How Should Clinicians Express Solidarity With Asylum Seekers at the US-Mexico Border?

Migrants along the US-Mexico border have been subjected to transnational violence created by international policy, militaristic intervention, and multinational organizational administration of border operations. The COVID-19 pandemic compounded migrants' vulnerabilities and provoked several logistical and ethical problems for US-based clinicians and organizations. This commentary examines how the concept of transnational solidarity facilitates analysis of clinicians' and migrants' shared historical and structural vulnerabilities. This commentary also suggests how actions implemented by one organization in Tijuana, Mexico, could be scaled more broadly for care of migrants and asylum seekers in other transnational health care settings.

Disparities in Research Participation by Level of Health Literacy

OBJECTIVE

To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes.

PATIENTS AND METHODS

Using a sample of 5872 patients hospitalized with cardiovascular disease approached for participation in the Vanderbilt Inpatient Cohort Study from October 2011 through December 2015, we examined the independent association of patients' health literacy with two steps in their research participation decision-making process: (1) research interest - willingness to hear more about a research study; and (2) research participation - the decision to enroll after an informed consent discussion. Best practices for effective health communication were implemented in recruitment approaches and informed consent processes. Using logistic regression models, we determined patient characteristics independently associated with patients' willingness to hear about and participate in the study.

RESULTS

In unadjusted analyses, participants with higher health literacy, and those who were younger, female, or had more education had higher levels of both research interest and research participation. Health literacy remained independently associated with both outcomes in multivariable models, after adjustment for sociodemographic factors.

CONCLUSION

Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.

A Systematic Review of Medical-Legal Partnerships Serving Immigrant Communities in the United States

The medical-legal partnership addresses social and political determinants of health. Yet, relatively little is known about best practices for these two service providers collaborating to deliver integrated services, particularly to im/migrant communities. To investigate evaluations of existing medical-legal partnerships in order to understand how they function together, what they provide, and how they define and deliver equitable, integrated care. We searched five databases (PubMed, Medline, Web of Science, HeinOnline, and Nexus Uni) using search terms related to “medical-legal partnerships”, “migrants”, and “United States”. We systematically evaluated ten themes related to how medical and legal teams interacted, were situated, organized, and who they served. Articles were published in English between 2010 and 2019; required discussion about a direct partnership between medical and legal professionals; and focused on providing clinical care and legal services to im/migrant populations. Eighteen articles met our inclusion criteria. The most common form of partnership was a model in which legal clinics make regular referrals to medical clinics, although the reverse was also common. Most services were not co-located. Partnerships often engaged in advocacy work, provided translation services, and referred clients to non-medical providers and legal services. This review demonstrates the benefits of a legal-medical partnership, such as enhancing documentation and care for im/migrants and facilitating a greater attention to political determinants of health. Yet, this review demonstrates that, despite the increasing salience of such partnership, few have written up their lessons learned and best practices.

Migration and Mental Health in Mexico: Domestic Migrants, Return U.S. Migrants, and Non-Migrants

In this paper, we use survey data from the Mexican Retrospective Demographic Survey (Encuesta Demográfica Retrospectiva) and National Survey of Households (Encuesta Nacional de Hogares) collected in 2017 to examine self-reports of depression, anxiety, chronic fatigue, and pain among domestic migrants, returned U.S. migrants, and non-migrants. Although self-reports do not always correspond to clinical diagnoses, they offer some insight into mental health, especially for those without a diagnosis because of limited access to services or stigma. Regression results reveal that domestic migrants, e.g., those who moved within Mexico, reported more anxiety, chronic fatigue, and pain, but risks for U.S. migrants were comparable to non-migrants, controlling for other characteristics. Findings from the decomposition analysis helps explain these findings. While domestic migrant vs. non-migrant differences result both from different migrant demographic attributes, such as age and gender, and differences in the effects of these characteristics between the groups, U.S. migrant vs. non-migrant differences in anxiety and pain emerge only after allowing for the relationship between each observed characteristic and the mental health outcome to vary. Thus, compared to domestic migrants, U.S. migrants are selected on characteristics associated with good mental health-they are positively selected-but those characteristics are not protective for them.

Migration and Parental Absence: A Comparative Assessment of Transnational Families in Latin America

Despite growing research on transnational families and children's welfare in migrant-sending countries, there is a dearth of information about the prevalence of, what we call, parental absence via migration, especially relative to other sources of parental absence, and a lack of estimates that are comparable across populations and places. This makes it difficult to determine the scale for policy interventions, and to justify future research on transnational families and children's welfare. Using harmonized surveys covering eight Latin American countries and Puerto Rico, validated by nationally representative census and survey data, we provide the first estimates of the prevalence parental absence via migration that are comparable across populations in contemporary Latin America. We show that between 7 and 21 percent of children live in transnational families where parents are absent because of migration. We compare our estimates to similar estimates of parental absence from other sources, and show that, in several populations, more children are experiencing parental absence due to migration than to union dissolution or parental mortality. Finally, we link our descriptive work to children's welfare by examining the characteristics of children's home environments when parents migrate. Children living in families with absent parents due to migration are less likely to coreside with extended family members, and to fare better in terms of household assets, relative to children living in other family forms. We conclude by highlighting the limitations of the data, and underscore the value of attempts to estimate the prevalence of parental absence via migration.

Something Old, Something New: When Gender Matters in the Relationship between Social Support and Health

This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and whether these effects differ between those with new versus established diagnoses. We find that gender differentiates the effect of nonmarital family contact on health but only when heart disease is newly diagnosed. When newly diagnosed, more frequent contact with family is associated with better self-rated health for women but not men. Men and women with preexisting diagnoses benefit equally from more frequent contact with family.

Variations in the Gender Composition of Immigrant Populations: How They Matter

This paper estimates and interprets empirical shifts in the gender composition of immigrants to add to scholarship about the gendering of international migrations over time. We map shifts in gender ratios using micro-level data that permit us to create age-standardized estimates among adult foreign born stock living in the United States since 1850 and in 26 other nations worldwide since 1960. We examine regional and national variations in these shifts, and ask whether and how the gendered composition of foreigners from diverse origins in the United States – the nation that has received the largest populations of migrants for over a century – differs from other nations that receive large numbers of immigrants. We also examine recent variations in gender ratios among immigrants living in six regional destination countries. Results show substantial variation in the gender composition of foreign-born populations, and they offer a starting point for examining causes and consequences in future research.

The Double Disadvantage Reconsidered: Gender, Immigration, Marital Status, and Global Labor Force Participation in the 21st Century

Although women's representation among international migrants in many countries has risen over the last 100 years, we know far less about gender gaps in the labor force participation of immigrants across a wide span of host societies. Prior studies have established that immigrant women are doubly disadvantaged in terms of labor market outcomes in the U.S., Canada, and Israel. These studies suggest an intriguing question: Are there gender gaps in immigrant labor force participation across destinations countries? In this paper, we investigate the extent to which the double disadvantage exists for immigrant women in a variety of host countries. We also examine how marriage moderates this double disadvantage. For the U.S., although we find that immigrant women have had the lowest labor force participation rates compared to natives and immigrant men since 1960, marital status is an important stratifying attribute that helps explain nativity differences. Extending the analysis to eight other countries reveals strong gender differences in labor force participation and shows how marriage differentiates immigrant women's labor force entry more so than men's.

The Cat and Mouse Game at the Mexico-U.S. Border: Gendered Patterns and Recent Shifts

This paper provides new insights into the process of undocumented border crossing by examining both men and women in the process. We investigate differences in the ways in which men and women make their way across the well-guarded Mexico-U.S. border, and the extent to which men and women by the end of the 1990s were similar to, or different from, their counterparts who crossed before 1986 and the implementation of immigration policy designed to reduce undocumented migration. We find substantial differences in how men and women crossed the border without legal documents and in their chances of being apprehended. Our analysis makes clear that shifts in U.S. immigration policy after 1986 have led to women's greater reliance on the assistance of paid smugglers to cross without documents but men were more likely to cross alone. Moreover, immediately after 1986, women on first U.S. trips faced higher risks of being apprehended compared to women who migrated in the early 1980s, but men faced lower risks. After accumulating some U.S. experience, however, both women and men faced lower risks of being detected after 1986 compared to earlier in that decade.

Weathering the Storm? The Great Recession and the Employment Status Transitions of Low-Skill Male Immigrant Workers in the United States1

Using matched data from the Current Population Survey from 2005 to 2011 ( n = 5,507), we use multinomial and binary logistic regression models to examine employment transitions related to the Great Recession for five groups of men with less than a high school degree: foreign-born Mexicans, other foreign-born, and US-born whites, blacks, and Latinos. We find that, during the recession, Mexican immigrants were the most likely to remain continuously employed. However, immigrant workers also experienced high levels of involuntary part-time employment during the recession, suggesting that their relative success in remaining employed was not without its costs.

Current Trends and Patterns of Female Migration: Evidence from Mexico

This study uses a new source of data to assess trends and patterns of female migration from Mexico. Data were collected from migrants interviewed in ten Mexican communities from 1987 through 1990, as well as from outmigrants from those communities who were later located in the United States. The first part of the analysis examines changes in migrant behavior throughout the 1980s by estimating trends in the probability of first-time and repeat migration and by assessing the impact of the Immigration Reform and Control Act (IRCA) on these trends. In general, migration probabilities were lower for women than those reported elsewhere for men, but the evidence suggests that, like men, once women begin migrating, they are virtually assured of migrating on a second trip. Results from the departure models in the second half of the article suggest that recent female migration reflects access to the productive resources in Mexican society and a process of family migration whereby women migrate after their husbands and fathers legalized as part of IRCA.

Effect of Health Literacy on Research Follow-Up

Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence, and health care system distrust. In a sample of 2,042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days, and 90 days after hospital discharge. In addition, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up.

Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS)

Background

The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes.

Methods

The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort.

Discussion

This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes.

Migration in the Americas: Mexico and Latin America in Comparative Context

Since the second half of the twentieth century, studies have documented the presence of women and men among migrants to and from Latin America. This study analyzes gendered patterns of U.S. migration from a variety of nations south of the border and examines how the probabilities of migrating on a first U.S. trip shift over the life course and by legal status. Using life history data from the Mexican and Latin American Migration Projects (MMP and LAMP), the author estimates the conditional likelihoods that male and female household heads and spouses of a given age migrate with or without documents on a first U.S. trip from four nations (Mexico, the Dominican Republic, Nicaragua, and Costa Rica) and from Puerto Rico. On the whole, findings suggest that the male-led process of undocumented migration from Mexico differs sharply from the female-led process of documented migration from the Dominican Republic and that the gendered patterns of U.S. migration from Nicaragua and Costa Rica fall somewhere in between. In contrast, Puerto Rico—U.S. mainland migration does not vary sharply by gender. These diverse gendered migration systems have implications for our understanding of migration in the Americas.

Does caregiving increase poverty among women in later life? Evidence from the Health and Retirement survey

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being.

Mapping Gender and Migration in Sociological Scholarship: Is It Segregation or Integration?

A review of the sociological research about gender and migration shows the substantial ways in which gender fundamentally organizes the social relations and structures influencing the causes and consequences of migration. Yet, although a significant sociological research has emerged on gender and migration in the last three decades, studies are not evenly distributed across the discipline. In this article, we map the recent intellectual history of gender and migration in the field of sociology and then systematically assess the extent to which studies on engendering migration have appeared in four widely read journals of sociology (American Journal of Sociology, American Sociological Review, Demography, and Social Forces). We follow with a discussion of these studies, and in our conclusions, we consider how future gender and migration scholarship in sociology might evolve more equitably.

Arab immigrants: a new case for ethnicity and health?

Community-based studies of Arab Americans point to significant health problems among the immigrants, a finding that runs contrary to theories of immigrant selectivity. This study is the first to use nationally representative data to test this question. Using new questions that identify region of birth in the 2000 and 2001 National Health Interview Surveys, we compare the self-rated health and activity limitation of Arab immigrants to US-born white Americans and test the extent to which social, demographic, and immigrant characteristics account for observed disparities. The results find that Arab immigrants do not significantly differ from US-born whites in their self-rated health and are less likely to report limitations in activity. Length of time in the US has no composite effect on health; however, US citizenship does. Compared to the most recent immigrant arrivals, Arab immigrants who are citizens report worse health while their peers who are not officially American (non-citizens) do not, regardless of their duration of US residency. Contrary to prior studies on Arab health, we find that Arab immigrants are not uniformly disadvantaged in their health outcomes and that their health profile is more diverse than currently documented. The results also suggest that controlling for years of US residency may be insufficient for capturing the cumulative effects of acculturation on immigrant health. We conclude by suggesting avenues of future research for capturing heterogeneity among emergent ethnic populations such as Arab Americans.

Migradollars and mortality: the effects of migration on infant survival in Mexico

We apply multilevel methods to data from Mexico to examine how village migration patterns affect infant survival outcomes in origins. We argue that migration is a cumulative process with varying health effects at different stages of its progression, and test several related hypotheses. Findings suggest higher rates of infant mortality in communities experiencing intense U.S. migration. However, two factors diminish the disruptive effects of migration: migradollars, or migrant remittances to villages, and the institutionalization of migration over time. Mortality risks are low when remittances are high and decrease as migration becomes increasingly salient to livelihoods of communities. Together, the findings indicate eventual benefits to all infants, irrespective of household migration experience, as a result of the development of social and economic processes related to U.S. migration.

Migradollars and mortality: The effects of migration on infant survival in Mexico

We apply multilevel methods to data from Mexico to examine how village migration patterns affect infant survival outcomes in origins. We argue that migration is a cumulative process with varying health effects at different stages of its progression, and test several related hypotheses. Findings suggest higher rates of infant mortality in communities experiencing intense U.S. migration. However, two factors diminish the disruptive effects of migration: migradollars, or migrant remittances to villages, and the institutionalization of migration over time. Mortality risks are low when remittances are high and decrease as migration becomes increasingly salient to livelihoods of communities. Together, the findings indicate eventual benefits to all infants, irrespective of household migration experience, as a result of the development of social and economic processes related to U.S. migration.

Current trends and patterns of female migration: evidence from Mexico

"This study uses a new source of data to assess trends and patterns of female migration from Mexico. Data were collected from migrants interviewed in ten Mexican communities from 1987 through 1990, as well as from outmigrants from those communities who were later located in the United States. The first part of the analysis examines changes in migrant behavior throughout the 1980s by estimating trends in the probability of first-time and repeat migration and by assessing the impact of the Immigration Reform and Control Act (IRCA) on these trends.... The study then considers the determinants of female Mexican-U.S. migration by examining whether and how women's recent moves reflect their personal characteristics, the resources in their households, or a process of family reunification." This paper was originally presented at the 1992 Annual Meeting of the Population Association of America.

Stemming the tide? Assessing the deterrent effects of the immigration reform and control act

This study uses a new source of data to assess the degree to which the Immigration Reform and Control Act (IRCA) deterred undocumented migration from Mexico to the United States. Data were collected from migrants interviewed in seven Mexican communities during the winters of 1987 through 1989, as well as from out-migrants from those communities who subsequently located in the United States. We conduct time-series experiments that examine changes in migrants’ behavior before and after passage of the IRCA in 1986. We estimate trends in the probability of taking a first illegal trip, the probability of repeat migration, the probability of apprehension by the Border Patrol, the probability of using a border smuggler, and the costs of illegal border crossing. In none of these analyses could we detect any evidence that IRCA has significantly deterred undocumented migration from Mexico.

Stemming the tide? Assessing the deterrent effects of the Immigration Reform and Control Act

This study uses a new source of data to assess the degree to which the Immigration Reform and Control Act (IRCA) deterred undocumented migration from Mexico to the United States. Data were collected from migrants interviewed in seven Mexican communities during the winters of 1987 through 1989, as well as from out-migrants from those communities who subsequently located in the United States. We conduct time-series experiments that examine changes in migrants' behavior before and after passage of the IRCA in 1986. We estimate trends in the probability of taking a first illegal trip, the probability of repeat migration, the probability of apprehension by the Border Patrol, the probability of using a border smuggler, and the costs of illegal border crossing. In none of these analyses could we detect any evidence that IRCA has significantly deterred undocumented migration from Mexico.