Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma

Variation by race/ethnicity-gender in the relationship between arrest history and alcohol use

BACKGROUND

Alcohol use contributes to the national burden of morbidity and mortality in the United States. Arrest, as a unique form of criminal justice system involvement, may be related to alcohol use from adolescence to adulthood. This study investigates the relationship between arrest and alcohol use across race/ethnicity-gender (R/E-G) status (e.g., Black, Latinx, and White men and women) as youth age.

METHODS

Data from 17 waves (1997-2015) of the National Longitudinal Survey of Youth, 1997 cohort (N = 8901) were used to explore how variation in R/E-G moderates the relationship between arrest history and alcohol use trajectories from 13 to 30 years old. Multilevel zero-inflated Poisson and Poisson regression were used to assess R/E-G variation in the relationship between arrest history and days of alcohol consumption, drinks per drinking occasion, and days of binge drinking after accounting for covariates, including incarceration.

RESULTS

The findings indicate that an arrest history is associated with alcohol use, and these results varied by R/E-G status, age, and alcohol use outcome. Those with an arrest history reported more days of drinking than their counterparts without an arrest; yet, the magnitude and direction of average drinks per occasion and binge drinking days varied by R/E-G status and age. Paradoxically, Black men, Black women, and Latinx men with an arrest history reported fewer days of binge drinking as they aged than their counterparts without an arrest.

CONCLUSIONS

A history of arrest is important for alcohol use from adolescence to adulthood and varies by R/E-G status, age, and alcohol use outcome. This work confirms previous scholarship showing that arrest and alcohol use are socially patterned and R/E-G status is an essential consideration in understanding the relationship. Future work should include additional identities and health behaviors and the consequences related to alcohol use outcomes.

Race/Ethnicity, Nativity, and Gender Disparities in Unmet Care Needs Among Older Adults in the United States

BACKGROUND AND OBJECTIVES

Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, although considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs.

RESEARCH DESIGN AND METHODS

The data for this study came from the National Health and Aging Trends Study (2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs.

RESULTS

Older adults of color, especially women, experienced higher rates of unmet care needs compared with their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates.

DISCUSSION AND IMPLICATIONS

These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.

Se Habla Español: The role of ethnic centrality in the effect of providing Spanish-language services in health clinics among Latinx Americans

The present work experimentally examines whether a Spanish-speaking healthcare provider (an identity safety cue) increases the anticipated quality of care and healthcare utilization intentions of Latinx Americans (N = 180) and whether this effect is moderated by ethnic centrality. We find that providing Spanish-language services, versus not, on a healthcare facility's webpage significantly increases both anticipated quality of care and healthcare utilization intentions-but only for Latinx Americans who perceive their ethnicity as highly central to their self-concept. Likewise, we find that anticipated quality of care mediates the effect that identity safety cues have on healthcare utilization intentions only for Latinx Americans high on ethnic centrality. These findings demonstrate that members of minoritized ethnic groups shown to be the most susceptible to experiencing concerns of discrimination (people high on ethnic centrality) are also the most likely to benefit from identity safety cues that are designed to mitigate these very concerns.

Heterogeneity of Asthma Care Among Hispanic Subgroups: Lower Utilization of Hospital-based Care among Spanish-speaking Hispanics

BACKGROUND

Studies found heterogeneity of asthma prevalence among Hispanic subgroups using survey data but addressed under-diagnosis issues due to limited access to health care and diagnosis bias.

OBJECTIVES

To examine heterogeneity by language in health care utilization for asthma among Hispanic subgroups.

RESEARCH DESIGN

A retrospective, longitudinal cohort study of Medi-Cal claims data (2018-2019) using logistic regression to estimate the odds ratio of health care utilization for asthma.

SUBJECTS

In all, 12,056 (ages 5-64) Hispanics living in Los Angeles were identified as having persistent asthma.

MEASURES

Primary language is the predictor variable and outcome measures include ED visits, hospitalizations, and outpatient visits.

RESULTS

The odds of ED visits among Spanish-speaking Hispanics were lower than English-speaking Hispanics in the subsequent 6 (95% CI=0.65-0.93) and 12 (95% CI=0.66-0.87) months. Spanish-speaking Hispanics were less likely than their English-speaking counterparts to utilize hospitalization in the 6 months (95% CI=0.48-0.98), while they were more likely to utilize outpatient care (95% CI=1.04-1.24). For Hispanics of Mexican origin, the odds of ED visits among Spanish-speaking Hispanics were also lower in the 6 and 12 months (95% CI=0.63-0.93, 95% CI=0.62-0.83), but their odds of outpatient visits were higher for outpatient visits in the 6 months (95% CI=1.04-1.26).

CONCLUSIONS

Spanish-speaking Hispanics with persistent asthma were less likely than English-speaking Hispanics to utilize ED visits and hospitalizations but were more likely to utilize outpatient visits. The findings suggest the reduced burden of asthma among the Spanish-speaking Hispanic subgroup and contribute to explaining the protection effect, specifically among Spanish-speaking Hispanics living in highly segregated communities.

Answering calls for rigorous health equity research: a cross-sectional study leveraging electronic health records for data disaggregation in Latinos

INTRODUCTION

Country of birth/nativity information may be crucial to understanding health equity in Latino populations and is routinely called for in health services literature assessing cardiovascular disease and risk, but is not thought to co-occur with longitudinal, objective health information such as that found in electronic health records (EHRs).

METHODS

We used a multistate network of community health centres to describe the extent to which country of birth is recorded in EHRs in Latinos, and to describe demographic features and cardiovascular risk profiles by country of birth. We compared geographical/demographic/clinical characteristics, from 2012 to 2020 (9 years of data), of 914 495 Latinos recorded as US-born, non-US-born and without a country of birth recorded. We also described the state in which these data were collected.

RESULTS

Country of birth was collected for 127 138 Latinos in 782 clinics in 22 states. Compared with those with a country of birth recorded, Latinos without this record were more often uninsured and less often preferred Spanish. While covariate adjusted prevalence of heart disease and risk factors were similar between the three groups, when results were disaggregated to five specific Latin countries (Mexico, Guatemala, Dominican Republic, Cuba, El Salvador), significant variation was observed, especially in diabetes, hypertension and hyperlipidaemia.

CONCLUSIONS

In a multistate network, thousands of non-US-born, US-born and patients without a country of birth recorded had differing demographic characteristics, but clinical variation was not observed until data was disaggregated into specific country of origin. State policies that enhance the safety of immigrant populations may enhance the collection of health equity related data. Rigorous and effective health equity research using Latino country of birth information paired with longitudinal healthcare information found in EHRs might have significant potential for aiding clinical and public health practice, but it depends on increased, widespread and accurate availability of this information, co-occurring with other robust demographic and clinical data nativity.

The capacity to adapt: Documenting the relationship between stressors and probable depression, anxiety, and posttraumatic stress at two time points during the COVID-19 pandemic

BACKGROUND

Psychological adaptability, or the reduction of psychiatric symptoms in the context of ongoing stressors, is well-documented. The present study assessed relationships between COVID-19 related stressors and depression, anxiety, and post-traumatic stress (PTS) during April and July 2020.

METHODS

Prevalence of, and changes in, symptom severity levels in April vs. July were measured with ANOVA F-tests. Logistic regressions were used to assess the odds of probable diagnosis.

RESULTS

Symptom distributions skewed lower in July, as compared to April for all three diagnostic categories. From April to July, prevalence of probable anxiety and depression decreased across all levels of stress, prevalence of PTS increased for high stress, and decreased for medium and low stress levels. In July, only high stress related to higher odds of probable diagnoses, as compared to April when both medium and high stress did.

LIMITATIONS

Due to use of cross-sectional self-report data, the present findings could not establish causality between variables, and provide probable, rather than clinical, diagnoses.

CONCLUSION

Findings emphasize adaptability phenomena during COVID-19 and highlight the nuanced impact of ongoing stress.

Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans

OBJECTIVE

Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans.

METHODS

Two hundred and sixty-seven Hispanic caregiver-child dyads (Mexican = 188, Puerto Rican = 79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups.

RESULTS

Higher caregiver depressive symptoms predicted better pulmonary function (β = .02, p = .001) in Mexican children, and fewer steroid bursts (β = -.41, p = .01) and better medication adherence (β = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup.

CONCLUSIONS

Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.

Asthma Ambulatory Care Quality in Foreign-Born Latino Children in the United States

BACKGROUND

Foreign-born Latino children in the United States (US) have poor asthma outcomes, but the role of routine care utilization in these outcomes is unclear. Our objective was to compare select ambulatory care utilization measures for asthma between foreign-born Latino, US-born Latino, and non-Hispanic white children.

METHODS

Using a multistate network of clinics with a linked electronic health record, we compared the International Classification of Disease (ICD)-coded asthma diagnosis among those with respiratory symptoms, electronic health records documentation of diagnosis, prescriptions, and influenza vaccination of foreign-born and US-born Latino children, and non-Hispanic white children over a 10+ year study period. We also examined outcomes by country of birth in children from Mexico, Cuba, and Guatemala.

RESULTS

Among our study population (n = 155,902), 134,570 were non-Hispanic white, 19,143 were US-born Latino, and 2189 were foreign-born Latino. Among those with suspicious respiratory symptoms, there was no difference between these groups in the predicted probability of an ICD-coded asthma diagnosis. US-born Latino children with asthma were less likely to have asthma documented on their problem list, more likely to have an albuterol prescription, and less likely to have an inhaled steroid prescribed. All Latino children had higher rates of influenza vaccination than non-Hispanic white children.

CONCLUSIONS

In a national network, there were few disparities between Latino (US- and foreign-born) children and non-Hispanic white comparators in many common asthma care services, except some measures in US-born Latino children. Providers should understand that their US-born Latino children may be at elevated risk for not receiving adequate asthma care.

Latino-white disparities in ICD-coded asthma diagnosis among US children

INTRODUCTION

It is uncertain if disparities in asthma diagnosis between Latino and non-Hispanic white children stem from differences in diagnosis over time among children presenting with similar clinical scenarios suggestive of asthma.

METHODS

We evaluated the odds of International Classification of Disease (ICD)-coded asthma diagnosis in Latino (English and Spanish preferring) and non-Hispanic white children, overall (N = 524,456) and among those presenting with possible asthma indicators (N = 85,516) over a 13-year period, using electronic health record data from a multi-state network of community health centers.

RESULTS

Among those with possible asthma indicators, Spanish-preferring Latinos had lower adjusted odds of ICD-coded asthma diagnosis compared to non-Hispanic whites (OR = 0.87, 95%CI = 0.77-0.99); English-preferring Latinos did not differ from non-Hispanic whites. Differences in ICD-coded diagnosis between ethnicity/language groups varied by presenting symptom.

CONCLUSIONS

Spanish-preferring Latino children may be less-likely to have ICD-coded asthma documented in the EHR when presenting with certain clinical indicators suggestive of asthma. Clinicians should be cognizant of the need for the follow-up of these indicators in Spanish-preferring Latino children.

Ethnicity and Self-reported Depression Among Hispanic Immigrants in the U.S

Viewed to be healthier than ethnic Hispanics born in the United States, Hispanic immigrants represent numerous subgroups with clearly heterogeneous geographic, cultural, structural, and social origins. This study asked how the factors length of U.S. residency, social status, lifestyle, and health care might explain self-reported depression within 5 large, discrete subgroups comprising immigrants from, in turn, Mexico, Puerto Rico, Cuba, the Dominican Republic, and other nations in Central and South America. The study also examined ethnicity's potential role moderating self-reported depression's associations. With pooled data from National Health Interview Surveys 1999-2015, it evaluated each ethnic group separately. Self-reported depression was associated generally with lengthening residence in the U.S., with being female, with poverty, with unemployment, with lack of education, and with lifestyle and health-care factors. These associations were not uniform across ethnic groups, however. Where self-reported depression is concerned, descriptive results suggest the proverbial health advantage may largely accrue specifically to Hispanic immigrants of Cuban and of Central/South American origin.

Data Consultations, Racism, and Critiquing Colonialism in Demographic Datasheets

Objective: We consider how data librarians can take antiracist action in education and consultations. We attempt to apply QuantCrit thinking, particularly to demographic datasheets. Methods: We synthesize historical context with modern critical thinking about race and data to examine the origins of current assumptions about data. We then present examples of how racial categories can hide, rather than reveal, racial disparities. Finally, we apply the Model of Domain Learning to explain why data science and data management experts can and should expose experts in subject research to the idea of critically examining demographic data collection. Results: There are good reasons why patrons who are experts in topics other than racism can find it challenging to change habits from Interoperable approaches to race. Nevertheless, the Census categories explicitly say that they have no basis in research or science. Therefore, social justice requires that data librarians should expose researchers to this fact. If possible, data librarians should also consult on alternatives to habitual use of the Census racial categories. Conclusions: We suggest that many studies are harmed by including race and should remove it entirely. Those studies that are truly examining race should reflect on their research question and seek more relevant racial questions for data collection.

An Overview of Health Disparities in Asthma

Asthma is a heterogeneous disease characterized by inflammation in the respiratory airways which manifests clinically with wheezing, cough, and episodic periods of chest tightness; if left untreated it can lead to permanent obstruction or death. In the US, asthma affects all ages and genders, and individuals from racial and ethnic minority groups are disproportionately burdened by this disease. The financial cost of asthma exceeds $81 billion every year and despite all the resources invested, asthma is responsible for over 3,500 deaths annually in the nation. In this overview, we highlight important factors associated with health disparities in asthma. While they are complex and overlap, we group these factors in five domains: biological, behavioral, socio-cultural, built environment, and health systems. We review the biological domain in detail, which traditionally has been best studied. We also acknowledge that implicit and explicit racism is an important contributor to asthma disparities and responsible for many of the socio-environmental factors that worsen outcomes in this disease.

Examining Associations Between Dietary Inflammatory Index in Pregnancy, Pro-inflammatory Cytokine and Chemokine Levels at Birth, and Offspring Asthma and/or Wheeze by Age 4 Years

BACKGROUND

Few studies have demonstrated associations between maternal dietary inflammatory index (DII) during pregnancy and offspring asthma and/or wheeze.

OBJECTIVE

The study aimed to assess associations between maternal DII during pregnancy and 1) offspring cord sera pro-inflammatory cytokines (interleukin [IL]-1β, IL-4, IL-6, IL-10, tumor necrosis factor-α) and chemokines (IL-8, monocyte chemoattractant protein-1) at birth and 2) offspring asthma and/or wheeze at age 4 years.

DESIGN

The Healthy Start study is a prospective prebirth longitudinal study that recruited pregnant women in Denver, Colorado and tracked their offspring.

PARTICIPANTS AND SETTING

This study used data from 1228 mother-child dyads enrolled in the Healthy Start study. Pregnant women were recruited in Denver, Colorado, between 2009 and 2014, and offspring tracked until age 4 years.

MAIN OUTCOME MEASURES

Cord sera cytokines and chemokines were analyzed with multiplex panel immunoassays. Offspring diagnosis of asthma and/or wheeze by age 4 years was extracted from electronic medical records.

STATISTICAL ANALYSES PERFORMED

Unadjusted and adjusted linear and logistic regression models were used to assess associations. Covariates included factors such as nulliparity, race/ethnicity, gestational smoking, and maternal history of asthma.

RESULTS

Unadjusted analysis showed that increasing maternal DII scores were associated with increased odds of child asthma and/or wheeze by 4 years (odds ratio = 1.17; 95% CI: 1.07-1.27), but the association was attenuated and no longer statistically significant in the adjusted model (odds ratio = 1.15; 95% CI: 0.99-1.33). There were no significant associations between DII scores and cord sera cytokine or chemokine levels.

CONCLUSIONS

The study showed that the inflammatory profile of the maternal diet was not associated with cytokines and chemokine levels at birth. The results suggested that a more inflammatory maternal diet was associated with increased odds of offspring asthma and/or wheeze by age 4 years, which could be considered of clinical relevance but the finding was not statistically significant at the .05 level.

The paradox does not fit all: Racial disparities in asthma among Mexican Americans in the U.S

Mexican Americans have a lower prevalence of asthma than White Americans, Black Americans, and Other Hispanics. This is concordant with the Hispanic Paradox, which posits that Hispanics have good health and lower mortality than White Americans despite their relative socioeconomic disadvantages. However, the research is limited in relation to the effects of race on health, independent of ethnicity, among this population. In this study, the author disaggregated Mexican Americans, foreign-born and U.S.-born into two categories, White and Black Mexicans, in order to assess their likelihood of having an asthma diagnosis, compared to White Americans and to each other. This study used harmonized data from the National Health Interview Survey from 2000–2018 with a final analytic sample of N = 1,094,516. The analysis was conducted using binary logistic regression, controlling for acculturation and health behavior-related variables, as well as sociodemographic characteristics. In the results, Black Mexicans had a significant disadvantage in relation to their White counterparts and White Americans. The findings suggest there is an intra-ethnic racial disparity in asthma and the Hispanic paradox is not applicable across racial lines for Mexican Americans. These findings also suggest Black Mexicans’ poor asthma outcomes are the byproduct of various mechanisms of racial inequality.

Asthma Care Quality, Language, and Ethnicity in a Multi-State Network of Low-Income Children

INTRODUCTION

Prior research has documented disparities in asthma outcomes between Latino children and non-Hispanic whites, but little research directly examines the care provided to Latino children over time in clinical settings.

METHODS

We utilized an electronic health record-based dataset to study basic asthma care utilization (timely diagnosis documentation and medication prescription) between Latino (Spanish preferring and English preferring) and Non-Hispanic white children over a 13-year study period.

RESULTS

In our study population (n = 37,614), Latino children were more likely to have Medicaid, be low income, and be obese than non-Hispanic white children. Latinos (Spanish preferring and English preferring) had lower odds than non-Hispanic whites of having their asthma recorded on their problem list on the first day the diagnosis was noted (odds ratio [OR] = 0.83; 95% CI, 0.77 to 0.89 Spanish preferring; OR = 0.93; 95% CI, 0.87 to 0.99 English preferring). Spanish-preferring Latinos had higher odds of ever receiving a prescription for albuterol (OR = 1.96; 95% CI, 1.52 to 2.52), inhaled corticosteroids (OR = 1.45; 95% CI, 1.01 to 2.09), or oral steroids (OR = 1.48; 95% CI, 1.07 to 2.04) than non-Hispanic whites. Among those with any prescription, Spanish-preferring Latinos had higher rates of albuterol prescriptions compared with non-Hispanic whites (adjusted rate ratio [aRR] = 1.0; 95% CI, 1.01 to 1.13).

CONCLUSIONS

In a multi-state network of clinics, Latino children were less likely to have their asthma entered on their problem list the first day it was noted than non-Hispanic white children, but otherwise did not receive inferior care to non-Hispanic white children in other measures. Further research can examine other parts of the asthma care continuum to better understand asthma disparities.

Pulmonary disease burden in Hispanic and non-Hispanic children with sickle cell disease

RATIONALE

Pulmonary complications are the leading cause of morbidity and mortality in sickle cell disease (SCD) patients. Research in SCD has predominantly been conducted on African-Americans, and the disease burden of SCD in other races and ethnicities, including Hispanic patients, is not well characterized.

OBJECTIVE

To compare pulmonary disease burden between Hispanic and non-Hispanic ethnic groups among children with SCD.

METHODS

In a retrospective chart review on 566 SCD patients followed at the Children's Hospital at Montefiore, NY, we compared the pulmonary disease burden and disease management in Hispanic patients to their non-Hispanic counterparts. We also compared the contribution of demographic and clinical variables to acute chest syndrome (ACS), vaso-occlusive crisis (VOC), and hospitalizations for SCD related complications between the two ethnic groups.

RESULTS

Hispanic patients had a greater proportion of ACS, and had lower forced expiratory volume (FEV1), forced vital capacity, and vital capacity, compared to non-Hispanics. Hispanic patients were more likely to be evaluated in pulmonary clinic and to be on inhaled corticosteroids, short-acting β agonizts, and leukotriene receptor antagonists. In addition, Hispanic children were more likely to be on hydroxyurea, and receive exchange transfusions. However, the association of asthma with the proportion of ACS did not differ between Hispanics and non-Hispanics.

CONCLUSION

Hispanic children with SCD had differences in their pulmonary function profile and received more pulmonary evaluations than non-Hispanic children.

Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support

OBJECTIVE

Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway.

METHODS

Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N = 165; mean age = 9.08, standard deviation = 2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support.

RESULTS

Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P = .07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years.

CONCLUSIONS

This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.

Explaining Chronic Illness and Self-Rated Health Among Immigrants of Five Hispanic Ethnicities

The largest racial/ethnic minority group in the United States, Hispanics, especially Hispanic immigrants, have been considered healthier than groups of other ethnicity (including Whites, the majority). However, chronic illnesses such as cancer and diabetes are often seen in this culturally, ethnically diverse group. The present study had two aims. First was to explain two health outcomes, which were presence of chronic illness (any of the five common conditions cardiovascular disease, stroke, hypertension, cancer, and/or diabetes/prediabetes) and self-rated health, in terms of links to certain factors in acculturation, social status, health, social support, and lifestyle. Second was to determine how uniform these links might be across five ethnic groups: Mexican, Puerto Rican, Cuban, Dominican, Central/South American. We combined data from 17 years of the National Health Interview Survey (1999-2015) and subjected these secondary measures to logistic and linear regression, separately by ethnicity, to explain both outcomes. With few exceptions, results generally linked illness/health to the tested independent variables. Additionally, results confirmed ethnicity to moderate the outcomes' associations with the independent variables. Ethnicity-specific analysis showed the two outcomes to exhibit dissimilar relationships with certain independent variables across ethnic groups. Research that (as has been common) lumps together respondents whose Hispanic ethnicities may differ disregards some meaningful variation rather than accounting for it. In future research-and in subsequent evidence-based policy/practice development-all essential sociocultural factors, including ethnicity, should be carefully outlined, advancing good health for the entire Hispanic immigrant population.

Social capital and physical health: An updated review of the literature for 2007-2018

PURPOSE

Social capital is frequently indicated as a determinant of population health. Despite an increase in the frequency of public health studies including such measures, our understanding of social capital's effects on health remains unclear. In 2008, a systematic review of the "first decade" of research on social capital and health was published in the textbook Social Capital and Health. Our study intends to update and expand upon this original review to account for developments in the literature over the second decade of research on social capital and health.

METHODS

We employed a systematic review of empirical studies investigating the relationship between measures of social capital and physical health outcomes published between January 1, 2007 and December 31, 2018. To identify potential studies, we conducted searches of PubMed, Embase, and PsychINFO databases in January 2019 using combinations of "social capital" and "physical health" search terms.

RESULTS

We identified 1,608 unique articles and reviewed 145 studies meeting our inclusion criteria. The most frequently examined health condition was self-reported health (57%), followed by mortality (12%), cardiovascular diseases (10%), obesity (7%), diabetes (6%), infectious diseases (5%), and cancers (3%). Of these studies, 127 (88%) reported at least partial support for a protective association between social capital and health. However, only 41 (28%) reported exclusively positive findings. The majority (59%) of results were mixed, suggesting a nuanced relationship between social capital and health. This finding could also be indicative of differences in study design, which showed substantial variation.

CONCLUSIONS

Despite limitations in the literature, our review chronicles an evolution in the field of social capital and health in terms of size and sophistication. Overall, these studies suggest that social capital may be an important protective factor for some physical health outcomes, but further research is needed to confirm and clarify these findings.

Burden of Illness, Primary Care Use, and Medication Utilization among US-México Border Children with Wheezing

OBJECTIVE

Among high-risk, underserved populations, such as children living along the US-México border, suffering from asthma-like symptoms without an asthma diagnosis can result in a high burden of illness. We estimated the prevalence of physician-diagnosed and possible undiagnosed asthma among students with histories of wheezing in the US-México border community of El Paso, Texas, and evaluated their burden of illness, primary care use, and medication utilization.

METHODS

We analyzed cross-sectional survey data collected in May 2012. The survey included validated International Study of Asthma and Allergies in Childhood (ISAAC) items. We performed bivariate and logistic regression analyses on data from 307 students who wheezed.

RESULTS

Forty-two percent of students had possible undiagnosed asthma and 58% had physician-diagnosed asthma based on primary caretaker reports. Children of Mexican origin were more likely to report undiagnosed vs. diagnosed asthma (p < 0.05). Children with an asthma diagnosis were more likely to report any medication use for wheezing/asthma and to experience a higher burden of illness in the last year compared to students with possible undiagnosed asthma (p < 0.05).

CONCLUSIONS

The burden of illness among these children was high; however, children with asthma-like symptoms were not faring worse than children with asthma symptoms and a diagnosis. Undiagnosed children were being evaluated and receiving treatment for their symptoms; however, by not receiving a diagnosis, they were eliciting an ameliorative rather than preventive treatment strategy.

Comparisons between 2015 US asthma prevalence and two measures of asthma burden by racial/ethnic group

Objective: Asthma affects approximately 20,383,000 Americans and costs the US $56 billion dollars annually. Asthma burden is not uniform across different racial/ethnic groups. Although annual asthma prevalences by racial/ethnic group are provided by the CDC, these numbers do not account for the influence of other sociodemographic and clinical factors. In this study, we evaluated several measures of asthma burden that controlled for sociodemographic and clinical factors and compared them to 2015 CDC asthma prevalences by racial/ethnic group. Methods: We obtained unadjusted asthma predictions directly from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. To estimate average adjusted predictions (AAP) and adjusted predictions at the means (APM) for asthma, we controlled for sociodemographic and clinical factors through logistic models and subsequently calculated marginal probabilities for these results. Results: We found substantial differences at the national and state level between unadjusted prevalences and AAPs and APMs for asthma by race/ethnicity group. In addition, states that had the highest and lowest unadjusted prevalences differed from states that had the highest and lowest AAPs and APMs. For unadjusted prevalences, AAPs, and APMs, we found that states that had the highest prevalences or probabilities of asthma for Whites tended to have the widest disparities between the estimates for Whites and those of other races. Conclusions: The study's results highlight the need to account for sociodemographic and clinical factors when addressing asthma burden by racial/ethnic group across the US.

Immigrant health trajectories in historical context: Insights from European immigrant childhood mortality in 1910

Recent studies of immigrant health have focused on an apparent paradox in which some new immigrants arrive healthier than expected but exhibit poorer health outcomes with duration of residence. Although a variety of explanations have been put forth for this epidemiological pattern, questions remain about the socio-historical generalizability of the empirical findings and accompanying theoretical explanations. By examining childhood mortality patterns of European immigrants to the United States in the early 20th century, this study tests hypotheses from current immigrant health literature in a previous era of immigration. In contrast with post-1965 immigrant groups, European arrivals did not have better outcomes than their U.S.-born white counterparts. Rather, their rates corresponded to a "middle tier" status in between U.S.-born black and white populations. Analysis of post-migration trajectories returned mixed results that similarly differ from contemporary patterns. Many new immigrant groups had higher rates of excess childhood mortality than their U.S-born counterparts, but outcomes appear to have improved with duration of residence or among the second generation. These findings suggest socio-historical variation in the context of reception may act as a "fundamental cause" of immigrant health and mortality outcomes.

An Examination of the Association of Multiple Acculturation Measures with Asthma Status Among Elementary School Students in El Paso, Texas

Some researchers posit that the lower prevalence of asthma among those of Mexican descent may result from an under-diagnosis and recommend a critical appraisal of factors related to race/ethnicity, like acculturation, and its influence on asthma status. Survey data were analyzed using multinomial logistic regression to examine the association of child's asthma status (no wheezing/no asthma symptoms, possible undiagnosed and diagnosed asthma) with measures of acculturation among Hispanic students (n = 1095). In this population, the prevalence of diagnosed asthma (15%) was higher than both national (7.6%) and state (6.8%) averages for Hispanic children in 2012. While bivariate analyses showed significant associations for asthma status and measures of acculturation, multivariate analyses did not. There is an underestimated burden of illness among Hispanic children in El Paso County. More research on the suitability of acculturation constructs is needed to delineate what they actually measure and how acculturation influences asthma status.

Pregnancy and Birth Outcomes Among Immigrant Women in the US and Europe: A Systematic Review

Human migration is not a new phenomenon, but it has changed significantly with the advance of globalization. We focus on differences in the published literature concerning migration and health (EU vs the US), centering specifically on reproductive health outcomes. We conducted a literature search in the Pubmed and Embase databases. We reviewed papers that contrast migrants to native-born populations and analyzed differences between countries as well as challenges for future research. The prevalence of low birthweight among migrants varies by the host country characteristics as well as the composition of migrants to different regions. The primary driver of migrant health is the migrant "regime" in different countries at specific periods of time. Future health outcomes of immigrants will depend on the societal characteristics (legal protections, institutions and health systems) of host countries.

Nativity as a Determinant of Health Disparities Among Children

Nativity is not often considered in the study of health disparities. We conducted a cross-sectional, parent-reported survey of demographics, socioeconomic characteristics, healthcare access, and health conditions in New York City schoolchildren (n = 9029). US-born children with US-born parents (US/US) had higher socioeconomic status, better access to healthcare, and reported higher rates of disease diagnoses compared to US-born children with immigrant parents and to immigrant children. Dental cavities were the only condition in which US/US children reported lower prevalence. US/US children had the best healthcare access, most favorable parent-reported health status and highest rate of satisfaction with healthcare. The magnitude of racial/ethnic disparities varied based on nativity of the children being compared. Factors such as the healthy immigrant effect and differential diagnosis rates may explain the results. In conclusion, nativity influences disease burdens and should be considered in health disparities studies.

The role of parental and perinatal characteristics on Langerhans cell histiocytosis: characterizing increased risk among Hispanics

PURPOSE

Potential roles of inherited and environmental risk factors in pathogenesis of Langerhans cell histiocytosis (LCH), a myeloid neoplastic disorder, are undefined. We therefore evaluated the role of parental and perinatal factors on the risk of this childhood cancer.

METHODS

Information on LCH cases (n = 162) for the period 1995-2011 was obtained from the Texas Cancer Registry. Birth certificate controls were frequency-matched on year of birth at a ratio of 10:1 for the same period. Variables evaluated included parental age, race/ethnicity, size for gestational age, and birth order. Logistic regression was used to generate an adjusted odds ratio (aOR) and 95% confidence interval (CI) testing the association between each factor and LCH.

RESULTS

Few perinatal or parental factors were associated with LCH risk, with the exception of race/ethnicity. Mothers of Hispanic ethnicity were more likely to have children who developed LCH compared to non-Hispanic whites (aOR: 1.51; 95% CI: 1.02-2.25). This risk increased when both parents were Hispanic (aOR: 1.80; 95% CI: 1.13-2.87). Non-Hispanic black mothers were suggested as less likely to give birth to offspring who developed LCH compared to non-Hispanic whites (aOR: 0.50; 95% CI: 0.24-1.02).

CONCLUSIONS

LCH is characterized by somatic mutations in MAPK pathway genes in myeloid precursors. Increased risk for LCH in children of Hispanic parents suggests potential impact of inherited factors on LCH pathogenesis.

Barriers to Physical and Mental Health: Understanding the Intersecting Needs of Cambodian and Latino Residents in Urban Communities

A community needs assessment was conducted to explore barriers and facilitators to good physical and mental health among Cambodian and Latino residents in an urban community in Southern California. Thirty-six Cambodians and 29 Latinos completed the interviewer-facilitated survey administered door-to-door, and another 20 Cambodian and 18 Latino residents participated in focus groups. Crime, limited knowledge of positive health behaviors, lack of access to affordable healthcare, and lack of access to safe spaces for recreational activities were identified as threats to good health. Participant recommendations to support health in the community included increasing police presence to improve safety and reduce violence, and increasing opportunities/locations for physical exercise. While differences between Cambodian and Latino residents exist, the identified threats and suggested improvements were primarily associated with environmental factors, highlighting the need for systems level approaches that recognize the relationship between community context and health.

Prevalence of Single and Multiple Leading Causes of Death by Race/Ethnicity Among US Adults Aged 60 to 79 Years

Introduction

Diabetes, cancer, cardiovascular disease (CVD) (coronary artery disease, heart attack, and angina pectoris), and chronic lung disease (emphysema, chronic bronchitis, and chronic obstructive pulmonary disease) are major causes of death in the United States. The objective of this study was to assess racial/ethnic differences in the prevalence of these conditions as cause of death among people aged 60 to 79 years with one or more of these conditions.

Methods

We used data on the prevalence of major chronic conditions from the National Health Interview Survey on 56,290 adults aged 60 to 79 years who reported having any of the chronic conditions assessed in the National Health Interview Survey for 2006 through 2014. We compared trends with age for 11 single and multiple conditions. Analyses employed multinomial logistic regression models.

Results

Hispanics and non-Hispanic blacks had the greatest prevalence of diabetes, and non-Hispanic whites had the greatest prevalence of cancer and chronic lung disease. The prevalence of multiple chronic diseases in an individual varied less by race/ethnicity. An exception was the prevalence of having both diabetes and CVD, which was higher among Hispanics and non-Hispanic blacks than non-Hispanic whites. Non-Hispanic blacks aged 65 years and 75 years had higher odds of having diabetes and cancer than non-Hispanic whites at the same ages. Hispanics had lower odds of having CVD with cancer or chronic lung disease than non-Hispanic whites. Women had a lower age-specific prevalence than men for most of the 11 single and multiple conditions. Most chronic diseases showed an inverse relationship with education and a higher prevalence in the South than in other regions.

Conclusion

Strong racial/ethnic differences exist in the prevalence of single chronic conditions, but differences are lower for prevalence of multiple conditions. Comparing races/ethnicities, the same disease dyads and triads may occur more often in different orders.

Breastfeeding and Asthmatic Symptoms in The Offspring of Latinas: The Role of Maternal Nativity

Previous research has generally found exclusive breastfeeding to protect against asthma in young children. However, maternal nativity in a Latina population has not been assessed as a potential confounder or effect modifier. Using cross-sectional data restricted to Latina mothers (n = 704) from a birth cohort in Los Angeles interviewed in 2003 and 2006, we estimated risk ratios (RR) for exclusive breastfeeding and asthmatic symptoms in the offspring. 56 children (8%) had asthmatic symptoms at age 3.5 years. We found a 49% reduction in risk of asthmatic symptoms with >3 months of exclusive breastfeeding (aRR 0.51, 95% CI 0.28, 0.90). Foreign-born Latinas were more likely to initiate and continue breastfeeding for at least 3 months compared with US-born Latinas. Three or more months of exclusive breastfeeding reduced the risk of asthmatic symptoms in the offspring of Latinas, and maternal nativity did not confound or modify this association.

The Perspectives of Six Latino Heritage Groups About Their Health Care

The Latino population in the US is projected to grow substantially in the years ahead. Although often referred to as a single group, Latinos are not homogeneous. This article, based mainly on a national telephone survey of 1,478 Latino adults, examines the perspectives of six Latino heritage groups on the health care issues they face. The six groups differ in their reported health care experiences in: the types facilities they use in getting medical care, their ratings of the quality of care they receive, their experiences with discrimination in getting quality care, the level of confidence they have in being able to pay for a major illness. One thing the heritage groups agree on is that diabetes is the biggest health problem facing their families. Community health leaders, particularly at the state level, need to focus on the specific Latino groups in their state or area and their unique situations.

Prevalence of Asthma in School Children on the Arizona-Sonora Border

BACKGROUND

Mexican-born children living in the United States have a lower prevalence of asthma than other US children. Although children of Mexican descent near the Arizona (AZ)-Sonora border are genetically similar, differences in environmental exposures might result in differences in asthma prevalence across this region.

OBJECTIVE

The objective of this study was to determine if the prevalence of asthma and wheeze in these children varies across the AZ-Sonora border.

METHODS

The International Study of Asthma and Allergy in Children written and video questionnaires were administered to 1753 adolescents from 5 middle schools: Tucson (school A), Nogales, AZ (schools B, C), and Nogales, Sonora, Mexico (schools D, E). The prevalence of asthma and symptoms was compared, with analyses in the AZ schools limited to self-identified Mexican American students.

RESULTS

Compared with the Sonoran reference school E, the adjusted odds ratio (OR) for asthma was significantly higher in US schools A (OR 4.89, 95% confidence interval [CI] 2.72-8.80), B (OR 3.47, 95% CI 1.88-6.42), and C (OR 4.12, 95% CI 1.78-9.60). The adjusted OR for wheeze in the past year was significantly higher in schools A (OR 2.19, 95% CI 1.20-4.01) and B (OR 2.67, 95% CI 1.42-5.01) on the written questionnaire and significantly higher in A (OR 2.13, 95% CI 1.22-3.75), B (OR 1.95, 95% CI 1.07-3.53), and Sonoran school D (OR 2.34, 95% CI 1.28-4.30) on the video questionnaire compared with school E.

CONCLUSIONS

Asthma and wheeze prevalence differed significantly between schools and was higher in the United States. Environmental factors that may account for these differences could provide insight into mechanisms of protection from asthma.

Racial and Ethnic Heterogeneity in Self-Reported Diabetes Prevalence Trends Across Hispanic Subgroups, National Health Interview Survey, 1997-2012

Introduction

We examined racial/ethnic heterogeneity in self-reported diabetes prevalence over 15 years.

Methods

We used National Health Interview Survey data for 1997 through 2012 on 452,845 adults aged 18 years or older. Annual self-reported diabetes prevalence was estimated by race/ethnicity and education. We tested for trends over time by education and race/ethnicity. We also analyzed racial/ethnic and education trends in average annual prevalence.

Results

During the 15 years studied, diabetes prevalence differed significantly by race/ethnicity (P < .001) and by Hispanic subgroup (P < .001). Among participants with less than a high school education, the 5-year trend in diabetes prevalence was highest among Cubans and Cuban Americans (β_5YR = 4.8, P = .002), Puerto Ricans (β_5YR = 2.2, P = .06), non-Hispanic blacks (β_5YR = 2.2, P < .001), and non-Hispanic whites (β_5YR = 2.1, P < .001). Among participants with more than a high school education, non-Hispanic blacks had the highest average annual prevalence (5.5%) and Puerto Ricans had the highest 5-year trend in annual diabetes prevalence (β_5YR = 2.6, P = .001).

Conclusions

In this representative sample of US adults, results show ethnic variations in diabetes prevalence. The prevalence of diabetes is higher among Hispanics than among non-Hispanic whites, unevenly distributed across Hispanic subgroups, and more pronounced over time and by education. Findings support disaggregation of data for racial/ethnic populations in the United States to monitor trends in diabetes disparities and the use of targeted, culturally appropriate interventions to prevent diabetes.