The Immigrant and Hispanic Paradoxes: A Systematic Review of Their Predictions and Effects

The Hispanic paradox in child maltreatment: Does it fade over time?

BACKGROUND

The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally.

OBJECTIVES

To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics.

DESIGN

Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…).

PARTICIPANTS AND SETTING

We included national child maltreatment data at the county level.

RESULTS

A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship.

CONCLUSION

Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults

INTRODUCTION

This study seeks to estimate health care expenditures and use associated with hypertension, focusing on differences among racial and ethnic groups.

METHODS

Data were from the 2019 Medical Expenditure Panel Survey, analyzed in 2023. The study sample included noninstitutionalized U.S. adults aged ≥18 years. Outcome variables were health care expenditures and events. Hypertension was determined by a self-reported diagnosis or diagnosis codes. Race and ethnicity were self-reported. A 2-part model was used to estimate expenditures associated with hypertension. A zero-inflated negative binomial model was used to estimate events associated with hypertension. Sampling designs were applied to generate nationally representative estimates.

RESULTS

Hypertension was associated with $2,759 (95% confidence interval [CI]: $2,039, $3,479) in health care expenditures and 10.3 (95% CI: 9.3, 11.3) health care events, including prescriptions filled, in 2019 per person. Compared with non-Hispanic White adults, hypertension-associated health care expenditures were significantly lower among Hispanic adults (difference: -$1,877; 95% CI: -$3,389, -$364) and Asian adults (difference: -$2,452; 95% CI: -$4,093, -$811), and hypertension-associated health care events were significantly lower among Hispanic adults (difference: -3.8; 95% CI: -6.1, -1.6) and non-Hispanic Asian adults (difference: -4.1; 95% CI: -6.9, -1.2). Differences between non-Hispanic White adults and non-Hispanic Black adults were not statistically significant in health care expenditures (difference: -$954; 95% CI: -$2,849, $941) and events (difference: 0.3; 95% CI: -2.1, 2.8).

CONCLUSIONS

This study reveals differences in health care expenditures and use associated with hypertension among racial and ethnic groups. Future studies are needed to examine potential drivers of these differences.

Health Care Access and Utilization and the Latino Health Paradox

BACKGROUND

The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization.

METHODS

The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year.

RESULTS

After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites.

CONCLUSIONS

In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Parent childhood experiences, parenting strategies, and youth health-related outcomes in Hispanic families with unhealthy weight: An intergenerational study

We aimed to examine whether (a) parents' childhood family mealtime experiences (CFM) (e.g., mealtime communication-based stress) and parents' socio-demographic characteristics (e.g., education level) predict parents' health-related parenting strategies (e.g., discipline), (b) health-related parenting strategies for eating and physical activity predict youth's health-related outcomes (e.g., dietary intake), (c) parenting strategies mediate the relationship between CFM and youth outcomes. A path model was used to examine the above-mentioned relationships. Data were obtained from the baseline assessment of a randomized clinical trial evaluating the efficacy of a family-based intervention to promote quality diet and increase physical activity. Participants were 280 Hispanic youth (52.1 % female, Mage = 13.01 ± 0.83) with unhealthy weight (MBody Mass Index %tile = 94.55 ± 4.15) and their parents (88.2 % female, Mage = 41.87 ± 6.49). Results indicated that childhood mealtime communication-based stress and mealtime structure were positively associated with control. Appearance weight control was positively associated with monitoring, discipline, limit-setting, and reinforcement. Parental mealtime control had positive associations with discipline, control, and limit-setting. Emphasis on mother's weight was positively associated with reinforcement. We also found positive associations between parental monitoring and youth's physical QOL and between parental discipline and fruits and vegetables intake. No mediating effect was found. Findings demonstrated significant effects of parents' childhood experience on parenting strategies, which in turn was associated with the youths' health-related outcomes. These results suggest the intergenerational effects of parent's childhood experience on their youth's health-related outcomes.

Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States

PURPOSE

Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals.

METHODS

Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC.

RESULTS

Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001).

CONCLUSION

Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.

Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations

Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65 years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.

National Prevalence of Diabetes and Barriers to Care Among U.S. Farmworkers and Association With Migrant Worker Status

OBJECTIVE

To quantify the prevalence of diabetes and barriers to care among U.S. migrant farmworkers (i.e., those who travel from their permanent residence for seasonal farmwork).

RESEARCH DESIGN AND METHODS

Age-adjusted prevalence of self-reported diabetes and barriers to care were calculated among adult U.S. farmworkers from 2008 to 2017 National Agricultural Workers Surveys.

RESULTS

Among 16,913 farmworkers, 30.7% reported one or more barriers to care, most often due to cost. Age-adjusted self-reported prevalence of diabetes was 13.51% (95% CI 10.0-17.1) among migrant farmworkers and 10.8% (95% CI 9.0-12.6) among nonmigrant farmworkers with access to health care. Migrant farmworkers without recent health care had 83% lower odds of reporting known diabetes (adjusted odds ratio 0.17; 95% CI 0.06-0.54) compared with nonmigrant farmworkers, likely because of poor health care access and/or a healthy worker effect.

CONCLUSIONS

Many migrant farmworkers face barriers to care, which may lead to significant underdiagnosis of diabetes in this vulnerable population.

Integrating human activity into food environments can better predict cardiometabolic diseases in the United States

The prevalence of cardiometabolic diseases in the United States is presumably linked to an obesogenic retail food environment that promotes unhealthy dietary habits. Past studies, however, have reported inconsistent findings about the relationship between the two. One underexplored area is how humans interact with food environments and how to integrate human activity into scalable measures. In this paper, we develop the retail food activity index (RFAI) at the census tract level by utilizing Global Positioning System tracking data covering over 94 million aggregated visit records to approximately 359,000 food retailers across the United States over two years. Here we show that the RFAI has significant associations with the prevalence of multiple cardiometabolic diseases. Our study indicates that the RFAI is a promising index with the potential for guiding the development of policies and health interventions aimed at curtailing the burden of cardiometabolic diseases, especially in communities characterized by obesogenic dietary behaviors.

Tobacco Use Patterns From Adolescence to Young Adulthood Among Latinx Youth From Rural Communities

PURPOSE

To examine patterns in adolescent and young adult tobacco use, comparing Latinx foreign-born children and children of foreign-born parents (i.e., children of immigrants(COI)) to Latinx US-born children of US-born parents (i.e., children of nonimmigrants,(CONI)) and to CONI White youth who grew up in small and rural towns.

METHODS

Data were from youth who lived in control communities that participated in a community-randomized trial of the Communities That Care prevention system. We compared Latinx CONI (n = 154) with Latinx COI (n = 316) and with non-Latinx White CONI (n = 918). We examined tobacco use in adolescence (any adolescent use, early onset, and chronic use) and young adulthood (any past-year tobacco use, any daily smoking, any nicotine dependence symptoms) with mixed-effects logistic regressions.

RESULTS

In adolescence, Latinx CONI had a higher prevalence of any and chronic tobacco use relative to Latinx COI, and of any and early onset tobacco use relative to non-Latinx White CONI. In young adulthood, Latinx CONI were more likely to report tobacco use in the past year, any symptoms of nicotine dependence, and daily smoking relative to Latinx COI; and more likely to report daily smoking relative to non-Latinx White CONI. Generation differences in young adult tobacco use were explained by chronic tobacco use in adolescence.

DISCUSSION

The study suggests targeting chronic tobacco use in adolescence to prevent disparities in tobacco outcomes among Latinx young adults from rural communities.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

The role of pharmaceutical side-effects in depression among immigrants

OBJECTIVES

This study explores the role of pharmaceuticals with depression or suicidality as a side-effect in explaining the immigrant depression paradox. Immigrants generally report less depression than their native-born peers, despite the socio environments that are less conducive to well-being. This immigrant advantage in mental health tends to recede with time in the US and more acculturation. To date, an explanation for this pattern has remained elusive, partly because acculturation is also associated with many desirable outcomes, suggesting less depression with more acculturation.

DESIGN

Data came from seven two-year waves (2005-2006 to 2017-2018) of the National Health and Nutrition Examination Survey (NHANES). Depression was measured using the Patient Health Questionnaire (PHQ-9). Linear and logistic regressions were used to estimate the immigrant differences in depression, while controlling for sociodemographic characteristics, healthcare access, health conditions, and the use of medications with depression or suicidality as a side-effect.

RESULTS

30.3% and 22.7% of US-born adults used at least one medication with depression or suicidality as a side-effect, compared to 16.4% and 9.2% of foreign-born adults. Access to healthcare improved with time in the US and with acculturation, and both of these factors were also positively associated with the use of medications with depression or suicidality as a side-effect. The magnitude of the mediation associated with medication side-effects was significant, in many cases sufficient to eliminate the relationship between acculturation - whether expressed in terms of time in the US, English-language use, or nativity - and depression.

CONCLUSION

Exposure to medications with depression or suicidality as a side-effect helped explain part of the relative mental health advantage of foreign-born residents, as well as the diminishing advantage associated with time in the US and with acculturation.

Social and Cultural Factors, Self-efficacy, and Health in Latino Cancer Caregivers

BACKGROUND

Latino cancer caregivers are at risk of physical, mental, and emotional health issues. Sociocultural factors such as informational support, Anglo orientation, and spiritual practice may compound or protect against these risks.

OBJECTIVE

The purpose of this research project was to examine self-efficacy as a mediator between sociocultural factors and health outcomes in Latino cancer caregivers.

METHODS

This is a secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions in Latina individuals with breast cancer and their caregivers. Caregivers (N = 233) completed items assessing self-efficacy, informational support, Anglo orientation, spiritual practice, depression, and global health. Caregiver data were analyzed using hierarchical linear regression and mediation analysis.

RESULTS

Spiritual well-being was not significantly associated with health outcomes or self-efficacy. In regression analysis, both informational support ( b = 0.32; 95% confidence interval [CI], 0.20 to 0.45; P < .001) and Anglo orientation ( b = 0.15; 95% CI, 0.11 to 2.48; P < .05) were significant predictors of global health, but informational support ( b = -0.43; 95% CI, -0.55 to -0.30; P < .001) was the only significant predictor of depression. There were indirect relationships through self-efficacy for symptom management for both informational support and Anglo orientation and health outcomes.

CONCLUSIONS

Informational support and Anglo orientation were significantly related to health outcomes directly and indirectly through self-efficacy in Latino cancer caregivers.

IMPLICATIONS FOR PRACTICE

Informational support through the health system and community, when provided with attention to culture and Spanish language translation, can increase Latino cancer caregivers' self-efficacy to care for themselves and improve health outcomes.

Household Social Needs, Emotional Functioning, and Stress in Low-Income Latinx Children and their Mothers

Latinx families may be particularly vulnerable to emotional dysfunction, due to higher rates of economic hardship and complex social influences in this population. Little is known about the impact of environmental stressors such as unmet social needs and maternal stress on the emotional health of Latinx children from low-income families. We conducted secondary analyses using survey and biomarker data from 432 Latinx children and mothers collected in a separate study. We used binomial and multinomial logistic regression to test if household social needs, or maternal perceived stress or hair cortisol concentration (HCC), predicted child measures of emotional functioning or child HCC, independent of relevant sociodemographic factors. Approximately 40% of children in the sample had symptoms consistent with emotional dysfunction, and over 37% of households reported five or more social needs. High perceived maternal stress predicted higher odds of child emotional dysfunction (OR = 2.15; 95% CI [1.14, 4.04]; p = 0.01), and high maternal HCC was positively associated with high child HCC (OR = 10.60; 95% CI [4.20, 26.74]; p < 0.01). Most individual household social needs, as well as the level of household social need, were not independently associated with child emotional dysfunction or child HCC. Our findings begin to define a framework for understanding emotional health, stress, and resilience when caring for Latinx children and mothers living with high levels of social need, and the need for integrated mental health and social needs screening and interventions in settings that serve this population.

Association between Feelings of Trust and Security with Subjective Health among Mexican Migrants in the New York City Area

The size of the foreign-born population living in the United States makes migrants' health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants' health.

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study

BACKGROUND

Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences.

METHOD

Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury.

RESULTS

Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables.

CONCLUSION

Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.

Examining the Independent Association Between Acculturative Stress and Psychological Distress Among Mexican Immigrants in New York City: An Exploratory Study

Objective

This study examines the association between acculturative stress and psychological distress among Mexican immigrants living in New York City. It takes account factors such as language barriers, legal status, fear of deportation, and avoidance of social health and human services, and how these factors are implicated in the mental health status of the study population.

Design

Study draws from a community-based sample of Mexican American adults from the Social Network of Mexican Americans study recruited from a church-based community center in the Bronx, New York. Eighty Mexican immigrants were included in this analysis. Descriptive statistics were used to display participants' characteristics. Pearson correlation and multiple regressions were run to determine the relationship between acculturative stress and psychological distress, and also with each of the items from the acculturative stress scale. Both scales have been validated among Spanish-speaking Latino immigrants.

Results

A significant moderate positive relationship was found between acculturative stress and psychological distress. Within the acculturative stress scale, those items related to language discrimination, evasion of health services, and feeling guilty for leaving family/friends in home country had significant associations with increased psychological distress.

Conclusion

The findings support the need for interventions that account for the major stressors associated with being a Mexican immigrant in the United States to prevent psychological distress, especially given the anti-immigration policies.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Social Needs and Acculturation as Predictors of Emotional Problems and Perceived Stress Among Latinx Mothers with Low Income

Associations between household social needs, acculturation, and emotional health remain understudied, particularly among Latinx mothers. We analyzed baseline survey data from 455 Latinx mothers in a previous study. Using multinomial regression, we examined whether emotional problems and perceived stress were associated with household social needs and acculturation. Almost half the sample reported four or more household social needs. Social needs cumulatively and independently predicted increased odds of frequent emotional problems or perceived stress. Lower acculturation predicted lower odds of frequent emotional problems. There is increased risk for emotional problems and stress in low-income Latinx mothers who experience high social need. Integrated social service and mental health care models may be one way to improve health outcomes. More research is needed to understand how clinical settings can leverage unique cultural protective factors to address the social and emotional health needs of Latinx mothers.

Obesity in Latinx and White U.S. military veterans: prevalence, physical health, and functioning

OBJECTIVE

While Latinx Americans in the general population are more likely to have obesity than non-Hispanic Whites, limited research has examined ethnic differences in obesity and its correlates among military veterans. To address this gap, we examined the prevalence, physical health and functional correlates of obesity in a population-based sample of Latinx and White U.S. military veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of veterans. Bivariate and multivariate analyses were conducted to evaluate the relation between obesity, and health and functioning measures in Latinx and White veterans.

RESULTS

The prevalence of obesity was significantly higher among Latinx veterans (weighted 43.6% vs. 35.5%; odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.10-1.81). While obesity was associated with a greater number of medical conditions, reduced functioning, higher somatic symptoms, and insomnia severity in both Latinx and White veterans, these differences were more pronounced in Latinx relative to White veterans, with higher rates of arthritis, liver disease, diabetes, high blood pressure and cholesterol, heart attack, stroke, migraine, and physical disability, and greater physical, mental, and psychosocial dysfunction.

CONCLUSION

Obesity is more prevalent in Latinx than in White U.S. veterans, and the associated elevated health and functional impairments are more pronounced in Latinx veterans. Characterization of co-occurring physical and functioning problems among Latinx and White veterans with obesity may help inform ethnically-sensitive obesity prevention and treatment efforts in this population.

How demographics and concerns about the Trump administration relate to prenatal mental health among Latina women

RATIONALE

The 2016 U.S. presidential election and its aftermath involved political rhetoric and policies that especially targeted women, Latinos, and immigrants. It is possible that concerns about the political environment could affect mental health of individuals in targeted groups.

OBJECTIVE

In a cohort of 148 pregnant Latina women, this study investigated how demographics and political concerns related to each other and to maternal anxiety, depression, and perceived stress, which have been associated with adverse birth and child development outcomes.

METHODS

In this cross-sectional, self-report study, participants in Southern California completed a one-time questionnaire from January 2017 to May 2018.

RESULTS

The highest rates of endorsement were for concerns regarding President Trump's racism, attitude towards women, and deportation risk for family or friends. From several demographic variables, the only significant predictor of state anxiety was expectant parents' birthplaces. From several political concerns variables, the only significant predictor of state anxiety was President Trump's attitude towards women or women's rights. There were no significant effects on other mental health outcomes.

CONCLUSIONS

Results suggest that birthplace and women's issues may be particularly salient anxiety risk factors for Latina pregnant women in this context. Because of the cross-sectional study design, it is possible that, conversely, pregnant women with high anxiety levels are particularly sensitive to the issue of birthplace or women's rights. Results imply that the political climate and events in the U.S. could have deleterious consequences that may cascade across generations of Latino Americans via effects on pregnant women.

A healthy migrant effect? Estimating health outcomes of the undocumented immigrant population in the United States using machine learning

This paper investigated whether the commonly observed immigrant health advantage persists among undocumented immigrants in the U.S. and provides nationally representative evidence on the health of this vulnerable population. Data were derived from pooled cross-sections of the National Health Interview Survey (NHIS, 2000-2018). The legal status of foreign-born NHIS respondents is imputed using a non-parametric machine learning model built based on information from the 2004, 2008 and 2014 cohorts of the Survey of Income and Program Participation (SIPP). Multivariate logistic regression analysis indicated that, despite exposure to numerous additional risk factors, the undocumented population experienced a more pronounced Healthy Migrant Effect, with lower odds of reporting fair or poor self-rated health, any physician-diagnosed chronic conditions or being obese. The observed patterns in undocumented health outcomes may be related to the additional challenges and exclusionary policies associated with undocumented migration that could in turn lead to a more pronounced selection of healthy and resilient individuals.

Adverse Pregnancy Outcomes and International Immigration Status: A Systematic Review and Meta-analysis

Background:

Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country.

Methods:

PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes’ prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I² statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source.

Findings:

This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0–1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0–1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2–1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1–0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0–1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0–3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7–0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5–0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6–0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7–0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7–0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin.

Conclusion:

The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.

Multimorbidity patterns across race/ethnicity as stratified by age and obesity

The objective of our study is to assess differences in prevalence of multimorbidity by race/ethnicity. We applied the FP-growth algorithm on middle-aged and elderly cohorts stratified by race/ethnicity, age, and obesity level. We used 2016–2017 data from the Cerner HealthFacts electronic health record data warehouse. We identified disease combinations that are shared by all races/ethnicities, those shared by some, and those that are unique to one group for each age/obesity level. Our findings demonstrate that even after stratifying by age and obesity, there are differences in multimorbidity prevalence across races/ethnicities. There are multimorbidity combinations distinct to some racial groups—many of which are understudied. Some multimorbidities are shared by some but not all races/ethnicities. African Americans presented with the most distinct multimorbidities at an earlier age. The identification of prevalent multimorbidity combinations amongst subpopulations provides information specific to their unique clinical needs.

Systems of Oppression: The Impact of Discrimination on Latinx Immigrant Adolescents' Well-Being and Development

With over 400 harmful immigration policy changes in the past 4 years, Latinx adolescents and families nationwide are developing within a context of extreme anti-immigrant sentiment (Dismantling and reconstructing the U.S. immigration system: A catalog of changes under the Trump presidency, Migration Policy Institute, 2020). This paper introduces the Multitiered Model of Oppression and Discrimination (MMOD), a conceptual model for understanding the impacts of multiple levels of discrimination on the well-being and development of Latinx immigrant adolescents. Interpersonal discrimination (Hispanic Journal of Behavioral Sciences, 2010, 32, 259), community-held stereotypes (Social Psychology of Education, 2001, 5, 201), institutional policies (Children and Youth Services Review, 2018, 87, 192), and structural practices (Journal of Criminal Justice, 2020, 66, 1) can negatively impact well-being and development among these adolescents. Culturally sustaining interventions, civic engagement and mobilization, and policies targeting inequitable policies and practices will provide healing and an avenue for liberation.

Moderating Influence of Social Support on the Relations between Discrimination and Health via Depression in Latinx Immigrants

The purpose of this study was to examine the relations among discrimination, depression, and health among a sample of diverse Latinx immigrants. A secondary aim was to examine whether direct and indirect effects among these variables were moderated by social support. A sample of 204 Latinx immigrants completed questionnaires in community centers, health clinics, and retail establishments. Depression was found to mediate the effect of discrimination on physical health. Social support was found to moderate this indirect effect, wherein higher levels of social support weakened the effect. Results from this study indicate that through depression, health can be impacted by minority stressors, and these relationships can be buffered by links to cultural strengths including social support.

Variation in Cancer Incidence Rates Among Non-Hispanic Black Individuals Disaggregated by Nativity and Birthplace, 2005-2017: A Population-Based Cancer Registry Analysis

Objectives

Compared to other racial and ethnic groups, little to no disaggregated cancer incidence data exist for subgroups of non-Hispanic Blacks (NHBs), despite heterogeneity in sociodemographic characteristics and cancer risk factors within this group. Our objective was to examine age-adjusted cancer incidence by nativity and birthplace among NHB cancer cases diagnosed in New Jersey.

Methods

Race, ethnicity, and birthplace data from the New Jersey State Cancer Registry were used to classify NHB cancer cases diagnosed between 2005-2017. Thirteen waves of population estimates (by county, nativity, gender, age-group) were derived from the American Community Survey using Integrated Public-Use Microdata to approximate yearly demographics. Age-adjusted cancer incidence rates (overall and by site) by birthplace were generated using SEER*Stat 8.3.8. Bivariate associations were assessed using chi-square and Fisher's exact tests. Trend analyses were performed using Joinpoint 4.7.

Results

Birthplace was available for 62.3% of the 71,019 NHB cancer cases. Immigrants represented 12.3%, with African-born, Haitian-born, Jamaican-born, 'other-Caribbean-born', and 'other-non-American-born' accounting for 18.5%, 17.7%, 16.5%, 10.6%, and 36.8%, respectively. Overall, age-adjusted cancer incidence rates were lower for NHB immigrants for all sites combined and for several of the top five cancers, relative to American-born NHBs. Age-adjusted cancer incidence was lower among immigrant than American-born males (271.6 vs. 406.8 per 100,000) and females (191.9 vs. 299.2 per 100,000). Age-adjusted cancer incidence was lower for Jamaican-born (114.6 per 100,000) and other-Caribbean-born females (128.8 per 100,000) than African-born (139.4 per 100,000) and Haitian-born females (149.9 per 100,000). No significant differences in age-adjusted cancer incidence were observed by birthplace among NHB males. Age-adjusted cancer incidence decreased for all sites combined from 2005-2017 among American-born males, immigrant males, and American-born females, while NHB immigrant female rates remained relatively stable.

Conclusions

There is variation in age-adjusted cancer incidence rates across NHB subgroups, highlighting the need for more complete birthplace information in population-based registries to facilitate generating disaggregated cancer surveillance statistics by birthplace. This study fills a knowledge gap of critical importance for understanding and ultimately addressing cancer inequities.

Comparative Methodologic and Practical Considerations for Life Expectancy as a Public Health Mortality Measure

INTRODUCTION

Life expectancy is a public health metric used to assess mortality. We describe life expectancy calculations for US counties and present methodologic considerations compared with years of potential life lost before age 75 (YPLL-75) and premature age-adjusted mortality (PAAM), 2 commonly used length-of-life metrics.

METHODS

We used death data from the National Center for Health Statistics for 2015-2017 and other health measures from the 2019 County Health Rankings & Roadmaps. We calculated life expectancy from birth at the county level using an abridged life table and the Chiang method of variance. Studentized residuals identified counties with discordant life expectancy and YPLL-75 or PAAM values. Correlations tested associations of life expectancy with key health measures (eg, smoking, child poverty, uninsured).

RESULTS

Among 3073 US counties, life expectancy ranged from 62.4 to 98.0 years, with a mean of 77.4 years. Life expectancy was strongly and negatively correlated with YPLL-75 (r = -0.91) and PAAM (r = -0.95) at the county level. Life expectancy was also associated with other key health metrics, such as smoking, employment, and education rates, where an improvement in the health factor indicated improvement in the respective length-of-life measure. Counties with discordant life expectancy and YPLL-75 or PAAM values had differing age structures.

PRACTICE IMPLICATIONS

Commonly used length-of-life metrics in population health settings are differentiated by methodological matters, such as computation complexity, data availability, and differential risk among age groups, especially among the very old or very young. The choice of metric should consider these factors, in addition to practical concerns, such as the communication needs of the audience.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population

A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.

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.

Cardiovascular Risk Factors and Cognitive Performance in Cognitively Normal Non-Hispanic Whites and Mexican Americans From the HABS-HD Cohort

Objectives: This study aimed to compare the impact of cardiovascular disease (CVD) and cardiovascular risk factors (CVRF) on cognition in non-Hispanic Whites (NHW) versus Mexicans Americans (MA). Methods: A cross sectional analysis was conducted on 663 NHW and 632 MA. Prevalence of specific CVRF were compared between both demographics. Cognition was tested with various neuropsychologic tests. Results: MA had a higher percentage of hypertension, abdominal circumference, diabetes, and current smoking while NHW had a higher prevalence of other CVD. However, specific CVRF impacted NHW neuropsychologic testing on cognition, executive function, and processing, while only memory was affected in MA. Discussion: MA have less access to healthcare services with a higher prevalence of specific CVRF, however previous research has cited a lower mortality compared to NHW, this is known as the Hispanic paradox effect. The Mexican American ethnicity may be a protective factor in cognition creating increased neuropsychologic resilience from CVRF.

Seasonal affective disorder and engagement in physical activities among adults in Alaska

Seasonal affective disorder (SAD) is a type of depression in which symptoms occur during a particular season. While physical activity has been shown to improve symptoms for depression in general populations, the relationships between physical activity and experiences of seasonality and SAD remain underexplored. We conducted a survey with adult members of a recreational gym in Fairbanks, Alaska. The survey collected self-report data on sociodemographics, health behaviours, and elements of the Seasonal Pattern Assessment Questionnaire (SPAQ). Results indicate that 18.68% of our study participants meet the criteria for winter-pattern SAD and 43.96% meet the criteria for subsyndromal SAD ("winter blues"). We conducted two regressions to understand experiences of SAD and predictors of seasonality more generally. Gender was a significant predictor of SAD, with women more likely than men to experience SAD (p = .04). Being social at the gym, whether going to the gym with others or participating in activities with others, was associated with higher seasonality than being independent at the gym (p = .03). Younger age was also associated with higher seasonality (p < .001). This study contributes new insights about the relationship between engagement in physical activities and experiences of seasonality among adults in a northern latitude.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

Typologies of Sexual Health Vulnerability Predicting STI Preventive Behaviors Among Latinx Adults in the U.S.: A Latent Class Analysis Approach

Vulnerability to poor sexual health among U.S. Latinx populations is poorly understood, despite high STI rates. We examined how vulnerability typologies differ in their STI preventive behaviors. Using data from the 2016 National Health Interview Survey, we performed latent class analysis to test the association between sexual health vulnerability and HIV testing, hepatitis testing or vaccination, and HPV vaccination from a subsample of Latinx adults. Three classes emerged: Under-Employed Females with Health Care Access, Slightly Under-Employed Females with Some Health Care Access, and Employed Males without Health Care Access. Slightly Under-Employed Females with Some Health Care Access were associated with lack of HIV testing, hepatitis B and C testing, and HPV vaccination. Employed Males without Health Care Access were associated with lack of HIV testing and HPV vaccination. Sexual health vulnerability may be associated with certain STI preventive behaviors, which can inform and refine sexual health promotion programming.

A Metabolomic Analysis of the Sex-Dependent Hispanic Paradox

In Mexican Americans, metabolic conditions, such as obesity and type 2 diabetes (T2DM), are not necessarily associated with an increase in mortality; this is the so-called Hispanic paradox. In this cross-sectional analysis, we used a metabolomic analysis to look at the mechanisms behind the Hispanic paradox. To do this, we examined dietary intake and body mass index (BMI; kg/m²) in men and women and their effects on serum metabolomic fingerprints in 70 Mexican Americans (26 men, 44 women). Although having different BMI values, the participants had many similar anthropometric and biochemical parameters, such as systolic and diastolic blood pressure, total cholesterol, and LDL cholesterol, which supported the paradox in these subjects. Plasma metabolomic phenotypes were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS). A two-way ANOVA assessing sex, BMI, and the metabolome revealed 23 significant metabolites, such as 2-pyrrolidinone (p = 0.007), TMAO (p = 0.014), 2-aminoadipic acid (p = 0.019), and kynurenine (p = 0.032). Pathway and enrichment analyses discovered several significant metabolic pathways between men and women, including lysine degradation, tyrosine metabolism, and branch-chained amino acid (BCAA) degradation and biosynthesis. A log-transformed OPLS-DA model was employed and demonstrated a difference due to BMI in the metabolomes of both sexes. When stratified for caloric intake (<2200 kcal/d vs. >2200 kcal/d), a separate OPLS-DA model showed clear separation in men, while females remained relatively unchanged. After accounting for caloric intake and BMI status, the female metabolome showed substantial resistance to alteration. Therefore, we provide a better understanding of the Mexican-American metabolome, which may help demonstrate how this population—particularly women—possesses a longer life expectancy despite several comorbidities, and reveal the underlying mechanisms of the Hispanic paradox.

Social support and healthcare utilization of caregivers of Latinas with breast cancer

BACKGROUND

Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer.

PURPOSE

The purpose of this study was to examine the moderating effect of gender and social support on the relationship between chronic illnesses and healthcare utilization in caregivers of Latina breast cancer survivors.

METHODS

This was a secondary analysis of family caregivers from an experimental study with breast cancer survivors and their designated family caregivers. Participants completed telephone surveys about demographics, presence of chronic illnesses, frequency of emergency department, urgent care, and hospital visits, social support, and acculturation. Data were analyzed for direct and moderated relationships.

RESULTS

There was a significant relationship between number of chronic illnesses and healthcare utilization, informational support, and social isolation. Income and acculturation were not related to chronic illnesses or healthcare utilization. Gender did not moderate the relationship between chronic illnesses and healthcare utilization. Informational support was a marginal moderator of the relationship between chronic illnesses and healthcare utilization alone and with acculturation and income included as covariates.

CONCLUSIONS

Clinicians should consider the influence of informational support and social isolation on chronic illnesses and healthcare use in caregivers of Latina breast cancer survivors, specifically, how these factors may influence navigation of the healthcare system.

Recent immigration actions and news and the adjustment of U.S. Latino/a adolescents

OBJECTIVES

This research describes how family immigrant statuses are related to Latino/a adolescents' responses to recent immigration actions and news and, in turn, adolescent adjustment.

METHOD

Study 1 included a school-based sample of 11- to 15-year-olds in suburban Atlanta, Georgia (N = 547); Study 2 included a convenience sample of 15- to 18-year-olds in the Washington, DC area (N = 340). Family immigrant status was defined by adolescents' immigrant generation status in Study 1 and by parent residency status in Study 2. In both studies, a 14-item measure assessed responses to recent immigration actions and news, including psychological worries and behavioral withdrawal. Dependent variables included internalizing and externalizing symptoms, suicidal ideation, e-cigarette use, and alcohol use (Study 1), and alcohol use and depressive symptoms (Study 2).

RESULTS

Psychological worry and behavioral withdrawal responses to immigration actions and news were significantly greater among adolescents with foreign-born, compared to U.S.-born, parents (Study 1), and among adolescents with undocumented, Temporary Protected Status (TPS), or permanent resident parents, as compared to citizen parents (Study 2). Results from tests of indirect effects indicated that these worries and behavioral withdrawal responses were, in turn, associated with higher levels of adolescent internalizing and externalizing symptoms, a higher odds of substance use and suicidal ideation (Study 1), and higher levels of adolescent depressive symptoms (Study 2).

CONCLUSIONS

As 1-quarter of the U.S. child population is Latino/a, there is a need to address immigration threats jeopardizing the adjustment of Latino/a teenagers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Life Expectancy At The US-Mexico Border: Evidence Of Disparities By Place, Race, And Ethnicity

The mortality experience for the cluster of US counties in the US-Mexico border region has not been well described. We calculated 2016-18 life expectancy for the border region (counties within 100 kilometers of the border), making key comparisons to the US overall and to nonborder counties in border states. Life expectancy from birth for the border region was 81.1 years, which was greater than for the US and for the nonborder counties of border states. However, the disparity in life expectancy between racial/ethnic subgroups in the border region was also greater, within a range of more than thirteen years. Although White, Black, and Asian residents of the border region could expect to live significantly longer than residents of the US and nonborder counties of border states, Hispanic and American Indian residents could not. Understanding the mortality experience via life expectancy can help public health professionals and leaders prioritize efforts to ensure that all border residents have an equal opportunity to live a long, healthy life.

Distancing the socially distanced: Racial/ethnic composition's association with physical distancing in response to COVID-19 in the U.S

Social distancing prescribed by policy makers in response to COVID-19 raises important questions as to how effectively people of color can distance. Due to inequalities from residential segregation, Hispanic and Black populations have challenges in meeting health expectations. However, segregated neighborhoods also support the formation of social bonds that relate to healthy behaviors. We evaluate the question of non-White distancing using social mobility data from Google on three sites: workplaces, grocery stores, and recreational locations. Employing hierarchical linear modeling and geographically weighted regression, we find the relation of race/ethnicity to COVID-19 distancing is varied across the United States. The HLM models show that compared to Black populations, Hispanic populations overall more effectively distance from recreation sites and grocery stores: each point increase in percent Hispanic was related to residents being 0.092 percent less likely (p< 0.05) to visit recreational sites and 0.127 percent less likely (p< 0.01) to visit grocery stores since the onset of COVID-19. However, the GWR models show there are places where the percent Black is locally related to recreation distancing while percent Hispanic is not. Further, these models show the association of percent Black to recreation and grocery distancing can be locally as strong as 1.057 percent (p< 0.05) and 0.989 percent (p< 0.05), respectively. Next, the HLM models identified that Black/White residential isolation was related to less distancing, with each point of isolation residents were 11.476 percent more likely (p< 0.01) to go to recreational sites and 7.493 percent more likely (p< 0.05) to visit grocery stores compared to before COVID-19. These models did not find a measurable advantage/disadvantage for Black populations in these places compared to White populations. COVID-19 policy should not assume disadvantage in achieving social distancing accrue equally to different racial/ethnic minorities.

Revisiting the Immigrant Epidemiological Paradox: Findings from the American Panel of Life 2019

Objective: Immigrants enjoy a health advantage over their US-born counterparts (termed the immigrant paradox), though the extent of this paradox may not extend to all health outcomes. Methods: We analyzed data from the RAND American Life Panel. Using multivariable logistic regression, we examined the associations between immigrant status and a wide range of health outcomes (e.g., cardiovascular diseases, mental health), adjusting for sociodemographic characteristics. Results: Being an immigrant was associated with lower odds of having any health condition, multimorbidity, and number of health conditions. When looking at specific conditions, however, immigrant status was only significantly associated with lower odds of depression, nerve problem causing numbness or pain, and obesity, but not other conditions. Conclusion: The immigrant paradox is evident when examining overall health, and specifically depression, nerve problems, and obesity.

Disparities in chronic kidney disease-the state of the evidence

PURPOSE OF REVIEW

The purpose of this review was to assess the prevalence of United States chronic kidney disease (CKD) health disparities, focusing on racial/ethnic groups, immigrants and refugees, sex or gender, and older adults.

RECENT FINDINGS

There are major racial/ethnic disparities in CKD, with possible contributions from the social determinants of health, socioeconomics, and racial discrimination. Racial/ethnic minority patients experience faster progression to end-stage kidney disease (ESKD) and higher mortality predialysis, however, once on dialysis, appear to live longer. Similarly, men are quicker to progress to ESKD than women, with potential biological, behavioral, and measurement error factors. There is a lack of substantial evidence for intersex, nonbinary, or transgender patients. There are also strikingly few studies about US immigrants or older adults with CKD despite the fact that they are at high risk for CKD due to a variety of factors.

SUMMARY

As providers and scientists, we must combat both conscious and unconscious biases, advocate for minority patient populations, and be inclusive and diverse in our treatment regimens and provision of care. We need to acknowledge that sufficient evidence exists to change treatment guidelines, and that more is required to support the diversity of our patient population.

Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data

Simple Summary

This study assessed renal cell carcinoma disparities in American Indians/Alaska Natives and Hispanic Americans using the National Cancer Database and the Arizona Cancer Registry, focusing on advanced-stage and mortality. Renal cell carcinoma disparities in American Indians/Alaska Natives have been partially explained by neighborhood socioeconomic factors and residence (rural or urban) pattern, but not in Hispanic Americans. Greater health disparities in renal cell carcinoma stage and mortality for Hispanic Americans and renal cell carcinoma mortality for American Indians/Alaska Natives were observed at the Arizona state level compared to national levels.

Abstract

Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.

Immigration Status, Ethnicity, and Long-term Outcomes Following Ischemic Stroke

OBJECTIVE

To assess the association between immigration status and ethnicity and the outcomes of mortality and vascular event recurrence following ischemic stroke in Ontario, Canada.

METHODS

We conducted a retrospective cohort study using linked administrative and clinical registry-based data from 2002 to 2018 and compared hazards of all-cause mortality and vascular event recurrence in immigrants and long-term residents using inverse probability of treatment weighting accounting for age, sex, income, and comorbidities. We stratified analyses by age (≤75 and >75 years) and used interaction terms to evaluate whether the association between immigration status and outcomes varied with age or ethnicity.

RESULTS

We followed 31,918 adult patients, of whom 2,740 (8.6%) were immigrants, for a median follow-up of 5 years. Immigrants had lower mortality than long-term residents (46.1% vs 64.5%), which was attenuated after adjustment (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.88-1.00), but persisted in those younger than 75 years (HR 0.82; 0.74-0.91). Compared to their respective ethnic long-term resident counterparts, the adjusted hazard of death was higher in South Asian immigrants, similar in Chinese immigrants, and lower in other immigrants (p value for interaction = 0.003). The adjusted hazard of vascular event recurrence (HR 1.01; 0.92-1.11) was similar in immigrants and long-term residents, and this observation persisted across all age and ethnic groups.

CONCLUSIONS

Long-term mortality following ischemic stroke is lower in immigrants than in long-term residents, but is similar after adjustment for baseline characteristics, and it is modified by age at the time of stroke and by ethnicity.

Asian, Latinx, or Multiracial? Assessing Filipinxs' Health Conditions and Outcomes by Aggregate Ethnic Category

INTRODUCTION

Filipinxs are the second-largest Asian subgroup in the USA. While Filipinxs are most often considered Asian when constructing aggregate ethnic categories, recent research has identified a trend of a small portion of Filipinxs identifying as Latinx or multiracial. However, little research had addressed how identification with different aggregate ethnic categories may have implications for identifying health disparities among Filipinxs and how these compare to non-Hispanic whites.

METHODS

Bivariate and multivariable regression analyses using 2011-2018 California Health Interview Survey data, comparing Asian Filipinxs, Latinx Filipinxs, and multiracial Filipinxs.

RESULTS

In bivariate analyses, Asian Filipinxs had a higher prevalence of diabetes than Latinx or multiracial Filipinxs. After controlling for sociodemographics, Latinx Filipinxs had significantly lower odds of having diabetes or heart disease than Asian Filipinxs. Compared to non-Latinx Whites, Asian Filipinxs reported higher odds of being in fair/poor health, obese or overweight, high blood pressure, and diabetes, multiracial Filipinxs reported higher odds of being obese or overweight, and Latinx Filipinxs reported lower odds of heart disease.

DISCUSSION

These findings suggest emerging differences in health linked to identification with different ethnic categories, underscoring the need to investigate nuances among Filipinxs in future research as well as highlighting the utility of emerging sociological insights in health research.

Stringent immigration enforcement and the mental health and health-risk behaviors of Hispanic adolescent students in Arizona

This study investigates the impact of the enforcement of SB 1070, a stringent immigration law, on the mental health, health-risk behaviors, and academic performance of Hispanic adolescent residents in Arizona. Using the difference-in-differences method, this study finds that SB 1070 increases their probability of feeling sad and decreases their physical activeness. The impact of SB 1070 on sad feelings and level of physical activity could have serious repercussions while it lasts. In addition, obese male Hispanic adolescents are more likely than their female or non-obese counterparts to develop mental health problems and engage in health-risk behaviors attributable to the stringent immigration policy. This study's empirical evidence on adverse mental health repercussions for Hispanic adolescents of state-level immigration enforcement suggests the need to be careful in formulating and implementing immigration policies.