Ruthmarie Hernández-Torres

Background: Hispanic patients with cancer who smoke are less likely to quit after diagnosis and underutilize evidence-based tobacco treatment. Understanding the complex factors influencing their engagement is crucial for developing effective and tailored interventions. Methods: Semi-structured individual interviews were conducted with 12 adult patients with cancer who self-identified as Hispanic or Latino referred between June 1, 2023, and June 30, 2024, to a tobacco treatment program embedded within a cancer center. Interviews were conducted via phone or video in English or Spanish. Transcripts were thematically analyzed, guided by the Socio-ecological Model, assessing individual, interpersonal, organizational, community, and policy barriers and facilitators affecting treatment engagement. Results: Median age was 65 and most participants (10) were women. Four multilevel themes emerged from the data: (1) Socio-Cultural Drivers and the Psychological Barrier of Fatalism; (2) Provider–Patient Relationship Enhances Engagement; (3) Community and Cultural Contexts Shaping Tobacco Use and Support Needs; and (4) Structural, Economic, And Policy-Level Determinants Constrain Access; Implementation and Enforcement are Key Levers. Additionally, the decision to accept or decline treatment further distinguished by differences in age/fatalism, provider relationship/trust, and the view of willpower versus external support. Conclusion: Engagement in tobacco treatment among Hispanic patients with cancer is shaped by the intersection of individual, cultural, and structural barriers and facilitators. Findings highlight the need for culturally and linguistically congruent interventions that address fatalism, integrate family support, reduce financial barriers, and leverage the patient-provider relationship to improve access and outcomes.

Objective: Transgender and gender diverse (TGD; e.g., non-binary) adults report higher cigarette smoking rates than cisgender adults. However, little is known about the prevalence and associations of current cigarette smoking among Latinx Transgender and Gender Diverse (LTGD) adults. This study examines the associations between current cigarette smoking and self-reported demographic and health characteristics (e.g., mental health diagnoses) among LTGD adults living in Puerto Rico (PR) and Florida (FL). Methods: Using secondary data from a cross-sectional exploratory study (n = 133), binary logistic regression was conducted to evaluate associations with current cigarette smoking status (smoking vs non-smoking). The Benjamini–Hochberg procedure was applied to control the false discovery rate (FDR) using R. Results: The mean age was 34.4 years (SD = 10.28). Almost half of participants self-identified as trans-women (45.8%), 33.6% as trans-men, and 21.1% as non-binary. More than half were born in Puerto Rico (53.5%), resided in Florida (53.5%), had an associate degree or higher (64.8%), and reported a monthly income of $0–$1000 (47.7%). Thirty-eight participants (28.6%) reported current smoking, with a median of 6 cigarettes daily (IQR: 2-10). Significant associations were observed between current smoking, country of birth, and lifetime diagnosis of depression ( P < 0.05). Conclusion: Findings highlight a high prevalence of cigarette smoking among LTGD adults and confirm associations with demographic factors and mental health. These results underscore the need to prioritize culturally adapted smoking cessation interventions for LTGD adults.

Objective: This preliminary study aimed to examine the smoking rate among Puerto Rican cancer survivors and identify correlations with demographic, clinical, and psychological factors. Methods: We conducted a secondary analysis using baseline data from 384 cancer survivors in Puerto Rico, collected between January 2018 and March 2023. Participants were recruited through community support groups and hospital settings. Data on sociodemographic characteristics, cancer type, treatments, psychological distress (assessed using the Patient Health Questionnaire-8 for depression and Generalized Anxiety Disorder-7 for anxiety), and smoking behaviors were analyzed. Significant associations with smoking were then tested in a logistic regression model, adjusted for all significant correlations. Results: 7.5% of the sample reported smoking in the past 6 months, with a median consumption of six cigarettes per day. Depression was the only significant factor correlated with smoking, with participants who smoked reporting higher levels of depression. Other variables, such as age, gender, cancer type, and treatments, showed no significant correlation with smoking behavior. In the logistic regression model, elevated depressive symptoms were significantly associated with an increased likelihood of smoking, with individuals reporting such symptoms being 3.03 times more likely to smoke (95% CI [1.39, 6.63], P = .005). Other variables, such as age, gender, cancer type, and treatments, showed no significant correlation with smoking behavior. Conclusion: Depressive symptoms are associated with smoking among Puerto Rican cancer survivors. This finding highlights the critical need for integrated mental health screening and support within smoking cessation programs tailored for this population.

In Puerto Rico, two in ten adults aged 18 to 64 (18.7%) are diagnosed with a mental illness (MI), such as schizophrenia, bipolar disorder, and major depressive disorder. People with MI diagnosis report higher frequencies of chronic diseases (e.g., diabetes, cancer, heart diseases) and cigarette smoking than the general population. This study explores associations between smoking, sociodemographic characteristics and health history (i.e. chronic diseases and MI diagnosis) among adults with a MI diagnosis in Puerto Rico. This cross-sectional study includes data from 285 Puerto Rican adults (> 21 years) with a MI diagnosis receiving psychiatric or psychological treatment in a community healthcare facility between May 2017 to May 2020. Chi-square tests evaluated the associations between smoking and sociodemographic characteristics, chronic diseases and MI diagnosis. Multiple logistic regression explained the relationship between smoking, sociodemographic characteristics, and MI diagnosis. A total of 25.3% (n=72) of participants reported current smoking. Significant associations were found between smoking with sociodemographic characteristics and MI diagnosis among Puerto Ricans diagnosed with MI. The logistic regression model explained 18.9% of the variance in smoking and classified 76.1% of cases. Results confirm high prevalence rates of current smoking and the potential impact on health among Puerto Ricans with MI diagnosis. Tailored treatments for smoking cessation for Puerto Ricans living with MI are needed.

Background: Puerto Rico (PR) is highly vulnerable to hurricanes, which severely impact cancer survivors by causing healthcare disruptions and increasing stress. This study investigates the reliability and factor structure of the Hurricane Hazards Inventory (HHI) and its relationship with psychological distress among cancer survivors and non-cancer controls in PR. Methods: Using secondary data from a longitudinal study following Hurricane Maria (HM), the baseline assessment included sociodemographic data from participants, HHI, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7). Statistical analyses involved descriptive statistics, Exploratory Factor Analysis (EFA), and Partial Least Squares Structural Equation Modeling (PLS-SEM). Results: Among 260 participants, 78.7% were women, with a median age of 58.0 years. EFA reduced the HHI to 17 items grouped into three factors explaining 62.6% of the variance with excellent reliability (Cronbach’s alpha 0.91). The three factors also showed good to excellent reliability (alpha 0.81 to 0.92). The median HHI score was 11.0 (range 4.0–26.5) out of 68. PLS-SEM revealed a direct effect of being a cancer survivor and tertiary hazards on depression and anxiety. Conclusion: The HHI is a valid and reliable tool for assessing mental health impact in cancer survivors after hurricanes. However, the study had limitations, including its small sample size and lack of control for all confounding variables. Future research with larger and more diverse samples is needed to further validate the HHI and examine its generalizability.

Background: Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. Methods: This secondary data analysis (n = 101) was part of a longitudinal case–control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January–July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. Results: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. Conclusions: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Evidence suggests an association between exposure to electronic cigarette (e-cigarette) marketing and e-cigarette use (vaping) among adolescents. However, there is limited evidence on exposure to e-cigarette marketing and susceptibility to future vaping, especially among Black and Latino adolescents. This study aimed to examine associations between exposure to e-cigarette marketing and susceptibility to future vaping among Black and Latino adolescents in the United States (US). Participants (N = 362; equal representation between Black and Latino adolescents) completed a baseline assessment (available in English and Spanish) including sociodemographic characteristics (e.g., racial/ethnic group, age, gender, sexual orientation, etc.), exposure to e-cigarette marketing, and susceptibility to future vaping. Exposure to e-cigarette marketing was recoded and organized into two categories (high exposure = 2 to 3; low exposure = 0 to 1). Cochran–Mantel–Haenszel tests were used to evaluate the association between exposure to e-cigarette marketing and susceptibility to future vaping, stratified by racial/ethnic group. Multiple logistic regressions assessed the association between exposure to e-cigarette marketing and susceptibility to future vaping, controlling for gender, sexual orientation, grade, and academic performance within each racial/ethnic group. Black adolescents reported significantly higher frequencies of exposure to e-cigarette marketing (p = 0.005). A significant interaction was found between exposure to e-cigarette marketing and racial/ethnic group (X² (1) = 6.294, p = 0.012). Among Black adolescents, high exposure to e-cigarette marketing (vs. low exposure) was associated with a higher probability of susceptibility to future vaping (OR: 2.399, 95% CI 1.147–5.021, p = 0.020). For Latino adolescents, exposure to e-cigarette marketing was not associated with susceptibility to future vaping (OR: 0.503, 95% CI 0.245–1.03, p = 0.062). Future studies should evaluate how and where adolescents are exposed to e-cigarette marketing. Prevention efforts must include the implementation of effective counter-marketing campaigns and the reduction of exposure to e-cigarette marketing among Black and Latino adolescents.

Objective: Acculturation stress can negatively impact Latinos immigrant mental and physical health related behaviors such as smoking. It is essential to have validated and updated instruments that allow the evaluation of acculturation stress on this population. This study aims to evaluate the psychometric properties of an abbreviated version of the Hispanic Stress Inventory Version 2 (HSI2) immigration scale among Latinos who smoke. Methods: The study consisted of a secondary data analysis from a baseline assessment of Decídetexto, a mobile health (mHealth) smoking cessation randomized clinical trial. Of 457 Latinos included in the parent study, 352 immigrants who smoke were included. Construct validity was analyzed by completing a Pearson correlation coefficient matrix. Structural validity was analyzed using an Exploratory Factor Analysis (EFA). Cronbach alpha analysis was used to estimate the internal consistency of the items constituting a factor. Results: The results included an abbreviated version of the HSI2 including 52 items. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 of the 52 items were excluded. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 items were excluded. Exploratory Factor Analysis (EFA) results in six factors extracted, explaining 69.1% of the variance. According to the EFA, two items were relocated in different factors from the original scale. The HSI2 30 items scale reflected excellent reliability with a Cronbach’s alpha coefficient of 0.93. The six factors reflect acceptable to excellent reliability, ranging from 0.77–0.93 across factors. The median for the HSI2 total score was 34.00 (25–45) out of a possible total score of 150. Conclusion: Results confirmed acceptable psychometric properties of the HSI2 simplified 30-item version and provided a reliable and shorter measure of acculturation stress for Latinos groups. Having a valid and reduced measure of acculturation stress is the first step in understanding diverse ethnic groups of Latinos that are at higher risk of presenting health risk behaviors such as smoking. The present results provided the possibility of assessing the impact of acculturation stress among adults who smoke.

The objective of this study was to assess the impact of COVID-19 pandemic worries (e.g., fear of contagion) and previous exposure to natural disasters (e.g., hurricanes) on Healthcare Workers (HCWs) mental health in Puerto Rico. Participants completed a self-administered online survey including items on sociodemographic information, working conditions, fears, and worries about the COVID-19 pandemic, past natural disaster experiences, depressive symptoms, and resilience. Logistic regressions models were performed to explain the relationship between depressive symptomatology and COVID-19 experiences and worries. 40.9% (n = 107) of the sample were classified as having some level (mild to severe) of depressive symptomatology (PHQ-8 ≥5). Results reflect normal to high levels of psychological resilience (BRS; M = 3.7, SD = 0.7). A significant association was found between depressive symptomatology and psychological resilience (OR = 0.44, 95% CI: 0.25–0.77). The odds of having depressive symptomatology were almost five times higher (OR = 4.79, 95% CI: 1.71–13.44) among those who reported emotional coping difficulties during the pandemic after experiencing a natural disaster compared to those that did not, when adjusting for psychological resilience and residence region. Despite normal to high psychological resilience levels, HCWs who reported emotional coping difficulties due to previous disasters were at risk of developing depressive symptomatology. Results suggest interventions to address the mental health of HCWs could benefit from considering other individual and environmental factors beyond resilience. Findings could inform future interventions to promote HCWs’ well-being before, during, and after a natural disaster or pandemic outbreak.

Smoking and sedentary lifestyle frequently co-occur among Latinos. Evidence suggests that moderate to vigorous physical activity (MVPA) may enhance smoking cessation rates. However, this synergistic phenomenon has not been studied among Latinos, the largest minority group in the United States. This qualitative study consisted of semi-structured interviews in English or Spanish with Latino adults who smoke (n = 20) to understand their perspectives on physical activity. Participants were recruited using community-based recruitment strategies. The Health Belief Model was used as a framework for qualitative theoretical analysis. Multiple perceived benefits (e.g., mood management, strategy to quit smoking), susceptibility (e.g., risk of cardiovascular diseases, physical impairment), and barriers (e.g., lack of social support, low financial resources) of being physically active were identified. Moreover, multiple cues to action to do physical activity (e.g., being a role model, spending time with family and friends) were identified. These factors provide concrete operational strategies to address smoking cessation and physical activity among Latinos. Further research is needed on how best to integrate these perspectives into smoking cessation interventions.