Correlates of Health Behaviors and Outcomes among U.S. Latinx Adults

In January 2018, 798 Hispanic/Latino adults living in the United States were recruited through Qualtrics Panels to complete a survey in English or Spanish. Respondents were diverse in their nativity (e.g., 52% Mexican or Mexican American; 17% Puerto Rican; 8.5% Cuban). The survey included the following measures: -Demographic and Health Information – Demographic and Health Data Questionnaire (DHDQ). This researcher-constructed questionnaire is designed to obtain participant information such as: (a) race/ethnicity, (b) age, (c) gender, (d) sexual orientation, (e) relationship status, (f) household income, (g) generational status, (h) education level, (i) presence of chronic health conditions, (j) self-reported height and weight, (k) overall health status, (l) native language and proficient language(s), (m) number of health care visits in the past year, and (n) perceived weight. -Media and Technology Usage and Attitudes Scale (MTUAS). The Media and Technology Usage and Attitudes Scale is a 60-item scale used to measure the frequency of use from specific forms of media and attitudes toward technology (Rosen, Whaling, Carrier, Cheever, & Rokkum, 2013). The scale consists of eleven media usage subscales and four attitude subscales. For the purposes of this study, only the smartphone usage subscale will be included (9 items). Prompts assessing the frequency of technology use stated: “Please indicate how often you do each of the following…” and asked about smartphone usage habits on a scale from 1(Never) to 10 (All the time). Higher scores are indicative of more technology use. The MTUAS was found to show sufficient proof of reliability for smartphone usage subscale (α = .93). Validity has also been shown through comparisons with measures of daily media usage hours, technology-related anxiety, and the Internet Addiction Test (Rosen et al., 2013). -The Sedentary Behavior Questionnaire (SBQ). The Sedentary Behavior Questionnaire is an 18-item scale designed to assess nine different sedentary behaviors including the use of technological devices, hobbies, and sitting due to transportation and work (Rosenberg et al., 2010). The measure is designed to assess sedentary behaviors over weekdays as well as the weekend and then are multiplied to estimate the sum amounts of sedentary hours during a week/weekend. The scale consisted of nine items with answer choices ranging from 1 (None) to 9 (6 hours or more). The current study will slightly alter the SBQ as some of the items may be dated in regards to the technology. An example is “sitting listening to music on the radio, tapes, or CDs.” The examples used in the items will be reflective of sedentary forms of technology used nowadays. The SBQ has been found to be a reliable measure for sedentary behaviors as intraclass correlation coefficients found that the items were sufficient for both weekday (.64-.90) and weekends (.51-.93). Validity of the measure was also sufficient as partial correlations were used to compare the self-reported ratings of the SBQ to accelerometer measures of activity. The study also found that in comparison to the International Physical Activity Questionnaire and body mass index, there were significant correlations with both male and female samples (Rosenberg et al., 2010). -PHQ-9- English: The Patient Health Questionnaire (PHQ-9). The PHQ-9 is a 9-item instrument that measures depressive symptoms (Kroenke, Spitzer, & Williams, 2001). Instructions on the PHQ-9 are as follows: “Over the last 2 weeks, how often have you been bothered by any of the following problems?” The assessment uses a 4-point Likert-type scale with responses ranging from 0 (not at all) to 3 (nearly every day). Scores for PHQ-9 scale are determined by assigning a score to each response ranging from 0 to 3 and then summing the responses. The PHQ-9 score can range from 0 to 27. Higher scores on the measure indicate higher levels of depressive symptoms. -Health Promoting Behaviors – Health Promoting Lifestyle Profile II (HPLP-II). The HPLP-II is a 52-item inventory designed to measure engagement in behaviors that characterize a health-promoting lifestyle (Walker, Sechrist, Pender, 1995). The HPLPII is comprised of a scale and six subscales, which include Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility, and Stress Management. Only the Nutrition (9 items) and Physical Activity (8 items) subscales will be used for the current study. Instructions on the HPLP-II are to indicate level of engagement in each listed behavior using a Likert-type scale, with responses ranging from 1 (never) to 4 (routinely). Scores for the HPLP-II scale and subscale are determined by calculating means for each. Higher scores on the scale and subscales indicate higher levels of engagement in the assessed health promoting behaviors. The alpha coefficients for internal consistency of the subscales have ranged from .79 - .82 (Walker & HillPolerecky, 1996). -Sleep Duration & Sleep Problems – Sleep Disorders Questionnaire from the National Health and Nutrition Examination Survey (NHANES). The NHANES Sleep Duration measure is one question that assesses the number of hours a respondent typically sleeps per night. Response options will be grouped into the following categories: very short (< 5 hours), short (5-6 hours), normative (7-8 hours) and long (≥ 9 hours) (Whinnery, Jackson, Rattanaumpawan, and Grandner, 2014). Sleep problems assessed include probable insomnia and/or sleep apnea. Insomnia will be assessed with two questions, “In the past month, how often did you have trouble falling asleep?” and “In the past month, how often did you wake up during the night and had trouble getting back to sleep?” Respondents endorsing either sleep problem ≥ 15 nights per month will be grouped as likely having insomnia. Sleep apnea will be assessed by the following questions. First, “In the past 12 months, how often did you snort, gasp, or stop breathing while you were asleep?” Responses will be grouped as likely having the problem (“occasionally” or “frequently”) or not. Snoring will be assessed with, “How often do you snore?” Responses will be grouped as likely having sleep apnea if they responded “Frequently.” Previous diagnosis of sleep apnea was assessed with the question, “Have you ever been told by a doctor or other health professional that you have a sleep disorder?” If “sleep apnea” or “insomnia” is indicated, the presence of the sleep problem will be confirmed (Whinnery, Jackson, Rattanaumpawan, and Grandner, 2014). -Ethnic Identity – The Multigroup Ethnic Identity Measure-Revised (MEIM-R). The MEIM-R is a 6-item scale that measures the process of ethnic identity (Phinney & Ong, 2007). The MEM-R consists of a total scale score and two subscales: exploration (e.g., “I have often done things that will help me understand my ethnic background better”) and commitment (“I have a strong sense of belonging to my own ethnic group”). Participants respond on a scale from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate greater sense of overall ethnic identity, exploration, or commitment. Earlier research has shown evidence for internally consistent subscales (exploration: α = .76; commitment: α = .78) and total score (α = .81; Phinney & Ong, 2007). -Discrimination/Health-related Stress – Hispanic Stress Inventory-2 (HSI2). The HSI2 is a culturally appropriate measure of assessing psychosocial stress among Hispanic/Latinos (Cervantes, Fisher, Padilla, & Napper, 2016). The HSI2 consists of seven subscales including Discrimination Stress (11 items) and Health Stress (6 items) – these are the 2 subscales being used in the current study. For each item, participants are asked if they have experienced the reported stressor (Yes/No). If they have experienced the stressor they are asked to rate how stressful the event was on a 5-point-Likert scale ranging from 1 (Not at all worried/tense) to 5 (Extremely worried/tense). -Brief COPE. The Brief Cope is a 28-item instrument designed to assess ways that individuals cope with stress in their lives (Carver, 1997). The Brief Cope consists of 14 subscales including: (1) self-distraction, (2) active coping, (3) denial, (4) substance use, (5) use of emotional support, (6) use of instrumental support, (7) behavioral disengagement, (8) venting, (9) positive reframing, (10) planning, (11) humor, (12) acceptance, (13) religion, and (14) self-blame. The current study does not use the self-distraction, denial, acceptance, venting, humor and self-blame subscales. Each subscale contains two items. Participants are asked to rate the degree to which they are doing a particular coping behavior on a 4-point Likert type scale ranging from 1 (I haven’t been doing this at all) to 4 (I’ve been doing this a lot). -Acculturation Level – The Abbreviated Multidimensional Acculturation Scale (AMAS-ZABB). The AMAS-ZABB (Zea, Asner-Self, Birman, & Buki, 2003) is a 42-item scale that examines level of acculturation in any ethnic group. Unlike other acculturation measures, the AMAS-ZABB does not focus solely on language but examines: cultural identity, language competence, and cultural competence. The cultural identity dimension has 12 items on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4(Strongly agree) with statements focused on the host culture and the culture of origin. Some example items are “I feel good about being U.S. American” or “I am proud of being ______ (culture of origin).” The language competence dimension had 18 items focusing on how well participants speak and understand English and their native language. The items were on a 4-point scale ranging from 1 (Not at all) to 4 (Extremely well) with five of the nine items focused on speaking a language and four items on how well participants understand a language. Some examples of the items were “How well do you speak English with strangers?” or “How well do you understand your native language in general?” The cultural competence dimension had 12 items, six for the host culture and six for participants’ culture of origin. These items were on the same scale as the language competence and had examples such as “How well do you know American national heroes?” or “How well do you know the history of your native culture?” Internal reliability was assessed for both the college and the community sample with Cronbach’s alpha coefficients ranging from .90 to .96 for the college sample and .83 to .97 for the community sample. Concurrent validity was assessed by examining the scores on the AMAS-ZABB from participants born in the U.S. and in Latin America and finding significant differences between the groups. To support evidence of discriminant and convergent validity, the AMAS-ZABB’s Latino subscales were compared to the Bicultural Inventory Questionnaire – Form B’s (BIQ-B; Birman, 1991, 1998; Azapocznik et al., 1980) Americanism scale and showed no correlation between the two measures while the Hispanicism scale of the BIQ-B was significantly correlated with the Latino subscales of the AMAS-ZABB (Zea et al., 2003). -Neighborhood Environment - Neighborhood Environment Walkability Scale- Abbreviated (NEWS-A). The following three scales from the abbreviated measure will be used: Places for Walking and Cycling (3 questions; strongly disagree-strongly agree), Neighborhood Surroundings (4 questions; strongly disagree-strongly agree), and Neighborhood Safety (9 questions; strongly disagree-strongly agree). The scales have demonstrated reliability and factorial validity (Cerin, Saelens, Sallis, and Frank, 2016).