Family Connections and the Latino Health Paradox: Exploring the Mediating Role of Loneliness in the Relationships Between the Latina/o Cultural Value of Familism and Health

Resiliency and Barriers to Successful Aging Among Middle-Aged Mexican Immigrants Residing in a Rural Agricultural Community

OBJECTIVES

The Latino population is one of the largest, most diverse, and fastest-growing demographic groups in the United States. Although Latinos enjoy longer life spans and reduced mortality risk relative to non-Hispanic Whites, they have higher rates of chronic health conditions such as diabetes and dementia and live more of their older years with poor health and disability. Such inequities point to the need for this research focused on examining resiliency strategies and barriers to successful aging among various U.S. Latino subgroups.

METHODS

This qualitative study used thematic content analysis to examine resiliency strategies and barriers to successful aging among Mexican immigrant women (n = 40) residing in an underserved agricultural community and entering mid-life (mean = 49 years old).

RESULTS

With regards to barriers to successful aging, 3 themes emerged: (1) stressful lifestyle in the United States compared to the participants' home countries; (2) stress from expectations at home; and (3) stress due to work and the various components around work. The following 4 resiliency strategies emerged: (1) family as a motivation for moving forward in life and focusing on the success of children; (2) having a positive mindset; (3) praying to God for strength to overcome obstacles; and (4) self-care.

DISCUSSION

Despite experiencing barriers to successful aging, participants practice various resiliency strategies to age successfully. Because many of the barriers identified are related to poverty-related stressors, systemic solutions addressing the social determinants of health are needed.

Racial/Ethnic Differences in Loneliness Among Older Adults: The Role of Income and Education as Mediators

Background and Objectives

Loneliness is a major public health concern; however, limited research has examined the mechanisms contributing to racial/ethnic inequities in loneliness. Race/ethnicity has been hypothesized to be a distal factor influencing loneliness, and racial/ethnic inequities in loneliness may be attributable to socioeconomic factors (e.g., income and education). Our study seeks to confirm these hypotheses by examining mechanisms that contribute to racial/ethnic inequities in loneliness. In other words, if racial/ethnic differences in loneliness among older adults are mediated by income and education.

Research Design and Methods

Data came from the Health and Retirement Study Leave-Behind Questionnaire, 2014-2016. Loneliness was measured by the UCLA 3-item loneliness scale. Race/ethnicity categories were White, Black, and Hispanic/Latino. The mediator variables were household income and education. Multivariable linear regression models were used to determine differences in loneliness by race/ethnicity. The Karlson-Holm-Breen (KHB) mediation method was used to determine if income and education mediated racial/ethnic differences in loneliness.

Results

In models examining income and education together, a complete mediation was found between White and Black older adults, in that income and education completely mediated differences in loneliness between these groups. A partial mediation was found between White and Hispanic, and Black and Hispanic older adults. When examining income and education separately, we found that income solely accounted for racial/ethnic differences in loneliness compared to education.

Discussion and Implications

Our study is the first to explicitly determine if socioeconomic factors mediate race/ethnicity differences in loneliness among a national sample of older adults. These findings illustrate that income may have greater proximate effects for loneliness among older adults in comparison to education. Additionally, these findings can inform evidence-based interventions to reduce loneliness among older adults. Interventions that enhance quality of life and provide opportunities for socialization for racialized low-income older adults may help decrease racial/ethnic inequities in loneliness.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

The Cultural Influence of Familismo in Prompting Vaccination Against COVID-19 Among U.S. Latina/o/x Border Residents

This study centers on familismo as a relevant cultural construct that adds a U.S. Latina/o/x perspective to the Health Belief Model. Employing a qualitative lens, we use in-depth semi-structured focus groups and interviews with participants living, working, and attending school in a mid-size city on the U.S./Mexico border on the decision to take the COVID-19 vaccine. We find that, for many members of these communities, getting vaccinated is seen as a way to protect not only oneself but also one's family, especially those with chronic health conditions, reflecting an obligation to prioritize the collective over the individual. We highlight various approaches that families take to discuss COVID-19 vaccines, ranging from women coordinating vaccination to a non-confrontational approach to the unvaccinated. The borderlands as a place also showcase the diversity of the U.S. Latina/o/x experience during the pandemic, since the perceived disparities of vaccine access in Mexico also seemed to cue the decision to get vaccinated. We propose this helps explain the exceptionally high vaccination rate in the city under study and seen in several other border communities. By illuminating how familial ties impact health communication surrounding this important issue, this study adds an expanded Latina/o/x cultural context for aspects of the Health Belief Model such as perceived severity and susceptibility.

Latina paradox in Spain? Arrival-cohort effects on the birthweight of newborns of Latina mothers

This study analyses the arrival-cohort effects on the newborn birthweight of Latina women residing in Spain. First, it has been tested whether women of Latin American origin in Spain have an advantage in terms of birth outcomes, a pattern previously documented in the United States and referred to as the 'Latin American paradox'. Second, it has been examined whether this health advantage of Latina mothers varies by arrival cohort.A novel database provided by the Spanish National Statistics Office that links the 2011 Census with Natural Movement of the Population records from January 2011 to December 2015 has been used. Poisson regression models were applied to test for differences in the incidence rates of low birthweight (LBW) and high birthweight (HBW) among children of Latina and native mothers, controlling for various demographic, socio-economic, and birth characteristics.Two distinct arrival-cohort effects on perinatal health were observed. On one hand, first-generation Latina women were found to be at a lower risk of giving birth to LBW infants; however, they experienced a higher incidence of HBW during the study period. Second, Latina women of 1.5 generation, likely stressed by increased exposure to the receiving country, exhibited adverse birthweight results.

Race and Ethnicity Disparities in Cardiovascular and Cancer Mortality: the Role of Socioeconomic Status-a Systematic Review and Meta-analysis

To clarify the role of socioeconomic status (SES) in cardiovascular and cancer mortality disparities observed between Black, Hispanic, and Asian compared to White adults, we conducted a meta-analysis of the longitudinal research in the USA. A PubMed, Ovid Medline, Web of Science, and EBSCO search was performed from January 1995 to May 2023. Two authors independently screened the studies and conducted risk assessments, with conflicts resolved via consensus. Studies were required to analyze mortality data using Cox proportional hazard regression. Random-effects models were used to pool hazard ratios (HR) and reporting followed PRISMA guidelines. Twenty-two studies with cardiovascular mortality (White and Black (n = 22), Hispanic (n = 7), and Asian (n = 3) adults) and twenty-three with cancer mortality endpoints (White and Black (n = 23), Hispanic (n = 11), and Asian (n = 10) adults) were included. The meta-analytic sample for cardiovascular mortality endpoints was 6,199,049 adults (White = 4,891,735; Black = 935,002; Hispanic = 295,623; Asian = 76,689), while for cancer-specific mortality endpoints was 7,745,180 adults (White = 5,988,392; Black= 1,070,447; Hispanic= 484,848; Asian = 201,493). Median follow-up was 10 and 11 years in cohorts with cardiovascular and cancer mortality endpoints, respectively. Adjustments for SES attenuated the higher risk for cardiovascular (HR, 1.46; 95% CI, 1.30-1.64) and cancer mortality (HR, 1.35; 95% CI, 1.32-1.38) of Black compared to White adults by 25% (HR, 1.21; 95% CI, 1.15-1.28) and 19% (HR, 1.16; 95% CI, 1.13-1.18), respectively. However, the Hispanic cardiovascular (HR, 0.79; 95% CI, 0.73-0.85) and Asian cancer mortality (HR, 0.81; 95% CI, 0.76-0.86) advantage were independent of SES. These findings emphasize the need to develop strategies focused on SES to reduce cardiovascular and cancer mortality in Black adults.

Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications

BACKGROUND

The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.

PURPOSE

Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.

METHODS

We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.

FINDINGS

To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.

DISCUSSION

Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.

Undocumented Latino Immigrants and the Latino Health Paradox

INTRODUCTION

Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants.

METHODS

This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years).

RESULTS

Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants.

CONCLUSIONS

This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

Longitudinal Analysis of Social Isolation and Cognitive Functioning among Hispanic Older Adults with Sensory Impairments

OBJECTIVES

Understanding the intersection of age, ethnicity, and disability will become increasingly important as the global population ages and becomes more diverse. By 2060, Hispanics will comprise 28% of the U.S.

POPULATION

This study examines critical associations between sensory impairment, social isolation, and cognitive functioning among Hispanic older adults.

METHODS

Our sample consisted of 557 Hispanic older adults that participated in Rounds 1-3 or Rounds 5-7 of the National Health and Aging Trends Study. Longitudinal mediation models across a three-year span were estimated using Mplus, with vision, hearing, and dual sensory impairments predicting cognitive functioning directly and indirectly through social isolation.

RESULTS

Findings indicated that cognitive functioning was concurrently and, in certain cases, longitudinally predicted by vision and dual sensory impairments and by social isolation. Contrary to expectations, vision and hearing impairments were not predictive of social isolation. Dual sensory impairment was associated with social isolation, yet no significant indirect associations were found for sensory impairments predicting cognitive functioning through social isolation.

DISCUSSION

The finding that social isolation did not mediate the relationship between sensory impairment and cognitive decline among Hispanic older adults in the U.S. is contrary to findings from other studies that were not specifically focused on this population. This finding may be evidence that culturally motivated family support and intergenerational living buffer the impact of sensory impairments in later life. Findings suggest that Hispanic older adults experiencing dual sensory impairments may benefit from interventions that foster social support and include family members.

Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review

In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.

Psychosocial and personality trait associates of phubbing and being phubbed in hispanic emerging adult college students

Phubbing is when one uses their smartphone in a social interaction instead of interacting with the other individual(s) in their presence. Phubbing and being phubbed are growing concerns as the number of smartphones and frequency of smartphone use increases. This study assessed the relationships between phubbing, being phubbed, psychosocial constructs, and socially adverse personality traits among Hispanic emerging adult college students. Hispanic college students (n = 452) completed a survey assessing: sociodemographics, phubbing, being phubbed, depression, anxiety, stress, Machiavellianism, narcissism, psychopathy, and need for drama (interpersonal manipulation, impulsive outspokenness, persistent perceived victimhood). Hispanic emerging adult college students reported low-to-moderate levels of phubbing and being phubbed. Regarding phubbing findings, nomophobia (fear of separation from one's phone), interpersonal conflict, and problem acknowledgement were positively associated with negative affect. Moreover, interpersonal conflict, self-isolation, and problem acknowledgement were positively associated with interpersonal manipulation. Regarding being phubbed findings, perceived norms, feeling ignored, and interpersonal conflict were positively associated with persistent perceived victimhood. Findings indicate that Hispanic college students may use their smartphones in social settings to alleviate negative affect. Moreover, a virtual environment on a smartphone may be easier to manipulate and can be used to continue garnering attention and portraying oneself as the victim, fulfilling one's need for drama. Regarding exploratory mediations, phubbing and being phubbed mediated the relationships between multiple socially adverse personality traits and negative affect. The clinical implications of these results are discussed. Prospective studies are warranted to determine temporality.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04767-y.

Examining Between-Group Differences in Social Network Density and High-Sensitivity C-Reactive Protein in Older Adults: Implications for the Hispanic Mortality Paradox

OBJECTIVE

Hispanic/Latino(x) and African American/Black older adults experience disproportionate cardiometabolic disease burdens when compared with their non-Hispanic White counterparts. Sources of resilience such as social networks have been found to mitigate the risk of this disease and its end points like high-sensitivity C-reactive protein (hs-CRP). However, little is known about the social network infrastructure among these groups. Moreover, existing work has largely ignored the degree to which members of one's network are connected to one another (network density), which may be important for navigating structural barriers within interdependent groups. The objective of this study was to understand the association between network density and 5-year hs-CRP (blood spot) and whether this association was moderated by race-ethnicity.

METHODS

A subsample of Hispanic/Latino(x), African American/Black, and non-Hispanic White older adults ( N = 1431) from the National Social Life Health and Aging Project was used. Multivariable regression was used to estimate the association between network density and its interaction with race-ethnicity, with hs-CRP 5 years later.

RESULTS

Although no main effect of network density on 5-year hs-CRP was found, results revealed a significant network density by race-ethnicity interaction (Wald χ2 (2, 1242) = 3.31, p = .037). Simple slopes analyses revealed that Hispanic/Latino(x) older adults with high network density had significantly lower hs-CRP levels when compared with their same-ethnic counterparts with low network density ( b = -0.73, standard error = 0.31, 95% confidence interval = -1.33 to -0.13, p = .018).

CONCLUSIONS

Results demonstrate population-level differences in social network structure and differential associations of this infrastructure with health. Implications for the Hispanic Mortality Paradox are discussed.

Acculturation in Context and Brain Health in Older Latino Adults: A Diffusion Tensor Imaging Study

BACKGROUND

Latinos are at higher risk of developing mild cognitive impairment (MCI) and Alzheimer's disease than non-Latino Whites. Acculturation factors may influence this risk, yet there are few studies that have examined associations of acculturation, particularly in the context of socioenvironmental and familial factors, and brain health in older Latinos.

OBJECTIVE

To examine potential associations between acculturation in context and brain health in older Latinos.

METHODS

Using three previously established composites of acculturation-in-context, (acculturation-related: nativity status, language preference, acculturation scores; contextually-related socioenvironmental: perceived discrimination, loneliness/social isolation, social network size; and familism), and diffusion-tensor imaging (DTI), associations with white matter structural integrity were examined in 92 Latino adults without dementia participating in one of three epidemiological studies of aging. Linear regression models were used to test associations with DTI-derived metrics (fractional anisotropy, FA; trace) as separate outcomes and acculturation composite scores as individual predictors, while adjusting for age, sex, education, scanner, and white matter hyperintensities (voxelwise and total volumes normalized by intracranial volume).

RESULTS

Higher scores on the socioenvironmental composite were associated with lower FA in two clusters of left-hemisphere connections. Cluster 1 was dominated by both short association pathways connecting frontal regions and projection pathways connecting frontal regions with the thalamus. Cluster 2 was dominated by long association pathways connecting parietal, frontal, and temporal regions.

CONCLUSIONS

This study of older Latino adults demonstrated an association between reduced brain white matter integrity and contextually related socioenvironmental experiences known to increase risk of MCI and Alzheimer's disease.