Patricia Y Miranda

Pennsylvania State University, University Park, Maryland, United States

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Publications (31)56.51 Total impact

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    ABSTRACT: A mother’s intent to breastfeed her infant is one of the strongest predictors of both breastfeeding initiation and duration of time spent breastfeeding. However, the variables associated with the intent to breastfeed remain somewhat underexplored. This study examines the association between the education of the mother and her partner and the mother’s intent to breastfeed. Univariates and logistic regressions were executed to examine a sample of 2,820 primiparous mothers surveyed in their third trimester. It was found that mothers with a high school degree or less have a 56% [95%CI: .27, .71] lower odds of intending to breastfeed and mothers with some college have a 36% [95%CI: .43,95] lower odds of intending to breastfeed relative to women with a college degree or higher. If the father of the infant has a high school degree or less the mother has a 42% [95%CI: .37, .90] lower odds of intending to breastfeed relative to mother’s who have partner’s with a college degree or higher. In addition, in combination, if both the mother and the father have a high school degree or less the mother is 74% less likely to intend to breastfeed relative to both partners having a college degree or more; in other words, an additive effect of partner education is observed. This shows the importance of considering both mother and father’s education when assessing breastfeeding intentions. It presents a potentially straightforward screening item to identify risk of not intending to breastfeed, which could have implications for breastfeeding initiation and duration.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Nengliang Yao, Cathy J Bradley, Patricia Y Miranda
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 10/2014;
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    ABSTRACT: The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear.METHODS: Data from the 2011-2012 National Survey of Children's Health were analyzed to examine differences by immigrant generational status in awareness of children's health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status.RESULTS: Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with <50 employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6-13.0]) and knowing where to find insurance information (AOR 7.7 [3.8-15.4]) compared with first-generation families.CONCLUSIONS: ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges.
    Pediatrics. 07/2014;
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    ABSTRACT: Farmwork is more than an occupation; it is also a condition of risk. An estimated 4 million farmworkers are exposed to pesticides annually, yet pesticide safety intervention efforts aimed to increase personal protective equipment (PPE) use show limited success. Improved PPE intervention efforts are needed to improve pesticide and safety among farmworkers, the vast majority of whom are Mexicans (over 80% self-identify as Mexican; another 10% identify as non-Mexican Latino). To this end, we present research findings of a place-based intervention aimed to reduce pesticide exposures by examining and promoting PPE use among Mexican farmworkers living along the Texas-Mexico Border of the United States. To deliver our intervention, we partnered with Texas Migrant Council's (TMC) Migrant and Seasonal Head Start to develop and evaluate the effectiveness of the novel intervention in a sample of 60 farmworkers. First, we integrated highly innovative mobile-health methodology with ethnographic research from the primary author to examine daily risk assessments of pesticide exposure in real, contextual time. Next, we offered farmworkers dynamically tailored motivational messages based on their actual PPE usage; messages included culturally-appropriate language delivered using highly interactive text messages on mobile smart phones aimed to increase PPE use and other protective practices. Our findings demonstrate a unique opportunity for use of multiple, interdisciplinary research methods toward innovative, culturally-tailored data collection in context and real-time. This work is also a pioneering effort for using mobile-health and ethnographic methodologies to reduce environmental risks among farmworker populations.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Under the Patient Protection and Affordable Care Act (PPACA), all foreign-born who are lawfully present in the United States will be eligible for healthcare coverage beginning January 1, 2014. Currently, pathways to citizenship include naturalization after 5 years of legal permanent residency, which has also been identified as a threshold for deteriorating health among immigrants. The objective of this study is to examine the association between citizenship, duration in the U.S., and cancer screening over time. We analyzed 11 years (2000-2010) of consolidated data from the Medical Expenditure Panel Survey linked with the National Health Interview Survey. Multivariate analyses were conducted, revealing that over time, compared to foreign-born citizens living in the U.S. for 5 years or more, foreign-born non-citizens living in the U.S. less than 5 years had lower odds of receiving a mammogram (N=70,585) or clinical breast exam (N=70,394) in the past 2 years {OR(95% CI) = .52(.41-.66); .53(.41-.67)}, as did U.S.-born citizens {.80(.71-.89); .85(.76-.95)}. Foreign born non-citizens living in the U.S. fewer than 5 years had lower odds of being screened for colorectal cancer (N=80,024) in the past 5 years and cervical cancer (N=109,467) in the past 3 years {.43(.32-.59); .54(.31-.95)}, as did foreign born non-citizens living in the U.S. at least 5 years {.75(.67-.85); .50(.41-.60)}. Evidence supporting a protective effect for citizenship with 5+ years of U.S. residency should be considered for best practices in immigration policy recommendations for who is considered lawfully present in the U.S. and eligible for a timely pathway to preventive healthcare.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • Adriana Reyes, Patricia Y. Miranda
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    ABSTRACT: In 2012, cancer became the leading cause of death for Latinos, with breast cancer remaining the leading cause of cancer mortality among Latinas, who are more likely to be diagnosed with more aggressive, premenopausal breast cancers at later stages compared to non-Hispanic white women. Along with suggested decreases in clinical- and self-breast exams, revised guidelines based on studies of predominantly non-Hispanic white women delay screening by ten years; therefore we project an increase in breast cancer disparities, and ultimately mortality, that disproportionately affects Latinas. Eleven years of linked data from the National Health Interview Survey and the Medical Expenditure Panel Survey show that rates of clinical breast exams start to decrease between 2007-2008, with mammography rates decreasing for Latinas in 2010. Before 2008, about 44% of breast cancers in women age 40-49 were detected by mammograms; however, with the implementation of the new screening guidelines these cases may not be detected as quickly, leading to a later stage diagnosis for some women. Factoring national rates of self-breast exam at less than 30%, and expected sensitivity and specificity of these methods of breast cancer screening, we project breast cancer mortality among Latinas is alarmingly expected to increase by as much as 10%. With most breast cancers cited as being discovered through self-exam or other incidental findings, considerations for best practices for the early detection and diagnosis of breast cancer among Latinas are revisited.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Latinas have lower rates of mammography than Anglo-American women, while among Latinas, lacking insurance and having lower acculturation are correlated with additional disparities in mammography screening. Possible ways to overcome these barriers have significant interest to health care professionals. In a survey of Latino border residents of El Paso County, Texas, we investigated health care use and lifetime mammography among a sample of (n= 324) Latinas with and without health insurance. Consistent with previous research, findings from our study show that Latinas with health insurance were significantly more likely to report ever having a mammogram than uninsured Latinas. Likewise, more acculturated Latinas were more likely to report ever having a mammogram than less acculturated Latinas. Yet, among insured Latinas overall, significant differences in mammography were found by health care site. Latinas who only accessed health care in the U.S. were more likely to have ever had a mammogram than Latinas who utilized a combination of U.S. and Mexican health care ( p
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: While breastfeeding has a number of benefits for child and mother, first time mothers in Pennsylvania are a unique population. The objective of this study is to examine sociobehavioral determinants of breastfeeding 6 months after birth among these women. Baseline, 1 month postpartum, and 6 month postpartum data from First Baby Study first time mothers who initiated breastfeeding were used (N=2,754). Multivariate logistic regressions were fit modeling breastfeeding 6 months after birth on prepartum behaviors, social factors, mother's health, and a full model of all sociobehavioral determinants and demographic covariates. Independently, significant prepartum behaviors were intent to breastfeed {OR(95% CI) = 4.82(3.93-5.93)} and gestational weight beyond recommendation {.70(.59-.83)}, while significant social factors included reporting trouble meeting basic needs during study period {.68(.56-.83)}, having public insurance ({.41(.31-.53)}; mother in service or labor occupations {.63(.49-.81); .78(.62-.98)}; and not being in poverty {1.51(1.13-2.03)}. Significant mother's health indicators included not having pregnancy complications {1.32(1.13-1.53)}, mother returning to the hospital in the one month since birth {.50(.26-.94)}, and number of prepartum depression symptoms suggesting further monitoring or need for professional referral {.69(.50-.96); .57(.37-.86)}. Once combined into a more efficient model, intent to breastfeed {5.03(4.06-6.23)}, gestational weight beyond recommendation {.73(.61-.88)}, trouble meeting basic needs {.67(.55-.82)}, public insurance {.51(.38-.67)}, prepartum depression symptoms suggesting professional referral {.57(.36-.90)}, mother's age {1.04(1.02-1.07)}, and being Hispanic {.52(.34-.79)} were significant predictors of breastfeeding 6 months after birth. Recommendations for best practices to encourage breastfeeding in this unique population are discussed.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: OBJECTIVE: The present study examined food shopping behaviours, particularly distance to grocery shop, and exposure to discrimination. DESIGN: Cross-sectional observational study utilizing data from a community survey, neighbourhood food environment observations and the decennial census. SETTING: Three communities in Detroit, Michigan, USA. SUBJECTS: Probability sample of 919 African-American, Latino and white adults in 146 census blocks and sixty-nine census block groups. RESULTS: On average, respondents shopped for groceries 3·1 miles (4·99 km) from home, with 30·9 % shopping within 1 mile (1·61 km) and 22·3 % shopping more than 5 miles (8·05 km) from home. Longer distance to shop was associated with being younger, African-American (compared with Latino), a woman, higher socio-economic status, lower satisfaction with the neighbourhood food environment, and living in a neighbourhood with higher poverty, without a large grocery store and further from the nearest supermarket. African-Americans and those with the lowest incomes were particularly likely to report unfair treatment at food outlets. Each mile (1·61 km) increase in distance to shop was associated with a 7 % increase in the odds of unfair treatment; this relationship did not differ by race/ethnicity. CONCLUSIONS: The study suggests that unfair treatment in retail interactions warrants investigation as a pathway by which restricted neighbourhood food environments and food shopping behaviours may adversely affect health and contribute to health disparities. Efforts to promote 'healthy' and equitable food environments should emphasize local availability and affordability of a range of healthy food products, as well as fair treatment while shopping regardless of race/ethnicity or socio-economic status.
    Public Health Nutrition 03/2013; · 2.25 Impact Factor
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    ABSTRACT: Overall, individuals from vulnerable populations groups who are less integrated because of their ethnicity/race, citizenship, or economic status are more likely to be diagnosed with advanced stages of cancer, suffer from larger tumors, and experience higher rates of cancer mortality. Individual behaviors have been shown to modify these risks. For example, lower rates of cancer screening and higher rates of obesity, sedentary lifestyle and smoking are described as independent risk factors for multiple cancers. To understand the link between behavior and cancer risk among vulnerable groups, specifically immigrants, this study links data from the Medical Expenditure Panel Survey (years 2000-2008) to the National Health Interview Survey to examine patterns and identify predictors of modifiable behaviors for cancer prevention among U.S. adults aged 18 years and older (N=190,965). This work provides a foundation for translation into future community-engaged interventions for cancer prevention among U.S.- and foreign-born vulnerable populations, whose communities hold a disproportionate burden of cancer health disparities that may be largely explained by social and behavioral determinants of health that inequitably impact modifiable risk factors for cancer prevention.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Colorectal cancer screening (CRC) disparities have worsened in recent years. To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups. Multivariate logistic regressions examined associations between ethnicity/race and primary outcomes of self-reported guideline-concordant CRC screenings considering time trends for 65,947 respondents of the Medical Expenditure Panel Survey from 2000 to 2007 age 50-years and older from six groups (non-Latino White, non-Latino Black, Puerto Rican, Cuban, Mexican, and Other Latino). We also tested for modification effects by education, income, and health insurance. Most groups approached Healthy People 2010 CRC screening rate goals, including non-Latino Whites (47%), non-Latino Blacks (42%) and Puerto Ricans (40%), while Mexicans remained disparately lower (28%). Higher education, income and insurance coverage, partially attenuated this lower likelihood, but Mexican rates remained significantly lower than non-Latino Whites for receiving endoscopy in the past 5 years {OR(95% CI)=0.68(0.59-0.77)} and having received any CRC screening {0.70(0.62-0.79)}. Among ethnic/racial groups examined, only Mexicans met healthcare disparity criteria in CRC screening. Findings suggest that healthcare equity goals can be attained if resources affecting continuity of care or ability to pay for preventive services are available, and targeted populations are adequately identified.
    Preventive Medicine 05/2012; 55(2):131-6. · 3.50 Impact Factor
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    Wassim Tarraf, Patricia Y Miranda, Hector M González
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    ABSTRACT: The objective of the study was to examine time trends and differences in medical expenditures between noncitizens, foreign-born, and US-born citizens. We used multi-year Medical Expenditures Panel Survey (2000-2008) data on noninstitutionalized adults in the United States (N=190,965). Source specific and total medical expenditures were analyzed using regression models, bootstrap prediction techniques, and linear and nonlinear decomposition methods to evaluate the relationship between immigration status and expenditures, controlling for confounding effects. We found that the average health expenditures between 2000 and 2008 for noncitizens immigrants ($1836) were substantially lower compared with both foreign-born ($3737) and US-born citizens ($4478). Differences were maintained after controlling for confounding effects. Decomposition techniques showed that the main determinants of these differences were the availability of a usual source of health care, insurance, and ethnicity/race. Lower health care expenditures among immigrants result from disparate access to health care. The dissipation of demographic advantages among immigrants could prospectively produce higher pressures on the US health care system as immigrants age and levels of chronic conditions rise. Barring a shift in policy, the brunt of the effects could be borne by an already overextended public health care system.
    Medical care 03/2012; 50(3):233-42. · 3.24 Impact Factor
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    ABSTRACT: Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics' main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health.
    Social Science [?] Medicine 02/2012; · 2.73 Impact Factor
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    ABSTRACT: There are compelling reasons to conduct studies of cancer in Hispanics, the fastest growing major demographic group in the United States (from 15% to 30% of the U.S. population by 2050). The genetically admixed Hispanic population coupled with secular trends in environmental exposures and lifestyle/behavioral practices that are associated with immigration and acculturation offer opportunities for elucidating the effects of genetics, environment, and lifestyle on cancer risk and identifying novel risk factors. For example, traditional breast cancer risk factors explain less of the breast cancer risk in Hispanics than in non-Hispanic whites (NHW), and there is a substantially greater proportion of never-smokers with lung cancer in Hispanics than in NHW. Hispanics have higher incidence rates for cancers of the cervix, stomach, liver, and gall bladder than NHW. With respect to these cancers, there are intriguing patterns that warrant study (e.g., depending on country of origin, the five-fold difference in gastric cancer rates for Hispanic men but not Hispanic women). Also, despite a substantially higher incidence rate and increasing secular trend for liver cancer in Hispanics, there have been no studies of Hispanics reported to date. We review the literature and discuss study design options and features that should be considered in future studies.
    Cancer Prevention Research 02/2012; 5(2):150-63. · 4.89 Impact Factor
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    ABSTRACT: The study objectives were to compare and examine mammography use trends among ethnic/racial women in the context of United States Healthy People 2010 goals. We analyzed pooled, multistage probability sample data from the 1996-2007 Medical Expenditure Panel Survey. Included in the sample were female respondents of ages 40 to 75 years (N = 64,811) from six ethnic/racial groups (Black, White, Mexican, Other Latinas, Puerto Rican, and Cuban). The primary outcome was self-reported, past two-year mammography use consistent with screening practice guidelines. We found that for most U.S. women, the Healthy People 2010 mammography goal (70%) was achieved between 1996 and 2007. Puerto Rican and White women, respectively, had the highest mammography rates, and Black and Cuban women had rates that approached the 2010 goal. Mexican Latinas reported the lowest rates of past two-year mammography; however, factors enabling healthcare access markedly moderated this lower likelihood. From 2000, Mexican Latinas' mammography use was markedly below (10%) the Healthy People 2010 goal and remained there for the duration. Impact: Our findings indicate that healthcare equity goals are attainable if efforts are made to reach a sizeable portion of vulnerable populations.
    Cancer Epidemiology Biomarkers &amp Prevention 12/2011; 21(2):351-7. · 4.56 Impact Factor
  • R Belue, A N Degboe, P Y Miranda, L A Francis
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    ABSTRACT: The patient-centered medical home model has the potential to reduce healthcare disparities among immigrant children. The purpose of this study is to examine the relationship between medical home (MH) participation and receipt of preventive services among immigrant children age 0-17. The study employed extant data from the National Survey of Children's Health, 2007 (NSCH). Logistic regression analyses were employed to assess the relationship between receipt of preventive services and MH status among immigrant and non-immigrant children. Due to primarily the lack of family-centered care, only 40% of immigrant children met the medical home criteria versus approximately 62% of non-immigrant children. Immigrant children have decreased odds of receiving preventive care despite MH status. Improving the family-centered care aspect of the MH is necessary to increasing medical home access to immigrant children and the receipt of preventive services for immigrant children who meet the MH criteria.
    Journal of Immigrant and Minority Health 11/2011; 14(4):617-25. · 1.16 Impact Factor
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    ABSTRACT: Background. Although most research has focused on implications of the food environment for diet, it may affect health and contribute to health disparities through additional pathways. This study examined whether the food environment (neighborhood store availability, store where shopped) was associated with reports of unfair treatment and depressive symptoms. Methods. We used the Detroit Healthy Environment Partnership's survey of 919 adults. Unfair treatment was measured as frequency of receiving poorer service than other people at restaurants or stores (dichotomized). Neighborhood food environment was measured as availability of five store types (large-grocery, small-grocery, convenience, liquor, specialty). Store where shopped was classified by type (supermarket, other) and location (Detroit, suburbs). CES-D measured depressive symptoms. Hierarchical regression estimated relationships, controlling for covariates (e.g., SES). Results. 27.7% of African-Americans reported unfair treatment compared to 17.4% and 14.7% of Latinos and Whites, respectively. Respondents with more liquor stores in their neighborhood were more likely to report unfair treatment, while those with a small grocer were less likely to report unfair treatment, though relationships were non-significant (p<0.10). Those shopping at a supermarket versus another store type were twice as likely to report unfair treatment (p<0.05). Store location was not related to unfair treatment. Associations did not differ by race/ethnicity. Unfair treatment was positively associated with depressive symptoms. Conclusions. African-Americans seeking healthy foods at supermarkets may encounter unfair treatment, with adverse consequences for mental health. Based on these results, planning and policy efforts that promote equity in physical and social access to food outlets will be discussed.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: Objectives: To illustrate the variability of indicators commonly analyzed as proxy measures of acculturation. Methods: Using logistic regression, we systematically examined associations between four indicators (nativity, English proficiency, country of residence during formative years and length of U.S. residence) with three health outcomes (self-rated health, chronic conditions, and behavioral risk) in a population-based cohort of Mexican-origin individuals in Harris County, Texas (n=12,464). Results: Being born in Mexico and reporting low English proficiency were associated with higher odds of reporting fair/poor health (OR=1.3; 95% CI: 1.19-1.43 & OR=1.55; 95% CI: 1.42-1.69), yet residing in the U.S. for 12 years or less was protective (OR=0.90; 95% CI: 0.82-0.99). For chronic conditions and behavioral risk, being born in Mexico was protective (OR=0.80; 95% CI: 0.72-0.89 & OR=0.65; 95% CI: 0.55-0.76). Residing in the US for 12 years or less (OR=0.74; 95% CI: 0.66-0.83) was protective against reporting chronic conditions while spending formative years in Mexico (OR=0.69; 95% CI: 0.51-0.93) was protective against behavioral risks. Conclusions: This methodical evaluation provides evidence of the limitations of the concept of acculturation and suggests a more nuanced, theoretically-grounded use in research.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: Understanding the factors that contribute to physical activity (PA) in Mexican-origin adolescents is essential to the design of effective efforts to enhance PA participation in this population. Multivariable logistic regression was used to identify sociodemographic and behavioral correlates of self-reported PA in school and community settings in 1154 Mexican-origin adolescents aged 12-17 years in Houston, TX. The majority of adolescents were born in the US (74%), approximately half (51%) were overweight or obese, and nearly three-quarters (73%) watched more than 2 hours of weekday television. Similarities and differences by setting and gender were observed in the relationships between sociodemographic and behavioral characteristics and PA. In boys, parental education and attending physical education (PE) were positively associated with PA across multiple PA outcomes. Adolescent linguistic acculturation was inversely associated with participation in community sports, whereas parental linguistic acculturation was positively associated with PA at school. In girls, PA in school and community settings was inversely associated with TV viewing and positively associated with PE participation. These findings highlight similarities and differences in correlates of PA among boys and girls, and point toward potential sources of opportunities as well as disparities for PA behaviors in Mexican-origin adolescents.
    Journal of Physical Activity and Health 08/2011; 9(6):829-39. · 1.95 Impact Factor
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    ABSTRACT: We examined the association between context of entry into the United States and symptoms of depression in an older age Mexican-origin population. We found that context of entry was associated with the number of depressive symptoms reported in this population. Specifically, immigrants who arrived to the U.S. following the Mexican Revolution (1918-1928) reported significantly fewer depressive symptoms, and those who arrived following enactment of the Immigration Reform Control Act (1965-1994) reported significantly more symptoms of depression, compared to those who arrived in the Bracero era (1942-1964). These findings suggest that sociopolitical context at the time of immigration may be associated with long-term psychological well-being. They contribute to a growing body of literature that suggests that the context of immigration may have long-term implications for the health of immigrant populations. We discuss implications of our findings for understanding relationships between immigration policies and the health of Mexican immigrant populations.
    Journal of Immigrant and Minority Health 08/2011; 13(4):706-12. · 1.16 Impact Factor

Publication Stats

141 Citations
56.51 Total Impact Points

Institutions

  • 2008–2014
    • Pennsylvania State University
      • Department of Health Policy and Administration
      University Park, Maryland, United States
  • 2011–2012
    • Wayne State University
      • Institute of Gerontology
      Detroit, MI, United States
    • University of Texas MD Anderson Cancer Center
      • Health Disparities Research
      Houston, TX, United States
  • 2007
    • University of Michigan
      • Department of Health Behavior and Health Education
      Ann Arbor, Michigan, United States