The border community and immigration stress scale: a preliminary examination of a community responsive measure in two Southwest samples

Strategies for recruitment and retention of diverse and underserved cancer survivor and caregiver dyads in clinical trials

Background

Cancer survivor-caregiver dyads from underrepresented racial and ethnic groups and those with lower socioeconomic status are less likely to participate in clinical research. Sociocultural and socioeconomic barriers perpetuate health inequity and increase disparities in cancer care.

Purpose

We describe our systematic approach to recruiting and retaining diverse survivor-caregiver dyads in supportive cancer care studies.

Methods

Matsuda's research recruitment guidelines of evaluate, engage, reflect, and carefully match ("EERC") were adapted and applied through a framework of six guiding principles.

Results

A systematic approach to recruitment of underrepresented dyads in cancer support research includes 1) Developing a bilingual, bicultural study team with shared language and culture of the study population, 2) Ensuring team members share a passion for cancer health equity and are trained with a community-centric approach, 3) Designing accessible interventions, study materials, and shared data collection tools across similar studies with community and stakeholder input, 4) Engaging local and regional stakeholders with expertise of health disparities among the catchment area, 5) Partnering with Community Health Workers (CHWs) and gatekeepers to enhance community presence, and 6) Ensuring careful application of matching study team members and participants beyond race and ethnicity to prioritize the cultural values and social factors that impact cancer survivors and caregivers.

Conclusion

Applying a systematic approach to recruiting and retaining underrepresented dyads in cancer research can potentially reduce sociocultural and socioeconomic barriers to cancer health equity.

Knowledge of the Stress-Health Link as a Source of Resilience Among Mexicans in the Arizona Borderlands

Mexicans who migrate to the United States endure significant stressors related to the migration process and social and environmental conditions of life in the United States. Given that chronic stress exposure has been linked to the onset of health conditions, these ecological factors may expose them to increased risk for poor health. However, Mexicans have many positive health outcomes compared to those monitored nationally, making it crucial to understand possible sources of resilience in this population. Here, we investigate Mexicans' lay health knowledge in response to stress as a possible source of health-related resilience. Health knowledge is considered a central facet of practical and traditional knowledge as well as adaptive modes of intelligence and has a tangible impact on health. Using an ethnographically grounded community-based participatory research design informed by the theory of embodiment, our hybrid team of bilingual university and community-based researchers interviewed Mexican-origin residents (N = 30) living in rural southwestern Arizona about how they experienced and responded to stress and incorporated it into their etiological frameworks. Thematic analysis revealed that participants paid close attention to how stress presented itself in their bodies, which informed their understanding of its potentially harmful health impacts and motivated them to employ multiple stress reduction strategies. Our results highlight the breadth of Mexicans' lay health knowledge, thereby challenging dominant narratives about low rates of health literacy in this population. Findings can be harnessed to optimize potential health protective effects in home and community settings as well as to inform preventive and clinical interventions.

Mamá Empoderada: study protocol for a pilot trial of a novel parenting and mental health prevention intervention for migrant mothers with young children at the Mexico-US border

INTRODUCTION

Migrant women in transit face high risk of developing mental health problems such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, limited access to services and gender inequities. Although migrant women who endure such conditions have high need for mental health prevention, few evidence-based interventions are tailored to this population. Moreover, while women and children's mental health are interconnected, few mental health interventions address parenting needs. The aim of this study is to pilot-test a novel parenting and mental health prevention intervention for migrant mothers with young children (MMC) in Tijuana, Mexico, including (a) assessing acceptability; (b) estimating effect sizes on symptoms of depression, anxiety, and parenting stress; (c) identifying which theory-based mechanisms of action predict changes in outcomes; and (d) identifying factors associated with differential intervention response.

METHODS AND ANALYSIS

'Mamá Empoderada' (Mom Power) is a theory-based, trauma-informed group intervention to promote mental health and responsive parenting among mothers with young children (0-5 years). This is an evidence-based intervention that has been previously evaluated in the USA and has been recently adapted for Spanish-speaking mothers. We have recently adapted this intervention for MMC in Mexico and will conduct a pilot randomised controlled trial (RCT) of the intervention with MMC (n=100; Ntreatment=50; Ncontrol=50). The intervention group (IG) will receive 10 group and three individual sessions addressing attachment-based parenting skills, linkage to resources (eg, food, shelter), social support, and self-care and resilience over a 5-week period. The control group will receive standard of care programming and will be offered participation in the intervention following completion. Both groups will complete baseline and exit surveys, as well as follow-up surveys at 2, 4 and 6 months postintervention. Statistical analyses will compare primary (ie, symptoms of depression and anxiety; parenting stress) and intermediate outcomes (eg, resilience, service utilisation) by exposure to intervention condition.

ETHICS AND DISSEMINATION

This study is approved by the San Diego State University and El Colegio de la Frontera Norte Institutional Research Boards. Findings will inform a larger trial to evaluate intervention efficacy. In collaboration with our community partners, results will be disseminated via peer-reviewed publications; presentations; and plain-language reports, infographics, and presentations to community, clinical, and policy audiences. If efficacious, this intervention is highly promising as a novel, low-cost, and feasible model that could be implemented in border settings in Mexico, the USA and elsewhere. Amid rising population displacement and prolonged and traumatic migration journeys, this study addresses an urgent need for scalable and tailored mental health prevention for MMC in border contexts.

TRIAL REGISTRATION NUMBER

NCT06468046.

Mental Health Challenges and Barriers to Veterans' Adjustment to Civilian Life on the U.S.-Mexico Border

BACKGROUND

Seeking mental health care is crucial for supporting effective reintegration among veterans. The U.S.-Mexico border presents a compelling and urgent case for study due to its proximity to economically marginalized and medically underserved areas, where the availability and accessibility of services are often limited.

OBJECTIVE

This study explored veterans' mental health challenges and factors that hindered their adjustment to civilian life on the U.S.-Mexico border.

METHODS

A total of 36 veterans were recruited using purposive sampling from a mental health agency located in Southwestern Texas on the U.S.-Mexico border between November 2023 and May 2024 to complete an in-depth semi-structured interview and a brief survey.

RESULTS

Using thematic analysis, we found six themes associated with our study: (1) mental health struggles, (2) enduring military-influenced mindset, (3) adjustment to civilian life, (4) strained family relationships, (5) past victimization and discrimination, and (6) barriers to opportunities and mental health care.

CONCLUSION

Understanding veterans' mental health well-being and their prospects for integration into the civilian world is critical for identifying risk and protective factors that can inform the development of targeted health promotion initiatives, strengthen the implementation of equitable health care efforts, and support strategies for enhancing treatment access that address the unique needs of veterans in the border region. Policy and practice implications are discussed.

Stress management preferences and stress experiences among Latinx immigrants in the United States during the COVID-19 pandemic: Mixed-methods results from a community-academic research team

Background

Latinx individuals in the U.S. have higher levels of stress than other ethnic groups. Latinx immigrants living in non-traditional immigration destinations (NTIDs) have worse access to social and medical support and were particularly vulnerable during the COVID-19 pandemic. This study aims to contextualize stress in Latinx immigrants in an NTID during the COVID-19 pandemic and to understand Latinx immigrants' preferences for stress management interventions given the sociopolitical and public health context.

Method

Using a community-based participatory research approach with mixed methods research design, community co-researchers gathered data using a quantitative survey and then contextualized survey results using a qualitative community conversation.

Results

Community conversation participants were surprised at the relatively low levels of reported stress and pandemic impact in survey participants, and they proposed the reason was the level of pre-pandemic stressors. Guatemalan immigrants in an NTID reported more stigma but fewer changes between pre- and post-pandemic stress levels. Survey respondents preferred to learn about stress management through YouTube videos or groups led by professionals.

Conclusions

Understanding the diversity of stress experiences among Latinx immigrant groups is critical to developing effective interventions. Coping strategy preferences are variable among different Latinx immigration groups, but asynchronous and/or professional-led stress management was preferred.

Stress Among Immigrants in the United States

BACKGROUND

Immigrants comprise a sizable proportion (15%) of the population living in the United States (U.S.). Given these proportions, it is imperative that we understand immigrant experiences of well-being and stress toward improved well-being and integration.

METHODS

To examine the experiences of first- and second-generation immigrants using a comparative approach, we utilized data from two surveys collected under Trump (n = 490) and Biden (n = 306) administrations. Both studies employed non-probability quota and convenience sampling techniques. Questions about experiences of stress (PSS-4), discrimination (Everyday Discrimination Scale), resilience (Brief Resilience Scale), border stress (Border Community and Immigration Stress Scale), immigration policies (general questions) were included in the surveys. Each study sample included diverse racial groups across both immigrant generations. We report frequencies, descriptive statistics, and ANOVAs/post hoc test results.

RESULTS

Findings highlight that levels of both stress and discrimination among non-White participants under the Trump administration were significantly higher than those of White participants, though neither relationship was significant under the Biden administration. Further, White participants exhibited higher resilience under the Trump administration, but not under the Biden administration.

DISCUSSION AND CONCLUSION

To our knowledge, this is the first study to comparatively examine immigrant experiences under the two most recent federal administrations. This study is seminal in highlighting discussions and making policy recommendations to limit immigrant exclusion, curtail exclusionary policies regarding travel bans, and improve pathways to citizenship, enhancing immigrant integration in the U.S. Roles of social workers in supporting immigrant communities and pathways for future research with immigrants are discussed.

Recalibrating the Scales: Enhancing Ethnographic Uses of Standardized Mental Health Instruments

This article reflects on the narrative data that can emerge through the use of standardized mental health scales, drawing from two studies related to emotional distress among immigrant populations in Texas. In both studies, standardized scales complemented in-depth interviews. The initial goal in using scales was to collect quantifiable data, yet through the research process, the scales also served to elicit complementary narratives that enhanced interview data, forcing the researchers to reconsider the potential uses of scales. In thinking about the ethnographic potential of standardized scales, the goal of this article is twofold. First, based on our findings, it presents methodological considerations for how to use scales in a way that can facilitate the emergence of in-depth responses that complement other ethnographic methods. Second, although the scope of data collected and analyzed utilizing scales is most often limited to quantitative data, this research demonstrates a need to more fully consider other forms of data that may emerge from using scales. Thus, this article reflects on three inter-related areas where scales provided ethnographic data, using examples from two studies. Overall, this research shows that scales have more ethnographic potential than what has typically been recognized.

US-Mexico Border Stress and Daily Substance Use among Latino Youth: a Cross-Sectional Study

Background

Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors.

Methods

In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support.

Results

Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use.

Discussion

Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

La vida en la frontera: protocol for a prospective study exploring stress and health resiliencies among Mexican-origin individuals living in a US-Mexico border community

BACKGROUND

Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies.

METHODS

La Vida en la Frontera is a mixed-methods participatory study linking a multi-disciplinary University of Arizona research team with Campesinos Sin Fronteras, a community-based organization founded by community health workers in San Luis, Arizona. This paper describes the current protocol for aims 2 and 3 of this multi-faceted investigation. In aim 2 a cohort of N≈300 will be recruited using door-to-door sampling of neighborhoods in San Luis and Somerton, AZ. Participants will be surveyed and undergo biomarker assessments for indicators of health and chronic stress at three time points across a year length. A subset of this cohort will be invited to participate in aim 3 where they will be interviewed to further understand mechanisms of resilience and wellbeing.

DISCUSSION

This study examines objective and subjective mechanisms of the relationship between stress and health in an ecologically diverse rural community over an extended timeframe and illuminates health disparities affecting residents of this medically underserved community. Findings from this investigation directly impact the participants and community through deepening our understanding of the linkages between individual and community level stress and chronic disease risk. This innovative study utilizes a comprehensive methodology to investigate pathways of stress and chronic disease risk present at individual and community levels. We address multiple public health issues including chronic disease and mental illness risk, health related disparities among Mexican-origin people, and health protective mechanisms and behaviors.

"Es Muy Tranquilo Aquí": Perceptions of Safety and Calm among Binationally Mobile Mexican Immigrants in a Rural Border Community

Perceptions of community can play an important role in determining health and well-being. We know little, however, about residents’ perceptions of community safety in the Southwestern borderlands, an area frequently portrayed as plagued by disorder. The qualitative aim of this community-based participatory research study was to explore the perceptions of Mexican-origin border residents about their communities in southern Yuma County, Arizona. Our team of University of Arizona researchers and staff from Campesinos Sin Fronteras, a grassroots farmworker support agency in Yuma County, Arizona, developed a bilingual interview guide and recruited participants through radio adds, flyers, and cold calls among existing agency clientele. Thirty individual interviews with participants of Mexican origin who live in and/or work in rural Yuma County were conducted remotely in 2021. Participants overwhelmingly perceived their communities as both calm and safe. While some participants mentioned safety concerns, the vast majority described high levels of personal security and credited both neighbors and police for ensuring local safety. These perceptions were stated in direct contrast to those across the border, where participants had positive familial and cultural ties but negative perceptions regarding widespread violence. In conclusion, we argue that to understand environmental factors affecting health and well-being in Mexican immigrant populations, it is critical to examine the role of binational external referents that color community perceptions.

Perceived Normalization of Drug Trafficking and Adolescent Substance Use on the US-Mexico Border

BACKGROUND

Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors.

METHODS

In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support.

RESULTS

Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use.

DISCUSSION

Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border

INTRODUCTION

Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border.

METHODS

Researchers at the Arizona Prevention Research Center conducted the Linking Individual Needs to Community and Clinical Services (LINKS) study during 2017-2018. Clinic-based CHWs referred participants to community-based CHWs who met with participants monthly for 6 months to assess participant needs, provide support for emotional well-being, and link them to resources. Two community-based CHWs collaborated to maximize participant care; they also administered an emotional well-being questionnaire at baseline and at 3-month and 6-month follow-up. We estimated changes in emotional well-being outcomes.

RESULTS

Scores for social support, perceived hopefulness, and quality-of-life measures among 189 LINKS participants increased significantly during the study period, especially among men and participants with low baseline scores. For each of the 3 outcomes, the standardized change was approximately 0.28 per 3 months of intervention, a decrease of more than half an SD (0.56) during 6 months of follow-up.

CONCLUSION

A CHW-led community-clinical linkage intervention can result in positive emotional well-being outcomes. We encourage policy makers, funders, and public health practitioners to further investigate such interventions as a solution to reduce disparities in emotional well-being.

Childhood adversity, socioemotional functioning and generalized anxiety in young adults from mixed immigration status families

BACKGROUND

The translation of research on adverse childhood experiences (ACEs) into effective prevention and treatment of psychopathology requires examination of how ACEs impact mental health. Moreover, increased attention to more marginalized populations, such as immigration-affected ethnic-minority young adults, is greatly needed.

OBJECTIVE

The current study tested the hypothesis that greater ACEs would be related to greater generalized anxiety symptoms directly and indirectly, via ACE-related deficits in coping efficacy, self-compassion, and perceived support, above and beyond immigration-related family stress.

PARTICIPANTS AND SETTING

Participants included ethnic minority young adults (n = 322) attending a public university who reported having at least one family member living in the United States without legal protection and/or being undocumented themselves.

METHODS

Data was collected online using validated measures of the primary study variables. Participants also completed a pilot measure of immigration-related stress in their family. A multiple mediation model was tested in a structural equation modeling framework.

RESULTS

A substantial percentage of young adults experienced 4 or more ACEs and clinically-significant generalized anxiety symptoms (38.5% and 20.5%, respectively); a greater number of ACEs were directly (β = 0.33, p < .001) and indirectly, via lower self-compassion (standardized indirect effect 95% CI: 0.04, 0.14), associated with significantly greater generalized anxiety symptoms, above and beyond immigration-related family stress and other indicators of socioemotional functioning.

CONCLUSION

Findings suggest that ACEs and generalized anxiety are prevalent in ethnic minority young adults from mixed legal status families and their association may be partially accounted for by ACE-related deficits in self-compassion.

Quantifying direct effects of social determinants of health on systolic blood pressure in United States adult immigrants

Identify the pathway by which social determinants of health (SDoH) variables impact systolic blood pressure (SBP) in immigrants. Latent variables were used to assess the relationship between SDoH and SBP. Latent variables were identified using confirmatory factor analysis (CFA) for (1) global socioeconomic status (SES) (education, income, number of hours worked per week), (2) stressors of immigration (life-course SES, immigration stress, immigration demand), (3) adaptation to immigration (perceived discrimination, perceived stress, health literacy), and (4) burden of disease (disability, comorbidities, chronic pain). Structural equation modeling (SEM) was used to investigate the relationship between immigrant specific latent variables and SBP. The study included 181 adult immigrants. The initial model (chi2 (77, n = 181) = 302.40, p < 0.001, RMSEA = 0.086, CFI = 0.84, TLI = 0.78, CD = 0.91) showed that stressors of immigration had a direct relationship with SBP (-0.35, p = 0.033); global (SES) had a direct relationship with burden of disease (-0.70, p = 0.007) and an indirect relationship with SBP by way of burden of disease (0.24, p = 0.015). The final model (chi2 (69, n = 181) = 149.98, p < 0.001, RMSEA = 0.054, CFI = 0.94, TLI = 0.91, CD = 0.96) maintained that global SES had a direct relationship with burden of disease (-0.40, p < 0.001) and an indirect relationship with SBP by way burden of disease (0.34, p < 0.001). This study suggests a direct relationship between burden of disease and SBP, and an indirect relationship between SES and SBP. Development of interventions should take burden of disease into account as a direct driver of blood pressure in immigrants, and address factors related to SES.

Socioenvironmental Risk Factors for Adolescent Marijuana Use in a United States-Mexico Border Community

PURPOSE

We examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there.

DESIGN

Cross-sectional design.

SETTING

The study was conducted at a high school on the United States-Mexico border.

SUBJECTS

A sample of 445 primarily Hispanic students (ages 14-18).

MEASURE

Perceived Disordered Neighborhood Stress Scale, Border Community and Immigration Stress Scale, and Normalization of Drug Trafficking Scale.

ANALYSIS

Logistic regression assessed the association between the socioenvironmental risk factors and past 30-day tobacco, alcohol, and marijuana use.

RESULTS

Participants with higher border community and immigration stress scores were significantly more likely to have used tobacco (adjusted odds ratio [aOR] = 1.41, P < .01) and alcohol (aOR = 1.31, P < .01) in the past 30 days. Perceived disordered neighborhood stress also was associated with past 30-day alcohol use (aOR = 1.46, P < .00). The normalization of drug trafficking was associated with past 30-day marijuana use (aOR = 1.45, P < .05).

CONCLUSIONS

Public health practitioners, educational institutions, and policy makers should consider the economic and normative environment of the United States-Mexico border for future substance use prevention and risk reduction efforts targeting border adolescents.

Unmet healthcare needs among migrants without medical insurance in Montreal, Canada

While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%). The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.

The negative self-perceived health of migrants with precarious status in Montreal, Canada: A cross-sectional study

Background

Knowledge about the health impacts of the absence of health insurance for migrants with precarious status (MPS) in Canada is scarce. MPS refer to immigrants with authorized but temporary legal status (i.e. temporary foreign workers, visitors, international students) and/or unauthorized status (out of legal status, i.e. undocumented). This is the first large empirical study that examines the social determinants of self-perceived health of MPS who are uninsured and residing in Montreal.

Methods and findings

Between June 2016 and September 2017, we performed a cross-sectional survey of uninsured migrants in Montreal, Quebec. Migrants without health insurance (18+) were sampled through venue-based recruitment, snowball strategy and media announcements. A questionnaire focusing on sociodemographic, socioeconomic and psychosocial characteristics, social determinants, health needs and access to health care, and health self-perception was administered to 806 individuals: 54.1% were recruited in urban spaces and 45.9% in a health clinic. 53.9% were categorized as having temporary legal status in Canada and 46% were without authorized status. Regions of birth were: Asia (5.2%), Caribbean (13.8%), Europe (7.3%), Latin America (35.8%), Middle East (21%), Sub-Saharan Africa (15.8%) and the United States (1.1%). The median age was 37 years (range:18–87). The proportion of respondents reporting negative (bad/fair) self-perception of health was 44.8%: 36.1% among migrants with authorized legal status and 54.4% among those with unauthorized status (statistically significant difference; p<0.001). Factors associated with negative self-perceived health were assessed using logistic regression. Those who were more likely to perceive their health as negative were those: with no diploma/primary/secondary education (age-adjusted odds ratio [AOR]: 2.49 [95% CI 1.53–4.07, p<0.001] or with a college diploma (AOR: 2.41 [95% CI 1.38–4.20, p = 0.002); whose family income met their needs not at all/a little (AOR: 6.22 [95% CI 1.62–23.85], p = 0.008) or met their needs fairly (AOR: 4.70 [95% CI 1.21–18.27], p = 0.025); with no one whom they could ask for money (AOR: 1.60 [95% CI 1.05–2.46], p = 0.03); with perception of racism (AOR: 1.58 [95% CI 1.01–2.48], p = 0.045); with a feeling of psychological distress (AOR: 2.17 [95% CI 1.36–3.45], p = 0.001); with unmet health care needs (AOR: 3.45 [95% CI 2.05–5.82], p<0.001); or with a health issue in the past 12 months (AOR: 3.44 [95% CI 1.79–6.61], p<0.001). Some variables that are associated with negative self-perceived health varied according to gender: region of birth, lower formal education, having a family income that does not meet needs perfectly /very well, insalubrious housing, not knowing someone who could be asked for money, and having ever received a medical diagnosis.

Conclusions

In our study, almost half of immigrants without health insurance perceived their health as negative, much higher than reports of negative self-perceived health in previous Canadian studies (8.5% among recent immigrants, 19.8% among long-term immigrants, and 10.6% among Canadian-born). Our study also suggests a high rate of unmet health care needs among migrants with precarious status, a situation that is correlated with poor self-perceived health. There is a need to put social policies in place to secure access to resources, health care and social services for all migrants, with or without authorized status.

Examination of the Association Between Latent Variables for Social Determinants of Health and Blood Pressure Control in Immigrants using Structural Equation Modeling

BACKGROUND

Hypertension is responsible for about 12.8% of deaths around the world. Immigrants' risk of developing hypertension increases with length of residency. There is limited work on the role of social determinants of health and blood pressure control in immigrants. We created a theory-based conceptual model for immigrant-specific and general social determinants variables and their relationship to blood pressure.

PURPOSE

Use a theory-based model to identify latent variables for immigrant-specific social determinants using confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test theoretical validity and relationship with blood pressure (BP).

METHODS

CFA was used to identify latent variables for global socioeconomic status, stressors of immigration, adaptation to immigration, acculturation, and burden of disease. SEM was used to test the structural relationships between latent variables and BP.

RESULTS

181 immigrants were included in the analysis. The final model (chi2 (68, n = 181) = 149.87, p < 0.001, RMSEA = 0.055, CFI = 0.94, TLI = 0.91, CD = 0.99) found burden of disease was significantly related to BP (r = 0.35, p < 0.001).

CONCLUSIONS

One latent variable measuring need was significantly associated with BP in an immigrant sample. This suggests that interventions targeting burden of disease are likely to be effective in controlling blood pressure in immigrants.

The RxHL study: community-responsive research to explore barriers to medication adherence

This study aims to contribute to the development of community-responsive research approaches by describing the research methods used in the RxHL study and the interprofessional and community-based collaboration that produced them. The mixed-method RxHL study was developed in close consultation with staff and providers at our research site, a federally qualified health center in Springfield, MA. We utilized quantitative methods including chart review, manual pill counts and self-report surveys to assess factors associated with medication adherence in a diverse population of low-income patients with chronic disease. We triangulated these results with findings from qualitative methods that included in-depth interviews, home visits and chronic disease diaries. We used the constant comparison method and interdisciplinary, participatory team meetings to integrate quantitative and qualitative findings. A community-responsive approach facilitated the recruitment and retention of a diverse sample of patients. Self-report surveys revealed the widespread scope of barriers to care such as medication costs and transportation, and limited health literacy among diverse groups. Qualitative research methods offered a deeper understanding of the social and environmental contexts in which medication adherence takes place. Prioritizing the needs of community partners and research participants facilitates rigorous data collection in clinical settings with maximum participation from community partners.

Relationship between social determinants of health and systolic blood pressure in United States immigrants

This study examined the relationship between immigrant specific social determinants of health (SDoH) and blood pressure control. Data on 181 adult immigrants from the Midwestern United States was analyzed. SDoH variables were categorized based on antecedents, predisposing, enabling, and need factors. Systolic blood pressure (SBP) was the primary outcome. Pearson's correlations for the association between SBP and SDoH variables were assessed. Then three different regression approaches were used to assess the relationship of SDoH variables with SBP: sequential model, stepwise regression with backward selection, and all possible subsets regression. About 66% were female and mean age was 45.4 years. Age (r ​= ​0.34, p ​< ​0.001), disability (r ​= ​0.20, p ​= ​0.0001), comorbidities (r ​= ​0.30, p ​< ​0.001), and chronic pain (r ​= ​0.12, p ​= ​0.02) were positively correlated with SBP, and number of hours worked per week (r ​= ​-0.11, p ​= ​0.028) was negatively correlated with SBP. The final sequential model found life-course socioeconomic status (SES) (β ​= ​1.40, p ​= ​0.039), age (β ​= ​0.39, p ​< ​0.001), and male sex (β ​= ​13.62, p ​< ​0.001) to be positively associated with SBP. Stepwise regression found that life-course SES (β ​= ​1.70, p ​= ​0.026), age (β ​= ​0.36, p ​< ​0.001), male sex (β ​= ​13.38, p ​< ​0.001), and homelessness as a child (β ​= ​13.14, p ​= ​0.034) were positively associated SBP. All possible subsets regression found that age (β ​= ​0.44, p ​< ​0.001), male sex (β ​= ​14.50, p ​< ​0.001), and homelessness as a child (β ​= ​14.08, p ​= ​0.027) were positively associated with SBP. This is the first study to use a theory-based model that incorporates social determinants of health and immigrant specific factors to examine the relationship between SDoH and blood pressure control and identifies potential targets for interventions to control BP in immigrants.

How the U.S.-Mexico border influences adolescent substance use: Youth participatory action research using photovoice

INTRODUCTION

The purpose of this study is to use Youth Participatory Action Research (YPAR) methods and Photovoice to identify the perceived environmental factors that influence substance use among adolescents living at the U.S.-Mexico border.

METHODS

One academic and a local youth health coalition engaged in Youth Participatory Action Research (YPAR) using Photovoice and qualitative methods to examine the perceived factors influencing adolescent substance use in their border community.

RESULTS

Identified novel risk factors for adolescent substance use on the border included the normalization of drug trafficking, normalization of substance use, and cross-border access to substances. Novel protective factors included living in a close-knit binational community and having strong binational family and social support systems. The findings also illustrate a nexus of 'factors' wherein risk and protective elements overlap.

CONCLUSION

This study contributes to the broader literature on international border health and how living in a border space influences adolescent substance use. The examination of influential border-bound factors provides a more complete understanding of the experiences of youth living on the U.S.-Mexico border, and informs the field of the importance of considering the border experience for future prevention and risk reduction efforts with border adolescents.

"Recognize Our Humanity": Immigrant Youth Voices on Health Care in Arizona's Restrictive Political Environment

The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.

"On Edge All the Time": Mixed-Status Households Navigating Health Care Post Arizona's Most Stringent Anti-immigrant Law

Arizona's state-level policies restricting undocumented immigrants' access to public benefits continue to have implications on mixed-status households' accessibility to care. More notably, the effects of prolonged stress, anxiety and trauma remain unaddressed whilst mental health services continue to be absent. This article examines the healthcare experiences of mixed-status households after Arizona's SB1070 (“Support Our Law Enforcement and Safe Neighborhoods Act”) was passed. Arizona Senate Bill 1070 (SB1070) was state legislation empowering police to detain individuals unable to prove their citizenship upon request. Of particular interest is how households navigate accessibility to care when members have varied immigration statuses, hence, varied healthcare availability. Interviews with 43 households in Tucson, Arizona, 81% of which had at least one undocumented member, reveal barriers and promoters to care. Barriers include complexity of applications, fear and trepidation in seeking care. Promoters include discount care programs that are a vital source of care as well as discretionary practices exercised by front-line staff. Findings have implications beyond Arizona as immigrants settle in new destination states while the current Trump administration borrows from Arizona's anti-immigrant policies.

Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care

We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite.

A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care

BACKGROUND

Consideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services.

OBJECTIVES

This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework.

RESEARCH DESIGN

Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis.

SUBJECTS

Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE.

MEASURES

The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data.

RESULTS

The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients.

CONCLUSIONS

Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.

Development of the Stress of Immigration Survey: A Field Test Among Mexican Immigrant Women

The Stress of Immigration Survey (SOIS) is a screening tool used to assess immigration-related stress. The mixed methods approach included concept development, pretesting, field testing, and psychometric evaluation in a sample of 131 low-income women of Mexican descent. The 21-item SOIS screens for stress related to language, immigrant status, work issues, yearning for family and home country, and cultural dissonance. Mean scores ranged from 3.6 to 4.4 (a scale of 1-5, higher is more stress). Cronbach α values were more than 0.80 for all subscales. The SOIS may be a useful screening tool for detecting high levels of immigration-related stress in low-income Mexican immigrant women.

Emotional Testimonies: An Ethnographic Study of Emotional Suffering Related to Migration from Mexico to Arizona

It is increasingly argued that social and economic inequities poorly affect overall health. One of the means through which these inequities are translated to the body is via negative emotions, which carry known psychological and physiological responses. This paper examines migration-related psychosocial stressors impacting first-generation Mexican immigrants in southern Arizona, and reports on the primary emotional experiences immigrants associate with these stressors. Data were drawn from a qualitative, ethnographic study conducted over the course of 14 months during 2013-2014 with first-generation Mexican immigrants (N = 40) residing in Tucson Arizona and service providers working directly in the immigrant community (N = 32). Results indicate that the primary structural vulnerabilities that cause emotional hardship among immigrants are pre-migration stressors and adversity, dangerous border crossings, detention and deportation, undocumented citizenship status, family separation, and extreme poverty. Many of these factors have intensified over the past decade due to increased border security and state level anti-immigrant legislation in Arizona. Immigrants connected these hardships to the emotions of trauma (50%), fear (65%), depression (75%), loneliness (75%), sadness (80%), and stress (85%), and most respondents reported suffering from three or more of these emotions. Given the heavy emotional toll of migration and the direct impact that regional legislation and border security had on well-being, this paper argues that emotion be considered an important mechanism for health declines in the immigrant community. In order to stem the frequency and intensity of emotional stress in the Mexican immigrant community in Tucson, it is imperative to support organizations and policies that promote community building and support networks and also expand access to and availability of mental health services for immigrants regardless of documentation status.

The Spillover of US Immigration Policy on Citizens and Permanent Residents of Mexican Descent: How Internalizing "Illegality" Impacts Public Health in the Borderlands

BACKGROUND

The militarization of the US-Mexico border region exacerbates the process of "Othering" Latino immigrants - as "illegal aliens." The internalization of "illegality" can manifest as a sense of "undeservingness" of legal protection in the population and be detrimental on a biopsychological level.

OBJECTIVE

We explore the impacts of "illegality" among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law.

METHODS

Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, "Challenges to Farmworker Health at the US-Mexico Border" study, a community-based participatory research project conducted at the Arizona-Sonora border, we compared Arizona resident farmworkers (N = 349) to Mexico-based farmworkers (N = 140) or Transnational farmworkers who cross the US-Mexico border daily or weekly to work in US agriculture.

RESULTS

Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear.

CONCLUSION

The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi-institutional and community-centered systems for reporting immigration-related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and permanent residents.

Investigating social ecological contributors to diabetes within Hispanics in an underserved U.S.-Mexico border community

Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.