Immigration-Related Trauma Associated With Metabolic Risk and Cognition in Hispanic and Latino Immigrant Populations

Recent immigrant and undocumented Hispanic/Latino adults in the United States (U.S.) are an underserved segment of the aging population. In this cross-sectional pilot study, we examined associations between self-reported stressors metabolic syndrome, emotional reactivity, and cognitive functioning in a heterogenous sample (N=80) of Hispanic/Latino adults (43.8% Central America; 43.8% South America; 7.5% Caribbean; mean years in the U.S.=18.1, SD=12.8). Participants (Meducation=10.2 years, SD=5.34; Mage=48.6 years, SD=12.3) underwent blood draw, anthropometrics and NIH-toolbox cognitive and behavioral measures. Linear regressions indicated that, elevated glucose was inversely associated with working memory (r=-.30), whereas higher HDL and controlled glucose were associated with better episodic memory (r=.27) and executive functioning (r=.32). Results further revealed associations between immigration-related trauma and elevated posttraumatic stress symptomatology. Implications for mental health and early detection of modifiable risk factors to promote healthy aging in vulnerable Hispanic/Latino immigrant populations are discussed.

Creation of a Latin-American Dementia Advance Care Planning Guide

The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia) is an advance care planning conversation guide for use within the context of dementia (Dassel et al., 2019). Considering that Latino adults have the highest risk of ADRD, a culturally sensitive and translated Spanish version of the LEAD Guide was needed. Therefore, the objective of this study was to: 1) translate the LEAD Guide into a Latin-American Spanish version (i.e., LA LEAD) and 2) assess the applicability and acceptability of the LA LEAD through focus groups with Latino older adults. First, the LEAD Guide was translated into a “neutral” Spanish version. Second, forward and backward translation was conducted to create the LA LEAD. Third, two 1.5-hour focus groups with Spanish-speaking Latino adults age 50+ who were: a) healthy adults (N=7) or b) current or previous dementia caregivers (N=7) were held. The focus groups were recorded, translated, and transcribed for descriptive analysis, which revealed three domains regarding the LA LEAD: 1) Family Dynamics: the guide could help prevent family conflict, designate a health care proxy, and reduce burden; 2) Cultural Expectations: acknowledgement of cultural nuances between LA countries, the familial responsibility of caring for family in the home, and the influence of religion on end-of-life care decisions, and 3) Health Literacy: lack of knowledge about advance care planning conversations, documentation, and dissemination. This process resulted in the creation of a validated LA LEAD Guide, which is a culturally and linguistically appropriate and acceptable advance care planning tool for Latino older adults.

Addressing cancer care needs for Latino adults: A formative qualitative evaluation.

105 Background: Cancer remains the number one cause of death among the Latino population despite the decrease in cancer incidence and mortality in the United States. Latino patients experience worse quality of life, more advanced stages of disease, and longer times to definitive diagnosis and treatment initiation. Yet there are few interventions that leverage clinical and community-based approaches to address these disparities. The aim of this formative qualitative study was to explore the specific care needs and barriers encountered by Latino patients to refine a community-based intervention delivered by community health workers (CHWs). Methods: We conducted semi-structured, in-depth, one-on-one qualitative interviews with low-income, Latino adults with a past or current history of cancer and/or their caregivers in a county comprised of 80% Latino populations in California. Interviews were conducted in Spanish, audio-recorded, transcribed and translated. Analysis was based in grounded theory and performed using the constant comparative method. Results: Fourteen interviews were conducted with a total of 18 participants; 9 involved the patient, 4 involved the patient and a designated caregiver, and 1 involved a caregiver only. Four major themes emerged that included: 1) lack of overall understanding of all aspects of cancer including their cancer diagnosis, significance of advance directives, precision medicine, and cancer care plans; 2) severe challenges in communicating cancer care needs and receiving support services due to language barriers; 3) stress and anxiety regarding financial hardships related to job loss and insurance barriers; 4) the need for supportive, bilingual and bicultural personnel to assist in overcoming these challenges. Conclusions: Latino patients with cancer and caregivers described major barriers they encounter after a cancer diagnosis. Participants described important approaches to address these cancer specific needs and reduce cancer disparities among these populations.

Association of Subjective Social Status With Life's Simple 7s Cardiovascular Health Index Among Hispanic/Latino People: Results From the HCHS/SOL

Background Evidence suggests that subjective (perceived) social status (SSS) may predict health outcomes more strongly than objective social status, but little is known about the relationship between SSS and cardiovascular health (CVH). This study focuses on this relationship among diverse Hispanic/Latino adults because while poor CVH profiles are prevalent in this population, immigration complicates attempts to measure their social status. Methods and Results We analyzed baseline HCHS/SOL (Hispanic Community Health Study/Study of Latinos) data on 15 374 Hispanic/Latino adults aged 18 to 74 years in 2008 to 2011. SSS was assessed using the McArthur Scale, a 10‐rung “social ladder.” CVH was based on levels of 7 metrics defined by the American Heart Association. Linear and logistic regressions were used to examine cross‐sectional associations of SSS with CVH (overall and single metrics) after adjusting for objective social status, demographic, and health factors. Less than half of the population (46%) had Ideal scores in ≥4 metrics of CVH. In multivariable‐adjusted models, an increase in SSS was associated with a higher overall CVH score (β=0.04; 95% CI, 0.01–0.06) and greater likelihood of Ideal levels of body mass index, physical activity, and fasting blood glucose levels. Nativity and time in the United States modified the association between SSS and Ideal smoking. Conclusions Subjective measures of social status can enhance an understanding of CVH among Hispanic/Latino people. Future studies should explore the stability of SSS over time in comparison with objective social status and the mechanisms through which SSS may influence CVH.