Exploring U.S. Hispanic parents' length of time in the United States: Influences on obesity outcomes among U.S. Hispanic children

The 2009 California Health Interview Survey was used to examine effects of Hispanic immigrant parents' length of stay (less or more than 10 years) in the United States on the overweight and obesity outcomes among their children (N = 956, aged 6-11). The socio-ecological model of health was used to conceptualize health risk behaviors and associations with overweight/obesity outcomes among children. Weight (using body mass index) among children was influenced by parents' length of stay, country of origin, income, and urban/rural residence. Future directions for social work professionals working with obese Hispanic children and their families are discussed.

Examining the Impact of Latino Nativity, Migration, and Acculturation Factors on Colonoscopy Screening

Latinos are a diverse population comprised of multiple countries of origin with varying cultural profiles. This study examines differences in colonoscopy completion across place of birth and migration-related factors in a sample of predominantly Dominican and Puerto Rican Latinos living in New York City after receiving a recommendation for colonoscopy screening and navigation services. The sample included 702 Latinos recruited for two cancer screening projects targeting Latinos eligible for colonoscopy who seek healthcare in New York City. Participants completed a survey that included sociodemographic, health-related questions, psychosocial assessments and cancer screening practices, in Spanish or English. Migration, acculturation, and language factors were found to predict colonoscopy completion. The results indicated that Latinos born in the Dominican Republic and Central America were more likely to complete a screening colonoscopy than their counterparts born in the US. Further, those who emigrated at an older age, who have resided in the US for less than 20 years, preferred Spanish and those with lower US acculturation levels were also more likely to complete a screening colonoscopy. The findings suggest that Latinos who are less acculturated to the US are more likely to complete a screening colonoscopy after receiving a physician recommendation for colonoscopy screening. The results provide important information that can inform clinical practice and public health interventions. Continued attention to cultural and migration influences are important areas for cancer screening intervention development.

Factors Associated With Ocular Health Care Utilization Among Hispanics/Latinos: Results From an Ancillary Study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

IMPORTANCE

Regular ocular care is critical to early detection and prevention of eye disease and associated morbidity and mortality; however, there have been relatively few studies of ocular health care utilization among Hispanics/Latinos of diverse backgrounds.

OBJECTIVE

To examine factors associated with ocular health care utilization among Cuban, Central American, and South American Hispanics/Latinos in a cohort study.

DESIGN, SETTING, AND PARTICIPANTS

An ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) evaluating ocular health, knowledge, risk factors, and health care use was conducted with 1235 HCHS/SOL participants (aged ≥40 years) at the Miami, Florida, study site. Data were collected from October 17, 2011, to September 30, 2013, and analyses were conducted from May 28, 2014, to March 18, 2015. Descriptive and multivariable logistic regression analyses were performed for 3 ocular health care outcomes. Regression models were built sequentially with variables conceptually grouped according to Andersen's Behavioral Model of Health Services Use.

MAIN OUTCOMES AND MEASURES

Ever having an eye examination, having an eye examination performed within the past 2 years, and difficulty obtaining needed eye care in the past year.

RESULTS

Of the 1235 participants, 478 were men and 757 were women, and they had a mean (SD) age of 53.6 (8.1) years. Those who never had insurance were less likely to have had an eye examination (with data reported as odds ratios [95% CIs]) ever, 0.19 (0.07-0.53) and in the past 2 years, 0.22 (0.15-0.33) and were more likely to have had difficulty obtaining needed eye care in the past year (3.72 [1.75-7.93]). Those with less than excellent or good self-rated eyesight were less likely to ever have had an eye examination (0.26 [0.12-0.56]) and more likely to have had difficulty obtaining care (3.00 [1.48-6.11]). Men were less likely to ever have had an eye examination (0.31 [0.18-0.53]). Older (55-64 years) Hispanics/Latinos (3.04 [1.47-6.31]) and those with a high school degree or general educational development certification (2.06 [1.02-4.13]) or higher levels of education (4.20 [2.12-8.30]) were more likely to ever have had an eye examination. Finally, those living in the United States for more than 15 years (0.42 [0.21-0.82]) were less likely to have had difficulty obtaining care.

CONCLUSIONS AND RELEVANCE

Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.

Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos

RATIONALE

Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking.

OBJECTIVES

To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States.

METHODS

The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation.

MEASUREMENTS AND MAIN RESULTS

The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration.

CONCLUSIONS

Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.

Disparities in colorectal cancer incidence among Latino subpopulations in California defined by country of origin

PURPOSE

In California, colorectal cancer (CRC) is the second most common cancer in Latinos. Using data from the California Cancer Registry, we investigated demographic and clinical characteristics of 36,133 Latinos with CRC living in California during 1995-2011 taking into account subpopulations defined by country of origin.

METHODS

Cases were defined as Latino according to the North American Association of Central Cancer Registries Hispanic Identification Algorithm, which was also used to group cases by country of origin: Mexico (9,678, 27 %), Central or South America (2,636, 7 %), Cuban (558, 2 %), Puerto Rico (295, 1 %), and other or unknown origin (22,966, 64 %; Other/NOS). 174,710 non-Hispanic white (NHW) CRC cases were included for comparison purposes. Annual age-adjusted incidence rates (AAIR) and proportional incidence ratios (PIRs) were calculated.

RESULTS

Differences were observed for age at diagnosis, sex distribution, socioeconomic status (SES), nativity (US born vs. foreign born), stage, and tumor localization across Latino subpopulations and compared to NHW. Mexican Latinos had the lowest AAIR and Cuban Latinos had the highest. PIRs adjusted for age, SES, and nativity showed an excess of CRC males and female cases from Cuba, female cases from Puerto Rico and reduced number of female cases from Mexico.

CONCLUSIONS

Differences in cancer incidence patterns and tumor characteristics were observed among Latino subpopulations in California. These disparities may reflect differences in cancer determinants among Latinos; therefore, given that country of origin information is unavailable for a large proportion of these patients, greater efforts to collect these data are warranted.

Self-Reported Cancer Prevalence among Hispanics in the US: Results from the Hispanic Community Health Study/Study of Latinos

Cancer has surpassed heart disease as the leading cause of death among Hispanics in the U.S., yet data on cancer prevalence and risk factors in Hispanics in regard to ancestry remain scarce. This study sought to describe (a) the prevalence of cancer among Hispanics from four major U.S. metropolitan areas, (b) cancer prevalence across Hispanic ancestry, and (c) identify correlates of self-reported cancer prevalence. Participants were 16,415 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who self-identified as Cuban, Dominican, Mexican, Puerto Rican, Central or South American. All data were collected at a single time point during the HCHS/SOL baseline clinic visit. The overall self-reported prevalence rate of cancer for the population was 4%. The rates varied by Hispanic ancestry group, with individuals of Cuban and Puerto Rican ancestry reporting the highest cancer prevalence. For the entire population, older age (OR = 1.47, p < .001, 95% CI, 1.26-1.71) and having health insurance (OR = 1.93, p < .001, 95% CI, 1.42-2.62) were all significantly associated with greater prevalence, whereas male sex was associated with lower prevalence (OR = 0.56, p < .01, 95% CI, .40-.79). Associations between study covariates and cancer prevalence also varied by Hispanic ancestry. Findings underscore the importance of sociodemographic factors and health insurance in relation to cancer prevalence for Hispanics and highlight variations in cancer prevalence across Hispanic ancestry groups. Characterizing differences in cancer prevalence rates and their correlates is critical to the development and implementation of effective prevention strategies across distinct Hispanic ancestry groups.

Danger and Dignity: Immigrant Day Laborers and Occupational Risk

The plight of immigrant workers in the United States has captured significant scholarly attention in recent years. Despite the prevalence of discourses regarding this population, one set of issues has received relatively little attention: immigrant workers' exposure to unhealthy and unsafe working conditions, and their corresponding susceptibility to workplace injuries and illnesses. Researchers have consistently found that immigrant workers suffer disproportionately from occupational injuries and fatalities, even when controlling for industry and occupation. Why, then, are foreign-born workers at greater risk for workplace injuries and fatalities, when compared with their native-born counterparts? This Article seeks to develop answers to that question with the aid of empirical research and to build upon a growing interdisciplinary literature. This Article presents findings from a qualitative research study designed to explore the factors that shape occupational risks for immigrants. The study, conducted over several months in 2014, centered on in-depth interviews of eighty-four immigrant day laborers seeking employment in different parts of Northern Virginia. The workers' responses present a complex picture of the immigrant worker experience, reflecting persistent dangers alongside powerful expressions of worker dignity: while the Virginia day laborers continue to encounter significant occupational risks, many comfortably asserted their rights, complicating standard narratives of immigrant worker subordination and vulnerability. The results of the study also point to ongoing economic insecurities, and regulatory failures relating to the provision of training, use of protective equipment, and oversight of smaller worksites. The findings also signal the need for a more holistic approach to workplace regulation that concomitantly examines a range of workplace concerns, including wage violations, hostile work environments, and health and safety risks. Finally, the day laborers' experiences reveal that worker centers are well positioned to insulate immigrant workers from workplace risks, by promoting transparency and accountability in the employer-employee relationship.

Pharmacogenetics in Central American healthy volunteers: interethnic variability

Ethnicity is one of the major factors involved in interindividual variability to drug response. This study aims to describe the frequency of the most relevant pharmacogenetic biomarkers and metabolic phenotypes in Central American healthy volunteers and to determine its interethnic variability. Twenty-six original research articles on allelic, genotypes or metabolic phenotype frequencies were analyzed, in which a total number of 7611 Central American healthy volunteers were included (6118 were analyzed for genotype and 1799 for metabolic phenotype). No reports were available for population from Belize and Honduras. The CYP2D6*4 and *5 frequencies in Amerindian populations from Costa Rica have shown to be among the highest frequencies so far reported in the world. Furthermore, NAT2*5 and *6 presented higher frequencies in admixed populations than in Amerindians, but, inversely, the NAT2*7 was more frequent in Amerindians compared to an admixed population. Likewise, different patterns of distribution have been shown in HLA-A*02, *03 and HLA-B*07 among Native populations from Latin America. Reports on Central American populations were also found for the CYP2C19, LDLR, CYP2E1, MDR1, G6PD, TP53, CYP1A2, CYP3A4 and CYP3A5 biomarkers, but no data were available for the other 91 pharmacogenetic biomarkers revised in Central American populations. Differences in the frequency of some pharmacogenetic biomarkers and metabolic phenotypes were found, showing interethnic variability within Central American and with other Latin American populations.

Immigration Enforcement, Parent-Child Separations, and Intent to Remigrate by Central American Deportees

Given the unprecedented increase in the flow of migrants from El Salvador, Guatemala, and Honduras to the United States, this article analyzes the impact of U.S. interior enforcement on parent-child separations among Central American deportees, along with its implications for deportees' intentions to remigrate to the United States. Using the EMIF sur survey data, we find that interior enforcement raises the likelihood of parent-child separations as well as the likelihood that parents forcedly separated from their young children report the intention to return to the United States, presumably without documents. By increasing parent-child separations, interior enforcement could prove counterproductive in deterring repetitive unauthorized crossings among Central American deportees.

Anxious-depression among Hispanic/Latinos from different backgrounds: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

Anxious-depression is a constellation of symptoms, frequently encountered among patients in primary care centers. There is a need to study how anxious-depression presents among Hispanic/Latinos of different backgrounds.

OBJECTIVE

To study the construct of anxious-depression among 16,064 Hispanic/Latinos of different backgrounds participating in the Hispanic Community Health Study/Study of Latinos. We hypothesized that Hispanic/Latinos will cluster in 3 classes: low anxiety/high depression, high anxiety/low depression and a combined anxious-depression construct.

METHODS

Using latent profile analysis, symptoms of depression and anxiety measured by the 10-item Center for Epidemiologic Studies Depression Scale and 10-item State-Trait Anxiety Inventory were evaluated to determine if an anxious-depression typology would result. A multinomial logistic regression analysis explored the association of the 3-class solution with different Hispanic/Latino backgrounds controlling for age, gender, language, education and income.

RESULTS

A 3-class mixed anxious-depression structure emerged with 10% of Hispanic/Latinos in the high, 30% in the moderate and 60% in the low anxious-depression category. After adjusting for age, gender, language preference, income and education, individuals of Puerto Rican background were more likely to experience high (OR = 1.79, p < 0.05) and moderate (OR = 1.36, p < 0.05) (vs. low) anxious-depression symptomatology compared to those of Mexican background. Individuals of Central American and South American background were less likely to experience high (OR = 0.68, p < 0.05) and moderate (OR = 0.8, p < 0.05) (vs. low) anxious-depression compared to those of Mexican background.

CONCLUSION

Anxious-depression symptomatology varied among this sample of Hispanic/Latino groups. These classes should be investigated as to their relationship with different health outcomes relevant to the Hispanic/Latino of different backgrounds.

Foreign-Born Persons Diagnosed with HIV: Where are They From and Where Were They Infected?

We sought to calculate rates of HIV diagnoses by area of birth among foreign-born persons in a high-incidence US city with many immigrants, and determine probable place of HIV acquisition. Data from the New York City HIV surveillance registry and American Community Survey were used to calculate HIV diagnosis rates by area of birth and determine probable place of HIV acquisition among foreign-born diagnosed in 2006-2012. HIV diagnosis rates varied by area of birth and were highest among African-born persons; absolute numbers were highest among Caribbean-born persons. Probable place of acquisition was a foreign country for 23 % (from 9 % among Middle Easterners to 43 % among Africans), US for 61 % (from 34 % among Africans to 76 % among South Americans), and not possible to estimate for 16 %. HIV prevention and testing initiatives should take into account variability by foreign area of birth in HIV diagnosis rates and place of acquisition.

Changes in pre- to post-immigration HIV risk behaviors among recent Latino immigrants

This prospective longitudinal study examined pre- to post-immigration HIV risk behavior trajectories among recent Latino immigrants in Miami-Dade County (Florida). We identified socio-demographic factors associated with these trajectories and collected retrospective pre-immigration HIV risk behavior data at baseline from a sample of 527 Caribbean, South American, and Central American Latinos ages 18-34 who immigrated to the U.S. less than one year prior. Two follow-up assessments (12 months apart) reported on participants' post-immigration HIV risk behaviors. Results indicated overall decreases in pre- to post-immigration condom use. In the sample, recent Latino immigrants with lower education, younger age, and higher incomes had steeper decreases in pre- to post-immigration condom use. We also found differences in the risk behavior trajectories of males and females. Latino women reported significant increases in the number of sexual partners post immigration, while men reported decreases in the number of sexual partners after immigrating to the U.S.

Dyslipidemia patterns among Hispanics/Latinos of diverse background in the United States

BACKGROUND

The prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known.

METHODS

Lipid and lipoprotein data were used from the Hispanic Community Health Study/Study of Latinos—a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74 years. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, and biological and acculturation characteristics were compared among those with and without dyslipidemia.

RESULTS

Mean age was 41.1 years, and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated low-density lipoprotein cholesterol was 36.0%, and highest among Cubans (44.5%; P < .001). Low high-density lipoprotein cholesterol (HDL-C) was present in 41.4% and did not significantly differ across Hispanic background groups (P = .09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; P < .001). Elevated non-HDL-C was seen in 34.7%, with the highest prevalence among Cubans (43.3%; P < .001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index, and low physical activity. Older age, female sex, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence.

CONCLUSION

Dyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds, with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population.

Healthcare coverage and use among undocumented Central American immigrant women in Houston, Texas

We investigated the prevalence and correlates of having current healthcare coverage and of having a usual formal source of care among undocumented Central American immigrant women. Participants were recruited using respondent driven sampling. Thirty-five percent of participants had healthcare coverage and 43% had a usual formal source of care. Healthcare coverage was primarily through the local indigent healthcare program and most of those with a usual formal source of care received care at a public healthcare clinic. Having healthcare coverage and having a usual formal source of care were both associated with older age; having a usual formal source of care was also marginally associated with increased time of residence in the US and increased income security. The primary barriers to healthcare use were not having money or insurance, not knowing where to go, and not having transportation. Healthcare interventions may benefit from targeting young and newly arrived immigrants and addressing the structural and belief barriers that impede undocumented immigrant women's use of healthcare services.

Mammography screening among Mexican, Central-American, and South-American women

Cancer and cancer screening disparities exist across Latino subgroups; however the reasons for these disparities are not fully known. This study examines (1) mammography screening among Latinas born in Mexico, Central-America and South-America and (2) the impact of birthplace and acculturation on mammography screening. Data were derived from the California Health Interview Survey 2007. Analyses included 1,675 Latina women 40 years of age and older. Multivariate logistic regression examined predictors of mammography screening. Mexican and Central-American women were less likely to report ever receiving a mammogram while Mexican women were less likely to report a recent mammogram. Low-acculturated women were less likely to report ever receiving a mammogram and less likely to report recent mammography. Different screening patterns across Latina subgroups were observed. Differences in screening patterns and the factors associated with screening highlight the need for unique intervention strategies tailored specifically to Latinas.

[Central American migrants' sexual experiences and rights in their transit to the USA]

OBJECTIVES

To explore the causes and circumstances that determine the way in which migrants experience their sexuality and how this impacts their sexual rights.

MATERIALS AND METHODS

Qualitative study conducted between April 2009 and July 2010 in Chiapas, Oaxaca, San Luis Potosí, and Tamaulipas. We conducted 22 in-depth interviews to migrants in transit and to ten different key actors. For the analysis we used elements of grounded theory.

RESULTS

Migrants know and identify the risks they may encounter in their transit but have scarce access to services to effectively exercise their sexual and reproductive rights. Their vulnerability makes them internalize and accept the violence enacted on them as part of their destiny and as what they must suffer in order to reach the USA.

CONCLUSIONS

Violence, including sexual violence, determines much of the experiences of their transit through Mexico. Differences between groups and between male and female migrants are determined by gender inequalities and power.

Acculturative stress and diminishing family cohesion among recent Latino immigrants

This study investigates a theorized link between Latino immigrants' experience of acculturative stress during their two initial years in the United States (US) and declines in family cohesion from pre- to post-immigration contexts. This retrospective cohort study included 405 adult participants. Baseline assessment occurred during participants' first 12 months in the US. Follow-up assessment occurred during participants' second year in the US. General linear mixed models were used to estimate change in family cohesion and sociocultural correlates of this change. Inverse associations were determined between acculturative stress during initial years in the US and declines in family cohesion from pre-immigration to post-immigration contexts. Participants with undocumented immigration status, those with lower education levels, and those without family in the US generally indicated lower family cohesion. Participants who experienced more acculturative stress and those without family in the US evidenced a greater decline in family cohesion. Results are promising in terms of implications for health services for recent Latino immigrants.

Battling discrimination and social isolation: psychological distress among Latino day laborers

Day labor is comprised of predominately male and recent Latino immigrants, mainly from Mexico and Central America who work in an unregulated and informal market. Three-quarters of the day labor force is undocumented and live under the federal poverty threshold as work is seasonal and highly contingent on the weather and the local economy. However, in spite of their exposure to significant health risks, little is known about the impact of Latino day laborers' (LDLs) work and life conditions on their mental health. This mixed methods study extends the literature by using the minority stress theoretical model to examine the relationship between discrimination and social isolation as well as participant identified protective factors such as religiosity and sending remittances with psychological distress. A quantitative survey with 150 LDLs was conducted and was followed by a qualitative member checking focus group to extend upon the quantitative results as well as the minority stress model with the lived experiences of these immigrant workers. Results reveal implications for prevention efforts with this hard-to-reach and marginalized population.

[Malaria diagnosis and treatment: analysis of a cohort of hospitalised patients at a tertiary level hospital (1998-2010)]

INTRODUCTION

The increasing frequency of malaria infection in our area is due to the rise in international travel and immigration from endemic malaria areas. The aim of this study is to describe the chemoprophylaxis taken and treatment given as well as the clinical, epidemiological and microbiological characteristics for those patients admitted to our hospital with malaria.

METHODS

A retrospective study of patients with malaria admitted to the Hospital Virgen de la Arrixaca, between January 1998 and December 2010, was carried out.

RESULTS

During this period, fifty one cases of malaria were diagnosed. 78.3% of them were immigrants of whom 65% resided in Spain and had travelled to their country of origin for a short stay. Seventy four per cent acquired the infection in central and west Africa, and Plasmodium falciparum was responsible for the majority of the cases (88%). Only four patients had taken antimalarial chemoprophylaxis but none correctly. The most frequently treatment used was a combination of quinine and doxycicline (64.7%). Inappropriate anti-malarial treatment occurred in 9 patients (17.6%). At least one indicator of severe malaria was established in 23.5% of the cases; however, the clinical outcome was successful in every case and no patient died.

CONCLUSIONS

Imported malaria is observed mostly among immigrants who travel to their countries of origin for a short stay and do not take anti-malarial prophylaxis, increasing the risk of acquiring malaria. Inappropriate malarial treatment is relatively frequent in the case management of imported malaria.

What leads non-U.S.-Born Latinos to access mental health care?

Latinos underutilize mental health care services. Of those who do, about 70% do not return after the initial visit. This study's purposes were: (1) to identify factors that led non-U.S.-born Latinos to utilize services from a nonprofit clinic in Texas and (2) to assess whether acculturation played a role in accessing mental health care. Data were collected over a 10-week period using an interview schedule and the Bidimensional Acculturation Scale for Latinos. Results indicate acculturation does not play a significant role in access, but patient knowledge of mental health care issues does. Specifically, the main barriers to access were: (1) lack of knowledge that there was a mental health issue; and (2) lack of knowledge of where to go for mental health services.

Sexual health of Latino migrant day labourers under conditions of structural vulnerability

The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.

HIV in persons born outside the United States, 2007-2010

CONTEXT

Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes.

OBJECTIVE

To describe the epidemiology of HIV among persons born outside the United States and among US-born persons diagnosed in the United States.

DESIGN, SETTING, AND PARTICIPANTS

Analysis of the estimated number of US-born persons and persons born outside the United States diagnosed with HIV from 2007 through 2010 in 46 states and 5 US territories, the demographic characteristics, and the HIV transmission risk factors reported to the National HIV Surveillance System. Foreign-born persons were defined as persons born outside the United States and its territories, inclusive of naturalized citizens.

MAIN OUTCOME MEASURE

Diagnosis of HIV infection.

RESULTS

From 2007 through 2010, HIV was diagnosed in 191,697 persons in the US population; of these, 16.2% (95% CI, 16.0%-16.3%) (n = 30,995) were born outside the United States. Of the 25,255 persons with a specified country or region of birth outside the United States, 14.5% (n = 3656) were from Africa, 41.0% (n = 10,343) were from Central America (including Mexico), and 21.5% (n = 5418) were from the Caribbean. The 4 states (California, Florida, New York, and Texas) reporting the highest numbers of persons born outside the United States and diagnosed with HIV were also the top 4 reporters of HIV cases overall. Among persons born outside the United States with HIV, 73.5% (n = 22,773) were male. Among whites, 1841 of 55,574 (3.3%) of HIV diagnoses were in persons born outside the United States; in blacks, 8614 of 86,547 diagnoses (10.0%); in Hispanics, 17,913 of 42,431 diagnoses (42.2%); and in Asians, 1987 of 3088 diagnoses (64.3%). The percentage infected through heterosexual contact was 39.4% among persons born outside the United States vs 27.2% for US-born persons.

CONCLUSIONS

Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics.

Prevalence of HIV risk behaviors among undocumented Central American immigrant women in Houston, Texas

Undocumented Central American immigrants in the United States are disproportionately affected by HIV infection. However, epidemiological data on sexual behaviors among undocumented women are sparse and the extent to which behaviors vary by duration of residence in the U.S.is largely unknown. In 2010, we used respondent driven sampling to conduct an HIV behavioral survey among Central American immigrant women residing in Houston, Texas without a valid U.S. visa or residency papers. Here we describe the prevalence of sexual risk behaviors and compare recent (5 years or less in the U.S.) and established immigrants (over 5 years in the U.S.) to elucidate changes in sexual risk behaviors over time. Our data suggest that recent immigrants have less stable sexual partnerships than established immigrants, as they are more likely to have multiple and concurrent sexual partnerships, as well as partnerships of shorter duration.

Acculturation, dietary practices and risk for childhood obesity in an ethnically heterogeneous population of Latino school children in the San Francisco bay area

Previous studies have found increased acculturation to the US lifestyle increases risk for obesity in Latinos. However, methodologies differ, and results in children are inconsistent. Moreover, previous studies have not evaluated risk factors within the heterogeneous US population. We recruited 144 self-identified Latino school children and their mother or father in grades 4-6 in San Francisco parochial schools and South San Francisco public schools using an information letter distributed to all students. Children and parents had weights, heights, demographic information, dietary patterns and lifestyle variables collected in English or Spanish through an interview format. A high percentage of our children were overweight [≥85th percentile body mass index (BMI)] (62.5%) and obese (≥95th percentile BMI) (45.2%). Correspondingly parents also had a high percentage of overweight (BMI ≥ 25 & <30) (40.8%) and obesity (BMI ≥ 30) (45.3%). Mexico was the country of origin for 62.2% of parents, and 26.6% were from Central or South America. In multivariate logistic analysis, speaking Spanish at home was an independent risk factor for obesity [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.28-6.86]. Eating breakfast daily (OR 0.34, 95% CI 0.15-0.78) and consumption of tortas (a Mexican fast food sandwich) (OR 0.45, 95% CI 0.21-1.00) were associated with decreased risk. In stratified analysis, significant differences in risk factors existed between Mexican origin versus Central/South American Latino children. The processes of acculturation likely impact eating and lifestyle practices differentially among Latino groups. Interventions should focus on ensuring that all children eat a nutritious breakfast and take into consideration ethnicity when working with Latino populations.