Miguel Fudolig

Background/Objectives: Routine depression screening is recommended in primary care, yet depression may remain underdetected among Filipino American patients. Provider-level factors, including culturally responsive preparation, communication challenges, workflow constraints, and attitudes toward mental health screening, may influence opportunities for early identification and referral. This exploratory cross-sectional study examined provider perspectives on barriers to depression screening and mental health discussions with Filipino American patients using the Capability, Opportunity, Motivation, and Behavior (COM-B) framework as an implementation-informed organizing lens. Methods: A cross-sectional survey was conducted among healthcare providers (N = 81) with experience caring for Filipino American patients in the United States. Survey items assessed provider confidence, perceived adequacy of mental health training, cultural and communication barriers, perceived stigma-related concerns, comfort discussing mental health, and interest in additional culturally responsive resources. Items from the adapted Attitudes Toward Assisting Filipino American Patients with Mental Health Symptoms (ATFA) scale and one item from the Mental Illness Clinicians’ Attitudes scale were conceptually mapped to the COM-B domains. Descriptive statistics, internal consistency estimates, and nonparametric tests were used to summarize findings and explore differences by provider characteristics. Results: Most providers recognized that Filipino cultural beliefs and customs may influence mental health help-seeking and symptom expression. Although many providers reported confidence identifying mental health symptoms, fewer reported adequate training to assess mental health concerns among Filipino American patients. Communication barriers, stigma-related concerns, and interest in additional culturally tailored resources were commonly reported. COM-B domain scores were not significantly associated with provider role or years of clinical experience. Providers who identified as Filipino reported greater perceived capability and opportunity related to initiating mental health discussions compared with non-Filipino providers. Conclusions: Findings suggest that provider motivation to address mental health concerns may be present, while capability- and opportunity-related barriers, including culturally responsive training, communication support, workflow integration, and referral resources, may remain important targets for future implementation efforts. Because this exploratory study used a modest convenience sample and an adapted measure that requires further psychometric validation, the findings should be interpreted with caution. Larger studies using validated instruments are needed to examine further provider-level determinants of culturally responsive depression screening among Filipino American patients.

Chronic stress can lead to physical and mental health conditions. This study aimed to identify the different stress profiles and stress relief methods among Filipinos living in the Philippines using latent class analysis. A secondary analysis of a cross-sectional study was employed in this study. The stressors and stress-relief practices among Filipinos were investigated using the I-HEART-FILIPINOS data set. Latent class analysis was used to identify the different profiles of stress causes and management methods among 1,196 Filipinos residing in the Philippines, specifically the Northern Luzon area. Four stress-related profiles were identified: (1) low financial stress relieved by eating and exercise; (2) work-related stress relieved by self-care; (3) familial and economic turmoil relieved by eating, exercise and prayer; (4) high financial stress relieved by staying at home and remaining indoors. The four-class solution explained 58% of the variation in the data through classification. Disparities were observed between classes in terms of emotional distress and sociodemographic variables, implying how sociocultural factors could affect stress presentation and management in Filipinos. The findings of this study inform the development of stress management interventions specifically designed to address the needs of underserved populations in the Philippines and neighboring countries to improve overall health.

Background/Objectives: Breast cancer is one of the most prevalent cancers among women, with notable increases among women younger than 50 years. Knowledge about breast cancer and preventive measures (e.g., early detection) are key to reducing breast cancer morbidity and mortality. Many graduate students fall within an age range when breast cancer risk starts to rise. However, research focused specifically on graduate students’ breast cancer knowledge and practices of preventive measures are sparse. Methods: This scoping review aims to synthesize the literature on breast cancer knowledge and practice of preventive measures among graduate students in a global context. Four databases (PubMed, CINAHL, APA PsycINFO, Embase) were searched for articles published between 2014 and 2024, and the following inclusion criteria were applied: full-text peer-reviewed articles available online; target population includes graduate students aged 20 to 50 years; English language; and, cross-sectional, cohort, case–control, ecological, and experimental/intervention studies. Two reviewers independently conducted article screening and data extraction using Covidence. Results: Sixteen studies met the selection criteria. Knowledge of breast cancer was examined in 94% (15/16) of the included studies and 75% (12/16) of the studies assessed practice of prevention measures (e.g., breast self-examination) among graduate students. Overall, most studies reported poor knowledge and limited uptake of prevention practices. Educational background (e.g., years of education, academic discipline and GPA), access to healthcare services, and other socioeconomic characteristics were commonly reported factors significantly associated with breast cancer knowledge and practice of preventive measures in graduate students. Conclusions: These findings may inform targeted educational interventions to increase knowledge and promote the early detection and prevention of breast cancer among graduate students.

Introduction: Rates of recreational cannabis (ie, marijuana) use in the United States have increased in recent years as have rates of cannabis use disorder. The aim of this study was to assess theoretical correlates of intentions to initiate and sustain marijuana cessation among adult user—using domains of the Multi-Theory Model (MTM) of health behavior change. Methods: A cross-sectional survey was administered to a sample of adult cannabis users (n = 227; mean age = 40.9 years; 48.5% female; 85.5% non-Hispanic white). We assessed intention to quit cannabis using MTM constructs of initiation (participatory dialogue, behavioral confidence, changes in physical environment) and sustenance (emotional transformation, practice for change, changes in social environment). The structure of the MTM scale was assessed using confirmatory factor analysis. Hierarchical linear regression models were used to assess constructs of initiation and sustenance of cannabis use controlling for demographic characteristics and Cannabis Use Disorder Identification Test score (12). Results: The MTM scale evidenced good reliability (Cronbach’s alphas > .7) and good model fit. Results indicated that only the change in physical environment construct was significantly associated with the intention of initiating cannabis cessation ( B = 0.27, P < .001) while practice for change ( B = 0.27, P < .001) and changes in social environment (B = 0.19, P = .001) was positively associated with the intentions of sustaining cannabis cessation. Conclusions: Results indicate that changes to physical and social environment are key features of initiating and sustaining cannabis use cessation, which aligns with research on tobacco cessation. Future research should explore how these factors interact and investigate additional influences on long-term cessation success.

Background/Objective: Relative proportion of cases in a multi-strain pandemic like the COVID-19 pandemic provides insight on how fast a newly emergent variant dominates the infected population. However, the behavior of relative proportion of emerging variants is an understudied field. We investigated the emerging behavior of dominant COVID-19 variants using nonlinear statistical methods and calculated the time to dominance of each variant. Method: We used a phenomenological approach to model national- and regional-level variant share data from the national genomic surveillance system provided by the Centers for Disease Control and Prevention to determine the best model to describe the emergence of two recent dominant variants of the SARS-CoV-2 virus: XBB.1.5 and JN.1. The proportions were modeled using logistic, Weibull, and generalized additive models. Model performance was evaluated using the Akaike Information Criteria (AIC) and the root mean square error (RMSE). Findings: The Weibull model performed the worst out of all three approaches. The generalized additive model approach slightly outperformed the logistic model based on fit statistics, but lacked in interpretability compared to the logistic model. These models were then used to estimate the time elapsed from emergence to dominance in the infected population, denoted by the time to dominance (TTD). All three models yielded similar TTD estimates. The XBB.1.5 variant was found to dominate the population faster compared to the JN.1 variant, especially in HHS Region 2 (New York) where the XBB.1.5 was believed to emerge. This research expounds on how emerging viral strains transition to dominance, informing public health interventions against future emergent COVID-19 variants and other infectious diseases.

Maintaining proper hand hygiene is crucial in preventing the spread of infections and other communicable diseases. It is imperative to determine the factors that affect the likelihood of initiating and maintaining the recommended handwashing behavior, especially during a pandemic. This quantitative, secondary study employed a latent profile analysis (LPA) to identify the different attitudes toward behavior change based on the Multi-Theory Model (MTM) framework in the context of following the guidelines provided by the Centers for Disease Control and Prevention (CDC) during the COVID-19 pandemic. Data were collected from 602 college students at a large university in the southern region of the United States (U.S.) in 2020. Seven distinct profiles were identified, each reflecting unique attitudes toward following the recommended handwashing guidelines. Age (p < 0.01) and gender (p < 0.01) disparities were observed between profiles. This study is the first to apply LPA within the MTM framework and provides new insights for the development of targeted interventions based on the construct score profile.

Background: Latino children in the United States (US) have a higher prevalence of overweight/obesity compared to white children. Previous studies suggest that acculturation to the US is associated with health behaviors such as diet, body mass index (BMI), and physical activity. However, the role of parental acculturation remains understudied, particularly with the use of validated measures. Objective: The objective of this study was to evaluate parental acculturation and its association with parental interpersonal factors and health behaviors in the preschool-aged child. Methods: Data were analyzed from 187 Latino parents in Nevada. Parents completed a self-reported, cross-sectional survey. Acculturation was assessed using Norris’ 4-item validated acculturation measure. The average age of the preschool-aged children was 45.5 months, and their mean BMI percentile was 96.4% (SD ± 18.7). The mean parental acculturation score was 2.1 (SD ± 1.2). Children were physically active an average of 4.9 (SD ± 2.0) days per week. After controlling for covariates, the results indicated that parental acculturation was positively associated with physical activity and sugar-sweetened beverage consumption. However, parental acculturation was not associated with child BMI percentile, or the consumption of fruits, vegetables, and sweet snacks. Conclusions: These findings can inform future research on culturally tailored intervention strategies to boost physical activity and reduce sugar-sweetened beverage intake among Latino preschool-aged children.

Background/Objective: Relative proportion of cases in a multi-strain pandemic like the COVID-19 pandemic provides insight on how fast a newly emergent variant dominates the infected population. However, the behavior of relative proportion of emerging variants is an understudied field. We investigated the emerging behavior of dominant COVID-19 variants using nonlinear statistical methods and calculated the time to dominance of each variant. Method: We used a phenomenological approach to model national- and regional-level variant share data from the national genomic surveillance system provided by the Centers for Disease Control and Prevention to determine the best model to describe the emergence of two recent dominant variants of the SARS-CoV-2 virus: XBB.1.5 and JN.1. The proportions were modeled using logistic, Weibull, and generalized additive models. Model performance was evaluated using the Akaike Information Criteria (AIC) and the root mean square error (RMSE). Findings: The Weibull model performed the worst out of all three approaches. The generalized additive model approach slightly outperformed the logistic model based on fit statistics, but lacked in interpretability compared to the logistic model. These models were then used to estimate the time elapsed from emergence to dominance in the infected population, denoted by the time to dominance (TTD). All three models yielded similar TTD estimates. The XBB.1.5 variant was found to dominate the population faster compared to the JN.1 variant, especially in HHS Region 2 (New York) where the XBB.1.5 was believed to emerge. This research expounds on how emerging viral strains transition to dominance, informing public health interventions against future emergent COVID-19 variants and other infectious diseases.