Beyond Acculturation: Health and Immigrants' Social Integration in the United States

Immigrants typically have more favorable health outcomes than their U.S.-born counterparts of the same race-ethnicity. However, little is known about how race-ethnicity and region of birth moderate the health outcomes of different immigrant groups as their tenure of U.S. residence increases. We study the association between time spent in the United States and health outcomes among non-Hispanic Black, non-Hispanic White, Asian, and Hispanic immigrants using National Health Interview Survey data. Although all immigrant groups initially report better health outcomes than their U.S.-born counterparts, the association between U.S. tenure and reported health outcomes varies among immigrants by race-ethnicity and region of birth. Black immigrants have the worst hypertension profiles, and Black and Hispanic immigrants have the worst obesity profiles. The results suggest that acculturation cannot fully explain racial-ethnic differences in the association between U.S. tenure and health outcomes. We advance a more complete sociological theory of immigrant integration to better explain disparate immigrant health profiles.

Evaluating the interactive impact of acculturative stress and anxiety sensitivity on behavioral health outcomes among Latinx during a period of high COVID-19 impact

As a multi-systemic disease, COVID-19 infection engendered a rise in co-occurring mental and physical health symptoms, particularly affecting the Latinx population. The current work sought to evaluate the main and interactive influence of acculturative stress and anxiety sensitivity in terms of mental and physical health symptoms among 181 Latinx persons (30.4% female, Mage = 34.1 years, SD = 8.20). Data were collected during a period of high COVID-19 impact (2020-2021) and analyses included five separate, two-step hierarchical regressions that were conducted for each of the criterion variables: (1) fear of coronavirus; (2) somatic symptoms; (3) fatigue severity; (4) anxiety symptoms; and (5) depression symptoms. For all analyses, step 1 covariates included years living in the U.S. COVID-19 impact, gender identity, education, and work life distress and home life distress. Results revealed an interactive effect of anxiety sensitivity and acculturative stress on COVID-19 fear, unique main effects for both anxiety sensitivity and acculturative stress on COVID-19 related fear and somatic symptoms, and main effects for anxiety sensitivity alone in relation to fatigue severity, anxiety, and depression. Overall, this study represents an initial investigation of the associations between acculturative stress, anxiety sensitivity, and a range of salient COVID-19 related outcomes among Latinx persons.

Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos

BACKGROUND AND PURPOSE

Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US.

METHODS

We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses.

RESULTS

For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH.

CONCLUSION

Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.

Undocumented Latino Immigrants and the Latino Health Paradox

INTRODUCTION

Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants.

METHODS

This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years).

RESULTS

Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants.

CONCLUSIONS

This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border

Background

Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project.

Methods/design

In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey.

Discussion

Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.

Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color

Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.

Diminished Advantage or Persistent Protection? A New Approach to Assess Immigrants' Mortality Advantages Over Time

Much research has debated whether immigrants' health advantages over natives decline with their duration at destination. Most such research has relied on (pooled) cross-sectional data and used years since immigration as a proxy for the duration of residence, leading to the challenge of distilling the duration effect from the confounding cohort-of-arrival and age-of-arrival effects. Because longitudinal studies tend to use self-rated health as the outcome, the changes they observed may reflect shifts in immigrants' awareness of health problems. We illuminate the debate by examining how immigrants' mortality risk-a relatively unambiguous measure tied to poor health-changes over time compared to natives' mortality risk. Our analysis uses the National Health Interview Survey (1992-2009) with linked mortality data through 2011 (n = 875,306). We find a survival advantage for U.S. immigrants over the native-born that persisted or amplified during the 20-year period. Moreover, this advantage persisted for all immigrants, regardless of their race/ethnicity and gender or when they began their U.S. residence. This study provides unequivocal evidence that immigrant status' health protection as reflected in mortality is stable and long-lasting.

Leisure Satisfaction Changes and Stress-coping during the Pandemic

Objectives: Leisure engagement has been considered as a salient stress-coping strategy. However, during the COVID-19 pandemic, people's leisure engagement has been restricted due to COVID-19- related regulations and policies. Moreover, many Asian immigrants, including Korean immigrants in the US, have been exposed to additional challenges (e.g., discrimination and harassment), which negatively affected their leisure experiences. Methods: in this study, we categorized participants into 3 groups based on their leisure satisfaction changes before and during the pandemic and compared the groups regarding COVID-19 risk perception, stress-coping, and life satisfaction. Results: The Maintained or Increased Group (MIG) scored significantly lower stress than the Highly Decreased group (HDG); the MIG scored significantly higher life satisfaction than both the Slightly Decreased Group (SDG) and the HDG. Conclusion: The research demonstrated the importance of satisfactory leisure experience to cope with stress and be satisfied with their life in a stressful life event.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

Language Use and Generation Status are Associated with Chronic Pain Differences in Mexican Americans

Little is known about the pain experience of the Mexican American (MA) population. We investigated the associations between language use and generation status with chronic pain prevalence, health insurance coverage, and analgesic medication use. We examined 3373 MA respondents from the National Health and Nutrition Examination Survey. We found higher levels of English use and generation status were associated with higher odds of reporting chronic pain. For respondents reporting chronic pain, higher levels of English use and generation status were associated with higher odds of being covered by health insurance, lower odds of having a period of time last year without health insurance, and higher odds of being prescribed any analgesic medication, especially opioid medications. We found language use and generation status play a role in MAs' experience, access, and treatment of chronic pain. Patient-, provider-, and systems-level interventions may be needed to reduce these disparities.

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

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

Diabetes prevalence among diverse Hispanic populations: considering nativity, ethnic discrimination, acculturation, and BMI

PURPOSE

To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI.

METHODS

Data from 6223 Hispanic respondents from the nationally representative NESARC-III study was used. Sociodemographic characteristics were compared across nativity groups, and adjusted odds of self-reported diabetes diagnosis (past year) tested. Differences by perceived discrimination (using endorsement of individual items assessing specific experiences) and by nativity were examined when accounting for sociodemographic characteristics, acculturation, and BMI.

RESULTS

Prevalence of self-reported diabetes diagnosis was significantly higher among the Puerto Rico-born Hispanics, and remained significantly elevated when adjusting for perceived discrimination, acculturation, and health risk behaviors. When adjusting further for BMI, there were no significant differences in the odds of diabetes by nativity. Prevalence of lifetime perceived discrimination was significantly lower among Cuba-born Hispanics. Mean BMI was significantly lower in South/Central America-born Hispanic individuals relative to U.S. state-, Mexico-, and Puerto Rico-born Hispanic groups. Higher BMI was associated with significantly greater risk of diabetes diagnosis across groups.

CONCLUSION

Marked heterogeneity exists in prevalence and in factors associated with diabetes risk and weight status across Hispanic groups in the U.S. Experiences with discrimination may play an important role in accounting for these differences. This should be considered when planning future research to inform the most optimal patient-centered prevention efforts.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort analytic study.

Indigenous Alaskan and mainstream identification explain the link between perceived discrimination and acculturative stress

Drawing from the rejection-identification model, acculturation, and acceptance threat literatures, we examined how Indigenous and mainstream identification influence the effect of discrimination on acculturative and physical stress. A community sample of 126 Indigenous Alaskans reported discrimination, identification with Indigenous Alaskans and mainstream Americans, and acculturative and physical stress. As perceptions of personal discrimination increased, so did Indigenous identification and reports of acculturative and physical stress. Contrary to the rejection-identification hypothesis, Indigenous identification did not reduce the effect of discrimination on stress. Instead, following personal discrimination, Indigenous and mainstream identification interacted to predict acculturative stress. As Indigenous identification increased, so did acculturative stress - particularly among those who strongly identified with mainstream culture. These associations were not present for group-based discrimination. Thus, experiencing personal rejection from mainstream society may be particularly stressful for Indigenous people who strongly identify with their ethnic group, placing them at higher risk for mental and physical illness.

The pathways from perceived discrimination to self-rated health among the Chinese diaspora during the COVID-19 pandemic: investigation of the roles of depression, anxiety, and social support

BACKGROUND

Research indicates the adverse impacts of perceived discrimination on health, and discrimination inflamed by the COVID-19 pandemic, a type of social exclusion, could affect the well-being of the Chinese diaspora. We analyzed the relationship and pathways of perceived discrimination's effect on health among the Chinese diaspora in the context of the pandemic to contribute to the literature on discrimination in this population under the global public health crisis.

METHODS

We analyzed data from 705 individuals of Chinese descent residing in countries outside of China who participated in a cross-sectional online survey between April 22 and May 9, 2020. This study utilized a structural equation model (SEM) to evaluate both direct and indirect effects of perceived discrimination on self-rated health (SRH) and to assess the mediating roles of psychological distress (namely, anxiety and depression) and social support from family and friends.

RESULTS

This online sample comprised predominantly young adults and those of relatively high socioeconomic status. This study confirmed the total and direct effect of recently perceived discrimination on SRH and found the indirect effect was mainly mediated by depression. Mediating roles of anxiety and social support on the discrimination-health relationship were found insignificant in this SEM.

CONCLUSIONS

Our findings suggest discrimination negatively affected the well-being of the Chinese diaspora, and depression acted as a major mediator between the discrimination-health relationship. Therefore, interventions for reducing discrimination to preserve the well-being of the Chinese diaspora are necessary. Prompt intervention to address depression may partially relieve the disease burden caused by the surge of discrimination.

You Have to Pay to Live: Somali Young Adult Experiences With the U.S. Health Care System

There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the United States. We draw on semistructured qualitative interviews (N = 35) with Somali young adults in three U.S. states-Minnesota, Massachusetts, and Maine. Using modified grounded theory analysis, we explore how experiences of discrimination in employment and health care settings impact health care access, utilization, and perceptions of health among Somali young adults. Discrimination was identified as a major barrier to using health services and securing employment with employer-sponsored insurance coverage. These findings highlight how interpersonal and structural discrimination in employment and health care are mutually reinforcing in their production of barriers to health care utilization among Somali refugees.

A Systematic Review of Physical Health Consequences and Acculturation Stress Among Latinx Individuals in the United States

The health of Latinx immigrants decays over time and across generations. Acculturation stress influences decays in behavioral and mental health in this population, but the effect on physical health outcomes is less understood. This systematic review synthesizes findings from 22 studies that examined the influence of acculturation stress on physical health outcomes among Latinx populations in the United States. The Society-to-Cell Resilience Framework was used to synthesize findings according to individual, physiological, and cellular levels. There is mounting evidence identifying acculturation stress as an important social contributor to negative physical health outcomes, especially at the individual level. More research is needed to identify the physiological and cellular mechanisms involved. Interventions are also needed to address the damaging effects of acculturation stress on a variety of physical health conditions in this population.

The impact that cultural food security has on identity and well-being in the second-generation U.S. American minority college students

Food contributes to an individual’s physical and mental well-being and expresses one’s cultural identity through preparation, sharing, and consumption (i.e., foodways). Inadequate access to cultural foods can create cultural stress and affect one’s identity and well-being. In particular, second-generation U.S. American student populations may have a higher risk for cultural stress due to being away from family, academic stress, environmental changes, and diminished financial stability to purchase cultural foods. Thus, an exploratory qualitative methodology was used to elicit information about second-generation U.S. Americans’ food experiences to identify how cultural foods play a role in individual identity and how individual well-being is influenced by the presence or lack of cultural foods. Sixteen semi-structured interviews were conducted with second-generation American students at the University of Nevada, Reno, who self-identified as a cultural or ethnic minority. A standard thematic analysis was conducted. The authors identified that cultural food security influenced the ability to practice foodways, which tied Second-generation American students to their cultural identities. The absence of foodways led to anxiety and depression among students, amplifying the feelings of identity degradation. Second-generation American students discussed that the ability to practice their foodways improved multiple well-being components and led to feelings of happiness, decreased stress, warmth, better digestion, and a sense of belonging, comfort, and safety. College populations continue to grow and become more diverse, and with the increasing Second-generation American students, it is essential to improve the access and availability of cultural foods to improve their overall well-being. (245/250 words).

Health effects of Muslim racialization: Evidence from birth outcomes in California before and after September 11, 2001

Although researchers have made progress in understanding how discrimination affects health outcomes, challenges remain in efforts to analyze the distribution of discrimination-linked stress as a population-level risk factor. Discrimination often does not align with categorical comparisons but is racialized in practice. This study explicitly tests the effects of such racialized discrimination by using the increase in anti-Muslim discrimination following the attacks of September 11, 2001 as a natural experiment. Sociological scholarship suggests anti-Muslim discrimination has been racialized in a way that affects a variety of Middle Eastern and South Asian populations who are often targeted based on physical appearance, rather than religious identification. Using a name-matching algorithm to classify mothers based on name characteristics, I examine birth outcomes for mothers with ancestry from the Middle East and North Africa, South Asia, and a subset of South Asian Sikhs. I find that rates of low birth weight births increased for both Middle Eastern and North African (1.15 RR, 95% CI: 1.00- 1.31) and South Asian Sikh (1.61 RR, 95% CI: 1.06-2.40) mothers in the 37 weeks following September 11, relative to the same period one year prior. The results highlight how processes of racialization can distribute discrimination-linked stress as a risk factor in ways that are overlooked when relying on institutionalized racial, ethnic, or religious categories to study disparities.

Parent Cultural Stress and Internalizing Problems in Latinx Preschoolers: Moderation by Maternal Involvement and Positive Verbalizations

Parent cultural stress has a pervasive and significant impact on family functioning and increases risk for socioemotional problems among Latinx children. Identifying factors that can protect against the negative influence of cultural stressors and enhance the developmental trajectories of Latinx children early in life is key as these children experience disproportionate risk for psychosocial adversity and internalizing mental health problems. The present study evaluated the effect of maternal cultural stress on young children´s internalizing problems, and the moderating role of maternal parenting behaviors. Participants were 65 Latinx children (3 to 5 years old, 50% female) and their mothers (21 to 47 years old, 68% immigrants) recruited from three Head Start Centers in the Chicagoland Area. Mother-reported cultural stress predicted young children's internalizing problems. In addition, maternal self-reported involvement and observed maternal positive verbalizations during one-on-one interactions with the child moderated the effect of cultural stress on child internalizing symptoms. Findings are discussed in the context of efforts to promote family and child resilience and implications for culturally sensitive measurement and intervention.

Discrimination and Psychosocial Well-Being of Migrants in Spain: The Moderating Role of Sense of Community

The discrimination migrants perceive during their adaptation process is one of the main sources of stress and it affects their well-being, health and integration severely. The present study analyses how the sense of community (SOC) can have a protective effect against the perception of discrimination and its negative consequences by verifying the following theoretical model: discrimination predicts three indicators of psychosocial well-being (psychological distress, satisfaction with life and feelings of social exclusion). Furthermore, the theoretical model proposed also considers the hypothesis that SOC has a moderating role on the effect of perceived discrimination regarding the three variables mentioned above. 1714 migrants from Eastern Europe, Africa and Latin America who live in Málaga, Spain, participated in the study. Data were collected using random-route sampling and survey methodology. After carrying out multiple regression analyses, using the PROCESS tool in SPSS 20, the theoretical model was verified: SOC reduces the negative effects of perceived discrimination for the variables psychological distress, satisfaction with life and social exclusion feelings. Therefore, migrants who have a greater SOC experience fewer negative consequences, as compared to those with a lower SOC, for whom the consequences of such variables are more negative. These results highlight the importance for migrants to rebuild social networks in the host country and develop a good SOC. Results also allow the development of intervention patterns to favor positive interactions between native population and migrants.

Advancing racial equity in oral health (research): more of the same is not enough

By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.

Stress and depression in the context of migration among Haitians in the United States

Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration-related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross-sectional pilot study used purposive sampling methods to recruit 76 first-generation Haitian immigrants living in South and West Florida from February 2018-May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration-related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration-related stress and depression (CESD (β =.606, 95% CI [.296, .556]) and ZLDSI (β = .624, 95% CI [.242, .440]). Relative to the standardized coefficient, migration-related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration-related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre-migration factors and the degree of migration-related stress encountered while adapting to life post-migration is critical because they play a significant role in shaping immigrants' depression realities. Community-based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration-related stressors and facilitate mental health promotion and prevention.

Moderating influence of enculturation on the relations between minority stressors and physical health via anxiety in Latinx immigrants

OBJECTIVES

The Latinx population in the United States has grown rapidly, now standing at over 56 million people. Discrimination and acculturative stress have been found to affect the mental and physical health of Latinx immigrants, yet enculturation has been identified as an important cultural strength for this population. The purpose of this study was to examine the relations among minority stressors, anxiety, and physical health in a sample of Latinx immigrants living in the United States. A secondary aim was to examine whether the direct and indirect effects among these variables were moderated by enculturation (i.e., moderated mediation).

METHOD

A community sample of 202 Latinx immigrants completed questionnaires measuring these constructs.

RESULTS

Both acculturative stress (b = -1.68, p < .001) and discrimination (b = -1.69, p < .001) yielded direct effects on physical health, as well as indirect effects (b = -.10, 95% confidence interval [-.23, -.01]; b = -.21, 95% confidence interval [-.40, -.08], respectively) through anxiety.

CONCLUSIONS

Psychologists and allied health care providers are recommended to assess for the impact of minority stressors on anxiety and physical health when providing care to Latinx immigrants. Future intervention research targeting Latinx mental and physical health can consider ways to include innate cultural strengths like enculturation and partner with Latinx cultural centers, churches, and local communities to make enculturation more salient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Racial discrimination and disability among Asian and Latinx populations in the United States

Purpose: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations.Materials and methods: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction.Results and conclusions: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.

The German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants -Measurement Invariance of Filter Questions and Validation

The Multidimensional Acculturative Stress Inventory (MASI) is an established measure of acculturative stress for people of Mexican origin living in the United States that has been associated with mental health outcomes in this population. We translated the MASI into German and adapted it for use with Turkish-origin immigrants in Germany. The MASI includes filter questions asking if a potentially stressful event had actually occurred before reporting the stress appraisal of these situations. Measurement invariance testing has become a standard practice to evaluate questionnaire translations, however, measurement invariance of filter questions has been scarcely studied. In Study I, we evaluated measurement invariance of the filter questions between a German-based Turkish sample (N = 233) and the Mexican-origin sample from the original study (N = 174) and could show partial strong factorial invariance for three of the four factors. In Study II, a validation study, relations between the German MASI scores and measures of acculturation and stress indicated discriminant validity. This study contributes to research on measurement invariance of filter questions, thereby providing a measure of acculturative stress that can be used in future research to understand the etiology of health disparities in Turkish-origin immigrants in Germany.

Acculturative Stress, Anxiety Sensitivity, and Smoking among Spanish-Speaking Latinx Adult Smokers

Objectives: Although acculturative stress is a known individual difference factor related to poor health, little is understood about its relationship to smoking among Latinx adults. One transdiagnostic factor that may serve a mediational role in the relation between acculturative stress and smoking is anxiety sensitivity. The current study evaluated whether anxiety sensitivity mediated the relations between acculturative stress and smoking among a large sample of adult Spanish-speaking Latinx smokers. Method: Participants were 359 Spanish-speaking Latinx daily smokers (58.8% female, M_age= 33.2 years, SD = 9.7) who provided self-report data on acculturative stress, anxiety sensitivity, and smoking outcomes of cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Independent mediation models were conducted for each smoking outcome, with acculturative stress entered as the predictor and anxiety sensitivity entered as the proposed explanatory factor. Results: There were statistically significant indirect effects of acculturative stress via anxiety sensitivity in relation to cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Conclusions: The present findings provide novel evidence that anxiety sensitivity serves a mediational role in relations between acculturative stress and smoking outcomes among Latinx adult smokers.

"Abrazame Que Ayuda" (Hug Me, It Helps): Social Support and the Effect of Perceived Discrimination on Depression among US- and Foreign-Born Latinxs in the USA

BACKGROUND

Higher level of social support is known to mitigate the effect of ethnic discrimination on depression symptoms, yet little is known as to which type of social support may be most effective for ameliorating the negative health effects of perceived ethnic discrimination among Latinxs varying in nativity status. The purpose of this study is to examine the association between perceived ethnic discrimination and depression among US- and foreign-born Latinxs, and to identify specific types of social support that may buffer the aforementioned association in this population.

METHODS

Data from 1340 Latinx respondents (70% US-born; 30% foreign-born) collected from the Texas City Stress and Health Study (TCSHS) was used in this study. The primary outcome was depression, and it was measured using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R).

RESULTS

Findings showed that higher perceived ethnic discrimination were associated with higher depressive symptoms for both foreign-born and US-born Latinxs, with higher levels of social support, specifically positive interaction support, being associated with lower depressive symptoms for both groups. Importantly, results also showed that regardless of nativity status, higher levels of affectionate support mitigated the adverse association between ethnic discrimination and depressive symptoms.

CONCLUSION

This study provides evidence that higher levels of positive interactions and affective support may be significant factors in helping Latinxs cope with ethnic discrimination. This information is essential to inform the development of interventions aimed at building resilience in the face of discrimination among the largest and fastest growing ethnic group in the USA.

Acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States

PURPOSE

Empirical research has largely ignored the potential links between immigration-related stress and disability as well as immigration-related stress and health service utilization despite increasing scholarship on the association between acculturative stress and health. This study examined the associations between acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States.

METHODS

Data were from the National Latino and Asian American Study (NLAAS), a nationally representative survey of Asians and Latinos living in the United States. The analytic sample contained 2653 immigrants. We utilized multivariable logistic regression and negative binomial regression analyses to examine the associations between acculturative stress and disability domains. We also examined the association between acculturative stress and treatment utilization, as this may have implications for how to best intervene to address any functional disability related to acculturative stress.

RESULTS

Acculturative stress was significantly associated with self-reported disability across five domains: self-care, cognition, mobility, time out of role, and social interaction. Additionally, acculturative stress was significantly associated with a greater frequency of disability domains. Acculturative stress was not significantly associated with utilization of services from mental health or general health sectors, but was significantly and positively associated with utilization of non-health care services. The findings were robust regarding the inclusion of everyday discrimination as well as demographic and socioeconomic covariates.

CONCLUSIONS

Acculturative stress may be an important yet overlooked correlate of disability among immigrants in the United States. Non-health care services may provide an effective pathway for intervening for these individuals.

Injustice Appraisal, but not Pain Catastrophizing, Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain

Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.

Moderate-vigorous physical activity and health-related quality of life among Hispanic/Latino adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Physical activity is a modifiable healthy behavior that has been shown to positively influence health-related quality of life. However, research examining the link between physical activity and health-related quality of life among Hispanic/Latino adults is limited and inconsistent. The purpose of this study is to assess whether accelerometer-measured moderate-vigorous physical activity (MVPA) is associated with self-reported (a) mental health-related quality of life, and (b) physical health-related quality of life among diverse Hispanic/Latino adults in the US.

Methods

Cross-sectional data from 12,379 adults ages 18–74 years in 2008–2011, who participated in HCHS/SOL and had complete data were analyzed using complex survey design methods. Accelerometer data were categorized into no MVPA, low, moderate, and high MVPA. Health-related quality of life was assessed with the Short-Form 12 and we used the mental and physical component subscales where higher scores indicate better health-related quality of life. Multivariate linear regression models were used to derive adjusted means with 95% confidence intervals and linear trends.

Results

We observed no significant linear trend between accelerometer-measured MVPA and mental health-related quality of life (p_trend = 0.73). There was a significant positive association between MVPA and physical health-related quality of life (p_trend < 0.001) where higher MVPA corresponded with higher scores in physical health-related quality of life. The adjusted means were 46.67 (44.85–48.48) for no MVPA, 49.33 (49.03–49.63) for low MVPA, 50.61 (50.09–51.13) for moderate MVPA, and 51.36 (50.86–51.86) for high MVPA.

Conclusions

Among diverse Hispanic/Latino adults in the US, accelerometer-measured MVPA was associated with physical health-related quality of life, but not mental health-related quality of life. Future interventions should evaluate if increases in MVPA lead to improvements in health-related quality of life.

Electronic supplementary material

The online version of this article (10.1186/s41687-019-0129-y) contains supplementary material, which is available to authorized users.

Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies

PURPOSE

Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH.

METHODS

Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH.

RESULTS

After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found.

CONCLUSIONS

For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.

Effect of Generational Status on Child Well-Being: Mediating Effects of Social Support and Residential Instability

Children in migrant families often encounter difficulties that have great impacts on their health. However, there is a lack of research to examine generational status and child health-related quality of life (HRQoL). This study compared the HRQoL of children, aged 3 to 19 years, born in Hong Kong to mainland parents with second- and third-or-higher-generation children; and explores the mediating effects of residential instability and of social support on the association between generational status and HRQoL. A sample comprised 4807 reports on children (mean age = 7.47 years) in Hong Kong was analyzed. Significantly lower HRQoL related to physical functioning was observed among children in migrant families. Association between generational status and child HRQoL was mediated by commute time between home and school, frequency of moving home, and social support. Findings lend utility to addressing similar issues amongst other developmental immigrant populations.

Implementing a Need-Adapted Stepped-Care Model for Mental Health of Refugees: Preliminary Data of the State-Funded Project "RefuKey"

Introduction: Refugees have been shown to be a rather vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By expanding regional psychosocial and psychiatric-psychotherapeutic care structures and adapting psychiatric routine care to refugees' needs, the state-funded project "refuKey" based in Lower Saxony, Germany, pursues to ease access to mental health care and increase service quality for refugees. A stepped-care treatment model along with intercultural opening of mental health care services is proposed. Methods: The project is subject to a four-part evaluation study. The first part investigates the state of psychiatric routine care for refugees in Lower Saxony by requesting data from all psychiatric clinics, participating and non-participating ones, regarding the numbers of refugee patients, their diagnoses, settings of treatment, etc. The second part explores experiences and work satisfaction of mental health care professionals treating refugees in refuKey cooperation clinics. The third part consists of interviews and focus group discussions with experts regarding challenges in mental health care of refugees and expectations for improvement through refuKey. The fourth part compares mental health parameters like depression, anxiety, traumatization, somatization, psychoticism, quality of life, as well as "pathways-to-care" of refuKey-treated refugees before and after treatment and, in a follow-up, to a non-refuKey-treated refugee control group. Results: RefuKey-treated refugees reported many mental health problems and estimated their mental health burden as high. The symptoms decreased significantly over the course of treatment. Mental health in the refuKey sample was strongly linked to post-migration stressors. Discussion: The state of mental health care for refugees is discussed. Implications for the improvement and the need for adaptation of routine mental health care services are drawn.

Inflammation among Children: Evidence of an Immigrant Advantage?

Past research on the immigrant health paradox suggests that children with immigrant parents may have a health advantage over those with U.S.-born parents, especially if the parent is a recent immigrant. Other research emphasizes the social and economic challenges children with immigrant parents face, in part due to disadvantaged social class and racial/ethnic positions. Underlying physiological changes due to chronic stress exposures among children in immigrant families is one potential health disadvantage that may not yet be apparent in traditional health measures. To explore these biological disparities during childhood, I use national biomarker and survey data from NHANES (N=11,866) to evaluate parent nativity and educational status associations with low-grade inflammation, indicated by C-reactive Protein (CRP), in children ages 2-15 years. I find that children with an immigrant parent, and particularly a low-education immigrant parent, have higher CRP, net of birth, BMI and other factors, than children with a U.S. born parent with either a low or higher education. Comparing children with low-educated parents, those with a foreign-born parent have higher predicted CRP. The findings from this study provide new evidence that children living in immigrant families in the U.S. may be facing higher levels of chronic stress exposure, as indicated by the increased risk of low-grade inflammation, than those with U.S.-born parents. The physiological changes related to increased risk of inflammation could set children in immigrant families on pathways towards mental and physical health problems throughout childhood and later in the life course.

Stress, migration, and allostatic load: a model based on Mexican migrants in Columbus, Ohio

Background

Immigration is a disruptive event with multiple implications for health. Stressors, including family separation, acculturation, job insecurity, restricted mobility, sojourns, dangerous border crossings, stigmatization, and marginalization, shape immigrant health in ways we are only beginning to untangle. Around the world, there are over 200 million international migrants. In 2015, there were 43.2 million immigrants living in the US, 26.8% of whom were born in Mexico. Investigating how stress affects health among migrants facilitates better understanding of their experiences.

Methods

Here, we review existing research on stress and how allostatic load varies among migrants with specific attention to Mexican migrants in the US. Next, we explore research incorporating biomarkers of allostasis and narratives of migration and settlement to examine disease risks of Mexican migrants residing in Columbus, Ohio. This mixed-methods approach allowed us to examine how social stressors may influence self-reports of health differentially from associations with assessed discrimination and physiological biomarkers of health.

Results

These data sources are not significantly associated. Neither narratives nor self-reports of health provide significant proxies for participants’ physiological health.

Conclusions

We propose, the pairing of objectively assessed health profiles with narratives of migration better illustrate risks migrants face, while allowing us to discern pathways through which future health challenges may arise. Immigration and acculturation to a new nation are biologically and culturally embedded processes, as are stress and allostatic responses. To understand how the former covary with the latter requires a mixed-methods bioethnographic approach. Differences across multiple social and physiological systems, affect individual health over time. We propose incorporating physiological biomarkers and allostatic load with migrants’ narratives of their migration to unravel complex relationships between acculturation and health.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008-2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

Linguistic Integration and Immigrant Health: The Longitudinal Effects of Interethnic Social Capital

The literature on immigrant health has by and large focused on the relationship between acculturation (often measured by a shift in language use) and health outcomes, paying less attention to network processes and the implications of interethnic integration for long-term health. This study frames English-language use among immigrants in the United States as a reflection of bridging social capital that is indicative of social network diversity. Using longitudinal data on self-rated health and the incidence of chronic conditions from the New Immigrant Survey (2003, 2007), I examine the contemporaneous and longitudinal associations between interethnic social capital and health. The results show evidence for a positive long-term effect of linguistic integration on health status, but no cross-sectional associations were observed. Overall, these results highlight the possible role of network processes in linking English-language use with immigrant health and the time-dependent nature of the relationship between linguistic integration and health status.

Ethnic Identity and Perceived Stress Among Ethnically Diverse Immigrants

Recent empirical research suggests that having a strong ethnic identity may be associated with reduced perceived stress. However, the relationship between perceived stress and ethnic identity has not been tested in a large and ethnically diverse sample of immigrants. This study utilized a multi-group latent class analysis of ethnic identity on a sample of first and second generation immigrants (N = 1603), to determine ethnic identity classifications, and their relation to perceived stress. A 4-class ethnic identity structure best fit the data for this immigrant sample, and the proportion within each class varied by ethnicity, but not immigrant generation. High ethnic identity was found to be protective against perceived stress, and this finding was invariant across ethnicity. This study extends the findings of previous research on the protective effect of ethnic identity against perceived stress to immigrant populations of diverse ethnic origins.

Pathways linking racial/ethnic discrimination and sleep among U.S.-born and foreign-born Latinxs

This study examined the association between racial/ethnic discrimination and sleep through psychological distress and body mass index (BMI), and determined whether the aforementioned associations vary between U.S. and foreign-born Latinxs. Participants were 1332 Latinx adults enrolled in the Texas City Stress and Health Study. Multistage sampling methods were used to select participants. A model linking racial/ethnic discrimination with sleep disturbances through direct and indirect (i.e., psychological distress and BMI) paths demonstrated good fit. Greater racial/ethnic discrimination was associated with greater psychological distress and higher BMI. Psychological distress and BMI were also significant predictors of sleep disturbances. The indirect path from racial/ethnic discrimination to sleep disturbances via psychological distress was significant. A model with parameters constrained to be equal between U.S.-born and foreign-born Latinxs suggested associations were comparable between these groups. Our study demonstrated the relevance of racial/ethnic discrimination to sleep disturbances, particularly its association via psychological distress among Latinxs.

How discrimination and perspective-taking influence adolescents' attitudes about justice

Little is known about factors influencing adolescents' justice attitudes. This online study investigates perspective-taking and experiences with discrimination for their associations with adolescents' beliefs about how justice is best served. Participants included 179 ethnically/racially diverse high school students (M_age = 16.67 years; SD = 1.02). Higher perspective-taking was associated with less punitive and more restorative attitudes. Youth reporting more personal and ethnic/racial discrimination experiences endorsed more restorative justice attitudes. Perspective-taking also moderated the associations between reports of family, personal, and religious discrimination and punitive justice attitudes: adolescents reporting higher discrimination showed a stronger inverse relationship between perspective-taking and punitive attitudes. Findings have implications for school and community programs aiming to implement restorative policies, and for adolescents' civic participation.

Acculturation and health: the moderating role of socio-cultural context

Acculturation represents an important construct for elucidating the determinants and consequences of health disparities in minority populations. However, the processes and mechanisms underlying acculturation's effects on health are largely undetermined and warrant further study. We integrate concepts from anthropology and statistics to describe the role of sociocultural context as a putative modifier of the relationship between acculturation and health. Sociocultural context may influence the extent to which exposure to host culture leads to internalization of host cultural orientation, and may influence the extent to which acculturation leads to stress and adoption of unhealthy behaviors. We focus on specific aspects of sociocultural context: (1) neighborhood ethno-cultural composition; (2) discrimination; (3) discrepancy between origin and host environments; (4) discrepancy between heritage and host cultures; (5) origin group, host group, and individual attitudes towards assimilation; (6) variation in targets of assimilation within host community; (7) public policy and resources; (8) migration selection bias. We review and synthesize evidence for these moderation effects among first- and later-generation immigrants, refugees, and indigenous populations. Furthermore, we propose best-practices data-collection and statistical-analysis methods for this purpose, in order to improve our understanding of the complex, multilevel aspects of the relationship between acculturation and health.

Cultural Distress: An Emerging Paradigm

Although cultural competence in practice is a common goal within the health care professions, little is known about the consequences of a lack of such competence in health and healing. We propose a novel theoretical framework of cultural distress to describe patient experiences of and reactions to care that does not incorporate attention to cultural needs. Use of the cultural distress model to guide research offers an innovative framework by which researchers may identify potential interventions such that patients never reach a level of cultural distress.

Lifetime history of traumatic events in a young adult Mexican American sample: Relation to substance dependence, affective disorder, acculturation stress, and PTSD

Mexican Americans comprise one of the most rapidly growing populations in the United States, and within this population, trauma and post-traumatic stress disorder (PTSD) are associated with physical and mental health problems. Therefore, efforts to delineate factors that may uniquely contribute to increased likelihood of trauma, PTSD, and substance use disorders over the lifetime in Mexican Americans are important to address health disparities and to develop treatment and prevention programs. Six hundred fourteen young adults (age 18-30 yrs) of Mexican American heritage, largely second generation, were recruited from the community and assessed with the Semi-Structured Assessment for the Genetics of Alcoholism and an acculturation stress scale. More males (51.2%) reported experiencing traumas than females (41.1%), however, a larger proportion of females received a PTSD diagnosis (15%) than males (8%). Alcohol dependence and affective disorders, but not anxiety disorders, antisocial disorders, nicotine, marijuana, or stimulant dependence, were significantly comorbid with PTSD. Endorsing higher levels of acculturation stress was also significantly associated with both trauma exposure and a diagnosis of PTSD. Logistic regression revealed that female gender, having an affective disorder, alcohol dependence, higher levels of acculturation stress, and lower levels of education were all predictors of PTSD status. Additionally, alcohol dependence generally occurred after the PTSD diagnosis in early adulthood in this high-risk population. These studies suggest that treatment and prevention efforts should particularly focus on young adult second generation Mexican American women with higher levels of acculturation stress, who may be at higher risk for PTSD, affective disorder, and alcohol dependence following trauma exposure.

Cervical and Breast Cancer Screening Among Mexican Migrant Women, 2013

INTRODUCTION

Information on cervical and breast cancer screening among Latinas in the United States is limited. Even less information is available on screening practices of migrant women who engage in circular migration. We examined rates of cervical and breast cancer screening and the extent to which sociodemographics and other characteristics explain screening practices of Mexican migrant women who return to Mexico from the United States.

METHODS

We used data from a cross-sectional probability survey of Mexico-born migrant women who returned, through Tijuana, to Mexico from the United States in 2013. The sample consisted of women who returned involuntarily (via deportation) or voluntarily; 177 reported authorized documentation status, and 36 reported unauthorized documentation status in the previous 12 months. Descriptive statistics were calculated and logistic regressions were estimated.

RESULTS

Of 36 undocumented migrant women, 8 (22.2%) had a Papanicolaou test and 11 (30.6%) had a mammogram in the previous year; of 177 documented migrants, 83 (46.9%) had a Papanicolaou test and 68 (38.4%) had a mammogram. Undocumented migrants were less likely than documented migrants to receive a Papanicolaou test (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.12-0.67); the likelihood was similar after adjustment for sociodemographic, migration, and acculturation factors (adjusted OR = 0.33; 95% CI, 0.12-0.90). Having health insurance (adjusted OR = 4.17; 95% CI, 1.80-9.65) and a regular source of health care (adjusted OR = 2.83; 95% CI, 1.05-7.65) were significant predictors of receiving a mammogram but not a Papanicolaou test.

CONCLUSION

Public health programs are needed to improve access to cervical and breast cancer screenings for Latina migrant women in general and undocumented circular migrants in particular.

Alcohol and Drug Use, Abuse, and Dependence in Urban Areas and Colonias of the Texas-Mexico Border

This study describes the prevalence of alcohol and drug use, abuse, and dependence among adults on the Texas-Mexico border in 2002-2003. The findings are based on survey responses from a random sample of 1,200 adults living in households in three communities: El Paso, a densely populated city in west Texas; the less dense urbanized areas of the lower Rio Grande Valley in south Texas; and rural or semirural colonias—unregulated settlements characterized by lack of basic public services—in south Texas. The findings revealed similarity in drug use across the three sites but higher rates of binge drinking and alcohol dependence in the colonias. Border alcohol and drug use appeared similar or lower than use among residents of Texas as a whole or Hispanics nationwide; however, problems of abuse and dependence appeared somewhat higher on the border.

Evaluating an Abbreviated Version of the Hispanic Stress Inventory for Immigrants

This study evaluates an abbreviated version of the Hispanic Stress Inventory-Immigrant version (HSI-I) with a nonclinical sample of 143 adult Hispanic immigrants residing in a large midwestern city. The HSI-I consists of 73 items and 5 distinct subscales that assess psychosocial experiences on five dimensions, namely, occupational/economic, parental, marital, immigration, and familial/cultural. Five items with the greatest loading in each of the five sub-scales were aggregated to compose the abbreviated HSI-I. Exploratory factor analysis supports a two-factor structure that combines factors identified in previous research. Internal consistencies are acceptable across all subscales, ranging from .68 to .83. Convergent validity of the abbreviated HSI-I revised is supported with moderately positive relations through self-report measures of depression, anxiety, and anger mood levels. These findings provide initial support for the reliability and validity of the abbreviated HSI-I in Hispanic adults.