Alcohol Use Behaviors Among Indigenous Migrants: A Transnational Study on Communities of Origin and Destination

The association between international and domestic migration and alcohol use among indigenous communities is poorly understood. We explored migration-related factors associated with alcohol use behaviors among an indigenous Mayan, binational population. From January to March 2012, 650 indigenous participants from the high-emigration town of Tunkás in the Mexican state of Yucatán (n = 650) residing in Mexico and California completed surveys. Multivariate logistic regression identified migration-related factors associated with alcohol use behaviors. US migration of shorter duration (<5 years) was independently associated with at-risk drinking (adjusted odds ratio (AOR) 2.34; 95 % confidence interval (CI) 1.09–5.03), as was longer-duration domestic migration (≥5 years) (AOR 2.34; 95 % CI 1.12–4.87). Ability to speak Maya (AOR 0.26; 95 % CI 0.13–0.48) was protective against at-risk drinking. Culturally appropriate alcohol use prevention interventions are needed for domestic and international indigenous Mexican migrants to address alcohol use behavior in the context of migration.     

Understanding the Effects of Mental Health on Reproductive Health Service Use: A Mixed Methods Approach

Appropriate and woman-led health care for displaced women is essential to respecting basic human rights. In this article, we describe the results of an analysis of the association between mental health and reproductive health service use from a sample of Congolese refugee women residing in short- and long-term camps in Rwanda, with a post-hoc qualitative potion added to expand upon the data-based results. Our findings suggest that structural factors including health policy initiatives affect or even inhibit individual care choices.     

未婚流动女性生殖健康状况调查分析

目的了解未婚流动女性的生殖保健和性病预防知识。方法采用问卷对215名未婚流动女性的生殖保健、性病预防知识以及生殖健康状况进行调查分析。结果婚前性行为发生率为48.84%,与年龄有关(χ2=13.040,p=0.001);妇科常见病症状知晓率为59.07%,与年龄、文化程度有关(H=39.656,p=0.000;H=7.512,p=0.006);妇科不适症状发生率为33.49%,与症状知晓得分有关(χ2=15.602,p=0.000);性病知晓率为92.58%,与年龄有关(H=15.935,p=0.000),性病预防知识的知晓得分与文化程度有关(H=7.457,p=0.006)。结论未婚流动女性的生殖健康状况存在较多问题,性病的预防知识相对薄弱,针对该群体文化程度低的特点,建议开展综合性教育以提高流动女性的生殖保健水平。     

未婚流动女性生殖健康状况调查分析

目的了解未婚流动女性的生殖保健和性病预防知识。方法采用问卷对215名未婚流动女性的生殖保健、性病预防知识以及生殖健康状况进行调查分析。结果婚前性行为发生率为48．84％，与年龄有关（χ^2=13．040，p=0．001）；妇科常见病症状知晓率为59．07％，与年龄、文化程度有关（H=39．656，p=0．000；H=7．512，p=0．006）；妇科不适症状发生率为33．49％，与症状知晓得分有关（χ^2=15．602，p=0．000）；性病知晓率为92．58％，与年龄有关（H=15．935，p=0．000），性病预防知识的知晓得分与文化程度有关（H=7．457，p=0．006）。结论未婚流动女性的生殖健康状况存在较多问题，性病的预防知识相对薄弱，针对该群体文化程度低的特点，建议开展综合性教育以提高流动女性的生殖保健水平。     

中国流动人口的性与生殖健康现况

近年,随着经济和社会的不断发展,流动人口这一特殊人群,成为社会各界关注的焦点。 流动人口的避孕节育、生殖道感染/性病/艾滋病知识缺乏、婚前性行为发生率高、避孕措施使用率低、人 工流产率高等问题日益凸显。这不仅严重危害流动人口的性与生殖健康状况,同时也影响经济发展和社 会稳定。为了解流动人口性与生殖健康现状及其影响因素,回顾近年来有关流动人口性与生殖健康的文 献,并在分析相关文献的基础上,根据多年来的研究和实践经验提出了若干建议和对策,以便为改善流动 人口性与生殖健康状况提供理论基础。     

Cultural Perceptions and Negotiations Surrounding Sexual and Reproductive Health Among Migrant and Non-migrant Indigenous Mexican Women from Yucatán,Mexico

Information regarding sexual and reproductive health of indigenous women from Mexican sending and US receiving communities is limited. This research aims to explore the perceptions of indigenous women from US migrant receiving and Mexican migrant sending communities regarding their sexual health experiences and reproductive health practices. From January to March 2012, two key informant interviews and 31 in-depth, semi-structured interviews were conducted among women ages 18–55 in Tunkás, Yucatán and Anaheim and Inglewood, California. Women reported challenges to obtaining routine reproductive clinical care, including access to care barriers and lack of perceived power over their own sexual health. This was further compounded by migration processes and deficiencies in health care delivery systems. Socio-cultural beliefs and gendered power dynamics influence sexual and reproductive health decisions and behaviors of migrant and non-migrant women. Findings underscore existing gender-based reproductive health norms and serve to inform future transnational research and public health education to improve the health of indigenous migrant and non-migrant women in the US and Mexico.     

A Cross-National Study on Prevalence of Mental Disorders,Service Use,and Adequacy of Treatment Among Mexican and Mexican American Populations

Objectives. We examined differences in the use of mental health services, conditional on the presence of psychiatric disorders, across groups of Mexico’s population with different US migration exposure and in successive generations of Mexican Americans in the United States.Methods. We merged surveys conducted in Mexico (Mexican National Comorbidity Survey, 2001–2002) and the United States (Collaborative Psychiatric Epidemiology Surveys, 2001–2003). We compared psychiatric disorders and mental health service use, assessed in both countries with the Composite International Diagnostic Interview, across migration groups.Results. The 12-month prevalence of any disorder was more than twice as high among third- and higher generation Mexican Americans (21%) than among Mexicans with no migrant in their family (8%). Among people with a disorder, the odds of receiving any mental health service were higher in the latter group relative to the former (odds ratio = 3.35; 95% confidence interval = 1.82, 6.17) but the age- and gender-adjusted prevalence of untreated disorder was also higher.Conclusions. Advancing understanding of the specific enabling and dispositional factors that result in increases in mental health care may contribute to reducing service use disparities across ethnic groups in the United States.Epidemiological studies have found that migration from Mexico to the United States is associated with a dramatic increase in psychiatric morbidity. Risk for a broad range of psychiatric disorders, which is relatively low in the Mexican general population, is higher among Mexican-born immigrants in the United States and higher still among US-born Mexican Americans.1–5 Risk among US-born Mexican Americans is similar to that of the non-Hispanic White population.6 Recent research suggests that the association between migration and mental health extends into Mexico, where return migrants and family members of migrants are at higher risk for substance use disorders than those with no migrant in their family.3,7Little is known about the influence of cultural and social changes associated with migration on the use of mental health services. As the mental health system is much more extensive8 and use of mental health service is much more common9 in the United States than in Mexico, we expect that Mexican Americans would use mental health services more frequently than their counterparts in Mexico. However, it is not known whether the increase in service use keeps pace with the increase in prevalence of psychiatric disorders. Moreover, in the United States, Hispanics in general and Mexican Americans in particular are less likely to receive mental health services than are non-Hispanic Whites,10–12 and immigrants are less likely to use mental health services than the US born, particularly if they are undocumented.13We made use of a unique data set formed by merging surveys conducted in Mexico and the United States that used the same survey instrument. We used these data to examine differences in past-year mental health service use, conditional on the past-year prevalence of psychiatric disorder, associated with migration on both sides of the Mexico–US border.     

Alcohol and Other Drug Use,Partner Violence,and Mental Health Problems Among Female Sex Workers in Southwest China

In this study we investigated the association between mental health problems and negative experiences among female sex workers (FSWs) in China. A total of 1,022 FSWs completed a self-administered survey on their demographic characteristics, mental health status, substance use behaviors, and experiences of partner violence. We found that alcohol use was independently predictive of mental health problems when both partner violence and illicit drug use were accounted for in the multivariate logistic regression models. The findings underscore the urgent need for effective alcohol reduction interventions and mental health promotion programs among FSWs in China and other developing countries.     

A Developmental Perspective in Mental Health Services Use Among Adults with Mental Disorders

This study examined factors associated with mental health services (MHS) use by individuals with mental disorders within a developmental perspective of adulthood. Bivariate and multivariate analyses were conducted separately for each developmental stage on independent variables using the Andersen’s behavioral health service model. For 18–29-year-old emerging adults (n = 141), autonomy, daily life/relations, Internet searching, alcohol dependence, cognitive impulsiveness, number of stressful events, and self-harm were associated with MHS use. For 30–49-year olds (n = 292), being female, country of origin, being on welfare, social integration, Internet searching, and number of stressful events were associated with MHS use. For 50–64-year-old middle-aged adults (n = 126), current occupation was associated with MHS use. Developing online resources for emerging adults may increase MHS use. For 30–49-year olds, outreach should target male, immigrants, and individuals less socially integrated and on welfare. For middle-aged adults, workplace programs that reduce stigma and offer psychological help could increase MHS use.     

Health Care Resources and Mental Health Service Use Among Suicidal Adolescents

Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n?=?1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (～11%–30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.     

Sexual and Reproductive Health Trends Among Women With Enduring Mental Illness: A Survey of Western Australian Community Mental Health Services

An exploratory cross-sectional survey was conducted to determine associations and potential modifiable risk factors for management of sexual and reproductive health needs for women attending community mental health services. Women (n = 220) had on average three pregnancies; 61.2% were unplanned. One quarter who were sexually active within the past 12 months denied using contraception with 51% using less effective methods. The majority (81.7%) engaged in Pap smear screening, and those with a general practitioner (GP) were more likely to participate (p =.004). Findings highlight GPs’ potential in optimizing women's health. Considering unplanned pregnancies and contraception trends, we suggest improved access to contraception options, particularly long-acting reversible methods.     

Understanding of Sexuality and Reproductive Health Among Women With and Without Physical Disabilities

This study compares differences in how women with disabilities and women without disabilities learned about their sexuality and reproductive functioning. A written questionnaire was sent to a national sample of women with disabilities and their non-disabled woman friends recruited through independent living centers and announcements in the media. Responses were received from 504 women with disabilities and 442 women without disabilities. Participants were asked how old they were when they first learned about the physical aspects of sexual intercourse. Women with disabilities learned about the physical aspects of sexual intercourse at about the same age (M = 13.16) as women without disabilities (M = 12.93). The most commonly reported sources for learning about sexuality and sexual functioning for both groups were books and other printed material, having sex, partners, friends, and teachers in primary school. More women with disabilities received information from a woman with a disability and a rehabilitation counselor. Women in both groups indicated that sex was never or seldom the subject of general family conversation. On average the women with physical disabilities had their first date at age 16.6, which is later than women without physical disabilities (M = 14.91). Women with physical disabilities who reported having acquired sexuality information at a later age reported having sexual intercourse at an older age (M = 20.37) than women without physical disabilities (M = 17.75). Age at acquiring sexuality information was neither associated with frequency of intimate touch nor frequency of sexual intercourse. The results of this study can be used to generate recommendations for health care professionals concerning ways to respond more effectively to the special needs for sexuality information of physically disabled women.     

Prevalence of Perceived Stress and Mental Health Indicators Among Reserve-Component and Active-Duty Military Personnel

Objectives. We examined stress levels and other indicators of mental health in reservists and active-duty military personnel by deployment status.Methods. We used data from the Department of Defense Health-Related Behaviors surveys, which collect comprehensive, population-based data for reserve and active-duty forces. Data were collected from 18 342 reservists and 16 146 active-duty personnel.Results. Overall, with adjustment for sociodemographic and service differences, reservists reported similar or less work and family stress, depression, and anxiety symptoms than did active-duty personnel. However, reservists who had been deployed reported higher rates of suicidal ideation and attempts than did active-duty personnel who had been deployed and higher rates of post-traumatic stress disorder symptomatology than did any active-duty personnel and reservists who had not been deployed. The highest rates of suicidal ideation and attempts were among reservists who had served in theaters other than Iraq and Afghanistan.Conclusions. Our results suggest that deployment has a greater impact on reservists than on active-duty members, thus highlighting the urgent need for services addressing reservists’ unique postdeployment mental health issues. Also, deployment to any theater, not only Iraq or Afghanistan, represents unique threats to all service members’ mental well-being.The US military reserve component, which includes both Reserve and National Guard personnel, provides trained units and qualified persons for active-duty service in time of war or national emergency. Reserve-component personnel may be called to active-duty status to supplement the active-duty component during such times. National Guard units also provide personnel in response to state emergencies. As of July 2008, the total strength of the US military reserve component was 1.1 million, with approximately 10% serving with the active-duty component.1 Once activated, reserve-component service members proceed through the same deployment stages and processes as do active-duty forces. However, they face additional challenges associated with being “citizen Soldiers,” such as arranging extended leaves of absence with civilian employers, planning for reintegration upon their return, and making arrangements for their families. Furthermore, the uncertainty that often accompanies activation and deactivation and the organizational constraints, such as lack of equipment and training readiness, have been associated with their psychological well-being.2Milliken et al.3 found, on the basis of Post-Deployment Health Assessment and Post-Deployment Health Re-Assessment interviews, that more than twice as many reserve-component as active-duty service members returning from Operation Iraqi Freedom (OIF) reported symptoms sufficient to require mental health treatment (42.4% vs 20.3%, respectively). Although important, their study was limited to a sample of recently returning service members who may not be representative of the broader active-duty and reserve-component populations and thus may not provide an accurate picture of the relative mental health needs between and within components of the total force. Therefore, a need exists for population-based data comparing the mental health needs of active-duty and reserve-component personnel.Drawing on 2 comprehensive surveys, we helped to fill this data gap by providing the first population-based assessment and comparison of reserve-component and active-duty mental health on the basis of selected indicators during the OIF and Operation Enduring Freedom (OEF) conflicts. This work augments existing research2 by examining specific mental health issues encountered by reservists, as suggested by Milliken et al.,3 rather than a global but somewhat vague construct of psychological well-being.     

School-Based Health Center Access,Reproductive Health Care,and Contraceptive Use Among Sexually Experienced High School Students

PurposeThe current analyses compared receipt of reproductive health care, contraceptive use, and screening for sexually transmitted diseases (STD) among adolescents who are sexually experienced, with or without access to a school clinic.MethodsA total of 12 urban California high schools, selected from areas with high teen pregnancy and STD rates, half with school-based health centers (SBHCs), participated in an intervention study designed to improve sexual health among adolescents. Of the participating students, 44% indicated that they had ever had intercourse and were included in these analyses.ResultsAccess to an SBHC did not influence receipt of reproductive health care for either males or females and did not influence contraceptive use, either hormonal or condoms, for males. For females, however, those with access to an SBHC had increased odds of having received pregnancy or disease prevention care (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.16–1.80), having used hormonal contraceptives at last sex (AOR = 1.68, 95% CI = 1.24–2.28), and were more likely to have ever been screened for an STD (AOR = 1.85, 95% CI = 1.43–2.40). Also among female students, those with access to an SBHC were more likely to have used emergency contraception at last sex (AOR = 2.1, 95% CI = 1.08–4.22).ConclusionAlthough access to an on-site clinic does not seem to lead to increases in all types of reproductive care in the population as a whole, sexually active females are more likely to have received more specific care and to have used hormonal contraceptives if their school has an SBHC.     

Garnering Partnerships to Bridge Gaps Among Mental Health,Health Care,and Public Health

Integrating mental health and public health chronic disease programs requires partnerships at all government levels. Four examples illustrate this approach: 1) a federal partnership to implement mental health and mental illness modules in the Behavioral Risk Factor Surveillance System; 2) a state partnership to improve diabetes health outcomes for people with mental illness; 3) a community-level example of a partnership with local aging and disability agencies to modify a home health service to reduce depression and improve quality of life among isolated, chronically ill seniors; and 4) a second community-level example of a partnership to promote depression screening and management and secure coverage in primary care settings. Integration of mental health and chronic disease public health programs is a challenging but essential and achievable task in protecting Americans'' health.