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Echeverría SE. Improving Latino Health Through Equity-Centered Physical Activity Research. Am J Public Health 2024; 114:S436-S438. [PMID: 39083733 PMCID: PMC11292282 DOI: 10.2105/ajph.2024.307764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Sandra E Echeverría
- Sandra E. Echeverría is Associate Professor in the Department of Public Health Education, School of Health and Human Sciences, University of North Carolina Greensboro
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2
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McKenzie-Sampson S, Baer RJ, Chambers Butcher BD, Jelliffe-Pawlowski LL, Karasek D, Oltman SP, Riddell CA, Rogers EE, Torres JM, Blebu BE. Risk of Adverse Perinatal Outcomes Among African-born Black Women in California, 2011-2020. Epidemiology 2024; 35:517-526. [PMID: 38567905 DOI: 10.1097/ede.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared with United States-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear. METHODS We conducted a population-based study of nonanomalous singleton live births to United States- and African-born Black women in California from 2011 to 2020 (n = 194,320). We used age-adjusted Poisson regression models to estimate the risk of preterm birth and SGA and reported risk ratios (RR) and 95% confidence intervals (CI). Decomposition using Monte Carlo integration of the g-formula computed the percentage of disparities in adverse outcomes between United States- and African-born women explained by individual-level factors. RESULTS Eritrean women (RR = 0.4; 95% CI = 0.3, 0.5) had the largest differences in risk of preterm birth and Cameroonian women (RR = 0.5; 95% CI = 0.3, 0.6) in SGA birth, compared with United States-born Black women. Ghanaian women had smaller differences in risk of preterm birth (RR = 0.8; 95% CI = 0.7, 1.0) and SGA (RR = 0.9; 95% CI = 0.8, 1.1) compared with United States-born women. Overall, we estimate that absolute differences in socio-demographic and clinical factors contributed to 32% of nativity-based disparities in the risk of preterm birth and 26% of disparities in SGA. CONCLUSIONS We observed heterogeneity in risk of adverse perinatal outcomes for African- compared with United States-born Black women, suggesting that nativity disparities in adverse perinatal outcomes were not fully explained by differences in individual-level factors.
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Affiliation(s)
- Safyer McKenzie-Sampson
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Rebecca J Baer
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA
- Department of Pediatrics, University of California San Diego, La Jolla, CA
| | | | - Laura L Jelliffe-Pawlowski
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Deborah Karasek
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Scott P Oltman
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Corinne A Riddell
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Jacqueline M Torres
- From the Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, CA
| | - Bridgette E Blebu
- Department of Obstetrics and Gynecology, Lundquist Institute/Harbor-UCLA, University of California, Los Angeles, CA
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Montoya-Williams D, Barreto A, Laguna-Torres A, Worsley D, Wallis K, Peña MM, Palladino L, Salva N, Levine L, Rivera A, Hernandez R, Fuentes-Afflick E, Yun K, Lorch S, Virudachalam S. Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care 2024; 62:404-415. [PMID: 38728679 PMCID: PMC11090453 DOI: 10.1097/mlr.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
RESEARCH DESIGN Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. OBJECTIVE To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. BACKGROUND Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally. PATIENTS AND METHODS Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. RESULTS Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. CONCLUSION Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alejandra Barreto
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia Laguna-Torres
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Worsley
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kate Wallis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle-Marie Peña
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lauren Palladino
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Salva
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | - Lisa Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | | | | | - Elena Fuentes-Afflick
- Division of General Pediatrics University of California, San Francisco, San Francisco, CA
| | - Katherine Yun
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Samari G, Wurtz HM, Abularrage TF, Sharif MZ. Structural gendered racism as conceptualized by immigrant women in the United States. Soc Sci Med 2024; 351 Suppl 1:116396. [PMID: 38825373 PMCID: PMC11149896 DOI: 10.1016/j.socscimed.2023.116396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 06/04/2024]
Abstract
RATIONALE Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact. OBJECTIVE This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City. METHOD Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach. RESULTS Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families. CONCLUSIONS The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.
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Affiliation(s)
- Goleen Samari
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Heather M Wurtz
- Anthropology Department, University of Connecticut, Storrs, CT, USA; Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, CT, USA; Population Studies and Training Center, Brown University, Providence, RI, USA
| | - Tara F Abularrage
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Mienah Z Sharif
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Center for the Study of Racism, Social Justice and Health, University of California, Los Angeles, CA, USA
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Camedda C, Righi M. Experiences and Suggestions of Nurses Involved in Caring for Migrant Populations in Italy: A Qualitative Study. Healthcare (Basel) 2024; 12:275. [PMID: 38275555 PMCID: PMC10815452 DOI: 10.3390/healthcare12020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this research is to explore nurses' experiences in caring for migrants, regular and non-regular, within outpatient clinics in Italy. MATERIALS AND METHODS Thirteen nurses have been interviewed through online semi-structured interviews, conducted with the support of a questionnaire, made by researchers, consisting of open-ended questions on legislative issues, cultural issues, and regarding best practices. Purposive sampling has been used, along with phone and email recruitment. The audio recordings of the interviews were verbatim transcribed, then examined. This study is a qualitative descriptive fundamental research project. RESULTS Interviewees highlight migrants' difficulties in accessing care, critical points of legislation, transcultural skills crucial to nurses, and good practices. A total of 105 labels were developed and grouped into 23 categories under 7 themes (Italian legislation and migrants; structural difficulties in assistance; the influence of politics; the work of NGOs and associations; nursing care; winning strategies; and the role of the Family and Community Nurse). CONCLUSION The research highlights how access to care for migrants is hindered by legislative, structural, and cultural barriers, with consequences on the NHS (improper accesses to the emergency room, increased workload, and economic expenditure). For the full realization of the right to health, as enshrined by Art. 32 of the Constitution, changes are needed with respect to regulations and professionals' training.
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Affiliation(s)
- Claudia Camedda
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Maddalena Righi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
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Robles-Ramamurthy B, Fortuna LR. Editorial: Institutional Commitment Is Needed to Promote Antiracist Care of Unaccompanied Immigrant Minors. J Am Acad Child Adolesc Psychiatry 2023; 62:1185-1187. [PMID: 36997113 DOI: 10.1016/j.jaac.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
Antiracism can be defined as the practice of opposing racism and promoting racial equity and justice. Within health care, antiracism also includes acknowledging and addressing the structural injustices resulting in health inequities. Racism plays a role in how the United States accepts and welcomes refugees and asylum seekers.1 From an intersectional perspective, children are innately in positions of disadvantage, with unaccompanied immigrant minors (UIMs) experiencing an even greater toll due to the lack of direct parental physical care. This editorial discusses antiracist care of UIMs and the need for institutional and structural support to sustain this important clinical work.
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Affiliation(s)
| | - Lisa R Fortuna
- University of California San Francisco, San Francisco, California
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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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