Adolfo Cuevas
Adolfo Cuevas
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Assistant Professor of Social and Behavioral Sciences
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Professional overview
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Adolfo G. Cuevas, PhD is an Assistant Professor in GPH’s Department of Social and Behavioral Sciences, as well as a scholar in its Center for Anti-Racism, Social Justice and Public Health. He employs epidemiological, psychological and biological approaches to investigate the effects of discrimination and other psychosocial determinants of health and health inequities. As a community psychologist, he uses population-level datasets and advanced statistical methods to understand how psychosocial determinants “get under the skin” and increase the risk of aging-related diseases.
For his research work on race, racism and health, Dr. Cuevas was selected one of the National Minority Quality Forum's 40 Under 40 Leaders in Minority Health in 2018. He is also a recipient of the Diversity Scholar Award by the Nutrition Obesity Research Center at Harvard University. Prior to joining NYU, he was the Gerald R. Gill Assistant Professor of Race, Culture and Society at Tufts University.
Dr. Cuevas’ work has been published in scientific journals such as the Proceedings of the National Academy of Sciences and the American Journal of Public Health, and he has been featured in HuffPost and NPR's Code Switch. While at Tufts he directed a multidisciplinary team of researchers investigating the obesogenic effects of discrimination across the life course.
Dr. Cuevas received both his MS and his PhD in applied psychology at Portland State University, with a concentration in community psychology and research methods. He earned a BA in psychology at City College of New York, and received additional training as a cancer prevention postdoctoral fellow at the Harvard T.H. Chan School of Public Health.
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Education
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PhD, Applied Psychology, Portland State UniversityMS, Applied Psychology, Portland State UniversityBA, Psychology, City College of New York, 2010Certificate, Applied Biostatistics, Harvard Catalyst
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Honors and awards
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National Institute of Health Loan Repayment-Renewal (2021)Diversity Scholar Award, Nutrition Obesity Research Center, Harvard University (2019)National Institute of Health Loan Repayment (2019)40 Under 40 Leaders in Health, National Minority Quality Forum (2018)Neubauer Faculty Fellowship, Tufts University (2017)Portland African American Leadership Fellowship (2013)National Cancer Institute R25E Summer Research Experience, The University of Texas MD, Anderson’s Cancer Prevention Research Training Program (2012)Bernard R. Ackerman Foundation Award for Outstanding Scholarship (2010)Search for Education, Elevation, and Knowledge Graduate of the Year (2010)City University of New York Pipeline Fellowship (2009)City University of New York Search for Education, Elevation, and Knowledge (SEEK) Scholarship (2009)Psi Chi Honor Society (2009)Dean’s List Scholar (20082009)Chi Alpha Epsilon (XAE) Honor Society (2008)City College of New York’s William Wright Scholarship (2008)City College of New York Community Service Award (2008)SEEK Scholarship (2008)
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Areas of research and study
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ObesityPsychosocial StressRacial/Ethnic Disparities
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Publications
Publications
What Predicts a Mayoral Official’s Opinion about the Role of Stress in Health Disparities?
AbstractCuevas, A. G., Levine, S., & Purtle, J. (n.d.).Publication year
2020Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
7Issue
1Page(s)
109-116AbstractHigh stress is a public health issue in the United States (US), that disproportionately affects socially-marginalized group members, including racial and ethnic minorities and those of low socioeconomic status. While city governments have the potential to reduce stress exposure and health disparities through municipal policies, very little is known about factors that are associated with mayor officials’ beliefs about stress as a determinant of disparities. This information is important because it can inform the design of interventions to educate city policymakers about evidence related to stress and health disparities. Using data from a 2016 survey of 230 mayor officials (101 mayors, 129 senior staff), multivariable logistic regression was used to determine the extent to which respondents’ individual characteristics (e.g., ideology, highest level of education) and the characteristics of their city’s population (e.g., percentage of residents non-white) were associated with their identification of stress as a factor that has a “very strong effect” on health disparities. Forty-four percent of respondents identified stress as having a very strong effect on health disparities. In the fully adjusted model, every percentage point increase in the proportion of a respondent’s city population that was non-White increased the odds of identifying stress as having a very strong effect on health disparities by 2% [adjusted odds ratio (aOR) = 1.02; 95% CI = 1.00,1.04]. Interventions are needed to increase city policymakers’ knowledge about the role of stress in the production of health disparities, which could, in turn, help cultivate political will for city policies that reduce disparities.Can patient-centered communication reduce the effects of medical mistrust on patients' decision making?
AbstractCuevas, A. G., O’Brien, K., & Saha, S. (n.d.).Publication year
2019Journal title
Health PsychologyVolume
38Issue
4Page(s)
325-333AbstractObjective: Mistrust in medical institutions has been implicated as a barrier that disproportionately affects the quality of health care received by patients. Although patient-centered communication has been shown to improve patient-provider relationships, little is known as to whether it may reduce the effects of medical mistrust on patients' decision-making and trust in physicians (physician mistrust). Method: In a laboratory study, 231 primary care patients (101 African American and 130 White participants) were randomly assigned to one of two conditions in which they viewed video recorded, standardized vignettes depicting a cardiologist recommending coronary bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In each vignette, the cardiologist-actor demonstrated either low or high patient-centered communication behavior. Participants were asked to assume the role of the patient interacting with the video-recorded physician. Results: Hypotheses were partially supported. High levels of medical mistrust were associated with greater physician mistrust and lesser endorsement of the hypothetical bypass surgery. Among patients exposed to high patient-centered communication, the relationships between medical mistrust and both physician mistrust and surgery endorsement were weaker than among patients exposed to low patient-centered communication. Although African American patients reported greater medical mistrust compared with White patients, respondents' race did not moderate the relationships. Conclusions: Results suggest that mistrust toward health care may unfavorably affect interactions and patients' health-related outcomes. Physicians may buffer the effects of mistrust by using patient-centered communication skills such as soliciting the patient's concerns and priorities and being responsive to the health care needs which patients identify.Intra-Ethnic Racial Differences in Waterpipe Tobacco Smoking among Latinos?
AbstractOrtiz, K., Cuevas, A. G., Salloum, R., Lopez, N., & LaVeist-Ramos, T. (n.d.).Publication year
2019Journal title
Substance Use and MisuseVolume
54Issue
1Page(s)
1-10AbstractBackground and Objectives: This study examined differences in waterpipe smoking (both lifetime and current) by race and ethnicity. More specifically, we evaluated intra-ethnic racial differences among Latinos using a nationally representative sample. Methods: Pooled data from the National Adult Tobacco Survey (NATS) [2012-2014] was used, in which Log-Poisson multivariable regression models were deployed to determine the prevalence of waterpipe smoking behavior. Models were stratified by gender and we further investigated acculturation, controlling for relevant sociodemographic characteristics. Results: In fully-adjusted models assessing lifetime WTS, Black Latinos and White Latinos exhibited an increase prevalence of lifetime WTS compared to their non-Hispanic white counterparts. Once stratifying by gender, Black Latino men (PR = 1.49; 95% CI = 1.16, 1.90) exhibited increased prevalence of lifetime WTS compared to their non-Hispanic white men counterparts; although white Latino men (PR = 0.88; 95% CI = 0.80, 0.98) exhibited decreased prevalence compared to their non-Hispanic white male counterparts. Similar trends were found for current WTS among men. In fully adjusted models assessing lifetime WTS, among women, only white Latina's (PR = 1.23; 95% CI = 1.04, 1.46) exhibited increased prevalence compared to their non-Hispanic white women counterparts. When evaluating current WTS, Black Latina's (PR = 2.19; 95% CI = 1.32, 3.65) and white Latinas (PR = 1.28; 95% CI = 1.00, 1.63) exhibited increased prevalence of WTS compared to their non-Hispanic white women counterparts. Conclusions/Importance: Among the U.S. general adult population, intra-ethnic racial differences in WTS behaviors exist among Latinos; and is shaped by gender. Future efforts to eliminate racial disparities in WTS should be attentive intra-ethnic racial differences among Latinos.Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research
AbstractCuevas, A. G., Trudel-Fitzgerald, C., Cofie, L., Zaitsu, M., Allen, J., & Williams, D. R. (n.d.).Publication year
2019Journal title
Cancer Causes and ControlAbstractBlack men are more likely to be diagnosed with prostate cancer compared with White men. Despite advances in prevention and treatment strategies, disparities in prostate cancer among Black men persist. While research on the causes of higher incidence and mortality is ongoing, there is limited evidence in the existing literature that clearly speaks to the potential psychological or social factors that may contribute to disparities in prostate cancer incidence. Given the lack of attention to this issue, we review scientific evidence of the ways in which social factors, including socioeconomic status and racial segregation, as well as psychological factors, like depression and anxiety, are related to subsequent prostate cancer risk, which could occur through behavioral and biological processes. Our objective is to illuminate psychosocial factors and their context, using a racial disparity lens, which suggests opportunities for future research on the determinants of prostate cancer. Ultimately, we aim to contribute to a robust research agenda for the development of new prostate cancer prevention measures to reduce racial disparities.Psychosocial Stress and Overweight and Obesity: Findings from the Chicago Community Adult Health Study
AbstractCuevas, A. G., Chen, R., Thurber, K. A., Slopen, N., & Williams, D. R. (n.d.).Publication year
2019Journal title
Annals of Behavioral MedicineVolume
53Issue
11Page(s)
964-974AbstractBackground: Psychosocial stress has been implicated as a risk factor for overweight and obesity. However, research on psychosocial stressors and overweight and obesity has typically focused on single stressors in isolation, which may overestimate the impact of a specific stressor and fail to describe the role of cumulative stress on overweight and obesity risk. Purpose: This study explores the association between overweight/obesity and cumulative exposure to a wide range of psychosocial stressors, among a multiracial/ethnic sample of adults. Methods: Using secondary data from the Chicago Community Adult Health Study (n = 2,983), we conducted multinomial logistic regression analyses to quantify associations between eight psychosocial stressors, individually and in combination, and measured overweight and obesity, adjusted for sociodemographic factors, alcohol use and smoking. Results: In separated covariate-adjusted models, childhood adversities (odds ratio [OR] = 1.16; confidence interval [CI] = [1.03, 1.30]), acute life events (OR = 1.18; CI = [1.04, 1.34]), financial strain (OR = 1.30; CI = [1.15, 1.47]), and relationship stressors (OR = 1.18; CI = [1.04, 1.35]) were associated with increased odds of obesity. In a model adjusted for all stressors simultaneously, financial strain was the only stressor independently associated with overweight (OR = 1.17; CI = [1.00, 1.36]) and obesity (OR = 1.21; CI = [1.05, 1.39]). Participants with stress exposure in the highest quintile across 2, 3, or ≥4 (compared to no) types of stressors had significantly higher odds of obesity. Conclusions: Multiple types of stressors may be risk factors for obesity, and cumulative exposure to these stressors may increase the odds of obesity. Reducing exposure to stressors at the population level may have the potential to contribute to reducing the burden of obesity.Racial centrality may be linked to mistrust in healthcare institutions for African Americans
AbstractCuevas, A. G., & O’Brien, K. (n.d.).Publication year
2019Journal title
Journal of health psychologyVolume
24Issue
14Page(s)
2022-2030AbstractEvidence suggests that racial identity is an important component to African Americans’ self-concepts and therefore may be relevant to patients’ trust in healthcare, yet little is known as to how racial identity may influence trust or mistrust. African American adults (N = 220) in the greater Portland, Oregon, area provided survey reports of healthcare-related attitudes and experiences. Those who reported higher racial centrality had lower trust in healthcare institutions. Based on these findings, clinicians employing patient-centered care approaches should recognize racial identity as an important component to patients’ experiences when they seek to deliver equitable care to African American patients.The Association between Perceived Discrimination and Allostatic Load in the Boston Puerto Rican Health Study
AbstractCuevas, A. G., Wang, K., Williams, D. R., Mattei, J., Tucker, K. L., & Falcon, L. M. (n.d.).Publication year
2019Journal title
Psychosomatic MedicineVolume
81Issue
7Page(s)
659-667AbstractObjective Perceived discrimination is a risk factor for poor health among ethnic and racial minority groups. However, few studies have examined the association between major lifetime and everyday perceived discrimination and allostatic load (AL), a preclinical indicator of disease. We examine the association between two measures of discrimination and AL among Puerto Rican adults. Methods Using primarily wave 3 data from the longitudinal Boston Puerto Rican Health Study, we examined the association between major lifetime and everyday perceived discrimination and AL (multisystem dysregulation of 11 physiological components) among Puerto Rican adults residing in the Boston metro area (N = 882). Five models were tested using multivariable regression. The final model adjusted for demographic factors, migration factors, socioeconomic status and work history, health behaviors/risk factors, and depressive symptom. Results Respondents had a M (SD) AL score of 5.11 (1.76; range = 0-11). They had an average score of 0.21 (0.42) for major lifetime perceived discrimination (0-3) and 0.29 (0.49) for everyday perceived discrimination (0-3). In a fully adjusted model, major lifetime perceived discrimination was associated with greater AL (b = 0.56; 95% CI = 0.19 to 0.92), whereas greater everyday perceived discrimination was marginally, but not significantly, associated with lower AL (b =-0.42; 95% CI =-0.87 to 0.04). Conclusions Perceived discrimination remains a common stressor and may be a determinant of AL for Puerto Ricans, although the type of perceived discrimination may have differing effects. Further research is needed to better understand the ways in which major lifetime and everyday perceived discrimination operate to effect physiological systems among Puerto Ricans.The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
AbstractCuevas, A. G., Ortiz, K., & Ransome, Y. (n.d.).Publication year
2019Journal title
BMC public healthVolume
19Issue
1AbstractBackground: The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity. Methods: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors. Results: The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001]. Conclusion: Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust
AbstractBenkert, R., Cuevas, A., Thompson, H. S., Dove-Meadows, E., & Knuckles, D. (n.d.).Publication year
2019Journal title
Behavioral MedicineVolume
45Issue
2Page(s)
86-101AbstractPeer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.Acculturation and Food Insecurity Among Puerto Ricans Living in Boston
AbstractWang, K., Chu, Y., Cuevas, A. G., Hasson, R. G., Tucker, K. L., & Falcón, L. M. (n.d.).Publication year
2018Journal title
Journal of Nutrition Education and BehaviorVolume
50Issue
8Page(s)
829-835AbstractObjective: To examine the associations among acculturation, food environment, and food insecurity among Puerto Ricans in Boston. Methods: The researchers used data from the second wave of the Boston Puerto Rican Health Study. The sample included 719 Puerto Rican adults in Boston. The researchers used logistic regression to examine the associations between psychological and language acculturation and food insecurity. Results: Individuals with medium psychological acculturation were more likely to be food insecure than were those with low or high psychological acculturation (P =.01). The association between language acculturation and food insecurity differed by distance of residence from primary shopping location (P =.02). Conclusions and Implications: This study extends the understanding of acculturation and food insecurity by investigating the impact of psychological and language acculturation. The findings highlight biculturalism, indicated by medium psychological acculturation, as a risk factor for food insecurity. People with low language acculturation who live far from food shopping locations had the highest prevalence of food insecurity.Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations
AbstractAllen, J. D., Shelton, R. C., Kephart, L., Tom, L. S., Leyva, B., Ospino, H., & Cuevas, A. G. (n.d.).Publication year
2018Journal title
Translational Behavioral MedicineVolume
10Issue
1Page(s)
213-222AbstractThe CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation. Forty-nine parishes (75%) completed the survey and were invited to participate in the CRUZA trial, which randomized parishes to either a "capacity enhancement intervention" or a "standard dissemination" group. Of these 49 parishes, 31 (63%) agreed to participate in the trial, whereas 18 parishes (37%) declined participation. Parishes that participated in the CRUZA intervention trial were similar to those that did not participate with respect to "inner organizational setting" characteristics of the CFIR, including innovation and values fit, implementation climate, and organizational culture. Change commitment, a submeasure of organizational readiness that reflects the shared resolve of organizational members to implement an innovation, was significantly higher among the participating parishes (mean = 3.93, SD = 1.08) as compared to nonparticipating parishes (mean = 3.27, SD = 1.08) (Z = -2.16, p =. 03). Parishes that agreed to participate in the CRUZA intervention trial were similar to those that declined participation with regard to organizational characteristics that may predict implementation of EBIs. Pragmatic tools to assess external generalizability in community-based implementation trials and to promote readiness among faith-based organizations to implement EBIs are needed to enhance the reach and impact of public health research. Clinical Trial information: The CRUZA trial identifier number with clinicaltrials.gov is NCT01740219.Occupational class and risk of renal cell cancer
AbstractZaitsu, M., Cuevas, A. G., Trudel-Fitzgerald, C., Takeuchi, T., Kobayashi, Y., & Kawachi, I. (n.d.).Publication year
2018Journal title
Health Science ReportsVolume
1Issue
6AbstractObjectives: We sought to examine the association between occupational class linked to job stress and the risk of renal cell cancer. To identify potential mediators, we additionally examined whether any observed associations persisted even after controlling for the contribution of stress-related factors (eg, smoking, hypertension, and obesity). Methods: Using nationwide inpatient records (1984 to 2016) from the Rosai Hospital group in Japan, we identified 3316 cases of renal cell cancer (excluding upper tract urothelial cancer) and 168 418 controls. We classified patients' occupational class (blue-collar workers, service workers, professionals, and managers) and cross-classified it by industry type (blue-collar, service, and white-collar) based on a standardized national classification. Unconditional logistic regression with multiple imputation was used for the analyses. Results: A significantly elevated risk of renal cell cancer was found among men in higher occupational class (eg, professionals and managers). The elevated odds in male managers across all industries persisted even after controlling for smoking and alcohol consumption, with the association being more pronounced in blue-collar industries (OR, 1.61; 95% CI, 1.34-1.93). The association appeared to be mainly mediated by hypertension. Conclusion: Occupational class is associated with the risk of renal cell cancer in men, particularly through modifiable risk factors.Psychosocial Factors and Hypertension: A Review of the Literature
AbstractCuevas, A. G., Williams, D. R., & Albert, M. A. (n.d.).Publication year
2017Journal title
Cardiology ClinicsVolume
35Issue
2Page(s)
223-230AbstractBlack people have the highest prevalence of hypertension in the United States. Evidence suggests that psychosocial factors increase the risks for hypertension and help to account for racial differences in this condition. This article reviews research on psychosocial factors and hypertension, and contextualizes the findings within a health disparities framework. A wide range of psychosocial factors contribute to hypertension but understanding remains limited about how these factors relate to each other and accumulate to contribute to hypertension disparities. Future research on psychosocial factors and hypertension needs to enhance the effectiveness of interventions to reduce hypertension risk in ethnic minority communities.What is the key to culturally competent care: Reducing bias or cultural tailoring?
AbstractCuevas, A. G., O’Brien, K., & Saha, S. (n.d.).Publication year
2017Journal title
Psychology and HealthVolume
32Issue
4Page(s)
493-507AbstractObjective: To gain a better understanding as to whether disparities in patient–provider relationships arise from ethnic minority patients being treated differently than European American patients while they would prefer to be treated the same, or whether disparities arise when ethnic minority patients are treated the same as European American patients while they would prefer to be treated differently. Method: African-American, Latina/Latino and European American community members were recruited to participate in one of 27 focus group discussions. Topics included what made a good or bad relationship with a doctor and what led one to trust a doctor. A thematic analysis was conducted using NVivo 10. Results: Patients of all groups described experiences that reflected the concepts of patient-centred care, such as wanting a clinician who is attentive to patients’ needs. African-American patients reported experiences they viewed as discriminatory. Some African-American patients felt it was appropriate to racially/ethnically contextualise their care, and most Latina/Latino patients preferred language/culturally concordant clinicians. Conclusion: Health care disparities might be reduced through a patient-centred approach to cultural competency training, general knowledge of the cultural context of clinicians’ patient population, and attention to the effects of racial bias and discrimination among both clinicians and non-clinical staff.African American experiences in healthcare: "I always feel like I'm getting skipped over"
AbstractCuevas, A. G., O’Brien, K., & Saha, S. (n.d.).Publication year
2016Journal title
Health PsychologyVolume
35Issue
9Page(s)
987-995AbstractObjective: Although African Americans perceive discrimination in health care settings, experience higher levels of medical mistrust compared with European Americans, and experience poorer communication with health care providers, little is known as to how these barriers to quality patient-provider relationships arise and manifest themselves. This study examined experiences of African American community members regarding these barriers and additionally explored participants' perspectives on race in the patient-provider relationship. Methods: Focus groups were conducted as part of a study exploring participants' experiences and relationships in health care settings. Sixty African American adults were recruited through community settings and activities to participate in 1 of 9 focus groups segmented by gender. Transcripts were reviewed for content related to perceived discrimination, mistrust, poor communication, and race discordance. Themes providing insight into participants' subjective experience of these potential relationship barriers were derived through qualitative coding (using NVivo 10) and iterative discussion. Results: Perceived discrimination arose when African American patients, particularly women, felt their symptoms or problems were discredited. Medical mistrust occurred when clinicians did not convey respect to patients, leaving patients to wonder whether their clinician's treatment was discriminatory or not. Poor communication arose when clinicians did not acknowledge patients' perspectives during interactions. Patients often viewed these actions as discriminatory. Conclusions: African Americans experience poor communication with their health care providers, medical mistrust, and perceived discrimination when accessing health care in numerous and sometimes interrelated ways. The investigators recommend ways to reduce the experience of such barriers and to improve patient-provider relationships for African Americans in health care.Race and skin color in latino health: An analytic review
AbstractCuevas, A. G., Dawson, B. A., & Williams, D. R. (n.d.).Publication year
2016Journal title
American journal of public healthVolume
106Issue
12Page(s)
2131-2136AbstractWe examined 22 articles to compare Black Latinos/as' with White Latinos/as' health and highlight findings and limitations in the literature. We searched 1153 abstracts, from the earliest on record to those available in 2016. We organized the articles into domains grounded on a framework that incorporates the effects of race on Latinos/as' health and well-being: health and wellbeing, immigration, psychosocial factors, and contextual factors. Most studies in this area are limited by self-reported measures of health status, inconsistent use of race and skin color measures, and omission of a wider range of immigration-related and contextual factors. We give recommendations for future research to explain the complexity in the Latino/a population regarding race, and we provide insight into Black Latinos/as experiences.Trends and Disparities in Postpartum Sterilization after Cesarean Section, 2000 through 2008
AbstractGarcia, G., Richardson, D. M., Gonzales, K. L., & Cuevas, A. G. (n.d.).Publication year
2015Journal title
Women's Health IssuesVolume
25Issue
6Page(s)
634-640AbstractPurpose: Tubal sterilization patterns are influenced by factors including patient race, ethnicity, level of education, method of payment, and hospital size and affiliation. However, less is known about how these factors influence tubal sterilizations performed as secondary procedures after cesarean sections (C-sections). Thus, this study examines variations in the prevalence of postpartum tubal sterilizations after C-sections from 2000 to 2008. Methods: We used data from the National Hospital Discharge Survey to estimate odds ratios for patient-level (race, marital status, age) and system-level (hospital size, type, region) factors on the likelihood of receiving tubal sterilization after C-section. Results: A disproportionate share of postpartum tubal sterilizations after C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and the Southern United States. Conclusions: Our findings indicate that Black women and those with Medicaid coverage in particular were substantially more likely to undergo postpartum tubal sterilization after C-section. We also found that hospital characteristics and region were significant predictors. This adds to the growing body of evidence that suggests that tubal sterilization may be a disparity issue patterned by multiple factors and calls for greater understanding of the role of patient-, provider-, and system-level characteristics on such outcomes.Advancing cessation research by integrating EMA and geospatial methodologies: Associations between tobacco retail outlets and real-time smoking urges during a quit attempt
AbstractWatkins, K. L., Regan, S. D., Nguyen, N., Businelle, M. S., Kendzor, D. E., Lam, C., Balis, D., Cuevas, A. G., Cao, Y., & Reitzel, L. R. (n.d.).Publication year
2014Journal title
Nicotine and Tobacco ResearchVolume
16Page(s)
S93-S101AbstractIntroduction: Residential tobacco retail outlet (TRO) density and proximity have been associated with smoking behaviors. More research is needed to understand the mechanisms underlying these relations and their potential relevance outside of the residential setting. This study integrates ecological momentary assessment (EMA) and geo-location tracking to explore real-time associations between exposure to TROs and smoking urges among 47 economically disadvantaged smokers in a cessation trial (59.6% female; 36.2% White). Methods: EMA data were collected for 1 week postquit via smartphone, which recorded smoking urge strength =4 random times daily along with real-time participant location data. For each assessment, the participants' proximity to the closest TRO and the density of TROs surrounding the participant were calculated. Linear mixed model regressions examined associations between TRO variables and smoking urges and whether relations varied based on participants' distance from their home. Covariates included sociodemographics, prequit tobacco dependence, treatment group, and daily smoking status. Results: Main effects were nonsignificant; however, the interaction between TRO proximity and distance from home was considered significant (p = .056). Specifically, closer proximity to TROs was associated with stronger smoking urges =1 mile of home (p = .001) but not >1 mile from home (p = .307). Significant associations were attributable to assessments completed at participants' home addresses. All density analyses were nonsignificant. Conclusions: Technological challenges encountered in this study resulted in a significant amount of missing data, highlighting the preliminary nature of these findings and limiting the inferences that can be drawn. However, results suggest that closer residential proximity to tobacco outlets may trigger stronger urges to smoke among economically disadvantaged smokers trying to quit, perhaps due to enhanced cigarette availability and accessibility. Therefore, limiting tobacco sales in close proximity to residential areas may complement existing tobacco control efforts and facilitate cessation.Discrimination, affect, and cancer risk factors among African Americans
AbstractCuevas, A. G., Reitzel, L. R., Adams, C. E., Cao, Y., Nguyen, N., Wetter, D. W., Watkins, K. L., Regan, S. D., & McNeill, L. H. (n.d.).Publication year
2014Journal title
American Journal of Health BehaviorVolume
38Issue
1Page(s)
31-41AbstractObjectives: 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. Results: 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. Copyright (c) PNG Publications. All rights reserved.Financial strain and cancer risk behaviors among African Americans
AbstractAdvani, P. S., Reitzel, L. R., Nguyen, N. T., Fisher, F. D., Savoy, E. J., Cuevas, A. G., Wetter, D. W., & McNeill, L. H. (n.d.).Publication year
2014Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
23Issue
6Page(s)
967-975AbstractBackground: 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.Financial strain and self-rated health among black adults
AbstractSavoy, E. J., Reitzel, L. R., Nguyen, N., Advani, P. S., Fisher, F. D., Wetter, D. W., Cuevas, A. G., & McNeill, L. H. (n.d.).Publication year
2014Journal title
American Journal of Health BehaviorVolume
38Issue
3Page(s)
340-350AbstractObjectives: 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.Loneliness and self-rated health among church-attending African Americans
AbstractFisher, F. D., Reitzel, L. R., Nguyen, N., Savoy, E. J., Advani, P. S., Cuevas, A. G., Vidrine, J. I., Wetter, D. W., & McNeill, L. H. (n.d.).Publication year
2014Journal title
American Journal of Health BehaviorVolume
38Issue
4Page(s)
481-491AbstractObjectives: To explore relations between loneliness and self-rated health among African-American adults of diverse ages. Methods: Associations between loneliness and self-rated health were investigated using covariate-adjusted linear regression models. Perceived social support was examined as a moderator. The potential indirect effects of stress and/or depressive symptoms were examined using nonparametric bootstrapping procedures. Results: Greater loneliness was associated with poorer self-rated health (p = .008), and social support did not moderate. Stress and depressive symptoms yielded significant indirect effects in single and multiple mediator models (p values ≤ 05). Conclusions: Loneliness may contribute to poorer health among African Americans. Results suggest that greater stress and depressive symptoms might underlie these associations, but longitudinal studies are needed to assess causal relations.Mediators of discrimination and self-rated health among African Americans
AbstractCuevas, A. G., Reitzel, L. R., Cao, Y., Nguyen, N., Wetter, D. W., Adams, C. E., Watkins, K. L., Regan, S. D., & McNeill, L. H. (n.d.).Publication year
2013Journal title
American Journal of Health BehaviorVolume
37Issue
6Page(s)
745-754AbstractObjectives: To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans. Methods: A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male). Results: Greater discrimination was associated with poorer selfrated health (β=-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05). Conclusions: Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.