William Armando Vega

• Managing Director at University of Southern California

This chapter compares counties with the highest prevalence of Alzheimer's disease and related dementias (ADRD) among Blacks, Latinos, and non-Latino Whites against counties with the lowest prevalence among these populations to identify trends related to the social determinants of health and risk factors for ADRD. Counties with the highest prevalenc...

This chapter examines the distinct cultural and political contexts in which Mexicans and Mexican Americans age. We begin with an overview of the history of the field, followed by a discussion of how it has evolved, and a discussion of the changing focus of the literature in the current century. This discussion summarizes the significant progress ov...

Objective: To carry out and evaluate a communications campaign (La CLAve) to reduce the duration of untreated psychosis (DUP) in a U.S. Latinx community. Method: We employed evidence-based messaging in multiple media outlets. We recruited 132 Latinxs with first-episode psychosis (FEP) and caregivers seeking mental health care within a high-densi...

As higher mental demands at work are associated with lower dementia risk and a key symptom of dementia is hippocampal atrophy, the study aimed at investigating the association between mental demands at work and hippocampal volume. We analyzed data from the population-based LIFE-Adult-Study in Leipzig, Germany ( n = 1,409, age 40–80). Hippocampal vo...

This chapter forecasts the impact of Alzheimer’s disease on the Latino population of the United States and examines the role of place and social determinants for increasing or decreasing disease risk. Latinos are believed to be at much higher risk than non-Latino Whites, attributable in part to key social determinants such as very low income and ed...

This chapter presents original research on within and across regional disparities in the prevalence and onset of ADL limitations among Latino, Black, and White older adults in the United States. We also present a summary analysis and discussion about how social determinants, such as income, are structuring associations between aging and declining f...

Objective To examine the temporal relationship of Medicaid funding on the implementation of evidence-based practices (EBPs) in outpatient substance use disorder (SUD) treatment. Methods We examined data from 61 publicly funded SUD treatment programs in 2011 and 2013 using crossed-lagged regressions. We tested the impact of Medicaid payment accepta...

Introduction: As higher dementia prevalence in ethnic minority groups could be attributed to low education, we studied individuals with low education and explored potential factors driving dementia disparities. Methods: We examined differences in dementia risk between low-educated non-Hispanic whites, Hispanics, and African Americans, and the im...

Background Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs’ acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. Methods We analyzed client and program dat...

Background: We compare the psychosis literacy of 3 samples of Latinos residing in Los Angeles County: persons with first episode of psychosis (FEP), their caregivers, and community residents. Methods: Individuals with FEP (n = 71) and their caregivers (n = 59) were recruited as part of a 2-year ongoing assessment of the duration of untreated psycho...

Millennials and Dementia Caregiving in the United States: This issue brief explores millennial caregiving in the United States with the goal of enhancing our understanding of the experiences and challenges of young adults providing care for a family member or friend living with Alzheimer's disease or other dementias.

Background Despite increasing concern about the quality of life of older adults, little is known about characteristics associated with health risk behaviors among older adults in middle-income countries. This study relied on unique longitudinal data to examine the relationship between sociodemographic characteristics and alcohol use among low-incom...

Resumen Antecedentes: Hemos examinado las barreras que perciben los migrantes mexicanos para acceder al tratamiento por abuso de sustancias, y las posibles diferencias según el género. Métodos: Este estudio analiza un subconjunto de datos de hogares que fueron recopilados en México en 2011 a través de la Encuesta Nacional de Adicciones (National Su...

Resumen Antecedentes: Hemos examinado las barreras que perciben los migrantes mexicanos para acceder al tratamiento por abuso de sustancias, y las posibles diferencias según el género. Métodos: Este estudio analiza un subconjunto de datos de hogares que fueron recopilados en México en 2011 a través de la Encuesta Nacional de Adicciones (National Su...

The authors examined the institutional challenges that underrepresented minority (URM) faculty perceive in higher education with use of family support workplace policies. Evidence reveals that faculty encounter differences in access to information and explanations of how to use workplace–family statutes. A qualitative study of 58 URM faculty member...

Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, Californ...

The current study seeks to identify the past-year prevalence of intimate partner violence (IPV) and to find out how factors from the ecological system perspectives relate to IPV among baby boomers and the current elderly. The 2010 National Domestic Violence Survey data of South Korea were used. The samples consisted of current elderly men (N = 180)...

Our understanding of the migration processes can be substantially improved by examining the “contexts of premigration experiences” including the environmental conditions that motivated migration and personal preparedness to facilitate the physical transition as well as the “contexts of reception” such as structural factors and social resistance to...

Research on culturally responsive interventions for substance use disorders among Latino older adults has been limited. This study examined the role of counselors’ Spanish language proficiency, among other indicators of quality of care, and client factors, such as gender and drug of choice, in the odds of sobriety at treatment discharge among Latin...

We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the re...

Background Little is known about how different components of the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS). Purpose To examine providers’ interpretation of their external environment and anticipation of how the ACA will affect AHS structure, organization, and capacity to deliver integrated ca...

Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit d...

Although rates of illicit drug use are considerably lower in Mexico than in the United States, rates in Mexico have risen significantly. This increase has particular implications for Mexican women and US migrants, who are considered at increased risk of drug use. Due to drug reforms enacted in Mexico in 2008, it is critical to evaluate patterns of...

Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed c...

Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that amo...

Immigrants have disproportionate lack of access to healthcare and insurance. Emergency departments could serve as a healthcare substitute and increased demand can negatively affect the US emergency services system. Medical Expenditures Panel Survey (2000-2008) data was modeled to compare emergency departments (ED) use between non-citizens, foreign-...

The U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity-A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update tha...

Colorectal cancer screening (CRC) disparities have worsened in recent years. To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups. Multivariate logistic regressions examined associations between ethnicity/race and primary outcomes of self-reported guideline-concorda...

Research suggests that health literacy (HL) is associated with clinical outcomes. Few studies, however, have examined the mechanisms accounting for this relationship. To understand why HL is related to outcomes, we tested a theoretical framework proposing that diabetes-related knowledge and behavior mediate (explain) the relationship between HL and...

We examined how US cultural involvement related to suicide attempts among youths in the Dominican Republic. We analyzed data from a nationally representative sample of youths attending high school in the Dominican Republic (n = 8446). The outcome of interest was a suicide attempt during the past year. The US cultural involvement indicators included...

Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys. To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of...

Globally, the population proportion of older adults is increasing and is projected to ascend for decades to come. As these demographic shifts occur, societies will need to adapt to afford citizens the highest quality of living at sustainable costs. First and foremost is maintaining older populations that are free from excess disease and healthcare...

Twin studies suggest that conduct disorder (CD) is under substantial genetic influence, which is stronger for aggressive than for nonaggressive symptoms. Studies of migrating populations offer an alternative strategy for separating environmental and genetic influences on psychiatric disorders. To examine variation in the prevalence of CD associated...

To compare models of attrition across race/ethnic groups of aging populations and discuss implications for health-related research. The Health and Retirement Study (1992-2008). A competing risks model was estimated using a multinomial logit model when respondents faced competing types of risks, such as dying, being lost from the study, and nonrespo...

The Hispanic Health Paradox refers to the usual finding in population health studies that the most vulnerable sub-population of immigrants actually have superior morbidity and mortality compared to either the US population or Hispanics born in the United States. In this paper we examine this paradox using an epidemiologic strategy of scrutinizing i...

Migration is suspected to increase risk for depressive and anxiety disorders. To test the hypothesized increase in risk for depressive and anxiety disorders after arrival in the United States among Mexican migrants. We combined data from surveys conducted separately in Mexico and the United States that used the same diagnostic interview. Discrete t...

Lower use of medication treatment, poorer doctor-patient communication (DPC) and depression stigma are key contributors to mental healthcare disparities among Latinos with depression. The current study investigated the relationship between these key variables and the long-term trajectory of depression in primary care among Latinos. Participants (N=...

To examine the relationship between patients' English proficiency, patient-provider language concordance, and health care quality among foreign-born Latinos in the United States. National probability sample data (from the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey) were analyzed from telephone interviews with foreign-bo...

To determine the prevalence, age of onset, severity, associated disability, and treatment of major depression among United States ethnic groups, national survey data were analyzed. National probability samples of US household residents aged 18-years and older (n=14,710) participated. The main outcomes were past-year and lifetime major depression (W...

Neighborhood social ecologies may have protective effects on depression in Latinos, after adjusting for demographic risk factors, such as nativity and length of stay in the US. This study examines the effects of neighborhood collective efficacy and linguistic isolation on depression in a heterogeneous urban Latino population from 1,468 adult respon...

In the case of large-scale epidemiological studies, there is evidence of substantial disagreement when lay diagnoses of schizophrenia based on structured interviews are compared with expert diagnoses of the same patients. Reasons for this level of disagreement are investigated in the current study, which made use of advances in text-mining techniqu...

Stigma associated with mental illness is an important yet understudied issue among Latinos. This study examined the psychometric properties of four stigma measures with a sample of Spanish-speaking Latino primary care patients. The study evaluated the scale for Perceived Discrimination Devaluation (PDD), the Stigma Concerns About Mental Health Care...

To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients. Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items...

Over the next fifty years, the racial and ethnic composition of the United States is projected to dramatically change. Currently, the Latino population makes up approximately 14 percent (41.3 million) of the total U.S. population, excluding the residents of Puerto Rico and many undocumented Latinos. It is estimated that 75 percent of all Latinos re...

Few areas of Latino health are as profoundly affected by changes in human behavior as drug abuse (Volkow 2006). Drug use is socially acquired behavior. Societies and the subcultures that compose them vary widely in their degree of toleration or outright condemnation of those who consume or become addicted to illicit drugs (Vega et al. 2002). Examin...

It is estimated that more than 50 million Latinos live in the United States. This is projected to more than double by 2050. In Health Issues in Latino Males experts from public health, medicine, and sociology examine the issues affecting Latino men's health and recommend policies to overcome inequities and better serve this population. It includes...

The chapters in this volume comprise a unique collection of studies about issues affecting the health of Latino males. To our knowledge, this is the first time this information has been presented in one volume. It should be borne in mind that interpreting the effects of structural factors on health is a synthetic process. Disease is usually produce...

To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. The 48 coterminous United States. Household residents 18 years and older (N = 15 762)...

To provide national prevalence estimates of usual source of healthcare (USHC), and examine the relationship between USHC and diabetes awareness and knowledge among Latinos using a modified Andersen model of healthcare access. Three thousand eight hundred and ninety-nine Latino (18-years or older) participants of the Pew Hispanic Center/Robert Wood...

There is suggestive evidence that lower rates of health insurance coverage increases the gaps in quality and access to care among Latinos as compared with non-Latino whites. In order to examine these potential disparities, we assessed the effects of insurance coverage and multiple covariates on perceived quality of care. To assess the distribution...

Objectives. We compared risk for several medical illnesses between immi- grant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. Methods. Cross-sectional, multistage probability sample data for 3050 Mex- ican Americans aged 65 years or older from 5 US southwestern...

Little information is available about accuracy of diagnoses in clinical care for affective and other major mental disorders experienced by Latino patients. This study addressed two central research questions: Do Latinos have disproportionate rates of clinical diagnoses of major depression based on structured diagnostic interviews? Are diagnostic pa...

We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Se...

In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and e...

Perinatal drug exposures pose a significant health hazard for women and imperil normal fetal and neonatal development. Little is known about patterns of drug exposure among pregnant immigrant and native-born Latinas in the United States. We present multivariate risk factor analyses for alcohol and illicit drug use from the California Perinatal Subs...

To examine the population prevalence, patterns of onset, and important demographic covariates for dual (co-occurring) diagnoses of substance and non-substance mental disorders. A nationally representative sample of U.S. Latino adults was interviewed face-to-face. Estimates were made using data from the National Latino and Asian Services Survey (NLA...

Based on social control perspectives and results from prior studies we test hypotheses about the extent to which characteristics of family and social networks are associated with substance use disorders (SUD), and whether these associations vary by sex. In this study SUD is alcohol or illicit drug abuse or dependence as defined by criteria of the D...

To evaluate the prevalence of mental disorders for persons of non-English-language origin, it is essential to use translated diagnostic interviews. The equivalence of translated surveys is rarely tested formally. In the National Latino and Asian American Study (NLAAS), the authors tested whether a carefully translated mental health survey administe...

This review addresses the influence of ethnicity on the expression of psychotic symptoms and the implications for evaluating and treating patients of diverse backgrounds. Growing clinical and population research from Europe and the United States supports a dimensional interpretation of psychosis, yet the evidence suggests that psychotic symptoms pl...

This study sought to describe the role of stigma in antidepressant adherence among Latinos. The study utilized data generated from six focus groups of Latino outpatients receiving antidepressants (N=30). By using a grounded theory approach, qualitative analysis focused specifically on the role of stigma in antidepressant treatment, as well as salie...

Data from the NHSDA (2000) which contained screening measures for assessing risk for DSM-IV psychiatric disorders, were used to estimate smoking prevalence and its association with these disorders, among European American, Hispanic, and African American adolescents. Prevalence estimates, odds ratios, and hazard models were used to compare ethnic su...

Depression is a major public health problem and a leading cause of disability worldwide. Compounding the high rates of morbidity and mortality and treatment challenges associated with depression are the tremendous disparities in quality of mental health care that exist between the majority of the population and those of racial and ethnic minorities...

This article reports on the outcome of an expert consensus meeting in August 2005 sponsored by the National Institute of Mental Health, which assembled 15 senior researchers with a background in treatment and services research with the Hispanic population. The purpose of the workshop was to identify research issues most pertinent for improving qual...

A measurement model was analyzed to demonstrate a differential distribution and cumulative exposure to psychosocial risk and protective influences of adolescent drug use among ethnically-diverse adolescent samples. The sample included U.S.-born (US) Latino (N = 837), foreign-born (FB) Latino (N = 447), White (N = 632), and African American (N = 618...

To establish a general context on the topic of cross-cultural diagnosis and suggest how it can be applied to substance use disorders. Critical reviews of the literature on psychiatric diagnosis, cross-cultural issues and the concept of ethnicity were conducted to provide a framework for making specific recommendations for substance use diagnoses. C...

This paper focuses on whether a consistent difference by ethnicity existed in the clinical diagnosis of children and adolescents in two behavioral health service environments and reviews plausible explanations for such a difference. Key measures were clinical diagnosis and ethnicity, abstracted from the administrative dataset of a New Jersey behavi...

The purpose of this article is to review the research status of illicit drug use and its data sources in Latin America, with particular attention to the research that has been produced in the past 15 years in epidemiology of illicit drug use services utilization, and relationship between HIV and drug use. This article complements the series of arti...

Drug abuse in the U.S. Hispanic population appears to be in a dynamic state of acceleration, although there are differences in drug use patterns between U.S.-born and foreign-born Hispanics, and across Hispanic subgroups (i.e., Mexican, Cuban, Puerto Rican, and Central or South American). An understanding of the consequences of cultural adjustments...

It is reported that Latin Americans describe culturally normative experiences or express putative psychotic symptoms in medical and mental health treatment settings that complicate the diagnostic process. Previous research reported that Latinos were more likely than European Americans and African Americans to have their diagnoses changed from schiz...

While it has been suggested that mistrust of the dominant White society may be an important protective factor for some members of racial minorities, the question of whether mistrust may also be related to nonnormative behaviors among minority members has not been explored. Using survey data from Miami, Florida, this study empirically tests this hyp...

Utilizing a cluster sampling design to maximize representativeness, we look at the health effects of acculturation and acculturation stressors among 1,001 adult migrant farmworkers in Fresno, California. Using self-ratings of mental and physical health as well as the CES-D depression scale, we find that the amount of time one spends in the United S...

Although Hispanics are the largest minority in the United States, we have only fragmentary information and scarce guidelines on the frequency, recognition, and treatment of mental illness in this population. In reviewing the literature on this issue, the authors found that Hispanics are younger, poorer, and less educated than the average American;...

Ethnic and racial diversity in the United States increases daily through immigration and population shifts, and multiculturalism in the mental health field has had a difficult time keeping pace. Delivery of adequate mental health care to Hispanics, now the largest and fastest-growing ethnic minority, has been plagued by low utilization rates and in...

Cultural competence, as a tool to overcome disparities in mental healthcare to ethnic minorities, is facing unprecedented challenges. Providers are turning to cultural competence as one of the few resources available for badly needed information and strategies for improving clinical care. This essay provides background information about this issue...

To estimate 12-month prevalence and co-occurrence of symptoms of specific mental problems among US adolescents (12-17 years) by age, sex and racial/ethnic subgroups. Data from the 2000 National Household Survey of Drug Abuse (NHSDA) adolescent sample are used to estimate prevalence and co-occurrence rates using the DISC predictive scales. Multiple...

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Drug progression models have been a cornerstone of scientific and public policy discussions for decades. These models have been criticized for their lack of causal mechanisms leading to drug dependence. Future research should focus on identification of pathways and covariates. This study re-examines tobacco use onset and progression to drug depende...

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigr...

Alcohol dependence is a serious problem in the Mexican-origin population of the United States. While the magnitude of these problems is well documented, the use of services and their relative effectiveness in accessing and treating alcohol dependence have been inadequately studied. This paper describes patterns of care for alcohol disorders by exam...

Objective. Using data from the Mexican American Prevalence and Services Survey (Vega et al., 1998), this research tests whether the impact of acculturation and gender role ideology on wife abuse depends on country of origin. Methods. Two separate logistic regressions, one for U.S.-born Latinas and one for Mexican-born Latinas, are compared to test...

Within somatization, unexplained neurological symptoms (UNSs) have been shown to mark a distinct subgroup with greater clinical severity. However, some UNSs resemble ataque de nervios somatic symptoms. This raises questions about cultural factors related to Hispanics with somatization characterized by UNSs. To examine cultural factors, preliminary...