Help Wanted: Mental Health and Social Stressors Among Latino Day Laborers

Determining the role of acculturative stress in predicting mental health service use among Latinx immigrants

OBJECTIVES

Acculturative stress is an important factor that affects health for Latinx immigrants in the US, with multiple studies identifying a link between depression and acculturative stress in this population. However, far fewer studies have examined the specific role and relationship of acculturative stress on mental health service use in this population. Through the lens of Yang's 2016 Model of Immigrant Health Service Use, this study aimed to examine the role of acculturative stress in predicting mental health service use in a sample of Latinx immigrants in the Southeast US.

DESIGN

We conducted a secondary data analysis from a longitudinal study of Latinx immigrant health (n = 391).

RESULTS

Our study found that while total acculturative stress was not significantly associated with mental health service use in this sample, parenting stress was a significant predictor of mental health service use in the past six months when controlling for covariates (OR: 1.043, 95% CI [1.009, 1.078]). Additionally, important Predisposing and Need for Healthcare factors were significantly associated with mental health service use, specifically: males were less likely to utilize mental health services than females (OR: 0.401, 95% CI [0.166-0.968]), English language acculturation was positively associated with mental health service use (OR: 1.953, 95% CI [1.130, 3.377]), and depression was positively associated with mental health service use (OR: 1.107, 95% CI [1.027, 1.194]).

CONCLUSION

These findings support the need for more culturally sensitive mental health services, and the need to develop strategies to engage males and less acculturated individuals in mental health services to promote health equity among Latinx immigrants.

Dignity of Work and at Work: The Relationship between Workplace Dignity and Health among Latino Immigrants during the COVID-19 Pandemic

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants' experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26-49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity-through job loss, underemployment, and poor working conditions-is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

Hazard and Injury Experiences of Latino Day Laborers in Houston, Texas

Latino day laborers in the United States provide skilled labor to businesses and homeowners through informal work arrangements. We conducted exploratory qualitative research with Latino day laborers in Houston, Texas, to investigate their perceptions of safety risks and circumstances related to work-related injuries. We conducted focus groups with 34 participants and used risk mapping and body mapping activities to elicit greater engagement by the Latino day laborers in the conversations. Participants described physical, occupational, and psychosocial hazards that affected their risk for workplace injuries. They indicated a significant risk for injury was employers failing to provide proper tools or equipment for the job being done. The themes that emerged from the analysis were lack of control over employment conditions and the risk of performing unsafe work in order to meet financial needs. This formative qualitative research informed a pilot test and subsequent clinical trial of injury risk reduction strategies for Latino day laborers. Interventions to protect day laborers from work-related injuries should be informed by recognizing the employment and social dilemmas they confront.

Race matters in addressing homelessness: A scoping review and call for critical research

Structural racism contributes to homelessness in the United States, as evidenced by the stark racial disparities in who experiences it. This paper reviews research at the intersections of race and homelessness to advance efforts to understand and address racial inequities. Part 1 offers a synthesis of homelessness research from the 1980s to 2015, where several scholars examined the role of race and racism despite mainstream efforts to present the issue as race-neutral. Part 2 presents the results of a systematic scoping review of research at the intersections of race and homelessness from 2016 to 2021. The 90 articles included demonstrate a growing, multidisciplinary body of literature that documents how needs and trajectories of people experiencing homelessness differ by race, examines how the racialized structuring of society contributes to homelessness risk, and explores how programs, policies, and grassroots action can address inequities. In addition to charting findings and implications, included studies are appraised against research principles developed by Critical Race Theory scholars, mapping the potential of existing research on race and homelessness to challenge racism.

Development and refinement of a corner-based injury prevention programme for Latino day labourers

Objective

Latino day labourers (LDLs) in the USA are at increased risk for non-fatal and fatal occupational injuries, which are compounded by stressors that include wage theft, job insecurity and discrimination. This paper describes the development and refinement of Vales+Tú (You are Worthy of More), an injury prevention programme currently being evaluated as part of a cluster randomised trial in which health promotion is taken directly to the 'corners' (e.g. street corners, home improvement store parking lots, and public parks) where workers gather to seek employment.

Design

Vales+Tú comprises two corner-based intervention approaches, group problem-solving (small group discussions) and brief motivational interviewing (one-on-one dialogue), that aim to activate LDL agency to control their safety and that of their peers.

Setting

Corners in Houston, Texas, where LDLs seek employment.

Method

Intervention Mapping informed the refinement of Vales+Tú for the current trial. We provide a narrative review of the development process based on needs assessment and formative development activities (surveys, focus group discussions and pilot tests).

Results

In addition to documenting the need for LDL injury prevention, with 20.2%-41.6% of Houston-based LDLs surveyed between 2013-2014 and 2019 reporting a severe work-related injury in the past year, we describe key facets of the Vales+Tú corner-based intervention approaches - including their theoretical basis and LDL-centred activities, as well as enhancements made informed by formative evaluation.

Conclusion

The community-engaged development process of Vales+Tú resulted in two practical intervention approaches that can be adopted by worker centres and other organisations to promote LDL worker safety.

Perceived Discrimination and Injury at Work: A Cross-Sectional Study Among Latino Day Laborers

BACKGROUND

Given the stigma of their undocumented status and their high prevalence of workplace injury, understanding the impact of discrimination on Latino day laborers (LDLs) is a critical public health issue.

METHODS

We surveyed LDLs (N = 149) and assessed their sociodemographics, experiences of and perceived reasons for discrimination, and work-related injury. A logistic regression examined the association between discrimination and injury, adjusting for sociodemographics. Next, Chi-square tests identified perceived reasons for discrimination associated with injury which were then included in a second logistic regression to test their association with injury, adjusting for discrimination and sociodemographics.

RESULTS

Participants reported a work-related injury (42%) and experiences of discrimination (81%). Discrimination was associated with injury in the first model (aOR = 2.25, p = 0.049), and discrimination attributed to immigration status was associated with injury in the second model (aOR = 5.04, p = 0.019).

DISCUSSION

Injury prevention programs should account for perceived mistreatment to reduce LDL risk for injury at work.

Help-Seeking Patterns and Barriers to Care Among Latino Immigrant Men with Unhealthy Alcohol Use

Latino immigrant men have high rates of unhealthy alcohol use, a wide range of behaviors, from drinking above the recommended limits to severe alcohol use disorder, yet have low levels of treatment-seeking. Little is known about their preferred sources of care and barriers to care. Using survey data from a community-based sample of Latino immigrant men (N=121) with unhealthy alcohol use (AUDIT≥6), we described help-seeking patterns and perceived barriers to care. The mean AUDIT score was 20 (SD 10; range 6-40), and 49% of men had severe levels of unhealthy alcohol use (AUDIT score ≥ 20). We observed low help-seeking rates and high levels of perceived internal and external barriers. Thirty percent reported having sought help for drinking. Most men reported wanting to solve their drinking problem on their own (65%). Our findings were consistent with previous research. Future studies should further describe barriers to treatment among low-income Latino immigrant men with unhealthy alcohol use and identify ways to increase access to low-cost, high-quality treatment options.

Discrimination, acculturative stress, alcohol use and their associations with alcohol-related consequences among Latino immigrant men

Latino immigrant men are at increased risk for unhealthy alcohol use and related consequences due to social stressors associated with immigration. We assessed the associations of, and examined whether social stressors moderated associations between, alcohol use and alcohol-related consequences in a community-based sample of Latino immigrant men in Washington (N = 187). The mean Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress. Linear regression models were fit to assess main effects (associations between both alcohol use and social stressors and alcohol-related consequences) and moderation (whether the association between alcohol use and consequences varied based on experience of social stressors using multiplicative interaction) after adjustment for potential confounders. Alcohol use (β = 0.47, 95% CI = 0.20-0.73; p = .001), discrimination (β = 0.85, 95% CI = 0.27-1.43; p = .004), and acculturative stress (β = 0.13, 95% CI = 0.02-0.24; p = .025) were all associated with increased experience of alcohol-related consequences. The association between alcohol use and alcohol-related consequences was stronger for those with high levels of acculturative stress (p = .025) but not experience of discrimination (p = .587). Findings underscore the importance of social and cultural context in alcohol use and related consequences. Efforts to reduce negative consequences of drinking may include focus on reducing exposure to discrimination and acculturative stress.

Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers

PURPOSE

Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers.

FINDINGS

The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity.

SUMMARY

Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.

Community health workers promote perceived social support among Latino men: Respaldo

Promotores or community health workers are trusted community members who offer information and support to marginalized groups in society. Latinx immigrants in new growth communities or emerging communities (areas with a small yet growing Latinx population) confront many challenges in their settling processes. De la Mano con la Salud was a community-based participatory project that trained Latino immigrant men as promotores. Promotores recruited 182 Latino immigrant men helped them to attain their own goals, connected them with health and social services and connected them to the larger community. We present data from 23 in-depth interviews with project participants conducted after six months of enrollment. Qualitative analysis confirmed participants’ vulnerabilities and showed that promotores addressed many of the health, legal, and occupational needs of participants. Emerging themes showed that 1) participants had a thirst for a united Latinx community; and 2) felt that promotores had their back (respaldo). The need for community may reflect the current invisibility of this Latinx population, as well as the desires for recognition and ethnic identity affirmation. Respaldo strongly resembles perceived social support, which is the kind of support most associated with health outcomes. Future research can determine what intervention components best foster respaldo.

Examining intentions to engage in sun protective behaviors among Latino day laborers: An application of the theory of planned behavior

Background: The past two decades has revealed an unprecedented increasing incidence of skin cancer within the Latinx population. Although Latino day laborers (LDLs) are at heightened risk for developing skin cancer because of the outdoor work in which they engage, there is limited research examining their intentions to engage in sun protective behaviors (SPBs). Therefore, this study sought to assess the explanatory power of the theory of planned behavior (TPB) to identify attitudinal, subjective norms, and perceived behavioral control factors associated with intentions to engage in SPB among LDLs.

Methods: This cross-sectional retrospective study consists of a non-random convenience,community-based, sample of 137 LDLs residing in Mississippi and Illinois. Data were collected using a self-report survey centered on health practices and sun-protective behaviors.

Results: Findings revealed that five significant factors shaped intentions to engage in SPBs, including barriers to engaging in SPBs (β =.30, P<0.001), benefits of engaging in SPBs (β =.27,P<0.001), education (β=0.20, P<0.01), and acculturation (β=0.18, P≤0.05). The independent variables tested in the model accounted for 42% of the change in intentions to engage in SPBs.

Conclusion: This study demonstrates TPB’s usefulness for predicting future intentions to engage in SPBs among LDLs. Moreover, the strongest factor associated with predicting intentions to engage in SPBs among LDLs was perceived behavioral control. Thus, since SPBs are malleable, emphasis is placed on implementing interventions for this population that promote intentions and address perceived behavioral control.

Acculturative Stress and the Effects on Health and Health Behaviors in Hispanic Immigrants: A Systematic Review

The purpose of this systematic review was to investigate previously published literature that examined the impact of acculturative stress on health in Spanish-speaking populations. The database search yielded a final count of 32 eligible articles for inclusion in this review. Age, acculturative stress measure, and study results were analyzed. Overall, 81.2% of studies investigated the impacts of acculturative stress on mental health with the majority concluding that increased acculturative stress had a significant relationship with greater mental health issues, such as depression, anxiety, and psychological stress. Other studies in this review examined impacts on physical health and health behaviors, but yielded inconclusive results indicating that these are areas for future research.

Immigration Policy Vulnerability Linked to Adverse Mental Health Among Latino Day Laborers

Latino day laborers in the United States are socially and economically vulnerable due to exclusionary immigration policies. Using data from a multi-mode survey, we examine the relationship between immigration policy legal vulnerability and mental health outcomes among 138 Latino, male day laborers (mean age = 45.65, SD = 12.05). Multivariable linear and logistic regression models separately estimated the effect of legal vulnerability, as measured by the Perceived Immigration Policy Effects Scale, on anxiety and depression symptoms and a positive depression and anxiety screening, respectively. Approximately 26.1% and 27.9% of day laborers reported depression and anxiety symptoms, respectively. In each adjusted model, we find a positive relationship between legal vulnerability and adverse mental health. Immigration policy legal vulnerability is associated with more depression and anxiety symptoms among Latino day laborers. Policies to reduce legal vulnerability, such as pathways to citizenship and employment authorization, may support Latino day laborers' mental health outcomes.

"The solitude absorbs and it oppresses": 'Illegality' and its implications on Latino immigrant day laborers' social isolation, loneliness and health

Despite a well-documented relationship between social isolation and health among men, this link has been understudied among marginalized populations such as undocumented immigrant men whose structural social exclusion may impede the cultivation and maintenance of social connections in the United States. This may be particularly so in new immigrant settlement cities that may lack an established Latina/o community or the social infrastructure often needed to ease the process of social integration. Studies that have examined social disconnectedness, social isolation, and/or loneliness have largely focused on individual level factors (i.e., older age) that may precipitate or contextualize experiences of social isolation, social support and social networks. Missing from such conceptualizations is a consideration of the role of structural factors, such as "illegality" among undocumented immigrant men, on experiences of social disconnection, social exclusion, social isolation and loneliness and resultant adverse health behaviors. This study, through in-depth qualitative participant narratives, explores the social condition of one group of "illegal" immigrant men, Latino immigrant day laborers (LIDL), and their experiences of social exclusion, social isolation, loneliness and health in the new immigrant settlement city of Baltimore. Using an ethnographic methodological approach, eight focus groups (N = 37) were conducted with participants recruited from two day labor sites from 2016 to 2019. Thematic analysis revealed a structural process of social exclusion and disconnection that exposed LIDLs to experiences of racism, structural vulnerability, and dehumanization which in turn may have heightened social isolation and loneliness and patterned substance use and sexual risk taking. Findings further emphasize the potential conceptual significance of structurally induced social disconnection, as distinct from lack of social support, in the study of LIDLs' social isolation, loneliness and health.

The Prevalence of Generalised Anxiety Disorder Among Prisoners of the Penitentiary Institution in North-Eastern Poland

Introduction: Generalised anxiety disorder (GAD) is one of the most common mental disorders. The psychosocial factors that may lead to generalised anxiety disorders include stress, traumatic events, conscious and unconscious internal conflicts, and low social and economic status. Imprisonment and forced isolation may favour the development of depression or anxiety disorders in inmates. Thus, this study aimed to analyse the prevalence of generalised anxiety disorder (GAD) in the population of inmates detained in one of the largest penitentiary units in north-eastern Poland. Materials and Methods: The data comes from 2017 and includes information on 635 male inmates incarcerated at the Czerwony Bór Prison. The information comes from the health records of individual inmates, kept by the prison outpatient clinician, and documented consultations with doctors of units outside the prison. The classification of generalised anxiety disorders (F41.1) was made in accordance with the 10th Revision of the International Statistical Classification of Diseases and Health Problems and the clinical diagnosis made by a psychiatrist. The Mann-Whitney test was used to compare quantitative data without normal distribution, chi-squared test or Fisher exact test for comparing qualitative data. A one-dimensional and multi-dimensional logistic regression model was used to examine the impact of the prison type on the prevalence of generalised anxiety disorder. Results: Generalised anxiety disorder was observed among 44 prisoners (6.9%), most often in the age range 30-39 years and among men younger than 30 years, respectively 40.9 and 31.8% of all diagnosed. The average age of patients was 34.6 years. The least number of prisoners with GAD was in the age group 50-59 (2.3%). Nearly 66% of patients were prisoners detained in a closed type prison; the chance of generalised anxiety disorder was three times higher than among the prisoners in a half-open and open type facility. Generalised anxiety disorder was diagnosed significantly more often with those currently serving a prison sentence than those before incarceration. Conclusions: In Polish conditions, the importance of the problem associated with GAD is evidenced by a significant increase in its prevalence in the prison environment and a three times higher chance of developing generalised anxiety disorder among prisoners in a closed type institution, which calls for highly organised psychiatric care and increased availability of psychological assistance for prisoners.

The Health of Undocumented Latinx Immigrants: What We Know and Future Directions

Undocumented Latinx immigrants experience unique factors prior to migration, during migration, and after migration that shape their health. Our review summarizes the limited but growing literature highlighting how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect the mental and physical health of undocumented Latinx immigrants. We also discuss how policies and social ties can promote their health. We focus on areas of particular concern, including health care, mental health, and HIV. Future research should use interdisciplinary approaches and intersectional frameworks to understand and address health inequities. Conducting research with undocumented Latinx immigrant communities requires community engagement, assurance of confidentiality, and creative recruitment and retention strategies. Recommendations for public health practice include investing in community health centers and organizations to ensure access to health and social services; presenting results with sufficient contextualization to interpret their generalizability; and advocating for federal-, state-, and local-level policy changes that reduce the negative health consequences associated with being undocumented.