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Barajas CB, Rivera-González AC, Vargas Bustamante A, Langellier BA, Lopez Mercado D, Ponce NA, Roby DH, Stimpson JP, De Trinidad Young ME, Ortega AN. Health Care Access and Utilization and the Latino Health Paradox. Med Care 2024:00005650-990000000-00220. [PMID: 38598667 DOI: 10.1097/mlr.0000000000002004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
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.
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Affiliation(s)
- Clara B Barajas
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Alexandra C Rivera-González
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management and the Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Damaris Lopez Mercado
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Ninez A Ponce
- Department of Health Policy and Management and the Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Dylan H Roby
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, Irvine, CA
| | - Jim P Stimpson
- Peter O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA
| | - Alexander N Ortega
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI
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Figuereo V, Rosales R, Zelaya DG, Inirio Z, Moreno O. Examining a Race-Sex Interaction Effect on Binge Drinking Among Afro-Latina/o Adults in the US. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01778-0. [PMID: 37697146 DOI: 10.1007/s40615-023-01778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
Latinx/es are often racially homogenized in alcohol use disparities research, leaving the behavioral and mental health status of Afro-Latinx/es unknown. Though Latina/o and Black adults consume less alcohol than non-Latina/o Whites, they may binge drink to cope with discrimination. Gendered racism uniquely and negatively affects Black women's psychological well-being and may increase their chances of engaging in risky drinking. This may be the case for Afro-Latina women, but no study has disaggregated alcohol use disparity outcomes among a nationally representative sample of Latina/o adults by race and sex. This study (1) examines the relationship between racial self-classification (White-Latina/os vs. Afro-Latina/os) and binge drinking in the past year and (2) tests whether sex (male vs. female) moderates the relationship between race and binge drinking. Secondary data that included a respondent sample of 9415 Latina/o adults was obtained and analyzed from the 2013-2018 National Health Interview Survey. Multivariate analyses included logistic regression models to assess the main effects of race, sex, and interaction effect of the two on binge drinking while controlling for sociodemographic variables. The probability of Afro-Latina/o adults binge drinking trends lower than White-Latina/os. Respondents' sex moderated the association between racial self-classification and binge drinking. We discuss racial identity salience, mujerismo, and gendered racism as possible protective and risk factors for Afro-Latina/os and Afro-Latina women to contextualize these findings.
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Affiliation(s)
- Victor Figuereo
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Robert Rosales
- School of Public Health, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - David G Zelaya
- School of Public Health, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Zuly Inirio
- Center for Ethnic Studies Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oswaldo Moreno
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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3
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Wilson FA, Stimpson JP, Ortega AN. Is use of a smuggler to cross the US-Mexico border associated with mental health problems among undocumented immigrants from Mexico? PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002232. [PMID: 37578952 PMCID: PMC10424853 DOI: 10.1371/journal.pgph.0002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Although numerous studies have found that Latine immigrants to the United States (US) have better health outcomes on average than persons born in the US, studies of persons living in Mexico have found that undocumented immigrants have worse health, especially those that were deported, compared to Mexican citizens that never migrated or migrated with authorization. However, the health outcomes of Mexican migrants using a smuggler to cross the US-Mexico border is a gap in the literature. We hypothesized that undocumented immigrant adults who used a smuggler to cross the US-Mexico border would be more likely to report mental health problems upon return to Mexico compared with undocumented immigrant adults that did not use a smuggler. We analyzed nationally representative, cross-sectional survey data of 1,563 undocumented immigrants currently living in Mexico. Most undocumented immigrants in the sample (87%) used a smuggler. Use of a smuggler by undocumented immigrant adults was associated with a 4.7% higher prevalence of emotional or psychiatric problems compared to undocumented immigrant adults that did not use a smuggler. We conclude that modality of ingress into the US is a risk factor for poorer mental health among undocumented immigrant adults.
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Affiliation(s)
- Fernando A. Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, United States of America
| | - Jim P. Stimpson
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Alexander N. Ortega
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
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4
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Lopez Mercado D, Rivera-González AC, Stimpson JP, Langellier BA, Bustamante AV, Young MEDT, Ponce NA, Barajas CB, Roby DH, Ortega AN. Undocumented Latino Immigrants and the Latino Health Paradox. Am J Prev Med 2023; 65:296-306. [PMID: 36890084 PMCID: PMC10363195 DOI: 10.1016/j.amepre.2023.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants. METHODS This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years). RESULTS Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants. CONCLUSIONS This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.
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Affiliation(s)
- Damaris Lopez Mercado
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
| | - Alexandra C Rivera-González
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P Stimpson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, Merced, California
| | - Ninez A Ponce
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; UCLA Center for Health Policy Research, Los Angeles, California
| | - Clara B Barajas
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Dylan H Roby
- Department of Health, Society, & Behavior, University of California Irvine, Irvine, California
| | - Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Lamar M, Estrella ML, Capuano AW, Leurgans S, Fleischman DA, Barnes LL, Lange‐Maia BS, Bennett DA, Marquez DX. A Longitudinal Study of Acculturation in Context and Cardiovascular Health and Their Effects on Cognition Among Older Latino Adults. J Am Heart Assoc 2023; 12:e027620. [PMID: 36926993 PMCID: PMC10111521 DOI: 10.1161/jaha.122.027620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Background We previously outlined the importance of considering acculturation within the context of older Latino adults' lived experience (ie, acculturation in context) to better capture contributors to cognitive aging. We now examine this conceptual framework as related to level of and change in cardiovascular health, and whether cardiovascular health modifies previously documented associations of acculturation in context with cognition. Methods and Results Acculturation in context data from 192 Latino participants without dementia at baseline (age ~70 years) were compiled into 3 separate composite scores: acculturation-related (nativity, language-, and social-based preferences), contextually related socioenvironmental (experiences of discrimination, social isolation, social networks), and familism-related (Latino-centric family ethos). A modified American Heart Association's Life's Simple 7 (mLS7; ie, smoking, physical activity, body mass index, blood pressure, total cholesterol, blood glucose) was used to measure cardiovascular health. Mixed effects regressions simultaneously tested the association of all 3 composite scores with total mLS7 adjusting for confounders. Separate models tested whether mLS7 modified associations of the 3 composite scores and cognition. The contextually related socioenvironmental composite score reflecting higher discrimination, higher social isolation, and smaller social networks (estimate=0.22, SE=0.10, P=0.02) and the familism score (estimate=0.16, SE=0.07, P=0.02) both significantly associated with change in total mLS7. The acculturation-related composite was not significantly associated with change in mLS7. No composite was significantly associated with level of mLS7. Total mLS7, however, significantly modified associations between the acculturation-related composite and change in working memory (estimate=-0.02, SE=0.01, P=0.043). Conclusions Acculturation within the context of older Latino adults' lived experience is important for maintaining cardiovascular health, relationships that also affect domain-specific cognitive decline.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIL
| | - Mayra L. Estrella
- Department of Epidemiology, Human Genetics and Environmental SciencesUniversity of Texas Health Science Center at Houston School of Public HealthBrownsvilleTX
| | - Ana W. Capuano
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Sue Leurgans
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Debra A. Fleischman
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - Brittney S. Lange‐Maia
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Preventive MedicineRush University Medical CenterChicagoIL
| | - David A. Bennett
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Neurological SciencesRush University Medical CenterChicagoIL
| | - David X. Marquez
- Rush Alzheimer’s Disease CenterRush University Medical CenterChicagoIL
- Department of Kinesiology and NutritionUniversity of Illinois ChicagoChicagoIL
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Ortega AN, Bustamante AV, Roby DH. New Directions for Public Health Research on the Health and Health Care of Undocumented Immigrants. Am J Public Health 2021; 111:1910-1912. [PMID: 34678052 PMCID: PMC8607342 DOI: 10.2105/ajph.2021.306506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Alexander N Ortega
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Arturo Vargas Bustamante
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
| | - Dylan H Roby
- Alexander N. Ortega is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Dylan H. Roby is with the Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
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