"Power, control, strain": Lay perceptions of health inequalities across England's 'North South divide'.

Latine individuals in the United States are disproportionally exposed to traumatic events and are at higher risk for developing posttraumatic stress disorder (PTSD) and depression relative to non-Latine Whites (; ; ; ; ). Such disparities extend to natural disasters as Latine individuals are overrepresented in seven of the top 10 U.S. counties for disaster risk according to the National Risk Index (). Further, census tracts that are majority Latine, Black/African American or Indigenous experience greater disaster risk (). Despite the wide availability of evidence-based mental health treatments, Latine adults disproportionately face a range of barriers (e.g., cost, language, insurance, lack of culturally appropriate services) that decrease their likelihood of accessing and using services (; ; ; ). Digital health solutions may be ideally suited to reduce some of the barriers to service access and use among trauma-exposed Latine adults. This paper examines () as a case example for adaptations needed for mHealth tools to reduce inequities in trauma-related mental health resource access among Latine populations. BBN was designed as a multi-function trauma-focused mental health mobile application for use in post-disaster settings. We conducted a controlled trial to test the efficacy of BBN during the 2017 and 2018 hurricane seasons, which included Hurricane Maria (Puerto Rico) and Hurricane Harvey (Houston). This resulted in a sample in which approximately half of participants identified as Latine (), which allows for important comparisons across access, use and efficacy. Digital health resources (e.g., mobile applications) are an acceptable, feasible, and effective way to deliver mental health interventions (; ). The Pew Research Center () reported that 98% of US adults use a cellphone and 91% own a smartphone. Latine adults (93%) are slightly more likely to own a smartphone than White adults (91%). Reliance on smartphones for online access (i.e., “smartphone dependent”) is higher among Latine adults compared to other racial/ethnic groups. Digital interventions delivered via cellphones, smartphones, tablets and other devices can address several barriers to care: they can be accessed instantly (barrier: scheduling, time commitment), freely (barrier: cost), privately (barrier: stigma), and almost anywhere (barriers: time commitment [travel, parking, waiting room, travel costs] and transportation). Finally, a robust literature indicates that digital mental health technologies are often effective (; ), including for trauma-related mental health outcomes, although effect sizes may be modest when used as self-help tools. Several mobile mental health apps have demonstrated efficacy among Latine populations (for a review, see ). However, access and use of mobile mental health apps is often low in “real world” settings (). Much of this gap may be the result of systemic barriers, such as language. At present, the broader mental health app market and apps used in published RCTs infrequently use Spanish (). Specifically, a marketplace review in 2021 indicated that only 14.5% of mental health apps were available in Spanish (). However, scant research has compared use and efficacy for Latine populations relative to non-Latine Whites, a key comparison for understanding the potential for digital mental health to bridge access disparities. Further, most studies examining digital mental health use and efficacy do not include sufficient representation of Latine participants to allow for comparisons (for a review see ().