Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (64 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2016)

ABSTRACT OF THE DISSERTATION

Psychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

by

Rebeca Espinoza Giacinto

Doctor of Philosophy in Public Health (Global Health)

University of California, San Diego, 2016

San Diego State University, 2016

Professor Gregory A. Talavera, Chair

Background: Individuals with uncontrolled diabetes are at higher risk for developing cardiovascular disease, dyslipidemia, hypertension and retinopathy. While there is evidence for poor diabetes management among high risk populations, such as Hispanic/Latinos, specific self-care and lifestyle practices that influence glycemic regulation remain poorly understood.

Aims: This dissertation will examine psychosocial, sociocultural, and biobehavioral correlates of glycemic control among diverse Hispanic/Latinos with diabetes in the US through the following aims: (1) to examine psychosocial and sociocultural correlates of glycemic status; (2) to examine the role of sleep duration and glycemic status; and (3) to examine the reported use of conventional and complimentary medicine and types of care accessed and its related influence on glycemic regulation status.

Methods: Chapters 2-4 employ data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data were collected as part of the HCHS/SOL study which included 16,415 self-identified Hispanic/Latinos ages 18-75 recruited between March 2008 and June 2011. Analyses for the current study involved a subset of individuals with diabetes.

Results: As presented in Chapter 2, older age, shorter duration of US residence, annual doctor visits, and better dietary quality were independently associated with improved glycemic control. No other variables, including those for psychosocial and sociocultural factors, were significantly associated with glycemic control. As presented in Chapter 3, individuals with long sleep duration (>9 hrs.) had suboptimal glycemic control status, compared to those who reported average sleep duration (6< 9hrs.). As described in Chapter 4, individuals with poor glycemic status were more likely to report being prescribed diabetes medication as well as reporting concomitant use of diabetes medication and botanical/herbal use compared to those who reported use of neither prescribed diabetes medications or supplement use.

Conclusion: Addressing social and structural barriers such as routine care, particularly among younger Hispanic/Latinos and those with longer residence in the US may aid in improving glycemic control status and preventing complications related to suboptimal diabetes management. Further research is needed to examine acculturative processes and glycemic control which may offer greater insights into specific correlates of diabetes management among ethnically diverse Hispanic/Latinos in the US.

    Cover page: Psychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
    • 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 San Diego Previously Published Works (2016)
        Cardiovascular diseases (CVD) are the leading cause of mortality in the United States and Western world for all groups with one exception: CVDs are the number 2 cause of death for Hispanics/Latinos behind cancer with overall cancer rates lower for Latinos relative to non-Hispanic Whites (NHWs). Despite a significantly worse risk factor profile marked by higher rates of traditional and non-traditional determinants, some CVD prevalence and mortality rates are significantly lower among Latinos relative NHWs. These findings support a need for greater understanding of CVDs specifically among Latinos in order to better document prevalence, appropriately model risk and resilience, and improve targeting of intervention efforts. The current aim is to provide a state-of-the-science review of CVDs amongst Latinos including a review of the epidemiological evidence, risk factor prevalence, and evaluation of the breadth and quality of the data. Questions concerning the generalizability of current risk models, the Hispanic paradox as it relates to CVDs, contributing psychosocial and sociocultural factors, and future directions are discussed.
          Cover page: Cardiovascular Disease in Hispanics/Latinos in the United States
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2018)
          OBJECTIVE: To study the associations of comprehensive measures of cardiac structure and function with multidimensional neurocognitive measures. PATIENTS AND METHODS: The Echocardiographic Study of Latinos is a population-based cohort of Hispanic/Latino adults older than 45 years enrolled from October 1, 2011, through June 30, 2014. Neurocognitive measures included Word Fluency (WF), Brief-Spanish English Verbal Learning Test (B-SEVLT), and Digit Symbol Substitution Test. The B-SEVLT included B-SEVLT-recall and B-SEVLT-sum. Echocardiographic measures included cardiac structure, systolic and diastolic function, and myocardial strain. Multivariable regression models were fit using survey statistics and sampling probabilities. RESULTS: A total of 1794 participants (mean age, 56±0.5 years; 56% women) were included in the analysis. In the adjusted model, higher left ventricular mass index was associated with lower B-SEVLT-sum and Digit Symbol Substitution Test scores. Left ventricular systolic dysfunction was associated with lower WF scores. Abnormal left ventricular geometry was associated with lower B-SEVLT-sum scores. Higher relative wall thickness was associated with B-SEVLT-recall and B-SEVLT-sum scores. Mitral annular relaxation velocities were associated with lower B-SEVLT-recall, B-SEVLT-sum, and WF scores. Higher mitral inflow to annular early diastolic velocity ratio was associated with lower B-SEVLT-recall and B-SEVLT-sum scores. Diastolic dysfunction was associated with lower B-SEVLT-sum scores. Finally, lower global longitudinal strain was associated with lower WF scores. CONCLUSION: Alterations in cardiac structure, systolic and diastolic function, and myocardial strain were associated with worse neurocognitive function. Further study is needed to determine the mechanisms (ie, impairment of cerebral flow and silent brain infarctions) mediating these heart-brain associations.
            Cover page: Association of Cardiac Structure and Function With Neurocognition in Hispanics/Latinos: The Echocardiographic Study of Latinos.
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2019)

            Background

            The association between sugar-sweetened beverage (SSB) consumption and colorectal cancer (CRC) risk remains unclear and published data are limited.

            Methods

            The analytic cohort included 99,798 women, free of cancer at baseline, from the California Teachers Study, a longitudinal cohort comprised of 133,477 female teachers and administrators who were active or recently retired members of the California State Teachers Retirement System in 1995. SSB consumption constituted caloric soft drinks, sweetened bottled waters and teas, and fruit drinks, derived from a self-administered food frequency questionnaire. Consumption was divided into four categories: Rare or never, >rare/never to <1 serving/week, ≥1 serving/week to <1 serving/day, and ≥1 serving/day. CRC endpoints were based on annual linkage with California Cancer Registry, defined as first diagnosis of CRC, and classified following the Surveillance, Epidemiology, and End Results Program coding system. Multivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HR) and 95% confidence intervals (CI) for assessing the association between SSB consumption and incident CRC.

            Results

            A total of 1,318 incident CRC cases were identified over 20 years of follow-up (54.5% proximal colon and 45.5% distal colorectum). Compared with rare/never consumers, the multivariable-adjusted HRs (95% CI) were 1.14 (0.86, 1.53) for total CRC; 1.11 (0.73, 1.68) for proximal colon; and 1.22 (0.80, 1.86) for distal colorectum cancers among women consuming ≥ 1 serving/day of SSBs.

            Conclusion

            SSBs were not significantly associated with CRC risk. The biological effects of high SSB consumption make it important to continue to evaluate whether SSBs are associated with CRC. Additionally, future studies should further assess SSBs in large, racial/ethnically diverse cohorts of males and females, and, if feasible, address changes in SSB consumption over time.
              Cover page: Sugar-sweetened beverages and colorectal cancer risk in the California Teachers Study
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2014)

              Background

              The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women.

              Methods

              To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer.

              Results

              Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants.

              Conclusions

              Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork.
                Cover page: Reducing time‐to‐treatment in underserved Latinas with breast cancer: The Six Cities Study
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2023)
                BACKGROUND: High sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation that has been associated with persistent depressive symptoms. Depression and anxiety are frequently associated with a chronic inflammatory state, yet the nature of this relationship has not been rigorously examined in diverse Hispanic/Latino populations. We aimed to study the association of anxiety and depressive symptoms as well as comorbid presentations, with circulating high sensitivity C-reactive protein (hsCRP) levels in a large Latino cohort of diverse heritages. We hypothesized a significant positive associations of both anxiety and depressive symptoms and hsCRP levels and potential variations among the heritage groups. METHODS: Depressive symptoms and anxiety were measured by the Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. Serum hsCRP (hsCRP) levels of 15,448 participants (age 18 to 75 years; 52.3% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were measured and categorized based on the established cardiovascular disease (CVD) risk reference values (< 1mg/L, low; 1-<3 mg/L, intermediate; ≥ 3mg/L, high). RESULTS: Mean CES-D, STAI scores, and hsCRP levels were 7.0 (SD = 5.9), 17.0 (SD = 5.7), and 3.84 (SD = 7.85), respectively. Generalized linear modeling, adjusted for sociodemographic characteristics revealed significant associations between depression (exp(β) = 1.12; p<0.01) and anxiety symptoms (exp(β) = 1.10; p<0.05) with continuous hsCRP levels. For categorical values of hsCRP, one SD increase in CES-D and STAI scores was associated with a 10% and 8% increase in the RRRs of high vs. low hsCRP, respectively. However, these relationships between CES-D or STAI and hsCRP were no longer statistically significant after adjustment for CVD risk factors and medications. CONCLUSION: We found modest associations between anxiety and depressive symptoms and systemic inflammation measured by hsCRP among diverse Hispanics/Latinos that did not appreciably differ between heritage groups.
                  Cover page: Association of anxiety and depressive symptoms with C-reactive protein in diverse Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2013)
                  BACKGROUND.: Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS.: The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS.: The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P = .007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P < .001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P = .989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P = .045; within 60 days: 86.2% vs 78.4%; P = .023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P < .001; within 60 days: 94.5% vs 67.2%; P < .001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS.: Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments.
                    Cover page: Navigating Latinas with breast screen abnormalities to diagnosis
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2020)
                    Nightly fasting duration (NFD) and eating timing and frequency may influence cardiometabolic health via their impact on circadian rhythms, which are entrained by food intake, but observational studies are limited. This 1-year prospective study of 116 US women (33 ± 12y, 45% Hispanic) investigated associations of habitual NFD and eating timing and frequency with cardiovascular health (CVH; American Heart Association Life's Simple 7 score) and cardiometabolic risk factors. NFD, eating timing and frequency, and nighttime eating levels were evaluated from 1-week electronic food records completed at baseline and 1 y. In multivariable-adjusted linear regression models, longer NFD was associated with poorer CVH (β = -0.22, p = 0.016 and β = -0.22, p = 0.050) and higher diastolic blood pressure (DBP) (β = 1.08, p < 0.01 and β = 1.74, p < 0.01) in cross-sectional and prospective analyses, respectively. Later timing of the first eating occasion at baseline was associated with poorer CVH (β = -0.20, p = 0.013) and higher DBP (β = 1.18, p < 0.01) and fasting glucose (β = 1.43, p = 0.045) at 1 y. After adjustment for baseline outcomes, longer NFD and later eating times were also associated with higher waist circumference (β = 0.35, p = 0.021 and β = 0.27, p < 0.01, respectively). Eating frequency was inversely related to DBP in cross-sectional (β = -1.94, p = 0.033) and prospective analyses (β = -3.37, p < 0.01). In cross-sectional analyses of baseline data and prospective analyses, a higher percentage of daily calories consumed at the largest evening meal was associated with higher DBP (β = 1.69, p = 0.046 and β = 2.32, p = 0.029, respectively). Findings suggest that frequent and earlier eating may lower cardiometabolic risk, while longer NFD may have adverse effects. Results warrant confirmation in larger multi-ethnic cohort studies with longer follow-up periods.
                      Cover page: Habitual Nightly Fasting Duration, Eating Timing, and Eating Frequency are Associated with Cardiometabolic Risk in Women
                      Top