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).2018年1月，研究人员通过Qualtrics调研面板（Qualtrics Panels）招募了798名居住在美国的西班牙裔/拉丁裔成年人，要求其以英语或西班牙语完成问卷。受访者的族裔出生地背景多样：其中52%为墨西哥裔或墨西哥裔美国人，17%为波多黎各人，8.5%为古巴裔。本次问卷包含以下测量工具： - 人口与健康信息：人口与健康数据问卷（Demographic and Health Data Questionnaire, DHDQ）。该问卷由研究者自行编制，用于收集参与者的以下信息：(a) 种族/族裔，(b) 年龄，(c) 性别，(d) 性取向，(e) 伴侣关系状况，(f) 家庭收入，(g) 世代身份，(h) 教育水平，(i) 慢性健康状况，(j) 自我报告的身高与体重，(k) 整体健康状况，(l) 母语与熟练掌握的语言，(m) 过去一年的就医次数，(n) 感知体重。 - 媒体与技术使用及态度量表（Media and Technology Usage and Attitudes Scale, MTUAS）：该量表包含60个条目，用于测量特定媒体的使用频率及对技术的态度（Rosen等人，2013）。量表涵盖11个媒体使用子量表与4个态度子量表。本研究仅使用其中的智能手机使用子量表（共9个条目）。技术使用频率的提示语为："请表明您进行以下每项行为的频率……"，针对智能手机使用习惯的评分范围为1（从不）至10（始终），得分越高代表技术使用频率越高。研究表明，MTUAS的智能手机使用子量表具有良好的信度（克朗巴哈α系数=0.93），其效度也通过与每日媒体使用时长、技术相关焦虑及网络成瘾量表的对比得到验证（Rosen等人，2013）。 - 久坐行为问卷（Sedentary Behavior Questionnaire, SBQ）：该量表包含18个条目，用于评估9类不同的久坐行为，包括电子设备使用、休闲爱好、交通与工作相关的久坐行为（Rosenberg等人，2010）。该问卷用于评估工作日与周末的久坐行为，并通过相乘计算每周/周末的总久坐时长。原量表的答案选项范围为1（无）至9（6小时及以上）。本研究将对SBQ进行小幅调整，因为部分条目涉及的技术已过时，例如"坐着收听广播、磁带或CD中的音乐"，修订后的条目将反映当前主流的久坐型技术使用场景。研究表明，SBQ具有良好的信度，组内相关系数显示其在工作日（0.64-0.90）与周末（0.51-0.93）的测量均表现优异；其效度也通过偏相关分析得到验证，即将自我报告的SBQ得分与加速度计测量的活动数据进行对比。此外，与国际体力活动问卷及身体质量指数的对比中，该量表在男性与女性样本中均表现出显著相关性（Rosenberg等人，2010）。 - PHQ-9：患者健康问卷（Patient Health Questionnaire, PHQ-9）。该量表包含9个条目，用于评估抑郁症状（Kroenke、Spitzer与Williams，2001）。PHQ-9的指导语为："在过去两周内，您被以下任何问题困扰的频率如何？"，采用4点李克特量表评分，选项从0（完全没有）至3（几乎每天）。PHQ-9的总得分为各条目得分（0-3分）之和，总分范围为0至27，得分越高代表抑郁症状越严重。 - 健康促进行为：健康促进生活方式量表Ⅱ（Health Promoting Lifestyle Profile II, HPLP-II）。该量表包含52个条目，用于评估健康促进生活方式相关行为的参与程度（Walker、Sechrist与Pender，1995）。HPLP-II包含1个总量表与6个子量表，分别为精神成长、人际关系、营养、身体活动、健康责任与压力管理。本研究仅使用其中的营养子量表（9个条目）与身体活动子量表（8个条目）。HPLP-II的指导语为：请使用李克特量表表明您参与每项所列行为的频率，评分范围为1（从不）至4（经常）。量表及子量表的得分为各条目得分的均值，得分越高代表参与评估的健康促进行为的程度越高。该量表子量表的内部一致性克朗巴哈α系数为0.79-0.82（Walker与HillPolerecky，1996）。 - 睡眠时长与睡眠问题：来自美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）的睡眠障碍问卷。NHANES睡眠时长测量仅包含1个问题，用于评估受访者每晚的平均睡眠时长，答案选项将被划分为以下类别：极短（<5小时）、短（5-6小时）、正常（7-8小时）与长（≥9小时）（Whinnery等人，2014）。睡眠问题评估包括疑似失眠与/或睡眠呼吸暂停。失眠将通过两个问题评估："在过去一个月内，您入睡困难的频率如何？"与"在过去一个月内，您夜间醒来后难以再次入睡的频率如何？"。若受访者报告任一睡眠问题每月出现≥15次，则被归类为疑似失眠。睡眠呼吸暂停将通过以下问题评估：首先，"在过去12个月内，您在睡眠中打鼾、喘息或呼吸暂停的频率如何？"，答案选项将被划分为"疑似存在该问题（偶尔或频繁）"与"无该问题"。此外通过"您打鼾的频率如何？"评估打鼾情况，若受访者回答"频繁"则被归类为疑似睡眠呼吸暂停。既往睡眠呼吸暂停诊断将通过问题"您是否曾被医生或其他健康专业人员告知患有睡眠障碍？"进行评估。若受访者提及"睡眠呼吸暂停"或"失眠"，则确认存在该睡眠问题（Whinnery等人，2014）。 - 族裔身份：多组族裔身份量表修订版（Multigroup Ethnic Identity Measure-Revised, MEIM-R）。该量表包含6个条目，用于评估族裔身份形成过程（Phinney与Ong，2007）。MEIM-R包含1个总量表得分与2个子量表：探索维度（例如"我经常参与有助于我更好了解自身族裔背景的活动"）与承诺维度（例如"我对自身所属的族裔群体拥有强烈的归属感"）。受访者采用1（非常不同意）至5（非常同意）的李克特量表进行作答，得分越高代表整体族裔身份、探索程度或归属感越强。既往研究表明该量表的子量表（探索维度：α=0.76；承诺维度：α=0.78）与总量表（α=0.81）均具有良好的内部一致性（Phinney与Ong，2007）。 - 歧视/与健康相关的压力：西班牙裔压力量表Ⅱ（Hispanic Stress Inventory-2, HSI2）。该量表是针对西班牙裔/拉丁裔人群的文化适配性心理社会压力评估工具（Cervantes等人，2016）。HSI2包含7个子量表，本研究将使用其中的歧视压力子量表（11个条目）与健康压力子量表（6个条目）。对于每个条目，受访者首先需表明是否经历过该压力事件（是/否），若经历过，则需采用1（完全不担心/紧张）至5（极度担心/紧张）的5点李克特量表对该事件的压力程度进行评分。 - 简明应对方式问卷（Brief COPE）：该量表包含28个条目，用于评估个体应对生活压力的方式（Carver，1997）。Brief COPE包含14个子量表，分别为：(1) 自我分心，(2) 积极应对，(3) 否认，(4) 物质依赖，(5) 情感支持利用，(6) 工具性支持利用，(7) 行为脱离，(8) 宣泄，(9) 积极重构，(10) 规划，(11) 幽默，(12) 接纳，(13) 宗教信仰，(14) 自我责备。本研究不使用自我分心、否认、接纳、宣泄、幽默与自我责备这6个子量表，每个子量表包含2个条目。受访者需采用1（我完全没有这样做）至4（我经常这样做）的4点李克特量表对自身参与特定应对行为的程度进行评分。 - 文化适应水平：简版多维文化适应量表（Abbreviated Multidimensional Acculturation Scale, AMAS-ZABB）。该量表（Zea等人，2003）包含42个条目，用于评估任何族裔群体的文化适应水平。与其他文化适应量表不同，AMAS-ZABB不仅关注语言能力，还涵盖文化身份、语言能力与文化胜任力三个维度。其中，文化身份维度包含12个条目，采用1（非常不同意）至4（非常同意）的4点李克特量表，条目围绕东道国文化与原生文化展开，例如"我为自己是美国人而感到自豪"与"我为自己属于______（原生文化）而感到自豪"。语言能力维度包含18个条目，聚焦受访者对英语与母语的听说能力，采用1（完全不会）至4（非常熟练）的4点量表，其中9个条目涉及语言表达能力，4个条目涉及语言理解能力，例如"您与陌生人交流时的英语水平如何？"与"您对母语的整体理解能力如何？"。文化胜任力维度包含12个条目，其中6个针对东道国文化，6个针对原生文化，评分标准与语言能力维度一致，例如"您对美国国家英雄的了解程度如何？"与"您对自身原生文化的历史了解程度如何？"。该量表的内部信度在大学生样本与社区样本中均得到评估，大学生样本的克朗巴哈α系数为0.90-0.96，社区样本为0.83-0.97。同时，通过对比美国出生与拉美出生的受访者的AMAS-ZABB得分，发现两组间存在显著差异，验证了其同时效度；为进一步支持区分效度与聚合效度，研究将AMAS-ZABB的拉丁裔子量表与双文化问卷量表B（Bicultural Inventory Questionnaire – Form B, BIQ-B; Birman，1991、1998; Azapocznik等人，1980）的美国主义量表进行对比，发现两者无相关性，而BIQ-B的西班牙裔主义量表则与AMAS-ZABB的拉丁裔子量表呈显著相关（Zea等人，2003）。 - 邻里环境：简版邻里环境步行性量表（Neighborhood Environment Walkability Scale- Abbreviated, NEWS-A）。本研究将使用该简版量表中的三个子量表：步行与骑行场所（3个问题，评分范围为非常不同意至非常同意）、周边社区环境（4个问题，评分范围为非常不同意至非常同意）与社区安全（9个问题，评分范围为非常不同意至非常同意）。该量表已被验证具有良好的信度与因子效度（Cerin等人，2016）。