Combinatorial Effects of Discrimination, Legal Status Fears, Adverse Childhood Experiences, and Harsh Working Conditions among Latino Migrant Farmworkers: Testing Learned Helplessness Hypotheses

Five years in the community dental service: clinicians' perspectives

Introduction Community dentists in England treat patients classed as vulnerable. The services in which they operate have faced challenges, with these known to have affected clinicians. It is important to monitor and understand the workforce and the effect the healthcare landscape, and its changes, has on them and the service they provide.Aims To explore and describe the evolution of working conditions of community dental service (CDS) dentists in England.Materials and methods Data for a cohort of dentists working in the CDS in England between 2017 and 2022, collected via questionnaire, were statistically and thematically analysed and data compared.Results Motivation in clinicians working in the service has significantly fallen since 2017 and concerns were held over the service meeting patient need. CDS dentists have become increasingly satisfied with the care they provide, though workload and job stress increased. Satisfaction with job terms and conditions increased significantly, though job satisfaction, with high and low morale, decreased over the period of interest. Working conditions and motivation were described as deteriorating, alongside increasing satisfaction with job terms and conditions, and fewer dentists reporting low morale. Factors cited as contributing to lower job satisfaction and morale were staffing, workload and working conditions.Conclusions We suggest that despite the increased pressures on the CDS, little improvement has been made to working conditions. The working environment continues to erode for CDS dentists in England and patient service is being negatively affected. While dentists appear to have adapted to these conditions, it is imperative that attention is paid both to CDS dentists and the service and improvements made.

Impacts of COVID-19 shelter in place across key life domains among immigrant farmworker Latina mothers and young adults

OBJECTIVE

Individuals and families from racial and ethnic groups experience social and economic disadvantage making them vulnerable to the disproportionate impact of the COVID-19 pandemic. This study sought to capture the impacts of Shelter in Place (SIP) across key life domains including family life, education, work, mental health, and coping strategies among a sample of Mexican-origin mothers who were currently engaged in agricultural work, or whose spouses were engaged in agricultural work, and young adults who had a parent working in agriculture.

METHOD

During the summer of 2020, while California was under SIP orders, we conducted three virtual focus groups using Zoom(r). We recruited focus group participants from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), an ongoing, 20-year, longitudinal cohort study of Mexican-origin families in a predominantly agricultural area of California. Three focus groups were conducted with mothers (n = 9), mean age = 48 years, young adult women (n = 8) and young adult men (n = 5), mean age = 18 years, respectively.

RESULTS

Mothers reported high levels of stress stemming from fear of Covid-19 infection, work instability and financial concerns, children's schooling, anxiety about an uncertain future, and the demands of caretaking for dependents. Adverse mental health impacts were particularly pronounced among participants experiencing multiple adversities pre-dating the pandemic, including unemployment, single motherhood, and having undocumented family members. For young adults, work instability and varying work hours were also a source of stress because they made it difficult to make decisions about the future, such as whether to attend college or how many classes to take. Families used coping strategies including expressing gratitude, focusing on what's under one's control, familismo, and community engagement to manage mental health challenges during SIP.

CONCLUSION

In the event of future pandemics or disasters, particular attention is needed to those who experience unemployment, are undocumented and/or have undocumented family members, and/or are single parents facing economic adversity. During public health emergencies, action at the local, state, and national level is needed to support farmworkers and other vulnerable groups' secondary major stressors stemming from inequities in access to affordable housing, childcare, living wages, healthcare, and other benefits.

The effect of childhood family adversity on adulthood depression among Chinese older migrant workers: gender differences in the mediating role of social-ecological systems

BACKGROUND

Older migrant workers (OMWs) in China face unique challenges rooted in their early life experiences, which increase their vulnerability to psychological and behavioral problems in adulthood. By utilizing the cumulative disadvantage model and the social-ecological systems theory, this study explored the effect of childhood family adversity on adulthood depression in the mediating roles of OMWs' social-ecological microsystem and mesosystem and further examined gender differences in these associations.

METHODS

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS), involving a sample of 4,309 OMWs aged 50 and above. The measures included the Center for Epidemiological Research Depression Scale, childhood family adversity, socioeconomic status, marital quality, and physical and cognitive health.

RESULTS

Childhood family adversity was positively associated with adulthood depression among OMWs. Social microsystem (physical and cognitive health) and mesosystem (marital quality and socioeconomic status) factors significantly mediated this relationship. Multi-group analysis revealed that the mediating effects of marital quality and socioeconomic status were stronger for female OMWs, while the mediating effects of physical and cognitive health were stronger for male OMWs.

CONCLUSIONS

The findings suggest that childhood family adversity has a lasting impact on the mental health of OMWs, and that social-ecological systems factors play an important role in this relationship. The study also highlights the need for gender-specific interventions to address the mental health needs of OMWs.

Mediational pathways exploring the link between adverse childhood experiences and physical health in a transgender population

BACKGROUND

Adverse childhood experiences (ACEs) consist of instances of abuse, neglect, or household dysfunction occurring before adulthood. Prevalence rates of ACEs are higher among specific populations, including gender minorities. In addition to ACEs, transgender individuals (TG) face many personal, social, and structural factors that have the potential to negatively impact their physical health.

OBJECTIVE

This study examines exploratory mediational pathways between ACEs and two health outcomes (i.e., general health and days physically ill) in TG. Mediators include everyday discrimination, social support, gender non-affirmation, and mental distress.

METHODS

Cross-sectional data from the U.S. Transgender Population Health Survey (TransPop) was used to conduct a serial/parallel mediation analysis. The TransPop survey included a total of 274 TG.

RESULTS

For both outcome variables, the same three indirect pathways were significant. First, ACEs were associated with increased mental distress, which was associated with a decrease in general health and an increase in days physically ill. Second, ACEs were associated with increased discrimination, which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. Finally, ACEs were associated with discrimination, which was associated with increased gender non-affirmation which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill.

CONCLUSION

Interventions focused on reducing discrimination, gender non-affirmation, and poor mental health may be vital to improving the health of TG and to mitigating the indirect role of ACEs on TG health.

Definitions of successful aging among middle-aged Latinas residing in a rural agricultural community

INTRODUCTION

Latinos are the fastest growing aging population in the U.S. However, there has been limited attention to conceptualizing successful aging among Latinos, especially those residing in rural communities. Latinos are the largest racial or ethnic group residing in rural underserved communities and rural Latinos experience significant structural barriers to access the conditions they need to age well. The goal of this study is to make unique contributions to the successful aging literature by describing what successful aging means for middle-aged Latinas residing in a rural community.

METHODS

This qualitative paper used inductive thematic content analysis to examine definitions of successful aging among Latina women (n = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old; age range 40-64).

RESULTS

With regards to definitions of successful aging, four themes emerged: 1) Having good health; 2) maintaining an active lifestyle; 3) the wellbeing of one's children; and 4) being independent.

DISCUSSION

Participants' definitions of successful aging aligned to some extent with existing frameworks, specifically related to health and independence. However, middle-aged Latina participants' unique definitions of successful aging also diverged from existing frameworks, especially around the wellbeing of their children and the importance of work as a way of maintaining an active lifestyle. More research is needed to understand the unique social context and circumstances of middle-aged Latinos residing in rural communities and how they influence their aging journeys. This can provide important information for the development of culturally sensitive services, interventions, and policies to help Latinos age well.

Understanding Latinx Child Farmworkers' Reasons for Working: A Mixed Methods Approach

Agricultural labor is extremely hazardous, yet young children are legally permitted to work on farms. This paper contextualizes and describes Latinx hired child farmworkers’ stated reasons for working. We conducted a mixed-methods study using in-depth interviews ( n = 30) and survey interviews ( n = 202) with Latinx child farmworkers aged 10 to 17 in North Carolina. Our qualitative thematic analysis identified children’s salient reasons for working, including supporting family, contextual factors that lead to farm work, and occupying summer time. Statistical analysis showed that children’s primary reasons for working included buying clothes (91.1%) and school supplies (64.7%), with few differences by gender, age, or other characteristics. The findings demonstrate that most Latinx children view farm work as a necessary but temporary experience that financially supports their families. We discuss the implications for protecting Latinx child workers by reducing their structural vulnerability in order to facilitate healthy development.

Adverse Childhood Experiences, Social Isolation, Job Strain, and Cardiovascular Disease Mortality in U.S. Older Employees

Stress is a key driver of cardiovascular disease (CVD), yet the contribution of psychosocial stressors to the development of CVD has not been systematically examined in United States (U.S.) populations. The objective of this study was to assess prospective associations of adverse childhood experiences (ACEs), social isolation, and job strain with CVD mortality. Data were from the large, nationally representative, population-based Health and Retirement Study (HRS). ACEs, social isolation and job strain were assessed using validated survey instruments at baseline between 2006-2008, and death information was followed up through 2018. Cox proportional hazards regression models were used to examine prospective associations of ACEs, social isolation, and job strain with CVD mortality among 4046 older employees free from CVD at baseline. During 42,149 person-years of follow-up time, 59 death cases of CVD were reported. After adjustment for covariates, ACEs and job strain were significantly associated with increased risk of CVD mortality (aHR and 95% CI = 3.67 [1.59, 8.48] and 2.24 [1.21, 4.11], respectively), whereas social isolation demonstrated an inflated but nonsignificant association (aHR and 95% CI = 1.62 [0.72, 3.66]). These findings highlight the role of psychosocial exposures as novel and clinically relevant risk factors for CVD.

"We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut

Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.

The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms

AIMS

The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach.

METHODS

Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation.

RESULTS

Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation.

CONCLUSION

The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.

Adverse childhood experiences and its association with emotional and behavioral problems in U.S. children of Latino immigrants

BACKGROUND

Research has long shown that Adverse Childhood Experiences (ACEs) are correlated with major risk factors for several of the leading causes of death in adults. However, only recently have studies begun to measure the impact of ACEs during childhood and on underserved populations.

OBJECTIVE

This study assessed the prevalence of 8 ACEs, including physical, emotional, and sexual abuse, among rural U.S. Latino children of immigrant parents. We examined the association of those adversities with several factors including emotional and behavioral difficulties, health problems and healthcare utilization.

PARTICIPANTS AND SETTING

A total of 100 Latino subjects (ages 8-17) were recruited from a community health center in Southwest Florida.

METHODS

Parents and children were asked to complete the Child Trust Events Survey to measure child ACEs; Parents were asked to complete the Strengths and Difficulties Questionnaire to measure child emotional and behavioral problems.

RESULTS

Child ACEs ranged from 1.38 (parent-report) to 1.56 (child self-report) with emotional abuse, incarceration, and loss/separation from a caregiver being the most common. ACEs were correlated with emotional symptoms (p = .038 for child-report; p = .043 for parent-report), hyperactivity/inattention problems (p = .011 for parent-report), and with total behavioral difficulties (p = .021 for parent-report). There was a negative correlation between ACES and child chronic health diagnosis (p = .038 for parent-report; p = .010 for child-report) and total health problems (p = .021). There was no significant relationship between ACEs and healthcare utilization.

CONCLUSIONS

ACEs appear to be more prevalent among rural Latino youth in immigrant families and may be associated with emotional and behavioral problems during childhood.

Early Childhood Education Programs as Protective Experiences for Low-Income Latino Children and Their Families

Research is accelerating toward a deeper understanding of early childhood education (ECE) environments as protective experiences for Latino children; however, more work remains. This paper provides a review of the evidence that ECE environments benefit Latino children and mitigate the impact of adverse childhood experiences (ACEs) and other poverty-related risks; however, Latino families face numerous barriers to accessing ECE opportunities for their children. While enrollment by Latino children in ECE programs has grown in prior decades, further increases in access to ECE are needed to benefit Latino children, who are disproportionately impacted by poverty. In addition, ECE programs, especially high-quality and dual generation-focused programs like Early Head Start and Head Start, are in a strong position to help offset the risk for poor educational and mental health outcomes due to Latino's children's exposure to stressors such as discrimination and ACEs. Gaps remain in how well ECE is serving Latino families due to a combination of factors including parental work schedules, heritage language and cultural factors, and the lack of affordable and available ECE programs in Latino communities. To remedy these gaps, researchers must continue to further elucidate the needs, preferences, and gaps regarding access to early care and education opportunities for Latino children. For those studying trauma and ACEs among low-income children, greater attention to how preventative interventions or treatments that are embedded in ECE settings serve Latino populations is warranted, as this has the tremendous potential to mitigate the long-term impact of ACEs on Latino children. The paper concludes with a set of early childhood practice and policy recommendations for enhancing protective experiences for low-income Latino children.