The purpose of this study is to describe Community Health Workers’ (CHWs) efforts in meeting unmet needs in underserved populations, especially with added COVID-19 pressures. Five focus groups were conducted with 28 CHWs across three counties. It was found that CHW’s served as puentes/bridges, in which the extent of their reach and foundational strength provides a connection between the Latino/a/x population across Arizona and social services, resources, and the healthcare system.

Adolescent substance use is a complex and significant public health concern that has received considerable attention among researchers and practitioners (Gray & Squeglia, 2018). The purpose of this dissertation was to examine factors associated with substance use intervention effects and to develop subgroups of risk factors for Mexican adolescents. This dissertation utilizes secondary data from a randomized controlled trial of the school-based substance use universal prevention program, keepin’ it REAL (kiR). The dissertation included two studies. Study 1: This study tested a model on the efficacy of the school-based substance use universal prevention program, keepin’ it REAL, among a sample of Mexican adolescents (N = 3,742, 11-17 years old). Study 1 analysis included Structural Equation Modeling and results demonstrated that participation in kiR positively predicted alcohol resistance strategies and those alcohol resistance strategies were negatively and significantly associated with alcohol use. Further, depressive symptomology was a moderator of intervention effects as the effects of kiR on resistance strategies increased as the level of depressive symptomology increased. Study 2: this study explored subgroups (classes) of Mexican adolescents (N = 5,520, 11-14 years old) based on their experiences with violence (witnessing, victimization, and perpetration), depressive symptomology, and substance use (alcohol, tobacco, and marijuana). Using Latent Class Analysis (LCA) four empirically, well-differentiated classes emerged representing adolescents various risk typologies (Moderate Risk-Violence at 55% of the sample, Low Risk at 35%, High Risk at ~8%; and Moderate Risk-Substance Use at ~2%) Implications for research and practice are discussed across both studies.

All ethnic groups in the U.S. have suffered from elder maltreatment (EM), but literature on this topic among Chinese Americans is sparse. Only one group of researchers has exclusively focused on the EM experiences of Chinese Americans in the U.S. A recent study indicated the prevalence rate of EM was 24% among residential-dwelling Chinese American elders and the most prevalent forms of EM are psychological maltreatment (10%) and financial maltreatment (10%). However, the effect of family relationship and cultural factors on EM have not yet been explored. The traditional Chinese culture emphasizing family cohesion and filial piety, along with the acculturation stress and language barriers may increase the risks of EM in this population.

This exploratory research aimed to understand EM perpetrated by family members in residential settings among Chinese American elders and the risk factors of EM in this population, focusing on the Phoenix metropolitan area. Particularly, understanding EM through both a cultural lens and a legal lens shed light on the roles of socio-cultural variables (family support and cultural variables) associated with EM among Chinese American elders, one of the fastest growing ethnic groups in the U.S.

To achieve these research aims, a larger quantitative component building on a small qualitative component was utilized. In Phase I, focus groups were conducted to ensure subsequent survey questions were culturally and linguistically appropriate. Feedback from the focus groups was used to refine the questionnaire designed for this study. In Phase II, revised questionnaires were distributed to 266 Chinese American older adults to detect EM prevalence and to identify the factors associated with victimization. The ecological theory provides guidance for the study.

In the end, one of ten Chinese American elders experienced general EM perpetrated by family members. The dominant forms of EM, elder neglect and emotional maltreatment, may have serious emotional outcomes and threaten the well-being of Chinese elders. To prevent the occurrence and recurrence of EM, service professionals and gatekeepers in the community need to work with Chinese American families to reduce elders’ depression levels, promote family cohesion and eliminate the intergenerational culture/acculturation differences.

In the face of rising rates of substance use among Mexican youth and rapidly narrowing gender differences in use, substance use prevention is an increasingly urgent priority for Mexico. Prevention interventions have been implemented in Mexico but few have been rigorously evaluated for effectiveness. This article presents the long term effects of a Mexico-based pilot study to test the feasibility of a linguistically specific (Mexican Spanish) adapted version of keepin’ it REAL, a school-based substance abuse prevention model program. University affiliated researchers from Mexico and the US collaborated on the study design, program implementation, data collection, and analysis. Students and their teachers from two middle schools (secundarias) in Guadalajara participated in this field trial of Mantente REAL (translated to Spanish). The schools were randomly assigned to treatment and control conditions. The sample of 431 students reported last 30 day substance use at three times (one pretest and two posttests). Changes in substance use behaviors over time were examined using growth curve models. Long term desired intervention effects were found for alcohol and marijuana use but not for cigarettes. The intervention effects were greater for girls than for boys in slowing the typical developmental increase over time in alcohol use. Marijuana effects were based on small numbers of users and indicate a need for larger scale studies. These findings suggest that keepin’ it REAL is a promising foundation for cultural program adaptation efforts to create efficacious school-based universal prevention interventions for middle school students in Mexico.

Although it has been established that children raised by lesbian and gay (LG) parents are comparable in psychological adjustment to those raised by heterosexuals, there are unique stressors that these families must face as members of a social minority group. For example, chronic exposure to stigma and discrimination has been associated with several poor psychological and behavioral outcomes in children, as well as high levels of stress experienced by LG parents. Thus, the current study sought to examine LG parents' coping actions and parenting strategies as used during and after an act of antigay discrimination which also involved their children, or as these involved an act which their children witnessed. This study also sought to define the parenting needs of LG parents. The research plan utilized an integrative mixed methods approach to examine the qualitative text narratives of 43 LG parents (29 mothers and 14 fathers) ranging in age from 28-56 years old with school-aged children (6-12 years). Results revealed that LG parents' negative emotion-based coping actions predicted higher depressive symptoms (β= .41,t(33) = 3.17, p < .01), LG parents' avoidant/escape coping actions predicted lower parenting self-agency (β = -.34, t(33) = -2.23, p < .05), and LG parents' engagement in understanding and coping with discrimination parenting strategies predicted lower post-traumatic stress problems in their children (β = -.33, t(33) = -1.96, yp = .059). Last, a family needs assessment survey was used to determine the unique parenting needs of these LG parents. The results of this survey indicated that LG parents endorsed the following three topic areas as most important to them: (a) LG Family Community Services, (b) Information about Child Development, and (c) Explaining LG Family to Others. These findings reinforce existing knowledge in terms of the effects of discrimination on LG parents and their children. Indeed, results indicate the importance of providing LG parents with adaptive discrimination coping and parenting strategies, as well as offering valuable information concerning their specific needs.

Communication skills within dating contexts are developed during the adolescent years, and are associated with a lifelong ability to have satisfying, enduring, and non-violent partnerships. As such, they are currently and increasingly implemented into both more general forms of healthy relationship education, as well as that targeting the prevention of teen dating violence specifically. Reaching Mexican American youth with culturally and developmentally appropriate relationship education, including communication skills, may be particularly important given their earlier transitions to marital and parenting relationships, acculturative stressors that present them with unique coupling challenges, and their higher rates of teen dating violence as compared to European American youth. We know very little about how Mexican American dating couples communicate about areas of conflict. This dissertation research utilizes Bell and Naugle's (2008) framework of interpersonal violence to explore how cultural and developmental considerations may be integrated in order to better understand how communication behaviors contribute to Mexican American middle adolescents' experiences with dating conflict. I use an observational study design in order to 1.) Qualitatively explore the communication strategies used by a sample of committed couples, including integration of culturally- and developmentally-relevant contexts, 2.) Quantitatively examine whether couple-level discrepancies in acculturation are associated with observed negativity, including whether this relationship may be mediated by dissimilar gender-related beliefs, and to 3.) Review empirical findings pertaining to the communication behaviors of Mexican American adolescents and to integrate ecodevelopmental theory in said framework as informed by Papers 1, 2, and literature specific to this topic area. The ultimate aim of this dissertation research is to generate findings that may improve the dating health of Mexican American adolescents living in the United States.

ABSTRACT The relationships between adaptive and maladaptive aspects of gender roles in predicting substance use were examined in a sample of 955 (450 boys, 505 girls) Mexican American 7th and 8th grade adolescents participating in a school-based substance use intervention. The moderating effect of linguistic acculturation, the mediating effects of antisociality, depressive symptoms, and adaptive and avoidant coping on gender role-substance use relationships were examined. Correlational and path analyses supported the Functional Model of Gender Roles that considers these roles as adaptive or maladaptive social coping strategies. For boys, the path analyses yielded significant direct paths from aggressive masculinity to composite alcohol, cigarette, and marijuana use measures, with all other effects of gender roles on substance use operating through the mediators. Bootstrapped mediation tests yielded significant indirect paths, where for boys the positive relationships between assertive and aggressive masculinity with substance use and the negative relationship of affective femininity with substance use were mediated through antisociality, which is predictive of increased substance use. For girls, the positive relationship between aggressive masculinity with cigarette and alcohol use and the negative relationship of affective femininity with alcohol and cigarette use were also mediated by adaptive coping, which is predictive of decreased substance use. A different set of significant indirect paths through avoidant coping connected assertive masculinity and submissive femininity to alcohol use for boys. For boys, the paths from affective femininity to antisociality and adaptive coping were found to be moderated by linguistic acculturation, with the negative correlation of affective femininity with antisociality and positive correlation of this gender role with adaptive coping being stronger in boys low in acculturation. In turn, the pathway from this acculturation by affective femininity interaction to substance use was found to be mediated by antisociality. The present analyses confirmed the importance of gender roles and their interaction with acculturation in predicting substance use in Mexican American adolescents. The analyses also were important in delineating functional mechanisms through which these gender roles have their effects, with implications for the design of interventions to reduce substance use in this population.

HIV/AIDS is the sixth leading cause of death worldwide and the leading cause of death among women of reproductive age living in low-income countries. Clinicians in industrialized nations monitor the efficacy of antiretroviral drugs and HIV disease progression with the HIV-1 viral load assay, which measures the copy number of HIV-1 RNA in blood. However, viral load assays are not widely available in sub-Saharan Africa and cost between 50-$139 USD per test on average where available. To address this problem, a mixed-methods approach was undertaken to design a novel and inexpensive viral load diagnostic for HIV-1 and to evaluate barriers to its adoption in a developing country. The assay was produced based on loop-mediated isothermal amplification (LAMP). Blood samples from twenty-one individuals were spiked with varying concentrations of HIV-1 RNA to evaluate the sensitivity and specificity of LAMP. Under isothermal conditions, LAMP was performed with an initial reverse-transcription step (RT-LAMP) and primers designed for HIV-1 subtype C. Each reaction generated up to a few billion copies of target DNA within an hour. Presence of target was detected through naked-eye observation of a fluorescent indicator and verified by DNA gel electrophoresis and real-time fluorescence. The assay successfully detected the presence of HIV in samples with a broad range of HIV RNA concentration, from over 120,000 copies/reaction to 120 copies/reaction. In order to better understand barriers to adoption of LAMP in developing countries, a feasibility study was undertaken in Tanzania, a low-income country facing significant problems in healthcare. Medical professionals in Northern Tanzania were surveyed for feedback regarding perspectives of current HIV assays, patient treatment strategies, availability of treatment, treatment priorities, HIV transmission, and barriers to adoption of the HIV-1 LAMP assay. The majority of medical providers surveyed indicated that the proposed LAMP assay is too expensive for their patient populations. Significant gender differences were observed in response to some survey questions. Female medical providers were more likely to cite stigma as a source problem of the HIV epidemic than male medical providers while males were more likely to cite lack of education as a source problem than female medical providers.