Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women

This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

Use of historical mapping to understand sources of soil-lead contamination: Case study of Santa Ana, CA

This paper investigates the historical sources of soil-lead contamination in Santa Ana, California. Even though dangerous levels of soil-lead have been found in a wide variety of communities across the United States, public health institutions lack clarity on the historical origins of these crises. This study uses geo-spatial data collected through archival research to estimate the impact of two potential sources of lead contamination in the past -- lead-paint and leaded gasoline. It examines, through a combination of statistical and historical methods, the association between lead concentrations in contemporary soil samples and patterns in the evolution of the city's physical features, such as the growth of urbanized areas and the historical flow of traffic. We emphasize the value of historical data collected through archival research for understanding the sources of environmental lead, particularly leaded gasoline, which our study found to be the most likely and most prominent contributor to soil-lead in Santa Ana's environment. This research contributes to environmental-justice advocacy efforts to reframe lead poisoning as a systemic environmental issue and outlines the path forward to community-level remediation strategies.

Using path analysis to model the process of change in HbA1c among African Americans and Latinos in a community health worker diabetes intervention

OBJECTIVE

To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes.

METHODS

The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c.

RESULTS

The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress.

CONCLUSIONS

Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os.

PRACTICE IMPLICATIONS

Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.

Use of Radioisotope Ratios of Lead for the Identification of Historical Sources of Soil Lead Contamination in Santa Ana, California

Lead (Pb) is an environmental neurotoxicant that has been associated with a wide range of adverse health conditions, and which originates from both anthropogenic and natural sources. In California, the city of Santa Ana represents an urban environment where elevated soil lead levels have been recently reported across many disadvantaged communities. In this study, we pursued a community-engaged research approach through which trained “citizen scientists” from the surrounding Santa Ana community volunteered to collect soil samples for heavy metal testing, a subset of which (n = 129) were subjected to Pb isotopic analysis in order to help determine whether contamination could be traced to specific and/or anthropogenic sources. Results showed the average 206Pb/204Pb ratio in shallow soil samples to be lower on average than deep samples, consistent with shallow samples being more likely to have experienced historical anthropogenic contamination. An analysis of soil Pb enrichment factors (EFs) demonstrated a strong positive correlation with lead concentrations, reinforcing the likelihood of elevated lead levels being due to anthropogenic activity, while EF values plotted against 206Pb/204Pb pointed to traffic-related emissions as a likely source. 206Pb/204Pb ratios for samples collected near historical urban areas were lower than the averages for samples collected elsewhere, and plots of 206Pb/204Pb against 206Pb/207 showed historical areas to exhibit very similar patterns to those of shallow samples, again suggesting lead contamination to be anthropogenic in origin, and likely from vehicle emissions. This study lends added weight to the need for health officials and elected representatives to respond to community concerns and the need for soil remediation to equitably protect the public.

Occupational health within the bounds of primary care: Factors shaping the health of Latina/o immigrant workers in federally qualified health centers

BACKGROUND

Many workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers.

METHODS

We conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA.

RESULTS

Using a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system.

CONCLUSION

This study underscores the complexities of addressing occupational health concerns in urban FQHCs.

Mexican-Origin Women's Construction and Navigation of Racialized Identities: Implications for Health Amid Restrictive Immigrant Policies

This study examines how Mexican-origin women construct and navigate racialized identities in a postindustrial northern border community during a period of prolonged restrictive immigration and immigrant policies, and it considers mechanisms by which responses to racialization may shape health. This grounded theory analysis involves interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. In response to institutions and institutional agents using racializing markers to assess their legal status and policing access to health-promoting resources, women engaged in a range of strategies to resist being constructed as an "other." Women used the same racializing markers or symbols of (il)legality that had been used against them as a malleable set of resources to resist processes of racialization and to form, preserve, and affirm their identities. These responses include constructing an authorized immigrant identity, engaging in immigration advocacy, and resisting stigmatizing labels. These strategies may have different implications for health over time. Findings indicate the importance of addressing policies that promulgate or exacerbate racialization of Mexican-origin communities and other communities who experience growth through migration. Such policies include creating pathways to legalization and access to resources that have been invoked in racialization processes, such as state-issued driver's licenses.

Risk assessment of soil heavy metal contamination at the census tract level in the city of Santa Ana, CA: implications for health and environmental justice

(1) Background: exposure to heavy metals is associated with adverse health effects and disproportionately impacts low-income communities and communities of color. We carried out a community-based participatory research study to examine the distribution of heavy metal concentrations in the soil and social vulnerabilities to soil heavy metal exposures across Census tracts in Santa Ana, CA. (2) Methods: soil samples (n = 1528) of eight heavy metals including lead (Pb), arsenic (As), manganese (Mn), chromium (Cr), nickel (Ni), copper (Cu), cadmium (Cd), and zinc (Zn) were collected in 2018 across Santa Ana, CA, at a high spatial resolution and analyzed using XRF analysis. Metal concentrations were mapped out and American Community Survey data was utilized to assess metals throughout Census tracts in terms of social and economic variables. Risk assessment was conducted to evaluate carcinogenic and non-carcinogenic risk. (3) Results: concentrations of soil metals varied according to landuse type and socioeconomic factors. Census tracts where the median household income was under $50 000 had 390%, 92.9%, 56.6%, and 54.3% higher Pb, Zn, Cd, and As concentrations compared to high-income counterparts. All Census tracts in Santa Ana showed hazard index >1, implying the potential for non-carcinogenic health effects, and nearly all Census tracts showed a cancer risk above 10-4, implying a greater than acceptable risk. Risk was predominantly driven by childhood exposure. (4) Conclusions: findings inform initiatives related to environmental justice and highlight subpopulations at elevated risk of heavy metal exposure, in turn underscoring the need for community-driven recommendations for policies and other actions to remediate soil contamination and protect the health of residents.

Facilitators and Barriers of a Chronic Care Management Intervention Addressing Diabetes Among Mexican-Origin Adults

BACKGROUND

Chronic care management (CCM) and community health worker (CHW) interventions hold promise for managing complex chronic conditions such as diabetes and related comorbidities. This qualitative study examines facilitators and barriers to the implementation of an expanded CCM intervention that explicitly incorporated program staff, clinic staff, CHWs, and partnerships with community-based organizations to enhance diabetes management among Mexican-origin adults.

METHOD

Grounded theory was used to analyze interviews conducted in 2018 with 24 members of the CCM team, including program staff, clinic staff, and community-based program partner staff.

RESULTS

Three themes emerged that characterize perceived facilitators and barriers to CCM implementation, based on analysis of interviews: (1) understanding roles and responsibilities across organizations, (2) building relationships across organizations, and (3) coordinating delivery of the model among different organizations. First, structured meetings and colocated workspaces enhanced understanding of CCM roles for each team member and across organizations. Barriers to understanding CCM roles were more common during the early stages of CCM implementation and amongst staff who did not participate in regular meetings. Second, regular meetings facilitated development of relationships across organizations to enhance implementation of the CCM model. In contrast, limited relationship building among some CCM team members served as a barrier to implementation. Third, CHWs and case review meetings fostered communication and coordination across the CCM model.

CONCLUSIONS

Results suggest the importance of understanding roles and building relationships among multidisciplinary teams to ensure effective communication and coordination of care.

Guideline-adherent treatment, sociodemographic disparities, and cause-specific survival for endometrial carcinomas

BACKGROUND

Adherence to National Comprehensive Cancer Network guidelines have been adopted as the standard of care for various cancers and have been cited to have survival benefits. Few studies have examined the association of adherent treatment and endometrial cancer survival among various racial/ethnic groups and socioeconomic statuses.

METHODS

Between January 1, 2006 and December 31, 2015, 83,673 women diagnosed with endometrial carcinomas were identified from the Surveillance, Epidemiology, and End Results database. Descriptive statistics of demographic and clinical characteristics were performed. Cox-proportional hazards models were used to examine the effect on cause-specific survival for adherence to guidelines across racial/ethnic and socioeconomic groups.

RESULTS

Within our sample, 59.5% were treated according to guidelines. Nonadherence to treatment guidelines was significantly associated with decreased survival compared with adherent care (adjusted hazard ratio [HR], 1.59; 95% CI, 1.52-1.67). Being of Black (adjusted HR, 1.41; 95% CI, 1.32-1.51) or Native Hawaiian/Pacific Islander (adjusted HR, 1.44; 95% CI, 1.19-1.73) race/ethnicity compared with White women was significantly associated with worse survival. Being of Asian race/ethnicity (adjusted HR, 0.86, 95% CI, 0.78-0.94) was significantly associated with improved survival compared with White women. Lower neighborhood socioeconomic status was associated with a negative effect on survival relative to women in the highest socioeconomic status category.

CONCLUSIONS

Findings from this study suggest treatment adherence is an independent predictor of improved survival; however, improved survival was not observed equally among all racial/ethnic and socioeconomic status groups.

LAY SUMMARY

The National Comprehensive Cancer Network (NCCN) has developed guidelines for physicians to follow in treating various cancers. Within this study of 83,673 women with endometrial cancer, 59.5% of women were treated according to the NCCN guidelines. The findings suggest following NCCN guidelines for treatment of endometrial cancer improves survival. Black or Native Hawaiian/Pacific Islander race and lower neighborhood socioeconomic status has worse survival rates compared with other groups, indicating the importance of exploring other factors that may shape treatment across racial/ethnic and socioeconomic status groups.

Preventing the Spread of COVID-19 in Immigration Detention Centers Requires the Release of Detainees

Immigration detention centers are densely populated facilities in which restrictive conditions limit detainees' abilities to engage in social distancing or hygiene practices designed to prevent the spread of COVID-19. With tens of thousands of adults and children in more than 200 immigration detention centers across the United States, immigration detention centers are likely to experience COVID-19 outbreaks and add substantially to the population of those infected.Despite compelling evidence indicating a heightened risk of infection among detainees, state and federal governments have done little to protect the health of detained im-migrants. An evidence-based public health framework must guide the COVID-19 response in immigration detention centers.We draw on the hierarchy of controls framework to demonstrate how immigration detention centers are failing to implement even the least effective control strategies. Drawing on this framework and recent legal and medical advocacy efforts, we argue that safely releasing detainees from immigration detention centers into their communities is the most effective way to prevent COVID-19 outbreaks in immigration detention settings. Failure to do so will result in infection and death among those detained and deepen existing health and social inequities.

The Washtenaw ID Project: A Government-Issued ID Coalition Working Toward Social, Economic, and Racial Justice and Health Equity

Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.

Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community

Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.

The State of Public Health Lead Policies: Implications for Urban Health Inequities and Recommendations for Health Equity

Although lead has been removed from paint and gasoline sold in the U.S., lead exposures persist, with communities of color and residents in urban and low-income areas at greatest risk for exposure. The persistence of and inequities in lead exposures raise questions about the scope and implementation of policies that address lead as a public health concern. To understand the multi-level nature of lead policies, this paper and case study reviews lead policies at the national level, for the state of California, and for Santa Ana, CA, a dense urban city in Southern California. Through a community-academic partnership process, this analysis examines lead exposure pathways represented, the level of intervention (e.g., prevention, remediation), and whether policies address health inequities. Results indicate that most national and state policies focus on establishing hazardous lead exposure levels in settings and consumer products, disclosing lead hazards, and remediating lead paint. Several policies focus on mitigating exposures rather than primary prevention. The persistence of lead exposures indicates the need to identify sustainable solutions to prevent lead exposures in the first place. We close with recommendations to reduce lead exposures across the life course, consider multiple lead exposure pathways, and reduce and eliminate health inequities related to lead.

It Works, But For Whom? Examining Racial Bias in Carding Experiences and Acceptance of a County Identification Card

Purpose: Policies that restrict access to U.S. government-issued photo identification (ID) cards adversely affect multiple marginalized communities. This context impedes access to health-promoting resources that increasingly require government-issued IDs and exacerbates health inequities. In 2015, Washtenaw County, Michigan, implemented the Washtenaw ID to improve access to resources contingent upon having an ID. We employed an audit study to examine whether Washtenaw ID users experienced racially biased treatment in carding experiences and acceptance of the Washtenaw ID.

Methods: Seven 25- to 32-year-old mystery shoppers (two Latina, three black, and two white women) attempted to purchase a standardized basket of goods, including an age-restricted item in Washtenaw County stores (n=130 shopping experiences). We examined whether experiences of being asked for ID and acceptance of the Washtenaw ID varied by race/ethnicity.

Results: Each shopper visited 9–22 stores. Shoppers were asked for ID in 63.1% of shopping experiences. Of these, the Washtenaw ID was accepted 91.5% of the time. Among those who were asked for ID, a higher percentage of Latina (16.0%) shoppers had their Washtenaw IDs rejected than black (6.3%) and white (4.0%) shoppers, although differences were not statistically significant (p=0.27). Latina shoppers had 2.9 times the odds of receiving a comment about their Washtenaw ID relative to white shoppers (OR=2.92, p=0.08), comments that were nonpositive.

Conclusion: Local IDs may improve access to resources contingent upon having an ID. However, racialization processes, including anti-immigrant sentiments, may inhibit the mitigating goal of local IDs. Continued attention to the health equity impacts of equity-driven interventions is warranted.

Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens

Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. One implication is that health insurance expansions may not reduce health care inequities among Latinos due to concern about exposure to immigration law enforcement authorities. Using data from the 2015 Latino National Health and Immigration Survey, we examine the extent to which the politics of immigration deters individuals from going to health care providers and service-providing institutions. Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities.

Social patterning of cardiovascular and metabolic risk in Colombian adults

OBJECTIVES

To test for differences in cardiovascular and metabolic risk (CMR) by educational attainment and physical capital. To compare CMR among black, indigenous, and mixed populations, accounting for socioeconomic status (SES).

DESIGN

We conducted multivariate analyses using cross-sectional data from a national survey of Colombian adults (n = 10,814) to examine the social patterning of CMR. In sex/gender-stratified models, a CMR index was regressed on educational attainment, physical capital, ethnicity/race, and age.

RESULTS

Women with a primary education (OR = 1.64, 95% CI: 1.25, 2.15) had higher age- and ethnicity/race-adjusted odds of CMR than women with more than secondary education. Men with a primary education (OR = 0.67, 95% CI: 0.48, 0.92) had significantly lower adjusted odds of CMR than men with more than secondary education; these associations did not remain significant after adjustments for physical capital. Men in the first (OR = 0.45, 95% CI: 0.36, 0.57) and second (OR = 0.72, 95% CI: 0.57, 0.91) physical capital tertiles had significantly lower adjusted odds of CMR than those in the highest tertile. There was not a significant patterning of CMR by ethnicity/race for women or men, or by physical capital for women.

CONCLUSIONS

Findings suggest that for Colombian adults CMR is patterned by SES; these associations differ by sex/gender.

Discrimination and Depressive Symptoms Among Latina/o Adolescents of Immigrant Parents

Discrimination is associated with negative mental health outcomes for Latina/o adolescents. While Latino/a adolescents experience discrimination from a number of sources and across contexts, little research considers how the source of discrimination and the context in which it occurs affect mental health outcomes among Latina/o children of immigrants. We examined the association between source-specific discrimination, racial or ethnic background of the source, and school ethnic context with depressive symptoms for Latina/o adolescents of immigrant parents. Using multilevel linear regression with time-varying covariates, we regressed depressive symptoms on source-specific discrimination, racial or ethnic background of the source of discrimination, and school percent Latina/o. Discrimination from teachers (β = 0.06, p < .05), students (β = 0.05, p < .05), Cubans (β = 0.19, p < .001), and Latinas/os (β = 0.19, p < .001) were positively associated with depressive symptoms. These associations were not moderated by school percent Latina/o. The findings indicate a need to reduce discrimination to improve Latina/o adolescents' mental health.

John Henryism, socioeconomic position, and blood pressure in a multi-ethnic urban community

OBJECTIVES

The John Henryism (JH) hypothesis suggests that, under adverse social and economic conditions, high-effort coping styles that reflect hard work and determination may contribute to elevated blood pressure. Results from tests of this hypothesis have been mixed, with variations by region, urban versus rural areas, race, gender, and age. The majority of studies reporting that socioeconomic position modifies associations between JH and blood pressure have been for non-Latino Blacks in rural communities. In contrast, most studies conducted in urban areas report little support for the JH hypothesis. Few studies have been conducted in samples that include Latinos. We extend previous research by testing the JH hypothesis in a multi-ethnic, low-to-moderate income urban community.

DESIGN

We used multivariate linear regression to test the hypothesis that associations between JH and blood pressure were modified by income, education, or labor force status in a multi-ethnic (non-Latino Black, Latino, non-Latino White) sample (N=703) in Detroit, Michigan. The outcome measures were systolic (SBP) and diastolic blood pressure (DBP).

RESULTS

John Henryism was associated with higher SBP (β=3.92, P=.05), but not DBP (β=1.85, P=.13). These associations did not differ by income, education, or labor force status. Results did not differ by race or ethnicity.

CONCLUSIONS

John Henryism is positively associated with SBP in this multi-ethnic, low-to-moderate income sample. This association did not differ by income, education, or labor force status. Results are consistent with studies conducted in urban communities, finding limited evidence that associations between JH and blood pressure vary by socioeconomic position.