Research has identified numerous mechanisms through which perceived social isolation and lack of social support negatively impact health. Little research attention has been dedicated to factors that influence the development of social networks, which have the potential to decrease perceptions of social isolation and provide social support. There is mixed evidence concerning the availability of supportive social networks for Latinos in the US. This study explores trauma-exposed Latina immigrants' experiences of social isolation in the US and its perceived causes. Twenty-eight Latina immigrant women participated in an interview about traumatic experiences. Informal help seeking and the availability of friendships in the US were also queried. Frequent comparisons between experiences in their home countries and in the US shaped the emerging themes of social isolation and lack of social support. Women reported feeling lonely, isolated, closed-in, and less free in the US due to family separation and various obstacles to developing and maintaining relationships. Socioeconomic, environmental, and psychosocial barriers were offered as explanations for their limited social networks in the US. Understanding experiences of social isolation as well as barriers to forging social networks can help inform the development of social support interventions that can contribute to improved health among Latinos.

Trauma has been understudied among Latina immigrants from Central and South America. This study examined the types and context of trauma exposure experienced by immigrant women from Central America, South America, and Mexico living in the United States. Twenty-eight women seeking care in primary care or social service settings completed life history interviews. The majority of the women reported some type of trauma exposure in their countries of origin, during immigration, and/or in the United States. In the interviews, we identified types of trauma important to the experience of these immigrants that are not queried by trauma assessments typically used in the United States. We also identified factors that are likely to amplify the impact of trauma exposure. The study highlights the importance of utilizing a contextualized approach when assessing trauma exposure among immigrant women.

Colombia has endured six decades of civil unrest, population displacement, and violence. We examined the relationships of contextual conditions, displacement, and HIV among gay, bisexual, and transgender individuals in Bogotá, Colombia. Nineteen key informants provided information about internal displacement of sexual minorities. Life history interviews were conducted with 42 participants aged 18 to 48 years, and included questions about displacement experiences, sexual behaviour, life prior to displacement, and participants’ economic and social situation in Bogotá. The interplay of a variety of factors—including internal conflict and violence, homonegativity and “social cleansing,” gender and sexual identity, and poverty—strongly shaped the varied experiences of displacement. Migration, sexual violence, exchange sex, and low rates of HIV testing were risk factors that increased vulnerability for HIV in this displaced sample. Although displacement and HIV in Colombia are major problems, both are understudied.

Latinos in the United States (U.S.) experience disparities in the detection and treatment of mental disorders. Although previous research has found that Latinos prefer individual psychotherapy and treatment in a primary care setting for common trauma-related mental disorders (e.g., depression, posttraumatic stress disorder), reasons for these treatment preferences are not fully understood and preferences regarding other mental health treatment characteristics are not known. Using a mixed-methods approach, the current study sought to identify preferences for treatment modality, type of psychotherapy, type of provider, and setting, as well as the influences of logistical factors and potential barriers on the help-seeking behaviors of trauma-exposed Latina immigrants who met screening criteria for PTSD and/or depression and were receiving health care in a primary care clinic. Consistent with previous research, participants expressed a preference for individual therapy, particularly supportive psychotherapy and cognitive–behavioral therapy. Participants preferred receiving mental health care in a primary care clinic by a mental health specialist. Cost emerged as the most important logistical consideration when determining whether to seek services. Unfamiliarity with mental health services and confidentiality concerns, particularly regarding immigration status, were identified as additional barriers that may decrease the likelihood of seeking treatment for depression or PTSD. Providers will need to be creative in incorporating the treatment preferences of Latinos in cost-efficient interventions. Efforts to decrease the mental health disparities faced by the growing Latino population may include psychoeducation, hybrid treatments, and systems-level interventions to integrate mental health treatment into primary care settings.

Background: The Affordable Care Act (ACA) improved health care coverage accessibility by expanding Medicaid eligibility, creating insurance Marketplaces, and subsidizing premiums. We examine coverage changes associated with ACA implementation, comparing adults with and without a cancer history. Methods: We included nonelderly adults from the 2012 to 2015 National Health Interview Survey. Using information on state Medicaid policies (2013), expansion decisions (2015), family structure, income, insurance offers, and current coverage, we assigned adults in all 4 years to mutually exclusive eligibility categories including: Medicaid-eligible pre-ACA; expansion eligible for Medicaid; and Marketplace premium subsidy eligible. Linear probability regressions estimated pre-post (2012–2013 vs. 2014–2015) coverage changes by eligibility category, stratified by cancer history. Results: The uninsured rate for cancer survivors decreased from 12.4% to 7.7% (P < 0.001) pre-post ACA implementation. Relative to income > 400% of the federal poverty guideline, the uninsured rate for cancer survivors decreased by an adjusted 8.4 percentage points [95% confidence interval (CI), 1.3–15.6] among pre-ACA Medicaid eligible; 16.7 percentage points (95% CI, 9.0–24.5) among expansion eligible, and 11.3 percentage points (95% CI, −0.8 to 23.5, with a trend P = 0.069) for premium subsidy eligible. Decreases in uninsured among expansion-eligible adults without a cancer history [9.7 percentage points (95% CI, 7.4–12.0), were smaller than for cancer survivors (with a trend, P = 0.086)]. Despite coverage gains, ~528,000 cancer survivors and 19.1 million without a cancer history remained uninsured post-ACA, yet over half were eligible for Medicaid or subsidized Marketplace coverage. Conclusions: ACA implementation was associated with large coverage gains in targeted expansion groups, including cancer survivors, but additional progress is needed.