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Devillanova C, Franco C, Spada A. Downgraded dreams: Labor market outcomes and mental health in undocumented migration. SSM Popul Health 2024; 26:101652. [PMID: 38516529 PMCID: PMC10950686 DOI: 10.1016/j.ssmph.2024.101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/02/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.
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Affiliation(s)
- Carlo Devillanova
- Department of Social and Political Sciences and Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy
| | - Cristina Franco
- European Commission, Directorate-General for Neighbourhood Policy and Enlargement Negotiations, Belgium
| | - Anna Spada
- On Behalf of Naga, Organizzazione di Volontariato per l’Assistenza Socio-Sanitaria e per i Diritti di Cittadini Stranieri, Rom e Sinti, Italy
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Santaularia NJ, Hunt SL, Bonilla Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01999-x. [PMID: 38713369 DOI: 10.1007/s40615-024-01999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines-regardless of citizenship status and increasing rates of preterm birth and low birth weight infants. METHODS AND RESULTS We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy. CONCLUSION Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Affiliation(s)
- N Jeanie Santaularia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Shanda Lee Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Hamad R. Immigrants to the United States contribute to society: Here are 3 ways to support their transition. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae019. [PMID: 38435810 PMCID: PMC10906102 DOI: 10.1093/haschl/qxae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
The number of migrants entering the United States in 2023 shattered records. Despite prevailing narratives, immigrants, on average, contribute substantially to US society. Rather than slamming the door in the faces of newcomers, federal, state, and local policymakers should provide services to these individuals to ensure they have the maximum opportunity to thrive, both for their own benefit and for the greater social good. Public health and social science research provides ample rigorous evidence on the benefits of different types of investments in these vulnerable individuals upon their arrival in our country. In this Commentary, I review 3 examples of potential evidence-based investments: social inclusion, meeting basic needs, and supportive neighborhoods.
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Affiliation(s)
- Rita Hamad
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA 02115, United States
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Platt R, Alvarez K, Vasquez MG, Bancalari P, Acosta J, Caicedo MR, Polk S, Wilcox H. Suicide prevention programming across ecological levels: Recommendations from Latinx immigrant origin youth and their parents. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2024; 42:101-115. [PMID: 37616106 PMCID: PMC10891300 DOI: 10.1037/fsh0000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Latinx immigrant-origin youth (IOY) have unique risks for suicidal thoughts and behaviors. It has been suggested that these risks should be addressed from an ecological perspective, addressing cultural and family context as well as structural and systemic barriers to prevention. This study sought to explore perspectives of immigrant-origin Latinx adolescents and their caregivers on suicide and its prevention, including the potential impact of stressors specific to immigrant status. METHOD Focus groups were conducted in 2018-2019 with Latinx immigrant-origin caregivers (N = 41, 97.5% female) and adolescents (ages = 14-19, N = 56, 50% female). Participants were recruited from community-based organizations in two different cities. A codebook approach to thematic analysis was used to identify themes, which were subsequently mapped onto levels of the Center for Disease Control's Social-Ecological Framework for Violence Prevention. RESULTS Participants identified both contributors to suicidal behavior and potential components of prevention programming across ecological levels. Specific recommendations for suicide prevention included engaging in recreation, parenting education and support, enhancing academic supports for adolescents, and enhancing school-family communication. Structural barriers (e.g., caregiver work schedules) to implementing recommendations were described. DISCUSSION Our results highlight the potential role of access to school and community-based supports as public health-oriented suicide prevention strategies and suggest a need to address barriers faced by immigrant families in accessing these supports alongside addressing barriers to mental health treatment. Policies impacting immigrant families' financial stability and increasing the availability of recreational and academic opportunities may promote mental health and prevent suicidal thoughts and behavior among IOY. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kiara Alvarez
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Pilar Bancalari
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- NYC Administration for Children’s Services, New York, NY
| | - Jennifer Acosta
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Maryland Department of Health, Baltimore, MD
| | - Mariana Rincon Caicedo
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychology, University of Kansas, Lawrence, KS
| | - Sarah Polk
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Holly Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Hodges JC, McKetchnie SM, González A, Hawkins SS. The Impacts of Inclusionary State Immigrant Policies on Psychosocial Outcomes Among Latinx Adolescents. J Am Acad Child Adolesc Psychiatry 2024; 63:355-364. [PMID: 37414094 DOI: 10.1016/j.jaac.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/28/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE State-level policies that exclude immigrants, primarily undocumented, from public services and benefits have been found to have negative psychosocial impacts on Latinx adults, regardless of nativity. The effects of inclusionary policies-that is, extending public benefits to all immigrants-remain underexamined, as well as the impacts on adolescents. METHOD We used data from the Youth Risk Behavior Survey from 2009 to 2019 to examine the association between 7 state-level inclusionary policies and bullying victimization, low mood, and suicidality among Latinx adolescents via 2-way fixed-effects log-binomial regression models. RESULTS Banning the use of eVerify in employment was associated with decreased bullying victimization (prevalence ratio [PR] = 0.63, 95% CI: 0.53-0.74), low mood (PR = 0.87, 95% CI: 0.78-0.98), and suicidality (PR = 0.73, 95% CI: 0.62-0.86). Extending public health insurance coverage was associated with decreased bullying victimization (PR = 0.57, 95% CI: 0.49-0.67), and mandating Culturally and Linguistically Appropriate Services (CLAS) training for health care workers was associated with decreased low mood (PR = 0.79, 95% CI: 0.69-0.91). Extending in-state tuition to undocumented students was associated with increased bullying victimization (PR = 1.16, 95% CI: 1.04-1.30), and extending financial aid was associated with increased bullying victimization (PR = 1.54, 95% CI: 1.08-2.19), low mood (PR = 1.23, 95% CI: 1.08-1.40), and suicidality (PR = 1.38, 95% CI: 1.01-1.89). CONCLUSION The relationships between inclusionary state-level policies and Latinx adolescent psychosocial outcomes were mixed. Although most inclusionary policies were associated with improved psychosocial outcomes, Latinx adolescents residing in states with inclusionary policies related to higher education had worse psychosocial outcomes. Results suggest the importance of elucidating the unintended consequences of well-intentioned policies and the importance of continued efforts to reduce anti-immigrant sentiment.
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Affiliation(s)
- James C Hodges
- School of Social Work, Boston College, Chestnut Hill, Massachusetts.
| | | | - Andrés González
- School of Theology and Ministry, Boston College, Chestnut Hill, Massachusetts
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Johnson AL, Levesque C, Lewis NA, Asad AL. Deportation threat predicts Latino US citizens and noncitizens' psychological distress, 2011 to 2018. Proc Natl Acad Sci U S A 2024; 121:e2306554121. [PMID: 38377187 PMCID: PMC10907276 DOI: 10.1073/pnas.2306554121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/02/2023] [Indexed: 02/22/2024] Open
Abstract
The national context of deportation threat, defined as the federal government's approach to deportation and/or deportation's salience to the US public, fluctuated between 2011 and 2018. US Latinos across citizenship statuses may have experienced growing psychological distress associated with these changes, given their disproportionate personal or proximal vulnerabilities to deportation. Drawing on 8 y of public- and restricted-access data from the National Health Interview Survey (2011 to 2018), this article examines trends in psychological distress among Latinos who are US-born citizens, naturalized citizens, and noncitizens. It then seeks to explain these trends by considering two theoretical pathways through which the national context of deportation threat could distress Latinos: 1) through discrete dramatic societal events that independently signal a change to the country's approach to deportation and/or that render deportation temporarily more salient to the public or 2) through more gradual changes to the country's everyday institutional (i.e., quotidian efforts to detain and deport noncitizens) and social (i.e., deportation's ongoing salience to a concerned public) environment of deportation threat. We find that, though both pathways matter to some degree, there is more consistent evidence that the gradual changes are associated with Latino US citizens and noncitizens' overall experiences of psychological distress. The article highlights how, even absent observable spillover effects of dramatic societal events bearing on deportation threat, the institutional and social environment in which they occur implicates Latinos' well-being.
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Affiliation(s)
- Amy L. Johnson
- Department of Sociology and Anthropology, Lehigh University, Bethlehem, PA18015
| | | | - Neil A. Lewis
- Department of Communication, Cornell University, Ithaca, NY14850
| | - Asad L. Asad
- Department of Sociology, Stanford University, Stanford, CA94305
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Timilsina L. Immigration policy shocks and infant health. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101309. [PMID: 37862953 DOI: 10.1016/j.ehb.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
This paper evaluates the effect of positive and negative immigration policy shocks on infant health outcomes in the U.S. I examine changes in mean birth weight and the incidence of low birth weight (LBW) at the metropolitan statistical area (MSA) level around two major institutional shocks: The 1986 Immigration Reform Act (IRCA), which favored immigrants, and the increase in Immigration and Customs Enforcement (ICE) agency arrests at the start of 2017 which might have put immigrants at greater risk of apprehension. It uses a triple difference approach, comparing birth outcomes of foreign-born mothers with U.S.-born mothers (relative to mothers living in MSAs with a higher and lower concentration of IRCA applications and an increase in ICE arrests) before and after the two immigration policies. I find that in MSAs that had higher IRCA applications, mean birth weight increased, and the incidence of LBW decreased by 3-6 percent for babies born to foreign-born mothers. By contrast, in MSAs that had higher ICE arrests starting in 2017, mean birth weight decreased, and the incidence of LBW increased by 3-7 percent for babies born to foreign-born mothers. The effect of the increase in ICE arrests was more pronounced among mothers who were born in Latin and Central American countries. Sub-sample analysis shows that the incidence of LBW increased by as much as 12 percent for babies born to foreign-born mothers of Hispanic origin.
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Affiliation(s)
- Laxman Timilsina
- Department of Economics, Connecticut College, United States of America.
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Garcini LM, Domenech Rodríguez MM, Mercado A, Silva M, Cadenas G, Galvan T, Paris M. Anti-immigration policy and mental health: Risk of distress and trauma among deferred action for childhood arrivals recipients in the United States. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:1067-1075. [PMID: 35482682 PMCID: PMC9867934 DOI: 10.1037/tra0001228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study examined the association between immigration legal status and distress from the announcement of the termination of the Deferred Action for Childhood Arrivals (DACA) program among individuals affected by this potentially traumatic event (PTE), along with identifying relevant risk factors. METHOD Participants (N = 233) affected by the termination announcement provided cross-sectional self-reports on distress from the announcement that was measured using the Impact of Events Scale-Revised. RESULTS Of the participants, 40.7% met the clinical cutoff for distress from the PTE indicative of posttraumatic stress disorder. DACA recipients had significantly higher levels of distress from the PTE compared with non-DACA undocumented immigrants and documented counterparts, χ²(2, N = 233) = 23.25, p < .001. After controlling for covariates, being a DACA recipient (OR = 4.11, 95% confidence interval [1.99, 8.50], p < .001), being male (OR = 2.06, [1.05, 4.03], p = .035), and having lower financial security (OR = .54, [.38, .75], p < .001) were significantly associated with distress. CONCLUSION The future of DACA recipients is uncertain, which can be trauma inducing. The field of psychology needs to make space for this kind of experience as potentially traumatic. Advocacy efforts to shift immigration policies can be strengthened to alter the negative effects of the potential termination of DACA on those affected by it. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Luz M. Garcini
- Joe R and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio
| | | | - Alfonso Mercado
- Department of Psychology, University of Texas Rio Grande Valley
| | | | | | - Thania Galvan
- Department of Psychiatry, Medical University of South Carolina
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Biddle L, Hintermeier M, Costa D, Wasko Z, Bozorgmehr K. Context, health and migration: a systematic review of natural experiments. EClinicalMedicine 2023; 64:102206. [PMID: 37936656 PMCID: PMC10626165 DOI: 10.1016/j.eclinm.2023.102206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Migration health research pays little attention to the places into which people migrate. Studies on health effects of contextual factors are often limited because of the ability of individuals to self-select their environment, but natural experiments may allow for the causal effect of contexts to be examined. The objective was to synthesise the evidence on contextual health effects from natural experiments among migrant groups. Methods We performed a systematic review of natural experiments among migrant populations in PubMed/MEDLINE, The Cochrane Library, Web of Science, CINAHL and Google Scholar for literature published until 13 October 2022. 5870 articles were screened in duplicate using the following inclusion criteria: quantitative natural experiment design, migrant population, context factor as treatment variable and health or healthcare outcome variable. Synthesis without meta-analysis was performed following quality appraisal using the EPHPP tool for quantitative studies and data extraction (PROSPERO: CRD42020169236). Findings The 46 included articles provide evidence for negative effects of neighbourhood disadvantage on physical health and mortality, while finding mixed effects on mental health. Articles comparing migrants with those that stayed behind demonstrate detrimental effects of migration and adverse post-migratory contexts on physical health and mortality, while demonstrating favourable effects for mental and child health. Natural experiments of policy environments indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality, as well as the positive health effects when restrictions are lifted. Interpretation Natural experiments complement observational studies and provide robust evidence to advocate for more inclusive migration, health and social policies as well as neighbourhood improvement programmes. In order to strengthen the methodological approach, future research utilising natural experiments should be more explicit in the mechanisms underlying the experiment and provide details on potential causal mechanisms for the observed effects. Funding German Science Foundation (FOR: 2928/GZ: BO5233/1-1).
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Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- German Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Maren Hintermeier
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
| | - Zahia Wasko
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Sepassi A, Garcia S, Tanjasiri S, Lee S, Bounthavong M. Predicted Health Literacy Disparities Between Immigrant and US-Born Racial/Ethnic Minorities: a Nationwide Study. J Gen Intern Med 2023; 38:2364-2373. [PMID: 36849863 PMCID: PMC10406741 DOI: 10.1007/s11606-023-08082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Racial/ethnic minorities in the USA exhibit reduced health literacy (HL) proficiency, leading to increased health disparities. It is unclear how the effect of birth status (immigrant/US-born) affects HL proficiency among racial/ethnic minorities. OBJECTIVE To identify the direct, indirect, and total effects of birth status on HL proficiency among a nationally representative population of racial/ethnic minority adults in the USA. DESIGN A cross-sectional study of 2019 data from the Medial Expenditure Panel Survey. PARTICIPANTS Participants aged 18 or older reporting as racial/ethnic minorities (Black, Asian, or Hispanic) with non-missing data. MAIN MEASURES We predicted HL proficiency for each participant using a previously published model. Path analysis was used to estimate the direct, indirect, and total effects of birth status on HL proficiency, accounting for several other covariates. Prevalence ratios were estimated using adjusted Poisson regression to evaluate differences in the "Below Basic" HL category. KEY RESULTS An estimated weighted 81,092,505 participants were included (57.5% US-born, 42.5% immigrant). More racial/ethnic minority immigrant participants fell into the lowest category of HL proficiency, "Below Basic" (14.3% vs 5.5%, p < 0.05). Results of the path analysis indicated a significant, negative direct effect of birth status on HL proficiency (standardized coefficient = - 0.24, SE = 0.01, 95%CI: - 0.26, - 0.23) in addition to an indirect effect mediated through insurance status, health-system resource use, and English proficiency. The total effect of birth status on HL proficiency was found to be - 0.29. The immigrant participant group had 81% higher prevalence of falling into the "Below Basic" HL category compared to US-born participants (prevalence ratio = 1.81, 95%CI: 1.52, 2.16). CONCLUSIONS Immigrant status has a strong, negative, direct effect on HL proficiency among racial/ethnic minorities in the USA. This may be a result of barriers that prevent equitable access to resources that improve proper HL proficiency. US policymakers may consider several methods to reduce this disparity at the health-system-, provider-, and patient-levels.
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Affiliation(s)
- Aryana Sepassi
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, 802 W Peltason Dr., Irvine, CA, 92617, USA.
| | - Samantha Garcia
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, Los Angeles, CA, USA
| | - Sora Tanjasiri
- Department of Epidemiology & Biostatistics, Program of Public Health, University of California, Irvine, Irvine, CA, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Mark Bounthavong
- Division of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
- Department of Veteran Affairs, Health Economic Resource Center, Menlo Park, CA, USA
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Refle JE, Fakhoury J, Burton-Jeangros C, Consoli L, Jackson Y. Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland. SSM Popul Health 2023; 22:101398. [PMID: 37123558 PMCID: PMC10130692 DOI: 10.1016/j.ssmph.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.
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Affiliation(s)
- Jan-Erik Refle
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Julien Fakhoury
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Corresponding author. Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Rue Gabrielle Perret Gentil 4, 1211, 14 Geneva, Switzerland.
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Clark EC, Cranston E, Polin T, Ndumbe-Eyoh S, MacDonald D, Betker C, Dobbins M. Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review. BMC Public Health 2022; 22:2162. [PMCID: PMC9685079 DOI: 10.1186/s12889-022-14603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractStructural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
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Squires A, Thompson R, Sadarangani T, Amburg P, Sliwinski K, Curtis C, Wu B. International migration and its influence on health. Res Nurs Health 2022; 45:503-511. [DOI: 10.1002/nur.22262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing New York University New York New York USA
- Grossman School of Medicine New York University New York New York USA
| | - Roy Thompson
- Sinclair School of Nursing University of Missouri Columbia Missouri USA
| | - Tina Sadarangani
- Rory Meyers College of Nursing New York University New York New York USA
| | - Polina Amburg
- School of Nursing Monmouth University Long Branch New Jersey USA
| | - Kathy Sliwinski
- School of Nursing, Center for Health Outcomes and Policy Research University of Pennsylvania Philadelphia Pennsylvania USA
| | - Cedonnie Curtis
- School of Nursing La Salle University Philadelphia Pennsylvania USA
| | - Bei Wu
- P50 Center for Asian Health Promotion and Equity, Rory Meyers College of Nursing New York University New York New York USA
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14
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Torres JM, Alcala E, Shaver A, Collin DF, Franck LS, Gomez AM, Karasek D, Nidey N, Hotard M, Hamad R, Pacheco-Werner T. The Deferred Action for Childhood Arrivals program and birth outcomes in California: a quasi-experimental study. BMC Public Health 2022; 22:1449. [PMID: 35906553 PMCID: PMC9338458 DOI: 10.1186/s12889-022-13846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts. METHODS We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009-2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012-2015) and in the subsequent 3 years (2015-2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage. RESULTS In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (- 0.018, 95% CI: - 0.035, - 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period. CONCLUSIONS These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time.
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Affiliation(s)
- Jacqueline M. Torres
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, UC San Francisco, 550 16th Street, 94143 San Francisco, CA USA
| | - Emanuel Alcala
- grid.263091.f0000000106792318Central Valley Health Policy Institute, California State University, Fresno, Fresno, San Francisco, CA USA ,grid.266096.d0000 0001 0049 1282Department of Public Health, UC Merced, Merced, CA USA
| | - Amber Shaver
- grid.263091.f0000000106792318Central Valley Health Policy Institute, California State University, Fresno, Fresno, San Francisco, CA USA
| | - Daniel F. Collin
- grid.266102.10000 0001 2297 6811Department of Family and Community Medicine, UC San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Preterm Birth Initiative, UC San Francisco, San Francisco, CA USA
| | - Linda S. Franck
- grid.266102.10000 0001 2297 6811Department of Family Health Care Nursing, University of California, San Francisco, CA USA
| | - Anu Manchikanti Gomez
- grid.47840.3f0000 0001 2181 7878Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA USA
| | - Deborah Karasek
- grid.266102.10000 0001 2297 6811Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Francisco, San Francisco, CA USA
| | - Nichole Nidey
- grid.239573.90000 0000 9025 8099Cincinnati Children’s Hospital, Cincinnati, OH USA
| | - Michael Hotard
- grid.168010.e0000000419368956Immigration Policy Lab, Stanford University, Stanford, CA USA
| | - Rita Hamad
- grid.266102.10000 0001 2297 6811Department of Family and Community Medicine, UC San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Philip R. Lee Institute for Health Policy Studies, UC San Francisco, San Francisco, CA USA
| | - Tania Pacheco-Werner
- grid.263091.f0000000106792318Central Valley Health Policy Institute, California State University, Fresno, Fresno, San Francisco, CA USA
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15
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Sudhinaraset M, Ling I, Gao L, Chavarin J, Gee GC. The association between Deferred Action for Childhood Arrivals, health access, and mental health: the role of discrimination, medical mistrust, and stigma. ETHNICITY & HEALTH 2022; 27:1075-1087. [PMID: 33276705 DOI: 10.1080/13557858.2020.1850647] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There are approximately 11 million undocumented immigrants in the US, including 1.3 million young adults who are eligible for the Deferred Action for Childhood Arrivals (DACA) program. It is unclear how DACA influences engagement in healthcare or depressive symptoms, and the role of discrimination, medical mistrust, and stigma in healthcare settings. This study assesses the association of DACA on undocumented young adults' engagement with health care and depressive symptoms. DESIGN We conducted an internet-based survey examining the health-related experiences of undocumented Latino and Asians and Pacific Islander (API) young adults in California (n = 218) between June and August 2017. Multivariable logistic regressions were conducted to assess the influence of DACA, discrimination, medical mistrust, and stigma on healthcare engagement and depressive symptoms. RESULTS Approximately 78% of respondents had a gap in healthcare, and about 31% reported high levels of depressive symptoms. Controlling for demographic characteristics, compared to those without DACA, DACA-recipients had lower odds of reporting gaps in healthcare engagement (aOR = 0.270, p < 0.05) and depressive symptoms (aOR = 0.115, p < 0.01). Those facing discrimination, medical mistrust, and stigma in healthcare settings were less likely to have a healthcare visit and more likely to have higher depressive symptoms. CONCLUSIONS DACA is a potential strategy to improve healthcare access and address the mental health of undocumented populations. In particular, issues of discrimination, stigma by healthcare providers, and medical mistrust need to be addressed.
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Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Irving Ling
- School of Medicine, University of California, San Francisco, CA, USA
| | - Leiwen Gao
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Gilbert C Gee
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
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16
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Crookes DM, Stanhope KK, Suglia SF. Immigrant-Related Policies and the Health Outcomes of Latinx Adults in the United States: A Systematic Review. Epidemiology 2022; 33:593-605. [PMID: 35439769 PMCID: PMC9156534 DOI: 10.1097/ede.0000000000001480] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND US federal and subfederal immigrant-related policy activity has increased in recent years. We hypothesize that these policies are structural determinants of health for Latinx communities, operating through access to resources, discriminatory enforcement, and stress. METHODS We searched seven databases for quantitative studies, published as of September 2021, examining the association between the presence of federal, state, or local immigrant-related policy(ies), over time or cross-sectionally, and mental or physical health outcomes among immigrant or US-born Latinx adults. We rated studies on methodologic quality. RESULTS Eleven studies were included. Policies included federal and state policies. Health outcomes included mental health (seven studies), self-rated health (n = 6), and physical disability (n = 1). Among immigrant, noncitizen, or Spanish-preferring Latinx adults, exclusionary policies were associated with poor self-rated health, physical disability, and poor mental health. Inclusive policies were associated with better health, although null findings were more common than among studies of exclusionary policies. Only three studies separately examined policy effects on US-born or citizen Latinx adults and these findings were often null. All studies received a weak overall study quality rating; among quality domains, studies were strongest in confounding control and weakest in outcome information bias and reporting missing data approaches. CONCLUSIONS These results support the hypothesis that immigrant-related policies, especially exclusionary policies, are structural drivers of health for immigrant or noncitizen Latinx adults. However, evidence is scant among US-born or citizen Latinx adults. Studies of policies and physical health outcomes besides disability are lacking, as are results disaggregated by nativity and/or citizenship status.
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Affiliation(s)
- Danielle M. Crookes
- Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences and College of Social Sciences and Humanities, Department of Anthropology and Sociology, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Kaitlyn K. Stanhope
- Emory University, School of Medicine, Department of Gynecology and Obstetrics, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Shakira F. Suglia
- Emory University, Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
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17
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Bacong AM, Đoàn LN. Immigration and the Life Course: Contextualizing and Understanding Healthcare Access and Health of Older Adult Immigrants. J Aging Health 2022; 34:1228-1243. [PMID: 35641140 DOI: 10.1177/08982643221104931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country. METHODS We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972-2000" and 2015-2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties. RESULTS Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country. DISCUSSION/IMPLICATIONS Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging.
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Affiliation(s)
- Adrian M Bacong
- Department of Community Health Sciences, 25808UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Lan N Đoàn
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, New York, NY, USA
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18
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Getrich CM, Ortez-Rivera A, Umanzor D, Burdette A. Manoeuvering through the Multilayered Jurisdictional Policy Patchwork: DACA Recipients' Navigational Capital in the Washington, D.C. Metropolitan Region. ETHNIC AND RACIAL STUDIES 2022; 46:141-165. [PMID: 36582943 PMCID: PMC9793846 DOI: 10.1080/01419870.2022.2062251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/29/2022] [Indexed: 06/17/2023]
Abstract
During its almost-decade of existence, Deferred Action for Childhood Arrivals (DACA) has been a focal point of immigration policy debate. Liminally legal DACA recipients have endured a rollercoaster of lawsuits and court decisions, yet are simultaneously incorporating into local communities characterized by distinctive socio-legal contexts. Drawing from a longitudinal qualitative study of 30 DACA recipients in the Washington, D.C. Metropolitan region, we argue that DACA recipients draw from their legal-spatial consciousness and local knowledge to forge navigational capital that allows them to adeptly maneuver between different jurisdictions. Over time, they deploy this navigational capital to strategically access distinct yet interconnected educational, health care, housing, and employment sectors and expand their spatial mobility, underscoring their capacity for adaptation and resilience. As forms of collective knowledge, their navigational capital reverberates through their social networks as they broker on-the-ground forms of inclusion for themselves and their families and communities within these socio-legal contexts.
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Affiliation(s)
| | | | - Delmis Umanzor
- Prince George's County Public Schools, University of Maryland, College Park
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19
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Manalo-Pedro E, Sudhinaraset M. Deferred depression? Mediation analysis of Deferred Action for Childhood Arrivals and immigration enforcement among Undocumented Asian and Pacific Islander students. SSM Popul Health 2022; 17:101008. [PMID: 35005188 PMCID: PMC8715231 DOI: 10.1016/j.ssmph.2021.101008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Undocumented Asians and Pacific Islanders (UndocuAPI) comprise 25% of undocumented students. Yet few studies have examined UndocuAPI mental health in the context of the contradictory political environment which encompasses both inclusionary policies, such as Deferred Action for Childhood Arrivals (DACA), and exclusionary policies, like immigration enforcement. METHODS Using cross-sectional survey data collected in 2019 from UndocuAPI college students and recent alumni in California (n = 174), we used multiple logistic regression to estimate the effect of DACA status on clinical levels of depressive symptoms. We tested whether immigration enforcement experiences mediated this relationship using the Karlson, Holm, and Breen (KHB) method. RESULTS Adjusted logistic regression results revealed that UndocuAPI with DACA had significantly lower odds of depression (OR = 0.32, 95% CI: 0.13-0.79). Out of five immigration enforcement factors, limited contact with friends and family (OR = 2.36, 95% CI: 1.08, 5.13) and fearing deportation most or all of the time (OR = 3.62, 95% CI: 1.15, 11.34) were associated with significantly higher odds of depression. However, we did not detect a statistically significant mediation effect of immigration enforcement using KHB decomposition. CONCLUSION Findings suggest that the benefits of DACA protected UndocuAPI in California from depressive symptoms, even when accounting for immigration enforcement experiences. Because it was unclear whether immigration enforcement mediates DACA, future research should investigate the underlying mechanisms between immigration policies and mental health with larger samples. Practitioners should consider the short-term need for mental health support and legal services for UndocuAPI students as well as the long-term goal to decriminalize immigrant communities to advance racial health equity.
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Affiliation(s)
- Erin Manalo-Pedro
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - May Sudhinaraset
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
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20
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Differences in Barriers to Healthcare and Discrimination in Healthcare Settings Among Undocumented Immigrants by Deferred Action for Childhood Arrivals (DACA) Status. J Immigr Minor Health 2022; 24:937-944. [PMID: 35226220 PMCID: PMC9256563 DOI: 10.1007/s10903-022-01346-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 10/25/2022]
Abstract
AbstractUndocumented immigrants face barriers to and discrimination in healthcare, but those with Deferred Action for Childhood Arrivals (DACA) status may fare better. This analysis uses the cross-sectional BRAVE Study of young undocumented Latinx and Asian immigrants to examine differences in barriers to and discrimination in healthcare by DACA status. A majority of respondents experienced financial, language, and cultural barriers, and up to half experienced documentation status barriers, discrimination when seeking healthcare or by a health provider, and negative experiences related to documentation status. In multivariable analyses, DACA recipients have over 90% lower odds of language and cultural barriers, approximately 80% lower odds of discrimination when seeking healthcare and by a health provider, and approximately 70% lower odds of documentation status barriers and negative experience related to documentation status compared to nonrecipients. These findings indicate that DACA recipients experience fewer barriers to healthcare and discrimination in healthcare compared to nonrecipients.
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21
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Sudhinaraset M, Landrian A, Choi HY, Ling I. Redefining communities: The association between deferred action, online and offline social capital and depressive symptoms among undocumented young adults. Prev Med Rep 2021; 24:101563. [PMID: 34976629 PMCID: PMC8683852 DOI: 10.1016/j.pmedr.2021.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/30/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
An explosion in Internet use, social networking sites, and COVID-19 has promoted a new concept in health - online social capital, defined as linkages to online social networks that promote trust and group norms. Particularly for the 1.3 million undocumented young adult immigrants who "live in the shadows," the Internet may serve as a place of support and information. This study examines the association between documentation status (defined as Deferred Action for Childhood Arrivals (DACA) status), offline social capital, online social capital, and depressive symptoms among foreign-born Latino and Asian and Pacific Islander young adults in California (N = 208) using data from an internet-based survey conducted in 2017. This study found that those without DACA status had higher online social capital (p < 0.001) and increased depressive symptoms (p = 0.01) than those with DACA status. Using linear regression, we found evidence of online social capital potentially mediating the relationship between DACA status and depressive symptoms. This study also found that as offline social capital increases, the association between online social capital on depressive symptoms decreases. This study points to the power of offline communities and the importance of increasing access to community resources, particularly to those without documentation status who may only have online social networks.
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Affiliation(s)
- May Sudhinaraset
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
| | - Amanda Landrian
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
| | - Hye Young Choi
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Irving Ling
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA
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22
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Torres A, Kenemore J, Benham G. A Comparison of Psychological Stress and Sleep Problems in Undocumented Students, DACA Recipients, and U.S. Citizens. J Immigr Minor Health 2021; 24:928-936. [PMID: 34822050 DOI: 10.1007/s10903-021-01315-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
Amidst the uncertainty of a shifting political landscape, our study examined stress and sleep problems experienced by both Deferred Action for Childhood Arrivals (DACA) undergraduates and non-DACA undocumented immigrants in an undergraduate population, in relation to students who were US citizens. We surveyed 969 students (93% Hispanic; 69% female) in 2017 or 2019 using established measures of stress, sleep quality, and insomnia. Collapsed across years, undocumented students reported significantly greater stress than citizens and DACA students, but DACA students did not differ from citizens. No differences were found in sleep for either quality or insomnia. Additionally, DACA student stress was significantly higher in 2019 than 2017, rising to a level similar to that of undocumented students and that differed significantly from citizens. Undocumented students appear to experience greater stress than students who are U.S. citizens, but these differences do not extend to sleep quality or insomnia.
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Affiliation(s)
- Andy Torres
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX, 78539, USA
| | - Jordan Kenemore
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX, 78539, USA
| | - Grant Benham
- Department of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr., Edinburg, TX, 78539, USA.
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23
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Recasting the Immigrant Health Paradox Through Intersections of Legal Status and Race. J Immigr Minor Health 2021; 23:1092-1104. [PMID: 33656653 PMCID: PMC10022586 DOI: 10.1007/s10903-021-01162-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/23/2022]
Abstract
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.
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24
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Friedman AS, Venkataramani AS. Chilling Effects: US Immigration Enforcement And Health Care Seeking Among Hispanic Adults. Health Aff (Millwood) 2021; 40:1056-1065. [PMID: 34228522 DOI: 10.1377/hlthaff.2020.02356] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aggressive deportation policy enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care. With 68 percent of undocumented immigrants coming from Mexico or Central America, US deportation policies particularly affect Hispanic residents. To examine how deportation enforcement relates to health care use in the Hispanic population in general, we matched survey data from the 2011-16 Behavioral Risk Factor Surveillance System to measures of Immigration and Customs Enforcement (ICE) activity. Quasi-experimental analyses demonstrated that Hispanic respondents were less likely to report having had a regular provider or annual checkup following increased ICE activity in their state. In contrast, these behaviors were unchanged among non-Hispanic adults, a group less likely to be affected by deportation enforcement. Parallel results were found among Hispanic and non-Hispanic adults with diabetes, for whom lapses in care may confer significant health risks.
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Affiliation(s)
- Abigail S Friedman
- Abigail S. Friedman is an assistant professor in the Department of Health Policy and Management at the Yale School of Public Health, in New Haven, Connecticut
| | - Atheendar S Venkataramani
- Atheendar S. Venkataramani is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia, Pennsylvania
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25
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Ortiz R, Farrell-Bryan D, Gutierrez G, Boen C, Tam V, Yun K, Venkataramani AS, Montoya-Williams D. A Content Analysis Of US Sanctuary Immigration Policies: Implications For Research In Social Determinants Of Health. Health Aff (Millwood) 2021; 40:1145-1153. [PMID: 34228526 DOI: 10.1377/hlthaff.2021.00097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Restrictive immigration policies are important social determinants of health, but less is known about the health implications and health-related content of protective immigration policies, which may also represent critical determinants of health. We conducted a content analysis of types, themes, and health-related language in 328 "sanctuary" policies enacted between 2009 and 2017 in the United States. Sanctuary policies were introduced in thirty-two states and Washington, D.C., most frequently in 2014 and 2017. More than two-thirds of policies (67.6 percent) contained language related to health, including direct references to access to services. Health-related themes commonly co-occurred with language related to supporting immigrants in communities, including themes of antidiscrimination, inclusion, trust, and privacy. Our work provides foundational, nuanced data about the scope and nature of sanctuary policies that can inform future research exploring the impacts of these policies on health and health care.
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Affiliation(s)
- Robin Ortiz
- Robin Ortiz is a National Clinician Scholar at the Perelman School of Medicine, University of Pennsylvania, and the Children's Hospital of Philadelphia, in Philadelphia, Pennsylvania
| | - Dylan Farrell-Bryan
- Dylan Farrell-Bryan is a PhD candidate in the Department of Sociology, University of Pennsylvania
| | - Gabriel Gutierrez
- Gabriel Gutierrez is a BA candidate in the Department of Anthropology, University of Pennsylvania
| | - Courtney Boen
- Courtney Boen is an assistant professor in the Department of Sociology, University of Pennsylvania
| | - Vicky Tam
- Vicky Tam is a data scientist in the Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Katherine Yun
- Katherine Yun is an assistant professor in the Division of General Pediatrics, Children's Hospital of Philadelphia
| | - Atheendar S Venkataramani
- Atheendar S. Venkataramani is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Diana Montoya-Williams
- Diana Montoya-Williams is an instructor in the Division of Neonatology, Children's Hospital of Philadelphia
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26
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Huang W, Aune D, Ferrari G, Zhang L, Lan Y, Nie J, Chen X, Xu D, Wang Y, Rezende LFM. Psychological Distress and All-Cause, Cardiovascular Disease, Cancer Mortality Among Adults with and without Diabetes. Clin Epidemiol 2021; 13:555-565. [PMID: 34285589 PMCID: PMC8286108 DOI: 10.2147/clep.s308220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To examine the association of psychological distress with all-cause, cardiovascular disease (CVD) and cancer mortality in US adults, and verified whether the associations differed between participants with and without diabetes. Methods A total of 485,864 adults (446,288 without diabetes and 39,576 with diabetes) who participated in the National Health Interview Survey from 1997 to 2013 were linked to the National Death Index through December 31, 2015. Psychological distress was measured by the Kessler 6 distress scale (K6). Multivariable Cox proportional hazards regression models were performed to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between psychological distress and mortality. Results We ascertained 11,746 deaths (mean follow-up, 7. 7 years) among people with diabetes and 51,636 deaths (9.9 years) among those without diabetes. Psychological distress was associated with higher all-cause, CVD, and cancer mortality. Compared to non-diabetic adults without psychological distress, HRs (95% CI) were 1.07 (1.04 to 1.09) for mild, 1.26 (1.22 to 1.30) for moderate and 1.46 (1.38 to 1.55) for severe psychological distress. Compared to the same reference group, in diabetic participants the HRs were 1.39 (1.33 to 1.44) for no psychological distress, 1.59 (1.53 to 1.66) for mild, 1.90 (1.80 to 2.00) for moderate and 1.98 (1.82 to 2.17) for severe psychological distress. Similar associations were also observed for CVD and cancer mortality but with non-statistically significant interaction. Conclusion Psychological distress was associated with higher mortality, particularly in participants with diabetes. Strategies to ameliorate psychological distress may be important to reduce mortality in this population.
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Affiliation(s)
- Wentao Huang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Department of Nutrition, Bjørknes University College, Oslo, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Gerson Ferrari
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Lei Zhang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yutao Lan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
| | - Jing Nie
- Department of Sociology & Institute for Empirical Social Science Research, School of Humanities and Social Sciences, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xiong Chen
- Department of Endocrinology, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, People's Republic of China
| | - Dali Xu
- Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, People's Republic of China
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Leandro F M Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Sao Paulo, Brazil
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27
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Acevedo-Garcia D, Joshi PK, Ruskin E, Walters AN, Sofer N. Restoring An Inclusionary Safety Net For Children In Immigrant Families: A Review Of Three Social Policies. Health Aff (Millwood) 2021; 40:1099-1107. [PMID: 34228532 DOI: 10.1377/hlthaff.2021.00206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Since the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act, known as "welfare reform," in 1996, US social policy has increasingly stratified immigrants by legality, extending eligibility exclusions, benefit limitations, and administrative burdens not only to undocumented immigrants but also to lawful permanent residents and US citizens in immigrant families. This stratification is a form of structural discrimination, which is a social determinant of health. Children in immigrant families, most of whom are US citizens, have not been able to fully realize the benefits from social safety-net programs-including the 2020 Coronavirus Aid, Relief, and Economic Security Act stimulus payments. Policy deliberations over pandemic recovery, the equity focus of the Biden administration, and proposals to address child poverty provide an opportunity to reexamine immigrant exclusions, restrictions, and administrative burdens in public programs. We discuss immigrant stratification by legal status in social policy and review how it affects citizen children in mixed-status families in three safety-net programs: the Earned Income Tax Credit, Supplemental Nutrition Assistance Program, and Child Care and Development Block Grant. We provide eight policy recommendations to restore equity to the social safety net for children in immigrant families.
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Affiliation(s)
- Dolores Acevedo-Garcia
- Dolores Acevedo-Garcia is the Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy and director of the Institute for Child, Youth, and Family Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts
| | - Pamela K Joshi
- Pamela K. Joshi is a senior research scientist at the Institute for Child, Youth, and Family Policy, Heller School for Social Policy and Management, Brandeis University
| | - Emily Ruskin
- Emily Ruskin is a senior policy analyst, Immigration Policy Project, UnidosUS, in Washington, D.C
| | - Abigail N Walters
- Abigail N. Walters is a research associate at the Institute for Child, Youth, and Family Policy, Heller School for Social Policy and Management, Brandeis University
| | - Nomi Sofer
- Nomi Sofer is the director of communications and strategy at the Institute for Child, Youth, and Family Policy, Heller School for Social Policy and Management, Brandeis University
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28
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Fakhoury J, Burton-Jeangros C, Guessous I, Consoli L, Duvoisin A, Jackson Y. Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study. BMC Public Health 2021; 21:1198. [PMID: 34162363 PMCID: PMC8220781 DOI: 10.1186/s12889-021-11239-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration. Methods This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included. Results Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables. Conclusion At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11239-0.
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Affiliation(s)
- Julien Fakhoury
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland. .,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland.
| | | | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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29
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Hamilton ER, Langer PD, Patler C. DACA's Association With Birth Outcomes Among Mexican-Origin Mothers in the United States. Demography 2021; 58:975-985. [PMID: 34042987 DOI: 10.1215/00703370-9099310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The 2012 Deferred Action for Childhood Arrivals (DACA) program granted work authorization and protection from deportation to more than 800,000 young undocumented immigrants who arrived to the United States as minors. We estimate the association between this expansion of legal rights and birth outcomes among 72,613 singleton births to high school-educated Mexican immigrant women in the United States from June 2010 to May 2014, using birth records data from the National Center for Health Statistics. Exploiting the arbitrariness of the upper age cutoff for DACA eligibility and using a difference-in-differences design, we find that DACA was associated with improvements in the rates of low birth weight and very low birth weight, birth weight in grams, and gestational age among Mexican immigrant mothers.
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Affiliation(s)
- Erin R Hamilton
- Department of Sociology, University of California, Davis, Davis, CA, USA
| | - Paola D Langer
- Department of Sociology, University of California, Davis, Davis, CA, USA
| | - Caitlin Patler
- Department of Sociology, University of California, Davis, Davis, CA, USA
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30
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Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Benjet C, Cheung EYL, Eaton J, Gonsalves P, Hailemariam M, Luitel NP, Machado DB, Misganaw E, Omigbodun O, Roberts T, Salisbury TT, Shidhaye R, Sunkel C, Ugo V, van Rensburg AJ, Gureje O, Pathare S, Saxena S, Thornicroft G, Patel V. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry 2021; 8:535-550. [PMID: 33639109 PMCID: PMC9764935 DOI: 10.1016/s2215-0366(21)00025-0] [Citation(s) in RCA: 336] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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Affiliation(s)
- Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Corina Benjet
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eliza Yee Lai Cheung
- The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China; The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China
| | - Julian Eaton
- CBM Global and Centre for Global Mental Health, London, UK
| | - Pattie Gonsalves
- Wellcome-DBT India Alliance, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Daiane B Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Centre for Data and Knowledge Integration for Health, CIDACS-FIOCRUZ, Bahia, Brazil
| | - Eleni Misganaw
- Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia; Global Mental Health Peer Network, Pretoria, South Africa
| | - Olayinka Omigbodun
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tessa Roberts
- Centre for Society and Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; WHO Collaborating Centre for Research and Training in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Charlene Sunkel
- Global Mental Health Peer Network, Johannesburg, South Africa
| | - Victor Ugo
- Mentally Aware Nigeria Initiative, Lagos, Nigeria; United for Global Mental Health, London, UK
| | - André Janse van Rensburg
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Wellcome-DBT India Alliance, Sangath, New Delhi, India
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31
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Bergmans RS, Kelly KM, Wegryn-Jones R. Healthy Debate: Major Depression among Older Immigrants and the United States 2016 Election. J Immigr Minor Health 2021; 24:360-367. [PMID: 34052978 DOI: 10.1007/s10903-021-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
This study investigated whether anti-immigrant sentiment leading up to the 2016 election increased risk of major depression among older U.S. immigrants. Drawing data from the Health and Retirement Study, we tested whether there was a disproportionate increase in major depression among U.S. immigrants than non-immigrants from 2014 to 2016 using a Difference in Difference approach. Older immigrants had a higher relative change in major depression from 2014 to 2016 than non-immigrants (RRR 1.35; 95% CI 1.06, 1.73). This relationship was driven by associations among those who are White (RRR 2.07; 95% CI 1.26, 3.41) or Hispanic (RRR 1.55; 95% CI 0.99, 2.40). Anti-immigrant sentiment leading up to the 2016 election was associated with an increase in major depression among older U.S. immigrants. Findings may help identify high-risk groups in future election years and inform treatment strategies for major depression that consider the influence of sociopolitical factors.
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Affiliation(s)
- Rachel S Bergmans
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- , 426 Thompson St, Ann Arbor, MI, 48104, USA.
| | - Kristen M Kelly
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Riley Wegryn-Jones
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
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32
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Somatic, Anxiety, and Depressive (SAD) Symptoms in Young Adult Latinx Immigrants: Prevalence and Predictors. J Immigr Minor Health 2021; 23:956-964. [PMID: 34043112 DOI: 10.1007/s10903-021-01218-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Certain immigration factors may increase somatic, anxiety, and depressive (SAD) symptoms in Latinx immigrants. Our study examined prevalence of SAD symptoms in Latinx immigrants 18-29 presenting to primary care with correlates of acculturation, immigration, and legal status. SAD symptoms were measured using the PHQ-14, GAD-7 and PHQ-8. Moderate somatization (37%), anxiety (20%), and depression (25%) were common. Multivariable analysis found five immigration factors predicted a higher composite SAD score and the presence of each additional factor increased likelihood of a SAD score ≥ 20 (OR 1.7; 95% CI, 1.1 to 2.5). SAD scores increased in a dose-response fashion (8.3, 10.5, 14.8, 17.1, 21.7, 29.3) with the added presence of each factor. Elevated SAD scores were not associated with gender, marital status, education, income, country of origin, or acculturation. Screening with our five factor immigration distress index may help identify patients at risk for higher SAD scores during a primary care visit.
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33
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Immigration status as a health care barrier in the USA during COVID-19. J Migr Health 2021; 4:100036. [PMID: 33778797 PMCID: PMC7979269 DOI: 10.1016/j.jmh.2021.100036] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/05/2020] [Accepted: 03/14/2021] [Indexed: 11/22/2022] Open
Abstract
In the context of the United States of America (U.S.), COVID-19 has influenced migrant experiences in a variety of ways, including the government's use of public health orders to prevent migration into the country and the risk of immigrants contracting COVID-19 while in detention centers. However, this paper focuses on barriers that immigrants of diverse statuses living in the U.S.—along with their families—may face in accessing health services during the pandemic, as well as implications of these barriers for COVID-19 prevention and response efforts. We report findings from a scoping review about immigration status as a social determinant of health and discuss ways that immigration status can impede access to health care across levels of the social ecology. We then develop a conceptual outline to explore how changes to federal immigration policies and COVID-19 federal relief efforts implemented in 2020 may have created additional barriers to health care for immigrants and their families. Improving health care access for immigrant populations in the U.S. requires interventions at all levels of the social ecology and across various social determinants of health, both in response to COVID-19 and to strengthen health systems more broadly.
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34
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Woolhandler S, Himmelstein DU, Ahmed S, Bailey Z, Bassett MT, Bird M, Bor J, Bor D, Carrasquillo O, Chowkwanyun M, Dickman SL, Fisher S, Gaffney A, Galea S, Gottfried RN, Grumbach K, Guyatt G, Hansen H, Landrigan PJ, Lighty M, McKee M, McCormick D, McGregor A, Mirza R, Morris JE, Mukherjee JS, Nestle M, Prine L, Saadi A, Schiff D, Shapiro M, Tesema L, Venkataramani A. Public policy and health in the Trump era. Lancet 2021; 397:705-753. [PMID: 33581802 DOI: 10.1016/s0140-6736(20)32545-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Steffie Woolhandler
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - David U Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA; Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Sameer Ahmed
- Harvard Immigration and Refugee Clinical Program, Harvard Law School, Harvard University, Boston, MA, USA
| | - Zinzi Bailey
- Medical Oncology Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary T Bassett
- Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | | | - Jacob Bor
- School of Public Health, Boston University, Boston, MA, USA
| | - David Bor
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Samantha Fisher
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | - Adam Gaffney
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helena Hansen
- Research Theme in Translational Social Science and Health Equity, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philip J Landrigan
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | | | - Martin McKee
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny McCormick
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alecia McGregor
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Reza Mirza
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana E Morris
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Joia S Mukherjee
- Harvard Medical School, Harvard University, Boston, MA, USA; Partners in Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marion Nestle
- Department of Nutrition and Food Studies, New York University, New York, NY, USA
| | - Linda Prine
- Department of Family and Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Altaf Saadi
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Davida Schiff
- Harvard Medical School, Harvard University, Boston, MA, USA; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lello Tesema
- Department of Public Health, Los Angeles County, Los Angeles, CA, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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35
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Gutierrez JR. Healthy Communities: Shifting Toward Inclusive Immigration Policy. Pediatrics 2021; 147:peds.2020-045880. [PMID: 33414237 DOI: 10.1542/peds.2020-045880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- J Raul Gutierrez
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
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36
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Understanding Health Priorities, Behaviors, and Service Utilization Among Brazilian Immigrant Women: Implications for Designing Community-Based Interventions. J Racial Ethn Health Disparities 2021; 9:135-145. [PMID: 33403650 PMCID: PMC7785287 DOI: 10.1007/s40615-020-00936-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/28/2022]
Abstract
Brazilians represent a growing proportion of immigrants in the USA. Little is known about their health or healthcare utilization after their arrival. This study aimed to gather formative data to understand the needs of Brazilian immigrant women to guide public health interventions. We conducted five focus groups with Brazilian women born in Brazil (n = 47) and 13 key informant interviews with representatives from Brazilian-serving organizations. Participants were recruited from churches and social service organizations in the Greater Boston area. Findings revealed that mental health was the most pressing health priority; many attributed high levels of anxiety and depression to worries about undocumented status, separation from social networks, and strenuous work schedules. Occupational health issues were frequently mentioned, including musculoskeletal complaints, skin rashes, and respiratory problems. Domestic violence was also a concern, and many women feared reporting to police due to undocumented status. Most reported good access to medical care and described the quality of healthcare services as superior to that available in Brazil. However, many reported challenges with interpersonal communication with providers, dissatisfaction with a perceived unwillingness from providers to order medical tests or prescribe treatment, and limited access to mental health services. There was agreement that effective intervention strategies should use social media, radio, and group education in churches.
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37
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Amirkhan JH, Velasco SE. Stress overload and the new nightmare for Dreamers. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:67-73. [PMID: 31478808 DOI: 10.1080/07448481.2019.1652182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/28/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
To determine if, following threats to DACA policies, Dreamer college students experienced greater stress overload, more symptoms, and worse grades than their classmates. Participants: Students (n = 424) from a large public university, including Dreamers (n = 64), participated between March 2017 and June 2018. Methods: Students completed an anonymous online survey containing self-report measures of stress overload, symptoms, grades, and background characteristics. Results: Dreamers reported significantly higher levels of stress overload than did other students, including minorities and immigrants. Dreamers reported more somatic symptoms but not lower grades than other students-outcomes mediated, wholly or partially, by stress overload. Conclusion: Findings document the health toll of current politics on Dreamers, and indicate disproportionate stress overload as a reason. They also attest to Dreamer "grit" in maintaining grades nevertheless. Implications include the need for proactive support by universities and broader social policy change to restore well-being to these students.
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Affiliation(s)
- James H Amirkhan
- Department of Psychology, California State University Long Beach, Long Beach, California, USA
| | - Sarah E Velasco
- Department of Psychology, California State University Long Beach, Long Beach, California, USA
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38
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Luo T, Escalante CL. Stringent immigration enforcement and the mental health and health-risk behaviors of Hispanic adolescent students in Arizona. HEALTH ECONOMICS 2021; 30:86-103. [PMID: 33085153 DOI: 10.1002/hec.4178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
This study investigates the impact of the enforcement of SB 1070, a stringent immigration law, on the mental health, health-risk behaviors, and academic performance of Hispanic adolescent residents in Arizona. Using the difference-in-differences method, this study finds that SB 1070 increases their probability of feeling sad and decreases their physical activeness. The impact of SB 1070 on sad feelings and level of physical activity could have serious repercussions while it lasts. In addition, obese male Hispanic adolescents are more likely than their female or non-obese counterparts to develop mental health problems and engage in health-risk behaviors attributable to the stringent immigration policy. This study's empirical evidence on adverse mental health repercussions for Hispanic adolescents of state-level immigration enforcement suggests the need to be careful in formulating and implementing immigration policies.
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Affiliation(s)
- Tianyuan Luo
- University of Florida, Gainesville, Florida, USA
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Morales-Alemán MM, Ferreti G, Scarinci IC. "I Don't Like Being Stereotyped, I Decided I Was Never Going Back to the Doctor": Sexual Healthcare Access Among Young Latina Women in Alabama. J Immigr Minor Health 2020; 22:645-652. [PMID: 31535273 PMCID: PMC7078038 DOI: 10.1007/s10903-019-00932-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young Latina women (YLW) in the US and in Alabama are disproportionately affected by sexual health disparities. Our community based participatory research (CBPR) study's purpose was to examine YLW's perceptions and experiences of sexual healthcare access (SHCA) toward developing community-driven, multilevel intervention strategies. We conducted 20 semi-structured qualitative interviews with YLW between 15 and 19 years old and who had been in the US for 5 or more years. We content-analyzed the data guided by the Socioecological Model of Sexual Health (SEMSH). We began analyses by coding independently, built consensus on the codes, then finished coding transcripts independently. Sixty-five percent of participants were US-born and 60% had health insurance. Participants identified barriers/facilitators to SHCA including discrimination in clinical settings and embarrassment/stigma about SHCA. Our study is the first in AL to use CBPR to work with YLW. Interventions should consider the multi-level and intersectional nature of SHCA challenges.
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Affiliation(s)
- Mercedes M Morales-Alemán
- Department of Community Medicine and Population Health, The University of Alabama, Box 870326, Tuscaloosa, AL, 35487, USA.
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, USA.
| | - Gwendolyn Ferreti
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Giuntella O, Lonsky J. The effects of DACA on health insurance, access to care, and health outcomes. JOURNAL OF HEALTH ECONOMICS 2020; 72:102320. [PMID: 32485653 DOI: 10.1016/j.jhealeco.2020.102320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
This paper studies the effects of the 2012 Deferred Action for Childhood Arrivals (DACA) initiative on health insurance coverage, access to care, health care use, and health outcomes. We exploit a difference-in-differences setup that relies on the discontinuities in the program eligibility criteria. We find that DACA increased insurance coverage. In states that granted access to Medicaid, the increase was driven by an increase in public insurance take-up. Where public coverage was not available, DACA eligibility increased individually purchased insurance. Despite the increase in insurance coverage, we find small or non-significant increases in health care use. There is some evidence that DACA increased demand for mental health services. After 2012, DACA-eligible individuals were also more likely to report a usual place of care and less likely to delay care because of financial restrictions. Finally, we find some evidence that DACA improved self-reported health and reduced depression symptoms, indicators of stress and anxiety, and hypertension. These improvements are concentrated among individuals with income below the federal poverty level.
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Russell EA, Tsai C, Linton JM. Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020; 21:100779. [PMID: 32922213 PMCID: PMC7480259 DOI: 10.1016/j.cpem.2020.100779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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Ferreti G, Morales-Alemán MM, Alemán CE. No Te Tratan Bien Porque Eres Mexicana: Intersectional Systemic Violence and Precarity in Latina Adolescent Life in the U.S. South. PEACE AND CONFLICT : JOURNAL OF PEACE PSYCHOLOGY : THE JOURNAL OF THE DIVISION OF PEACE PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2020; 26:126-135. [PMID: 33776399 PMCID: PMC7989643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Young Latina women (YLW) in Alabama are disproportionately affected by sexual health disparities. However, to access needed reproductive services, YLW must navigate a healthcare landscape that restricts access for youth. YLW also face racialized immigration enforcement in their communities which is designed to attrition the region's emergent Latina/o/x immigrant population. This paper describes the intersectional, structural forces that contribute to experienced systemic violence for YLW as they try to access sexual healthcare services. In 2017, we conducted semi-structured qualitative interviews with 20 YLW and 24 key stakeholders (parents, providers, Latino/a/x community leaders etc.) in West Alabama to examine attitudes and perceptions about sexual health and healthcare access (HCA) among YLW in the region. We used purposeful convenience sampling and snowballing to recruit a community-based sample. That is, we purposefully recruited YLW, adjusting through the recruitment period for a diverse sample, who represented the various voices that we were trying to capture in the study (i.e., younger and older adolescents, adolescents born in the U.S. and those born in other countries etc.). Through a focus on YLW's access to sexual/reproductive healthcare, we conclude that YLW experience systemic violence and resulting precarity because laws and health policies restrict access to evidence-based sexual health education and reproductive healthcare services. We discuss implications for future research and policy recommendations.
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Venkataramani A, Daza S, Emanuel E. Association of Social Mobility With the Income-Related Longevity Gap in the United States: A Cross-Sectional, County-Level Study. JAMA Intern Med 2020; 180:429-436. [PMID: 31961379 PMCID: PMC6990844 DOI: 10.1001/jamainternmed.2019.6532] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Despite substantial research, the drivers of the widening gap in life expectancy between rich and poor individuals in the United States-known as the longevity gap-remain unknown. The hypothesis of this study is that social mobility may play an important role in explaining the longevity gap. OBJECTIVE To assess whether social mobility is associated with income-related differences in life expectancy in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, ecological study used data from 1559 counties in the United States to assess the association of social mobility with average life expectancy at age 40 years by sex and income quartile among adult men and women over the period of January 2000 through December 2014. Bayesian generalized linear multilevel regression models were used to estimate the association, with adjustment for a range of socioeconomic, demographic, and health care system characteristics. EXPOSURES County-level social mobility, here operationalized as the association of the income rank of individuals born during the period of January 1980 through December 1982 (based on tax record data, averaged over the period January 2010 through December 2012) with the income ranks of their parents (averaged over the period January 1996 through December 2000) using the location where the parent first claimed the child as a dependent at age 15 years to identify counties. MAIN OUTCOMES AND MEASURES The main outcome was life expectancy at age 40 years by sex and income quartile. RESULTS The sample consisted of 1559 counties, which represented 93% of the US population in 2000. Each 1-SD increase in social mobility-equivalent to the difference between a low-mobility state, such as Alabama (ranked 49th on this measure), and a higher-mobility state, such as Massachusetts (ranked 23rd on this measure)-was associated with a 0.38-year (95% credible interval [CrI], 0.29-0.47) and a 0.29-year (95% CrI, 0.21-0.38) increase in county-level life expectancy among men and women, respectively, in the lowest income quartile. Estimates for life expectancies among county residents in the highest income quartile were smaller in magnitude and not robust to covariate adjustment (men: 0.10-year [95% CrI, -0.02 to 0.22] increase; women: 0.08-year [95% CrI, -0.05 to 0.20] increase). Increasing social mobility in all counties to the value of the highest social mobility county was associated with decreases in the life expectancy gap between the highest and lowest income quartiles by 1.4 (95% CrI, 0.7-2.1) years for men and 1.1 (95% CrI, 0.5-1.6) years for women nationally, representing a 20% decrease. CONCLUSIONS AND RELEVANCE In this cross-sectional study, higher county-level social mobility was associated with smaller county-level gaps in life expectancy by income. These findings motivate further investigation of causal relationships between policies that shift social mobility and health outcomes.
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Affiliation(s)
- Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sebastian Daza
- Center for Demography and Ecology, University of Wisconsin-Madison.,Department of Sociology, University of Wisconsin-Madison
| | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Rosenberg J, Rosenthal MS, Cramer LD, Lebowitz ER, Sharifi M, Yun K. Disparities in Mental and Behavioral Health Treatment for Children and Youth in Immigrant Families. Acad Pediatr 2020; 20:1148-1156. [PMID: 32599347 PMCID: PMC7655594 DOI: 10.1016/j.acap.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Children and youth in immigrant families (CIF)-children and youth with at least 1 foreign-born parent-face unique psychosocial stressors. Yet little is known about access to mental and behavioral health (MBH) services for CIF. Among US CIF and non-CIF with MBH problems, we assessed access to MBH treatment. METHODS We used the National Survey of Children's Health-2016, a nationally representative survey of predominantly English- or Spanish-speaking US parents. The sample included 2- to 17-year-olds whose parent reported at least 1 MBH problem. The primary outcome was prior-year receipt of MBH treatment (counseling, medication, or both). RESULTS Of 50,212 survey respondents, 7164 reported a current MBH problem (809 CIF and 6355 non-CIF). The majority of CIF were Hispanic/Latinx (56% CIF vs 13% non-CIF, P < .001). CIF were less likely than non-CIF to have an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis (35% vs 59%, P < .001) and less likely to have received MBH medication and/or counseling (61% vs 71%, P = .02). This difference was pronounced for receiving medication (32% vs 50%, P < .001). When controlling for multiple covariates, differences in any MBH treatment were no longer statistically significant (adjusted odds ratios 0.76, 95% confidence interval 0.52-1.11), while the odds of receipt of medication remained significantly lower for CIF (adjusted odds ratios 0.61, 95% confidence interval 0.42-0.88). CONCLUSIONS Among children and youth with at least 1 parent-reported MBH problem, CIF, compared with non-CIF, were less likely to receive MBH treatment, specifically medication. This may be explained, in part, by differences in the proportion of CIF and non-CIF diagnosed with ADHD.
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Affiliation(s)
- Julia Rosenberg
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine (J Rosenberg, MS Rosenthal, and M Sharifi), New Haven, Conn; Yale University National Clinician Scholar Program (J Rosenberg, MS Rosenthal, LD Cramer, and M Sharifi), New Haven, Conn.
| | - Marjorie S. Rosenthal
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine Department of Pediatrics, PO Box 208064, New Haven, CT 06520-8064.,Yale University National Clinician Scholar Program, 333 Cedar Street, PO Box 208088, New Haven,CT 06510
| | - Laura D. Cramer
- Yale University National Clinician Scholar Program, 333 Cedar Street, PO Box 208088, New Haven,CT 06510
| | - Eli R. Lebowitz
- Yale Child Study Center, 230 South Frontage Rd, New Haven, CT 06520
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine Department of Pediatrics, PO Box 208064, New Haven, CT 06520-8064.,Yale University National Clinician Scholar Program, 333 Cedar Street, PO Box 208088, New Haven,CT 06510
| | - Katherine Yun
- Division of General Pediatrics, Children’s Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
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Intergenerational Mobility and Goal-Striving Stress Among Black Americans: The Roles of Ethnicity and Nativity Status. J Immigr Minor Health 2019; 21:393-400. [PMID: 29611019 DOI: 10.1007/s10903-018-0735-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility-or improved socioeconomic standing relative to one's parents-may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity.
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Linton JM, Green A, Chilton LA, Duffee JH, Dilley KJ, Gutierrez JR, Keane VA, Krugman SD, McKelvey CD, Nelson JL. Providing Care for Children in Immigrant Families. Pediatrics 2019; 144:peds.2019-2077. [PMID: 31427460 DOI: 10.1542/peds.2019-2077] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.
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Affiliation(s)
- Julie M. Linton
- Departments of Pediatrics and Public Health, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
| | - Andrea Green
- Larner College of Medicine, The University of Vermont, Burlington, Vermont
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Cha BS, Enriquez LE, Ro A. Beyond access: Psychosocial barriers to undocumented students’ use of mental health services. Soc Sci Med 2019; 233:193-200. [DOI: 10.1016/j.socscimed.2019.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/17/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
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Jackson Y, Courvoisier DS, Duvoisin A, Ferro-Luzzi G, Bodenmann P, Chauvin P, Guessous I, Wolff H, Cullati S, Burton-Jeangros C. Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study. BMJ Open 2019; 9:e028336. [PMID: 31154311 PMCID: PMC6549650 DOI: 10.1136/bmjopen-2018-028336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Migrants without residency permit, known as undocumented, tend to live in precarious conditions and be exposed to an accumulation of adverse determinants of health. Only scarce evidence exists on the social, economic and living conditions-related factors influencing their health status and well-being. No study has assessed the impact of legal status regularisation. The Parchemins study is the first prospective, mixed-methods study aiming at measuring the impact on health and well-being of a regularisation policy on undocumented migrants in Europe. METHODS AND ANALYSIS The Parchemins study will compare self-rated health and satisfaction with life in a group of adult undocumented migrants who qualify for applying for a residency permit (intervention group) with a group of undocumented migrants who lack one or more eligibility criteria for regularisation (control group) in Geneva Canton, Switzerland. Asylum seekers are not included in this study. The total sample will include 400 participants. Data collection will consist of standardised questionnaires complemented by semidirected interviews in a subsample (n=38) of migrants qualifying for regularisation. The baseline data will be collected just before or during the regularisation, and participants will subsequently be followed up yearly for 3 years. The quantitative part will explore variables about health (ie, health status, occupational health, health-seeking behaviours, access to care, healthcare utilisation), well-being (measured by satisfaction with different dimensions of life), living conditions (ie, employment, accommodation, social support) and economic situation (income, expenditures). Several confounders including sociodemographic characteristics and migration history will be collected. The qualitative part will explore longitudinally the experience of change in legal status at individual and family levels. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Geneva, Switzerland. All participants provided informed consent. Results will be shared with undocumented migrants and disseminated in scientific journals and conferences. Fully anonymised data will be available to researchers.
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Affiliation(s)
- Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Institute of sociological research, University of Geneva, Geneva, Switzerland
| | - Giovanni Ferro-Luzzi
- Haute Ecole de Gestion, University of applied sciences of Western Switzerland, Carouge, Switzerland
- Geneva School of Economics and Management, Universite de Geneve, Geneva, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pierre Chauvin
- Department of Social Epidemiology, Inserm, UMRS 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- UMRS 1136, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Institute of sociological research, University of Geneva, Geneva, Switzerland
- Swiss NCCR LIVES, Universite de Geneve, Geneva, Switzerland
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Venkataramani AS, Cook E, O’Brien RL, Kawachi I, Jena AB, Tsai AC. College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study. PLoS Med 2019; 16:e1002821. [PMID: 31211777 PMCID: PMC6581254 DOI: 10.1371/journal.pmed.1002821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND College affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states-including California, Texas, and Michigan-banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents. METHODS AND FINDINGS We conducted a difference-in-differences analysis using data from the 1991-2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th-12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: -0.1, 7.2, p = 0.058), among underrepresented minority 11th-12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes. CONCLUSIONS In this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Erin Cook
- Analysis Group, Boston, Massachusetts, United States of America
| | - Rourke L. O’Brien
- La Follette School of Public Affairs, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | - Ichiro Kawachi
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alexander C. Tsai
- Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Khullar D, Chokshi DA. Challenges for immigrant health in the USA-the road to crisis. Lancet 2019; 393:2168-2174. [PMID: 30981536 DOI: 10.1016/s0140-6736(19)30035-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Dave A Chokshi
- New York City Health and Hospitals Corporation, New York, NY, USA; Departments of Population Health and Medicine, New York University Langone Health, New York, NY, USA
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