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Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2017)

Background: Hispanic/Latinos experience high rates of uncontrolled chronic conditions that place this large segment of the population at risk for cardiovascular disease and mortality. Despite evidence that poor medication adherence is a major contributor to disparities in glycemic and lipid control; there is a gap in knowledge regarding the measurement and correlates of medication adherence among Hispanic/Latinos.

Aims: Using the World Health Organization’s Multidimensional Adherence Model, this dissertation focused on: 1) examining patient-, social/economic-, health condition-, therapy-, and health system-related correlates of poor adherence; and 2) identifying ways to effectively measure medication adherence among Hispanic/Latinos adults.

Methods: Aims 1 and 2 involved cross-sectional analyses of data on 149 participants enrolled in a randomized trial (Chapter 2); cross-sectional analyses of data on 279 participants enrolled in a randomized trial (Chapter 3); and, a historical cohort study of 1,485 patients from a federally qualified health center (Chapter 4).

Results: As measured by self-report, objective, and health record data, Hispanic/Latinos exhibit high rates of poor medication adherence. Bivariate analyses revealed numerous factors associated with poor adherence. Patient-related factors included younger age, sex, forgetting, multiple medications, and side effects. Health condition-related factors included higher depressive symptomatology, anxiety, and perceived stress. Social/economic-related factors included social support and limited health literacy. In logistic regression analyses, age was inversely related to poor adherence (OR 0.97; CI 0.96- 0.99, p < 0.01). Social support predicted low medication adherence (OR = 2.22; 1.03-4.76, p < 0.05) among males. The odds of low adherence were higher among males with limited health literacy (OR = 6.26; 1.06-37.10, p < 0.05). Comparison of measurement methods confirmed patients overestimate adherence to medications by self-report. Objective measures of adherence, including Medication Event Monitoring systems and Proportion of Days covered, showed lower adherence than self-report.

Conclusion: This study provides insight to the suboptimal levels of medication adherence among Hispanic/Latinos receiving services at federally qualified health centers. The findings from this study may help to inform future intervention research aiming to improve medication adherence among Hispanic/Latinos in a similar settings. Further research is needed to examine the multidimensional factors related to poor adherence among this population.

    Cover page: Socio-ecological correlates of non-adherence to prescribed medications among low-income Hispanic/Latino adults with chronic conditions
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2019)

    Aims

    We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes.

    Methods

    Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/economic- related factors and low medication adherence stratified by sex.

    Results

    More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p < 0.05). We found significant differences between levels social support and medication adherence (p < 0.05). In hierarchical models, being US born and higher levels of social support were associated with low adherence among males (p < 0.05, and p < 0.001).

    Conclusions

    Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males.
      Cover page: Correlates of low-adherence to oral hypoglycemic medications among Hispanic/Latinos of Mexican heritage with Type 2 Diabetes in the United States
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2019)
      The objective of this study was to examine the prevalence and patterns of alcohol use among U.S. Hispanic/Latino adults of diverse backgrounds. The population-based Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 years at time of recruitment, from four US metropolitan areas between 2008-11. Drinking patterns and socio-demographics questionnaires were administered as part of the baseline examination. The relationship between age, sex, socio-demographics, acculturation, current alcohol use, and alcohol risk disorder, defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [no risk (i.e., never drinker), low risk (i.e., women<7 drinks/week; men<14 drinks/week), and at-risk (i.e., women>7 drinks/week; men>14 drinks/week)] were assessed in unadjusted and adjusted multinomial logistic regression analyses. Men reported a higher prevalence than women of at-risk drinking. For women, increased odds of at-risk alcohol use was associated with: a younger age, greater education, full-time employment, and acculturation after adjustment. For men, having a lower income (vs. higher income) or a higher income (vs. not reported) and being employed fulltime (vs. retired) was associated with at-risk alcohol use. For both men and women, there were variations in odds of at-risk drinking across Hispanic/Latino heritage backgrounds, after adjustment. Exact values, odds ratios and p-values are reported within the text. Common factors across sex associated with at-risk drinking included being of Mexican background and being employed full-time. Intervention strategies should consider diversity within the Hispanic/Latino community when designing alcohol abuse prevention programs.
        Cover page: Alcohol use, acculturation and socioeconomic status among Hispanic/Latino men and women: The Hispanic Community Health Study/Study of Latinos.
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2021)
        Socioeconomic factors appear to impact mental health conditions such as depression, but little is known about the relative and combined role of neighborhood and personal socioeconomic deprivation among Hispanics/Latinos. This study examined cross-sectional associations of neighborhood and personal socioeconomic deprivation with depression symptoms in a US Hispanic/Latino population from the San Diego Field Center of the Hispanic Community Health Study/Study of Latinos (n = 3,851). Depression symptoms were assessed with the ten-item Centers for Epidemiological Studies in Depression Scale. Neighborhood socioeconomic deprivation was a composite of eleven variables (e.g., neighborhood income, education, employment, household crowding). Greater personal socioeconomic deprivation based on education, income, and employment was generally associated with higher depression symptoms, including after adjusting for neighborhood socioeconomic deprivation. Greater neighborhood socioeconomic deprivation was associated with higher depression symptoms in females but not males, but the association in females became non-significant when adjusting for personal socioeconomic deprivation. Neighborhood socioeconomic deprivation did not significantly interact with personal socioeconomic deprivation in relation to depression symptoms. The present findings support the association of personal socioeconomic status with mental health (indicated by depression symptoms) among Hispanic/Latino populations, whereas neighborhood socioeconomic deprivation did not relate to depression beyond the impact of personal indicators.
          Cover page: Neighborhood Socioeconomic Deprivation and Depression Symptoms in Adults From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
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