Frances Aranda | University of Illinois at Chicago (original) (raw)

Papers by Frances Aranda

Psychiatric Services, Mar 29, 2023

Springer eBooks, 2015

In the past two decades there has been a proliferation of research, services and political and so... more In the past two decades there has been a proliferation of research, services and political and social advocacy for sexual minority individuals. Despite these gains, knowledge about sexual minorities of color remains quite limited. The majority of studies on LGBT and cancer are hindered by low representation of non-Whites and few studies have large enough samples of people of color to permit reliable statistical analyses and meaningful results. Smaller-scale studies that rely on volunteer samples often include larger proportions of race/ethnic minority women, but even studies that purposefully target these groups are limited by relatively small subgroup sample sizes, particularly for groups other than African American and Latina. At least part of the problem of recruitment of LGBT individuals of color relates to historical distrust of research and White researchers in communities of color. However, other factors likely include the lack of cultural competency of researchers, failure to utilize evidence-based and proven approaches to recruit and retain individuals of color, research protocols that include exclusion criteria that disproportionately impact participants of color, and the reluctance of some people to disclose a sexual- or gender-minority status, to name just a few challenges. Against this backdrop of limited empirical data, we provide an overview of the unique issues facing LGBT individuals of color, and provide a discussion of general and unique risk factors across the cancer control continuum.

LGBT health, Jun 1, 2015

Purpose: Using Andersen's Behavioral Model of Health Services Utilization, we examined the associ... more Purpose: Using Andersen's Behavioral Model of Health Services Utilization, we examined the associations between negative experience in a health care setting and subsequent reductions in health care utilization among African American sexual minority women (SMW). Methods: The data were collected as part of a larger study exploring health and health care experiences of a volunteer sample of African American SMW (n = 226). We examined predisposing, enabling, and need factors as predictors of a negative experience and changes in health care utilization. Results: More than one-third of the sample reported a negative health care experience in the past 5-years. One fourth of those reporting a negative experience attributed it to discrimination including race/ethnicity (70.4%), gender (58.2%), and sexual orientation (46.2%). (The categories were not mutually exclusive). Reduction in health care utilization (i.e., didn't see a doctor next time when they were ill) following the negative experience was common (34%). Predisposing (younger age), enabling (lack of insurance, part-time employment, and no regular provider), and need factors (living with a chronic illness) predicted experiencing a negative event. In multivariate analysis, health care factors (quality of health care, negative experience due to discrimination) and patient factors (passive coping response) were factors associated with reduced health care utilization. Conclusion: Problems in the patient-provider relationship were a significant factor in decreasing healthcare use among SMW. Anderson's model helped to inform our understanding of who might be at risk of experiencing a negative experience but not subsequent changes in health care utilization. Modifiable variables related to the health care environment and patient coping responses predicted changes in health care use.

Rehabilitation Education, Oct 1, 2006

Journal of health disparities research and practice, 2014

Introduction: Readiness to quit smoking-a pattern of attitudes, intentions, and behaviors that re... more Introduction: Readiness to quit smoking-a pattern of attitudes, intentions, and behaviors that reflect a likelihood of engaging in cessation activities-is a useful heuristic for understanding smoking disparities based on sexual orientation. This study examined demographic, tobacco-use patterns, psychosocial and cognitive factors associated with readiness to quit among gay and bisexual male smokers. Methods: A cross-sectional survey was conducted as part of a larger Tobacco Elimination and Control Collaboration (Q-TECC) initiative in the lesbian, gay, bisexual, and transgender (LGBT) community. Readiness to quit was measured by a composite score created from four variables (motivation to quit, importance of quitting, plan to quit, and confidence in quitting) (alpha=.87, M=3.42, SD=.96, range 1-5). Results: The sexual minority smokers in the sample (N=208; M=33 years) were racially/ethnically diverse. Latino men had significantly lower levels of readiness to quit compared to African American and White men. Hierarchical linear regression analyses were performed to explore the relative contributions of sociodemographic, tobacco-use patterns, psychosocial and cognitive factors on Readiness to Quit. In the final model, the following variables were associated with readiness to quit scores: Latino ethnicity, fewer quit attempts, positive expectancies for the beneficial effects of smoking, and lower perceived importance of smoking as an important LGBT health issue. None of the psychosocial factors were associated with readiness to quit. Discussion: Readiness to quit scores were largely predicted by modifiable attitudes, behaviors, and expectancies. Study findings have implications for improving outreach and awareness and for the development of effective treatment approaches.

Psychiatric Rehabilitation Journal, Mar 1, 2022

OBJECTIVE Little is known about the employment experiences of people with preexisting behavioral ... more OBJECTIVE Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. METHOD Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April-May 2020. Multivariable analysis examined the effects of sleep and dietary changes, COVID-19 exposure, anxiety (Generalized Anxiety Disorder-2), and depressive symptoms (Patient Health Questionnaire-2) on employment status and job changes. Respondents' open-ended descriptions of pandemic-related changes in employment were analyzed using the constant comparative method. RESULTS Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work's positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This is the first study to suggest the important role that work played for people with preexisting behavioral health disorders during the pandemic, with both positive and negative influences, and important implications for services and supports. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cancer Nursing, May 1, 2018

Background: Studies on colorectal cancer (CRC) screening among Korean Americans (KAs) lack cultur... more Background: Studies on colorectal cancer (CRC) screening among Korean Americans (KAs) lack culturally sensitive, reliable, and validated belief scales. Objective: The purpose of this study was to adapt, modify, and validate instruments measuring cultural beliefs (physical space, health temporal orientation, personal control, colon cancer fatalism, and health fatalism) about CRC screening in KAs. Methods: In phase I, instrument adaptation and modification (translation from English into Korean, individual interviews using cognitive interviewing, and expert reviews) were used to make existing cultural beliefs instruments culturally appropriate for KAs. In phase II, instrument validation (pilot test and cross-sectional survey) was used to examine the psychometric properties of the instrument among 202 KAs. Results: Construct validity and reliability of the final Korean version of the instruments were examined using exploratory and confirmatory factor analyses and internal consistency reliability. Exploratory factor analysis using all of the cultural beliefs items resulted in 5 factors accounting for 46.55% of the variance. Factor loadings were greater than 0.40 for most items to be added to the scales reflecting Korean cultural perspectives. Cronbach's !s for all the cultural beliefs subscales were greater than .70. Conclusions: Findings from this study show that KAs have unique cultural beliefs that should be reflected in the instruments used for CRC screening research with this population.

Sleep, Apr 1, 2018

However, improvements in these subscales were not sustained at follow-up. No significant differen... more However, improvements in these subscales were not sustained at follow-up. No significant differences were found between groups for the remaining subscales (desire, arousal, satisfaction, and orgasm). An additional sub-analysis examining sexual activity found that of those who indicated not sexually active at baseline, 50% of those in the CBT-I condition became sexually active at post-treatment, compared to 12.5% and 25% of SRT and IC recipients respectively. At follow-up, sexual activity was 27.3%, 25%, and 20% for CBT-I, SRT, and IC respectively. Conclusion: While both CBT-I and SRT reduce insomnia in post-menopausal women, CBT-I may suggest additional benefits for sexual functioning whereas SRT may not. However, these gains only appear acutely, as they were not maintained at 6-month follow-up. Future research should explore what factors unique to CBT-I and not SRT may explain an increase in sexual functioning, and how these increases may be maintained over time. Support (If Any): MENO:R01NR013959.

Psychiatric Rehabilitation Journal, 2021

Psychiatry Research, 2020

While evidence suggests that adults with serious mental illness have an elevated rate of 30-day r... more While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who were discharged from medical hospitalizations in 2011. Our outcome was unplanned all-cause readmissions within 30 days of discharge. In a multivariable analysis, compared to those with no SMI, people with schizophrenia had the highest odds of 30-day readmission (aOR: 1.46, 95% CI: 1.33-1.59), followed by those with bipolar disorder (aOR: 1.25, 95% CI: 1.14-1.38), and those with major depressive disorder (aOR: 1.18, 95% CI: 1.06-1.30). Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults with schizophrenia. Given their greater psychological, social, and economic vulnerability, our findings can be used to design transition interventions and service delivery systems that address their complex needs.

LGBT Health, 2017

Purpose: The study purpose was to examine demographic, healthcare, and contextual correlates of s... more Purpose: The study purpose was to examine demographic, healthcare, and contextual correlates of smoking among sexual minority women (SMW). Methods: Data were from the Chicago Health and Life Experiences of Women study (2010-2012, N = 726). Results: The rate of current smoking was 29.6%, with 29.5% and 40.9% former or nonsmokers, respectively. A history of ever smoking was associated with lower educational levels, having a partner who smokes, heavy drinking, illicit drug use, and a bisexual identity. Statistically significant correlates of former versus current smoker included higher education, having a nonsmoking partner, being from the newest recruited cohort, and less illicit drug use. A past-year quit attempt among current smokers was associated with higher levels of illicit drug use, longer time until first cigarette, and being from the original cohort. Conclusion: The study results highlight key correlates of smoking behaviors among SMW and make an important contribution to the literature on smoking disparities. Additional research is needed to inform smoking cessation prevention and control efforts to reduce known and persistent smoking disparities among SMW.

Nicotine & Tobacco Research, 2017

Introduction: This study examined the relationships between experiences of childhood and adulthoo... more Introduction: This study examined the relationships between experiences of childhood and adulthood victimization and current smoking among heterosexual and sexual minority women. The main hypothesis was that victimization experiences would predict current smoking status. Further, we hypothesized that the effect of childhood victimization on self-reported smoker status would be mediated by adult victimization. Methods: Data are from two studies conducted in the United States that used similar methods and questionnaires in order to conduct a comparative analysis of women based on sexual orientation. Data from Wave 1 (2000-2001) of the Chicago Health and Life Experiences of Women (CHLEW) study and from Wave 5 (2001) of the National Study of Health and Life Experiences of Women (NSHLEW) study were used in these analyses. Results: Twenty-eight percent of the sample reported current smoking. Victimization experiences were common, with 63.4% of participants reporting at least one type of victimization in childhood and 40.2% reporting at least one type in adulthood. Women who identified as heterosexual were less likely to be victimized during childhood than were women who identified as lesbian or bisexual. Adult victimization had a significant effect on current smoker status, and the effect of childhood victimization on smoker status was mediated by adult victimization. When examined by sexual orientation, this indirect relationship remained significant only among bisexual women in the sample. Conclusions: Study findings make a valuable contribution to the literature on victimization and health risk behaviors such as smoking. Given the negative and long-term impact of victimization on women, strategies are needed that reduce the likelihood of victimization and subsequent engagement in health risk behaviors such as smoking. Implications: The study findings make a valuable contribution to the literature on sexual minority women's health on the influence of victimization on health risk behaviors. With the goal of reducing the likelihood of adult victimization and subsequent engagement in health risk behaviors, programs and policies aimed at preventing victimization of women are warranted. Providers

Substance Use & Misuse, 2016

Background-Although sexual minority women (SMW) are at increased risk of hazardous drinking (HD),... more Background-Although sexual minority women (SMW) are at increased risk of hazardous drinking (HD), efforts to validate HD measures have yet to focus on this population. Objectives-Validation of a 13-item Hazardous Drinking Index (HDI) in a large sample of SMW. Methods-Data were from 700 adult SMW (age 18-82) enrolled in the Chicago Health and Life Experiences of Women study. Criterion measures included counts of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms, average daily and 30-day ethanol consumption, risky sexual behavior, and Diagnostic and Statistical Manual (DSM-IV) measures of alcohol abuse/dependence. Analyses included assessment of internal consistency, construction of receiver operating characteristic (ROC) curves to predict alcohol abuse/dependence, and correlations between HDI and criterion measures. We compared the psychometric properties (diagnostic accuracy and correlates of hazardous drinking) of the HDI to the commonly used CAGE instrument. Results-KR-20 reliability for the HDI was 0.80, compared to 0.74 for the CAGE. Predictive accuracy, as measured by the area under the receiver operating characteristic curve for alcohol abuse/dependence, was HDI: 0.89; CAGE: 0.84. The HDI evidenced the best predictive efficacy and tradeoff between sensitivity and specificity. Results supported the concurrent validity of the HDI measure. Conclusions-The Hazardous Drinking Index is a reliable and valid measure of hazardous drinking for sexual minority women. Keywords hazardous drinking; sexual minority women; alcohol abuse; alcohol dependence Research with sexual minority women (SMW) has consistently demonstrated an increased risk for hazardous drinking (HD) compared to heterosexual women. In a U.S. national

Journal of clinical nursing, Jan 27, 2016

To examine unmet needs for mental health and substance use treatment among a diverse sample of se... more To examine unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (SMW; lesbian, bisexual). Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about SMW's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. Cross-sectional analysis of existing data. Analyses included data from 699 Latina, African American, and white SMW interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women (CHLEW) study. Using logistic regression, we examined associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance us...

Journal of Health Disparities Research and Practice, 2015

Nicotine & Tobacco Research, 2014

introduction: We conducted a longitudinal evaluation of factors associated with persistent smokin... more introduction: We conducted a longitudinal evaluation of factors associated with persistent smoking behaviors among sexual minority women (SMW; lesbians and bisexual women). Methods: Structured interview data were collected as part of a larger longitudinal study of SMW's health: the Chicago Health and Life Experiences of Women study. We conducted multivariate analyses to evaluate the influence of 4 groups of predictor variables on smoking: (a) demographic, (b) childhood victimization, (c) other substance use, and (d) health variables. results: At Wave 1, 30.9% (n = 138) of participants reported current smoking, with substance-use and demographic factors having the strongest relationships to smoking status. The majority (84.9%) of Wave 1 smokers were also smoking at Wave 2. Among demographic variables, level of education was inversely associated with continued smoking. With respect to substance use, hazardous drinking and cocaine/heroin use were significantly associated with continued smoking. None of the victimization or health variables predicted smoking status. Conclusions: Consistent with previous studies, smoking rates in this sample of SMW were elevated. Despite intensive efforts to reduce smoking in the general population, 84% of SMW smokers continued smoking from Wave 1 to Wave 2. Findings suggest that the majority of SMW will continue to smoke over time. Additional research is needed to increase motivation and access to smoking cessation resources.

Journal of Youth and Adolescence, 2013

Background: Research has consistently shown that early onset of drinking (EOD) is associated with... more Background: Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. Methods: Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14-16 years) to late adolescence/young adulthood (18-25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends' substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. Results: Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. Conclusion: Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Sleep, 2018

Introduction: National Sleep Foundation recommends 7-9 hours of sleep for all adults. Women are m... more Introduction: National Sleep Foundation recommends 7-9 hours of sleep for all adults. Women are more likely than men to have difficulty falling and staying asleep. Decreased sleep results in daytime sleepiness, difficulty in concentration and depression. There is lack of data regarding factors affecting sleep duration in women. We studied the influence of socioeconomic and demographic factors on the prevalence of self-reported abnormal sleep duration in women participating in a mobile health clinic in Indiana. Methods: A questionnaire was administered to all participants. They were asked how many hours of sleep they got on most days and were divided into three groups based on their report (Group 1:<6 hours, Group 2: 6-7 hours, Group 3: >7 hours). Socioeconomic and demographic factors were compared between the three groups. Results: Data was collected on 973 participants. Mean age of participants was 39 (SD 16) years. 426 (44%) of participants identified their race as African-American. 252 (26%) participants reported <6 hours of sleep. Logistic regression models were computed to identify significant relationship between duration of sleep and the following variables: age, zip based median household income, race, health insurance, history of relationship abuse, stress/depression/anxiety, and general health. African American women were more likely to have less sleep (Odds ratio: 2.06 (1.51,2.82; p<.0001) than White women. Participants who experienced stress, depression, anxiety or problems with emotions in the past 30 days, were more likely to report less sleep (odds ratio: 1.51 (1.15,1.97, p=0.0028). Participants with less than 6 hours of sleep had lower odds of reporting excellent or good health compared to those with more than 6 hours of sleep (odds ratio: 0.66 (0.49, 0.87, p=.0040). Conclusion: 1 in 4 women reported less than 6 hours of sleep, which is less than the recommended sleep range. African American women and women who experienced anxiety/stress/depression were more likely to have less sleep. Women with less sleep were more likely to report poor health. More studies are needed to identify the cause of less sleep in this vulnerable population. Support (If Any): None.

Pain, 2020

PTSD symptoms and other negative psychosocial factors have been implicated in the transition from... more PTSD symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city Emergency Department (ED) with complaints of acute pain were followed for 3 months. They completed a comprehensive battery of questionnaires at an initial visit, and provided ratings of pain intensity at the site of pain presented in the ED during 3 monthly phone calls. Latent class growth analyses were used to detect possible trajectories of change in pain intensity from initial visit to 3 months later. A 3-trajectory solution was found which identified three groups of participants. One group (early recovery; n = 93) had recovered to virtually no pain by the initial visit, whereas a second group (delayed recovery; n = 120) recovered to no pain only after one month. A third group (no recovery; n = 162) still reported elevated pain at 3-months post ED visit. The no recovery group reported significantly greater PTSD symptoms, anger and sleep disturbance, as well as lower social support, at initial visit than both the early recovery and delayed recovery groups. Results suggest that women with high levels of PTSD symptoms, anger, sleep disturbance and low social support who experience an acute pain episode serious enough to prompt an ED visit may maintain elevated pain at this pain site for at least three months. Such an array of factors may place women at increased risk of developing persistent pain following acute pain.