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The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science
Abstract
Similar to non-Hispanic Blacks, Hispanics/Latinos experience a range of psychosocial and physical health challenges, including high rates of poverty, neighborhood segregation, discrimination, poor healthcare access, and high rates of obesity, diabetes, and undiagnosed and late-stage diagnosed diseases. Despite such risks, Hispanics generally experience better physical health and lower mortality than non-Hispanic Whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. With the basic phenomenon increasingly well-established, attention now turns to the sources of such resilience. The current aims are to briefly examine the epidemiological paradox and highlight potential sociocultural resilience factors that may contribute to the paradoxical effects. We conclude with presentation of a framework for modeling sociocultural resilience and discuss future directions for psychological contributions.
... The most significant health disparities in this population, including diabetes and other metabolic disorders, have known linkages to compromised immune function and heightened inflammatory response [6,7]. However, despite exposure to economic and social stressors, Mexican-origin individuals and the broader Latino/a population living in the United States (US), have a higher life expectancy and suffer lower rates of many major causes of death than the overall US population [8][9][10][11]. The purpose of the La Vida en la Frontera study is to investigate how stress is related to chronic disease risk and to explore sources of resilience within social, cultural, and community-based contexts among Mexican-origin people living along the southwestern Arizona/Sonora border. The study is novel in providing a longitudinal examination of chronic stress on multiple types of biomarkers while quantitatively and qualitatively exploring potential sources of resilience that have protective influences on health. ...
... Despite these disproportionate economic, social, and structural inequities, Latino/as have a longer life expectancy than the overall US population [18]. The Sociocultural Resilience Model (SRM) is one framework to explain this phenomenon [9,11]. This model identifies important protective factors including social networks, social support, and interrelated coping processes as providing a buffering effect against stress exposure [4,11]. ...
... The Sociocultural Resilience Model (SRM) is one framework to explain this phenomenon [9,11]. This model identifies important protective factors including social networks, social support, and interrelated coping processes as providing a buffering effect against stress exposure [4,11]. (Fig. 1). ...
Background
Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies.
Methods
La Vida en la Frontera is a mixed-methods participatory study linking a multi-disciplinary University of Arizona research team with Campesinos Sin Fronteras, a community-based organization founded by community health workers in San Luis, Arizona. This paper describes the current protocol for aims 2 and 3 of this multi-faceted investigation. In aim 2 a cohort of N≈300 will be recruited using door-to-door sampling of neighborhoods in San Luis and Somerton, AZ. Participants will be surveyed and undergo biomarker assessments for indicators of health and chronic stress at three time points across a year length. A subset of this cohort will be invited to participate in aim 3 where they will be interviewed to further understand mechanisms of resilience and wellbeing.
Discussion
This study examines objective and subjective mechanisms of the relationship between stress and health in an ecologically diverse rural community over an extended timeframe and illuminates health disparities affecting residents of this medically underserved community. Findings from this investigation directly impact the participants and community through deepening our understanding of the linkages between individual and community level stress and chronic disease risk. This innovative study utilizes a comprehensive methodology to investigate pathways of stress and chronic disease risk present at individual and community levels. We address multiple public health issues including chronic disease and mental illness risk, health related disparities among Mexican-origin people, and health protective mechanisms and behaviors.
... Social disconnection is associated with decrements and disparities in physical and mental health for vulnerable and minoritized groups such as immigrants [37][38][39][40]. Notably, the Hispanic health paradox shows more positive health advantages for Latino immigrants, but these associations are actually moderated by social networks [41]. In other words, the Hispanic health paradox is dependent on the number and quality of social connections. ...
... Social support has a robust base of evidence for positive associations with immigrant physical and mental health [14,[47][48][49][50], but likewise, the concept of social support is diffused, with operationalizations ranging from family support [51] to social cohesion [52] to engagement in online forums [53]. Social networks have been identified as a protective factor against depression, anxiety, and substance use disorders in immigrants [54] and have been theorized to be the link between cultural processes and positive health outcomes [41]. Social capital has also been associated with better physical and mental health and improved quality of life in immigrants [55][56][57][58]. ...
Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.
... The expanding discourse regarding SDH has not been accompanied by significant expansion of epidemiologic research regarding mortality rates for major health conditions by SDH among Latinas. Deficiencies in the extant knowledge base on Latina health restricts the applicability of findings and ignores important subgroup differences in risk profiles and health outcomes that ultimately undermine surveillance efforts and treatment efficacy [82]. Characterizations and examinations of the U.S. Latino populations health research can no longer be described without attention to and recognition of demographic characteristics (e.g., race, ethnic origin, education, nativity) [7] and the disaggregation of data by Latino subgroups. ...
... Together, the lack of context regarding SDH and the consistent disregard for Latino heterogeneity have resulted in generalized narratives, such as the "Latino/ Hispanic health paradox, " [85] which claims that Latinos exhibit longer life expectancy and better health outcomes compared to NLWs, despite Latinos' high-risk social and economic profile [82], and the "healthy immigrant paradox" [86] which postulates that Latino immigrants have better health outcomes than their U.S.-born counterparts. Explanations of these purported immigrant health advantages often are explained by the selective migration of healthy people to the US and the return migration of less healthy people to their countries of origin in late life (sometimes labeled "salmon bias"), and personal and family health behaviors [86]. ...
Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-024-17721-9.
... Recent research has shown that the Hispanic health paradox is also found in lung cancer survival rates (Price et al. 2021). These latter results have been related to differences in cultural values that lead to higher social connections that may have health related benefits (Ruiz et al. 2016). Gordon (1964) argued that immigrants in the US experienced a gradual process of assimilation to the host country. ...
... More generally speaking, the differences in health outcomes among Hispanic subgroups demonstrates that the advantages in health reported by the Hispanic health paradox literature (Vega et al. 2009) is heterogeneous, as previous research has shown (Jerant et al. 2008;Garcia et al. 2018), and not found in all health outcomes, including deaths by COVID-19. Further research is needed to better understand the roots for these differences, since research has argued that these differences in health outcomes may be linked to differences in dietary habits, rates of smoking (Dominguez et al. 2015), differences in cultural habits that may lead to differences in family and social support (Ruiz et al. 2016), and to meso-and macro-level factors linked to residential segregation ). Further research is needed to understand how these different factors influence mortality rates in general and in specific health crises like the one faced under COVID-19. ...
This article studies the differences in the correlation between deaths and the Hispanic share for different Hispanic subgroups in New York City. Such differences are predicted by Segmented Assimilation Theory as different assimilation paths. The study is carried out at the level of PUMAs, and it is argued that such geographic locations are macro-level factors that determine health outcomes, as the theory of Racialized Place Inequality Framework claims. The study presents a spatially correlated model that allows to decompose the spatial effects into direct and indirect effects. Direct effects are linked to the macro structure where the individual lives, while indirect effects refer to effects in the adjacent macro structures where the individual lives. The results show that both types of effects are significant. The importance of the direct effects is predicted by RPIF, while the importance of the indirect effects is a new result that shows the complexity of the effects of macro structures. The article also shows results for subsamples that allow to test the importance of different factors that have been linked to the excess deaths observed among Hispanics. The effects of such factors are also found to be heterogenous among the different Hispanic subgroups, which also provides evidence in favor of the Segmented Assimilation Theory. Access to health insurance and doctor density are found to be the most important elements that serve as protective factors for all Hispanic subgroups in New York City, signaling its importance in achieving assimilation for Hispanic immigrants to New York City.
... Many have endured significant adversity (i.e., ACEs) and are at risk of experiencing NSSI and SA. Due to ACE exposure and trauma burden, Central American migrant youth may not benefit from health advantages demonstrated by the immigrant health and Hispanic health paradox (Ruiz et al., 2016;Venta, 2019). These factors have not been systematically studied, and it is necessary to do so in order to identify variables that can protect these demographic groups and establish clinical interventions. ...
... While NSSI has been shown to be predictive of later SA (Chan et al., 2016;Ribeiro et al., 2016), other works have failed to identify such an association, with Wichstrøm (2009) specifically recognizing that NSSI and SA have both shared and independent predictors, conceiving them as only partially overlapping events. Additionally, results from the present study contradict historical evidence of the Hispanic Health Paradox, which supports that despite greater risk for poor physical and mental health outcomes, Hispanic demographics tend to exhibit fewer overall health deficits compared to non-Hispanics (Abraído-Lanza et al., 1999;Ruiz et al., 2016). This supports the need for future research to investigate recognized factors of resiliency among Latinx populations outside of attachment security, such as ethnic identity (Taylor & Jones, 2020) and familismo (Ayón et al., 2010;Walker et al., 2022). ...
En los últimos años, la prevalencia de autolesiones no suicidas (NSSI) y los intentos de suicidio (SA) entre los grupos de adolescentes y adultos jóvenes latinos ha aumentado en comparación con otras razas y etnias, y se cree que las experiencias adversas en la infancia (ACE) contribuyen a esta disparidad. Los jóvenes y adultos jóvenes migrantes centroamericanos están en alto riesgo de exposición a experiencias adversas en la infancia y son un grupo demográfico cada vez mayor en los EE. UU. Sin embargo, son escasas las investigaciones existentes sobre la prevalencia de autolesiones no suicidas e intentos de suicidio en esta población. Por lo tanto, se considera un grupo demográfico crítico de estudio. De manera inversa, las relaciones de apego seguro se han asociado con un menor riesgo de autolesiones no suicidas y de intentos de suicidio entre los jóvenes latinos. Esto concuerda con la teoría interpersonal del suicidio de Joiner (2005), que pone de relieve la ausencia de relaciones afectivas como un componente de pertenencia frustrada. El presente estudio tuvo por objeto investigar la importancia de las experiencias adversas en la infancia como factor de riesgo de autolesiones no suicidas o de intentos de suicidio en una muestra de estudiantes de secundaria migrantes centroamericanos, con la seguridad paterna y materna como factores moderadores. Se encontró que la seguridad que aporta el apego materno, aunque no la seguridad del apego paterno, amortiguaba la relación entre las experiencias adversas en la infancia y la historia de autolesiones no suicidas o de intentos de suicidio. En este estudio se subraya que la seguridad que aporta el apego materno constituye un factor de protección crucial contra el riesgo de autolesiones no suicidas o de intentos de suicidio en alumnos de secundaria migrantes centroamericanos.
... Of interest, Davidson et al.'s (this issue) findings indicated that Latinx caregivers reported lower individual SES but comparable levels of social support satisfaction, and depressive symptoms, which is consistent with the so-called Hispanic paradox. The Hispanic paradox describes the phenomenon in which Hispanic Americans (including Latinx individuals) have on average been found to experience better health outcomes than their White counterparts despite experiencing a disproportionate burden of SES, psychosocial, and physical health challenges (Ruiz et al., 2016). Indeed, scholars have suggested that these health advantages may reflect resilience through cultural factors, and increased social support based on the emphasis on familismo in Hispanic families, that facilitate healthpromoting processes (e.g., Campos et al., 2014;Gallo et al., 2009;Ruiz et al., 2016). ...
... The Hispanic paradox describes the phenomenon in which Hispanic Americans (including Latinx individuals) have on average been found to experience better health outcomes than their White counterparts despite experiencing a disproportionate burden of SES, psychosocial, and physical health challenges (Ruiz et al., 2016). Indeed, scholars have suggested that these health advantages may reflect resilience through cultural factors, and increased social support based on the emphasis on familismo in Hispanic families, that facilitate healthpromoting processes (e.g., Campos et al., 2014;Gallo et al., 2009;Ruiz et al., 2016). Additionally, Davidson et al. (this issue) explored ethnicity (Latinx vs. non-Latinx) as a moderator of the relationship between individual SES and depressive symptoms, and individual SES and social support satisfaction. ...
“Your child has cancer.” Each year, parents and caregivers of over 15,000 children in the USA will hear those words as cancer is the number one cause of death by disease in children across all ages, ethnic groups, and socioeconomic status (American Cancer Society, 2023; CureSearch for Children’s Cancer, 2022). Although the survival rate for pediatric cancer has largely increased, the number of annual diagnosed cases has not declined (American Cancer Society, 2022). A child’s new cancer diagnosis can profoundly affect caregivers by imposing tremendous stress which may affect their own mental health and adjustment. Caregiver depression and distress may influence their child’s cancer treatment by impacting caregiving behaviors and support, threaten overall family functioning, as well as affect the continuation of care and treatment follow-up (e.g., Bakula et al., 2019). As such, it is critical for pediatric psychologists to understand factors that can influence caregivers’ well-being in the context of pediatric oncology.
... As aforementioned, the Latinx Health Paradox has led to the assumption that the association between SES and health is universally paradoxical among all Latinx subgroups [11,13]. However, this does not appear to be the case, particularly when examining psychological distress-a strong predictor of the population's mental health status [35]. ...
... This is consistent with previous investigations looking at the effects of unemployment on mental health in the general population of the US [52]. However, as anticipated, these findings contradict the predominant literature in the Latinx health space, which indicates that Latinx have better health outcomes in the presence of worse socioeconomic standing [11]. Unfortunately, due to the limited nature of studies that examine mental health and SES among Latinx subgroups, particularly among individuals who identify as Dominican, we cannot point to previous literature that identifies similar trends. ...
Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014–2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.
... The Black-White mental health paradox is in fact a part of a much larger ethno-racial paradox pertaining to other ethno-racial groups and a range of psychiatric conditions. Hispanic/Latino Americans frequently experience social stressors and barriers to resources (Colen et al., 2018), yet often exhibit a mental health advantage (Alcántara et al., 2017;Oh et al., 2022;Ruiz et al., 2016), depending on the ethnic subgroup and generational status (Alegría et al., 2008). The mental health advantage is less pronounced for US-born Hispanics/Latines or Hispanics/Latines who arrived as children , but nonetheless reveal paradoxical findings. ...
Background
Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their White counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox.
Methods
We analyzed data from the Healthy Minds Study (2020–2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression.
Results
Black students reported lower mean impairment scores relative to White students at moderate and severe anxiety. Hispanic/Latine students only reported lower impairment relative to White students at severe anxiety. Asian students reported relatively lower mean impairment than White students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression.
Conclusion
Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to White students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.
... In addition, all foreign-born Latinos with ≥ 15 years in the US and US-born Latinos had a higher predicted probability of being overweight/obese than US-born non-Latino Whites. This is consistent with studies that have found that Latinos have among the highest percentages of obesity in the United States, [43][44][45] and obesity has been found to increase with length of residence in the United States. 21,46 Cofie and Cuevas (2023) 47 also found that recent Latino and Black immigrants had a higher prevalence of obesity than other racial and ethnic immigrant groups, and their prevalence was lower than that of US-born adults. ...
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.
... This leads to the possibility that social cohesion and support systems may be factors causing the Hispanic paradox, as neighborhoods with a high percentage of Mexican Americans (or African Americans) are typically economically disadvantaged. Ruiz et al. (2016) present a model for Hispanics and Latinos in which their sociocultural values, which place greater emphasis on social ties and family, may provide some (sociocultural) resilience in the event of illness. There are, however, some health indicators outside the paradox, namely related to diabetes, breast and cervical cancer, and communicable diseases especially tuberculosis and hiv (United States-Mexico Border Health Commission, 2020). ...
The areas near a country border have interesting demographics since they are the zones where two cultures collide. The USA has two long land borders with Canada and Mexico. Mortality between 1999-2019 is examined at the county level in the two border regions, compared to the non-border regions of the border states. Analysis is based on single figure indices, with combinations of confounders age, gender and cause of death. Findings confirm differences between border and non-border regions, with opposite results at each border. As far as is known there is no previous mortality study concerning both borders and therefore the contribution of the work is to demonstrate the differences between the border and non-border regions for the two borders and discuss possible reasons. Further, we show that the more detailed analysis at the county level, even with certain data limitations, gives important insights to the topic.
... Social support has a robust base of evidence for positive associations with immigrant mental health, [14,41,42] but likewise the concept of social support is diffused, with operationalizations ranging from family support [43] to social cohesion [44] to engagement in online forums [45]. Social networks have been identified as a protective factor against depressive, anxiety, and substance use disorders in immigrants [46] and have been theorized to be the link between cultural processes and positive health outcomes [47]. Social capital has also been associated with better mental health [48,49]. ...
Social connectedness connection is a core dimension of health and wellness among all populations, yet the experience of moving to, and living in, a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Illustrated in a model of socioecological connectednesssocial connection, Using hybrid (inductive/deductive) qualitative analysis, we identified seven themesdomains of social connection from the perspective of the interviewed participants: 1) Lens of the individual is a filter for the social world; 2) Immigrant experience colors everything; 3) Interpersonal support enhances quality of life; 4) Community belonging fosters a sense of connectedness; 5) Community capital boosts security; 6) Community navigation promotes integration; and 7) Social acceptance strengthens inclusion. In the healthcare field, we lack conceptual clarity of the distinct connectedness domains that drive positive health outcomes in immigrant populations. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of socioecological connectednesssocial connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. health. Additionally, our model of socioecological connectednessthese results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess connectedness social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.
... 23,24 For example, Latinos not only have longer life expectancies than non-Hispanic whites but also have lower rates of deadly diseases such as stroke and heart disease. 25 Such 'Latino health paradox' is often ascribed to the beneficial effects of migrants' close-knit groups of peers, particularly those with the same ethnic background. 26 These strong group ties convey social support, including emotional, instrumental, informational and appraisal-based assistance, which contribute to better health outcomes. ...
Objectives
This study examined how Mexican and Central American immigrants' social support was associated with three selected dental outcomes among recent immigrants, prior to the 2020 COVID‐19 pandemic.
Methods
Using baseline wave data from the 2017–2022 VidaSana study about the health and social networks of Mexican and Central American immigrants living in Indiana, this study utilized logistic and ordinal logistic regression to predict lifetime fluoride use, lifetime dental restoration and flossing frequency, across levels of social support and differences between Mexican and Central American immigrants.
Results
Data from 547 respondents were included in the present analysis (68% women; mean age 34.4 years [SD 11.2]; Central American 42%; Mexican 58%). Results show a high level of social support was associated with increased probability of fluoride use, dental restoration and higher flossing frequency for Mexican immigrants. However, social support for Central American immigrants was associated with a decreased likelihood of fluoride use, more infrequent flossing, and had no significant association with dental restorations experience. What would be a negative association between Central American immigrants and dental restoration was accounted for by education level and never having been to a dentist.
Conclusions
While higher social support was linked to beneficial outcomes for oral health in Mexican immigrants, the opposite was found in Central Americans. These findings highlighted the complexities of social relationships among new immigrants, and potential heterogeneity within the Hispanic population, particularly regarding social and behavioural measures as they pertain to oral health. Further research is needed to identify the underlying mechanisms producing both differences in social support and oral health outcomes.
... Residence in socially integrated ethnic enclaves may also provide a place where more health-sustaining cultural habits are maintained (e.g., improved nutrition and lower smoking rates) [9]. In some cases, these advantages superseded the influence of material factors such as poverty, difficulty accessing health services, substandard housing and lack of availability and affordability of healthy foods, which serve as barriers to optimal health [10,11]. ...
Background
Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis.
Methods
A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011–2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering.
Results
Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78–1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49–0.90). Null associations were observed among patients ≥ 64 years.
Conclusions
Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.
... D. Williams et al., 2020). Further, caregivers' cultural socialization (i.e., caregivers' efforts to teach children about their cultural background; Hughes et al., 2006) has also been found to be an important protective process in Mexican-origin families (Ruiz et al., 2016). Although ERI and cultural socialization have been protective in mitigating relations between risk and maladjustment among adolescents (e.g., Neblett et al., 2012), less work has been conducted with young children, especially children born to adolescent mothers. ...
Objectives: The present study examined whether sociocultural risk factors (i.e., mothers’ risky behaviors, mothers’ and grandmothers’ ethnic discrimination, and family economic hardship) predicted children’s internalizing behaviors. We also tested whether sociocultural protective factors, including children’s positive ethnic–racial identity (ERI) attitudes and mothers’ cultural socialization, moderated relations. Method: Participants were 182 5-year-old Mexican-origin children, their mothers, and grandmothers. Results: Findings indicated that children’s positive ERI attitudes were protective, such that grandmothers’ discrimination predicted children’s greater internalizing at low levels of children’s positive ERI attitudes, but this relation was not significant at high levels of children’s positive ERI attitudes. Mothers’ cultural socialization was also protective, such that mothers’ risky behaviors predicted children’s greater internalizing at low levels of mothers’ cultural socialization, but this relation was not significant at high levels of mothers’ cultural socialization. Economic hardship predicted children’s greater internalizing and no variables moderated this relation. Conclusions: Findings highlight that mothers’ engagement in risky behaviors, grandmothers’ ethnic discrimination experiences, and family economic hardship contribute to children’s greater internalizing behaviors. However, in some of these relations, children’s positive ERI attitudes and mothers’ cultural socialization are protective. In future research and programming, a consideration of the role of individual, family, and cultural factors will be important for addressing and reducing children’s internalizing behaviors.
... It is possible that as participants lived in cohesive neighborhoods, more women learned about the U.S. health care system from their neighbors and friends, as indicated by the increase in perceived access to health care for the average study participant. Such information, if beneficial, would then facilitate their access to health care and promote health (Ruiz et al., 2016(Ruiz et al., , 2018. Beyond increased information and awareness, cohesive neighborhoods also may provide Latina young adult immigrants with supportive social networks that improve their access to health care (Flores et al., 2022) through various mechanisms. ...
The present longitudinal study examined changes in perceived access to health care among a recently immigrated cohort of Latina young adults who were assessed annually during their first 3 years in the United States. A parallel process growth model of perceived access to health care and neighborhood collective efficacy was examined, accounting for socioeconomic indicators and immigration status. Five hundred thirty Latina young adults (ages 18–23) participated at baseline assessment, and approximately 95% were retained over three annual assessment time points. Participants’ mean level of perceived access to health care increased during their initial 3 years in the United States. Women who reported more of an increase in perceived access to health care tended to also indicate increased neighborhood collective efficacy relative to their peers during their first 3 years in the United States. Findings offer important information about the individual- and community-level factors that influence recently immigrated Latinas’ health care access.
... A study done with PR elders found that support from neighbors was vital to daily functioning when family was unavailable or unreliable (Guzzardo & Sheehan, 2013). Due to Latinx cultural emphasis on interpersonal harmony and warmth (i.e., simpatía; Ojeda et al., 2011;Ruiz et al., 2018), connections with community members may facilitate greater social integration and tighter community ties, which may lead to more social capital and collective coping (Campos & Kim, 2017;Ruiz et al., 2016). However, to our knowledge, there is limited research that examines the cultural significance of community support and cultural values on PR men's well-being. ...
Objectives:
Structural and interpersonal discrimination can lead to social exclusion and limited social integration, inhibiting the use of support networks to gain access to health-protective material and social resources. Social support theories suggest that connectedness may moderate the link between discrimination and health risk. This study examined how risk factors (i.e., structural and interpersonal discrimination) further marginalize Puerto Rican men by limiting access to social support. We also aimed to identify resiliency factors, such as cultural values related to social interactions and community support, which may be protective for these men's well-being.
Method:
We conducted 40 semistructured interviews with a stratified purposeful sample of Puerto Rican (92.5%) men aged 25-70 (Mage = 50.7) in the U.S. Northeast. A hybrid deductive and inductive thematic qualitative analysis was used to analyze data.
Results:
Participants discussed how structural and interpersonal discrimination result in inequities and barriers to resources and services (e.g., lack of adequate shelter, insecurity, employment) which impacted their well-being through the inability to access fundamental support for survival. The men identified cultural values (e.g., familismo, simpatía) and emphasized the importance of community support as protective factors that may provide a respite from the difficulties of navigating discrimination experiences.
Conclusion:
Findings suggest discrimination limits Puerto Rican men's ability to access resources, which has a detrimental impact on their well-being. Identifying social support beyond the family, and considering cultural values related to support, can enhance community interventions by focusing on incorporating multiple forms of support that may improve Puerto Rican men's health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... As Ruiz et al. (2016) defined it, the Hispanic health paradox is an epidemiological phenomenon by which Latinos, despite all the social, emotional, and cultural hardships experienced in the United States, in addition to biological predispositions for chronic disease, enjoy a lower mortality rate and better physical health than non-Hispanic whites. As a prime example, Hispanics have a lower incidence of the most common type of cancers, such as breast, lung, colorectal, and prostate -non-infectious cancers that affect non-Hispanic whites at higher rates. ...
This paper examines the "Hispanic (American) Health Paradox," the juxtaposition of Hispanics' longer lifespan than the average American amid numerous inequities regarding social determinants of health. Hispanic Americans endure multiple health disparities with a higher incidence and prevalence of chronic conditions. They also experience multiple psychosocial and physical health challenges, including higher rates of food insecurity, poverty, segregation, discrimination, and limited or no access to medical care. Nevertheless, Hispanics enjoy better physical well-being and lower mortality rates when compared to non-Hispanics in the United States (Ruiz et al., 2021). This project aims to analyze the sources of this group's biosocial advantages and resilience, allowing them to have a longer lifespan amidst their lower health status and increased risk for chronic conditions. It explores the political and social justice implications of these inequities. It also examines the strategies to close the gap on Latinos' current health care disparities via public policy aspects of federal and state legislature. A narrative review method was utilized to examine the existing literature on this paradoxical effect. Keywords based on Medical Subject Headings (MeSH) used to search resources for relevant studies included: Hispanic health paradox (health paradox, immigrant paradox), ethnic minorities (Latinos, LatinX), health disparities (disproportionate health, health inequities), social justice (healthcare stakeholders, health inequities solutions, inequities recommendations), mental health, physical health, and co-morbidities. A quality assessment of full-text peer-reviewed articles yielded 80 articles to compile this narrative review. The research revealed that, despite glaring disparities in social determinants of health, Hispanic Americans have overall experienced better health outcomes through a culture that emphasizes spirituality, community support, and strong family ties.
... Greater life expectancy has also been documented specifically among Mexican-origin individuals living in border communities [9]. propose the sociocultural resilience model (SRM) as a means to conceptualize attributes of Latino/a culture that may be health-promoting [10]. The SRM posits that cultural values associated with strong family ties and interpersonal relationships work in tandem with strong reciprocal social networks to increase social integration to buffer stress and ultimately improve health outcomes [11]. ...
U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study’s initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.
... The lower mortality rates throughout the period for infants of Hispanic teens, despite their higher birth rates compared with white teens, may be partially explained by the "Hispanic paradox," a phenomenon in which the Hispanic population of the United States has health outcomes that are similar to-or often better than-the white population despite being more likely to be socioeconomically disadvantaged. [37][38][39][40] Infants of Hispanic mothers have similar or lower rates of infant mortality and low birth weight compared with their white counterparts. 1 Furthermore, living in communities with a high proportion of Hispanic residents is associated with lower infant mortality, higher birth weight, and lower smoking rates during pregnancy for Hispanic mothers, regardless of their socioeconomic status or healthrelated behaviors. ...
Background and objectives:
Although mortality rates are highest for infants of teens aged 15 to 19, no studies have examined the long-term trends by race and ethnicity, urbanicity, or maternal age. The objectives of this study were to examine trends and differences in mortality for infants of teens by race and ethnicity and urbanicity from 1996 to 2019 and estimate the contribution of changes in the maternal age distribution and maternal age-specific (infant) mortality rates (ASMRs) to differences in infant deaths in 1996 and 2019.
Methods:
We used 1996 to 2019 period-linked birth and infant death data from the United States to assess biennial mortality rates per 1000 live births. Pairwise comparisons of rates were conducted using z test statistics and Joinpoint Regression was used to examine trends. Kitagawa decomposition analysis was used to estimate the proportion of change in infant deaths because of changes in the maternal age distribution and ASMRs.
Results:
From 1996 to 2019, the mortality rate for infants of teens declined 16.7%, from 10.30 deaths per 1000 live births to 8.58. The decline was significant across racial and ethnic and urbanization subgroups; however, within rural counties, mortality rates did not change significantly for infants of Black or Hispanic teens. Changes in ASMRs accounted for 93.3% of the difference between 1996 and 2019 infant mortality rates, whereas changes in the maternal age distribution accounted for 6.7%.
Conclusions:
Additional research into the contextual factors in rural counties that are driving the lack of progress for infants of Black and Hispanic teens may help inform efforts to advance health equity.
... Interestingly, individuals who identified as Mexican followed Puerto Ricans as the group with the second lowest levels of SRH when compared to non-Latinx whites. Although this is a group that is typically expected to have better health outcomes when compared to non-Latinx whites (Ruiz et al., 2016), previous studies have found that health advantages among Mexican immigrants disappear in subsequent US-born generations of individuals who identify as Mexican (Boen & Hummer, 2019;Giuntella, 2016). Consistent with previous literature, our findings revealed that individuals who identify as Mexican and were born outside of the US were more likely to report better levels of SRH when compared to individuals who were born in the US states. ...
Latinx represent a growing population in the United States (US) that continue to experience a disproportionate burden of disease. However, health disparities vary across Latinx subgroups, including Mexican, Puerto Rican, and Cuban communities, particularly when assessing self-rated health. Given the nature of political exclusion in the US, these differences may be associated with underexplored political factors, or political determinants of health, within the social environment that distinctly shape health among racial and ethnic minorities. To explore potential pathways that connect the political environment to individual-level health outcomes among Latinx subgroups, political efficacy (or one's perceptions about one's power to influence political affairs) was assessed as a correlate of self-rated health. We used secondary data from the 2016 Collaborative Multiracial Post-election Survey to conduct ordered logistic regression analysis to determine whether two domains of political efficacy, internal and external political efficacy, were correlates of self-rated health among Mexican, Puerto Rican, and Cuban subgroups as compared to non-Latinx whites in the US. We also tested for differential associations across Latinx subgroups as compared to non-Latinx whites. The sample consisted of 3156 respondents (1486 Mexicans, 484 Puerto Ricans, 159 Cubans and 1027 non-Latinx whites). Among Puerto Ricans, results revealed that lower levels of internal political efficacy were associated with higher levels of self-rated health. Conversely, among other subgroups, positive associations between internal political efficacy and self-rated health were observed. This study provides empirical evidence of a relationship between internal political perceptions and health perceptions that has not previously been established within the Latinx health disparities literature. Future investigations should continue to examine pathways that connect political determinants to individual-level health outcomes, particularly among communities that disproportionately experience political exclusion.
... Most Latina mothers within our sample were born in the US and foreign-born experiences were not as represented in this study. This may be an important dimension to consider in future studies as epidemiological studies support a "Latinx Health Paradox" such that foreign-born Latinx individuals show better physical health compared to their US-born counterparts [26,65]. Lastly, measuring parental values and practices with infant caregiving would allow for greater insight into conceptualizations of motherhood, which have been indicated to vary across cultures [33]. ...
Cultural neuroscience is an emerging framework positing that culture (for example, values, beliefs, practices, and modes of emotional expression) critically informs socialization goals and desired behaviors, which are perhaps accompanied by differential patterns of brain activation. Using fMRI, the current study examines brain activation to infant cry stimuli and matched white noise among 50 first-time biological mothers identifying as Latina or White in the United States. Results showed that brain activation to infant cries in the right posterior insula, left cerebellum, and left auditory were higher for White mothers compared to Latina mothers, p's <.05. White mothers showed greater activation to cry sounds compared to white noise in the right dorsolateral prefrontal cortex, left somatosensory, right and left premotor cortices, p's <.05, whereas Latina mothers did not. These brain regions are involved in motor planning, movement, sensory processing, and social information processing. It is important to note that mothers in the two groups did not show differences in stress and behavioral parenting measures. Therefore, Latina and White mothers differentially recruiting brain regions related to infant parenting behaviors indicates the potential role of cultural context in shaping patterns of neural activation. Our exploratory analysis suggests that this difference might be due to greater pre-parenting exposure among Latina mothers to children compared to White mothers. Taken together, although our data did not completely explain the differences in brain activation between groups, findings suggest potential culture-related influences in brain activation occurring in the postpartum period.
... The role of individual versus community level social support is an important factor in how resilience is developed in the face of difficult circumstances. Because individuals in the United States are socialized to be individualistic, inherited social networks have been proposed in recent models of health to promote sociocultural resilience and mental well-being, generally consistent with frameworks of social engagement that are embedded in South American cultures (Ruiz et al., 2016). Those who inherit connections through their family or community (as opposed to creating new networks) often inherently have more access to resources and more social support when needed than those who do not inherit such linkages. ...
Objectives:
Language barriers, isolation, and challenges related to social integration, acculturative stress, and systemic discrimination are correlated with poor physical and mental health outcomes among immigrant populations. Emerging literature highlights the importance of social networks for resiliency and well-being. This study explores the experiences of Venezuelan immigrants in central Florida, factors that have promoted resilience, and considerations for mental health providers to meet the needs of this population.
Method:
A phenomenological approach was used to engage Venezuelan immigrants who had been in the United States for at least 6 months (n = 48) in dialogue about forced migration, identity, and adaptation. Five focus groups using a semistructured format were conducted to explore aspects of the experience before, during, and after migration. Recruitment was done through word of mouth and community gatekeepers.
Results:
Participants were 54% female with an average age of 45, 85% had at least 1 college degree, and more than half left Venezuela since 2011. Themes were identified from the focus group transcripts and clustered into three broad areas: characteristics and individual experiences, mental health, and family and social context. Major findings included the need for culturally responsive mental health support, which appeared to mitigate distress and the centrality of social networks in support of resiliency.
Conclusions:
Findings from the present study suggest that community context, support for ethnic identity, and the ability to foster meaningful connections to others with similar experience and identity are critical factors in resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Past research on the Latino health paradox demonstrates that Latinx individuals have higher life expectancy and overall comparable physical health to nonHispanic Whites, despite the greater psychosocial risk factors that they face (e.g., low socioeconomic status, discrimination, poor health care access; Franzini et al., 2001). Some researchers propose that this paradox is due to sociocultural factors that promote resilience among the Latinx population, specifically collectivistic values such as family (familismo), interpersonal harmony (simpatía), and respect for elder community members (respeto; Ruiz et al., 2016). These values facilitate familial and communal support systems that can protect against negative health outcomes (Ayón et al., 2010) and may also affect the attributional tendencies of Latinx individuals. ...
Past research demonstrates that perceived discrimination predicts a range of negative psychological and physical health outcomes. However, most research has been limited by a sole focus on individuals’ attributions of negative life outcomes to discrimination and fails to account for potentially simultaneous self-blame attributions. The current research examined the independent and interactive effects of discrimination and self-blame attributions on health over a 3-year time period. A longitudinal study was conducted at a 4-year university in the western United States. Overall, 274 Latinx students were followed from college entry in Fall 2016 through the end of their third year in Spring 2019. Discrimination and self-blame attributions each uniquely predicted poorer psychological health. Discrimination attributions were a stronger predictor of physical health than self-blame. As predicted, self-blame also moderated the effect of discrimination attributions such that the combination of blaming negative events on discrimination and on the self was particularly harmful for self-reported mental and physical health. In the absence of self-blame, the effect of discrimination attributions was reduced to nonsignificance. Self-blame did not moderate the negative impact of discrimination attributions on physiological health markers. Findings highlight the importance of understanding how discrimination and self-blame attributions jointly negatively impact health.
... Second, Prescott et al. (2018) conducted a meta-analysis that examined only studies that used a prospective design (those that measure predictor variables at two points in time, but only measure the dependent variable of interest at the second point in time), found that Latinx samples (also from North America) showed a nonsignificant effect of media violence exposure on aggression. 2 These two findings may be consistent with research that has found positive health outcomes in Latinx samples despite hardship associated with societal oppression. This "Hispanic Paradox" (Llabre, 2021;Ruiz et al., 2016;Weden et al., 2017), combined with the findings of Greitemeyer and Mügge and of Prescott et al., suggests that there may be protective factors (e.g., family support and social support) that may reduce the media violence effect on aggression in some Latinx samples, especially those in North American. ...
Numerous studies from various countries and cultural backgrounds have found a link between media violence consumption and aggressive behaviors and cognition. However, some failures to replicate these findings potentially suggest that some Latinx cultures may be relatively invulnerable to such harmful effects. To investigate this, media violence exposure and aggression data were collected from samples of predominantly Latinx communities in Brazil, Mexico, and Southwest Texas U.S., as well as from a Canadian sample for contrast. Replication and extension tests of hypotheses derived from the general aggression model and the 7 Nations Media Violence Project (Anderson et al., 2017) were conducted. This cross-sectional study (N = 862) revealed violent media exposure-to-aggression effect sizes with Latinx samples that are comparable to those from other ethnicities and countries in previous studies. This relation remained significant in statistical “destructive tests” that included other major risk factors for aggression in the model. The effect generalized across samples, sex, and type of aggression (physical, verbal, and relational).
... Most Latina mothers within our sample were born in the US and foreign-born experiences were not as represented in this study. This may be an important dimension to consider in future studies as epidemiological studies support a "Latinx Health Paradox" such that foreign-born Latinx individuals show better physical health compared to their US-born counterparts [26,65]. Lastly, measuring parental values and practices with infant caregiving would allow for greater insight into conceptualizations of motherhood, which have been indicated to vary across cultures [33]. ...
... 67 Previous studies suggest that variations in both stress exposure and health among Hispanic and Latino populations may differ by nativity status (foreign-born versus US-born Hispanic adults), 35 differences in Hispanic or Latino subgroups, 68 and/or sociocultural factors, such as acculturation and return migration later in life, which can differentially impact health. [69][70][71] Given that the present study examined Hispanic and Latino ethnicity as Hispanic or Latino versus not Hispanic or Latino because of small sample sizes within Hispanic or Latino ethnicity, there may be important subgroup differences based on country of origin or acculturation that could be further explored. ...
Background
Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time.
Methods and Results
Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively).
Conclusions
Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.
... Lower mortality rates are despite all socioeconomic and systemic disparities to which Hispanic individuals are subjected. 8 Although this concept has been studied for more than 30 years, the reason behind this unique paradox is still not completely known, but is often attributed to resiliency through social support and optimism offsetting stress. 9 A strong argument has been made to attribute the positive health status of Hispanics to language. ...
Cross-cultural communication has many challenges due to the complexity of culture, communication, and language. Improving cross-cultural communication in health care is critical to reducing disparities and improving health equity. Specifically, improving cross-cultural communication must be prioritized to overcome systemic barriers and to eliminate disparities that stem from stigma and biases. Communication must be improved, ideally via a cultural humility framework. Unconscious bias and communication training must be intentional. Culture is an attribute and should be celebrated and incorporated into health practice at all levels to prioritize health equity.
... 18 In women, lung cancer mortality is substantially higher in both Mexican immigrants and Mexican Americans. 19,20 Regarding disparities in lung cancer screening, there is not a lot known yet because the practice is being adopted slowly, but there is also concern that the revised US Preventive Services Task Force guidelines may perpetuate lung cancer disparities because racial and ethnic minority groups are still less likely to be eligible for lung cancer screening. 21 If social determinants cannot only fully explain the disparities seen in Hispanics, we need to investigate the biology and the genomic profile of lung cancer in Hispanics to try to explain the HHP. ...
Lung cancer is a public health problem and causes more deaths than any other cancer.1-3 We expect to have 130,000 deaths in the United States in 2021, and more than 60,000 deaths per year have been registered in Latin America (LATAM).4,5 Hispanics are the largest minority group in the United States (18% of the population), and there are more than 20 countries with Hispanic populations in LATAM. Disparities in the diagnosis and clinical outcomes of Hispanic patients with lung cancer compared with non-Hispanic White (NHW) patients are well documented. Hispanics have disadvantages in social determinants of health: access to care, health insurance, cultural differences, and immigration status. Moreover, there are also genetic and other biological differences that need to be considered. Hispanics in LATAM have some extra hardships; most of them live
in countries classified as low- and middle-income countries. In this editorial, we comment on disparities in genetics, biomarker testing, and therapy outcomes in Hispanic patients with lung cancer in the United States and abroad, which significantly affect access to precision medicine and survival.
... This trend has also been noted for other health outcomes, which has given rise to the term "Hispanic health paradox." 11 Some limitations to our study include the use of county-level variables to capture socioeconomic status and screening habits. Individual-level factors may have a different effect on survival. ...
Introduction
Thyroid cancer incidence has increased substantially in the past 4 decades, estimated at 3.5% annually. Incidence is highest in white patients, yet black patients have the worst survival. Racial/ethnic differences in presentation and outcomes are hypothesized to be a result of differences in access to care. Analyses delineating the relative contribution of access to racial/ethnic survival disparities are scarce. We aimed to explore the association of delay in access to care and early/increased detection with racial/ethnic disparities in thyroid cancer survival.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was queried from 2007 to 2011 for patients with a first primary thyroid cancer diagnosis and up to 5 years of follow-up. Composite scores were generated from county-level variables to capture socioeconomic status and screening habits. Kaplan-Meier analysis and Cox proportional hazards models were utilized for survival analysis.
Results
We identified 46,970 patients (67% white, 7% black, 15% Hispanic, 10% Asian or Pacific Islander, and 1% unknown/other). Compared to white patients, black, Hispanic, and Asian or Pacific Islander patients were more likely to present with distant disease (3% vs 5%, 5%, and 6%, respectively; P < .001). After adjusting for sex, age, stage, subtype, tumor size, surgery, radiation, socioeconomics, and screening habits, black patients were the only race/ethnicity found to have increased odds of 5-year mortality compared to white patients (24%, P < .001).
Conclusion
Thyroid cancer survival is worst for black patients regardless of socioeconomic status or screening habits. Racial/ethnic disparities in survival are not attributable to early detection alone.
... Son muy numerosos los estudios que han corroborado la denominada paradoja de la salud hispana, que hace referencia a unas condiciones de salud relativamente mejor de los inmigrantes hispanos en Estados Unidos comparados con otros grupos sociodemográficos similares, a pesar de que los primeros presentan menores niveles de educación, mayores tasas de pobreza y un menor acceso a los servicios de atención médica (Morales et al., 2002;García Gómez y oliva, 2009: 39;Ruiz et al., 2016;Basu Roy et al., 2020). Las ventajas de salud de los inmigrantes mexicanos han sido atribuidas a dos factores: i./ los individuos sanos son los que más comúnmente emigran, y ii./ los enfermos suelen regresar a sus comunidades de origen (Donato et al., 2004: 48). ...
Resumen | El trabajo asalariado agrario es una de las actividades laborales que comporta riesgos más elevados. Este artículo, sustentado en una metodología cualitativa que implicó la realización de entrevistas en profundidad a 23 jornaleros migratorios veracruzanos que se asentaron en la comarca citrícola de Tamaulipas, tiene como objetivo examinar los problemas de salud que padecen los jornaleros migratorios que se asentaron en esta región, y analizar el impacto que ha tenido la pandemia de COVID-19 en la población estudiada. Concluimos que la mayor parte de los entrevistados padecían severos problemas de espalda debido a las pesadas cargas que deben levantar. Los jornaleros migratorios muy pocas veces se recuperan totalmente de las lesiones sufridas en el trabajo, de modo que su salud sufre un deterioro progresivo. Finalmente, los elevados gastos médicos derivados del COVID-19 han conducido a severos problemas de endeudamiento de las familias jornaleras. Palabras clave: Agricultura, Jornaleros migratorios, Salud, COVID-19, Tamaulipas. | Abstract | Agricultural wage labour is one of the activities with the highest risks. This article, based on a qualitative methodology that involved conducting in-depth interviews with 23 migrant farmworkers from Veracruz who settled in the citrus-growing region of Tamaulipas, aims to examine the health problems suffered by migrant farmworkers who have settled in this region, and analyze the impact that the COVID-19 pandemic has had on the population under study. We concluded that most interviewees suffered from severe back problems due to the heavy loads they must lift. Migrant farmworkers rarely fully recover from injuries at work. Therefore, their health suffers a progressive deterioration. Finally, the high medical expenses derived from COVID-19 have caused migrant farmworkers severe debt problems.
The construct of machismo has been useful for understanding masculinity and the negative health-related outcomes associated with adherence to it among Mexican and Mexican American men. Machismo, as a sociocultural construct, is theorized to represent the negative aspects of masculinity, and as a result, omits the positive dimensions of masculinity. Researchers have discovered that machismo is, in fact, bidimensional, containing two separate constructs which represent both the positive and negative aspects of masculinity. This chapter will survey the research literature regarding machismo and Caballerismo, an assessment developed to measure these constructs, and implications for culturally responsive counseling practice of Mexican American men in the United States.
There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.
Objective
Health disparities may be driven by hospital‐level factors. We assessed whether racial and ethnic composition of populations hospitals serve explain or modify disparities in hospital outcomes of children with systemic lupus erythematosus (SLE).
Methods
In this retrospective cohort study of patients 5 to 26 years old with SLE at 47 children's hospitals in the Pediatric Health Information System (2006–2021), race and ethnicity were assessed at the patient level and hospital level (proportion of total admissions composed of Black or Hispanic patients, respectively). Outcomes included intensive care unit (ICU) admission or adverse renal outcome (end‐stage renal disease, dialysis, or transplant) during follow‐up. We estimated racial and ethnic disparities, adjusted or stratified by hospital racial or ethnic composition.
Results
Of 8,125 patients with SLE, 2,293 (28%) required ICU admission, and 698 (9%) had an adverse renal outcome. Black and non‐Hispanic White disparities in ICU admission were observed only at hospitals serving higher proportions of Black patients (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.04–1.59 vs OR 1.07, 95% CI 0.83–1.38). Larger Black and non‐Hispanic White disparities in adverse renal outcomes were observed at hospitals with higher Black racial composition (OR 2.0, 95% CI 1.4–2.8 vs OR 1.7, 95% CI 1.1–2.4). Conversely, Hispanic versus non‐Hispanic disparities in renal outcomes persisted after adjustment for hospital‐reported Hispanic ethnic composition but were observed only at hospitals with lower proportions of Hispanic patients.
Conclusion
Worse Black and White disparities in SLE outcomes are observed at children's hospitals serving more Black children, whereas distinct patterns are observed for Hispanic and non‐Hispanic disparities. Reporting of hospital characteristics related to populations served is needed to identify modifiable drivers of hospital‐level variation.
INTRODUCTION
Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women.
METHODS
Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos‐Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7‐year change, and mild cognitive impairment [MCI] prevalence).
RESULTS
Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence.
DISCUSSION
Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women.
This chapter defines concepts related to diversity and summarizes a foundational framework in the field of rehabilitation counseling that conceptualizes disparities in the disability community. It provides an extensive overview of different cultural perspectives of disability for each of the main racial and ethnic groups represented in the United States. This is followed by documented disparities found in research literature for each racial and ethnic groups in intellectual, psychiatric, cognitive, and/or physical disabilities. The cultural aspects of culturally diverse racial and ethnic people with disabilities are summarized. Brief suggestions are provided to deliver culturally responsive services. The future research directions section suggests that since cultural competence is evolving, it is important to acknowledge the expansion of the definition of culture and provide more rigorous research to address the intersectionality of cultural concepts, as well as mixed methodology and qualitative research to provide a rich description of the multicultural and disability experience.
Background:
Residential segregation is an important factor that negatively impacts cancer disparities, yet studies yield mixed results and complicate clear recommendations for policy change and public health intervention. In this study, we examined the relationship between local and Metropolitan Statistical Area (MSA) measures of Black isolation (segregation) and survival among older non-Hispanic (NH) Black women with breast cancer (BC) in the United States. We hypothesized that the influence of local isolation on mortality varies based on MSA isolation-specifically, that high local isolation may be protective in the context of highly segregated MSAs, as ethnic density may offer opportunities for social support and buffer racialized groups from the harmful influences of racism.
Methods:
Local and MSA measures of isolation were linked by Census Tract (CT) with a SEER-Medicare cohort of 5,231 NH Black women aged 66-90 years with an initial diagnosis of stage I-IV BC in 2007-2013 with follow-up through 2018. Proportional and cause-specific hazards models and estimated marginal means were used to examine the relationship between local and MSA isolation and all-cause and BC-specific mortality, accounting for covariates (age, comorbidities, tumor stage, and hormone receptor status).
Findings:
Of 2,599 NH Black women who died, 40.0% died from BC. Women experienced increased risk for all-cause mortality when living in either high local (HR = 1.20; CI = 1.08-1.33; p < 0.001) or high MSA isolation (HR = 1.40; CI = 1.17-1.67; p < 0.001). A similar trend existed for BC-specific mortality. Pairwise comparisons for all-cause mortality models showed that high local isolation was hazardous in less isolated MSAs but was not significant in more isolated MSAs.
Interpretation:
Both local and MSA isolation are independently associated with poorer overall and BC-specific survival for older NH Black women. However, the impact of local isolation on survival appears to depend on the metropolitan area's level of segregation. Specifically, in highly segregated MSAs, living in an area with high local isolation is not significantly associated with poorer survival. While the reasons for this are not ascertained in this study, it is possible that the protective qualities of ethnic density (e.g., social support and buffering from experiences of racism) may have a greater role in more segregated MSAs, serving as a counterpart to the hazardous qualities of local isolation. More research is needed to fully understand these complex relationships.
Funding:
National Cancer Institute.
In 2016, the Spanish Theatre Company (STC) opened the doors of its Cervantes Theatre (CT), the first British (and European) venue devoted to showcasing productions of Spanish and Latin American plays in a bilingual format. Four years on – and at a critical juncture given Brexit and the COVID-19 pandemic – this article reflects on the current state and future prospects of this nascent migrant theatre initiative based in Southwark. This, I hope, will serve as a first step to re-think the Arts Council England's diversity strategies in relation to multilingual initiatives. Drawing on in-depth interviews and critical analysis of archival and online documents, I focus on four interrelated factors crucial for understanding how and why this unique project sprung into life in a London hotspot for real estate speculation just as the UK split from the EU, with the aim of exploring if the STC case could be used as a model for future endeavours.
Although available evidence indicates that Mexican-origin (MO) adults experience unique stressful life events, little is known about how stress may influence risk for developing non-alcoholic fatty liver disease (NAFLD) for this high-risk group. This study investigated the association between perceived stress and NAFLD and explored how this relationship varied by acculturation levels. In a cross-sectional study, a total of 307 MO adults from a community-based sample in the U.S-Mexico Southern Arizona border region completed self-reported measures of perceived stress and acculturation. NAFLD was identified as having a continuous attenuation parameter (CAP) score of ≥ 288 dB/m determined by FibroScan®. Logistic regression models were fitted to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for NAFLD. The prevalence of NAFLD was 50 % (n = 155). Overall, perceived stress was high (Mean = 15.9) for the total sample. There were no differences by NAFLD status (No NAFLD: Mean = 16.6; NAFLD: Mean = 15.3; p = 0.11). Neither perceived stress nor acculturation were associated with NAFLD status. However, the association between perceived stress and NAFLD was moderated by acculturation levels. Specifically with each point increase in perceived stress, the odds of having NAFLD were 5.5 % higher for MO adults with an Anglo orientation and 1.2 % higher for bicultural MO adults. In contrast, the odds of NAFLD for MO adults with a Mexican cultural orientation were 9.3 % lower with each point increase in perceived stress. In conclusion, results highlight the need for additional efforts to fully understand the pathways through which stress and acculturation may influence the prevalence of NAFLD in MO adults.
Despite significant economic growth in both developed and emerging markets, several disadvantaged and marginalized segments of the global population still live in poverty. Recognizing the important role of business in alleviating poverty, management scholars have been increasingly investigating the topic of poverty. Although reviews of the extant literature have provided overviews of select poverty-related themes, such as that of the base of the pyramid, no one study has reviewed the topic of poverty across the management literature. The present systematic literature review collects, organizes and analyzes several hundred articles on poverty research, published in business and management journals during the past twenty-five years. The study identifies major themes in poverty research, reveals thematic overlaps among subdisciplines, summarizes adopted research methodologies and recognizes opportunities for future research. We find that, despite the wide variation of research topics and approaches, the studied themes remain relatively insulated within each subdiscipline of management research. Drawing on United Nations' Sustainable Development Goals, we conclude that, although the number of articles on poverty has increased considerably during the last decade, there are several research niches that future management scholars can investigate to alleviate one of the most pressing global challenges of our time.
Clinicians trained to assess and treat child psychopathology are facing an increasing need to expand their clinical expertise outside of traditional frameworks, which have historically focused largely on the child or the child-mother dyad. Clinicians treating children also need to be prepared to assess and address the systems of care that affect a child's mental health, starting with their family. There is a scarcity of Latino mental health providers and limited clinical opportunities or settings that serve this population by incorporating a developmental, cultural, and sociopolitical framework into high quality care of the whole family.
The theory of intersectionality proposes that an individual’s experience of society has aspects that are irreducible to the sum of one’s various identities considered individually, but are “greater than the sum of their parts”. In recent years, this framework has become a frequent topic of discussion both in social sciences and among popular movements for social justice. In this work, we show that the effects of intersectional identities can be statistically observed in empirical data using information theory, particularly the partial information decomposition framework. We show that, when considering the predictive relationship between various identity categories such as race and sex, on outcomes such as income, health and wellness, robust statistical synergies appear. These synergies show that there are joint-effects of identities on outcomes that are irreducible to any identity considered individually and only appear when specific categories are considered together (for example, there is a large, synergistic effect of race and sex considered jointly on income irreducible to either race or sex). Furthermore, these synergies are robust over time, remaining largely constant year-to-year. We then show using synthetic data that the most widely used method of assessing intersectionalities in data (linear regression with multiplicative interaction coefficients) fails to disambiguate between truly synergistic, greater-than-the-sum-of-their-parts interactions, and redundant interactions. We explore the significance of these two distinct types of interactions in the context of making inferences about intersectional relationships in data and the importance of being able to reliably differentiate the two. Finally, we conclude that information theory, as a model-free framework sensitive to nonlinearities and synergies in data, is a natural method by which to explore the space of higher-order social dynamics.
Objectives
The first objective is to examine the relationships between adverse childhood experiences (ACEs) and violent and nonviolent offending across generations of Hispanic adults in the United States. The second objective is to examine whether these relationships vary based on nativity.
Methods
Data come from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 6866 Hispanic adults). Negative-binomial regression was used to estimate the relationships between ACEs and offending. Analyses for violent and nonviolent offending were conducted separately. Comparisons were made across nativity by examining the differences in the marginal effects across groups.
Results
A wider range of ACEs were associated with violent offending among native-born U.S. Hispanics. The number of ACEs associated with nonviolent offending across nativity was comparable with some differences in magnitude. Cumulative ACEs were significant for all groups across both types of offending but varied in magnitude across nativity.
Conclusions
Nativity contextualizes the relationship between ACEs and offending among U.S. Hispanics, especially for violent behavior. However, there is notable comparability between groups as well. These results highlight the importance of ACEs on later adult outcomes and the need to better consider how demographic and cultural factors can inform those relationships.
Background
Although the incidence of breast cancer is highest in White women, Black women die at a higher rate. Our aim was to compare the relative association between race/ethnicity and socioeconomic status on breast cancer mortality.
Methods
We identified female breast cancer patients diagnosed between 2007 and -2011 and followed through 2016 in the SEER database. Patients were grouped into socioeconomic quartiles by a prosperity index. The primary outcome of interest was 5-year cancer-specific survival.
Results
A total of 286,520 patients were included. Five-year survival was worst for Black women compared to other races/ethnicities in each socioeconomic quartile. When compared to White women in the lowest quartile, Black women in the lowest quartile, 2nd quartile, and 3rd quartile experienced the lowest 5-year survival rates (Hazard ratio 1.33, 1.23, 1.20; P < 0.01).
Conclusion
Regarding cancer mortality, only in the most prosperous quartile do Black women achieve a similar outcome to the poorest quartile White women.
Research has consistently shown that positive psychological constructs are linked to better physical health, but few studies have examined the role that race plays in this connection. We explored whether positive self-evaluations were equally protective against upper respiratory infection for 271 African American adults and 700 European American adults in a series of virus-exposure studies. Participants were assessed at baseline for psychological functioning and physical health, quarantined and exposed experimentally to a respiratory virus, and then monitored for infection and symptoms. Regression analyses revealed significant interactions between race and multiple positive psychological factors; several factors that were helpful to European Americans were unhelpful or even harmful to African Americans. Building on past work showing cross-cultural variation in the health correlates of affect, this study provides evidence that the health benefits of positive psychological constructs may not be universal and points to the need to explore factors that underpin these observed differential patterns.
Background:
As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population.
Objective:
A systematic review and meta-analysis was conducted to 1) provide an updated review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research.
Methods:
Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively.
Results:
Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = -0.31, 95% CI -0.46 to -0.16; I2 = 50.16%) and burden (SMD = -0.28, 95% CI -0.37 to -0.18; I2 = 11.06%).
Conclusion:
Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.
The purpose of this integrative review is to synthesize the literature examining the relationship between parenting stress and social support in Hispanic parents of children with autism spectrum disorder (ASD). A database search of studies that evaluated parenting stress and social support in this population was conducted. Fourteen studies met inclusion criteria. Despite high stress levels, both informal and formal social supports improved parenting stress among Hispanic families. Few studies evaluated culturally sensitive social support interventions. With the increasing prevalence of ASD, the development of culturally sensitive social support interventions is necessary to promote the well-being of Hispanic families.
Objective: Latinos disproportionately experience overweight/obesity (OWOB) and insufficient physical activity (PA), which are risk factors for numerous health conditions. Whereas numerous studies investigate acculturation as a determinant of OWOB and PA, few have examined acculturation multidimensionally, and none has examined its interaction with gender. Methods: Participants were 140 Latino adults. Primary outcomes were status as OWOB and endorsement of insufficient PA. Acculturation was measured with the Multidimensional Acculturation Scale II. Logistic regression analyses were used to examine the moderating effect of gender on the relationship between each acculturation scale and outcome, controlling for education, nativity, and smoking status. Results: Greater Spanish proficiency was significantly associated with lower odds of insufficient PA. Greater American Cultural Identity was significantly associated with higher odds of OWOB. Women had significantly higher odds of endorsing insufficient PA compared to men. Gender did not moderate the relationship between acculturation and either OWOB or PA. Conclusions: Acculturation is similarly associated with OWOB and insufficient PA for Latino men and women. Cultural identity may need to be considered to target OWOB interventions. Acculturation may be less important, and gender more important, to consider for appropriate targeting of PA interventions.
Rationale
The 2016 U.S. presidential election and its aftermath involved political rhetoric and policies that especially targeted women, Latinos, and immigrants. It is possible that concerns about the political environment could affect mental health of individuals in targeted groups.
Objective
In a cohort of 148 pregnant Latina women, this study investigated how demographics and political concerns related to each other and to maternal anxiety, depression, and perceived stress, which have been associated with adverse birth and child development outcomes.
Methods
In this cross-sectional, self-report study, participants in Southern California completed a one-time questionnaire from January 2017 to May 2018.
Results
The highest rates of endorsement were for concerns regarding President Trump's racism, attitude towards women, and deportation risk for family or friends. From several demographic variables, the only significant predictor of state anxiety was expectant parents' birthplaces. From several political concerns variables, the only significant predictor of state anxiety was President Trump's attitude towards women or women's rights. There were no significant effects on other mental health outcomes.
Conclusions
Results suggest that birthplace and women's issues may be particularly salient anxiety risk factors for Latina pregnant women in this context. Because of the cross-sectional study design, it is possible that, conversely, pregnant women with high anxiety levels are particularly sensitive to the issue of birthplace or women's rights. Results imply that the political climate and events in the U.S. could have deleterious consequences that may cascade across generations of Latino Americans via effects on pregnant women.
In this community case study, we describe the process within an academic-community partnership of adapting UNIDOS, a community health worker (CHW)-led community-clinical linkages (CCL) intervention targeting Latinx adults in Arizona, to the evolving landscape of the COVID-19 pandemic. Consistent with community-based participatory research principles, academic and community-based partners made decisions regarding changes to the intervention study protocol, specifically the intervention objectives, participant recruitment methods, CHW trainings, data collection measures and management, and mode of intervention delivery. Insights from this case study demonstrate the importance of community-based participatory research in successfully modifying the intervention to the conditions of the pandemic and also the cultural background of Latinx participants. This case study also illustrates how a CHW-led CCL intervention can address social determinants of health, in which the pandemic further exposed longstanding inequities along racial and ethnic lines in the United States.
The paper analyses the effects of perceived discrimination on the self-rated health of immigrants living in Germany. Previous research indicates that immigrants’ health is negatively affected by the psychosocial strain caused by perceived discrimination. I analyse whether feelings of belonging to both the origin and the host country play a moderating role in this association: While feelings of belonging to the origin country might buffer the health threat of perceived discrimination, a strong sense of belonging to the host country might exacerbate it because it increases immigrants’ sensitivity and vulnerability to discrimination by the majority society. Using data from the German Socio-economic Panel Study (N = 10,412), I confirm previous research on the harmful effect of perceived discrimination on health. While feelings of belonging to the origin country are not a protective factor, the health threat of perceived discrimination indeed exacerbates with an increasing sense of belonging to the host country.
Latinos are the nation’s largest racial/ethnic minority group, yet knowledge of their physical health is less well documented or understood relative to other groups. Like other racial/ethnic minorities and underserved populations, Latinos experience significant educational, economic, environmental, social, and physical health risks coupled with significant health care access issues. Despite these challenges, Latinos appear to experience better health and live longer than non-Hispanics including non-Hispanic Whites; an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. These contradictory findings cast doubt on the generalizability of several tenets of psychosocial health and health disparities, spur new questions regarding the nature of risk and the cause of such resilience, and generate opportunities for psychologists to contribute to improving understanding of the ways by which sociocultural factors shape health. The aim of this special issue is to provide concise, state-of-the-science reviews synthesizing current knowledge and future directions on key aspects of Latino health. Here we introduce the issue, identify key themes, discuss the current status of the emerging sociocultural hypothesis of Latino health resilience, and offer considerations for future directions.
Purpose:
Perceived discrimination has been associated with lower adherence to cancer screening guidelines. We examined whether perceived discrimination was associated with adherence to breast, cervical, colorectal, and prostate cancer screening guidelines in US Hispanic/Latino adults.
Methods:
Data were obtained from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, including 5,313 Hispanic adults aged 18-74 from Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA, and those who were within appropriate age ranges for specific screening tests were included in the analysis. Cancer screening behaviors were assessed via self-report. Perceived discrimination was measured using the Perceived Ethnic Discrimination Questionnaire. Confounder-adjusted multivariable polytomous logistic regression models assessed the association between perceived discrimination and adherence to cancer screening guidelines.
Results:
Among women eligible for screening, 72.1 % were adherent to cervical cancer screening guidelines and 71.3 % were adherent to breast cancer screening guidelines. In participants aged 50-74, 24.6 % of women and 27.0 % of men were adherent to fecal occult blood test guidelines; 43.5 % of women and 34.8 % of men were adherent to colonoscopy/sigmoidoscopy guidelines; 41.0 % of men were adherent to prostate-specific antigen screening guidelines. Health insurance coverage, rather than perceived ethnic discrimination, was the variable most associated with receiving breast, cervical, colorectal, or prostate cancer screening.
Conclusions:
The influence of discrimination as a barrier to cancer screening may be modest among Hispanics/Latinos in urban US regions. Having health insurance facilitates cancer screening in this population. Efforts to increase cancer screening in Hispanics/Latinos should focus on increasing access to these services, especially among the uninsured.
This study examines the potential effects of nativity and acculturation on active life expectancy (ALE) among Mexican-origin elders.
We employ 17 years of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly to calculate ALE at age 65 with and without disabilities.
Native-born males and foreign-born females spend a larger fraction of their elderly years with activities of daily living (ADL) disability. Conversely, both foreign-born males and females spend a larger fraction of their remaining years with instrumental activities of daily life (IADL) disability than the native-born. In descriptive analysis, women with low acculturation report higher ADL and IADL disability. Men manifest similar patterns for IADLs.
Although foreign-born elders live slightly longer lives, they do so with more years spent in a disabled state. Given the rapid aging of the Mexican-origin population, the prevention and treatment of disabilities, particularly among the foreign born, should be a major public health priority.
© The Author(s) 2015.
Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes.
People with type 2 diabetes (n = 1,299) were invited to participate as either 'peer' or 'peer support facilitator' (PSF) in a 2x2 factorial randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline.
The 4 arms were well matched (Group n = 330, 1:1(individual) n = 325, combined n = 322, control n = 322); 1035 (79•7%) completed the mid-point postal questionnaire and 1064 (81•9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session. Mean baseline HbA1c was 57 mmol/mol (7•4%), with no significant change across arms. Follow up systolic blood pressure was 2•3mm Hg (0.6 to 4.0) lower among those allocated group peer-support and 3•0mm Hg (1.1 to 5.0) lower if the group support was attended at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication.
Group diabetes peer support over 8-12 months was associated with a small improvement in blood pressure but no other significant outcomes. Long term benefits should be investigated.
ISRCTN.com ISRCTN6696362166963621.
Background:
Social support improves health and has been shown to attenuate stress and pain. The precise characteristics of social support responsible for these effects, however, remain elusive.
Purpose:
The purpose of this study is to examine the relative efficacy of social support versus a neutral non-verbal social presence to attenuate stress and pain.
Methods:
Seventy-six participants provided pain ratings and task assessments during a cold pressor task (CPT) in one of three conditions: verbal social support, neutral non-support, or alone. Reactivity to the CPT was assessed via cardiovascular measures, cortisol, and subjective ratings.
Results:
Participants receiving social support showed attenuated blood pressure, heart rate, and cortisol reactivity, as well as reduced pain ratings, task difficulty, tension, and effort compared to neutral non-support and alone conditions.
Conclusions:
Social support, not the mere presence of another individual, attenuated stress and pain during a CPT. Given the negative health consequences of stress and pain, clinical studies incorporating social support into medical procedures and treatments are warranted.
The present study was a random-effects model meta-analysis of 26 studies published between 1990 and 2010 (k = 32; n = 39,777) that (a) examined the association between acculturation and cigarette smoking in Hispanic women and (b) evaluated age, national origin, and measure and dimensionality (unidimensional vs. bidimensional) of acculturation as moderating variables. Results indicate a strong positive relationship and suggest larger effects of acculturation on cigarette smoking in women of Mexican descent as compared with women originating from other Latin American countries for current and lifetime smoking, as well as smoking overall. The effect of acculturation on cigarette smoking was larger in adults as compared with adolescents for current smoking and smoking overall. Few differences in effect size by measure or dimensionality of acculturation emerged. Results are discussed with regard to implications for future research and the measurement of acculturation.
The goal of this special issue is to highlight recent research examining the role of social networks in adults' physical health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010.
To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults.
Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey.
In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012).
In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006).
Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.
Little is known about how online social networking can help enhance weight loss. To examine the types of online social support utilized in a behavioral weight loss intervention and relationship of posting and weight loss. A sub-analysis of the content and number of posts to Twitter among participants (n = 47) randomized to a mobile, social network arm as part of a 6-month trial among overweight adults, examining weight loss, use of Twitter, and type of social support (informational, tangible assistance, esteem, network, and emotional support). A number of Twitter posts were related to % weight loss at 6 months (p < 0.001). Initial reported weight loss predicted engagement with Twitter (p < 0.01) but prior Twitter use or initial Twitter engagement did not. Most Twitter posts (total posts n = 2,630) were Informational support (n = 1,981; 75 %), with the predominant subtype of Teaching (n = 1,632; 62 %), mainly in the form of a status update (n = 1,319). Engagement with Twitter was related to weight loss and participants mainly used Twitter to provide Information support to one another through status updates.
Using the interpersonal perspective, we examined social correlates of dispositional optimism. In Study 1, optimism and pessimism were associated with warm-dominant and hostile-submissive interpersonal styles, respectively, across four samples, and had expected associations with social support and interpersonal stressors. In 300 married couples, Study 2 replicated these findings regarding interpersonal styles, using self-reports and spouse ratings. Optimism–pessimism also had significant actor and partner associations with marital quality. In Study 3 (120 couples), husbands’ and wives’ optimism predicted increases in their own marital adjustment over time, and husbands’ optimism predicted increases in wives’ marital adjustment. Thus, the interpersonal perspective is a useful integrative framework for examining social processes that could contribute to associations of optimism–pessimism with physical health and emotional adjustment.
To examine differences in alcohol consumption among Hispanic national groups in the United States [Puerto Ricans, Mexican, Cuban, and Dominican South Central (D/SC) Americans] and identify sociodemographic predictors of drinking and binge drinking (four drinks for women and five for men in a 2-hr period).
The study used a household probability sample of adult Hispanics in five metropolitan areas in the United States. Comprehensive data on alcohol consumption were collected. Analyses included bivariate and multivariate regression techniques.
Puerto Rican and Mexican American men reported higher drinking rates, weekly consumption, and binge drinking than D/SC and Cuban Americans. Women drank significantly less than men. Mexican American women reported the highest abstention rate (61%); Puerto Rican women drank more per week and binged more frequently compared with their counterparts in other groups. Puerto Rican origin, initiating drinking during high school years (<18), and male gender (US- or foreign-born) were significant predictors of weekly alcohol consumption. Being younger, being single, Puerto Rican or D/SC American origin, initiating drinking at <18 years, being a US- or foreign-born male and being a US-born female were significant predictors of binge drinking.
There are considerable differences in drinking behavior across Hispanic national groups as well as between men and women. Results underscore the need to recognize heterogeneity in drinking practices while designing effective prevention interventions in the community.
Objectives:
In the United States, Hispanic mothers have birth outcomes comparable to those of White mothers despite lower socioeconomic status. The contextual effects of Hispanic neighborhoods may partially explain this "Hispanic paradox." We investigated whether this benefit extends to other ethnic groups.
Methods:
We used multilevel logistic regression to investigate whether the county-level percentage of Hispanic residents is associated with infant mortality, low birth weight, preterm delivery, and smoking during pregnancy in 581,151 Black and 2,274,247 White non-Hispanic mothers from the US Linked Birth and Infant Death Data Set, 2000.
Results:
For White and Black mothers, relative to living in counties with 0.00%-0.99% of Hispanic residents, living in counties with 50.00% or more of Hispanic residents was associated with an 80.00% reduction in the odds of smoking, an infant mortality reduction of approximately one third, and a modest reduction in the risks of preterm delivery and low birth weight.
Conclusions:
The health benefits of living in Hispanic areas appear to bridge ethnic divides, resulting in better birth outcomes even for those of non-Hispanic origin.
This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in more than 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality (r = .11) and lower cardiovascular reactivity during marital conflict (r = −.13), but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health.
To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting Hispanic individuals’ mortality from any cause compared with any other race/ethnicity. We searched MEDLINE, PubMed, EMBASE, HealthSTAR, and PsycINFO for published literature from January 1990 to July 2010.
Across 58 studies (4 615 747 participants), Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (odds ratio = 0.825; P < .001; 95% confidence interval = 0.75, 0.91). The difference in mortality risk was greater among older populations and varied by preexisting health conditions, with effects apparent for initially healthy samples and those with cardiovascular diseases. The results also differed by racial group: Hispanics had lower overall risk of mortality than did non-Hispanic Whites and non-Hispanic Blacks, but overall higher risk of mortality than did Asian Americans.
These findings provided strong evidence of a Hispanic mortality advantage, with implications for conceptualizing and addressing racial/ethnic health disparities.
Context Major cardiovascular diseases (CVDs) are leading causes of mortality among US Hispanic and Latino individuals. Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation.
Objectives To describe prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among US Hispanic/Latino individuals of different backgrounds, examine relationships of SES and acculturation with CVD risk profiles and CVD, and assess cross-sectional associations of CVD risk factors with CVD.
Design, Setting, and Participants Multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos including individuals of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American backgrounds (n = 1022) aged 18 to 74 years. Analyses involved 15 079 participants with complete data enrolled between March 2008 and June 2011.
Main Outcome Measures Adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were ascertained from self-reported data.
Results Age-standardized prevalence of CVD risk factors varied by Hispanic/Latino background; obesity and current smoking rates were highest among Puerto Rican participants (for men, 40.9% and 34.7%; for women, 51.4% and 31.7%, respectively); hypercholesterolemia prevalence was highest among Central American men (54.9%) and Puerto Rican women (41.0%). Large proportions of participants (80% of men, 71% of women) had at least 1 risk factor. Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P < .001) among participants with less education (16.1%), those who were US-born (18.5%), those who had lived in the United States 10 years or longer (15.7%), and those who preferred English (17.9%). Overall, self-reported CHD and stroke prevalence were low (4.2% and 2.0% in men; 2.4% and 1.2% in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios [ORs], 1.5-2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (ORs, 1.7-2.6).
Conclusion Among US Hispanic/Latino adults of diverse backgrounds, a sizeable proportion of men and women had adverse major risk factors; prevalence of adverse CVD risk profiles was higher among participants with Puerto Rican background, lower SES, and higher levels of acculturation.
Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics related to heart disease, stroke, and other cardiovascular and metabolic diseases and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, and others seeking the best available data on these conditions. Together, cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Statistical Update brings together in a single document up-to-date information on the core health behaviors and health factors that define cardiovascular health; a range of major clinical disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, …
Objective: The role of changes in Alcoholics Anonymous (AA) involvement and social networks in relation to abstinence following substance abuse treatment is studied. Specifically, the role of AA and network support for abstinence are examined in relation to their effect on changes in abstinence states between follow-ups. Method: Study sites were 10 representative public and private alcohol treatment programs in a northern California county. A recruitment of 367 men and 288 women seeking treatment were interviewed at intake and re-interviewed I and 3 years later to collect information about alcohol consumption, dependence symptoms, social support for reducing drinking, number of heavy drinkers in the social network and AA involvement. Results: Significant predictors of 90-day abstinence at both the 1- and 3-year follow-up interviews included AA involvement in the last year, percentage of heavy or problem drinkers in the social network, percentage encouraging alcohol reduction and AA-based support for reducing drinking. Panel models estimated an increase in AA participation between 12 and 36 months posttreatment increased the odds of abstinence at 3 years by 35% above those at 12 months. The only significant mediator of AA's effect on abstinence was the number of AA-based contacts supporting reduced drinking, which reduced the magnitude of the relationship by 16%. Conclusions: AA involvement and the type of support received from AA members were consistent contributors to abstinence 3 years following a treatment episode. The enduring effects observed from supportive networks demonstrate the importance of ongoing mechanisms of action that contribute to an abstinent lifestyle.
Studies of urban ethnic enclaves, or residential areas where minorities experience cohesion as a group, are growing in popularity in the present era of globalization, which is marked by historically high rates of migration. Such studies almost universally treat the ethnic groups in question in relation to the "host societies" or "charter groups" that constitute the historically dominant peoples of the regions in which migrants settle (Pacione 2001: 362-366). In the case of ethnic enclaves of the United States, the host society is usually, but not always, Anglo. Mike Davis (2000), for example, shows us that traditionally black inner-city areas can become Latino-dominant enclaves as blacks migrate to suburbs, as has occurred in greater Los Angeles, New York, and other northern cities. Thus, as demonstrated throughout this volume, most Latino communities, whether urban or rural, have recently been established and, in many cases, constitute a new phase of the filtering process in historically Anglo or black areas of cities. Such is not the case, however, with Laredo, Texas, a historically Hispanic city comprising multiple generations of continuous occupation by Spaniards, Mexicans, and their offspring. This reality calls for a somewhat distinctive approach to the study of the Hispanic geography of Laredo, a city located directly on the border between Texas and Mexico. In Lower Rio Grande Valley cities of Texas such as McAllen, Brownsville, and Har-lingen, Anglo majorities historically dominated the community's social and economic structure. A Hispanic underclass existed chiefly as labor, and, with few exceptions, a Hispanic middle class has only recently emerged. In Laredo, on the other hand, Hispanics have been dominant politically and socially for three centuries and, as a result, have constructed the social geography of the city and its surrounding rural hinterland (Arreola 2002). Accordingly, this chapter examines the social geography of Laredo's neighborhoods and the increasing socioeconomic disparities that occur within the majority-Hispanic city. Such an approach will demonstrate the relatively unusual role that ethnicity and ethnic relations play in the social construction of this highly stratified community. Our study reveals that Laredo's historical isolation from other population centers in Texas and Mexico has created a geographical distinctiveness in this border city. Shared cultural traits transcend social class in Laredo, yet there are a variety of lifestyles and urban-design elements seen throughout the metropolitan area. When Yoder recently announced in a lower-division college world geography class comprising predominantly Laredoans that the Latino population of the United States had reached parity with that of African Americans, surprisingly few of the students in the class reacted in any visible way. Follow-up questions posed on the spot produced the same result. It would be reasonable to regard this as an indication that the average world-view of students born in Laredo is framed more in terms of Laredo than of "mainstream" Anglo America. Ethnic identity among Laredo's Mexican Americans is quite unlike what is found in Los Angeles, Houston, or other American cities with sizable Latino populations. One might argue that Laredo represents a departure from the cultural norms of mainstream America and, as such, exhibits a relationship between a distinctive group of people and their place that is typical of ethnic enclaves (Abrahamson 1996: 2). Many Laredoans identify with the particular place they occupy. Just as Latino enclaves within American cities are defined by language, local cuisine, family-run retail shops, architecture, and the like, Laredo is unique as an American city by virtue of such traits. Furthermore, despite strong kinship ties that bind the entire city, people nonetheless identify with particular neighborhoods in Laredo (Valdez 1993). This is especially evident in the dichotomy between the South Laredo of working-class barrios and low-income subdivisions and the North Laredo of middle- and upper-middle-class subdivisions and fast-paced, automobile-oriented commercial land uses that typify mainstream North American suburban style, or "suburbia Americana." In this chapter, we provide a brief overview of Laredo's settlement history, particularly those aspects that underlie the city's unique character among Hispanic places. The discussion then turns to a description of the contemporary Laredo economy and the city's role in international trade insofar as these relate to social variability throughout the city. We describe the various sectors of the city and its neighborhoods and discuss pertinent aesthetic and lifestyle characteristics, such as housing, with attention to spatial patterns. Case studies of five neighborhoods, from working class to upper middle class, indicate the unique character of each of Laredo's many inner-city barrios and suburban subdivisions. Significantly, the case studies also shed light on the universality of many cultural practices throughout Laredo, lifestyle preferences, and kinship patterns that transcend social class. Examination of the social geography of neighborhoods enables researchers better to understand the dynamics that occur between and among the various social classes that make up a city whose citizenry is 94 percent Hispanic, 37 percent of whom lived below the poverty line in 1990 (U.S. Bureau of the Census 1992; Valdez 1993).
Aims and objectives:
To compare drug adherence to lipid-lowering therapy among outpatients with coronary artery disease who received information via short message service, via short message service and Micro Letter, or via phone only.
Background:
Messaging applications and short message service are commonly used internationally. However, little is known about how coronary artery disease outpatients in China may benefit from receiving health education through these technologies.
Design:
Random sampling method.
Methods:
Data were collected from March-December 2013. Subjects from Chengdu City, China, were randomised to three groups: short message service, short message service + Micro Letter, and phone (control). Appointment reminders and health information were delivered to patients in accordance with designations. After six months, adherence to statin prescriptions was compared among the groups by using the Morisky Medication Adherence Scale. Logistic regression analysis was applied to determine those independent variables that were related to adherence.
Results:
The short message service and short message service + Micro Letter groups had better cumulative adherence (lower Morisky Medication Adherence Scale scores) after six months than phone group, and the short message service + Micro Letter group had better cumulative adherence (lower Morisky Medication Adherence Scale scores) than the short message service group. Female sex, older age and marriage show positive associations with adherence.
Conclusions:
Short message service and messaging applications, such as Micro Letter, are effective means of providing discharged patients with reminders and coronary artery disease-related health information. Implementation of a short message service + Micro Letter program can improve outpatient adherence to medication.
Relevance to clinical practice:
This research offers useful information to help medical staff design effective interventions to improve medication compliance among coronary artery disease patients.
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.4% (55.4 million/318 million) of the total US population in 2014. Every 3 years, the American Cancer Society reports on cancer statistics for Hispanics based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among Hispanics in 2015, there will be an estimated 125,900 new cancer cases diagnosed and 37,800 cancer deaths. For all cancers combined, Hispanics have 20% lower incidence rates and 30% lower death rates compared with non-Hispanic whites (NHWs); however, death rates are slightly higher among Hispanics during adolescence (aged 15-19 years). Hispanic cancer rates vary by country of origin and are generally lowest in Mexicans, with the exception of infection-associated cancers. Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer. Variations in cancer risk between Hispanics and NHWs, as well as between subpopulations, are driven by differences in exposure to cancer-causing infectious agents, rates of screening, and lifestyle patterns. Strategies for reducing cancer risk in Hispanic populations include increasing the uptake of preventive services (eg, screening and vaccination) and targeted interventions to reduce obesity, tobacco use, and alcohol consumption. CA Cancer J Clin 2015. © 2015 American Cancer Society.
To assess whether group dynamics are associated with weight loss, session attendance, and self-monitoring adherence after 6 months of lifestyle intervention for obesity.
Women with obesity (N = 125; mean ± SD BMI = 37.84 ± 3.94 kg/m(2) ; age = 51.99 ± 10.81 years) participated in a 24-week group-based lifestyle weight loss intervention and achieved a weight loss of 9.13 ± 7.15 kg after 6 months. Participants reported their perceptions of group conflict, avoidance, engagement, social support, and attraction at the end of treatment. Multiple regression with forward selection assessed which group dynamic variables were associated with weight loss, attendance, and adherence.
Greater perceived group conflict was associated with smaller weight losses (β = 1.833, P = 0.044) and lower attendance (β = -2.313, P = 0.002) and adherence rates (β = -2.261, P = 0.030). Higher group attraction was associated with higher attendance rates (β = 0.051, P = 0.039). The association between perceived conflict and weight change was mediated by attendance and adherence (P = 0.019).
Findings demonstrate that group dynamics associate with weight loss outcomes, attendance, and adherence. Addressing conflicts and fostering acceptance among group members may promote success in group-based lifestyle interventions for obesity.
© 2015 The Obesity Society.
We examined the effects of duration of residence and age at immigration on mortality among US-born and foreign-born Hispanics aged 25 and older.
We analyzed the National Health Interview Survey-National Death Index linked files from 1997-2009 with mortality follow-up through 2011. We used Cox proportional hazard models to examine the effects of duration of US residence and age at immigration on mortality for US-born and foreign-born Hispanics, controlling for various demographic, socioeconomic and health factors. Age at immigration included 4 age groups: <18, 18-24, 25-34, and 35+ years. Duration of residence was 0-15 and >15 years.
We observed a mortality advantage among Hispanic immigrants compared to US-born Hispanics only for those who had come to the US after age 24 regardless of how long they had lived in the US. Hispanics who immigrated as youths (<18) did not differ from US-born Hispanics on mortality despite duration of residence.
Findings suggest that age at immigration, rather than duration of residence, drives differences in mortality between Hispanic immigrants and the US-born Hispanic population.
The National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III)1 identified the metabolic syndrome as a multiplex risk factor for cardiovascular disease (CVD) that is deserving of more clinical attention. The cardiovascular community has responded with heightened awareness and interest. ATP III criteria for metabolic syndrome differ somewhat from those of other organizations. Consequently, the National Heart, Lung, and Blood Institute, in collaboration with the American Heart Association, convened a conference to examine scientific issues related to definition of the metabolic syndrome. The scientific evidence related to definition was reviewed and considered from several perspectives: (1) major clinical outcomes, (2) metabolic components, (3) pathogenesis, (4) clinical criteria for diagnosis, (5) risk for clinical outcomes, and (6) therapeutic interventions.
ATP III viewed CVD as the primary clinical outcome of metabolic syndrome. Most individuals who develop CVD have multiple risk factors. In 1988, Reaven2 noted that several risk factors (eg, dyslipidemia, hypertension, hyperglycemia) commonly cluster together. This clustering he called Syndrome X , and he recognized it as a multiplex risk factor for CVD. Reaven and subsequently others postulated that insulin resistance underlies Syndrome X (hence the commonly used term insulin resistance syndrome ). Other researchers use the term metabolic syndrome for this clustering of metabolic risk factors. ATP III used this alternative term. It avoids the implication that insulin resistance is the primary or only cause of associated risk factors. Although ATP III identified CVD as the primary clinical outcome of the metabolic syndrome, most people with this syndrome have insulin resistance, which confers increased risk for type 2 diabetes. When diabetes becomes clinically apparent, CVD risk rises sharply. Beyond CVD and type 2 diabetes, individuals with metabolic syndrome seemingly are susceptible to other conditions, notably polycystic ovary syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances, and some …
This multiple method pilot evaluation aimed to generate preliminary data on the effectiveness of the Residential Care Transition Module (RCTM). The RCTM is a six-session, 4-month psychosocial intervention designed to help families manage their emotional and psychological distress following residential care placement of a cognitively impaired relative. Seventeen family caregivers of relatives in a nursing home or assisted living memory care unit were randomly assigned to the RCTM treatment condition and 19 family caregivers were assigned to a usual care control group. Caregivers in the treatment condition reported significantly (p < 0.05) less emotional distress at 4 and 8 months on self-reported surveys than those in the control group. Post-RCTM focus groups emphasized the importance of readily available psychosocial support for families following the placement transition. The findings suggest that the provision of skilled psychosocial support can help families manage emotional distress and crises in the months following a cognitively impaired relative's admission to residential long-term care. [Res Gerontol Nurs. 20xx; x(x):xx-xx.].
Copyright 2015, SLACK Incorporated.
Perceived social support has been hypothesized to protect against the pathogenic effects of stress. How such protection might be conferred, however, is not well understood. Using a sample of 404 healthy adults, we examined the roles of perceived social support and received hugs in buffering against interpersonal stress-induced susceptibility to infectious disease. Perceived support was assessed by questionnaire, and daily interpersonal conflict and receipt of hugs were assessed by telephone interviews on 14 consecutive evenings. Subsequently, participants were exposed to a virus that causes a common cold and were monitored in quarantine to assess infection and illness signs. Perceived support protected against the rise in infection risk associated with increasing frequency of conflict. A similar stress-buffering effect emerged for hugging, which explained 32% of the attenuating effect of support. Among infected participants, greater perceived support and more-frequent hugs each predicted less-severe illness signs. These data suggest that hugging may effectively convey social support.
© The Author(s) 2014.
Background
Mexicans in the US have lower rates of several important population health metrics than non-Hispanic Whites, including infant mortality. This mortality advantage is particular pronounced among infants born to foreign-born Mexican mothers. However the literature to date has been relegated to point-in-time studies that preclude a dynamic understanding of ethnic and nativity differences in infant mortality among Mexicans and non-Hispanic Whites.
Methods
We assessed secular trends in the relation between Mexican ethnicity, maternal nativity, and infant mortality between 1989-2006 using a linked birth-death dataset from one US state.
Results
Congruent to previous research, we found a significant mortality advantage among infants of Mexican relative to non-Hispanic White mothers between 1989-1991 after adjustment for baseline demographic differences (RR=0.78, 95%CI 0.62-0.98). However, because of an upward trend in infant mortality among infants of Mexican mothers the risk of infant mortality was not significantly different from non-Hispanic White mothers in later time periods.
Conclusion
Our findings suggest that the ‘Mexican paradox’ with respect to infant mortality is resolving. Changing sociocultural norms among Mexican mothers and changes in immigrant selection and immigration processes may explain these observations, suggesting directions for future research.
Previous studies find U.S. immigrants have weaker socioeconomic gradients in health relative to non-Hispanic whites and their U.S.-born co-ethnics. Several explanations have been advanced but few have been tested empirically. We use data from the Mexican Family Life Survey and the U.S. National Health Interview Survey, including longitudinal data in the former measuring SES and health previous to emigration, to test if 1) immigrants "import" their gradients from the sending country, or if 2) they may be changing as a result of SES-graded acculturation among Mexican migrant men in two health indicators: obesity and current smoking. We find evidence consistent with the first hypothesis: the gradients of migrants measured prior to coming to the U.S. are not statistically different from those of non-migrants, as the gradients of each are relatively weak. Although the gradients for obesity and smoking appear to weaken with time spent in the U.S., the differences are not significant, suggesting little support for the selective acculturation hypothesis.
Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum – the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.
Perceived social support has long been recognized as associated with better health and longevity. However, important factors that may moderate this relationship have not been sufficiently explored. The authors used meta-analyses and meta-regressions to examine 178 all-cause mortality risk estimates from 50 publications, providing data on more than 100,000 persons. The mean hazard ratio (HR) for mortality among those with lower levels of perceived social support was 1.11 (95% confidence interval [CI]: 1.05, 1.17) among multivariate-adjusted HRs. Meta-regressions suggest that support from family members was more beneficial than support provided by friends, and that a moderate level of support may be enough to achieve positive results. The results also show that the importance of having support increases with age. No substantial difference was found between men and women with respect to the relationship between support and mortality.
Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.
© Association for Psychological Science 2011.
Hispanics, the largest minority in the U.S., have a higher prevalence of several cardiovascular (CV) risk factors than non-Hispanic whites (NHW). However, some studies have shown a paradoxical lower rate of CV events among Hispanics than NHW.
To perform a systematic review and a meta-analysis of cohort studies comparing CV mortality and all-cause mortality between Hispanic and NHW populations in the U.S.
We searched EMBASE, MEDLINE, Web of Science, and Scopus databases from 1950 through May 2013, using terms related to Hispanic ethnicity, CV diseases and cohort studies. We pooled risk estimates using the least and most adjusted models of each publication.
We found 341 publications of which 17 fulfilled the inclusion criteria; data represent 22,340,554 Hispanics and 88,824,618 NHW, collected from 1950 to 2009. Twelve of the studies stratified the analysis by gender, and one study stratified people by place of birth (e.g. U.S.-born, Mexican-born, and Central/South American-born). There was a statistically significant association between Hispanic ethnicity and lower CV mortality (OR 0.67; 95% CI, 0.57-0.78; p<0.001), and lower all-cause mortality (0.72; 95% CI, 0.63-0.82; p<0.001). A subanalysis including only studies that reported prevalence of CV risk factors found similar results. OR for CV mortality among Hispanics was 0.49; 95% CI 0.30-0.80; p-value <0.01; and OR for all-cause mortality was 0.66; 95% CI 0.43-1.02; p-value 0.06.
These results confirm the existence of a Hispanic paradox regarding CV mortality. Further studies are needed to identify the mechanisms mediating this protective CV effect in Hispanics.
Hispanics in the United States have lower age-adjusted mortality resulting from non-small-cell lung cancer (NSCLC) compared with non-Hispanic whites (NHWs). The purpose of this study was to evaluate individual, clinical, and neighborhood factors in survival among Hispanics with NSCLC.
We performed a retrospective analysis of NHWs and Hispanics with NSCLC between 1998 and 2007 in the California Cancer Registry (follow-up to December 2009). Kaplan-Meier curves depict survival by nativity for Hispanics with NSCLC. Cox proportional hazards models estimated hazard of mortality by race with adjustment for individual (age, sex, marital status), clinical (histologic grade, surgery, irradiation, chemotherapy), and neighborhood factors (neighborhood socioeconomic status, ethnic enclave).
We included 14,280 Hispanic patients with NSCLC. Foreign-born Hispanics had 15% decreased risk of disease-specific mortality resulting from NSCLC compared with NHWs (hazard ratio [HR], 0.85; 95% CI, 0.83 to 0.88) after adjustment for individual, clinical, and neighborhood factors. After adjustment for individual factors, compared with US-born Hispanics, foreign-born Hispanics had 10% decreased risk of disease-specific mortality (HR, 0.90; 95% CI, 0.87 to 0.96). Clinical and neighborhood factors slightly moderated the survival benefit for foreign-born patients. A modestly more pronounced survival advantage was seen for foreign-born Hispanics living in low socioeconomic and high Hispanic enclave neighborhoods as compared with US-born Hispanics (HR, 0.86; 95% CI, 0.81 to 0.90).
Foreign-born Hispanics with NSCLC have a decreased risk of disease-specific mortality compared with NHWs and US-born Hispanics with NSCLC. Neighborhood factors slightly moderate this survival advantage. This survival advantage is slightly more pronounced in lower socioeconomic and higher Hispanic enclave neighborhoods.
The Acculturation Rating Scale for Mexican Americans (ARSMA) was revised for the purpose of developing an instrument that assessed acculturation processes through an orthogonal, multidimensional approach by measuring cultural orientation toward the Mexican culture and the Anglo culture independently. Two subscales, Anglo Orientation Subcale (AOS) and Mexican Orientation Subscale (MOS), were developed from items from the original ARSMA scale. The two cultural orientation subscales were found to have good internal reliabilities (Cronbach's Alpha = .86 and .88 for the AOS and the MOS, respectively. The revised scale (ARSMA-JJ) yielded a high Pearson correlation coefficient (r = .89) with the original scale. Strong construct validity of ARSMA -II was demonstrated using a sample of 379 individuals representing generations I to 5. ARSMA-II is multifactorial and capable of generating multidimensional acculturative types, for example, integrated, separated, assimilated and marginalized.
Background:
Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation.
Study design:
National retrospective cohort study.
Setting & participants:
Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007.
Predictors:
Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier).
Outcomes:
All-cause and cause-specific mortality.
Results:
We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83).
Limitations:
Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes.
Conclusions:
Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.
Importance Breast cancer in women between the ages of 15 and 39 years (adolescents and young adults [AYAs]) constitutes 5% to 6% of all breast cancer cases in the United States. Breast cancer in AYA women has a worse prognosis than in older women. Five-year survival rates are lowest for AYA women, and only a few studies have examined the impact of delay in treatment, race/ethnicity, and other socioeconomic factors on survival in AYA women.
Objective To examine the impact of treatment delay time (TDT), race/ethnicity, socioeconomic status, insurance status, cancer stage, and age on the survival from breast cancer among AYA women.
Design, Setting, and Participants This is a retrospective case-only study of 8860 AYA breast cancer cases diagnosed from 1997 to 2006 using the California Cancer Registry database.
Exposure Treatment delay time was defined as the number of weeks between the date of diagnosis and date of definitive treatment. Kaplan-Meier estimation was used to generate survival curves, and a multivariate Cox proportional hazards regression model was performed to assess the association of TDT with survival while accounting for covariates (age, race/ethnicity, socioeconomic status, insurance status, cancer stage [American Joint Committee on Cancer], tumor markers, and treatment).
Main Outcomes and Measures Five-year survival rates for breast cancer as influenced by host factors, tumor factors, and TDT.
Results Treatment delay time more than 6 weeks after diagnosis was significantly different (P < .001) between racial/ethnic groups (Hispanic, 15.3% and African American, 15.3% compared with non-Hispanic white, 8.1%). Women with public or no insurance (17.8%) compared with those with private insurance (9.5%) and women with low socioeconomic status (17.5%) compared with those with high socioeconomic status (7.7%) were shown to have TDT more than 6 weeks. The 5-year survival in women who were treated by surgery and had TDT more than 6 weeks was 80% compared with 90% (P = .005) in those with TDT less than 2 weeks. In multivariate analysis, longer TDT, estrogen receptor negative status, having public or no insurance, and late cancer stage were significant risk factors for shorter survival.
Conclusions and Relevance Young women with breast cancer with a longer TDT have significantly decreased survival time compared with those with a shorter TDT. This adverse impact on survival was more pronounced in African American women, those with public or no insurance, and those with low SES.
Objective:
To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection.
Design:
After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold.
Setting:
Quarantine.
Participants:
A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant.
Outcome measures:
Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication.
Results:
In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds.
Conclusions:
More diverse social networks were associated with greater resistance to upper respiratory illness.
To determine whether maternal nativity (US-born versus foreign-born) is associated with the first year mortality rates of term births. Stratified and multivariable binomial regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files. Only term (37-42 weeks) infants with non-Latina White, African-American, and Mexican-American mothers were studied. The infant mortality rate (<365 days, IMR) of births to US-born non-Latina White mothers (n = 3,684,569) exceeded that of births to foreign-born White mothers (n = 226,621): 2.4/1,000 versus 1.3/1,000, respectively; relative risk (RR) = 1.8 [95 % confidence interval (CI) 1.6-2.0]. The IMR of births to US-born African-American mothers (n = 787,452) exceeded that of births to foreign-born African-American mothers (n = 118,246): 4.1/1,000 versus 2.2/1,000, respectively; RR = 1.8 (1.6-2.1). The IMR of births to US-born Mexican-American mothers (n = 338,337) exceeded that of births to Mexican-born mothers (n = 719,837): 2.4/1,000 versus 1.8/1,000, respectively; RR = 1.3 (1.2-1.4). These disparities were not limited to a singular cause of death and were widest among deaths due to Sudden Infant Death Syndrome. In multivariable binomial regression models, the adjusted RR of infant mortality for non-LBW, term births to US-born (compared to foreign-born) for White, African-American, and Mexican-American mothers equaled 1.5 (1.3-1.7), 1.7 (1.5-2.1) and 1.6 (1.4-1.8), respectively. The IMR of term births to White, African-American, and Mexican-American mothers exceeds that of their counterparts with foreign-born mothers independent of traditional individual level risk factors.
This study focuses on the relationship between cultural values and personal experiences, and Hispanics/Latinos' most frequently used identity labels. The authors hypothesized that there would be a relationship between participants' identity labels and demographics, and participants' identity label and the 5 independent variable categories: (a) physical appearance, (b) familism/collectivism, (c) ethnic pride, (d) political beliefs, and (e) discrimination. Among the results for the independent variable categories, only the relationship between political beliefs and identity label was significant. Identity label was also found to moderately predict levels of ethnic pride. In terms of demographics, significant relationships were found between identity label and earned income, first language, and language most comfortable in. Significant interaction effects were found between physical appearance and experience of discrimination, and between politicization and ethnic pride.
I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995-2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.
The "Latina epidemiologic paradox" postulates that despite socioeconomic disadvantages, Latina mothers have a lower risk for delivering low birth weight (LBW) babies than non-Latina Whites. However, these patterns may be changing over time and may differ depending on the mother's birthplace and legal status in the United States. This study investigates differences in risk for three birth outcomes among Whites, U.S.-born Latinas, and foreign-born Latinas.
We undertook a cross-sectional study of rates of LBW, preterm, and small-for-gestational-age (SGA) births among 196,617 women delivering live, singleton births in Utah from 2004 to 2007. Each group was compared using logistic regression.
U.S.-born Latinas had a similar or greater risk for all three outcomes when compared with Whites. Foreign-born Latinas had lower risk for preterm birth (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.80-0.90) compared with Whites, but not for LBW and SGA; foreign-born Latinas had a lower risk for LBW (OR, 0.82; 95% CI, 0.74-0.92), preterm birth (OR, 0.81; 95% CI, 0.74-0.89), and SGA (OR, 0.91; 95% CI, 0.83-0.99) compared with U.S.-born Latinas. Among foreign-born Latinas only, there was no difference in risk between documented (i.e., those who had a legal social security number) and undocumented women for LBW, preterm birth, or SGA.
These data support the existence of a variation of the "Latina paradox" among Latinas according to birthplace, where U.S.-born Latinas do not experience better birth outcomes than Whites, but foreign-born Latinas experience better birth outcomes for several endpoints compared with U.S.-born Latinas. Prevention efforts may prove more effective by considering the different composition of risk factors among foreign- and U.S.-born Latina populations.
This study examined how patients' satisfaction with their care is affected by racial/ethnic concordance and patients' perceived interpersonal sensitivity of their providers. The sample consisted of non-Hispanic Whites, African Americans/Blacks, Hispanics/Latinos, and Asian Americans age 50 and older.
Data came from the population-based Commonwealth Fund 2001 Health Care Quality Survey (n = 2,075). A hierarchical regression model of satisfaction was estimated for each racial/ethnic group with a sequential entry of variables: demographic and health-related variables, racial/ethnic concordance between patient and provider, and interpersonal sensitivity.
The influence of patient-provider racial/ethnic concordance on satisfaction with care was negligible, but the influence of interpersonal sensitivity was substantial (p < .001) in all racial/ethnic groups.
Findings suggest that racial/ethnic concordance may not be universally effective for diverse older populations, but perceived interpersonal sensitivity of the provider has a strong influence on older adults' satisfaction with care regardless of their racial/ethnic background.
From the neighborhoods we live in to those we marry, other people are a part of our everyday lives. Mounting evidence suggests that these social factors constitute risk and resilience influences for coronary heart disease (CHD). The current aim is to summarize the literature into four representative categories relating to CHD risk: social environments, social roles, social resources, and close relationships. The argument is made that these factors moderate and mediate stress and associated physiological responses constituting a psychosomatic pathway to disease.
Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services.
This study examined factors that helped to explain patients' perceptions of their providers' interpersonal sensitivity - one component of cultural competence.
The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey.
Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients.
Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.
a b s t r a c t Stereotypes about Mexicans are that they are outgoing, talkative, sociable, and extraverted. However, in self-reports, Mexicans rate themselves as less extraverted than Americans. To resolve this paradox, we measured self-reported sociability using a personality questionnaire, and behavioral sociability using the Electronically Activated Recorder (EAR) in Mexican and American students. The results showed that Mexicans saw themselves as less sociable than Americans, but they behaved more sociably in their every-day lives. The results also showed that expressions of sociability differed across cultures in accordance with manifestations of interdependent–independent selves. Whereas Mexicans socialized more often in public environments and by interacting with a person who is immediately present, Americans social-ized more in private environments and by interacting with remote persons.
This article examines subgroup differences in the health status of Hispanic adults in comparison to non-Hispanic whites and non-Hispanic blacks. We pay particular attention to the influences of nativity and duration of residence in the United States. Data are pooled from the National Health Interview Survey (NHIS) for 1989–94. Puerto Ricans exhibited the worst health outcomes of any group (including whites and blacks) for each of the three health measures. Persons of Central/South American origin exhibited the most favorable outcomes for activity limitations and bed sick days, advantages that were eliminated when controlled for nativity/duration. For two of the three health status variables, Mexican Americans were very similar to non-Hispanic whites in baseline models and were more favorable than non-Hispanic whites once socio-economic factors were controlled; this was not the case, however, for self-reported overall health. Immigration also helped to explain the relatively positive outcomes among Central/South American origin individuals, Cubans, and Mexican Americans. For most Hispanic groups (as well as non-Hispanic whites and non-Hispanic blacks), immigrants reported better health than the U.S. born, which is consistent with a selectivity hypothesis of immigrant health. In addition, this advantage tended to be significantly smaller among immigrants with ten or more years' duration in the United States. Although the latter finding is consistent with the negative acculturation hypothesis, alternative interpretations, including the generally more limited access of immigrants to the formal health care system, are suggested.