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OBJECTIVE: To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. METHOD: Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). RESULTS: In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. CONCLUSION: CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
Assuntos
Colonoscopia/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Cooperação do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Fezes/citologia , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , Cooperação do Paciente/etnologia , Autoeficácia , Fatores Socioeconômicos , TexasRESUMO
Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.
Assuntos
Cultura , Dependência de Heroína/etnologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/etnologia , Síndrome de Abstinência a Substâncias/etnologia , Idoso , Idoso de 80 Anos ou mais , Dependência de Heroína/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/reabilitação , Síndrome de Abstinência a Substâncias/prevenção & controle , Inquéritos e Questionários , TexasRESUMO
CONTEXT: Studies to determine the decisional control preferences (DCPs) in Hispanic patients receiving palliative care are limited. OBJECTIVES: The aims of this study were to describe DCPs, disclosure of information, and satisfaction with decision making among Hispanics and to determine the degree of concordance between patients' DCPs and their self-reported decisions. METHODS: We surveyed 387 cancer patients referred to outpatient palliative care clinics in Argentina, Chile, Guatemala, and the U.S. DCPs were measured with the Control Preference Scale, disclosure preferences with the Disclosure of Information Preferences questionnaire, and satisfaction with care with the Satisfaction with Decision Scale. RESULTS: In this study, 182 patients (47.6%) preferred shared decisional control, 119 (31.2%) preferred active decisional control, and 81 (21.2%) preferred a passive approach. Concerning their diagnosis and prognosis, 345 (92%) patients wanted to know their diagnosis, and 355 (94%) wanted to know their prognosis. Three hundred thirty-seven (87%) patients were satisfied with the decision-making process. DCPs were concordant with the self-reported decision-making process in 264 (69%) patients (weighted kappa = 0.55). Patients' greater satisfaction with the decision-making process was correlated with older age (P ≤ 0.001) and with a preference for enhanced diagnostic disclosure (P ≤ 0.024). Satisfaction did not correlate with concordance in the decision-making process. CONCLUSION: The vast majority preferred a shared or active decision-making process and wanted information about their diagnosis and prognosis. Older patients and those who wanted to know their diagnosis seemed to be more satisfied with the way treatment decisions were made.
Assuntos
Tomada de Decisões , Hispânico ou Latino/psicologia , Neoplasias/terapia , Cuidados Paliativos/psicologia , Participação do Paciente , Satisfação do Paciente/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Chile , Estudos Transversais , Feminino , Guatemala , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/etnologia , Neoplasias/psicologia , Cuidados Paliativos/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Autorrelato , Estados Unidos , Adulto JovemRESUMO
This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.
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Dependência de Heroína/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Apoio Social , Abuso de Substâncias por Via Intravenosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dependência de Heroína/etnologia , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/etnologiaRESUMO
BACKGROUND: Understanding family caregivers' decisional role preferences is important for communication, quality of care, and patient and family satisfaction. The family caregiver has an important role in a patient's decisional role preferences. There are limited studies on family caregivers' preferences of the patient's decision control at the end of life among Hispanics. AIMS: To identify Hispanic caregivers' preferences of the decision control of patients with advanced cancer and to compare the preferences of caregivers in Hispanic Latin American and Hispanic American caregivers. DESIGN: We surveyed patients and their family caregivers referred to outpatient palliative care clinics in the United States, Chile, Argentina, and Guatemala. Caregiver preferences of patient's decision control were evaluated using the Control Preference Scale. Caregivers' and patients' sociodemographic variables, patient performance status, and Hispanic American patient acculturation level were also collected. PARTICIPANTS: A total of 387 caregivers were surveyed: 100 (26%) in Chile, 99 (26%) in Argentina, 97 (25%) in Guatemala, and 91 (24%) in the United States. The median age was 56 years, and 59% were female. RESULTS: Caregiver preference of patient's decision control was passive, shared, and active for 10 (11%), 45 (52%), and 32 (37%) Hispanic American caregivers and 54 (19%), 178 (62%), and 55 (19%) Hispanic Latin American caregivers (p = 0.0023), respectively. Caregiver acculturation level did not affect the preferences of the Hispanic American sample (p = 0.60). CONCLUSIONS: Most Hispanic family caregivers preferred the patient to make shared decisions. Hispanic Latin American caregivers more frequently preferred patients to assume a passive decisional role. Acculturation did not influence the preferences of Hispanic American caregivers.
Assuntos
Aculturação , Cuidadores/psicologia , Tomada de Decisões , Cuidados Paliativos/organização & administração , Argentina/epidemiologia , Chile/epidemiologia , Feminino , Guatemala/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/normas , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
CONTEXT: Characterizing where people die is needed to inform palliative care programs in Mexico. OBJECTIVES: To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. METHODS: We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. RESULTS: The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). CONCLUSION: Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services.
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Morte , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Doente Terminal/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , México/epidemiologiaRESUMO
This article examines comparative risk behaviors associated with methamphetamine use in a binational sample of women in the border cities of Tijuana, Mexico, and San Diego, California. Specifically, the study examined the differences and similarities in drug use and sexual risk behavior and the patterns of initiation to methamphetamine use. The binational pilot sample consisted of 70 adult women in Tijuana and 55 women in San Diego. Although there were important differences in the presentation of risk behavior and patterns of initiation between the two binational samples, women on both sides of the US-Mexico border also showed remarkable similarities in their risk profile. Results from this study suggest that despite significant cultural and socioeconomic differences between the study cities, certain specific substance abuse patterns (e.g., methamphetamine use) in border regions with an increasing demographic exchange and integration are emerging as an "equalizer" of risk, capable of dissolving context-based differentiating factors, and creating a more homogenous subpopulation of substance users.
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Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Metanfetamina/efeitos adversos , Assunção de Riscos , Comportamento Sexual/etnologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/etnologia , California/epidemiologia , Comparação Transcultural , Coleta de Dados , Feminino , Humanos , México/epidemiologia , Projetos Piloto , Fatores SocioeconômicosRESUMO
OBJECTIVE: We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia. METHODS: Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US-Mexico border. We assessed caregivers' intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament's brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers' mental and physical health, depressive symptomatology and perceived burden. RESULTS: Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients' functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression. CONCLUSION: Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.
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Adaptação Psicológica , Cuidadores/psicologia , Americanos Mexicanos/psicologia , Religião e Psicologia , Estresse Psicológico/etnologia , Atividades Cotidianas , Adulto , Idoso , California , Pessoas com Deficiência , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Pessoa de Meia-Idade , Análise de Regressão , Adulto JovemRESUMO
This paper describes an innovative Pan-American survey on advanced-cancer care and examines the quality-of-care provided by Latin American institutions. A convenience sample of 777 physicians and nurses who treat cancer patients in Argentina, Brazil, Cuba, Mexico, and Peru were surveyed. Providers were identified through mass mailings, distribution at professional meetings and conferences, collaboration with regional institutions, professional organizations, and PAHO and online posting. Multiple linear regression analyses were conducted to identify predictors of quality-of-care assessments in each country. The five predictive models were subsequently compared descriptively. Higher access to care ratings and greater availability of end-of-life services corresponded with improved institutional quality-of-care ratings for all five countries. Barring respondents from Cuba, providers from the other four nations who practice in public institutions rated the quality of advanced-cancer care in their own institutions lower than those practicing in private hospitals or specialized cancer centers. Other institutional quality-of-care predictors included type of city, affordability-of-care ratings, availability of opioid analgesics, where patients die, barriers to cancer pain management, and the provider's specialty and gender. These findings highlight the need for providing accessible care and services to improve the quality of advanced-cancer care in Latin American institutions. Efforts should be aimed at improving the care offered in public institutions and addressing other types of disparities that may exist within countries by creating supportive and palliative cancer care programs that are accessible and affordable to those most in need.
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Atitude do Pessoal de Saúde , Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Neoplasias/terapia , Auditoria de Enfermagem , Cuidados Paliativos , Argentina , Brasil , Institutos de Câncer , Cuba , Progressão da Doença , Inquéritos Epidemiológicos , Hospitais Privados , Hospitais Públicos , Humanos , América Latina , México , Peru , Padrões de Prática MédicaRESUMO
Colorectal cancer (CRC) screening rates are comparatively low for U.S. Hispanics. To learn more about the factors influencing CRC screening among Hispanics living along the U.S.-Mexico border, 12 focus groups were conducted with Hispanic men and women aged 50 years and older in three Texas counties; Cameron County (Brownsville), Webb County (Laredo), and El Paso County, (El Paso). The focus group guide contained questions about health care behavior, knowledge about CRC, experiences with cancer, and factors that influence CRC screening. A total of 92 individuals participated with the majority aged 50-69 (75%). Twenty percent were born in the United States and 51% had lived in the United States for more than 20 years. Participants had low levels of education, income, and insurance coverage. The analysis revealed several overarching and contextual themes relating to knowledge, attitudes, beliefs, and emotions about cancer and CRC screening. A prevalent theme that emerged from all groups was frustration and a lack of confidence in the U.S. healthcare system. Few participants had been advised by their providers to obtain CRC screening. Lack of patient knowledge about colorectal cancer and screening appeared to be a critical factor influencing screening. Themes about death and pain due to cancer were prevalent as were cultural factors such as machismo and embarrassment. System level barriers such as cost, medical insurance and transportation also impacted screening. These findings suggest that strategies are needed to educate Hispanic residents of border communities about CRC and to motivate them to undergo CRC screening.
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Atitude Frente a Saúde , Neoplasias Colorretais/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/etnologia , Programas de Rastreamento/psicologia , Sangue Oculto , Adulto , Idoso , Colonoscopia/psicologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/psicologia , Escolaridade , Feminino , Grupos Focais , Hispânico ou Latino/psicologia , Humanos , Renda , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , TexasRESUMO
Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations (P<0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta=0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries.