Browsing by Author "Wetter, David W."
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Item A cross-lagged path analysis of five intrapersonal determinants of smoking cessation(Elsevier, 2014) Castro, Yessenia; Cano, Miguel Ángel; Businelle, Michael S.; Correa-Fernández, Virmarie; Heppner, Whitney L.; Mazas, Carlos A.; Wetter, David W.Background: Prominent theories of drug use underscore the importance of considering the inter-relationships (e.g., reciprocal relations, indirect effects) of determinants of drug use behavior. In the area of smoking, few studies have examined multiple determinants of cessation in this way, and in prospective analyses. The current study is an examination of the prospective cross-lagged relationships among five intrapersonal determinants of cessation. Methods: Data from a longitudinal cohort study on racial differences in the process of smoking cessation were used to examine reciprocal relations among abstinence motivation, abstinence self-efficacy, positive affect, negative affect, and craving. Each of these five measures assessed on the quit day were regressed onto the same measures assessed 1–2 weeks pre-quit. The relationships of these variables at quit day with 1-week post-quit abstinence from smoking were also examined. Results: When the five variables were examined simultaneously in a cross-lagged path analysis, motivation and self-efficacy, and self-efficacy and positive affect showed cross-lagged relations. Only self-efficacy on the quit day uniquely predicted 1-week post quit abstinence. There were significant indirect effects of motivation and positive affect on cessation via self-efficacy. Conclusions: The current study reaffirms the importance of motivation and self-efficacy in smoking cessation, and suggests that positive affect may play a role in smoking cessation.Item Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors Among Overweight/Obese Latino Smokers(Sage, 2015) Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Robles, Eden Hernandez; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers.Item Association of Acculturation, Nativity, and Years Living in the United States with Biobanking among Individuals of Mexican Descent(American Association for Cancer Research, 2014) Lopez, David S.; Fernandez, Maria E.; Cano, Miguel Angel; Mendez, Claudia; Tsai, Chu-Lin; Wetter, David W.; Strom, Sara S.Background: Biobanking is the collection of human biospecimens (tissues, blood, and body fluids) and their associated clinical and outcome data. Hispanics are less likely to provide biologic specimens for biobanking. The purpose of this study was to investigate the association of acculturation, nativity status, and years living in the United States with participation in biobanking among individuals of Mexican descent. Methods: Participants were 19,212 adults of Mexican descent enrolled in an ongoing population-based cohort in Houston, TX. Participants were offered the opportunity to provide a blood, urine, or saliva sample for biobanking. Acculturation was assessed with the bidimensional acculturation scale for Hispanics and scores were categorized into モlow acculturation,ヤ モbicultural,ヤ and モhigh-acculturation.ヤ Results: After multivariable adjustment, we found an increased likelihood of participation in biobanking among individuals classified as モbiculturalヤ as compared with モhighly acculturatedヤ individuals [OR, 1.58; 95% confidence intervals (CI), 1.10ヨ2.26]. The associations of nativity status and years living in the United States with biobanking were not statistically significant. After stratifying by gender, the associations of acculturation, nativity status, and years living in the United States with biobanking were not statistically significant. Conclusion: Although individuals of Mexican descent who were モbiculturalヤ were more likely to participate in biobanking than individuals who were モhighly acculturated,ヤ the difference in rates of participation among acculturation categories was small. The high participation rate in biospecimen collection is likely due to extensive community-engaged research efforts. Future studies are warranted to understand individuals' participation in biobanking. Impact: Community-engaged research efforts may increase Hispanics' participation in biobanking.Item Cognition and Craving During Smoking Cessation: An Ecological Momentary Assessment Study(Oxford University Press, 2014) Waters, Andrew J.; Szeto, Edwin H.; Wetter, David W.; Cinciripini, Paul M.; Robinson, Jason D.; Li, YishengIntroduction: Some studies using ecological momentary assessment (EMA) have revealed an association between craving for cigarettes and relapse. It is therefore important to understand the correlates of craving during smoking cessation. Attentional bias to smoking cues is a potential correlate of craving, but it has not previously been assessed using EMA during smoking cessation. Methods: Smokers enrolled in a research smoking cessation study were offered the opportunity to take part in an EMA study. Volunteers carried around a personal digital assistant (PDA) for the first week of their quit attempt. They completed up to 4 random assessments (RAs) per day as well as assessments when they experienced a temptation to smoke and when they relapsed. Craving for cigarettes was assessed with a single item (1ヨ7 scale). Attentional bias was assessed with a smoking Stroop task (a reaction time task) at every other assessment, as was self-reported attention to cigarettes. Results: Data were available from 119 participants. Across 882 assessments, participants exhibited a significant smoking Stroop effect. Linear mixed models revealed a significant between-subject association between craving and the smoking Stroop effect. Individuals with higher levels of craving exhibited greater attentional bias. The within-subject association was not significant. Similar results were obtained for the relationship between self-reported attention to cigarettes and attentional bias. Conclusions: Attentional bias can be assessed in the natural environment using EMA during smoking cessation, and attentional bias is a correlate of craving during the early stages of a quit attempt.Item Density and Proximity of Fast Food Restaurants and Body Mass Index Among African Americans(American Public Health Association, 2014) Reitzel, Lorraine R.; Regan, Seann D.; Nguyen, Nga; Cromley, Ellen K.; Strong, Larkin L.; Wetter, David W.; McNeill, Lorna H.Objectives. The purpose of this study was to address current gaps in the literature by examining the associations of fast food restaurant (FFR) density around the home and FFR proximity to the home, respectively, with body mass index (BMI) among a large sample of African American adults from Houston, Texas. Methods. We used generalized linear models with generalized estimating equations to examine associations of FFR density at 0.5-, 1-, 2-, and 5-mile road network buffers around the home with BMI and associations of the closest FFR to the home with BMI. All models were adjusted for a range of individual-level covariates and neighborhood socioeconomic status. We additionally investigated the moderating effects of household income on these relations. Data were collected from December 2008 to July 2009. Results. FFR density was not associated with BMI in the main analyses. However, FFR density at 0.5, 1, and 2 miles was positively associated with BMI among participants with lower incomes (P???.025). Closer FFR proximity was associated with higher BMI among all participants (P?Item Discrimination, Affect, and Cancer Risk Factors among African Americans(PNG Publications, 2014) Cuevas, Adolfo G.; Reitzel, Lorraine R.; Adams, Claire E.; Cao, Yumei; Nguyen, Nga; Wetter, David W.; Watkins, Kellie L.; Regan, Seann D.; McNeill, Lorna H.Objectives: To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults. Methods: Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation.ᅠResults: Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05).Conclusions: Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.Item Dispositional Mindfulness Predicts Enhanced Smoking Cessation and Smoking Lapse Recovery(Springer, 2016) Heppner, Whitney L.; Spears, Claire Adams; Correa-Fernández, Virmarie; Castro, Yessenia; Li, Yisheng; Guo, Beibei; Reitzel, Lorraine R.; Vidrine, Jennifer Irvin; Mazas, Carlos A.; Cofta-Woerpel, Ludmila; Cinciripini, Paul M.; Ahluwalia, Jasjit S.; Wetter, David W.Background: Although mindfulness has been hypothesized to promote health behaviors, no research has examined how dispositional mindfulness might influence the process of smoking cessation. Purpose: The current study investigated dispositional mindfulness, smoking abstinence, and recovery from a lapse among African American smokers. Methods: Participants were 399 African Americans seeking smoking cessation treatment (treatments did not include any components related to mindfulness). Dispositional mindfulness and other psychosocial measures were obtained pre-quit; smoking abstinence was assessed 3 days, 31 days, and 26 weeks post-quit. Results: Individuals higher in dispositional mindfulness were more likely to quit smoking both initially and over time. Moreover, among individuals who had lapsed at day 3, those higher in mindfulness were more likely to recover abstinence by the later time points. The mindfulness-early abstinence association was mediated by lower negative affect, lower expectancies to regulate affect via smoking, and higher perceived social support. Conclusions: Results suggest that mindfulness might enhance smoking cessation among African American smokers by operating on mechanisms posited by prominent models of addiction.Item Financial strain and cancer risk behaviors among African Americans(American Association for Cancer Research, 2014) Advani, Pragati S.; Reitzel, Lorraine R.; Nguyen, Nga T.; Fisher, Felicia D.; Savoy, Elaine J.; Cuevas, Adolfo G.; Wetter, David W.; McNeill, Lorna H.BACKGROUND: African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1,278 African American adults (age, 46.5 ± 12.6 years; 77% female) and explored potential mediators (stress and depressive symptoms) of those associations. METHODS: Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation. RESULTS: Greater financial strain was associated with greater odds of insufficient physical activity (P < 0.003) and smoking (P = 0.005) and was positively associated with the total number of cancer risk factors (P < 0.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively. CONCLUSIONS: Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms. IMPACT: Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans.Item Financial Strain and Self-rated Health among Black Adults(PNG Publications, 2014) Savoy, Elaine J.; Reitzel, Lorraine R.; Nguyen, Nga; Advani, Pragati S.; Fisher, Felicia D.; Wetter, David W.; Cuevas, Adolfo G.; McNeill, Lorna H.Objectives: To explore associations between financial strain and self-rated health among 1341 black adults. Methods: Associations were investigated using a covariate-adjusted linear regression model. Mediation (via stress and/or depressive symptoms) was explored in additional models using a nonparametric bootstrapping procedure. Results: Higher financial strain was associated with poorer self-rated health (p < .001). Stress and depressive symptoms were each significant mediators of this relation in both single and multiple mediator models (p values < .05). Conclusions: Financial strain may contribute to poorer health among black adults, partially via greater stress and depressive symptoms. Potential theoretical, intervention, and policy implications are discussed. Future studies with longitudinal designs are needed to confirm these results.Item Health Literacy, Smoking, and Health Indicators in African American Adults(Taylor & Francis, 2015) Stewart, Diana W.; Vidrine, Jennifer I.; Shete, Sanjay; Spears, Claire A.; Cano, Miguel A.; Correa-Fernández, Virmarie; Wetter, David W.; McNeill, Lorna H.We examined cross-sectional associations of health literacy (HL) with smoking and other established health indicators among 1,467 African American adults. Data emanated from a longitudinal cohort study designed to investigate cancer risk factors among church-going African American adults. We conducted linear and logistic regression analyses to assess associations between HL and health indicators. HL was assessed using an established single-item screening question. Outcomes included indicators of poor physical health (cigarette smoking, self-rated general and physical health) and mental health (self-rated mental health, depressive symptoms, perceived stress). Nearly 19% of participants had low HL. Low HL was significantly associated with current smoking, poorer self-rated general and physical health, and higher perceived stress (ps < .05) even after we controlled for demographic variables (i.e., age, gender, relationship status) and indicators of socioeconomic status (i.e., education, income, insurance status). Low HL appears to be an independent risk factor for smoking and other indicators of poor physical and mental health in a large sample of African American adults. Future directions and clinical implications are discussed.Item HPV Awareness, Knowledge and Attitudes among Older African-American Women(Ingenta Connect, 2015) Watkins, Kellie L.; Reitzel, Lorraine R.; Wetter, David W.; McNeill, LornaObjective: To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women.ᅠMethods: Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses.ᅠResults: Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values <.038). Higher education was related to HPV knowledge (p = .006).ᅠConclusions: African-American women of older age, less education, no family history of cancer, and/or higher spirituality might benefit from targeted church-based HPV educational campaigns.Item Impact of a Mobile Phone Intervention to Reduce Sedentary Behavior in a Community Sample of Adults: A Quasi-Experimental Evaluation(JMIR Publications, 2016) Kendzor, Darla E.; Shuval, Kerem; Gabriel, Kelley Pettee; Businelle, Michael S.; Ma, Ping; High, Robin R.; Cuate, Erica L.; Poonawalla, Insiya B.; Rios, Debra M.; Demark-Wahnefried, Wendy; Swartz, Michael D.; Wetter, David W.Background: Greater time spent sedentary is linked with increased risk of breast, colorectal, ovarian, endometrial, and prostate cancers. Given steadily increasing rates of mobile phone ownership, mobile phone interventions may have the potential to broadly influence sedentary behavior across settings. Objective: The purpose of this study was to examine the short-term impact of a mobile phone intervention that targeted sedentary time in a diverse community sample. Methods: Adults participated in a quasi-experimental evaluation of a mobile phone intervention designed to reduce sedentary time through prompts to interrupt periods of sitting. Participants carried mobile phones and wore accelerometers for 7 consecutive days. Intervention participants additionally received mobile phone prompts during self-reported sitting and information about the negative health impact of prolonged sedentariness. The study was conducted from December 2012 to November 2013 in Dallas, Texas. Linear mixed model regression analyses were conducted to evaluate the influence of the intervention on daily accelerometer-determined estimates of sedentary and active time. Results: Participants (N=215) were predominantly female (67.9%, 146/215) and nonwhite (black: 50.7%, 109/215; Latino: 12.1%, 26/215; other: 5.6%, 12/215). Analyses revealed that participants who received the mobile phone intervention had significantly fewer daily minutes of sedentary time (B=–22.09, P=.045) and more daily active minutes (B=23.01, P=.04) than control participants. Conclusions: A simple mobile phone intervention was associated with engaging in less sedentary time and more physical activity. Findings underscore the potential impact of mobile phone interventions to positively influence sedentary behavior and physical activity.Item Lower health literacy predicts smoking relapse among racially/ethnically diverse smokers with low socioeconomic status(BioMed Central, 2014) Stewart, Diana W.; Cano, Miguel Ángel; Correa-Fernández, Virmarie; Spears, Claire Adams; Li, Yisheng; Waters, Andrew J.; Wetter, David W.; Vidrine, Jennifer IrvinBackground: Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are disproportionately affected by poor HL. They also have higher smoking prevalence and more difficulty quitting smoking. Thus, lower HL may be uniquely associated with poorer cessation outcomes in this population. Methods: This study investigated the association between HL and smoking cessation outcomes among 200, low-SES, racially/ethnically diverse smokers enrolled in smoking cessation treatment. Logistic regression analyses adjusted for demographics (i.e., age, gender, race/ethnicity, relationship status), SES-related characteristics (i.e., education, income), and nicotine dependence were conducted to investigate associations between HL and smoking relapse at the end of treatment (3 weeks post quit day). Results: Results indicated that smokers with lower HL (score ofItem Mindfulness Predicts Lower Affective Volatility among African Americans During Smoking Cessation(American Psychological Association, 2014) Adams, Claire E.; Chen, Minxing; Guo, Lin; Lam, Cho Y.; Stewart, Diana W.; Correa-Fernández, Virmarie; Cano, Miguel A.; Heppner, Whitney L.; Vidrine, Jennifer Irvin; Li, Yisheng; Ahluwalia, Jasjit S.; Cinciripini, Paul M.; Wetter, David W.Recent research suggests that mindfulness benefits emotion regulation and smoking cessation. However, the mechanisms by which mindfulness affects emotional and behavioral functioning are unclear. One potential mechanism, lower affective volatility, has not been empirically tested during smoking cessation. This study examined longitudinal associations among mindfulness and emotional responding over the course of smoking cessation treatment among predominantly low-socioeconomic status (SES) African American smokers, who are at high risk for relapse to smoking and tobacco-related health disparities. Participants (N = 399, 51% female, mean age = 42, 48% with annual income <$10,000) completed a baseline measure of trait mindfulness. Negative affect, positive affect, and depressive symptoms were assessed at five time points during smoking cessation treatment (up to 31 days postquit). Volatility indices were calculated to quantify within-person instability of emotional symptoms over time. Over and above demographic characteristics, nicotine dependence, and abstinence status, greater baseline trait mindfulness predicted lower volatility of negative affect and depressive symptoms surrounding the quit attempt and up to 1 month postquit, ps < 0.05. Although volatility did not mediate the association between greater mindfulness and smoking cessation, these results are the first to show that mindfulness is linked to lower affective volatility (or greater stability) of negative emotions during the course of smoking cessation. The present study suggests that mindfulness is linked to greater emotional stability and augments the study of mindfulness in diverse populations. Future studies should examine the effects of mindfulness-based interventions on volatility and whether lower volatility explains effects of mindfulness-based treatments on smoking cessation.Item Nonjudging facet of mindfulness predicts enhanced smoking cessation in Hispanics(American Psychological Association, 2015) Spears, Claire Adams; Houchins, Sean C.; Stewart, Diana W.; Chen, Minxing; Correa-Fernández, Virmarie; Cano, Miguel Ángel; Heppner, Whitney L.; Vidrine, Jennifer I.; Wetter, David W.Although most smokers express interest in quitting, actual quit rates are low. Identifying strategies to enhance smoking cessation is critical, particularly among underserved populations, including Hispanics, for whom many of the leading causes of death are related to smoking. Mindfulness (purposeful, nonjudgmental attention to the present moment) has been linked to increased likelihood of cessation. Given that mindfulness is multifaceted, determining which aspects of mindfulness predict cessation could help to inform interventions. This study examined whether facets of mindfulness predict cessation in 199 Spanish-speaking smokers of Mexican heritage (63.3% male, mean age of 39 years, 77.9% with a high school education or less) receiving smoking cessation treatment. Primary outcomes were 7-day abstinence at weeks 3 and 26 postquit (biochemically confirmed and determined using an intent-to-treat approach). Logistic random coefficient regression models were utilized to examine the relationship between mindfulness facets and abstinence over time. Independent variables were subscales of the Five Facet Mindfulness Questionnaire (Observing, Describing, Acting With Awareness, Nonjudging, and Nonreactivity). The Nonjudging subscale (i.e., accepting thoughts and feelings without evaluating them) uniquely predicted better odds of abstinence up to 26 weeks postquit. This is the first known study to examine whether specific facets of mindfulness predict smoking cessation. The ability to experience thoughts, emotions, and withdrawal symptoms without judging them may be critical in the process of quitting smoking. Results indicate potential benefits of mindfulness among smokers of Mexican heritage and suggest that smoking cessation interventions might be enhanced by central focus on the Nonjudging aspect of mindfulness.Item Positive Smoking Outcome Expectancies Mediate the Association between Negative Affect and Smoking Urge among Women During a Quit Attempt(American Psychological Association, 2014) Cano, Miguel Ángel; Lam, Cho Y.; Chen, Minxing; Adams, Claire E.; Correa-Fernández, Virmarie; Stewart, Diana W.; McClure, Jennifer B.; Cinciripini, Paul M.; Wetter, David W.Ecological momentary assessment was used to examine associations between negative affect, positive smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 302 female smokers who enrolled in an individually tailored smoking cessation treatment study. Multilevel mediation analysis was used to examine the temporal relationship among the following: (a) the effects of negative affect and positive smoking outcome expectancies at 1 assessment point (e.g., time j) on smoking urge at the subsequent time point (e.g., time j + 1) in Model 1; and, (b) the effects of negative affect and smoking urge at time j on positive smoking outcome expectancies at time j + 1 in Model 2. The results from Model 1 showed a statistically significant effect of negative affect at time j on smoking urge at time j + 1, and this effect was mediated by positive smoking outcome expectancies at time j, both within- and between-participants. In Model 2, the within-participant indirect effect of negative affect at time j on positive smoking outcome expectancies at time j + 1 through smoking urge at time j was nonsignificant. However, a statistically significant indirect between-participants effect was found in Model 2. The findings support the hypothesis that urge and positive smoking outcome expectancies increase as a function of negative affect, and suggest a stronger effect of expectancies on urge as opposed to the effect of urge on expectancies.Item Promoting Tobacco Cessation and Smoke-Free Workplaces Through Community Outreach Partnerships in Puerto Rico(The Johns Hopkins University Press, 2014) Díaz-Toro, Elba C.; Fernández, Maria E.; Correa-Fernández, Virmarie; Calo, William A.; Ortiz, Ana Patricia; Mejía, Luz M.; Mazas, Carlos A.; Santos-Ortiz, María del Carmen; Wetter, David W.Background: Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. Objectives: The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. Methods: Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. Results: Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. Conclusions: This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.Item Psychosocial Mechanisms Linking the Social Environment to Mental Health in African Americans(Public Library of Science, 2016) Mama, Scherezade K.; Li, Yisheng; Basen-Engquist, Karen; Lee, Rebecca E.; Thompson, Deborah; Wetter, David W.; Nguyen, Nga T.; Reitzel, Lorraine R.; McNeill, Lorna H.Resource-poor social environments predict poor health, but the mechanisms and processes linking the social environment to psychological health and well-being remain unclear. This study explored psychosocial mediators of the association between the social environment and mental health in African American adults. African American men and women (n = 1467) completed questionnaires on the social environment, psychosocial factors (stress, depressive symptoms, and racial discrimination), and mental health. Multiple-mediator models were used to assess direct and indirect effects of the social environment on mental health. Low social status in the community (p < .001) and U.S. (p < .001) and low social support (p < .001) were associated with poor mental health. Psychosocial factors significantly jointly mediated the relationship between the social environment and mental health in multiple-mediator models. Low social status and social support were associated with greater perceived stress, depressive symptoms, and perceived racial discrimination, which were associated with poor mental health. Results suggest the relationship between the social environment and mental health is mediated by psychosocial factors and revealed potential mechanisms through which social status and social support influence the mental health of African American men and women. Findings from this study provide insight into the differential effects of stress, depression and discrimination on mental health. Ecological approaches that aim to improve the social environment and psychosocial mediators may enhance health-related quality of life and reduce health disparities in African Americans.Item The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border(BioMed Central, 2014) Kendzor, Darla E.; Chen, Minxing; Reininger, Belinda M.; Businelle, Michael S.; Stewart, Diana W.; Fisher-Hoch, Susan P.; Rentfro, Anne R.; Wetter, David W.; McCormick, Joseph B.Background: The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border. Methods: The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N?=?492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c). Results: Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c). Conclusions: Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.Item The influence of discrimination on smoking cessation among Latinos(Elsevier, 2014) Kendzor, Darla E.; Businelle, Michael S.; Reitzel, Lorraine R.; Castro, Yessenia; Vidrine, Jennifer I.; Mazas, Carlos A.; Cinciripini, Paul M.; Lam, Cho Y.; Adams, Claire E.; Correa-Fernández, Virmarie; Cano, Miguel Ángel; Wetter, David W.Background: Although studies have shown a cross-sectional link between discrimination and smoking, the prospective influence of discrimination on smoking cessation has yet to be evaluated. Thus, the purpose of the current study was to determine the influence of everyday and major discrimination on smoking cessation among Latinos making a quit attempt. Methods: Participants were 190 Spanish speaking smokers of Mexican Heritage recruited from the Houston, TX metropolitan area who participated in the study between 2009 and 2012. Logistic regression analyses were conducted to evaluate the associations of everyday and major discrimination with smoking abstinence at 26 weeks post-quit. Results: Most participants reported at least some everyday discrimination (64.4%), and at least one major discrimination event (56%) in their lifetimes. Race/ethnicity/nationality was the most commonly perceived reason for both everyday and major discrimination. Everyday discrimination was not associated with post-quit smoking status. However, experiencing a greater number of major discrimination events was associated with a reduced likelihood of achieving 7-day point prevalence smoking abstinence, OR = .51, p = .004, and continuous smoking abstinence, OR = .29, p = .018, at 26 weeks post-quit. Conclusions: Findings highlight the high frequency of exposure to discrimination among Latinos, and demonstrate the negative impact of major discrimination events on a smoking cessation attempt. Efforts are needed to attenuate the detrimental effects of major discrimination events on smoking cessation outcomes.