Diabetes is a worldwide epidemic, especially as the prevalence of Type 2 diabetes has increased in recent years. Minorities are disproportionately affected by the disease and, at the same time, often have less access to resources including medication and education. The Emory Latino Diabetes Education Program (ELDEP) is a culturally component diabetes education program aimed at promoting increased knowledge about diabetes disease management within the Latino population of metropolitan Atlanta. The program considers cultural competence and acculturation theory in its learning structure. The purpose of this study was to evaluate ELDEP’s effectiveness in increasing knowledge of diabetes, healthy behaviors, and disease management in the study population. The study evaluated changes in knowledge for those participants who attended only the initial intervention and those patients who attended both the initial session and at least one follow-up intervention. Data was collected through a selfreport questionnaire completed by patients at the beginning of each intervention session. The results of this study indicate that specific participant characteristics may be associated with attendance at follow-up sessions. Participant knowledge about certain factors related to diabetes also increased. Based on these results, recommendations will be made to the program staff at ELDEP.

BACKGROUND: Maladaptive patterns of alcohol consumption can lead to clinically significant impairment or distress and have been established as a partial cause of a wide variety of health conditions, including neuropsychiatric disorders, cardiovascular diseases, hepatic inflammations, certain cancers, and infectious diseases. In the United States, Hispanic and non-Hispanic white (NHW) men have comparable rates of moderate alcohol consumption, however, Hispanic men are more likely to consume higher volumes of alcohol and with more frequency and experience disproportionate levels of adverse health and social consequences of alcohol abuse when compared to NHW men. Further, Hispanic men face greater barriers than NHW men in accessing, engaging, and completing alcohol abuse treatment services despite the contrasting burden of alcohol-related consequences they face. OBJECTIVES: This dissertation is composed from three studies addressing the following aims to: 1) synthesize the culturally- and gender-responsive components of alcohol and substance abuse and dependence treatment programs designed for Hispanic males in the United States; 2) explore Hispanic male perspectives and opinions regarding alcohol use and abuse patterns that may lead to disparate rates of alcohol abuse in Hispanic males in the United States; and 3) examine U.S. Hispanic male perspectives regarding the barriers to alcohol abuse treatment-seeking related behaviors that lead to disparate treatment engagement and completion rates. METHODS: A systematic literature search was conducted for Aim 1 in which articles reporting on culturally- and/or gender-adapted alcohol and/or substance abuse interventions designed exclusively for Hispanic males were identified. Aim 2 and Aim 3 used semi-structured interviews to elicit Hispanic male perspectives of alcohol abuse and alcohol abuse treatment seeking behaviors. Separate thematic analyses were conducted as per the objectives of Aims 2 and 3. Data analysis was based on a deductive process including a preliminary codebook that was supplemented with inductive codes that surfaced during iterative thematic analyses. RESULTS: Regarding Aim 1, literature searches yielded 2685 titles, resulting in 12 articles that fit the parameters of the review. The most scientifically rigorous findings suggest that cultural adaptations may outperform standard treatment for Hispanic men (n=6). Nevertheless, a fraction of the included interventions (n=4) did not improve outcomes compared to standard treatment. Considering the scarce number of publications, it is difficult to discern how much findings reflect ineffective interventions or methodological limitations. Findings for Aim 2 indicate that there are intersected effects of machismo, a culture of normalized overconsumption, social context stressors, and poor coping strategies that may influence maladaptive relationships with alcohol use. Findings for Aim 3 suggest that treatment seeking behaviors are highly influenced by; a) structural factors related to treatment accessibility, and linguistic and cultural-responsiveness of available treatment, b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of knowledge and cultural normalization of consumption, and societal stigmatization of alcohol abuse treatment, and c) individual factors related to machismo-bound pride as well as lack of knowledge. CONCLUSIONS: Given the rapid expansion of the Hispanic population in the United States, and the parallel growth of alcohol abuse implications in this population, it is imperative that we learn where these problems may be rooted to better understand how to diminish the existing gaps. Collectively, these findings point to the need for treatment providers to disseminate accurate information about treatment availability and eligibility, and the treatment process. This work also illustrates the need to for consciousness building efforts targeting the Hispanic male community regarding the detrimental effects of alcohol-related problems and treatment, in order to diminish the stigma. Increased or redistributed funding for linguistically and culturally responsive programs is also needed in communities with large Hispanic populations in order to meet the growing demand, particularly for the uninsured. Further research is needed to identify other potential barriers and recovery resources for this population and other Hispanic subgroups in other parts of the United States.

Background: Historically, US immigration policy, including border enforcement, has served to define national belonging and through this process, has constructed particular groups as undesirable or threatening to the nation. Such political-economic strategies contribute to oppression through gender, ethnic, and class discrimination and economic and political exclusion. This dissertation is based on three studies that collectivity explored these issues as structural determinants of health (SDH) and forms of structural and everyday violence. Objectives: These studies aimed to (1) examine the relations between immigration related mistreatment and practices of ethno-racial profiling by immigration officials on health of Mexican immigrants of the Arizona border (2) contextualize the structural and everyday violence of such institutional practices through mistreatment narratives and (3) evaluate the impact of an intensive Border Health Service Learning Institute (BHSLI) on public health students' ability to locate such forms of violence and identify the role of public health advocacy. Methods: Study one and two are a secondary analysis of quantitative and qualitative data drawn from a random household sample of 299 Mexican-origin farmworkers. Study three is a qualitative analysis of 25 BHSLI student reflection journals from 2010-2012. Results: Farmworkers were US permanent residents and citizens, employed in US agriculture for 20 years. Approximately 25% reported immigration related mistreatment, more than 50% were personally victimized and 75% of mistreatment episodes occurred in a community location while residents engaged in routine activities. Immigration mistreatment was associated with a 2.3-increased risk for stress in adjusted models (OR 2.3, CI 1.2, 4.1). After a week at the US-Mexico border, BHSLI students articulated aspects of immigration and economic policy impacting health. Students framed economic and immigration policies as health policy and found the role of public health to convene stakeholders toward multi-institutional policy solutions. Conclusion: Immigration related mistreatment and ethno-racial profiling are historically embedded at institutional and individual levels and reproduce inequality overtime. Such institutional practices of discrimination are SDH and forms of structural and everyday violence. Academic public health programs, engaged in service learning strengthen students' abilities to learn and act on such SDH and contribute to campus-community engagement on related ethno-racial health disparities.

Immigration is a highly politicized topic increasingly on the forefront of the nation’s consciousness. Though news media and academia have drawn attention to evidence of physical health needs of undocumented immigrants being compromised due to their documentation status, relatively less attention is brought to their mental health needs. The purpose of this paper is to review literature about the mental health care needs of immigrants and refugees to the United States, with a particular focus on recent adult immigrants from Latin America and their youth, who may directly or indirectly suffer trauma related to deportation, violence, family separation and/or loss. This paper serves to provide ethical arguments for increased awareness, education and resources towards trauma-informed, culturally sensitive mental health care for immigrants and refugees to the United States. The ultimate aim of this paper is to provide its readers with essential information regarding the impact of trauma and cultural identity in the mental health care (or lack thereof) of Latinx immigrants. / Urban Bioethics

Among the health disparities affecting the U.S. Hispanic population today are those relating to risky behaviors such as substance abuse, intimate partner violence (IPV) and HIV/AIDS. However, few studies have examined how these conditions may impact this population. The purpose of this dissertation was to explore the experiences that Hispanic women in South Florida have with regard to substance abuse, IPV and risks for HIV/AIDS, to describe how these conditions may be related, and to develop a model that can be used to guide research and interventions targeting this population. This dissertation uses data collected in Project DYVA (Drogas y Violencia en las Americas- Drugs and Violence in the Americas), a pilot research study that utilized both qualitative (Phase I) and quantitative (Phase II) research methods to describe the experiences of Hispanic women in South Florida between the ages of 18 and 60 with regard to substance abuse, violence and risky sexual behaviors. Three studies were conducted as part of this dissertation. The first study utilizes data collected during the qualitative phase of Project DYVA. During this phase eight focus groups were conducted and analyzed using qualitative content analysis (N = 81). The second and third studies utilize data collected during the second phase of Project DYVA. In this phase cross-sectional questionnaires collecting information regarding demographics, acculturation, self-esteem, depression, substance abuse, IPV and risks for HIV, were administered to 82 Hispanic women. Univariate and multivariate statistics were used to explore the relationships between substance abuse, IPV and risk for HIV (study 2) and between resource availability, IPV and depression (study 3). The findings from this dissertation suggest that substance abuse, IPV and risk for HIV are closely related intersecting health issues. IPV, the condition that emerged as the most salient of the three, also appears to be closely associated with resource availability (i.e., self-esteem and income) and depression. Additional individual, cultural, relationship and socio-environmental factors that may play a significant role in shaping the experiences that Hispanic women have with regards to these intersecting conditions were also identified and organized into a model.

Historically, Hispanic/Latino (H/L) students have been under-referred, under-identified, and under-served by the U.S. Special Education (SPED) system, particularly under the emotional behavioral disturbance (EBD) category. This finding is alarming given that numerous federal sources report that H/L students continue a disturbing trend of struggling academically as well as being at a higher risk for poor mental health outcomes such as elevated levels of depression, anxiety, and suicidality when compared to their peers. Unfortunately, the existing mental health and education literature on H/L students provides limited guidance in understanding the disproportionate underrepresentation of H/L in the EBD category of the SPED system; an underrepresentation well-documented in the report to congress on the implementation of the Individuals with Disabilities Education Improvement Act (IDEIA). Using survey methods, the purpose of this study was to shed light on the possible mediating role teachers' perceptions have on the SPED referral and identification decisions by looking at teacher ratings of risk for EBD-like behaviors of students across behavioral conditions (i.e., internalizing versus externalizing types of behaviors) and across ethnic/racial groups (i.e., White, African Americans, and H/L students) using a response-to-intervention framework. Using the Qualtrics software, an online survey tool, 114 self-selected pre-service teachers were surveyed; data was collected and analyzed using a One-way Analysis of Variance. Two main effects and two interaction effects were explored: does the students' ethnic/racial background moderate the teachers' at risk score (ARS) regardless of the behavior displayed?; does the type of behavioral expression moderate the ARS regardless of ethnic/race?; is there an interaction effect between H/L students exhibiting internalizing behaviors that systematically results in a lower ARS and AA students exhibiting externalizing behaviors that systematically results in a higher ARS? Results indicated that (a) when compared to White, Hispanic/Latino students are indeed less likely to be perceived by the pre-service teachers as exhibiting EBD-like behaviors regardless of the behavior (externalizing, internalizing, or neutral) displayed, (b) externalizing behaviors was the strongest predictor for perceiving someone as at-risk for having EBD-like behaviors, and (c) no interaction effects were found.