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Martinez-Donate AP, Rangel G, Correa C, Bakely L, Gonzalez-Fagoaga JE, González AA, Amuedo-Dorantes C, Zhang X, Magis-Rodriguez C, Lê-Scherban F, Guendelman S, Parrado E. The next phases of the Migrante Project: Study protocol to expand an observatory of migrant health on the Mexico-U.S. border. Front Public Health 2023; 11:1032420. [PMID: 37139391 PMCID: PMC10150099 DOI: 10.3389/fpubh.2023.1032420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Mexican migrants traveling across the Mexico-United States (U.S.) border region represent a large, highly mobile, and socially vulnerable subset of Mexican nationals. Population-level health data for this group is hard to obtain given their geographic dispersion, mobility, and largely unauthorized status in the U.S. Over the last 14 years, the Migrante Project has implemented a unique migration framework and novel methodological approach to generate population-level estimates of disease burden and healthcare access for migrants traversing the Mexico-U.S. border. This paper describes the rationale and history of the Migrante Project and the protocol for the next phases of the project. Methods/design In the next phases, two probability, face-to-face surveys of Mexican migrant flows will be conducted at key crossing points in Tijuana, Ciudad Juarez, and Matamoros (N = 1,200 each). Both survey waves will obtain data on demographics, migration history, health status, health care access, COVID-19 history, and from biometric tests. In addition, the first survey will focus on non-communicable disease (NCD), while the second will dive deeper into mental health and substance use. The project will also pilot test the feasibility of a longitudinal dimension with 90 survey respondents that will be re-interviewed by phone 6 months after completing the face-to-face baseline survey. Discussion Interview and biometric data from the Migrante project will help to characterize health care access and health status and identify variations in NCD-related outcomes, mental health, and substance use across migration phases. The results will also set the basis for a future longitudinal extension of this migrant health observatory. Analyses of previous Migrante data, paired with data from these upcoming phases, can shed light on the impact of health care and immigration policies on migrants' health and inform policy and programmatic responses to improve migrant health in sending, transit, and receiving communities.
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Affiliation(s)
- Ana P. Martinez-Donate
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Gudelia Rangel
- Mexico Section of the U.S.-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | - Catalina Correa
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Leah Bakely
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Ahmed Asadi González
- School of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | | | - Xiao Zhang
- School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | | | - Félice Lê-Scherban
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Sylvia Guendelman
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Emilio Parrado
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States
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Gehlbach D, Vázquez E, Ortiz G, Li E, Sánchez CB, Rodríguez S, Pozar M, Cheney AM. Perceptions of the Coronavirus and COVID-19 testing and vaccination in Latinx and Indigenous Mexican immigrant communities in the Eastern Coachella Valley. BMC Public Health 2022; 22:1019. [PMID: 35596225 PMCID: PMC9122545 DOI: 10.1186/s12889-022-13375-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 05/05/2022] [Indexed: 01/24/2023] Open
Abstract
Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths. Methods This study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
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Affiliation(s)
- Daniel Gehlbach
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Evelyn Vázquez
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | | | - Erica Li
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Cintya Beltrán Sánchez
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Sonia Rodríguez
- Center for Health Disparities Research, University of California Riverside, Riverside, USA
| | - María Pozar
- Center for Health Disparities Research, University of California Riverside, Riverside, USA
| | - Ann M Cheney
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
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Aleman-Tovar J, Rios K, Burke MM. Transition Planning: Knowledge and Preferences of Latinx Families of Youth With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:128-144. [PMID: 35297987 DOI: 10.1352/1934-9556-60.2.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 06/14/2023]
Abstract
Due to systemic barriers, Latinx parents of youth with intellectual and developmental disabilities (IDD) report having limited involvement in transition planning. To facilitate parent involvement in transition planning, it is critical to solicit feedback from Latinx families to inform the content and mode of a transition planning intervention. The purpose of this study was to explore Latinx parents' knowledge and preferred mode for a transition planning intervention. Twenty-eight Latinx parents of transition-aged youth with IDD completed surveys and focus groups. Participants reported wanting an intervention to focus on school-based transition planning and adult services; to a lesser extent, participants wanted information about natural supports. Regarding modality, participants desired in-person or online training (versus a brochure). Implications for research and practice are discussed.
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Affiliation(s)
| | | | - Meghan M Burke
- Meghan M. Burke, University of Illinois at Urbana Champaign
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4
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Gehlbach D, Vázquez E, Ortiz G, Li E, Sánchez CB, Rodríguez S, Pozar M, Cheney AM. COVID-19 Testing and Vaccine Hesitancy in Latinx Farm-Working Communities in The Eastern Coachella Valley. RESEARCH SQUARE 2021:rs.3.rs-587686. [PMID: 34189524 PMCID: PMC8240686 DOI: 10.21203/rs.3.rs-587686/v1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. In the United States, Latinx, African American, and Indigenous populations across the country have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial/ethnic minority groups is needed in order to alleviate the widespread disparity in new cases and deaths. Methods From November to December 2020 the research team conducted focus groups with members of Latinx farm-working communities in the Eastern Coachella Valley, located in the inland southern California desert region. A total of seven focus groups, six in Spanish and one in Purepecha, with a total of 55 participants were conducted. Topics covered include knowledge of the coronavirus, COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural factors that underly perceptions held by immigrant, migrant, and indigenous Latinx community members about COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This racial/ethnic minority population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Findings from the focus groups indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
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Affiliation(s)
| | | | | | - Erica Li
- University of California Riverside School of Medicine
| | | | - Sonia Rodríguez
- University of California Riverside Center for Health Disparities Research
| | - María Pozar
- University of California Riverside Center for Health Disparities Research
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5
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Smith-Miller CA, Berry DC, Miller CT. Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:44-55. [PMID: 33906459 DOI: 10.1177/15404153211011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
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Affiliation(s)
- Cheryl A Smith-Miller
- UNC Medical Center, Nursing Quality and Research, Chapel Hill, NC, USA.,Office of Human Research Ethics, University of North Carolina-Chapel Hill, NC, USA.,School of Nursing, University of North Carolina-Chapel Hill, NC, USA
| | - Diane C Berry
- Co-Director Interventions for Preventing and Managing Chronic Illness (T32-NIH/NINR); Optimizing Outcomes in Women with Gestational Diabetes and their Infants (NIH/NIDDK); Diabetes Group Visits (Kate B. Reynolds), School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Cass T Miller
- Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
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Tulimiero M, Garcia M, Rodriguez M, Cheney AM. Overcoming Barriers to Health Care Access in Rural Latino Communities: An Innovative Model in the Eastern Coachella Valley. J Rural Health 2020; 37:635-644. [PMID: 32603004 DOI: 10.1111/jrh.12483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Latino farmworkers lack access to basic needs, including health care services. These farmworkers face barriers common to rural areas (eg, limited health services and public transportation), as well as language barriers, an unfamiliar medical system, no health insurance, and income-based financial challenges exacerbated by a lack of workers' rights. METHODS This study involved focus group discussions to elicit community health priorities and barriers to health care service use among Latinos in rural farm working communities, as well as participants' ideal model for health care services delivery. Free mobile clinics were subsequently implemented at locations and times the community identified as ideal, and pre- and postinterviews of patients' experiences utilizing clinic services, and perceptions of access barriers, were conducted. RESULTS Results from focus group discussions (n = 82) and one-on-one interviews (n = 15) to evaluate mobile clinic health care services use confirmed documented barriers to health care for this population, shed light on structural and cultural barriers to service access, and suggested innovative models for service delivery to Spanish-speaking Latino farmworkers in rural communities. These models should (1) provide care within farm working communities, (2) offer services at times outside of business hours, and (3) encourage provider immersion in patient communities to better understand their health care needs. DISCUSSION Traditional models of care that expect patients to access health care services at brick and mortar structures are impractical for Latino farmworkers in rural communities. Innovative models bringing health care services to community spaces can reduce access barriers and emergency department utilization and improve health outcomes for this structurally vulnerable population.
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Affiliation(s)
- Monica Tulimiero
- Department of Family Medicine, Ventura County Medical Center, Ventura, California
| | - Michael Garcia
- Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, California
| | - Maria Rodriguez
- Department of Anthropology, University of California Riverside, Riverside, California
| | - Ann M Cheney
- Department of Social Medicine Population and Public Health, School of Medicine, University of California Riverside, Riverside, California
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Heckert C. Syndemics in Symbiotic Cities: Pathogenic Policy and the Production of Health Inequity across Borders. JOURNAL OF BORDERLANDS STUDIES 2019; 37:37-55. [PMID: 35321446 PMCID: PMC8937002 DOI: 10.1080/08865655.2019.1700823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Carina Heckert
- Department of Sociology and Anthropology, The University of Texas at El Paso
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Zaslavsky R, Goulart BNGD, Ziegelmann PK. Cross-border healthcare and prognosis of HIV infection in the triple border Brazil-Paraguay-Argentina. CAD SAUDE PUBLICA 2019; 35:e00184918. [PMID: 31508700 DOI: 10.1590/0102-311x00184918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022] Open
Abstract
The act of crossing an international border for healthcare is a reality in border areas and the flow is in the direction of the city with more human and healthcare resources. Although several prognostic factors related to HIV+ patients are known, the prognostic value of this type of mobility for long term care is still neglected. This study compares the prognosis of HIV patients from three groups, one involved in regional mobility, another in cross-border mobility in search for healthcare and the reference group which is composed by patients living in the same city of the health facility. This is a retrospective cohort study using medical records from a healthcare service in Brazil. Following survival analysis with log-rank test and Cox proportional hazard models, overall survival had no significant difference between patients who were involved in regional (HR = 1.03; 95%CI: 0.69-1.54; p = 0.89) or international (HR = 1.07; 95%CI: 0.58-1.97; p = 0.83) mobility and those who were not. This lack of difference was kept when adjusted for known prognostic factors. In this retrospective cohort study, exposure to both regional and international migration did not have a significant association with the risk of death by any cause in crude or adjusted analyses for already known prognostic factors. This is the first study to consider the prognostic role of cross-border healthcare for HIV patients. Despite these findings, the need of monitoring the extent and the clinical and demographic characteristics of healthcare demand originated in the other side of the border and the use of these data for decision making in health management is emphasized.
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Affiliation(s)
- Ricardo Zaslavsky
- Universidade Federal da Integração Latino-Americana, Foz do Iguaçu, Brasil.,Secretaria Municipal de Saúde de Foz do Iguaçu, Foz do Iguaçu, Brasil
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Abstract
Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.
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Cheney AM, Newkirk C, Rodriguez K, Montez A. Inequality and health among foreign-born latinos in rural borderland communities. Soc Sci Med 2018; 215:115-122. [DOI: 10.1016/j.socscimed.2018.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023]
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Non-communicable chronic diseases and timely breast cancer screening among women of the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study. Cancer Causes Control 2018; 29:315-324. [PMID: 29423760 DOI: 10.1007/s10552-018-1005-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 01/30/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE The Caribbean population faces a growing burden of multiple non-communicable chronic diseases (NCDs). Breast cancer is the leading cause of cancer death for women in the Caribbean. Given the substantial burden of NCDs across the region, cancer prevention and control strategies may need to be specifically tailored for people with multiple co-morbidities. Preventive screening, such as timely mammography, is essential but may be either facilitated or hampered by chronic disease control. The main objective of this study is to examine the relationship between a chronic disease and timely breast cancer screening. METHODS We conducted a cross-sectional data analysis using baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study-ECS. Our independent variables were presence of chronic diseases (hypertension or diabetes), defined as having been told by a clinical provider. Our dependent variable was timely screening mammography, as defined by receipt of mammography within the past 2 years. We examined bivariate and multivariate associations of covariates and timely screening mammography. RESULTS In our sample (n = 841), 52% reported timely screening mammography. Among those with timely screening, 50.8% reported having hypertension, and 22.3% reported having diabetes. In our bivariate analyses, both diabetes and hypertension were associated with timely screening mammography. In partially adjusted models, we found that women with diabetes were significantly more likely to report timely screening mammography than women without diabetes. In our fully adjusted models, the association was no longer significant. Having a usual source of healthcare and a woman's island of residence were significantly associated with timely screening mammography (p < 0.05). CONCLUSIONS We found that half of eligible women received timely screening mammography. Diabetes and hypertension, though common, are not associated with timely screening mammography. Usual source of care remains an important factor to timely breast cancer screening.
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Wassink J. Uninsured Migrants: Health Insurance Coverage and Access to Care Among Mexican Return Migrants. DEMOGRAPHIC RESEARCH 2018; 38:17. [PMID: 29657545 PMCID: PMC5894520 DOI: 10.4054/demres.2018.38.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. OBJECTIVE Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care. METHODS I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n=632,678). RESULTS Analyses reveal a large and persistent gap between recent return migrants and non-migrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to non-migrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care. CONCLUSION This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources such as health care.
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Affiliation(s)
- Joshua Wassink
- University of North Carolina at Chapel Hill, Department of Sociology and Carolina Population Center
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13
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Smith-Miller CA, Berry DC, Miller CT. Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking hispanic immigrants. Res Nurs Health 2017; 40:541-554. [PMID: 28877552 DOI: 10.1002/nur.21817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/11/2017] [Indexed: 12/20/2022]
Abstract
This article is a report of qualitative findings of a mixed-methods study of the relationships among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes mellitus (T2DM) self-management among limited-english-proficient recent Hispanic immigrants, a population with increased incidence of T2DM and barriers to successful T2DM management. Semi-structured interviews were conducted with 30 participants, and physiological and demographic data also were collected. The participants generally attributed developing the disease to strong emotions and viewed T2DM as a serious disease. Although a majority understood the importance of exercise and diet in T2DM self-management, other aspects such as medication adherence were not well-understood. Obstacles to effective T2DM self-management were negative interactions and communications with health care providers and other personnel, cultural stigma related to the disease, financial constraints, immigration status, and the complexity of the disease. Suggested interventions to improve the care and self-management of this at-risk population are discussed.
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Affiliation(s)
- Cheryl A Smith-Miller
- University of North Carolina Hospital, Nursing Quality and Research, Adjunct Professor, School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Diane C Berry
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Cass T Miller
- Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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14
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Zhang X, Martinez-Donate AP, Nobles J, Hovell MF, Rangel MG, Rhoads NM. Substance Use Across Different Phases of the Migration Process: A Survey of Mexican Migrants Flows. J Immigr Minor Health 2017; 17:1746-57. [PMID: 25595206 DOI: 10.1007/s10903-014-0109-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study examined the levels of substance use and changes across different migration stages, including pre-departure, travel, destination, and return, among Mexican migrants converging on the US-Mexico border. A cross-sectional survey was conducted in Tijuana, Mexico, between 2009 and 2010 among Mexican migrants returning from the US and those travelling from other Mexican regions. The overall prevalence of last 12-month at-risk drinking, illicit drug use, and current smoking, was 42.3, 17.7 and 31.4%, respectively. Compared to pre-departure migrants, males were at increased risk for illicit drug use at the destination and return stages. In contrast, females' alcohol consumption at the destination stage was lower than at pre-departure (p < 0.05). The level of smoking was stable across all stages for both genders. In the destination stage, undocumented migrants were more likely to use illicit drugs relative to their documented peers (p < 0.05). Binational interventions promoting substance use reduction are needed among this mobile population.
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Affiliation(s)
- Xiao Zhang
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 N. Walnut St., 630 WARF, Madison, WI, 53726, USA
| | - Ana P Martinez-Donate
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 N. Walnut St., 605 WARF, Madison, WI, 53726, USA.
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, 4406 Sewell Social Sciences, 1180 Observatory Dr., Madison, WI, 53706, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, San Diego State University, 9245 Sky Park Ct., Suite 230, San Diego, CA, 92123, USA
| | - Maria Gudelia Rangel
- Departamento de Estudios de Poblacion, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Natalie M Rhoads
- Department of Population Health Sciences, University of Wisconsin-Madison, 610 N. Walnut St., 632 WARF, Madison, WI, 53726, USA
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15
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Pineros-Leano M, Liechty JM, Piedra LM. Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review. J Affect Disord 2017; 208:567-576. [PMID: 27810273 DOI: 10.1016/j.jad.2016.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/14/2016] [Accepted: 10/22/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND In order to address the needs of the growing Latino immigrant population, this study aimed to systematically review peer-reviewed articles of intervention studies that used cognitive behavioral therapy to treat depressive symptoms among Latino immigrants in the U.S. METHODS We searched PsycINFO, PubMed, and Medline databases from January 1995 through July 2016 as part of a registered review protocol (PROSPERO) following PRISMA guidelines. Inclusion criteria were intervention studies that used cognitive behavioral techniques to treat depressive symptoms among a predominantly U.S. Latino immigrant sample -- or subsample with disaggregated results, and the use of standardized measures of depression. We used the National Heart, Lung, and Blood Institute quality assessment tools for systematic reviews to assess risk of bias. RESULTS We identified 11 studies that met inclusion criteria. Nine of the included studies reported a reduction of depressive symptoms. Each study used a least one cultural adaptation to deliver the intervention. Using an existing content model, cultural adaptations were categorized as (a) cognitive-informational adaptations, (b) affective-motivational adaptations, and (c) environmental adaptations. LIMITATIONS Heterogeneity of articles in terms of sample size, cultural adaptations, methodological rigor, and setting limited comparability of effectiveness across studies. CONCLUSIONS Culturally adapted CBT to address depressive symptoms among Latino immigrants appears promising but further research is needed. The most commonly used cultural adaptations included language, inclusion of migration experience, and adjusting for literacy level. Study design elements and adaptations were often responsive to geographic characteristics and available resources.
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Affiliation(s)
| | - Janet M Liechty
- School of Social Work, University of Illinois at Urbana-Champaign, USA; College of Medicine, University of Illinois at Urbana-Champaign, USA
| | - Lissette M Piedra
- School of Social Work, University of Illinois at Urbana-Champaign, USA
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16
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Martinez-Donate AP, Ejebe I, Zhang X, Guendelman S, Lê-Scherban F, Rangel G, Gonzalez-Fagoaga E, Hovell MF, Amuedo-Dorantes C. Access to Health Care among Mexican Migrants and Immigrants: A Comparison across Migration Phases. J Health Care Poor Underserved 2017; 28:1314-1326. [PMID: 29176097 PMCID: PMC5728113 DOI: 10.1353/hpu.2017.0116] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We examined differences in, and factors associated with, access to health services among Mexican im/migrants to the U.S. across migration phases, including pre-departure, destination, interception, and return. METHODS Using data from a cross-sectional survey conducted in Tijuana, Mexico (N = 1,541), we computed descriptive statistics and staged logistic regressions to estimate health care access indicators and factors associated with access to services. RESULTS Im/migrants at post-migration phases had lower likelihood of receiving health care and having a usual source of care, and higher rates of forgone care, than their counterparts at pre-departure. These differences were partly explained by length of migration phase, health insurance status, transportation barriers, and detention or imprisonment. CONCLUSIONS Mexican im/migrants face challenges in accessing health services across the migration continuum, especially at post-migration phases. Binational efforts to provide affordable insurance coverage and reduce transportation limitations and incarceration could contribute to improving health care access among Mexican im/migrants.
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Affiliation(s)
| | - Ifna Ejebe
- School of Medicine and Public Health, University of Wisconsin, Madison
| | - Xiao Zhang
- School of Medicine and Public Health, University of Wisconsin, Madison
| | | | | | - Gudelia Rangel
- Mexico Section of the U.S.-Mexico Border Health Commission
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17
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Martinez-Donate AP, Rangel MG, Zhang X, Simon NJ, Rhoads N, Gonzalez-Fagoaga JE, Gonzalez AA. HIV Prevention Among Mexican Migrants at Different Migration Phases: Exposure to Prevention Messages and Association With Testing Behaviors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:547-65. [PMID: 26595267 PMCID: PMC4751078 DOI: 10.1521/aeap.2015.27.6.547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Mobile populations are at increased risk for HIV infection. Exposure to HIV prevention messages at all phases of the migration process may help decrease im/migrants' HIV risk. We investigated levels of exposure to HIV prevention messages, factors associated with message exposure, and the association between exposure to prevention messages and HIV testing behavior among Mexican im/migrants at different phases of the migration process. We conducted a cross-sectional, probability survey of Mexican im/migrants (N = 3,149) traveling through the border city of Tijuana, Mexico. The results indicate limited exposure to prevention messages (57-75%) and suboptimal last 12-month HIV testing rates (14-25%) across five migration phases. Compared to pre-departure levels (75%), exposure to messages decreases at all post-departure migration phases (57-63%, p < .001). In general, exposure to prevention messages is positively associated with greater odds of HIV testing at the pre-departure, destination, and interception phases. Binational efforts need to be intensified to reach and deliver HIV prevention to Mexican im/migrants across the migration continuum.
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Affiliation(s)
- Ana P. Martinez-Donate
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - M. Gudelia Rangel
- U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico
| | - Xiao Zhang
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Norma-Jean Simon
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Natalie Rhoads
- Department of Community Health & Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Ahmed Asadi Gonzalez
- School of Medicine and Psychology, Autonomous University of Baja California (Universidad Autonoma de Baja California), Tijuana, Baja California, Mexico
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18
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Martínez-Donate AP, Rangel MG, Rhoads N, Zhang X, Hovell M, Magis-Rodriguez C, González-Fagoaga E. Identifying opportunities to increase HIV testing among mexican migrants: a call to step up efforts in health care and detention settings. PLoS One 2015; 10:e0123631. [PMID: 25860261 PMCID: PMC4393219 DOI: 10.1371/journal.pone.0123631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/02/2015] [Indexed: 11/18/2022] Open
Abstract
HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities.
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Affiliation(s)
- Ana P. Martínez-Donate
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
- * E-mail:
| | | | - Natalie Rhoads
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Xiao Zhang
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Melbourne Hovell
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - Carlos Magis-Rodriguez
- Centro de Investigaciones en Infecciones de Transmision Sexual, Programa de VIH y SIDA de la Ciudad de Mexico, la Ciudad de Mexico, Mexico
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19
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Martinez-Donate AP, Hovell MF, Rangel MG, Zhang X, Sipan CL, Magis-Rodriguez C, Gonzalez-Fagoaga JE. Migrants in transit: the importance of monitoring HIV risk among migrant flows at the Mexico-US border. Am J Public Health 2015; 105:497-509. [PMID: 25602882 PMCID: PMC4330846 DOI: 10.2105/ajph.2014.302336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/04/2022]
Abstract
We conducted a probability-based survey of migrant flows traveling across the Mexico-US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.
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Affiliation(s)
- Ana P Martinez-Donate
- Ana P. Martinez-Donate and Xiao Zhang are with the Department of Population Health Sciences, University of Wisconsin, Madison. Melbourne F. Hovell is with the Graduate School of Public Health, San Diego State University, San Diego, CA. Maria Gudelia Rangel and J. Eduardo Gonzalez-Fagoaga are with El Colegio de la Frontera Norte, Tijuana, Mexico. Carol L. Sipan is with the School of Social Sciences, University of California, Merced. At the time of the study, Carlos Magis-Rodriguez was with the Sexually Transmitted Infections Research Center, HIV/AIDS Program, Mexico City, Mexico
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20
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Ejebe IH, Zhang X, Rangel MG, Martinez-Donate AP. Seasonal influenza vaccination among Mexican migrants traveling through the Mexico-US border region. Prev Med 2015; 71:57-60. [PMID: 25514546 PMCID: PMC4329086 DOI: 10.1016/j.ypmed.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Mobile populations are at high risk for communicable diseases and can serve as a bridge between sending and receiving communities. The objective of this study is to determine the rates of, and factors associated with, seasonal influenza vaccination among Mexican migrants traveling through the US-Mexico border. METHODS We used a 2013 cross-sectional population-based survey of adult mobile Mexican migrants traveling through the Mexico-US border region (N=2313; weighted N=652,500). We performed a multivariable logistic regression analysis to model the odds of receiving an influenza vaccination in the past year by sociodemographics, migration history, health status, and access to health care. RESULTS The seasonal influenza vaccination rate in this population was 18.6%. Gender, health status, and health insurance were associated with the likelihood to receive an influenza vaccination. CONCLUSION Overall, the rates of seasonal influenza vaccination in circular Mexican migrants are low compared to adults in Mexico and the US Efforts are needed to increase influenza vaccination among this highly mobile population, particularly in adults with chronic conditions.
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Affiliation(s)
- Ifna H Ejebe
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Xiao Zhang
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | | | - Ana P Martinez-Donate
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison WI, USA.
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