Health insurance moderates the association between immigrant length of stay and health status

Trust in physicians, health insurance, and health care utilization among Chinese older immigrants

OBJECTIVE

Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status.

DESIGN

The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), N = 3,157. The sample is representative of Chinese older immigrants (60+ years) in Chicago. Guided by Andersen's behavioral model, hierarchical regression analyses examined the role of TIP in physician visits, ER visits, and hospitalization among Chinese older immigrants. An interaction term was added to examine whether the aforementioned associations differed by insurance status.

RESULTS

TIP was positively associated with the likelihood of physician visits (Odds Ratio [OR] = 1.07, p < 0.001) but not with ER (OR = 1.02, p = 0.054) or hospitalization (OR = 1.01, p = 0.13). The results of the moderation analyses further showed that TIP was more positively associated with ER visits (OR=0.94, p=0.006) and hospitalization (OR = 0.93, p = 0.004) among the uninsured population, compared to those insured.

CONCLUSIONS

TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

Immigration-related stressors and health outcomes among low-wage immigrant hotel workers: A pilot study

BACKGROUND

Immigrants comprise over 40% of the low-wage workforce. They are more likely to be employed in service industries, paid less, and experience more illness and injuries than their native counterparts.

DESIGN/OBJECTIVE

The aim of this cross-sectional pilot study was to explore the relationship between immigrant workers' stressors and health.

SAMPLE

Twenty-five female Mexican immigrant hotel workers.

MEASUREMENTS

Surveys and blood samples were analyzed and compared to national data. Descriptive statistics and linear regression were used for analysis.

RESULTS

Longer length of stay, older age at migration, and higher Demands of Immigration (DI) were significantly associated with more chronic conditions. Higher DI were significantly associated with more depressive symptoms. This is comparable to national data (n = 468) which shows a significant relationship between length of stay, Allostatic Load (AL), and chronic conditions (β = 0.14, p = .043; β = 0.13, p = .025).

CONCLUSIONS

Immigrant-specific factors affect individuals' health. More studies are needed to further explore the relationship between DI and health among foreign-born workers.

Physical Intimate Partner Violence, Childhood Physical Abuse and Mental Health of U.S. Caribbean Women: The Interrelationship of Social, Contextual, and Migratory Influences

The literature has shown an increased risk for mental health conditions among victims of domestic violence. Few studies have examined the relationship between mental health disorders and domestic violence among Caribbean women, and how the association might be influenced by migratory and contextual factors. This study addresses the mental well-being of U.S. Caribbean Black women victims of domestic violence, and the relationships between acculturation, discrimination, and demographic influences. An analysis of data from the 2001-2003 National Survey of American Life (NSAL) re-interview, the first and most complete study on U.S. Caribbean Blacks, was conducted. Bivariate analysis revealed an association between acts of physical domestic violence and mental health conditions, with generally higher risk among women who reported both severe physical intimate partner violence and childhood physical abuse. Multivariate logistic regression indicates an association between specific mental disorders and acts of domestic violence. Acculturation, length of residence in the United States, age, education, poverty, and country of origin were also associated with mental health. The study highlights future directions for exploration including additional investigation of the influence of acculturation on the physical health of victims of domestic violence.

Duration of United States Residence and Self-Reported Health Among African-Born Immigrant Adults

Although researchers have found an inverse relationship between length of U.S. residence and health, research on this issue among African-born immigrants is limited. Data from the 2011-2015 National Health Interview Surveys were pooled for African-born immigrants (N = 1137) and used to estimate weighted ordinary least squares regression models on self-reported health, adjusting for common immigrant health predictors. Length of U.S. residence was associated with significant health status declines only among those that had lived in the U.S. for 10 to less than 15 years (b = - 0.235, p < 0.05), net of covariates. African-born immigrants may have both different selection processes than other immigrants and not follow common integration patterns. These findings suggest that existing immigrant health frameworks may need modification to fully apply to this growing U.S. immigrant population.

Explaining Health Outcomes of Asian Immigrants: Does Ethnicity Matter?

The present study intended to evaluate whether 4 discrete ethnic groups of Asian immigrants could, for empirical reasons, be assigned a set of unique operating factors explaining health outcomes of members. The set comprised several acculturation, social structure, lifestyle, and health-related factors. Our study asked if these factors uniformly explained health outcomes across the 4 groups. We pooled National Health Interview Survey (NHIS) data dating 1999-2015 and developed 2 outcomes: self-rated health and self-reported chronic illness (specifically, diagnosis of cardiovascular disease, prediabetes/diabetes, hypertension, cancer, or stroke). Since data for smaller Asian ethnic groups are not readily available, we confined our analyses to respondents of Chinese, Filipino, Asian Indian, and "other Asian" ethnicity. Descriptive statistics suggested that Asian Indian respondents were least likely to report having 1 of the 5 specified serious illnesses and self-rated their health higher than the other 3 respondent groups. Additionally, while some factors (e.g., body mass index, depression) proved related to the health outcomes across the 4 ethnic groups, we did observe for each group a unique pattern of factors associated with the outcomes. Our results confirmed, furthermore, a moderating role for ethnicity in associations between the outcomes and those operating factors in the set we evaluated. The study results should be of use in tailoring preventive and intervention programs to various ethnic groups of Asian immigrants; clearly, in promoting health, one approach will not fit all.

The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N = 253) were aged 35-74 years and resided in Baltimore-Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05-14.35) and eightfold (95% CI 2.09-30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04-6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24-0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18-0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants' CVD risk.

Factors Associated with Health Insurance Status in an Asian American Population in New York City: Analysis of a Community-Based Survey

BACKGROUND

Immigrants comprise approximately 13% of the US population and 33% lack health coverage. Asian Americans are the fastest growing immigrant group; many lack a usual source of care. This study examines factors associated with health insurance among Asian American immigrants living in New York City.

METHODS

Community needs assessments were conducted among Asian American subgroups in New York City from 2013 to 2015; analysis was completed in 2017 and 2018. Descriptive statistics examined factors associated with health insurance status while stratifying by Asian ethnic subgroup; multivariable logistic regression models further assessed these associations (p < 0.05 significance level).

RESULTS

Approximately 19% of the study population (n = 1399) was uninsured. Logistic regression models adjusted for all factors. Among East Asians, insurance status was associated with female sex (OR = 2.8, p = 0.005), excellent/very good health status (OR = 3.5, p = 0.014), and seeing a private doctor when sick or injured (OR = 3.2, p = 0.033). Among South Asians, insurance status was associated with high school/some college and college education (OR = 2.6 and 2.9, respectively, p = 0.039 and p = 0.021), having a routine health check in the past year (OR = 6.4, p < 0.001), no diabetes diagnosis (OR = 2.7, p = 0.030), and a tuberculosis diagnosis (OR = 4.7, p = 0.019). Among Southeast Asians, insurance status was associated with less than high school education (p < 0.05), living in the USA > 20 years (OR = 3.7, p = 0.009), having a routine health check in the past year (OR = 5.6, p = 0.025), and seeing a private doctor when sick or injured (OR = 2.6, p = 0.018).

CONCLUSIONS

Health insurance status was associated with differing factors among each subgroup. Findings may inform strategies to address challenges and barriers of healthcare access to immigrants, making healthcare more accessible to this underserved population.

Korean immigrants don't buy health insurance: The influences of culture on self-employed Korean immigrants focusing on structure and functions of social networks

Culture has been pinpointed as a culprit of disparities in health insurance coverage between Korean immigrants and other ethnic groups. This study explored specific mechanisms by which culture influences a decision to buy health insurance among self-employed Korean immigrants living in ethnic enclaves by focusing on the structure and functions of social networks. Between March and June 2015, we recruited 24 Korean immigrant adults (aged 18 or older) who identified as self-employed and being uninsured for substantial periods before 2014 in Southern California. Interviews were conducted in Korean, and Korean transcripts were translated into English by two bilingual interpreters. Using constant comparative analysis, we explored why participants didn't purchase health insurance after migrating to the United States and how their social networks influenced their decisions whether to purchase health insurance. Results indicate Korean immigrants sought health information from dense and homogeneous social networks whose members are mostly Korean immigrants embedded in similar social contexts. Social learning was frequently observed when people sought health care while uninsured. However, respondents often noted social ties do not provide helpful information about benefits, costs, and ways to use health insurance. "Koreans don't buy health insurance" was a dominant social norm reported by most respondents. Findings indicate that social learning and normative influence occur inside social networks and these mechanisms seemingly prevent purchasing of health insurance. In addition to the individual mandate in the Patient Protection and Affordable Care Act, more targeted approaches that consider the structure and functions of social networks could improve the public health of Korean immigrants.

Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care

Homeless African Americans with serious mental illness experience higher rates of morbidity and mortality than adults with severe mental illness alone. Peer navigators, individuals with similar lived experiences, may help these individuals navigate the healthcare system to improve healthcare utilization. This study examined whether the Peer Navigator Program (PNP) improved scheduling and achieving healthcare appointments compared to treatment as usual (TAU) over the course of 12 months, including three periods within that timeframe: engagement (first three months), impact (middle six months), and maintenance (final six months). Results indicated no change during the first three months of the study, a significantly greater improvement in scheduled and achieved appointments for PNP compared to TAU during the middle six months, and maintenance of appointment change improvements over the final three months of the study. This research suggests peer navigators may offer a promising solution to barriers in utilizing the healthcare system for people with severe mental illness, especially those who may be homeless or from minority racial groups.

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness

OBJECTIVE

The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless.

METHODS

Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health, recovery, and quality of life were collected at baseline and at four, eight, and 12 months.

RESULTS

Findings from group × trial analyses of variance of omnibus measures of the four constructs showed significant impact over the year for participants in PNP compared with those in the control group, with analyses showing small to moderate effect sizes: general health status (η²=.24), psychological experience of physical health (η²=.42), recovery (η²=.36), and quality of life (η²=.14). These differences emerged even though both groups showed significant reductions in homelessness and increases in insurance coverage.

CONCLUSIONS

Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research.

Community-based participatory research examining the health care needs of African Americans who are homeless with mental illness

African Americans with mental illness who are homeless experience significant health risks and illnesses leading to high mortality and morbidity rates. A community-based participatory research (CBPR) team conducted a qualitative study to begin to describe these problems. Results from focus groups and key informant interviews of 42 individuals yielded 98 themes which were sorted into three categories: problems, solutions, and peer navigators. Results included a review of the problems and solutions which the community or people might adopt. An additional goal was to understand and develop impact of peer navigators for addressing health problems in this group. Results yielded a list of values in hiring peer navigators as well as skills and resources they might need to successfully do their job. Findings from the study are currently being used by the CBPR team to develop a peer navigator program for this community.

Factors affecting length of stay in teaching hospitals of a middle-income country

Introduction

The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence.

Methods

In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05.

Results

The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p<0.05). Other factors, including gender, place of residence, and type of admission, did not affect LOS.

Conclusion

Because hospitals consume a perceptible part of resources in a health system, controlled and optimized use of its resources help to save a lot. Therefore, this study showed many clinical and nonclinical factors affect LOS in evaluating these factors, which may reduce inappropriate hospital stays and decrease costs.

Considerations of Methodological Approaches in the Recruitment and Retention of Immigrant Participants

OBJECTIVE

This study aims to identify effective strategies related to recruitment and retention of immigrant survey participants.

METHODOLOGY

The study used a multi-mode approach in, first, conducting a literature review of recent articles on surveys that either targeted immigrants or included large numbers of immigrants in their samples. Next, six surveys were reviewed that either targeted or included large numbers of immigrants. Finally, expert opinions on immigration were gathered regarding recruitment and retention of immigrant survey participants.

RESULTS

Although immigrants may be difficult to recruit due to limited English proficiency, mistrust of strangers, and/or high mobility, many of these challenges can be overcome by adopting the same strategies used when surveying ethnically diverse populations (e.g., snowballing versus advertisement, establishing a personal connection with data collectors). Nonetheless, a few practices were identified as most relevant for recruitment and retention of immigrant populations, including involving local community organizations relevant to immigrants, translation of materials tailored to the vernacular language of the various ethnicities, and customizing non-monetary incentives to the specific ethnicity.

CONCLUSIONS

Based on the reviews and expert interviews, multiple strategies have been shown to be effective in recruiting and retaining immigrant participants.

Acculturation and cancer screening among Asian Americans: role of health insurance and having a regular physician

Cancer is the leading cause of death among Asian Americans, but screening rates are significantly lower in Asians than in non-Hispanic Whites. This study examined associations between acculturation and three types of cancer screening (colorectal, cervical, and breast), focusing on the role of health insurance and having a regular physician. A cross-sectional study of 851 Chinese, Korean, and Vietnamese Americans was conducted in Maryland. Acculturation was measured using an abridged version of the Suinn-Lew Asian Self-Identity Acculturation Scale, acculturation clusters, language preference, length of residency in the US, and age at arrival. Age, health insurance, regular physician, gender, ethnicity, income, marital status, and health status were adjusted in the multivariate analysis. Logistic regression analysis showed that various measures of acculturation were positively associated with the odds of having all cancer screenings. Those lived for more than 20 years in the US were about 2-4 times [odds ratio (OR) and 95 % confidence interval (CI) colorectal: 2.41 (1.52-3.82); cervical: 1.79 (1.07-3.01); and breast: 2.11 (1.25-3.57)] more likely than those who lived for less than 10 years to have had cancer screening. When health insurance and having a regular physician were adjusted, the associations between length of residency and colorectal cancer [OR 1.72 (1.05-2.81)] was reduced and the association between length of residency and cervical and breast cancer became no longer significant. Findings from this study provide a robust and comprehensive picture of AA cancer screening behavior. They will provide helpful information on future target groups for promoting cancer screening.

Peer navigators and integrated care to address ethnic health disparities of people with serious mental illness

People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.

Change in self-reported health status among immigrants in the United States: associations with measures of acculturation

Although acculturation may have positive effects for immigrants, including better socioeconomic profiles and increased occupational opportunities, their health profiles deteriorate with longer duration in the U.S. Prior research indicates that increasing acculturation is associated with some poorer health outcomes among immigrants in the U.S. However, most of these studies have used length of stay or English language proficiency as proxies for acculturation, and have mainly examined self-reported “current” health outcomes. This study advances knowledge on associations between acculturation and health among immigrants by explicitly examining self-reported “change” in health since immigration, in relation to acculturation-related variables. We use data from the New Immigrant Survey (NIS; 2003-2004), a cross-sectional study of legal immigrants to the U.S. In addition to testing more conventionally examined proxies of acculturation (length of stay and English proficiency), we also examine English language use and self-reported change in diet. Multivariable logistic regression analyses on 5,982 participants generally supported previous literature indicating a deleterious impact of acculturation, with increasing duration of stay and greater self-reported change in diet being associated with a poorer change in health since moving to the U.S. Although English language proficiency and use were associated with greater odds of reporting a worse change in health when examined individually, they were non-significant in multivariable models including all acculturation measures. Findings from this study suggest that when taking into account multiple measures of acculturation, language may not necessarily indicate unhealthy assimilation and dietary change may be a pathway leading to declines in immigrant health. Increasing duration in the U.S. may also reflect the adoption of unhealthy behaviors, as well as greater exposure to harmful sources of psychosocial stress including racial and anti-immigrant discrimination. Our study suggests that multiple indicators of acculturation may be useful in examining the effect of acculturation on changes in health among immigrants.