The Relationship Between Educational Attainment and Health Care Access and Use Among Mexicans, Mexican Americans, and U.S.-Mexico Migrants

Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors

BACKGROUND

The unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria.

METHODS

This cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05).

RESULTS

Mean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40-49 years compared to the younger women in age group 20-29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14-1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63-2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women.

CONCLUSIONS

A high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.

Predictors of Mpox vaccine uptake among sexual and gender minority young adults living in Illinois: Unvaccinated vs. double vs. single dose vaccine recipients

INTRODUCTION

The 2022 global outbreak of Monkeypox virus (Mpox), which has primarily spread through the sexual networks of sexual and gender minority (SGM) individuals, has introduced new public health challenges. While an efficacious Mpox vaccine is in active circulation, few Mpox vaccine studies have examined its uptake among SGM groups. The aims of this study were to investigate (a) the prevalence of Mpox vaccine uptake among SGM and (b) the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine among SGM.

METHODS

We conducted a cross-sectional survey in Illinois, USA in September 2022; 320 young SGM completed self-administered questionnaires. Multinomial logistic regression was used to assess the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine uptake. Adjusted Odds Ratios (aORs) and 95 % Confidence Intervals (CI) are reported.

RESULTS

Approximately 50 % of the SGM participants included in this study had received at least their first dose of the Mpox vaccine. Multinomial regression analysis showed that individuals who had recently experienced food insecurity, had higher degrees of fear of social rejection due to Mpox acquisition, and were more Mpox-vaccine hesitant were more likely to be unvaccinated. Conversely, knowing people who have contracted Mpox, having higher formal educational attainment, having higher degrees of Mpox-related internalized heterosexism, and being more concerned about one's safety regarding Mpox morbidity were more likely to be double-dosers.

CONCLUSION

Approximately 50 % of the SGMs included in this study received at least their first dose of the Mpox vaccine; however, only one-quarter of participants completed the recommended 2-dose Mpox regimen. Our findings indicate that socioeconomic stability, fear of social rejection due to disease acquisition, and Mpox-specific vaccine hesitancy may be important structural targets to consider when developing vaccine-uptake prevention and intervention strategies tailored to the needs of sexual and gender minorities.

Evaluation for causal effects of socioeconomic traits on risk of female genital prolapse (FGP): a multivariable Mendelian randomization analysis

BACKGROUND

Although observational studies have established some socioeconomic traits to be independent risk factors for pelvic organ prolapse (POP), they can not infer causality since they are easily biased by confounding factors and reverse causality. Moreover, it remains ambiguous which one or several of socioeconomic traits play predominant roles in the associations with POP risk. Mendelian randomization (MR) overcomes these biases and can even determine one or several socioeconomic traits predominantly accounting for the associations.

OBJECTIVE

We conducted a multivariable Mendelian randomization (MVMR) analysis to disentangle whether one or more of five categories of socioeconomic traits, "age at which full-time education completed (abbreviated as "EA")", "job involving heavy manual or physical work ("heavy work")", "average total household income before tax (income)", "Townsend deprivation index at recruitment (TDI)", and "leisure/social activities" exerted independent and predominant effects on POP risk.

METHODS

We first screened single-nucleotide polymorphisms (SNPs) as proxies for five individual socioeconomic traits and female genital prolapse (FGP, approximate surrogate for POP due to no GWASs for POP) to conduct Univariable Mendelian randomization (UVMR) analyses to estimate causal associations of five socioeconomic traits with FGP risk using IVW method as major analysis. Additionally, we conducted heterogeneity, pleiotropy, and sensitivity analysis to assess the robustness of our results. Then, we harvested a combination of SNPs as an integrated proxy for the five socioeconomic traits to perform a MVMR analysis based on IVW MVMR model.

RESULTS

UVMR analyses based on IVW method identified causal effect of EA (OR 0.759, 95%CI 0.629-0.916, p = 0.004), but denied that of the other five traits on FGP risk (all p > 0.05). Heterogeneity analyses, pleiotropy analyses, "leave-one-out" sensitivity analyses and MR-PRESSO adjustments did not detect heterogeneity, pleiotropic effects, or result fluctuation by outlying SNPs in the effect estimates of six socioeconomic traits on FGP risk (all p > 0.05). Further, MVMR analyses determined a predominant role of EA playing in the associations of socioeconomic traits with FGP risk based on both MVMR Model 1 (OR 0.842, 95%CI 0.744-0.953, p = 0.006) and Model 2 (OR 0.857, 95%CI 0.759-0.967, p = 0.012).

CONCLUSION

Our UVMR and MVMR analyses provided genetic evidence that one socioeconomic trait, lower educational attainment, is associated with risk of female genital prolapse, and even independently and predominantly accounts for the associations of socioeconomic traits with risk of female genital prolapse.

The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border

Background

Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project.

Methods/design

In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey.

Discussion

Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.

Hospice Care Preferences and Its Associated Factors among Community-Dwelling Residents in China

Hospice care is a comprehensive approach addressing patients’ physical, psychosocial, and spiritual needs at the end of life (EoL). Despite the recognition of its effectiveness in improving the quality of EoL care, little is known about hospice care in mainland China. In this study, we aimed to examine the preferences for hospice care and its related factors among community-dwelling residents in mainland China. Participants were recruited using a convenience sampling method, and 992 community-dwelling residents responded to an online survey from June 2018 to August 2019. The majority (66.7%) of the participants were female, and the mean age was 48.4 years. Approximately 28% of the participants had heard of hospice care, and 91.2% preferred to receive hospice care if diagnosed with a terminal illness. Participants who had heard of hospice care, and with higher levels of education (bachelor’s degree or above) and health insurance coverage were more likely to accept hospice care than their counterparts. Community-based education on hospice care is imperative to improve public knowledge and the acceptance of hospice care. Meanwhile, there is a need to develop policies to integrate and expand hospice care into clinical settings.

Health insurance, healthcare utilization and language use among populations who experience risk for tuberculosis, California 2014–2017

Background

California tuberculosis (TB) prevention goals include testing more than ten million at-risk Californians and treating two million infected with tuberculosis. Adequate health insurance and robust healthcare utilization are crucial to meeting these goals, but information on these factors for populations that experience risk for TB is limited.

Methods

We used data from the 2014–2017 California Health Interview Survey (n = 82,758), a population-based dual-frame telephone survey to calculate survey proportions and 95% confidence intervals (CI) stratified by country of birth, focusing on persons from countries of birth with the highest number of TB cases in California. Survey proportions for recent doctor’s visit, overall health, smoking, and diabetes were age-adjusted.

Results

Among 18–64 year-olds, 27% (CI: 25–30) of persons born in Mexico reported being uninsured in contrast with 3% (CI: 1–5) of persons born in India. Report of recent doctor’s visit was highest among persons born in the Philippines, 84% (CI: 80–89) and lowest among Chinese-born persons, 70% (CI: 63–76). Persons born in Mexico were more likely to report community clinics as their usual source of care than persons born in China, Vietnam, or the Philippines. Poverty was highest among Mexican-born persons, 56% (CI: 54–58) and lowest among Indian-born persons, 9% (CI: 5–13). Of adults with a medical visit in a non-English language, 96% (CI: 96–97) were non-U.S.-born, but only 42% (CI: 40–44) of non-U.S.-born persons had a visit in a non-English language.

Discussion

Many, though not all, of the populations that experience risk for TB had health insurance and used healthcare. We found key differences in usual source of care and language use by country of birth which should be considered when planning outreach to specific providers, clinic systems, insurers and communities for TB prevention and case-finding.

Health Care and Education Access of Transnational Children in Mexico

Between 2001 and 2018, more than 5.5 million Mexican migrants were removed from the United States or returned to Mexico with their families as immigration enforcement escalated. Learning how this transition affected their children-also referred to as "the invisibles"-is a policy-relevant topic for both the United States and Mexico. Using representative data on 7.6 million Mexican- and U.S.-born children from the 2015 Mexican Intercensal Survey, we provide evidence of the gaps in access to education and health care between these two groups and of the factors potentially responsible for the existing barriers. Relative to children born in Mexico, U.S.-born children are at a considerable disadvantage in terms of health care access, but less so in terms of education. Lack of a Mexican-issued birth certificate is among the persistent factors responsible for the gaps in services. Policies aimed at changing the approach to immigration enforcement in the United States, lessening paperwork requirements in Mexico, and easing access to documentation in both countries could improve transnational children's access to basic services, as well as their present and long-term well-being.

Cardiovascular Risk Factors and Cognitive Performance in Cognitively Normal Non-Hispanic Whites and Mexican Americans From the HABS-HD Cohort

Objectives: This study aimed to compare the impact of cardiovascular disease (CVD) and cardiovascular risk factors (CVRF) on cognition in non-Hispanic Whites (NHW) versus Mexicans Americans (MA). Methods: A cross sectional analysis was conducted on 663 NHW and 632 MA. Prevalence of specific CVRF were compared between both demographics. Cognition was tested with various neuropsychologic tests. Results: MA had a higher percentage of hypertension, abdominal circumference, diabetes, and current smoking while NHW had a higher prevalence of other CVD. However, specific CVRF impacted NHW neuropsychologic testing on cognition, executive function, and processing, while only memory was affected in MA. Discussion: MA have less access to healthcare services with a higher prevalence of specific CVRF, however previous research has cited a lower mortality compared to NHW, this is known as the Hispanic paradox effect. The Mexican American ethnicity may be a protective factor in cognition creating increased neuropsychologic resilience from CVRF.

The Weight of Migration: Reconsidering Health Selection and Return Migration among Mexicans

While migration plays a key role in shaping the health of Mexican migrants in the US and those in Mexico, contemporary Mexican migration trends may challenge the health selection and return migration hypotheses, two prevailing assumptions of how migration shapes health. Using data from the Mexican Family Life Survey (2002; 2005), we tested these two hypotheses by comparing the cardiometabolic health profiles of (1) Mexico-US future migrants and nonmigrants and (2) Mexico-US return migrants and nonmigrants. First, we found limited evidence for health selection: the cardiometabolic health of Mexico-US future migrants was not measurably better than the health of their compatriots who did not migrate, although migrants differed demographically from nonmigrants. However, return migrants had higher levels of adiposity compared to those who stayed in Mexico throughout their lives; time spent in the US was also associated with obesity and elevated waist circumference. Differences in physical activity and smoking behavior did not mediate these associations. Our findings suggest positive health selection might not drive the favorable health profiles among recent cohorts of Mexican immigrants in the US. However, the adverse health of return migrants with respect to that of nonmigrants underscores the importance of considering the lived experience of Mexican migrants in the US as an important determinant of their health.