. Latin@ immigrants face many obstacles to affordable healthcare that push them to disproportionately rely on the primary safety-net for their healthcare needs. This system is mostly funded with public monies that will be significantly reduced when Affordable Care Act is fully implemented. Since undocumented Latin@ immigrants are prohibited from accessing federally funded healthcare, they will be left out of the health care reform. This thesis examines two community-based clinics in the Greater New Orleans area that serve this population, and have developed linguistically and culturally appropriate programs that address its needs. The New Orleans Faith Health Alliance and Common-Ground Health Clinic are cases used to explore the impact that the Affordable Care Act will have in the already unstable safety-net in New Orleans. Through the analysis of other models around the nation, this thesis presents viable recommendations to both clinics and the City of New Orleans Health Department.

Cultural competence is widely recognized as an essential strategy for reducing health disparities. As the United States' population becomes increasingly ethno-culturally diverse, these disparities are becoming even more pronounced. One particular challenge in this regard concerns overweight/obesity prevalence among American adults, as a disproportionately high number of racial and ethnic minority adults are classified as overweight or obese. Dietary behavior assessments are often utilized by health and human services professionals to obtain the data necessary to promote goals such as the reduction and elimination of overweight/obesity across all ethno-cultural groups. The primary objective of this research study was to develop, test, and evaluate a culturally-competent dietary behavior assessment instrument by effectively synthesizing qualitative methods from Cognitive Anthropology with appropriate survey research and quantitative statistical methods. Specifically, a quantitative methods triangle of hierarchical cluster analysis, binary logistic regression, and Poisson regression in conjunction with the free listing qualitative research technique from Cognitive Anthropology was explored as a possible combined methodological approach for researchers and public health professionals wishing to develop a comprehensive understanding of dietary behaviors at the local community level. Binary logistic regression and Poisson regression enabled the relationship between selected food categories and certain demographic/cultural indicators to be modeled, while hierarchical cluster analyses enabled modeling of the distinct patterns of food category groupings that comprise individuals' regular diet. Additionally, initial qualitative analyses of the raw data promoted an understanding of the influence that the local fast food and dine-in restaurant environment has on the dietary behaviors of the target population. The results of this study suggest that a quantitative methods triangle of hierarchical cluster analysis, binary logistic regression analysis, and Poisson regression analysis founded upon qualitative research principles has potential for use as a combined methodological approach for researchers and public health professionals wishing to develop a comprehensive understanding of dietary behaviors at the local community level. By employing these techniques, researchers can analyze individual dietary behaviors and eating patterns from a multifaceted perspective. In turn, public health professionals can develop community-based, cross-culturally relevant programs and interventions that are equally effective across all ethno-cultural groups in their target population.

Guided by attachment theory and principles of positive psychology, a conceptual model was developed depicting the direct and indirect effects of attachment insecurity, state hope, belongingness, and meaning in life on wellness indicators (i.e., life satisfaction, physical health, and depression) of first generation Latino immigrants in the U.S. Specifically, the present study proposed that the effects of attachment insecurity on Latino immigrants' wellness would be mediated by two tiers of factors. The first tier consisted of state hope (i.e., general state hope, spiritual state hope, mastery state hope) and sense of belonging (i.e., general belongingness; connectedness with mainstream/ethnic community), which represented individual-level and relational factors, respectively, salient in Latino culture. Greater attachment insecurity was hypothesized to contribute to a compromised MIL and poorer wellness by decreasing state hope and sense of belongingness. A total of 352 first-generation Latino immigrants from Texas participated in this study. The exploratory factor analysis on the Experiences in Close Relationships Scale revealed a two-factor factor structure that is different from the two factors of adult attachment typically found with American samples (i.e., anxiety and avoidance). The emerged two factors represent anxious-distancing attachment and comfort-seeking attachment. Results from structural equation modeling analysis showed adequate model fit with the data. The final model indicated that the effects of comfort-seeking attachment on wellness were fully mediated by two layers of mediators (belongingness and state hope as the first layer and meaning in life as the second layer). In addition, the effect of anxious-distancing attachment on wellness was fully mediated by belongingness and meaning in life but not through state hope. Bootstrap methods were used to assess the significance magnitude of these indirect effects. Comfort-seeking attachment explained 13% of the variance in state hope and both attachment variables explained 36% of the variance in sense of belongingness. Anxious-distancing attachment, comfort-seeking attachment, state hope, and sense of belongingness explained 78% of the variance in meaning in life, and the overall model explained 75% of the variance in wellness. Limitations, future directions, and implications for counseling and theory are discussed from attachment theory, positive psychology, and immigration perspectives.