Diverging Demography: Hispanic and Non-Hispanic Contributions to U.S. Population Redistribution and Diversity

Ethnic Discrimination, Sexual Orientation Discrimination, and DSM-5 Alcohol Use Disorder Among U.S. Latino or Hispanic Adults

We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III (n = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07-1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06-1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97-6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25-5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.

Neural reactivity to infant emotion cues during pregnancy: Associations with peripartum anxiety and depressive symptoms

BACKGROUND

Pregnancy is marked by physiological and psychosocial changes for women, and event-related potentials (ERP) are comfortable and safe for examining brain function across pregnancy. The late positive potential (LPP) ERP, a measure of allocated attention to emotional stimuli, may provide insight into associations between internalizing symptoms and neural processing of infant emotion cues, which may be particularly salient in this life stage.

METHODS

We developed a task to examine neural and behavioral responses to infant faces in pregnant women (N = 120, Mage=31.09, SD=4.81), the impact of auditory infant cries on the LPP to faces, and associations between the LPP and anxiety and depressive symptoms. Participants matched distressed, happy, and neutral infant faces and shapes as a comparison condition with interspersed auditory conditions (infant cry sounds vs. white noise) while electroencephalogram data were collected. Participants also completed self-report measures of anxiety and depressive symptoms.

RESULTS

Reaction time (RT) was faster for the infant cry vs. white noise condition and when matching shapes vs. infant faces. Depressive symptoms were associated with slower RTs to neutral infant faces. The LPP was enhanced overall to faces vs. shapes, but there was no main effect of auditory condition. Anxiety symptoms were associated with an enhanced LPP to infant distressed faces in the infant cry condition.

CONCLUSIONS

Results support these methods for measuring neural and behavioral responses to infant emotional cues in pregnancy and provide evidence that combinations of auditory and visual stimuli may be particularly useful for capturing emotional processes relevant to anxiety.

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest

BACKGROUND

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts.

OBJECTIVES

This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community.

METHODS

This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area.

RESULTS

FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education.

CONCLUSIONS FOR PRACTICE

Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

The Pre-exposure Prophylaxis (PrEP) Care Continuum Among English-Speaking Latino Sexual Minority Men in the United States (2014-2020)

BACKGROUND

There is limited understanding of the pre-exposure prophylaxis (PrEP) care continuum specific to Latino/x gay, bisexual, and other sexual minority men (SMM) that encompasses the population residing outside of large metropolitan or urban areas.

SETTING

We examined trends and characteristics associated with the PrEP care continuum with data from the 2014-2020 cycles of the American Men's Internet Survey, an annual online cross-sectional behavioral survey of cisgender SMM in the United States.

METHODS

We calculated PrEP continuum outcomes overall and by year among Hispanic/Latino SMM (n = 9010). We used generalized estimating equations with Poisson links to examine (1) temporal trends (2014-2020) in each step of the PrEP continuum and PrEP use in the past year stratified by PrEP eligibility and (2) correlates of each step of the PrEP continuum in 2020 using multivariable models.

RESULTS

Among 2283 Latino SMM in 2020, 84% reported PrEP awareness, 30% discussed PrEP with a provider, 15% used PrEP in the past year, and 12% were currently using PrEP. PrEP awareness increased from 52% in 2014 to 84% in 2020; and PrEP use in the past year increased from 4% in 2014 to 15% in 2020. In the multivariable models, age and PrEP eligibility were associated with PrEP use in the past year, and urban-rural classification was associated with current PrEP use.

CONCLUSIONS

While most of the Latino SMM are aware of PrEP, significant gaps remain in this population in discussing PrEP with a provider and using PrEP that require tailored strategies to enhance access to HIV prevention services.

Negative perceived context of reception and sociocultural resources on mental health among Hispanic and Somali adolescents

Although immigrant negative perceived context of reception (PCOR), perceptions of the opportunities and degree of acceptance in an immigrant-receiving community, has been linked with compromised adolescent well-being, receiving contexts may differ by region and for youth from different ethnic backgrounds. The current study examines how negative PCOR and factors that promote resilience differentially shape mental health among Hispanic and Somali adolescents in Minnesota. Hispanic (n = 163) and Somali (n = 186) first- and second-generation youth aged 12-19 completed a survey on negative PCOR, assets and resources (i.e., ethnic identity, social support, religious participation), and mental well-being (i.e., anxiety and depressive symptoms). Parents and caregivers also completed a survey on PCOR and social support. Adolescent negative PCOR, relative to parent/caregiver negative PCOR, was associated with higher adolescent anxiety and depressive symptoms. Religious participation and social support, reported by both parent/caregiver and adolescent, was associated with lower anxiety and depressive symptoms. Additionally, among Hispanic adolescents, social support buffered the effects of negative PCOR on depressive symptoms. Conversely, strong ethnic identity was associated with higher depressive symptoms for both groups, suggesting acculturative and assimilative pressures play an important role in adolescent mental health. Although social ties can be weakened postmigration, our results indicate that social and religious resources remain beneficial. Given that by the end of the next decade over 50% of the US youth population will identify as part of a racial or ethnic minority group, positive postimmigration adaptation is a critical public health concern.

Risk profiles, access to care, and outcomes in Hispanics hospitalized for lower extremity peripheral artery disease

OBJECTIVE

Previous studies have shown that Hispanics have worse clinical outcomes for lower extremity peripheral artery disease (PAD) than non-Hispanic White (NHWs). Using a national database, this study aimed to document the contemporary burden of PAD in Hispanics by evaluating their risk profiles, access to care, and outcomes compared with NHWs.

METHODS

Hospitalizations of Hispanics and NHWs with a primary diagnosis of PAD were identified using 2011-2017 National Inpatient Sample data. Patient sociodemographic characteristics, comorbidities, whether the admission was through the emergency department (ED) or elective, length of stay, and costs accrued were compared by ethnicity. Temporal trends in revascularizations, amputations, and ED admissions by year were evaluated with the Cochran-Mantel-Haenszel test and stratified by ethnicity. Data were combined across years and multivariable logistic regression was used to evaluate the association of ethnicity with inpatient revascularization, amputation, and mortality, adjusting for sociodemographic and cardiovascular risk factors.

RESULTS

From 2011 to 2017, there were a total of 1,018,220 PAD hospitalizations among Hispanics (13.9%) and NHWs (86.1%) between 2011 and 2017. Hispanics were more often low income and uninsured and presented with higher burden of comorbidities including diabetes, renal failure, prior amputations, and chronic limb-threatening ischemia compared with NHWs. Most Hispanics were admitted via the ED compared with NHWs (58.0% vs 36.7%; d = 0.48), and median length of stay was almost a day longer (4.5 days vs 3.7 days). Hispanic ethnicity was associated with lower odds of surgical (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.57-0.67) and endovascular revascularization (OR, 0.94; 95% CI, 0.89-0.996) and mortality (OR, 0.83; 95% CI, 0.75-0.93), but higher odds of minor (OR, 1.25; 95% CI, 1.20-1.31) and major (OR, 1.08; 95% CI, 1.03-1.14) amputation.

CONCLUSIONS

Two tiers of health care consumption for inpatient PAD care and outcomes manifested among Hispanics and NHWs. First, Hispanics with PAD had a more vulnerable socioeconomic profile and presented with more severe PAD than NHWs. Second, they sought care more disproportionately through the ED and underwent more amputations than NHWs. To eradicate these inequities in PAD care and risk, strategies that improve access to outpatient care and expand health care coverage, as well as targeted management of risk factors in these vulnerable minority groups are needed.

Husband's income, wife's income, and number of biological children in the U.S

Previous studies have found that the positive relationship between personal income and fertility for men in the United States is primarily due to childlessness among low-income men. Yet because of the opposite effects of income on fertility for men and women, it is important to examine the effects of income net of spouse's income. An analysis of income from all sources and biological fertility data for husbands and wives from the Survey of Income and Program Participation (2014) shows that for men their own income is positively associated with the number of their biological children, while their spouse's income is negatively associated with total children ever fathered. The reverse is true for women. These results are not because of childlessness among low-income men and high-income women, but also hold true among all those with children. For men and women aged 45-65, who likely have completed fertility, these results hold regardless of whether or not education is controlled. These findings suggest that if status is measured as personal income for men and husband's income for women, the positive relationship between status and fertility persists in a postdemographic transition society.

The Social Economy as a Factor of Economic Development and Resilience of Population in Rural Areas. A Study of Mediating Effects in Castilla-La Mancha (Spain)

Depopulation is a serious problem facing developed countries, among them Spain. It is especially severe in rural areas, where some vicious circles emerge, nourished by reduced infrastructures and services, deteriorated quality of life, the low inflow of new inhabitants, low local development and an aged population. In this context, social economy institutions may be a key factor in the fight against population decline, having a leading role in reactivating economic dynamism through the creation of stable, high-quality jobs, promoting the local endogenous development of rural areas, helping enhance income in those spaces, encouraging the arrival of people and impacting positively on social cohesion, and enabling sustainable growth. This paper focuses on Castilla-La Mancha, an eminently rural region, which is among the areas most severely impacted by the loss of population in Spain. The aim is to analyze the factors that affect the settlement of population, and to demonstrate that social economy institutions may be a resilience factor of rural population. A partial least squares model, composed of 8 constructs related to 21 variables extracted from data for 2017 and 2018 on the 613 municipalities, allows us to demonstrate that the existence of social economy entities helps to anchor population and increase the resilience of this territory.

Population Change and Income Inequality in Rural America

This paper examines the effects of population growth and decline on county-level income inequality in the rural United States from 1980 to 2016. Findings from previous research have shown that population growth is positively associated with income inequality. However, these studies are largely motivated by theories of urbanization and growth in metropolitan areas, and do not explicitly test for differences between the impacts of population growth and decline. Examining the effects of both forms of population change on income inequality is particularly important in rural counties of the United States, the majority of which are experiencing population decline. We analyze county-level data (N=11,320 county-decades) from the U.S. Decennial Census and American Community Survey, applying fixed-effects regression models to estimate the respective effects of population growth and decline on income inequality within rural counties. We find that both forms of population change have significant effects on income inequality relative to stable growth. Population decline is associated with increases in income inequality, while population growth is marginally associated with decreases in inequality. These relationships are consistent across a variety of model specifications, including models that account for counties' employment, sociodemographic, and ethno-racial composition. We also find that the relationship between income inequality and population change varies by counties' geographic region, baseline level of inequality, and baseline population size, suggesting that the links between population change and income inequality are not uniform across rural America.

Demographics in Rural Populations

This article reviews key population trends affecting rural American health. The article explains the role of demography in defining and studying rural health using example data from the 2014 to 2018 American Community Survey. Specific trends, including depopulation, aging, racial/ethnic diversification, socioeconomic status, and health characteristics found in rural areas, are highlighted. Insights are offered into how population trends, changing age and sex structures, and socioeconomic distributions have implications for rural health care practitioners and surgeons. Several areas and opportunities to address current and future rural health needs are identified.

Metropolitan Reclassification and the Urbanization of Rural America

We highlight the paradoxical implications of decadal reclassification of U.S. counties (and America's population) from nonmetropolitan to metropolitan status between 1960 and 2017. Using data from the U.S. Census Bureau, we show that the reclassification of U.S. counties has been a significant engine of metropolitan growth and nonmetropolitan decline. Over the study period, 753-or nearly 25% of all nonmetropolitan counties-were redefined by the Office of Management and Budget (OMB) as metropolitan, shifting nearly 70 million residents from nonmetropolitan to metropolitan America by 2017. All the growth since 1970 in the metropolitan share of the U.S. population came from reclassification rather than endogenous growth in existing metropolitan areas. Reclassification of nonmetropolitan counties also had implications for drawing appropriate inferences about rural poverty, population aging, education, and economic growth. The paradox is that these many nonmetropolitan "winners"-those experiencing population and economic growth-have, over successive decades, left behind many nonmetropolitan counties with limited prospects for growth. Our study provides cautionary lessons regarding the commonplace narrative of widespread rural decline and economic malaise but also highlights the interdependent demographic fates of metropolitan and nonmetropolitan counties.

Sex Differences in the Association of Family and Personal Income and Wealth with Fertility in the United States

Evolutionary theory predicts that social status and fertility will be positively related. It also predicts that the relationship between status and fertility will differ for men and women. This is particularly likely in modern societies given evidence that females face greater trade-offs between status and resource acquisition and fertility than males. This paper tests these hypotheses using newly released data from the 2014 wave of the Survey of Income and Program Participation by the US Census, which has the first complete measures of fertility and number of childbearing partners for a large, representative, national probability sample of men and women and also contains comprehensive measures of economic status as measured by personal and family resources, including income from all sources and all assets. Multivariate analyses show that personal income is positively associated with total fertility and number of childbearing unions for men only. For men, personal net worth is positively associated with number of childbearing unions; it is also positively associated with fertility for married men with a spouse present. These findings support evolutionary predictions of a positive relationship between status, access to mates, and reproductive success for males. Whereas personal income and personal net worth are negatively associated with total fertility and number of childbearing unions for women, family income (net of personal income) is positively associated with total fertility for women. For married men living with a spouse, family income (net of personal income) is negatively associated with total fertility. These findings are consistent with evolutionary theory given the existence of greater trade-offs between production and reproduction for women in an advanced industrial society. For women and men, family net worth (net of personal net worth) is negatively associated with number of childbearing unions and fertility. Implications are discussed.

The Demography of Families: A Review of Patterns and Change

The authors review demographic trends and research on families in the United States, with a special focus on the past decade. They consider the following several topics: (a) marriage and remarriage, (b) divorce, (c) cohabitation, (d) fertility, (e) same-gender unions, (f) immigrant families, and (g) children's living arrangements. Throughout, the authors review both overall trends and patterns as well as those by social class and race-ethnicity. The authors discuss major strands of recent research, emphasizing emerging themes and promising directions. They close with a summary of central patterns and trends and conclude that recent trends are not as uniform as they tended to be in earlier decades, making the description of family change increasingly complex.

We are at Full Capacity": Social care workers persisting through work-related stress in a new immigrant settlement context in the United States

Cities without a prior established history of Latina/o migration are experiencing the fastest rate of growth in new immigrants in the United States (Wainer, A tale of two cities (and a town): Immigrants in the Rust Belt, 2013; Lichter & Johnson, Immigrant gateways and Hispanic migration to new destinations. International Migration Review, 43, 496, 2009). These new immigrant settlement cities experience the challenge of adapting their social care context to become more responsive to the needs of immigrants. Yet as cities and social care organisations struggle to keep up with the "lag" time in the availability of culturally and linguistically responsive resources and services, social care providers often work in conditions of scarcity in a social care context that is often lacking in its ability to fully respond to the needs of immigrants. Literature indicates that such conditions of scarcity can lead to work related stress, burn-out, and can have a negative impact on the quality of services delivered by social care workers. Yet little is known regarding social care providers' motivations and responses to work stress; and how providers may positively respond and persist in their jobs despite such stressors. This study conducted in the new immigrant settlement city of Baltimore from 2014 to 2016, utilises semi-structured interviews to qualitatively explore the personal motivational beliefs, workplace and demographic factors associated with buffering stress and frustration among social care workers in a new immigrant settlement city (N = 29). Findings highlight important motivational and work-related factors that appear to minimise the impact of stress and frustration for social care providers and can be used in the development of burn-out interventions as well as improving quality of services for vulnerable populations such as, immigrants, especially in low-resource new immigrant settlement contexts.

Whither the urban diaspora? The spatial redistribution of Latino origin groups in metropolitan America since 1990

Our research advances what is known about the urban portion of the Latino diaspora, focusing on the extent to which Hispanic country-of-origin groups have spread throughout metropolitan America. Analyzing 1990-2010 census data for the seven largest origin groups, we find that all seven have become more evenly dispersed across metro areas, with group shares declining in primary gateways and increasing in other types of destinations. At the same time, Dominicans and Cubans remain highly concentrated in New York and Miami, respectively, and certain pairs of groups (e.g., Mexicans and Dominicans) continue to inhabit different metropolises despite a modest trend toward convergent settlement among most pairs. All groups have experienced some growth in exposure to ethnoracial diversity, particularly in primary gateway settings. However, Mexicans are less exposed than any other origin group to African Americans. The variation in our results by group attests to the delicate balance between the forces driving spatial concentration and dispersion. We conclude that multiple diasporas are underway rather than a single, uniform one. This pattern has relevance both for diversity within local Hispanic communities and for relations between Hispanics and other panethnic populations, most notably Whites and Blacks.

It's time for a change!: The appreciative inquiry/bootcamp translation to address disparities in the Latino community with autism spectrum disorders

OBJECTIVE

Autism spectrum disorder (ASD) is underidentified and misidentified in the Latino community, and numerous barriers limit this community's ability to access quality health care for ASD. Appreciative inquiry/boot camp translation (AI/BCT) is a novel method of community engagement that can be used within community-based participatory research partnerships. AI/BCT uses qualitative methods to uncover strategies that the community is already successfully using and develops actionable messages to increase the use of those strategies throughout the community. We describe this method and outline how it is likely to be more effective at reducing disparities related to ASDs in the Latino community than traditional methods.

CONCLUSION

AI/BCT is a promising method of community engagement that is responsive to cultural differences. It is a strength-based approach focused on increasing the use of strategies that already work within the community. Therefore, it has the potential to reduce health disparities in the Latino community who have loved ones with autism ASD much more rapidly than traditional methods of inquiry. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

"The Only Thing We Can Do is Treat Them Well Here": Public Health With Latinos in a New Immigrant Destination

Human service agencies in new immigrant destinations often lack the experience and bilingual staff required to provide inguistically and culturally appropriate services to Latino immigrant families. This qualitative study examined the ways one new destination public health agency responded to this demographic shift. The agency leveraged a culture of collaboration and a team approach so that serving immigrants became the responsibility of all workers, not only a few bilingual staff. Implications for practice including the potential benefits and pitfalls of including monolingual workers in immigrant clients' care are discussed.

Divergent Pathways to Assimilation? Local Marriage Markets and Intermarriage among U.S. Hispanics

The growing diversity of the U.S. population raises questions about integration among America's fastest growing minority population-Hispanics. The canonical view is that intermarriage with the native-born white population represents a singular pathway to assimilation, one that varies over geographic space in response to uneven local marital opportunities. Using data on past-year marriage from the 2009-2014 American Community Survey, we demonstrate high rates of intermarriage among Hispanics. Our analyses identify whether Hispanics marry co-ethnics, non-co-ethnic Hispanics, non-Hispanic whites, non-Hispanic blacks, or other minorities. We highlight variation by race, nativity, and socioeconomic status, but also reveal that Hispanics living in new immigrant destinations are more likely to intermarry than those living in traditional Hispanic gateways. Indeed, the higher out-marriage in new destinations disappears when the demographic context of reception is taken into account. Our analysis underscores that patterns of marital assimilation among Hispanics are neither monolithic nor expressed uniformly across geographic space.