BACKGROUND: Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. OBJECTIVE: Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. DESIGN: Prospective, pre-post intervention implementation study using propensity analysis. SUBJECTS: Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. INTERVENTION: Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. MAIN MEASURES: Primary predictor: pre-vs. postimplementation group; secondary predictor: postimplementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. KEY RESULTS: We enrolled 152 Chinese-and Spanishspeaking patients with LEP (84 pre-and 68 postimplementation) and 86 English speakers. Postimplementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had

Unhealthy behaviors may modify relationships between chronic stress and depression among diverse older adults. We analyzed nationally representative cross-sectional data from participants aged 40-79 years of the 2005-2012 National Health and Nutrition Examination Survey. Unhealthy behaviors included current smoking, excessive/binge drinking, insufficient physical activity, and fair/poor diet. Allostatic load was defined by 10 biomarkers indicating the cumulative physiologic burden of stress. Depressive disorder was assessed using the Patient Health Questionnaire. Multivariable logistic regression examined whether current smoking, excessive/binge drinking, insufficient physical activitiy, and fair/poor diet modified relationships between allostatic load and depressive disorder. Mean age of 12,272 participants was 55.6 years (standard error = 0.19), 51.9% were women, and most had at least a high school education (81.8%). Latinos (11.3%) and African Americans (10.4%) were more likely than Whites (7.1%; p < 0.001) to meet depressive disorder criteria. Allostatic load was not associated independently with depressive disorder in any racial/ethnic group and this lack of a relationship did not differ by the extent of unhealthy behaviors. Although Latinos and African Americans report higher levels of depression than Whites, physiological markers of stress do not appear to explain these differences.

Background Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. Methods We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient–physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. Results A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25–1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02–5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13–6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34–3.68). Among high-risk women, all intervention effects were stronger. Conclusions An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Impact Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems.

Many women did not accurately perceive their risk for breast cancer. Women with accurate risk perception had an appropriate level of concern about breast cancer. Improved methods of assessing and informing women of their breast cancer risk could motivate high risk women to apply appropriate prevention strategies and allay unnecessary concern among average risk women.

Objective: To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults. Method: Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where ≥4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008. Results: A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95% CI = [1.15, 2.05]; and aOR = 1.40, 95% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95% CI = [1.02, 2.33]). Discussion: Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.