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We are a research lab that collaborates with the community to address social determinants of health and the inequities of cancer prevention in medically under-served people and hidden populations.

Black Health

Health Is Power, and Health Is Wealth: Understanding the Motivators and Barriers of African American/Black Male Immigrants With Gastrointestinal Conditions

Potter, D., & Valera, P. (2024). Health Is Power, and Health Is Wealth: Understanding the motivators and barriers of African American/Black Male Immigrants with gastrointestinal conditions. American Journal of Men’s Health, 18(1). doi:10.1177/1557988324122733

Abstract
The digestive health of African American/Black male immigrants in the United States has not been previously studied. Much of what is known about gastrointestinal (GI) concerns in this population is based on studies conducted on the overall Black American population. The purpose of this narrative study was to understand how African American/Black male immigrants with GI concerns navigated their GI condition. Fifteen African American/Black male immigrants from various cities in the United States participated in two remote focus groups to discover what motivates them to take control of their illness. Narrative analysis was used to analyze the qualitative data. Most men, 47% (n = 7), did not have health insurance, and 67% (n = 10) reported their income was less than US$52,000. The themes identified were: (1) lack of knowledge of GI, (2) denial of initial diagnosis, (3) self-discipline, (4) positive provider interactions, (5) health as a priority, and (6) advice to other African American/Black male immigrants experiencing GI. A strengths-based approach is necessary for describing the health-seeking behaviors among African American/Black male immigrants.

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A systematic review of HIV/AIDS, STI, Teen Pregnancy, and Substance Use Prevention Interventions for Black Adolescent Girls

Opara, I., Pierre, K., Assan, M.A., Scheinfeld, L., Alves, C., Cross, K., Lizarraga, A., % Brawner, B. (2022). A systematic review on sexual health and drug use prevention interventions for Black girls. Int J Environ Res Public Health, 8, 3176. doi: 10.3390/ijerph19063176.

Abstract

Background: The relationship between drug use and poor sexual health outcomes in Black adolescent females such as diagnoses of sexually transmitted infections, HIV, and early/unwanted pregnancy has been established in the literature. Yet, very few interventions have been successful in reducing the risk of poor sexual health outcomes and drug use for adolescent girls. Even more rare are interventions that are catered to specifically to Black girls in the United States, which is a group that has the highest rates of poorer sexual health outcomes and negative consequences associated with drug use. Therefore, this systematic review sought

to identify and organize interventions that are focused on preventing HIV, STIs, early pregnancy and drug use for and include large samples of Black girls. Fifteen interventions were identified that met the review’s search criteria. Results: A total of 15 interventions that were published between 2005 and 2020 were included in the review. While all but one intervention focused on sexual health outcomes, two interventions infused drug use education for girls. Conclusion: This review provides recommendations for sexual health and drug use prevention researchers to engage in an intersectional framework and concludes with a summary of next steps to guide future research and policy work to address disparities that impact Black girls.

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“The only thing new is the cameras”: A study of U.S. college students’ perceptions of police violence on social media

Campbell, F., & Valera, P. (2020). “The only thing new is the cameras”: A study of U.S. college students’ perceptions of police violence on social media. Journal of Black Studies, 51, 654–670. https://doi.org/10.1177/0021934720935600

Abstract

The present study explored the impact of publicized incidents of police violence on racially underrepresented college students in the U.S. Approximately 134 college students at various colleges and universities in the U.S. completed a questionnaire that examined their engagement with police brutality videos, reactions about police killings of unarmed Black men (and boys), their encounters with police, and perceptions toward the issue of police violence. The majority of participants were students of color, from the middle to high socioeconomic backgrounds and attended private and public institutions of higher education. The main findings included: (1) social media as a medium to learn about incidents of police violence; (2) students displayed symptoms consistent with post-traumatic stress disorder (i.e., anger, sadness, and fear) after viewing the videos; and (3) student’s race affected how they viewed police violence in social media. These findings reflect that witnessing publicized police killings of unarmed Black men (and boys) is traumatic for college students and contributes to anxiety and fear for future police encounters.

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Digital Health, Information Technology and Social Media

Exploring the role of telehealth: A novel approach to group-based smoking cessation treatment for men incarcerated in a rural state prison

Valera, P., Malarkey, S., Smith, N., & McLaughlin, C. (2024). Exploring the role of telehealth: A novel approach to group-based smoking cessation treatment for men incarcerated in a rural state prison. Journal of Telemedicine and Telecare, 30, 42-150. doi:10.1177/1357633X211034734

Abstract

Introduction. Tobacco smoking remains an important public health issue in the United States (US), specifically among people who are incarcerated. There is little to no information about smoking behaviors of incarcerated people in rural areas and there is a lack of resources for smoking cessation interventions in rural settings. Telehealth might be efficient for delivering care to incarcerated people in rural areas. The purpose of this study was to determine the feasibility of delivering group-based smoking cessation treatment via telehealth to incarcerated male smokers in a rural prison. Methods. A 6-week group-based smoking cessation treatment program was conducted with 1-month follow up. Video conferencing was used from Weeks 2–5 to deliver treatment. A cross-sectional survey was administered collecting measures including criminal justice experience, smoking behaviors, withdrawal and triggers, mental health, physical health, and substance use. Baseline exhaled carbon monoxide (CO) levels were collected at Session 1, and a final CO level at Session 6 and 1-month follow-up. Results. Twenty (n = 20) incarcerated male smokers were recruited from a rural prison facility. The majority of the inmates were White (85%). Approximately, 80% of the inmates smoked about 20 or more cigarettes per day, and on average smoked for 28 years (SD = 9). Most inmates scored a moderate or high dependence score on the Fagerström Test for Nicotine Dependence. Conclusion. Telehealth programs such as video conferencing smoking cessation treatment ought to be implemented to reduce tobacco-related disparities among incarcerated smokers housed in rural prisons.

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Remote Mental Health First Aid Training for Correctional Officers: A Pilot Study

Valera, P., Malarkey, S., Owens, M., Sinangil, N., Bhakta, S., & Chung, T. (2024). Remote mental health first aid training for correctional officers: A pilot study. Psychological Services, 21(2), 328–336. https://doi.org/10.1037/ser0000860

Abstract

Mental health first aid (MHFA) training is a low-cost, evidence-based intervention that teaches trainees to recognize signs of mental distress. Thirty correctional officers (COs) were recruited to participate in a remote MHFA intervention study. The COs were divided into three MHFA training sessions, with no more than 10 COs per group. Data collection assessments included pretest and posttest surveys and a focus group meeting. Of the 30 eligible CO participants, 27 completed the study, including follow-up assessments. Nine COs participated in a focus group meeting—one third (n = 9) of the CO participants identified as female, and the remaining identified as male. Most CO participant s self-identified as White (n = 17), and two thirds (n = 18) of the CO participants were 35–54 years old. There was a strong military influence, with about close to half (48%) of COs identifying as a veteran. A paired sample t test was used to analyze whether there were any differences in mental health knowledge scores from pre- and postintervention. There were no significant differences between the pre- and postintervention results for the five MHFA knowledge items. The Wilcoxon signed-rank test was used to analyze differences in pre- and postintervention data for mental health referral items. From pre- to posttraining, COs reported that it would be easier to make a mental health referral for someone experiencing a mental health challenge (Z = −2.087, p = .037). At 12 weeks, COs referred 2.6 (SD: 4.30, range 1–20) people incarcerated for mental health services. The reasons for referral included: “suicidal thoughts,” “experiencing anxiety over being incarcerated during COVID,” and “considering self-harm.” A phenomenological approach was used to analyze the focus group meeting. The themes identified were: (a) COs experience with MHFA training was viewed positively (facilitators); (b) there is a need to improve mental wellness in correctional settings (barriers); and (c) mental health referral process for incarcerated individuals needs enhancement when implementing MHFA (barriers). MHFA training for COs is necessary to equip COs with the skills to safely support and refer incarcerated people experiencing a mental health crisis.

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Understanding search autocompletes from the perspectives of English and Spanish speakers during the early months of the COVID‐19 pandemic

Valera, P., Carmona, D., Singh, V., Malarkey, S., Baquerizo, H., & Smith, N. (2024). Understanding search autocompletes from the perspectives of English and Spanish speakers during the early months of the COVID-19 pandemic. J Community Psychol, 52, 665-683. doi: 10.1002/jcop.23013. 

Abstract
The purpose of the study was to explore differences in Google search autocompletes between English and Spanish-speaking users during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-nine individuals who were in areas with shelter-in-place state orders participated in a virtual focus group meeting to understand the algorithm bias of COVID-19 Google autocompletes. The three focus group meetings lasted for 90–120 minutes. A codebook was created and transcripts were coded using NVivo qualitative software with a 95% intercoder reliability between two coders. Thematic analysis was used to analyze the data. Among the 29 participants, six self-identified as White, seven as Black/African American, five as American Indian or Alaska Native, four as Asian Indian, and three as Native Hawaiian or Pacific Islander. In terms of ethnicity, 21 participants identified as Hispanic/Latino. The themes that emerged from the study were: (1) autocompletes evoked fear and stress; (2) skepticism and hesitation towards autocomplete search; (3) familiarity with COVID-19 information impacts outlook on autocomplete search; (4) autocompletes can promote preselection of searches; and (5) lesser choice of autocomplete results for Spanish-speaking searchers. Spanish speakers expressed concerns and hesitation due to social factors and lack of information about COVID-19.

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“The only thing new is the cameras”: A study of U.S. college students’ perceptions of police violence on social media

Campbell, F., & Valera, P. (2020). “The only thing new is the cameras”: A study of U.S. college students’ perceptions of police violence on social media. Journal of Black Studies, 51, 654–670. https://doi.org/10.1177/0021934720935600
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Harnessing Digital Videos to Promote Cancer Prevention and Education: a Systematic Review of the Literature from 2013–2018

Acuna, N., Vento, I., Alzate-Duque, L., & Valera P. (2020). Harnessing digital videos to promote cancer prevention and education: a systematic review of the literature from 2013-2018. J Cancer Educ, 35, 635-642.

Abstract

Social media has transformed the way cancer patients search for information about their chronic health problems. The purpose of this systematic review is to identify the use of online digital videos to increase cancer knowledge and to understand information preference, behavioral changes, and attitudes towards online cancer education videos. The databases used for this review included MedLine, PsychINFO, and PubMed. These medical databases were used to locate peer-reviewed academic journals from 2013-2018 using the following MeSH terms: “cancer education videos,” “cancer prevention videos,” and “cancer education digital videos.” A total of 4996 articles were retrieved from the initial search, and 33 articles were reviewed. Articles were excluded if videos did not (1) focus on cancer education and prevention; (2) posted on an online platform; and (3) assessed participants’ knowledge, attitude, or beliefs about cancer. Eleven articles were found to meet inclusion criteria for final review. All of the studies focused on increasing education on preventive health behaviors (i.e., sunscreen use, smoking, and diet) and/or early detection strategies (i.e., screening testing and/or self-skin exams). While online digital health videos have the potential to improve health outcomes, issues related to technology access and health literacy must be considered when developing online health education videos.

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Latino Health

Understanding search autocompletes from the perspectives of English and Spanish speakers during the early months of the COVID‐19 pandemic

Valera, P., Carmona, D., Singh, V., Malarkey, S., Baquerizo, H., & Smith, N. (2024). Understanding search autocompletes from the perspectives of English and Spanish speakers during the early months of the COVID-19 pandemic. J Community Psychol, 52, 665-683. doi: 10.1002/jcop.23013. 
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Social Determinant of Health Framework to Examine the Impactof COVID‑19 on Latino Health

Acevedo, S., Malarkey, S., Baquerizo, H, Lefebre, A., Sackey, J., & Valera P. (2024). Social determinant of health framework to examine the impact of COVID-19 on Latino health. J Racial Ethn Health Disparities,11, 2236-2246. doi: 10.1007/s40615-023-01691-6.

Abstract

Objectives: Evaluated how COVID-19 impacted Latino health across social, economic, and emotional dimensions and differentiated whether adverse COVID-19-related effects persisted across respondents.
Methods: In both English and Spanish, a cross-sectional survey was conducted in the USA from June 2021 to April 2022. Chi-square tests, Z-tests, and T-tests were used to test for significant differences between Spanish- and English-speaking respondents. Multiple linear regressions were carried out to understand whether previously established determinants of health for Latinos accounted for greater COVID-19-related adversity across social, economic, and mental health dimensions. English as a primary language was significantly related to greater adverse emotional/mental health COVID-19 experiences after controlling for other social determinants of health factors (β = – 0.355, p < 0.001). Individuals who reported worrying about housing loss were significantly more likely to experience more adverse economic adversity due to COVID-19 (β = – 0.234, p < 0.001). Household income < $35,000 (β = 0.083, p < 0.05), having more than 5 people living in the same home (β = -0.102, p < 0.05), and work-related transportation barriers (β = – 0.114, p < 0.05) all increased the likelihood of household-related stressors occurring because of the pandemic.
Conclusions: The study highlights the heterogeneity in the Latino community and the key social, economic, and community-level factors most strongly correlated with adverse COVID-19-related outcomes.

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COVID‑19 on Food Insecurity in Hispanic/Latino Essentialand Non‑essential Workers

Amad, T., Valera, P., Sackey, J., Baquerizo, H., Malarkey, S., & Acevedo, S. (2024). COVID-19 on Food Insecurity in Hispanic/Latino Essential and Non-essential Workers. J Racial Ethn Health Disparities. doi: 10.1007/s40615-024-01937-x.

Abstract

Introduction: The COVID-19 pandemic’s economic fallout has further exacerbated the health and well-being among Hispanics/Latinos, who maybe overrepresented in essential job industries and are vulnerable to experiencing food insecurity. This study explores whether the COVID-19 pandemic affected food security status differently among Latino/Hispanic essential and non-essential workers in the United States. Methods: The COVID-19 Latino health cross-sectional survey was conducted and administered in person and virtually. Bivariate analyses and chi-square tests were performed to investigate the association between essential worker status and changes in food security status during the COVID-19 pandemic. All reported p-values were two-sided; p < 0.05 was considered statistically significant. Results: Of the 869 Hispanic/Latino respondents, 393 (45%) were deemed essential workers, and 476 (55%) were non-essential workers. About 22% of essential workers reported a household income of less than $20,000, whereas 19% of non-essential workers had an income above $100,000. Half (54%) of essential workers reported food insecurity. Over one-third (35%) of essential and 22% of non-essential workers reported increased food insecurity during the COVID-19 pandemic. Moreover, there was a significant difference in food insecurity status between essential and non-essential Hispanic/Latino workers (p < 0.001). Conclusion: The results underscore the prevalence of food insecurity due to the COVID-19 pandemic and the need to create comprehensive food policies that address the lack of availability of adequate food among Hispanic/Latino essential workers who already face pandemic-related challenges.

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COVID-19 Public Messaging: Using Google Autocompletes in Spanish to Understand the Lived Experience of Latinos in the Early Days of the Pandemic

Barnes, L., Lefebre, A., Mercado, K., Cuevas, R., Malarkey, S., Smith, N., . . .Valera, P. (2023). COVID-19 Public Messaging: Using Google autocompletes in Spanish to understand the lived experience of Latinos in the early days of the pandemic. Journal of Latinos and Education, 23, 12266-1273. https://doi.org/10.1080/15348431.2023.2244070

Abstract

The purpose of this study was to understand the lived experience of the Spanish-speaking Latino community during the COVID-19 shelter-in-place orders. A single remote focus group meeting was conducted with nine Spanish-speaking participants to explore how residents living amidst shelter-in-place orders made informed decisions about health, safety, and security during the early months of the pandemic. The focus group meeting lasted about 60–90 minutes, and this meeting was facilitated by bilingual/bicultural Latino research assistants trained in qualitative research methods. Study participants also completed the Household Pulse Survey developed by the U.S. Census Bureau, a 20-minute survey to understand the social, health, and economic impact of COVID-19. The mean age was 33 years [range 21–60, SD = 12.44], and most participants attended some or completed a college degree. The participants self-reported as heterosexual, and five self-reported as single or never married. At least four noted making less than $25,000 annually, and four reported that they were self-employed. Most of the participants resided in New Jersey (n = 6), whereas two were from Michigan and one was from New York. The themes that emerged from the focus group meeting were the following: (1) social media and televised news outlets propagated confusing and harmful public messages; (2) COVID-19 elicited negative feelings of uncertainty; and (3) participants had widespread concerns about the health of their family, others, and self. Public messages on COVID-19 were not only confusing but harmful, as Latino families were highly dependent on them when determining how to protect their families in the early days of the pandemic.

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Spanish Language News Coverage and the COVID-19 Pandemic: Inequities in News Media Reporting

Lefebre, A., & Valera, P. (2022). Spanish language news coverage and the COVID-19 pandemic: Inequities in news media reporting. Journal of Latinos and Education, 23, 290-293. https://www.tandfonline.com/doi/full/10.1080/15348431.2022.2125396

ABSTRACT
COVID-19 continues to disproportionately impact the health of Hispanics/ Latinos. While Hispanics/Latinos are considered one of the fastest-growing racial/ethnic groups, media news coverage in Spanish concerning COVID-19 is stunningly low. The Hispanic/Latino population comprises close to 25% of COVID-19 cases and 17% of COVID-19 deaths. Lack of access to Spanish news coverage and limited attention to Spanish-speaking Hispanics/Latinos has created inconsistent messaging about COVID-19. Improving public health media initiatives for the Hispanic/Latino population should focus on increasing
Spanish news coverage to respond against systematic discrimination, misinformation, fear, and vaccine hesitancy.

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Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

Acuna, N., Plascak, J.J., Tsui, J., Stroup, A.M., & Llanos, A.A.M. (2021). Oncotype DX Test Receipt among Latina/Hispanic women with early invasive breast cancer in New Jersey: A Registry-Based Study. 
Int. J. Environ. Res. Public Health, 18, 5116. https://doi.org/10.3390/ijerph18105116

Abstract

Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy
benefit. The purpose of this study was to examine prevalence of and factors associated with receipt
of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor
data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were
from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on
National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of
ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics
diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing.
Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being
uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While
there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey,
our findings suggest that age, insurance status, and area-level SES contribute to unequal access to
genetic testing in this group, which might impact BC outcomes.

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Subjective well-being among Latino day laborers: Examining the role of religiosity, social networks, and cigarette use

Boyas, J.F., Valera, P., & Ruiz, E. (2018). Subjective well-being among Latino day laborers: Examining the role of religiosity, social networks, and cigarette use. Health Promot Perspect, 8, 46-53. doi: 10.15171/hpp.2018.06

Abstract

Background: Latino day laborers (LDLs) experience chronic stressors, that adversely affects their subjective well-being (SWB). The purpose of the study was to determine whether LDLs’ sociodemographic characteristics, religiosity, social networks, and cigarette use were significantly associated with SWB. Methods: Approximately 150 LDLs from 4 informal day laborer sites in Dallas and Arlington, Texas, participated in the cross-sectional survey. Informed consent was obtained from all participants and data on SWB were collected face-to-face from April 2013 through July 2013. Results: Most respondents were of Mexican ancestry, (n = 112; 75%), were foreign-born (n = 140; 93%), and undocumented (n = 108; 72%). LDLs reported a mean satisfaction with life score of 19.07 (SD=8.52). Thirty percent of LDLs reported not smoking any cigarettes in the past 30 days. However, 20% reported smoking 20–39 cigarettes, while another 20% reported smoking 40 or more cigarettes in the past 30 days. Hierarchical multiple regression results indicated that marital status (β = 0.13, P ≤ 0.05), connectedness to friends (β = 0.21, P ≤ 0.001), the influence of religion on life (β = 0.57, P ≤ 0.01), frequency of attendance to religious institution (β = 0.11, P ≤ 0.005), and cigarette use (β = -0.15, P ≤ 0.05) were significantly associated with the SWB appraisals of LDLs. Conclusion: These findings show that LDLs are resilient and rely on noneconomic factors to enhance their perceived quality of life. The results underscore the need to identify pathways to improve SWB among LDLs. Doing so may address the broader mental health and occupational health disparities gaps that affect LDLs.

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Sun Protective Behaviors among Latino Day Laborers 

Boyas, J.F., & Nahar, V.K. (2018). Predictors of sun protective behaviors among Latino day laborers. Journal of Skin Cancer, 3454309, 11, https://doi.org/10.1155/2018/3454309


Abstract

Objectives. Despite the substantial solar ultraviolet radiation experienced by Latino day laborers, little attention has been given to factors that are associated with sun protective behaviors. The purpose of this study was to examine psychological and nonpsychological predictors of sun protective behaviors among Latino day laborers. Methods. This cross-sectional study included a nonrandom sample of 137 Latino day laborers recruited from Mississippi and Illinois. Participants completed a self-report survey instrument, available in English and Spanish, on sun protective behaviors. Results. Multivariate regression results showed that sun protective behaviors were significantly greater among Latino day laborers: (a) who had greater perceptions that their supervisor also engaged in sun protective behaviors (β = 0.25, p ≤ 0.01); (b) who reported higher levels of health literacy (β = 0.23, p ≤ 0.001); (c) who have greater knowledge of skin cancer risk factors (β = 0.21, p ≤ 0.01); and (d) who have skin tone that was self-perceived to be more prone to sunburns (β  = 0.19, p ≤ 0.01). Conclusions. Latino day laborers possess marginal levels of skin cancer knowledge and engage minimally in sun protective behaviors. Skin cancer prevention interventions are warranted for this high-risk group, particularly in the locations in which Latino day laborers work.

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Correctional Health

Remote Mental Health First Aid Training for Correctional Officers: A Pilot Study

Valera, P., Malarkey, S., Owens, M., Sinangil, N., Bhakta, S., & Chung, T. (2024). Remote mental health first aid training for correctional officers: A pilot study. Psychological Services, 21(2), 328–336. https://doi.org/10.1037/ser0000860
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Remote Mental Health First Aid Training for Correctional Officers: A PilotStudy

Pamela Valera, Sarah Malarkey, Madelyn Owens, Noah Sinangil, Sanjana Bhakta, and Tammy Chung Online First Publication, April 11, 2024. https://dx.doi.org/10.1037/ser0000860

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The COVID-19 Pandemic and the Health of Incarcerated People

Acevedo, S., & Valera, P. (2024). The COVID-19 pandemic and the health of incarcerated people. Columbia University Journal of Global Health. Retrieved from: https://journals.library.columbia.edu/index.php/jgh/article/view/10683/6152

ABSTRACT

COVID-19 has upended the daily operations of the U.S. correctional system. Correctional COVID-19
policies have altered how incarcerated people navigate legal proceedings, receive visitors, procure healthcare services, and maintain mental well-being and physical health. Although some of these changes have been positive (e.g., increased access to tablets, de-incarceration policies), other strategies have exposed societal inequities that fail to meet the needs of people who are incarcerated. Lockdown orders have had unintended consequences for incarcerated people, particularly among those with mental health disorders. This commentary examines the impact of U.S. correctional system policies on the well-being of incarcerated people.

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Improving the Mental Health and Well‑Being of Correctional Officers through Mental Health First Aid Training

Flumo, R., Valera, P., Malarkey, S., & Acevedo, S. (2024). Improving the mental health and well-being of correctional officers through mental health first aid training. Journal of Police and Criminal Psychology, 39(1), 131–140. https://doi.org/10.1007/s11896-023-09620-3

Abstract

This study aimed to understand the perspectives of correctional officers participating in Mental Health First Aid (MHFA) training. A total of 54 correctional officers from two State Department of Corrections participated in the study. Correctional officers completed two focus group meetings. The focus group meetings were analyzed using narrative analysis. The themes of the focus group meetings were (1) the emotional toll of working in the criminal justice system, (2) correctional officers managing poor mental health, (3) barriers to mental health-seeking behaviors, (4) benefits and facilitators to MHFA, and (5) recommendations for future MHFA training. In summary, correctional officers emphasized the need for additional mental health resources to cope with the unpredictable and challenging work environment. State Departments of Corrections should prioritize the mental health of correctional officers and work toward destigmatizing mental health across these settings by implementing MHFA for all correctional professionals.

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Exploring Pre-Exposure Prophylaxis(PrEP) and Post-Exposure Prophylaxis(PEP) Knowledge in Incarcerated Men

Valera, P., Ali, Z.S., Cunningham, D., McLaughlin, C., (2022). Acevedo, S. Exploring Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) Knowledge in Incarcerated Men. Am J Mens Health, 16, 15579883221107192. doi: 10.1177/15579883221107192. 

Abstract
People who are incarcerated have a disproportionately high risk of contracting human immunodeficiency virus (HIV). While there is no known cure for HIV, there are biomedical approaches that can successfully manage the virus and prevent its transmission. A total of 267 men who are incarcerated completed a cross-sectional survey focused on cancer health, HIV prevention, and mental health in three state prisons. The mean age was 39 years. The majority had an annual income of US$10,000 or less, self-identified as heterosexual, not married, had children, did not have any military status, and identified as African American/Black. Less than 4% indicated that they had heard about Pre-Exposure Prophylaxis (PrEP), and only 3% had heard of Post-Exposure Prophylaxis (PEP). PrEP and PEP effectively prevent HIV infection, but little attention has focused on increasing the knowledge and awareness of these HIV prevention interventions in the incarcerated population.

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Suicidal Ideation in a Sample of Incarcerated Men

Malarkey, S., Valera, P., Golembeski, C., Sackey, J., & Pierre, K. (2022). Suicidal ideation in a sample of incarcerated men. J Correct Health Care, 28, 405-413. doi: 10.1089/jchc.21.06.0058.

Abstract
This article examined the factors associated with thoughts of ending life in a sample of incarcerated men.
Data were obtained from the Cancer Risk in Incarcerated Men Study, a pilot study designed to examine cancer health disparities and cancer health education in a racially/ethnically diverse sample of male smokers in three state prisons in the northeast region of the United States from 2015 to 2017. Of the 225 participants, only 11 reported having thoughts of ending life. The median age of the participants was 38 years. Thoughts of ending life had a significant association with race/ethnicity. Latinos and Whites were 8 out of the 11 participants who had thoughts of ending life. The majority of participants who had thoughts of ending life reported a history of solitary confinement. Almost half of all participants reported that they sometimes or often felt a risk of attack or abuse from prison officers. Findings demonstrate the need to investigate further the association of mental health symptomology with incarcerated individuals’ perceived experience with suicidal thoughts and behavior.

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Examining Attitudes, Expectations, and Tobacco Cessation Treatment Outcomes Among Incarcerated Tobacco Smokers

Acuna, N., Malarkey, S., Plaha, J., Smith, N., & Valera, P. (2022). Examining attitudes, expectations, and tobacco cessation treatment outcomes among incarcerated tobacco smokers. J Correct Health Care, 28, 252-259. doi: 10.1089/jchc.20.08.0074. 

Abstract

People who are incarcerated have limited resources to help them quit tobacco smoking. This study
assessed the association between baseline attitudes and expectations of the program with final smoking
status as the outcome. A 6-week group-based counseling with nicotine patches was provided to incarcerated individuals to quit smoking. A cross-sectional survey was given at the first session. Questions surrounding attitudes such as interest, confidence, motivation, and expectations were used to assess associations with smoking cessation. Exhaled carbon monoxide (CO) levels were taken at each sessions. Participants were categorized as nonsmoking or continued smoking at a 6.0 parts per million (ppm) CO at their final session attended. Overall, 123 participants had a CO higher than 6.0 ppm or missed more than two sessions at their final session, and 54 had a CO under 6.0 ppm. A total of 102 participants completed the 6-week program. Differences among the two groups in exhaled CO began at Session 3 and continued throughout the study.

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Perceived social ties and mental health among formerly incarcerated men in New York City.

Valera, P., & Boyas, J. F. (2019). Perceived Social Ties and Mental Health Among Formerly Incarcerated Men in New York City.  International Journal of Offender Therapy and Comparative Criminology ,  63 , 1843-1860.  https://doi.org/10.1177/0306624X19832239

Abstract

The incarcerated population has been substantially burdened by syndemic productions involving mental health illness and substance abuse problems. The present analysis describes the mental health symptoms of a nonprobability sample of 225 formerly incarcerated men and establishes the types of perceived support they received during incarceration as predictors of their psychological well-being upon release. The men were between 35 and 67 years of age; the mean age was 47.27 (SD = 6.64), and Blacks and Latinos were about equally represented. Most respondents did not finish high school, were unemployed, convicted of a nonviolent crime, and were housed in a New York state prisons. The majority were also single (never married) and had children. The findings indicate that greater social, community, and spiritual support were correlated with lower mental health scores. The strongest predictor was perceived social support. Access and use of social resources, including social support, are important factors in influencing the psychological functioning among formerly incarcerated men.

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A Pilot Study of Cancer 101 for Incarcerated Male Smokers

Valera, P., Mackey, D., & Cropsey, K. (2019). A pilot study of cancer 101 for incarcerated male smokers. 
Behavioral Medicine, 46, 112–119. https://doi.org/10.1080/08964289.2019.1588219

ABSTRACT

Incarcerated men in the United States, an understudied population, have not been the focus of cancer prevention research. This pilot study explored the impact of Cancer 101 for imprisoned male smokers to increase cancer knowledge and promote cancer prevention activities in the prison population. Cancer 101 was pilot tested for adoption with representatives from the target audience in three prison facilities located in the northeastern region of the United States, and based on their feedback, modifications were implemented. Pretest and posttest surveys were used to assess knowledge of attitudes regarding the benefits of cancer prevention activities at baseline and immediately after completing Cancer 101.
Furthermore, a paired t test procedure was used to determine whether cancer knowledge improved after participating in the Cancer 101 program. A total of 161 men completed all of the modules, participated in pre/post assessments, and qualitatively described their behavioral intentions to participate in activities that could reduce cancer risk. The mean cancer knowledge scores differed before and after completing Cancer 101, t(163) ¼ 14.67, p < .001. Regarding age, the older the respondent, the higher their cancer knowledge score, r ¼ .29, p < .001. This study showed improvements in cancer knowledge scores and behavioral intentions to participate in activities to reduce cancer. Cancer 101 provides opportunities for inmates to increase cancer knowledge, as well as promote action for cancer control during incarceration.

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Queer Health

Marketing Strategies Used by Tobacco Companies Targeting the Queer Community

Lewis, K., Cunningham, D., & Valera, P. (2024). Marketing strategies used by tobacco companies targeting the queer community. Tobacco Use Insights,17. doi:10.1177/1179173X241265743

Abstract

Background: This study described the marketing strategies tobacco companies use to advertise tobacco products to the Queer community. Methods: In this secondary qualitative analysis, 15 Queer participants were interviewed to explore their life experiences with tobacco product advertisements during the early days of the COVID-19 pandemic. Results: Participants self-reported as male (n = 5), followed by female (n = 4), gender non-binary (n = 4) and, transgender (n = 2). In addition, most participants identified as Black/African American (n = 7) or White (n = 7). Many participants identified as Bisexual (n = 5) or Queer (n = 4). Using narrative analysis, the themes for this study were: (1) tobacco and vaping companies target minoritized and Queer people; (2) tobacco and vape companies maintain their presence by sponsoring local Lesbian, gay, bisexual, transgender, questioning, intersex, asexual, and other community (LGBTQIA+) bars and Pride events, often through giveaways and coupons; and (3) the use of social media influencers represents a new social marketing technique. As a result, Queer participants were more likely to encounter many different types of advertisements from tobacco companies and, most recently, social media influencers. Conclusion: Social media influencers are a new factor that needs further study to understand the new tobacco advertising landscape.

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Exploring Tobacco and E-Cigarette Use among Queer Adults during the Early Days of the COVID-19 Pandemic

Valera, P., Owens, M., Malarkey, S., & Acuna, N. (2021). Exploring tobacco and e-cigarette use among queer adults during the early days of the COVID-19 pandemic. Int J Environ Res Public Health,18, 12919. doi: 10.3390/ijerph182412919.

Abstract: The purpose of this narrative study is to describe the vaping and smoking characteristics of Queer people ages 18–34 before March of 2020 and to better understand how the COVID-19 pandemic as impacted those behaviors since March of 2020. In total, 31 participants were screened. Thirteen participants were screened prior to the emergence of COVID-19, and 18 were screened when study protocols transitioned to a remote setting (pre and during). Of the 27 eligible participants, a total of 25 participants completed the study. Most participants (n = 13) self-identified as male, followed by five identified as female, four self-identified as gender non-binary, and three identified as transgender. The most common sexual orientation amongst participants was gay (n = 10), with bisexual being the second-most reported. Approximately 20 Queer participants reported using cigarettes, 14 participants self-reported using electronic devices, and 11 reported using hookah. Twenty participants reported smoking ten or less, and four self-reported using 11–20 cigarettes per day. Approximately, 92% of participants (n = 23) indicate that they are using an e-cigarette and regular cigarettes, and 57% of participants (n = 12) report using one pod or cartridge per day. The three themes that emerged in this study are: (1) Queer people during COVID-19 are experiencing heightened minority stress; (2) Queer people are unfamiliar with smoking cessation; and (3) vaping and smoking are attributed to stress and anxiety. Queer participants are likely to be dual users of cigarette and vaping products. This present study provides increasing evidence that Queer people are experiencing heightened stress and anxiety and using cigarette smoking and vaping to cope during the COVID-19 pandemic.

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PrEP (Pre-Exposure Prophylaxis) Education for Clinicians: Caring for anMSM Patient

Perucho, J., Alzate-Duque, L., Bhuiyan, A., Sánchez, J.P., & Sánchez, N.F. (2020). PrEP (Pre-Exposure Prophylaxis) Education for Clinicians: Caring for an MSM Patient. MedEdPORTAL, 29,16,10908. doi: 10.15766/mep_2374-8265.10908

Abstract

Introduction: Gaps exist in educational materials addressing LGBTQ patient care and LGBTQ health. One such area is prescribing HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM). PrEP awareness, familiarity, and comfort in prescribing are very important in the rollout and success of PrEP as a preventative measure. Our needs assessments showed a lack of familiarity and comfort among clinicians/medical students in prescribing PrEP. Furthermore, studies have shown that since its launch as an effective prevention method of HIV transmission, PrEP has not been widely prescribed to at-risk populations. Educating clinicians about PrEP may increase its use among high-risk MSM populations and reduce the incidence of HIV infections. Methods: For medical students, we developed a didactic presentation and video recording discussing (1) a brief history of HIV prevention, (2) indications for PrEP prescription, (3) medical testing for PrEP onboarding, (4) common PrEP side effects, and (5) appropriate follow-up and testing for PrEP maintenance and discontinuation. We also developed a videotaped clinical encounter demonstrating communication skills used in PrEP counseling. Pre- and postworkshop surveys assessed participants’ PrEP attitudes and knowledge. Results: All 43 survey respondents were second- through fourth-year medical students. Pre- and postpresentation evaluation of questions assessing comfort demonstrated a statistically significant improvement in level of comfort with understanding when to prescribe PrEP and in level of knowledge in prescribing PrEP. Discussion: Workshop participants acknowledged their training gaps in PrEP prescribing and acquired knowledge and comfort with prescribing PrEP for at-risk populations.

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The Community Health Justice Lab

Pamela Valera, PhD, MSW, ACSW, NCTTP
Assistant Professor
Rutgers School of Public Health
Affiliated Faculty, Rutgers School of Social Work
Newark, NJ 07107

✉ E-Mail

Tel: 973-972-6555

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