Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans

Focusing on Asian Americans, this study examines how self-rated physical and mental health depends on the layered social connections (including 4 types: family cohesion, relative support, friend support, and neighborhood cohesion), socioeconomic status, and immigration-related factors (including nativity, length of residence in the U.S., and proficiency of the English language). It draws on the 2002–2003 National Latino and Asian American Study, a nationally representative household survey of Latino and Asian Americans. Findings of this study include: (1) there are significant differences in self-rated physical health among Asian Americans of different national origin, but their self-rated physical health differences diminish after indicators of socioeconomic status and immigration-related factors are considered; (2) four types of social connections are all related to the self-rated physical and mental health of Asian Americans, but the patterns of the associations as well as the mechanisms linking the associations vary; and (3) family cohesion has independent and direct effects on both self-rated physical and mental health over and above controls and mediators, whereas the effects of other social connection measures are partially mediated by socioeconomic status and immigration-related factors. In sum, this study indicates the significant effects of social connections, socioeconomic status, and immigration-related factors on the self-rated physical and mental health of Asian Americans.     

John Henryism and self-reported physical health among high-socioeconomic status African American men

We performed a cross-sectional survey of high-socioeconomic status (SES) African American men and their health to examine the relationship between John Henryism (the strong behavioral predisposition to directly confront barriers to upward social mobility) and self-reported physical health status. We found a positive association between John Henryism and better physical health among high-SES African American men. The study of social and behavioral implications of health of men of differing SES is required to develop strategies to improve the health of African American men.     

Discrimination and health among Asian American immigrants: Disentangling racial from language discrimination

We examined whether self-reported discrimination based on race and language was associated with the number of chronic health conditions among Asian American immigrants. We also examined whether these relationships were moderated by years in the United States. Data are from adults participating in an Asian American supplement to the 2001 Health Care Quality Survey. Language and racial discrimination in seeking health care were independently associated with increased number of chronic health conditions after controlling for age, sex, education, family income, health insurance, primary language, nativity, and ethnicity. Language discrimination was significantly associated with health conditions even with the presence of racial discrimination in the statistical model. Racial discrimination did not show a significant association in the full analytic model. The relationship between language discrimination and chronic conditions was stronger for Asian immigrants living in the USA 10 years or more compared to more recently arrived immigrants. Language discrimination may be an understudied type of discrimination associated with chronic illness among Asian Americans.     

The association between self-reported racial discrimination and 12-month DSM-IV mental disorders among Asian Americans nationwide

Growing research finds that reports of discrimination are associated with mental health. However, many US studies are focused on regional samples and do not control for important confounders such as other stressors and response factors. The present study examines the association between self-reported racial discrimination and DSM-IV defined mental disorders among Asian respondents to the 2002-2003 US National Latino and Asian American Study (n=2047). Logistic regression analyses indicated that self-reported racial discrimination was associated with greater odds of having any DSM-IV disorder, depressive disorder, or anxiety disorder within the past 12 months-controlling for sociodemographic characteristics, acculturative stress, family cohesion, poverty, self-rated health, chronic physical conditions, and social desirability. Further, multinomial logistic regression found that individuals who reported discrimination were at a twofold greater risk of having one disorder within the past 12 months, and a threefold greater risk of having two or more disorders. Thus, self-reported discrimination was associated with increased risk of mental disorders among Asian Americans across the United States and this relationship was not explained by social desirability, physical health, other stressors, and sociodemographic factors. Should these associations ultimately be shown enduring and causal, they suggest that policies designed to reduce discrimination may help improve mental health.     

A life course perspective on migration and mental health among Asian immigrants: the role of human agency

The relationship between human agency and health is an important yet under-researched topic. This study uses a life course perspective to examine how human agency (measured by voluntariness, migratory reasons, and planning) and timing (measured by age at immigration) affect mental health outcomes among Asian immigrants in the United States. Data from the National Latino and Asian American Study showed that Asian immigrants (n=1491) with multiple strong reasons to migrate were less likely to suffer from mental health problems (i.e., psychological distress and psychiatric disorders in the past 12 months) than those without clear goals. Moreover, Asian immigrants with adequate migratory planning had lower levels of distress and lower rates of 12-month psychiatric disorders than those with poorly planned migration. Compared with migrants of the youngest age category (six or younger), those who migrated during preteen and adolescent years without clear goals had higher levels of psychological distress, and those who migrated during adulthood (25 years or older) were less likely to suffer from recent depressive disorders (with the exception of those migrating for life-improving goals). Furthermore, we found that well-planned migration lowered acculturative stress, and multiple strong reasons for migration buffered the negative effect of acculturative stress upon mental health. Findings from this study advance research on immigrant health from the life course perspective by highlighting the effects of exercising human agency during the pre-migration stage upon post-migration mental health.     

Education and self-rated health: An individual and neighborhood level analysis of Asian Americans,Hawaiians, and Caucasians in Hawaii

Focusing on Asian Americans, Hawaiians, and Caucasians in Hawaii, this study contributes to the literature by examining (1) the geographical distributions of education in relation to self-rated general health at neighborhood levels, and (2) the individual variations in self-rated health by ethnicity and education at both individual and neighborhood levels. Using the 2007 Hawaii Health Survey with linked zip-code information, and applying GIS (Geographic Information System) and binary logistic regression models, this study found that (1) there are significant between ethnic differences in self-rated health in Hawaii, with Hawaiians being the most disadvantaged population compared to Japanese, Chinese, and Caucasians; (2) individual socioeconomic characteristics are all related to self-rated health, and education (in particular) mediates the Japanese vs. Hawaiian and Chinese vs. Hawaiian health differences; (3) the neighborhood level of education has an independent effect on self-rated health over and above individual characteristics for the whole sample and it partially mediates the between ethnic health differences; and (4) the relative importance of education to self-rated health is more significant and salient for Caucasians and Japanese/Chinese than for Filipinos and Hawaiians. In sum, this study not only demonstrates a geographical profile of health and education distributions in Hawaii, but also reveals significant mediating effects of education, at both individual and neighborhood levels, in explaining the between and within ethnic differentials in self-rated health.     

Differences in self-rated health by immigrant status and language preference among Arab Americans in the Detroit Metropolitan Area

Arab Americans are a growing minority in the U.S., yet only a few studies have examined their health utilizing representative samples. Using data from the 2003 Detroit Arab American Study, which is based on a probability sample, we examined the self-rated health (SRH) of Arab Americans by two measures of acculturation – immigrant status and language preference. We specified logistic regression models to test whether immigrants report better or poorer health status compared to U.S.-born Arab Americans and whether language preference among the immigrant generation accounts for the association between immigrant status and SRH. Our findings reveal that the health status of Arab Americans improves with acculturation. Arab immigrants are more likely to report poorer SRH compared to U.S.-born Arab Americans. When language preference is taken into account, Arabic-speaking immigrants are more likely to report poorer SRH compared to both U.S.-born Arab Americans and to English-speaking immigrants. We discuss these findings in light of similar ones obtained in the literature on SRH among other immigrant groups in the U.S. We conclude by arguing that language is an important measure to include in SRH studies among Arab Americans as well as other non-English speaking ethnic groups.     

Stress and physical health: the role of neighborhoods as mediating and moderating mechanisms

Using data from the 1995 Detroit Area Study (N = 1106) in conjunction with tract-level data from the 1990 census, this paper evaluates the relationship between residential stability and physical health among black and white adults. Results suggest that neighborhood-level variation in health is primarily mediated by key sociodemographic characteristics of individuals (e.g., age, race, and socioeconomic status). However, a significant portion of health differentials across neighborhoods is due to disparate stress levels across neighborhoods. Further, high levels of neighborhood stability provide an important buffer to the otherwise deleterious effects of increased stress levels on adults' overall health.     

Associations of physical symptoms with perceived need for and use of mental health services among Latino and Asian Americans

Although many believe that low rates of perceived mental health need and service use among racial/ethnic minorities are due, in part, to somatization, data supporting this notion are lacking. This study examined two hypotheses: (1) increased physical symptoms are associated with lower perceived need for mental health services and actual service use; and (2) physical symptoms are most strongly associated with perceived mental health need and service use among first-generation individuals. Data come from the National Latino and Asian-American Study, a nationally-representative household survey in the United States conducted from 2002 to 2003. Participants reported on the presence of fourteen physical symptoms within the past year. Perceived mental health need was present for individuals who endorsed having an emotional or substance use problem or thinking they needed treatment for such a problem within the past year. After adjusting for sociodemographic and clinical covariates, the number of physical symptoms was positively associated with perceived mental health need and service, an effect that differed by generation. Among first-generation individuals, physical symptoms were associated with increased perceived need and service use. Physical symptoms were not significantly associated with perceived need or service use among third-generation Latinos, but were associated with service use among third-generation Asian-Americans. Physical symptoms do not appear to interfere with mental health problem recognition or service use. In contrast, individuals, especially of the first-generation, with more physical symptoms were more likely to perceive need for and utilize mental health services. Our findings do not support the notion that physical symptoms account for low rates of perceived mental health need and service use among Latino and Asian-Americans.     

农村地区老年人自评身体状况和睡眠质量的关系研究——心理健康的中介作用

目的 探讨心理健康在农村地区老年人自评身体状况和睡眠质量间的中介作用。方法 采用EQ-5D量表中的VAS评分、GHQ-12老年人健康问卷和匹兹堡睡眠质量量表(PSQI)分别评估老年人自评身体状况、心理健康和睡眠质量;采用bootstrap法进行中介效应检验。结果 自评身体状况与睡眠质量、身体健康得分呈负相关(r=-0.422,-0.224, P<0.001),心理健康与睡眠质量得分呈正相关(r=0.258, P<0.001);中介作用结果显示,农村地区老年人的心理健康在自评身体状况与睡眠质量之间起部分中介作用,其中介效应值为-0.476 (95%CI:-0.648～-0.319),占总效应的39.18%。结论 自评身体状况与睡眠质量存在关联,同时,心理健康在其中发挥了部分中介的作用。     

Social cohesion, social support, and health among Latinos in the United States

The role of individual versus community level social connections in promoting health is an important factor to consider when addressing Latino health. This analysis examines the relationships between social support, social cohesion, and health in a sample of Latinos in the United States. Using data from the National Latino and Asian American Study, the analysis uses ordered logistic regression to explore the relationships of family support, friend support, family cultural conflict, and neighborhood social cohesion with self-rated physical and mental health, taking into account language proficiency and use, nativity, and sociodemographic variables. Family support, friend support, and neighborhood social cohesion were positively related to self-rated physical and mental health, and family cultural conflict was negatively related when controlled only for sex and age. After controlling for education, income, and other demographic measures, only family support was found to have a weak association with self-rated physical health; however, the relationship seemed to be mediated by language. In contrast, family support and family cultural conflict were strongly associated with self-rated mental health, after controlling for language, education, income, and other demographic measures. The study did not find neighborhood social cohesion to be significantly related to either self-rated physical or mental health, after accounting for the effects of the other social connection variables. Language of interview did not explain the highly significant effects of language proficiency and use. Social connections are important for health and mental health, but language and other sociodemographic factors seem to be related to how Latinos establish these social linkages. Further investigation into the role of language in the development and maintenance of social connections may help unravel the mechanisms by which they promote or decrease health.     

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.     

Race/ethnic differences in adult mortality: the role of perceived stress and health behaviors

We examine the role of perceived stress and health behaviors (i.e., cigarette smoking, alcohol consumption, physical inactivity, sleep duration) in shaping differential mortality among whites, blacks, and Hispanics. We use data from the 1990 National Health Interview Survey (N = 38,891), a nationally representative sample of United States adults, to model prospective mortality through 2006. Our first aim examines whether unhealthy behaviors and perceived stress mediate race/ethnic disparities in mortality. The black disadvantage in mortality, relative to whites, closes after adjusting for socioeconomic status (SES), but re-emerges after adjusting for the lower smoking levels among blacks. After adjusting for SES, Hispanics have slightly lower mortality than whites; that advantage increases after adjusting for the greater physical inactivity among Hispanics, but closes after adjusting for their lower smoking levels. Perceived stress, sleep duration, and alcohol consumption do not mediate race/ethnic disparities in mortality. Our second aim tests competing hypotheses about race/ethnic differences in the relationships among unhealthy behaviors, perceived stress, and mortality. The social vulnerability hypothesis predicts that unhealthy behaviors and high stress levels will be more harmful for race/ethnic minorities. In contrast, the Blaxter (1990) hypothesis predicts that unhealthy lifestyles will be less harmful for disadvantaged groups. Consistent with the social vulnerability perspective, smoking is more harmful for blacks than for whites. But consistent with the Blaxter hypothesis, compared to whites, current smoking has a weaker relationship with mortality for Hispanics, and low or high levels of alcohol consumption, high levels of physical inactivity, and short or long sleep hours have weaker relationships with mortality for blacks.     

Implications of perceived physical and social aspects of the environment for self-reported physical and mental health

The purpose of the present study is to explore the relative importance of certain socio-demographic variables, perceived physical and social attributes of the home and neighborhood for self-reported physical and mental health. The sample of the present study comprised 137 men and women (51.83% women and 48.17% men) ranging in age from 26 to 54 years selected randomly from shoppers visiting a crowded shopping plaza. A sociodemographic data sheet, scales to measure perceptions of the physical environment and neighborhood characteristics, and the SF-36 to assess physical and mental health components were used. Data were analyzed using multivariate analyses of variance, Pearson's correlation coefficients and multiple regression analysis. No age and gender differences in physical and mental health scores emerged (p < 0.05), but people who perceived their socio-economic status as low also reported lower total mental health scores (p < 0.05). No socioeconomic differences were noted on indices of physical health (p > 0.05). Correlation analysis revealed that negative perceptions of the interior home environment were associated negatively with physical and mental health scores (p < 0.05). Regression analysis indicated that perceived decay and disorganization in the home interior as well as perceived socioeconomic status accounted for a significant portion of the variance in mental health scores.     

Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States

This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.     

Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment

Using data from the 1995 Detroit Area Study (N=1106) this paper finds that black adults report significantly worse self-rated health when compared to whites with similar levels of self-reported morbidity. This relationship, called health pessimism, persists despite statistical controls for age, gender, socioeconomic status, health care access, and health related behaviors. Interpersonal maltreatment is found to be positively associated with health pessimism and more importantly, when comparing adults who perceive similar levels of maltreatment, white and black adults do not differ with respect to health pessimism. This suggests that the increased risk of health pessimism among black adults is due in part to race differences in the perception of interpersonal maltreatment.     

成都市高新区老年人健康自评影响因素分析

目的 了解成都市社区老年人健康自评状况及影响因素,为提高老年人健康水平和生命质量提供依据。 方法 利用2014年成都市高新区居民家庭健康入户调查数据,共有983名老年人纳入研究。分析健康自评与老年人社会人口特征、躯体健康、心理及行为因素的关系。单因素分析采用秩和检验的方法,多因素分析运用多分类Logistic回归模型进行分析。 结果 983名老年人中健康自评为好的占47.9%,一般的占40.8%;差的占11.3%。老年人健康自评状况与是否空巢（u=3.433,P=0.001,）、锻炼时间（χ2=11.863,P<0.001）、两周是否患病（u=7.261,P<0.001）、1个月内是否感到焦虑或抑郁（u=9.173,P<0.001）、患慢病种类（χ2=44600,P<0.001）、记忆力是否受损（u=9.562,P<0.001）等因素有关。 结论 应加大对城市社区空巢老年人健康问题的关注。鼓励老年人参与社区活动,保证足够的锻炼时间,做好老年人的心理卫生保健工作,进行记忆力恢复训练对提高老年人健康水平有重要作用。     

Social stress,obesity, and depression among women: clarifying the role of physical activity

Objective: This study examined the role of stress in the association among physical activity, obesity, and depression among women. The extent to which physical activity moderated these relationships was also examined.

Design: Data from the National Survey of American Life (N?=?3235) and multivariable regression analyses were used to examine the effects of chronic stress, material hardship, racial discrimination, and physical activity on obesity and depression among African American, Caribbean Black and White women.

Results: Stress was not related to body mass index (BMI) for African American or White women, but chronic stress was associated with higher BMI for Caribbean Black women. Stress was associated with depressive symptoms, but there was variation by the type of stressor under consideration. Physical activity was associated with fewer depressive symptoms and lower BMI, but the relationships varied by type of stressor and race/ethnicity. Physical activity moderated the effect of chronic stress on depressive symptoms and BMI, but only for African American women who reported high levels of chronic stress. Among White women, physical activity moderated the effect of racial discrimination on BMI for those who reported experiencing both high and low levels of discrimination.

Conclusion: This study was the first to document physical activity as a moderator in the relationship among stress, depression, and obesity using a nationally representative sample of racially/ethnically diverse women. Findings provide insight into the role of stress in relation to depression and obesity while highlighting heterogeneity among Black Americans.     

Early childhood origins of the income/health gradient: the role of maternal health behaviors

Several recent studies in the US, Canada, and the UK have demonstrated a positive relationship between family income and child health, though the mechanisms underlying this relationship are poorly understood. Using data from the 1988 US National Maternal and Infant Health Survey and the 1991 follow-up, this paper tests whether maternal health status and health behaviors during pregnancy and early infancy can explain the relationship between family income and subjective health status at age 3. We find that, while a detailed set of controls for health risk factors including maternal smoking, drinking, and vitamin use during pregnancy, as well as breastfeeding and secondhand smoke exposure after birth, are significantly related to family income and maternal education, they do not explain the relationship between family income and maternal-assessed health of the child. We suggest that these results point to either more salient pathways through which family income impacts child health, such as maternal stress, or to the possibility that differences in subjective health status do not correspond to differences in objective health status in the same way for higher- and lower-income respondents.