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Mental Health Issues Within Latinx Populations: Evaluating the State of the Field
Abstract
Despite chronic exposure to social stressors that are known to undermine health, the Latinx population within the USA is healthier than the non-Latinx White population on most indicators of mental health. However, Latinx children and youth who were born and/or raised in the USA amid a culture of anti-immigrant sentiment, racial/ethnic discrimination, and socioeconomic disadvantage are in a context that increases the risk for depression and maladaptive behaviors. In this chapter, we examine mental health within the Latinx population by summarizing extant epidemiologic data and highlighting theoretical models that are applied to the study of Latinx mental health. We also explore how culture shapes mental health outcomes and mental health disparities related to national origin and immigrant status. We conclude with a discussion of a key mental health issue, adolescent depression, through a systems dynamics approach to illustrate potential future directions.
... Exploring the significant impact of culture, racism, and discrimination on the well-being of Latina immigrants necessitates an intersectional approach that captures their complex identities and experiences. Intersectionality, a concept introduced by Crenshaw (1989) Latina immigrants (Zvolensky et al., 2022;Calzada et al., 2020;Romero et al., 2007). The subsequent sections will provide a more in-depth analysis of the framework's principles. ...
... Familia holds a crucial role in Latinx culture, where any family member is counted on during times of need (Calzada et al., 2020;Mendez-Luck et al., 2016). For instance, Mexican women rely on their family members for various tangible and intangible resources, including employment, housing, financial and emotional support, encouragement, and socialization (Calzada et al., 2020;Mendez-Luck et al., 2016;Pérez-Escamilla et al., 2010). ...
... Familia holds a crucial role in Latinx culture, where any family member is counted on during times of need (Calzada et al., 2020;Mendez-Luck et al., 2016). For instance, Mexican women rely on their family members for various tangible and intangible resources, including employment, housing, financial and emotional support, encouragement, and socialization (Calzada et al., 2020;Mendez-Luck et al., 2016;Pérez-Escamilla et al., 2010). Intersectionality recognizes that machismo and marianismo intersect with racism, discrimination, and gender inequalities Latina immigrants face in the United States (Calzada et al., 2020;Mendez-Luck et al., 2016). ...
... But we also expect that despite that stress rooted in structural discrimination, individuals not racialized as White may also have positive mental health. For example, Black (Thomas Tobin et al. 2020;Erving, Thomas, and Frazier 2018;Barnes and Bates 2017) and Latina/o/x individuals (Alegría et al. 2008;Calzada et al. 2020) have fewer mental health problems than Whites. Following what is called Black Advantage Vision (Pattillo 2021), framing these findings as a paradox introduces a racist lens (Doucet 2021) and diminishes key social and individual resources available to marginalized groups that shape responses to discrimination (Brown, Mitchell, and Ailshire 2020; Pamplin and Bates 2021). ...
... Even before the pandemic, Black Americans were more likely to experience the death of a loved one, including family members and friends, with serious life course implications including a loss of social support and detri- (Prime, Wade, and Browne 2020) and Minority Stress Model (Meyer 1995;Meyer and Frost 2013). Yet, our analyses align with the Black Advantage Vision (Pattillo 2021) show a mental health advantage for respondents racialized as Black (for all mental health outcomes) and Latina/o/x (for depression and stress overload) that is consistent with research prior to the pandemic (Thomas Tobin et al. 2020;Erving, Thomas, and Frazier 2018;Barnes and Bates 2017;Calzada et al. 2020;Alegría et al. 2008), even with the inclusion of stress. COVID-19 and racial trauma stress were both associated with elevated levels of depression and anxiety, more loneliness, and more stress overload, net of demographic and mediator controls. ...
In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a population representative sample of 20-60 year-olds who were married or cohabiting, the National Couples' Health and Time Study (N =3,642), we examine two specific sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial/ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after accounting for a rich set of potential mechanistic indicators, including discrimination and social climate. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals impacted by systemic and interpersonal discrimination.
... Spanish-speaking families often cannot access language-concordant, culturally-affirming professional or peer support inside or outside the mental health system (Bauer et al., 2010;Calzada et al., 2020;Eamranond et al., 2009). Pro and colleagues (2022) found that between 2014 and 2019, there was a decrease of 17.8% in mental health facilities offering treatment in Spanish, while the Spanish-speaking population increased. ...
The Spanish-speaking community is the largest underserved language group in the United States. To advance social justice advocacy and multicultural humility for this language group, the field of counselor education needs to create pedagogical scaffolding for non-Spanish-speaking counselors-in-training to work with interpreters to support Spanish-speaking families, while also enhancing language-concordant training for Spanish-English bilingual counselors-in-training. We utilized a critical race research design to explore six counselors-in-training’s experience participating in service-learning through online facilitation of Child-Parent Relationship Therapy with Spanish-speaking families. Interpretative phenomenological analysis of qualitative data yielded four major themes: (a) collaboration, (b) improved awareness, (c) growth and strength, and (d) the need for more resources. Findings highlight the importance of iterative pedagogical and service-learning opportunities and supervision to enhance counselors-in-training’s culturally affirming interventions, knowledge, and social justice advocacy skills. Limitations and future directions are discussed.
... We also assessed depressive symptoms given that mental health continues to be a growing concern for children in the United States (Bitsko et al., 2022), with important implications for children's school engagement (Finning et al., 2019) and prosocial behaviors (Schwartz-Mette et al., 2020). Some research points to greater mental health risks for Latinx children, especially in regard to depressive symptoms (Calzada et al., 2020) and the role of parent-child conflict in child's depressive symptoms in childhood (Katsantonis & McLellan, 2024). Considering these outcomes in relation to parent-child relationships has the potential to advance understanding of family relationships as resources for Latinx children's success in school, their peer relationships, and their mental health. ...
Grounded in family systems theory and using latent profile analysis, the present study examined (a) patterns of parent–child warmth and parent–child conflict within multiple dyads (mother–older child, mother–younger child, father–older child, father–younger child) among 305 U.S. Latinx families with fifth graders (Mage = 10.6; 46.6% female) and younger siblings (Mage = 8.20; 47.2% female) and (b) tested links of profile membership with child academic competence, negative peer relationships, and depressive symptoms. Two profiles were characterized by differential maternal and paternal warmth toward older versus younger siblings, with one of the profiles characterized by higher levels of conflict than the other, and a third profile included families where parent–child dyads were similar in their levels of moderately high warmth and low conflict. Profile membership was concurrently linked with children’s academic competence, peer relationships, and depressive symptoms, with notable within-family differences for older versus younger siblings. Findings underscore the value of studying families as interrelated subsystems by capturing multiple dimensions of two children’s relationships with mothers and fathers and provide insights for family-based prevention.
... The current authors use the pan-ethnic terms Latine or Latinx as encompassing the terms Hispanic (derived from Spain plus the entire Spanish colonized empire), Latino/a (gendered, for those with ties to Latin America specifically), and Chicano/a (a racist slur reclaimed as a symbol of pride for Mexican Americans specifically) [4]. Latine/x includes widely varied acculturation, language, and immigration statuses, all of which impact an individual's ability and willingness to enter the United States mental health system and seek services [5,6]. Indigenous individuals from Latin America likely do not align with this term, and may or may not speak Spanish, however, are likely placed in the above monolithic categories in the databases referenced herein. ...
Limited English language proficiency by Spanish speakers in the United States presents a challenge to both those seeking effective mental health services as well as for health care providers. This study sought to understand how many Spanish speakers with mental health or substance use disorders in the United States are impacted by limited English proficiency. It also sought to understand the number of Spanish language clinicians required to meet the current and future needs. Estimates were developed by combining published statistics from three public data sources: the United States Census Bureau Decennial Survey, the United States Census Bureau American Community Survey, and the Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Health- Hispanics. The data revealed that the Latine/x population comprises nearly 19% of the United States at over 62 million. Spanish speakers within this population are the largest non-English language group in the United States, at nearly 42 million and growing. Over 16 million of the Spanish-speaking population report limited English proficiency. Approximately 7.9 million Latine/x suffer from mental health or substance use disorders. All three data sources were combined to estimate that 2.3 million Spanish speakers with limited English proficiency have either substance use or mental health disorders. The availability of Spanish language services is one of the most important factors if we want to encourage the 2.3 million to seek help. The available research on the Spanish-speaking mental health care workforce demonstrates a significant shortfall in meeting the needs of those numbers. More action is needed to increase the Spanish language skills of the mental health workforce to meet the needs of this at-risk population.
Keywords: Latine/x, Spanish, mental health, language proficiency, language-concordant services
... Within the U.S., individuals belonging to minoritized groups encounter greater instances of contextual stressors that stand to undermine positive mental health outcomes (Calzada et al., 2020), and these preexisting disparities have been exacerbated by the ongoing COVID-19 pandemic. Among such groups, Latinx and Hispanic individuals seem to be notably impacted by COVID-19; approximately 19% of the U.S. population is Latinx/Hispanic, yet these individuals account for one third of reported COVID-19 cases (Center for Disease Control, 2022). ...
The COVID-19 pandemic has created unprecedented disruptions in the daily lives and mental health of adolescents. Less attention has been given to the psychosocial resources that may mitigate the impact of COVID-19 on adolescent mental health, particularly among minoritized populations. In the present study, 259 youth (aged 11–18) were recruited from a community center for integrated prevention and intervention services in a predominantly Latinx and Hispanic community. Youth completed questionnaires about the impact COVID-19 has had on their lives, psychosocial resources (humor, optimism, emotion regulation, social support), and psychiatric symptoms (depressive symptoms, anxiety symptoms, sleep disturbances, aggression). After accounting for age, sex, and exposure to early life adversity, higher reported COVID-19 impact was associated with more depressive symptoms, b = 6.37 (SE = 1.67), 95% CI [3.08, 9.66], p < 0.001, more anxiety symptoms, b = 9.97 (SE = 1.63), 95% CI [6.75, 13.18], p < 0.001, and more sleep disturbances, b = 1.24 (SE = 0.34), 95% CI [0.57, 1.91], p < 0.001. Youth that reported infrequent expressive suppression and the lowest scores on giving social support were at the greatest risk for aggressive behavior in the context of high COVID-19 impact, ps < 0.007. Increasing emotion regulation skills, such as expressive suppression, and opportunities to give social support may promote resilience among high risk youth in the context of this ongoing community stressor.
Social strain and lack of social support are associated with depression, but it remains unclear whether racial/ethnic differences in social relationships shape racial/ethnic disparities in late-middle age and late-life mental health. Using data from Health and Retirement Study 2006–2016 ( N = 5,139), this study estimated negative binomial regressions to examine whether differential exposure to and differential effect of social support and strain with spouses, children, family members, and friends explain Black-White and Latinx-White disparities in depressive symptoms. The findings indicate that minority older adults, especially Latinx, have more depressive symptoms than Whites. Although social support compensates for some mental health gaps, mediation and moderation analyses reveal that such disparities are attributable to Black and Latinx late-middle-aged and older adults’ greater exposure to social strain and diminished returns of social support from spouses and children as compared with Whites. This study offers insights regarding how mental health inequality is impacted by racial/ethnic differences in stress exposure and the protective effect of social relationships.
The Latinx immigrant population experienced one of the highest COVID-19 death rates. Those left behind have exhibited rising rates of mental illness, particularly, pandemic-related prolonged grief disorder. The Latinx immigrant population is uniquely vulnerable to this disorder as a result of disrupted culturally appropriate bereavement practices, constrained social support, and concurrent COVID-19 stressors and immigration-related trauma. Despite a rising call for research on pandemic-related prolonged grief disorder, little is known about the true prevalence, cause, and appropriate treatment protocol behind this disorder in the Latinx immigrant population. Four areas of research critical to the identification and understanding of pandemic-related prolonged grief disorder in this population are recommended: 1) death and bereavement in transnational settings, 2) immigrant social networks and disrupted bereavement, 3) COVID-19 stressors and grieving, and 4) prolonged grief disorder and mental illness comorbidities. An understanding of these four contributing areas to Latinx immigrants’ vulnerability to prolonged grief disorder is imperative to providers’ development of assessments and treatment protocols needed to identify and treat prolonged grief disorder in this population.
The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others’ support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people’s needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.
As previous research points to the importance of studying a specific ethnic group due to within group differences among the Latinx community, this research focused on Mexican Americans’ mental health disparities by examining mental health and attitudes toward seeking counseling in relation to relevant cultural factors, such as cultural values, generational status, and social class. Based on a sample of 350 Mexican American college students, the findings revealed that better mental health was related to lower adherence of the familism value, higher adherence of the respect value, and higher subjective social class. Moreover, more positive attitudes toward seeking counseling was related to lower adherence to familism and traditional gender role cultural values. Lastly, our findings did not support the moderation hypothesis by generational status. Mental health professionals need to consider that multidimensional cultural aspects operate differently by hindering or enhancing help-seeking attitudes and mental health.
This study investigated the relationship between race and psychological distress among Latinxs in the United States. Using data from the National Health Interview Survey (NHIS) 2010-2018, we estimated the relative risk ratios (RRR) of experiencing psychological distress among White, Black, and Other Latinxs from Mexico, Cuba, Dominican Republic, and Puerto Rico. Results revealed that Black Latinxs experienced higher levels of psychological distress than their White counterparts. Additional analysis among and within groups showed that Puerto Ricans and Dominicans reported higher psychological distress than Mexicans, and that race was associated with the distress of Cubans and Mexicans, but not with the distress of Puerto Ricans and Dominicans. Future work on the effect of racial self-identification on Latinxs’ mental health-related outcomes, such as psychological distress, should include multidimensional measures of racial identity, such as self-reported and ascribed race, racial ideology, as well as measures of skin color and discrimination. Integrating racialization experiences during clinical assessments would help practitioners to gain a more comprehensive picture of how these identities and experiences may shape the stress, distress, and mental health outcomes (e.g., depression, anxiety) of different racial and ethnic Latinx groups in the U.S.
While the United States hosts the greatest number of international students in the world, Latino international students remain understudied, especially in regards to substance use. The present study tests differences between Latino international and Latino domestic undergraduates in how they use alcohol, cigarette, and illicit drugs. Participants (N = 786 students, 386 international and 400 domestic, 65% female, mean age = 21.2 years) were a subsample of Latino students surveyed in the 2009 American College Health Association’s revised National College Health Assessment (ACHA-NCHA II). Results indicate that Latino international students reported more alcohol use than Latino domestic students, but had similar use of cigarettes and illicit drugs. Among international students, gender, participation in Greek life, cigarette use, marijuana use, and year in school were associated with alcohol use. Similarly, gender, cigarette use, and marijuana use were significantly related to international students’ binge drinking. Prevention and research implications are discussed.
Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.
Hispanic/Latino migrants and immigrants are vulnerable to infection by HIV and other sexually transmitted diseases (STDs). Participation in social support networks helps them cope with circumstances in the U.S. Studies of Hispanic/Latino migrants suggest that participation may also be protective against HIV/STD infection. However the studies do not satisfactorily explain how participation leads to protective actions, and recommend externally-induced interventions for HIV/STD prevention rather than incorporating the spontaneously occurring forms of social support they describe. Given the potential protective effects of support networks, a database search was conducted to ascertain the extent to which published HIV/STD prevention interventions for these populations incorporate their support networks. Very few interventions were identified and fewer still incorporate support networks. This commentary calls for research to understand more fully how support networks affect HIV/STD risks among Hispanic/Latino migrants and immigrants and identifies potential benefits of incorporating these networks in HIV/STD prevention for these vulnerable populations.
Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population.
Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States.
Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches.
Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status.
Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian–Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups.
Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P = .001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses.
Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience.
Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services. (Am J Public Health. Published online ahead of print November 29, 2018: e1–e8. doi:10.2105/AJPH.2018.304727)
Lack of legal immigration status is associated with poor HIV-related outcomes for immigrant Latinx sexual and gender minorities (LSGM). LSGM often meet eligibility criteria for legal immigration relief. A Medical-Legal Partnership (MLP) may thus be strategic to improve their health. We know little about the challenges LSGM face during the immigration legal process. We conducted in-depth interviews with six key informants and sixteen LSGM who recently applied for immigration legal relief. We coded and analyzed the data for emergent themes. Challenges to instituting an MLP for LSGM included lack of specialized training on working with SGM for immigration attorneys, and for clients: knowledge about legal deadlines, lack of housing and family support, and re-traumatizing experiences. Clients’ outcomes were positive when attorneys and mental health providers collaborated. For LSGM, the benefits of immigration relief included reduced HIV risk. An MLP that addresses the surmountable challenges could improve HIV-related outcomes among LSGM.
Introduction
The Latino population in the United States is rapidly growing and faces profound health disparities; however, engagement of Latinos in biomedical research remains low. Our community-based participatory research partnership has recruited 2083 Spanish-speaking Latinos into 21 studies over 15 years. We sought to identify and describe the strategies we have used to successfully recruit and retain Spanish-speaking Latinos in research.
Methods
We abstracted and analyzed data from archived study notes, progress reports, team meeting minutes, and in-depth interviews conducted annually from community-based participatory research partnership members. We used a nominal group process to refine and prioritize strategies.
Results
Overall, 13 recruitment strategies and 12 retention strategies emerged. These strategies relied on the creativity and perseverance of the study team and partners.
Conclusions
It is essential that we develop and disseminate effective recruitment and retention strategies that engage Latinos in biomedical research to reduce health disparities and promote health equity.
Various methods, approaches, and strategies designed to understand and reduce health disparities, increase health equity, and promote community and population health have emerged within public health and medicine. One such approach is community-engaged research. While the literature describing the theory, principles, and rationale underlying community engagement is broad, few models or frameworks exist to guide its implementation. We abstracted, analyzed, and interpreted data from existing project documentation including proposal documents, project-specific logic models, research team and partnership meeting notes, and other materials from 24 funded community-engaged research projects conducted over the past 17 years. We developed a 15-step process designed to guide the community-engaged research process. The process includes steps such as: networking and partnership establishment and expansion; building and maintaining trust; identifying health priorities; conducting background research, prioritizing "what to take on"; building consensus, identifying research goals, and developing research questions; developing a conceptual model; formulating a study design; developing an analysis plan; implementing the study; collecting and analyzing data; reviewing and interpreting results; and disseminating and translating findings broadly through multiple channels. Here, we outline and describe each of these steps.
This article presents an overview of our research team's disaster response to the massive destruction of Hurricanes, Irma and Maria, in September 2017, in light of the 120-year colonial legacy and long-term, widespread environmental contamination in Puerto Rico. Both local and federal governmental responses have been extremely inadequate, especially in light of the long-standing issues of environmental contamination throughout the island. Community organizations in Puerto Rico have been fighting for environmental justice for decades, often succeeding, and always confronting government unwillingness to address environmental protection. Hurricanes Irma and Maria afforded attention to Puerto Rico through international news coverage and awareness of its colonial status, rundown infrastructures (especially the electric grid), indebtedness, and environmental hazards. Since the hurricanes, the research teams of the Puerto Rico Test Site to Explore Contamination Threats (PROTECT), the Center for Research on Early Childhood Exposure and Development (CRECE), and Zika in Infants and Pregnancy (ZIP) have worked tirelessly to address the needs of our research participants, partnering clinics, as well as the local team to ensure safety and wellness. We have been able to continue our environmental public health work with pregnant women and children. In response to the historical problems and current crisis, we offer a "visionary rebuilding" approach for remediation of the hurricanes' effects, and for a deeper solution to the environmental and other social injustices Puerto Rico has long faced.
Throughout the world, we continue to face profound challenges to reducing the impact of the HIV epidemic. Community-engaged research has emerged as an approach to increase our understanding of HIV and reduce health disparities, increase health equity, and promote community and population health. Our partnership has conducted more than 25 community-engaged research studies in the U.S. and Guatemala, and members have identified nine themes to facilitate community-engaged research and expedite advances in HIV prevention, care, and treatment. These themes include the inclusion of multisectoral partners, trust building and maintenance, the alignment of partner priorities, a can-do attitude, capacity and desire to move beyond service and conduct research, flexibility, power sharing, empowerment, an assets orientation, the shared and timely use of findings, and a stepwise approach. To reduce HIV disparities, community-engaged research is as critical now as ever, and we desperately need to reinvigorate our commitment to and support of it.
Among Latinos in the United States, particularly in new settlement states, racial/ethnic discrimination, violence, and immigration enforcement contribute to health disparities. These types of experiences were explored among Latino men in North Carolina through quantitative assessment data (n = 247). Qualitative in-depth interviews were also conducted with a subsample of Latino men who completed the assessment (n = 20) to contextualize quantitative findings. Participants reported high rates of unfair treatment, discrimination or violence, and questioning about their immigration status. Having been questioned about one’s immigration status was significantly associated with increased drug use (adjusted odds ratio [AOR] = 2.16; 95% confidence interval [CI] [1.07, 4.38]) and increased depressive symptoms (AOR = 2.87; 95% CI [1.07, 7.67]). Qualitative themes included: reports of frequent discrimination based on immigration status, race/ethnicity, and language; workplaces and police interactions as settings where reported discrimination is most common and challenging; frequent violent victimization; psychological consequences of experiences of discrimination and violence and concerns related to immigration enforcement for Latino men and their families; inter- and intra-community tensions; health-care services as safe spaces; use of coping strategies; and system-level approaches for reducing discrimination and violent victimization of Latinos. Findings point to the need to address underlying causes of discrimination and violence toward Latinos, particularly those related to immigration enforcement, to support health and well-being.
Assimilation theory has been subject to intensive critique for decades. Yet no other framework has provided the social science community with as deep a corpus of cumulative findings concerning the incorporation of immigrants and their descendants. We argue that assimilation theory has not lost its utility for the study of contemporary immigration to the United States. In making our case, we review critically the canonical account of assimilation provided by Milton Gordon and others; we refer to Shibutani and Kwan's theory of ethnic stratification to suggest some directions to take in reformulating assimilation theory. We also examine some of the arguments frequently made to distinguish between the earlier mass immigration of Europeans and the immigration of the contemporary era and find them to be inconclusive. Finally, we sift through some of the evidence about the socioeconomic and residential assimilation of recent immigrant groups. Though the record is clearly mixed, we find evidence consistent with the view that assimilation is taking place, albeit unevenly.
The process of immigrant assimilation is typically and uncritically conceived as one of linear progress – becoming similar to the dominant group in the place of destination is presumed to be a good thing. But a compelling body of evidence on the adaptation of immigrants and their children points to a deterioration of outcomes over time and generation in the United States, as well as to nonlinear processes of change. While linguistic assimilation among children of immigrants does proceed rapidly and inexorably as a linear function, other outcomes – in such diverse areas as infant and adolescent health, diet and divorce, delinquency and risk behaviors, educational achievement and aspirations, an ethos of hard work, and the development of an ethnic identity – contradict conventional expectations, expose underlying ethnocentric pretensions, and point instead to assimilation's discontents. By examining such paradoxes of immigrant adaptation that emerge in the conceptual interstices between rhetoric and reality, fruitful reformulations of a seminal sociological concept may be stimulated and advanced.
Purpose:
Research on healthcare among gender-diverse populations has largely focused on people who describe their gender in binary terms, either as trans men or trans women. This qualitative study examined the healthcare experiences of young adults who identify as genderqueer or nonbinary (GQ/NB).
Methods:
Participants (N = 10) were interviewed about experiences seeking and accessing healthcare. All were young adults (ages 23-33) in the San Francisco Bay area who had accessed healthcare at least once in the prior 6 months. A semistructured interview guide elicited conversations about gender identity and experiences of healthcare. Interview transcripts were analyzed using emergent coding analysis to identify themes.
Results:
Participants faced unique challenges even at clinics specializing in gender-affirming healthcare. They felt misunderstood by providers who approached them from a binary transgender perspective and consequently often did not receive care sensitive to nonbinary identities. In response to this perceived bias, participants sometimes "borrowed" a binary transgender label to receive care, modified the healthcare they were prescribed, or went without healthcare. The GQ/NB young adults in our study regularly felt disrespected and frustrated as they sought and accessed healthcare. Participants felt that the binary transgender narrative pressured them to conform to binary medical narratives throughout healthcare interactions.
Conclusions:
GQ/NB young adults have unique healthcare needs but often do not feel understood by their providers. There is a need for existing healthcare systems to serve GQ/NB young adults more effectively.
Objective:
"Arte con Salud" is an HIV/AIDS prevention intervention tailored for Puerto Rican women who have sex with men. The intervention curriculum was refined through a community-academic collaboration between Taller Salud, the UPRCayey Campus, and the UCC-School of Medicine, subsided in 2012-13 by PRCTRC. The collaboration has been crucial to validate the impact of using art as a tool to facilitate sexual negotiation skills and safer sexual practices among adult women have sex with men participating in HIV prevention education.
Methods:
This article describes the vision, valley, victory phases endured to establish a community-academia partnership based on the CPPR framework as an effective mean to implement a randomized controlled trial intervention (RCT). We also discuss the barriers, outcomes, and lessons learned from this partnership.
Results:
Some of the identified solutions include: setting goals to secure funding, regular meetings, and the inclusion of undergraduate level students to assist in the implementation of the intervention. These solutions helped to build trust among the community and academic partners. As a result of this collaboration, a total of 86 participants were enrolled and 5 competitive research grants have been submitted.
Conclusion:
The community-academic collaboration was essential in order to build a solid research infrastructure that addresses the complexities of HIV prevention education among groups of Puerto Rican women.
Objectives:
To determine whether non-US citizens have a higher mortality risk of heat-related deaths than do US citizens.
Methods:
We used place of residence reported in mortality data from the National Vital Statistics System from 2005 to 2014 as a proxy for citizenship to examine differences in heat-related deaths between non-US and US citizens. Estimates from the US Census Bureau American Community Survey of self-reported citizenship status and place of birth provided the numbers for the study population. We calculated the standardized mortality ratio and relative risk for heat-related deaths between non-US and US citizens nationally.
Results:
Heat-related deaths accounted for 2.23% (n = 999) of deaths among non-US citizens and 0.02% (n = 4196) of deaths among US citizens. The age-adjusted standardized mortality ratio for non-US citizens compared with US citizens was 3.4 (95% confidence ratio [CI] = 3.2, 3.6). This risk was higher for Hispanic non-US citizens (risk ratio [RR] = 3.6; 95% CI = 3.2, 3.9) and non-US citizens aged 18 to 24 years (RR = 20.6; 95% CI = 16.5, 25.7).
Conclusions:
We found an increased mortality risk among non-US citizens compared with US citizens for heat-related deaths, especially those younger and of Hispanic ethnicity. (Am J Public Health. Published online ahead of print October 26, 2017: e1-e6. doi:10.2105/AJPH.2017.304006).
This timely volume serves as a comprehensive and much-needed update to the literature on Latinx health. As both the United States and Latinx subgroups experience and anticipate demographic shifts, it is critical to examine the current epidemiology of Latinx health, as well as the factors influencing this population's health and well-being. Chapters in this book, written by highly respected experts, illuminate the diversity of the Latinx population and provide strategies to mitigate many of the challenges faced by them, including challenges related to migrating to new destinations. The book is designed to enrich dialogue around the multilevel determinants of Latinx health, and concludes with a call to action for both increased culturally congruent and sound Latinx-focused research and the mentorship of Latinx early-career investigators.
A selection of the perspectives included among the chapters:
• Chronic disease and mental health issues in Latinx populations
• Substance use among Latinx adolescents in the United States
• Health insurance reform and the Latinx population
• Immigration enforcement policies and Latinx health
• Research priorities for Latinx sexual and gender minorities
• Racial and ethnic discrimination, intersectionality, disability, and Latinx health
New and Emerging Issues in Latinx Health is an invaluable compendium that provides a foundation of understanding Latinx health and well-being and guides future research and practice. The book is essential for researchers, practitioners, and students in the fields of public health, health education, population and community health, preventive medicine, health administration and policy, and community and health psychology, and is also relevant for federal, state, and local agencies including health departments and other Latinx- and immigrant-serving community-based organizations.
Much of the literature on family networks of Hispanic elders in the United States assumes that the family is the natural support network without considering the structural, cultural, and psychosocial impact of immigration, or exile, on the family. However, there has been an increasing tendency of elder Cuban immigrants in the United States to live alone. With increasing mobility and varying degrees of acculturation across generations, it is important to understand how older people make sense of their rapidly changing familial life to themselves and to others. This paper compares the results of structured interviews of 79 Cuban elders in Miami-Dade County, Florida (U.S.) and focus groups on intergenerational relations held among a subset of fifteen of these elders using content analysis. Themes covered include desired family size, actual family size and its perceived effect, reasons for family size and roles of the family. The aim was to explore the ideal verses the real of Cuban elder family life and how elders themselves make sense of it. Results indicated that the ideal is larger families, but not co-residence. Migration and related economic necessity are understood as the primary reason for smaller families, as well as changes in intergenerational exchanges. The concept of the family, however, expands beyond the nuclear unit to include extended kin in the absence of co-residence and regular exchanges with children. The ideal family relations and perceived affect of migration on this dynamic were more likely to be expressed in the focus group setting than in the individual interviews.
The relationship between undocumented immigrants and law enforcement officials continues to be a politically contentious topic in the United States. Nolan Kline focuses on the hidden, health-related impacts of immigrant policing to examine the role of policy in shaping health inequality in the U.S., and responds to fundamental questions regarding biopolitics, especially how policy can reinforce ‘race’ as a vehicle of social division. He argues that immigration enforcement policy results in a shadow medical system, shapes immigrants’ health and interpersonal relationships, and has health-related impacts that extend beyond immigrants to affect health providers, immigrant rights groups, hospitals, and the overall health system. Pathogenic Policing follows current immigrant policing regimes in Georgia and contextualizes contemporary legislation and law enforcement practices against a backdrop of historical forms of political exclusion from health and social services for all undocumented immigrants in the U.S. For anyone concerned about the health of the most vulnerable among us, and those who interact with the overall health safety net, this will be an eye-opening read.
The plight of immigrant workers in the United States has captured significant scholarly attention in recent years. Despite the prevalence of discourses regarding this population, one set of issues has received relatively little attention: immigrant workers' exposure to unhealthy and unsafe working conditions, and their corresponding susceptibility to workplace injuries and illnesses. Researchers have consistently found that immigrant workers suffer disproportionately from occupational injuries and fatalities, even when controlling for industry and occupation. Why, then, are foreign-born workers at greater risk for workplace injuries and fatalities, when compared with their native-born counterparts? This Article seeks to develop answers to that question with the aid of empirical research and to build upon a growing interdisciplinary literature. This Article presents findings from a qualitative research study designed to explore the factors that shape occupational risks for immigrants. The study, conducted over several months in 2014, centered on in-depth interviews of eighty-four immigrant day laborers seeking employment in different parts of Northern Virginia. The workers' responses present a complex picture of the immigrant worker experience, reflecting persistent dangers alongside powerful expressions of worker dignity: while the Virginia day laborers continue to encounter significant occupational risks, many comfortably asserted their rights, complicating standard narratives of immigrant worker subordination and vulnerability. The results of the study also point to ongoing economic insecurities, and regulatory failures relating to the provision of training, use of protective equipment, and oversight of smaller worksites. The findings also signal the need for a more holistic approach to workplace regulation that concomitantly examines a range of workplace concerns, including wage violations, hostile work environments, and health and safety risks. Finally, the day laborers' experiences reveal that worker centers are well positioned to insulate immigrant workers from workplace risks, by promoting transparency and accountability in the employer-employee relationship.
Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements.
Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities.
Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.
Spanish and English have fought a centuries-long battle for dominance in the Southwest North American Region, commonly known as the U.S.-Mexico transborder region. Covering the time period of 1540 to the present, Hegemonies of Language and Their Discontents provides a deep and broad understanding of the contradictory methods of establishing language supremacy in the region and the manner in which those affected have responded and acted, often in dissatisfaction and at times with inventive adaptations. Well-regarded author Carlos G. Vélez-Ibáñez details the linguistic and cultural processes used by penetrating imperial and national states. He argues that these impositions were not linear but hydra-headed, complex and contradictory, sometimes accommodating and at other times forcefully imposed. Such impositions created discontent resulting in physical and linguistic revolts, translanguage versions, and multilayered capacities of use and misuse of imposed languages-even the invention of community-created trilingual dictionaries. Vélez-Ibáñez gives particular attention to the region, including both sides of the border, explaining the consequences of the fragile splitting of the area through geopolitical border formation. He illustrates the many ways those discontents have manifested in linguistic, cultural, educational, political, and legal forms. From revolt to revitalization, from silent objection to expressive defiance, people in the Southwest North American Region have developed arcs of discontent from the Spanish colonial period to the present. These narratives are supported by multiple sources, including original Spanish colonial documents and new and original ethnographic studies of performance rituals like the matachines of New Mexico. This unique work discusses the most recent neurobiological studies of bilingualism and their implications for cognitive development and language as it spans multiple disciplines. Finally, it provides the most important models for dual language development and their integration to the Funds of Knowledge concept as creative contemporary discontents with monolingual approaches.
The containment of immigrants along the US/Mexico border illuminates the complex spatial implications associated with the securitization of migration enforcement. The production of marginalized, carceral national spaces has particular consequences for the people that inhabit them, as processes of spatial illegality shape their daily lives. Our analyses draw on five years of ethnographic study in the Rio Grande Valley of Texas. Here, we focus on the experiences of sixty‐one undocumented youth, including recipients of Deferred Action for Childhood Arrivals (DACA), to explore how the spatial violence created by checkpoints and everyday policing practices lead to experiences of confinement and accelerate processes of social exclusion. Spillover effects occur as all inhabitants must pass through inspection points and demonstrate proof of identity and legal residency; this contributes to the reformulation of citizenship. To this, our article adds insight into how social membership is experienced at the checkpoints so that “citizenship” and “authorization” become conflated. Early childhood and youth experiences of freely crossing spaces with school programs yet living with uncertain and precarious status contributes to persistent fear, instability, and confusion under a multilayered immigration policy regime.
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Anthropological research on policy and health underscores how policy reflects cultural ideologies and results in marginalizing specific populations. Ethnographic inquiry can further reveal the broader, unexpected effects of policy change. In this article, I describe how state legislators in Georgia revised an existing entitlement program to specifically exclude undocumented immigrants with kidney failure from receiving life‐sustaining care. This health policy change converged with broader efforts to financialize the US health system and resulted in undocumented immigrant patients dying; being medically repatriated to their countries of birth; placed in private, for‐profit dialysis centers; or obtaining care through a burdensome process involving a public hospital's emergency room. Drawing from Mbembe's concept of necropolitics, I show how policy changes left undocumented kidney failure patients in a state between life and death, revealing the hidden outcomes of policies targeting immigrants. As anti‐immigrant policies continue to be proposed in the United States, findings from this article provide a cautionary tale about the sweeping consequences of legislation that targets immigrants.
Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participants' descriptions of positive and negative health care experiences, and what they wish providers knew about caring for TGGNB patients. Health care experiences went well when providers and staff used inclusive language, demonstrated their experience and education, and treated identity disclosure as routine. Negative interactions were characterized by misgendering, unfamiliarity with TGGNB people and health issues, and transphobic practices. Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving TGGNB patient experiences. Through a framework of cultural safety, we recommend several changes to ensure more equitable treatment in health care.
This article examines the provision of public parks in Latino and non-Latino neighbourhoods in the Phoenix Metropolitan Area. Though previous research has examined the socio-spatial distribution of urban parks, few have analysed both accessibility and variations in park features associated with the Latino composition of neighbourhoods. In this study, geographical information systems were employed to assess the availability and accessibility of neighbourhood parks, and Google Earth was used to audit their natural and built environmental features. Analysis of variance (ANOVA) with Games-Howell post hoc test was applied to examine the hypothesis that park resources are not equitably distributed across neighbourhoods, and that Latino places are disproportionally affected by a suboptimal provision of park space and services. The analysis points to invariance across neighbourhoods in terms of quantity and features of public parks, so the expected systemic pattern of inequality affecting Latino neighbourhoods in Phoenix Metro was not found. The study suggests, however, some areas wherein cities in the Phoenix Metropolitan Area could act to improve the allocation of public park resources and engage the diversity of local populations.
The Trump administration has made the construction of an “impregnable” 2,000-mile wall across the length of the US-Mexico border a centerpiece of its executive orders on immigration and its broader immigration enforcement strategy. This initiative has been broadly criticized based on:
• Escalating cost projections: an internal Department of Homeland Security (DHS) study recently set the cost at $21.6 billion over three and a half years;
• Its necessity given the many other enforcement tools — video surveillance, drones, ground sensors, and radar technologies — and Border Patrol personnel, that cover the US-Mexico border: former DHS Secretary Michael Chertoff and other experts have argued that a wall does not add enforcement value except in heavy crossing areas near towns, highways, or other “vanishing points” (Kerwin 2016);
• Its cost-effectiveness given diminished Border Patrol apprehensions (to roughly one-fourth the level of historic highs) and reduced illegal entries (to roughly one-tenth the 2005 level according to an internal DHS study) (Martinez 2016);
• Its efficacy as an enforcement tool: between FY 2010 and FY 2015, the current 654-mile pedestrian wall was breached 9,287 times (GAO 2017, 22);
• Its inability to meet the administration's goal of securing “operational control” of the border, defined as “the prevention of all unlawful entries to the United States” (White House 2017);
• Its deleterious impact on bi-national border communities, the environment, and property rights (Heyman 2013); and
• Opportunity costs in the form of foregone investments in addressing the conditions that drive large-scale migration, as well as in more effective national security and immigration enforcement strategies.
The Center for Migration Studies (CMS) has reported on the dramatic decline in the US undocumented population between 2008 and 2014 (Warren 2016). In addition, a growing percentage of border crossers in recent years have originated in the Northern Triangle states of Central America (CBP 2016). These migrants are fleeing pervasive violence, persecution, and poverty, and a large number do not seek to evade arrest, but present themselves to border officials and request political asylum. Many are de facto refugees, not illegal border crossers.
This report speaks to another reason to question the necessity and value of a 2,000-mile wall: It does not reflect the reality of how the large majority of persons now become undocumented. It finds that two-thirds of those who arrived in 2014 did not illegally cross a border, but were admitted (after screening) on non-immigrant (temporary) visas, and then overstayed their period of admission or otherwise violated the terms of their visas. Moreover, this trend in increasing percentages of visa overstays will likely continue into the foreseeable future.
The report presents information about the mode of arrival of the undocumented population that resided in the United States in 2014. To simplify the presentation, it divides the 2014 population into two groups: overstays and entries without inspection (EWIs). The term overstay, as used in this paper, refers to undocumented residents who entered the United States with valid temporary visas and subsequently established residence without authorization. The term EWI refers to undocumented residents who entered without proper immigration documents across the southern border.
The estimates are based primarily on detailed estimates of the undocumented population in 2014 compiled by CMS and estimates of overstays for 2015 derived by DHS. Major findings include the following:
• In 2014, about 4.5 million US residents, or 42 percent of the total undocumented population, were overstays.
• Overstays accounted for about two-thirds (66 percent) of those who arrived (i.e., joined the undocumented population) in 2014.
• Overstays have exceeded EWIs every year since 2007, and 600,000 more overstays than EWIs have arrived since 2007.
• Mexico is the leading country for both overstays and EWIs; about one-third of undocumented arrivals from Mexico in 2014 were overstays.
• California has the largest number of overstays (890,000), followed by New York (520,000), Texas (475,000), and Florida (435,000).
• Two states had 47 percent of the 6.4 million EWIs in 2014: California (1.7 million) and Texas (1.3 million).
• The percentage of overstays varies widely by state: more than two-thirds of the undocumented who live in Hawaii, Massachusetts, Connecticut, and Pennsylvania are overstays. By contrast, the undocumented population in Kansas, Arkansas, and New Mexico consists of fewer than 25 percent overstays.
We examine racialization processes experienced by women of Mexican origin in a northern border community during a protracted period of restrictive immigrant policies that have disparately affected Mexican-origin communities, and consider pathways through which these experiences may affect health. This grounded theory analysis draws on interviews conducted in 2013–2014 with 48 first, 1.5, and second generation Mexican-origin women living in Detroit, MI. Racialization processes blurred boundaries between Latinas/os, immigrants, and undocumented immigrants. Racialized policies and interactions required women to negotiate shifting and often precarious social and political terrain. We describe racializing markers used by agents of multiple institutions to assess the legal status of women and members of their social networks, shaping their access to the resources over which institutional agents held power. Specifically, we consider the dynamic mechanisms by which multiple legal, social, and employment institutions exacted immigrant policing and bureaucratic surveillance. These include: (1) interior and border immigration enforcement agents’ active surveillance of residents; (2) local law enforcement officials’ assertion of authority over driver’s licenses and contact with immigration officials, often in traffic-related encounters; (3) Secretary of State clerks’ discretion in assessing legal status and issuing driver’s licenses and state IDs; (4) social welfare agents’ scrutiny of citizenship status in determining access to nutritional, economic, and medical resources; and (5) employers’ exploitation of these structural vulnerabilities to justify unfair treatment of immigrant workers. We theorize several mechanisms, by which these processes affect health, including: stigmatization; hypervigilance; and restricted access to health-promoting resources.
The evening of June 12, 2016 at Pulse night club started like most other Saturday nights at Orlando’s popular gay bar. Hundreds of patrons were in the bar that night for the weekly “Latin night” event, dancing to reggaeton, merengue, and other hits expected during noche Latina. At around 2:00am, a man entered the club and fired a semi-automatic rifle onto the crowd. The shooter killed 49 people and injured 58 others. In what was the largest mass shooting in US history at the time, and the deadliest terrorist attack since September 11, 2001, the Pulse shooting disproportionally affected the LGBTQ+ Latinx population in Central Florida.
Purpose
The purpose of this study is to assess the weighted prevalence and odds ratios of obesity, prediabetes, and diabetes by (1) female sexual orientation (lesbian, bisexual, and straight) with racial/ethnic (Hispanic, non-Hispanic black, and non-Hispanic white) groups combined and (2) across and within racial/ethnic groups by sexual orientation.
Methods
A secondary analysis of pooled 2014-2015 Behavioral Risk Factor Surveillance System data from 28 states (N = 136 878) was conducted. Rao-Scott chi-square test statistics were computed and logistic regression models were developed to assess weighted prevalence and odds ratios of obesity, prediabetes, and diabetes with adjustments for demographics (age, income, and education), depression, and health care access factors.
Results
With racial/ethnic groups combined, lesbian and bisexual women, relative to straight women, had a significantly increased likelihood for obesity when controlling for demographics. Bisexual women were found to have significantly reduced odds for diabetes, compared with straight women, with adjustments for demographics, depression, and health care access factors. Compared with their non-Hispanic white counterparts, Hispanic lesbian women had significantly increased odds for obesity and diabetes, while non-Hispanic black bisexual women had a significantly greater likelihood for obesity, holding demographics, depression, and health care access factors constant. Non-Hispanic white lesbian women had an increased likelihood for obesity relative to their straight, ethnic/racial counterparts. Prediabetes subsample analysis revealed the prevalence was low across all female sexual orientation groups.
Conclusion
Sexual minority women, particularly those of color, may be at increased risk for obesity and diabetes. Research is needed to confirm the findings.
'Imagined Communities' examines the creation & function of the 'imagined communities' of nationality & the way these communities were in part created by the growth of the nation-state, the interaction between capitalism & printing & the birth of vernacular languages in early modern Europe.
Hispanics or Latinos constitute the largest racial/ethnic minority in the United States. They are also a very diverse population. Latino/Hispanic's health varies significantly for subgroups defined by national origin, race, primary language, and migration-related factors (place of birth, immigration status, years of residence in the United States). Most Hispanics speak Spanish at home, and one-third have limited English proficiency (LEP). There is growing awareness on the importance for population health monitoring programs to collect those data elements (Hispanic subgroup, primary language, and migration-related factors) that better capture Hispanics' diversity, and to provide language assistance (translation of data collection forms, interpreters) to ensure meaningful inclusion of all Latinos/Hispanics in national health monitoring. There are strong ethical and scientific reasons for such expansion of data collection by public health entities. First, expand data elements can help identify otherwise hidden Hispanic subpopulations' health disparities. This may promote a more just and equitable distribution of health resources to underserved populations. Second, language access is needed to ensure fair and legal treatment of LEP individuals in federally supported data collection activities. Finally, these strategies are likely to improve the quality and representativeness of data needed to monitor and address the health of all Latino/Hispanic populations in the United States.
Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.
Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002–2003, with follow-up at the same addresses in 2007–2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.
Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.
Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.
Puerto Rico is an archipelago located in the Caribbean basin, 1000 miles southeast of Florida. On September 20, 2017, Hurricane Maria struck Puerto Rico as a category 4 hurricane. This was just 2 weeks after category 5 Hurricane Irma impacted Puerto Rico and caused significant damage to the electric infrastructure, houses, and roads leading to the declaration of disaster zones in nearly 30 municipalities. In early October 2017, it was estimated that the impact of Hurricane Maria in Puerto Rico included nearly 50 confirmed deaths, the total destruction of the electric infrastructure, major interruptions in telecommunications, significant damage to highways and roads, and limited access to potable water and food. In the aftermath of Hurricane Maria, issues of governance were evident, as well as limited ability in the implementation of emergency preparedness plans, and, perhaps most importantly, the impact of structural determinants of health.
Objectives:
We examined differences in, and factors associated with, access to health services among Mexican im/migrants to the U.S. across migration phases, including pre-departure, destination, interception, and return.
Methods:
Using data from a cross-sectional survey conducted in Tijuana, Mexico (N = 1,541), we computed descriptive statistics and staged logistic regressions to estimate health care access indicators and factors associated with access to services.
Results:
Im/migrants at post-migration phases had lower likelihood of receiving health care and having a usual source of care, and higher rates of forgone care, than their counterparts at pre-departure. These differences were partly explained by length of migration phase, health insurance status, transportation barriers, and detention or imprisonment.
Conclusions:
Mexican im/migrants face challenges in accessing health services across the migration continuum, especially at post-migration phases. Binational efforts to provide affordable insurance coverage and reduce transportation limitations and incarceration could contribute to improving health care access among Mexican im/migrants.
The purpose of this study was to examine the association between known cultural protective factors, immigration factors, and perceived consequences of restrictive immigration climate. Survey data were collected in the state of Arizona (N = 300). Over eighty percent (83%, n = 248) of the participants were mothers, the remaining participants were fathers (17.3% or n = 52). Eighty-six percent of the participants were married and had three children (SD = 1.12). Participants were more established immigrants (M = 15.8, SD = 6.42). Hierarchical linear regressions were used to assess the associations between immigration variables, protective factors, and perceived effects of immigration policies. The results revealed social support, familismo, deportations, and financial hardship were significant predictors. Implications of the impact of restrictive policies on immigrant families are discussed.
Associations between parks and mental health have typically been investigated in relation to the presence or absence of mental illness. This study uses a validated measure of positive mental health and data from RESIDential Environments (RESIDE) Project to investigate the association between the presence, amount and attributes of public green space in new greenfield neighbourhood developments and the mental health of local residents (n = 492). Both the overall number and total area of public green spaces were significantly associated with greater mental wellbeing, and findings support a dose-response relationship. Positive mental health was not only associated with parks with a nature focus, but also with green spaces characterised by recreational and sporting activity. The study demonstrates that adequate provision of public green space in local neighbourhoods and within walking distance is important for positive mental health.
Each year, tens of thousands of Latino migrant farmworkers return to the hills and fields of North Carolina to live in employer-provided labor camps that often fail to meet regulatory and ethical standards. Little attention has been paid to how these workers and their families perceive and respond to substandard housing conditions. This paper analyzes how far and in what ways Latino migrant farmworkers living in eastern North Carolina labor camps feel their agency extends in responding to substandard housing and work conditions, while also considering who among them has the power to exercise this agency. Based on qualitative analysis of interviews with twenty-Three migrant farmworkers or partners of farmworkers, our findings indicate that the limits of migrant farmworker agency are strongly dictated by the close relationship between migrant farmworker employment and housing; by the importance of remittance wages for dependents; and by individual immigration, gender, and education characteristics. In the current context, the informal and reparative nature of agentive acts in substandard labor camps creates real but minor improvements while also co-constructing the very structural neglect to which it responds. We conclude that current housing and labor policy frameworks do little to amplify and support differentially distributed migrant farmworker agency and its individualized successes.
Objectives:
To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions.
Methods:
We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences.
Results:
Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 29.7% (P = .11). There were no differences in patient activation or self-rated physical health.
Conclusions:
A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems.
Trial registration:
clinicaltrials.gov identifier: NCT01900470. (Am J Public Health. Published online ahead of print August 17, 2017: e1-e8. doi:10.2105/AJPH.2017.303985).
Objective:
This analysis was conducted to identify industry exposures strongly associated with reports of finger amputation.
Methods:
Reports of severe occupational injuries in the Occupational Safety and Health Administration (OSHA) Severe Injury Report (SIR) database were analyzed in relation to U.S. Census Bureau industry employment data. Industries with significantly elevated reporting odds ratios (RORs) and relative reporting risks (RRRs) were identified. Multiple population association measures including population attributable fraction (PAF) were calculated by industry.
Results:
Among industries with statistically significant RRR and ROR, the poultry processing industry (RRR = 12.60, ROR = 3.37) accounted for the highest PAF by RRR (2.34%) and ROR (1.65%) CONCLUSION:: The results of this analysis identify the poultry processing industry as a leading source of reports of occupational finger amputations and substantiate the need for further collaboration with this industry.