who have sex with men, white women, and people with a history of injection drug use. Our findings suggest that preventing drug- and alcohol-related deaths among PLWH could narrow disparities in life expectancy among some key populations, but other causes of death must be addressed to further narrow the disparities.

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PURPOSE: To examine associations between knowledge of health conditions and sugar-sweetened beverage (SSB) intake among Hispanic adults. DESIGN: Quantitative, cross-sectional study. SETTING: The 2015 Estilos survey data. PARTICIPANTS: One thousand US Hispanic adults (≥18 years). MEASURES: The outcome variable was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, and sweetened coffee/tea drink). Exposure variables were knowledge of 6 SSB-related health conditions (weight gain, diabetes, dental caries, high cholesterol, heart disease, and hypertension). ANALYSIS: Six multinomial logistic regression models were used to estimate adjusted odds ratios for consuming SSBs ≥3 times/day (high intake), in relation to knowledge of SSB-related health conditions. RESULTS: Overall, 58% of Hispanic adults consumed SSBs ≥2 times/day and 36% consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) were related to drinking SSBs, only half identified this relation with dental caries (57%) and hypertension (41%). Even fewer identified high cholesterol (32%) and heart disease (32%) as related. In crude analyses, SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, dental caries, and heart disease; however, after adjusting for sociodemographics and acculturation, associations were no longer significant. CONCLUSIONS: Although SSB intake was very high, knowledge of SSB-related health conditions was low and was not related to high SSB intake among US Hispanic adults. Education efforts alone may not be adequate for Hispanic adults to change their behaviors.

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Hispanics have an increased risk for metabolic disorders, which evidence suggests may be due to interactions between lifespan biological, genetic, and lifestyle factors. Studies show the diet of many U.S. Hispanic groups have high sugar consumption, which has been shown to influence future preference for and consumption of high-sugar foods, and is associated with increased risk for insulin-related disorders and obesity. Taste is a primary determinant of food preference and selection. Differences in neural response to taste have been associated with obesity. Understanding brain response to sweet taste stimuli in healthy Hispanic adults is an important first step in characterizing the potential neural mechanisms for this behavior. We used fMRI to examine brain activation during the hedonic evaluation of sucrose as a function of ethnicity in Hispanic and non-Hispanic young adults. Taste stimuli were administered orally while subjects were scanned at 3T. Data were analyzed with AFNI via 3dROIstats and 3dMEMA, a mixed effects multi-level analysis of whole brain activation. The Hispanic group had significantly lower ROI activation in the left amygdala and significantly lower whole brain activation in regions critical for reward processing, and hedonic evaluation (e.g. frontal, orbitofrontal, and anterior cingulate cortices) than the non-Hispanic group. Differences in processing of sweet tastes have important clinical and public health implications, especially considering increased risk of metabolic syndrome and cognitive decline in Hispanic populations. Future research to better understanding relationships between health risk and brain function in Hispanic populations is warranted to better conceptualize and develop interventions for these populations.

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The greater prevalence of type 2 diabetes is a critical issue among the U.S. Hispanic population. This study examined the struggles of Hispanic adults managing type 2 diabetes with limited resources. Ten Hispanic adults (enrolled in a larger study to determine the effects of diabetes self-management intervention), 25 to 80 years of age and living in a rural West Texas county in the United States, were selected. Three categories of challenges emerged: (a) diabetes self-care behaviors and challenges, (b) challenges with limited resources, and (c) challenges with support mechanisms. "Making it all work" was the overarching theme that tied all the categories together. This study offers lessons for health care providers and policymakers on how to maximize the availability of resources for Hispanic individuals with type 2 diabetes living within the constraints of limited resources.

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BACKGROUND: Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language barriers, and stigma. Cultural adaptations to existing evidence-based treatments have been encouraged to improve access. However, little is known about mental health treatments translated from English to Spanish targeting anxiety among this Hispanic age group. Objctive: This case study offers an example of how an established, manualized, cognitive-behavioral treatment for adults 55 years and older with generalized anxiety disorder (known as "Calmer Life") was translated to Spanish ("Vida Calma") and delivered to a monolingual, Hispanic 55-year-old woman. RESULTS: Pre- and post-treatment measures showed improvements in symptoms of anxiety, depression, and life satisfaction. CONCLUSION: Findings suggest Vida Calma is a feasible treatment to use with a 55-year-old Spanish-speaking adult woman. CLINICAL IMPLICATIONS: Vida Calma, a Spanish language version of Calmer Life, was acceptable and feasible to deliver with a 55-year-old participant with GAD. Treatment outcomes demonstrate that Vida Calma improved the participant's anxiety, depression, and life satisfaction.

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Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.

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PURPOSE: This study assessed the feasibility of adapting a patient-centered educational intervention for type 2 diabetes (T2D) self-management for a Hispanic population with low health literacy skills. DESIGN: A descriptive qualitative study design and phenomenological analyses were used. Nine Hispanic adults with T2D recruited from a rural community health center participated in an educational program that instructed on low glycemic food choices, meaningful glucose self-monitoring, and physical activity to decrease blood glucose spikes. Participants' feedback was recorded during four 2-hour focus group sessions. Findings/Results: Participants' feedback clustered around four themes: information and knowledge, motivation and barriers to change, experiences with new behaviors, and personal responsibility. DISCUSSION/CONCLUSIONS: Data support the feasibility of adapting an established health-enhancing approach for promoting self-management of T2D to a low health literacy Spanish-speaking population. IMPLICATIONS FOR PRACTICE: The findings may help in further development of tools and strategies for improved T2D self-management in the study population.

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In this pilot study, we explore the genetic variation that may relate to type 2 diabetes (T2D) among Hispanic adults. The genotypes of 36 Hispanic adults were analyzed by using the Cardio-Metabochip. The goal is to identify single nucleotide polymorphisms (SNPs) associated to T2D among Hispanic adults. A total of 26 SNPs were identified to be associated with T2D among Hispanic adults. None of these SNPs have been reported for T2D. By using the principle components analysis to analyze the genotype of 26 SNPs in 36 samples, the samples obtained from diabetic patients could be distinguished from the control samples. The findings support genetic involvement in T2D among Hispanic adults.

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Many factors influence ways in which middle-aged and older Hispanic adults prefer to receive health-related information. While Spanish-language disease management programs are increasingly offered in community and healthcare settings, less is known about their utilization among the Hispanic population. This study aimed to identify participant and workshop factors associated with middle-aged and older Hispanic adults attending Spanish-language disease self-management program workshops and receiving the recommended intervention dose (i.e., successful workshop completion is defined as attending four or more of the six workshop sessions). Data were analyzed from 12,208 Hispanic adults collected during a national dissemination of the Stanford suite of Chronic Disease Self-Management Education (CDSME) programs spanning 45 states, the District of Columbia, and Puerto Rico. Two logistic regression analyses were performed. Over 65% of participants attended Spanish-language workshops, and 78.3% of participants successfully completed workshops. Relative to participants in English-language workshops, participants who attended Spanish-language CDSME workshops were more likely to successfully complete workshops, as were those aged 80 years and older, females, and those who lived alone. Participants who were aged 50-79 years and female were significantly more likely to attend Spanish-language workshops than their counterparts under age 50. Conversely, those with more chronic conditions were less likely to attend Spanish-language workshops. Those who attended workshops with more participants and where the Hispanic population was less affluent were more likely to attend Spanish-language workshops. This study provides insight into Spanish-language CDSME program recruitment and utilization with implications for program adoption in underserved Hispanic community settings.