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Xie QW, Fan XL, Luo X, Chang Q. Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors. J Affect Disord 2024; 349:384-393. [PMID: 38211749 DOI: 10.1016/j.jad.2024.01.078] [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: 08/27/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults. METHODS Data for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors. RESULTS LCA identified four potential subpopulations: "least marginalized", "immigrant minorities", "disabled, less-educated non-workers", and "low-income minorities" groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The "disabled, less-educated non-workers" group had the highest rates of depression; in contrast, the "immigrant minorities" group had the best mental health, even better than that of the "least marginalized" group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression. LIMITATIONS The cross-sectional design prevented establishment of the causality of relationships. CONCLUSIONS This study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China; Research Center for Common Prosperity, Future Regional Development Laboratory, Innovation Center of Yangtze River Delta, Zhejiang University, Jiaxing, China; Center of Social Welfare and Governance, Zhejiang University, Hangzhou, China; Institute for Common Prosperity and Development, Zhejiang University, Hangzhou, China
| | - Xu Li Fan
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Xiangyan Luo
- Department of Social Welfare and Risk Management, School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen City, China.
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2
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Çayci E, Zemouri C, van den Broek T. The contribution of parity to ethnic differences in mothers' body mass index in the Netherlands: A Blinder-Oaxaca decomposition approach. Prev Med Rep 2023; 36:102484. [PMID: 37965128 PMCID: PMC10641688 DOI: 10.1016/j.pmedr.2023.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
Women of Turkish and Moroccan origin in the Netherlands are relatively likely to have an unhealthy bodyweight. This study sheds light on how ethnic differences in parity, i.e., the number of times a female carried pregnancies to a viable gestational age, contribute to body mass index (BMI) differences between Turkish-born and Moroccan-born mothers aged 35 + and their native Dutch counterparts. We applied a Blinder-Oaxaca decomposition approach to pooled data from four migrant surveys based on national probability samples (n = 2,532). Unlike conventional mediation analyses, the Blinder-Oaxaca approach recognizes that the association between parity and bodyweight may vary across different groups. Our results indicated that Turkish-born and Moroccan-born mothers in the Netherlands had more children and a higher BMI than native Dutch mothers. Regression analyses moreover showed that the parity-BMI gradient was steeper for Turkish-born mothers than for native Dutch mothers. Decomposition using the Blinder-Oaxaca approach indicated that the higher number of children of Turkish-born and Moroccan-born mothers compared to native Dutch mothers contributed substantially to the higher mean BMI in the former groups. The steeper parity-BMI gradient in Turkish-born mothers further amplified the contribution of parity to the higher mean BMI of Turkish-born mothers as compared to native Dutch mothers. Future research is needed to assess to which extent the steep parity-BMI gradient in Turkish-born mothers can be explained by relatively strong barriers to a healthy lifestyle that Turkish-born mothers of a larger number of children may face due to a relatively strongly gendered division of household and childrearing tasks.
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Affiliation(s)
- Enise Çayci
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands
| | - Charifa Zemouri
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
- Zemouri Public Health Research & Consultancy, Amsterdam, the Netherlands
| | - Thijs van den Broek
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands
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3
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Tsuchiya K, Schulz AJ, Niño MD, Caldwell CH. Perceived Racial/Ethnic Discrimination, Citizenship Status, and Self-Rated Health Among Immigrant Young Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01731-1. [PMID: 37566180 PMCID: PMC11134944 DOI: 10.1007/s40615-023-01731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Both racial/ethnic discrimination and citizenship status are manifestations of racism. Few empirical studies have examined the role of multiple stressors and how both stressors are interlinked to influence health among immigrant young adults. Informed by the theory of stress proliferation, the current study seeks to examine the interplay between perceived racial/ethnic discrimination and citizenship status on health. We used the third wave of the Children of Immigrants Longitudinal Study (CILS) to examine the influence of perceived racial/ethnic discrimination and citizenship status on self-rated health (SRH) among immigrant young adults (N = 3344). Perceived racial/ethnic discrimination was initially associated with SRH. After adjusting for both predictors, those experiencing perceived racial/ethnic discrimination and non-citizen youth were less likely to report better health than youth who did not report perceived racial/ethnic discrimination or citizen youth. In fully adjusted multivariate regression models, racial/ethnic discrimination remained significant, while citizenship status was no longer associated with SRH. To test stress proliferation, an interaction term was included to assess whether the relationship between perceived racial/ethnic discrimination and SRH varied by citizenship status. The interaction term was significant; non-citizen young adults who experienced racial/ethnic discrimination were less likely to report better health in comparison to citizen young adults and those who did not report perceived racial/ethnic discrimination. Results suggest that the interplay between perceived racial/ethnic discrimination and citizenship status may be influential for health among immigrant young adults. These findings underscore the need for further assessment of the role of stress proliferation on immigrant young adults' health.
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Affiliation(s)
- Kazumi Tsuchiya
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
| | - Amy Jo Schulz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Michael David Niño
- Department of Sociology and Criminology, 1 University of Arkansas, Fayetteville, AR, 72701, USA
| | - Cleopatra Howard Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
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4
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Haro-Ramos AY, Bacong AM, Rodriguez HP. Racial Discrimination, Social Disadvantage, and Racial-Ethnic Disparities in COVID-19 Vaccine Uptake. AJPM FOCUS 2023; 2:100072. [PMID: 36744154 PMCID: PMC9889250 DOI: 10.1016/j.focus.2023.100072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction Racial-ethnic disparities in COVID-19 vaccination are well documented. The extent to which racism, manifested at the individual and ZIP code levels, explains disparities in early vaccination uptake remains unclear. Methods Data from a statewide poll of California registered voters (N=10,256), conducted between April 29 and May 5, 2021, linked to area-level resource data, were analyzed. Weighted multivariable logistic regression models examined racial disparities in COVID-19 vaccination. Decomposition analyses quantified how much of the observed racial disparities in vaccination were explained by racial discrimination and social disadvantage (i.e., educational attainment, 2019 household income, and ZIP code social vulnerability). Results Latinx (64.6%) and Black (66.7%) adults were less likely to have at least 1 COVID-19 vaccine dose by April or May 2021 than White adults (74.7%). In adjusted analyses, Latinx (AOR=0.69, 95% CI=0.57, 0.84) and Black (AOR=0.51, 95% CI=0.37, 0.70) adults had a lower likelihood of being vaccinated than Whites. Social disadvantage accounted for 77.4% (p<0.05) and 35.8% (p<0.05) of the explainable variation in Latinx-White and Black-White disparities, respectively. Self-reported racial discrimination was not associated with COVID-19 vaccination in adjusted analyses. Conclusions Social disadvantage but not self-reported racial discrimination explained racial-ethnic disparities in COVID-19 vaccination in California. Removing resource-related barriers may help to increase the relatively low COVID-19 vaccination rates among Black and Latinx populations.
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Affiliation(s)
- Alein Y Haro-Ramos
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Adrian M Bacong
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California
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5
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Richardson BN, Noh HI, Webster CI, Zhang W, Kim S, Yang I, Bai J. Oral Microbiome, Mental Health, and Sleep Outcomes During the COVID-19 Pandemic: An Observational Study in Chinese and Korean American Immigrants. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:180-190. [PMID: 36946910 PMCID: PMC10122216 DOI: 10.1089/omi.2022.0182] [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: 03/23/2023]
Abstract
COVID-19 is a systemic disease whose effects are not limited to the respiratory system. The oral microbiome (OM)-brain axis is of growing interest in understanding the broader, neuropsychiatric, impacts of the COVID-19 pandemic through a systems biology lens. In this context, mental health and sleep disturbance are often reported by Asian Americans. In a cross-sectional observational study design, we examined the associations of the oral microbiome with mental health among Asian Americans during the COVID-19 pandemic (between November 2020 and April 2021). Participants (n = 20) were adult Chinese and Korean American immigrants in Atlanta, Georgia, and primarily born outside the United States (60%) with a mean age of 34.8 years ±14 (standard deviation). Participants reported depressive symptoms, anxiety, and sleep disturbance, as measured by standard questionnaires. The OM was characterized by 16S rRNA V3-V4 gene using saliva. Depressive symptoms and anxiety were reported by 60% (n = 12) of participants, whereas 35% (n = 7) reported sleep disturbance. The α-diversity was significantly associated with depressive symptoms, and marginally with anxiety. Participants with depressive symptoms and anxiety had enriched Rothia and Scardovia, respectively, whereas those without symptoms had enriched Fusobacterium. Individuals with sleep disturbance had enriched Kingella. In conclusion, this study suggests significant associations of the OM diversity with certain mental health dimensions such as depressive symptoms and anxiety. Specific taxa were associated with these symptoms. The present observations in a modest sample size suggest the possible relevance of the OM-brain axis in studies of mental health during COVID-19.
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Affiliation(s)
- Brianna N. Richardson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Hye In Noh
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Caitlin I. Webster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Sangmi Kim
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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6
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Stafford AM, Tanna A, Bueno KM, Nagy GA, Felsman IC, de Marchi S, Cholera R, Evans K, Posada E, Gonzalez-Guarda R. Documentation Status and Self-Rated Physical Health Among Latinx Young Adult Immigrants: the Mediating Roles of Immigration and Healthcare Stress. J Racial Ethn Health Disparities 2023; 10:761-774. [PMID: 35175583 PMCID: PMC8853124 DOI: 10.1007/s40615-022-01264-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 01/14/2023]
Abstract
Previous research has demonstrated that undocumented Latinx immigrants in the USA report worse physical health outcomes than documented immigrants. Some studies suggest that immigration-related stress and healthcare related-stress may explain this relationship, but none have tested it empirically. The purpose of this study was to determine if immigration-related stress and healthcare-related stress in the USA explain the relationship between documentation status and physical health among Latinx immigrants in North Carolina. The conceptual model was tested utilizing baseline data from a longitudinal, observational, community-engaged research study of young adult (18-44 years) Latinx immigrants residing in North Carolina (N = 391). Structural equation modeling was used to determine relationships among documentation status, healthcare, and immigration stress in the past six months, and self-rated physical health. Goodness-of-fit measures indicated that data fit the model well (RMSEA = .008; CFI = 1.0; TLI = .999; SRMR = .02; CD = .157). Undocumented individuals were more likely to experience immigration stress than their documented counterparts ([Formula: see text] = - 0.37, p < 0.001). Both immigration stress ([Formula: see text] = - 0.22, p < 0.01) and healthcare stress ([Formula: see text] = - 0.14, p < 0.05) were negatively related to physical health. Additionally, immigration stress was positively related to healthcare stress ([Formula: see text] = 0.72, p < 0.001). Results demonstrate that documentation status is an important social determinant of health. Passage of inclusive immigration and healthcare policies may lessen the stress experienced by Latinx immigrants and subsequently improve physical health.
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Affiliation(s)
| | - Aneri Tanna
- Trinity College of Arts and Sciences, Duke University, Box 90046, Durham, NC 27710 USA
| | - Karina Moreno Bueno
- Trinity College of Arts and Sciences, Duke University, Box 90046, Durham, NC 27710 USA
| | - Gabriela A. Nagy
- Duke University School of Nursing, 307 Trent Dr. DUMC 3322, Durham, NC 27710 USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba St, Durham, NC 27705 USA
| | - Irene Crabtree Felsman
- Duke University School of Nursing, 307 Trent Dr. DUMC 3322, Durham, NC 27710 USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710 USA
| | - Scott de Marchi
- Department of Political Science, Duke University, 140 Science Dr, Durham, NC 27708 USA
| | - Rushina Cholera
- Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27707 USA
| | - Kate Evans
- Duke University School of Law, 210 Science Dr, Durham, NC 27708 USA
| | - Eliazar Posada
- El Centro Hispano Inc, 2000 Chapel Hill Rd, Durham, NC 27707 USA
| | - Rosa Gonzalez-Guarda
- Duke University School of Nursing, 307 Trent Dr. DUMC 3322, Durham, NC 27710 USA
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7
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Zajdel RA. Divergent Immigrant Health Trajectories: Disparities in Physical Health Using a Multidimensional Conceptualization of Legal Status. INTERNATIONAL MIGRATION REVIEW 2023. [DOI: 10.1177/01979183221149021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Immigrant health research demonstrates that foreign-born individuals generally experience lower morbidity rates relative to native-born individuals. However, this research often overlooks structural factors that influence the immigrant experience, such as legal status. The present study examines legal status as a multidimensional and dynamic characteristic that shapes immigrant health over time. I use two waves of the New Immigrant Survey (n = 3550) to assess if three dimensions of legal status — initial documentation classification, legal permanent residence (LPR) admission category, and US citizenship — predict likelihoods of reporting a chronic condition among a sample of immigrants who attained LPR. Results indicate that each of the three dimensions of legal status predicted health. Immigrants who obtained US citizenship improved their relative health over time, while immigrants with previous temporarily documented, undocumented, legalization, or refugee experience exhibited persistent disadvantage in the hierarchy of immigrant health. Findings demonstrate that the sociopolitical context continually shapes the physical health of immigrants, and a dynamic and multidimensional conceptualization of legal status can expose previously obscured disparities in the overarching pattern of an immigrant health advantage.
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8
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Haro-Ramos AY, Bacong AM. Prevalence and risk factors of food insecurity among Californians during the COVID-19 pandemic: Disparities by immigration status and ethnicity. Prev Med 2022; 164:107268. [PMID: 36150445 PMCID: PMC9487147 DOI: 10.1016/j.ypmed.2022.107268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic exacerbated socioeconomic disparities in food insecurity. Non-citizens, who do not qualify for most publicly-funded food assistance programs, may be most vulnerable to food insecurity during the pandemic. However, no study has examined heterogeneity in food insecurity by immigration status and ethnicity in the context of the pandemic. We analyzed the 2020 non-restricted California Health Interview Survey to examine disparities in food insecurity by ethnicity and immigration status (i.e., US-born, naturalized, non-citizen) among Asians and Latinxs (N = 19,514) compared to US-born Whites. Weighted multivariable logistic regression analyses assessed the association of immigration status and ethnicity with food insecurity. Decomposition analyses assessed the extent to which pandemic-related economic stressors, including experiencing reduced work hours or losing a job versus pre-pandemic socioeconomic position (SEP), accounted for disparities in food insecurity by ethnicity and immigration status. Regardless of immigration status, Latinxs were more likely to experience food insecurity than Whites. Based on the adjusted analyses, non-citizen, naturalized, and US-born Latinxs had a predicted probability of 12%, 11.4%, and 11.9% of experiencing food insecurity, respectively. In contrast, non-citizen Asians, but not US-born or naturalized Asians, reported greater food insecurity than Whites (12.5% vs. 8.2%). SEP accounted for 43% to 66% of the relationship between immigration status-ethnicity and food insecurity. The pandemic exacerbated economic hardship, but food insecurity was largely explained by long-standing SEP-related factors among Latinxs, regardless of immigration status, and non-citizen Asians. To address disparities in food insecurity, social assistance programs and COVID-19 economic relief should be extended to non-citizens.
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Affiliation(s)
- Alein Y Haro-Ramos
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way West, Berkeley, CA 94704, United States.
| | - Adrian M Bacong
- Stanford University, School of Medicine, 1215 Welch Rd, Stanford, CA 94305, United States.
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9
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León‐Pérez G, Patterson EJ, Coelho L. Legal status history, gender, and the health of Latino immigrants in the US. INTERNATIONAL MIGRATION 2022. [DOI: 10.1111/imig.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Larissa Coelho
- Department of Sociology Virginia Commonwealth University Richmond VA USA
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10
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Bacong AM, Hing AK, Morey B, Crespi CM, Kabamalan MM, Lee NR, Wang MC, de Castro AB, Gee GC. Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000324. [PMID: 36082314 PMCID: PMC9450558 DOI: 10.1371/journal.pgph.0000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.
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Affiliation(s)
- Adrian Matias Bacong
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - Anna K. Hing
- University of Minnesota – Twin Cities, Minneapolis, Minnesota, United States of America
| | - Brittany Morey
- University of California-Irvine, Irvine, California, United States of America
| | - Catherine M. Crespi
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | | | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - May C. Wang
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - A. B. de Castro
- University of Washington, Seattle, Washington, United States of America
| | - Gilbert C. Gee
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
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11
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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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12
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Douglas JA, Bostean G, Miles Nash A, John EB, Brown LM, Subica AM. Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095066. [PMID: 35564460 PMCID: PMC9102427 DOI: 10.3390/ijerph19095066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 12/04/2022]
Abstract
U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.
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Affiliation(s)
- Jason A. Douglas
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
- Correspondence: ; Tel.: +1-714-516-5612
| | - Georgiana Bostean
- Sociology and Environmental Science & Policy Programs, Schmid & Wilkinson Colleges, Chapman University, Orange, CA 92866, USA;
| | - Angel Miles Nash
- Donna Ford Attallah College of Educational Studies, Chapman University, Orange, CA 92866, USA;
| | - Emmanuel B. John
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
| | | | - Andrew M. Subica
- Department of Social Medicine, Population & Public Health, Riverside School of Medicine, University of California, Riverside, CA 92521, USA;
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13
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Hamilton ER, Patler C, Savinar R. Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09689-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractRestrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.
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Sohn H, Bacong AM. Selection, experience, and disadvantage: Examining sources of health inequalities among naturalized US citizens. SSM Popul Health 2021; 15:100895. [PMID: 34430702 PMCID: PMC8368999 DOI: 10.1016/j.ssmph.2021.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives We integrated major theories in immigrant health and assimilation into a single analytical framework to quantify the degrees to which demographic composition, pathways to citizenship, and socioeconomic assimilation account for physical and mental health disparities between naturalized immigrants by region of origin. Methods Using the restricted data from the 2015–2016 California Health Interview Survey, we decomposed differences in physical and mental health into demographic factors, path to citizenship, and socioeconomic characteristics by region of origin using the Karlson, Holm, and Breen (KHB) method. Results Differences in socioeconomic status mediated most of the disparity in physical health between naturalized immigrants from different regions. Factors associated with major immigrant health theories—demographic composition, pathways to citizenship, and socioeconomic assimilation—did not mediate disparities in mental health. Conclusion This article argues that the study of health disparities among immigrants must simultaneously account for differences in demographic composition, immigration experience, and socioeconomic disadvantage. The findings also underscore the need for theory development that can better explain mental health disparities among immigrants. Socioeconomic disadvantage accounted for poorer physical health among naturalized citizens who were born in Mexico. Psychological distress is pervasive among naturalized citizens from Central and Latin America. Differences in SES mediated the disparity in physical health between naturalized immigrants from different regions. Demographic characteristics, time to citizenship, and SES did not mediate disparities in mental health.
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Affiliation(s)
- Heeju Sohn
- Department of Sociology, Emory University, 1555 Dickey Drive, 232 Tarbutton Hall, Atlanta, GA, 30322, United States
| | - Adrian Matias Bacong
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, 36-071 CHS, Box 951772, Los Angeles, CA, 90095-1772, United States
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