Person: Alegria, Margarita
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Alegria
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Margarita
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Alegria, Margarita
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Publication Impact of Participatory Health Research: A Test of the Community-Based Participatory Research Conceptual Model(Hindawi, 2018) Oetzel, John G.; Wallerstein, Nina; Duran, Bonnie; Sanchez-Youngman, Shannon; Nguyen, Tung; Woo, Kent; Wang, Jun; Schulz, Amy; Keawe‘aimoku Kaholokula, Joseph; Israel, Barbara; Alegria, MargaritaObjectives: A key challenge in evaluating the impact of community-based participatory research (CBPR) is identifying what mechanisms and pathways are critical for health equity outcomes. Our purpose is to provide an empirical test of the CBPR conceptual model to address this challenge. Methods A three-stage quantitative survey was completed: (1) 294 US CBPR projects with US federal funding were identified; (2) 200 principal investigators completed a questionnaire about project-level details; and (3) 450 community or academic partners and principal investigators completed a questionnaire about perceived contextual, process, and outcome variables. Seven in-depth qualitative case studies were conducted to explore elements of the model not captured in the survey; one is presented due to space limitations. Results We demonstrated support for multiple mechanisms illustrated by the conceptual model using a latent structural equation model. Significant pathways were identified, showing the positive association of context with partnership structures and dynamics. Partnership structures and dynamics showed similar associations with partnership synergy and community involvement in research; both of these had positive associations with intermediate community changes and distal health outcomes. The case study complemented and extended understandings of the mechanisms of how partnerships can improve community conditions. Conclusions The CBPR conceptual model is well suited to explain key relational and structural pathways for impact on health equity outcomes.Publication Statistics Can Lie but Can also Correct for Lies: Reducing Response Bias in NLAAS via Bayesian Imputation(International Press of Boston, Inc., 2013) Liu, Jingchen; Meng, Xiao-li; Chen, Chih-Nan; Alegria, MargaritaThe National Latino and Asian American Study (NLAAS) is a large scale survey of psychiatric epidemiology, the most comprehensive survey of this kind. A unique feature of NLAAS is its embedded experiment for estimating the effect of alternative orderings of interview questions. The findings from the experiment are not completely unexpected, but nevertheless alarming. Compared to the survey results from the widely used traditional ordering, the self-reported psychiatric service-use rates are often doubled or even tripled under a more sensible ordering introduced by NLAAS. These findings explain certain perplexing empirical findings in literature, but at the same time impose some grand challenges. For example, how can one assess racial disparities when different races were surveyed with different survey instruments that are now known to induce substantial differences? The project documented in this paper is part of an effort to address these questions. It creates models for imputing the original responses had the respondents under the traditional survey not taken advantage of the skip patterns to reduce interview time, which resulted in increased rates of incorrect negative responses over the course of the interview. The imputation modeling task is particularly challenging because of the complexity of the questionnaire, the small sample sizes for subgroups of interests, and the need for providing sensible imputation to whatever sub-population that a future user might be interested in studying. As a case study, we report both our findings and frustrations in our quest for dealing with these common real-life complications.Publication One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD(American Psychiatric Publishing, 2010) Gonzalez, Jodi; Bowden, Charles; Berman, Nancy; Frank, Ellen; Bauer, Mark; Kogan, Jane; Alegria, Margarita; Miklowitz, DavidObjective Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S. Systematic Treatment Enhancement Program for Bipolar Disorder compared one-year outcomes for bipolar I or II disorder from each of these racial-ethnic groups. Methods African Americans (N=155) were retrospectively compared with a matched group of non-Hispanic whites (N=729), and Hispanics (N=152) were compared with a separate matched group of non-Hispanic whites (N=822). Response and recovery outcomes were examined. Survival analysis was used to compare time to treatment response for depression (Montgomery-Asberg Depression Rating Scale) and mania (Young Mania Rating Scale) as well as global assessment of functioning (Global Assessment of Functioning). Results For manic and depressive symptoms, time to response and proportion of responders were similar across groups. Over the study year the proportion of days well was similar across groups. A smaller proportion of African Americans met criteria for improved global functioning. Depression response among African Americans with psychotic symptoms was slower than the response among African Americans without psychotic symptoms and among non-Hispanic whites with or without psychotic symptoms. No differences between Hispanics and non-Hispanic whites in response times and recovery were observed. Conclusions Results are consistent with U.S. clinical trials for other psychiatric disorders, which have reported similar outcomes for ratings of primary symptoms. Baseline psychotic symptoms are likely a significant contributor when African Americans with bipolar disorder are slow to recover. These results may be less generalizable to uninsured patients.Publication The Happy Older Latinos are Active (HOLA) health promotion and prevention study: study protocol for a pilot randomized controlled trial(BioMed Central, 2015) Jimenez, Daniel E.; Reynolds, Charles F.; Alegria, Margarita; Harvey, Philip; Bartels, Stephen J.Background: Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos. Methods/Design HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). This prevention approach will be tested against a fotonovela, an enhanced psychoeducation control condition, in a sample of Latino elderly with minor or subthreshold depression or anxiety. A total of 60 older Latinos (aged 60+) will be randomized to receive HOLA or the fotonovela. The primary outcomes of interest are recruitment, adherence, retention, and acceptability. Data will also be collected on: preemption of incident and recurrent major depression, generalized anxiety, and social phobia; reduction in depression and anxiety symptom severity; physical functioning; sedentary behaviors; social engagement; and self-efficacy. Discussion The results of this study could have implications for other high-risk, highly disadvantaged populations. The development of a health promotion intervention designed to prevent common mental disorders could be a means of addressing multiple disparities (for example, mental health outcomes, mental health service use, stigma) among racial/ethnic minority elderly. ClinicalTrials.gov Identifier NCT02371954. Date of registration: 21 January 2015.Publication Association Between Language Proficiency and the Quality of Primary Care Among a National Sample of Insured Latinos(Ovid Technologies (Wolters Kluwer Health), 2007) Pippins, Jennifer R.; Alegria, Margarita; Haas, JenniferContext: Latinos experience substantial barriers to primary care. Limited English language proficiency may be a mechanism for these deficiencies, even for Latinos with health coverage. Objective: To determine the relationship between English language proficiency and the experience of primary care reported by insured Latinos. Design, Setting, Participants: Analysis of the National Latino and Asian American Study (NLAAS), a nationally representative household survey, 2002–2003. This analysis was restricted to Latinos who reported current health insurance (n=1,792), and included information on ethnic subgroups. Main Outcome Measures: Four outcomes addressed different aspects of the quality of primary care: 1) not having a regular source of care or lacking continuity of care; 2) difficulty getting an appointment over the phone, 3) long waits in the waiting room, and 4) difficulty getting information or advice by phone. Results: English language proficiency was associated with the experience of primary care for three of the four outcomes. Insured Latinos with poor/fair English language proficiency were more likely than those with good/excellent proficiency to report not having a regular source of care or lacking continuity (odds ratio {OR} 2.20, 95% confidence interval {CI} 1.60–3.02), long waits (OR 1.88, CI 1.34–2.64), and difficulty getting information/advice by phone (OR 1.76, 95% CI 1.25– −2.46). Conclusions: Among insured Latinos, low English language proficiency is associated with worse reports of the quality of primary care. These results suggest that interventions to address limited English proficiency may be important to improving the quality of primary care for this rapidly growing population.