Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders

The impact of acculturative stress on internalizing problems among racially and ethnically minoritized adolescents and young adults in the U.S.: A systematic review and meta-analysis

Due to demographic changes of the U.S. population in the past few decades, more attention has been placed on understanding the sociocultural factors that have an impact on the mental health of racially and ethnically minoritized (REM) groups. One factor that has gained increased attention in recent years is acculturative stress. Acculturative stress is associated with negative mental health outcomes, such as depression, anxiety, psychological distress, and suicide ideation (SI). However, the magnitude of this association remains unclear. A systematic review and meta-analysis were conducted to provide a comprehensive review of the impact of acculturative stress on depression, anxiety, psychological distress, and SI among REM youth. We also aimed to explore whether sociodemographic variables (i.e., race/ethnicity, generational status, sex/gender, and age) moderate the relationships between acculturative stress and mental health outcomes. Forty-six peer-reviewed articles examining the link between acculturative stress and internalizing problems among REM youth in the U.S. (mean age range: 13-29) met inclusion criteria and were included in this systematic review and meta-analysis. A positive relationship of moderate size between acculturative stress and depression, anxiety, psychological distress, and SI was found. Moderation analyses also revealed that the impact of acculturative stress on depression may be greater among those who are older and for first-generation immigrants. Similarly, its impact on anxiety may also be more pronounced for first-generation immigrants. Results also suggested that the impact of acculturative stress on depression and psychological distress may be greater among men compared to women. These findings highlight the importance of making sure clinicians assess for acculturative stress when working with REM youth, as well as factors that may be contributing to an individual's acculturative stress level.

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review

The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.

Employment-related mental health outcomes among Australian migrants: A 19-year longitudinal study

BACKGROUND

Migrants experience various stressors at different stages of migration based on their country of origin, ethnic backgrounds, migration context and host country. Employment is one important post-settlement factor associated with mental health among migrant groups. The study investigates whether the country of origin modifies the association between employment and mental health for Australian migrants.

METHODS

Nineteen waves of data from the Household Income and Labour Dynamics in Australia Survey were used. Using fixed-effects regression, we examined the effects of within-person changes in employment status on mental health outcomes as measured by the Mental Health Inventory (MHI-5), controlling for time-varying confounders and stratified by sex and examined effect modification by country of origin.

RESULTS

The relationship between unemployment and mental health was modified by country of origin for men but not women. Unemployed men from Asian (β = -4.85, p < 0.001), African and Middle Eastern (β = -3.61, p < 0.05) countries had lower mental health scores compared to employed Australian-born men. For men, there was evidence of effect modification of the association between employment and mental health by country of origin, with the combined effect of being unemployed and being a migrant from an Asian country was almost three points lower than the summed independent risks of these factors (β = -2.72; p = 0.01). Also, for men, the combined mental health effect of not being in the labour force and coming from a non-English-speaking European country was greater than the summed effects of these factors (β = -2.33; p < 0.001).

CONCLUSION

Tailored employment-support programmes may be beneficial for migrants from ethnic minorities, particularly those from Asian, African and Middle Eastern countries in Australia. Further research is needed to understand why the mental health of migrant men from these countries is particularly vulnerable to unemployment.

Dismantling the monolith: ethnic origin, racial identity, and major depression among US-born Black Americans

PURPOSE

Numerous investigations have sought to understand why Black Americans have a lower prevalence of major depressive disorder (MDD) than white Americans, yet fewer have explored within-racial group variation or its causes. Limited extant evidence indicates that US-born Caribbeans have higher levels of MDD relative to African Americans. Among African Americans, racial identity is considered protective against depression, yet it is unclear how it functions among Black Americans with recent immigrant origins. We examined the extent to which differential effects of racial identity on MDD by ethnic origin explain the elevated prevalence among US-born Caribbeans relative to all other US-born Black Americans.

METHODS

With data from the largest nationally representative study of Black mental health, log-binomial models assessed effect modification of ethnic origin (Caribbean, non-Caribbean) on the relationship between racial identity and MDD. Separate models evaluated four indicators of racial identity-"closeness to Black people," "importance of race to one's identity," "belief that one's fate is shared with other Black people," and "Black group evaluation."

RESULTS

Belief in "shared fate" was positively associated with MDD for US-born Caribbeans alone (PR = 3.43, 95% CI 1.87, 6.27). Models suggested that "importance of race" and "Black group evaluation" were detrimental for Caribbeans, yet protective for non-Caribbeans. "Closeness" appeared protective for both groups.

CONCLUSION

Findings suggest that the protective effect of racial identity against MDD among US-born Black Americans may depend on both ethnic origin and the operationalization of racial identity. Results provide new insight into the role of racial identity on depression and suggest promising directions for future research.

Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark

PURPOSE

Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement.

METHODS

We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults).

RESULTS

Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth.

CONCLUSION

Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.

A Data-Driven Approach to Identify the Predictors of Perceived Health Status Among Chinese and Korean Americans

Asian Americans are the country's fastest-growing racial group, and several studies have focused on the health outcomes of Asian Americans, including perceived health status. Perceived health status provides a summarized view of the health of populations for diverse domains, such as the psychological, social, and behavioral aspects. Given its multifaceted nature, perceived health status should be carefully approached when examining any variables' influence because it results from interactions among many variables. A data-driven approach using machine learning provides an effective way to discover new insights when there are complex interactions among multiple variables. To date, there are not many studies available that use machine learning to examine the effects of diverse variables on the perceived health status of Chinese and Korean Americans. This study aims to develop and evaluate three prediction models using logistic regression, random forest, and support vector machines to find the predictors of perceived health status among Chinese and Korean Americans from survey data. The prediction models identified specific predictors of perceived health status. These predictors can be utilized when planning for effective interventions for the better health outcomes of Chinese and Korean Americans.

Trends of cardiovascular health in Asian American individuals: A national health and nutrition examination survey study

Objective

Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US.

Methods

The Life's Essential 8 (LE8) score and its components were calculated in self-reported Asian American individuals ≥20 years of age and free of cardiovascular disease in the NHANES cycles from 2011-March 2020. Multivariable adjusted linear and logistic regression models were used for analysis.

Results

Among 2,059 Asian American individuals, the weighted mean LE8 score was 69.1 (0.4) with US-born [69.0 (0.8)] and foreign-born individuals [69.1 (0.4)] having similar CVH. From 2011 to March 2020, CVH in the overall population [69.7 (0.8) to 68.1 (0.8); Ptrend: 0.009] and foreign-born individuals [69.7 (0.8) to 67.7 (0.8); Ptrend: 0.005] declined. Decreasing trends were noted in the body mass index score irrespective of stratification and in the blood pressure scores in the overall population and foreign-born Asian American individuals. Compared with US-born individuals, the odds of ideal levels of smoking [ORadj:<5 years: 2.23 (95%CI: 1.45-3.44); 5-15 years: 1.97 (95%CI: 1.27-3.05); 15-30 years: 1.61 (95%CI: 1.11-2.34); ≥30 years: 1.69(95%CI:1.20-2.36)] and diet [ORadj: <5 years: 1.87 (95%CI: 1.26-2.79); 5-15 years: 2.00 (95%CI: 1.38-2.89); 15-30 years: 1.74 (95%CI: 1.14-2.68)] were higher in foreign-born individuals. Foreign-born individuals had lower odds of ideal physical activity levels [ORadj: 5-15 years: 0.55 (95%CI: 0.39-0.79); 15-30 years: 0.68 (95%CI: 0.49-0.95)] and ideal cholesterol levels [ORadj: 5-15 years: 0.59 (95%CI: 0.42-0.82); 15-30 years: 0.54 (95%CI :0.38-0.76); ≥30 years: 0.52 (95%CI: 0.38-0.76)].

Conclusion

The CVH in Asian American individuals declined from 2011 to March 2020. The odds of ideal CVH decreased with increasing duration of stay in the US, with foreign-born individuals residing in the US for ≥30 years having ∼28% lower odds of ideal CVH compared with US-born individuals.

COVID-19 related distress and sleep health among trauma-exposed South Asians: Does generational status matter?

The COVID-19 pandemic has resulted in substantial changes in individual and socio-economic factors that may negatively impact sleep health. We examined associations between COVID-19 related distress and sleep among trauma-exposed South Asian adults in the United States. Since a health advantage among foreign-born individuals has been previously noted in the literature (the 'immigrant paradox'), we also explored if generational status (number of generations one's family has been in the U.S.) moderated associations between COVID-19 related distress and sleep health. Participants were 196 trauma-exposed South Asian adults residing in the U.S. (54% male, 63% U.S.-born citizens, average age = 34.51 years), who completed measures of generational status, COVID-19 related distress, trauma exposure, sleep-related impairment (SRI), and sleep disturbances. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.15, p < 0.001) and SRI (b = 0.24, p < 0.001). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Findings highlight the potential importance of developing interventions to reduce stress and sleep difficulties during the pandemic. Our results did not support the immigration paradox. Future studies are needed to better understand the role of generational status on sleep health across immigrant subgroups.

Life expectancy, life disparity, and differential racialization among Chinese, Asian Indians, and Filipinos in the United States

This article advances differential racialization as a lens to frame health disparity trends within the Asian racial category. Using formal demographic methods, I analyzed data from the Multiple Cause of Death File and the American Community Survey to examine the trends in life expectancy and life disparity among Chinese, Asian Indians, and Filipinos in the United States between 2005 and 2019. While Chinese, Asian Indian, and Filipino life expectancy oscillated between each period under study, those oscillations contributed to an overall widening advantage for Chinese over their Asian Indian and Filipino counterparts. I posit that widening inequalities between the three groups are suggestive of their increasingly disparate racial statuses. These findings underscore the importance of contextualizing disaggregated health data within the social conditions that produce inequalities, namely race/racialization/racism.

Epidemiology of depression among displaced people: A systematic review and meta-analysis

INTRODUCTION

Displaced people are prone to develop mental health problems due to resettlement in new environments, traumatic events and forced migration. Depression is a mental health problem repeatedly observed among displaced people such as refugees, migrants, asylum seekers and internally displaced persons (IDPs). Therefore, estimating the global pooled prevalence of depression as well as pinpointing its determinants may support policymakers and health care workers to mitigate the disease burden and improve the psychological well-being of displaced people.

METHODS

PubMed, EMBASE, CINAHIL, Psych-INFO, and SCOPUS databases were searched for English written relevant observational studies conducted between 1984 and 2020. The methodological quality of studies was assessed using the Newcastle Ottawa Scale (NOS). Heterogeneity across studies was checked using the Q- and I² test. Publication bias was checked by observing Funnel plot symmetry and using Egger's regression test. STATA 16 was used to combine studies using a random effect model.

RESULTS

Of the 4102 studies identified, 81 studies with an overall sample size of 53,458 were included in the current systematic review and meta-analysis. The pooled prevalence estimate of depression among displaced people was 26.4% (95% CI; 22.2-31.1). Also, three in five IDPs, one in three refugees and asylum seekers and one in four migrants suffer from depression globally. Being female migrant [AOR: 2.46 95% CI: 1.79-3.13, I²=34.5%), non-partnered marital status [AOR: 2.29, 95% CI: 1.29-3.30, I²= 0.00%], and perceived low social support [AOR: 1.76, 95% CI: 1.00-2.52, I²=34.6%] were significant determinants of depression among displaced people.

CONCLUSION

Overall, around 1 in 4 displaced people suffer from depression and exceed the prevalence of depression reported by community samples in different nations and demonstrate a need for culturally fitting and targeted responses from migrant/refugee host nations and their serving clinicians.

Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.

Differential COVID-19 testing, admissions, and mortality for Arab Americans in Southern California

BACKGROUND

Understanding of COVID-19 acquisition and severity risk in minoritized groups is limited by data collection on race and ethnicity; very little is known about COVID-19 risk among Arab Americans in the United States.

PURPOSE

To quantify whether Arab Americans in the El Cajon region of California experienced differential levels of SARS-CoV-2 infection, severity and mortality when compared to other racial/ethnic groups.

METHODS

A retrospective study was conducted using Sharp Grossmont Hospital's electronic medical records. Patients were included in the study if they were: 18 years of age or older, tested for SARS-CoV-2, admitted for COVID-19 infection, or had COVID-19 listed as a cause of death between March 1, 2020 and January 31, 2021. The primary outcomes of interest were a positive COVID-19 test result, admission to the hospital due to COVID-19, and in hospital COVID-19 related mortality. Comparisons were made across racial/ethnic groups using chi-squared statistics and logistic regression models adjusted for sociodemographics, comorbidities, and time from March 2020.

RESULTS

Arab Americans had greater odds of testing positive for SARS-CoV-2 than non-Hispanic White (adjusted odds ratio, AOR: 3.83, 95% confidence interval, CI: 3.29, 4.46) and non-Hispanic Black (AOR: 2.34, 95% CI: 1.91, 2.88) patients but lower odds of admission (AOR: 0.47, 95% CI: 0.36, 0.63) and in-hospital mortality (AOR: 0.43, 95% CI: 0.28, 0.65) than Hispanic patients.

CONCLUSIONS

There were distinct patterns for COVID-19 infection, severity, and mortality for Arab Americans in Southern California. Without a dedicated ethnic identifier, COVID-19 disparities facing Arab Americans will continue to go undocumented.

The association of acculturative stress with self-reported sleep disturbance and sleep duration among Asian Americans

STUDY OBJECTIVES

This study aims to examine associations between acculturative stress-defined as the psychological impact, or stress reaction, of adapting to a new cultural context-and self-reported sleep outcomes among Chinese and Korean immigrants in the United States.

METHODS

In this cross-sectional study, acculturative stress was assessed using a 9-item scale, and sleep disturbance was measured using the 8-item scale. Sleep duration was self-reported. Poisson and linear regression analyses were conducted to examine the associations between acculturative stress, sleep disturbance, and sleep duration.

RESULTS

Our sample consists of 400 participants (females: 52%, Chinese: 50%, Koreans: 50%, the mean of age = 58.4). 81.8% of them were classified as having no sleep disturbance, whereas 18.2% were classified as having sleep disturbance. Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (Prevalence Ratio (PR): 1.18, 95% confidence interval (CI): 1.06% to 1.31%). In linear models, a one-unit increase in acculturative stress was associated with 0.08 hr less sleep (p < .05). Interaction tests indicated effect modification for sleep disturbance by sex and ethnic identity: only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13 to 1.49), while the association was significant for individuals identifying as "very Asian" (PR: 1.21; 95% CI: 1.08 to 1.35), but not for those identifying as "mostly Asian" or "bicultural/western".

CONCLUSIONS

If findings are replicated, we suggest developing intervention programs for Asian immigrants to minimize acculturative stress and bolster protective factors that decrease the risk for poor sleep outcomes.Information on Clinical Trial: Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.

Depression, diabetes and immigration status: a retrospective cohort study using the Canadian Longitudinal Study on Aging

BACKGROUND

A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada.

METHODS

We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin A_1c level was 7% or more; we defined participants as having depression if their Center for Epidemiological Studies Depression score was 10 or higher or if they were currently undergoing depression treatment. We excluded those with baseline depression (Cohort 1) and baseline diabetes (Cohort 2) to evaluate the associations between diabetes and depression incidence, and between depression and diabetes incidence, respectively. We constructed logistic regression models with interaction by immigrant status.

RESULTS

Cohort 1 (n = 20 723; mean age 62.7 yr, standard deviation [SD] 10.1 yr; 47.6% female) included 3766 (18.2%) immigrants. Among immigrants, 16.4% had diabetes, compared with 15.6% among nonimmigrants. Diabetes was associated with an increased risk of depression in nonimmigrants (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.08-1.49), but not in immigrants (adjusted OR 1.12, 95% CI 0.80-1.56). Younger age, female sex, weight change, poor sleep quality and pain increased depression risk. Cohort 2 (n = 22 054; mean age 62.1 yr, SD 10.1 yr; 52.2% female) included 3913 (17.7%) immigrants. Depression was associated with an increased risk of diabetes in both nonimmigrants (adjusted OR 1.39, 95% CI 1.16-1.68) and immigrants (adjusted OR 1.60, 95% CI 1.08-2.37). Younger age, male sex, waist circumference, weight change, hypertension and heart disease increased diabetes risk.

INTERPRETATION

We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.

What do We Know About Acculturation? A Measurement Invariance Examination of Acculturation Domains Between Asian and Latinx Populations

Objectives

Acculturation has emerged as a key variable in racial/ethnic minorities and immigrant research. Although findings generally conclude acculturation leads to adverse outcomes (e.g., risk behaviors), scholars often find contradicting results. This increased attention to the core definitional questions about what acculturation is and how it should be measured, specifically across different racial/ethnic groups.

Methods

This study examined the measurement invariance using Multigroup Confirmatory Factor Analysis (MG-CFA) by comparing three common domains of acculturation measures across Asian and Hispanic populations (i.e., Ethnic Identification, Language Proficiency and Preference, and Acculturative Stress) using the National Latino and Asian American Study (NLAAS).

Results

A total sample of 4,649 (nLatinx=2,554 and nAsian=2,095) was used. The results suggested that aspects of ethnic identification and acculturative stress measures significantly varied between groups. For example, Latinxs had higher factor loadings in certain Acculturative Stress items related to government and legal status. In contrast, Asians had higher factor loadings in an item related to Ethnic Identification.

Conclusions

The results suggested that aspects of acculturation do not necessarily measure the same way across all populations; researchers/clinicians should consider racial/ethnic specific scales when using acculturation related measures. Future research should test universal acculturation scales across other ethnic subgroups and include more complex acculturation measures like cultural values and norms.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

The Mutually Reinforcing Cycle Of Poor Data Quality And Racialized Stereotypes That Shapes Asian American Health

The Asian American health narrative reflects a long history of structural racism in the US and the complex interplay of racialized history, immigrant patterns, and policies regarding Asians in the US. Yet owing to systematic issues in data collection including missing or misclassified data for Asian Americans and practices that lead to indiscriminate grouping of unlike individuals (for example, Chinese, Vietnamese, and Bangladeshi) together in data systems and pervasive stereotypes of Asian Americans, the drivers and experiences of health disparities experienced by these diverse groups remain unclear. The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes-the model minority, healthy immigrant effect, and perpetual foreigner-that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This codifies racist biases against the Asian American population in a mutually reinforcing cycle. In this article we describe the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and we highlight examples from the health disparities literature. We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.

Ethnicity and Self-reported Depression Among Hispanic Immigrants in the U.S

Viewed to be healthier than ethnic Hispanics born in the United States, Hispanic immigrants represent numerous subgroups with clearly heterogeneous geographic, cultural, structural, and social origins. This study asked how the factors length of U.S. residency, social status, lifestyle, and health care might explain self-reported depression within 5 large, discrete subgroups comprising immigrants from, in turn, Mexico, Puerto Rico, Cuba, the Dominican Republic, and other nations in Central and South America. The study also examined ethnicity's potential role moderating self-reported depression's associations. With pooled data from National Health Interview Surveys 1999-2015, it evaluated each ethnic group separately. Self-reported depression was associated generally with lengthening residence in the U.S., with being female, with poverty, with unemployment, with lack of education, and with lifestyle and health-care factors. These associations were not uniform across ethnic groups, however. Where self-reported depression is concerned, descriptive results suggest the proverbial health advantage may largely accrue specifically to Hispanic immigrants of Cuban and of Central/South American origin.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Recasting the Immigrant Health Paradox Through Intersections of Legal Status and Race

Immigrant health research has often noted an "immigrant health paradox", the observation that immigrants are "healthier" compared to their native-born peers of similar demographic and socioeconomic profile. This paradox disappears as immigrants stay longer in the host country. Multiple arguments, including migrant selectivity and cultural and behavioral factors have been proposed as reasons for the apparent paradox. Recently, the field has focused on immigrant legal status, especially its racialization. We review the literature on the immigrant health paradox, legal status, and racialized legal status to examine how this debate has taken a more structural approach. We find that immigrant health research has taken a needed intersectional approach, a productive development that examines how different markers of disadvantage work concurrently to shape immigrants' health. This approach, which factors in immigration enforcement practices, aligns with explanations for poor health outcomes among other racialized groups, and promises a fruitful avenue for future research.

A Data-Driven Analysis of Sociocultural, Ecological, and Economic Correlates of Depression Across Nations

The prevalence of depression varies widely across nations, but we do not yet understand what underlies this variation. Here we use estimates from the Global Burden of Disease study to analyze the correlates of depression across 195 countries and territories. We begin by identifying potential cross-correlates of depression using past clinical and cultural psychology literature. We then take a data-driven approach to modeling which factors correlate with depression in zero-order analyses, and in a multiple regression model that controls for covariation between factors. Our findings reveal several potential correlates of depression, including cultural individualism, daylight hours, divorce rate, and GDP per capita. Cultural individualism is the only factor that remains significant across all our models, even when adjusting for spatial autocorrelation, mental healthcare workers per capita, multicollinearity, and outliers. These findings shed light on how depression varies around the world, the sociocultural and environmental factors that underlie this variation, and potential future directions for the study of culture and mental illness.

Differences in post-disaster mental health among Vietnamese and African Americans living in adjacent urban communities flooded by Katrina

Some communities recover more quickly after a disaster than others. Some differentials in recovery are explained by variation in the level of disaster-related community damage and differences in pre-disaster community characteristics, e.g., the quality of housing stock. But distinct communities that are similar on the above characteristics may experience different recovery trajectories, and, if so, these different trajectories must be due to more subtle differences among them. Our principal objective is to assess short-term and long-term post-disaster mental health for Vietnamese and African Americans living in two adjacent communities in eastern New Orleans that were similarly flooded by Hurricane Katrina. We employ data from two population-based cohort studies that include a sample of African American adults (the Gulf Coast Child and Family Health [GCAFH study]) and a sample of Vietnamese American adults (Katrina Impacts on Vietnamese Americans [KATIVA NOLA study]) living in adjacent neighborhoods in eastern New Orleans who were assessed near the second and thirteenth anniversaries of the disaster. Using the 12-Item Short Form Survey (SF-12) as the basis of our outcome measure, we find in multivariate analysis a significant advantage in post-disaster mental health for Vietnamese Americans over their African American counterparts at the two-year mark, but that this advantage had disappeared by the thirteenth anniversary of the Katrina disaster.

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.

Understanding differences within ethnic group designation: comparing risk factors and health indicators between Iranian and Arab Americans in Northern California

BACKGROUND

The Middle Eastern and North African (MENA) ethnic group is a diverse group composed of two primary subsets in the United States: Iranian and Arab Americans. We aimed to compare health risk factors, chronic health conditions, and mental health conditions of Iranian and Arab American adults in Northern California.

METHODS

We used cross-sectional electronic health record (EHR) data from a 2016 Northern California health plan study cohort to compare adults classified as Iranian or Arab American based on ethnicity, language, or surname. We produced age-standardized prevalence estimates of obesity, smoking, hyperlipidemia, prediabetes, diabetes, hypertension, depression, and anxiety for Iranian and Arab American men and women by age group (35-44, 45-64, and 65-84) and overall (35-84). We used generalized linear models to calculate prevalence ratios (PR) to compare Iranian and Arab American adults ages 35-84 on all health indicators.

RESULTS

Compared to Arab Americans, Iranian Americans had a lower prevalence of obesity (PR: 0.77, 95% confidence interval, CI: 0.73, 0.82), current smoking (PR: 0.80, 95% CI: 0.73, 0.89), and ever smoking (PR: 0.95, 95% CI: 0.91, 0.99), but a higher prevalence of hyperlipidemia (PR: 1.09, 95% CI: 1.06, 1.12), prediabetes (PR: 1.12, 95% CI: 1.09, 1.16), depression (PR; 1.41, 95% CI: 1.30, 1.52), and anxiety (PR: 1.52, 95% CI: 1.42, 1.63). Similar patterns were observed for men and women.

CONCLUSION

This work supports the need to collect granular data on race and ethnicity within the MENA ethnic group to improve identification in clinical care settings and population health reporting to better address the physical and mental health needs of different MENA subgroups.

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N = 1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

INTRODUCTION

The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.

METHODS

Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.

RESULTS

Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.

CONCLUSIONS

Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.

Depressive Symptom Severity and Immigration-Related Characteristics in Asian American Immigrants

The study examined immigration factors associated with depressive symptom severity among Asian American immigrants. Participants were 458 Chinese, Korean and Vietnamese adults. Depressive symptom severity was measured by PHQ-9. Overall, the likelihood of being moderately to severely depressed was significantly increased among immigrants living in the US for < 10 years and Korean Americans compared to Chinese Americans. However, mild level of depressive symptoms was not associated with any immigration-related factors. The positive impact of shorter duration of living in the US and a younger age at immigration (≤ 17) on depressive symptoms was evident among women but not among men. For men, marital status and education level were significant predictors of being moderately to severely depressed. Differentiating immigrant factors and identifying depressive symptom severity can help drive community and clinical interventions to detect and treat depression early among Asian American immigrants.

Resilience, Trauma, and Cultural Norms Regarding Disclosure of Mental Health Problems among Foreign-Born and US-Born Filipino American Women

Resilience refers to a set of personal qualities and abilities that allow an individual to confront challenges, risks, or traumatic experiences in an integrated manner and to thrive in the face of significant adversities. This cross-sectional study explores resilience, posttraumatic stress disorder (PTSD), and family norms with disclosure of mental health problems (FNAD) in a sample of 182 Filipino American women (FAW). Participants completed survey measures of resilience, PTSD, and FNAD and open-ended questions about beliefs and reasons for (not) disclosing mental health problems outside the family. Previous research found that the rates of psychological trauma and depression among FAW are higher than those in other Asian ethnic groups, which makes it necessary to investigate the protective characteristic of resilience among FAW. According to our results, foreign-born FAW had a significantly lower PTSD and greater resilience as compared to their US-born counterparts. A significant negative relationship between PTSD and resilience was observed only among foreign-born FAW. We also found a conditional moderating effect of FNAD on the negative relationship between resilience and PTSD. The results of our qualitative analysis of the participants' responses to the open-ended questions of the survey showed that FAW's family norms of nondisclosure are related to the cultural value of "saving face," a salient cultural construct among Asian family members. Results suggest that protective properties of resilience against PTSD are influenced by cultural factors, such as FNAD. Taken together, our findings underscore the importance of considering the impact of collectivistic cultural values (e.g., FNAD) in future research on resilience among Asian Americans.

Heterogeneity in the Association of Citizenship Status on Self-Rated Health Among Asians in California

Citizenship is considered an egalitarian legal identity but may function differently among minorities because of racial/ethnic stratification and historical context. Using Asians, I examine whether the association between citizenship and self-rated health differs by ethnicity. I examine the moderating effect of Asian ethnic group (Chinese, Filipino, Korean, Vietnamese, and Other Asian) on citizenship and self-rated health using the 2012-2016 California Health Interview Survey (n = 11,084). Models account for demographics, socioeconomic status, healthcare, and English proficiency. Adjusting for demographics, naturalized citizens and non-citizens were statistically significantly more likely to report fair/poor health compared to U.S.-born citizens. Naturalized and non-citizen Vietnamese reported statistically significantly poorer health to all U.S.-born groups. These trends largely disappear when controlling for all covariates. Citizenship status can be useful in considering structural barriers for immigrants. Future work should interrogate the non-citizen category and why trends are seen among Vietnamese, but not others.

Evaluating Residential Segregation's Relation to the Clustering of Poor Health across American Cities

Residential segregation by race/ethnicity is widely recognized as a leading source of health disparities. Not clear from past research, however, is the overall health burden cities face due to clustering brought about by segregation. This study builds on previous research by directly measuring how spatially unequal health outcomes are within segregated cities. Utilizing Census-tract data from the Center for Disease Control and Prevention's 500 Cities project, we examine how different dimensions of spatial segregation are associated with the clustering of poor self-rated health in cities. We make novel usage of the Global Moran's I statistic to measure the spatial clustering of poor health within cities. We find spatial segregation is associated with poor health clustering, however the race/ethnicity and dimension of segregation matter. Our study contributes to existing research on segregation and health by unpacking the localized associations of residential segregation with poor health clustering in U.S. cities.

Perceived Discrimination and Mental Well-being in Arab Americans from Southeast Michigan: a Cross-Sectional Study

There is growing evidence for the adverse health effects of structural and individual forms of discrimination in multiple religious, ethnic, and racial groups. Since the September 11, 2001 terrorist attacks, Arab Americans have experienced increasingly more frequent and visible forms of discrimination. However, the impact of these experiences on their mental well-being requires further investigation. This study examines the association between perceived discrimination and several markers of mental health and well-being, using cross-sectional data from a convenience sample of 279 Arab American adults from southeast Michigan. After adjustment for a series of relevant confounders, perceived discrimination was significantly associated with depressive symptoms (estimate 0.93, 95% CI 0.53, 1.34, p < 0.01), anxiety symptoms (estimate 0.48, 95% CI 0.19, 0.77, p < 0.01), and poor self-rated health (OR 1.31, 95% CI 1.08, 1.58, p < 0.01). The study highlights the need to address and mitigate health disparities among individuals of Arab descent and improves awareness of the potential health effects of ongoing structural and interpersonal discrimination toward this 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.

Explaining Chronic Illness and Self-Rated Health Among Immigrants of Five Hispanic Ethnicities

The largest racial/ethnic minority group in the United States, Hispanics, especially Hispanic immigrants, have been considered healthier than groups of other ethnicity (including Whites, the majority). However, chronic illnesses such as cancer and diabetes are often seen in this culturally, ethnically diverse group. The present study had two aims. First was to explain two health outcomes, which were presence of chronic illness (any of the five common conditions cardiovascular disease, stroke, hypertension, cancer, and/or diabetes/prediabetes) and self-rated health, in terms of links to certain factors in acculturation, social status, health, social support, and lifestyle. Second was to determine how uniform these links might be across five ethnic groups: Mexican, Puerto Rican, Cuban, Dominican, Central/South American. We combined data from 17 years of the National Health Interview Survey (1999-2015) and subjected these secondary measures to logistic and linear regression, separately by ethnicity, to explain both outcomes. With few exceptions, results generally linked illness/health to the tested independent variables. Additionally, results confirmed ethnicity to moderate the outcomes' associations with the independent variables. Ethnicity-specific analysis showed the two outcomes to exhibit dissimilar relationships with certain independent variables across ethnic groups. Research that (as has been common) lumps together respondents whose Hispanic ethnicities may differ disregards some meaningful variation rather than accounting for it. In future research-and in subsequent evidence-based policy/practice development-all essential sociocultural factors, including ethnicity, should be carefully outlined, advancing good health for the entire Hispanic immigrant population.

Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients: The Unique Experience of Universally Insured Older Adults

OBJECTIVES

To determine whether racial/ethnic disparities in 30/90/180-day mortality, major morbidity, and unplanned readmissions exist among universally insured older adult (≥65 years) emergency general surgery patients; vary by diagnostic category; and can be explained by variations in geography, teaching status, age-cohort, and a hospital's percentage of minority patients.

SUMMARY OF BACKGROUND DATA

As the US population ages and discussions surrounding the optimal method of insurance provision increasingly enter into national debate, longer-term outcomes are of paramount concern. It remains unclear the extent to which insurance changes disparities throughout patients' postacute recovery period among older adults.

METHODS

Survival analysis of 2008 to 2014 Medicare data using risk-adjusted Cox proportional-hazards models.

RESULTS

A total of 6,779,649 older adults were included, of whom 82.8% identified as non-Hispanic white (NHW), 9.2% non-Hispanic black (NHB), 5.6% Hispanic, and 1.5% non-Hispanic Asian (NHA). Relative to NHW patients, each group of minority patients was significantly less likely to die [30-day NHB vs NHW hazard ratio (95% confidence interval): 0.88 (0.86-0.89)]. Differences became less apparent as outcomes approached 180 days [180-day NHB vs NHW: 1.00 (0.98-1.02)]. For major morbidity and unplanned readmission, differences among NHW, Hispanic, and NHA patients were comparable. NHB patients did consistently worse. Efforts to explain the occurrence found similar trends across diagnostic categories, but significant differences in disparities attributable to geography and the other included factors that combined accounted for up to 50% of readmission differences between racial/ethnic groups.

CONCLUSION

The study found an inversion of racial/ethnic mortality differences and mitigation of non-NHB morbidity/readmission differences among universally insured older adults that decreased with time. Persistent disparities among nonagenarian patients and hospitals managing a regionally large share of minority patients warrant particular concern.

Neighborhood Social Cohesion, Resilience, and Psychological Well-Being Among Chinese Older Adults in Hawai’i

Background and Objectives

A growing body of literature indicates that neighborhood social cohesion is generally associated with lower levels of psychological distress and higher levels of life satisfaction (LS). However, very few studies have examined these relationships among Chinese older adults, the fastest growing aging population across all racial/ethnic groups in the U.S. Focusing on this population, the current study aims to examine the associations of neighborhood cohesion with psychological distress and LS as well as the mediating role of resilience and the moderating role of birth place in the associations.

Research Design and Methods

Ordinary least squares regressions were applied to analyze data collected among 430 Chinese older adults aged 55 and older residing in Honolulu, Hawai’i.

Results

Results show that neighborhood social cohesion was positively associated with lower levels of psychological distress and higher levels of LS for the whole sample. The association between social cohesion and psychological distress was moderated by birth place such that the protecting effects of neighborhood cohesion on distress were only salient for the U.S.-born but not for the foreign-born. Moreover, the mediating role of resilience was identified: It contributed to more than 60% of the association between social cohesion and psychological distress, and more than 22% of the association between social cohesion and LS.

Discussion and Implications

Our findings indicate the importance of a cohesive social environment and resilience in shaping psychological well-being and quality of life for older Chinese adults, the U.S.-born in particular, living in Honolulu, Hawai’i.

Changes in Self-Rated Health Right After Immigration: A Panel Study of Economic, Social, Cultural, and Emotional Explanations of Self-Rated Health Among Immigrants in the Netherlands

Immigrants are often found to rate their health better than the native population does. It is, however, suggested that this healthy immigrant effect declines with an enduring length of stay. With Dutch panel data, we investigate which patterns in self-rated health can be found among immigrants shortly after their migration. We test to what extent economic, social, cultural and emotional explanations affect the changes that immigrants report in self-rated health. Based on a four-wave panel, our results support the immigrants' health decline hypothesis, since the self-rated health decreases in the first years after immigration to the Netherlands. The major change occurs between immigrants rating their health no longer as "very good," but as "good." Shortly after immigration, self-rated health is associated with being employed and a higher income. Hazardous work and physically heavy work decrease self-rated health. Notwithstanding these effects, social, cultural, and emotional explanations turn out to be stronger. A lack of Dutch friends, perceptions of discrimination, perceived cultural distance, and feelings of homesickness strongly affect self-rated health. Furthermore, in understanding changes in self-rated health, the effects of making contact with Dutch people and changes in the perception of discrimination are definitive. However, contact with Dutch people did not decrease and discrimination did not increase over time, making them ineligible as an explanation for overall health decrease. Only the small effect that first-borns have may count as a reason for decreased self-rated health, since many of the recent immigrants we followed started families in the first years after immigration. Our findings leave room for the coined "acculturation to an unhealthier lifestyle thesis," and we see promise in a stronger focus on the role of unmet expectations in the first years after immigration.

Discourse on culture in research on immigrant and migrant workers' health

BACKGROUND

Health and safety researchers and practitioners have proposed that cultural differences help explain inequalities between foreign and native-born workers. While cultural explanations for inequalities have long been debated in other fields, there exists little critique of cultural discourses in occupational health.

METHODS

This article examines and discusses the discourse on culture in 107 articles on immigrant or migrant workers' health published between 2011 and 2015. For each article, passages on culture were identified and analysed for both the context and the manner in which culture was discussed.

RESULTS

The discourse on culture was found to be generally simplistic, individualistic, and uncritical, intentionally or unintentionally supporting the worldview that workers' "otherness" is both cause of inequalities and target for interventions.

CONCLUSION

The article argues that empirical, theoretical and interdisciplinary work is needed to document the mechanisms and pathways that underlie health and safety inequalities by foreign-born status.

Heterogeneity in Tobacco-Use Behaviors Among U.S. Blacks per Global Region of Origin

Heterogeneity in tobacco-use behaviors among U.S. blacks by global region of origin and age at immigration was examined. Self-identified black participants from the 2006-2015 Tobacco Use Supplement to the Current Population Survey were included (n = 47,857). Countries of origin were classified by global regions (U.S., Africa, Europe, West Indies). Multivariable logistic regression models, adjusted for sociodemographic characteristics, were used to examine the association of global region of origin and age at immigration with tobacco-use behaviors. Prevalence of current cigarette smoking among U.S. blacks varied significantly by global region of origin (U.S.-born = 17.4%, Europe-born = 17.7%, Africa-born = 4.7%, West-Indies-born = 4.9%; p < 0.01). Furthermore, foreign-born blacks were less likely than U.S.-born blacks to smoke menthol flavored cigarettes (p < 0.05). Participants who immigrated to the U.S. at ≥ 13 years old were less likely than U.S.-born blacks to start regular smoking as minor (p < 0.05). Tobacco-use behaviors differ by global region of origin and age at immigration in the U.S. black population.

Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk

BACKGROUND

Depression can be debilitating, as well as a risk factor for self-harm and suicide. Social rank theory (SRT) suggests depression stems from feelings of defeat and entrapment that ensue from experiencing oneself to be of lower rank than others. This study aims to review the literature investigating the relationship between self-perceptions of social rank and depressive symptoms or suicidal ideation/behaviour.

METHODS

A keyword search of three psychological and medical databases was completed (Psychinfo, Medline, Web of Knowledge). Studies were quality assessed using established criteria.

RESULTS

An initial 1290 records were identified. After application of inclusion and exclusion criteria, 70 remained measuring depressive symptoms (n = 68), self-harm (n = 3) and suicidal ideation (n = 3). The main measures assessing social rank were the social comparison scale (SCS; n = 32) and subjective social status (SSS, n = 32), with six additional papers including another measure of social rank. In univariate analyses, as perceptions of social rank decreased, depressive symptoms (and suicidal ideation/self-harm) increased. Multivariate analyses indicated that social rank may act as a psychosocial mechanism to explain the relationship between social factors (in particular socio-economic status) and depressive symptoms. Additionally, psychological variables, such as rumination or self-esteem, may mediate or moderate the relationship between social rank and depressive or suicidal symptoms.

LIMITATIONS

Study quality was variable and 89% of studies were cross-sectional.

CONCLUSIONS

Although more prospective research is required, this review highlights the importance of understanding an individual's perception of their social position compared to others as it may lead to an enhanced understanding of the aetiology of depressive disorders.

Is There a Healthy Immigrant Effect Among Women Through Transnational Marriage? Results from Immigrant Women from Southeast Asian Countries in Taiwan

In this study we examine whether there is healthy immigrant effect among women immigrated to Taiwan through transnational marriage. A sample of immigrant women (N = 246) with original nativity of Southeast Asian countries and Taiwanese-born women sample (N = 201) was recruited from December 2008 to December 2009. Their depressive symptoms, acculturative stresses and family functioning were assessed by a series of questionnaires. Immigrant women had lower depressive scores than their native-born counterparts when other potential confounders were controlled for in the multiple regression model. Our findings suggest that the healthy immigrant effect exists among immigrant women in Taiwan. Although such effect may due to immigrant women is a highly selective population with hardy mental characteristics, it is crucial to improve immigrant women's mental health by helping them to enhance the ability of expressing emotions between family members as well as by mitigating socioeconomic inequality of cross-cultural immigrant families.

An association between multiculturalism and psychological distress

Amidst increasing focus on rising rates of substance abuse and suicide among white Americans and extending prior research on intergroup attitudes and health, this study examines a novel factor associated with psychological distress: disagreement with multiculturalism. Using the Portraits of American Life Study (N = 2,292), logistic regressions indicate that for Whites and Hispanics, increased likelihood of psychological distress (depression, hopelessness and worthlessness) is associated with stronger disagreement with multiculturalism, measured as "If we want to create a society where people get along, we must recognize that each ethnic group has the right to maintain its own unique traditions." For Blacks, however, attitudes toward multiculturalism are not associated with psychological distress. Future research might determine if these results can be replicated, and if so, identify the causal mechanism(s) at work.

Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis

As the number of migrants worldwide increases, it is worthwhile to examine the extent to which depression has affected this group of often vulnerable individuals. The purpose of this systematic review and meta-analysis is to examine the aggregate prevalence of depression among international migrants and to explore the variations in prevalence with demographic and educational factors. A search was conducted on the online databases PubMed and ScienceDirect whole using the terms "depression", "depressive disorder", "immigration", "immigrant", "migration", and "migrant". A total of 25 studies met our inclusion criteria. A random-effects model meta-analysis calculated an aggregate prevalence of 15.6% among migrants. Heterogeneity was identified by meta-regression and subgroup analyses, and the level of educational attainment, employment status, and length of residency spent in country of migration were found to be significant moderators contributing to depression prevalence. In conclusion, newly arrived migrants appear to be susceptible to developing depression and it is imperative that more in the form of preventive strategies and increased assistance be incorporated to ensure their psychological wellbeing and improve their mental health outcomes. Further research should be conducted to better understand the risk of psychiatric disorders among members of this subpopulation.

Immigrant health trajectories in historical context: Insights from European immigrant childhood mortality in 1910

Recent studies of immigrant health have focused on an apparent paradox in which some new immigrants arrive healthier than expected but exhibit poorer health outcomes with duration of residence. Although a variety of explanations have been put forth for this epidemiological pattern, questions remain about the socio-historical generalizability of the empirical findings and accompanying theoretical explanations. By examining childhood mortality patterns of European immigrants to the United States in the early 20th century, this study tests hypotheses from current immigrant health literature in a previous era of immigration. In contrast with post-1965 immigrant groups, European arrivals did not have better outcomes than their U.S.-born white counterparts. Rather, their rates corresponded to a "middle tier" status in between U.S.-born black and white populations. Analysis of post-migration trajectories returned mixed results that similarly differ from contemporary patterns. Many new immigrant groups had higher rates of excess childhood mortality than their U.S-born counterparts, but outcomes appear to have improved with duration of residence or among the second generation. These findings suggest socio-historical variation in the context of reception may act as a "fundamental cause" of immigrant health and mortality outcomes.