Heart failure is ranked as one of the leading causes of hospitalizations and mortality among adults of all racial/ethnic groups in the United States. Telemonitoring, as a homecare intervention for heart failure management, has been used across all groups although the benefit for Hispanics not established. The purpose of this retrospective, quantitative study was to determine the differences in hospital readmission between Hispanic, non-Hispanic Black, and non-Hispanic White patients with heart failure disease who either received or did not receive home telemonitoring services from a homecare agency in Connecticut. The research questions for this study examined the effect of home telemonitoring, race, age, gender, and insurance on heart failure hospitalization across the 3 groups. The chronic care model was used as the theoretical framework for this study because it offers a method for reforming healthcare to ensure optimization in chronic disease management. A purposive sample of 138 records of patients admitted between January 1, 2012 and June 30, 2017 with a diagnosis of heart failure provided the data for the study. Data were analyzed by conducting a simple and multiple logistic regression analysis. The key findings of the simple logistic analysis showed that only Hispanics who used telemonitoring were almost 4 times less likely to be readmitted to the hospital compared to Hispanics who did not use telemonitoring (p = 0.04). The multiple logistic analysis revealed race, age, gender, and insurance were not significant predictors of readmissions (p > 0.05). The findings from this study may promote positive social change by providing healthcare providers with a better understanding of the effects of home telemonitoring for treating adult Hispanic patients with heart failure disease.

Latinos are now the largest public school minority population in the U.S. Because of a shift in the states, cities, and counties where Latinos are choosing to live, many schools that did not previously serve substantial numbers of Latinos are doing so now. Additionally, many of the Latinos in these new settlement areas are recent immigrants who speak little or no English. This qualitative study examined how immigrant Latino parents who speak little or no English supported their children in the English-speaking school system of the U.S. It specifically examined how 12 Spanish-speaking parents negotiated language and culture with their children's school in a new settlement area in the state of Utah. From the interviews I conducted with the Latino parents and school staff members, along with school observations and the collection of other data such as forms and notices, I examined how the parents negotiated language and culture with the school. I then analyzed the themes that emerged from this collection of data using a theoretical framework consisting of postcolonial theory, social and cultural capital, and the concept of social discourses. Major themes that emerged included the concern the parents had for their children's education, the parents' limited participation in the school discourse, children serving as language brokers, the maintenance and growth of their children's heritage language, the hegemony of the English language, and issues involving social and cultural capital, linking capital, and racism. Recommendations include assuring availability of interpreters, increasing bridging and linking capital, supporting children's heritage language, and being culturally sensitive and proactive to reduce racism. Hopefully, this research will add to the literature that will help educators better serve the growing Latino school population.

The number of adolescents in the U.S. who engage in risk behaviors such as alcohol and drug use and unsafe sexual practices has reached alarming levels, with Hispanic adolescents in particular reporting high rates of substance use and sexual activity. This study explored risk and protective factors that influence high-risk behaviors in Hispanic adolescents. A theoretical model was developed based on an integration of Ecodevelopmental Theory and the Theory of Reasoned Action to investigate individual and social factors that affect the risk behaviors of Hispanic adolescents. This study was a cross-sectional, descriptive, secondary investigation of the baseline data of a combined sample of 493 Hispanic adolescent 7th and 8th graders and their immigrant parents who had been recruited for participation in the Familias Efficacy I and II studies. The hypothesized model of relationships included 3 direct effects variables: parent-adolescent communication about sex; adolescent condom use self-efficacy; and family functioning, which integrated 4 constructs: parental involvement; positive parenting; family communication; and parent-adolescent communication. The study model also included 3 indirect variables: parents' acculturation; differential acculturation; and parent's HIV knowledge. Three adolescent risk behaviors served as outcome variables: condom use; drinking alcohol while having sex ; and substance use. It was hypothesized that (1) family functioning, parent-adolescent communication about sex, and adolescent self efficacy would all be directly related to adolescent risk behaviors; (2) parent's acculturation would be related to adolescent risk behaviors indirectly through its association with parent's HIV knowledge and parent-adolescent communication about sex; and (3) differential acculturation would be related to adolescent risk behaviors indirectly through its association with family functioning, adolescent condom use self-efficacy, and parent-adolescent communication about sex. Cronbach's alpha computed for all measures yielded good to excellent reliability coefficients. Pearson linear correlation coefficients were calculated between all of the study variables, followed by confirmatory factor analysis to ascertain the feasibility of collapsing multiple indicators of family functioning and HIV/STIs risk behaviors into single latent variables. Finally, the hypothesized structural equation model was estimated. Beta coefficients were calculated to examine direct effects and Mackinnon's asymmetric distribution of product test was used to evaluate mediated effects. Data analysis failed to confirm any of the study hypotheses; however, post-hoc analyses yielded findings that merit further study. Family functioning emerged as the heart of the model, embedded within a web of direct and mediated relationships. Additional findings suggest that family functioning mediates the effect of parents' acculturation and of parents' HIV knowledge on adolescent risk behaviors. Study limitations include its cross-sectional design, self-report measures, convenience sample and integration of clinical and non-clinical samples. Suggestions are provided for researchers to further explore relationships among the variables, and recommendations made for community nursing practitioners to develop, implement and evaluate HIV/STIs prevention programs for Hispanic adolescents.

Latinos are now the largest public school minority population in the U.S. Because of a shift in the states, cities, and counties where Latinos are choosing to live, many schools that did not previously serve substantial numbers of Latinos are doing so now. Additionally, many of the Latinos in these new settlement areas are recent immigrants who speak little or no English. This qualitative study examined how immigrant Latino parents who speak little or no English supported their children in the English-speaking school system of the U.S. It specifically examined how 12 Spanish-speaking parents negotiated language and culture with their children's school in a new settlement area in the state of Utah. From the interviews I conducted with the Latino parents and school staff members, along with school observations and the collection of other data such as forms and notices, I examined how the parents negotiated language and culture with the school. I then analyzed the themes that emerged from this collection of data using a theoretical framework consisting of postcolonial theory, social and cultural capital, and the concept of social discourses. Major themes that emerged included the concern the parents had for their children's education, the parents' limited participation in the school discourse, children serving as language brokers, the maintenance and growth of their children's heritage language, the hegemony of the English language, and issues involving social and cultural capital, linking capital, and racism. Recommendations include assuring availability of interpreters, increasing bridging and linking capital, supporting children's heritage language, and being culturally sensitive and proactive to reduce racism. Hopefully, this research will add to the literature that will help educators better serve the growing Latino school population.

Media are powerful agents of socialization; mediated images affect individual and group behavior as well as inter-group attitudes. In the case of the Hispanic/Latino community in the U.S., frequently underrepresented and stereotyped in mainstream media, identity politics and perspectives of self-representation are complicated by the vast diversity of this membership. This project analyzed the current discourse on Hispanic/Latino ethnic identity proposed by Latina magazine and its social standing in relation to the mainstream culture. A quantitative content analysis that compared Latina’s visual portrayals of women to the female portrayals found in the mainstream magazine Glamour suggested that Latina constructed a homogenized and non-conflictive identity for Hispanic/Latino women; an identity that supports U.S. dominant discourses on ethnicity and race and is subjugated to marketing practices.

This thesis examines the discursive messages and specific practices that Latino families use to transmit messages about culture, race, and racism. Scholars have not fully explored the complexity and range of practices and discourses that are involved in Latinos’ ethno-racial socialization. The use of the phrase “ethno-racial socialization” is important because it combines the concepts of racial socialization and ethnic socialization in an effort to account for how the lived experiences of Latinos who mostly think of themselves as a racial group, are treated as one race, and thus, discuss race with family members. This research explores this process using twelve in-depth, semi-structured interviews with seven U.S. born children of immigrants between the ages of 18-30 and five of their parents (3 immigrant, 1 migrant, and 1 U.S. born). The immigrant families were middle-class and had at least one parent that was born in the Dominican Republic, Cuba, or Puerto Rico. To theoretically ground the project, I draw on Annette Lareau’s concepts of concerted cultivation and the accomplishment of natural growth, which are two major frames to describe how middle-class and lower-class families socialize their family members. I apply this framework to strategies of ethno-racial socialization and develop through the concepts of ethno-racial concerted cultivation and the accomplishment of natural growth, which, I argue, respectively correspond to ‘explicit’ and ‘implicit’ socialization approaches to conveying messages about culture, race, and racism. I argue that ethno-racial concerted cultivation and the accomplishment of natural growth stand in opposite ends of a continuum of approaches to instilling messages related to race and ethnicity. In some cases, the strategies can be mutually reinforcing because a practice that can be considered ethno-racial concerted cultivation can create opportunities for the accomplishment of natural growth to occur (and vice versa). Intra-familial differences in how family members socialize their children mean that they receive diverse and at times contradictory messages about culture and race from different family members such as parents and extended family members. The differences in how family members use ethno-racial socialization strategies are further heightened due to the experiences of the family member (such as their maintenance or rejection of immigrant culture and experiences with racial discrimination or lack thereof) and family structure (such as the varying messages children receive in single-parent households with extended family members living in the home, two-parent households, and households with transnational family ties). The young adults who were consistently exposed to encouraging and empowering messages that implicitly or explicitly emphasized a sense of commitment, belonging, and identity to the ethno-racial group experienced the most positive outcomes, some resulting in cultural capital, such as: racial literacy, preparation for bias, ethnic/racial identity, language skills, access to co-ethnic networks, cosmopolitanism, social flexibility, and social capital (in the form of familial capital). The young adults who did not receive consistent messages or who received messages that promoted anti-blackness or erased the importance of their immigrant family’s culture experienced some of the following outcomes: limited racial literacy, ambiguous ethno-racial identity, limited Spanish skills, limited access to co-ethnic networks, and parent-child conflict. Overall, this research illustrates how ethno-racial socialization in Latina/o families does not easily fit into one discrete model of socialization, but rather is a complex, multi-layered interplay of mechanisms that draw on both ethno-racial concerted cultivation and the accomplishment of natural growth approaches. This interplay also brings sometimes conflict due to the various and, at times, opposing messages that children receive from different family members.

This dissertation consists of three quantitative papers addressing contemporary issues in health policy. The first paper draws on a survey of 2,678 adults from the United States and four European countries to assess demand for a hypothetical early medical test for Alzheimer's disease (AD). Overall, 67% of respondents reported that they would be "very" or "somewhat" likely to get the test if it were available. Through logistic regression analysis, we find that interest was higher among those worried about developing AD, with an immediate blood relative with AD, and who have provided care for AD patients. Knowing that AD is fatal did not influence demand, except among those with an affected blood relative. We expect that a test becoming available could precipitate the creation of a large constituency of asymptomatic, diagnosed adults, affecting a range of health policy decisions. The second paper utilizes Current Population Survey data to explore state-level Medicaid enrollment rates among eligible parents between 2003 and 2010, focusing on the interaction of race and ethnicity and political ideology. Using logistic regression analysis, we find that average take-up for Hispanics in conservative states was 23%, whereas take-up was 38% for both whites and blacks in those states, adjusting for state and individual demographics. These differences abated in liberal and moderate states. Among eligible Hispanics, enrollment rates were less than half as high in conservative states than in liberal states (23% versus 61%). Adjusting for differences in state Medicaid policies narrowed these disparities significantly, highlighting the importance of new provisions aimed at streamlining enrollment procedures across all states. The last paper draws on public and private data from 2007 to 2010 to analyze how administrative spending by health insurers and providers varied across states with different levels of insurance and hospital market concentration. Using regression analysis, we find that in provider offices, high levels of insurance concentration were associated with lower administrative costs. If all states were as concentrated as the most concentrated state in our sample, we would expect nationwide savings of $3.6 billion in administrative expenses. However, market concentration did not reduce administrative spending by insurers or hospitals.

Nutrient deprived diets are major contributors to the development of childhood obesity and metabolic diseases. Total and site-specific adiposity, such as visceral and skeletal muscle fat, have been associated with an increased risk of metabolic syndrome, insulin resistance, and other cardiometabolic risk factors in youths. C-reactive protein (CRP), a circulating inflammatory biomarker, is an established risk factor for cardiovascular disease and is associated with adiposity even at a young age. Diet quality indexes have been developed for use in adolescents and have evaluated the relationships between diet quality and selected health outcomes. Studies that assess relationships between diet quality, adiposity measured using direct methods, and metabolic risk are lacking in youth, particularly Hispanic Americans. Therefore, the objective of this dissertation was to evaluate the relationships between diet quality, assessed by the Youth Healthy Eating Index (YHEI), measures of total and site-specific adiposity, by dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and inflammation, assessed by high-sensitivity CRP (hs-CRP) in a cross-sectional study at baseline of 576 healthy Hispanic American and non-Hispanic girls aged 8-13 years. Diet was assessed using the validated semi-quantitative Harvard Youth/Adolescent Food Frequency Questionnaire (YAQ). Diet quality was assessed from the YHEI, developed based on the YAQ. Muscle density (mg/cm³), a surrogate for fat infiltration, was measured at tibial and femoral sites using pQCT. Total body and android fat (surrogate for visceral fat) were measured by DXA. Serum hs-CRP concentrations were measured by nephelometry. Multiple linear and logistic regression analyses were employed to assess these relationships. Total YHEI score was inversely associated with total body fat percent (p= 0.01) and android percent fat (p= 0.02), but not body mass index (BMI) or muscle density. Lower "margarine and butter use" and higher "meat ratio" were associated with higher leg muscle density. Higher "meat ratio" was inversely associated with BMI and greater "multivitamin use" was inversely associated with visceral adiposity. In a subsample of 113 Hispanic girls, over 50% of study participants demonstrated non-detectable serum hs-CRP levels. In adjusted models, there was no significant relationship between overall YHEI score and hs-CRP in this sample of adolescent girls. For every 1-unit increase in "whole grains" score there was a 44% increase in odds of being in the "high" category compared to the "undetectable" category of hs-CRP, after adjusting for maturity offset, PYPAQ score, total energy intake, total body fat, and all other individual YHEI components (OR: 1.44, 95% CI: 1.06, 1.97). The odds of being in the "high" category of hs-CRP were 38% higher compared to those with "non-detectable" hs-CRP for every 1-kg/m² increase in BMI (OR: 1.33, 95% CI 1.16, 1.53, p<0.0001). The odds of being in the "high" hs-CRP category increased with every 5 percent unit increase in total body percent fat (OR: 2.38, 95% CI 1.58, 3.58, p<0.0001) and android percent fat (OR: 1.89, 95% CI 1.39, 2.57, p<0.0001), compared to those with "non-detectable" concentrations. Calf muscle density was associated with lower odds of elevated hs-CRP compared to the "non-detectable" group (OR: 0.58, 95% CI 0.35, 0.75, p<0.001). The findings suggest that higher diet quality scores are associated with lower total and visceral body fat in adolescent girls. While greater total and regional adiposity are associated with increased inflammation, independent of biological and lifestyle factors, diet quality is not significantly associated with inflammation, as assessed by concentrations of hs-CRP, in Hispanic American girls.

High attrition rates from community participatory research studies need to be explored more by non-traditional methods and participant profiles need to be developed to prevent high attrition rates. The purpose of this dissertation is to characterize compliance and drop out rates using the cardiovascular disease IQ quiz and the life priorities questionnaire. It is important to examine both compliance and dropouts in this context because both diabetes and cardiovascular disease are emerging as a major focus of public health efforts in the United States and abroad. These diseases are accelerating due to the current trends in obesity, which is a preventable, modifiable risk factor for diabetes and cardiovascular disease. Diabetes and cardiovascular disease continue to be the number seven and number one leading causes of death, respectively. We explore these concepts in a largely Hispanic border community in the Southwest, in the small town of Douglas, Arizona. The Hispanic population is increasing in the United States and is now the most populous minority group. Additionally, among this group are some of the highest rates of pre-diabetes, diabetes, and uncontrolled diabetes, all cardiovascular disease risk factors. We found that the cardiovascular disease IQ quiz was a much stronger predictor for compliance and drop out rates in this sample population than the life priorities questionnaire. Compliance did not seem to differ among the study participants who remained in the study. Interestingly, among the participants who were compliant, especially those who kept their eye check-up, were also those more likely to have health insurance and be employed. Though males only represented about 10% of the population sample, they tended to drop out more frequently than females. Dropouts tended to be younger, gainfully employed, and more educated. Qualitative analysis and logistic regression will further help explain the aforementioned associations.

By 2043, its projected that there will not be one single racial or ethnic group that would dominate the minority group (Tennessee Higher Education Commission, 2016). However, the number of Hispanics grew 230% from 2000 to 2014, representing an 8.6% of the national's youth (Tennessee Higher Education Commission, 2016). Hispanic population in states like California, New Mexico, Texas, and Arizona constitutes more than 30% (U.S. Census Bureau, 2016). However, in Tennessee, it only constitutes a 5.20%. Going further, in the Tri-Cities it constitutes a 2.34% of the population. Since states with larger Hispanic communities can provide a variety of resources, experiences, and support organization that a state with a small percentage might not consider in providing or may not be able to provide, this research tries to identify what factors influence individuals' decision to go to higher education. By doing so, we will be able to identify the areas that need more attention to better serve the population. To get this information, we obtained IRB approval to send our survey to ETSU Hispanic students. It is expected to see that the students whose parents have obtain an education past high school will be more encouraged to attend to higher education, than those whose parents earned less than a high school diploma. It is also expected to find that the student’s grit, hardiness, and motivation to lead will vary according to the grades that the students had in the United States, finally it is expected to find that students’ grit, hardiness, and motivation to lead will depend on whether or not they are a first generation student.