TESS reflects a mixed methods survey of two large adjacent neighborhoods in response to community-driven health and social justice concerns. The standardized English and Spanish instruments were developed by an interdisciplinary team that consisted of community representatives and scholars with a background in psychology, sociology, anthropology, history and/or health professions. Questions from reliable and validated surveys used by the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) Survey, previous and new measures of culturally-specific stressors, acculturation and ethnic identity, and prior mistreatment surveys conducted in a nearby community11 ,12 were employed. Items were selected from the interdisciplinary team to match community and research goals while not overburdening participants. Translated items were available in most instances; multiple native Spanish speakers were involved in any required translations and reviewed all previous Spanish translations (and made adjustments) for appropriateness to current and local community usage.
This survey’s closed ended, open ended, and narrative questions were asked by trained bilingual interview pairs in houses, apartments, libraries, churches and community centers. A convenience, cross-sectional sample of 174 adults was obtained. Overall response rate could not be determined because the total number of all persons who became aware of the announcement of the survey opportunity was not determined. Anecdotally we believe the participation rate was about 40%, with interviewers perceiving palpable concerns among community members to participate in an official appearing survey. Interviewers were instructed to be inclusive in recruitment toward all community residents, participant refusals once the survey process began were minimal.
All interview pairs included highly fluent Spanish and English speakers within them, though not necessarily a native Spanish speaker. All human subjects protocols were approved by the overseeing institution’s federally approved internal review board and the project complied with American Psychological Associations ethical guidelines.
Stress was measured with the previously described 21item BCISS scale (items are presented inTable 1 ). The following were notes for the interviewers prior to administering the scale: “Within the last 3 months, has/have (each item, e.g., the need to speak better Spanish) made you_______ not all stressful, a little stressful, moderately stressful, very stressful, or extremely stressful, or have you not experienced stress due to this situation in the last 3 months, or have you never experienced stress over it?”/ “Dentro de los ultimos 3 meses [la situacion; por ejemplo, “la necesidad de hablar mejor espanol”] le he causado que no siente estres, que sienta un poco de estres, que siente un estres moderado, que sienta mucho estres, que sienta demasiado estres, o que no ha sentido estres por dicha situacion durante los ultimos tres meses, o que nunca le ha causado estres dicha situacion.” The interviewers were trained to note whether the stressor was ever experienced, experienced in the last 3 months, and for those who experienced the stressor in the last 3 months, the intensity of the stressor in a 5-point Likert format (i.e., not at all stressful/ le he causado que no siente estres to extremely stressful/ que sienta demasiado estres). The current study focused on summation of intensely reported stressors, those reported in the last two categories (very and extremely stressful), and total stress using a quantitative stress index considering the presence and intensity of stressors.7 (link),21 (link) When the items were represented by presence/intensity the scale showed high internal consistency (α= 0.91) and had a range of 0–58 (M = 14.3; SD = 14.6; Mdn = 10). As a follow up after the scale was completed, an open-ended question asked “Do you have other worries or sources of stress that you want to talk about?”/”¿Le gustaría hablar de otras preocupaciones o estresantes que pueda tener?”.
Other variables from the TESS study and selected for current study are reports of general health (an established predictor of objectively measured health markers), physical health, mental health, and depressive symptoms. Depressive symptoms were measured with a five-item shortened version of the CES-D.22 The measure included assessments of the frequency of experiencing each of the four major symptom domains within the past week. Depressive symptoms was kept continuous6 (link), internal consistency of the scale was adequate (α =0.79).
Descriptive analysis included reported frequencies and percentages of each item. Bivariate correlations were used to express the strength of association, direction of influence and statistical significance between total stress and health outcomes; these were conducted in the full sample as well as stratified by gender and by place of birth. Analysis of variance and multiple linear regressions were used to test for mean differences in gender and place of birth in total stress as well as their potential operation as effect modifiers in explaining the health outcomes.
This survey’s closed ended, open ended, and narrative questions were asked by trained bilingual interview pairs in houses, apartments, libraries, churches and community centers. A convenience, cross-sectional sample of 174 adults was obtained. Overall response rate could not be determined because the total number of all persons who became aware of the announcement of the survey opportunity was not determined. Anecdotally we believe the participation rate was about 40%, with interviewers perceiving palpable concerns among community members to participate in an official appearing survey. Interviewers were instructed to be inclusive in recruitment toward all community residents, participant refusals once the survey process began were minimal.
All interview pairs included highly fluent Spanish and English speakers within them, though not necessarily a native Spanish speaker. All human subjects protocols were approved by the overseeing institution’s federally approved internal review board and the project complied with American Psychological Associations ethical guidelines.
Stress was measured with the previously described 21item BCISS scale (items are presented in
Other variables from the TESS study and selected for current study are reports of general health (an established predictor of objectively measured health markers), physical health, mental health, and depressive symptoms. Depressive symptoms were measured with a five-item shortened version of the CES-D.22 The measure included assessments of the frequency of experiencing each of the four major symptom domains within the past week. Depressive symptoms was kept continuous6 (link), internal consistency of the scale was adequate (α =0.79).
Descriptive analysis included reported frequencies and percentages of each item. Bivariate correlations were used to express the strength of association, direction of influence and statistical significance between total stress and health outcomes; these were conducted in the full sample as well as stratified by gender and by place of birth. Analysis of variance and multiple linear regressions were used to test for mean differences in gender and place of birth in total stress as well as their potential operation as effect modifiers in explaining the health outcomes.
